Private health insurance waiting periods – what are they?

Before you can start claiming your Hospital and Extras cover you need to understand what waiting periods are applicable. This can help determine what the best health insurance policy is for your circumstances as waiting periods will vary by fund (and even their offers).

A waiting period is the initial period of health fund membership during which no benefit is payable for certain procedures or services. So for example, if you have no health insurance policy and you tear your ACL joint it’s highly unlikely that you will be able to join a health fund and immediately be covered for this injury. Instead for such treatments, there are often up to 12 month waiting periods.

Bronze Hospital & Bronze Extras Set Benefits

Entry level hospital cover. Includes preventative dental and optical.
$ 20.35
per week
Select

Bronze Hospital & Silver Extras Set Benefits

Entry level cover. Cover for a range of popular services that suit your lifestyle.
$ 24.35
per week
Select

Silver Hospital Plus & Bronze Extras Set Benefits

Moderate cover. Includes private hospital with some exclusions. Includes cover for preventative dental.
$ 29.90
per week
Select

Bronze Hospital & Bronze Extras Set Benefits

Entry level hospital cover. Includes preventative dental and optical.
$ 20.35
per week
Select

Bronze Hospital & Silver Extras Set Benefits

Entry level cover. Cover for a range of popular services that suit your lifestyle.
$ 24.35
per week
Select

Silver Hospital Plus & Bronze Extras Set Benefits

Moderate cover. Includes private hospital with some exclusions. Includes cover for preventative dental.
$ 29.90
per week
Select

* The price shown is per week and applies to a Single living in VIC with a $500 excess. It excludes LHC loading and includes a Base Tier Government Rebate

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*For new health insurance members on direct debit. Must pay first month to be eligible. Prize does not include flights or transfers. Promotional period 4 August 2017 – 24 September 2017. Valued at $1000. view full terms and conditions.
NSW Permit No. LTPS/17/16360
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For hospital cover most funds have a minimum two month waiting period (especially for services such as psychiatric care, rehabilitation or palliative care and;

  • A twelve month wait for any benefits for pre-existing conditions
  • A twelve month wait for benefits for obstetric treatment.

Extra’s cover also in most cases has a minimum two months waiting period (for example a dental check-up) and;

  • A six month waiting period on optical, home and domestic aids and medical aids
  • A twelve month waiting period on major dental services including dentures, orthodontics, surgical extractions, crown and bridgework, endodontic services
  • A twelve month wait on health appliances, prostheses, podiatry surgical procedures and orthotic appliances.

If you need immediate treatment for an extra’s element (eg major dental) then it may be worth comparing health fund offers. The best health insurance policy in this case may have a special offer that has no waiting period for such claims which means you don’t have to delay your treatment. You can find the current no waiting offers on most health funds website or feel free to call GMHBA on 1300 446 422 for more details on their current offer(s).

Waiting periods also apply to any additional benefits when you upgrade an existing policy. So if you transfer to a higher level of hospital cover with your existing fund or with a different fund you may have to wait an addition 12 months before you can claim at this higher level.

Waiting periods apply to:

  • New members to health insurance (members who have never held hospital or extras cover with a health fund)
  • Existing members who upgrade to a higher level of cover or reduce their excess payable
  • Members who transfer from another health fund who have not fully served the required waiting and/or benefit limitation period for equivalent benefits
  • Treatment for a pre-existing condition
  • Additions to a membership except newborns, adopted and permanent foster children where the family membership has been in existence for at least two months and where the addition has already served all waiting periods.

Pre-existing Conditions

A pre-existing condition is an illness, ailment or condition where the signs or symptoms existed at any time during the six months before taking out private health insurance or transferring to a higher level of cover. The pre-existing condition rule applies to all new members or existing members who are upgrading their level of cover. A 12 month waiting period applies to all pre-existing conditions except for psychiatric, palliative care and rehabilitation which are covered by the two month waiting period.

If you have a pre-existing ailment and you are a new member to private health insurance you will have to wait 12 months before you can receive benefits for items or services to a pre-existing condition. This means that if you receive treatment for a pre-existing condition within the 12 month waiting period you will not be eligible for benefits.

Under the Federal legislation, health funds are required to offer you continued cover if you transfer to another health fund. This means when switching health funds on an equivalent or lower level of hospital cover you won’t have to serve any new waiting periods- even if you have a pre-existing aliment or condition. You will however have to provide your new fund with a clearance certificate that can be issued by your previous fund and provides the new fund proof of the waiting periods you have already served.

When purchasing private health insurance make sure you are fully aware of any waiting periods that will apply to you. At GMHBA Health insurance we are here to help you every step of the way and will look at your specific needs for you and your family to help you determine the best cover for you.