Beware of waiting periods

Usually only treatment for accidents is covered when you first join a health fund. Waiting periods usually apply to all other types of treatment. Below are three common waiting periods which almost all health funds apply:

  • A 2 month waiting period before new members can make a claim other than for emergency treatment. From time to time private health funds run promotions offering the waiver of this waiting period which effectively gives immediate cover to new members – this “immediate” cover usually does NOT apply to obstetrics and pre-existing ailments.
  • A 12 month waiting period for obstetrics and maternity claims.
  • A 12 month waiting period for pre-existing ailments and conditions. Funds firmly apply this rule – so, if you're not certain how this may affect your cover, ask the fund to explain the rule. Remember, even undiagnosed illnesses may not be covered by your health insurance policy.

Many policies incorporate other waiting periods for ‘ancillary' benefits such as dental and optical work; and lengthy waiting periods for some specific medical and surgical procedures, such as cardio thoracic surgery.
Note that waiting periods apply to the additional benefits members get when they upgrade their health insurance.
Waiting periods can be extended further by ‘benefit limitation periods'.