Private health insurance no waiting period
If you are keen to sign up for a new private health insurance policy or increase the level of cover you already have, you should be aware of waiting periods. These can apply to both hospital and extras cover, and affect the benefits you can access after you join. Waiting periods can vary between health insurers and the type of cover you are after. But the good news is, you can access shorter waiting periods or private health insurance with no waiting period if you know how. And that’s where the expert team at No Worries come in. Know-how is what we excel in!
What are health insurance waiting periods?
In Australia, a health insurance policy waiting period is a set amount of time you may have to wait before you can claim some of the benefits and services of your policy. The amount of time depends on your health fund, the type of cover (extras cover or hospital cover), your health fund and the type of benefits and services you want to claim.
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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 things like expensive hospital treatments, and then cancel their policy before paying anything substantial. This would effectively allow any Australian to access discounted private health care, which would result in higher premiums to compensate and impact customers with increased costs.
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Who sets the maximum waiting periods for private health insurance?
The Australian Government sets the maximum waiting periods for private health insurance hospital policies, which is regulated by the Private Health Insurance Ombudsman. This is why many health funds have similar (or no) waiting periods. After private health with no waiting period?
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Do I serve waiting periods again when I switch insurers?
If you transfer to another health insurance policy, your health fund will carry across any waiting periods you’ve already completed with a comparable or lower cover, so you don’t have to serve another waiting period. In fact, if there was no gap in your coverage and your new plan offers the same or fewer benefits as the old one, your new insurer is required to honour the waiting period for hospital cover that you’ve already served.
Some insurers will also waiver waiting periods if you take out extras cover with them as a new customer, even though they are not required to do so by law. You can then use your health insurance straight away without a break in coverage if you have already served a period of time with a different provider before switching.
Is there hospital cover with no waiting period?
Many insurance policy holders stick with an expensive or outdated health insurance policy because they believe they’ll need to re-serve any hospital benefit waiting periods if they switch to a different health fund. But this simply isn’t true. Any hospital cover waiting periods you’ve already served with a health fund will be protected by law as long as you switch to an equal or lower level of cover, and funds generally honour extras waiting periods as well.
If you are a new customer or upgrading your level of cover, many insurers will also regularly grant special offers to waive waiting periods. That’s why talking to experts like us who know the ins and outs of health insurance — including hospital cover with no waiting period — is so valuable.
In Australia, hospital cover waiting periods can vary depending on the treatment you need and the private health insurer you choose. The Private Health Insurance Ombudsman and the Private Health Insurance Act 2007 outlines the maximum limits for specific hospital benefits, but none last longer than 12 months. These include:
- 12 months for pre-existing conditions. These are defined as “any condition, illness, or ailment that you had signs or symptoms of during the six months before you joined a hospital policy or upgraded to a higher hospital policy”. However, it’s worth noting that in Australia, it is illegal for insurers to charge you a higher premium because you are more likely to need certain procedures.
- 12 months for obstetrics (pregnancy and birth). This means you should consider health insurance for you and your unborn child before you fall pregnant.
- Two months for psychiatric care, rehabilitation and palliative care, even for pre-existing conditions. This can include treatment for eating disorders, post-natal depression and drug and alcohol rehabilitation, among other treatments. However, there is a benefit called the Mental Health Waiver for those seeking immediate hospital care for mental health services or drug and alcohol treatment. It allows those who have served their two-month waiting period for restricted hospital psychiatric services (typically included on all hospital policies) to upgrade and receive the higher benefits with no waiting period. However, access to this benefit is limited and can generally only be used once per person in their lifetime.
- Two months for accidents and new conditions.
- Two months for other services that require hospitalisation that aren’t pre-existing conditions or subject to other waiting times.
Depending on your health cover policy, you may also be able to use your private health cover in a public hospital. Your cover can be used to pay for services offered in a public hospital that
Medicare doesn’t cover, or treatment in a public hospital with your choice of medical practitioner.
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Is there extras cover with no waiting period?
Waiting periods for general treatment, also known as extras or ancillary cover, are set by individual private health insurance providers and are not subject to the same laws as hospital cover. Holding an extras policy also doesn’t count towards waiting periods for a hospital policy.
Waiting periods vary from two months to three years. However, if you transfer from one health insurer to another, many health insurers will not require you to re-serve waiting periods again for certain treatments and offer extras cover with no waiting period. This means you can start using your benefits straight away.
Insurers also often hold promotions where they waive some of the extras health cover waiting periods on combined hospital policies to encourage new members to join with them. But with the number of health insurers in Australia, having to research all the options available can be stressful and time-consuming.
And that’s where the team at No Worries can help. We live and breathe health insurance, so can help you find the best cover that suits your individual circumstances, so you can start accessing your extras cover benefits straight away.
Some of the maximum waiting periods outlined by the Private Health Insurance Ombudsman include:
- Two months for general dental and physiotherapy.
- Six months for optical items like glasses or contact lenses.
- 12 months for major dental services like crowns and bridges.
- One, two or three years for braces, orthodontics and other high-cost procedures.
What about ambulance cover?
Private health insurance providers also offer different forms of ambulance cover that differ by state. For this reason, you shouldn’t assume that just because you have private health insurance, you are covered for ambulance services. Cover depends on the type of services you require, which are typically deemed as an “emergency” or “non-emergency”. An emergency is generally an unplanned event where you need immediate medical treatment. A non-emergency could be transportation from a hospital to your home, nursing home or a hospital for ongoing medical treatment. Some insurers offer unlimited cover, others limit or exclude cover or cap the amount you’re entitled to. There are also situations where you might not be covered, including:
- Air and helicopter and road transport services that aren’t operated by a state or territory government or an organisation recognised by your health provider.
- Where your state Government provides an ambulance benefit (for example, Queensland and Tasmania) or you are covered through a state-based reciprocal arrangement.
- When you hold a subscription with your state ambulance service.
In terms of general ambulance cover entitlements in Australia by state:
- Queensland. All Queensland residents are covered by Queensland Ambulance Service (QAS) arrangements, including interstate travel.
- NSW/ACT. An ambulance levy to cover transportation or attendance by NSW ambulance is typically included in your hospital cover. If you require ambulance assistance in another state, you should be covered if you have combined hospital and extras cover.
- Tasmania. All Tasmanian residents are covered by Ambulance Tasmania. If a Tasmanian resident requires services in Queensland or South Australia, they are not covered by the state scheme and can only claim if they have combined hospital and extras cover.
- All other states and territories. You are generally entitled to cover for emergency ambulance transportation or attendance if you have both hospital and extras cover.
In terms of waiting periods, many health funds stipulate a one-day waiting period for emergency ambulance and on-the-spot treatment, and a one-month waiting period for non-emergency ambulance transportation.
