When taking out hospital or extras cover, waiting periods may apply. This is the period of time between when you take out your health insurance and when you are eligible to claim.
All health funds have waiting periods. This is to ensure that those who make a claim for benefits have contributed to the fund.
If there were no waiting periods, you could have people join the fund, make a claim immediately and then depart the fund, leaving existing members to pick up the tab via increased premiums.
When do waits apply?
If you’re new to private health insurance, if your private health insurance has lapsed and you are starting over, or if you’re upgrading your cover (including reduced excess or increased benefits payable), you may have to serve waiting periods. For hospital cover, it also depends on whether you have a pre-existing condition.
For those who have previously served waiting periods and are upgrading their cover, you’ll only have to serve waits on the services and benefits that are over and above what your existing cover provides.
What happens if I switch?
If you’re switching to Latrobe Health from another fund where you’ve already served your waiting periods, you won’t have to re-serve those waits provided you are purchasing the same level of cover.
However, if you are upgrading your cover including reducing your excess or moving from single cover to family cover for the birth of a baby, you should expect to re-serve waiting periods for those services that are over and above what your existing cover provides.
If you’re part-way through waiting periods, you’ll have to serve the remainder of the waiting period before being eligible to make a claim.
What are Latrobe’s waiting periods?
For hospital cover, the following waiting periods apply:
• 12 months for pre-existing conditions;
• 12 months for pregnancy and birth (if your policy covers this), or two months if upgrading from a single membership to a family membership for the birth of a child;
• Two months for treatments where no other waiting period is specified;
• Two months for psychiatric care, rehabilitation and palliative care.
For extras cover, the following waits generally apply:
• One day for emergency ambulance transports;
• Two months for general dental and allied health services such as physio and podiatry;
• Six months for optical;
• 12 months for major dental and health appliances such as C-PAP machine and blood glucose monitors.
Latrobe applies a waiting period of 12 months for pre-existing conditions, with the exception of psychiatric care, rehabilitation and palliative care.
A pre-existing condition is defined as any ailment, illness or condition that you had signs or symptoms of during the six months before you took out hospital cover or upgraded to a higher hospital policy. You don’t have to have seen a doctor or received a diagnosis for it to be considered pre-existing.
You can find out more on pre-existing conditions on the Commonwealth Ombudsman’s website.
Latrobe applies a waiting period of 12 months for pregnancy and birth – and it is the mother that will need to be covered. If you are planning a pregnancy and have no current hospital insurance, or a cover that does not include obstetrics, you will need to take out an appropriate private hospital insurance before you get pregnant.
Waiting periods will also apply if you are changing from a single membership to a family membership for the birth of a baby. In these circumstances, for your baby to be covered from birth, you will need to upgrade to a family membership at least two months before the expected due date.
For information specific to your circumstances, please contact our Member Service Centre on 1300 362 144 for a confidential chat with a member of the Latrobe team.
Or, you can find out more about waiting periods on the Federal Government private health website.