Question 1

How do I make an Ambulance claim?

Accepted Answer

Emergencies do happen – that’s why having ambulance cover offers peace of mind knowing you’re covered for the unexpected.

There are two types of ambulance travel – emergency and non-emergency patient transport (NEPT).

Services available under non-emergency patient transport might be:

Inter-Hospital transfers (except public hospital to public hospital)
Admissions to hospital from home
Ambulance service fees where subsequent transport isn’t required (call out fees).

Just like making an extras claim, you can make an ambulance claim through Members Online or via our app. Alternatively, you can email your completed claim form and your account to claims@westfund.com.au.

Already paid the ambulance bill? Get in contact with us and we’ll review the account for you.

Remember, depending on your state of residence, you may be covered by a state ambulance scheme.

Check the ambulance cover arrangements in your state.

Question 2

How is my Hospital account paid?

Accepted Answer

In most cases, when you are treated in a Westfund-contracted hospital, the bill will come directly to us for payment. Once we’ve paid the hospital account, a Benefit Statement will be available at the start of the following month.

If you would like to view a Benefit Statement at any time, you can do so through your correspondence history in Members Online or our app, or by requesting a copy over the phone.

Question 3

How do I claim my doctors bill?

Accepted Answer

Your specialist may require any out-of-pocket costs to be paid prior to the surgery. In most cases, they will send the claim to Westfund and Medicare for the ‘scheduled fee’ portion. This should be advised in your Informed Financial Consent.

Should your specialist not claim on your behalf, you will be required to submit a Medicare two-way claim form to Medicare first and they will send the claim directly to Westfund.

This process applies to all doctors associated with your treatment. Other fees may arise from pathology or radiology services – your specialist will decide if these services are required.

Question 4

Can I claim from Westfund and Medicare?

Accepted Answer

Unfortunately, legislation prevents private health insurers from paying a benefit on outpatient services that attract a Medicare benefit. As a result, we are unable to pay any additional benefits for out-of-pocket expenses related to Medicare claimable outpatient services.

Once your limit with Medicare for an outpatient service is reached, then you may submit your claim to Westfund accompanied with a finalised statement from Medicare.

Question 5

How do I make an Extras claim?

Accepted Answer

Making an Extras claim is simple when using our online services – Members Online or our app. If you’re on-the-go, you can make a quick photo claim by taking a photo of your receipt and uploading it to our app.

You can also lodge your claim online using Members Online. Sign in or register for Members Online today.

Alternatively, you can email your extras claim to claims@westfund.com.au attaching your completed claim form and any relevant receipts.

Question 6

How can I check my receipts are correct?

Accepted Answer

We know how important it can be to get your claims processed quickly and one of the easiest ways to make this happen is to ensure you have all the paperwork you need. While claiming some services is as simple as swiping your membership card, for others you may need to supply receipts or other documents.

Checking to make sure you’ve got the correct and valid details and documents can be confusing.

Luckily, there are a few simple checks you can make to ensure that your claims are processed as efficiently as possible.

Don't forget - if you're submitting your claim via mail, fax or email, you'll need to submit a claim form along with your receipts.

Is the document free of alterations?

We can’t accept documents if any type of alteration is visible. Alterations can include:

Whiteout and lines through information
Erasing or crossing out information

If you have a receipt with an alteration, please ask the provider to issue another receipt or invoice so we can process your claim.

Note: Initialling an alteration is not proof that the alteration is official

Does the document contain adequate information?

In order to pay a benefit for an extras service, the receipt must include the following information:

The name and provider number of the issuing provider
The date of issue of the invoice
The name of the patient (with the exception of Vitamins, Probiotics, Omega 3 and Cancer Council UV products)
Date of service
Description of service and any applicable item number. Services that require an item number include:
- Dental
- Optical
- Physiotherapy / Exercise Physiology
- Chiropractic / Osteopathic
- Podiatry
- Speech Therapy
- Occupational Therapy
- Clinical Psychology
- Dietetics
Cost of services or services should be shown as individual amounts
Any amount paid to the provider and date paid, including any discounts given
Any amount outstanding
Any notations such as ‘Quote’ or ‘Duplicate’ where necessary.

