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.
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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
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.
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.
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 treatment as a result of an accident||1 day|
|Ambulance services||2 day|
|Travel and accommodation||3 day|
|Doctor’s health checks and healthy heart checks||2 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 appliances||12 months|
|Obstetrics related services||12 months|
|Pre-existing conditions||12 months|
|Speech processor and insulin pump replacements||12 months|
|Emergency ambulance||1 day|
|All other services (applies to some covers, check policy)||2 months|
|Optical appliances (applies to some covers, check policy)||6 months|
|Complex dental||12 months|
|Major dental||12 months|
|Hearing aids||12 months|
|Joint fluid replacement injections||12 months|
|Medical gases||12 months|
|Midwife assisted home births||12 months|
|Orthotics and orthopaedic shoes||12 months|
|Podiatric surgery||12 months|
|Pre and post natal services||12 months|
|Refractive sight correcting laser eye Extras or Super Extras for two years before you’re entitled to this benefit)||24 months|
|Psychiatric, rehabilitation and palliative care||2 months|
|All pre-existing conditions except palliative care, psychiatric and rehabilitation||12 months|
|General dental and endodontic|
|Therapies including acupuncture, chiropractic, chiropractic, myotherapy, naturopathy, osteopathy and physiotherapy||2 months|
|Obstetrics and maternity||12 months|
|Pre-existing ailment, illness or condition||12 months|
|Any other benefit for hospital treatment||2 months|
|All extras benefits except as specified below||2 months|
|Domestic, home and optical aids and medical aids||6 months|
|Major dental||12 months|
|Health appliances||12 months|
|Palliative care||2 months|
|Psychiatric services||2 months|
|Rehabilitation services||2 months|
|Pre-existing ailments or conditions||12 months|
|Pregnancy & birth related services||12 months|
|All other hospital services||2 months|
|Health Management Programs||6 months|
|Artificial appliances (e.g. low vision aids, blood glucose monitors)||12 months|
|Foot orthotics||12 months|
|Pre-existing ailments & conditions||12 months|
|Dental bleaching||12 months|
|Crowns and Bridges||12 months|
|Indirect fillings||12 months|
|Occlusal therapy||12 months|
|Oral surgery||12 months|
|Hearing aids||24 months|
|All other extras services||2 months|
Ambulance waiting periods
|Emergency ambulance (where not for pre-existing ailments)||1 day|
|Pre-existing ailments||12 months|
|Accidental injury||1 day|
|Ambulance services||1 day|
|Other hospital services, except those listed||2 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 conditions||12 months|
|Healthier lifestyle||6 months|
|Optical appliances and repairs||6 months|
|Artificial aids (except orthotics and orthopaedic shoes)||12 months|
|Dentures, denture maintenance/repairs, other prosthodontic services||12 months|
|Periodontic surgical, root therapy and endodontic services by a dentist not registered as a specialist||12 months|
|Removal of wisdom teeth and oral surgery||12 months|
|Specialty dental (e.g. endodontia, periodontia)||12 months|
|Hearing aids||36 months|
|All other services, except those listed below||2 months|
|Emergency ambulance transportation||Nil|
|Psychiatric, rehabilitation and palliative care||2 months|
|Pregnancy related conditions||18 months|
|Pre-existing conditions||17 months|
|Reproductive treatment||19 months|
|All other Hospital Services||2 months|
|All services, except as specified below||2 months|
|CPAP Machine||12 months|
|Elective procedures||12 months|
|Orthodontic treatment||14 months|
|Foot Orthotics||15 months|
|Major dental||16 months|
|Hearing aids||24 months|
|Replacement of Dentures||36 months|
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.
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.
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.
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.
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.
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:
|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|
|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|
|Femoral on Inguinal Hernia||$464.50||$640.60||$657.50||$909.70||$662.70||$636.05||$623.05||$557.40||$557.40|
|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||$354.85||354.85|
|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|
I recognise most of these funds except for the AHSA, what is that?
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
- Budget Direct Health Insurance
- Frank Health Insurance
- GU Health
- HBF Health Ltd
- Health Care Insurance Limited
- Health Insurance Fund of Australia Limited
- Health Partners
- Navy Health
- 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
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.