Health Insurance Waiting Periods

Waiting periods may vary from one health fund to another.

The information provided below is specific to iSelect’s participating health funds.

It also generally applies to all Australian Private Health Insurance Funds and policies, although some funds may set specific conditions.

The following waiting periods generally apply for:

  1. New memberships, and
  2. When upgrading your policy to cover to items not previously covered.

Need Help understanding waiting periods? Call us on 1300 905 472 for expert advice.

Why do private health funds impose waiting periods?

Waiting periods protect you and your chosen health fund from consumers joining for financial gain, as this can lead to increased premiums and/or loss of benefits.

What will happen to my waiting periods if I upgrade my cover?

If you decide to upgrade your private health cover, you may be required to serve waiting periods for any increase in your limits, as well as any new services that you were not covered for previously.

What do health funds classify as pre-existing conditions?

Pre-existing conditions are defined by a medical practitioner as, ‘any illness or ailment that existed at any time during the 6 months prior to joining your chosen health fund or upgrading your cover’.

The fund will not pay a claim on a pre existing condition/ailment for the first 12 months of the policy.

You may know about this condition, you may not.

Will I be covered for pre-existing conditions?

Yes, if you are suffering from a pre-existing condition prior to taking out health cover, you will be covered for this condition. You will however, will be subject to a 12 month waiting period before your health fund will cover any treatment of this type.

Health funds are not allowed to refuse you membership due to any condition you may suffer from prior to joining.

If you are transferring to a new fund any waiting periods that you have already served will transfer with you, so coverage for pre existing conditions/ailments only apply to the first 12 months of your health insurance policy unless you are upgrading your cover to include treatment that was not previously covered on your policy.

What is ‘community rating’?

Private health insurance is ‘community-rated’. This means that everyone is entitled to buy the same product, at the same price, and is guaranteed the right to renew their policy.

A health insurer cannot refuse to insure you, or refuse to sell you any policy you want to buy. (Lifetime Health Cover is an exception to community rating – you will have to pay a higher premium if you have a LHC loading)

Private health insurance is different from life, trauma and disability insurance. These insurances are ‘risk-rated’ rather than ‘community-rated’ and generally offer lump-sum payments in the event of specific illness or loss. They are not a substitute for private health insurance.

What is continuity, and how do I apply?

Continuity is when you are offered continued cover if you transfer to another health fund. Your new health fund must provide continuous cover and not make you re serve any waiting period you have already served.

You are required to provide your new fund with a “clearance certificate ” this is issued by your previous fund and provides the new fund proof of the waiting have already served.

What happens to my waiting periods if I go overseas?

If you are planning an overseas trip (be it for work or a extended holiday) contact your health fund immediately as you may be eligible for a suspension of cover.

When suspending your cover you will remain a member of your health fund but not pay your premiums for the time you are overseas.Your waiting periods will be preserved.

When you return, you will need provide proof of your re entry into Australia, a copy of your passport or boarding pass is required by the fund. To be eligible to suspend your cover you must be paid 30 days in advance of your departure date.

If you were still serving your waiting periods at the time of suspension, you will have to continue serving the remainder of this
waiting period when you return.

You can not claim benefits whilst you cover is suspended.

The above mentioned is a guide only and should be view as such.
For further clarification on waiting periods, consult the specific policy brochure or contact iSelect.

Searching for a waiting period not listed above? Call us on 1300 905 472 for expert advice.