What are waiting periods?

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.

Waiting periods protect us and our members against people who simply join us, claim large amounts and then leave. 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 or higher level of cover.

Did you know... Waiting periods for different services can sometimes vary between health insurers, but the Government pre-defines maximum waiting periods for certain hospital benefits, including:

  • 12 months for pregnancy and birth-related services
  • 12 months for pre-existing conditions and ailments
  • 2 months for psychiatric care, rehabilitation and palliative care (regardless of whether it's pre-existing or not)
  • 2 months for general hospitalisation

Waiting period exemption for Psychiatric Care: New members transferring from another health fund who previously had restricted psychiatric cover, can now upgrade their policy without serving a two month waiting period for the higher or additional benefits. The waiting period exemption for psychiatric care benefits can only be accessed once in a lifetime, and is only available after a person has served their initial two month waiting period for any psychiatric cover.

What is a pre-existing condition?

The pre-existing condition waiting period applies to new members and members upgrading their policy to any higher level benefits under the new policy. A pre-existing condition is defined as: ‘Any ailment, illness, or condition where, in the opinion of a medical adviser appointed by the health insurer, the signs or symptoms of that illness, ailment or condition existed at any time in the period of six months ending on the day on which the person became insured under the policy.’

A pre-existing condition can be identified by the presence of signs or symptoms of the illness, ailment or condition (i.e. it’s not necessary for the member or their doctor to know what their condition is, or for it to be diagnosed). In assessing whether a condition/illness is a pre-existing condition or not, an HIF-appointed medical practitioner will take into account information provided by your treating doctor. This rule applies whether the condition was known to the member or not.