my.bupa.com.au Open in urlscan Pro
107.154.100.151  Public Scan

Form analysis
1 forms found in the DOM

Name: DeferredClaimsLiability —

<form ng-if="!deferredClaimsLiabilityCtrl.showConfirmation" name="DeferredClaimsLiability" novalidate="" bupa-step="steps" ng-submit="DeferredClaimsLiability.$valid &amp;&amp; deferredClaimsLiabilityCtrl.submitForm();"
  class="ng-pristine ng-scope ng-invalid ng-invalid-required ng-valid-pattern ng-valid-maxlength ng-valid-date-today-before ng-valid-date ng-valid-email ng-valid-minlength ng-valid-bsb">
  <div ng-transclude="formTokens"><form-tokens class="ng-scope">
      <div bupa-token="token" class="ng-isolate-scope">
        <div style="display: none;"> If you see this, leave it blank. Only bots should see this <input name="Spam" data-bind="value: honeyPot" type="text">
        </div>
        <input name="__RequestVerificationToken" type="hidden" value="e9a2lFdETMEepdoHsFNoKTvpxNqpddR351mmgh6cKm-W5UI6rKN1bDsMByFPsBrAlE6mSHG3nfAswx4O13AE-Fv0Aic1" autocomplete="off">
      </div>
    </form-tokens></div>
  <bupa-steps-tabs step-labels="[
    { Name: 'Customer details' },
    { Name: 'Review' }]">
    <div class="steps__wrapper">
      <div class="container add-padding-bottom">
        <h2 class="sr-only ng-binding">Steps (2 in total)</h2>
        <ol class="steps" id="steps">
          <!-- ngRepeat: step in stepsTabsCtrl.labels track by $index -->
          <li ng-repeat="step in stepsTabsCtrl.labels track by $index" class="steps__item ng-scope steps__item--current"
            ng-class="{'steps__item--current': stepsTabsCtrl.isCurrentStep($index), 'steps__item--completed': stepsTabsCtrl.isCompletedStep($index)}">
            <span class="steps__label ng-binding" ng-class="{true:'steps__label--completed'}[stepsTabsCtrl.isCompletedStep($index)]"> Customer details </span>
            <!-- ngIf: stepsTabsCtrl.isCompletedStep($index) -->
            <!-- ngIf: stepsTabsCtrl.isCurrentStep($index) --><span class="sr-only ng-scope" ng-if="stepsTabsCtrl.isCurrentStep($index)"> current step </span><!-- end ngIf: stepsTabsCtrl.isCurrentStep($index) -->
          </li><!-- end ngRepeat: step in stepsTabsCtrl.labels track by $index -->
          <li ng-repeat="step in stepsTabsCtrl.labels track by $index" class="steps__item ng-scope" ng-class="{'steps__item--current': stepsTabsCtrl.isCurrentStep($index), 'steps__item--completed': stepsTabsCtrl.isCompletedStep($index)}">
            <span class="steps__label ng-binding" ng-class="{true:'steps__label--completed'}[stepsTabsCtrl.isCompletedStep($index)]"> Review </span>
            <!-- ngIf: stepsTabsCtrl.isCompletedStep($index) -->
            <!-- ngIf: stepsTabsCtrl.isCurrentStep($index) -->
          </li><!-- end ngRepeat: step in stepsTabsCtrl.labels track by $index -->
        </ol>
      </div>
    </div>
  </bupa-steps-tabs>
  <bupa-steps-content>
    <div class="tab-content container">
      <div class="tab-content__section" ng-show="stepsContentCtrl.activeTab === 0" aria-hidden="false">
        <div ng-form="steps.step1" class="ng-pristine ng-invalid ng-invalid-required ng-valid-pattern ng-valid-maxlength ng-valid-date-today-before ng-valid-date ng-valid-email ng-valid-minlength ng-valid-bsb">
          <div class="row add-padding-vertical">
            <div class="col-md-5">
              <div class="heading text--center-xs text--center-sm">
                <h2 class="heading__title heading__title--primary heading__title--standard js__focus ng-binding" tabindex="-1">Membership details</h2>
                <div ng-transclude="customerDetailsDescription" class="heading__description heading__description--light"><customer-details-description class="ng-scope">
                    <p>Please provide the details of the policy holder that is or was listed on the membership to allow for accurate identification.</p>
                    <p>* Required field</p>
                  </customer-details-description></div>
              </div>
            </div>
            <div class="col-md-6 col-md-offset-1">
              <div class="add-padding-bottom">
                <div class="form-group">
                  <label for="FirstName" class="form-label form-label--mandatory">Policy holder first name</label>
