What is a period in health insurance?

Are you thinking about taking out a new private health insurance policy or increasing the level of cover you already have? You may be wondering if there are waiting periods for hospital cover and extras policies.

Table of Contents Show

Why are there waiting periods with Private Health Insurance?
Health insurance with no waiting periods
What are the typical private health insurance waiting periods?
What are the waiting periods for hospital cover?
What are the waiting periods on extras cover?
Why do private health funds have waiting periods?
Are there waiting periods for mental health hospital treatment?
Do waiting periods apply when you switch private health cover?
Can health insurance have no waiting periods?
Do private patients have to go on waiting lists for surgery?
How to get the most from your private health cover

When you first join a health fund or upgrade your policy, you will typically incur waiting periods for private health insurance before you can claim your hospital and extras cover for the services you are gaining.

Waiting periods can vary between insurers but refer to the amount of time you’ll have to wait before claiming on your private health insurance policy.

We break down waiting periods for both hospital and extras, including when you may not need to serve waiting periods to claim on treatment.

Why are there waiting periods with Private Health Insurance?

Insurers have private health insurance waiting periods to make pricing fair for existing customers. Without waiting periods, people could sign up for cover and immediately claim on expensive hospital treatment (like joint replacement surgery) and then cancel their policy before paying anything substantial.

This would effectively allow anyone to access significantly discounted private health care, which would see higher premiums to compensate, impacting customers with increased costs.

Is it possible to use your private health insurance immediately?

You can use health insurance straight away if you have transferred to a new hospital or extras policy without a break in coverage, provided you have already served the applicable waiting periods for the service you are looking to claim on – even if you have served this period of time under a different provider before switching.

Keep in mind that if you are adding to or upgrading your existing hospital or extras cover, you will still be subject to waiting periods for the additional services you are gaining. However, you can usually switch to a lower level of cover with a new insurer if you have served waiting periods.

Some insurers may offer waiting period waivers as a joining offer on extras policies, allowing you to use extras health insurance straight away.

Health insurance with no waiting periods

In some circumstances, health funds may have shorter or no waiting periods for cover for accidents. Other than that, funds won’t generally waive the waiting periods for hospital cover.

If there’s a certain feature of your health insurance policy you wish to claim on sooner rather than later, ask about the waiting periods that apply before you join. Or compare health insurance policies to review waiting periods.

Always check your policy document for applicable waiting periods.

What are the typical private health insurance waiting periods?

Waiting periods can be as little as a few months for some hospital services, such as psychiatric care and rehabilitation, or can blow out to 36 months for extras procedures, such as hearing aids (with some funds).

Of course, other extras cover, such as general dental services and physiotherapy, often have a two-month wait, while many hospital procedures and major dental procedures such as denture treatment have a maximum waiting period of 12 months.

Private health insurance waiting periods can vary between providers and whether you opt for hospital cover or extras cover. So it’s important you clearly understand these wait times when signing up by reading the policy document carefully.

What are the waiting periods for hospital cover?

Waiting periods for hospital cover vary for the treatment you require and the fund you’ve got. The Private Health Insurance Ombudsman outlines the maximum limits for specific hospital benefits, but none last longer than 12 months.1 These include:

12 months for pre-existing conditions or illnesses you showed signs or symptoms of in the 6 months leading up to taking out a hospital policy;
12 months for pregnancy and birth (obstetrics). This means you’ll need to consider health insurance for you and your unborn child before you fall pregnant;
two months for palliative care, rehabilitation and psychiatric care; and
two months for other services that require hospitalisation (and aren’t pre-existing conditions or subject to other waiting times).

What are the waiting periods on extras cover?

The waiting periods for extras cover, also known as general treatment or ancillary care, are set by each health fund and may vary between insurers.

The Private Health Insurance Ombudsman outlines some typical waiting periods for general treatment, as listed alongside hospital waiting periods in the table below.1

Insurers often hold promotions where they waive some of the extras cover waiting periods on combined hospital policies to encourage new members to join private health insurance.

Despite this, it is uncommon for insurers to waive 12-month waiting periods. For example, you may not need to serve waiting periods for general or preventative services like routine dental check-ups. Still, you will need to wait before claiming on major dental treatment, like root canals or denture care.

Confused about waiting periods with private health funds? Get the lowdown on how they work and why they exist.

When you pay for a service, you generally want it to kick in immediately – like with internet, water and electricity. However, private health insurance works a little differently.

Serving waiting periods before you start claiming on private health insurance is common in Australia. Why? As it turns out, there’s a really important reason.

Why do private health funds have waiting periods?

Having to wait to use some parts of your private health cover – like major dental – can be frustrating, but the reason could save you money.

If health funds don’t have waiting periods, people could join the fund and take out private health insurance, make a high-cost claim, then cancel their insurance. What this means is that people who are regularly paying their premiums bear the cost of that claim.

In short, waiting periods protect existing members and reduce the rate of premium increases in the long run.

