What are waiting periods?
Waiting periods are designed to protect the interest of our members. Without them it would be easy for people to join only at the times when they need cover and to receive benefits.
This would lead to higher premiums for all fund members. Like all private health funds, Emergency Services Health has waiting periods for new members, including people transferring from another insurer when taking out a higher level of cover.
Waiting periods also apply to current members upgrading their cover.
A ‘waiting period’ in the context of private health insurance means the period of time from the commencement of cover or increase in cover, to when the benefit or new benefit can be claimed by the member under their chosen cover (excludes accidents).
Waiting periods for Emergency Services Health's Hospital Benefits (relevant for Gold Hospital or Gold Combined cover):
- 2 months membership for all benefits, excluding accidents
- 12 months membership for obstetric treatment
- 12 months membership for pre-existing conditions, excluding psychiatric care, rehabilitation or palliative care.
- 12 months membership for aids & appliances (12 months membership for continuous positive air pressure (CPAP) machines, and goods and services under Non-surgically Implanted Prosthesis and Appliances and other aids and appliances.)Extras benefits for Rolling Extras and Gold Combined:
Waiting periods for Emergency Services Health's Extras Benefits (relevant for Rolling Extras or Gold Combined cover):
- 2 months membership for all benefits, excluding accidents
- 12 months membership for major dental (like crowns and dentures) and orthodontics, hearing aids, nebulisers, blood glucose & blood pressure monitors, blood coagulation monitor and for pre-existing conditions
- 12 month membership for Rollover Benefit (2 years Major Dental).
- Available on Gold Combined Cover only: 3 years membership for corrective laser eye surgery.
Waiting periods for Pre-existing Conditions
If a new member has a pre-existing condition before joining Emergency Services Health, they may need to serve a 12-month waiting period under the terms of our policy before benefits are payable for the particular condition.
This does not apply for psychiatric care, rehabilitation or palliative care.
A pre-existing condition is one where signs or symptoms of your ailment, illness or condition existed at any time during the six months preceding the day on which you purchased your insurance or upgraded to a higher level of cover.
A medical practitioner appointed by Emergency Services Health (not your own doctor) is the only person authorised to decide that a condition is pre-existing.
The practitioner must, however, consider any information regarding signs and symptoms provided by your own treating doctor or specialist.
Further information on waiting periods for pre-exisiting conditions is available through the Private Health Insurance Ombudsman.
Continuity of cover
It is important to note that if you are transferring from another insurer, waiting periods only apply to the level of cover that is greater than previously held.
For instance, if you previously had a top hospital cover with the previous insurer but with an excess, the waiting period only applies to the excess when joining Emergency Services Health.
Further information on waiting periods is available through the Private Health Insurance Ombudsman.