                  <input class="form-control ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required ng-valid-pattern ng-valid-maxlength" type="text" maxlength="50" name="FirstName" id="FirstName" placeholder=""
                    ng-class="{true: 'form-control--error'}[(steps.step1.FirstName.$touched || steps.step1.$submitted) &amp;&amp; steps.step1.FirstName.$invalid]" ng-model="deferredClaimsLiabilityCtrl.form.FirstName" ng-pattern="/^[a-zA-Z-'`\s]+$/"
                    ng-maxlength="50" required="" aria-invalid="true">
                  <!-- ngIf: steps.step1.FirstName.$touched || steps.step1.$submitted -->
                </div>
                <div class="form-group">
                  <label for="LastName" class="form-label form-label--mandatory">Policy holder last name</label>
                  <input class="form-control ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required ng-valid-pattern ng-valid-maxlength" type="text" maxlength="50" name="LastName" id="LastName" placeholder=""
                    ng-class="{true: 'form-control--error'}[(steps.step1.LastName.$touched || steps.step1.$submitted) &amp;&amp; steps.step1.LastName.$invalid]" ng-model="deferredClaimsLiabilityCtrl.form.LastName" ng-pattern="/^[a-zA-Z-'`\s]+$/"
                    ng-maxlength="50" required="" aria-invalid="true">
                  <!-- ngIf: steps.step1.LastName.$touched || steps.step1.$submitted -->
                </div>
                <div class="form-group">
                  <div class="row">
                    <div class="col-sm-4 col-md-6">
                      <label for="DateOfBirth" class="form-label form-label--mandatory">Date of birth</label>
                      <input class="form-control ng-pristine ng-untouched ng-empty ng-valid-date-today-before ng-valid-date ng-invalid ng-invalid-required" type="text" ng-model="deferredClaimsLiabilityCtrl.form.DateOfBirth" name="DateOfBirth"
                        id="DateOfBirth" ng-class="{true: 'form-control--error'}[(steps.step1.DateOfBirth.$touched || steps.step1.$submitted) &amp;&amp; steps.step1.DateOfBirth.$invalid]" bupa-date-picker="" v-date="" v-date-today-before=""
                        required="" autocomplete="off" maxlength="10" placeholder="DD/MM/YYYY" aria-invalid="true">
                      <!-- ngIf: steps.step1.DateOfBirth.$touched || steps.step1.$submitted -->
                    </div>
                  </div>
                </div>
                <div class="form-group">
                  <label for="EmailAddress" class="form-label form-label--mandatory"> Email address </label>
                  <input class="form-control ng-pristine ng-untouched ng-empty ng-valid-email ng-invalid ng-invalid-required ng-valid-pattern" type="email" name="EmailAddress" id="EmailAddress" placeholder=""
                    ng-class="{true: 'form-control--error'}[(steps.step1.EmailAddress.$touched || steps.step1.$submitted) &amp;&amp; steps.step1.EmailAddress.$invalid]" ng-model="deferredClaimsLiabilityCtrl.form.EmailAddress"
                    ng-pattern="/(?=^.{6,254}$)(^[A-Za-z0-9'._%+-]+@(?:[A-Za-z0-9-]+\.)+[A-Za-z]{2,8}$)/" required="" aria-invalid="true">
                  <!-- ngIf: steps.step1.EmailAddress.$touched || steps.step1.$submitted -->
                </div>
                <div class="form-group">
                  <label for="MembershipNumber" class="form-label form-label--mandatory"> Membership number </label>
                  <input class="form-control form-control--small add-padding--form-element ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required ng-valid-pattern ng-valid-minlength ng-valid-maxlength"
                    aria-describedby="membershipNumberDescription" type="text" maxlength="8" name="MembershipNumber" id="MembershipNumber" placeholder=""
                    ng-class="{true: 'form-control--error'}[(steps.step1.MembershipNumber.$touched || steps.step1.$submitted) &amp;&amp; steps.step1.MembershipNumber.$invalid]" ng-model="deferredClaimsLiabilityCtrl.form.MembershipNumber"
                    ng-pattern="/^[0-9]*$/" ng-maxlength="8" ng-minlength="8" required="" aria-invalid="true">
                  <p id="membershipNumberDescription" ng-hide="steps.step1.MembershipNumber.$invalid &amp;&amp; (steps.step1.MembershipNumber.$touched || steps.step1.$submitted)" aria-hidden="false"> This is your 8 digit number found on the front of
