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Compare Westfund health insurance

How Westfund rates for member complaints, gap cover and ambulance.


Westfund summary

Westfund began its life as a nonprofit health fund for miners in 1953 and continues to focus on local communities today, particularly in regional NSW and Queensland. It has 99,000 members.

Westfund contact details

Phone: 1300 937 838



Is Westfund nonprofit?


Does Westfund get many complaints from members?

Westfund complaints rating: Low

When we score policies we give each fund a complaints rating, based on the number of complaints and serious disputes the Ombudsman deals with. We take into account the size of the fund, so big funds don't get automatically penalised for having more complaints.

  • The ratings are Low, Medium and High. A Low rating is better than a High rating – it means the fund has fewer complaints and fewer serious disputes for its size.
  • The infographic below shows the complaints about the fund to the Ombudsman as a percentage of all complaints. Complaints can be about benefits or customer service. The most serious complaints are escalated for investigation.
  • The higher the share of complaints a fund receives above its market share, the worse its performance compared to other funds. If its share of complaints is below its market share, that's a better result.

How good is Westfund's gap cover?

A medical gap is the difference between Medicare's recommended fee and what your doctor actually charges for a treatment or service.

Health funds have agreements with particular doctors and hospitals to cover all of the gap, which are called 'no gap agreements', or part of that gap, which are called 'known gap agreements' (these will have lower out-of-pocket costs, usually less than $500).

Our graphic below displays the CHOICE gap rating, which takes into account the percentage of services where members either paid no gap or a known gap, compared to the state average.

Rating scale

  • Above average
  • Average
  • Below average
  • Well below average

We also display the percentage of medical services that Westfund covers with no gap, and compare it to the industry average. The higher the percentage, the more effective the fund's gap scheme is in a state or territory.

How many hospital agreements does Westfund have in my state?

The benefit amount your fund pays you for hospital services depends not only on the type of cover you buy, but also whether your fund has an agreement with the hospital where you're treated. 

The table below shows how many hospital agreements Westfund has in your state compared to the fund with the highest number (the industry maximum). Note that public hospitals don't have agreements with specific funds and are generally treated as though they're agreement hospitals.

Does Westfund offer any discounts?

Discount for direct debit: None

Discount for annual prepay: None

Total discount for annual prepay via direct debit: None.

Does Westfund offer ambulance cover?

All Westfund extras, hospital and combined policies have emergency ambulance cover.

Cover is capped for non-emergency patient transport at $5000 per member.

Does Westfund offer family policies that cover adult children?

Yes, adult children are covered up to age 25.

Does Westfund let you claim online or in-app?

Most extras can be claimed online.

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