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Waiting periods explained

4 min read
Summary

Author: Compare Club

Overview

Although it can be frustrating having to wait a certain amount of time for a procedure, waiting periods exist so people aren’t able to join or switch and take out expensive cover only when they need a specific treatment. If these waiting periods didn’t exist, health cover would be more expensive for everyone. Waiting periods exist for both hospital and extras cover, but health funds sometimes offer to waive a few of them to attract new customers.

Key Points

  • Some funds offer deals that waive selected waiting periods when you join.

  • If you switch to a policy with equivalent or lesser benefits, you don’t need to serve new waiting periods.

  • Top tier items like pregnancy cover or orthodontics generally come with a 12 month waiting period.

Why does health insurance have waiting periods?

Waiting periods are designed to stop people from joining a fund, making expensive claims, and then cancelling their membership. Essentially, waiting periods aim to keep the cost of private health cover affordable for everyone.

What are the waiting periods for hospital cover?

Waiting periods are different for hospital and extras cover. Hospital waiting periods are set by the government. Current hospital waiting periods are:

  • 12 months for pre-existing conditions.

  • 12 months for pregnancy and birth services.

  • 2 months for psychiatric, rehabilitation and palliative care, including pre-existing conditions (waiting periods for psychiatric treatment can be waived for a cover upgrade once in your lifetime^).

  • 2 months for other services.

What are the waiting periods for extras cover?

Unlike hospitals, health insurers are free to set their own waiting periods on extras cover. Examples of typical waiting periods are:

  • 2 months for general dental and physiotherapy*

  • 6 months for optical purchases, including glasses and contact lenses*

  • 12 months for major dental treatment such as crowns and bridges*

  • 1-3 years for high-cost procedures such as orthodontics*

How long do you need to hold private health insurance before claiming?

This depends on the waiting periods outlined in your policy. With the exception of ambulance cover, you generally need to wait a minimum of two months to start claiming basic services. Maximum waiting periods vary depending on your fund, but our experts at Compare Club can help you find what you need from your policy.

Can health funds waive waiting periods?

Yes. Keep an eye out for promotions where health funds waive waiting periods on certain services. Waiving two and six-month waiting periods on extras is quite common to attract new members, particularly in the lead up to the annual health insurance premium rate increases between April-October. In such cases, waiting periods for pre existing conditions may still apply. Compare Club’s team are experts at finding funds with special offers to waive waiting periods.

What if I go to the hospital before my waiting period is up?

You generally won’t be able to claim for services where you haven’t served the waiting period. Whatever your policy, be sure to contact your insurer straight away to see if you’re entitled to any hospital benefits.

Can waiting periods for pre-existing conditions be waived?

Generally, no. Waiting periods for pre-existing conditions are rarely waived. 

Can waiting periods for pregnancy and birth-related services be waived?

It’s rare for insurers to waive waiting periods on pregnancy and birth. However, the maximum waiting period for obstetrics is 12 months. If you’re planning on having a child and want to be covered, it’s best to organise your health insurance when you’re at the very early stage of family planning. 

How can I find health insurance with no waiting periods?

While you’re unlikely to find health cover with no waiting periods at all, the best way to find a policy to suit your needs is to compare your options.

Do I have to re-serve waiting periods if I switch funds?

If you switch from one private health insurance policy to another, you don’t need to serve new waiting periods for policies with an equivalent or lower level of benefits. Our specialists at Compare Club do our best to make sure you don’t have to serve new waiting periods when you switch your cover. Over the last 5 years, we’ve saved our customers an average of $300** off their annual health insurance cost when they switched policies through us.

This guide is an opinion only and should not be taken as medical or financial advice. Check with a financial professional before making any decisions. Compare Club does not compare all policies or all insurers in the market. 1. PrivateHealth Gov, Waiting Periods, accessed September, 2023. 

2. PrivateHealth Gov, Mental Health waiting period exemption for higher benefits, accessed September, 2023.

3. Commonwealth Ombudsman, Waiting periods for health insurance, accessed September, 202s. 

4. Based on 136,746 customers between 1 Jan 2018 – 23 December 2022.

^Privatehealth.gov.au, Waiting periods, mental health.

*Commonwealth Ombudsman, Waiting periods for private health insurance, accessed.

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Author: Compare Club Overview Although it can be frustrating having to wait a certain amount of time for a procedure, waiting periods exist so people aren’t able to join or switch and take out expensive cover only when they need a specific treatment. If these waiting periods didn’t exist, health cover would be more expensive for […]