                    your Bupa membership card<span class="sr-only"> and on your welcome email</span>. </p>
                  <!-- ngIf: steps.step1.MembershipNumber.$touched || steps.step1.$submitted -->
                </div>
              </div>
            </div>
          </div>
          <hr class="add-padding-vertical">
          <div class="row">
            <div class="col-md-5">
              <div class="heading text--center-xs text--center-sm">
                <h2 class="heading__title heading__title--primary heading__title--standard ng-binding"> Bank account</h2>
                <div ng-transclude="bankAccountDetailsDescription" class="heading__description heading__description--light"><bank-account-details-description class="ng-scope">
                    <p>Please provide us with the details of the bank account you would like the payment to be sent to.</p>
                  </bank-account-details-description></div>
              </div>
            </div>
            <div class="col-md-6 col-md-offset-1">
              <div class="add-padding-bottom">
                <input class="checkbox__input ng-pristine ng-untouched ng-valid ng-empty" type="checkbox" name="UseExistingDebitForRefund" id="UseExistingDebitForRefund" value="true"
                  ng-model="deferredClaimsLiabilityCtrl.form.UseExistingDebitForRefundChecked" aria-invalid="false">
                <label class="add-padding-bottom checkbox__label" for="UseExistingDebitForRefund">I’d like to use the BSB and account number I’m currently using for my direct debit payments.</label>
                <hr class="add-padding-bottom divider--subtle divider-or" ng-hide="deferredClaimsLiabilityCtrl.form.UseExistingDebitForRefundChecked" aria-hidden="false">
                <bupa-bank-account-au is-required="!deferredClaimsLiabilityCtrl.form.UseExistingDebitForRefundChecked" ng-hide="deferredClaimsLiabilityCtrl.form.UseExistingDebitForRefundChecked" aria-hidden="false">
                  <div ng-form="bankAccountAuCtrl.ngForm" class="ng-pristine ng-valid-bsb ng-invalid ng-invalid-required ng-valid-pattern ng-valid-minlength ng-valid-maxlength">
                    <fieldset>
                      <legend class="sr-only">Australian bank account</legend>
                      <!-- ngIf: !bankAccountAuCtrl.excludeAccountNameField -->
                      <div class="row ng-scope" ng-if="!bankAccountAuCtrl.excludeAccountNameField">
                        <div class="col-xs-12">
                          <div class="form-group">
                            <label for="accountName" class="form-label form-label--mandatory"> Account name </label>
                            <input class="form-control qa__form--account-name ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required ng-valid-pattern ng-valid-maxlength" type="text" name="accountName" id="accountName" placeholder=""
                              ng-class="{true: 'form-control--error'}[bankAccountAuCtrl.ngForm.accountName.$invalid &amp;&amp; (bankAccountAuCtrl.ngForm.accountName.$touched || bankAccountAuCtrl.ngForm.$submitted)]"
                              ng-model="bankAccountAuCtrl.form.accountName" ng-pattern="/^(?!.*\s{2,})[A-Za-z][A-Za-z\s\-&amp;'`]*$/" maxlength="32" ng-required="bankAccountAuCtrl.isRequired" required="required" aria-invalid="true">
                            <!-- ngIf: bankAccountAuCtrl.ngForm.accountName.$touched || bankAccountAuCtrl.ngForm.$submitted -->
                          </div>
                        </div>
                      </div><!-- end ngIf: !bankAccountAuCtrl.excludeAccountNameField -->
                      <div class="row">
                        <div class="col-sm-4">
                          <div class="form-group">
                            <label for="bsbNumber" class="form-label form-label--mandatory"> BSB </label>
                            <input class="form-control qa__form--bsb ng-pristine ng-untouched ng-empty ng-valid-bsb ng-invalid ng-invalid-required ng-valid-pattern ng-valid-minlength ng-valid-maxlength" type="text" maxlength="6" ng-minlength="6"
                              ng-maxlength="6" name="bsbNumber" id="bsbNumber" placeholder=""
