Gold

Benefit Changes from 1 April 2020

This product is closed to new members, refer to Compare our Covers for our current covers.

At Westfund Health Insurance, we know that providing quality cover that is both easy to understand and use is important.

Our annual review of our products has facilitated a number of changes to your Gold cover. These changes will come into effect from 1 April 2020 and are outlined below.

It is important that you read and understand this information as it pertains to your benefit coverage. For further information, please don’t hesitate to call us on 1300 937 838 or via email to enquiries@westfund.com.au.

Excess waivers – for Gold 500 members only

Current excess waivers New excess waivers How this affects you
No excess is payable for private or public hospitals, if you are admitted as a private patient due to an accident, same-day procedures or for dependants.
Excess of $500 is payable once per adult member, per calendar year.
No excess payable for private hospitals, if you are admitted as a private patient due to an accident or for a same-day procedures. No excess payable for admissions to a private or public hospital for dependants.
Excess of $500 is payable once per adult member, per calendar year.
Adult members will be required to pay their excess when admitted to a public hospital as a private patient for all hospitalisations.  
This change has no impact on your current hospital inclusions.

If you have scheduled or are undergoing treatment at a public hospital following 1 April 2020, Westfund has implemented transitional arrangements that may be relevant to you.
Jump to transitional arrangements explained

Members are required to pay an excess when:

Admitted to Private Hospital

Admitted forSame-day
procedure
AccidentAll other admissions
Main Member or Spouse / Partnerxx
Dependantsxxx

Admitted to Public Hospital

Admitted forSame-day
procedure
AccidentAll other admissions
Main Member or Spouse / Partner
Dependantsxxx

Removal of the Advanced Surgery Benefit

Current Benefit From 1 April 2020 How this affects you
A benefit of $200 per night up to $2,400 per hospitalisation for advanced surgery admissions due to heart disease, stroke or cancer. To comply with Australian Government legislation, this benefit will be removed. This benefit will no longer be available for advanced surgery admissions. This will have no impact on your current hospital and medical entitlements.

Savings from the removal of this benefit have been reinvested into the revised Accommodation and Travel Benefit.

Removal of the Accident Benefit

Current Benefit From 1 April 2020 How this affects you
A benefit of $100 per night for admissions due to an accident. To comply with Australian Government legislation, this benefit will be removed. This benefit will no longer be available for admissions due to an accident. This will have no impact on your current hospital and medical entitlements.

Savings from the removal of this benefit have been reinvested into the revised Accommodation and Travel Benefit.

Accommodation and Travel Benefit

Current Benefit New Benefit How this affect you
A limit of $400 per policy, per calendar for Accommodation and Travel Benefits. A benefit of $100 per night is available for accommodation expenses. A Travel Benefit of up to $70 per trip is available for travel to inpatient or outpatient medical services. An uncapped per calendar year Accommodation and Travel Benefit applies. Nights 1-4 will be paid at $100 per night and nights 5 and onward will be paid at $40 per night. A Travel Benefit of up to $70 per admission is available for inpatient medical services. Travel Benefits for outpatient services are listed below under ‘Travel Benefit’. This new benefit further assists our rural and regional members with the additional expenses of travelling to receive medical treatment in hospital.

Dental Benefits

Current Benefit New Benefit How this affects you
Benefits for certain dental treatments vary depending whether the treatment is performed by a General or Specialist Dentist. Benefits for dental treatment will be the same regardless whether the treatment is performed by a General or Specialist Dentist. This will simplify dental entitlements for our members; making it easier to understand the benefits you’re entitled to.  
Some per item benefits that were previously performed by a Specialist Dentist may now receive a lower benefit whereas some item numbers that were performed by General Dentists may now receive a higher benefit.
Services covered under the Major Dental limit include Crowns, Bridges, Veneers and Implants.
A 2 month waiting period applies for Oral Surgery, Endodontics and Periodontics.
Additional dental services will now come under the Major Dental limit. These include Dentures, Oral Surgery, Endodontics and Periodontics.
A 12 month waiting period will now apply to Oral Surgery, Endodontics and Periodontics.
Any members who have already served existing waiting periods will not be required to serve any additional waiting period.
The Annual Group Limit for Major Dental services is $1,275 per member. The Annual Group Limit for Major Dental services is $1,400 per member. A higher Annual Group Limit available for Major Dental services.

