How Long Before I Can Claim on my Health Insurance?

If you take out private health insurance, how long do you have to wait before making a claim? Canstar explores health-insurance waiting periods.

Private health insurance provides policy holders peace of mind that they’ll have easy access to possible life-saving medical treatments.

But when you take out a policy, you might not have instant access to all its benefits. Depending on your insurer and level of cover, you might have to wait up to three years before you are able to claim for certain treatments.

Canstar reveals what you need to know about health-insurance waiting periods.

How long do I have to wait before I can claim on my health insurance?

Whether you’ve basic health insurance, or a more expensive policy that offers comprehensive cover, generally, you can claim on your health insurance’s core features from its start date.

However, many optional extras, such as dental and optical, GP visits and serious condition financial benefits come with stand-down, or waiting, periods.

For example, in a selection of health insurance policies from large providers reviewed by Canstar, the following stand-down periods applied:

90-day waiting period

  • GP visits
  • Serious condition cover

Three-month waiting period

  • Dental treatments
  • Optometrist visits
  • Prescription glasses/contact lenses

Six-month waiting period

  • Proactive health checks

One-year waiting period

  • Extraction of unerupted/impacted teeth
  • Obstetrics
  • Vasectomy

Three-year waiting period

  • Breast reduction
  • Gastric banding/bypass
  • Palliative care
  • Prophylactic treatment

In addition, elective treatments can also come with lifetime policy caps, limiting the amount that can be claimed.

Waiting periods for pre-existing conditions

Most health insurance providers do not cover pre-existing conditions. However, if you have a long-term health issue, it’s worth discussing possible stand-down exceptions in detail with your health insurance provider or broker when arranging your policy.

For some health insurers can provide cover for some healthcare services relating to pre-existing conditions after periods of continuous cover, for example three years.

Compare Health Insurance with Canstar


About the author of this page

This report was written by Canstar’s Editor, Bruce Pitchers. Bruce has three decades’ experience as a journalist and has worked for major media companies in the UK and Australasia, including ACP, Bauer Media Group, Fairfax, Pacific Magazines, News Corp and TVNZ. Prior to Canstar, he worked as a freelancer, including for The Australian Financial Review, the NZ Financial Markets Authority, and for real estate companies on both sides of the Tasman.

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