Your guide to private health insurance waiting periods

If you’re new to private health insurance, or even if you’re looking to change your level of health cover or switch health insurers, it pays to know about waiting periods.

Here’s some info on waiting periods – what they are and why they exist, how they can apply your hospital cover and your extras cover.

What are waiting periods?

A waiting period is the amount of time you need to wait before you can start to claim on your private health insurance.

Waiting periods help to reduce future premium increases for existing members. Without waiting periods, people could join, make high-cost claims and then cancel their memberships as soon as possible. This means current members would be impacted by higher premiums in the future.

When will waiting periods apply?

You may need to serve a waiting period if:

you’re taking out private health insurance for the first time
you’re re-joining after a break from being covered
you change to a higher level of cover (there’s a waiting period for new included services not previously covered)
you lower your excess and if you do go to hospital during this waiting period, you’ll pay the higher excess amount
you’re transferring from another health insurer (see below for further info).

For each person covered, the waiting period starts on the first day the person is insured under the policy and ends at the time specified by the policy.

How long are waiting periods?

The Australian Government sets the maximum waiting periods that private health insurers can put in place for hospital treatment. We’ve outlined them below.

12 months for pre-existing conditions. (More about pre-existing conditions below.)
12 months for pregnancy and birth-related services.
2 months for psychiatric care, rehabilitation and palliative care.
2 months for all other services.

Waiting periods on your extras cover for services like dental, optical and physiotherapy are set by private health insurers.

Some of the common waiting periods that may apply to RT Health members and their policies (depending on your type and level of cover) are below.

2 months

General dental. This includes services like preventative treatments, X-rays, fillings, scale and clans, mouthguards and tooth extractions.
Specialist therapies. Services like physio, chiro, osteo, occupational therapy and psychology.
Alternative therapies. Claims for alternative therapies can include consultations for services like Swedish and remedial massage, exercise physiology and myotherapy.
Optical. Benefits for prescription frames, lenses and contact lenses.

12 months

Health aids. These are medical devices and equipment that help you manage a health condition. They include items like custom-made orthotics, blood glucose and blood pressure monitors, wheelchairs, wigs, BPAP (Bilevel Positive Airway Pressure) and CPAP (Continuous Positive Airway Pressure) machines and masks and compression garments. If you’ve got a letter from your medical practitioner stating the health aid they’re recommending for you (and the reason), you’ll be able to claim.
Major dental. Most RT Health extra services like orthodontics, crowns and bridges, dentures (only claimable every two years when included in your cover) and periodontics have a 12-month waiting period.

24 months

Hearing aids. These (if included in your cover) can be claimed after 24 months of membership. Hearing aids are claimable every three years.

You can check out any waiting periods that apply to your RT Health policy by taking a look at your RT Health Cover Guide. You’ll find all waiting periods clearly listed on each policy.

Pre-existing conditions

What’s a pre-existing condition? A pre-existing condition is any ailment, illness or condition that you had signs or symptoms of during the six months before you took out or upgraded your health cover. A condition can still be classed as pre-existing even if you hadn’t seen your doctor about it or known about it before taking up your health insurance policy or upgrading to a higher hospital cover.

Will I need to serve a waiting period? If you’re new to private health insurance, upgrading your cover or switching to a new health insurer, you may need to serve a 12-month waiting period before you’re covered for certain conditions.

If your condition is pre-existing, you won’t be covered until your waiting period has been served. Or you’ll be able to claim at the level of your previous, lower cover.

Switching health insurers

If you’re transferring from another health fund to an equivalent level of cover where you’ve already served waiting periods, you won’t need to serve them again provided the transfer is within the maximum period permitted by your new health insurer (we set this at 2 months).

But if you switch to another insurer or a higher cover or excess level, you’ll need to serve waiting periods for any services, treatments or benefits you weren’t previously covered for, including the balance of any unexpired waiting periods.

If you’re switching health insurance providers and upgrading your cover (getting higher benefits) at the same time, you’ll need to serve the relevant waiting periods on the higher level of cover.

Upgrading your cover

If you’re upgrading your cover (for example, switching your hospital cover from a silver policy to gold or taking out a high level of extras), you’ll need to serve the relevant waiting periods before your higher coverage kicks in.

It’s the same when you choose a lower excess. You’ll pay your lower excess amount if you’re admitted to hospital after you’ve served the 12-month waiting period. Up until then, you’ll need to pay your previous, higher excess amount.

Optimising mental health cover

Fast access to mental health services when you need them is important. To support our members to get faster access to mental health services, health fund members with limited cover for psychiatric care may be eligible to upgrade their hospital cover to access higher benefits without serving the two-month waiting period. This exemption is only available once per person per lifetime, even if they’ve switched between health insurers.

Eligible RT Health members^* can also claim for online cognitive behavioural courses delivered by This Way Up. These evidence-based programs have been developed by psychiatrists and clinical psychologists and help you manage depression, generalised anxiety, social anxiety, health anxiety, panic and Obsessive Compulsive Disorder (OCD) – just to name a few. You can find our more here.

Know your cover

Knowing what you’re covered for is important, especially when it comes to understanding and knowing which waiting periods may apply to you.

Your RT Health Cover Guide is the best place to start. It’s worth checking in to make sure you understand what waiting periods may apply to the cover you’ve chosen.

To find your Cover Guide, log in to the online Member Services portal. Or just go to our website any time that suits you. You should also check the fund rules relating to waiting periods.

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