Health insurance waiting periods explained
A waiting period is the time you must hold a policy before you can claim for a particular treatment. You can't buy new hospital cover with no wait for a pre-existing condition or for pregnancy, but accidents after you join usually have no wait, switching funds keeps the waits you've already served, and some funds waive certain extras waits. For hospital cover the law sets the maximums: 12 months for pre-existing conditions and for pregnancy and birth, and two months for everything else, including psychiatric care, rehabilitation and palliative care even when the condition is pre-existing. Extras waits are set by each fund.
Waits apply when you first join and again to any higher benefits when you upgrade. They do not restart when you switch to another fund at the same or a lower level of cover, which is the most misunderstood rule in health insurance.
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General advice only. It doesn't consider your circumstances. Read the PDS and TMD before you decide.
The maximum waiting periods
These are ceilings. A fund can apply shorter waits, or none, and the actual waits for any policy are listed on its Private Health Information Statement.
| Treatment | Maximum wait | Notes |
|---|---|---|
| Pre-existing conditions (other than the three below) | 12 months | Signs or symptoms in the 6 months before you joined or upgraded, judged by the insurer's appointed medical practitioner |
| Pregnancy and birth (obstetrics) | 12 months | The mother must have served the full wait before admission |
| Psychiatric care, rehabilitation, palliative care | 2 months | Applies even if the condition is pre-existing |
| All other hospital treatment | 2 months | Includes most new illnesses |
| Accidents after your cover starts | Usually none | privatehealth.gov.au says there is usually no wait for accident treatment; check your policy |
| Extras (general treatment) | Set by each insurer | Typically 2 to 6 months for general dental, optical and physio; 12 months or more for major items such as orthodontics and hearing aids |
What counts as a pre-existing condition
Under the Private Health Insurance Act 2007, a pre-existing condition is any ailment, illness or condition you had signs or symptoms of in the six months before you joined or upgraded. It does not matter whether you or your doctor knew what it was, or whether it had been diagnosed.
The decision is made by a medical practitioner appointed by your fund, who must take into account information from your own doctor. Because it takes time, ask your fund to assess a planned admission well before you book. And even with a pre-existing condition, a fund must let you buy any policy at the same price as anyone else; you simply serve the wait before claiming for that condition.
Pregnancy and birth
The maximum wait for pregnancy and birth is 12 months, and the mother must have served it in full before admission. Because a pregnancy lasts about nine months, the cover generally needs to start before conception. Pregnancy and birth is only guaranteed on Gold policies. If you are on a singles or couples policy, you also need to move to a family or single parent membership before the birth for your newborn to be covered from birth, and each fund sets how far in advance.
The once-in-a-lifetime mental health exemption
If your hospital policy restricts psychiatric care and you need a higher benefit, you would normally upgrade and serve a two-month wait. Since 1 April 2018 you can upgrade and skip that wait once in your lifetime, provided you have already held any hospital cover for at least two months. Ask your fund to apply the exemption when you upgrade.
Extras waiting periods
Funds set their own extras waits. privatehealth.gov.au says they generally range from two to six months for items such as general dental, optical and physiotherapy, and 12 months or more for major items such as orthodontics and hearing aids. Some funds waive or shorten certain extras waits for new members. If you are joining for a known cost, check the wait for that exact service.
Switching funds without re-serving waits
If you move to another fund at the same or a lower level of cover, your new fund must give you credit for the waits you have already served. You only serve waits on benefits that are new or higher than before.
Keep the break short. There is no fixed legal window for moving between funds; privatehealth.gov.au notes some insurers allow a break of up to two months and others only a week, and if you lose continuity you re-serve waits. Ask your old fund for a clearance (transfer) certificate, which it must provide within 14 days, and give it to your new fund.
Can you avoid waiting periods?
Some waits can be avoided or shortened, and two can't on new cover. In the meantime, the public system remains available for treatment as a public patient.
| Situation | Can the wait be avoided? | How |
|---|---|---|
| Switching funds at the same or a lower level of cover | Yes | Your new fund must credit the waits you've served. Keep the break short and get a clearance certificate from your old fund |
| An accident after your cover starts | Usually | privatehealth.gov.au says there is usually no wait for treatment of an accident that happens after you join; check the policy's definition of an accident |
| Extras (general treatment) | Sometimes | Extras waits are set by each fund, and some waive certain waits as a joining offer. Read the offer terms for which services it covers |
| Upgrading for higher psychiatric benefits | Once in your lifetime | The mental health exemption lets you upgrade without the two-month wait, after two months on any hospital cover |
| A pre-existing condition on new or upgraded hospital cover | No | Up to 12 months applies. Join or upgrade well before you expect to need treatment |
| Pregnancy and birth on new or upgraded hospital cover | No | Up to 12 months applies, and the mother must serve it in full before admission |
Extras cover with no waiting period
If you're joining extras for a particular service, the wait on that service matters more than the headline offer. Our guide to extras cover with no waiting period explains what to check in a joining offer before you rely on it.
General advice only. This information doesn't take into account your objectives, financial situation or needs. Consider whether the product is right for you and read the Product Disclosure Statement (PDS) and Target Market Determination (TMD) before you decide. We don't compare every product in the market, and we may earn a commission if you take up a product through our links.
What to watch for
- 12 months is the maximum wait for pre-existing conditions and pregnancy; the PHIS shows the actual wait for each policy.
- A condition can be pre-existing even if it was never diagnosed. Signs or symptoms in the six months before joining are enough.
- Upgrading restarts waits on the new benefits only, not on cover you already had.
- Falling more than two months behind on premiums means you are no longer insured, and waits may apply when you resume.
- When you switch, get your clearance certificate and keep any gap between policies as short as possible.
Common questions
How long are waiting periods for pregnancy and obstetrics in Australia?
Up to 12 months. That is the legislated maximum for pregnancy and birth (obstetrics) on new or upgraded hospital cover, and the mother must serve it in full before admission. Because a pregnancy lasts about nine months, the cover generally needs to start before conception.
Are there any exemptions to the extras cover waiting period?
Sometimes. Extras waiting periods are set by each fund rather than by law, and some funds waive certain extras waits as a joining offer. Read the offer terms to see which services it covers, and check the waits in the policy's Private Health Information Statement.
What is the longest waiting period for health insurance?
For hospital cover, 12 months, which applies to pre-existing conditions and to pregnancy and birth. Extras waits are set by funds and can be 12 months or more for items such as orthodontics and hearing aids.
What is the minimum waiting period for health insurance?
There is no legal minimum; the law sets maximums. A fund may apply no wait at all to some services, particularly extras, and accidents after you join usually have no hospital wait.
Do I have to serve waiting periods again if I switch funds?
No, not for cover at the same or a lower level, provided you move without a long break. You only serve waits on new or higher benefits. Ask your old fund for a clearance certificate.
Is there health insurance with no waiting periods?
Not for hospital cover of pre-existing conditions or pregnancy on a new policy. Some funds waive certain extras waits as a promotion. Switching funds keeps waits you have already served.
How does the pre-existing condition rule work?
If you had signs or symptoms of a condition in the six months before joining or upgrading, the fund's appointed doctor can classify it as pre-existing and apply a wait of up to 12 months for hospital treatment of it. Psychiatric, rehabilitation and palliative care are limited to two months.
About the figures on this page
The maximum waiting periods on this page are set by the Private Health Insurance Act 2007 and change rarely. They were checked against privatehealth.gov.au on 2 October 2026. A policy's Private Health Information Statement shows the waits that actually apply to it.