I've transferred to Westfund from another fund - what are my waiting periods and benefits?
Transferring between health insurers can be confusing - moving to a different fund and different policy means that there are some things to consider and be aware of.
One of the most commonly discussed topics is what moving to Westfund means in terms of waiting periods and benefits.
Portability rules protect people who want to change to another private health insurance policy with their current insurer or another insurer.
If you're transferring from another health fund, provided there’s been no break in coverage when leaving your previous fund, good news - you won't need to re-serve any waiting periods that you have already served.
Waiting periods will apply for:
- Any benefits or services under your Westfund policy which weren’t included in your previous cover.
- Waiting periods not fully served under your previous cover. If you've partially served waiting periods, you'll only need to serve the remainder of the waiting period before being able to claim; the waiting periods won't start again when you move to Westfund.
- Any benefits or services provided under your previous cover where the benefit provided by your new Westfund policy is higher. This means that if your Westfund policy has any new services, high benefits and/or higher annual limits that weren't on your previous policy, you'll need to serve any applicable waiting periods. This also applies if you decrease the excess on your hospital cover.
When transferring from another health insurer, we'll ask your previous fund to provide us with a copy of your Transfer Certificate, which outlines which waiting periods you've served and what benefits you had available/used on your previous cover
Read more about waiting periods
What if I've served part of the waiting period?
If you've partially served waiting periods, you'll only need to serve the remainder of the waiting period before being able to claim; the waiting periods won't start again when you move to Westfund.
- Example - Hospital benefits:
Jenny is new to health insurance and was a member of XYZ Fund with coverage for Pregnancy & Birth for 6 months before transferring to a Westfund policy that also includes coverage for Pregnancy & Birth. Jenny will need to wait another 6 months before being covered for Pregnancy & Birth related admissions, which have a 12-month waiting period. - Example - Extras benefits:
Ken joined private health insurance 5 months ago on a policy that included Blood Pressure Monitors. He’s decided to move to Westfund. Ken still needs to wait 7 months before he can claim a Blood Pressure Monitor, which has a 12 month waiting period.
If you've already served all hospital or extras waiting periods on your previous policy, waiting periods will only apply to any extra benefits or better conditions that are available on your new policy.
- Example - Hospital benefits:
Ben has served all relevant waiting periods for the benefits he had with XYZ Fund and has decided to move to a Westfund policy. His XYZ policy did not cover Joint Replacements, but his new policy with Westfund does. Any pre-existing Joint Replacement related admissions have a 12 month waiting period, Ben would need to wait 12 months before he would be able to claim for this service. - Example - Extras benefits:
Ian has served all waiting periods for the benefits he had with XYZ Fund and transfers from a policy that did not cover Major Dental. If Ian joins a cover with Westfund that includes Major Dental, he would need to serve the 12 month waiting period before he is eligible to claim a benefit for Major Dental.
If you change your hospital or extras policy to a policy that has lower benefits than your previous cover or excludes benefits for some treatments, the lower benefits and/or exclusions will apply immediately. Not happy with the change of cover? There is a cooling off period - providing you haven't made a claim within the 30 day cooling off period, you can change to a different level of cover from when your policy started.
. Read more.
Want to know more?
The Commonwealth Ombudsman provides comprehensive information for anyone transferring between health funds - read more here.
Common questions
If I have already claimed a benefit via my previous health fund, am I entitled to the same benefit with Westfund?
If you've transferred from another fund, any benefits that have been paid that were subject to an annual limit or other limits under your previous policy may be taken into account when determining the benefit payable under your new policy.
Example:
Jim was on XYZ Fund's top extras cover and transferred to a Westfund policy. On Jim's Transfer Certificate it shows he claimed $1000 for Major Dental. If Jim was needing to claim for any additional Major Dental services in the same calendar year, any available benefit (depending on his limit with XYZ fund) would be reduced by the $1000 he had claimed under his previous fund.
I'm switching from one Westfund policy to another. Does any of this information apply to me?
Yes - switching between Westfund policies is basically the same as switching from one fund to another, the same rules and procedures apply.