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Waiting Periods in Health Insurance

Megan Fraser Fact Checked Updated: 27 November 2023
Types of Health Insurance

Worried about waiting periods for private health insurance? We understand that it can be confusing to figure out how long you have to wait before your policy kicks in. We’ve put together this guide to help you understand the different waiting periods for various treatments in both Extras and Hospital cover. With this information, you can avoid paying out of pocket for treatments and get the coverage you need.

Waiting periods generally last from two to 12 months, depending on your level of coverage, treatment, and insurance company. Remember to review your private health insurance policy and the relevant waiting periods to ensure you receive the healthcare treatment you need without paying out-of-pocket costs.

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What is a waiting period?

Private health insurance policies have specific waiting periods that apply when you take out a new policy, increase your Hopsital or Extras cover level or go overseas. These time frames let the insurer know how long it will take before benefits are given for certain medical services and treatments.

The Private Health Insurance Act 2007 sets maximum waiting periods that insurers can prescribe for all coverage. However, these are usually fixed by your insurer and apply not only for Hospital cover but also Extras such as procedures or treatments associated with a specific episode of illness/injury. This means you could be delayed from receiving care if it’s not urgent enough.

Why are waiting periods for private health insurance?

Health insurance companies have a waiting period before allowing you to sign up for their product, claim the benefits and leave without paying anything. It doesn’t seem fair when other members who are just trying to contribute money can get in right away. If everyone only signed up for health insurance when they needed something serious treatment, premiums would skyrocket, and nobody would be able to afford private health insurance anymore. So how do providers keep things affordable? They use waiting periods to encourage people who might want Hospital cover and will pay for it regardless.

Can I get health insurance with no waiting period?

No, every private health insurance company and policy generally has relative waiting periods. However, there are certain ways to get around waiting periods when signing up with a new insurance provider. If you switch private health insurance plans, the waiting period for Hospital cover might be avoided.

This is because if there was no gap in your coverage and both plans offer roughly comparable benefits, then it’s possible to shorten or even bypass the waiting periods stage of settling into a new policy.

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

Contact your health insurance provider as soon as you know you may not be able to serve your waiting periods in time. It’s important to check if they cover hospital benefits and the limits of those payments because it will save time if something goes wrong with treatment or medication later on.

Your insurer should then send you the documents your hospital requires to process you. You will need to fill this in, and your insurer will get the health fund doctors to review the information and decide whether it is a pre-existing condition and the treatment can continue. If you go to hospital for emergency treatment, you may not hear back from your insurer in time and will have to process the claim and information at a later stage.

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What are the waiting periods for Hospital cover?

The waiting period for some hospital services under Hopsital cover can be as little as a few months, while others may require more than one year. The Private Health Insurance Ombudsman outlines the maximum limits for specific hospital benefits, but none last longer than 12 months.

Waiting periods for Hospital cover include:

  • Pregnancy and birth: 12 months
  • Psychiatric treatments, rehabilitation or palliative care, even for a pre-existing condition: 2 months
  • All other circumstances: 2 months

What are the waiting periods for Extras cover?

Health insurance providers decide how long you have to wait for care under Extras cover, like dental surgery or physiotherapy. Below are the general waiting periods for specific treatments:

Who is exempt from Waiting periods?

Psychiatric care is now available to you without a further waiting period. This only applies if your last psychiatric benefit was claimed after two months of enrolling in the programme. You can use this benefit at any point in time, but it can only be applied once in your lifetime. However, if you upgrade your policy, you will not have to use this once-only exemption unless you claim higher benefits.

Frequently Asked Questions and Answers

  • What are waiting periods in health insurance?

    When you apply for a private health insurance policy with specific waiting periods, the length of time before coverage starts is important. A waiting period is the amount of time you will have to wait before being able to claim back for that specific treatment. Generally, waiting periods last between two and 12 months. Once you have served these waiting periods, you will be able to receive the benefits and claim back.
  • Can health insurers waive waiting periods?

    Generally, health funds have set waiting periods before they will cover you. However, some may waive or shorten these depending on what promotion it is and if there’s been an accident with your plan in mind. With the exception of twelve-month waiting periods for pre-existing conditions and obstetrics, major dental treatments are rare inclusions on health insurance plans. It’s always worth checking with your fund before scheduling any procedures, as you may have to cover all costs out-of-pocket if they aren’t covered by an employer or private plan that provides benefits through work.
  • What is 4 year waiting period in health insurance?

    When you enrol in a health insurance policy, there is often an initial waiting period before coverage begins. This cooling-off period allows the company to review your medical history and determine whether or not they will cover any pre-existing conditions present at enrollment. For instance, 4 years has been found as one common length of stay allotted towards addressing this concern among customers who purchase policies through providers.
  • Is it possible to use your health insurance immediately?

    Generally, no, you’ll need to complete all waiting periods before making use of your health insurance cover. If you change insurers and purchase a similar policy with the same level of cover without taking any breaks in-between, it will be covered immediately upon switching over. However, there might still be some waiting periods depending on what kind of Extras products were added to your old hospital plan, which would need time before being able to use those benefits again after completion.
  • What is the waiting period for dental insurance?

    The length of time you have to wait before receiving dental care can vary depending on the provider and procedure. For example, general dentistry patients should be prepared for a 2-month waiting period. At the same time, major treatments such as crowns or bridges may require 12 months’ worth in order to serve their necessary healing process properly without any complications. Costly procedures such as orthodontics may have a 1, 2 or even 3-year waiting period depending on the insurer
  • Why is there a waiting period for pre-existing conditions?

    Health fund members who stay up to date on their payments end up covering the cost of those that claim and leave, which results in higher fees for all members. There are waiting periods before pre-existing conditions that prevent members from claiming and leaving without the payment of premiums.
  • How long is the waiting period for pre-existing conditions in health insurance?

    Hospital policyholders will be entitled to the lower benefits for pre-existing conditions in their first 12 months as a member. If you upgrade your policy, you will still receive the lower benefits until you’ve served your initial waiting period. After completing any waiting period on your new higher level of coverage, you’ll have access to upgraded service levels tailored specifically toward meeting your needs.
  • What are the waiting periods for psychiatric and rehabilitative care?

    There’s a 2-month waiting period for all psychiatric services, but if you are upgrading your existing hospital cover to include mental health benefits, then there might be an exemption. If you upgrade your policy, you will still receive the lower benefits until you’ve served your initial waiting period. After completing any waiting period on your new higher level of coverage, you’ll have access to upgraded service levels tailored specifically toward meeting your needs.

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