Worked Examples and Checklists
Switching health insurer without losing waiting periods: a step-by-step guide
How portability protects waiting periods when you change policy or fund, the transfer certificate, timing the switch, extras limits and a worked downgrade example.
You can switch private health insurer or policy at any time, and the rules under the Private Health Insurance Act 2007 mean you do not serve waiting periods again for benefits you already had, as long as you move to the same or lower cover without a break. Any higher benefits in the new policy come with new waiting periods, including up to 12 months for pre-existing conditions. Your Lifetime Health Cover history moves with you on a transfer certificate, and an age-based discount may or may not carry over, depending on the new insurer. The usual way to switch is to join the new policy first and let the new insurer arrange the transfer.
This guide is part of how to compare policies step by step. The interactive switching checklist lets you tick off each step.
Why people switch
- The 1 April premium increase made the policy too expensive.
- Circumstances changed: a partner, a baby, children leaving, a separation.
- They are paying for categories they will not use, such as pregnancy after their family is complete.
- They need a category the current policy restricts or excludes.
- Their specialist uses a different insurer's gap scheme.
What carries over and what does not
| Item | Carries over? |
|---|---|
| Hospital waiting periods served, for equal or lower benefits | Yes |
| Waiting periods for higher benefits or new categories | No, new waiting periods apply |
| Lifetime Health Cover loading and days of absence | Yes, via the transfer certificate |
| Progress towards the 10 years to remove your loading | Yes, if there is no gap |
| Age-based discount | Insurer's choice |
| Extras waiting periods for equivalent services | Commonly recognised, but check |
| Extras benefits already used this limit period | Often counted against the new insurer's limits |
| Extras loyalty bonuses | Usually not |
Worked example: downgrading to save money (illustrative)
Ben and Kate, both 48, have a Gold family policy at $6,400 a year after rebate. Their youngest is 12 and they do not plan more children. They look at a Silver Plus policy at $4,700 that adds joint replacements and cataracts but not pregnancy and birth or assisted reproduction.
- Saving: $6,400 − $4,700 = $1,700 a year
- Waiting periods for every category in Silver Plus: already served on Gold, so they carry over. No new waiting period.
- Lost categories: pregnancy and birth, assisted reproduction, dialysis, insulin pumps, sleep studies, weight loss surgery, pain management with device. They check with their GP whether any are likely.
- If they later upgrade back to Gold, the categories they gave up would carry new waiting periods, including 12 months for anything pre-existing.
Worked example: an upgrade during treatment
Priya's Bronze policy does not cover back, neck and spine. She has had back pain for three months and her GP has mentioned imaging. If she upgrades to Silver now, the insurer's medical adviser will likely treat a back condition as pre-existing, so she serves 12 months before getting benefits in that category. In the meantime she keeps her Bronze benefits. Waiting is a cost to weigh against public-system treatment; it is not a reason to delay care her doctor recommends.
Steps in order
- Check what you have: download your current Private Health Information Statement and note your excess, categories and extras limits used this year.
- Shortlist: compare policies with the step-by-step method.
- Ask the new insurer in writing: which waiting periods will be recognised, whether your age-based discount carries over, and how it treats extras already claimed.
- Time it: set the new policy's start date as the day after your old policy is paid to, so there is no gap. A gap can mean the surcharge for those days, absence days for LHC and, if long enough, new waiting periods.
- Join the new fund: it usually requests the transfer certificate from your old insurer and can cancel the old policy for you. Confirm that happens.
- Claim before you leave if you have extras benefits available for treatment already received.
- Prepaid premiums: if you paid in advance, ask the old insurer for a refund of the unused portion.
- Rebate: tell the new insurer your rebate tier.
- Keep both tax statements for your next return.
Avoid these switching mistakes
- Cancelling the old policy before the new one is confirmed.
- Switching right before planned surgery, when the new insurer's gap scheme or hospital agreements may differ.
- Moving to a policy that restricts psychiatric care when you have used mental health services.
- Assuming "Silver Plus" at one insurer matches "Silver Plus" at another.
When to get help
If an insurer refuses to recognise waiting periods you believe you served, ask for its decision in writing and use its complaints process. The Private Health Insurance Ombudsman at the Commonwealth Ombudsman can help if it is not resolved; see health insurance complaints.
FAQ
Is there a penalty for leaving a fund?
Standard health insurance policies generally have no exit fee, but read your policy terms and check whether any prepaid premiums are refundable.
Can I switch in the middle of a waiting period?
Yes. Time already served counts towards the same waiting period on equal cover with the new insurer.
How long can the gap between policies be?
As short as possible. Insurers set how long a break they accept before waiting periods restart, so ask both insurers before you cancel.
Will my premium go up because of my age when I switch?
No. Premiums are community rated; you pay the same as anyone else on that policy, plus your own LHC loading or minus any age-based discount.
Sources
- PrivateHealth.gov.au — changing policies or insurers, policy statements
- Commonwealth Ombudsman — complaints about transfers and waiting periods
- Federal Register of Legislation — Private Health Insurance Act 2007
