Common use of Claiming Clause in Contracts

Claiming. You will use an electronic claiming system, such as HealthPoint or HICAPS, for the processing of services. Services processed through the electronic claiming system must be done so in the presence of the cardholder. Where the system is inoperable, fully itemised invoices must be issued to customers for claiming. Invoices for professional services must be received by us within two years of the date of service. All invoices presented to Bupa for the purposes of a benefit must be correct and accurate, including the service details, provider number, patient’s name, date of service, and service type. Ancillary Provider Terms The Rules of Participation govern your participation in Bupa’s Members First network and do not replace Bupa’s Ancillary Provider Terms which apply to you and anyone else who Bupa recognises as a provider of services for whom we pay benefits. You must, however, comply with the Ancillary Provider Terms (updated from time to time and available at xxx.xxxx.xxx.xx/xxx-xxxxxxxxx/xxxxxxxxx/xxxxxxxxxxx-xxxxxxxxx) in order to be a recognised provider eligible to join or remain in the Members First network. Quality assurance undertakings In order to participate and continue in the Bupa Members First chiropractic network, you must comply with the quality assurance undertakings for chiropractic providers detailed in Table 3 and give evidence of this to us, as requested. Patient eligibility We pay benefits to our customers in accordance with their level of cover and our policy terms and conditions. Conditions that may affect a customer’s eligibility to receive benefits include, but are not restricted to: waiting periods; annual limits; compensation payable by another party and premium payments in arrears. Practice Standards Practitioners must be aware of, and comply with all standards, guidelines and policies set out by the Chiropractic Board of Australia. For a copy of the Code of Conduct and registration standards please visit the AHPRA web site. Promotion Public notice and information of your participation in our chiropractic network may be given through point of service material provided by us, to be placed in a noticeable position at your professional premises. You acknowledge that Bupa may promote details of your practice and involvement in our chiropractic network, by providing information of participating chiropractors to its members or by publishing your clinic details, including on any Bupa website. Bupa may include your clinic details in search results on any provider search tools made available by Bupa. Bupa may suspend promotion for any reason without notice to you. Bupa may disclose your confidential information for the purposes contemplated by this agreement, as required or permitted by law, to the AHPRA (or its equivalent), or with your consent. Any other promotional material you choose to use must be approved in writing by us prior to use (see Table 4 on page 6). You may only use a Bupa Trademark if Bupa has provided written approval as per the terms set out in Table 4. You must not, and must procure that any corporate entity associated with, representing or acting on behalf of your practice does not, without our prior written approval, undertake any marketing or promotional campaigns or initiatives using wording such as “Use It or Lose It” or engage in any initiatives using the same or any other wording in which in Bupa’s reasonable opinion the intent is to convey the impression that Bupa members will “lose” their health insurance benefits if they do not use them by a certain date, such as 31 December. without our prior written approval. Variation Except in the case of a change required as the result in a change of law, we may alter the Rules of Participation, including any of the Tables and/or the Maximum Chargeable Amounts in Table 1 by giving 28 days written notice to you. If the change is needed because of a change in law, we must notify you, if possible, before the change takes effect.

