Health insurance waiting periods are mandatory timeframes you must wait before you can claim benefits for certain treatments after purchasing or upgrading your policy. Understanding these periods is crucial for planning your health insurance purchase effectively.
Types of Waiting Periods
Standard Waiting Periods
Most health insurance policies have these standard waiting periods:
- General treatment/Extras: 2 months for most services
- Hospital psychiatric treatment: 2 months
- Rehabilitation and palliative care: 2 months
- Pregnancy and birth-related services: 12 months
- Pre-existing conditions: 12 months
Major Dental Waiting Periods
Dental services often have longer waiting periods:
- General dental: 2 months
- Major dental (crowns, bridges): 6-12 months
- Orthodontics: 12 months
Pre-Existing Conditions
A pre-existing condition is any illness, injury, or symptom you had signs of within 6 months before joining health insurance. These conditions face a 12-month waiting period before you can claim benefits.
Examples include:
- Ongoing back problems
- Heart conditions
- Diabetes complications
- Joint problems requiring surgery
Reducing or Avoiding Waiting Periods
Transferring Between Funds
You may avoid waiting periods when:
- Switching between similar or lower levels of cover
- Transferring from one insurer to another with equivalent benefits
- Moving from a group scheme (like employer-sponsored) to individual cover
Ambulance and Emergency
Some services have no waiting periods:
- Emergency ambulance transport
- Accident-related treatments (in some cases)
- Some preventive services
Planning your health insurance purchase is important - consider your age for LHC loading and income level for the Medicare Levy Surcharge. For specific needs like pregnancy, see our guide on maternity cover.
Strategies for Managing Waiting Periods
- Join early: Don't wait until you need treatment
- Start with basic cover: Avoid waiting periods when upgrading later
- Maintain continuous cover: Gaps in coverage restart waiting periods
- Plan major treatments: Schedule procedures after waiting periods end
FAQs
Can waiting periods be waived in emergencies?
Emergency treatment may be covered immediately, but this depends on your policy terms and the nature of the emergency.
Do waiting periods restart if I upgrade my policy?
Waiting periods only apply to new benefits. If you upgrade, you'll wait only for the additional services not previously covered.
What happens if I let my policy lapse?
If there's a gap in your coverage, waiting periods will restart when you rejoin, even with the same insurer.