What’s a waiting period and why do we have them?

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Why are there private health insurance waiting periods?

03 November 2020 3 minute read

Whether it’s holding out for a text back or standing by a box of unripened mangoes, no one enjoys waiting around for the good stuff; so why are there waiting periods when it comes to health insurance?

Understanding your health cover should be simple, which is why we’ve explained what a waiting period is and why we have them.

What’s a waiting period?

Whenever you increase your level of health cover, or sign up for a new policy, you’ll be required to serve a ‘waiting period’. This is the time frame you’ll have to wait before you can start claiming benefits and it applies to both Hospital and Extras Cover at different levels.

To make it as fair as possible for all Australians, the Government sets the maximum hospital waiting periods that health funds can apply.

Waiting periods for Hospital services

Hospital service	Waiting period
Accidental injury benefit	1 day
Emergency Ambulance Cover	1day
Other conditions requiring hospitalisation (except those listed) that aren't pre-existing conditions	2 months
Hospital psychiatric services	2 months*
Rehabilitation or palliative care (whether or not a pre-existing condition)	2 months
Other pre-existing ailments/conditions (an illness or condition where evident at any time during the 6 months immediately prior to joining nib)	12 months
Pregnancy and birth	12 months

Note: Your cover may exclude some of these procedures. You should also check if a Restriction applies to your cover.

^*A two month waiting period applies to members who take out a product that includes Hospital Psychiatric Services. Members upgrading to a product with full benefits for Hospital Psychiatric Services may be able to waive the 2 month waiting period. This Mental Health Waiver is only available to members who have held hospital cover for at least the previous 2 months, have not previously used their waiver with nib or any other fund, have been admitted to hospital and are under the care of an addiction medicine specialist or consultant psychiatrist.

Waiting periods for Extras services

Extras service	Waiting period
Ambulance services	1 day
All other services, except those listed below	2 months
Optical appliances and repairs	6 months
Healthier lifestyle	6 months
Specialty dental (e.g. endodontia, periodontia)	12 months
Removal of wisdom teeth and oral surgery	12 months
Periodontic surgical, root therapy and endodontic services by a dentist not registered as a specialist	12 months
Dentures, denture maintenance/repairs, other prosthodontic services	12 months
Orthodontia	12 months
Artificial aids (except orthotics and orthopaedic shoes)	12 months
Hearing aids	36 months

Note: Your cover may not include some of these Extras services.

Why do we have them?

Waiting periods protect the majority of our members by ensuring that individuals don’t join a health fund, claim immediately and then cancel their private health insurance as soon as they’ve received their benefits. This would lead to premiums increasing - potentially making health insurance unaffordable for many Aussies.

What’s a pre-existing condition and how does that affect my waiting period?

A pre-existing condition (PEC) is an ailment, illness or condition where, in the opinion of a medical practitioner appointed by nib (not your own doctor), the signs or symptoms of the condition existed during the six months prior to you first joining hospital cover or upgrading to a higher level of hospital cover.

A health condition can still be considered pre-existing even if the illness had not been formally diagnosed prior to you purchasing or upgrading your hospital cover.

If your condition is determined to be a pre-existing condition, in most instances a 12-month waiting period applies from the date of joining or upgrading your hospital cover. nib will not pay hospital benefits for treatment for the pre-existing condition during this waiting period.

Check out our pre-existing conditions page for more information.

When do waiting periods not apply?

If you’re considering switching health insurers, don’t worry, if you’re transferring from a policy that has an equivalent cover or a lower level of benefits, you won’t have to re-serve any waiting periods¹. We’ll also recognise partially served waiting periods – so even if you’ve only served three months of a 12 month waiting period, the three months still counts when you transfer to us.

How can I check my waiting periods?

To find out what waiting periods apply on your policy log in to view your cover details, or refer to your Policy Booklet or Fund Rules for more information. You can also contact us if you have any questions.

¹Applies where there is a break in cover of 59 days or less. Waiting periods will apply for services not currently covered, services with higher benefits or where waiting periods haven’t been fully served. Where the excess on the new product is lower than the excess on the previous cover, the excess on the previous cover will apply until the unexpired waiting period has been served. Any benefit limits already used with your current fund will apply to your nib policy.