Westfund will pay towards your theatre fees, hospital accommodation and prosthetics costs when you are admitted to a contracted hospital for procedures that are included under your policy.
While this isn’t a complete list of the procedures covered under your policy, we recommend you contact us prior to any admissions to hospital or refer to your Policy Summary.
The listed procedures have ‘restricted’ cover if you are admitted to a Private Hospital – meaning we will only pay up to the public hospital shared room accommodation rate.
Significant out of pocket expenses may apply for admissions into a Private Hospital.
No cover is provided for procedures for which Medicare pays no benefit (non-therapeutic cosmetic surgery), if disallowed by the Private Health Insurance Act 2007 or if listed as an exclusion on the policy.
You can still be treated as a Medicare patient in a Public Hospital for these exclusions.
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|
|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.
|Obstetric-related services||12 months|
|Treatment of a pre-existing condition||12 Months|
|All other services||2 Months|
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.
Unlimited medically necessary emergency ambulance transport1 day waiting period
Up to $5,000 per member per calendar year for non-emergency patient transport (eg. Hospital to Hospital transfer)2 month waiting period
There's amazing benefits you'll receive because you choose Westfund.
$200 per night per hospitalisation as the result of an accident
Available after 1 day
A limit of $600 per policy per calendar year applies to the Accommodation and Travel
A benefit of $150 per night is available for Accommodation expenses.
Up to $70 per round trip (minimum 150 km) towards travel expenses for inpatient or outpatient specialist medical services.
Available after 12 months
$400 per night following the procedure, up to $4,800 per hospitalisation for advanced surgery admissions due to heart disease, stroke or cancer.
Available after 24 months
Waiver of premiums up to six months due to forced retrenchment or protected industrial action.
Available after 36 months