Waiting period

Health insurance waiting periods

Find out how waiting periods affect your health insurance.

Waiting periods are something we all should consider when comparing health insurance policies.

Waiting periods vary and are different for hospital cover and general treatment (extras) cover.

The government sets the maximum waiting periods that funds can impose for hospital treatment:

  • Two months for palliative care, psychiatric care and rehabilitation
  • 12 months for pre-existing conditions
  • 12 months for obstetrics (pregnancy)

This guide looks at what waiting periods are, how long they’re likely to be and the circumstances in which they may or may not apply to you when you take out private health cover.

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What are waiting periods?

A waiting period is the amount of time you must wait after joining a health fund before any benefit will be paid for procedures or services. A waiting period usually applies in each of the following circumstances:

  • When you first join a health fund
  • When you re-join after not having had health insurance for a while
  • When you upgrade to a higher level of cover

Got a minute? Find out how health insurance waiting periods work

Why do waiting periods apply?

The reason health funds impose waiting periods is to prevent people with existing medical conditions from taking out cover, obtaining the benefit and then cancelling their policy. This would not only cost the fund, but every member of the health fund, as premiums would rise if this practice was not prevented by waiting periods.

Do all health funds apply the same waiting periods?

Most insurers apply the same waiting periods on their hospital policies because the government caps these at a level that are already as low as insurers are comfortable going. It's a little different with extras, because the insurers can make those waiting periods however long they want.

Waiting periods for Australian health funds

The table below shows all the hospital and extras waiting periods offered by health funds in the finder.com.au panel:

Hospital

BenefitWaiting period
Hospital treatment as a result of an accident1 day
Ambulance services2 day
Travel and accommodation3 day
Doctor’s health checks and healthy heart checks2 months
Hospital treatment (where there are no pre-existing conditions)2 months
Rehabilitation, psychiatric services and palliative care (regardless of whether the condition is pre-existing)2 months
Disease management appliances12 months
Obstetrics related services12 months
Pre-existing conditions12 months
Speech processor and insulin pump replacements12 months

Extras

Emergency ambulance1 day
All other services (applies to some covers, check policy)2 months
Optical appliances (applies to some covers, check policy)6 months
Complex dental12 months
Major dental12 months
Hearing aids12 months
Joint fluid replacement injections12 months
Medical gases12 months
Midwife assisted home births12 months
Orthotics and orthopaedic shoes12 months
Podiatric surgery12 months
Pre and post natal services12 months
Refractive sight correcting laser eye Extras or Super Extras for two years before you’re entitled to this benefit)24 months
Hospital

Benefit

Waiting period
Psychiatric, rehabilitation and palliative care2 months
All pre-existing conditions except palliative care, psychiatric and rehabilitation12 months

Extras

General dental and endodontic
  • 2 months for general
  • 6 months for surgical
Preventative dentalNil
Physiotherapy2 months
Optical6 months
Therapies including acupuncture, chiropractic, chiropractic, myotherapy, naturopathy, osteopathy and physiotherapy2 months

Hospital

BenefitWaiting period
AccidentsNil
Obstetrics and maternity12 months
Pre-existing ailment, illness or condition12 months
Any other benefit for hospital treatment2 months

Extras

All extras benefits except as specified below2 months
Domestic, home and optical aids and medical aids6 months
Major dental12 months
Health appliances12 months
BenefitWaiting periods

Hospital

Palliative care2 months
Psychiatric services2 months
Rehabilitation services2 months
Pre-existing ailments or conditions12 months
Pregnancy & birth related services12 months
All other hospital services2 months

Extras

Health Management Programs6 months
Artificial appliances (e.g. low vision aids, blood glucose monitors)12 months
Foot orthotics12 months
Pre-existing ailments & conditions12 months
Dental bleaching12 months
Crowns and Bridges12 months
Indirect fillings12 months
Dentures12 months
Endodontics12 months
Occlusal therapy12 months
Oral surgery12 months
Orthodontics12 months
Periodontics12 months
Prosthodontics12 months
Veneers12 months
Hearing aids24 months
All other extras services2 months

Ambulance waiting periods

Emergency ambulance (where not for pre-existing ailments)1 day
Pre-existing ailments12 months
BenefitWaiting period

