Hoping to skip the queue with health cover? We’ll fill you in on all you need to know about waiting periods and how they may affect you.

One of the most important factors you need to consider when taking out private health insurance is the waiting periods. The fund’s waiting periods will determine how long you’ll have to wait before you can claim on certain benefits. Some waiting periods will vary from fund to fund and there’s different waiting times for services under hospital and extras cover.

Understanding what waiting periods are, the circumstances they may be applied and how long you may have to wait are all crucial when choosing a policy to suit your needs. Otherwise, you could end up with a big surprise when it comes time to make a claim.

In this guide we’ll take out all the confusion and share with you everything you need to know about waiting periods and how they may affect you.

What are waiting periods on private health insurance?

A waiting period on health insurance is the time you must wait before you’re allowed to take advantage of the benefits of your insurance policy.

Here are the three scenarios for waiting periods:

  • If you’re new to private health insurance, when you take out your first policy you’ll need to serve a waiting period, which can range from 2 months for extras benefits on dental and optical to 12 months for things like major dental and elective surgery.
  • If you’re already a member of a health fund, you won’t need to re-serve the waiting periods if you choose to switch to another health fund or a policy of lower or equal level of cover.
  • If you choose to upgrade your cover to a higher level, you’ll need to serve the relevant waiting periods. So if you choose to upgrade from a basic singles cover to a family policy that includes pregnancy, you’ll need to serve the waiting periods before any benefit will be paid to you for the procedure or service claimable under obstetrics.

To better understand why waiting periods are put in place and what the circumstances they may be applied, keep reading on. If you feel you’ve got a handle on the basics and you’re ready to compare the waiting periods and other health cover benefits, you can skip ahead and compare right now.

The Members Own comparison tool allows you to compare a range of options from 20 not-for-profit health funds in just a few minutes.

Our funds exist solely to give members more benefits and better coverage, while investing a higher percentage of your premiums to improve services and keep you happy. In fact, over one million Australians are already with one of our not-for-profit or mutual funds.

Why do private health funds impose waiting periods?

Health funds apply waiting periods to their policies to protect you as a member and the fund itself. That’s because waiting periods discourage people from joining a health fund with an existing medical condition, making a large claim and then cancelling their policy shortly after.

Not only can this behaviour cost the health fund financially, it will also impact every member of the fund. Premiums would likely increase and benefits may even be reduced to compensate. That simply won’t make health insurance appealing to anyone!

What are the waiting periods for hospital cover?

The maximum waiting periods health funds can impose for hospital cover are set by the Australian Government. This helps regulate the waiting periods to ensure it’s fair for everyone and no one is waiting an unreasonable amount of time for treatment.

The maximum waiting periods for in-hospital services include:

  • 12 months for pre-existing conditions
  • 12 months for obstetrics (pregnancy)
  • Two months for psychiatric care, rehabilitation or palliative care (even for a pre-existing condition)
  • Two months in all other circumstances requiring hospital admission.

While hospital waiting periods are pretty standard for most health insurers, many funds may waive the two-month waiting period for hospital treatment in the event of an accident.

What are the waiting periods for extras cover?

Unlike hospital cover, waiting periods for extras cover (sometimes called general and ancillary services) are typically determined by the individual health fund. This means the waiting periods for extras treatments will differ from insurer to insurer.

The Private Health Insurance Ombudsman does outline the general waiting periods for some extras treatments. Most funds will apply a two-month waiting period for services such as:

  • Optical

  • General Dental

  • Physiotherapy

  • Osteotherapy

  • Chiropractic therapy

  • Complementary
    therapies

Depending on the individual fund, you may have to wait up to 12 months for treatments such as major dental, and up to 36 months for hearing aids.

Comparing the policies from a variety of funds and paying close attention to the individual waiting periods applied will help you find a cover that suits your needs without any surprises.

Some funds are fairly inflexible on waiting periods, especially on those with a longer duration.

However, when you’re comparing funds you may notice some policies offer a health insurance waiting period waiver for general treatments. This means you’ll be able to claim on the relevant services immediately after joining.

These special promotions are a great way for health funds to attract new members. Typically, you’ll find more of these offers in the lead up to the end of the financial year in June or the end of March before the annual premium rate rise in April.

What are pre-existing conditions and how do they affect the waiting period?

Health funds impose a 12-month waiting period on any hospital treatment benefits for pre-existing conditions. This exists solely to prevent people with existing health complaints from claiming benefits shortly after signing up and then cancelling their policy once they’ve received treatment.

