When you start a new private health insurance policy or increase your level of cover, you have to complete waiting periods before you can claim benefits under your new level of cover.
The maximum hospital waiting periods are 12 months for pre-existing conditions and pregnancy, 2 months for psychiatric care, rehabilitation or palliative care (even for a pre-existing condition), and 2 months for all other circumstances.more
When you start a new private health insurance policy or increase your level of cover, you have to complete waiting periods before you can claim benefits under your new level of cover. A waiting period protects members of the insurer by ensuring that individuals are not able to make a large claim shortly after joining and then cancelling their membership. This kind of behaviour would result in increased premiums for all policy holders.
When purchasing health insurance, make sure you are fully aware of any waiting period you may have to serve. There is usually no waiting period if you need hospital or medical treatment because of an accident that happens after you start your policy.
The government sets the maximum waiting periods that insurers can impose for hospital treatment:
The waiting periods for general treatment (ancillary or extras) cover are set by individual health insurers.
Generally, waiting periods vary from two to six months for items such as general dental, optical and physiotherapy, and up to 12 months or more for major items such as orthodontics or hearing aids.
Under the Private Health Insurance Act 2007, a health insurer may impose a 12 month waiting period on benefits for hospital treatment for a pre-existing condition. Some important facts to remember about this rule:
The exceptions to the 12 month waiting period for pre-existing conditions are psychiatric treatment, rehabilitation and palliative care. These services have a two month waiting period, even if the condition pre-existing.
In some cases, you may be able to access an exemption to the two month waiting period for upgrading psychiatric benefits - see Mental health - waiting period exemption.
For more information, see the Ombudsman's factsheet on the pre-existing conditions rule.
The maximum waiting period for pregnancy and birth benefits is 12 months - if you are planning to become pregnant and wish to be covered, you will need to organise appropriate health insurance for both yourself and your newborn child well in advance (before you become pregnant). Some important facts to remember:
If you are on a hospital policy which provides restricted benefits for psychiatric care, then to access higher benefits you usually upgrade and complete a two month waiting period.
However, from 1 April 2018, you can upgrade without having to serve this waiting period to access higher benefits for psychiatric care in a hospital or hospital substitute treatment.
This exemption applies only once per lifetime and can only be accessed if you have already completed an initial two months of membership on any level of hospital cover. For more information about accessing the exemption, please contact your health insurer.
For general information about the exemption, see the Department of Health website: Supporting mental health - waiting period exemption for higher benefits.
Before 1 July 2018 some private health insurers imposed benefit limitation periods (BLPs) of up to 24 months for some categories of hospital treatment. During a BLP, you were only entitled to restricted benefits for a particular condition or treatment for a set period of time. Insurers have now ceased this practice.
For more information, see the Department of Health website: Private Health Insurance Benefit Limitation Periods – Changes to improve information for private health insurance members.