Health Insurance Waiting Periods

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Updated 09/05/2023
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What are health insurance waiting periods; maximum waiting periods; updated sources
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Written by

Francis Taylor

Updated 09/05/2023

What changed?

What are health insurance waiting periods; maximum waiting periods; updated sources
Our aim is to help you make better informed decisions. That’s why iSelect’s content is produced in accordance with our fact-checking and editorial guidelines.

Edited by

Laura Crowden

Find out more about how we make money.

View our Privacy Policy.

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I need cover for…

What are health insurance waiting periods?
Can I get health insurance with no waiting periods?
What are the waiting periods for pre-existing conditions?
Do I always have to serve waiting periods?
What if I go to the hospital before my waiting period is up?
What happens if I suspend my policy?
How can I find a fund with the shortest waiting periods?

What are health insurance waiting periods?

Put simply, a waiting period is how long you need to wait before you can claim for certain conditions on your policy.1Commonwealth Ombudsman | Private Health Insurance Ombudsman – Waiting periods for private health insurancep2

Waiting periods start ticking down the moment you take out a policy. Different conditions and treatments typically have different waiting periods. For example, some might apply for two months, others some might apply for twelve months and so on. 

For example, let’s say you take out hospital cover and the policy places a two month waiting period on dental surgery. That means your policy won’t cover the costs of dental surgery for the first two months you hold it. Additionally, you might have to wait even longer for other treatments – especially if they’re for pre-existing conditions. But we’ll dive into this a little more detail later. 

Can I get health insurance with no waiting periods?

Unfortunately, finding hospital cover where no waiting periods apply can be rare.  

That being said, there are maximum waiting periods for all hospital cover policies.2As above, p2 Insurers legally aren’t allowed to make you wait any longer than the Maximum Waiting Period stated below for the following: 

ConditionsMaximum Waiting Period
 Palliative Care  2 Months
 Rehabilitation  2 Months
 Psychiatric Treatment  2 Months*3*You can upgrade your hospital cover for psychiatric care without a further waiting period if you have finished a 2 month waiting period for limited psychiatric benefits.  Note you can only do this once in your lifetime.  Terms and conditions apply, for more information
 Obstetrics (Pregnancy)  12 Months
 Any Other Pre-existing Conditions 12 Months
 All Other Treatments  2 Months

Now, when it comes to extras cover, the rules aren’t so hard and fast. These policies are for medical services like physio or check-ups at the dentists, and insurers can set their own waiting periods here.4As above, p4

While it’s not across the board, some typical waiting periods for extras cover might look like the following: 

Conditions Maximum Waiting Period
 General Dental Services  2 Months
 Physiotherapy 2 Months
 Optical and Glasses 2 Months
 Major Dental Services 12 Months
 Orthodontics 1-3 Years

In truth, the waiting periods for extras cover generally stretch from anywhere from 2 months to 3 years.  Sometimes funds waive extras waiting periods for new customers, while others offer policies that don’t have waiting periods for certain services5ahm – Super Extras Cover Product Guidep2 (such as routine dental treatments). However, you should always carefully your document to find out when waiting periods apply. 

What are the waiting periods for pre-existing conditions?

A “pre-existing condition” is any health problem that you had before you took out your insurance policy. More specifically, it’s a health problem where any symptoms were showing 6 months before it started.6Commonwealth Ombudsman – What is the Waiting Period for Pre-Existing Conditions?

When it comes to hospital cover, there will usually be a 12 month waiting period for pre-existing conditions. The good news? This doesn’t apply for palliative care, rehabilitation or psychiatric treatment, where the waiting period can’t be more than 2 months.7As above.  

If waiting periods didn’t exist, there would basically be no reason for anyone to take out or maintain actually need medical treatment. This would essentially have a knock-on effect, driving up the premiums for everyone.8Australian Government | Department of Health and Aged Care – Waiting periods and exemptions

Do I always have to serve waiting periods?

In short, no.  There are exceptions which mean you don’t always have to serve waiting periods.  

The first relates to hospital cover. If you are switching to an equal or lower level of hospital cover, even with a different insurer, you won’t have to re -serve waiting periods. However, if you’re upgrading your policy – whether with the same or a new insurer – you will need to serve waiting periods for any new or higher hospital benefits.   For example, if you switch from a bronze level of hospital cover to silver, you can claim straight away for any of the services that were already covered under your previous bronze hospital policy but you’ll need to serve waiting periods for any new or upgraded services such as heart and vascular.  

For extras cover, many insurers will choose to honour your old waiting periods, even though they’re not required to do so by law.9Commonwealth Ombudsman | Private Health Insurance Ombudsman – Waiting periods for private health insurance, p4 But if you’ve accrued benefits or loyalty limits, those usually do not transfer over to your new policy. However, it can be worth asking if this can be done. 

You might also be able to avoid extras waiting periods by keeping an eye out for insurers who offer to waive waiting periods on extras products for new customers. Keep in mind these types of promotions and incentives may be limited time offers.

Helpful Tip:

Many policy holders stick with an outdated or expensive policy because they mistakenly believe they’ll need to re-serve any hospital benefit waiting periods if they switch to a different fund. The good news is that this simply isn’t true. Any hospital waiting periods you’ve already served will be protected by law as long as you switch to any equal or lower level of cover, and funds generally honour extras waiting periods too. If you are a new customer or upgrading your level, keep an eye out for special offers from funds to waive waiting periods.

Remember, if you want to be covered for a private birth (which may also include wanting a private room and better accommodation and facilities), make sure that you are covered for a full 12 months before the baby is born.

Sarah McKay

Neuroscientist, author, speaker, & media personality.

What if I go to the hospital before my waiting period is up?

In a perfect world, you would never need to visit the hospital before your pre-existing condition waiting period was up. But if you do need to go to hospital, contact your health insurance provider straight away to check if you are entitled to hospital benefits. As a minimum, you’ll generally need to have been with your insurer for at least two months before any benefits can be paid.   

To determine whether or not your condition was pre-existing, your insurer should:10As above, p6

  • Give you some information about the pre-existing conditions that apply to your policy. 
  • Get their health fund doctors to look at the information provided by your specialist to deem whether the condition is pre-existing.11Commonwealth Ombudsman | Private Health Insurance Ombudsman – The Pre-Existing Conditions Rule 
  • Contact you within five days with a decision on whether the condition is deemed a new condition where benefits are payable or advise that you will not be covered for the admission and treatment if the condition is pre- existing.

It is worth noting that if you need to receive urgent care, you might not hear back from your insurer before you are admitted for treatment.

What happens if I suspend my policy? 

You may be able to suspend your Aussie health insurance if you’re travelling overseas. This might be appealing to those looking to save money while outside of Australia, but keep in mind that the days you suspend your cover won’t be counted toward your waiting period.12Australian Government | Department of Health and Aged Care – Getting the best from your private health insurance  Once you resume your policy in Australia, the waiting period clock continues.

How can I find a fund with the shortest waiting periods?

The best way to find a new health insurance provider with a shorter waiting period is to compare your options. Use our online Comparison Tool to see how our range of providers* stack up when it comes to waiting periods, plus other key features and benefits that are important to you. 

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