What are the waiting periods I need to understand included in my hospital cover?

How do waiting periods work?

Hospital waiting periods are a part of every health fund. They aren’t there to make hospital cover difficult for new members, but to make it fair for all members. Without hospital waiting periods, health cover premiums would be unaffordable for most Australians. They are a security net against people who might join a health fund, or upgrade their cover, because they have an ailment that needs immediate treatment. Without waiting periods, those people could join, make a claim and then cancel their membership soon afterwards, leaving those existing members footing the bill. Hospital waiting periods apply to all new members who have previously not been insured, as well as those members who add people to their membership, unless, of course, those people have already served their valid waiting periods with GMHBA or another fund.

Bronze Hospital & Bronze Extras Set Benefits

Entry level hospital cover. Includes preventative dental and optical.
$ 20.35
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Bronze Hospital & Silver Extras Set Benefits

Entry level cover. Cover for a range of popular services that suit your lifestyle.
$ 24.35
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Silver Hospital Plus & Bronze Extras Set Benefits

Moderate cover. Includes private hospital with some exclusions. Includes cover for preventative dental.
$ 29.90
per week
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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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The other exception to this hospital waiting periods rule is newborn babies, adopted or permanent foster children where the family membership has been valid for two months or more. Existing GMHBA members may also be required to serve out waiting periods if they have upgraded their cover or benefit and not completed the relevant waits. That is also the case for members of other funds who switch to GMHBA. But, if you are a member of another fund and have served your hospital waiting periods, you are eligible to claim as long as your new cover is equal or less than the cover you had with your previous fund. It is clear the rules are there to protect those who need it most, those who want peace of mind and private health insurance just in case they need it. At GMHBA, we put people first, not profits, and want to do the best we can to protect you and your health. It is what being healthier together is all about.

How long are waiting periods?

There are a few different hospital waiting periods to consider when you sign up for cover with GMHBA. These generally apply whether you prefer to be treated in a private hospital, or in a public hospital as a private patient. If you are unsure, please give us a call before going in for your treatment. Perhaps the most important of all the hospital waiting periods for you and your family to remember is if you need to be admitted to hospital, including emergency, because of an accident or injury which occurred after the date you signed up or upgraded your insurance, you will be covered. There is no waiting period. That makes sense and can give you peace of mind immediately after you become a GMHBA member.

If you have a pre-existing ailment or injury, then hospital waiting periods across most funds will be 12 months. That is usually except for treatments such as psychiatric, rehabilitation or palliative care. This can highlight the important and sometimes urgent nature of these treatments, and how significant they can be to your health and wellbeing. Another important one of the hospital waiting periods to remember is for pregnancy. If you are planning to have a baby and do not have cover for obstetric services, then it is important to upgrade your cover at least 12 months before you have a child. The 12 month waiting period is a key one to remember, because obviously that means being covered before you fall pregnant.

At GMHBA, our Gold policy offers cover for pregnancy, but it can also offer cover without pregnancy, giving you the choice to add it later. Most pregnancy covers, including ours, will cover you for pregnancy and birth-related services, reproductive services, or IVF, special care nursing and labour ward and accommodation fees. It can also cover you for inpatient hospital doctor services, including anaesthetics. However, most pregnancy policies do not include cover for out-of-hospital specialist fees during the ongoing pregnancy.

Once your baby is born, it is unlikely they will need hospital admission, which will still be covered as long as you have served the 12-month hospital waiting periods. If your baby requires intensive care treatment, then the costs of that should be borne by Medicare.  

What else do I need to know?

There are a couple of other areas where hospital waiting periods can be a little complex, but they are worth taking note of. The first one is if you have a pre-existing condition. Unlike some other countries, you can generally not be refused health cover if you have a pre-existing condition in Australia. Pre-existing conditions are defined as where signs or symptoms of your ailment, injury or condition existed at any time in the six months before you became a member of GMHBA or upgraded your cover. However, it is important to know here that the diagnosis of a pre-existing condition must be made by a medical practitioner GMHBA appoints.

A special waiting period of 12 months applies to all hospital benefits, other than, as we mentioned above, psychiatric, rehabilitation and palliative care treatments or services. However, if you are an existing member and, before you upgraded, and had membership for more than 12 months, you can be eligible for all the benefits of your former cover.

Another thing worth noting around hospital waiting periods is what is called benefit limitation periods. With some covers, there can be treatments – usually psychiatry, gastric banding and dialysis – where during the first two years of your cover, after the standard hospital waiting periods have been served, you can only claim public hospital default benefits. However, if you take out our Gold hospital cover with Gap Saver, no benefit limitation periods apply. If you have any queries about anything to do with waiting periods, it is worth giving us a call before any treatments begins.