Do waiting periods apply for hospital cover?

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 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 switch to HIF 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

CategoryGoldVitalGoldStarterGoldSaverGoldGoldStar
Treatment received as the result of an accident ^1 dayNo waitsNo waitsNo waitsNo waits
General hospitalisation2 months2 months2 months2 months2 months
Psychiatric care, rehabilitation and palliative care2 months2 months2 months2 months2 months
All obstetric and pregnancy related servicesNot coveredNot covered12 months12 months12 months
Pre-existing conditions or ailments (PEA)* 12 months12 months12 months12 months12 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.
* A Pre-existing Ailment (PEA) is an ailment, condition or illness where the signs and symptoms, in the opinion of a HIF appointed medical practitioner, existed at any time in the six months prior to joining HIF - even if you were not aware of it. As with all Australian health funds, you are required to wait 12 months before claiming on any pre-existing condition.
Category: Hospital Cover
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HIF Official Response posted at 11:54 AM 12-Feb-2016

Hi Emma, great question!
While your logic makes perfect sense, policyholders are required to serve the full 12 month hospital waiting period for pre-existing conditions before a claim can be made, even if the annual premium has been paid upfront.
This is due to the Federal Government’s "Pre-Existing Conditions Rule" which was implemented to protect health funds and their members from customers who could otherwise purchase an insurance policy, make a large claim and then leave again. The rule states, "If there was no waiting period for pre-existing conditions, people could take out cover only when they knew or suspected that they might need hospital treatment and immediately make a claim. If these new members then ceased their membership, their hospital costs would have to be paid for by the long-term members who remain on their previous hospital policy. This would not be fair to long-term members."
If you need more clarification on this, please email social@hif.com.
Thanks, Nikki

Emma Shishkin posted at 9:24 AM 10-Feb-2016

I understand and can appreciate the reasons behind your waiting periods. It states that you must wait 12 months for pre-existing ailments and have paid your 12 months worth of premiums before being able to make a claim for medical treatment regarding these pre-existing ailments.
My query is, if I pay my 12 months premiums upfront, am I still required to wait 12 months before being able to make a claim on possible pre-existing ailments? The outcome would be the same if I waited 12 months and pay up front, or whether I can access the benefits now and pay upfront. The only difference is the time I wait. You would still have received your 12 months premiums.
Thanks. :)

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