| Bupa | |
|---|---|
| Registered insurer | Bupa HI Pty Ltd |
| Who can join | Open to anyone |
| Business structure | For-profit, owned by BUPA Group International |
| Hospital policies (30 June 2025) | 1,498,193 (24.5% of all hospital policies), covering 3,146,433 people |
| Hospital tiers on sale (1 September 2026) | Gold, Silver Plus, Bronze Plus, Bronze, Basic Plus, Basic |
| Excess options on open hospital policies | $250, $500, $750 |
| Age-based discount (18-29) | Offered on its open hospital policies |
| Ambulance | Emergency ambulance on its open hospital policies; some also cover non-emergency transport |
| Question | What the official data shows |
|---|---|
| Out-of-pocket costs in hospital | 90.2% of in-hospital medical services had no gap for the member (industry 87.1%), and 89.0% of hospital charges were covered (industry 89.0%), 2024-25 |
| Waiting periods and pre-existing conditions | The legal maximums apply: 12 months for a pre-existing condition (signs or symptoms in the 6 months before you joined or upgraded) and for pregnancy and birth, 2 months for other hospital treatment. Every hospital policy open to new members in the Government's data at 1 October 2026, at every fund, used the 12-month pre-existing wait |
| Switching from another fund | Waits you've already served on the same or a lower level of cover carry across to Bupa, and from it. Ask your old fund for a clearance certificate and keep the break between policies short |
| The Medicare Levy Surcharge | Excess options on its open hospital policies go up to $750, so all are within the $750 singles limit, and every policy was flagged as meeting the surcharge rules in the Government's data at 1 October 2026 |
| Adult children (dependants) | Up to age 31, studying or not, in the fund's own record (Government data, 1 October 2026). Adult dependants often need an extended family option |
| Claims experience | 25.2% of Ombudsman complaints about insurers on a 25.5% market share (ratio 0.99), and 16.4% of the complaints the Ombudsman investigated, 2024-25 |
General advice only. This information doesn't take into account your objectives, financial situation or needs. Consider whether the product is right for you and read the Product Disclosure Statement (PDS) and Target Market Determination (TMD) before you decide. We don't compare every product in the market, and we may earn a commission if you take up a product through our links.
Who owns Bupa and how it's structured
PrivateHealth.gov.au describes Bupa HI Pty Ltd as operating on a for-profit basis and owned by Bupa Group International, which it says operates on a not-for-profit basis. In practice that means the Australian insurer can make a profit, and that profit goes to its parent rather than being returned to members the way a mutual fund's surplus is. It is an open fund: there are no membership restrictions.
Bupa is big enough that its figures sit very close to the industry average on most measures. That is useful context when you read the table below: a fund with a quarter of the market largely is the market.
What Bupa's complaint numbers show
In 2024-25 Bupa accounted for 25.2% of the complaints the Ombudsman received about insurers, against a 25.5% market share. That is almost exactly proportional: Bupa drew neither more nor fewer complaints than its size would predict. Its share of complaints that went on to a formal investigation was 16.4%, lower than its market share.
Its member retention (the share of hospital members who kept their cover with Bupa over the year) was 86.1%, slightly above the industry result of 85.0%.
Benefits, gaps and hospital agreements
Bupa returned 82.4% of its premium income as benefits in 2024-25, below the industry result of 84.5%. Its management expenses were 11.3% of contribution income against an industry 10.9%. Neither gap is large, but together they mean a slightly smaller share of each premium dollar went to claims than across the industry as a whole.
On the measures members feel directly, Bupa is at or above average: 89.0% of hospital charges were covered (industry 89.0%) and 90.2% of in-hospital medical services had no gap for the member (industry 87.1%). In the Government's agreement-hospital data at 1 October 2026 it had agreements with 95 private hospitals in NSW, the most of any insurer, and 69 in Victoria.
What Bupa sells
Among its policies open to new members at 1 September 2026, Bupa sells every hospital tier: Gold, Silver Plus, Bronze Plus, Bronze, Basic Plus and Basic, with excess options of $250, $500 and $750. All of its open hospital policies were listed as offering the age-based discount for under-30s. Emergency ambulance is included on almost all of its open hospital policies, and some also cover non-emergency transport.
