What is a waiting period?
A waiting period is simply the period of time you have to wait between signing up with Frank and being able to claim. They apply to both hospital and extras cover.
Can you give me an example of how that works?
Sure! Frank's Some Extras cover has a six-month waiting period for optical.
Which means if you take out Some Extras today, you’ll need to keep that cover continuously for six months before you can claim for glasses.
It doesn’t mean you can take out extras cover today, get glasses today, and then wait six months to lodge the claim. You need to wait out the ‘waiting period’ before you can actually use a service and then claim on it.
How is a benefit limitation period different?
A benefit limitation period is a period of time that the procedure will be covered (after any waiting periods) but only in a public hospital.
Within the benefit limitation period, your health fund limits what benefits they pay towards a certain hospital service. If you haven't served the benefit limitation period, your health fund will still pay something back, but it's restricted to the minimum shared room rate under the Private Health Insurance Act for private hospital admissions.
Benefit limitation periods mean that members can be covered for the services they need, as well as keep the cost of cover down, and make sure that health funds aren’t taken advantage of by people who join, claim what they need, and then leave again.
How long are the waiting periods?
The following table outlines the waiting periods and benefit limitation periods that apply for any services included on your cover:
||Benefit Limitation Periods apply to gastric banding and all obesity surgeries, psychiatric or renal dialysis (that means you’re covered but for public hospital benefits in a shared room after your other waiting periods have been served)
||Pregnancy and pre-existing conditions (except psychiatric, rehab or palliative care)
||Psychiatric, rehab or palliative care and any other hospital treatment
||Accidents (bodily injuries that happen the day after you join or upgrade to a higher level of cover) and Emergency Ambulance transport
||Major Dental, Orthodontics, Orthotics and Podiatry Surgery
||Acupuncture, Chiropractor, Dietetics, Exercise Physiology, General and Preventative Dental, Homeopathy, Hydrotherapy, Myotherapy, Naturopathy, Osteopath, Pharmacy, Physiotherapy, General Podiatry, Psychology, Remedial Massage, Speech Therapy
||Ambulance Subscription (VIC, SA, WA and NT)
Will my waiting periods reset if I switch or upgrade cover?
You won’t need to serve waiting periods for anything you have previously served waiting periods for. If your new Frank cover has higher benefits than your old cover, you’ll have to serve the standard waiting periods to receive those higher benefits. You’ll be covered for your old (lower) benefits during that time though.
If I add a new person to my cover will they have to serve the waiting periods?
Yes, the new person will have to wait the standard waiting periods listed above. Unless:
- They are your newborn baby and have been added to the family policy from their date of birth (and you have served a two month waiting period with Frank)
- They are your new adopted or permanent foster child and are added to the policy within 30 days of being adopted or fostered
- They have already served the waiting periods with another fund (at an equal or higher level of cover) and have been added to the policy within 30 days of ending cover with their previous insurer
- They have already served the waiting periods with Frank (at an equal or higher level of cover) and transfer from their policy straightaway to yours.
What if I have a pre-existing condition?
There’s a special waiting period for pre-existing conditions. For services that relate to your condition the waiting periods will be extended, generally to 12 months. Find out more about pre-existing conditions.
Do I still serve waiting periods if I’m pregnant?
Yes, but they’re calculated differently. The 12-month waiting period is worked out from the time you join up to the due date. This means that if the baby decides to come early you're still covered as long as the due date was 12 months from the time you joined up. Usually your health insurer will ask for a letter from your doctor stating your due date.