What Is A Waiting Period In Health Insurance?

Find out all about waiting periods in health insurance here with Savvy. 

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, updated on July 10th, 2023       

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Health Insurance Banner - Middle-aged man holding his hands to his chest due to a heart condition.

If you're considering getting private health insurance or switching to a new policy, it's essential to understand what health insurance waiting periods are and how they may affect when you can make a claim on your policy.  

You can find out all about health insurance waiting periods here with Savvy, the difference between waiting periods for hospital and extras policies and how to compare waiting periods when choosing a new policy. Get the information you need to help you make an informed choice about the waiting periods which come with different health insurance policies through our handy guide today.

What are health insurance waiting periods?

Health insurance waiting periods refer to the length of time that a policyholder must wait before they can claim certain benefits under their health insurance policy. The time you may have to wait before you can claim will depend on: 

  • Australian Government health insurance regulations 
  • the type of health insurance you buy 
  • individual funds’ rules and regulations about waiting periods 

There are different regulations about waiting periods which apply to hospital cover and extras cover: 

  • waiting periods for hospital cover are clearly defined under health insurance legislation, so all health funds have to offer the same deal when it comes to waiting periods and hospital cover, regardless of the tier of hospital cover you may choose to buy
  • there are fewer rules which apply to extras cover, meaning health insurers can decide what the waiting periods are for different treatments. This means they have more freedom to put together innovative packages or special offers which may be attractive to their customers. These special offers may include reduced or waived waiting periods or no waiting periods for certain categories of health cover

What are the Australian Government regulations about maximum waiting periods for hospital cover?

With hospital cover policies in Australia, there are minimum waiting periods that all health funds must include with each policy they offer. These are:  

  • 12 months for pre-existing conditions
  • 12 months for pregnancy and birth-related services 
  • 2 months for psychiatric care, rehabilitation or palliative care (even if it’s for a pre-existing condition) 
  • 2 months for all other services 

As these regulations don’t apply to extras policies, different health funds offer a wide variety of waiting periods according to individual fund packages. Waiting periods for different types of extras healthcare treatments can vary from one month right up to two years or more.  

For example, one company may offer a two-month waiting period for optical and dental, while another may offer to waive waiting periods for these treatments in a special package designed to attract new customers.  

It’s well worth comparing a wide selection of health insurance policies because the waiting periods on offer vary widely with extras policies and there are frequently special offers available which may represent great value to you.

Is it possible to get a new health insurance policy with no waiting periods?

Yes, it may be possible to get a new health insurance policy and be able to immediately make a claim with no waiting periods:  

  • if you decide to switch to a new hospital cover policy which is the same or a lower tier or level as you’ve held previously, you may not have to re-serve waiting periods you’ve already served 
  • some extras policies come with ‘no waiting period’ special offers for particular types of treatments such as physiotherapy, optical or dental 
  • the waiting periods you’ve already completed with your current policy may well carry over to the new policy, and you may be eligible for immediate coverage of those specific clinical areas that you’ve already waited for 
  • if you switch to a new insurance provider, your existing fund will provide your new insurer with a transfer certificate, also known as a clearance certificate. This document will list exactly what waiting periods you have already served. Your new insurer will take these waiting periods into account and you probably won’t have to re-serve those specific waiting periods again  
  • if you change hospital cover policies to a higher tier or level of cover, either with your existing provider or a new one, you may still have to serve waiting periods for new clinical areas that you haven’t previously paid for 

Frequently asked questions about waiting periods for health insurance

Why do private health insurers have waiting periods before you can make a claim on a policy?

Health insurers have waiting periods to keep the cost of health insurance down for all policyholders. If there were no waiting periods, people could take out hospital cover insurance or upgrade to a higher tier of policy only when they know or suspect they need hospital treatment and cancel their health insurance policy once they’ve made an expensive claim. This would lead to much higher premiums for all existing contributors to the health insurance pool. 

Is it possible to get a hospital cover waiting period waived?

Yes – but only for mental health hospital cover. The Mental Health Waiver allows members to upgrade their hospital cover to a higher tier and waive the standard two-month waiting period to access full benefits for in-hospital psychiatric treatment. This waiver can only be claimed once in a lifetime per person. 

If we’re planning to have a baby, what will the waiting period be before we can claim on a new health insurance policy?

The standard waiting period for pregnancy and obstetrics services on a new hospital cover health insurance policy is 12 months. This means that if you’re planning to have a baby, you may need to wait for 12 months before your policy covers pregnancy-related expenses. However, waiting periods vary depending on the policy and provider, so it's crucial to check with your health fund to understand the specific waiting period that applies to the policy you’re considering. Planning ahead and being aware of waiting periods are important to help you make informed decisions about your health insurance coverage if you’re planning a pregnancy. 

What is a Private Health Information Statement (PHIS)?

A Private Health Information Statement (PHIS) is a summary of your private health insurance policy terms and conditions. It outlines the main features of your policy and the waiting periods that apply to different benefits. The PHIS is a handy overview of your policy which can provide important information about what’s covered and excluded and the waiting periods which may apply before you’re able to make a claim. It's important to read your PHIS carefully to understand your coverage and waiting periods. 

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