What is a waiting period in health insurance?
A waiting period is the period of time you need to wait after taking out (or upgrading) your cover before you claim any costs for services included in your cover. This period is generally set by health insurance providers in accordance with guidelines set by the Australian Government.
When do waiting periods apply?
Waiting periods usually apply when you first take out health insurance or upgrade to a higher level of cover. For example, if you upgraded your level of cover to include pregnancy and birth, you will need to wait 12 months before you can access these benefits.
However, while serving any waiting periods on added inclusions, you can still receive benefits for services on your previous level of cover if you've already served the waiting periods that applied.
Waiting periods may also apply if you're a new member or if you're rejoining a health fund after not having health cover for some time.
How do waiting periods work for different types of cover?
What if I have a pre-existing condition?
From a health insurance point of view, a pre-existing condition is any ailment, illness or condition with signs or symptoms that exist in the six months before your health insurance policy started or changed.
Waiting periods on pre-existing conditions are 12 months. Once you’ve served this waiting period, you’re able to receive benefits towards treatment for that condition.
Waiting periods when switching health insurance
If you're switching from another Australian health fund, you typically won’t need to re-serve waiting periods for services previously included in your cover if you join within two months of switching. Meaning you could make the most out of your new cover straight away.
However, keep in mind that if your new Medibank cover includes additional or upgraded services, or a lower hospital excess, there will be waiting periods for these. Benefits that have already been paid under your previous cover will be deducted from your limits on your new cover.
Learn more: Switching health insurance
Can health funds waive waiting periods?
In some cases, health funds may waive waiting periods as part of special offers for new members, particularly for services which have 2 or 6 month waiting periods within Extras cover. However, waiting periods for pre-existing conditions and hospital cover are generally not waived, as they are regulated by the government.
Sometimes you need support sooner
Prioritising your mental health is an important decision and we're here so that you may access the support you need, when you need it.
No waiting periods on psychology and counselling consultations
If you’re a new member or have upgraded your cover recently to include mental health support, we’ll pay benefits towards psychology and counselling consultations without the need to serve waiting periods.$
Mental health waiver
Eligible members* with hospital cover who have served a waiting period for restricted hospital psychiatric services on Basic, Bronze or Silver Hospital cover, can choose to upgrade their cover to one with included hospital psychiatric services, and have the 2-month waiting period for those higher benefits on psychiatric services waived. This waiver applies only once per lifetime.
Ready to choose the right cover for you?
It's important to choose a policy that aligns with your health needs now and in the future. If your current policy doesn't seem right for you, consider upgrading or switching—just keep waiting periods in mind.
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Things you need to know
^ Waiting period applies. For ambulance attendance or transportation to a hospital where immediate medical attention is required and your condition is such that you couldn't be transported any other way. TAS and QLD have State schemes that provide ambulance services for residents of those States.
# Medibank has Members' Choice providers for these services. Not available in all areas.
~ Some items and services may require a Referral Letter and may have a benefit replacement period. Please see the Cover Summary or Member Guide for more information.
$ For members with mental health support included in their Extras cover. Annual limits apply. Counsellors must be registered with Australian Counselling Association, Psychotherapy and Counselling Federation of Australia, Australian Traditional Medicine Society. Mental Health Social Workers must hold a mental health accreditation by the Australian Association of Social Workers.
* To be eligible for the waiver, you need to have held hospital cover without a break of more than 2 months. You can only use the Mental Health Waiver once in your lifetime. The waiver only applies to the 2-month waiting period for the higher Included benefits for in-hospital psychiatric services and all other applicable waiting periods will continue to apply.
While we hope you find this information helpful, please note that it is general in nature. It is not health advice and is not tailored to meet your individual health needs. You should always consult a trusted health professional before making decisions about your health care. While we have prepared the information carefully, we can’t guarantee that it is accurate, complete or up-to-date. And while we may mention goods or services provided by others, we aren’t specifically endorsing them and can’t accept responsibility for them. For these reasons we are unable to accept responsibility for any loss that may be sustained from acting on this information (subject to applicable consumer guarantees).