When claiming for a prescription, vaccination or injection, you’ll need to provide an official pharmacy receipt.

In addition to the above information, these receipts must also include:

Prescription number
Prescriber name
Prescriber number
Indication that it’s a Private, Non-NHS or Non-PBS item

Read more about claiming for a prescription, vaccination or injection..

When claiming for an inpatient medical service, you'll need to submit your accounts to Medicare first. Your doctor or Medicare will provide you with a ‘Statement of Claim and Benefit Payment’ or ‘Statement of Medicare Benefits’ that can be used to process your claim.

The Medicare Claims History Statement does not provide sufficient information and cannot be used.

Read more about claiming doctor’s bills

Are there any other pieces of supporting documentation required?

In some cases, we may need some extra documents to pay a benefit towards your claims:

Benefit	Supporting documents
Orthodontic	Additional information may be required where benefit is not accrued in full when orthodontic treatment commences.
Prescriptions, Injections, Vaccinations: Contraceptives Anabolic steroids Cosmetic injections	Must be accompanied with a letter by a medical practitioner detailing that the pharmaceutical is treating a specific health condition (letter is valid for lifetime of the membership).
Health Management: Aquatic Programs Fitness Centre Virtual Gastric Banding Weight Loss Programs Mental Health Programs	A letter of recommendation or Health Management Declaration Claim Form must be completed by a Medicare Registered Practitioner, detailing the specific health condition being treated (letter/form is required per calendar year).
Health Aids and Appliances: Artificial Limbs Braces Burns Suit Cardiac Monitors Compression Garments/Devices Devices for Sleep Apnoea and Diagnosed Snoring INR Monitor Low Vision Aids Mammary Prostheses and Brassieres Mobility Aids Orthopaedic Boots (custom made) Orthotics (custom made/preformed) Oximeter Oxygen and Accessories Repairs to Devices Respiratory Aids TENS Machine Wigs	A letter of recommendation or Health Management Declaration Claim Form must be completed by a Medicare Registered Practitioner, detailing the need for the appliance to treat the specific health condition. Lifetime documentation required for: Artificial Limbs Cardiac Monitors Compression Garments/Devices Devices for Sleep Apnoea and Diagnosed Snoring INR Monitor Low Vision Aids Mammary Prostheses and Brassieres (no letter is required if a hospitalisation for a mastectomy is recorded with Westfund) Oximeter Oxygen and Oxygen Accessories Repairs to devices (unless initial purchase is recorded with Westfund) Respiratory Aids TENS Machine Wigs (no letter required if a hospitalisation for a medical condition is recorded with Westfund) Documentation required every calendar year: Braces Burns Suit Mobility Aids Orthopaedic Boots Orthotics
Accommodation	Travel & Accommodation Claim Form (claim will be assessed once the hospital account is received)
Inpatient Travel	Travel & Accommodation Claim Form (claim will be assessed once the hospital account is received)
Outpatient Travel	Travel & Accommodation Claim Form and a receipt or letter of attendance from specialist

Do I need to keep my receipts?

In the case of photocopied and emailed receipts (including app claims), you'll need to keep your original receipts for a minimum of 24 months from the date the claim is made. Westfund may request to sight the original receipts during this time.

Question 7

Can I claim for medical imaging?

Accepted Answer

Generally, diagnostic imaging services such as MRIs, CT Scans and PET scans are considered outpatient services. Unfortunately, legislation prevents private health insurers from paying a benefit on these services; where eligible, they’re claimable through Medicare only. However, if you have medical imaging services performed whilst you are an inpatient in hospital and the service has a Medicare Benefit Schedule (MBS) item number, then you may be able to claim a benefit from Westfund. We recommend reaching out to our team if you’d like to find out more.

In some instances, Medicare places certain conditions on benefit entitlements for medical imaging services. We suggest that you speak directly with your referring doctor and radiology provider to check if your diagnostic medical imaging services will be eligible for a Medicare rebate and if there may be any out-of-pocket expenses.

Question 8

Can I claim for vitamins probiotics or omega-3?

Accepted Answer

Vitamins and minerals

What is covered?

