Waiting periods
When you join a health fund or upgrade your existing cover, you may have to wait some time before you can claim benefits.
No-one plans to become unwell. However, the need for some treatments and services can be anticipated. To ensure private health insurance is fair for all, some waiting periods apply.
Waiting periods apply where a person:
- is insured for the first time
- has had a break in cover of two or more months immediately prior to joining
- upgrades to a higher level of cover (including reducing or removing an excess)
- transfers from another fund and has not completed an applicable waiting period at that fund for equivalent benefits or chooses to upgrade their cover when they transfer.
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 major dental treatment 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 claimable from another source such as Workers Compensation, third party or other liability provision.
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.
A pre-existing condition is determined by a medical or other health practitioner appointed by Defence Health. The practitioner will consider the opinion 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
Make sure you tell us the good news and your newborn will be covered from birth with no waiting period.
After your baby is born, you have up to two months to upgrade your singles or couples policy to a family policy. The new premium will be payable from the date of your baby’s birth.
If you already have a family policy, 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. It’s that easy - immediate cover with no waiting periods.
Avoid waiting periods on discharge
If you join within 2 months of discharge from the ADF your new cover takes effect from the day following your discharge. That means continuity of cover and absolutely no waiting periods on your own cover.
You may also be eligible for the 10% transition discount for your first year on civilian premiums.
Waiting periods may apply to dependants not previously covered by private health insurance or those upgrading their cover.