Health Insurance Waiting Periods
What are waiting periods?
A waiting period is the time you need to wait before you are allowed to make any claims through your health insurance fund. If you are new to private health insurance, you will need to serve a waiting period when you sign up to a new health fund. If you already have health insurance, you won’t need to re-serve waiting periods when transferring to the same, or lower level, of cover. You’ll only need to serve waiting periods for any new or increased levels of cover.
Why do private health funds have waiting periods?
Waiting periods are applied to protect you and your health fund. They discourage customers from joining funds, making large claims, and then cancelling their membership as soon as they no longer need those services . These actions could lead to increased premiums and/or a loss of benefits for other members.
Hospital cover waiting periods
The Australian Government has set the following (maximum) waiting periods  for hospital services:
- 12 months for pre-existing questions
- 12 months for obstetrics (pregnancy)
- Two months for psychiatric care, rehabilitation or palliative care (even for a pre-existing condition)
- Two months for hospital admissions
Extras cover waiting periods
Waiting periods for extras cover (ancillary and general services) are generally set by individual health funds. Always check specific waiting periods with your individual health fund. Some funds and products may waive waiting periods on selected extras services from time to time. Call an expert to find out more on 13 19 20.
Private health insurance is ‘community rated’
Health funds are not allowed to refuse to insure customers or refuse to sell any policies on the basis of a customer’s health status, any conditions they might experience, or the likelihood that they will lodge a claim. This means that everyone is entitled to purchase the same product, at the same price. The only exception would be to those customers paying additional fees due to Lifetime Health Cover. If you have a LHC loading, you will have to pay a higher premium.
Community rating also ensures customers will always be guaranteed the right to renew their policy.
What is continuity and how do I apply?
Continuity is when you are offered ‘continued cover’ when transferring to another health fund. If you are transferring to a new health insurance fund, any hospital waiting periods that you have already served will transfer with you.
By law, your new health fund must provide continuous hospital cover without making you re-serve any waiting periods. iSelect can facilitate the transfer on your behalf with your new health fund. For more information on continued cover visit PrivateHealth.org.au.
What do health funds classify as pre-existing conditions?
According to PrivateHealth.gov.au, a pre-existing condition is “defined by law as any ailment, illness, or condition that you had signs or symptoms of during the six months before you joined a hospital table or upgraded to a higher hospital table. It is not necessary that you or your doctor knew what your condition was or that the condition had been diagnosed. A condition can still be classed as pre-existing even if you hadn’t seen your doctor about it before joining the hospital table or upgrading to a higher hospital table.”
Will I be covered for pre-existing conditions?
Health insurance funds will not pay benefits for any services related to pre-existing conditions or ailments during the first 12 months of your policy membership. If your illness or ailment is determined to be a pre-existing condition, you will be required to serve the full 12-month waiting period before you can claim. After you have served this waiting period, your health fund will cover any treatments relating to pre-existing medical conditions.
Pre-existing conditions will only be investigated by a Medical Arbiter in the first 12 months of your policy, when you change health funds or take out or upgrade your level of cover.
What happens to my waiting periods if I go overseas?
If you are planning an overseas trip, contact your health fund because you might be eligible to suspend your cover. While your cover is suspended, you will remain a member of your health fund but you won’t pay premiums for the duration of time you spend overseas. This means your waiting periods will be preserved and the time you have already served will not be affected.
When you return from overseas, your health fund will require proof of your re-entry into Australia, so you’ll need to provide a copy of your passport or boarding pass. Each fund has different rules relating to suspension of cover so please contact your fund for more information.
If you are in the middle of serving waiting periods at the time you suspend your health insurance cover, you will be required to continue serving the remainder of your waiting periods when you return.
Please note: You cannot claim any health insurance benefits while your cover is suspended.
For further information on how waiting periods and overseas travel will impact you, call our experts on 1300 905 472.
When choosing a health insurance policy, be sure to investigate all relevant waiting periods to determine how they will affect you.
Call our experts on 13 19 20 to discuss your individual health insurance needs.
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