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Health Insurance Waiting Periods

Waiting Periods

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What are waiting periods?

Waiting periods are the initial periods after joining (or upgrading) your private health cover during which you can’t 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’ve already served waiting periods on a previous cover.

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:

ServiceWaiting period
Major Dental, Endodontics & Periodontics12 months
Orthodontics12 months
CPAP Apparatus12 months
Other Aids and Appliances12 months
Laser Eye Surgery36 months

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:

ServiceWaiting period
Accidental Injury*No waiting period
Pregnancy and birth related services including IVF/GIFT12 months
Pre-existing conditions12 months
Home Nursing12 months
Home Sleep Studies12 months
Insulin Pumps – initial12 months
Speech or sound processor – initial (e.g. Cochlear implant)12 months
Insulin Pumps – replacements36+ months
Speech or sound processor – replacement (e.g. Cochlear implant)36+ months

Not all benefits are available on all covers.

*provided treatment is required immediately after the accident and it’s not related to a pre-existing condition. 

When you transfer from another fund

If you’re transferring from another health fund, we won’t ask you to re-serve waiting periods for the equivalent benefits.

Waiting periods will apply for:

  • Benefits that were excluded and restricted from your previous cover
  • Partially-served waiting periods, including waiting periods for benefits where ‘lifetime limits’ apply (you’ll need to serve the remainder of the waiting period before benefits can be paid).
  • Additional benefits if you transfer to a higher level of cover.

When you upgrade your cover

For current members upgrading their cover, waiting periods will only apply for the additional benefits on the higher level of cover. If you need to claim during the waiting period, you’ll receive the same benefits as your previous level of cover. Your new, higher benefits/limits will kick-in after the waiting period ends.

Pregnancy and obstetrics

A 12 month waiting period applies for all hospital benefits for pregnancy services. To be eligible for benefits, the baby’s delivery date (not ‘expected’ or ‘due’ date) must be after the 12 month period. This means, if you want private hospital care when you have your baby, you’ll need to take out Hospital cover that includes maternity, before you get pregnant.

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

Pre-existing conditions

With Hospital cover, a 12 month waiting period applies for pre-existing conditions.

A pre-existing condition is one where signs or symptoms of an ailment, illness or condition, in the opinion of a medical practitioner appointed by the fund, existed at any time during the six months preceding the date on which you purchased or upgraded your Hospital cover.

This does not apply to psychiatric conditions, palliative care and rehabilitation which have a 2 month waiting period (level of benefits may vary depending on the cover you purchased).

For full details on Waiting Periods and more information refer to the Health Partners Member Guide.

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