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Last Updated on 3 July 2020

Private Health Insurance: Can You Avoid the Waiting Period?

Before you can make a claim through your private health insurer, you need to make sure your waiting period is over.

Most funds have waiting periods to start off with, and some may be longer than others. However, the government has enforced legal limits to waiting periods for all hospital cover policies to ensure you won’t be waiting forever.

Taking out general (or ‘extras’ cover) is a different story. There are no legal limits to these waiting periods so each fund will vary.

It’s important to shop carefully to find a health insurance policy that offers minimal waiting periods, not only if you require prompt treatment, but also for peace of mind. You want to feel secure from the moment you purchase your policy.

Key Points
  • Waiting periods exist to protect all members of health funds from people who want to join and immediately make large claims – which would force up premiums for all.
  • Some health insurers will advertise no waiting periods for General (extras) cover. This doesn’t necessarily mean you are free of all restrictions. You may find certain treatments can be claimed straight away while others do have a wait time involved.
  • You will not have to reserve waiting periods when switching policies, provided you purchase the same or a lower level of coverage.

What are Standard Waiting Periods?

After taking out a private health insurance policy, there is a set amount of time known as a waiting period, where you’ll be unable to make any claims. It is not only applied when you take out a new policy but also if you decide to increase your level of cover on a current policy.

When this set amount of time is up, your policy will kick in and allow you to make claims and receive the full benefits of your insurance.

The government sets maximum waiting periods for all private health funds when it comes to hospital cover only. The waiting periods for general cover (also known as ancillary or extras cover) are set by each individual health fund, and are not influenced by the government in any way.

Here’s a quick look at the current maximum waiting periods for hospital treatment:

  • For all pre-existing illnesses or health conditions; that is, any health condition you already deal with when you take out a new policy, you must wait a maximum of 12 months before making a claim.
  • For obstetrics benefits, you must wait a maximum of 12 months before claiming any pregnancy-related services.
  • For psychiatric, palliative or rehabilitation care, needed for both new and pre-existing conditions, the maximum waiting time is 2 months.
  • In all other circumstances, the waiting period is 2 months.

Private Health Insurance Waiting Periods

Why Do Waiting Periods Exist?

Waiting periods may seem like a nuisance, but they are necessary. Here’s why:

  • They protect all members of the fund by ensuring that people cannot join a fund, make a large claim immediately and then leave the fund. That type of ‘hit and run’ behaviour would force premiums up for the many loyal and long term health fund members.It allows private health insurance to do what it’s meant to. That is, cover members for unforeseeable health conditions or illnesses. After all, insurance exists to protect people in case of an emergency.
  • It allows private health insurance to do what it’s meant to. That is, cover members for unforeseeable health conditions or illnesses. After all, insurance exists to protect people in case of an emergency.
  • Insurance companies rely on healthy people taking out cover to pay for those who end up needing medical services covered.
  • If waiting periods ceased to exist, the price of your premium would soar, and potentially become unaffordable.

Can I Avoid Waiting Periods?

You may be able to avoid some waiting periods with General (extras) Insurance cover depending on the health insurer you go with. Some funds will advertise no waiting periods. However, even if the waiting period is waived, this doesn’t mean you’ll be free of all restrictions. For example, you may find that coverage is readily available for routine optical or dental care, but if you require further treatment, you may not be covered until the waiting period is over.

Check with the health fund you are considering purchasing from to see whether there are any fineprint details you should be aware of in regards to waiting periods.

So, you’re thinking of upgrading your private health insurance to a higher level of hospital coverage or a new extras policy. Have you checked the following:

  • Your policy terms. Know and understand your fund’s rules around waiting periods.
  • Which treatments you get immediate access to, if any, and which ones you must wait for.
  • How long you will have to wait for these treatments before you can make a claim.

Will Waiting Periods Apply When Switching Policies?

You will not have to re-serve waiting periods if you switch funds, provided you are taking out coverage of the same level, or of a lower level. On the other hand, if you wish to upgrade your policy, you will have to wait for new, higher benefits to kick in. Your fund will be able for provide you with further information on how long this wait will be.

Use our calculator below to find out what your waiting periods might look like should you wish to upgrade or purchase a new policy.

Health Insurance Waiting Period Estimator

You will have to serve a waiting period when you start a new private health insurance policy or increase your level of cover. A waiting period protects members of the fund by ensuring that individuals aren't able to make a large claim shortly after joining and then cancelling their membership. This kind of behaviour would result in increased premiums for all members.

Use this calculator to choose a hypothetical date in the future (or leave it on the default setting, which is today's date) to determine when you will be covered for various types of coverage.

Months Standard Waiting Period
  • Accidents
  • Ambulance
  • Chiropractic/Osteopathic
  • Alternate/Natural Therapies
  • Dietetics
  • Eye Therapy
  • Hospital Treatment
  • Occupational Therapy
  • Pharmaceutical Perscriptions
  • Physiotherapy
  • Podiatry
  • Speech Therapy
  • General Dental
  • Optical
  • Orthotics
  • Major Dental
  • Pre-Existing Conditions
  • Pregnancy Related Services

Disclaimer: The above information is correct and current at the time of publication

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