A pre-existing condition is a medical issue that existed before you joined a health fund, or upgraded to a new health insurance policy. Australian health funds generally impose a 12 month waiting period before you can claim on a pre-existing condition, except for psychiatric, rehabilitative or palliative care, which only require a two month wait.

Are you covered for a pre-existing health condition?

Here are the most important things you need to know about pre-existing conditions in regards to your health insurance policy.

  1. You do not pay more for health insurance because of pre-existing conditions.
  2. Conditions do not need to have been previously diagnosed to be considered ‘pre-existing’.
  3. You seek private treatment for your pre-existing condition following the waiting period without penalty.

How is a pre-existing condition defined?

A pre-existing condition is defined as any illness, ailment or condition that existed in the six months prior to joining a health insurance policy.

It is not necessary for a condition to have been diagnosed in order to be considered pre-existing. You and your doctor may not have even been aware of the condition, but if it was there prior to joining your health insurance policy, it will be classified as pre-existing.

However, signs or symptoms should have been reasonably evident in order for this to be considered.

Your health fund will determine whether your condition is pre-existing by appointing a medical practitioner to examine you. They are also required to take into account information provided by your doctor.

How will a pre-existing condition affect my insurance policy?

If your condition is considered to be pre-existing, your health fund will impose a 12 month waiting period before you can claim for benefits relating to that condition – simple as that.

If you need to be admitted to hospital for a condition that you think may be pre-existing, check with your health fund in advance to ensure you’ll be covered for your medical treatment.

It’s important to realise that even if you need to sit through this waiting period, you can still seek treatment through Medicare, if you think it’s medically urgent.

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

No, you won’t. Even if you have a pre-existing condition, you can purchase any health insurance policy at the same price as anyone else, and you can claim as soon as your waiting periods have been completed.

Why do health insurers impose waiting periods for pre-existing conditions?

Because anyone who’s fallen ill could sign up for health insurance, claim on this cover immediately, and then leave. Insurers would have to shoulder the costs, and then these costs would be passed on to others who hold health insurance policies…in the form of more expensive premiums. It’s essentially for the same reasons why health funds impose waiting periods.

So, what are you waiting for?

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