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Waiting periods and pre-existing conditions

Q: What are waiting periods?

Waiting periods protect members by ensuring that people can’t join the fund simply to make a large claim and then cancel their membership straight away after receiving the benefit, leading to much higher premiums for all members. We’re not trying to stop you from claiming – some benefits have maximum waiting periods set by the government. Other waiting periods are decided by the insurer. Read more.

Q: What waiting periods do I have?

When transferring from another fund or to a higher level of cover with Westfund , provided there's been no break in coverage, waiting periods apply to: Any benefits under your new Westfund policy that weren’t included in your previous cover Any benefits where waiting periods were not fully served under your previous cover Any benefits provided under your previous cover where the benefit provided under your new Westfund policy is higher. Read more about what moving to Westfund means in terms of waiting periods and benefits. When transferring from another fund on the same or lower level of cover , provided there’s been no break in coverage when leaving your previous fund, you won't have to re-serve waiting periods for the same treatments and will be able to enjoy continuous cover. Waiting periods also apply to our Health and Wellbeing Programs . As always, we recommend checking your Policy Summary for detailed information about your cover, including waiting periods. You can view your Policy Summary on Members Online or on our app. If you don't have the app, you can download it from the App Store or via Google Play .

Q: Why do I have to re-serve my waiting period?

Portability rules protect people who want to change to another private health insurance policy with their current insurer or another insurer. This means you will not have to wait waiting periods again before benefits can be paid to you, provided you’re switching to an equivalent or lower level of cover. If there has been a break in your cover however waiting periods will apply.

Q: Why do I have waiting periods?

Waiting periods protect members by ensuring that people can’t join the fund simply to make a large claim and then cancel their membership straight away after receiving the benefit, leading to much higher premiums for all members. We’re not trying to stop you from claiming – some benefits have maximum waiting periods set by the government. Other waiting periods are decided by the insurer. Read more.

Q: What are the waiting periods for Extras cover?

The following waiting periods apply to extras benefits: Extras Waiting Periods Emergency Ambulance Transport 1 Day Non-emergency Ambulance Transport, General Dental, Optical (excluding Laser Eye Surgery), Other Therapies (excluding surgical treatment by a podiatrist), Prescriptions/Vaccinations/Injections, Prevention and Health Management (excluding antenatal classes) 2 Months Major Dental, Orthodontic, Dental Top-Up, Antenatal Classes, Health Aids & Appliances (excluding Hearing Aids), Surgical Treatment by a Podiatrist, Outpatient Travel Benefit 12 Months Hearing Aids, Laser Eye Surgery 36 Months We recommend checking your Policy Summary for detailed information about your cover, including waiting periods.

Q: What is a pre-existing condition?

We know – there’s plenty of jargon involved when it comes to private health insurance. One of the most common questions we get is about pre-existing conditions. A pre-existing condition is an illness or condition for which, in the opinion of a medical advisor appointed by Westfund, signs and symptoms existed during six months before the date you joined Westfund or upgraded to a higher level of cover. A 12-month waiting period applies to all new members for hospital costs relating to the treatment of pre-existing conditions. It's important to note that the only exceptions to this are treatments for hospital psychiatric services, rehabilitation and palliative care, which have a 2 month waiting period. Planning on hospital treatment before this period ends? You’ll need to ask your GP and surgeon/specialist to complete a Medical Practitioner Certificate regarding ‘Pre-Existing Conditions' form . This certificate helps Westfund determine the level of benefits that will apply when hospitalisation is required for members who have: Been with Westfund for less than 12 months or; Transferred or upgraded to a higher level of cover with Westfund less than 12 months ago. Once this period is over, you’re entitled to the full benefits available under your cover.

Q: Who determines if my condition is pre-existing?

A medical advisor appointed by Westfund will determine if a condition is pre-existing. This decision is based on the assessed Medical Practitioner Certificate regarding ‘Pre-Existing Conditions’ . It's important to remember that part one of the form is to be completed by your referring practitioner and part two is to be completed by your surgeon or specialist. Using this information, the medical advisor will decide if a condition is pre-existing or not.

What are waiting periods, what is a pre-existing condition and more

Waiting periods

What are waiting periods? →
What waiting periods do I have? →
Why do I need to re-serve waiting periods? →
Why do I have waiting periods? →
What are the waiting periods for Hospital cover? →
What are the waiting periods for Extras cover? →

Pre-existing conditions

What is a pre-existing condition? →
Who determines if my condition is pre-existing? →