Offers no exclusions on hospital cover, combined with ambulance cover. It’s suitable for people who want to ensure they get the best care in hospital, but don’t feel they need cover for extras like dentistry and complementary therapies.
- from $36.37* for singles
- from $72.86* for couples
- from $74.26* for families
(covers kids aged up to 25)
Prices effective 1 April 2018.
- $500 per adult per calendar year
Top Hospital Cover
Top hospital cover with no exclusions and minimal restrictions. An excess option is available.
Ambulance cover is included as part of this plan.
Access to a great range of our Westfund Member Advantages, including our Accident Benefit, Accommodation Benefit, and much more.
No extras cover
Browse our Hospital and Extras plans if you need to be covered for extras.
You're covered for
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 the Policy Summary.
- Appendicitis (Appendectomy)
- Tonsillitis (Tonsillectomy)
- Hospitalisation for Cancer Treatment
- Surgical extraction of wisdom teeth
- Joint reconstructions
- Surgical treatment of a hernia
- Minor Gynaecological procedures
- Removal of kidney and gall stones
- Joint Replacements
- Cataract surgery and intraocular lens insertion
- Obesity surgery and lipectomy
- Dialysis for chronic renal failure
- Assisted reproductive services
- Spinal fusion
You're partially covered for
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.
- Psychiatric Care
You're not covered for
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.
There are no hospital exclusions, no co-payments and no benefit limitation periods on Gold Hospital
Hospital Waiting Periods
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:
|Psychiatric, Rehabilitation and Palliative Care||2 Months|
|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.
More about Hospital Cover
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.
More about Medical Cover
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 period
Up to $5,000 per member per calendar year for non-emergency patient transport
(eg. Hospital to Hospital transfer)
2 month waiting period
We're easy to deal with
Our Care Centres are in regional locations so you can talk to someone in person, give our friendly staff a call or use our online services.
No excess for kids or if you're in an accident
For peace of mind if something unexpected should happen.
We're for regional Australians
Just like you, we work and live in regional Australia, so we understand what’s important to you.
Not for profit
We’re here for our members. We’re returning approx. $3.5 million to eligible Gold and Platinum members in 2017.
Westfund Member Advantages
There's amazing benefits you'll receive because you choose Westfund.
No Excess for day surgery, kids or in an accident
Unlike many other funds, we don't charge an excess for day surgery, dependants on your policy or if you're hospitalised as a result of an accident.
Standard hospital waiting periods apply
We'll pay you an additional payment of $100 per night if you're hospitalised as the result of an accident.
Available after 1 day
Accommodation and Travel Benefit
Up to $400 per calendar year per policy which includes:
- up to $100 per night for accommodation expenses incurred in relation to a hospital admission
- up to $70 per round trip (minimum 150km) towards travel expenses for an outpatient specialist appointment
Available after 1 year
Advanced Surgery Benefit
$200 per night additional benefit for advanced surgical procedures due to heart disease, stroke or cancer – up to $2,400 per hospitalisation.
Available after 2 years
Forced Retrenchment Benefit
We’ll waive your premiums for up to 6 months if you’re made redundant.
Available after 3 years
Protected Industrial Action
We’ll waive your premiums for up to 6 months due to protected industrial action.
Available after 3 years
Access to Westfund Dental and Eyecare
Receive dental and eye care at our local Westfund Care Centres