OSHC waiting periods explained: nil, 2-month, 12-month and the pregnancy rule
The OSHC Deed's waiting period table set out row by row, so you can check any insurer's waiting period against the legal cap yourself.
If you have been quoted a waiting period and you are not sure whether it is legal, the answer is in a table. Schedule 4 of the OSHC Deed commencing 1 July 2025 sets a maximum waiting period for every category of benefit. An insurer may apply a shorter one. They may not apply a longer one.
This article reproduces that table so you can hold any insurer’s product document up against it.
The statutory waiting period table
From Schedule 4 of the Deed:
| Benefit | Maximum waiting period |
|---|---|
| (a) Out-of-hospital services claimed for items on the Medicare Benefits Schedule under Group A1, A2, Sub-groups 2 and 10 of Group A7, Group A22, Group A23, Sub-groups 1 and 2 of Group A40, and Group A46 | Nil |
| (b) Emergency Treatment | Nil |
| (c) Hospital treatment or hospital-substitute treatment that is psychiatric care, except for Emergency Treatment | 2 months from the OSHC start date |
| (d) Hospital treatment or hospital-substitute treatment that is for a Pre-existing Condition | 12 months from the OSHC start date |
| (e) Pregnancy related condition hospital treatment and pregnancy related condition out-of-hospital services, for OSHC Products less than 2 years duration, commencing from the implementation date of the Insurer’s premium change that occurs after 1 July 2025 | 12 months from the OSHC start date |
| (f) Pregnancy related condition hospital treatment and pregnancy related condition out-of-hospital services, for OSHC Products of 2 or more years duration, commencing from the implementation date of the Insurer’s premium change that occurs after 1 July 2025 | Nil |
| (g) Pregnancy related condition hospital treatment and pregnancy related condition out-of-hospital services, prior to the implementation date of the Insurer’s premium change that occurs after 1 July 2025 | 12 months from the OSHC start date |
| (h) Any other service in Schedule 1 not listed in Schedule 4 | 2 months from the OSHC start date |
Two details in that table catch people out, and both are covered in their own sections below.
The MBS groups that have no waiting period at all
Row (a) is worth reading twice. General practice, specialist consultations, pathology, imaging and the other listed MBS items carry a nil waiting period. This applies to out-of-hospital services claimed for those items.
The practical consequence: a wait is not a blanket start-date delay on everything. General outpatient care is payable from day one, subject to your policy’s terms. The Private Health Insurance Ombudsman explains waiting periods in this general framing, and the Pre-existing Conditions Rule factsheet covers the pre-existing side.
Emergency treatment is always nil
Row (b) is unambiguous: emergency treatment carries a nil waiting period. Combined with row (c)‘s carve-out — psychiatric care except for emergency treatment — this means a psychiatric presentation treated as an emergency is not held behind the two-month wait. The Mental Health Treatment and Private Health Insurance factsheet covers the treatment side in more detail.
Psychiatric: 2 months, not 12
Row (c) caps hospital psychiatric care at 2 months from your OSHC start date. This is a hard ceiling, not a typical figure.
If you are joining a policy after psychiatric hospital treatment, the worst an insurer may impose before it will pay a psychiatric hospital claim is two months. Anything longer is not permitted under the Deed. Our guide to psychiatric and mental health cover covers how this interacts with telehealth and outpatient care.
Pre-existing conditions: 12 months
Row (d) allows a maximum of 12 months from the OSHC start date for hospital treatment relating to a Pre-existing Condition. The Deed defines a Pre-existing Condition as one that a reasonable medical practitioner would have advised the person to seek treatment for, or that was diagnosed or treated, in the 12 months before the OSHC start date.
The 12 months is a ceiling. Insurers routinely apply less, and a shorter waiting period is a legitimate point of comparison between policies. If you have a known pre-existing condition, that difference is one of the few things genuinely worth comparing.
Pregnancy: the rule depends on product length
This is the row most often quoted wrongly, and it is covered in full in our article on pregnancy and OSHC. In short:
- Under a product of two years or more, the waiting period for pregnancy-related treatment is nil, from the implementation date of the insurer’s premium change occurring after 1 July 2025.
- Under a product of less than two years, the maximum is 12 months from the start date.
- Before that premium-change implementation date, 12 months applies.
The Obstetrics and Pregnancy factsheet from the Ombudsman sets out the general framework.
Waiting periods already served carry over
Schedule 4 closes with the point that matters most if you switch insurer:
“For clarity, a waiting period served under a previous OSHC Product will be off set against, or credited towards, the waiting period of a new OSHC Product, provided there is continuous cover.”
So a wait you have already served does not restart because you changed insurer — provided you had continuous cover. Our guide to switching OSHC insurers covers the mechanics, including the credit mechanism and the premium refund events.
How to use this table
- Find the claim category your treatment falls into.
- Compare the insurer’s stated waiting period against the maximum in that row.
- If it is longer, that is not permitted under the Deed.
- If you have already served a wait elsewhere, check that it is being credited.
Key takeaways
- Every waiting period has a legal maximum in Schedule 4 of the Deed.
- General practice and other listed MBS items: nil. A wait is not a blanket delay on all care.
- Emergency treatment: nil, including psychiatric emergencies.
- Psychiatric hospital care: 2 months maximum. Not 12.
- Pre-existing condition hospital treatment: 12 months maximum, and insurers may apply less.
- Pregnancy depends on product duration — nil for products of two years or more from the relevant premium-change date.
- Served waiting periods carry over when you switch, provided cover is continuous.
Sources
- OSHC Deed commencing 1 July 2025 (PDF) — Schedule 4, and the definition of Pre-existing Condition.
- Private Health Insurance Ombudsman — Waiting periods
- Ombudsman — The Pre-existing Conditions Rule (factsheet)
- Ombudsman — Obstetrics and Pregnancy (factsheet)
- Ombudsman — Mental Health Treatment and Private Health Insurance (factsheet)
Information is current as at 1 October 2026. This is general information, not personal advice, and it does not consider your personal circumstances. CompareOSHC is not an insurer or underwriter. We may receive a commission from insurers; commissions do not influence our comparisons.