Waiting Periods & Pre-Existing Conditions

Pre-existing conditions

A pre-existing condition is any ailment, illness or condition that you had signs or symptoms of (in the opinion of a medical practitioner appointed by the health insurer) that existed during the 6 months before you joined a hospital cover or upgraded to a higher hospital cover. It's not necessary that you or your doctor knew what your condition was or that the condition had been diagnosed. A condition can still be classed as pre-existing even if you hadn't seen your doctor about it before joining hospital cover or upgrading to a higher hospital cover.

If you are new to health insurance and have a pre-existing condition, you will need to serve a 12 month waiting period (under Hospital cover, not Extras) before we’re able to cover the condition. If you have health insurance with another fund and have served all of your waiting periods with them, you will be covered immediately and won’t have to re-serve your waits if you move to a similar or lower level of cover with onemedifund.

 

 


 

Waiting periods

Waiting periods are established to protect all contributors by encouraging people to maintain their health cover. A waiting period is a length of time applied to each new health cover and also applies when cover is upgraded. During this period, benefits are not payable.

onemedifund will provide continuity of cover for anyone transferring from another fund or from another onemedifund product provided that equivalent or a higher level of cover was held.

To be eligible for continuity of cover the transferring health cover must be financial, all waiting periods from the previous fund must have been served and a clearance certificate provided. Please note that if you upgrade from extras only to hospital cover, full hospital cover waiting periods will apply.

 

Service Waiting Period
Accidents requiring hospitalisation Nil
Ambulance Nil
Transferring equivalent cover from another fund or parent’s cover
Note: previous cover must be financial at the time of transfer and waiting periods must be served 
 Nil
General Dental, Pharmaceutical, Physiotherapy and Complementary Therapies 2 Months
On commencement of or upgrading cover (apart from services noted below) 2 Months
Rehabilitation, Psychiatric and Palliative Care 2 Months
Health Programs   2 Months
Optical benefits & Health Management benefits 6 Months
High cost dentistry – including crowns, bridgework, implants, orthodontics and dentures 12 Months
Pre/post-natal services   12 Months
Obstetrics (pregnancy-related services), including midwifery 12 Months
Assisted-reproductive services (IVF)   12 Months
Pre-existing ailments* 12 Months
Laser eye surgery and hearing aids 24 Months

Please note that not all items are listed and other waiting periods may apply. Please contact the fund for more information.

* Pre-existing conditions: any ailment, illness or condition that you had signs or symptoms of (in the opinion of a medical practitioner appointed by the health insurer) that existed during the 6 months before you joined a hospital cover. It is not necessary that you or your doctor knew what your condition was or that the condition had been diagnosed. A condition can still be classed as pre-existing even if you hadn't seen your doctor about it before joining hospital cover. This waiting period applies to Hospital cover, not Extras cover.

Please note:

  • Waiting periods will be waived for contributors transferring from another fund provided that:
      • the previous cover was an equivalent or higher level
      • the previous cover was financial at the time of transfer
      • waiting periods have been served with that fund
  • If your previous level of cover was lower than your new level of cover, you will only be able to claim the lower benefits until waiting periods have been served.
  • If annual limits have been used at the time of transfer you won’t be able to claim for that service in the first year of cover with onemedifund. If part of the annual limit has been used you will only be able to claim the remainder of the limit within the first year.
  • The 6 month waiting period for health management programs is not transferrable between funds. This period must be served with onemedifund before benefits are payable.

For more information on waiting periods, Transfer Certificates or continuity of cover click here, call 1800 148 626 or email info@onemedifund.com.au.