Private Health Insurance Waiting Periods

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What are waiting periods?

When do waiting periods apply?

What are the waiting periods for hospital cover?

What are the waiting periods for extras cover?

How do pre-existing conditions affect waiting periods?

Can waiting periods be reduced or waived?

Do waiting periods apply if you switch private health cover?

Where can I find and compare health insurance?

Long story short

Waiting periods apply before you can claim

You’ll need to serve a waiting period whether your policy covers hospital, extras, or both.

Waiting periods vary in length depending on cover type, policy, and inclusions

Some waiting periods can be as short as two months, while others can be a year or more.

You might not have to re-serve waiting periods when switching policies

If you move to the same or lower level of cover, any waiting periods already served usually carry over.

What are waiting periods?

When you take out health insurance you need to hold your cover for a set amount of time before you can claim on services, like hospital treatment. These set times are called waiting periods. They vary between hospital and extras cover, between polices, and between services.

Once you’ve served the waiting periods for a policy, you will not need to sit through them again for that policy (assuming you maintain continual coverage). This is different to limits, which are a cap for claims and can reset your health insurance (usually annually).

Waiting periods help stop people from taking out health insurance cover, quickly making a large claim, and then cancelling their policy. This behaviour could mean other health fund members see a dramatic hike in their premiums to cover these claims.

When do waiting periods apply?

Waiting periods apply if you:

• take out new cover (for the first time or there’s been a break since your previous cover)
• upgrade your cover (including moving to a similar policy with a different health insurer)
• decrease your excess or increase your benefits (even if you stay on the same policy)
• add someone to an existing policy (waiting periods apply for the new member typically).

If you’re not sure if a waiting period applies to you, you can check your policy documents or speak with your health insurer.

What are the waiting periods for hospital cover?

Hospital insurance waiting periods are typically at most two months for planned care. Treatment after an accident usually only has a one-day waiting period.

Cover for pregnancy and birth-related services, and for pre-existing conditions both have a maximum 12-month waiting period.

If you want to give birth in a private hospital, it’s a good idea to take out hospital cover with obstetrics included before trying for a baby.

We’ll explain more about pre-existing conditions and waiting periods a bit later.

The Australian Government sets the maximum waiting periods for hospital cover.

What are the waiting periods for extras cover?

Extras cover waiting periods can range from two months to 12 months to even longer. It depends on the policy, extras service, and the health fund.

Because health insurance is a competitive market, health funds often have similar waiting periods, like:

• one day for emergency ambulance services
• two months for general dental
• two months for physiotherapy and chiropractic
• two months for psychology and mental health
• two months for pharmacy
• two months for podiatry
• six months for optical
• six months for health management programs, like gym memberships and weight management
• 12 months for major dental
• 12 months for orthodontics
• 12 months for health appliances and aids, like hearing aids.

You might find an extras policy with different waiting periods to these, though.

How do pre-existing conditions affect waiting periods?

If you have a pre-existing condition before you take out hospital cover, your health fund can set a maximum 12-month waiting period.

In this instance, a pre-existing condition is one that you’ve had for at least six months before taking out or upgrading your cover. You don’t need to have been diagnosed with the condition for it to count; signs or symptoms can be enough.

Some health funds might have similar rules about pre-existing conditions and waiting periods for extras cover.

Can waiting periods be reduced or waived?

Waiting periods can be reduced or waived for health insurance in some circumstances, like special joining offers or for psychiatric care.

Hospital cover

Your two-month waiting period for psychiatric care could be waived on a hospital policy.

This only happens if you upgrade to a policy that offers higher benefits for hospital psychiatric services and you’ve already held hospital cover for two months (any level of hospital cover is fine). You will need to ask your health fund to be exempt from serving the usual waiting period, but keep in mind, you can only use this exemption waiver once in your lifetime.

Extras cover

Health insurers might offer extras cover where some inclusions have no waiting periods, like dental cleans and check-ups.

Other times, health insurers might have a promotion where new members have some extras waiting periods waived. This is usually for extras inclusions that have shorter waiting periods, like two or six months.

Do waiting periods apply if you switch private health cover?

If you switch hospital cover – including getting a new policy or moving to a new health insurer – you do not have to re-serve hospital waiting periods if:

• You’re moving to a policy with the same coverage, including level of excess.
• You have continuity of cover (that means there’s only a short gap between switching policies).
• You’re up to date with your premiums.

This portability or right to switch is a legally protected right in Australia. It also applies to partially served waiting periods. So, if you have served eight months of a 12-month waiting period and switch to a similar policy with a different health insurer, you could only need to serve the remaining four months.

Portability laws don’t apply to extras cover, but many health funds follow similar rules if you switch extras policies.

If you’re moving to a higher level of cover, including a lower excess, having an excess waived, or getting more back, you’ll likely have to serve waiting periods again.

Helpful tip

Switching health insurance can be a great way to save on your health insurance, plus ensure it fits you and where you’re at in life.

If you do decide to switch, look out for a transfer certificate from your old health fund. It’ll include important details about your cover history, including any waiting periods you’ve sat through. Your previous health insurer has 14 days from when you give them notice to send this certificate over to your new health insurer.

Andres Gutierrez

General Manager – Health

Where can I find and compare health insurance?

Like ripping off a bandaid or checking your bank balance after a big night out, it can be better to get waiting periods over and done with sooner. And to help get you moving swiftly, iSelect makes it easy to compare a range of health insurance policies from different providers. All you need to do is call one of our friendly health comparison experts on 1800 784 772 or use our online comparison tool.