Are you thinking about taking out a new private health insurance policy or increasing the level of cover you already have? You may be wondering if there are waiting periods for hospital cover and extras policies.
When you first join a health fund or upgrade your policy, you will typically incur waiting periods for private health insurance before you can claim your hospital and extras cover for the services you are gaining.
Waiting periods can vary between insurers but refer to the amount of time you’ll have to wait before claiming on your private health insurance policy.
We break down waiting periods for both hospital and extras, including when you may not need to serve waiting periods to claim on treatment.
Insurers have private health insurance waiting periods to make pricing fair for existing customers. Without waiting periods, people could sign up for cover and immediately claim on expensive hospital treatment (like joint replacement surgery) and then cancel their policy before paying anything substantial.
This would effectively allow anyone to access significantly discounted private health care, which would see higher premiums to compensate, impacting customers with increased costs.
Is it possible to use your private health insurance immediately?
You can use health insurance straight away if you have transferred to a new hospital or extras policy without a break in coverage, provided you have already served the applicable waiting periods for the service you are looking to claim on – even if you have served this period of time under a different provider before switching.
Keep in mind that if you are adding to or upgrading your existing hospital or extras cover, you will still be subject to waiting periods for the additional services you are gaining. However, you can usually switch to a lower level of cover with a new insurer if you have served waiting periods.
Some insurers may offer waiting period waivers as a joining offer on extras policies, allowing you to use extras health insurance straight away.
In some circumstances, health funds may have shorter or no waiting periods for cover for accidents. Other than that, funds won’t generally waive the waiting periods for hospital cover.
If there’s a certain feature of your health insurance policy you wish to claim on sooner rather than later, ask about the waiting periods that apply before you join. Or compare health insurance policies to review waiting periods.
Always check your policy document for applicable waiting periods.
Waiting periods can be as little as a few months for some hospital services, such as psychiatric care and rehabilitation, or can blow out to 36 months for extras procedures, such as hearing aids (with some funds).
Of course, other extras cover, such as general dental services and physiotherapy, often have a two-month wait, while many hospital procedures and major dental procedures such as denture treatment have a maximum waiting period of 12 months.
Private health insurance waiting periods can vary between providers and whether you opt for hospital cover or extras cover. So it’s important you clearly understand these wait times when signing up by reading the policy document carefully.
Waiting periods for hospital cover vary for the treatment you require and the fund you’ve got. The Private Health Insurance Ombudsman outlines the maximum limits for specific hospital benefits, but none last longer than 12 months.1 These include:
The waiting periods for extras cover, also known as general treatment or ancillary care, are set by each health fund and may vary between insurers.
The Private Health Insurance Ombudsman outlines some typical waiting periods for general treatment, as listed alongside hospital waiting periods in the table below.1
| 2 months | 6 months | 12 months | 1,2 or 3 years |
| Psychiatric care, rehabilitation, palliative care, post-natal depression, eating disorders, drug and alcohol rehabilitation (H) | Optometry, e.g. Glasses (E) | Pre-existing conditions (H) | Orthodontics and other high-cost procedures (E) |
| General dental (E) | Pregnancy and birth-related services, e.g. IVF, labour ward fees, private obstetricians (H) | ||
| Physiotherapy (E) | Major dental procedures, like crowns (E) | ||
| H= Hospital cover | E= Extras cover | |||
Insurers often hold promotions where they waive some of the extras cover waiting periods on combined hospital policies to encourage new members to join private health insurance.
Despite this, it is uncommon for insurers to waive 12-month waiting periods. For example, you may not need to serve waiting periods for general or preventative services like routine dental check-ups. Still, you will need to wait before claiming on major dental treatment, like root canals or denture care.
Depending on your policy, you may be able to use your private health cover in a public hospital. If your health insurer allows it, your cover can be used to pay for:
The Australian Government sets the maximum waiting periods for private health insurance hospital policies, which is why many health funds offer similar waiting periods.
Keep in mind that insurers can set their own fees below these caps and can also set prices for extras policies.
As you’re searching for cover, you may be wondering if health funds can waive waiting periods. While health insurance wait times can be waived in some circumstances on extras products, all health insurance offered in Australia will incur some sort of waiting period as a general rule. These times may vary between providers or the condition(s) you need covered.
Always check with your insurer for your wait times.
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There are two things people tend to ask about when we talk about waiting periods: pre-existing conditions and pregnancy.
Pre-existing conditions
There’s a 12-month waiting period for hospital cover relating to any pre-existing medical conditions you have (except psychiatric care and rehabilitation or palliative care for a pre-existing condition, where claiming on these services only requires a two-month wait). After that, you can claim for treatments outlined in your policy brochure. Pre-existing conditions aren’t taken into account when claiming on your extras cover.
Obstetrics treatment
You need to take out pregnancy cover at least 12 months before the confirmed expected due date to be covered. If you deliver your baby early and your waiting period isn’t over yet, be aware that health funds may not pay a benefit in most circumstances.
By sitting through the waiting period prior, you may enjoy your own private hospital room (if one is available) and choose your obstetrician. In addition to this, you may need to alert your health fund several months in advance that you intend to cover your newborn child on your insurance policy. Otherwise, they may not be covered from day one.
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When you switch health insurance policies, your health fund will carry across any waiting periods you’ve already completed for comparable (or lower) cover. For example, if you’ve already served the waiting periods for basic optometry benefits, you won’t have to do so again with your new health insurance policy. The only waiting periods you may be required to serve are:
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Moving overseas will affect your private health waiting periods. Speak to your health fund, who will decide if you are eligible to suspend your cover until you return. If you are, you won’t pay premiums while you’re overseas, but you won’t be able to claim on your policy while it is suspended. You will also be able to resume your cover upon your return. Remember, you will still be subject to any incomplete waiting periods.
You might need to provide proof of your return to Australia, depending on your fund. Be sure to check with any of your health fund’s requirements before you leave for your trip. If you are not eligible to suspend your cover, you can cancel and re-serve all waits when you return and rejoin.
Compare health insurance through our free comparison service today.
As General Manager for Health and Life Insurance at Compare the Market, Anthony Fleming is passionate about helping Australians better understand their health insurance. Waiting periods, for instance, need only be served once before you’re eligible to claim on your policy.
Anthony has close to 20 years’ experience in various roles across the health and general insurance industries. He’s also a Board Member of the Private Health Insurance Intermediaries Association.
1 Private Health Insurance Ombudsman – ‘Waiting periods for private health insurance’ Accessed 27/10/2021
2 Parliament of Australia – ‘Private Health Insurance Legislation Amendment Bill 2018 [and related bills]‘ – Accessed 27/10/2021
