7 questions to ask when reviewing your health cover

If the last time you assessed your health cover was five years ago, there’s a chance it may no longer suit your needs.

Just as you get regular health check-ups, it also makes sense to review your policy annually to make sure you’re covered for the things you need and aren’t paying for things you don’t. Reviewing your cover could save you money now, and more importantly, down the track by ensuring you’re covered for the things you’re most likely to need.

Here are our top seven questions you should ask yourself

1. Does my cover suit my life stage?

It seems like an obvious question, but many people may not be on a cover suitable to their life stage. Think about what extras services you regularly use now. What might you need a year from now? For example if you’re looking to start a family, you’ll generally need pregnancy cover for 12 months before you can make a claim so it might be time to change policies.

If you’re young and healthy, you may be after an affordable policy in order to avoid paying extra tax or the Lifetime Health Cover Loading. But consider if this is really the right cover for you. You may find that a spending few dollars extra a week comes with far better value.

2. What am I actually covered for again?

Unfortunately many people assume that they’re covered for a lot more than they actually are, only to find out too late that they’re not. Avoid this situation by digging out your cover documents and checking your inclusions and waiting periods. When reviewing hospital cover, look for the terms ‘minimum benefit’ and ‘restricted service’. If you see these words, it means you’ll only be partly covered and will be likely to have large out of pocket expenses if you need a private hospital stay. It’s better to find this out before you need to use it.

3. How much can I claim back on extras?

The amount you can claim per visit and in a year (or a lifetime in some cases) will differ from cover to cover. What percentage will you get back on extras? Are a range of services bundled into a combined yearly limit? The more services that are bundled together, the more limiting it can be. You should also check if the limits are applied per person or per family. These things can all greatly affect the value you get from your cover.

At Bupa, we think you should know what to expect before a visit. That’s why we’ve built great relationships with thousands of providers in our Members First network, which includes dentists, physios, chiros and optical providers across Australia. By visiting one of these ‘Members First’ providers and depending on your level of cover, you can get between 60% and 100% when you make a claim (up to your yearly limits)#.

4. Am I covered for a private room in hospital?

If privacy in hospital is important to you, make sure a private room is included in your cover. Some hospital policies only cover the full cost of a shared room, not a single room.

All Bupa hospital policies include cover for a private room. We’ve also gone one step further. Our arrangements with Members First hospitals mean that if you book a private room more than 24 hours before your admission and don’t receive one, you’ll get $50 back per night from the hospital~.

5. Could I reduce my premium without reducing my cover?

Some policies come with the option of reducing your premium via an excess or co-payment. With an excess, you’ll pay an amount upfront if you’re admitted to hospital. A co-payment is an amount you agree to pay each day towards your hospital stay. There can be advantages to doing it either way.

6. What benefits are available for kids?

Some covers offer benefits specifically for kids, which can make a big difference to the cost of a hospital stay or a visit to the dentist or optometrist. For instance, Bupa family packages don’t include an excess if your kids are admitted to hospital. Plus for most kids’ visits to a Members First dentist, physio or optometrist, you’ll have nothing more to pay on the day (up to your yearly limits)^.

7. What other benefits does your health cover provide?

Health cover can be a great support when you’re sick and need it most, but does your policy provide any value beyond that? Be sure to take a look at any extra support your insurer provides. Bupa members can access various support programs and discount partners. We’ve also teamed up with the National Home Doctor Service to give our member’s access to After Hours Plus. That means if a doctor is needed after hours, common medications can be prescribed on the spot at no cost.


If you’re thinking of changing your cover or moving to another insurer, the good news is that you may not have to re-serve waiting periods if you switch to an equivalent or lower level of cover.

If you would like more help with reviewing your cover, talk to a Bupa consultant on 134 135.

Don’t forget to mention your company name if you have access to a Bupa corporate health plan.



# For most items at our Members First extras providers covering dental, physio, chiro and selected optical packages. Excludes orthodontics and hospital treatments. Fund and policy rules, waiting periods apply.

~ Conditions apply – contact us for details

^ For most items covering dental, physio or selected optical items. Fund and policy rules, and waiting periods apply. Child dependants only. Excludes orthodontics and hospital treatment.