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If you have a health condition and you’re worried it might disqualify you for health insurance, we have good news. In Australia, health insurers legally can’t deny you cover for a pre-existing condition nor for a family history of illness. But they can impose a waiting period, which means you won’t be able to claim right away. Here’s everything you need to know about private health insurance pre-existing conditions.
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What is a health insurance pre-existing condition?
According to the Commonwealth Ombudsman, a pre-existing condition for health insurance purposes is any ailment, illness or condition where there were signs or symptoms in the 6 months before the policy was taken out – even if you didn’t have a diagnosis. For example, if you had signs of cataracts, such as vision problems, in the 6 months before taking out or upgrading your health insurance policy, your insurer might consider it a pre-existing condition. That means you might not be able to claim for cataract removal surgery as a private patient.
Having high risk factors for a condition, such as a family history, isn’t considered a sign or symptom of a pre-existing condition.
Waiting periods on private health insurance with pre-existing conditions
A waiting period is how long you have to wait before you can claim for hospital services or health treatments, and it applies when you take out a new policy, upgrade to a higher level of cover or, in some cases, lower your excess. The waiting period for pre-existing conditions on Hospital Cover is up to 12 months. Waiting periods don’t usually apply for pre-existing conditions on Extras Cover, but you should check with your insurer to make sure.
The good news is that if you’re changing to a new Hospital Cover policy at the same level or tier as your existing cover, you won’t have to serve waiting periods again – even for pre-existing conditions.
Always check with your insurer about the waiting period on a policy before you buy. Occasionally health insurers do waive waiting periods to attract members, so it’s definitely worth asking.
What if my insurer says I have a pre-existing condition?
If you believe your condition is not pre-existing but your insurer says otherwise and imposes a waiting period that you think shouldn’t apply, you can complain to the Commonwealth Ombudsman.
How do I find the best private health insurance with pre-existing conditions?
Waiting periods for pre-existing conditions in Hospital Cover are set by law so they’re the same across every policy, while Extras Cover policies are determined by each insurer. To find the cheapest Hospital Cover policy that covers your health needs, or an Extras Cover policy with the best waiting period criteria, save both time and money by using the healthslips.com.au calculator. It provides unbiased comparisons across every policy in Australia, and you can tailor the results across different levels of cover, to see how much upgrading or downgrading will affect your price. The best part: you don’t have to enter your contact details to get your results.
healthslips.com.au does not provide general or personalised advice. Your particular circumstances are likely to impact the accuracy, completeness and relevance of the information or results. Take this into account before making a decision and talk to an expert for financial advice.
Trudie McConnochie
Writer and Researcher
Knowledge is power – that’s the guiding principle behind everything Trudie writes, and it’s a philosophy she brings to her work at healthslips.com.au. By breaking down complex information into easy-to-understand blogs and stories, she aims to empower Australians to make the best choices and an informed decision around private health insurance.
Trudie understands firsthand some of the complexity of private health insurance having moved to Australia from New Zealand and having to navigate a vastly different public healthcare system and health insurance structure.
Trudie holds a Bachelor of Communication Studies (journalism major) from the Auckland University of Technology.
