Navy Health understands that Private Health Insurance can be quite confusing for our members with various impositions on your cover that may impact you using it when you need it.

To assist our members, we have created Be Informed, an online resource to provide you with information relating to the Private Health Insurance industry and to provide you with resources to make better informed decisions relating to your health needs.

What are waiting periods?

Waiting periods are placed on policies in the following scenarios:

Why do waiting periods exist?

In Australia, all health insurers are required by law to provide health insurance for Australian residents regardless of their health status and cannot charge higher premiums based on whether a person is more likely to require treatment.

If there were no waiting periods, people could take out hospital insurance or upgrade to a higher policy only when they knew or suspected they might need hospital treatment. This would lead to much higher premiums for all existing contributors to health insurance.

Ref: Private Health Insurance Ombudsman.

How long are the waiting periods?

Hospital Cover:

General Treatment (Extras Cover):

General treatment or extras cover are set by Navy Health and they are not subject to the same laws as hospital cover, however there are rules surrounding waiting to ensure all of our members have a fair and equitable experience.
Examples of the wait periods on extras covers are below; however to view your product waits please go to our website.

If you have transferred from another funds and have served similar waits, you will not need to re-serve any waits when you join Navy Health.

What is the pre-existing condition waiting period?

A pre-existing condition is defined by law as any condition, illness, or ailment that in the opinion of the health insurers doctor (not you, or your doctor), you had signs or symptoms of during the six months before you joined a hospital policy, or upgraded to a higher hospital policy. Navy Health utilise an independent doctor to make these impartial determinations on our behalf.
Under Navy Health fund rules, we will not pay for hospital admissions within the first 12 months of joining or upgrading your level of cover.
If you require a hospital admission within your waiting periods, Please contact our member’s services team on 1300 306 289 to discuss the process and the options that may be available to you.

Pre-existing conditions example

Example 1: Pre-existing rule applies:

Example 2: Pre-existing rule does not apply:

Exclusions and restrictions?

Some of Navy Health’s hospital policies contain exclusions and restrictions i.e. silver or bronze policies. Exclusions and restrictions exist to provide our members with varying levels of cover and varying premium prices and allow members to choose a policy suited to their health needs.

Exclusions:

If your policy contains exclusions for specific categories/conditions, Navy Health will not pay for that treatment in either a private or public hospital if you are admitted.

For example, if you are admitted into hospital for a heart attack (cardiac), Navy Health will not pay any benefits toward your hospital or medical costs that are incurred if the policy you have purchased has cardiac excluded.

Restrictions:

If your policy contains restrictions for specific categories/conditions, Navy Health will pay for treatment, but only as a private patient in a public hospital.

For example, if your policy contains restrictions for pregnancy and birth related services, you will only be covered in full if you are admitted to public hospital as a private patient to give birth.

It is important for all members to regularly review their policy to ensure that it is suited to their health needs now and into the future. If you would like to discuss your policy options please contact Navy Health on 1300 306 289.