Hospital and Extras
Affordable cover for young singles and couples as well as basic extras cover.
- from $23.33* for singles
- from $46.67* for couples
- not available for families
Prices effective 1 April 2017.
Excess^: $400 per adult per calendar year^ Excess does not apply to hospitalisations due to an accident or same day procedures. Get a quote Join Online
More about the Gift Card offer. New members only. Not available in conjunction with any other offer.
Basic Hospital Cover
Basic hospital cover for simple procedures.
Basic Extras Cover
Basic extras cover for optical, physio, chiro and complementary therapies.
Ambulance cover is included as part of this plan.
Access to a range of our Westfund Member Advantages, including our Accident Benefit, Forced Retrenchment, and more.
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
- Joint reconstructions
- Surgical treatment of a hernia
- Minor Gynaecological procedures (excluding IVF)
- Removal of kidney and gall stones
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
- Palliative 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.
- Joint Replacements
- Cataract surgery and intraocular lens insertion
- Cardiology procedures
- Obesity surgery and lipectomy
- Dialysis for chronic renal failure
- Assisted reproductive services
- Spinal fusion
- Non-cosmetic Plastic Surgery
There are no co-payments and no benefit limitation periods on Value 4U
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*
* 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.
- General Dental
$400 per member per year for services like checkups, cleans and fillings.
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
2 month waiting period
- Optical, Complementary Therapies and Preventative Health Management
$400 per member annual limit
2 month waiting period
Service Item limit Optical Frame $80 Single Vision Lenses $100 Contact Lenses $180 Total limit per member $180 Chiropractic Consultation $25 X-ray (one per member per calendar year) $30 Osteopathic Consultation $25 Physiotherapy Consultation $25 Remedial Massage Initial Consultation $25 Subsequent Consultation $15 Acupuncture Initial Consultation $25 Subsequent Consultation $15 Naturopathy Initial Consultation $25 Subsequent Consultation $15 Podiatry Initial Consultation $25 Subsequent Consultation $15 Fitness Centre Membership or class fees recommended by a Medicare Registered Practitioner for a specific health condition $75 Vitamins Must be TGA approved Vitamins A-Z or Minerals containing iron, zinc, potassium, magnesium or calcium Omega 3
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 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.
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
Receive $50 per member per calendar year for sunglasses bought from any Westfund Care Centre.
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 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 $10 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 $20 if no optical claims are made.
Available after 2 months