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All health insurance policies come with waiting periods, but you don't necessarily have to serve every one. Here's our expert run-down on which waiting periods you can avoid and how to do it.
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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 benefits you can't access until you've held your policy for a while.
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 vary depending on the treatment though. Some medical conditions have a 2-month waiting period, others have a 6-month waiting period, and some – like pregnancy – have a 12-month waiting period. We'll explain all of these later.
Once you've served your waiting periods with one health fund, you won't have to serve them again if you switch unless there's a break in cover.
Waiting periods can be frustrating, but health insurance wouldn't work without them. If they didn't exist, people might buy cover just to lodge a big claim then cancel shortly after. If too many people did that, there wouldn't be enough money in the health insurance pot to cover claims anymore and nobody would benefit.
Within hospital insurance, most waiting periods are just two months. There are only two health categories with a longer waiting period – pre-existing conditions and pregnancy and childbirth.
That's because the Private Health Insurance Ombudsman sets the maximum possible waiting periods for every circumstance and insurers usually stick to them. Here they are:
⚠️ Important: The two-month waiting period for psychiatric care, rehabilitation and palliative care applies even if they are considered pre-existing conditions. This category can include treatment of post-natal depression, eating disorders and drug and alcohol rehabilitation.
Extras insurance is a little bit different. The Private Health Insurance Ombudsman doesn't set maximum waiting periods so they vary between brands, policies and specific benefits.
For example, you might have no waiting period for optical services but you might have to wait two years for high-cost items such as braces or laser eye surgery.
Here are some examples of how waiting periods differ between similarly priced extras policies:
| Policy | Weekly cost | General dental | Major dental | Orthodontics | Optical | Physio | Psychology |
|---|---|---|---|---|---|---|---|
| ahm Lifestyle Extras | $12.40 | None | 12 months | 12 months | None | None | None |
| CUA Classic Extras | $13.27 | 2 months | 12 months | 12 months | 6 months | 2 months | 2 months |
| HCF Vital Extras | $13.50 | 2 months | 12 months | 12 months | 2 months | 2 months | 2 months |
| Medibank Top Extras | $12.61 | 2 months | 12 months | 12 months | 6 months | 2 months | None |
| AAMI Everyday Active | $14.83 | 2 months | 12 months | 12 months | 6 months | 2 months | 2 months |
*Prices are from April 2021 and based on a single individual living in Sydney.
We checked over 20 Australian health funds in December 2020 and our research found most health funds have a two-month waiting period for general dental.
However, we did find one that doesn't have a waiting period! Lifestyle Extras from ahm has a $500 annual general dental limit with no waiting period and 2 no-gap check-ups.
Remember: You may be able to get no waiting period dental with more funds if you take advantage of sign-up deals or offers. Check them out here.
For hospital insurance, you'll have to wait 12 months before pre-existing medical conditions are covered by your policy. That includes any illnesses you showed symptoms of in the six months prior to taking out a hospital policy.
However, there are a couple of exceptions to this rule. If your pre-existing medical condition falls under psychiatric care, rehabilitation or palliative care, it's likely you will only have to serve a two-month waiting period.
Pre-existing conditions don't come into the picture 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.
If you've already served a waiting period with one fund, you shouldn't have to serve them again if you decide to switch. The new insurance company will recognise the time you've waited.
Even if you've only waited out part of the period, that should still apply. For example, if you served 6 months of your 12-month waiting period with one fund, your new fund will only require you to serve 6 months with them.
Be careful though, insurers won't recognise the time served if there is a significant break in cover. So when switching, try and get the company to start your cover from the day after your old policy ends.
For this to work, your old health insurance history needs to be sent to your new insurer. According to the Private Health Insurance Ombudsman, you can ask your new insurer to do this for you or handle it yourself.
Pregnancy and childbirth hospital services come with a 12-month waiting period. The only way to get this waiting period waived is if you've already served it with another health fund.
Be aware though. Even if you've been with a fund for years, they won't count that time unless you've held a policy that covers childbirth.
So, if you have a bronze-level hospital policy for 10 years, and upgrade to gold so you're covered for childbirth, you'll still have to wait another 12 months before you can claim.
