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What happens if I have a pre-existing condition?


How is a pre-existing condition defined?

Typically, pre-existing conditions can be any illness, injury or condition where, in the opinion of a medical advisor appointed by the health insurer, the signs or symptoms of that illness, ailment or condition existed during the 6 months before joining a health fund or upgrading a policy.

An undiagnosed condition can still be classified as pre-existing. You or your doctor may not have diagnosed the specific condition, however, if it’s found that the signs or symptoms of the condition existed at any time in the 6 months prior to joining a health fund, or upgrading a policy, then it may still be classified as pre-existing.


I think I have a pre-existing condition, what does this mean?

If you have a pre-existing condition, health insurance funds typically impose a 12-month waiting period before you can claim benefits, except for psychiatric, rehabilitative or palliative care, which typically only require a 2-month wait.

If you have already served all waiting periods for the pre-existing condition, you can switch to an equivalent or lower level of cover with another health fund and you won’t have to re-serve the pre-existing waiting period.

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Why is there a waiting period?

Pre-existing conditions can often be expensive to treat. Because of this, the waiting period exists so that members of a health fund cannot claim an expensive procedure immediately upon joining, then terminate their membership with minimal financial contribution.

This protects long term members from higher premiums.

Is health insurance more expensive if I have a pre-existing condition?

Health insurance costs the same for all members; there is no increased charge for members with pre-existing conditions.

Waiting periods are designed to ensure that health cover remains affordable and fair for all members and that those with pre-existing conditions can still take out affordable cover.

Choosewell can help you understand how private health insurance, pre-existing conditions and waiting periods are defined and help ensure you get the cover you need at a suitable price. If you have any questions about pre-existing conditions, call us on 1300 421 154 and ask if we can help reduce your waiting periods or premiums.

Learn more about pre-existing medical conditions health insurance from the Private Health Insurance Ombudsman.

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