Your Complete Guide to Health Insurance Waiting Periods

A health insurance waiting period is the initial phase of your membership, during which no benefit is payable for certain procedures or services. Waiting periods can also apply to any additional benefits gained when you change your policy.

A waiting period protects members of a health fund by ensuring that people don’t join up, make an expensive claim, then cancel their membership – resulting in increased premiums for all members of that fund.

What are health insurance waiting periods?

Health insurance waiting periods are mandatory time periods you have to honour before you can claim health insurance benefits. The standard waiting period for health insurance depends on the procedure, type of cover (e.g. extras cover or hospital cover) and health fund.

Let’s say you needed a dental check-up. From the moment you bought your extras health cover, you would have to honor an average waiting period of two months before you can claim any benefits. If you needed a more complicated procedure such as dental surgery, you would have to serve a much longer waiting period before you could claim any benefits.

The Australian Government sets the health insurance waiting periods for all services that fall under hospital cover (those in-hospital fees such as surgery and accommodation), while your health insurer will have their own waiting periods for services under extras cover (such as dental, optical, and physiotherapy). Health insurers are strict on enforcing waiting periods, so it’s important to do your research before committing to a fund.

Why do health insurers have waiting periods?

Health insurance waiting periods exist so that providers can keep premiums lower. It prevents customers from joining for a particular service and claiming immediately.

When do waiting periods apply?

Health insurance waiting periods apply in a number of situations. If you’re new to health insurance, have recently re-joined health insurance after cancelling, or have upgraded your health insurance policy, you’ll need to serve a waiting period.

If you’re switching to a health insurance provider or a policy that has the equivalent or fewer benefits, the waiting period you’ve already served will be protected by the law for hospital related treatments. Most funds won’t apply waiting periods for dental and other general treatments you’ve already served with another health fund.

Are there different waiting periods for hospital cover?

Hospital cover relates to any in-hospital fees including accommodation, operations, nursing care, and medication taken while you’re in hospital. The Australian Government determines the maximum health insurance waiting periods that you need to serve in regards to hospital cover.

If you have a pre-existing condition, you’ll still be able to claim for your treatment provided you serve the 12 month waiting period. Pre-existing condition examples include heart disease, high blood pressure, cancer, and diabetes or any other conditions that have been showing signs or symptoms during the past six months.

Pregnancy and obstetrics cover also requires a waiting period of 12 months. Psychiatric care, rehabilitation, palliative care (even for a pre-existing condition) and hospital admission only require a two-month waiting period.

What are the different waiting periods for extras cover?

Unlike hospital cover waiting periods that are protected by law, health insurance waiting periods for extras depend on your specific fund. For instance, the Medibank waiting period may be different to the nib waiting period. In general, waiting periods for extras can range from two to 12 months depending on the complexity and cost of your treatment.

Typical examples of waiting periods for extras include two months for dental checkups and physiotherapy, six months for optical and 12 months for major dental procedures such as orthodontics.

What happens to my waiting periods if I suspend my policy?

In certain cases, you’ll be able to suspend your local health insurance when you travel overseas for work or play. While this can be helpful if you want to save money, it’s important to remember that the days you suspend your cover for won’t be counted towards your health insurance waiting periods.

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

Comparing health insurance providers is one of the best ways to find a provider with suitable health insurance waiting periods and great value.

See how much you could save on health insurance with iSelect.

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