HCi waiting periods
You must meet waiting periods before you are eligible to claim some cover.
This helps keep member premiums down and maintain services at a sustainable level.
Waiting periods apply to all health cover, including that offered by HCi.
The what and why of waiting periods
A waiting period simply means a set amount of time before you are eligible to make a claim on a particular service. Most insurance providers apply the same waiting periods, although there are some variations between extras options.
At HCi, we accept all members. However, if members joined only when they knew they had a health issue, our premiums would have to be much higher for everyone.
Australian law sets maximum waiting periods that we can apply for hospital procedures. For extras, HCi sets waiting periods that are as short as possible for members whilst maintaining reasonable premiums.
What waiting periods apply to HCi members?
We will always inform you of any applicable waiting periods when you join HCi.
Psychiatric services and rehabilitation only require a two month waiting period, even with pre-existing conditions.
Since 1 April 2018, policy holders may be able to upgrade from a policy that offers restricted benefits for hospital psychiatric services to a policy with full cover for psychiatric services, without having to serve the normal two month wait. This exemption can only be used once in a person’s lifetime, including if you have transferred between insurers.
If you are taking out private health insurance for the first time, you will need to serve full waiting periods before you can start claiming benefits. This includes people joining an existing member’s policy as dependants who were not health fund members within the previous two months.
When upgrading to a higher level of cover, you will serve waiting periods on the higher level.
Transferring from another fund
If you switch to HCi from another health fund (within 2 months of ceasing with the other fund), you may join a similar level of cover with HCi and receive the same level of cover with no new waiting periods.
If you transfer to a level of HCi cover that provides benefits not covered by your previous fund, you will need to serve the relevant waiting periods for the additional or higher level of cover. Where limits apply, the benefit entitlement transferred to HCi may be reduced by any benefits received by the previous fund.
Pre-existing condition waiting periods
A pre-existing condition is any illness, ailment or condition you have had for the last 6 months. It doesn’t matter if the condition wasn’t identified or diagnosed. Risk factors (such as family history) are not counted as part of a pre-existing condition.
HCi will appoint an independent medical practitioner for a medical opinion as to whether signs or symptoms existed during the six months prior to taking out hospital cover or upgrading to a higher level of cover.
Claims will not be paid for pre-existing conditions during the waiting period.
The pre-existing condition waiting period applies to new members and existing policy upgrades.
If you have less than 12 months of cover with HCi, please contact us before you plan a hospital visit so we can determine if a pre-existing condition waiting period applies.
What about hospital treatment during a waiting period?
Please contact us if you need to visit hospital before your waiting period has completed.
After a chat about your situation, we will send you any relevant paperwork to complete with your doctor. Then we will review your paperwork and generally respond within 5 business days. Our response will be that it is a pre-existing condition (so we don’t cover it until the waiting period is complete) or it is not pre-existing (so you can claim everything covered by your policy).
If you are admitted to hospital before we confirm your eligibility, you may be liable for all costs from that hospital admission.
If you want to delay your hospital treatment until you know of our decision (or your waiting period ends), please discuss with your doctor as a delay may not be medically advisable.
IVF and assisted reproductive services.
A 12 month waiting period applies to all IVF and assisted reproductive services where utilisation of these services generally relates to treatment of a pre-existing condition. If there is not a pre-existing condition, a 2 month waiting period applies to IVF and assisted reproductive services.*
Check with HCi before proceeding with assisted reproductive services, such as IVF, to confirm what services you will be required to pay for and that you have completed any required waiting periods. Only an admission to hospital can be covered under private hospital insurance.
Always check with the hospital, HCi and your doctor before proceeding with a hospital booking to ensure you will be covered and to discuss what costs you may incur.
(for new cover)
|Treatment in hospital or equivalent|
|Pre-existing conditions||12 months|
|Obstetrics (pregnancy related services)||12 months|
|Psychiatric care, rehabilitation or palliative care||2 months|
|All other hospital treatment services||2 months|
|Accident cover||2 months|
|Audiology (hearing tests)||2 months|
|Dental – General||2 months|
|Dental – Major (excl. orthodontics)||12 months|
|Dental – Orthodontics||12 months|
|Diabetes education||2 months|
|Diabetes Australia membership||2 months|
|Eye Therapy (Orthoptics)||2 months|
|Funeral (eligible members only*)||120 months|
|Health screening checks||2 months|
|Hearing aids||24 months|
|Home nursing||2 months|
|Laser eye surgery||12 months|
|Medical appliances||12 months|
|Natural Therapy||2 months|
|Non-surgical Prostheses||12 months|
|Occupational Therapy||2 months|
|Podiatry / Chiropody||2 months|
|Quit smoking programs||2 months|
|Speech Therapy||2 months|
|Surgical footwear||2 months|
|Travel & accommodation||6 months|
|Weight loss programs||2 months|
* Note that while a 2 month waiting period applies to assisted reproductive services, utilisation of these services generally relates to treatment of a pre-existing condition, meaning a 12 month waiting period would apply.
Adding a baby to your cover
If you already have a parent or family policy there will be no waiting periods provided your policy premiums are up to date and the new child is added to your plan within 2 months of their birth.
If your policy covers just you or just you and a partner, you will need to contact us to upgrade to a parent or family policy from the birth date.
Whenever possible, it’s best to get in touch before becoming pregnant so we can be there to help you best plan the next year for you and your baby.
Have a look at our Nourish program for support and answers during pregnancy and the early years of parenting – it’s free for our Gold hospital members!