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.

Accident cover is currently available via Basic Hospital policies only. A two month Waiting Period applies after acquiring the product to be eligible for Accident cover Benefits.

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.

New members

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.

Existing members

When upgrading to a higher level of cover, you will serve waiting periods on the higher level.

Transferring from another fund

Icon of a light switch and a wifi signalIf 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.

Smiling man with nice teeth and crossed arms on an orange background
Services Waiting period
(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
Extras cover
Acupuncture 2 months
Ambulance 2 months
Audiology (hearing tests) 2 months
Chiropractic 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
Dietetics 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
Hydrotherapy 2 months
Laser eye surgery 12 months
Medical appliances 12 months
Natural Therapy 2 months
Non-surgical Prostheses 12 months
Occupational Therapy 2 months
Optical 6 months
Orthotics 2 months
Osteopathy 2 months
Pharmacy 2 months
Physiotherapy 2 months
Podiatry / Chiropody 2 months
Psychology 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!

// Mobile App

HCi App

The HCi claiming app allows you to easily claim at any time via your mobile!

Download the app and, when you have to claim, simply take a photo of your service provider’s receipts and submit!