Platinum

Hospital and Extras

A premium level of health cover, offering hospital with no exclusions and extras with very high dental, optical, physiotherapy and chiropractic cover.

Download the Platinum Policy Summary

  • from $54.22* for singles
  • from $108.50* for couples or families
  • from $125.68* for families with adult kids
    (aged 21-25)
* per week. Based on NSW prices, including $500 excess, claiming base tier Aust. Gov. rebate for under 65 and no Lifetime Health Cover loading.
Prices effective 1 April 2017.

Excess^:

  • Nil
  • $500 per adult per calendar year
^ Excess does not apply to hospitalisations due to an accident, same day procedures or for dependants. Get a quote Join Online

Extended policies for dependant children aged between 21-25 are changing from 1 April 2018. 

  • Dependants aged between 21 & 25 will no longer need to be studying to remain on Family cover.
  • Families with dependants in this age bracket will only require a regular Family policy, and will no longer need to pay a higher premium for an Extended Family policy.
Special Offer Join on Platinum by 31 December 2017 and receive either a $300 gift card (single policies) or a $600 gift card (couple and family policies).
Terms and Conditions apply. New members only. Not available in conjunction with any other offer.

What's included

Premium Hospital Cover

Premium hospital cover with no exclusions or restrictions. An excess option is available.

High Extras

Premium level of extras cover with very high benefits and rebates.

Ambulance Cover

Ambulance cover is included as part of your plan

Member Advantages

Access to the full range of our Westfund Member Advantages, including our Accident Benefit, Advanced Surgery Benefit, and much more.

Hospital Cover

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
  • Colonoscopies
  • Gastroscopies
  • Removal of kidney and gall stones
  • Joint Replacements
  • Cataract surgery and intraocular lens insertion
  • Obesity surgery and lipectomy
  • Dialysis for chronic renal failure
  • Obstetrics
  • Assisted reproductive services
  • Sterilisation
  • Spinal fusion
  • Psychiatric Services

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 Platinum

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.

Accident Related One day
Psychiatric, Rehabilitation and Palliative Care Two months
Obstetrics-related services One year
Treatment of a Pre-existing Condition*
One year

* 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.

Extras Cover

What's included

General and Major Dental

General Dental
No annual or lifetime limit on General Dental like checkups, cleans and fillings. No out-of-pocket expenses on selected preventative dental at Westfund Dental Care or Provider of Choice practices.

Dental Top Up
Bonus benefits to contribute to out of pocket expenses for general dental, dentures and denture repairs.
$300 per year for singles , $600 per year for couples or families

Major Dental
$1,500 per member per calendar year to use on major dental treatment like crowns, bridges, implants and veneers.

Specialist Dental
no annual or lifetime limit

General Dental Rebates
Dental Services Maximum rebate per service
Examination up to $37.50
Simple extraction up to $80
Plaque removal up to $31.50
Calculus removal up to $69
Small filling up to $71.50
Medium filling up to $107.50
Large filling up to $150
Root canal up to $122
Mouth guard up to $94 per member
per calendar year
Full Dentures up to $977
Full Crown up to $1,000
Orthodontics

$650 per member per policy year to use on orthodontics completed by a registered orthodontist with a maximum accrued lifetime benefit of $3,250.

$240 per member per policy year to use on orthodontics completed by a general dentist with a maximum accrued lifetime benefit of $1200.

Optical

$350 per member per calendar year with sub-limits listed below.

No sub-limits for Optical from 1 January 2018

Optical Rebates and Sublimits
Type Sublimit per calendar year
Frame $100
Single vision lenses $150
Bifocal lenses $350
Multifocal lenses $350
Contact Lenses $350
Chiropractic and Osteopathy

Annual limit shared between all members on the policy

  • $400 per calendar year for singles
  • $800 per calendar year for couples or families
  • $1,000 per calendar year for extended families
    (including 21-25 year old dependants)
Chiro and Osteo Rebates
Type Rebate per service
Chiropractic $40
Chiropractic x-ray $50
Osteopathic $40
Physiotherapy and Exercise Physiology

