Westfund Health Insurance Overview

fund-iconOverview

Westfund can trace its roots back to the mining communities of Bathurst and Lithgow as far back as 1881, although the current company was formally created as a non-profit health fund for miners in 1953. It continues to focus on regional communities today.

The fund has almost 100,000 members, with branches across Queensland and New South Wales.

This health fund values giving back to the community, and participates in many local fundraising events and other initiatives, including the annual Westfund Christmas Appeal and a community service called the Vision Screening Program.

fund-iconKey features

  • Benefits and perks through the Member Advantages Program
  • Eye care clinics across regional NSW and QLD provided at no extra cost to members.
  • Online portal to process claims.

fund-iconHospital cover

Nobody chooses to go to hospital. But when you do, hospital cover will help you get the treatment you need, where and when you want it. It also helps to pay the bills, as fees for hospital rooms and specialists can add up.

Think about what services you’re likely to need, in line with your budget. If you earn over $90,000 individually or $180,000 as a couple, you could avoid paying the Medicare Levy Surcharge.

Westfund Health Insurance has a range of hospital-only covers, from Basic to Gold, to suit all budgets and needs. Their excess options range from $0 through to $750 per calendar year.

Basic Hospital

This basic cover provides restricted cover on a few popular services, and is typically taken up by healthy singles and couples on a budget.

Key inclusions:

  • Unlimited emergency ambulance transport
  • All items bar weight-loss and dialysis are covered but with significant restrictions and potentially large out of pocket expenses if you were treated in a private hospital.
Silver Hospital

Only pay for what you need with mid-level hospital cover that’s suitable for established families and couples.

Key inclusions:

  • Implantation of hearing devices
  • Insulin pumps
  • Medically necessary plastic and reconstructive surgery
  • Sleep studies
Silver Plus Assure Hospital

Higher-level hospital cover suitable for older adults, that covers services likely to be needed later in life.

Key inclusions:

  • Cataracts
  • Joint replacements
  • Dialysis for chronic kidney failure
  • Chemotherapy, radiotherapy and immunotherapy for cancer
Gold Hospital

This is Westfund’s most comprehensive hospital cover, with no exclusions or restrictions. It’s a popular option for those wanting to start a family or just want top-tier coverage.

Key inclusions:

  • Weight loss surgery
  • Pregnancy and birth
  • Assisted reproductive services

fund-iconAmbulance Cover

All Westfund Health Insurance cover options include emergency ambulance transportation. If you don’t want to take out hospital or extras cover, you can purchase emergency ambulance cover on its own.

Note: Emergency ambulance costs for Queensland and Tasmanian residents are covered by their state schemes.

fund-iconExtras cover

extras-coverExtras reset

From dental, to optical, to chiro and more, extras insurance helps cover the bills for routine treatments with rebates of up to 100%.

While we’ve summarised the key points of each plan below, it’s always worth digging a little deeper into any gap fees, how much you can claim back, and whether your preferred healthcare provider, such as your local dentist, has an agreement with the health fund.

Take time to work out what you need and what you’re prepared to pay. If this feels a bit overwhelming, you can speak to one of our experts who can talk you through what is and isn’t included in each extras policy.

Westfund Health Insurance offers a variety of extras cover options. You can purchase a policy on its own or combine it with hospital cover.

Essential Extras

Basic cover for the price-conscious, suitable for healthy young singles, couples and families. Extras include general dental, selected major dental, optical and physio.

Advantage Extras

Mid-level cover with competitive rebates and benefits for key services such as optical, dental, physio and chiropractic, plus additional services like orthodontics.

Advantage Pro Extras

Top-level extras cover for growing families. It provides a higher level of rebates for the same services than the Advantage Extras policy but at a higher monthly cost.

Esteem Extras

Extras that have large limits per person on highly-used services like optical, dental and physio. Designed for older singles and couples.

Ultimate Extras

This is the top-tier extras cover with generous limits on a comprehensive range of benefits. Suitable for those who proactively want to cover the full range of treatments.

fund-iconWaiting periods

To stop people signing up, claiming, then cancelling their health insurance, all insurers apply waiting periods. Generally, the more expensive the treatment, the longer you’ll wait. But keep an eye out for special deals with waiting periods reduced or waived.

Basic Hospital, Bronze Hospital
  • 1 day – accident-related treatment
  • 2 months – psychiatric, rehabilitation and palliative care
  • 2 months – all other services
  • 12 months – treatment of a pre-existing condition
Silver Hospital, Silver Plus Assure Hospital
  • 1 day – accident-related treatment
  • 2 months – psychiatric, rehabilitation and palliative care
  • 2 months – all other services
  • 12 months – treatment of a pre-existing condition
  • 12 months – boarding at a hospital or nearby motel by the patient or one Member covered by the same Westfund Policy
  • 12 months – months – inpatient travel: available for round trips exceeding 150km from the member’s home locality to the locality of the hospital
Gold Hospital
  • 1 day – accident-related treatment
  • 2 months – psychiatric, rehabilitation and palliative care
  • 2 months – all other services
  • 12 months – treatment of a pre-existing condition
  • 12 months – pregnancy and birth
  • 12 months – hospital accommodation boarding at a hospital or nearby motel by the patient or one Member covered by the same Westfund Policy
  • 12 months – inpatient travel: available for round trips exceeding 150km from the member’s home locality to the locality of the hospital

fund-iconMember benefits

Westfund Health Insurance member receive:

  • Discounted member fees at the Westfund Dental Centre in Lithgow and all Westfund Eye Care Centres
  • No excess for day surgery, kids or in an accident for private hospital admissions
  • The option to suspend membership for up to six months if you’re made redundant or face protected industrial action
  • The option to suspend your membership for up to 24 months due to overseas travel

fund-iconHow to claim

Claim through the Westfund app, email, fax or post. You can also claim on the spot at participating HICAPS providers.

fund-iconHospital agreements

Westfund Health Insurance has agreements with many private hospitals and day clinics across Australia. When comparing policies, it’s worth checking if your local hospitals and clinics are covered. Our specialists at Health Insurance Comparison can do this for you.

You can use Westfund’s search tool to find a hospital or clinic near you that the fund covers.

fund-iconCustomer service

In 2019 Westfund Health Insurance’s complaints amounted to 0.6% of total complaints – which is on par for a fund of their size*.

fund-iconWestfund FAQs

Yes, Westfund is a non-for-profit insurer.
Any person over the age of 18 can apply for a Westfund Health Insurance Policy. Members must comply with the requirements of the fund and give full and complete disclosure on all matters required by Westfund.
Westfund is not on Health Insurance Comparison’s panel, but we’re confident we can find you a good deal from the other funds we compare. You’ll need to contact Westfund directly if you want to move to them.

You won’t need to re-serve any waiting periods for benefits you were entitled to under your old cover, as long as they’re included in your new Westfund health cover and you’ve already completed the relevant waiting periods

If your new policy includes new items or higher benefits that were not part of your old policy, there will be waiting periods for those new services and/or higher benefits.

Yes, you can choose a lower or higher level of cover. If you move to a higher level of cover, you will usually need to serve waiting periods on the extra services.
Most Australians are eligible to receive a rebate from the government. This will depend on your age and income. To learn what you’re entitled to, see this rebate table.
If you’re 31 or over when you first join an eligible cover, you usually need to pay 2% loading for each year you’ve gone without health cover. You can find out more here.
Extras reset 1 January each year.
Westfund allows children on a family policy up to the age of 25. Children must not be married or living in a de facto relationship. Read our guide to learn more.
Visit westfund.com.au, email enquiries@westfund.com.au or call 1300 937 838.
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