Let’s talk about waiting periods

Confused about waiting periods? We don’t want that.

That’s why we’ve put together some information to explain why we have waiting periods, how they work and when they may apply to you.

Why are there waiting periods?

A waiting period is the amount of time you’ll need to wait before you can start to claim on your RT Health policy. You cannot claim for treatments received during the waiting period.

If we didn’t have waiting periods, people could take out hospital cover or upgrade to comprehensive cover only when they knew or suspected that they might need hospital treatment and immediately make a hospital claim.

If these new members then cancelled (or downgraded) their policy, the impact is that their hospital costs would have to be paid for by the fund’s long-term policy-holders.

That’s just not fair to existing members, and it would lead to increased premiums across the board for all members. Waiting periods help funds avoid this problem.

How long are waiting periods?

The Australian Government sets the maximum waiting periods that private health insurers can put in place for hospital treatment. We’ve outlined them below:

12 months for pre-existing conditions. A pre-existing condition is any ailment, illness or condition that you had signs or symptoms of during the six months before you took out or upgraded health cover with us (or any Australian private health insurer). A condition can still be classed as pre-existing even if you hadn’t seen your doctor about it or known about it before joining RT Health or upgrading to a higher hospital cover with us.
12 months for pregnancy and birth-related services.
2 months for psychiatric care, rehabilitation and palliative care.
2 months for all other services.

When it comes to waiting periods on your Extras cover for services like dental, optical, and physiotherapy, these are set by individual private health insurers.

Some of the common waiting periods that apply:

2 months: General dental
2 months: Specialist therapies
2 months: Alternative therapies
3 or 6 months: Optical
12 months: Health aids

Do waiting periods apply to me?

You may need to serve a waiting period if:

you’re taking out private health insurance for the first time
you’re re-joining after letting your cover lapse
you’re an existing member and change to a higher level of cover (e.g. if you increase your cover from Bronze Plus Classic Hospital cover to Gold Optimum Hospital cover, there’s a waiting period for new included services not previously covered)
you reduce your excess. You’ll need to serve the relevant waiting periods before you can pay the lower excess. If you do go to hospital during this waiting period, you’ll pay the higher excess amount
you’re transferring from another health fund (see below for further info)

For each person covered, the waiting period starts on the first day the person is insured under the policy and ends at the time specified by the policy.

You cannot claim for products, services and/or treatments that you receive during a waiting period. Only services provided after the waiting period is completed are covered.

What if I need to go to hospital within the waiting period?

While you won’t be covered by your private health insurance for any hospital treatments or services you receive in the waiting period, this does not mean that you can’t access treatment. It just means you won’t be covered under your policy for the costs associated with that treatment or service.

As always, you can access treatment in the public system under Medicare - but you’ll have to join the public wait list for your treatment in the public system.

Do I need to re-serve waiting periods if switching from another health fund?

When you transfer to RT Health from another fund, the only time waiting periods will apply is when your RT Health policy offers a higher level of benefits than you had with your previous fund. In this case, you’ll be entitled to the same level of benefits you had under your previous policy until you’ve served the waiting period for the additional benefits covered by your new RT Health policy.

If you’re transferring from another health fund where you have already served waiting periods on an equivalent level of cover, you don’t have to serve them again with us.

Know your cover

We want you to make the most of your health policy. It pays to make sure you know which treatments and services you’re covered for and how much you can claim.

If you don’t have your Cover Guides handy, they’re available 24/7 on our website. Understanding your cover will help you avoid unexpected costs and you might discover more benefits you’d like to use to be well, get well and stay well.

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