                              ng-class="{true: 'form-control--error'}[bankAccountAuCtrl.ngForm.bsbNumber.$invalid &amp;&amp; (bankAccountAuCtrl.ngForm.bsbNumber.$touched || bankAccountAuCtrl.ngForm.$submitted)]"
                              ng-model="bankAccountAuCtrl.form.bsbNumber" ng-model-options="{allowInvalid: true}" ng-pattern="/^\d+$/" aria-controls="bsbDetails" ng-change="bankAccountAuCtrl.query(bankAccountAuCtrl.form.bsbNumber)" v-bsb=""
                              ng-required="bankAccountAuCtrl.isRequired" required="required" aria-invalid="true">
                            <!-- ngIf: bankAccountAuCtrl.ngForm.bsbNumber.$touched || bankAccountAuCtrl.ngForm.$submitted -->
                          </div>
                        </div>
                        <div class="col-sm-8">
                          <div class="form-group">
                            <label for="accountNumber" class="form-label form-label--mandatory"> Account number </label>
                            <input class="form-control form-control--number qa__form--account-number ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required ng-valid-pattern ng-valid-minlength ng-valid-maxlength" type="text"
                              name="accountNumber" id="accountNumber" placeholder=""
                              ng-class="{true: 'form-control--error'}[bankAccountAuCtrl.ngForm.accountNumber.$invalid &amp;&amp; (bankAccountAuCtrl.ngForm.accountNumber.$touched || bankAccountAuCtrl.ngForm.$submitted)]"
                              ng-model="bankAccountAuCtrl.form.accountNumber" ng-pattern="/^\d*$/" ng-minlength="6" ng-maxlength="9" maxlength="9" ng-required="bankAccountAuCtrl.isRequired" required="required" aria-invalid="true">
                            <!-- ngIf: bankAccountAuCtrl.ngForm.accountNumber.$touched || bankAccountAuCtrl.ngForm.$submitted -->
                          </div>
                        </div>
                        <!-- Bank name -->
                        <!-- ngIf: bankAccountAuCtrl.bank -->
                      </div>
                    </fieldset>
                  </div>
                </bupa-bank-account-au>
              </div>
            </div>
          </div>
          <hr class="add-padding-vertical">
          <div class="row">
            <div class="col-md-5">
              <div class="heading text--center-xs text--center-sm">
                <h2 class="heading__title heading__title--primary heading__title--standard ng-binding"> Update details</h2>
                <div ng-transclude="consentDetailsDescription" class="heading__description heading__description--light"><consent-details-description class="ng-scope"> Your account details will be updated with this information.
                  </consent-details-description></div>
              </div>
            </div>
            <div class="col-md-6 col-md-offset-1">
              <div class="add-padding-bottom">
                <div class="form-group">
                  <div class="checkbox">
                    <input class="checkbox__input ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required"
                      ng-class="{true: 'form-control--error form-control--padding'}[steps.step1.ConsentToUpdateDetailForRefund.$invalid &amp;&amp; (steps.step1.ConsentToUpdateDetailForRefund.$touched || steps.step1.$submitted)]" type="checkbox"
                      name="ConsentToUpdateDetailForRefund" id="ConsentToUpdateDetailForRefund" value="true" ng-model="deferredClaimsLiabilityCtrl.form.ConsentToUpdateDetailForRefund" required="" aria-invalid="true">
                    <label class="checkbox__label ng-binding" for="ConsentToUpdateDetailForRefund">I consent to Bupa using the details provided for the purpose of this payment and for the payment of my future claims.</label>
                    <!-- ngIf: steps.step1.ConsentToUpdateDetailForRefund.$touched || steps.step1.$submitted -->
                  </div>
                </div>
                <div class="note note--wysiwyg bg-grey--10 add-padding-bottom">
                  <h3 class="heading__title heading__title--primary heading__title--standard-extra-small ng-binding"> Privacy: </h3>
                  <div ng-transclude="privacyDetailsDescription" class="note__text"><privacy-details-description class="ng-scope"> The information collected here will be used by Bupa to verify the policy holder's identity and to process the payment.
