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Waiting periods refer to the amount of time you will have to wait before you can claim on your private health insurance policy. New policyholders are required to serve these waiting periods when they first join a health fund.

Why do health insurers have waiting periods?

It’s simple: without waiting periods, people could sign up for cover and immediately claim on something expensive (like dental surgery), and then cancel their policy before paying anything substantial. This would effectively allow anyone to access greatly discounted private treatment, which would mean insurers would need to increase premiums to compensate for their losses. Regular Aussies would then have to shoulder these increased costs.

Hospital waiting times: How long do you have to wait before claiming?

Waiting periods vary between health funds, but the Federal Government sets maximum limits for specific hospital benefits. None of them – from pregnancy services to rehabilitation – last longer than a year, and some are as little as two months.

Extras waiting periods

As for extras cover (sometimes called general treatment), the waiting periods are set entirely by the health funds, and will therefore differ from insurer to insurer. The Private Health Insurance Ombudsman does outline some typical waiting periods for general treatment, which we have listed alongside hospital waiting periods below.

2 months 6 months 12 months 1,2 or 3 years
Psychiatric care, rehabilitation, palliative care (H) Optometry, e.g. Glasses (E) Pre-existing conditions (H) Orthodontics, and other high cost procedures (E)
 General dental (E) Pregnancy & birth-related services e.g. IVF, labor ward fees, private obstetricians (H)
Physiotherapy (E) Major dental procedures, like crowns (E)

(H) – Hospital Cover
(E) – Extras Cover

Source: PHIO

Health insurance with no waiting periods

Under certain conditions, health funds may have shorter or no waiting periods for cover for accidents. But other than that, they won’t generally waive the waiting periods for hospital cover. If there’s a certain feature of your health insurance policy you wish to claim on regularly, ask about the waiting periods before you join, or compare health insurance policies to review waiting periods tailored to your needs.

Extras cover with no waiting periods

Insurers typically hold promotions where they waive extras cover waiting periods on combined hospital policies to encourage new customers to join private health insurance.

Despite this, it is uncommon for insurers to waive 12 month waiting periods. For example, you may not need to serve waiting periods for general or preventative services like routine dental check-ups, but you will need to wait before you can claim on major dental treatment, like root canals.

Frequently asked questions about waiting periods

How do waiting periods affect pre-existing conditions and obstetrics?

There are two things people tend to ask about when we talk about waiting periods: pre-existing conditions and pregnancy. Here’s the full scoop.

  • Pre-existing conditions: There is a 12 month waiting period for hospital cover in relation to any pre-existing medical conditions you have (with the exception of psychiatric care and rehabilitation or palliative care for a pre-existing condition – claiming on these services generally only require a two-month wait).After that, you can claim for treatments outlined in your policy brochure – no worries. Pre-existing conditions are not taken into account when claiming on your extras cover.
  • Obstetrics treatment. Can you take out pregnancy cover at any time before childbirth and be covered for the delivery of your baby? No. In fact, the mother-to-be needs to get insured at least 12 months prior to the birth of the child. So, if you deliver your baby early and your waiting period isn’t over yet, be aware that the fund will not pay a benefit. By sitting through the waiting period, you can enjoy your own private hospital room and obstetrician.In addition to this, you may need to alert your health fund several months in advance that you intend to cover your newborn child on your insurance policy – otherwise they may not be covered from day one.
Do I serve waiting periods again when I switch insurers?

When you switch health insurance policies, your health fund will waive any waiting periods you’ve already completed if you move to comparable (or lower) cover.

For example, if you’ve already served the waiting periods for basic optometry benefits, you won’t have to do so again with your new health insurance policy. The only waiting periods you may be required to serve are:

  • If you haven’t completed your original waiting period. For example, if you’ve served six months for a benefit requiring a 12 month wait, you’ll need to complete the remaining six months before you can claim on an equal level of cover for what you were covered for on your previous policy.
  • For new or higher benefits. For example, if your new policy includes a feature you weren’t previously covered for (e.g. orthodontics), you’ll still need to complete the waiting period before claiming those benefits. However in the meantime, you can still claim for any benefits you were covered for on your previous policy (provided they are also included on your new policy) while you are serving the waiting period for those new or higher benefits.
I’m heading overseas; how does this affect my waiting periods?

If you’re heading overseas for a period of time, you can choose to contact your health fund, and if you’re eligible, you may be able to suspend your cover. This means you’ll still be a member of your health fund, but won’t be required to pay premiums during your time overseas. Your waiting periods will be halted until you return back to Australia, where you’ll continue to serve them.

You won’t be able to make any claims if your cover is still suspended, so be sure to call your health fund as soon as you return home. You might need to provide proof your return to Australia, depending on your fund. Be sure to check with any of your health fund’s requirements before you leave for your trip.

What are Benefit Limitation Periods?

Benefit Limitation Periods are additional waiting periods that can be set by health insurers (and chosen by you). These periods often range from one to three years, where only minimal benefits are paid on treatment claims.

For example, a two year Benefit Limitation Period for a feature like a hip replacement means you’ll need to wait two extra years after the completion of the initial waiting period before you can claim on that feature in a private hospital. While you are waiting, those two additional years you will only be covered as a private patient in a public hospital, so if you did need to use your cover in private hospital during that time, large out of pockets would apply.

Still have more questions about waiting periods and how they could affect your access to services? Talk to our health insurance experts, because we’re happy to run through how long you’ll wait for treatment, and find you the right policy.

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