Our annual review of our products has facilitated a number of changes to our Silver Hospital.More about changes to Silver Hospital
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 |
| Treatment of a pre-existing condition | 12 Months |
| All other services | 2 Months |
An excess is payable once per adult member, per calendar year. Please refer to the table to understand when you are required to pay an excess.
| Excess Payable | |||
|---|---|---|---|
| Admitted to Private Hospital for | Same-day procedure | Accident | All other admissions |
| Main Member or Spouse / Partner | |||
| Dependants | |||
| Admitted to Public Hospital for | Same-day procedure | Accident | All other admissions |
| Main Member or Spouse / Partner | |||
| Dependants | |||
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 $50 per night and nights 5 and onward will be paid at $20 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.
Westfund pays benefits for the fees charged by a doctor, surgeon, other specialist services, including pathology and radiology, while you are in hospital. Medicare pays 75% of the Commonwealth Medical Benefits Schedule (CMBS) fee and Westfund pays the additional 25% up to 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 in-patient 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.
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.
Suspension of membership for up to six months due to forced retrenchment
Protected Industrial Action Suspension
Suspension of membership for up to six months due to protected industrial action
Overseas Travel Suspension
Suspension of membership for up to 24 months due to overseas travel
Forced Retrenchment / Protected Industrial Action available after 36 months
Member Fees at Westfund Dental Centre, Lithgow and Westfund Eye Care Centres.
Available after 2 months
