All health funds have waiting periods. These are periods following the time you join or upgrade your benefits before you can claim on your health insurance.
New members
As a new member to health insurance (no previous cover) you will need to serve waiting periods before you can claim benefits. The length of the waiting periods will vary for different benefits. For example, the waiting period for glasses or contact lenses might be 6 months while the waiting period for general dental services might be 3 months. Contact us to find out what waiting periods may apply to your health insurance.
Existing members who upgrade their health insurance
When you upgrade your health insurance or reduce your hospital excess, you are increasing your benefit entitlements. Your health fund can therefore require that your serve waiting periods for the increased benefits. Under these circumstances, you will usually continue to receive the same benefits as you would have before the benefit upgrade, but will be required to wait for the higher benefits/lower excess to take effect. These waiting periods for the higher benefit entitlements will apply regardless of whether you upgrade your health insurance with the same health fund or switch health funds at the time you upgrade.
Switching Health Funds
Under Federal legislation, health funds are required to allow ‘portability’ for hospital cover. That 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 ailment or condition.
So if you’ve served all your waiting periods with your current health fund, you’ll usually be covered straight away by your new health fund providing you transfer to an equivalent or lower level of health insurance cover.
Most health funds also allow portability for General Treatment Cover (Extras Cover) although this is not legislated. See our section on switching health funds for more information.
Pre-Existing Ailments/Conditions
A pre-existing ailment as an ailment, illness or condition, the signs or symptoms of which, in the opinion of a medical practitioner appointed by the health fund, existed at any time during the six months prior to you joining a hospital table or upgrading to a higher level of cover.
Health funds are able to impose a maximum waiting period of 12 month for hospital treatment for ailments, illnesses or conditions that are considered to be pre-existing.
When you transfer to a higher level of health insurance, the payment of benefits for a pre-existing ailment or condition will be limited to the benefits available on the lower level of cover until 12 months of continuous membership is served on the higher level of cover.
Many health funds also impose a 12 month waiting period for pre-existing ailments/conditions for General Treatment (Extras) Covers.
If you are aware of the need to go to hospital or receive treatment you should always contact your health fund to confirm your health insurance benefit entitlement before you are admitted to hospital or receive treatment.
Waiting Period examples
While the maximum waiting periods for hospital cover are set by the Federal Government, health funds can offer lesser waiting periods. Similarly, health funds are able to set their own waiting periods for General Treatment (Extras) Cover.
While you should refer to your health fund’s policy documents to determine the specific waiting periods that may apply to your health insurance, the following information is provided as a guide to some industry waiting periods.
No Waiting Period
• Accidents
2 Month Waiting Period
• Ambulance
• Chiropractic
• Complimentary therapies
• Diabetes education
• Dietetics
• Eye Therapy
• Hospital accommodation and Theatre (not pre-existing)
• Occupational therapy
• Osteopathy
• Pharmacy
• Physiotherapy
• Podiatry
• Speech therapy
6 month Waiting Period
• Spectacles
• Contact lenses
• General Dental (fillings, check ups etc)
12 Month Waiting Period
• Major Dental (crowns, bridge work, surgical removal of teeth etc)
• Maternity/obstetrics
• Podiatry
• Orthotics
• Pre-existing conditions
• Prostheses
2 year Waiting Period
• Monitors/appliances (hearing aids, blood pressure monitor, blood glucose monitor etc)
Health Link can help with your health insurance
You should contact Health Link Consultants if you are looking to join a health fund as we are often aware of special offers and waiting period waivers made available by health funds from time to time.
Health Link Consultants has access to a huge selection of policies from a range of health funds to ensure we can find the most appropriate and competitive cover for your needs.
Simply provide us with details of your health insurance needs using the online form or call us on (03) 9670 5555 or 1800 808 026. We’ll then review your situation and forward a policy recommendation to you. Best of all, Health Link’s health insurance review and personal recommendation service is available to you free of cost and without obligation.
More information about health insurance waiting periods
For more information about health insurance waiting periods or any other health insurance related matter, contact Health Link Consultants on (03) 9670 5555 or 1800 808 026 – or Contact Us.