Certain Hospital and Extras benefits have changed from 1 January 2024. You can learn more about the Benefit Changes and how they may apply to you here.

We’re proud to support over 135,000 members on their health journey. We're privileged that you have chosen Westfund to look after your health - thank you. As your health fund, we’re focused on providing quality health cover and genuine care to our members every day.

To keep our commitment to you, we review benefits annually to ensure we continue to provide a range of support and services to help protect our members' health and wellbeing.

Changes to Extras cover

We’re committed to helping members access more from their membership and to proactively take care of their health and wellbeing. That’s why we’ve made a number of improvements to your cover. These changes were implemented from 1 January 2024. We’ve outlined these changes below in detail. 

The best way to view your updated benefits is by checking your Policy Summary, available on the Westfund App or via Members Online.

We’ve increased the existing Outpatient Travel benefit

Your cover prior to 1 January 


You had an annual group limit for your Outpatient Travel benefit for outpatient medical specialist services. Benefits were paid on a grouped kilometre basis for round trips over 150 kilometres from your home to the location of the consultation.

  • Gold, Gold 500, Overseas Top Hospital with Extras, Gold Classic 500, Gold Classic and High Extras - $140 per policy, per calendar year
  • Overseas Top Plus Hospital with Extras, Ultimate Pro Extras and Ultimate Extras - $210 per policy, per calendar year

Your cover from 1 January

Your benefit for outpatient travel has increased. Benefits will still be paid on a grouped kilometre basis for round trips over 150 kilometres from your home to the location of the consultation.

 

  • Gold, Gold 500, Overseas Top Hospital with Extras, Gold Classic 500, Gold Classic and High Extras - $210 per policy, per calendar year
  • Overseas Top Plus Hospital with Extras, Ultimate Pro Extras and Ultimate Extras - $315 per policy, per calendar year

What this means for you 

Increasing our Outpatient Travel benefit will help support members’ accessing specialist healthcare services. There’s no change to your existing item benefits.

This change applies to Ultimate Pro Extras, Ultimate Extras, Overseas Top Plus Hospital with Extras, High Extras, Gold, Gold 500, Gold Classic, Gold Classic 500 and Overseas Top Hospital with Extras.

We’ve added Mental Health Programs to your Health Management benefit

Your cover prior to 1 January

There was no benefit available for Mental Health Programs.

 

Your cover from 1 January

You can now claim for Mental Health Programs, whether they are online or in-person, as long as the program is not Medicare claimable. You will need a Health Management Declaration Claim Form to accompany your claim.

What this means for you

Mental health programs play a crucial role in supporting overall wellbeing. That’s why we’ve improved your existing benefit to include online or face-to-face Mental Health Programs. You can make a claim as long as you’re referred by a Medicare Registered Practitioner this includes your GP, psychologist or mental health nurse. You can find a copy of the Health Management Declaration Claim form on our website. There’s no change to your existing limits.

Download form

This change applies to Ultimate Pro Extras, Ultimate Extras, High Extras, Mid Extras, Essential Pro Extras, Starter Extras, High Extras Over 50s, Choice Extras, Gold, Gold 500, Gold Classic, Gold Classic 500, Overseas Top Plus Hospital with Extras, Overseas Top Hospital with Extras, Athlete Protect Extras, Athlete Shield Extras, Athlete Defend Extras, Athlete Vital Extras and Athlete Core Extras.

You can now claim Counselling services offered by a Medicare accredited Mental Health Nurse

Your cover prior to 1 January

No benefit was payable when a Mental Health Nurse provided services for Counselling.

Your cover from 1 January 

Counselling services provided by Medicare accredited Mental Health Nurses are now claimable.

What this means for you

To improve access to personalised treatment for mental health conditions for our members, we’ve expanded our existing benefit for Clinical Psychology & Counselling to incorporate Counselling services offered by a Mental Health Nurse. Accredited Mental Health Nurses have a breadth of experience in treating mental health conditions and offer additional options for members looking for personalised mental health support. There’s no change to your existing item benefits or annual group limits.

 

This change applies to Ultimate Pro Extras, Ultimate Extras, High Extras, Choice Extras, Gold, Gold 500, Gold Classic, Gold Classic 500, Overseas Top Plus Hospital with Extras, Overseas Top Hospital with Extras, Athlete Protect Extras, Athlete Shield Extras, Athlete Defend Extras, Athlete Vital Extras and Athlete Core Extras.

We’ve added Psychometric/Learning Assessments to your Clinical Psychology benefit

Your cover prior to 1 January 

There was no benefit for Psychometric/Learning Assessments.

