Do People Worry Unnecessarily About Waiting Periods?
Ben Thomas,
Customer Experience Manager
Health Insurance Expert, who’d sign up for that job title? Ben Thomas did in 2008 and hasn’t looked back.

Understanding waiting periods is a major factor for many people deciding to take out private health insurance. Here's an overview before you make a decision.

 

The Inside Scoop on Waiting Periods for Health Insurance

We all face health issues throughout our lives. While some are relatively minor, like a bad head cold or sprained ankle, there are those that are more chronic or acute. These often require regular, ongoing treatments with specialists on top of the possibility of surgery in a hospital.

Understanding waiting periods for health concerns is a major factor for many people deciding to take out private health insurance. In fact, “How do waiting periods work?” is probably the most common question we get asked at Members Own.

Waiting periods are designed to prevent people from claiming shortly after joining and then cancelling their policy once they’ve received treatment. This “hit-and-run” behaviour would drive up health premiums overall and negatively affect members.

So, how do waiting periods work and what does it mean for you?

For many Australians, understanding how to navigate both public and private services for your health needs can go a long way to reducing your overall stress and further financial shocks for medical bills.

Typical waiting periods before you can make a claim include the following:

Hospital treatment type
  • Pre-existing conditions – 12 months
  • Pregnancy and birth-related services – 12 months
  • Joint reconstructions – 12 months
  • Eye surgery – 2 months
  • Psychiatric care – 2 months
  • Rehabilitation or palliative care – 2 months
  • Emergency treatment due to an accident – usually no waiting period.
Extras treatment type
  • Major dental – 12 months
  • General dental, optical, physiotherapy and other Extras services – 2 months

 

Different health funds often have different waiting periods or conditions for these services. For a start, it can be helpful to know what’s classified as a “pre-existing condition”:

A pre-existing condition is defined by law as any ailment, illness, or condition that you had signs or symptoms of during the 6 months before you joined a hospital table or upgraded to a higher hospital table. Your health fund will need time to advise you if your condition is pre-existing so be sure to check with your fund well before you go to hospital to make sure you are covered. (source www.privatehealth.gov.au)

A quick chat with a Members Own representative could help answer any questions you have about your own pre-existing condition – you can call us on 1300 34 34 36.

When you switch to comparable cover, waiting periods are waived

If you’re switching health insurance to a policy that includes services comparable to your old cover, the waiting periods you’ve already completed are waived by your new health fund.

This is known as “portability” and is a rule set down by the Australian Government in the Private Health Insurance Act 2007. The portability rule only applies to hospital cover, but health funds usually waive the extras cover waiting periods too.

For example, if you are 9 months into a policy and decide to switch to comparable cover from a Members Own fund, your new fund will recognise the 9 months. This would mean that you’d still have 3 months to serve on hospital services such as pregnancy and joint reconstructions or for any pre-existing conditions. But the 2 month waiting periods for services like general dental and optical would be waived because you’ve already served them.

With health insurance there are no penalties or exit fees, like the kind you might find if you’re switching home loans or breaking a mobile phone contract.

The final step: shop around to get the best value for your health needs

The best way to ensure you’re getting the best combination of price and benefits is to compare policies and shop around. To save valuable time, you can use our online comparison service to do most of the work for you.

Call us on 1300 34 34 36, and we’ll help you find the best health cover for you from our panel of not-for-profit and mutual health funds.