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Last Updated on 24 February 2019

Private Health Insurance Waiting Periods for Pre-Existing Conditions

When you set out to compare private health insurance policies, you don’t want to think about some conditions not being covered by the policy you’re paying for.  After all, you don’t want to fork over payments each month for nothing.

But the reality is that certain ailments are counted as “pre-existing conditions,” and there is a waiting period before your insurance will pay for any treatment involving a pre-existing condition.  Your guide to pre-existing conditions and the waiting periods that result is below.

What defines a pre-existing condition?

A pre-existing condition is one with signs or symptoms occurring during the six months before you purchased your health insurance.  Even if you did not receive treatment for the ailment, it can still be classed as a pre-existing condition if signs and symptoms were present.

Why are there waiting periods?

Waiting periods exist to prevent a person who knows they need treatment from purchasing health insurance, getting treatment, and then dropping coverage.  Why? Because this type of “cheating” would result in higher premiums for people still insured by the company.

How long is the waiting period?

Waiting periods vary for different medical conditions. The maximum waiting period for pre-existing conditions is 12 months.  However, the waiting period for psychiatric care is only 2 months, even with a pre-existing mental health condition.

Will the waiting period apply to me?

The good news is that if you’ve had your current insurance policy for more than 12 months, you are definitely out of the waiting period.  If you’ve had your policy for less than 12 months, you’ll need to know if your ailment is considered a pre-existing condition or not.  Injury or treatment needed due to an accident that occurs after joining, though, generally cannot be counted as pre-existing, so no waiting period applies.

What if I increase my health insurance coverage?

If you stay with the same insurer and increase your level of coverage, you’ll still have to serve the waiting period for any pre-existing conditions before you can receive your higher level of benefits.  Your old level of health insurance benefits will still fully apply during the waiting period.

What if I switch to another insurance provider?

If you switch to a different insurance provider but stay at the same level of coverage, you should be able to avoid any waiting periods.  As long as you had already served the full waiting period under your old insurer, you should be able to switch to the new insurer without serving a second waiting period.

What if I need to go to hospital?

If you are still within the waiting period and you are going to need treatment in hospital for an ailment, contact your insurance provider as soon as possible.  They will need at least a week to tell you whether the condition is counted as pre-existing or not.  The more advance notice you can give, the better; it will give you time to plan for treatment if your insurance won’t cover you yet.

Although waiting periods for coverage are certainly no fun, it still pays to buy private health insurance.  After all, once your waiting period has been served, it is over for as long as you stick with the same level of insurance.  The security of full coverage is worth the wait.

Disclaimer: The above information is correct and current at the time of publication

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