Waiting Periods

Health Insurance Waiting Periods Explained

Waiting periods are one of the most misunderstood parts of private health insurance. Get them wrong and you could be without cover when you need it most. Here's a clear breakdown of every waiting period you need to know.

2 months

Standard hospital waiting period

12 months

Pre-existing conditions & obstetrics

0 days

Wait when switching to same-level cover

What Are Waiting Periods and Why Do They Exist?

A waiting period is the amount of time you must be covered before you can claim benefits for certain services. They exist to prevent people from joining a fund only when they need immediate treatment — which would make the insurance system unsustainable.

Waiting periods apply to specific services, not your entire policy. You might be able to claim immediately for accidents while waiting 12 months for a pre-existing condition.

Standard Hospital Waiting Periods

Waiting period	Applies to
2 months	Most general hospital treatments (illnesses and conditions arising after joining)
2 months	Psychiatric care, rehabilitation, and palliative care — even if pre-existing
12 months	Pre-existing conditions (signs or symptoms existed in the 6 months before joining)
12 months	Pregnancy and obstetrics (Gold hospital only)
12 months	IVF and assisted reproductive services (Gold hospital only)

Source: privatehealth.gov.au — Waiting Periods

Psychiatric care exception

By law, psychiatric, rehabilitation, and palliative care have a maximum 2-month waiting period — even if the condition is pre-existing. The pre-existing condition rule does not apply to these three categories. This is a legal protection, not a fund discretion.

Extras Cover Waiting Periods

Unlike hospital waiting periods (which are set by law), extras waiting periods are set by individual funds. Typical ranges:

🦷 General dental (checkups, scale & clean)Typically 2 months

👓 Optical (glasses, contact lenses)Typically 2 months

🏃 Physiotherapy, chiropractic, remedial massageTypically 2–6 months

🦷 Major dental (crowns, bridges, root canals)Typically 12 months

🦷 Orthodontics (braces)Typically 12 months

👂 Hearing aidsTypically 36 months (where included)

Always confirm exact waiting periods with your specific fund before joining. Some funds waive or reduce extras waiting periods as a joining incentive.

Not sure where you stand?

Tell us your situation — current cover, health history, what you need soon — and our agents will map out exactly which waiting periods apply to you.

Talk to an agent →

Portability: Switch Funds Without Re-Serving Waiting Periods

One of the most important rules in Australian health insurance: if you switch from one fund to another at the same or lower level of cover, your served waiting periods transfer with you. You do not restart from zero.

Switching at same level (e.g. Silver → Silver)

All served waiting periods transfer immediately. Your new fund is legally required to recognise them.

Upgrading cover (e.g. Silver → Gold)

Silver-level waiting periods transfer. But new 12-month waiting periods apply to Gold-only benefits (obstetrics, joint replacements, IVF) from the upgrade date.

Gap in cover (more than 30 days)

Gaps in coverage can affect portability. Keep your old policy active until the new one starts — overlap is better than a gap.

Common Questions

If I join and get sick next month, am I covered?+

It depends. If you develop a new condition after joining, the standard 2-month hospital waiting period applies. If the condition had signs or symptoms in the 6 months before you joined, the pre-existing 12-month wait applies.

Can waiting periods be waived?+

In general, no — waiting periods are a legal requirement. However, some funds offer reduced or waived extras waiting periods as a joining promotion. Hospital waiting periods cannot be waived except through portability when switching.

Do waiting periods apply to accidents?+

Acute injuries (accidents occurring after you join) are generally covered after the standard 2-month wait. Check your fund's Product Disclosure Statement for emergency treatment rules as these vary.

I was on my parents' policy — do waiting periods transfer?+

Possibly. If you transition from a dependant on a family policy to your own individual policy with the same fund, served waiting periods typically carry over. Switching to a different fund is treated as a new policy — portability rules apply.