Vitamins and minerals are claimable under the 'Health Management' benefit on your extras policy, provided they meet the following criteria:

Listed with the Therapeutic Goods Administration (TGA).
Item/product must contain any vitamin A-K or iron, potassium, calcium, magnesium or zinc as an active ingredient on the TGA.
Vitamins/minerals must be administered orally or intravenously.
Must be intended to aid in a specific vitamin or mineral dietary deficiency.

The following vitamins and minerals are approved by Westfund under the Vitamin benefit:

Vitamin A (retinyl, retinol)
Vitamin B1 (thiamine)
Vitamin B2 (riboflavin)
Vitamin B3 (niacin, niacinamide, nicotinic acid, nicotinamide, nicoscorbine)
Vitamin B5 (pantothenic acid, dexpanthenol)
Vitamin B6 (pyridoxine, pyridoxal)
Vitamin B7 (biotin, vitamin h)
Vitamin B9 (folic acid, folate)
Vitamin B12 (cyanocobalamin, hydroxocobalamin, mecobalamin)
Vitamin C (ascorbic acid)
Vitamin D (calcitriol, calcipotriol)
Vitamin D2 (ergocalciferol)
Vitamin D3 (colecalciferol, cholecalciferol)
Vitamin E (tocopheryl)
Vitamin K (menadione, acetomenaphthone, phytomenadione, menaquinone)
Calcium
Iron (ferric, ferrous)
Magnesium
Potassium
Zinc

What isn't covered?

There are certain vitamin and mineral products that Westfund is unable to pay a benefit for. These include:

Any product not TGA approved.
Vitamin/mineral products purchased outside of Australia, either in person or online. This means that the business won't have an Australian Business Number (ABN).
Bodybuilding, weight loss or meal replacement products.
Any consumable food or drink product containing vitamins and minerals.
Any compounded items/products made by a compound pharmacy; however you may be eligible under your pharmacy benefit.
Any items/products that have been subsidised under the Pharmaceutical Benefits Scheme.
Any items/products that do not aid in a specific vitamin or mineral dietary deficiency.
Any items/products that are a S4 or S8 item (prescription-only medicine or controlled drug). However, you may be eligible under your pharmacy benefit.

Examples -

Reflux medications
CO-Enzyme Q10
Cold and flu tablets
Vitamin or mineral infused water
Detox or cleanse tablets

Probiotics

What is covered?

Probiotics are claimable under the ‘Health Management benefit on your extras policy, provided they meet the following criteria:

Listed with the Therapeutic Goods Administration (TGA)
Contain Lactobacillus as an active ingredient; or
Bifidobacterium; or
Streptococcus Thermophilus

What isn't covered?

Any product not TGA approved.
Some yeast-based probiotics.

Omega-3

What is covered?

Omega-3 products are claimable under the ‘Health Management benefit on your extras policy, provided they meet the following criteria:

Listed with the Therapeutic Goods Administration (TGA)
Contain Omega 3 as an active ingredient; or
Fish Oil; or
Krill Oil (euphausia superba oil).

What isn't covered?

Any product not TGA approved.
Any product where they do not contain an approved active ingredient, including:
- Evening primrose oil
- Cod liver oil
- Emu Oil
- Flaxseed oil
- Linseed oil
- DHA-rich oil derived from microalgae Schizochytrium sp

How can I make my claim?

The easiest and quickest way to make your claim is via the Westfund app. However, we provide several other options (online, by mail or email) to submit your claim so you can select the way that suits you best.

Please ensure you include your receipt/s when lodging your claim.

Question 9

Can I claim for prescriptions, injections and vaccinations?

Accepted Answer

If you hold an eligible extras cover and have served the two month waiting period, you may be able to claim a benefit towards the cost of some prescriptions, injections and vaccinations. Your Policy Summary will provide detailed information on your level of benefit and any limits that apply.

What is covered?

To be eligible for a benefit, the prescription, injection or vaccination must meet certain criteria.