Claiming. You will use an electronic claiming system, such as HealthPoint or HICAPS, for the processing of services. Services processed through the electronic claiming system must be done so in the presence of the cardholder. Where the system is inoperable, fully itemised invoices must be issued to customers members for claiming. Invoices for professional services must be received by us within two years of the date of service. All invoices presented to Bupa for the purposes of a benefit must be correct and accurate, including the service details, provider number, patient’s name, date of service, and service type. Ancillary Provider Terms The Rules of Participation govern your participation in Bupa’s Members First network and do not replace Bupa’s Ancillary Provider Terms which apply to you (and anyone else else) who Bupa recognises as a provider of services for whom we pay benefits. You must, however, comply with the Ancillary Provider Terms (updated from time to time and available at xxx.xxxx.xxx.xx/xxx-xxxxxxxxx/xxxxxxxxx/xxxxxxxxxxx-xxxxxxxxxxxxx://xxx.xxxx. xxx.xx/xxx-xxxxxxxxx/xxxxxxxxx/xxxxxxxxxxx-xxxxxxxxx) in order to be a recognised provider eligible to join or remain in the Members First network. Quality assurance undertakings In order to participate and continue in the Bupa Members First chiropractic dental network, you must comply with the quality assurance undertakings for chiropractic dental providers detailed in Table 3 2 and give evidence of this to us, as requested. Patient eligibility We pay benefits to our customers in accordance with their level of cover and our policy terms and conditions. Conditions that may affect a customer’s eligibility to receive benefits include, but are not restricted to: waiting periods; annual limits; health fund rules; compensation payable by another party and premium payments in arrears. Practice Standards Practitioners must be aware of, and comply with all standards, guidelines and policies set out by the Chiropractic Dental Board of Australia. For a copy of the Code of Conduct and registration standards please visit the AHPRA web site. Promotion Public notice and information of your participation in our chiropractic dental network may be given through point of service material provided by us, to be placed in a noticeable position at your professional premises. You acknowledge that Bupa may promote details of your practice clinic and involvement in our chiropractic dental network, by providing information of participating chiropractors dentists to its members customers or by publishing your clinic details, including on any Bupa website. Bupa may include your clinic details in search results on any provider search tools made available by Bupa. Bupa may suspend promotion for any reason without notice to you. Bupa may disclose your confidential information for the purposes contemplated by this agreement, as required or permitted by law, to the AHPRA (or its equivalent), or with your consent. Any other promotional material you choose to use must be approved in writing by us prior to use (see Table 4 3 on page 6). You may only use a Bupa Trademark Trademark, including any Bupa logo, if Bupa has provided written approval as per the terms set out in Table 43. You must not, and must procure that any corporate entity associated with, representing or acting on behalf of your practice does not, without our prior written approval, undertake any marketing or promotional campaigns or initiatives using wording such as “Use It or Lose It” or engage in any initiatives using the same or any other wording in which in Bupa’s reasonable opinion the intent is to convey the impression that Bupa members will “lose” their health insurance benefits if they do not use them by a certain date, such as 31 December. without our prior written approval. Variation Except in the case of a change required as the result in a change of law, we may alter the Rules of Participation, including any of the Tables and/or the Maximum Chargeable Amounts in Table 1 by giving 28 days written notice to you. If the change is needed because of a change in law, we must notify you, if possible, before the change takes effect.

Claiming. You will use an electronic claiming system, such as HealthPoint or HICAPS, for the processing of services. Services processed through the electronic claiming system must be done so in the presence of the cardholder. Where the system is inoperable, fully itemised invoices must be issued to customers for claiming. Invoices for professional services must be received by us within two years of the date of service. All invoices presented to Bupa for the purposes of a benefit must be correct and accurate, including the service details, provider number, patient’s name, date of service, and service type. Ancillary Provider Terms The Rules of Participation govern your participation in Bupa’s Members First network and do not replace Bupa’s Ancillary Provider Terms which apply to you and anyone else who Bupa recognises as a provider of services for whom we pay benefits. You must, however, comply with the Ancillary Provider Terms (updated from time to time and available at xxx.xxxx.xxx.xx/xxx-xxxxxxxxx/xxxxxxxxx/xxxxxxxxxxx-xxxxxxxxx) in order to be a recognised provider eligible to join or remain in the Members First network. Quality assurance undertakings In order to participate and continue in the Bupa Members First chiropractic podiatry network, you must comply with the quality assurance undertakings for chiropractic podiatry providers detailed in Table 3 