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Westfund health insurance at a glance

  • Westfund private health insurance is a proudly not-for-profit and member-owned health fund
  • Member-first philosophy with a 93% member retention rate
  • One of Australia’s longest-running health funds, with origins dating back to 1881
  • Focused on supporting the health of regional communities and local communities

About Westfund health insurance

Westfund started from humble beginnings in 1953, playing a pivotal role in forging the private health insurance industry. Since then, they have expanded across Australia to become a national health fund providing cover for over 110,000 people across the country.

Westfund believes in building a new type of healthcare focused on collective good by bringing affordable cover to regional communities and raising hundreds of thousands of dollars for local organisations through Westfund Community Grants.

What does Westfund health insurance cover?

Westfund offers a range of hospital and extras cover products for a variety of circumstances. By offering cover for singles, couples, growing families, established families and mature singles and couples, Westfund has you covered at every stage of life.

This information is current as of December 2022. For the full details of what’s covered under a Westfund health insurance policy, refer to the relevant policy documents.

Hospital cover

With Westfund hospital insurance, you’ll be covered for treatment as a private patient in hospital, provided your policy benefit covers the treatment up to the applicable limit. Depending on your level of cover, a Westfund hospital policy could also grant you access to a range of health and wellbeing programs.

Benefits to hospital insurance include avoiding public waiting times, choosing your own doctor and staying in a private room (on availability). A Westfund hospital policy gives you access to a national network of doctors and healthcare providers across metro and regional areas. You’ll also be covered for emergency ambulance services on a Westfund policy.

Extras cover

With Westfund extras insurance, you’re covered for healthcare services outside a hospital that aren’t covered by Medicare, provided they’re listed on your policy, up to the benefit limit. This includes services like dental, optical, physiotherapy and chiropractic.

Westfund health insurance offers a range of low, mid, high and top-level extras, so regardless of your circumstances, you can find a level of cover for you. If you only want cover for the basics like dental and physio, a low or mid-level policy might be enough for you. Or, if you want cover for swimming classes, gym memberships or hypnotherapy for quitting smoking, these services can be covered with top-level extras.

Why choose Westfund health insurance?

  • Westfund supports regional communities through its Community Grants and by partnering with a range of regional and metro health services.
  • Westfund members have access to the largest private hospital network in the country with agreements with 90% of hospitals and day facilities.
  • As a proudly not-for-profit health fund, 9 out of 10 members rate Westfund 10/10 in customer satisfaction.

Frequently asked questions

Is ambulance cover included with Westfund health insurance?

Yes, ambulance cover is offered on all Westfund policies. This includes unlimited emergency ambulance services and up to $5000 per member for non-emergency ambulance trips. Alternatively, you can take out an ambulance-only policy.

Depending on your state of residence, you may already be covered by your state government or be able to purchase an ambulance subscription through your state ambulance service. For the full details of how ambulance services are covered state by state, see our guide to ambulance cover.

Does Westfund health insurance cover pre-existing conditions?

Yes, Westfund will cover you for deemed pre-existing conditions, although you may need to serve a waiting period before you can receive hospital treatment for services relating to your condition. Waiting periods for pre-existing conditions are typically 12 months.

If you’ve already served a waiting period with a previous health fund, you won’t have to re-serve your waiting period when you switch to the same or lower level of cover with Westfund health insurance. Your pre-existing condition also won’t affect your waiting period for extras services.

Does Westfund health insurance have waiting periods?

For hospital cover, waiting periods are standard across all health funds. That’s 12 months for pre-existing conditions (excluding rehabilitation, palliative care and psychiatric services), pregnancy, and two months for everything else.

For extras cover services, waiting periods typically range from 2-12 months, depending on the service covered, with some select services having a 36-month wait. Longer waiting periods usually apply to more expensive services that are claimed less often. This is to prevent people from signing up, taking advantage of high-value items, and cancelling their cover, which would raise premiums for other members.

How do I make a health insurance claim with Westfund insurance?

To make an extras claim with Westfund health insurance, you can scan your membership card at your healthcare provider’s HICAPS machine. Alternatively, you can make a claim through their online service or mobile app.

If neither option is applicable, you can fill out a claim form and email it to Westfund at [email protected].

When you receive treatment as a private patient for a service covered on your policy, the hospital will send the bill to Westfund, who will then reach out to you to pay any out-of-pocket expenses or excess.

How can I pay for my Westfund health insurance, and is it cheaper to pay my premium annually?

You can pay your Westfund health insurance premiums by direct debit, online or over the phone using the automated phone system. While you won’t receive a discount for paying annually, you may still save by locking in a lower rate before the annual premium increase.

Do I have to pay an excess with Westfund health insurance?

Yes, when you claim on your Westfund hospital insurance, you will likely have to pay an excess, although you can elect to pay no excess on select policies. You will only need to pay your excess once per person per calendar year.

Most Westfund policies let you choose your excess from a range of options. When you elect to pay a lower excess, you will have to pay a higher premium. Some policies offer a zero-excess option, although this isn’t always available to new members.

How do I cancel my Westfund health insurance?

To cancel your Westfund health insurance, give them a call, and they will walk you through the cancellation process. Depending on your reason for cancelling, you may be able to temporarily suspend your cover instead. This means you won’t be covered and, therefore won’t have to pay your premiums. You won’t accrue days without cover towards the Lifetime Health Cover Loading.

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