Pharmaceuticals must:

be prescribed or administered by a medical practitioner
be a category S4 or S8 item (prescription-only medicine or controlled drug)
not be subsidised by the Pharmaceutical Benefits Scheme (PBS). You can read more about the PBS here
cost more than the standard PBS co-payment of $25.00 (effective from 1 January 2026)
be approved by the Therapeutic Goods Administration (TGA) for supply and sale in Australia. The TGA is in charge of regulating medicines and vaccines, as well as other products that relate to your health. You can read more about the TGA’s role here.

If the above criteria are met, then a benefit for the amount which exceeds the standard PBS co-payment is available, up to any item limits and annual group limits.

What isn’t covered?

There are certain prescriptions, injections and vaccinations that Westfund is unable to pay benefits towards. These include:

Medicinal preparations not prescribed or administered by a medical practitioner
Pharmaceuticals subsidised by the Pharmaceutical Benefits Scheme (PBS)
Pharmaceuticals that cost less than the standard PBS co-payment of $25.00 (effective from 1 January 2026)
Pharmaceuticals not approved by the Therapeutic Goods Administration (TGA) for supply or sale in Australia. This may include compounded medications (where one ingredient does not have approval), Special Access Scheme items as well as experimental and clinical trial prescriptions
General use contraceptives, anabolic steroids or cosmetic injections (e.g. botox). However, when the use of these items is prescribed specifically for the treatment of a health condition, we can pay benefits on receipt of a supporting letter from your medical practitioner
Pharmaceuticals that can be purchased without a prescription (e.g. category S2 pharmacy medicine or category S3 pharmacist only medicine).

Making your claim

The easiest and quickest way to make your claim is via the Westfund app. However, we provide several other options (online, by mail or email) to submit your claim so you can select the way that suits you best. You can download a claim form here.

Please ensure your receipt/s include the following information:

supplier details including any applicable provider numbers - please refer to the provider recognition criteria (more information here)
patient details
supply date
name of pharmaceutical
individual costings
any amounts paid or outstanding.

An official pharmacy receipt is required when purchasing items from a pharmacy. In addition to the above information, these receipts must also include:

Prescription number
Prescriber name
Prescriber number
Indication that it’s a Private, Non-NHS or Non-PBS item

Question 10

Can I claim for health management programs?

Accepted Answer

If you hold an eligible Extras cover and have served the two month waiting period, you may be able to claim a benefit towards the cost of certain health management programs. Your Policy Summary will provide detailed information on your benefit entitlement and any limits that apply.

Health management programs can help manage the treatment of a health condition. Programs need to be recommended by a Medicare practitioner to be eligible.

What health management programs are covered?

Westfund pays a benefit towards the following programs:

Aquatic programs – membership and classes
Fitness centres – membership, classes and personal training sessions
Pilates – membership and classes
Tai Chi – membership and classes
Yoga - membership and classes
Virtual gastric banding – sessions
Weight loss programs – joining and membership fees
Mental health programs – membership, joining and class fees
Cancer Council-approved products - UV sunscreen, hats and rash shirts are claimable under your existing Health Management benefit.

To claim for these programs, a Medicare Registered Practitioner, such as a GP, Medical Specialist, or Exercise Physiologist, must complete a Health Management Declaration Claim Form every calendar year to confirm the program is for the management of a health condition.

What providers can I access for this benefit?

Westfund can provide a benefit for the following providers:

Aquatic programs	Accredited with AUSTSWIM, Australian Swim School, SWIM Coaches & Teachers Australia or AUSactive
Pilates, Yoga and Tai Chi	Refer to our provider recognition criteria here.
Fitness centres	Registered AUSactive personal trainers and businesses
Virtual Gastric Banding	Hypnotherapist registered with Australian Society of Clinical Hypnotherapists, Professional Hypnotherapists of Australia or Australian Hypnotherapy Association
Weight Loss Programs	Refer to our provider recognition criteria here.
Mental Health Programs	Refer to our provider recognition criteria here .

What isn’t covered?

Westfund is unable to pay a benefit for health management programs where:

It is not required for treatment of a specific condition or part of a Health Management Program
The provider does not fulfil the recognised provider requirements
The Health Management Program has not been recommended by a Medicare Registered Practitioner
The benefit is in relation to goods and services which are primarily for the purposes of sport, recreation or entertainment
Any meal replacement, food or drink products are charged

How can I make my claim?