and give evidence of this to us, as requested. Patient eligibility All Bupa customers will have access to these arrangements. We pay benefits to our customers in accordance with their level of cover and our policy terms and conditions. Conditions that may affect a customer’s eligibility to receive benefits include, but are not restricted to: waiting periods; annual limits; compensation payable by another party and premium payments in arrears. Practice Standards Practitioners must be aware of, and comply with all standards, guidelines and policies set out by the Chiropractic Podiatry Board of Australia. For a copy of the Code of Conduct and registration standards please visit the AHPRA web site. Promotion Public notice and information of your participation in our chiropractic podiatry network may be given through point of service material provided by us, to be placed in a noticeable position at your professional premises. You acknowledge that Bupa may promote details of your practice and involvement in our chiropractic podiatry network, by providing information of participating chiropractors podiatrists to its members or by publishing your clinic details, including on any Bupa website. Bupa may include your clinic details in search results on any provider search tools made available by Bupa. Bupa may suspend promotion for any reason without notice to you. Bupa may disclose your confidential information for the purposes contemplated by this agreement, as required or permitted by law, to the AHPRA (or its equivalent), or with your consent. Any other promotional material you choose to use must be approved in writing by us prior to use (see Table 4 on page 6). You may only use a Bupa Trademark if Bupa has provided written approval as per the terms set out in Table 4. You must not, and must procure that any corporate entity associated with, representing or acting on behalf of your practice does not, without our prior written approval, undertake any marketing or promotional campaigns or initiatives using wording such as “Use It or Lose It” or engage in any initiatives using the same or any other wording in which in Bupa’s reasonable opinion the intent is to convey the impression that Bupa members will “lose” their health insurance benefits if they do not use them by a certain date, such as 31 December. without our prior written approval. Variation Except in the case of a change required as the result in a change of law, we may alter the Rules of Participation, including any of the Tables and/or the Maximum Chargeable Amounts in Table 1 by giving 28 days written notice to you. If the change is needed because of a change in law, we must notify you, if possible, before the change takes effect.. April 2019 3

Claiming. You will use an electronic claiming system, such as HealthPoint or HICAPS, for the processing of services. Services processed through the electronic claiming system must be done so in the presence of the cardholder. Where the system is inoperable, fully itemised invoices must be issued to customers for claiming. Invoices for professional services must be received by us within two years of the date of service. All invoices presented to Bupa for the purposes of a benefit must be correct and accurate, including the service details, provider number, patient’s name, date of service, and service type. Ancillary Provider Terms The Rules of Participation govern your participation in Bupa’s Members First network and do not replace Bupa’s Ancillary Provider Terms which apply to you and anyone else who Bupa recognises as a provider of services for whom we pay benefits. You must, however, comply with the Ancillary Provider Terms (updated from time to time and available at xxx.xxxx.xxx.xx/xxx-xxxxxxxxx/xxxxxxxxx/xxxxxxxxxxx-xxxxxxxxxxxxx://xxx.xxxx. xxx.xx/xxx-xxxxxxxxx/xxxxxxxxx/xxxxxxxxxxx-xxxxxxxxx) in order to be a recognised provider eligible to join or remain in the Members First network. Quality assurance undertakings In order to participate and continue in the Bupa Members First chiropractic physiotherapy network, you must comply with the quality assurance undertakings for chiropractic physiotherapy providers detailed in Table 3 and give evidence of this to us, as requested. Patient eligibility All Bupa customers will have access to these arrangements. We pay benefits to our customers in accordance with their level of cover and our policy terms and conditions. Conditions that may affect a customer’s eligibility to receive benefits include, but are not restricted to: waiting periods; annual limits; compensation payable by another party and premium payments in arrears. Practice Standards Practitioners must be aware of, and comply with all standards, guidelines and policies set out by the Chiropractic Physiotherapy Board of Australia. For a copy of the Code of Conduct and registration standards please visit the AHPRA web site. Promotion Public notice and information of your participation in our chiropractic physiotherapy network may be given through point of service material provided by us, to be placed in a noticeable position at your professional premises. You acknowledge that Bupa may promote details of your practice and involvement in our chiropractic physiotherapy network, by providing information of participating chiropractors physiotherapists to its members or by publishing your clinic details, including on any Bupa website. Bupa may include your clinic details in search results on any provider search tools made available by Bupa. Bupa may suspend promotion for any reason