A Guide To Backdating Health Insurance

Private health insurance is an important safety net, providing peace of mind when you need medical care and financial protection for unforeseen health expenses. However, understanding the rules around backdating health cover can be confusing. This guide clearly sets out everything you need to know about backdating health insurance, waiting periods, switching health funds, and premium refunds.

At Compare Club, we’re committed to helping you navigate the complexities of health insurance with useful, straightforward advice.

Can Health Insurance Be Backdated?

The short answer is no. Australian private health insurance policies are not designed to cover treatments or costs incurred before you purchase or upgrade your policy. This means that if you undergo a procedure without insurance, your new policy will only cover future treatments and will not reimburse you for claims retroactively.

Health insurance requires that you are actively covered and have completed any relevant waiting periods at the time of treatment to access benefits.

Why Waiting Periods Exist

Waiting periods are safeguards put in place by Australian health insurers to ensure that members don’t purchase insurance only when they require expensive procedures. They balance the system by protecting both health funds and their members from sudden cost spikes due to opportunistic claims.

Standard Waiting Periods for Hospital Cover

Accidents: Up to 1 day (some funds waive this entirely).

New conditions: Typically 2 months, for illnesses or injuries where no symptoms were evident in the six months before joining a fund.

Pre-existing conditions: 12 months, for conditions where signs or symptoms existed before joining or upgrading cover.

Pregnancy and birth-related costs: 12 months (waiting period applies up to the date of birth).

Waiting Periods for Extras

Extras cover (policies that cover services like dental, optical, and physiotherapy) also comes with waiting periods. These are typically:

2 months: Preventative and general dental, physiotherapy, chiropractic, massage, and some optical services.

6 months: Basic glasses and contact lenses.

12 months or more: Major dental services, orthodontics, or expensive medical devices.

Tip: Some health insurers may waive some waiting periods on extras as part of introductory offers for new members. It’s worth checking the latest promotions.

Exceptions to Waiting Periods: Adding a Newborn to Your Policy

A notable exception to the rule on backdating health cover applies when you add a dependent child to your policy. Most Australian health insurers allow the backdating of cover for a newborn, adopted child, or fostered child, typically within a two- to three-month window from the date they join your family.

Key Points to Remember: The child’s coverage will often begin from their date of birth or adoption, protecting them from waiting periods already served by the main policyholder. Failing to add the child within the required timeframe could lead to out-of-pocket expenses or new waiting periods.

Check specific rules with your insurer, as each fund may have unique requirements.

Switching Health Funds and Portability Rules

If you’re thinking about switching health insurers for better cover or more competitive premiums, portability laws ensure that you won’t have to restart waiting periods for any equivalent hospital cover. This means that your hospital cover waiting periods transfer seamlessly to the new policy, provided there’s no gap in coverage.

How Portability Works:

When you switch to a new provider, any waiting periods you've already completed (e.g., the 12-month wait for pre-existing conditions) will be recognised.

If you upgrade your cover (e.g., from basic to top-tier hospital policy or adding new extras), waiting periods will apply only for those new or enhanced benefits.

Portability laws guarantee this continuity of coverage for hospital cover only . Extras cover portability depends on the specific insurer, and you may need to complete new waiting periods.

Important Notes

Your previous coverage must remain active until your new policy begins to maintain portability. Most funds offer a grace period of up to 30 days between cancellations and starting new cover.

Double-check the product information documents for your new policy to ensure portability applies in full.

Refunding Health Insurance Premiums

Many people assume that if they haven’t used their private health insurance, they’re entitled to a refund. However, premium payments are non-refundable except under specific circumstances.

When Refunds May Be Possible:

Cooling-Off Period: Most insurers offer a 30-day cooling-off period for new members. During this time, you can cancel your policy and get a full refund, provided no claims have been made.

In rare cases, some policies may allow a partial reimbursement if coverage is ended partway through a billing cycle, but this depends on your insurer's terms.

Reminder: Once the cooling-off period expires, you’ll no longer be eligible for a refund of any period you’re covered, even if you stop using the service.

Frequently Asked Questions

Can I claim for treatments received before I bought health insurance?

No, health cover cannot be backdated, and claims can only be made for treatments received after completing waiting periods.

Does switching funds reset my waiting periods?

Not for hospital cover. Waiting periods you’ve already completed with your previous fund are transferred to your new policy, provided you don’t have a gap in coverage. For extras cover, this can vary depending on the fund.

Can I backdate cover for my newborn?

Yes, most providers allow you to backdate cover for a dependent child within two to three months after birth or adoption.

How do waiting periods work with upgraded cover?

New or extended benefits (e.g., adding maternity cover) will still be subject to waiting periods, even if you've held other cover in the past.

Sources

• PrivateHealth.gov.au, Waiting Periods

• Department of Health, Private Health Insurance Portability

• Medicare Levy Surcharge and Lifetime Health Cover Information

Chris Stanley is the sales & operations manager of health insurance at Compare Club. With extensive experience and expertise, Chris is a trusted leader known for his deep understanding of health insurance markets, policies, and coverage options. As the sales & operations manager of health insurance, Chris leads a team of dedicated professionals committed to helping individuals and families make informed decisions about their health insurance needs.

Meet our health insurance expert, Chris Stanley

Chris's top health insurance tips

• 1

  Australia’s public health system is world-class, but wait times for public hospitals can be long, inconvenient - and leave you living in constant pain while you wait.

• 2

  An appropriate private health insurance policy can speed up your surgery, relieving your pain sooner.

• 3

  Family health cover means your children are covered under the same policy as you.

• 4

  Many health insurance policies come with a 12-month waiting period for pregnancy-related cover, so it’s a good idea to get a family policy organized well before starting your family. This means your child will be covered from birth until at least their early twenties (depending on which health fund you select).