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What Are Waiting Periods in Health Insurance?

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Every health insurance provider in Australia will make you serve a waiting period if it’s your first time taking out private health
You cannot claim money back from your provider until you’ve served the waiting period (anywhere from 2 months to 12 months)
All hospital policies have the same waiting periods but extras vary depending on your health fund.
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Every health insurance provider in Australia will make you serve a waiting period if it’s your first time taking out private health
You cannot claim money back from your provider until you’ve served the waiting period (anywhere from 2 months to 12 months)
All hospital policies have the same waiting periods but extras vary depending on your health fund.
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WANT TO SKIP THE QUEUE WITH HEALTH COVER & TAKE OUT PRIVATE HEALTH WITH NO WAITING PERIOD? HERE’S ALL YOU NEED TO KNOW.

When it comes to private health insurance, it's essential to understand waiting periods to make informed decisions and avoid any surprises when making claims.

Waiting periods

Refer to the duration you must wait before you can start enjoying specific benefits provided by your insurance policy. These waiting periods can vary between different insurance providers and also depend on whether you are considering hospital cover or extras cover.

Hospital cover waiting periods

Hospital cover waiting periods typically apply to services like surgeries, treatments, and hospital stays. These waiting periods ensure that you have been an active member of the private health insurance fund for a certain period before you can access these services. The waiting periods for hospital cover can range from a few months to several years, depending on the treatment or procedure.

Extras cover waiting periods

On the other hand, extras cover waiting periods usually apply to services such as dental, optical, physiotherapy, and other ancillary treatments. These waiting periods ensure that you have been a member for a specified time before you can claim benefits for these services. Waiting periods for extras cover are generally shorter than hospital cover waiting periods and can range from a few weeks to a few months.

Why waiting periods matter when choosing a health insurance policy

When choosing a private health insurance policy, it's crucial to consider the waiting periods associated with the benefits you anticipate needing. If you require immediate access to certain services and want to skip the public hospital and healthcare queue, you may consider private health insurance options that offer no or reduced waiting periods. However, it's important to remember that such policies may have higher premiums or other conditions attached.

On this page, you’ll find everything you need to know about taking out health insurance cover for the first time and how to find the right provider for you.

Take charge of your healthcare today with a health insurance policy that suits your needs. Use our simple comparison tool to find your perfect health fund provider.

WHAT ARE WAITING PERIODS IN 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.
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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 as part of a health insurance policy are:

  • 12 month wait for pre-existing conditions
  • 12 months for obstetrics (pregnancy)
  • Two months for hospital psychiatric services/mental health, rehabilitation or palliative care (even for a pre-existing condition)
  • Two months in all other circumstances requiring hospital admission or medical treatment

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 health insurance 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 outlines the general waiting periods for some extras treatments. Most funds will apply a two-month waiting period for services such as dental treatments, optical services, physiotherapy, chiropractic consultations, podiatry, and psychology.

Optical Optical
General Dental General Dental
Physiotherapy Physiotherapy
Osteopathy Osteopathy
Chiropractic Chiropractic
Complimentary therapies Complimentary 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 of a longer duration.

However, when you’re comparing health insurance cover, you may notice some policies offer health insurance with no waiting period 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.

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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 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 is 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 an obstetrician in a private hospital 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, your 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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Who needs cover?

Single Male Single Female Couple Family Family (Single Parent)

What happens to the waiting period when I switch funds?

This is probably the most common question health insurers get asked by new customers. If you’re considering switching health funds and taking out a new policy, any waiting period you’ve already served will be automatically waived if you’re switching to the same or lower level of cover (this might not be applicable if you're switching to a higher 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 wait 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 know all about waiting periods, you're ready to dive into comparing policies with complete confidence and without any unexpected surprises.

With the help of Compare Health Insurance Compare Health Insurance, finding a policy that perfectly suits your unique needs becomes a breeze. Our user-friendly online tool takes away all the stress associated with policy comparisons.

Within minutes, you can assess and compare the offerings from various health funds, ensuring you discover the ideal coverage that provides excellent value for your needs and budget.

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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 1300 806 119

FAQs

Is it possible to find private health insurance with no waiting period for hospital & extras cover?

Yes, some private health insurance providers offer policies with no waiting period for hospital and extras cover. These policies allow you to access benefits immediately after joining.

What is the difference between hospital and extras cover in private health insurance?

Hospital cover typically includes expenses related to in-hospital treatments, surgeries, and accommodation. An extras policy, on the other hand, provides benefits for out-of-hospital services like dental, physiotherapy, and optical care.

How does the government rebate work for private health insurance?

The government rebate is a financial incentive provided by the Australian government to help individuals with the cost of private health insurance. The rebate amount is based on factors such as income, age, and family status. It can be claimed as a reduction in premiums or as a tax offset when lodging your tax return.

What are out-of-pocket costs in private health insurance?

Out-of-pocket costs are expenses that you need to pay directly, even if you have private health insurance. These costs may include deductibles, co-payments, or the difference between the actual cost of a service and the amount covered by your insurance.

Who is eligible for private health insurance in Australia?

Generally, anyone can purchase private health insurance and relevant health services in Australia. There are no specific eligibility criteria based on age or employment status. However, certain visa holders may have specific requirements for health insurance.

What’s the difference between Lifetime Health Cover Loading (LHC) and the Medicare Levy Surcharge?

Lifetime Health Cover (LHC) loading is a financial loading imposed on individuals in Australia who don't have private hospital cover before the age of 31. It increases their health insurance premiums by 2% for each year they are aged over 30 when they first take out hospital cover, up to a maximum of 70%. The loading is in place for ten consecutive years but can be removed if continuous hospital cover is maintained. On the other hand, the Medicare Levy Surcharge (MLS) is an additional tax applied to high-income earners who don't have private hospital cover. It aims to encourage individuals to obtain private health insurance and lessen the strain on the public Medicare system.