without notice to you. Bupa may disclose your confidential information for the purposes contemplated by this agreement, as required or permitted by law, to the AHPRA (or its equivalent), or with your consent. Any other promotional material you choose to use must be approved in writing by us prior to use (see Table 4 on page 6). You may only use a Bupa Trademark if Bupa has provided written approval as per the terms set out in Table 4. You must not, and must procure that any corporate entity associated with, representing or acting on behalf of your practice does not, without our prior written approval, undertake any marketing or promotional campaigns or initiatives using wording such as “Use It or Lose It” or engage in any initiatives using the same or any other wording in which in Bupa’s reasonable opinion the intent is to convey the impression that Bupa members will “lose” their health insurance benefits if they do not use them by a certain date, such as 31 December. without our prior written approval. Variation Except in the case of a change required as the result in a change of law, we may alter the Rules of Participation, including any of the Tables and/or the Maximum Chargeable Amounts in Table 1 by giving 28 days written notice to you. If the change is needed because of a change in law, we must notify you, if possible, before the change takes effect.

Claiming. You will use an electronic claiming system, such as HealthPoint or HICAPS, for the processing of services. Services processed through the electronic claiming system must be done so in the presence of the cardholder. Where the system is inoperable, fully itemised invoices must be issued to customers for claiming. Invoices for professional services must be received by us within two years of the date of service. All invoices presented to Bupa for the purposes of a benefit must be correct and accurate, including the service details, provider number, patient’s name, date of service, and service type. Ancillary Provider Terms The Rules of Participation govern your participation in Bupa’s Members First network and do not replace Bupa’s Ancillary Provider Terms which apply to you and anyone else who Bupa recognises as a provider of services for whom we pay benefits. You must, however, comply with the Ancillary Provider Terms (updated from time to time and available at xxx.xxxx.xxx.xx/xxx-xxxxxxxxx/xxxxxxxxx/xxxxxxxxxxx-xxxxxxxxx) in order to be a recognised provider eligible to join or remain in the Members First network. Quality assurance undertakings In order to participate and continue in the Bupa Members First chiropractic network, you must comply with the quality assurance undertakings for chiropractic providers detailed in Table 3 and give evidence of this to us, as requested. Patient eligibility We pay benefits to our customers in accordance with their level of cover and our policy terms and conditions. Conditions that may affect a customer’s eligibility to receive benefits include, but are not restricted to: waiting periods; annual limits; compensation payable by another party and premium payments in arrears. Practice Standards Practitioners must be aware of, and comply with all standards, guidelines and policies set out by the Chiropractic Board of Australia. For a copy of the Code of Conduct and registration standards please visit the AHPRA web sitewebsite. Promotion Public notice and information of your participation in our chiropractic network may be given through point of service material provided by us, to be placed in a noticeable position at your professional premises. You acknowledge that Bupa may promote details of your practice and involvement in our chiropractic network, by providing information of participating chiropractors to its members or by publishing your clinic details, including on any Bupa website. Bupa may include your clinic details in search results on any provider search tools made available by Bupa. Bupa may suspend promotion for any reason without notice to you. Bupa may disclose your confidential information for the purposes contemplated by this agreement, as required or permitted by law, to the AHPRA (or its equivalent), or with your consent. Any other promotional material you choose to use must be approved in writing by us prior to use (see Table 4 on page 6). You may only use a Bupa Trademark if Bupa has provided written approval as per the terms set out in Table 4. You must not, and must procure that any corporate entity associated with, representing or acting on behalf of your practice does not, without our prior written approval, undertake any marketing or promotional campaigns or initiatives using wording such as “Use It or Lose It” or engage in any initiatives using the same or any other wording in which in Bupa’s reasonable opinion the intent is to convey the impression that Bupa members will “lose” their health insurance benefits if they do not use them by a certain date, such as 31 December. without our prior written approval. Variation Except in the case of a change required as the result in a change of law, we may alter the Rules of Participation, including any of the Tables and/or the Maximum Chargeable Amounts in Table 1 by giving 28 days written notice to you. If the change is needed because of a change in law, we must notify you, if possible, before the change takes effect. Privacy and Confidentiality Bupa may disclose your confidential information for the purposes contemplated by this agreement: • as required or permitted by law; • to a regulator; or • with your consent.

