Waiting periods are set periods of time where you need to hold your private health insurance before you can claim benefits for treatments or services.
Waiting periods are a standard part of private health insurance and apply to both Hospital and Extras cover.
Understanding how waiting periods work can help you better understand when you’re covered and avoid unexpected out-of-pocket costs.
Key Points
- Waiting periods are set periods of time before you can claim benefits under your cover
- Waiting periods apply to both Hospital and Extras cover
- Different treatments and services have different waiting periods
- If you receive treatment during a waiting period, benefits won’t be payable under your policy
What are waiting periods?
Waiting periods are a standard part of private health insurance and are designed to prevent people from joining or upgrading their cover only when they need immediate treatment.
Different treatments and services under your hospital cover and extras cover have different waiting periods, depending on the type of cover and treatment involved.
Once you’ve served a waiting period, you can claim benefits for included services under your policy, subject to any limits, exclusions or out-of-pocket costs.
Why do waiting periods apply?
Waiting periods help keep private health insurance fair and sustainable for all members.
Without waiting periods, people could wait until they needed treatment before joining or upgrading their cover to claim immediately.
If this happened, the cost of claims across the health insurance system would increase significantly, leading to higher premiums for all members.
Waiting periods are a standard part of private health insurance across the industry and are regulated under private health insurance legislation.
Do waiting periods apply when you first take out cover?
Yes. If you’re taking out private health insurance for the first time, full waiting periods apply before you can claim benefits for services covered under your policy.
Different treatments and services have different waiting periods depending on the type of treatment and level of cover.
If you receive treatment during a waiting period, benefits won’t be payable under your policy.
Do waiting periods apply if you switch health funds?
If you switch from one Australian private health insurer to another and maintain continuous cover, you won’t need to re-serve waiting periods already completed on equivalent cover.
However, if you upgrade your cover or add new services that weren’t included under your previous policy, waiting periods apply to the new services or new benefits.
When switching health funds, your new insurer will request a Transfer Certificate from your previous fund to confirm your level of cover and waiting periods already served.
Do all treatments and services have the same waiting periods?
No. Different treatments and services have different waiting periods depending on the type of treatment and level of cover.
For example, shorter waiting periods commonly apply to general Extras services, while longer waiting periods often apply to treatments such as major dental, pregnancy and pre-existing conditions.
Your health fund can provide information about the waiting periods that apply to your specific cover.
What waiting periods apply at Phoenix Health Fund?
Waiting periods depend on the type of cover and the treatment or service you’re claiming for. The table below shows the standard waiting periods that apply to Phoenix Health Fund Hospital and Extras cover.
Waiting periods for Hospital Cover
| Treatment or Service | Waiting Period |
|---|---|
| Pre-existing conditions (excluding Hospital Psychiatric services, Rehabilitation and Palliative Care) | 12 months |
| Pregnancy and birth | 12 months |
| Hospital Psychiatric services, Rehabilitation and Palliative Care | 2 months |
| All other hospital conditions not considered pre-existing | 2 months |
| Hospital treatment as the result of an accident | No waiting period |
| Ambulance Cover | 1 day |
Waiting periods for Extras Cover
| Treatment or Service | Waiting Period |
|---|---|
| Major Dental and Orthodontics, Hearing Aids and Aids to Recovery | 12 months |
| Optical | 6 months |
| All other Extras services | 2 months |
Note: Waiting periods can vary depending on your cover, previous health insurance history and whether you’re joining, switching or upgrading. You can view more information on our waiting periods page.
Can waiting periods be waived?
In some situations, health funds may choose to waive or reduce waiting periods as part of a special offer or promotional campaign.
Waiting period waivers commonly apply to Extras cover and are generally only available to new members joining an eligible product.
Hospital waiting periods for pre-existing conditions, pregnancy and birth are regulated under private health insurance legislation and generally won’t be waived.
How do you check your waiting periods?
You can check the waiting periods that apply to your cover by reviewing your policy information or contacting your health fund.
Phoenix Health Fund members can contact our team on 1800 028 817 for help understanding waiting periods, services included under their cover and when benefits become payable.
