What is a Waiting Period?
A waiting period is the time you’ll need to wait before you can claim a benefit on your membership, and will apply whether you’re taking out private health insurance for the first time, switching to Phoenix Health from another fund, or you’re a current Phoenix Health member changing your level of cover.
Click here for everything you need to know about Waiting Periods, including what happens if you’re new to private health insurance, transferring from another fund or you’re already a member.
What are the waiting periods?
Waiting periods for Hospital Cover
Cover | Waiting Period |
Pre-existing conditions Excluding Hospital Psychiatrics services, Rehabilitation and Palliative Care | 12 months |
Pregnancy and birth | 12 months |
Hospital Psychiatric Services, Rehabilitation and Palliative Care Regardless of whether they are pre-existing or not | 2 months |
All other conditions that are not considered pre-existing | 2 months |
Hospital Care Programs | 2 months |
Hospital Treatment as the result of an accident | No waiting period |
Waiting periods for Ambulance
Cover | Waiting Period |
Ambulance | 1 day |
For all the information you need to know about Waiting Periods, including what happens if you’re new to private health insurance, transferring from another fund or a current Phoenix Health member changing your level of cover, click here.
What is an Accident?
An accident for the purpose of Accident Cover means an unplanned or unforeseen event that has occurred in Australia resulting in bodily injury that requires immediate hospital treatment. The accident has happened by chance and was caused by an unintentional and external source and cannot be attributed to medical causes.
Where a member hasn’t completed serving their hospital waiting periods (or holds a level of cover that has exclusions) and is hospitalised as a result of an accident, we’ll waive the standard waiting period for that condition and benefits will be payable for their admission in a private hospital, regardless of whether the service they require is excluded on their level of cover or not. Any excesses applicable will not be waived as a part of Accident Cover.
For more information about Accident Cover, click here.
What is a Pre-Existing Condition?
A pre-existing condition is any illness or ailment that, in the opinion of a Medical Practitioner, existed at any point in the 6 months prior to taking out or upgrading your cover.
If you require hospitalisation within the first 12 months of taking out hospital cover or upgrading your level of hospital cover, and have served the general 2 month waiting period, the fund may request a Pre-Existing Condition Assessment Form to be completed by your regular GP and Specialist. This information would then be assessed by an independent Medical Practitioner appointed by the fund who will determine if the condition is pre-existing or not and as such whether or not a benefit will be paid or not.
For more information about Pre-Existing conditions click here.