Hospital Cover Waiting Periods

Hospital cover that's worth the wait.

Whether we’re answering your call, or helping you switch from another health fund, we don’t like to keep people waiting. But unfortunately waiting periods (the time you have to wait before you can claim for treatment) are a universal necessity. All health funds have them. We wouldn’t be able to offer our affordable premiums and generous rebates without them.  

Protecting your interests.

Waiting periods protect us and our members against people who simply join our health fund to claim large amounts and then leave. However, we always try to keep waiting periods to an absolute minimum. That’s why, if you join us from another health fund, we’ll take your previous membership into account so you don’t have to re-serve waiting periods on an equivalent level of hospital cover.

PRIVATE HOSPITAL COVER WAITING PERIODS GoldStarter GoldStarter GoldSaver Gold GoldStar
Treatment received as the result of an accident ^ 1 day No waiting period No waiting period No waiting period No waiting period
General hospitalisation 2 months 2 months 2 months 2 months 2 months
All obstetric related services Not covered Not covered 12 months 12 months 12 months
All treatment related to a pre-existing ailment or condition, but not including pre-existing conditions or ailment (PEA)* for psychiatric care, rehabilitation or palliative care. 12 months 12 months 12 months 12 months 12 months
^ An accident means an unforeseen event, occurring by chance and caused by an external force or object which results in an injury to the body requiring immediate medical treatment in hospital within 24 hours of the accident. If further hospital treatment (as an admitted patient) is required, the patient must be re-admitted to a hospital within 90 days of the initial hospital treatment.

Under the Private Health Insurance Act 2007, Australian health insurers impose a 12 month waiting period on benefits for hospital treatment for pre-existing conditions. A pre-existing condition is defined as any ailment, illness, or condition where, in the opinion of a medical adviser appointed by HIF, the signs or symptoms of that illness, ailment or condition existed at any time in the period of 6 months ending on the day on which the person became insured under the policy. The pre-existing condition waiting period applies to new members and members upgrading their policy to any higher level benefits under the new policy. The test applied under the law relies on the presence of signs or symptoms of the illness, ailment or condition; not on a diagnosis. It is not necessary for the member or their doctor to know what their condition is, or for it to be diagnosed. In forming an opinion about whether or not an illness is a pre-existing condition, HIF;s appointed medical practitioner who makes the decision must take into account information provided by the member’s treating doctor. Once a member has been on their HIF Hospital policy for a continuous period of 12 months, the pre-existing condition waiting period no longer applies and the member is entitled to the full benefits under their policy.

Switching to HIF? Allow us to organise it.

If you're switching from another Australian health insurance provider, we'll need a clearance certificate from your previous fund as proof of the waiting periods you've already served. But don't worry, we can take care of all that for you. Simply give us your authorisation and we can request a certificate on your behalf.