Waiting periods are exactly what their name suggests; the length of time you need to wait before being able to make claims on services.

They apply when you join any health fund for the very first time, or when you upgrade to a higher level of cover. Waiting periods are designed to keep health cover fair for everyone, by protecting the fund and Members against people who join intentionally to make big claims, and then cancel their membership.

If you're transferring from another fund and take out an equivalent level of cover, or if you've previously been covered by your parents' membership, we recognise that you've already served the waiting periods, so you can claim straight away. If you upgrade to a higher level of cover when you switch, you'll only need to serve the waiting period on the increased benefits.

Our tables below outlines the waiting periods that apply to hospital and extras:

2 month waiting period

Hospital services Extras services

  • For all hospital treatments or services where there are no pre-existing conditions (excluding accidental injury^)

  • Rehabilitation eg. inpatient rehabilitation, stroke recovery, cardiac rehabilitation
  • Hospital psychiatric services
  • Palliative care
  • General dental services
    • Diagnostic – includes examinations and consultations
    • Preventive – includes cleaning and scaling, fluoride treatment, mouth guards etc. 
    • Simple extraction 
    • Restorative – composite and amalgam filling
    • General services – includes occlusal splints
  • Optical
  • Pharmaceutical
  • Sporting accidents* 
  • School Accidents*
  • Healthy Living benefits
  • Acupuncture
  • Audiology
  • Chiropractor
  • Massage therapy
  • Chinese Medicine
  • Dietician
  • Foot orthoses and orthopaedic shoes
  • Occupational therapy
  • Orthoptic therapy
  • Physiotherapy
  • Exercise physiology
  • Podiatry
  • Psychology
  • Speech therapy

*The two month waiting period is waived for treatment arising from an accident that occurred after joining (excluding sporting accidents sustained by sportspeople in activities relating to their full-time employment as a sporting professional, including training and competition).

12 month waiting period

Hospital services Extras services
  • Pre-existing conditions (excluding rehabilitation, hospital psychiatric services and palliatve care)
  • Pregnancy and birth
  • Mechanical aids and appliances
  • Assisted reproductive services
  • Australian hearing services
  • Nursing home type patients
  • Nursing services
  • Mammograms and bone density tests
  • Hospital boarder
  • Major dental services
    • Periodontics – specialised gum treatment
    • Surgical extraction – includes wisdom tooth extraction
    • Endodontic services – includes root canal therapy
    • Crowns and bridges
    • Prosthodontics – dentures
    • Orthodontics – braces etc.
  • Childbirth education
  • Supply of hearing aids

^ The two month waiting period is waived for treatment arising from an accident that occurred after joining (excluding sporting accidents sustained by professional sportspeople in activities relating to their employment, including training and competitions).

Emergency Ambulance:

A one day waiting period applies to emergency ambulance treatment

Changes to your circumstances

If you're expecting a change in your circumstances in the future, such as starting a family, it's important to review your policy to make sure you are covered. For example, if you have a single policy, you'll need to upgrade to a Single Parent/Family policy no less than two months from the date of the baby's birth. Please refer to our Membership Guide under the heading "Adding a newborn baby" for more information on cover for your baby.

Similarly, if you think you'll need a particular type of surgery, it's important to check that it's covered by the Health Fund and your policy, and that you'll have served the appropriate waiting period before you undergo the procedure.