Waiting is a necessary part of life. We wait in lines at the bank and grocery stores, we wait at the airport and in doctors’ rooms, and we eagerly await payday. At some point, we all have to wait for something we need.
The amount of time you have to wait before claiming on your insurance could have a significant impact on your health and bank account. All health cover policies have specific waiting periods applicable after joining; the time you have to wait before you’re able to claim any benefit.
We want to help you choose the right health plan with the shortest waiting period. Use our comparison tool to find private health insurance that suits your unique requirements. In this article, we’ll look at what waiting periods are and when they apply, as well as periods associated with pre-existing conditions.
The Federal Government requires health funds to provide all Australian residents with cover, regardless of their health status and prohibits them from charging higher premiums based on whether a person is more likely to require treatment.
However, the Federal Government have set maximum limits for certain hospital benefits, as per the Private Health Insurance Act 2007. This is because people could take advantage of the system by applying for hospital insurance or upgrading cover only when they need medical attention, and then cancelling once their claim has successfully been processed, which means insurers would have to charge higher premiums to offset increased claims payouts.
Because these periods can differ between health funds, it’s an important consideration when comparing health insurance policies.
The 3 Instances when waiting periods will apply:
Waivers for health insurance waiting periods
No waiting period health insurance is not available, however there are special circumstances under which private health insurers will waive waiting periods associated with general treatments. However, these are waived on a ‘case-by-case’ basis and are extremely rare, especially for pre-existing medical conditions.
Examples of when a health fund might waive your waiting period:
- As part of a promotion to attract new members. However, it’s important that you always check which waiting periods will still apply.
- Under certain medical emergency conditions, if for example you’ve been in an accident and require immediate assistance.
Waiting periods for hospital treatments and services
Hospital waiting periods are set by the Federal Government and thus strictly enforced. However, if you transfer from one health insurer to another without a break in cover, you do not need to re-serve the waiting period. Here’s what you need to know about hospital treatment waiting periods:
- Psychiatric and rehabilitation: If psychiatric illness or drug addiction is pre-existing you don’t have to wait the regular 12 months. You only need to wait 2
- Pregnancy: Almost all health funds enforce a 12-month waiting period, so if you’re planning to have children, you should buy obstetrics cover a minimum of 3 months before falling pregnant.
- Pre-existing conditions: If your health fund’s appointed medical expert determines that you have had a condition for a maximum of 6 months before buying your policy, it is considered a pre-existing condition and you will need to wait the mandatory 12 months before claiming any benefits.
- For all other general hospital treatments, there is a 2-month waiting period.
What is a benefit limitation period?
Some health funds impose a benefit limitation period, but by law, it will not be applied if you are transferring from an existing hospital policy to one that has the same waiting period, or to another insurer with the same level of cover and the same waiting period.
You also have the option to select a hospital cover policy with one (or more if you choose) benefit limitation periods in exchange for a lower premium. Consider this decision very carefully, because you will be subject to increased risk. For example, if you choose lower benefits on pregnancy-related services and then fall pregnant within the benefit limitation period, you could jeopardize your personal finances by receiving less money back and therefore paying more out of pocket.
Be aware that when a waiting time applies for a particular condition or treatment, then the healthcare fund might only kick the benefit limitation period into gear from the end of the initial waiting period. For example, if the period is 12 months and your benefit limitation period is two years, then you will NOT receive full benefits for three years from when your membership commences. That’s three years of paying premiums without being able to claim a full benefit back.
Check with your insurer and make sure you are aware of the implications of benefit limitation periods in your health cover policy before deciding to go with this option.
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Each private health insurance fund is free to set their own waiting periods for the extras healthcare services that they offer. Examples of typical waiting periods are:
- General dental services and physiotherapy: 2 months from the start of your policy.
- Eye care, like prescription glasses or contact lenses: 6 months from the start of your policy.
- Major dental procedures, like crowns or bridges: 12 months from the start of your policy.
- Certain high-cost procedures, like orthodontics: 1, 2 or 3 years from the start of your policy.
If you transfer from one health insurer to another, most health insurers will not require you to re-serve many waiting periods. However, loyalty limits and accrued benefits don’t necessarily transfer between insurers. This is something that you must check with your insurer.
Because waiting periods vary significantly between insurers it’s important you compare the different health funds to see which one suits you best.
Waiting periods for pre-existing conditions
These pre-existing conditions don’t need to have been diagnosed in the six months before you joined the health fund, but signs or symptoms are counted as evidence that it existed. It’s important to note that a pre-existing condition is NOT determined by yourself or your GP; it is the health insurer’s appointed medical practitioner that determines whether an ailment, illness or condition is pre-existing.
A condition, like cancer, obesity, and diabetes can still be classified as pre-existing even if you weren’t aware you had it before joining or upgrading to a higher policy.
Waiting periods for pregnancy cover
The general waiting period for pregnancy cover is12 months. Pregnancy treatments excluded during this period are:
- In vitro fertilisation (IVF) treatment and other reproductive services.
- Hospital accommodation.
- Theatre/labour ward fees.
- Intensive care relating to the birth, or post-birth for the mother
- Pharmacy services administered in hospital.
- 100% of the Medicare Benefits Schedule fee for doctor fees (75% Medicare + 25% fund)
Even in the case of an unplanned pregnancy, the 12-month waiting period will still apply. Therefore, it is really important to consider getting health insurance that includes cover for pregnancy if there is even the slightest chance that you could become pregnant.
IVF and assisted reproductive services
In vitro fertilisation (IVF) treatment and other reproductive services have a standard waiting period of 12 months. However, there are some policies that restrict benefits for these services for up to three years. Make sure your policy covers IVF and other assisted reproductive services before signing. If you do have cover, check with your fund to confirm which services you will need to pay for and if there are any required waiting periods.
What is the waiting period for dental insurance?
The dental insurance waiting periods include:
- 2 months for general dental services.
- 12 months for major dental procedures, like crowns or bridges.
- 1, 2, or 3 years depending on the insurer for certain high-cost procedures, like orthodontics.
Before choosing a policy, shop around and read company reviews to know exactly what they’re offering. If you already have a policy, make sure you know what you’re covered for and whether you’re receiving true value for money.
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