Bupa also sells overseas visitors and overseas student cover and corporate products, according to its PrivateHealth.gov.au record.
What regulators and courts have said about Bupa
The official measure of service is the Private Health Insurance Ombudsman's. In 2024-25 Bupa drew 25.2% of all complaints about insurers on a 25.5% market share, almost exactly in proportion, and 16.4% of the complaints the Ombudsman went on to investigate.
In December 2025 the Federal Court ordered Bupa HI Pty Ltd to pay $35 million in penalties in proceedings brought by the ACCC (Australian Competition and Consumer Commission v Bupa HI Pty Ltd [2025] FCA 1564, judgment of 11 December 2025). The Court declared that between May 2018 and August 2023 Bupa told some members, hospitals and doctors that members weren't entitled to any benefit for a claim when part of the treatment was covered by their policy. Most of the affected claims were hospital admissions where two or more procedures were done at once and only some were covered. The Court also declared that some of Bupa's handling of those claims between June 2020 and February 2021 was unconscionable conduct.
The ACCC says the Court also ordered a five-year injunction against the conduct, and that Bupa, which began compensating people before the case started, had paid more than $14.3 million for more than 4,100 affected claims. If you think a Bupa claim was wrongly refused, you can ask Bupa to review it and then complain to the Private Health Insurance Ombudsman.
Bupa against the industry: 2024-25 data
Every year the Private Health Insurance Ombudsman compares all insurers on the same measures, and PrivateHealth.gov.au republishes the results on each insurer's profile. The table below is Bupa's, with the industry result beside each figure. Its complaints-to-market-share ratio was 0.99: a figure of 1.00 means complaints exactly in proportion to size.
| Measure | Bupa | Industry | Reading |
|---|---|---|---|
| Share of all Ombudsman complaints | 25.2% | Market share 25.5% | In proportion to its size |
| Share of investigated complaints | 16.4% | Market share 25.5% | |
| Member retention (hospital cover) | 86.1% | 85.0% | Better than industry |
| Benefits paid as % of premiums | 82.4% | 84.5% | Weaker than industry |
| Management expenses % of premium income | 11.3% | 10.9% | In line with industry |
| Hospital charges covered | 89.0% | 89.0% | In line with industry |
| Medical services with no gap | 90.2% | 87.1% | Better than industry |
| Medical services with no gap or a known gap | 97.8% | 97.1% | Better than industry |
| Extras (general treatment) charges covered | 51.3% | 50.7% | Better than industry |
Bupa vs Medibank: the official data side by side
Here are both insurers' 2024-25 figures on every measure the Ombudsman publishes, with the industry result beside them. In 2024-25, Bupa had the stronger figure on member retention and the no-gap rate; Medibank (incl. ahm) on complaints relative to size, benefits paid as a share of premiums, management expenses and hospital charges covered. They were level on extras charges covered. Neither set of figures is a price, and the right policy depends on what it covers.
| Measure | Bupa | Medibank (incl. ahm) | Industry |
|---|---|---|---|
| Share of all Ombudsman complaints | 25.2% | 23.9% | - |
| Market share | 25.5% | 26.5% | - |
| Complaints ÷ market share (1.00 = in proportion) | 0.99 | 0.90 | 1.00 |
| Share of investigated complaints | 16.4% | 17.3% | - |
| Member retention (hospital cover) | 86.1% | 85.4% | 85.0% |
| Benefits paid as % of premiums | 82.4% | 85.6% | 84.5% |
| Management expenses % of premium income | 11.3% | 7.6% | 10.9% |
| Hospital charges covered | 89.0% | 89.6% | 89.0% |
| In-hospital medical services with no gap | 90.2% | 81.8% | 87.1% |
| Medical services with no gap or a known gap | 97.8% | 96.2% | 97.1% |
| Extras charges covered | 51.3% | 51.3% | 50.7% |
| Private hospital agreements, all states | 273 | 252 | - |
| Day hospital agreements, all states | 273 | 225 | - |
| Hospital policies (30 June 2025) | 1,498,193 | 1,532,670 | 6,125,068 |
Read our Medibank review, or see the five largest health funds side by side.
