A waiting period is a set amount of time during which you can’t claim a benefit from your health fund. If you’ve never had health insurance or you’re upgrading your level of cover, you may need to serve a waiting period before you can claim. All health funds have waiting periods. They stop people from signing up, claiming and leaving without contributing money (premiums) to the fund. Without waiting periods, health fund members who do the right thing by regularly paying their premiums end up covering the cost of people who sign up, claim and leave, resulting in higher premiums for members.
If you’re switching from another fund, you won’t have to re-serve waiting periods that you’ve already served with your previous health fund. If you’re part way through serving your waiting periods, your new health fund will take the time you’ve already served into account.
How do waiting periods work for hospital insurance?
The government sets the maximum waiting period health funds can impose before you can claim on hospital treatment. Below is a breakdown of the maximum amount of time you’ll have to wait before making a claim for:
- Pre-existing conditions - 12 months
- Obstetrics (pregnancy) - 12 months
- Psychiatric care, rehabilitation or palliative care, even for a pre-existing condition - 2 months
- All other circumstances - 2 months
What is a pre-existing condition?
A pre-existing condition is an ailment, illness or condition which was known to exist, or signs or symptoms of which would have been evident during the six month period prior to date of joining or transferring to a higher level of cover - this includes the day the member joined. It is the medical practitioner appointed by the health fund who decides if an ailment, illness or condition is pre-existing.
It is not necessary for the ailment, illness or condition to have been diagnosed in the 6 month period – only that signs or symptoms were, or would have been evident.
How do pre-existing conditions affect waiting periods for hospital insurance?
If the health fund’s appointed medical practitioner confirms you have a pre-existing condition, you’ll have to wait 12 months from when you joined before you’re able to make a claim relating to that condition.