Changes to Excess Waivers

We’re removing the excess waiver on same-day procedures for adults on our Gold, Silver Plus and Silver Hospital covers.
This change will affect members with a Gold, Silver Plus or Silver Hospital cover with a $250, $500 or $750 excess option.

Excess waivers - from 1 April
No excess payable for private hospital admissions, if an adult member is admitted as a private patient due to an accident or for any dependants registered on your membership. An excess is payable once per adult member per calendar year.

What this means for you
We're removing the excess waiver on same-day procedures for all adults on your membership. This means that if an adult member is admitted for a same-day procedure on or after 1 April, they will be charged an excess. An excess is payable once per adult member per calendar year. We have implemented transitional arrangements that may be relevant to you. You can view them below.

Changes to Silver Hospital cover

We are introducing further exclusions on this cover.

Silver Hospital - Now
Current exclusions and restrictions on your Silver Hospital cover:

  • Hospital Psychiatric Services (restricted)
  • Cataracts
  • Joint replacements
  • Dialysis for chronic kidney failure
  • Pregnancy and birth
  • Assisted reproductive services
  • Weight loss surgery
  • Pain management with device

Silver Hospital - from 1 April
Exclusions and restrictions that will apply from 1 April on your Silver Hospital cover:

  • Hospital Psychiatric Services (restricted)
  • Cataracts
  • Joint replacements
  • Dialysis for chronic kidney failure
  • Pregnancy and birth
  • Assisted reproductive services
  • Weight loss surgery
  • Pain management with device
  • Insulin pumps
  • Sleep studies

What this means for you
From 1 April 2021, the following clinical categories will be excluded from your Silver Hospital cover: Insulin pumps and Sleep studies. This means you won’t be covered as a private patient for these services.

If you are currently undergoing treatment, have a treatment scheduled or want to ensure you can keep cover for services in these categories, we will support you. We have implemented transitional arrangements to help you. You can view them below.

If you wish to upgrade to cover these categories after 1 April 2021, a 12 month waiting period will apply for pre-existing conditions.

Changes to Bronze Hospital cover

We are introducing further exclusions on this cover.

Bronze Hospital - Now
Current exclusions and restrictions on your Bronze Hospital cover:

  • Rehabilitation (restricted)
  • Hospital Psychiatric Services (restricted)
  • Palliative Care (restricted)
  • Heart and vascular system
  • Lung and chest
  • Back, neck and spine
  • Plastic and reconstructive surgery (medically necessary)
  • Cataracts
  • Joint replacements
  • Dialysis for chronic kidney failure
  • Pregnancy and birth
  • Assisted reproductive services
  • Weight loss surgery
  • Pain management with device

Bronze Hospital - from 1 April
Exclusions and restrictions that will apply from 1 April on your Bronze Hospital cover:

  • Rehabilitation (restricted)
  • Hospital Psychiatric Services (restricted)
  • Palliative Care (restricted)
  • Heart and vascular system
  • Lung and chest
  • Back, neck and spine
  • Plastic and reconstructive surgery (medically necessary)
  • Cataracts
  • Joint replacements
  • Dialysis for chronic kidney failure
  • Pregnancy and birth
  • Assisted reproductive services
  • Weight loss surgery
  • Pain management with device
  • Implantation of hearing devices
  • Insulin pumps
  • Sleep studies

What this means for you
From 1 April 2021, the following clinical categories will be excluded from your Bronze Hospital cover: Implantation of hearing devices, Insulin pumps and Sleep studies. This means you won’t be covered as a private patient for these services.

If you are currently undergoing treatment, have a treatment scheduled or want to ensure you can keep cover for services in these categories, we will support you. We have implemented transitional arrangements to help you. You can view them below.

If you wish to upgrade to cover these categories after 1 April 2021, a 12 month waiting period will apply for pre-existing conditions.

Changes to Extras cover

Advantage Extras cover - we're combining General Dental and Major Dental benefits

Advantage Extras - Now
General Dental - Treatments include Diagnostic, Preventive, Fillings and Extractions, are paid at set item benefits with no overall annual limit.

Major Dental - Treatments include Periodontics, Oral Surgery, Endodontics, Veneers, Crowns, Bridges, Implants and Dentures are paid at set item limits up to an annual limit of $1125 per member per calendar year.

Advantage Extras - from 1 April
General Dental and Major Dental - Treatments including Diagnostic, Preventive, Fillings, Extractions, Periodontics, Oral Surgery, Endodontics, Veneers, Crowns, Bridges, Implants and Dentures, will be paid at set item benefits up to $1125 per member per calendar year.

What this means for you
From 1 April 2021, the General Dental and Major Dental benefits on your Advantage Extras cover will be combined. You will be able to claim up to $1125 per member per calendar year for any combination of General Dental and Major Dental services. Your per item benefits remain unchanged.
If you have scheduled or are undergoing treatment, we recommend getting in touch to ensure you're on an appropriate level of cover.

We're changing the number of preventative dental item numbers covered with no gap from Provider of Choice Network providers.

Preventative Dental Coverage - Now
You are currently covered for 19 items provided by Provider of Choice Network providers (classed as preventative dental) under a no out-of-pocket agreement.

