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If you're new to health insurance or upgrading your cover, you may need to complete a waiting period before you can claim for some treatments and services.
Find out why waiting periods exist, how long they are and how they affect you.Â
A waiting period is the time you need to wait before your health insurance benefits are payable for certain treatments or services.
Different waiting periods apply depending on your cover and what you're claiming for.
Under the Private Health Insurance Act 2007, the following maximum waiting periods apply to private hospital insurance cover in Australia:
Log in to your myBupa account to find out which waiting periods apply to you.
Waiting periods are designed to help keep health insurance fair and affordable.
Without them, people could join only when they need treatment, make a claim and then cancel their cover. This would drive up the cost of health insurance for everyone.
Different waiting periods apply to different treatments and services because not all healthcare needs are the same. Some treatments are unexpected, while others are planned in advance or involve higher costs.
Waiting periods for hospital cover often apply when you start a new policy or change your level of cover. This may include:Â
If an accident happens after your cover starts, Bupa may waive waiting periods for treatment linked to that accident.1
Check your policy to find out which waiting periods may affect you.
Yes. Hospital cover and extras cover generally have different waiting periods. Check your policy to find out the waiting periods that apply to you.
For hospital cover, maximum waiting periods are set under the Private Health Insurance Act 2007 and apply to health insurers in Australia. For extras cover, waiting periods are set by each insurer and can vary depending on the service you’re claiming for.
Many hospital treatments have a 2‑month waiting period, while pregnancy and pre-existing conditions typically require 12 months.
If you switch health insurers, you generally won't need to serve the same waiting periods again.
This applies when you move to the same or a lower level of hospital cover. If you choose a higher level of cover, waiting periods may apply if there are any new inclusions.
To keep the waiting periods you've already served, you'll need to switch within 60 days of your previous cover ending.
Usually not. If you switch health funds and maintain the same level of cover, waiting periods you've already completed are generally recognised.
However, waiting periods can apply if you upgrade to a higher level of cover or add new benefits.
Yes. If you upgrade your cover, waiting periods may apply to any new or higher benefits you've added.
You generally won't need to re-serve waiting periods for benefits included in your previous level of cover.
If you receive treatment before completing the relevant waiting period, you generally won't be able to claim benefits for that treatment through your health insurance.
Depending on the circumstances, Medicare may still contribute towards eligible medical costs, based on Medicare Benefits Schedule (MBS) fees. However, out-of-pocket costs may apply.
Alternatively, you may choose to pay for private treatment yourself.
Sometimes. Waiting periods may be reduced or waived in certain circumstances, such as when using the mental health waiting period exemption to access higher psychiatric benefits.
Some insurers also provide promotional offers that reduce or waive 2- or 6-month waiting periods on selected extras services for new members.
No. Under the Private Health Insurance Act 2007, maximum waiting periods apply to hospital cover in Australia.
For extras cover, waiting periods are set by individual insurers and can vary depending on the policy and service.
1 Available on selected hospital products only. For accidents sustained after joining, treatment which is restricted or is an exclusion on your cover, will be payable in the same way as an included service. Must meet Bupa’s definition of an Accident as defined in the Bupa Fund Rules, must seek medical treatment within 72 hours, and receive any further treatment within 180 days, of the Accident occurring. Out-of-pocket costs may apply.
2 Available to eligible Bupa members who have served a 2-month waiting period on hospital cover and are upgrading to cover that includes inpatient psychiatric services. Eligibility criteria and conditions apply. The exemption can only be used once in a lifetime.
A pre-existing condition is any ailment, illness or condition you had signs or symptoms of in the 6 months before you joined your health insurer or upgraded to a higher level of cover.
The rules for pre-existing conditions, including the 12‑month waiting period, are set by the Private Health Insurance Act 2007. A medical practitioner appointed by your insurer assesses whether a condition is pre-existing.
Key things to know
Hospital cover for pregnancy and birth-related services has a 12-month waiting period.
Key things to know
Private hospital cover for psychiatric treatment, rehabilitation and palliative care has a maximum 2-month waiting period.
Key things to know
Hospital psychiatric waiting period exemption
Most hospital services covered by private health insurance have a maximum 2-month waiting period.
Key things to know
Services like general dental and physio are often available after 2 months. Major dental and orthodontics typically require 12 months. You may wait up to 36 months (3 years) for major extras like hearing aids or blood glucose monitors.
Compare Bupa with other health insurers and find the cover that's right for you.
No. You generally can't claim for a service until you've served the waiting period that applies to that service.
However, different services can have different waiting periods. This means you may be able to claim for some services after completing their waiting periods, while still waiting to claim for others.
The services you can claim for, and the waiting periods that apply, depend on your level of cover and insurer.