Your cover from 1 January

You can now claim for Psychometric/Learning Assessments when completed by a clinical psychologist, up to your applicable annual group limit.

  • Mid Extras and Essential Pro Extras - $100 
  • Overseas Top Plus Hospital with Extras, Overseas Top Hospital with Extras, High Extras, High Extras Over 50s, Ultimate Extras, Gold 500, Gold, Gold Classic 500, Gold Classic - $200
  • Ultimate Pro Extras - $250

What this means for you 

You can now claim on a wider range of services completed by a psychologist. These assessments can play an important role in early detection and early intervention, opening up a wider range of treatment options. There’s no change to your existing annual group limit. 

This change applies to Ultimate Pro Extras, Ultimate Extras, High Extras, High Extras Over 50s, Gold, Gold 500, Gold Classic, Gold Classic 500, Overseas Top Plus Hospital with Extras, Overseas Top Hospital with Extras, Mid Extras and Essential Pro Extras.

You can now claim on a wider range of Eye Health Checks

Your cover prior to 1 January

Eye Health Check benefits were only available for retinal photography, optical coherence tomography and corneal topography.

Your cover from 1 January 

We’ve increased our range of claimable Eye Health Tests under the Ear and Eye Health Checks benefit. In addition to tests that we have previously accepted, here are some examples of new tests you can now claim on:

  • Visual Field Test
  • GDx Scan
  • Dilation Test



 

 

What this means for you

Prevention and early detection improves health outcomes. That’s why we’re providing our members with greater access to preventive eye health services. The Eye Health Test will still need to be completed by a recognised provider and cannot be claimable from Medicare. There’s no change to your existing limits or benefit amounts.

This change applies to Ultimate Pro Extras, Ultimate Extras, High Extras, Mid Extras, Essential Pro Extras, Starter Extras, High Extras Over 50s, Choice Extras, Gold, Gold 500, Gold Classic, Gold Classic 500, Overseas Top Plus Hospital with Extras, Overseas Top Hospital with Extras, Athlete Protect Extras, Athlete Shield Extras, Athlete Defend Extras, Athlete Vital Extras and Athlete Core Extras.

We’ve amended the limitation on a comprehensive oral examination

Your cover prior to 1 January 

A dental comprehensive oral examination was claimable once per member, per calendar year.

Your cover from 1 January

A dental comprehensive oral examination is now claimable once per member, per provider, per calendar year.



What this means for you

If you’ve already had a dental comprehensive oral examination (item number 011) within the calendar year, you are now able to claim again if you visit a different provider. This means that you can now claim a benefit for additional dental services, as long as you haven’t reached your annual limit. There’s no change to your dental limits or benefit amounts.

 

This change applies to Ultimate Pro Extras, Ultimate Extras, High Extras, Mid Extras, Essential Pro Extras, Starter Extras, High Extras Over 50s, Choice Extras, Gold, Gold 500, Gold Classic, Gold Classic 500, Overseas Top Plus Hospital with Extras, Overseas Top Hospital with Extras, Athlete Protect Extras, Athlete Shield Extras, Athlete Defend Extras, Athlete Guard Extras, Athlete Vital Extras and Athlete Core Extras.

We’ve removed the requirement of an orthodontic treatment plan

Your cover prior to 1 January 

An orthodontic treatment plan was required to be supplied prior to commencing a complete course of orthodontics.

 

Your cover from 1 January

You no longer need to provide us with your orthodontic treatment plan. Under your Orthodontic benefit, we will continue to pay benefits as per the existing terms and conditions. If the benefit amount is still accruing when you start your treatment, you may be asked to provide additional documentation for confirmation.

 

 

What this means for you  

Orthodontic treatments can be stressful enough without having to navigate through complicated processes. That’s why we’ve simplified the claiming process for members.

 

This change applies to Ultimate Pro Extras, Ultimate Extras, High Extras, Mid Extras, Gold, Gold 500, Overseas Top Plus Hospital with Extras, Overseas Top Hospital with Extras, Athlete Protect Extras, Athlete Shield Extras, Athlete Defend Extras, Athlete Guard Extras, Athlete Vital Extras and Athlete Core Extras.

We’ve increased your Annual Group Limit for Speech Therapy and Occupational Therapy 

Your cover prior to 1 January

You received a benefit per subsequent service for Speech Therapy, up to your applicable annual group limit.

  • Gold, Gold 500, Gold Classic, Gold Classic 500, High Extras, Overseas Top Hospital with Extras - $36
  • Ultimate Extras, Overseas Top Plus Hospital with Extras- $42 
  • Ultimate Pro Extras - $50

Your cover from 1 January

Your benefit has increased per subsequent service for Speech Therapy, up to your applicable annual group limit. There is no change to the item benefit for initial or group services.

