Can I waive my waiting period for health insurance?

In some circumstances, you might be able to avoid health insurance waiting periods. Find out how and when it can happen.

When you take out a health insurance policy, waiting periods set by the insurer typically apply. During these waiting periods, you won’t be able to make a claim on your health cover. You usually need to serve waiting periods when you sign up for a new health fund, and they often apply to both hospital and extras cover.

Why do waiting periods apply to health cover?

At first glance it can seem like not having to serve a waiting period would be a plus for consumers, but when you take a closer look it becomes clearer why health cover with no waiting period could work out to be a lot more expensive.

The Private Health Insurance Ombudsman (PHIO) explains that all health insurers are required by law to offer health cover for Australians no matter what their health is like. Even better, insurers cannot charge higher premiums even if a person talking out health cover is more likely to need treatment. That’s very reassuring for consumers thinking of joining a private health fund.

But if health cover with no waiting periods was available, consumers could potentially sign up for cover, make a large claim shortly after, and then cancel their membership. This could see health fund payouts escalate, and the PHIO says this would lead to increased premiums for all health fund members.

The good news is that while waiting periods typically apply, there can be situations when it might be possible to avoid waiting periods on health insurance, and we’ll go through them below.

Bear in mind though, waiting periods are just one element to take into account when considering health insurance options. Other factors, such as the level of cover offered by the policy and cost, are also important. You may also still be weighing up the pros and cons of choosing private health insurance entirely.

Are there ways to get health insurance with no waiting period?

Although most health insurance policies have waiting periods, there are a few ways to potentially avoid them. These include changing policies, but retaining a similar or lower level of cover, and looking out for special offers that waive the waiting period. There can also be exemptions for mental health treatments in some limited circumstances.

1. Changing to a different policy with a similar or lower level of cover

If you switch from one health insurer to another, you may not need to re-serve waiting periods you have already completed.

According to the PHIO, you do not have to re-serve hospital waiting periods if there is no break in cover. But if you add or upgrade your hospital cover, you will generally have to sit the waiting period for new or upgraded items.

For extras cover, the Ombudsman says most health insurers will not require you to re-serve these waiting periods. But loyalty limits and accrued benefits may not transfer between your insurers, so check with the individual insurer.

2. Mental health waiting period exemptions

In some cases, you can upgrade your hospital policy to receive higher benefits for psychiatric care in a hospital without a further waiting period. This applies if you have already served the two-month waiting period for limited benefits.

You can do this at any time but only once in your lifetime, according to the Department of Health and Aged Care.

3. Special offers to waive policy waiting periods

Some health insurers may offer to waive waiting periods for new customers to entice them to join the fund. Often, these promotions involve waiving waiting periods for certain treatments and conditions. Typically, two- to six-month periods are waived on extras. According to the Ombudsman, it’s very rare for insurers to waive the 12-month waiting periods for pre-existing conditions, obstetrics or major dental.

You may see more of these deals during March and April, as April 1 is when health insurers typically increase their premiums and consumers tend to shop around for cover.

Canstar compiles a list of some of the health insurance sign-up offers that are available from providers. These offers are designed to attract new customers and terms and conditions generally apply.

How long are waiting periods?

Waiting periods for hospital treatment can typically range from two months to 12 months, depending on the treatment and insurer. For extras, some providers may have no waiting periods for certain services. But other providers may have waiting periods of up to three years for some treatments.

Waiting periods for hospital cover

The federal government sets the maximum waiting periods that insurers can apply for hospital treatment. These are:

• 12 months for pre-existing conditions
• 12 months for obstetrics (pregnancy and birth)
• Two months for psychiatric care, rehabilitation and palliative care, even for a pre-existing condition
• Two months in all other circumstances

Waiting periods for extras cover

The waiting periods for extras or ancillary cover are set by individual insurers, rather than the government. This means they can vary from insurer to insurer. To give you an idea of how long you might have to wait, check with your insurer.

Ann Lund updating an article by Tamika Seeto
Cover image source: Brian A Jackson/Shutterstock.com