Preventative Dental Coverage - from 1 April
The number of items included in no out-of-pocket agreements will drop to the eight most commonly used preventative dental items:

  • 011 Comprehensive oral examination
  • 012 Periodic oral examination
  • 022 X-ray
  • 111 Removal of plaque and/or stain
  • 114 Scale and clean
  • 121 Fluoride treatment
  • 151 Provision of a mouthguard
  • 161 Fissure and/or tooth surface sealing

What this means for you

We've revised our Provider of Choice Network agreements and the 19 preventative dental treatments currently provided.
From 1 April 2021, Providers of Choice can provide eight of the most commonly used preventative dental services with no out-of-pocket cost to you, up to your annual limit.
You're still able to have the other services at your selected dentist, but you may now have an out-of-pocket cost up to your annual limit. The best way to view your current annual limits is by checking your Policy Summary.

We're making it easier to claim a benefit for Low Vision Aids on eligible covers.

Low vision aids - Now
An up-to-date letter of recommendation from a Medicare-registered practitioner is required every 12 months so you can claim Low Vision Aids.

Low vision aids - from 1 April
A letter of recommendation from a Medicare-registered practitioner is required just once, removing the requirement to provide one each year.

What this means for you
We're making it easier for you to claim Low Vision Aids. We've removed the annual requirement to provide a letter from your Medicare-registered practitioner - you'll now just need one while ever you are covered by Westfund.

We're renaming some benefits to provide consistency.

Benefit names - Now
We currently refer to:

  • CPAP Masks and Accessories
  • Orthodontia
  • Complementary Therapies

Benefit names - from 1 April
We will refer to these items as:

  • Sleep Apnoea Masks and Accessories
  • Orthodontic
  • Other Therapies

What this means for you
This is just a change in the way we refer to certain benefits. There will be no change to your limits or benefit amounts.

More information

Why are you removing certain clinical categories from my cover?

It's important to us that we continue to deliver quality products and benefits to our members.

This means we need to review policies on a regular basis - to make sure we continue to provide benefits and services that support the majority of our members.

How long do I have to upgrade my cover to include a clinical category you have removed from my cover?

The last thing we want to do is cause any additional stress - you’re still covered for these clinical categories under your current Hospital cover up to 30 September 2021 if a booking has already been made prior to 1 April 2021.

However, if you wish to continue to be covered for these clinical categories after 1 April 2021, you will need to upgrade your Hospital cover before 1 April 2021 in order to avoid re-serving waiting periods. 

If you wait until after 1 April 2021, a 12 month waiting period will apply for pre-existing conditions and a 2 month waiting period for a new condition. Read more about our transitional measures below.

Why are you removing dental item numbers from Provider of Choice?

Don’t worry, we’re not removing any dental services from our Provider of Choice Network. From 1 April 2021, the number of items included in no out-of-pocket agreements will drop to the eight most commonly used preventative dental services:

  •         011 Comprehensive oral examination
  •         012 Periodic oral examination
  •         022 X-ray
  •         111 Removal of plaque and/or stain
  •         114 Scale and clean
  •         121 Fluoride treatment
  •         151 Provision of a mouthguard
  •         161 Fissure and/or tooth surface sealing

You're still able to have the other services at your selected dentist, but you may now have an out-of-pocket cost.

Transitional Measures

Changes to Excess Waivers and Clinical Categories

Westfund will apply transitional measures for a period of six months following the 1 April 2021 benefit changes. Between 1 April 2021 and 30 September 2021, the following transitional arrangements will apply for the removal of Same-day Procedures Excess Waiver (applicable to the covers outlined above) and removal of clinical categories from Silver Hospital and Bronze Hospital covers:

Situation Excess Waiver Clinical Categories
If your treatment has commenced Not applicable If you were admitted on or before 31 March 2021 and are discharged after 1 April 2021, you will be covered.
If you're receiving a course of treatment If you're currently being treated (e.g. chemotherapy, dialysis, psychiatric, rehabilitation) the excess waiver applies for your course of treatment, or a continuous period of up to six months from the excess waiver change (1 April 2021), whichever occurs first. If you're currently undertaking a course of treatment that commenced prior to 1 April 2021, you'll be covered for the duration of the treatment, or a continuous period of up to six months from the clinical category changes (1 April 2021) - whichever occurs first.
If you have booked your treatment If you have a booking that's received by the hospital prior to 1 April 2021 (including bookings notified by the doctor or where you have completed the necessary forms, but where admission occurs within six months of the date of the Same-day Procedures Excess Waiver change - i.e. between 1 April 2021 and 30 September 2021), the Same-day Procedure Excess Waiver will apply. If you have a booking that's received by the hospital prior to 1 April 2021 (including bookings notified by the doctor or where you have completed the necessary forms, but where admission occurs within six months of the date of the clinical category changes - i.e. between 1 April 2021 and 30 September 2021), the clinical category will be covered.
If you're being admitted after 1 April 2021 If you're admitted after 1 April 2021 and no other pre-arrangements have been confirmed prior, your excess will apply. If you're admitted after 1 April 2021 and no other pre-arrangements have been confirmed prior, the clinical category will not be covered - you'll have to upgrade and serve all relevant waiting periods if you want to be covered for the treatment.

We offer our Dependant Excess Waiver as an additional benefit to our members, and this benefit is only available on certain covers – Gold, Silver Plus and Silver Hospital. It’s not available on our Bronze and Basic Hospital covers. If you’re a current Bronze or Basic Hospital member and you’re interested in increasing the level of your hospital cover, we’re here to chat about what options are available.

Your health and wellbeing is our priority. We're asking our members to contact us to advise of on-going or scheduled treatment, so we can advise how these changes may affect your treatment.

If you're on a Silver Hospital or Bronze Hospital cover, we can discuss upgrade options with you if you wish to maintain coverage for the removed clinical categories.