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Waiting Periods for Health Insurance Cover

Sally Aquire January 17th, 2012 0 comments
Health insurance waiting periods

If you’ve not previously seen the need to compare private health insurance, you may not be aware of waiting periods. When you first join a private health fund, you’ll need to serve waiting periods before you’re eligible to claim benefits.

This may seem unfair, but it is in place to ensure that there is no possibility to make large scam claims straight after becoming a health fund member. Preventing such claims is in the best interests of everyone as it could otherwise increase the costs of premiums. Here is an overview of typical waiting periods and how they affect your private health insurance.

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How long can I expect to wait?

Waiting periods may vary between health funds, but there are some maximum time frames set by the Australian government. For pre-existing conditions and pregnancy/birth-related health care, the maximum waiting period is twelve months, so if you’re planning to start a family in the near future, be sure to arrange pregnancy-related benefits some time in advance. For psychiatric care, rehabilitation and palliative care, the maximum waiting period is two months, even if it relates to a pre-existing condition.

Knowing what constitutes a pre-existing condition can be confusing but if you’ve had symptoms in the previous six months before joining a health fund, you’re usually deemed to have a pre-existing condition, and this can be the case even if no official diagnosis has taken place. If in doubt, your health fund can advise you further on what they consider to be a pre-existing condition.

Beyond this, the waiting periods for general treatment (e.g. ancillary and extras benefits) are determined by the health funds themselves so be sure to check with your health fund to see what their specific waiting periods are.

If you’re involved in an accident which requires medical treatment after joining a health fund, waiting periods won’t usually apply.

What happens if I switch health insurance?

As long as you have already served your waiting periods, you should not need to serve them again if you switch to a different health fund without any break in coverage. However, if you upgrade your coverage to a policy with higher benefits, you’ll need to serve waiting periods for these benefits before you’re able to make a claim.

Benefit limitation periods

You can often get cheaper private health insurance if you choose to have benefit limitation periods. These work like extended waiting periods for certain benefits. For example, if you arranged a two year benefit limitation period for a specific benefit, it would be two years before you could claim for that benefit. If an initial waiting period is also needed, the two year benefit limitation period would usually exist on top of that.

When you’re looking to compare health insurance, don’t forget to think about waiting periods. While the maximum waiting periods for some services are dictated by the government (e.g. pre-existing conditions, pregnancy/birth-related benefits and psychiatric care), health funds are free to set their own time frames for general treatment so you’ll want to look at the variations in this when you compare health cover.

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

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