Waiting Periods: What Are They?
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Waiting Periods: What Are They?

Katie Douglass

Katie Douglass

26/03/2021 • 5 minute read

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When taking out private health cover for the first time or upgrading your policy, you might have to wait a certain period of time before you can make a claim. This is what’s known as a waiting period.

In this guide, we give a rundown of waiting periods including how long they are, how you might be able to waive them, and plenty more.

What is a waiting period?

A waiting period refers to the set amount of time you have to wait before you can make a claim on a service or treatment. Generally, waiting periods apply when you’re taking out private health insurance as a new member, switching to another health fund, or increasing your level of cover.

The amount of time you have to wait will depend on the insurance provider, type of cover (i.e. extras or hospital), and the treatment you’re wanting to claim a benefit for.

Example:

Let’s say you’re currently experiencing chronic back pain and want to seek regular treatment from a physiotherapist. As a result, you decide to take out private health insurance to help cover the costs. However, you’ll likely have to wait two months before you can make a claim for physiotherapy treatment.

Why do private health insurers have waiting periods?

In a nutshell, a waiting period protects health insurance providers and their members. If they didn’t exist, people could sign up for private health cover, make an expensive claim, and then cancel their policy straight away. This would result in higher premiums for existing policyholders as insurers wouldn’t have enough money to cover claims. Ultimately, waiting periods ensure private health cover is fair for everyone.

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Did you know?

In Australia, it’s illegal for insurers to charge you a higher premium based on your health status and how likely you’ll need treatment. This is because, unlike life or car insurance, private health insurance is a ‘community rated’ system, not ‘risk rated’.

How long are waiting periods?

From two months to three years, waiting periods can vary depending on the insurance provider and type of cover you’re taking out. Before taking out a policy, it’s important to check with your insurance provider how long you’ll have to wait before you can make claims.

Hospital cover

For hospital cover, the Australian government sets the maximum waiting periods that health insurance providers can apply. Below, we’ve put together a handy table of the maximum waiting times insurers can set as outlined in the Private Health Insurance Act 2007:

12 months for pre-existing conditions For pre-existing conditions, the maximum waiting period is 12 months. According to the Private Health Insurance Ombudsman, a pre-existing condition is defined by law as:

“Any condition, illness, or ailment that you had signs or symptoms of during the six months before you joined a hospital policy or upgraded to a higher hospital policy”

Generally, the health insurer will appoint a medical practitioner to determine if you have a condition that is considered pre-existing. It’s important to remember that a condition can still be considered pre-existing even if it hadn’t been diagnosed prior to taking out cover.

12 months for pregnancy and birth (obstetrics) There is a 12 month wait for hospital cover in relation to pregnancy and birth (obstetrics). Given the general length of pregnancy is nine months, you’ll need to consider taking out obstetrics cover before you fall pregnant. After you complete the waiting period, private health cover can give you more flexibility and care options. For example, you might be able to get a private hospital room and choose your own doctor.
2 months for palliative care, rehabilitation, and psychiatric care For palliative care, rehabilitation, and psychiatric care, there is a 2 month waiting period (even if they are considered a pre-existing condition).
2 months for other circumstances There is a 2 month waiting period for other circumstances not outlined above.

What if you have an accident?

Generally, waiting periods on hospital cover don’t apply if you have an accident not related to a pre-existing condition.

Extras

For extras cover (also known as ancillary or general treatment), waiting periods are determined by the health insurers themselves. As a result, they can vary significantly between insurance providers.

To get an idea of how long you might have to wait for extras, here are some typical waiting times:

    • 2 months: general dental and physiotherapy
    • 6 months: optical items (glasses or contact lenses)
    • 12 months: major dental procedures
    • 1, 2, or 3 years: orthodontics

Can I get health insurance with no waiting periods?

Generally, all health insurers have waiting periods when you take out cover as a new member, or when you add to or upgrade your policy. However, there are some circumstances in which you might have a shorter or no waiting period:

Switching to a new health fund

When you switch your current health fund over to a new one, any waiting periods you’ve served for extras cover might be carried over. For example, if you’ve completed four months of a six month waiting period for a certain benefit, you might only need to complete the remaining two months. Keep in mind that for extras cover, insurers aren’t required by law to honour your old waiting periods.

According to the Private Health Insurance Ombudsman, when you switch health funds without a break in cover, you don’t need to restart waiting periods you’ve served for hospital cover. It’s important to note waiting periods are rarely waived for pre-existing conditions, obstetrics, or major dental.

Joining offers

To attract new members, some insurers offer to waive waiting periods on extras cover if you sign up and take out a combined hospital and extras policy. If you want to take out or upgrade your cover, it’s worth keeping an eye out for these promotions. However, it shouldn’t be the only factor to consider when choosing a policy.

Learn more about health insurance

Here at Oiyo, we’re all about making your financial decisions easier by equipping you with helpful articles and guides. If you enjoyed this article and want to learn more about health insurance, make sure to check out some of our other articles.

Whether you want to learn more about extras cover, discover the latest health insurance offers, or get a rundown of what private health insurance covers, we’ve got plenty of useful reads on offer.

Oiyo is a consolidated online resource, we are not financial advisors. We work with a range of industry professionals and compliance check our articles to ensure factual accuracy. However, we do not provide professional financial advice. Consider seeking independent legal, financial, taxation or other advice to check how the information and ideas presented in this article relate to your unique circumstances.


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Katie Douglass

Written by Katie Douglass

Katie Douglass is the Communications Manager at Oiyo and a writer. In recent years, Katie's work has appeared in publications such as Marie Claire, InStyle, and THE ICONIC. She has a Bachelor of Creative Industries in Fashion Communication & Journalism from the Queensland University of Technology. At Oiyo, Katie is responsible for overseeing editorial strategy.

More about Katie Douglass

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