This product meets the Department of Home Affairs VISA requirements for a 457 Working Visa and relevant subclasses.
Westfund will pay benefits towards your admission for hospital treatment that forms part of an admitted episode of care. This may include hospital accommodation, theatre fees and prosthetic costs.
Services which Westfund covers to a limited extent and pays reduced benefits on admissions for hospital treatment that forms part of an admitted episode of care. The benefit is not sufficient to cover the cost of a private room in a public hospital or any room in a private hospital. If you are admitted to a private hospital for services that are restricted, large out-of-pocket expenses will apply.
Westfund will not pay benefits towards hospital or medical costs for these services. If you choose to proceed as a private patient for an excluded service, you will have very large out-of-pocket expenses.
A Member who has held a Policy with Hospital cover for at least 2 months and upgrades to a Policy which includes psychiatric treatment may elect to waive the 2 month Waiting Period that applies to psychiatric treatment upon upgrade. This waiver can only be accessed once in a Member's lifetime.
When you switch health funds, we will guarantee continuity of cover for the benefits included in your previous cover. This applies only to the benefits you were entitled to under your previous cover, as long as these benefits are included under your new Westfund cover.
Benefits are not payable in respect of services provided during a waiting period. The following waiting periods apply to benefits payable for Hospital Treatment.
| Hospital Waiting Periods | |
|---|---|
| Accident-related | 1 Day |
| Psychiatric, Rehabilitation and Palliative Care A Member who has held a Policy with Hospital cover for at least 2 months and upgrades to a Policy which includes psychiatric treatment may elect to waive the 2 month Waiting Period that applies to psychiatric treatment upon upgrade. This waiver can only be accessed once in a Member's lifetime. |
2 Months |
| Pregnancy and Birth | 12 months |
| Treatment of a pre-existing condition | 12 Months |
| All other services | 2 Months |
When a member is admitted to hospital as a private patient, an Accommodation Benefit is payable for costs incurred as the result of boarding at a hospital or nearby motel by the patient or one Member covered by the same Westfund Policy.
| Accommodation | ||
|---|---|---|
|
Accommodation Benefits are paid for the night before admission, for the nights during the hospitalisation and the night of discharge. This Benefit is not claimable for the patient while admitted. Nights 1-4 will be paid at $100 per night and nights 5 and onward will be paid at $40 per night per policy per calendar year. |
12 month waiting period | |
Inpatient Travel is available for round trips exceeding 150km from the member’s home locality to the locality of the hospital.
| Inpatient Travel | ||
|---|---|---|
| When a member is admitted to hospital as a private patient, an Inpatient Travel Benefit of up to $70 per member per episode of hospitalisation is available. | 12 month waiting period | |
The Commonwealth Ombudsman also provides general information about waiting periods.
* A pre-existing condition is an illness or condition for which, in the opinion of a medical practitioner appointed by Westfund, signs or symptoms existed during the 6 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.
Westfund has contracts with numerous private hospitals throughout Australia covering theatre fees and hospital accommodation costs for most procedures. Hospital policies do not provide cover for treatment for which Medicare pays no benefit eg. Non-Therapeutic Cosmetic Surgery, or if disallowed by the Private Health Insurance Act 2007. Where no contract exists with a private hospital, benefits are payable at a default rate determined by the Government. In these cases, out of pocket expenses may be incurred. We recommend that members check with us prior to admission to hospital to ensure they are covered.
As a private patient in a public hospital, you will receive cover for accommodation and your choice of doctor from doctors with a right to practice at that hospital. Westfund will pay benefits for surgically implanted prostheses up to the approved benefits in the Government's Prostheses List and in accordance with the requirements of the Act.
All Pharmaceutical Benefits Scheme (PBS) listed drugs that are prescribed according to the PBS approved indications, that are administered during and form part of an admitted episode of care - a benefit equal to the PBS listed price in excess of the patient contribution will be paid.
For inpatient services, Westfund pays benefits for the fees charged by your specialist while you are in hospital. Common and support services such as anaesthetic, consultations, pathology and radiology that are in relation to your hospital admission are also eligible for benefits. Benefits are only eligible where a Commonwealth Medical Benefits Schedule (CMBS) item number is used. Westfund will pay the lesser of charges or 100% of the CMBS fee. Where the fees charged exceed the CMBS fee, Westfund will pay an additional benefit to reduce or eliminate out-of-pocket expenses where the doctor or specialist participates in our Access Gap Scheme.
Our Access Gap Scheme allows patients with hospital cover to eliminate or reduce out-of-pocket expenses for medical gap payments for inpatient hospital treatments. Westfund does not pay an amount charged by your doctor above the CMBS fees unless your doctor agrees to participate in the Access Gap Scheme. If a doctor does not use the Access Gap Scheme, patients will be responsible for any additional charges. Doctors are independent of Westfund and each doctor can choose on a case by case basis whether to participate in the Access Gap Scheme. No benefits are paid for non-therapeutic cosmetic surgery.
For outpatient services, Westfund will pay a benefit of 100% of the CMBS fee for services provided by a General Practitioner and a benefit of 85% of the CMBS fee for services provided by a Specialist (including pathology and radiology).
For diagnostic, preventative dental, fillings and extractions
To use on major dental treatment like periodontics, oral surgery, endodontics, veneers, crowns, bridges, implants and dentures.
