Hospital and Extras

Great mid-level hospital and extras cover for young couples and families.

Download the Silver Policy Summary

  • from $38.57* for singles
  • from $77.15* for couples
  • from $78.64* for families
    (covers kids aged up to 25)
* per week. Based on NSW prices, claiming base tier Aust. Gov. rebate for under 65 and no Lifetime Health Cover loading.
Prices effective 1 April 2018.

Excess^: $250 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

What's included

Mid Level Hospital Cover

Mid-level hospital cover with some exclusions and restrictions. An excess applies.

Mid Level Extras

Mid-level extras cover with great annual limits.

Ambulance Cover

Ambulance cover included is as part of this plan.

Member Advantages

Access to a great range of our Westfund Member Advantages, including our Accident Benefit, Accommodation 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 (excluding IVF)
  • Colonoscopies
  • Gastroscopies
  • Removal of kidney and gall stones
  • Obstetrics

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.


  • Cataract surgery and intraocular lens insertion
  • Obesity surgery and lipectomy
  • Assisted reproductive services
  • Hip replacement
  • Knee replacements

There are no co-payments and no benefit limitation periods on Silver

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:

Hospital Waiting Periods
Accident-related1 Day
Psychiatric, Rehabilitation and Palliative Care2 Months
Obstetric-related services12 months
Treatment of a pre-existing condition12 Months
All other services2 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.

Extras Cover

What's included

General Dental

General Dental
$400 limit for singles and $800 limit for families and couples per calendar year 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.

Specialist Dental
$1,020 lifetime limit per member for surgical extraction of wisdom teeth

General and Specialist Dental Rebates
Dental Services Maximum rebate per service
Examination up to $30
Simple extraction up to $80
Plaque removal up to $25
Calculus removal up to $55
Small filling up to $57
Medium filling up to $86
Large filling up to $120
Root canal up to $122
Mouth guard up to $75 per member
per calendar year
Benefits are provided for:
General Dentistry (most ADA items 011 - 171), Oral surgery (ADA items 311, 314, 322, 323, 324 only), Endodontic (ADA items 411 - 421 only), Restorative (ADA items 511 - 578, items 595 - 597), and other services (most ADA items 911 - 986) provided by a general dentist.
Surgical extraction of wisdom teeth (ADA items 311, 314, 322, 323, 324 only)

$250 per member per calendar year

No sub-limits for Optical from 1 January 2018

Physiotherapy, Chiropractic and Complementary Therapies

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

Annual limit shared between all members on the policy

  • $500 per calendar year for singles
  • $1,000 per calendar year for couples or families
Complimentary Therapies Sublimits and Rebates
Type Rebate per service Single sublimits
per calendar year
Family or couple sublimits
per calendar year
Chiropractic and Osteopathic
Chiropractic X-ray (one per member per calendar year)


$150 $300
Physiotherapy $25 $150 $300
Massage Therapies
(Remedial Massage/Therapy, Bowen Therapy)
$25 $150 $300
Acupuncture $25 $150 $300
Dietetics/Nutrition $25 $150 $300
Home Nursing - up to 6 hours / over 6 hours $12 / $48 $150 $300
Naturopathy $25 $150 $300
Occupational Therapy $25 $150 $300
Orthoptics $25 $150 $300
Podiatry $25 $150 $300
Speech Therapy - Initial / Subsequent $48 / $36 $300 $588
Prescriptions/Vaccinations and Injections

$50 per prescription for the amount that exceeds the standard PBS co-payment.
Annual limit of $400 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 programs 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, Yoga, Vitamins etc.

Prevention and Health Management Policy Limits
Service Single Policy Limit Couple or Family Policy Limit
Fitness Centre
Omega 3
Weight Loss Programs (Health Management Claim Form required)
Virtual Gastric Banding
$75 $150
Antenatal Classes and pre-postnatal consultations (12 month waiting) $120 lifetime limit

Prevention and Health Management Member Limits
Service Benefit per member
Mole Scanning $30 per calendar year
Retinal Photography $20 per calendar year
Optical Coherence Tomography $80 per calendar year
Hypnotherapy for Quit Smoking $250 lifetime 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.

Benefits available for purchase and hire fees from 1 Jan 2018

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
Mammary Prostheses and Brassieres $225 per calendar year Yes (unless relevant hospitalisation recorded) Lifetime
Nebuliser $110 calendar year No  
Custom made orthopaedic boots $200 per calendar year Yes (unless provided by a physiotherapist or podiatrist) 12 months
Custom made / preformed orthotics $200 per calendar year Yes (unless provided by a physiotherapist or podiatrist) 12 months
Peak Flow Meter $35 per calendar year No  
Compression Garments $120 per calendar year No  
ISC Compression Calf Garments No  
Braces Yes 12 months
INR Monitor $200 every two years Yes Lifetime
Wigs $150 every calendar year Yes (unless relevant hospitalisation recorded) Lifetime

Ambulance Cover

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 in an accident

For peace of mind if something unexpected should happen.

Not for Profit

We’re here for our members. We’re returning approx. $3.5 million to eligible Gold and Platinum members in 2017. 

We're for regional Australians

Just like you, we work and live in regional Australia, so we understand what’s important to you.


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 $100 per night if you're hospitalised as the result of an accident.
    Available after 1 day

  • Sunglasses Benefit

    Receive $50 per member per calendar year for sunglasses bought from any Westfund Care Centre.
    Available after 2 months

  • Accommodation and Travel Benefit

    Up to $320 per calendar year per policy which includes:
    - up to $80 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

  • 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

  • Westfund Dental and Eyecare

    Higher per item benefits at Westfund Dental Care Centres than at other providers.
    Additional benefit of $40 per member to use on out of pocket costs associated with purchasing prescription glasses or contacts at Westfund Eye Care Centres. This amount will accrue up to $80 if no optical claims are made.
    Available after 2 months

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