How private health insurance waiting periods can affect your hospital and extras cover

A few months can seem like a long time when you need medical services not covered by Medicare and don’t have the funds to cover the cost.

Waiting can be tough when you need to access medical services and can’t afford to pay the out-of-pocket costs. Pictuer: iStock

When was the last time you checked your health insurance policy? If you set it up years ago and haven’t looked at it since, you’re not alone.

But with health insurance premiums set to increase by 2.74 per cent on April 1, which will cost families on average an estimated $126 extra per year, it might be time to review.

You may be wondering if it’s worth changing providers if it means you’ll have to serve waiting periods again. However, if you already have medical insurance, there are a few ways to avoid waiting periods when signing up to a new provider.

Here we break down waiting periods for both hospital and extras and provide the lowdown on when you might not need to serve them before claiming for treatment.

Why is there a waiting period for health insurance? How long is it?

Although waiting periods can be annoying, they’re designed to keep health insurance costs fair, competitive and affordable.

Without them, people might buy cover just to lodge a big claim (like knee reconstruction) then cancel the policy shortly after. If a large number of people did that, there wouldn’t be enough money in the health insurance pot to cover future claims and premium rates would sky rocket.

The length of a waiting period depends on what it relates to. The maximum waiting periods insurers can impose for hospital treatment is set by the Australian Government are:

* 12 months for pre-existing conditions [

* 12 months for pregnancy and birth

* Two months for psychiatric treatments, rehabilitation or palliative care, even for a pre-existing condition

* Two months in all other circumstances

However, in some cases, you can upgrade to receive mental health treatment in hospital without a waiting period. Also, there’s usually no waiting period if you need hospital or medical treatment because of an accident that happens after you start your policy.

For extras or ‘ancillary’ cover, waiting periods are set by individual health insurers and usually range from two to six months for things like physiotherapy, general dental and optical and 12 months for major items like braces or hearing aids.

Can I get my health insurance waiting period waived?

There are a few ways you can try and get private health insurance with no waiting period,

keep your eyes peeled for promotions and shop around for health insurance quotes.

Usually, insurers are more willing to waive hospital and extras policies waiting periods for items such as general dental (think check ups and cleaning rather than complex treatment), claiming for new glasses and therapies such as remedial massage and acupuncture.

Also, if you switch between private health funds, you may not need to re-serve waiting period. In fact, if there was no gap in your coverage, and your new plan offers the same or fewer benefits as the old one, your new insurer is required to honour the waiting period for hospital cover that you’ve already served.

However, if you’re upgrading your plan or switching to a provider with more benefits such as a lower excess, you can be asked to serve another waiting period for the new benefits.

Who offers the shortest waiting periods on both hospital and extras?

The best way to find providers with the shortest waiting periods is to compare health insurance using an online comparison site.

That way, you can see at a glance how different providers stack up when it comes to waiting periods plus other key features and benefits and find the best private health insurance for you.

Can an employer waive health insurance waiting period?

According to the Ombudsman, if your employer is offering to waive a health insurance period it’s likely in conjunction with the insurance provider. Usually, they only waive some of the waiting periods for general treatment services. Always check which waiting periods will still apply. It is very rare for insurers to waive the 12 month waiting periods for pre-existing conditions, obstetrics, or major dental.

What are the waiting periods for hospital cover?

Waiting periods for hospital treatment are set by the government ranging from 12 months for pre-existing conditions, pregnancy and birth to two months for psychiatric treatments, rehabilitation, palliative care, and in all other circumstances.

If you need hospital or medical treatment due to an accident after you start your policy there’s usually no waiting period.

Do pre-existing conditions affect the waiting period?

Under the Private Health Insurance Act 2007, health insurers can impose a 12-month waiting period on benefits for hospital treatment for pre-existing conditions.

There are certain exceptions to this though, including rehabilitation, palliative care and psychiatric care, which have a two-month waiting period even if pre-existing.

If you suffer from mental illness you can upgrade your cover and immediately access in-hospital mental health services if you are transferring from a policy that had minimum benefits.

The mental health waiting period exemption applies to everyone covered by your policy. Each person can access the exemption at any time once in their lifetime.

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This article was created in sponsorship with iSelect.

Originally published as How private health insurance waiting periods can affect your hospital and extras cover