Bupa creates public hospital medical gap scheme

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Bupa says it will contact all customers regarding its previously announced changes to the removal of minimum benefits to explain what they can do if they are impacted.

Australia's largest private health insurer announced changes earlier this year to its Medical Gap Scheme and policies that provide 'minimum benefits'.

Changes to the Medical Gap Scheme mean it no longer applies to the four percent of private hospital beds not contracted by Bupa.

The change will require doctors to inform a patient if they are going to be treated in a contracted hospital and what out-of-pocket medical costs they will face.

According to CEO Richard Bowden, “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.

“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,” said Mr Bowden.

The insurer has also announced the creation of a Public Hospital Medical Gap Scheme. The changes announced earlier this year meant public hospitals were excluded from Bupa's medical gap scheme.

Mr Bowden said new the Public Hospital Medical Gap Scheme will 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.

“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,” he added.