Bupa gives choice, peace of mind for customers in public hospitals

Bupa says it will be contacting customers to ensure they've understood previously announced changes regarding the removal of minimum benefits paid for some services, highlighting what the change involves and how affected customers can upgrade if they wish to retain cover for those services. 

Australia’s largest private health insurer​ also says members treated in a public hospital would receive peace of mind around out-of-pocket costs while maintaining choice of doctor under a ‘public hospital medical gap’ scheme. This includes no gap for public hospital emergency admissions.

Clarifying changes to minimum benefits

Richard Bowden, Bupa Australia and New Zealand CEO, said Bupa has committed to contacting all customers regarding the previously announced changes to the removal of minimum benefits (restricted cover), and what customers can do if they are impacted.

“We’ve spoken with the Commonwealth Ombudsman and agreed to make sure customers fully understand how the removal of minimum benefits may impact them, a contribution paid to the cost of a small number of expensive procedures for customers on basic and mid-level policies,” Mr Bowden said.

“The change to minimum benefits doesn’t impact customers on comprehensive policies and brings Bupa in line with other insurers. This will make it easier for our customers to compare products and know if they are covered for a procedure or not.

“We recognise though some people who were affected by the change may not have not known how that change impacted them or what they needed to do to stay covered.

“As a result, those customers on basic and mid-level policies impacted by this change can increase their level of cover before 1 September 2018 to a policy under which these procedures are covered. Bupa will waive the usual waiting periods so members can access benefits for those treatments without delay and benefits paid will be higher than under their basic or mid-level policy,” Mr Bowden said.

Public Hospital Gap Scheme

In February, Bupa announced a proposal to allow doctors to use its medical gap scheme only at hospitals which had contracts with Bupa. This was designed to improve transparency around out-of-pocket costs, but meant public hospitals were not included.

Mr Bowden said customer feedback led to the creation of the Public Hospital Medical Gap Scheme, to remove confusion and provide certainty for customers.

“We listened to customers and know they wanted to maintain choice of doctor in a public hospital, but also wanted to see value for money and no surprises over gap charges from doctors,” Mr Bowden said.

Richard Bowden, CEO Bupa ANZ
Australia’s health system is one of the best in the world and achieves that through a successful balance of public and private hospitals. This new scheme means people still have access to a choice of hospital and choice of doctor, while also better meeting community expectations around affordability and billing practices.
Richard Bowden, CEO Bupa ANZ

“It means if a doctor elects to use the scheme in a public hospital, then members will face no additional out-of-pocket costs in an unplanned admission such as through emergency and no more than $500 for each doctor or specialist for pre-booked procedures. This means members have certainty over their doctors’ fees.

“The Bupa No-Gap Scheme pays doctors over and above the Medicare rate, in return for customers not facing further bills. Affordability and value for money of health insurance impacts all parts of the health system and requires everyone to work together for the benefit of patients,” Mr Bowden said.

Bupa’s Public Hospital Medical Gap scheme will operate as follows:

- As is the case today, it continues to be your doctor’s choice whether to use the Bupa Medical Gap Scheme. This applies to each doctor or specialist involved in your treatment.

- From 1 August 2018, for each of your doctors or specialists who use the scheme in public hospitals, the scheme will work in the following way:

  • If you have a pre-booked admission, you may be charged up to a limit of $500 by each doctor or specialist involved in your treatment while you’re in that hospital.

  • If you are admitted any other way, such as through the Emergency Department, you will not be charged for your treatment by that doctor or specialist while you’re in that hospital.

- Whether your doctor or medical specialist chooses to participate in the scheme or not, you will continue to be able to choose your doctor.​