Waiting period

Health Insurance Waiting Periods

Want to know how waiting periods affect your health insurance? Keep reading to find out.

Waiting periods are something we all need to 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.

Compare health insurance policies now or speak with an adviser

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

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 insurer, 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?

Waiting periods vary with insurance providers, but as a general rule, health funds apply a two (2) month waiting period for most procedures covered by hospital cover and a two (2) month waiting period for most services covered by extras cover.

Waiting periods for Australian health funds

While most insurers apply the same waiting periods with their hospital policies, many differ when it comes to waiting periods of extras cover. Below are the waiting periods for the 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

Waiting periods for hospital cover

The government sets the maximum waiting period that funds can impose for hospital treatment, which is 12 months for existing conditions and 12 months for obstetrics (pregnancy). Otherwise, you generally only have to wait two (2) months to receive hospital benefits. The only exception to this is in the event of an accident, when many funds waive the waiting period for hospital cover.

Is there such a thing as no waiting period health insurance?

Waiting periods are sometimes waived as in the above example or in a bid to lure new customers. Funds will run promotions waiving certain waiving periods on hospital or extras in a bid to secure new customers.

Waiting periods for general treatment cover

Most health funds apply a two (2) month waiting period for general treatment (extras) services such as optical, general dental, physio, osteo, chiro and healthy lifestyle and complimentary therapies.

Generally, you'll have to wait up to 12 months for major dental and up to 36 months for hearing aids. While many health funds are fairly inflexible on these longer waiting periods, some may waive the two (2) month waiting period on the majority of other services as a way of attracting new members. If you are looking for no waiting period health insurance, you are less likely to find it with hospital cover, but more likely to with general treatment cover.

How do waiting periods work?

The following examples demonstrate when waiting periods may and may not apply. While the government sets the maximum waiting period for existing medical conditions at 12 months, this may vary in the following circumstances:

  • Example 1 – John experienced abdominal pain a month before taking out hospital cover. His doctor referred him to a specialist who diagnosed gallstones and recommended surgery. The health fund’s doctor determined that because John’s symptoms were apparent in the six months prior to taking out health cover, he would have to wait the full 12 months before receiving any benefits.
  • Example 2 – Bill experienced symptoms of heart disease a month before changing his hospital cover from restricted cover (where only a percentage of benefit is paid on some treatments) to cover with no restrictions. When he suffered a heart attack three months later, the health fund’s doctor determined that, as he showed symptoms of heart disease in the six months prior to switching, he would only be entitled to restricted cover for a further nine months.
  • Example 3 – Tony had hospital cover for three months when he suffered a stroke. The treating physician at the hospital identified risk factors such as high blood pressure, but because Tony had not exhibited any actual symptoms of stroke in the six months prior to taking out cover, the health fund’s doctor determined it was not an existing condition and the 12 month waiting period would not apply.

Hospital waiting periods explained

As hospital waiting periods are usually enforced more rigorously than those for general treatment (extras), it may be useful to examine them in greater detail.

Two (2) month waiting period

As mentioned previously, most health funds have a two (2) month waiting period before you are eligible for benefits under hospital cover. While many funds will waive this waiting period in the event of an accident, it is usually not negotiable in most other circumstances.

Psychiatric and rehabilitation waiting period

Even if a psychiatric illness or drug addiction is technically ‘existing’, you do not have to wait the full 12 months to receive hospital treatment. Cover for psychiatric services and drug and alcohol rehabilitation only requires a two (2) month waiting period.

Obstetrics (pregnancy) waiting period

This is one area of cover where almost all health funds enforce a strict 12 month waiting period. The implication of this is that if you plan to fall pregnant and want private treatment in a private hospital, you will need to take out obstetrics cover well in advance. You should also make sure that your newborn baby is covered under your policy.

Existing conditions waiting period

As discussed previously, if you have an existing medical condition, you will have to wait up to 12 months to receive any benefits under hospital cover. An existing condition is defined as any condition that you experienced symptoms of in the six months prior to joining a hospital fund or upgrading to a higher policy. This applies whether or not those symptoms were diagnosed by a doctor.

Are there waiting periods if I switch providers?

Many people are hesitant to switch health funds even when they find a better deal because they fear that, not only will they lose any privileges they currently enjoy, but they will also have to re-serve the waiting periods they have already served with their current provider.