Annual limit shared between all members on the policy

  • $520 per calendar year for singles
  • $1,040 per calendar year for couples or families
  • $1,000 per calendar year for extended families
    (including 21-25 year old dependants)

New limits above are effective 1 January 2018

Physiotherapy and Exercise Physiology Rebates
Type Rebate per service
Physiotherapy $52
Exercise Physiology $40
Group Exercise Physiology $10
Group/Class Physiotherapy $10
Complementary Therapies

Includes services such as Massage, Acupuncture, Chinese Herbalism, Dietetics, Naturopathy, Podiatry, Psychology, Speech Therapy

Annual limit shared between all members on the policy

  • $750 per calendar year for singles
  • $1,500 per calendar year for couples or families
  • $2,000 per calendar year for extended families (including 21 - 25 year old dependants)

Higher sublimits from 1 January 2018

Current Rebates and Sublimits (2017)

Complementary Therapies Sublimits and Rebates
Type Rebate per service Single sublimits
per calendar year
Family or couple sublimits
per calendar year
Extended family sublimits
per calendar year
Massage Therapies
(Remedial, Bowen Therapy, Aromatherapy, Myotherapy, Alexander Technique and Kinesiology)
$35 $225
$450 $600
Acupuncture and Chinese Herbalism $35 $225 $450 $600
Dietetics/Nutrition $35 $225 $450 $600
Home Nursing - up to 6 hours / over 6 hours $18 / $72 $225 $450 $600
Naturopathy and Homeopathy $35 $225 $450 $600
Occupational Therapy $35 $225 $450 $600
Orthoptics $35 $225 $450 $600
Podiatry $42 $225 $450 $600
Clinical Psychology $70 $225 $450 $600
Speech Therapy - Initial / Subsequent $60 / $42 $354 $690 $690

Rebates and Sublimits from 1 January 2018

Complementary Therapies Sublimits and Rebates
Type Rebate per service Single sublimits
per calendar year
Family or couple sublimits
per calendar year
Extended family sublimits
per calendar year
Massage Therapies
(Remedial, Bowen Therapy, Aromatherapy, Myotherapy, Alexander Technique and Kinesiology)
$35 $350 $700 $600
Acupuncture and Chinese Herbalism $35 $350 $700 $600
Dietetics/Nutrition $35 $350 $700 $600
Home Nursing - up to 6 hours / over 6 hours $18 / $72 $225 $450 $600
Naturopathy and Homeopathy $35 $350 $700 $600
Occupational Therapy $35 $350 $700 $600
Orthoptics $35 $350 $700 $600
Podiatry $42 $336 $672 $600
Clinical Psychology $70 $420 $840 $600
Speech Therapy - Initial / Subsequent $60 / $42 $384 $768 $690
Prescriptions/Vaccinations and Injections

$75 per prescription for the amount that exceeds the standard PBS co-payment.
Annual limit of $600 per member per calendar year.

Prevention and Health Management

Health Management Benefits are for members with a chronic disease, such as diabetes, to have access to programmes that are intended to improve a specific health condition.

Preventative health tests provide members assistance in the prevention of chronic disease.

Items such as Gym Classes, Weight Loss Programs, Pilates, Yoga, Vitamins etc.

Prevention and Health Management Policy Limits
Service Single Policy Limit Couple or Family Policy Limit Extended Family Policy Limit
Fitness Centre
Yoga
Vitamins
Omega 3
Probiotics (effective 1 January 2018)
Weight Loss Programs (Health Management Claim Form required from 1 Jan 2018)
Virtual Gastric Banding
Pilates Centre
Swimming Lessons/Training for children under 18
$150 $300 $400
Antenatal Classes and pre-postnatal consultations (12 month waiting) $120 lifetime limit

Prevention and Health Management Member Limits
Service Benefit per member
Preventative Health Tests
Mole Scanning, Bowel Testing Kits, Bone Density Tests, Mammograms, Thin Prep Pap Test, Calcium Score
$45 per calendar year
Hypnotherapy for Quit Smoking $250 lifetime limit
Current benefit to 31 December 2017
Ear and Eye Preventative Health Checks
Audiology test, Optical Coherence Tomography, Retinal Photography
$50 per calendar year
New benefits from 1 January 2018
Ear and Eye Preventative Health Checks
Audiology test, Retinal Photography
Optical Coherence Tomography


$50 per calendar year
$80 per calendar year
Chronic Disease Association Fees $30 per calendar year
$60 per policy limit
Non-surgically Implanted Prostheses

No overall limit see sub-limits listed below. A letter of recommendation is required from a practitioner in some instances.

