Waiting periods & pre-existing conditions

Pre-existing conditions

(only applies to hospital cover)

A pre-existing condition is any ailment, illness or condition that you had signs or symptoms of (in the opinion of a medical practitioner appointed by the health insurer) that existed during the 6 months before you joined a hospital cover or upgraded to a higher hospital cover. It's not necessary that you or your doctor knew what your condition was or that the condition had been diagnosed. A condition can still be classed as pre-existing even if you hadn't seen your doctor about it before joining hospital cover or upgrading to a higher hospital cover.

If you’re new to health insurance and have a pre-existing condition, you’ll need to serve a 12-month waiting period (under Hospital cover, not Extras) before we’re able to cover the condition. If you’ve got health insurance with another fund and have served all of your waiting periods with them, you’ll be covered straight away and won’t have to re-serve your waits if you move to a similar or lower level of cover with Peoplecare.

 

Waiting periods

Nobody loves waiting. But all health funds have waiting periods to protect their whole membership from ‘hit-and-run’ claims from new members, or people who might join a health fund to claim after the event. Sort of like trying to get car insurance after you’ve already had an accident. (We know you wouldn’t do that, but there are some people out there who do!)

Some things you can claim straight away, and usually more expensive treatments have a longer waiting period. Just to be on the safe side for all our members.

Any waiting periods you have served or partly served when transferring from a similar level of cover within 30 days will be recognised. When upgrading your cover, waiting periods still apply. Please give us a buzz on 1800 808 690 (Peoplecare members) or 1800 808 704 (looking for cover?) for details.

Going to public hospital as a private patient? Public hospital waiting lists apply, so check with your doctor and the hospital.

Following is an outline of our waiting periods.

 

Waiting period Hospital cover
No waiting period Hospitalisation related to an accident
No waiting period Services covered by your old fund (if you transfer straight to a similar level of cover with us and have already served your waiting periods)
1 day Ambulance
2 months All other services, except for those listed below
2 months Upgrading your cover
2 months Health programs
2 months Hospital substitution programs
2 months Rehabilitation, psychiatric services and palliative care‚Ä®(even for pre-existing conditions)
12 months Pregnancy and birth
12 months Assisted reproductive services
12 months Pre-existing conditions (except rehab, psych and palliative)

Please note that not all items are listed and other waiting periods may apply. Please contact the fund for more information.

Waiting period Extras cover
No waiting period Services covered by your old fund (if you transfer straight to a similar level of cover with us)
1 day Ambulance
2 months All other services, except for those listed below
2 months General dental, pharmacy, physio, chiro, podiatry & natural therapies
6 months Optical
6 months Health management programs
12 months High cost dentistry
12 months Pre/post-natal services (including midwifery)
24 months Laser eye surgery & hearing aids

Please note that not all items are listed and other waiting periods may apply. Please contact the fund for more information.

If your upgrading your extras cover, waiting periods still apply for the services that you weren't previoulsy covered for.

 

Transferring from another health fund

If you transfer to us from another fund where you had similar or higher cover and you’ve finished your waiting periods, you won’t have those waiting periods again. This means you can claim straight away for the things you were already covered for.

On the other hand, if your old cover had lower limits or benefits than your new one, you’ll have waiting periods before you can claim more than you were covered for before.

For more info on waiting periods and pre-existing conditions, read more from this government brochure.