Waiting Periods for Health Insurance

When you join health insurance, you may need to wait some time before certain benefits become available to you. This is to protect all the members of health funds by ensuring that noone takes advantage of the system by making a large claim directly after joining, and then dropping their health cover when the claim has been paid.

What are the current waiting periods?

Waiting periods are set by the health funds, but the Australian Government sets maximum waiting periods for certain hospital benefits:

• 12 months for pre-existing conditions
• 12 months for pregnancy and birth-related services
• 2 months for psychiatric care, rehabilitation or palliative care, even for a pre-existing condition
• 2 months in all other circumstances

Generally there is no waiting period for medical treatment that results from an accident that occurs after you join your health fund.

What are benefit limitation periods?

Benefit limitation periods are offered by the health funds to reduce your health insurance premium, and operate like extended waiting periods.

For example, you may be able to get a cheaper health cover if you opt for one with 2 year benefit limitation periods on certain features, like hip joint replacement. This means that after the intial waiting period has been served (12 months for pre-existing conditions, 2 months in most other cases), you will need to wait another 2 years (or however long the benefit limitation period is) before you can receive full benefits on those features.

You should read the policy documents for specific information on benefit limitation periods for your health insurance policy, and keep in mind that they do not apply if you're switching health funds.

What about when I switch health funds?

When you switch health funds, any waiting periods you have already served with your previous health fund are waived by your new health fund, as long as the benefits are of equivalent or lesser value. Circumstances in which you may be required to serve a waiting period include:

• If your original waiting period has not been completed (eg. if you have served 9 months for a benefit that has a 12 month waiting period, you will need to complete the remaining 3 months with your new health fund); and
• If your new health fund offers higher benefits (i.e you can claim up to the equivalent value applicable under your old health cover, but the higher benefits won't apply until the full waiting periods have been served with your new health fund).

In the case of benefit limitation periods, they will not apply if you are switching health funds.

New-born children

If you want cover for a new-born child but are covered under a single membership, you'll need to transfer over to a single-parent or family membership several months before your child is born. Different health funds have different requirements so please check with your health fund beforehand.

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