                      We will also use these details to pay your future claim benefits to this account. Bupa will handle your information in accordance with
                      its&nbsp;<a rel="noopener noreferrer" href="https://www.bupa.com.au/-/media/Dotcom/Files/pdfs/bupa-info-handling-policy" target="_blank">Information Handling Policy</a>
                    </privacy-details-description></div>
                </div>
              </div>
            </div>
          </div>
        </div>
      </div>
      <div class="tab-content__section ng-hide" ng-show="stepsContentCtrl.activeTab === 1" aria-hidden="true">
        <div ng-form="steps.step2" class="ng-pristine ng-valid">
          <div class="row add-padding-top">
            <div class="col-md-5">
              <div class="heading text--center-xs text--center-sm">
                <h2 class="heading__title heading__title--primary heading__title--standard js__focus ng-binding" tabindex="-1">Review</h2>
                <div ng-transclude="reviewDescription" class="heading__description heading__description--light"><review-description class="ng-scope"> Please review the details you've provided us and ensure they're correct. Don't worry, you can go
                    back to the previous screen to make changes if necessary. </review-description></div>
              </div>
            </div>
            <div class="col-md-6 col-md-offset-1">
              <div class="add-padding-bottom">
                <dl class="details-list">
                  <dt class="details-list__title details-list__divider">Policy holder first name</dt>
                  <dd class="details-list__info details-list__divider text-forcewrap ng-binding"></dd>
                  <dt class="details-list__title details-list__divider">Policy holder last name</dt>
                  <dd class="details-list__info details-list__divider text-forcewrap ng-binding"></dd>
                  <dt class="details-list__title details-list__divider">Date of birth</dt>
                  <dd class="details-list__info details-list__divider ng-binding"></dd>
                  <dt class="details-list__title details-list__divider">Email address</dt>
                  <dd class="details-list__info details-list__divider text-forcewrap ng-binding"></dd>
                  <dt class="details-list__title details-list__divider">Membership number</dt>
                  <dd class="details-list__info details-list__divider ng-binding"></dd>
                </dl>
              </div>
            </div>
          </div>
          <hr class="add-padding-vertical">
          <div class="row">
            <div class="col-md-5">
              <div class="heading text--center-xs text--center-sm">
                <h2 class="heading__title heading__title--primary heading__title--standard ng-binding"> Bank account</h2>
              </div>
            </div>
            <div class="col-md-6 col-md-offset-1">
              <div class="add-padding-bottom" ng-show="!deferredClaimsLiabilityCtrl.form.UseExistingDebitForRefundChecked" aria-hidden="false">
                <dl class="details-list">
                  <dt class="details-list__title details-list__divider">Bank</dt>
                  <dd class="details-list__info details-list__divider ng-binding"></dd>
                  <dt class="details-list__title details-list__divider">Account name</dt>
                  <dd class="details-list__info details-list__divider text-forcewrap ng-binding"></dd>
                  <dt class="details-list__title details-list__divider">BSB</dt>
                  <dd class="details-list__info details-list__divider ng-binding"></dd>
                  <dt class="details-list__title details-list__divider">Account number</dt>
                  <dd class="details-list__info details-list__divider ng-binding"></dd>
                </dl>
              </div>
              <div class="add-padding-bottom note note--wysiwyg bg-grey--10 ng-hide" ng-show="deferredClaimsLiabilityCtrl.form.UseExistingDebitForRefundChecked" aria-hidden="true">
                <p>We’ll send the funds to the BSB and account number you have with us. You can confirm your direct debit details in myBupa by visiting <a href="/payment">Payments</a></p>
