A Guide To Health Insurance Waiting Periods

Although it can be frustrating having to wait a certain amount of time for a procedure, waiting periods exist so people aren’t able to join or switch and take out expensive cover only when they need a specific treatment. 

If these waiting periods didn't exist, health cover would be more expensive for everyone.

Waiting periods exist for both hospital and extras cover, but health funds sometimes offer to waive a few of them to attract new customers.

Why does health insurance have waiting periods?

Waiting periods are designed to stop people from joining a fund, making expensive claims, and then cancelling their membership.  

Essentially, waiting periods aim to keep the cost of private health cover affordable for everyone.

What are the waiting periods for hospital cover?

Waiting periods are different for hospital and extras cover. Hospital waiting periods are set by the government.

Current hospital waiting periods are:

• 12 months for pre-existing conditions.

• 12 months for pregnancy and birth services.

• 2 months for psychiatric, rehabilitation and palliative care, including pre-existing conditions (waiting periods for psychiatric treatment can be waived for a cover upgrade once in your lifetime^).

• 2 months for other services.

What are the waiting periods for extras cover?

Unlike hospitals, health insurers are free to set their own waiting periods on extras cover.

Examples of typical waiting periods are:

• 2 months for general dental and physiotherapy*

• 6 months for optical purchases, including glasses and contact lenses*

• 12 months for major dental treatment such as crowns and bridges*

• 1-3 years for high-cost procedures such as orthodontics*

How long do you need to hold private health insurance before claiming?

This depends on the waiting periods outlined in your policy. 

With the exception of ambulance cover, you generally need to wait a minimum of two months to start claiming basic services. Maximum waiting periods vary depending on your fund, but our experts at Compare Club can help you find what you need from your policy.

Can health funds waive waiting periods?

Yes. Keep an eye out for promotions where health funds waive waiting periods on certain services. 

Waiving two and six-month waiting periods on extras is quite common to attract new members, particularly in the lead up to the annual health insurance premium rate increases between April-October. In such cases, waiting periods a pre existing condition may still apply.

Compare Club’s team are experts at finding funds with special offers to waive waiting periods.

What if I go to the hospital before my waiting period is up?

You generally won’t be able to claim for services where you haven’t served the waiting period. Whatever your policy, be sure to contact your insurer straight away to see if you’re entitled to any hospital benefits.

Do I have to re-serve waiting periods if I switch funds?

If you switch from one private health insurance policy to another, you don’t need to serve new waiting periods for policies with an equivalent or lower level of benefits. 

Our specialists at Compare Club do our best to make sure you don’t have to serve new waiting periods when you switch your cover.

Frequently Asked Questions

Can I get optical health insurance with no waiting period?

Yes. While most health funds apply waiting periods for extras coverage – including optical – it is possible to find optical health insurance with no waiting period from time to time. As above, switching to a new extras policy with an equivalent or lower level of coverage than your existing policy could mean that you don’t have to serve another waiting period for optical insurance.

Can you get dental health insurance with no waiting period?

Yes. Dental health insurance is covered under many extras policies. The above no-waiting-period conditions also apply to dental insurance from time to time.  

Can you get health insurance for IVF with no waiting period?

It is quite rare for insurers to offer IVF and private health insurance for pregnancy with no waiting period in Australia. Private health insurance policies typically have a 12-month waiting period for pregnancy-related services. However, as with other types of health insurance, if you switch to a new insurer with an equivalent or lower level of coverage than your existing policy, your new insurer usually can’t apply waiting periods you’ve already served. 

Can you get private health insurance with no waiting period for pre-existing conditions in Australia? 

Under the Private Health Insurance Act 2007, a health insurer may impose a 12 month waiting period on benefits for hospital treatment for pre-existing conditions. While it’s rare for health funds to waive pre-existing condition waiting periods for new or upgrading customers, you shouldn’t have to serve a waiting period again if you’re switching to a new policy or insurer with an equivalent or lower level of coverage. 

Additional resources

• Find out more about the costs associated with specialist medical services with Medical Costs Finder.

• Check the scheduled fee for medical services covered by Medicare on the Medicare Benefits Schedule (MBS).  

Sources

PrivateHealth Gov, Waiting Periods, accessed September, 2023. 

PrivateHealth Gov, Mental Health waiting period exemption for higher benefits, accessed September, 2023.

Commonwealth Ombudsman, Waiting periods for health insurance, accessed September, 202s. 

Based on 136,746 customers between 1 Jan 2018 - 23 December 2022.

Privatehealth.gov.au, Waiting periods, mental health.

Commonwealth Ombudsman, Waiting periods for private health insurance, accessed.

Waiting periods and exemptions, Australian Government Department of Health and Aged Care

The Australian state paying the highest health insurance premiums, YourLifeChoices

What is the Waiting Period for Pre-Existing Conditions?, Commonwealth Ombudsman

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).