Understanding your coverageFrequently asked questions

This depends on your insurance product. Your full policy terms and conditions can be found in your membership guide. You can find your guide on MembersWorld here: https://membersworld.bupaglobal.com/my-plan/documents.

Alternatively, you can access a network of qualified international doctors using Global Virtual Care, at no extra cost, without affecting your benefits.

A benefit limit is the maximum amount we’ll pay towards a specific treatment or treatment type, or the maximum number of times we will cover a specific treatment or treatment type. They typically apply per person and can either be a monetary limit or maximum amount of sessions. Most apply each policy year, which means that once a limit has been reached, the benefit will no longer be available until you renew your health plan.

Other benefit limits may apply per lifetime, which means that once a limit has been reached, no further benefits will be paid, regardless of the renewal of your health plan.

You can find your benefit limits on MembersWorld here: https://membersworld.bupaglobal.com/my-plan.

A waiting period means you can't make a claim for a particular benefit until you've been covered for the full duration of the waiting period stated. Waiting periods can be found in your membership guide.

You can find your guide on MembersWorld here: https://membersworld.bupaglobal.com/my-plan/documents.

An exclusion is a specific treatment, condition, or situation that we don't cover as part of your health plan.

There are general exclusions that apply to all customers, which can be found in your membership guide.

For specific exclusions to your cover, such as underwritten conditions, please see your insurance certificate. You can find your membership guide and insurance certificate on MembersWorld here: https://membersworld.bupaglobal.com/my-plan/documents.

If you choose a healthcare provider outside our network, we will only cover reasonable and customary costs. This means the healthcare provider's charges must be typical for the region and comparable to other healthcare providers offering similar services. We determine these costs based on our experience and published guidelines from government or medical bodies. If guidelines exist, we may use them to assess and pay claims. If you visit an out-of-network healthcare provider, charges exceeding these guidelines or reasonable and customary rates will not be covered.

If you choose a healthcare provider which is outside of our network, we’re happy to settle bills directly, but they may ask you to pay for the treatment and claim for reimbursement from Bupa. However, you may need to pay any difference in cost if the treatment is more than what we believe is reasonable and customary.

There are also a small number of healthcare providers where we will not cover the cost of treatment. These healthcare providers can be found at bupaglobal.com/en/ineligible-providers.

To avoid cost differences of these types, we recommend using one of our in-network providers where all eligible costs are covered as charges are pre-negotiated as part of their contract with Bupa Global. You can easily find a healthcare provider in our network by using our Facilities Finder here: bupaglobal.com/en/facilities/finder.

In-network providers are healthcare providers that have contracts with Bupa Global and are usually happy for us to pay claims directly to them. If you choose to have your treatment with a healthcare provider in our network, we will cover the costs up to your policy and benefit allowances. You may need to provide your healthcare provider with confirmation of your insurance or relevant benefits. You can do this by obtaining a pre-authorisation or by presenting a digital or physical membership card.

You can easily find a healthcare provider in our network by using our Facilities Finder here: bupaglobal.com/en/facilities/finder.

Out-of-network providers are healthcare providers who do not have contracts with Bupa Global. This means that if you decide to have treatment with a healthcare provider that is out-of-network, we'll only cover costs that are reasonable and customary.

If you decide to have treatment with a healthcare provider outside of our network, it is possible to pay bills directly to them if that is what they choose. However, if the cost of the claim is higher than what we consider to be reasonable and customary, Bupa will pay a portion of the claim, and you will have to pay any difference in cost directly to your healthcare provider.

If the healthcare provider prefers for you to pay them directly and claim the cost from Bupa, that is their choice. If the cost of the claim is higher than what we consider to be reasonable and customary, Bupa will reimburse the covered portion of the claim to you, and you will not be reimbursed for any remaining amount.

To avoid unexpected costs, we recommend using one of our in-network providers where all eligible costs are covered as part of the contract we have with them.

You can easily find a healthcare provider in our network by using our Facilities Finder at bupaglobal.com/en/facilities/finder.