Help Centre

Pre-existing conditions explained

A pre-existing condition is a medical condition (e.g. ailment, illness or condition) that you had signs or symptoms of during the six months before you arrived in Australia or your visa was granted, whichever is later.

Most health funds apply waiting periods to pre-existing conditions to prevent people who are knowingly unwell from signing up for health insurance, claiming for a planned procedure, then leaving once they’ve received their benefits after minimal premium payments.

What’s a waiting period?

A waiting period is the amount of time you need to wait before you can make a claim through your OSHC or OVHC policy. A waiting period is calculated from either the date you arrived in Australia or the date your visa was granted.   The waiting period will start from whichever of those dates is the most recent.

Who decides if your condition is pre-existing?

We will appoint or approve a medical practitioner to assess whether there were signs or symptoms of the condition prior to purchasing your cover. 

A health condition can still be considered pre-existing even if an illness had not been diagnosed prior to when you first got health cover from us.

A pre-existing condition includes a secondary related condition or disability directly arising from a pre-existing condition.

When can you claim for a pre-existing condition?

When you can claim for a pre-existing condition will depend on the type of cover you have.

How can we help you?

Still need help? Our team is here to help