Westfund Health Insurance

Westfund is a member-owned health fund – Full policy review and comparison

If you’re looking for a private health fund to offer peace of mind and help you take better care of yourself, Westfund Health can help. Established in 1929, Westfund is a member-owned health fund, which means all its profits are returned to members in the form of cheaper premiums and better products.

With an aim of providing quality cover at an affordable price, Westfund Health offers the following plans to its members: Hospital and Extras Cover, Hospital Only Cover, Extras Only Cover, Overseas Cover and Ambulance Cover.

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Westfund Health Insurance option

There’s certainly no shortage of health cover options available from Westfund Health, with cover ranging from standalone hospital or extras cover through to combined policies. Whether you want the most basic and affordable level of cover, a mid-range option or comprehensive protection, Westfund Health has options designed to suit you.

Hospital and Extras Cover

Hospital and Extras Cover from Westfund is available in a massive 13 different levels of protection:

  • Platinum Plus. No exclusions, no excess, no co-payment for hospital treatment and covers a wide range of extras services.
  • Platinum Extended. Same comprehensive protection as Platinum Plus but also covers adult children aged 21 to 25.
  • Platinum. High level of hospital and extras cover with a $500 excess option to reduce premiums.
  • Platinum Public. Combines cover for public hospital treatment with the highest level of extras.
  • Gold Extended. Slightly less cover than Platinum but still comprehensive. Allows you to cover adult children aged 21 to 25.
  • Gold Classic. This combined policy is designed specifically for those aged 65 or over and couples.
  • Gold. Identical to Gold Extended but without the ability to cover adult children.
  • Silver Plus. Mid tier hospital cover that is combined with a superior level of extras.
  • Silver. This option is suited for people after value for money and mid-range hospital and extras cover.
  • Bronze Plus. Pairs basic hospital cover for vital treatments with a wide range of extras services.
  • Bronze. Affordable cover for those who are young, fit and healthy.
  • Value 4U. This policy combines specified hospital and extras treatments with ambulance cover.

Hospital Only Cover

Westfund offers two stand alone hospital policies that both offer top cover:

  • Gold Hospital. Covers an extensive range of treatments in a private hospital and includes ambulance benefits. No excess, co-payment or exclusions apply.
  • Gold Hospital 500. Same level of cover as Gold Hospital but requires you to pay a $500 excess which reduces the cost of the policies premium.

Extras Only Cover

Two levels of stand alone extras cover are available from Westfund:

  • Platinum Extras. Provides generous annual benefit limits for out-of-hospital services including major dental, orthodontics, optical, physiotherapy and medical prescriptions.
  • Gold Extras. Covers the same range of extras services as Platinum Extras but with slightly less annual benefit limits.

Full list of treatments covered by Platinum and Gold Extras

  • Emergency ambulance transport
  • General dental
  • Specialist dental
  • Major dental
  • Orthodontics
  • Optical
  • Chiropractic
  • Physiotherapy
  • Complementary therapies
  • Prescriptions
  • Health management
  • Medical appliances
  • Member advantages

Overseas Cover

These policies are designed for people coming to Australia to work and fulfil Department of Immigration and Border Protection health insurance requirements regarding working visas:

  • Platinum Overseas. Offers a high level of cover for your hospital costs, outpatient GP costs, dental, optical costs and more. No co-payment or excess apply.
  • Gold Overseas. Covers the same amount of treatments and services as Platinum Overseas but with lower benefit levels.
  • Hospital Overseas. Only covers treatments that are administered in hospital. Does not include extras cover.

Ambulance Cover

There are two ambulance policies currently available from Westfund:

  • Premium Ambulance. Provides unlimited cover anywhere in Australia including a $5,000 annual benefit for non-emergency transport, a $2,000 annual benefit for emergency dental and more.
  • Basic Ambulance. Covers the cost of two emergency ambulance trips for singles and four for couples and families. Includes a $2,000 annual benefit for non-emergency transport.

Are there any additional benefits?

Westfund's Member Advantages program rewards its customers for maintaining their policies with the following bonuses:

  • After serving your waiting period: Receive up to an additional $200 per night if you are hospitalised following an accident.
  • After 1 year: Receive $75 towards sunglasses from any Westfund Care Centre.
  • After 2 years: Get $150 per night accommodation expenses up to $600 per year as well as an additional $400 per-night benefit for advanced surgical procedures.
  • After 3 years: Enjoy the flexibility of being able to suspend your premiums for up to six months if you’re made redundant.
  • After 5 years: Get up to $2,000 for hearing aids and enjoy eligibility for any special premium discounts that may arise.

General exclusions and waiting periods

There are certain circumstances under which Westfund Health will not pay your claim, including if:

  • It is for a procedure or treatment excluded from your policy
  • It is for services rendered by a provider who is not recognised by Westfund or not in private practice
  • It is for services received more than 24 months prior to you lodging your claim
  • You have received treatment from your business partner, spouse, de facto or relative
  • It is for services received by the dependents of your dependents
  • It is for benefits that are claimable from another source, for example Medicare or workers’ compensation insurance
  • It is for services or health care goods provided outside Australia
  • It is for a service for which Medicare does not pay a benefit, for example cosmetic surgery.

Just as with any other health fund, you’ll also need to consider the waiting periods you will need to serve when you join Westfund Health. For example, you’ll only have to serve a one-day waiting period for accident and ambulance cover, while all other hospitalisations (excluding obstetrics and pre-existing conditions) require you to serve a two-month waiting period. Other treatments, for example major dental work and obstetrics, require you to sit out a 12-month waiting period.