Luckily, thanks to government legislation, this is not the case. All current entitlements such as Lifetime Health Cover (LHC) and government rebate status travel with you to your new fund, and this includes any waiting periods you have already served. As long as you have served the full term of a waiting period with your current insurer and are not upgrading to a higher level of cover, you will not be required to serve a further waiting period with your new health fund.

What are benefit limitation periods?

Another form of waiting period is known as a benefit limitation period (BLP). Some insurers apply this restriction to certain hospital products, where only a minimum benefit is payable for a period of up to three years.

BLPs only apply to new fund members, as those switching from another fund are not affected. Opting for hospital cover with benefit limitation periods can be one way to reduce the cost of your premiums (the less cover, the lower the premiums), but you would need to make sure that treatments you are more likely to need do not have such limitations placed upon them.

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 the best value for money.

This report card can give you an idea of how they vary between providers:

ProcedureMBSHBFSt.LukesHealthAHSA*BUPA*Medibank#nibMDHFGMHBA
Appendicectomy$445.40$614.45$629.45$632.10$635.45$609.95$597.45$534.50$534.40
Basal Cell Carcinoma or Squamous Cell Carcinoma removal from nose, eyelid, lip, ear, digit or genitalia$221.35$335.85$311.85$366.10$315.80$303.15$296.90$265.65$265.65
Breast, benign lesion surgical biopsy of excision$260.05$355.20$367.25$356.40$380.55$355.30$348.80$312.10$312.10
Carpal Tunnel Release$276.80$459.05$426.80$440.20$453.75$404.90$417.55$332.20$332.20
Cataract Surgery$760.55$1,242.25$1,163.30$1,239.70$1,184.20$1,126.25$1,144.90$912.80$912.80
Cholecystectomy$739.35$1,019.80$1,045.10$1,091.90$1,054.85$1,012.45$993.60$887.25$887.25
Colonoscopy$334.35$456.45$461.95$435.00$470.25$442.50$429.80$401.22$401.22
Complicated Delivery (of baby)$1,629.35$2,649.15$2,307.90$1,855.90$2,406.65$2,198.50$2,280.10$1,955.20$1,955.25
Coronary Artery Bypass$2,200.00$3,665.20$3,404.40$3,783.30$3,294.85$3,265.15$3,064.80$2,640.00$2,640.00
Craniotomy$1,586.75$2,631.75$2,443.70$2,420.80$2,602.05$2,322.10$2,393.60$1,904.10$1,904.10
Cytotoxic Chemotherapy$97.95$127.55$119.60$107.80$118.05$115.30$111.00$117.55$117.55
Femoral on Inguinal Hernia$464.50$640.60$657.50$909.70$662.70$636.05$623.05$557.40$557.40
Haemorrhoidectomy$367.75$502.25$524.65$602.90$517.20$503.80$472.75$441.30$441.30
Hip Replacement$1,317.80$2,146.75$2,318.15$2,214.50$2,094.35$2,000.75$2,013.85$1,581.40$1,581.40
Knee Replacement$2,047.60$2,146.75$2,318.15$2,563.40$2,094.35$2,000.75$2,013.85$1,581.40$1,581.40
Overnight investigation for sleep apnoea$588.00$747.65$707.85$682.20$703.45$694.25$709.40$705.60$705.60
Tonsils or Tonsils and Adenoid$295.70$522.05$493.85$513.90$481.30$472.35$442.65$354.85354.85
Uncomplicated Delivery (of baby)$693.95$2,150.35$1,979.05$1,484.50$2,057.05$1,886.95$1,550.60$832.74$832.74
Vaginal Hysterectomy$674.70$1,252.85$1,024.65$1,066.20$1,076.80$986.20$1,012.05$809.65$809.65
Varicose Veins$109.80$149.95$169.05$164.80$164.45$160.70$148.35$131.80131.80
Vasectomy$229.85$317.20$365.95$343.80$353.15$348.95$349.30$275.85$275.85

*NSW, #AHM

I recognise most of these funds except for the AHSA, what is that?

The Australian Health Service Alliance is a management services organisation that represents a number of small to medium sized health insurance funds, allowing them to combine resources to deliver a higher quality of service to their members.

