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 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?

Waiting periods vary between funds, 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 funds 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.

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 may need to take out obstetrics cover well in advance and confirm 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 fund?

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 fund.

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 fund 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 funds 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 value for money.

Compare cover from 30+ health funds

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.

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