Westfund Health Insurance excess

Many health insurers require you to pay an excess when you are admitted to hospital. This is the amount that you contribute to the cost of your hospital treatment and is typically paid when you are admitted. Whether or not you need to pay an excess depends on the Westfund policy and level of cover you choose. You may also be required to pay an excess if you have transferred from another health fund that requires you to pay an excess, and if a waiting period still applies to your policy.

Claim amounts per medical treatment

When you lodge a claim with Westfund Health Insurance, the amount of benefit payable to you will be determined by the specific type of medical treatment you received. As can be expected, more severe conditions and complex surgeries or procedures will merit a larger payment.

Here you can find 22 of the most commonly claimed for medical services and the corresponding benefit that Westfund Health Insurance members are eligible for. Also listed are the equivalent Medicare (MBS) benefits for comparison.

Please note that Westfund Health Insurance falls under the title AHSA, due to them being a member of that organisation. More information on the AHSA can be found at the bottom of the table:

ProcedureMBSAHSA*
Appendicectomy$445.40$632.10
Basal Cell Carcinoma or Squamous Cell Carcinoma removal from nose, eyelid, lip, ear, digit or genitalia$221.35$366.10
Breast, benign lesion surgical biopsy of excision$260.05$356.40
Carpal Tunnel Release$276.80$440.20
Cataract Surgery$760.55$1,239.70
Cholecystectomy$739.35$1,091.90
Colonoscopy$334.35$435.00
Complicated Delivery (of baby)$1,629.35$1,855.90
Coronary Artery Bypass$2,200.00$3,783.30
Craniotomy$1,586.75$2,420.80
Cytotoxic Chemotherapy$97.95$107.80
Femoral on Inguinal Hernia$464.50$909.70
Haemorrhoidectomy$367.75$602.90
Hip Replacement$1,317.80$2,214.50
Knee Replacement$2,047.60$2,563.40
Overnight investigation for sleep apnoea$588.00$682.20
Tonsils or Tonsils and Adenoid$295.70$513.90
Uncomplicated Delivery (of baby)$693.95$1,484.50
Vaginal Hysterectomy$674.70$1,066.20
Varicose Veins$109.80$164.80
Vasectomy$229.85$343.80

*NSW, #AHM

I recognise most of these funds except for the AHSA, what is that?

The Australian Health Service Alliance is a management services organisation that represents a number of small to medium sized health insurance funds, allowing them to combine resources to deliver a higher quality of service to their members.

The funds represented by the ASHA are:

  • ACA Health Benefits Fund
  • Australian Unity Health Limited
  • CBHS Health Fund Limited
  • CUA Health Limited
  • Defence Health
  • GMF Health
  • GMHBA
  • Budget Direct Health Insurance
  • Frank Health Insurance
  • GU Health
  • HBF Health Ltd
  • Health Care Insurance Limited
  • health.com.au
  • Health Insurance Fund of Australia Limited
  • Health Partners
  • Navy Health
  • onemedifund
  • Peoplecare Health Insurance
  • Phoenix Health Fund
  • Police Health Limited
  • Queensland Country Health Fund Limited
  • Reserve Bank Health Society Ltd
  • rt health fund
  • Teachers Health Fund > UniHealth Insurance
  • Teachers Union Health
  • The Doctors' Health Fund Pty Ltd
  • Transport Health
  • Westfund

Making a claim

If you need to make an extras claim, you can simply swipe your Westfund membership card at any provider that offers on-the-spot electronic claiming. Where this is not an option, you can download a claim form from the Westfund website, fill it out, sign it and return it to the health fund via email, mail or fax. A handy online claims portal is also available through the members area of the Westfund Health website.

In terms of hospital claims, most hospitals will send the bill directly to your health fund. However, in other cases you can lodge a claim via the Westfund website.

Frequently asked questions about Westfund

Question: Does Westfund Health have any branches I can visit?

  • Answer: Yes, Westfund operates branches in Lithgow, Mudgee, Bathurst, Orange, Dubbo, Wollongong, Moranbah, Emerald, Maroochydore, Townsville, Mackay and Rockhampton.

Question: How can I join Westfund Health?

  • Answer: It’s simple to sign up for a Westfund Health membership online, however you can also phone or email Westfund to run through your cover options before you make your final decision.

Question: Does a waiting period apply to pre-existing conditions?

  • Answer: Yes, you’ll need to serve a 12-month waiting period before you can receive any benefits related to the treatment of pre-existing conditions.

Question: Am I eligible for the private health insurance rebate?

  • Answer: Whether or not you are entitled to the Australian Government Rebate on private health insurance is determined by your income level. To find out whether you qualify you can examine the income tiers on the ATO website.

Compare health insurance policies online and find the right cover

Westfund Health offers an extensive range of benefits to its members, so consider the cover it offers when you’re looking for a private health fund. Just make sure to compare Westfund Health with other private health funds before you make the all-important decision of where to get cover.

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4 Responses to Westfund Health Insurance

  1. Default Gravatar
    snags2009@live.com | November 12, 2015

    I am paying $314 a month for my wife and I. We are both in our 80′s. Is there a lower premium that I can pay that leaves out pregnancy and similar benefits.

    • Staff
      Richard | November 12, 2015

      Hi Snags,

      Thanks for your question. finder.com.au is a comparison service and not an insurer. If you would like to speak with an advisor about the options available to you, please complete the form on the health insurance homepage and a broker will be in touch to walk you through the options available to you.

      I hope this was helpful,
      Richard

    • Default Gravatar
      Gwynneth | March 28, 2016

      What benefits do we lose if my husband I drop to gold instead of platinum cover on 1st April 2016

    • Staff
      Richard | March 29, 2016

      Hi Gwynneth,

      Thanks for your question. finder.com.au is a comparison service and not an insurer. You should contact Westfund directly about its cover and benefits.

      All the best,
      Richard

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