Claiming. You will must use an electronic claiming system, such as HealthPoint or HICAPS, for the processing of services. Services processed through the electronic claiming system must be done so in the presence of the cardholder. Where the system is inoperable, fully itemised invoices must be issued to customers members for claiming. Invoices for professional services must be received by us within two years of the date of service. All invoices presented to Bupa for the purposes of a benefit must be correct and accurate, including the service details, provider number, patient’s name, date of service, and service type. Ancillary Provider Terms The Members First Platinum – Rules of Participation govern your participation in Bupa’s Members First Platinum network and do not replace Bupa’s Our Ancillary Provider Terms which apply to you (and anyone else else) who Bupa recognises as a provider of services for whom we pay benefits. You must, however, comply with the Our Ancillary Provider Terms (updated from time to time and available at xxx.xxxx.xxx.xx/xxx-xxxxxxxxx/xxxxxxxxx/xxxxxxxxxxx-xxxxxxxxxwww.bupa. xxx.xx/xxx-xxxxxxxxx/xxxxxxxxx/xxxxxxxxxxx-xxxxxxxxx) in order to be a recognised provider eligible to join or remain in the Members First Platinum network. Quality assurance undertakings In order to participate and continue in the Bupa Members First chiropractic Platinum dental network, you must comply with the quality assurance undertakings, and additional undertakings for chiropractic dental providers detailed in Table 3 2 – Platinum, and 2B – Platinum and give evidence of this to us, as requestedif and when reasonably requested to do so. Patient eligibility We pay benefits to our customers in accordance with their level of cover and our policy terms and conditions. Conditions that may affect a customer’s eligibility to receive benefits include, but are not restricted to: waiting periods; annual limits; health fund rules; compensation payable by another party and premium payments in arrears. Practice Standards Practitioners must be aware of, and comply with all standards, guidelines and policies set out by the Chiropractic Dental Board of Australia. For a copy of the Code of Conduct and registration standards please visit the AHPRA web site. Promotion Public notice and information of your participation in our chiropractic network Members First Platinum Network may be given through point of service material provided by us, to be placed in a noticeable position at your professional premises. You acknowledge that Bupa may promote details of your practice clinic and involvement in our chiropractic networkMembers First Platinum Network, by providing information of participating chiropractors dentists to its members customers or by publishing your clinic details, including on any Bupa website. Bupa may include your clinic details in search results on any provider search tools made available by Bupa. Bupa may suspend promotion for any reason without notice to you. Bupa may disclose your confidential information solely for the purposes contemplated by this agreement, as required or permitted by law, to the AHPRA (or its equivalent), or with your consent. Any other promotional material you choose to use in relation to the Bupa Members First Platinum Dental Network or Bupa in general, must be approved in writing by us prior to use (see Table 4 3 on page 6). You may only use a Bupa Trademark trade mark, including any Bupa logo, if Bupa has provided written approval as per the terms set out in Table 43. You must not, and must procure that any corporate entity associated with, representing or acting on behalf of your practice does not, without our prior written approval, undertake any marketing or promotional campaigns or initiatives using wording such as “Use It or Lose It” or engage in any initiatives using the same or any other wording in which in Bupa’s reasonable opinion the intent is to convey the impression that Bupa members will “lose” their health insurance benefits if they do not use them by a certain date, such as 31 December. without our prior written approval. Variation Except in the case of a change required as the result in of a change of in law, we may alter the these Members First Platinum – Rules of Participation, including any of the Tables and/or the Maximum Chargeable Amounts in Members First Platinum – Table 1 by giving 28 days written notice to you. If the change is needed because of a change in law, we must notify you, if possible, before the change takes effect.