Basically, this means you should lock in gold-level cover before you start trying to conceive. Otherwise, you won't be able to take advantage of those benefits.
However, there are some pregnancy benefits you may be able to access without serving a 12-month waiting period – but only out-of-hospital services. Some extras policies include benefits for pre and postnatal services, including birthing classes, lactation consultants and visits from a registered midwife.
Earlier on, we gave you four top tips for finding health insurance with no waiting periods. Here's a more in-depth look into how these really work.
Keep your eyes peeled for promotions.
Lots of health funds offer sign-up deals for new customers. Often, these deals will let you waive two-month and six-month waiting periods on hospital insurance.
Be aware though, you might have to sign up to a combined hospital and extras policies to access these deals. If that wasn't what you had in mind, think carefully about whether it's worth the extra cost.
Compare policies
Although waiting periods are generally the same across hospital insurance, there are differences when it comes to extras. Don't forget, you can mix and match your hospital and extras policies. Don't feel obligated to stick with one brand for both, when you could find a better deal elsewhere.
Share your insurance history
Be proactive about sharing your health insurance history with your new insurance company. Even if you've only served 2 months of a 12-month waiting period, the new company should honour that time served.
According to the Private Health Insurance Ombudsman, you can either do this yourself or have your new insurance company handle it for you. If you choose the latter, be sure to follow up and get confirmation that your waiting periods have been honoured.
Sign up for an extras only policy
Some extras policies let you claim for benefits without having to serve any waiting period at all. For example, ahm's Lifestyle Extras policy has no waiting period for general dental or optical.
That means you can buy the policy in the morning and claim for new glasses or a dental appointment in the afternoon.
Be aware though, this isn't across every fund so always check your waiting periods carefully before committing to a policy.
Get in touch with your insurer as soon as possible to find out if you'll receive hospital benefits. For example, you may have served the waiting period for the digestive system, but not pre-existing conditions.
At this stage, your health insurer should give you some general advice about the pre-existing condition rule, send you forms that your doctor needs to fill out and return, then contact you within five working days with a decision.
If you need to go to hospital urgently, your insurer might not have enough time before you are admitted to decide whether your condition is pre-existing. This means that you may not know before you are admitted whether you'll receive any benefits.
If you haven't served the waiting period for the specific medical category, you won't be covered by your policy. You may want to consider the public system at this point.
Looking to do more research? You can use this free tool to see health insurance quotes side by side. Keep an eye out for the yellow banner highlighting any insurers waiving waiting periods as a sign-up deal.
All hospital policies have the same waiting periods, although you may be able to skip some if you take advantage of sign-up offers.For extras, there are differences between funds, so it really does pay to compare. You may find one policy with a six-month waiting period for optical while another fund offers no waiting period.
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I have been with a fund for many years and I recently upgrade to premium hospital cover. Due to the upgrade I now have to wait 12 months for some pre-existing conditions. If I were to transfer to another fund to cover of the same level would the wait time continue?
Hi Kym,
Thanks for getting in touch with finder. I hope all is well with you. :)
Generally, if you switch to another, according to Private Health Ombudsman, “you will not have to re-serve waiting periods if you transfer to a policy that is at the same or a lower level of benefit. Your new fund must give you continuity for the waiting periods you have already served. However, if your new plan includes new or higher benefits that were not part of your old policy, you will have to complete a waiting period before you can access those benefits.”
To give you a short answer, you should not wait another 12 months if you are to transfer to another fund and that fund will cover the same level.
I hope this helps. Should you have further questions, please don’t hesitate to reach us out again.
Have a wonderful day!
Cheers,
Joshua
Hi how long waiting period for pregnancy insurance.
Hi Kin,
Thanks for reaching out.
Generally, waiting periods vary and are different for hospital cover and general treatment (extras) cover. As for obstetrics (pregnancy), the government sets 12 months as the maximum waiting period that funds can impose for hospital treatment. You may like to read more about how waiting periods work on health insurance.
I hope this helps.
Cheers,
May
Is there any promotions about waiting periods being waived with any health fund with extras only if we are in WA
Hi Karen,
Thank you for your question.
Currently, in our panel of health funds, AHM has an offer of waiving waiting periods on extras services only. To check the details, please head to our list of health insurance deals and offers.
Cheers,
Zubair