              </div>
            </div>
          </div>
          <hr class="add-padding-vertical">
          <div class="row">
            <div class="col-md-5">
              <div class="heading text--center-xs text--center-sm">
                <h2 class="heading__title heading__title--primary heading__title--standard ng-binding"> Update details</h2>
              </div>
            </div>
            <div class="col-md-6 col-md-offset-1">
              <div class="add-padding-bottom">
                <dl class="details-list">
                  <dt class="details-list__title details-list__divider ng-binding"> You have consented to Bupa using the details provided for the purpose of this payment and for the payment of your future claims.</dt>
                  <dd class="details-list__info details-list__divider ng-binding"></dd>
                </dl>
              </div>
            </div>
          </div>
        </div>
      </div>
    </div>
  </bupa-steps-content>
  <bupa-steps-buttons cancel-modal-url="/" class="ng-isolate-scope">
    <div class="container">
      <hr>
      <div class="row add-padding-bottom flex--xs">
        <div ng-transclude="left" class="col-xs-12 col-sm-3"><button-container-left class="ng-scope">
            <steps-button-back step-controller="sc" class="ng-isolate-scope"><!-- ngIf: $ctrl.showButton() --></steps-button-back>
          </button-container-left></div>
        <div ng-transclude="right" class="col-xs-12 col-sm-9 text--right flex--order"><button-container-right class="ng-scope">
            <steps-button-cancel step-controller="sc" modal-id="cancel" class="ng-isolate-scope"><!-- ngIf: $ctrl.showButton() --></steps-button-cancel>
            <steps-button-next step-controller="sc" class="ng-isolate-scope"><!-- ngIf: $ctrl.showButton() --><button class="button button--primary button--group-spacing button--block-xs qa__button--next" type="button"
                ng-class="{true: 'button--disabled'}[$ctrl.isDisabled()]" ng-click="$ctrl.goToNextStep()" ng-if="$ctrl.showButton()" ng-disabled="$ctrl.isDisabled()"> Next </button><!-- end ngIf: $ctrl.showButton() --></steps-button-next>
            <steps-button-submit step-controller="sc" is-busy="deferredClaimsLiabilityCtrl.isBusy" class="ng-isolate-scope"><!-- ngIf: $ctrl.showButton() --></steps-button-submit>
          </button-container-right></div>
      </div>
      <div id="cancel" data-backdrop="static" data-keyboard="false" class="modal qa__confirm" tabindex="-1" role="dialog" aria-label="Are you sure you want to cancel?" modal-id="cancel" modal-title="Are you sure you want to cancel?" confirm-url="/">
        <div class="modal-dialog modal--md">
          <div role="document">
            <div class="modal__content">
              <div class="modal__header">
                <h2 class="modal__title ng-binding" ng-bind-html="confirmCtrl.modalTitle">Are you sure you want to cancel?</h2>
              </div>
              <div class="modal__body">
                <div ng-transclude="modalContent"><modal-content class="ng-scope">
                    <p>You have made changes on this page that you have not yet confirmed. If you navigate away from this page you will lose your unsaved changes. Press Ok to continue or Cancel to stay on the current page.</p>
                  </modal-content></div>
              </div>
              <div class="modal__footer modal__footer--confirm">
                <button type="button" data-dismiss="modal" ng-disabled="confirmCtrl.isBusy" ng-class="{true: 'button--disabled'}[confirmCtrl.isBusy]" ng-click="confirmCtrl.cancelAction(); confirmCtrl.cancelIsBusy()"
                  class="modal__button button button--secondary button--block-xs button--small qa__confirm--close"> Cancel </button>
                <!-- ngIf: confirmCtrl.confirmAction -->
                <!-- ngIf: confirmCtrl.confirmUrl --><button type="button" ng-if="confirmCtrl.confirmUrl" ng-click="confirmCtrl.confirmUrlAction()" class="modal__button button button--primary button--block-xs button--small qa__confirm--action"> OK
                </button><!-- end ngIf: confirmCtrl.confirmUrl -->
              </div>
            </div>
          </div>
        </div>
      </div>
      <div ng-transclude="customModals"></div>
    </div>
  </bupa-steps-buttons>
</form>

