Waiting periods

It’s the period of time you have to ‘wait’ before you can claim because you’re either new to private health insurance or you’ve upgraded your cover.

In a similar way to how queuing up or taking a number works, it helps keep health insurance fair for all. Waiting periods prevent people from only getting health cover when they need it and then cancelling once they don’t, which would lead to insurance costing a lot more for everyone.

You’ll have ‘served your waiting periods’ after you’ve had your cover for that period of time without making a claim.

All health insurers in Australia have waiting periods. For Hospital cover, there’s legislation that sets out limits around how long these can be.

Yes, if any of these describe you:

You’re new to private health insurance. If it’s your first time getting private health cover (Hospital or Extras), you’ll have to wait before you can claim.

You’ve upgraded your cover. You’ll need to wait before you can claim for services that were excluded or restricted on your previous Hospital cover or are new (covered at a higher level) on your Extras cover.

You’ve changed to a lower excess. Because reducing your excess is considered an upgrade, there’s a waiting period before the new lower excess kicks in. So, if you need to use your Hospital cover within those two months, your previous (higher) excess still applies.

In some cases, there’s no need to wait if you’re new to Teachers Health but not to private health insurance.

With Hospital cover, if you switch within two months of leaving your previous fund, take up an equivalent level of cover and have already served all relevant waiting periods, you could claim straight away.

With Extras cover, you don’t need to wait if you switch to the same level of cover, have unused benefits and have already served the waiting periods with your previous fund.

For both Hospital and Extras, if you switch on a higher level of cover, you’ll typically need to wait before you can claim on anything that’s new (services that weren’t included on your previous lower level of cover). But that’s only for the new stuff, you won’t need to re-serve all the waiting periods for anything that was previously covered.

Here’s how long you’ll have to wait:

• Pre-existing conditions. What this means, how long you need to wait to claim and what you need to do if you need treatment during the waiting period.
• Hospital excess. See what it is, when you’d need to pay it and how to change yours.
• Switching funds. How to join us from another fund and what happens when you switch.
• Pregnancy and birth. Helpful guidance on when you should think about getting Hospital cover.
• Mental Health Waiver. Helps you get immediate access to hospital psychiatric treatment.