  • Gold, Gold 500, Gold Classic, Gold Classic 500, High Extras, Overseas Top Hospital with Extras- $48
  • Ultimate Extras, Overseas Top Plus Hospital with Extras - $60
  • Ultimate Pro Extras - $80

What this means for you

You now get more back per service for your Speech Therapy consultations helping to reduce your out-of-pocket costs. There’s no change to your existing annual group limit.

This change applies to Ultimate Pro Extras, Ultimate Extras, Overseas Top Plus Hospital with Extras, High Extras, Gold, Gold 500, Gold Classic, Gold Classic 500 and Overseas Top Hospital with Extras.

We’ve made claiming pharmaceuticals easier

Your cover prior to 1 January 

Contraceptives, anabolic steroids or cosmetic injections required a letter from the prescribing medical practitioner detailing that the item is treating a specific health condition. 

Your cover from 1 January 

We now accept a letter from a medical practitioner for contraceptives, anabolic steroids or cosmetic injections. The letter will still need to detail that the pharmaceutical is treating a specific health condition.

What this means for you 

We understand that it’s not always possible to see the same doctor every time you need a repeat prescription. That’s why we’ve simplified the process. We now accept a letter detailing the pharmaceutical is treating a specific health condition from any medical practitioner. 

It's important to note that you only need to provide this letter once for the same pharmaceutical.

 

This change applies to Ultimate Pro Extras, Ultimate Extras, High Extras, Mid Extras, Essential Pro Extras, High Extras Over 50s, Gold, Gold 500, Gold Classic, Gold Classic 500, Overseas Top Plus Hospital with Extras and Overseas Top Hospital with Extras, Athlete Protect Extras, Athlete Shield Extras, Athlete Defend Extras, Athlete Guard Extras, Athlete Vital Extras and Athlete Core Extras.

We’ve expanded your current Compression Garment benefit to now cover compression devices

Your cover prior to 1 January 

No benefits were available for compression devices.

Your cover from 1 January

Compression devices are now claimable under your Compression Garments benefit, up to your existing annual group limit.

What this means for you 

Compression devices can help with managing health issues and improving quality of life. That’s why we’ve added compression devices to your cover. There’s no change to your existing annual group limit.

 

This change applies to Ultimate Pro Extras, Ultimate Extras, High Extras, Mid Extras, Essential Pro Extras, High Extras Over 50s, Gold, Gold 500, Gold Classic, Gold Classic 500, Overseas Top Plus Hospital with Extras and Overseas Top Hospital with Extras, Athlete Protect Extras, Athlete Shield Extras, Athlete Defend Extras, Athlete Guard Extras, Athlete Vital Extras and Athlete Core Extras.

We’ve added Chronic Disease Health Screens to your cover

Your cover prior to 1 January 

There was no benefit available for Chronic Disease Health Screens under your Preventative Health Tests benefit.

Your cover from 1 January 

You can now claim on a Chronic Disease Health Screen completed by a medical practitioner or pharmacist that is not Medicare claimable. This is available under your existing Preventative Health Tests benefit. No benefits are payable if a Chronic Disease Health Screen is primarily for employment-related medical evaluations.



 

What this means for you 

You will now receive a benefit for a Chronic Disease Health Screen. These screens can help detect potential health issues before they become a problem. Early detection often means a better prognosis and may give you more treatment options. There’s no change to your existing annual group limit.

 

This change applies to Ultimate Pro Extras, Ultimate Extras, High Extras, Mid Extras, Essential Pro Extras, Starter Extras, High Extras Over 50s, Choice Extras, Gold, Gold 500, Gold Classic, Gold Classic 500, Overseas Top Plus Hospital with Extras, Overseas Top Hospital with Extras, Athlete Protect Extras, Athlete Shield Extras, Athlete Defend Extras, Athlete Vital Extras and Athlete Core Extras.

We’ve increased your benefit for Antenatal and Pre/Postnatal services

Your cover prior to 1 January 

You could claim up to $120 per policy, per calendar year for Antenatal and Pre/Postnatal services.

Your cover from 1 January 

We’ve increased your benefit to $200 per policy, per calendar year.

What this means for you

Antenatal and postnatal services play an important role in supporting the health and wellbeing of mothers and their newborns. This increase means families can get more value for both face-to-face and online services

This change applies to Ultimate Pro Extras, Ultimate Extras, High Extras, Gold, Gold 500, Overseas Top Plus Hospital with Extras and Overseas Top Hospital with Extras.

