Waiting periods refer to the amount of time you will have to wait before you can claim on your private health insurance policy.

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.

What are waiting periods?

How long do I have to wait until I can claim?

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

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

Under certain conditions, health funds may waive your waiting period (for example, if you’re in an accident). If there’s a certain feature of your health insurance policy you wish to claim on regularly, ask about the waiting periods as soon as you join.

About 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. If anyone with a pre-existing condition took out health cover and claimed immediately, it would be bad for customers. Why? Because insurers would lose a lot of money, and have to increase the cost of insurance to make up for their loss. This is why there is a 12 month waiting period for any pre-existing medical conditions you have. After that, you can claim for treatments outlined in your policy brochure – no worries.
  • Obstetrics treatment . Did you think you could take out pregnancy cover any time before the birth? You’d be wrong. Actually, you’ll need to get covered at least 12 months ahead of the birth. Sit through the waiting periods, and enjoy your own private hospital room and obstetrician!

Do I sit waiting periods again when I switch insurers?

When you switch health insurance policies, any waiting periods you’ve already completed will be waived if you’re moving to comparable (or lower) cover.

For example, if you’ve already sat through 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:

  1. If you haven’t completed your original waiting period.For example, if you’ve served 6 months for a benefit requiring a 12 month wait, you’ll need to complete the remaining 6 months before you can claim.
  2. 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.

Benefit limitation periods

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.

Benefit limitation periods do not automatically transfer if you are switching health funds, so be sure to read the product disclosure statement for specific information regarding any waiting periods for your particular policy.

Still have more questions about waiting periods? Call us on 13 32 32

So, what are you waiting for?

Call us on1800 304 709   or Compare Now