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A waiting period is the time you must hold a policy before you can claim for a particular treatment. 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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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 |
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.
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.
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.
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.
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.
Beyond these, a wait on hospital cover for a pre-existing condition or pregnancy cannot usually be avoided on a new policy. In the meantime, the public system remains available for treatment as a public patient.
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.
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.
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.
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.
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.
Medicare Levy Surcharge thresholds and government rebate percentages are reviewed regularly, so this page does not quote them. For the current figures see the ATO and the government's privatehealth.gov.au.
