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StlukesHealth

Waiting periods

All you need to know about waiting periods.

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Waiting periods

A waiting period is the length of time you have to wait before you become eligible for benefits.

 

The following waiting periods apply to Hospital cover

Pre-existing conditions* 12 months
Pregnancy and related conditions 12 months
All other services
(including Psychiatric, Rehabilitation & Palliative care)
2 months

The following waiting periods apply to Extras cover

Health management programs 3 months
Optical 6 months
Major Dental
(including Periodontics, Endodontics, Crowns & Bridges, Dental Implants, Dentures & Orthodontics)
12 months

Orthotic appliance and other health appliances and aids

12 months

Clinical Psychology

12 months

Hearing aids

36 months

All other services

2 months

Waiting periods apply to new members and to members rejoining after a lapse in cover. Waiting periods may also apply to additional benefits when you change your level of cover. In addition to waiting periods, some benefit limitation periods apply to specific services on hospital cover.

*For more information on waiting periods and the pre-existing condition, refer to the membership conditions.

Benefit Limitation Periods

A benefit limitation period is an initial period of time during which only a minimum benefit is paid for some types of hospital treatment.

Benefit limitation periods apply to new members to private health insurance and to members rejoining after a lapse in cover. They do not apply to existing members changing their hospital cover or to new members transferring from another private health insurer providing their previous cover did not exclude the following services and they are transferring within 2 months of ceasing their previous cover.

A benefit limitation period of two years applies from the date of joining on the following services:

  • Joint replacements (excluding joint replacement that results from an accident)
  • Bariatric procedures (weight loss surgery, including repair, replacement, removal and adjustment)
  • Spinal surgery (excluding spinal surgery that results from an accident)
  • Psychiatric services (including drug and alcohol rehabilitation)
  • Dialysis for chronic renal failure
  • Assisted reproductive services including IVF and GIFT

The hospital benefits payable on all hospital covers during a designated benefit limitation period will be the minimum benefit as declared by the Minister for Health and Ageing, except when a waiting period is also being served, in which case no benefit applies.

Transferring from another fund?

If you have served all your waiting periods with another fund, you can transfer to equivalent or lower cover with St.LukesHealth without having to reserve waiting periods on benefits common to both funds, providing you transfer within 2 months of ceasing to be covered by your previous fund. If you transfer to a higher level of cover, some waiting periods may apply for the higher benefits.

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