A Guide To Backdating Health Insurance

Can health insurance be backdated? It's a fair question, but the answer probably isn't what you were hoping for.

Ahead, we'll answer this question and give you some more information about backdating health cover, switching health funds, and refunding premium payments.

Health insurance backdating rules

Part of the reason buying private health insurance is so important is that it's there when you need it. Without cover, you won't be able to receive benefits outside of the Medicare system.

Can health insurance be backdated? No. You need to have health insurance and have served out any applicable waiting periods at the time of your procedure in order to receive coverage.

Buying health insurance after receiving treatment will only cover you for any future procedures. You cannot backdate your health insurance to receive benefits from procedures already performed.

Waiting periods

One way health funds protect themselves from people who buy health insurance too late is through their waiting periods. Health funds have waiting periods for many treatments you will receive. This is to make sure you establish a history of coverage before seeking treatment with your new cover.

Waiting periods -- while they can be inconvenient -- protect health funds and health fund members from those who would otherwise buy health insurance right before a costly procedure. These waiting periods can be frustrating for those who are trying to receive treatment legitimately, but they help keep the cost down for everyone.

The more money health funds pay out, the more costly premiums become. These waiting periods prevent backdating even further. You might have coverage, but won't be able to receive a benefit if you're still under the waiting period.

For hospital cover, there are standard waiting periods for people new to insurance or for items added to a cover. For accidents, the waiting period is sometimes only 1 day. For new conditions, 2 months. For pre-existing conditions, 12 months. For pregnancy the waiting period is 12 months until the date of birth (not conception).

A new condition is one in which there weren't any signs of symptoms in the preceding 6 months. So the good news is that waiting periods are known and clear.

Waiting periods for extras are most often 2 months for services like preventative and general dental, physiotherapy, chiropractic or massage. For glasses they are typically 6 months. These waiting periods are sometimes waived by health funds to attract new members. Waiting periods on more expensive procedures like Major Dental Services or Orthodontics are typically 12 months.

Are there any exceptions? 

There is an exception to the backdating rule we described above. This comes when you want to add a new born as a dependent to your policy. Each policy has its own rules about adding a child as a dependent -- whether this is through birth, adoption, marriage, or fostering -- so make sure you check with your fund first.

After a child joins your family, health funds will often give you a window within which you can add them as a dependent on your health insurance. This is typically two to three months after birth or the date the child joined the family.

Once you add them as a dependent, the insurer will backdate the health coverage. They won't usually have to serve any waiting periods that have already been served by the policyholder. It's important that you don't miss this window, however.

Waiting too long to claim a child as a dependent might mean paying out of your pocket for some procedures, or being subject to new waiting periods. Check with your insurer to see how long they allow you to wait before claiming a child as a dependant.

Switching healthcare providers

One area that relates to the question of "can health insurance be backdated?" is switching health insurance providers. Those who currently have health insurance might be reluctant to switch with waiting periods in mind. Fortunately, there are laws that protect health fund members from such problems.

Any waiting periods you've already served with your current health fund will transfer to your new policy. That means that if you've already waited for six of the twelve months required for benefits, these six months will come with you. If you've been with your fund for more than 12 months and you are not adding services, then you won't have any waiting periods.

This law is called portability and allows people to find better value health insurance when they already have coverage. We should note that portability laws only apply to hospital cover. Those who are switching insurance providers for their extras may need to repeat waiting periods although most health funds recognise portability with their extras policies.

There are some important rules around portability. First, you'll need to make sure there is no gap in coverage. You also need to serve any applicable waiting periods when you upgrade cover on the services that are being upgraded only.

Funds will allow a small gap between funds, generally to a maximum of 30 days.

Refunding health insurance premiums

Not everyone is pleased with their health fund, and you may think you're entitled to a refund of your premiums if you don't use it. While this might be convenient, you are not allowed to refund any of your premium payments.

The only exception to this rule is if you're currently in a "cooling off" period. The cooling off period is the first 30 days of your coverage. At any point during this time, you are allowed to cancel your policy and receive a refund of your premium payments, as long as you haven't made a claim.

Backdating health insurance

As we've covered, you are not allowed to backdate health insurance. If you were, it would essentially defeat the purpose of anyone buying private health insurance before they needed to. Different rules apply when switching health insurance providers, and you're able to avoid repeating the same waiting periods when changing coverage.

Do you need private health insurance? There are a lot of health funds out there. Compare now to get your free quote today.

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).