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What is a waiting period for health insurance?

A health insurance waiting period is the amount of time you have to wait before you can claim on your hospital or extras cover.

How waiting periods work

When you buy health insurance, there are some things you'll be able to claim almost immediately, such as the cost of an emergency ambulance trip. But there are other services you can't access until you've held your policy for a while.

Waiting periods vary depending on the treatment. In most cases, you'll need to serve a 2-month waiting period before you're covered, with a few exceptions. For example, you have to hold a gold-standard hospital policy for at least 12 months before you can claim for pregnancy or childbirth benefits.

Waiting periods were put in place to keep people from signing up only when they need treatment and then cancelling afterwards. If you were allowed to do this, insurance premiums would go up for all policyholders because there would be so much pressure on the health funds.

Switching health funds?

Once you've served your waiting periods with 1 health fund, you won't have to serve them again if you switch unless there's a break in cover.

Finder survey: What conditions have people made a hospital claim for?

ResponseMaleFemale
I've never made a hospital claim21.04%18.01%
Gynaecology1.67%7.47%
Pregnancy and birth1.67%6.7%
Other5.83%3.83%
Gastrointestinal endoscopy5%5.56%
Dental surgery3.96%4.98%
Heart and vascular system4.79%2.3%
Bone joint and muscle3.96%2.87%
Cataracts3.96%3.26%
Ear nose and throat3.96%3.45%
Hernia and appendix3.54%2.3%
Cancer treatment3.33%1.92%
Joint replacements2.92%1.72%
Tonsils, adenoids and grommets1.04%2.68%
Sleep studies2.5%0.57%
Digestive system1.46%2.49%
Eye surgery (not cataracts)2.29%2.11%
Rehabilitation2.29%1.72%
Skin2.29%1.72%
Pain management1.67%2.11%
Joint reconstructions1.88%1.15%
Breast surgery1.72%
Back neck and spine1.67%1.34%
Male reproductive system1.67%0.77%
Hospital psychiatric services1.46%1.34%
Assisted reproductive services0.21%1.34%
Miscarriage0.21%1.34%
Kidney and bladder1.25%0.77%
Pain management with device0.42%1.15%
Blood1.04%0.77%
Lung and chest1.04%0.96%
Brain and nervous system0.63%0.96%
Plastic or reconstructive surgery0.21%0.96%
Weight loss surgery0.83%0.96%
Podiatric surgery0.42%0.77%
Palliative care0.63%0.38%
Diabetes management0.42%0.19%
Dialysis for chronic kidney failure0.38%
Source: Finder survey by Pure Profile of 1006 Australians, December 2023

Hospital waiting periods

With hospital cover, the Private Health Insurance Ombudsman sets the maximum possible waiting periods for every circumstance and insurers have to stick to them. This means the same waiting periods will apply no matter what hospital policy you get.

Hospital benefitWaiting period
Most pre-existing conditions12 months
Pregnancy and childbirth12 months
All psychiatric care, rehabilitation and palliative care2 months
Other in-hospital treatment2 months
Accidents and ambulance servicesNo waiting period

Extras waiting periods

Extras waiting periods are set by individual health funds so unlike hospital cover, they can vary. However, due to competition between insurers, you'll find that they are typically the same across the majority of health funds. In some cases, health insurers will let you skip waiting periods for certain treatments such as general dental, optical and physiotherapy.

Extras benefitTypical waiting period
General dental2 months
Major dental12 months
Optical2 months
Physiotherapy, chiropractic and osteopathy2 months
Remedial massage2 months
Dietetics, nutrition and weight loss2 months
Pharmacy (non-PBS pharmacy items)2 months
Hearing aids12 months

Private health insurance waiting periods and pre-existing conditions

Hospital

Hospital

You'll have to wait 12 months before pre-existing medical conditions are covered by your hospital insurance policy. That includes any illnesses you showed symptoms of in the 6 months prior to taking out a hospital policy. The only exception is if your pre-existing medical condition falls under psychiatric care, rehabilitation or palliative care – in which case, you'll only need to serve a 2-month waiting period.

Extras

Extras

There are no pre-existing condition waiting periods with extras health insurance. That means if you've already got bad eyesight, you won't have to wait any longer to claim benefits. You'll just have the standard waiting period.

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