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Waiting periods explained

What waiting periods are, why we have them and how they affect you.

How waiting periods affect your cover

All health funds, including HBF, have waiting periods to stop people from signing up, claiming and leaving without contributing money (premiums) to the fund - which wouldn’t be fair to our other members.

A waiting period is a set amount of time from the day your policy starts during which you can’t make a claim from HBF. Waiting periods apply when you have:

  • Never had health insurance

  • Upgraded your level of cover

  • Rejoined after a break from cover

Waiting periods when you’ve switched health funds

You won’t have to re-serve waiting periods if you’ve switched from a different health fund, as long as your HBF cover includes the same services as your previous cover. If you’re part way through serving your waiting periods, you will just have to serve the remainder before you can claim.

It’s important to note that all health funds have different types of products so though we honour waiting periods you’ve already served on similar services included in your new HBF product, variances might still exist. This means you may have to serve additional waiting periods for:

  • Any new services
  • Services with increased benefits and annual limits
  • Services where only part of the waiting period has been served

Refer to your product sheet in myHBF or contact us before beginning treatment so we can provide a quote on what benefits you will receive.

Government maximums for waiting periods

The Government sets the maximum waiting period health funds can impose before you can make a claim. The maximum amount of time you’ll have to wait before making a claim is:

Pre-existing conditions
12 months
Maternity and assisted reproductive services (IVF)
12 months
Psychiatric, rehabilitation or palliative care
2 months
Major dental (root canals, crowns, bridges, implants and orthodontics)
12 months
Hearing aids and appliances
12 months to 36 months
Urgent ambulance
7 days
Non-urgent ambulance
30 days
Other services
2 months

Contact us for details of your personal waiting periods and the time you have left to serve. We can also provide a benefit quote, which tells you what you’re covered for and how much you will get back when you make a claim.

Pre-existing conditions

A pre-existing condition is one where symptoms were known to exist during the six month period prior to the date of joining HBF or transferring to a higher level of cover. It’s not necessary for the condition to have been diagnosed in this 6 month period – only that symptoms were, or would have been evident.

HBF will appoint an independent medical practitioner to examine information provided by your doctor, together with other relevant claim details, to assess whether a condition is pre-existing. If it is confirmed that you have a pre-existing condition, you’ll need to wait 12 months from when you joined HBF or transferred to a higher level of cover before you’re able to make a claim relating to that condition. Be aware that if you choose to go ahead with the treatment and it is found to be a pre-existing condition, you will be liable for all costs not covered by Medicare.

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