Westfund Health Insurance Review

Overview

Westfund health insurance is a regional, Not-For-Profit health fund that was established 60 years ago for miners in the heart of regional Australia.

Westfund is member-owned, which means that returns are invested back into members in the form of higher benefits and lower premiums.

The fund has several branches across regional Queensland and NSW

Westfund Health Insurance Key Facts

Founded: 1953

For-Profit or Not-For-Profit? Not-For-Profit

Private Hospital Agreements Nationwide: 287

Day Hospital Agreements Nationwide: 271

Health Deal Represented? No

Headquarters: New South Wales

Westfund Health Insurance Hospital Cover

Westfund has a wide range of hospital covers to suit all needs and ages. These range from Basic Hospital all the way up to Gold Hospital. Here are the current hospital covers available:

  • Basic Hospital
  • Bronze Hospital
  • Silver Hospital
  • Silver Plus Assure Hospital
  • Gold Hospital

Westfund Health Insurance Extras Cover

Extras Cover takes care of the everyday healthcare service expenses that are not generally covered under Medicare such as dental services, prescription glasses, and physiotherapy. Here is a list of the current extras covers available:

  • Essential Extras
  • Esteem Extras
  • Advantage Extras
  • Advantage Pro Extras
  • Ultimate Extras

Westfund Health Insurance Waiting Periods

Westfund recognises the waiting periods you have already served with a previous health fund if you switch, this is called “portability”. For first-timers taking out a hospital cover, members who may have lapsed in hospital coverage and those upgrading their level of cover, the waiting periods below will have to be served before members can claim on services:

Westfund Health Insurance Hospital Waiting Periods

Ambulance services: 1 day

Accidental Injury: 1 day

New Conditions: 2 months

Pregnancy and birth-related services: 12 months

Pre-existing conditions: 12 months

Rehabilitation & Palliative care: 2 months

Weight Loss Surgery: 12 months

How Do You Claim with Westfund Health Insurance?

Westfund members can claim extras by following any of these 5 convenient steps:

On the spot: Swipe your membership card at a health provider that uses the HICAPS system to have your claim processed immediately.

Via a mobile app: You can lodge a claim using the Westfund Health app by submitting a photo of your receipt.

Fax: Claim by faxing a completed claim form along with your receipts to 02 6352 3408

Online: You can log into https://helper.westfund.com.au/MemberServiceCenter/Home/Login.aspx  and lodge your claim by providing the details on your receipt.

By Mail:  You can lodge your claim by posting a completed claim form along with the relevant accounts and receipts to:

PO Box 235

Lithgow NSW 2790

Westfund Health Insurance Gap Cover

Westfund Health’s gap cover is called the Access Gap Cover. If your doctor charges you more than the standard MBS fee, this is known as the ‘gap’ and can leave you with an out-of-pocket expense.  Access Gap can help to minimise or eliminate personal expense but it is the choice of the physician to participate in any given gap scheme.

 

Gap Cover Ratings by State

To determine how beneficial a gap scheme will be, we suggest comparing health funds in the same state or territory to show which of the funds offer a greater proportion of medical services covered with no gap. While it is more likely that a medical service covered under your health fund can be utilized at no personal cost to you, it is entirely the choice of the physician whether or not to participate in the gap cover scheme. 

 

Medical Services with No Gaps — The percentage of claims that were fully refunded.

Medical Services with No or Known Gaps — The percentage of claims that were fully refunded, or where the policy holder knew the cost before the surgery was performed.

Westfund medical services with No Gap: 59.4%

Industry Average: 79.1%

Westfund medical Services with No or Known Gap: 68.2%

Industry Average: 90.5%

Westfund medical services with No Gap: 92.4%

Industry Average: 89.5%

Westfund medical Services with No or Known Gap: 96.8%

Industry Average: 95.7%

Westfund medical services with No Gap: 93.0%

Industry Average: 86.7%

Westfund medical Services with No or Known Gap: 98.1%

Industry Average: 95.1%

Westfund medical services with No Gap: 89.4%

Industry Average: 89.2%              

Westfund medical Services with No or Known Gap: 96.1%

Industry Average: 94.5%

Westfund medical services with No Gap: 92.3%

Industry Average: 89.5%

Westfund medical Services with No or Known Gap: 98.3%

Industry Average: 96.6%

Westfund medical services with No Gap: 88.0%

Industry Average: 84.4%

Westfund medical Services with No or Known Gap: 96.6%

 

Industry Average: 96.2%

Westfund medical services with No Gap: 76.8%

Industry Average: 90.2%

Westfund medical Services with No or Known Gap: 84.6%

Industry Average: 96.7%

Westfund medical services with No Gap: 86.3%

Industry Average: 84.2%

Westfund medical Services with No or Known Gap: 98.0%

Industry Average: 93.8%

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