Westfund will provide a transitional period up to 1 October 2020, for pre-scheduled treatment for Dentures, Oral Surgery, Endodontics and Periodontics, please contact Westfund with your applicable dental quote prior to 1 April 2020.

Provider of Choice

Benefit increases to our Dental Provider of Choice (POC) network and Westfund Dental Centre. Westfund has also committed to further expand our POC network including dental, optical and physiotherapy services. The Sunglasses Benefit is now available through selected Optical POC providers.

Podiatry

Additional items for podiatry services have been made available for members to claim including surgical treatment items.

Health Aids & Appliances

To help clarify benefits available on your policy, Westfund has renamed Non-Surgically Implanted Prostheses to Health Aids & Appliances.

Current Benefit New Benefit How this affects you
Devices for Sleep Apnoea and diagnosed snoring include CPAP Machines, EPAP Treatment and Oral Appliances for diagnosed snoring.  Additional items have been added to the Devices for Sleep Apnoea and diagnosed snoring benefit. These include BiPAP, BPAP and APAP Machines. This allows for a broader range of devices to be claimable to assist members who have sleep apnoea or diagnosed snoring.
A benefit of $35 per member, per calendar year is available for Peak Flow Meters. A benefit of $110 per member, per calendar year is available for Nebulisers. No recommendation from a Medicare Registered Practitioner is required to claim these devices. These two devices will now be claimable under a $110 per member, per calendar year benefit for Respiratory Aids. Additional items will also be available under Respiratory Aids including spacer and mucus clearing devices. A lifetime recommendation from a Medicare Registered Practitioner will be required to claim these devices. This will allow a broader range of devices to be claimable to assist with chronic diseases such as asthma, cystic fibrosis and chronic bronchitis.   Recommendation from a Medicare Registered Practitioner will be required and is valid for the lifetime of your policy.
No recommendation from a Medicare Registered Practitioner is required to claim for Compression Garments. Recommendation from a Medicare Registered Practitioner will be required to claim Compression Garments. Recommendation from a Medicare Registered Practitioner will be required when claiming Compression Garments and is valid for the lifetime of your policy.

Recommendation from a Medicare Registered Practitioner will no longer be required when a Health Aid or Appliance is purchased through a Medicare Registered Practitioner. The Practitioner’s name and provider number needs to be included on the receipt.

Antenatal Classes

Current Benefit New Benefit How this affects you
A lifetime limit of $120 per policy was available for antenatal classes and pre/ postnatal consultations The $120 benefit will now be available per policy, per calendar year. This will allow families to claim more frequently for Antenatal Classes and pre/ postnatal consultations including lactation consultations and post-partum assessments.

Westfund will now include Registered Nurses as a recognised provider for Antenatal Classes. This allows for a broader range of claimable services that may be performed by a Registered Nurse.

Travel Benefit

Current Benefit New Benefit How this affects you
A Travel Benefit for outpatient medical services was available under the Accommodation and Travel Benefit which was capped at $400 per policy, per calendar year. A benefit of up to $70 was available per trip that exceeded 150 kilometres. For outpatient medical services, a Travel Benefit of up to $70 per trip is available, with an overall limit of $140 per policy, per calendar year. Travel Benefits for inpatient services are listed under ‘Accommodation and Travel Benefit’. This assists our rural and regional members with the additional expenses of travelling to receive outpatient medical services such as specialist appointments.    

Transitional Arrangements Explained

Westfund will apply transitional measures for a period of six months following the change of the hospital excess waiver. From 1 April 2020, the following transitional arrangements will apply for the removal of excess waivers. Examples of transitional measures are provided below;

  • Treatment commenced: For patients admitted prior to the effective date of the excess waiver change but discharged on or after 1 April 2020, the excess waiver will apply.
  • Pre-bookings: For patients with a booking received by the hospital prior to 1 April 2020, including bookings notified by the doctor or where the patient has completed the necessary forms, but where admission occurs within six months of the date of excess waiver removal, the excess waiver will apply.
  • Course of treatment: For all patients undertaking a course of treatment (e.g. chemotherapy, dialysis, psychiatric, rehabilitation), the excess waiver applies for the duration of the course of treatment or a continuous period of up to 6 months from the excess waiver change, whichever occurs first.
  • Emergency admissions: For emergency admissions the excess waiver will apply for a continuous period of at least 6 months.

If you believe you meet one of the above criteria please contact Westfund on 1300 937 838 or enquiries@westfund.com.au with all relevant information relating to your hospitalisation.