Continuity of Cover
If you transfer to Westfund from another registered health fund we will guarantee continuity of cover for the benefits included in your previous cover. This applies only to the benefits you were entitled to under your previous cover, as long as they are included in your new Westfund cover.
Benefits are not payable in respect of services provided during a waiting period.
The following waiting periods apply to benefits payable for Hospital Treatment:
|Hospital Waiting Periods|
|Accident-related hospitalisation||1 day|
|Psychiatric, Rehabilitation and Palliative Care
A Member who has held a Policy with Hospital cover for at least 2 months and upgrades to a Policy which includes psychiatric treatment may elect to waive the 2 month Waiting Period that applies to psychiatric treatment upon upgrade. This waiver can only be accessed once in a Member’s lifetime.
|Pregnancy and Birth||12 Months|
|Accommodation Benefit||12 Months|
|Inpatient Travel Benefit||12 Months|
|Treatment of a pre-existing condition||12 Months|
|Chronic Disease Management Programs||12 Months|
|All other services||2 Months|
The following waiting periods apply to benefits payable for General Treatment:
|Extras Waiting Periods|
|Emergency Ambulance Transport||1 Day|
|Non-emergency Ambulance Transport, General Dental, Optical, Chiropractic, Osteopathy, Physiotherapy, Exercise Physiology, Complementary Therapies, Prescriptions/Vaccinations/Injections, Sunglasses, Prevention and Health Management (excluding antenatal classes)||2 Months|
|Major Dental, Orthodontia, Dental Top-Up, Antenatal Classes, Health Aids & Appliances, Surgical Treatment by a Podiatrist, Outpatient Travel Benefit||12 Months|
|Hearing Aids, Laser Eye Surgery||36 Months|
The following Waiting Periods apply to Benefits payable for Member Advantages:
|Forced Retrenchment Suspension||36 Months|
|Protected Industrial Action Suspension||36 Months|
The Commonwealth Ombudsman also provides general information about waiting periods.
Before you select your health plan please review the policy summary which can be found at the top of each product page. This has full details on the important Terms and Conditions, waiting periods and benefits available.
What is a pre-existing condition?
A pre-existing condition is an illness or condition for which, in the opinion of a medical practitioner appointed by Westfund, signs and symptoms existed during 6 months before the date you joined Westfund or upgraded to a higher level of cover. A 12 month waiting period applies to all new members for hospital costs relating to the treatment of pre-existing conditions.
Should you wish to claim a benefit for hospital treatment before this period ends, you will need to ask your certified medical practitioner to complete the Medical Practitioner Certificate regarding ‘Pre-Existing Ailments’ form. This certificate helps Westfund determine the level of health insurance benefits that will apply when hospitalisation is required for members who have been with Westfund for less than 12 months. Once this period is over you are entitled to the full benefits available under your policy.
Cooling off period
If you’ve just joined Westfund or changed to a different level of cover, you have a 30 day review period from the date your policy starts.
During this period, if you don’t want the cover or want to change it, you can. We’ll either refund your premium or transfer you to a different level of cover. If you choose a higher level of cover, you’ll have to pay the additional premium from the start date of your cover. Any waiting periods associated with the higher level of cover will also apply.
This review period does not apply if a claim has been paid during the 30-day cooling off period.
For more information on this cooling off period, read the Westfund Membership Terms and Conditions.