Health insurance waiting periods: can they be waived?

Waiting periods are the part of private health insurance that surprises people at the worst moment — when they try to claim. They exist so people cannot buy cover on the way to the hospital, claim, and cancel. The rules are actually more consumer-friendly than most people think, especially when switching funds — but only if you know how they work.

Hospital cover: the waits are capped by law

For hospital policies, the maximum waiting periods are set by legislation. A fund can be more generous, but never stricter:

• 12 months — pre-existing conditions.
• 12 months — pregnancy and birth (obstetrics).
• 2 months — psychiatric care, rehabilitation and palliative care, even for pre-existing conditions.
• 2 months — everything else.

There is also a one-off exception worth knowing: you can upgrade to higher psychiatric cover once without serving the 2 month wait again on the higher benefit.

The pre-existing condition rule

This is the waiting period that catches people who upgrade their cover when they learn they need surgery. The upgrade is allowed — but the higher benefit for that condition only kicks in after 12 months on the new tier. If you are planning treatment, the timing of upgrades matters enormously.

Extras cover: each fund sets its own waits

Extras (general treatment) waiting periods are not capped by law, but typical waits look like:

• 2 months — general dental, physio, optical and most day-to-day extras.
• 12 months — major dental, crowns, orthodontics and hearing aids at many funds (some stretch to 24–36 months for high-cost items).

Funds regularly waive the 2 month extras waits as a sign-up promotion. The longer waits on major dental and orthodontics are almost never waived.

Switching funds: the clock carries over

The biggest myth about waiting periods is that switching restarts them. It does not. Move to equivalent or lower hospital cover and every waiting period you have served comes with you. Only if the new policy pays higher benefits — or covers something your old one did not — do you wait for the difference. So being "locked in" by waiting periods is rarely true, and it should not stop you reviewing your cover at premium-rise time each April.

Keep track of what you've served

Waiting periods are dates: when cover started, when each wait ends, when an upgrade reset a specific benefit. That information lives in policy letters and emails most people cannot find two years later — exactly when they need to prove what they have served.