Waiting periods

Why have waiting periods?

If waiting periods did not exist, people could take out or upgrade their cover immediately before their treatment, then leave or downgrade when their treatment is complete. Their gain would be everyone else’s loss and this would not be fair.

Therefore, when you join a health fund or upgrade your existing cover, you may have to wait some time before you can claim benefits.

Waiting periods that apply to Defence Health cover are:

• 2 months for rehabilitation, psychiatric and palliative care
• 12 months for a pre-existing condition excluding rehabilitation, psychiatric and palliative care
• 12 months for obstetric (pregnancy) related treatment
• 12 months for laser refractive eye surgery
• 12 months for the supply of blood glucose monitors, blood pressure monitors, TENS machines, CPAP machines, nebulisers and spacers, mobility aids, foot orthoses, orthopaedic shoes, compression garments, non-cosmetic prostheses, splints and braces
• 12 months for treatment under major dental categories including periodontics, oral surgery, endodontics, crowns and bridgework, orthodontics, prosthodontics and high cost dentistry
• 36 months for the supply of hearing aids, and
• 2 months for all other treatments.

Cover for an accident is immediate provided it is not recoverable from another source such as Workers Compensation, third party or other liability provision.

When do waiting periods apply?

Waiting periods apply where a person: 

• is insured for the first time or has not been insured within the previous two or more months 
• upgrades to a higher level of cover (includes reducing or removing an excess or co payment), and 
• transfers from another fund and has not completed our waiting periods for equivalent benefits or chooses to upgrade their cover when they transfer.

When upgrading your cover you will be entitled to the benefits of your previous cover for the duration of any waiting periods.

Waiting periods for pre-existing conditions

A pre-existing condition is an ailment or illness, where signs or symptoms existed at any time in the six months prior to you joining or upgrading to a higher level of cover.

The only person authorised to decide whether you have a pre existing condition is a medical or other health practitioner appointed by Defence Health. The practitioner will consider the opinion of, and evidence presented by, your treating practitioners before making an informed judgement.

If you have had your cover for less than 12 months and need treatment, you should confirm with Defence Health whether the pre-existing condition waiting period will apply. Defence Health may require you and your treating practitioners to complete a Pre existing Ailment form in order to obtain facts about your illness. The practitioner appointed by Defence Health to review your case will need a number of business days to investigate and make an assessment.

Avoid waiting periods for a newborn

If you currently have single or couples cover and wish to add a newborn child, you can transfer to family or single parent family cover from the date of your child’s birth. As long as you add your newborn within two months of their birth, with premiums paid from the date of birth, cover for the newborn will be immediate with no waiting periods.

If you currently have family cover, you can add your newborn child by advising us of the baby’s name and date of birth (by phone, email, fax or post) within two months of their birth. Their cover will be immediate with no waiting periods.