The Australian Government sets the maximum hospital cover waiting periods. Here’s what the government has decided are the maximum lengths:

Two-month wait for psychiatric care, rehabilitation and palliative care, plus all other circumstances (any new health conditions that require hospitalisation).
12-month waiting period for treatment of pre-existing conditions. ‘Pre-existing’ means any condition, illness or ailment you had signs or symptoms of in the six months before you joined a hospital policy or changed your cover to a higher hospital policy – even if it wasn’t officially diagnosed.
12-month wait for pregnancy and birth-related services.
12-month wait to access HCF No-Gap Joints Program*.

There is great news, as well, for HCF members when it comes to emergency ambulance cover.

It’s good to know that with HCF, there’s a waiting period of two months for hospital cover, but your emergency ambulance cover kicks in after only one day.

When it comes to extras waiting periods for cover like dental, optical, physiotherapy and remedial massage, these are set by individual private health insurers. Wait times vary between insurers depending on the service.

Waiting periods apply if:

you’re a new member
you rejoin after having a break in private health cover
you’re an existing member and change your cover to a higher policy e.g. if you increase your cover from HCF's Silver Hospital cover to Premium Gold Hospital, there’s a waiting period for new included services not previously covered
you reduce your excess because this is considered an increase in your cover as you’re lowering the amount to pay if you go into hospital. If you do go to hospital during this waiting period, you’ll pay the old, higher excess amount, rather than the excess you’re changing to.

Are there waiting periods for mental health hospital treatment?

The waiting period to access hospital treatment for any mental health issue is usually two months, including psychiatric care.

But if you’re moving from a policy with restricted benefits for psychiatric care to a higher graded policy, you may be exempt from any waiting period if you have already served at least two months on your previous policy.

Eligible HCF members# can access the HealthyMinds program including video or phone contact with a psychologist, with navigation to psychiatry and other allied health services as needed by calling our partner PSYCH2U on 1300 472 866.

Do waiting periods apply when you switch private health cover?

If you transfer from another fund, without a break in cover, you generally don’t need to re-serve waiting periods you have previously completed.

For example, if your new HCF cover includes the same benefits and services as your previous cover, and you’ve already served the equivalent waiting periods, then the HCF waiting periods may be waived.

Some timeframes and exceptions may apply so it’s best to speak to an expert by calling us on 13 13 34 to find out.

Can health insurance have no waiting periods?

Generally, health funds keep to established waiting periods to ensure fairness for all members, but occasionally they may waive waiting periods for extras cover items like general dental services (not the more complex treatment), some optical treatments, and therapies like remedial massage.

You might also see promotions [waiving waiting periods] from time to time.

Do private patients have to go on waiting lists for surgery?

While waiting periods refer to accessing your health fund benefits, waiting lists usually refer to elective surgery.

Elective surgery is non-urgent surgery that has been recommended to you by a medical professional. This includes knee replacements, cataract extractions and tonsillectomies.

Elective surgery waiting lists in the public system tend to be much longer than in the private system. With private health insurance, you are also able to choose your doctor and where you are treated and may be able to access further benefits like a private room.

Find a HCF Participating Hospital to lower your out-of-pocket hospital costs for elective surgery.

How to get the most from your private health cover

Be sure to contact your health fund before you have any health treatment or before going to hospital as a private patient, to check whether you’ve served any relevant waiting periods.
Be as prepared as you can be. If you’re planning a family and would like to be covered for the pregnancy and birth, make sure you arrange private health cover with enough time, taking into account a 9 month pregnancy and the 12 month waiting period. If you want your baby covered from birth, let your private health insurer know within two months of their arrival.
For unexpected situations, like emergency hospitalisation where you haven’t served out the two-month waiting period for new conditions, you can access the public health system.

For more information on waiting periods, call on 13 13 34, or log in to online member services.

A reminder of when waiting periods might apply?

When you’re a brand-new member
When you’re swapping over from a different fund
When you’re reducing your excess
When you’re increasing your cover on your current policy
When accessing HCF No-Gap Programs.

Words by Bonnie Bayley and Angela Tufvesson
Updated August 22

Future health
The healthcare system

Back to

Research & insights

* HCF will waive any applicable excess for same-day treatment for members who have held HCF Hospital Premium Gold or HCF Corporate Premium Gold for at least 12 months.

# Service is available free to all members who are financial with hospital and/or extras product for a limited time that ends 31 December 2022. Excludes Ambulance Only, Accident Only and Overseas Visitors Health Cover.

This communication contains information which is copyright to The Hospitals Contribution Fund of Australia Limited (HCF). It should not be copied, disclosed or distributed without the authority of HCF. Except as required by law, HCF does not represent, warrant and/or guarantee that this communication is free from errors, virus, interception or interference. All reasonable efforts have been taken to ensure the accuracy of material contained on this website. It’s not intended that this website be comprehensive or render advice. HCF members should rely on authoritative advice they seek from qualified practitioners in the health and medical fields as the information provided on this website is general information only and may not be suitable to individual circumstances or health needs. Please check with your health professional before making any dietary, medical or other health decisions as a result of reading this website.