A waiting period is the time between when you first take out health insurance or upgrade your cover and when you are covered for a treatment or service.
Waiting periods exist to deter people from joining the fund or increasing their level of cover only when they have a condition or illness that may require immediate treatment. This practice can place pressure on premiums for all members of the fund.
Waiting periods will apply to:
- New members who have never held private health insurance before. If you receive a service or treatment during a waiting period, you are not eligible to receive a benefit under your health insurance cover, regardless of when you submit the claim.
- Members who transfer from another health fund and have had a gap in and/or upgraded their cover (see Switching to GMHBA below).
- Existing GMHBA members who upgrade to a higher level of cover or reduce their excess payable. If treatment or service was included on the previous cover at a lower level, and waiting periods have previously been served, members are entitled to the lower benefits on their previous cover while serving the new waiting period for higher benefits or reduced excess.
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Additional members added onto a policy (unless they've already served their relevant waiting periods). Exceptions apply for newborns, adopted and permanent foster children where the family membership has been in existence for at least two months.
Switching to GMHBA
If you have already served your waiting periods on an equivalent or higher level of cover with another fund, and joined GMHBA within 30 days of leaving that fund, you won't have to re-serve your waiting periods. Otherwise, waiting periods will apply from the date you take out your new cover with GMHBA. If you’ve upgraded your cover, your waiting periods for higher cover will start on the date you upgraded, but you can still claim the equivalent benefit to your previous level of cover during that period.
Mental health waiver
The mental health waiver allows members who have served their 2 month waiting period for restricted psychiatric benefits to upgrade their cover to a product which includes in-hospital psychiatric treatment without serving an additional 2 month wait. Any other applicable waiting periods will still need to be served. Members can use the waiver at the time of upgrading, or before the 2 month period for psychiatric treatment ends and can only use the waiver once in their lifetime.
Hospital waiting periods
| Hospital services (when included on cover) | Waiting period |
|---|---|
| Accidents – bodily injuries resulting from accidents which occur after the date of joining GMHBA or upgrading to a higher cover. | 0 days (accidents must occur after joining) |
| Ambulance benefits | 0 days |
| Pregnancy and birth-related services | 12 months |
| Pre-existing ailment, illness or condition (other than psychiatric, rehabilitation and palliative care). See important information regarding pre-existing conditions. | 12 months |
| Psychiatric, rehabilitation or palliative care | 2 months |
| Any other benefit for hospital (or hospital substitution) treatment | 2 months |
Extras waiting periods
| Extras services (when included on cover) | Waiting period |
|---|---|
| Ambulance benefits | 0 days |
| Any eligible extras benefits that are not specified below | 2 months |
| Optical | 6 months |
| Major dental services (including full & partial dentures, crown & bridgework, endodontic services such as root canal, gold fillings, indirect restorations, surgical extractions of a tooth/teeth including wisdom teeth) and orthodontics. | 12 months |
| Medical devices and aids including nebuliser pump, blood glucose monitor, pressure garments, sleep apnoea monitor, extremity pump, hearing aids, orthopaedic appliances (GMHBA approved), prostheses (GMHBA approved non-surgical), tens monitor, orthotic appliances (foot), and podiatry surgical procedures. | 12 months |
Planning for a child
If you are preparing to start or expand your family and want the option of choosing your obstetrician and giving birth as a private patient in a private hospital, you’ll need to have pregnancy and birth included as a clinical category on your hospital cover.
If you upgrade your hospital cover to include pregnancy and birth, you’ll need to do this at least 12 months before you plan to give birth. This is to make sure that all waiting periods have been served before you claim for pregnancy-related hospital admissions. If a baby is born early, waiting periods are assessed from the baby's estimated due date.
In a standard delivery, your newborn baby will not be admitted as a patient in hospital. If you have complications and your newborn baby requires any separate accommodation or medical attention, they will be covered for accommodation or medical services, provided:
- waiting periods have been served by the parent, and
- the baby is added to the policy within 6 months of their date of birth, and
- cover change is backdated to their date of birth.
When a newborn is added to a policy, a single policy automatically becomes a single parent policy, and a couples policy becomes a family policy.
Note: cover changes may result in a change to your premiums.
Pre-existing conditions (PEC)
A pre-existing condition is one where signs or symptoms of your ailment, illness or condition, in the opinion of an external medical advisor appointed by GMHBA (not your own doctor), existed at any time during the six months preceding the day on which you purchased your hospital insurance or upgraded to a higher level of hospital cover and/or benefit entitlement.
A special waiting period applies to obtain benefits for hospital treatment for new members who have pre-existing conditions. The waiting period also applies to existing members who have recently upgraded their level of hospital cover. If the ailment, illness or condition is considered pre-existing:
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New members must wait 12 months for any hospital benefits (other than psychiatric, rehabilitation and palliative care).
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Members transferring/upgrading to a higher hospital cover must wait 12 months to get the higher hospital benefits (other than psychiatric, rehabilitation and palliative care).
Existing members with at least 12 months membership in total across their old and new cover are entitled to the lower benefits on their old cover.
If you haven’t held your current level of cover for at least 12 months, you are required to go through the PEC check for any hospitalisation. This involves asking your GP and specialist their written opinion on whether your condition is pre-existing. The process can take some time and it’s best to get this done as soon as possible to confirm whether GMHBA can cover your procedure. The documentation will then be assessed by an external medical advisor appointed by GMHBA, who will decide whether your condition is deemed pre-existing or not.
More information
For more information about waiting periods and pre-existing conditions please refer to our Important Information Guide.