APPLYING FOR PRIVATE HEALTH INSURANCE WITH A PRE-EXISTING CONDITION? HERE’S HOW YOUR CONDITION WILL AFFECT YOUR COVER AND WAITING PERIOD.
If you’re looking to join a health fund or upgrade your policy and have an existing medical condition, you may have to endure a waiting period. But what really counts as a pre-existing health condition? Eczema? A food allergy? Diabetes? High Blood Pressure?
This guide will explore what pre-existing conditions are and the waiting periods you may have to serve before you can take advantage of your health cover.
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What are the most common pre-existing conditions?Some of the most common pre-existing conditions that people applying for or upgrading their health insurance may encounter are:
It’s important to note this list is just some of the pre-existing conditions and while your condition may not be one of the common illnesses, it may still be deemed pre-existing in the world of health insurance cover.
Key points to consider with waiting periods and pre-existing conditionsIf you have a pre-existing condition and are looking for adequate health insurance that meets your needs, it’s important to consider the following:
- The pre-existing condition definition only applies to hospital cover, however some funds stipulate these rules under their extras cover.
- It is the fund’s GP / medical examiner, not your own, that decides whether or not you have a pre-existing condition.
- A pre-existing condition is determined based on your individual circumstances.
- The condition must have existed in the 6 months prior to joining or upgrading your hospital cover to be deemed pre-existing.
- A diagnosis is not required. Signs and symptoms may be enough to decide you have a pre-existing condition.
- Risk factors such as genetics and family history are not considered signs and symptoms.
- The pre-existing waiting period cannot exceed 12 months.
HOW DO PRE-EXISTING MEDICAL CONDITIONS AFFECT YOUR COVER?
If your symptoms, illness, or ailment is determined to have met the definition of a pre-existing condition, a 12-month waiting period is applied to your new policy/hospital cover . This period begins from the date you joined the fund or upgraded your level of cover and applies to all health insurers.
If you have resumed your hospital cover after suspending it for a period of time, the pre-existing waiting period applies. You’ll also have to wait 12 months if you have decreased your level of hospital cover hospital cover in the last year.
This means your insurer may not pay any hospital benefits for the treatment of the identified condition during the 12-month waiting period. If you have upgraded your cover, your chosen fund may pay benefits that are in line with the level of your previous policy.
While pre-existing conditions affect your ability to access benefits and treatments through the private system, it’s important to keep in mind you can still seek treatment using Medicare healthcare during this waiting period.