Non Surgically Implanted Prostheses Limits
Health Aid or Appliance Sublimit per member Letter of recommendation required Letter valid for
Blood Glucose Monitor $100 per calendar year No  
Blood Pressure Monitor $150 per calendar year No  
Burn Suits $800 per calendar year Yes 12 months
Oral Appliance for diagnosed snoring $750 every three years
(every year for Oxygen and Accessories)
Yes Lifetime
CPAP (sleep apnoea) Machine Yes Lifetime
EPAP Treatment Yes Lifetime
Oxygen and Accessories Yes Lifetime
CPAP Masks and Accessories /
TENS Accessories (from 1 January 2018)
$100 per calendar year No  
Mammary Prostheses and Brassieres $400 per calendar year Yes (unless relevant hospitalisation recorded) Lifetime
Nebuliser $200 calendar year No  
Custom made orthopaedic boots $400 per calendar year Yes (unless provided by a physiotherapist or podiatrist) 12 months
Custom made / preformed orthotics $300 per calendar year Yes (unless provided by a physiotherapist or podiatrist) 12 months
Peak Flow Meter $35 per calendar year No  
Compression Garments $200 per calendar year No  
ISC Compression Calf Garments No  
Braces Yes 12 months
TENS Machine $200 every three years Yes Lifetime
INR Monitor $200 every two years Yes Lifetime
Wigs $300 every calendar year Yes (unless relevant hospitalisation recorded) Lifetime
Artificial Limbs $200 per calendar year Yes Lifetime
Mobility Aids $100 per calendar year Yes 12 months
Low Vision Aids for Age-Related Macular Degeneration Yes Lifetime
Repairs to Devices $100 per calendar year Yes (unless initial purchase of the device is recorded) 12 months
Hearing Aids and Frequency Modulated Systems $2,000 every three years No  

Ambulance Cover

Unlimited medically necessary emergency ambulance transport
1 day waiting period

Up to $5,000 per member per calendar year for non-emergency 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 in an accident

For peace of mind if something unexpected should happen.

Cover for adult children

Keep your grown children on your policy until they turn 25.

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 apply an excess^ on any claim for day surgery, kids or hospitalisation resulting from an accident.
    ^ may apply within 12 months of transferring from another fund. Standard hospital waiting periods apply.

  • Accident Benefit

    We'll pay you an additional payment of $200 per night if you're hospitalised as the result of an accident.
    Available after 1 day

  • Sunglasses Benefit

    Receive $75 per member per calendar year for sunglasses bought from any Westfund Care Centre.
    Available after 1 year
    Waiting period is changing from 12 months to 2 months for new members effective 1 January 2018

  • Accommodation Benefit

    Current Accommodation Benefit
    Up to $150 per night for accommodation expenses incurred in relation to a hospital admission, up to $600 a year per policy
    Available after 2 years

    New Accommodation and Travel Benefit effective 1 January 2018
    Up to $600 per calendar year per policy
    Up to $150 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

    $400 per night additional benefit for advanced surgical procedures due to heart disease, stroke or cancer – up to $4,800 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 union strike.
    Available after 3 years

  • Westfund Dental and Eyecare

    Higher per item benefits at Westfund Dental Care Practices than at other providers.
    Additional benefit of $80 per member to use on out of pocket costs associated with purchasing prescription glasses or contacts at Westfund Eye Care Practices. This amount will accrue up to $160 if no optical claims are made.
    Available after 2 months

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