Claiming. You will use an electronic claiming system, such as HealthPoint or HICAPS, for the processing of services. Services processed through the electronic claiming system must be done so in the presence of the cardholdercardholder or, solely in the case of telehealth services, during the telehealth appointment. Where the system is inoperable, fully itemised invoices must be issued to customers for claiming. Invoices for professional services must be received by us within two years of the date of service. All invoices presented to Bupa for the purposes of a benefit must be correct and accurate, including the service details, provider number, patient’s name, date of service, and service type. Ancillary Provider Terms The Rules of Participation govern your participation in Bupa’s Members First network and do not replace Bupa’s Ancillary Provider Terms which apply to you and anyone else who Bupa recognises as a provider of services for whom we pay benefits. You must, however, comply with the Ancillary Provider Terms (updated from time to time and available at xxx.xxxx.xxx.xx/xxx-xxxxxxxxx/xxxxxxxxx/xxxxxxxxxxx-xxxxxxxxxxxxx://xxx.xxxx. xxx.xx/xxx-xxxxxxxxx/xxxxxxxxx/xxxxxxxxxxx-xxxxxxxxx) in order to be a recognised provider eligible to join or remain in the Members First network. Quality assurance undertakings In order to participate and continue in the Bupa Members First chiropractic physiotherapy network, you must comply with the quality assurance undertakings for chiropractic physiotherapy providers detailed in Table 3 and give evidence of this to us, as requested. July 2022 Patient eligibility All Bupa customers will have access to these arrangements. We pay benefits to our customers in accordance with their level of cover and our policy terms and conditions. Conditions that may affect a customer’s eligibility to receive benefits include, but are not restricted to: waiting periods; annual limits; compensation payable by another party and premium payments in arrears. Practice Standards Practitioners must be aware of, and comply with all standards, guidelines and policies set out by the Chiropractic Physiotherapy Board of Australia. For a copy of the Code of Conduct and registration standards please visit the AHPRA web sitewebsite. Promotion Public notice and information of your participation in our chiropractic physiotherapy network may be given through point of service material provided by us, to be placed in a noticeable position at your professional premises. You acknowledge that Bupa may promote details of your practice and involvement in our chiropractic physiotherapy network, by providing information of participating chiropractors physiotherapists to its members or by publishing your clinic details, including on any Bupa website. Bupa may include your clinic details in search results on any provider search tools made available by Bupa. Bupa may suspend promotion for any reason without notice to you. Bupa may disclose your confidential information for the purposes contemplated by this agreement, as required or permitted by law, to the AHPRA (or its equivalent), or with your consent. Any other promotional material you choose to use must be approved in writing by us prior to use (see Table 4 on page 6). You may only use a Bupa Trademark if Bupa has provided written approval as per the terms set out in Table 4. You must not, and must procure that any corporate entity associated with, representing or acting on behalf of your practice does not, without our prior written approval, undertake any marketing or promotional campaigns or initiatives using wording such as “Use It or Lose It” or engage in any initiatives using the same or any other wording in which in Bupa’s reasonable opinion the intent is to convey the impression that Bupa members will “lose” their health insurance benefits if they do not use them by a certain date, such as 31 December. without our prior written approval. Variation Except in the case of a change required as the result in a change of law, we may alter the Rules of Participation, including any of the Tables and/or the Maximum Chargeable Amounts in Table 1 by giving 28 days written notice to you. If the change is needed because of a change in law, we must notify you, if possible, before the change takes effect. Privacy and Confidentiality Bupa may disclose your confidential information for the purposes contemplated by this agreement: • as required or permitted by law; • to a regulator; or • with your consent.