Text Content

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BUPA GIVEBACK

If you see this, leave it blank. Only bots should see this


STEPS (2 IN TOTAL)

    
 1. Customer details current step
    
 2. Review
    


MEMBERSHIP DETAILS

Please provide the details of the policy holder that is or was listed on the
membership to allow for accurate identification.

* Required field

Policy holder first name
Policy holder last name
Date of birth
Email address
Membership number

This is your 8 digit number found on the front of your Bupa membership card and
on your welcome email.

--------------------------------------------------------------------------------


BANK ACCOUNT

Please provide us with the details of the bank account you would like the
payment to be sent to.

I’d like to use the BSB and account number I’m currently using for my direct
debit payments.

--------------------------------------------------------------------------------

Australian bank account
Account name
BSB
Account number

--------------------------------------------------------------------------------


UPDATE DETAILS

Your account details will be updated with this information.
I consent to Bupa using the details provided for the purpose of this payment and
for the payment of my future claims.


PRIVACY:

The information collected here will be used by Bupa to verify the policy
holder's identity and to process the payment. We will also use these details to
pay your future claim benefits to this account. Bupa will handle your
information in accordance with its Information Handling Policy


REVIEW

Please review the details you've provided us and ensure they're correct. Don't
worry, you can go back to the previous screen to make changes if necessary.
Policy holder first name Policy holder last name Date of birth Email address
Membership number

--------------------------------------------------------------------------------


BANK ACCOUNT

Bank Account name BSB Account number

We’ll send the funds to the BSB and account number you have with us. You can
confirm your direct debit details in myBupa by visiting Payments

--------------------------------------------------------------------------------


UPDATE DETAILS

You have consented to Bupa using the details provided for the purpose of this
payment and for the payment of your future claims.

--------------------------------------------------------------------------------

Next


ARE YOU SURE YOU WANT TO CANCEL?

You have made changes on this page that you have not yet confirmed. If you
navigate away from this page you will lose your unsaved changes. Press Ok to
continue or Cancel to stay on the current page.

Cancel OK


Bupa would like to acknowledge the traditional owners of the many lands our
offices and stores are located on, as well as the lands our customers are
connected to. We pay our respects to Elders past and present.

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 * Privacyopens in a new window
 * Code of conductopens in a new window
 * Accessibilityopens in a new window

Bupa HI Pty Ltd ABN 81 000 057 590