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 |
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).
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