Limit accrues at $650 per member per policy year to use on orthodontics with a maximum accrued lifetime benefit of $3250.
100% of fee (up to annual limit) for frames, single vision lenses, bifocal lenses, multifocal lenses, contact lenses.
No benefit towards tinting, coating or add-ons. Benefits also apply for Irlen lenses.
Optical Bonus $80 per member to use towards out of pocket costs, accrues to $160 if no optical claims made at any provider in consecutive years
Available only at Westfund Eye Care Centres. Bonus can be used towards prescription glasses and contacts only.
Sunglasses $75 per member per calendar year
Available at Westfund Care Centres and selected Providers of Choice
Annual limit shared by all members on the policy.
| Group / Class Item Limit | Individual Item Limit | |
|---|---|---|
| Physiotherapy | $10 | $52 |
| Exercise Physiology | $10 | $40 |
Annual limit shared by all members on the policy.
| Item Limit | |
|---|---|
| Chiropractic | $40 |
| Chiropractic X-ray | $70 |
| Osteopathic | $40 |
| Type | Maximum rebate per service | Single sub-limits per calendar year |
Family or couple sub-limits per calendar year |
|---|---|---|---|
| Remedial Massage and Myotherapy | $35 | $350 | $700 |
| Acupuncture and Chinese Herbalism | $35 | $350 | $700 |
| Dietetics and Nutrition | $55 | $350 | $700 |
| Home Nursing | $18 (up to 6 hours) $72 (over 6 hours) |
$225 | $450 |
| Vision (Eye) Therapy | $35 | $350 | $700 |
| Occupational Therapy | $70 | $350 | $700 |
| Podiatry Podiatry Surgical Treatment |
$42 100% |
$336 | $672 |
| Clinical Psychology | $100 | $420 | $840 |
| Speech Therapy | $60 (initial) $42 (subsequent) |
$384 | $768 |
$75 per prescription for the amount that exceeds the PBS co-payment for Private, Non-PBS, Non-NHS.
Doctor letter required in some instances (see Membership Terms and Conditions)
100% of fee (up to annual limit) for Fitness Centre, Aquatic Programs, Weight Loss Programs, Virtual Gastric Banding, Diabetes Education, Vitamins, Omega 3 or Probiotics.
Fitness Centre, Weight Loss, Virtual Gastric Banding and Aquatic Programs require a Medicare Registered Practitioner to complete a Health Management Declaration Claim Form to confirm the Program is medically necessary.
| Type | Item Limit | Annual Group Limit |
|---|---|---|
| Preventative Health Tests (Bone Density Test, Bowel Testing Kit, Calcium Score, Mammogram, Mole Scan, Thin Prep Pap Test) |
100% | $45 per member |
| Ear and Eye Preventative Health Checks (Audiology Test, Corneal Topography, Optical Coherence Tomography, Retinal Photography) |
$80 | $160 per member |
| Antenatal Classes and Pre/Postnatal Consultations | 100% | $120 per policy per calendar year |
| Hypnotherapy for Quit Smoking | 100% | $250 per member Lifetime Limit |
| Chronic Disease Association Fees | 100% | $30 per member |
| Health Aid or Appliance | Sub-limit per member | Letter of recommendation required |
|---|---|---|
| Artificial Limbs | $200 per calendar year | Lifetime letter |
| Braces | $200 per calendar year | Every 12 months |
| Compression Garments | Lifetime letter | |
| Blood Glucose Monitor | $100 per calendar year | No |
| Blood Pressure Monitor | $150 per calendar year | No |
| Burn Suits | $800 per calendar year | Every 12 months |
| Devices for Sleep Apnoea and diagnosed snoring | $750 every 3 years | Lifetime letter |
| CPAP Masks, Accessories and TENS Accessories | $100 per calendar year | No |
| INR Monitor | $200 every 2 years | Lifetime letter |
| Low Vision Aids | $100 per calendar year | Every 12 months |
| Mobility Aids | Every 12 months | |
| Mammary Prostheses and Brassieres | $400 per calendar year | Lifetime letter unless relevant hospitalisation is recorded with Westfund |
| Respiratory Aids | $200 per calendar year | Lifetime letter |
| Custom Made Orthopaedic Boots | $400 per calendar year | Every 12 months |
| Custom Made/Preformed Orthotics | $300 per calendar year | Every 12 months |
| Oximeter Oxygen and Accessories |
$750 per calendar year | Lifetime letter |
| Repairs to Devices | $100 per calendar year | Lifetime letter unless initial purchase of the device is recorded with Westfund |
| TENS Machine | $200 every 3 years | Lifetime letter |
| Wigs | $300 per calendar year | Lifetime letter unless relevant hospitalisation is recorded with Westfund |
| Hearing Aids and Frequency Modulated Systems | $2000 every 3 years | No |
Up to $70 per outpatient service, to a maximum of $210 per policy per calendar year
Unlimited medically necessary emergency ambulance transport
1 day waiting periodUp to $5,000 per member per calendar year for non-emergency patient transport (eg. Hospital to Hospital transfer)
2 month waiting periodThere's amazing benefits you'll receive because you choose Westfund.
Member Fees at Westfund Dental Centre, Lithgow and Westfund Eye Care Centres.
Available after 2 months