The funds represented by the ASHA are:

  • ACA Health Benefits Fund
  • Australian Unity Health Limited
  • CBHS Health Fund Limited
  • CUA Health Limited
  • Defence Health
  • GMF Health
  • GMHBA
  • Budget Direct Health Insurance
  • Frank Health Insurance
  • GU Health
  • HBF Health Ltd
  • Health Care Insurance Limited
  • health.com.au
  • Health Insurance Fund of Australia Limited
  • Health Partners
  • Navy Health
  • onemedifund
  • Peoplecare Health Insurance
  • Phoenix Health Fund
  • Police Health Limited
  • Queensland Country Health Fund Limited
  • Reserve Bank Health Society Ltd
  • rt health fund
  • Teachers Health Fund > UniHealth Insurance
  • Teachers Union Health
  • The Doctors' Health Fund Pty Ltd
  • Transport Health
  • Westfund

Compare health funds today

Waiting periods are yet another factor to be considered when comparing health insurance policies. While most health funds require a waiting period on their hospital cover, some are prepared to be more flexible with their general treatment products and it is here that it may be possible to get immediate cover without serving a two (2) month waiting period. So, as is the case with other health insurance features, it pays to shop around to see if you can find No Waiting Period Health Insurance.

Get covered today and get a quote direct from a health fund or from an adviser

Details Features
High 65 / 75 / 85% - $0/$250/$500 Excess
High 65 / 75 / 85% - $0/$250/$500 Excess
Combines High Hospital Cover with its highest level of extras cover.
  • Cover starting from $44.74 weekly
  • 12 month waiting period for pregnancy
  • 65% back on extras
  • Choice of $0, $250 and $500 excess
Enquire Now More info
Premier Package
Premier Package
Top tier combined hospital and extras policy that covers you for an extensive range of hospital and general treatment services.
  • All the benefits of HCI's Premier Hospital policy
  • All the benefits of HCI's Premier Extras policy
  • Cover for pregnancy and IVF treatment
  • Cover for general and major dental
Get Quote More info
Deluxe flexi
Deluxe flexi
Deluxe flexi provides cover for a range of treatments including hip replacement, spinal fusion, dialysis and major eye surgery.
  • No excess for kids
  • All joint replacements
  • Major eye surgery
  • Rehabilitation
Enquire Now More info
GoldStar
GoldStar
Premium hospital cover with complete cover for hospital expenses. Save 4% when you pay for 12 months of your cover upfront.
  • All theatre fees covered
  • Unlimited maternity cover
  • Choose no excess or $200, $400, $500 per admission
Get Quote More info
Smart Combination
Smart Combination
Smart combination provides a high level of cover for both hospital and extras.
  • Claim up to $2725 back on extras
  • Hip and knee replacements
  • General and major dental
  • Physio
Enquire Now More info
Prestige
Prestige
Highest level of combined cover offered by CBHS. Includes the same benefits as Comprehensive Hospital and Top Extras plus more. Restricted fund: Only current or former staff (and their families) of Commonwealth Bank Group and their subsidiaries which include Aussie, Bankwest, Colonial First State and more can join.
  • No excess or co-payments on hospital cover
  • Non-student dependent under 25 can be kept on policy
  • Access to Chronic Disease Management Programs
  • Widest range of extras including orthodontics
Enquire Now More info
Bronze Hospital (no pregnancy) and Bronze Extras Set Benefits
Bronze Hospital (no pregnancy) and Bronze Extras Set Benefits
High level of hospital cover and extras cover for a range of popular services including knee and should reconstructions.
  • Most comprehensive hospital options
  • Cover for general and major dental
  • Shared or single room in a private hospital
  • Intensive and coronary care
Enquire Now More info
Premium Hospital and Silver Extras Cover
Premium Hospital and Silver Extras Cover
Comprehensive hospital cover including pregnancy cover. Also included affordable mid-level extras cover for dental, optical and therapies.
  • Cover from $39.50 per week
  • Pregnancy and birth-related services cover
  • Heart surgery cover
  • 100% cash back on two dental check per year
Enquire Now More info
Top Hospital with Top Extras
Top Hospital with Top Extras
Get comprehensive hospital and extras cover and tailor your policy to your needs.
  • Pregnancy and birth services cover
  • Back surgery cover
  • $1000 general dental annual limit
  • $600 physiotherapy annual limit
Enquire Now More info
Young Couples Combined Cover
Young Couples Combined Cover
Mid-level hospital and basic level Extras package with an excess for young, healthy couples that are not quite ready to start a family.
  • Emergency ambulance cover
  • Cancer-related surgery cover
  • 70% back on extras
  • $300 dental annual limit per person
Enquire Now More info
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