Waiting periods are exactly what their name suggests; the length of time you need to wait before being able to make claims on services.

They apply when you join any health fund for the very first time, or when you upgrade to a higher level of cover. Waiting periods are designed to keep health cover fair for everyone, by protecting the fund and Members against people who join intentionally to make big claims, and then cancel their membership.

If you're transferring from another fund and take out an equivalent level of cover, or if you've previously been covered by your parents' membership, we recognise that you've already served the waiting periods, so you can claim straight away. If you upgrade to a higher level of cover when you switch, you'll only need to serve the waiting period on the increased benefits.

Our tables below outlines the waiting periods that apply to hospital and extras:

2 month waiting period

Hospital servicesExtras services
  • For all hospital treatments or services where there are no pre-existing conditions (excluding accidental injury^)
  • Approved psychiatric treatment*
  • Approved rehabilitation treatment
  • Palliative care
  • Diagnostic dental
  • Preventative dental - cleaning and scaling, fluoride treatment etc.
  • Simple tooth extraction
  • Restorative dental - fillings
  • General services - mouth guards and occlusal splints
  • Optical
  • Acupuncture
  • Audiology
  • Chiropractor
  • Remedial massage therapy, Bowen therapy, myotherapy
  • Osteopathy
  • Naturopathy
  • Dietician
  • Occupational therapy
  • Orthoptic therapy
  • Physiotherapy
  • Exercise physiology
  • Podiatry
  • Psychology
  • Speech therapy
  • Healthy Living benefits
  • Foot orthoses and orthopaedic shoes
  • Pharmaceuticals
  • School accidents

*In-hospital psychiatric treatment - waiting period exemption

In-hospital psychiatric treatment has a standar two month waiting period.

Under the Department of Health's Private Health insurance Reform changes effective 1 April 2018 the folowing amendments to this standard two month waiting period apply:

  • Person's currently insured with an Australian registered health fund on a policy with limited/restricted benefits payable for in-hospital psychiatric treatment will be able to uprade their hospital cover without having to serve an initial waiting period for in-hospital mental health services.
  • This waiting period exemption will only apply to in-hospital psychiatric treatment and only apply once in a person's lifetime.

To be eligible for the waiting period exemption patients must be referred by a consultant psychiatrist to be admitted to hospital.

The waiting period exemption for in-hospital psychiatric treatment does not apply to:

  • Consumers joining private health insurance for the first time, or re-joining after a period of more than 63 days of non-coverage under a complying health insurance product with a registered Australian health fund.

For these consumers the standard two month waiting period for access to psychiatric benefits will apply.

12 month waiting period

Hospital servicesExtras services
  • Pre-existing conditions
  • Obstetrics-related services
  • Mechanical aids and appliances
  • Surgery for assisted fertility programs such as IVF or GIFT, sterilisation or vasectomy
  • Mammograms and bone density tests
  • Hearing aids
  • Major dental services
    • Periodontics – specialised gum treatment
    • Surgical extraction – includes Wisdom tooth extraction
    • Endodontic services – includes root canal therapy
    • Crowns and bridges
    • Prosthodontics – dentures
    • Orthodontics – braces etc.
  • Childbirth education

^ Two month waiting periods apply for most other items or services. The 2 month waiting period is waived for treatment arising from an accident (excluding school or sporting accidents) that occurred after joining. Cover for an accident is immediate provided it is not recoverable from another source such as Workers Compensation, third party or other liability provision. Sporting accidents sustained by sportspeople in activities relating to their fulltime employment as a sporting professional, including training and competition have a two month waiting period.

Changes to your circumstances

If you're expecting a change in your circumstances in the future, such as starting a family, it's important to review your policy to make sure you are covered. For example, if you have a single policy, you'll need to upgrade to a Single Parent/Family policy no less than two months from the date of the baby's birth. Please refer to our Membership Guide under the heading "Adding a newborn baby" for more information on cover for your baby.

Similarly, if you think you'll need a particular type of surgery, it's important to check that it's covered by the Health Fund and your policy, and that you'll have served the appropriate waiting period before you undergo the procedure.