A pre-existing condition is defined as any ailment, illness or condition that you have had signs or symptoms of in the last 6 months before you’re joining a fund or upgrading your health cover.

The condition doesn’t necessarily need to be diagnosed to be deemed pre-existing. You also may not even be experiencing noticeable symptoms of the condition. It’s up to a health insurer appointed medical practitioner to make the decision on whether or not an illness was pre-existing.

You can read more about pre-existing conditions and how they may affect you here

If you have a pre-existing condition, it’s important to know that while you may have to wait 12 months before you can claim, you’ll be able to purchase any cover at the same price as every other person.

How do waiting periods affect pregnancy cover?

If you’re searching for a health insurance deal for pregnancy cover with no waiting period, you may be looking for a long time. That’s because almost all health funds enforce a strict 12-month waiting period for obstetrics cover.

If you’re considering starting a family and want to be treated in a private hospital during the birth of your child, you’ll need to plan to take out extras cover well in advance. Even if you’re already a member of a health fund and simply want to upgrade your cover to include obstetrics, you’ll still need to wait 12 months before you can be treated by a private hospital obstetrician and enjoy the comforts of your own hospital room.

It’s also important to check with your individual health fund that your newborn baby will be covered under your policy.

What about dental cover no waiting period?

Regardless of whether you’re choosing an extras cover or a stand-alone dental policy, you’ll have to serve the relevant waiting periods before you can claim the benefits of your dental treatments.

However, you may find a policy offering a special promotion that allows you to claim on any dental treatments that typically have a two or six-month waiting period. Generally, you’ll only be able to do this once.

Is there such a thing as no waiting period extras or no waiting period hospital cover?

While health funds do offer special promotions waiving the waiting periods from time to time, there’s no policy that offers no waiting periods as a standard feature.

Regardless of whether you’re choosing an extras or hospital cover, waiting periods will typically be applied to the benefits of the individual policy.

What happens to my waiting periods if I suspend my cover?

Planning an overseas holiday? Some funds may offer you the option to suspend your cover while you are overseas. If agreed, you’ll be able to remain a member of the fund, but won’t be paying the premiums for the duration you are away. This means more money to spend on travel and souvenirs and less on health insurance you won’t be using!

Because you’ll still remain a member, you’re waiting periods will be preserved. The time you’ve already served won’t be affected when you reactivate your health insurance. If you’ve only served part of your term, you’ll need to complete the remainder of your waiting period when you return from your travels before you can make a claim.

Each individual fund has different rules relating to suspending health cover, so it’s important you contact your own fund for all the details. If suspending your cover is agreed, most funds will require proof of your re-entry into Australia to reactivate your cover. A copy of your boarding pass or passport is typically required.

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What happens to the waiting period when I switch funds?

This is probably the most common questions health insurers get asked by new customers. If you’re considering switching health funds, any waiting period you’ve already served will be automatically waived if you’re switching to the same or lower level of cover.

For example, if you’ve already completed the 12-month waiting period for obstetrics benefits and want to switch to a fund offering better value, you won’t have to reserve this period again with your new insurer.

However, you may have to complete a waiting period with your new health fund if you:

  • Haven’t completed the entire waiting period

    If you’ve only completed some of your waiting period under your old policy, you’ll need to serve the remaining time before you can claim with your new fund.

    For example, if you’ve served 8 months of your 12-month major dental waiting period, you’ll need to wait another 4 months with your new health fund before you can claim the benefits.

  • Are upgrading your cover

    If you are upgrading your cover to include new or higher benefits, you’ll need to complete the relevant waiting period before you can make a claim.

    For example, if your previous cover didn’t include obstetrics and you upgrade to a policy with this feature, you’ll need to wait 12 months before taking advantage of the benefits.

Ready to take out health insurance or switch funds?

Now that you’re aimed with all the information about waiting periods, you’ll be able to compare all the details of the individual policies without any surprises.

By using the Members Own comparison service you can easily compare policies to find one that suits your individual needs

Our online tool takes out all the the stress of comparing insurance policies. Within minutes, you’ll be able to compare the policies of 20 not-for-profit health funds and find out which offer the best value for your individual needs and budget.

All you need to do is jump onto the online comparison site and within a few minutes, you’ll be presented with a range of policies that could see you enjoying the benefits of private health insurance in no time!

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If you have any questions or queries with your health cover or how waiting periods work, we have friendly staff who are all health insurance experts. You can call one of our team on 13 10 66.

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