Hospital

Accidental injury1 day
Ambulance services1 day
Other hospital services, except those listed2 months
Psychiatric care, rehabilitation or palliative care services (including pre-existing)2 months
Other pre-existing ailments/conditions (an illness or condition where evident at any time during the 6 months immediately prior to joining nib)12 months
Obstetric conditions12 months

Extras

Healthier lifestyle6 months
Optical appliances and repairs6 months
Artificial aids (except orthotics and orthopaedic shoes)12 months
Dentures, denture maintenance/repairs, other prosthodontic services12 months
Orthodontia12 months
Periodontic surgical, root therapy and endodontic services by a dentist not registered as a specialist12 months
Removal of wisdom teeth and oral surgery12 months
Specialty dental (e.g. endodontia, periodontia)12 months
Hearing aids36 months
All other services, except those listed below2 months
BenefitWaiting period

Hospital

AccidentsNil
Emergency ambulance transportationNil
Psychiatric, rehabilitation and palliative care2 months
Pregnancy related conditions18 months
Pre-existing conditions17 months
Reproductive treatment19 months
All other Hospital Services2 months

Extras

All services, except as specified below2 months
Optical6 months
CPAP Machine12 months
Elective procedures12 months
Appliances13 months
Orthodontic treatment14 months
Foot Orthotics15 months
Major dental16 months
Hearing aids24 months
Replacement of Dentures36 months

Hospital waiting periods

The government protects you by limiting how long the insurer can make you wait for hospital services. Insurers usually won't go less than that, so these waiting periods will largely remain line with what the government sets out and they won't change much from policy to policy.

Here is the maximum amount of time an insurer is allowed to make you wait for various services:

  • Pregnancy and birth-related services. The waiting period for pregnancy is 12 months, so if you’re getting this cover for the first time you’ll need to take it out well before you start trying to conceive.
  • Pre-existing conditions: You’ll have to wait 12 months to receive benefits for pre-existing conditions. These are any conditions that showed symptoms in the six months before signing up for the policy, regardless of whether it was diagnosed or not.
  • All other conditions including psychiatry, rehab and end-of-life care: Your waiting periods for these and all other hospital claims are capped at two months.
  • Accidents. Accidents are different because you can’t see them coming. Insurers understand that and will only make you wait two days max, sometimes zero. The government doesn’t regulate these.

Extras waiting periods

Insurers can make you wait as long as they want for extras so these waiting periods can vary widely from one insurer to the next.

Although they can vary, here are some common waiting periods you might find as you review policies:

  • General dental (eg, check-ups, cleanings, fluoride): 2 months
  • Major dental (eg, crowns, bridges, root canals): 12 months
  • Specialty dental (eg, orthodontics): 12-36 months
  • Physio, chiro, podiatry: 2 months
  • Glasses and lenses: 6 months
  • Hearing aids: 36 months

These aren't regulated by law, so you may be able to get some of these waived with the right promotional offer, or by negotiating with the insurer.

Are there waiting periods if I switch funds?

Many people are hesitant to switch health funds even when they find a better deal because they fear that they will also have to re-serve the waiting periods they have already served with their current fund.

Luckily, thanks to government legislation, this is not the case. All of your hospital waiting periods that you've already served travel with you to the new policy. Keep in mind, you'll still have to serve waiting periods for any new benefits that you didn't have before (such as pregnancy cover).

This doesn't apply to extras waiting periods and insurers aren't required to honor ones you've already served elsewhere. However, insurers who want your business bad enough can often be persuaded to accept them.

What are benefit limitation periods?

Certain very expensive elective treatments like weight loss surgery or hip replacements will require a different sort of waiting period called a benefit limitation period (BLP). With a BLP, you'll have to wait much longer than a typical waiting period before you can fully claim, but you will be able to claim partially.

Insurers can't make you wait longer than the government allows without giving you any benefits, so in these cases they will pay the minimum amount that Medicare would pay if you went through the public system. You can apply this toward private care, but you'll be responsible for the difference.

One last thing to remember

It's worth mentioning that just as waiting periods may change between health funds, so to do the cover amounts paid for specific medical services. When selecting a policy take into account both the waiting periods and treatment benefits to ensure that you are getting value for money.

Compare cover and waiting periods from 30+ health funds

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