Private health insurance with pre-existing conditions

How health insurance works when you have pre-existing medical conditions

Average customer rating: 4.3/5
Written by Joshua Malin
Reviewed by Steven Spicer
Updated 26 March, 2024

Pre-existing conditions explained

Pre-existing conditions explained by Dr Ginni Mansberg.
Dr. Ginni Mansberg

What is a pre-existing condition?

A pre-existing condition is a medical issue that you had before you joined a health fund or upgraded to a higher level of cover. A pre-existing condition is defined as any illness, ailment or condition which, in the opinion of a health fund’s appointed health professional, showed associated signs or symptoms of the condition’s existence at any time in the six months prior to purchasing a private health insurance policy.

Essentially, conditions don’t need to be diagnosed beforehand to be considered pre-existing. You may not have even been aware of the condition, but if it was there before purchasing your private health insurance policy, it may be classified as pre-existing.

However, for a condition to be considered a pre-existing condition, signs or symptoms should have been reasonably evident to you or a medical practitioner (had you been examined in the prior six months).

Your health fund can determine whether your condition is pre-existing by appointing a medical practitioner to examine you. Your health fund is also required to consider information provided by your treating doctor, so they may ask you to provide a medical report by your doctor (for example) from when you were first assessed for your pre-existing condition.

Expert tips for pre-existing conditions

Our health insurance expert, Steven Spicer, has some tips on taking out health insurance with a pre-existing condition.

Steven Spicer
Executive General Manager – Health, Life & Energy

Look for a policy with accident cover

Even if you’re serving waiting periods for a pre-existing condition, you may be glad to know that many health funds cover ambulance services and hospital treatment as the result of an accident with little to no waiting period after taking out hospital cover. It’s always a good idea to check the fund’s policy brochure for more details around coverage and waiting periods.

Consider health insurance for rehabilitation

Private hospital cover could be a suitable solution for those with a pre-existing condition that requires in-hospital rehabilitation after a surgery. If you’re able to get the surgery through the public system or fund a private surgery yourself, cover for rehabilitation could be accessed after only a two-month waiting period (regardless of pre-existing conditions). This will allow those who are upgrading or new to cover (as long as they’ve served the two-month waiting period) to seek more personalised treatment or treatment in a quicker timeframe.

Get cover for your condition as early as possible

At a time of need, the last thing you will want to do is worry about whether a surgery is covered or if there’ll be a waiting period for pre-existing conditions. It’s important to make sure you’ve got the right policy for your needs; it pays to compare your health insurance on a regular basis or as your circumstances change.

Health insurance with pre-existing conditions

How pre-existing conditions affect health insurance

Can you get health insurance with a pre-existing condition?

Why health insurers impose waiting periods for pre-existing conditions

Types of pre-existing conditions

Is mental illness a pre-existing condition?

Is pregnancy a pre-existing condition?

Are conditions in my family considered pre-existing?

More information

Will I pay more if I have a pre-existing condition?

How are pre-existing conditions affected when switching health insurance?

What if I don’t agree with my health fund’s decision about my pre-existing condition?

Meet our health insurance expert, Steven Spicer

Steven Spicer
Executive General Manager – Health, Life & Energy

As the Executive General Manager of Health, Life and Energy, Steven Spicer is a strong believer in the benefits of private cover and knows just how valuable the peace of mind that comes with cover can be. He is passionate about demystifying the health insurance industry and advocates for the benefits of comparison when it comes to saving money on your premiums.