Buy Health InsuranceIndependent guide · not a health fund
The guide · receipt 01 of 06
Switching health funds: what carries over
You can change health funds at any time, and hospital waiting periods you have already served carry over if the new policy is at the same or a lower level of benefit. Anything new or higher starts a fresh waiting period, and your old fund’s clearance certificate is the record that proves what you have served.
The ledger: what carries over
Think of the move as a transfer slip. Some lines carry forward to the new fund; some start again from zero; a few depend on the new fund’s rules and need checking.
| Line | Status | What the official pages say |
|---|---|---|
| Hospital waiting periods already served | Carries | Your new insurer must give you continuity for waiting periods you have already served, if you move to the same or a lower level of benefit. |
| New or higher benefits | Starts again | Anything your old policy did not include, or paid less for, comes with a waiting period before you can claim it. |
| Lower excess or lower gap fees | Starts again | Moving to a policy with lower excesses or gap fees can also mean a wait before you can claim at the new level. |
| Lifetime Health Cover position | Carries | Changing insurers does not affect your Lifetime Health Cover entitlements, as long as you keep hospital cover. |
| Extras benefits already claimed this year | Check | The new insurer may count benefits your previous insurer paid when it works out your annual limits. |
| Lifetime limits used up | Check | If you have used a lifetime limit, the new insurer may deduct what you have already claimed from its own lifetime limit. |
| Bonus points, loyalty limits, accrued benefits | Usually lost | Accrued benefits, credits and bonus points usually cannot be transferred, accrued orthodontic benefits for example; loyalty limits are generally not transferable. |
| Premiums paid in advance | Refunded | If you cancel, your old insurer should pay back contributions paid in advance, and may deduct a small administration charge. |
The word for it: portability
The ability to move from one insurer to another without re-serving waiting periods is called portability. It usually applies only if you transfer within a set time of leaving your previous insurer, and that time is set by the new insurer.
The gap allowed varies. The Private Health Insurance Ombudsman’s site says some insurers allow a break of up to two months while others allow only one week, and that losing continuity means re-serving waiting periods. The new insurer can tell you its rule before you cancel the old policy.
A separate clock matters too. If you fall more than two months behind on premiums, you are not insured, and some insurers may impose waiting periods again when you resume paying.
The clearance certificate
The record that carries your history across is the clearance certificate, also called a transfer certificate. It is a record of your membership that keeps your waiting periods and Lifetime Health Cover entitlements continuous.
- You ask your old insurer for it and give it to your new insurer.
- Under the Private Health Insurance Act 2007, your old insurer must provide it within 14 days.
- The Ombudsman’s site suggests checking that its details are correct, and raising any discrepancy with the old insurer.
A changeover, in order
Pulled together from the Ombudsman’s and the Department of Health’s pages, a move between funds tends to run like this.
- Before you decide
Compare like with like
Before changing insurer, the Department of Health suggests checking whether there will be any new waiting periods and how long they will be. The Private Health Information Statement for each policy sets out its waiting periods and limits.
- Before you cancel
Ask the new fund about the gap it allows
A break of one week to two months may be allowed, depending on the insurer.
- When you leave
Request the clearance certificate
Your old insurer has 14 days to provide it.
- After you join
Read what arrives in the first month
The Ombudsman’s site suggests reading every document from the new insurer within your first month of membership, and contacting the insurer about anything you don’t understand.
Moving within the same fund
The same rules apply when you change policy without changing insurer. You can change your cover at any time, waiting periods already served transfer to a policy with the same benefits, and new or higher benefits carry their own waiting period.
In-hospital psychiatric care has its own once-only waiting period exemption, explained on privatehealth.gov.au’s waiting periods page.
When the fund moves you
Sometimes the change starts with the insurer. If it plans to discontinue your policy and move you to a new one, it must tell you clearly how the change will affect you: the services that won’t be covered, any change to excesses or co-payments, the waiting periods that will apply and your new premium.
You don’t have to accept the replacement. You can transfer to a policy of your own choice instead, including one with a different insurer.
Pausing instead of leaving
If the reason for leaving is time overseas or money, a suspension may be an option. Insurers may grant one at their own discretion, for example for working or studying overseas, financial hardship or temporary unemployment. You can’t claim during a suspension, and suspension rules differ between insurers.
An agreed suspension doesn’t affect your Lifetime Health Cover entitlements, but if you are over the income threshold you pay the Medicare levy surcharge for the suspended period.