How Waiting Periods Work in Private Health Insurance Plans
Published May 20, 2026
A waiting period is a certain period of time that you have to complete before making a claim for a specific service under your private health insurance. Awaiting periods may be associated with both the hospital and extras parts of private health insurance, but what differs them is that the Australian government stipulates maximum awaiting periods for procedures under the hospital part, while the extras waiting periods are decided by the insurer.
How does the waiting period work?
The waiting period begins on the day when you either purchase a new package or increase your current cover (for instance, move from a Silver hospital cover to a Gold one). In case, you think about giving birth to a baby, but your existing private hospital cover doesn’t provide services connected with pregnancy and birth, you should buy a proper package of insurance and wait for your awaiting period to end in order to receive this cover.
What are the waiting periods in hospitals for Australians?
The Government of Australia provides information about the maximum waiting period which can be used by any private health fund regarding hospital cover. Though waiting periods can vary according to the insurer, Department of Health, Disability and Ageing explains that the waiting periods for hospitals in Australia will never exceed:
- 12 months for any pre-existing condition as well as pregnancy/birth-related services (obstetricians);
- 2 months for psychiatric treatment, rehabilitation and palliative services (irrespective of whether it’s for a pre-existing condition or not)
- 2 months for all other services.
Why are there waiting periods for health insurance?
Waiting periods have been introduced by private health insurance companies in order to ensure that they remain financially stable. Without waiting periods, members can simply buy or upgrade their insurance cover before getting a certain medical service and then cancel the cover after using it. In such a case, the health insurer would need to increase its premiums because of the claims made and thus, would have to bear the brunt of those increased costs.
How do waiting periods change if you change insurers?
There is usually a transition period if you switch your insurer in terms of your waiting periods on your health insurance coverage in Australia. This implies that if you decide to switch your health insurance cover from one insurance company to another, it’s highly likely that you won’t be required to go through those same waiting periods as long as there was no gap in your coverage. Nonetheless, you will still be required to go through those waiting periods for the treatments that you couldn’t access using your old health plan, or if you decided to increase your coverage level for specific treatments.
How do waiting periods change if you suspend your health insurance?
If for whatever reasons you decide to take a break from your health insurance plan, such as if you go abroad, or you just don’t have the money to pay premiums for your plan, you’ll be allowed to resume coverage after the suspension without repeating waiting periods. This implies that you can resume your health insurance plan whenever you wish, without having to serve waiting periods. The period that one might be allowed to suspend their private health insurance varies from insurer to insurer. Therefore, should you contemplate suspending your private health insurance coverage, it is best to inquire about the maximum allowable period for suspension.
Waiting Periods: Your Questions Answered
Usually, no. If you switch to a new insurer without a break in cover and move to the same or a lower level of cover, you generally will not need to re-serve waiting periods for services you were already covered for. However, if your new policy includes higher benefits or services not covered under your previous policy, waiting periods can apply to those additional benefits only.
Under Australian private health insurance regulations, the maximum waiting period for pregnancy and birth-related services (obstetrics) and pre-existing conditions is 12 months. For most other hospital treatments, the maximum waiting period is 2 months.
Yes. Many Australian health insurers allow members to suspend their cover temporarily for reasons such as overseas travel or financial hardship. When the policy is reactivated within the insurer’s allowed suspension rules, you generally will not need to re-serve waiting periods already completed. However, suspension conditions and maximum suspension periods vary between insurers, so you should always check your fund’s policy details before pausing your cover.
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