The easiest and quickest way to make your claim is via the Westfund app. However, we provide several other options to submit your claim so you can select the way that suits you best.

Please ensure you include your Health Management Declaration Claim Form and receipt/s when lodging your claim.

Question 11

Can I claim on Preventative Health Checks?

Accepted Answer

If you hold an eligible Extras cover and have served the two month waiting period, you may be able to claim a benefit towards the cost of certain Preventative Health Checks. Your Policy Summary will provide detailed information on your level of benefit and any limits that apply.

Preventative Health Checks assist members in detecting chronic conditions like cancer or osteoporosis in their early stages, enabling timely intervention and improving future health outcomes.

What Preventative Health Checks are covered?

Preventative Health Checks include but are not limited to:

Cancer Screening Checks
Cardiac Screening Checks
Chronic Disease Screening Checks
Musculoskeletal Screening Checks

Please check our provider recognition criteria to make sure you are seeing a recognised provider.

What isn’t covered?

There are certain times that we are unable to pay a benefit, these include:

When a Preventative Health Check has received a Medicare benefit
Services not performed/provided by a recognised provider

How can I make my claim?

The easiest and quickest way to make your claim is via the Westfund app. However, we provide several other options so you can select the way that suits you best.

Please ensure you include your receipt/s when lodging your claim.

Can I claim a benefit on multiple Preventative Health Checks?

If you've already claimed part of the benefit for one Preventative Health Check, you can still claim the remaining benefit for other eligible checks, up to your applicable limits.

Some levels of cover offer the flexibility to use your benefit across multiple checks within the total Annual Group Limit. It’s important to note that the benefit applies per person, not across all members on the cover.

You can check your Extras limits on the Westfund app or via Members Online.

Question 12

Can I claim for sunglasses?

Accepted Answer

We're here to look after your eyes. Westfund is proud to provide a benefit towards sunglasses, available under eligible Extras cover.

Exposure to UV radiation over long periods can lead to severe and irreversible eye damage. Overexposure to UV radiation can cause short-term eye damage in the form of mild irritation, sunburn to the cornea and inflammation. Chronic over-exposure may lead to permanent damage, such as squamous cell cancers around the eyes. Wearing sunglasses has been proven to help prevent some of these conditions, lower the risk of cataracts, reduce headaches/migraines and prevent the macular from deteriorating rapidly.*

*Information sourced from the Australian Cancer Council.

Question 13

Can I claim on Natural Therapies?

Accepted Answer

Natural Therapies – More services included in Extras from 1 June 2026

At Westfund we’re always looking for ways to increase value for our members.

From 1 June 2026, more natural therapy services were added to eligible Extras cover, meaning you can now access these services as part of your existing cover.

What’s changing?

The following services will now be claimable on eligible Extras products within existing benefit categories and annual limits:

Massage Therapies

Alexander Technique
Shiatsu

Acupuncture, Chinese Herbalism & Natural Medicine

Western Herbal Medicine
Naturopathy

Health Management Programs

Pilates
Tai Chi
Yoga

A completed Health Management Declaration Form will be required when claiming Pilates, Tai Chi or Yoga services.

Which products are impacted?

New services are available on eligible Extras products that currently include:

Other Therapies benefits, and/or
Health Management Programs.

This includes products such as:

Starter Extras
Essential Pro Extras
Choice Extras
Mid Extras
Freedom Extras
High Extras
Ultimate Extras
Gold Combined products
Silver Plus Family
Eligible Overseas Visitors products
Eligible Athlete Extras products

How do I claim?

Claims can continue to be submitted through the usual claiming channels.

New claiming options now appear online for:

Shiatsu
Alexander Technique
Western Herbal Medicine
Naturopathy

Pilates, Tai Chi and Yoga can be claimed under the existing Health Management Programs option.

As with all Extras claims, services must be provided by an appropriately qualified provider and meet Westfund claiming requirements.

You can check your Extras limits* on the Westfund app or via Members Online.

Annual limits, waiting periods and eligibility criteria apply. Benefits and programs are subject to your level of cover.

Making a claim

Hospital and Ambulance Claims

Extras Claims