You can now claim Myasthenia Gravis Association fees

Your cover prior to 1 January

No benefit was payable for Myasthenia Gravis Association fees under your Chronic Disease Association Fees.

Your cover from 1 January

You can now claim a benefit for Myasthenia Gravis Association fees (includes state-based subsidiaries) under your Chronic Disease Association Fees benefit.

What this means for you

This improvement is part of our ongoing commitment to enhance the wellbeing of our members across a broad range of conditions. There’s no change to your existing annual group limit.

This change applies to Ultimate Pro Extras, Ultimate Extras, High Extras, Mid Extras, High Extras Over 50s, Choice Extras, Gold, Gold 500, Gold Classic, Gold Classic 500, Overseas Top Plus Hospital with Extras, Overseas Top Hospital with Extras, Athlete Protect Extras, Athlete Shield Extras, Athlete Defend Extras, Athlete Vital Extras and Athlete Core Extras.

You can now use electronic claiming for Counselling services provided by a social worker

Your cover prior to 1 January

Claims for Counselling services provided by a social worker needed to be submitted via the Westfund App, Members Online or in person at a Care Centre.

Your cover from 1 January

You’re now able to claim your benefit using your physical or digital membership card whilst seeing an eligible provider.

What this means for you 

Your benefit can now be paid while you’re at the provider, meaning an easier and more convenient claiming experience. You can still submit your claim via the Westfund App, Members Online or in person at a Care Centre if your provider doesn’t offer electronic claiming.

 

This change applies to Ultimate Pro Extras, Ultimate Extras, High Extras, Choice Extras, Gold, Gold 500, Gold Classic, Gold Classic 500, Overseas Top Plus Hospital with Extras, Overseas Top Hospital with Extras, Athlete Protect Extras, Athlete Shield Extras, Athlete Defend Extras, Athlete Vital Extras and Athlete Core Extras.

We’ve clarified our requirements for the Health Management Declaration Claim Form for Health Aids and Appliances and Health Management Programs

We’ve listened to your feedback and have clarified our Health Management Declaration terms for members.

A Health Management Declaration Claim Form is required by a Medicare Registered Practitioner to claim benefits for some health aids and appliances as well as health management programs. A form is required every calendar year, as opposed to every 12 months. This means from 1 January each year, you will need a new Health Management Declaration Claim Form. Download form.

This change applies to Ultimate Pro Extras, Ultimate Extras, High Extras, Mid Extras, Essential Pro Extras, High Extras Over 50s, Starter Extras, Choice Extras, Gold, Gold 500, Gold Classic, Gold Classic 500, Overseas Top Plus Hospital with Extras, Overseas Top Hospital with Extras, Athlete Guard Extras, Athlete Protect Extras, Athlete Shield Extras, Athlete Defend Extras, Athlete Vital Extras and Athlete Core Extras.

Changes to Hospital cover

We want doctors to keep using Access Gap Cover, so we need to ensure the benefits are reasonable. So we've made updates to our benefits, to better align with the current industry standards and ensure you continue to receive quality service without increasing the cost of premiums.

Part of our review was looking at where we could potentially decrease out-of-pocket costs on as many services as possible. We want you to remain confident in your coverage and fully aware of any out-of-pocket expenses, ensuring they remain manageable.

How will these changes affect me?

  • Some benefits have increased, which may mean lower gaps to you or even no gap.
  • You may experience some gaps due to the reduction of some other benefits – but only where it is reasonable to do so.
  • We only decreased benefits that we felt were too high in the current market and that hopefully would not have a negative impact on gaps.

Common questions

I am booked in to have my second knee replacement in August 2024. Will my out-of-pocket gap be different this time?

Please get in touch with us so we can check your quote.

I already have a quote from my doctor for my procedure which is booked for August 2024. Do I need to get a new quote?

Please get in touch with us and we will let you know if the benefit has changed. You may need to re-check with your doctor and request an updated quote.

Can I continue to see my current specialist or attend my current (or intended) hospital?

Yes. However, you should always check with your specialist and ask the following questions:

  • Will you use Access Gap Cover for my claim?
  • Will I need to pay any out-of-pocket expenses for my treatment? If so, can you give me a written estimate of how much I’ll need to pay?
  • Will any of the doctors assisting with my treatment also participate in Access Gap Cover?
  • Will you send the bill to my fund directly so that they can claim my Medicare benefit and pay the claim on my behalf?

We're here to help.

We want to ensure that you are aware of how these changes apply to you and of any medical gaps that you might receive.

If you have more questions, please get in touch with us on 1300 937 838 or email [email protected]