Waiting Periods

What are waiting periods?

A waiting period is a specific period after a new cover has commenced during which benefits are not payable or benefits are only payable as per the entitlements of a previous cover or policy for treatment received.

When you join without current health cover

If you’re taking out private health cover for the first time or you’ve been without private health cover for 30 days or more, you’ll have waiting periods for all services on your selected level of cover. Most waiting periods are 2 months, but some are longer (e.g. major dental, orthodontics, pregnancy).

Extras waiting periods

After 2 months, you can start claiming benefits for all Extras on your chosen cover, except for:

Not all benefits are available on all covers.

Hospital waiting periods

After 2 months, you can start claiming benefits for all Hospital on your chosen cover, except for:

* Refer to loyalty benefit for more information

+ Waiting periods do not apply to benefits for treatment provided immediately after and related to an accident. Accidents must not have occurred within 1 day of membership commencement. When an accident has occurred within 1 day of membership commencing the accident rule does not apply and waiting periods apply.

Not all benefits are available on all covers. Terms and Conditions Apply, see below for details.

Accidental Injury

Provided treatment is required immediately after the accident from a registered Medical Practitioner and it’s not related to a pre-existing condition. If an accident has occurred within 1 day of membership commencing, waiting periods apply. Refer to our Member Guide for full conditions.

When you transfer from another fund

If you are transferring from another Australian Health Fund and you have served the waiting period for an equivalent cover, meaning a policy with the same inclusions and limits, you will not need to serve the waiting periods again.

Waiting periods will apply for:

• Any additional services, treatments, goods and any higher limits. During this time you will receive the same benefits you received on your previous cover
• If you have only partially served waiting periods with your previous fund, the remainder of the waiting period will be served with us.
  Refer to our Member Guide for full conditions.

When you upgrade your cover

If you’re a current member with us and change your level of cover, waiting periods apply for any increased benefits and limits of cover. During this period you will receive the same benefits. For hospital cover you will also pay the same excess and co-payment as your previous level of cover, if applicable.

When you change your cover, we will explain to you which benefits you can claim immediately and any waiting periods that may apply.

Pregnancy and Birth

A 12 month waiting period applies for all hospital benefits for pregnancy and birth services. This means, you will need to take out Hospital cover that includes these services, before you get pregnant.

For more information about pregnancy and hospital cover, read the Having a Baby flyer.

Pre-existing conditions

Pre-existing condition is an ailment, illness or condition where the signs or symptoms existed at any time six months before you became insured with us. We will appoint a medical practitioner to determine if the treatment required is related to a pre-existing condition. Refer to our Member Guide for full conditions.