How to read it: complaint share is the fairest single comparison of service across funds of different sizes, because it's measured against market share. Benefits as a % of premiums shows how much of the premium pool went back to members as claims; a mutual that returns more is not necessarily cheaper, and a fund can move this figure by changing prices. The gap measures show how often members avoided an out-of-pocket medical bill after a hospital stay, which is what most people mean by "good cover".
Hospital agreements
| ACT | NSW | VIC | QLD | SA | WA | TAS | NT | |
|---|---|---|---|---|---|---|---|---|
| Private hospitals | 6 | 95 | 69 | 56 | 17 | 22 | 7 | 1 |
| Most held by any insurer | 7 | 95 | 73 | 63 | 17 | 23 | 7 | 1 |
| Day hospitals | 8 | 92 | 59 | 52 | 28 | 22 | 11 | 1 |
| Most held by any insurer | 11 | 109 | 73 | 58 | 35 | 28 | 12 | 2 |
What to check before you join Bupa
- Bupa's product range is large. Two Silver Plus policies can cover different 'Plus' categories, so compare the clinical category list rather than the tier name.
- Benefits returned (82.4%) were below the industry result in 2024-25. That's a fund-wide number, not a statement about any one policy.
- If you hold cover to avoid the Medicare Levy Surcharge, keep the excess at $750 or less for a single policy ($1,500 for couples and families).
- Over 31 and joining for the first time? Work out your Lifetime Health Cover loading first, and if you earn over the threshold, check the Medicare Levy Surcharge you'd avoid.
Common questions about Bupa
Is Bupa a not-for-profit health fund?
No. PrivateHealth.gov.au lists Bupa HI Pty Ltd as operating on a for-profit basis. It is owned by Bupa Group International, which the listing describes as operating on a not-for-profit basis.
How many complaints does Bupa get?
In 2024-25 Bupa accounted for 25.2% of complaints about health insurers to the Private Health Insurance Ombudsman, against a 25.5% share of the market. That is in line with its size.
Does Bupa offer the age-based discount?
Yes. In the Government's product data at 1 September 2026, all of Bupa's hospital policies open to new members were listed as offering the age-based discount of up to 10% for people who join aged 18 to 29.
Is Bupa health insurance worth it?
That depends on the policy and what you need it to cover, and we don't rate funds. On the official 2024-25 measures Bupa was in line with its size on complaints (25.2% of complaints on a 25.5% market share), below the industry on benefits paid (82.4% of premiums against 84.5%) and above it on in-hospital medical services with no gap (90.2% against 87.1%). Compare a Bupa policy's clinical categories, excess and price with equivalent policies from other funds before you decide.
Which is the worst health insurance company in Australia?
There is no official ranking of best or worst insurers. The closest official measure of service is each insurer's share of complaints to the Private Health Insurance Ombudsman set against its market share, which we list for every fund on our health fund comparison. In 2024-25 Bupa's complaints were in proportion to its size.
Why was Bupa taken to court?
The ACCC took Bupa HI Pty Ltd to the Federal Court over how it handled claims. In December 2025 the Court ordered Bupa to pay $35 million in penalties, declaring that between May 2018 and August 2023 it told some members they weren't entitled to any benefit for a claim when part of the treatment was covered, mostly hospital stays with several procedures where only some were covered, and that some of that conduct was unconscionable. The ACCC says Bupa had paid more than $14.3 million to people affected.
Who are the big three health insurers?
By 2024-25 market share: Medibank (including ahm) 26.5%, Bupa 25.5% and HCF (including RT Health) 12.8%, on the Private Health Insurance Ombudsman's figures published on privatehealth.gov.au (checked 2 October 2026). nib (including GU Health, 9.8%) and HBF (7.9%) complete the top five.
Other fund reviews
See every registered health insurer compared on complaints and benefits, or read how the private health insurance rebate and hospital cover tiers work.
General advice only. It doesn't consider your circumstances. Read the PDS and TMD before you decide.
This review is general information based on published government and regulator data. We don't rate or rank funds, and it doesn't consider your circumstances. Check a policy's Private Health Information Statement before you buy.