Am I affected by pre-existing conditions?

Many Australians believe that a pre-existing condition will either prevent them from getting private health insurance or increase the cost to a point where it becomes unaffordable.

Good news! This is not the case.

Even if you have a pre-existing condition, you can purchase any health insurance policy at the same base price anyone else would pay for it, and you can claim as soon as you complete your waiting periods.

If you’ve ever put health insurance off because of a pre-existing condition, now is probably a good time to re-evaluate your options. Start by comparing health insurance here.

Will a pre-existing condition affect my ability to claim?

Yes, health insurers impose 12 month waiting period on benefits for hospital treatment for pre-existing conditions.

This means that if you buy private hospital insurance today to help pay for costs associated with a pre-existing condition, you won’t be covered for any procedures related to that condition in the next 12 months.

The only exceptions to this rule are if you need to claim on psychiatric, rehabilitative or palliative care benefits, which only require a two month wait.

However, there’s nothing stopping you from using all the other features of your health insurance policy in the meantime, or claiming against new conditions once their applicable waiting periods are served.

How is a pre-existing condition defined?

A pre-existing condition is defined as any ailment, illness, or condition where, in the opinion of a medical adviser appointed by the health insurer, the signs or symptoms of that condition existed in the six months before you became insured.

The waiting period for pre-existing condition applies to:

• people taking out a hospital policy for the first time;
• people who have discontinued their hospital policy; and
• anyone upgrading their hospital policy to include higher limits/additional benefits.

Why doesn’t a pre-existing condition affect the cost of health insurance?

Australia’s private health insurance is based on a community rating.

What does that mean?

It means that everyone pays the same base premium for their health insurance, because health funds cannot discriminate based on your health status, age or claims history.

For example, a single, healthy 20-year-old will pay the same base premium for the same cover as a single, unwell 60-year-old. That said, Lifetime Health Cover loading may affect your private hospital insurance premiums, depending on whether or not you get covered before you turn 30.

The cost of premiums for similar cover varies greatly between health insurers, so we always recommend you review your options, to make sure you get the best value possible.

Call 1800 338 253 to chat to one of our health insurance experts, or compare policies online to find a product that puts your health first.