The findings concern conduct between May 2018 and August 2023. During that period, Bupa told certain policyholders, hospitals, and medical providers that members were not entitled to any benefits on particular claims, despite those members being eligible for benefits for treatments covered under their policies.
The court also found that Bupa engaged in unconscionable conduct between June 2020 and February 2021 in relation to a subset of claims categorised as Mixed Coverage Claims. In addition to the financial penalty, the court granted an injunction restraining Bupa from repeating the contravening conduct for five years. Bupa cooperated with the Australian Competition and Consumer Commission (ACCC) during the investigation and made joint submissions with the regulator on liability and the proposed penalty.
The proceedings focus on two types of private health insurance claims:
Most of the affected claims related to hospital admissions where two or more procedures were performed at the same time. Where one procedure was covered under the member’s policy and another was not, Bupa rejected the entire claim rather than paying the portion attributable to covered treatment.
According to the ACCC, the approach affected a large number of members. “Bupa’s conduct impacted thousands of consumers. During our investigation, we heard from Bupa members who suffered significant harm, including financial harm as well as pain, suffering, and emotional distress as a result of Bupa’s conduct. Some of Bupa’s members decided to cancel, delay, or forego necessary treatment, resulting in potential medical risks or complications, because they were incorrectly told they were not entitled to health insurance benefits. Private health insurance can be a significant expense for consumers, and people rightly expect to receive the level of coverage they pay for,” said ACCC deputy chair Catriona Lowe.
The ACCC said the conduct had consequences for both insured members and the health sector. Hospitals and medical practitioners did not receive payments they were entitled to for certain claims submitted on behalf of Bupa members whose benefits had been incorrectly assessed.
Lowe characterised the outcome as a significant enforcement action under the Australian Consumer Law. “We consider this to be extremely serious conduct, and this is reflected in Bupa’s admission that it engaged in unconscionable conduct, which is one of the most serious types of misconduct under the consumer laws that we enforce. [The] outcome should serve as a reminder to all health insurers of their obligations under the Australian Consumer Law, including that they must ensure that claims are assessed correctly so that their members receive the benefits they are entitled to under their policies,” she said.
Bupa has commenced a remediation program in relation to affected claims prior to the court action. In June 2025, the insurer gave the ACCC a court-enforceable undertaking to complete that remediation for members, hospitals, and medical providers impacted by the conduct. Under the undertaking, Bupa is required to compensate affected parties for the benefits they should have received, plus interest. According to information provided to the ACCC and referred to in Bupa’s public statements, more than $14.3 million has been paid across more than 4,100 affected claims to date.
Current and former members who believe they may have been impacted can seek review of their claims through Bupa’s remediation process. The insurer has published information about the process on its website, including a remediation form for mixed coverage claims, and has advised customers to use contact details obtained independently.
In a statement issued after the court’s final orders, Bupa Health Insurance Australia said it acknowledged the breaches of Australian Consumer Law and the agreed penalty. The proceedings covered the incorrect assessment of certain mixed coverage and uncategorised item claims and related eligibility checks between May 2018 and August 2023.
The company said: “Bupa Health Insurance Australia acknowledges the orders the Federal Court made in response to breaches of Australian Consumer Law. We remain deeply sorry for these errors and have apologised to our affected customers for the impact this has had on them and their families and have taken actions to ensure this doesn’t occur again. Bupa Australia has already compensated almost all our impacted customers, and as of November 5, 2025, we have paid back a total of $14.3 million. We have accepted the Federal Court’s decision and have cooperated fully with the ACCC throughout this process.”
Bupa, which holds about 25.5% of the Australian private health insurance market and has around 4.5 million members, is ultimately controlled by British United Provident Association Ltd through Bupa HI Holdings Pty Ltd. For insurance professionals, the case underlines the need for accurate benefit eligibility checks, clear benefit communication to policyholders and providers, and strong oversight of claims rules where multiple procedures or non-standard items are involved.
