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News • 18 February 2021

What are waiting periods?

What health insurance waiting periods could mean for you

You may have heard about waiting periods for private health insurance, but do you understand how and when they might apply to you? Navigating the world of private health insurance can sometimes be hard work, we know, so we’re here to break it down in a way that’s easy to understand.

Let’s take a closer look at the ins and outs of private health cover waiting periods. 

What are waiting periods?

Waiting periods are the time you are required to wait after taking out private health insurance before you can make certain claims. New members generally have a waiting period apply to their policy, and sometimes waiting periods might also apply if you are changing your policy. 

Why do we have waiting periods?

Private health cover often comes with a waiting period as a form of protection for us and our members. Otherwise, new members would be able to join and immediately make large claims, then cancel their membership. This kind of situation would lead to higher costs for TUH, and steep membership increases for our members. Waiting periods help keep private health cover fair and affordable. 

Does a waiting period apply to me?

A waiting period will apply to you if you are a new member, or in the event that you upgrade your cover to include more services, higher benefits or lower excess. (including if you have upgraded while also transferring from another fund).

Can waiting periods ever be waived?

They sure can! If you’re transferring from another health fund on a comparable level of cover, and have already served the waiting periods, we’ll waive those waiting periods when you join TUH so you can claim straight away.

For any services that you are covered for, there are also no waiting periods for any accidents you may be unfortunate enough to have. 

And, in some circumstances, you may not have to serve the waiting period to upgrade your cover for hospital psychiatric services. Under a 2018 initiative from the Australian Government, you can upgrade your cover to include psychiatric care without a waiting period once in your lifetime, if you have already served the initial two-month waiting period on any level of cover. See our guide on the lifetime mental health waiting period waiver for more information. 

Waiting periods explained

Our hospital waiting periods explained

Our hospital waiting periods are:

  • Two months for all hospital services and home care programs, unless otherwise specified

  • 12 months for pre-existing ailments or conditions (excluding palliative care, hospital psychiatric services and rehabilitation) and pregnancy and birth.

Our extras waiting periods explained

Our extras waiting periods are:

  • Two months for most extras services including general dental, physiotherapy, massage, chiropractic, speech therapy and more

  • Six months for optical items (such as glasses and contact lenses), active health bonus and midwife services

  • 12 months for major dental procedures, orthodontic treatment, orthotics, hearing aids and mechanical health devices.

  • 24 months for refractive laser eye surgery

As you can see, there a few factors that can affect how soon you can claim with TUH, but our goal is to take care of you and all of our members. We are, and always have been, a not-for-profit organisation that exists purely for the benefit of our members.

Our waiting periods exist so that we can keep premiums affordable, and so we can return the majority of those premiums to our members in the form of benefits and services. 

If you’d like to find out more, or to discuss your current cover and any waiting periods, click here to book a call back. 

18 February 2021