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Waiting Periods

Waiting periods are an initial period after joining or upgrading your private health cover during which you cannot claim on certain goods, treatments and services. The length of a waiting period depends on the type of service you wish to claim and whether or not you have already served waiting periods on previous cover. 

  • Joining without current health cover
  • Transferring from another health fund
  • Upgrading your cover
  • Adding pregnancy cover

Joining without current health cover

If you are taking out private health cover for the first time or you have been without private health cover for 30 days or more, you must first serve waiting periods for all services on your selected level of cover. The following waiting periods apply:

Extras waiting periods (effective until 31 March 2017)

All other services, except those listed below   2 months 
Laser Eye Surgery  3 years
Major Dental (e.g. crowns, implants, dentures)  12 months
Orthodontics   12 months
Apparatus benefits (e.g. asthmatic spray appliances, blood glucose monitors, blood pressure machines, hearing aids, sleep apnoea machines)  12 months

 

Extras waiting periods (effective from 1 April 2017)

All other services, except those listed below   2 months 
Laser Eye Surgery  3 years
Major Dental (e.g. crowns, implants, dentures) & Periodontic  12 months
Endodontic  12 months
Orthodontic   12 months
Apparatus benefits (e.g. asthmatic spray appliances, blood glucose monitors, blood pressure machines, hearing aids, sleep apnoea machines)  12 months

 

Loyalty benefits and lifetime limits apply for certain services (e.g. orthodontics and hearing aids). For full details please refer to the relevant Extras Cover information.
 

 

Hospital Waiting Periods (effective until 31 March 2017)

All other services, except those listed below   2 months 
Pregnancy and birth related services, including IVF 12 months
Pre-existing conditions (excluding psychiatric conditions, palliative care and rehabilitation). Click here for more information. 12 months
Home nursing 12 months
Home sleep studies 12 months
Unemployment Cover 12 months


Hospital Waiting Periods (effective from 1 April 2017)

All other services, except those listed below   2 months 
Pregnancy and birth related services, including IVF 12 months
Pre-existing conditions (excluding psychiatric conditions, palliative care and rehabilitation). Click here for more information. 12 months
Home nursing 12 months
Home sleep studies 12 months
Cochlear Implant replacements  3 years
Insulin Pump replacements  3 years

If hospitalisation is contemplated within the first 12 months of membership, we strongly recommend that you contact us so that eligibility for hospital benefits can be determined. Please note that not all private treatment is covered by private health insurance (e.g. cosmetic surgery not medically required).

 

 

Transferring from another health fund

If you transfer from another fund with an equivalent level of cover, and have served the relevant waiting periods, you obtain immediate access to all services on your selected level of cover.

Waiting periods will apply in the following circumstances:

  • If there is a lapse in cover of 30 days or more when transferring. We recommend that you keep your cover with your former health fund until the date you transfer to Health Partners.
  • If you transfer to a higher level of cover, waiting periods apply to the additional benefits available on the higher level of cover. During this time you will receive the same benefits and pay the same excess and co-payment (Hospital Cover only) as the Health Partners equivalent of your previous level of cover.
  • Where your previous cover had excluded benefits, waiting periods will apply for these specific services.
  • If you have only partially served your waiting periods with the previous fund, including waiting periods for benefits where 'lifetime limits' apply, the remainder of the waiting period will be served with Health Partners.

Additional information for transferring members:

  • When transferring from your former fund to Health Partners, your Lifetime Health Cover loading will remain the same.
  • Benefits paid by your former fund will count towards yearly maximums in your first year of membership with Health Partners. Loyalty bonuses or accrued entitlements with your former fund are not transferable to Health Partners.
  • The 'Right to Change' brochure produced by the PHIO is a useful guide when transferring between health funds. Please visit phio.org.au if you would like a copy.

When you upgrade your cover

For current members upgrading their cover, waiting periods only need to be served for the additional benefits on the higher level of cover. During this period you will receive the same benefits as your previous level of cover.

Waiting periods for pregnancy cover

When you change or increase your level of cover to include benefits for pregnancy and birth related services, a 12 month waiting period applies.  This waiting period applies to the actual delivery date of the baby – ie. your hospital admission date – not the “expected” delivery date your medical practitioner provides you.

So if you’re already pregnant but only joined or upgraded in the last 12 months, your benefits may be lower or you may not be entitled to any benefits.

Refer to the “Having a Baby” flyer for information about your pregnancy care options.

 

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Get a quote

Call Health Partners on 1300 113 113 1300 113 113 or get a quote online

(or 1800 182 322 1800 182 322 if you are outside the Adelaide metropolitan area or interstate)