With 6 hospital cover options and 7 extras to choose from, Westfund may have a policy for you.
Once known as the Western District Mine Workers Medical Benefits Fund, Westfund is now a widely recognised not-for-profit health insurer. Westfund aims to provide value-for-money cover for its members across regional Australia, including rural Queensland and NSW.
What hospital and extras cover is available?
Westfund have a range of hospital and extras policies available that you can choose individually or mix and match with.
The recent government reforms to private health insurance mean that Westfund have a range of new hospital cover options available, particularly mid-range (silver) cover:
- Gold Hospital: This is the most comprehensive hospital cover and comes with no exclusions or restrictions, ideal for families, the elderly and those with ongoing health issues.
- Silver Plus Assure Hospital: A good level of hospital cover that saves you a little by cutting some services only Gold offers, suitable for older adults and families.
- Silver Plus Nurture Hospital: Mid-level hospital cover designed for couples who want to extend or start a family.
- Silver Hospital: Good for paying for what you need, this mid-level hospital cover is suitable for completed families and couples not planning on having children.
- Bronze Hospital: Entry-level hospital cover for those on a budget. Most suited to young singles and couples.
- Basic Hospital: Covers you as a private patient in a public hospital.
Hospital Cover Inclusions:
|Emergency ambulance transportation||All|
|Eye (Not Cataracts)||All|
|Lung and Chest||Gold, Silver Plus Assure, Silver Plus Nurture, Silver|
|Heart and Vascular System||Gold, Silver Plus Assure, Silver Plus Nurture, Silver|
|Rehabilitation||Gold, Silver Plus Assure, Silver Plus Nurture, Silver|
|Joint Replacements||Gold, Silver Plus Assure|
|Pregnancy and Birth||Gold, Silver Plus Nurture|
|Hospital Psychiatric Services||Gold|
Westfund have 2 top level extras cover options, 3 mid-level and 2 basic options to choose from.
- Ultimate Pro Extras: The highest extras cover supports those who want to improve and maintain their health and wellbeing.
- Ultimate Extras: Comprehensive extras cover suitable to those who maintain a proactive and healthy lifestyle, with generous limits on a wide range of benefits.
- Esteem Extras: Good for benefits per person on dental, physiotherapy, optical and chiropractic services, this one may be best for older couples.
- Advantage Pro Extras: For growing families, this policy provides a higher level of benefit on important services like dental, physiotherapy, optical and chiropractic.
- Advantage Extras: Mid-level cover with benefits for all the important services.
- Essential Pro Extras: Designed for young singles, couples and families looking for important services but not much else.
- Essential Extras: For anyone on a budget, this is suited to fit, young and healthy singles, couples and maybe some families.
Extras Cover Inclusions:
|Ultimate Pro Extras||100% of gap to use towards eliminating the gap on general dental and dentures, with $1250 per calendar year limit on physiotherapy for couples, $400 for optical and $1000 for complementary therapies.|
|Ultimate Extras||· 100% of gap (up to annual limit) to use towards eliminating the gap on general dental and dentures, with $1040 per calendar year limit on physiotherapy for couples, $350 for optical and $750 for complementary therapies.|
|Esteem Extras||$1600 limit per member for general dental combined with major dental as well as $600 per calendar year limit for physiotherapy, $250 for optical and $400 for complementary therapies.|
|Advantage Pro Extras||No annual limit for general dental as well as $300 per calendar year limit for physiotherapy, $250 for optical and $500 for complementary therapies.|
|Advantage Extras||No annual limit for general dental with $50 per member optical bonus.|
|Essential Pro Extras||$800 per calendar year for couples or families.|
|Essential Extras||$400 per calendar year for singles.|
Other benefits of Hospital & Extras Cover
Westfund offers member benefits for those who take out extras cover. These include:
- Sunglasses: Up to $100 per member per calendar year off sunglasses at Westfund Eye Care Centres.
- Forced Retrenchment/ Protected Industrial Action: Waiver of premiums up to 6 months due to force retrenchment or protected industrial action.
How do the costs work?
Westfund pays benefits for fees charged by your doctor, surgeon and any other specialist service depending on your coverage. Medicare pays 75% of the Commonwealth Medical Benefits Schedule (CMBS) fee and Westfund pays the rest: that is, the additional 25% up to the CMBS fee.
Their Access Gap Scheme allows patients with hospital cover to reduce out of pocket expenses for medical gap payments for in-patient hospital treatments but only if your doctor agrees to participate in the scheme. Otherwise you are responsible for our of pocket expenses. Westfund does not pay an amount charged by your
Like most providers, Westfund offer a '% back', depending on your extras coverage, with 100% of the gap covered on various mid and top level services including dental and optical. They also have various annual limits up to $1000 per calendar year for top level products.
Waiting periods and limitations
Standard waiting periods that apply to Westfund Hospital & Extras cover include:
- One day. Accident-related
- Two months. Psychiatric, rehabilitation, palliative care and all other services
- 12 months. Obstetric-related services (single membership must upgrade to family 2 months prior to expected day of birth) and treatment of pre-existing conditions
- One day. Emergency ambulance transport, accident benefit
- Two months. Non-emergency ambulance transport, general dental, optical, chiropractic, osteopathy, physiotherapy, exercise physiology, complementary therapies, prescriptions, vaccinations and injections, prevention and health management (excluding antenatal classes)
- 12 months. Specialist dental, major dental, orthodontia, dental top up, antenatal classes, non-surgically implanted prostheses, sunglasses, surgical treatment by a podiatrist
- 36 months. Forced retrenchment, protected industrial action, hearing aids
Other standard limitations that apply include maximum amounts payable per service, excesses on some services and exclusions on some services where no benefit will be paid.
How to make a claim
The majority of hospitals will send the bill directly to your health fund. If this isn't the case, you can lodge a claim on the Westfund website.
To make an extras claim, you just need to swipe your Westfund membership card at any provider that offers on-the-spot electronic claiming. If this isn't an option, you can download a claim's form off the website, fill it out and send it to the health fund via email or in person. There's also an online claims portal through the members area of the Westfund Health website.