Waiting periods
If you have not previously held private health insurance, or you up-grade your cover, the following waiting periods will apply:
|
Type of claim |
Waiting period |
|
Accident cover |
No waiting |
|
Pre-existing illness or ailment |
12 months |
|
Obstetrics-related conditions |
12 months |
|
Crowns and bridges, dentures, orthodontic, periodontic, wisdom teeth, hearing aids, orthotic appliances, podiatry-related aids, prostheses benefits, nebulisers, blood glucose monitors and continuous positive airway pressure (CPAP) pumps# |
12 months |
|
Optical benefits, health management programs |
6 months |
|
All other benefits |
2 months |
# Replacements for hearing aids, blood glucose monitors, nebulisers, CPAP pumps, crowns, bridges and dentures are payable every three years.
If you have upgraded your cover with us or transferred from another private health insurer, benefits will be paid under your previous cover until the waiting period for your higher level of cover is served.
Pre-existing ailment period
Private health insurers can apply a special waiting period to new members of hospital tables who have pre-existing ailments. This waiting period also applies to existing members who have recently upgraded their level of hospital cover.
If the ailment, illness or condition is considered pre-existing:
- new members must wait 12 months for any hospital benefits
- members transferring/upgrading to a higher hospital table must wait 12 months to get the higher hospital benefits. Existing members with at least 12 months membership in total across their old and new cover are entitled to the lower benefits on their old cover
What is an accident?
An accident means an unforseen and sudden event occurring by chance and caused by an external force or object, resulting in involuntary bodily injury requiring immediate treatment from a medical practitioner. It does not include any condition which can be attributed to medical causes.
What is a pre-existing ailment?
A pre-existing ailment is one where signs or symptoms of your ailment, illness or condition – in the opinion of a medical practitioner appointed by us (not your own doctor) – existed at any time during the six months ending on the day on which you purchased your hospital insurance or upgraded to a higher level of hospital cover.
The only person authorised to decide that an ailment is pre-existing is the medical practitioner appointed by us. The medical practitioner must, however, consider any information regarding signs and symptoms provided by your treating medical practitioner(s).
