What Are Waiting Periods?

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What is a waiting period, and why do we have them?

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 other members.

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A waiting period is a set amount of time during which you must continuously hold your level of health cover but cannot claim a benefit. Once you’ve served your waiting periods, you can submit a claim. Waiting periods apply when you:

Purchase health insurance for the first time
Change your level of cover and end up with new services that were not on your previous cover. You’ll have to serve the relevant waiting periods for the new services before you can claim any benefits.
Change your level of cover and end up with higher benefits and/or limits. You’ll have to serve the relevant waiting periods before you can claim the increased benefits and/or limits. During this waiting period, you may be able to claim as per your previous cover.
Decrease your hospital excess. You’ll have to serve the relevant waiting periods before you can pay the lower excess. During this waiting period, you may be able to claim and the excess on your previous cover will apply.
Re-join a fund after a break from cover

HBF hospital cover waiting periods

Service	Waiting period
Rehabilitation	2 months
Palliative care	2 months
Hospital psychiatric services	2 months
Pre-existing conditions	12 months^*
Pregnancy and birth	12 months
Accident cover	1 day
All other services	2 months^*

HBF extras cover waiting periods

Service	Waiting period
Foot orthoses	12 months
Major dental (root canals, crowns, bridges) and Implants	12 months
Orthodontics	12 months
Hearing aids and appliances	2 to 24 months^*
All other services	2 months

HBF ambulance cover waiting periods

Service	Waiting period
Urgent ambulance (by road)	7 days
Non-urgent ambulance (by road)	30 days

Things to keep in mind

Pre-existing conditions (applies to hospital cover)

A pre-existing condition is an illness or condition which, in the opinion of an independent medical practitioner (appointed by HBF), was known to exist, or where signs or symptoms were evident during the six-month period before you became an HBF member, including on the day you joined. This also applies if you transfer to a level of cover with higher benefits or reduce your excess level.

If you proceed with a hospital admission without confirming what benefits you’re eligible for and your condition is determined to be pre-existing, you will be required to pay all outstanding hospital and medical charges not covered by Medicare. It is not necessary for the ailment, illness or condition to have been diagnosed in the six-month period – only that signs or symptoms were, or would have been, evident.

If our appointed medical practitioner confirms that you have a pre-existing condition, before you can make a claim relating to that condition you’ll have to serve a 12-month waiting period from the date you joined HBF, or from the date your cover for that condition started.

View our pre-existing query form

Using the mental health waiver

The Mental Health Waiver allows a person with eligible hospital cover to upgrade from restricted to full benefits for Hospital psychiatric services without serving the usual two month waiting period.

How does it work?

If you have held an eligible hospital cover for two months with restricted benefits for Hospital psychiatric services, you can upgrade your cover so you will be fully covered for these services. If you do, we will waive the usual two month waiting period^* on Hospital psychiatric services. This mental health waiver can only be used once in your lifetime – even if you cancel your cover and re-join in the future, or switch health funds.

For more information on the Mental Health Waiver, please visit the Australian Government Department of Health’s website.

Level of cover change or switching from another fund

Where you have continuous hospital cover and change your level of cover or switch to HBF hospital cover, we’ll honour any waiting periods you served on your previous health cover. This means there will be no waiting period for those services that you have previously served waiting periods for. If you are part-way through a waiting period, you’ll 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 while we will honour waiting periods you’ve already served on similar services included on your new HBF product, there are some waiting periods you may still need to serve.

If you’re unsure of what waiting periods you need to serve, or what you’re eligible to claim on, please call us on 133 423.

Adding a baby to your policy

You will need to add your newborn to your policy within three months of your baby’s birth. This way, your baby will be covered from their birth and won’t have to serve any waiting periods that you have already served.

If you’re currently on a single or couple policy with HBF and want your newborn to be covered, an increase to an HBF Parent Plus or Family policy will apply from your baby’s date of birth. If you’re already on an HBF family policy, you won’t need to pay anything additional to add your newborn to your policy.

Is there overseas visitor health insurance with no waiting period?

No. All OVHC will have various waiting periods, including a 12-month waiting period for pregnancy and birth and pre-existing conditions, and two months for psychiatric services, rehabiltation, and palliative care (where covered). However, there is no waiting period for outpatient medical treatment (for example, consultations with a general practitioner or emergency ward care).

What is the waiting period for HBF Urgent Ambulance cover?

There is a 7-day waiting period before you can claim on HBF Urgent Ambulance.

Can I purchase maternity cover with no waiting period?

No. HBF, like most health funds, have a 12-month waiting period for pregnancy and birth. Waiting periods help to discourage people from signing up for health cover, claiming and leaving soon after, which drives premiums up for all other members of the health fund.

Will I need to serve waiting periods if I switch my level of excess on my hospital cover?

This will depend on whether you switch to a higher or lower excess.

Switching to a higher excess

No waiting periods will need to be served.

Switching to a lower excess

Waiting periods will apply when you reduce or remove your excess.

The length of waiting period will vary depending on the service. For example, HBF Bronze Hospital Plus’ waiting period for in-hospital treatment is two months; if you decrease your excess from $500 to $250, you will have to serve a two-month waiting period before your new level of excess will apply to in-hospital treatment services. If you need those services during your two-month waiting period, you will be required to pay your original $500 excess.

If you have a pre-existing condition at the time that you lower or remove your excess, you may need to serve a 12-month excess waiting period before your new level of excess will take effect.

Please note: Pre-existing waiting periods do not apply for Hospital psychiatric services, Rehabilitation or Palliative care.

What are the maximum waiting periods for HBF hospital insurance?

The Australian Government sets the maximum waiting periods that health funds can impose on hospital insurance 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
Pregnancy and birth: 12 months
Other in-hospital treatments: Two months

At HBF, a pre-existing condition is an illness or condition which, in the opinion of an independent medical practitioner (appointed by HBF), was known to exist, or where signs or symptoms were evident during the six-month period before you became an HBF member, including on the day you joined. This also applies if you transferred to a level of cover with higher benefits or reduce your excess level. If you proceed with a hospital admission without confirming what benefits you're eligible for and your condition is determined to be pre-existing, you will be required to pay all outstanding hospital and medical charges not covered by Medicare.

It is not necessary for the ailment, illness or condition to have been diagnosed in the six-month period — only that signs or symptoms were, or would have been, evident.

Note: Hospital psychiatric services, Rehabilitation and Palliative care are not considered pre-existing so only the two-month waiting period applies.

More questions? For any questions related to your HBF cover, call us on 133 423 and we’ll be happy to help.

Waiting periods explained