Westfund

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About Westfund

What is Westfund?

Westfund Health Insurance (Westfund) is a private health insurer that operates as an open health fund. 

Background

Established in 1953, Westfund began as the Western District Mineworkers Medical Benefits Fund. It was set up to help miners based in central western New South Wales with hospital and medical expenses. In the 1990s, the fund expanded into regional Queensland. 

In 2021, it re-branded as Westfund Health Insurance.

Today, Westfund has over 110,000 members mainly located in regional New South Wales and Queensland.

Who can join Westfund?

Anyone can join Westfund as it is an open health fund.

What products does Westfund offer?

Westfund offers:

• Hospital Cover
• Extras Cover
• Ambulance Only Cover
• Overseas Visitors Health Cover (OVHC).

Do Westfund policies include Ambulance Cover?

Westfund includes emergency Ambulance Cover with:

• Hospital Cover
• Extras Cover.

This also includes non-emergency transport but your policy may place a cap on this service. Check your policy for details.

Does Westfund Health offer corporate policies?

Yes. Westfund Health provides corporate policies to certain organisations. Search your organisation’s website or intranet to find out whether a corporate health insurance policy is available to you, and what conditions apply.

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Is Westfund Health a not-for-profit health insurer?

Yes. Westfund is a not-for-profit health insurer.

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Does Westfund Health operate in all Australian states and territories?

Yes. Westfund operates in all Australian states and territories.

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How does Westfund Health Hospital Cover compare with other insurers?

Benchmarks	Westfund	Industry average
Member retention for Hospital Cover	87.1%	86.9%
% hospital-related charges covered	90.7%	89.9%

Source: Private Health Insurance Ombudsman: State of the Health Funds Report: 2023

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Does Westfund Health have agreements with some private hospitals or day hospitals to provide services at low cost or with no out-of-pocket costs?

Yes. Westfund has agreements with a number of private hospitals that allow it to provide services to its members at low cost or with no out-of-pocket costs:

Location	Number of private Agreement Hospitals	Industry maximum
ACT	5	6
NSW	96	98
NT	2	2
QLD	52	60
SA	20	23
TAS	8	9
VIC	73	76
WA	21	24

Westfund also has agreements with a number of day hospitals to allow it to provide services at low cost or no out-of-pocket costs:

Location	Number of day Agreement Hospitals	Industry maximum
ACT	8	9
NSW	86	103
NT	1	2
QLD	49	57
SA	24	30
TAS	4	8
VIC	69	79
WA	20	24

Source: Westfund Health: performance

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How does Westfund Extras Cover compare with other insurers?

Benchmark	Westfund	Industry average
% Extras Cover charges covered	44.9%	51.1%

Source: Private Health Insurance Ombudsman: State of the Health Funds Report: 2023

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How does Westfund Health compare with other private health insurers?

Benchmarks	Westfund	Industry average
Market share	0.9%	–
% services with no gap	90.3%	88.3%
% services with no gap or where known gap payment made	97.8%	97.2%
Market share of complaints to the PHIO	0.5%	3.1%
% complaints investigated by the PHIO	0.5%	3.1%
Benefits as a % of contributions	83.3%	80.5%
Management expenses as a % of contribution income	12.8%	13.1%
Management expenses per average policy	$548	$592

Source: Private Health Insurance Ombudsman: State of the Health Funds Report: 2023

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Is Westfund a member of any industry organisations?

Yes. Westfund is a member of Private Healthcare Australia (PHA), a body that represents 20 registered health insurers and 97% of people covered by private health insurance.

It is also a member of the Members Health Fund Alliance, an alliance of not-for-profit, member-owned, regional or community-based health insurers.

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Does Westfund let me claim online or via an app?

Yes. Westfund Health allows you to make a claim online via the Members Online portal or using the Westfund app.

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How to contact Westfund

Phone:

1300 937 838

Website:

https://www.westfund.com.au/

Email:

enquiries@westfund.com.au

Address:

59 Read Avenue
LITHGOW NSW 2790

Postal address:

PO Box 235
LITHGOW NSW 2790

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