Central West

Under the provisions of the Private Health Insurance Act 2007, health insurers are prohibited from charging a premium based on a person's state of health or history of claiming. This system, called Community Rating, aims to ensure that groups with a higher level of claims are not disadvantaged.

Contracted Hospitals and Alliances

Central West Health Cover has contracts with many Australian private hospitals and registered Day Surgery Centres.

To check if your hospital is a Central West Health Cover contracted hospital, you can contact one of our Member Service Consultants by calling 133 206 or click here.

Children can be covered on a family membership up to the end of the calendar year in which they turn 18.

If they are unmarried, dependent on parents and earning less than $19,500 per annum, children can be covered on the family membership until they turn 25.

Federal Government Rebate for Private Health Insurance

The Federal Government provides a rebate on private health insurance premiums. The rebate is not means tested, so everyone can benefit from it. The level of rebate you receive depends on the age of the oldest person covered on the policy.

If the policy covers anyone 70 years of age or older then the rate is equal to 40% of the total premium you need to pay for private health insurance. If the oldest person covered on the policy is aged between 65 and 70 then the rebate applicable is 35%. For all other members under the age of 65 years the rebate is 30% of the total premium.

For example, a family policy covering a 67 and 72 year old would receive a 40% rebate as the entitlement is based on the oldest member. In this case, for every $100 in premium these members should pay, the government will contribute $40 and the member only pays $60.

General Terms and Conditions are contained in our Fund Rules.

I recently joined and have now changed my mind about my health cover.

If you decide that the health cover you've chosen isn't right for you, you can transfer to a different level of cover at any time. Keep in mind that you may have to serve additional waiting periods if you transfer up to a higher level of cover.

Alternatively, if you have taken out your cover within the last 30 days, Central West Health have a 'cooling off period' which means you can cancel your policy and receive a full refund provided that you haven't made a claim.

Lifetime Health Cover

Lifetime Health Cover is a Government initiative that recognises the length of time a person has had hospital cover with a registered Health Fund. People who take out hospital cover earlier in life and maintain their hospital cover will pay lower premiums throughout their life compared to someone who joins when they are older. Lifetime Health Cover commenced on 1 July 2000.

To lock in the lowest possible premiums for life under Lifetime Health Cover, a person needs to take out hospital cover with a registered Health Fund by 1 July following their 31st birthday. If a person does not have hospital cover by 1 July following their 31st birthday and decides to take out hospital cover later in life, they will pay a 2% loading on top of their premium for every year they are aged over 30. For example, someone who first takes out hospital cover at age 40 will pay 20% more than someone who first took out hospital cover at age 30.

For more information about Lifetime Health Cover visit the Private Health Government web site at www.privatehealth.gov.au/information/surcharges/lifetime.htm

The Medical Gap is the difference between the Medicare Benefit Schedule (MBS) fee set by the Federal Government, and the amount Medical Practitioners charge private patients when they are admitted to a hospital or day hospital facility.

Some Medical Practitioners only charge the MBS fee. In these cases, there is no Medical Gap to pay because Medicare covers 75% of the cost of treatment, and the remaining 25% is covered by Central West Health Cover (provided that the treatment is not specifically excluded from your level of cover).

However, many Medical Practitioners charge more than the MBS fee. It is the amount above the MBS fee that is known as the Medical Gap. Having Central West Health Hospital cover means that you may be able to substantially reduce this gap, and in some cases avoid having to pay the gap at all.

For full details of Central West Health Cover's Medical Gap arrangements please refer to our Membership Guide.

The Federal Government applies an additional 1% Medicare Levy to people who don't have private hospital cover and who earn more than $50,000 per annum as a single or $100,000 per annum as a couple or family.

So, no matter what your income, you won't have to pay the additional Medicare Levy for the period that you have Central West Health Hospital cover.

Pre-existing Ailments or Conditions

A 12 month waiting period applies on Central West Hospital Cover before you can claim benefits for pre-existing ailments or conditions.

A pre-existing ailment or condition is an illness or condition which in the opinion of a Medical Practitioner (appointed by Central West Health Cover) was known to exist, or where signs or symptoms were evident, during the 6 month period before you became a member or transferred to a higher level of cover.

Previous Fund Details

Central West Health Cover will provide you with immediate benefits for the same level of cover offered by your previous Health Fund provided you have already served the relevant waiting periods, and have transferred to us within 2 months of your financial date with your previous Fund.

In order for your entitlements to be transferred you must pay from the financial date of your previous Health Fund. This means that there isn't any gap between being covered by your previous Fund, and being covered by Central West Health Cover.

State of the Health Funds Report

Every year the Private Health Insurance Ombudsman publishes a State of the Health Fund report to assist consumers in assessing the comparative performance and service delivery of Australia's private health insurance providers. A copy of the report can be downloaded from www.phio.org.au.

In July each year we send a Tax Statement to everyone who has been a Central West Health Cover member during the previous financial year. This statement identifies you as being entitled to the Federal Government Rebate on Private Health Insurance.

Your Tax Statement details how much you have paid in premiums during the financial year and the value of your Rebate entitlement. It is issued in accordance with Government legislation and is sent to members regardless of whether they receive the Rebate as a reduced premium, claim it via their tax return, or directly from Medicare.

In each Tax Pack there is a reference to a Private Health Insurance Statement for the Private Health Insurance Rebate. If you receive the Rebate as a reduced premium or want to claim the Rebate via your tax return you will need to retain this statement to correctly complete your return. Alternatively you can claim the Rebate directly from Medicare � to do this you'll need to obtain a contribution receipt from us.

If you receive your Rebate as a reduced premium and you are not lodging a tax return you only need to keep your Private Health Insurance Statement for your personal records.

When you join Central West Health Cover there are waiting and benefit limitation periods that apply before you can receive benefits. These waiting periods also apply if you transfer to a higher level of cover (ie from Family Health to Comprehensive Hospital cover).

Full details of waiting periods are available in our Membership Guide.

What if I have a Concern?

Central West Health is continually looking for ways to provide you with exceptional service and quality health care. Should you have any concerns regarding your Central West Health membership, contact us directly on 133 206 so they can be resolved as quickly as possible.

Will I be covered for treatment received overseas?

We don't pay benefits for treatment that occurs outside Australia, including general treatment such as dental and glasses and any hospital or medical treatment. In this case, it might be best to consider taking out travel insurance.

Making a Complaint

If you have a complaint, please talk it over with one of our employees. Our people are well trained and have specialist knowledge in Health Insurance matters.

Central West Health has a complaints handling process where our people can, if needed, escalate your issue to a senior manager.

However, if we still can't resolve your issue, Central West Health has an Internal Dispute Resolution process. You can access the Internal Dispute Resolution process by addressing your complaint to:

Member Relations Manager
Central West Health Cover
GPO Box D158, Perth WA 6840

Central West Health would also like to advise you that the Private Health Insurance Ombudsman has been established to deal with complaints regarding health funds. We sincerely hope that you would contact us first with any concerns, but if we cannot resolve the matter, the Ombudsman can be contacted TOLL FREE on 1800 640 695, or you can write to Level 7, 362 Kent Street, Sydney NSW 2000.