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.

There are thousands of conditions that can be assessed and found to be pre-existing so it is not practical to post a full list here.

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. 

The medical practitioner will take into account any information relating to your ailment, illness or condition. The information will usually come from the medical practitioner who treated you. The condition may have been given a diagnosis, but if the symptoms or signs were there, then it can be considered a pre-existing condition.

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. 

Some insurers impose certain waiting periods on their policies, during which time, claims cannot be made for expenses that occur in relation to pre-existing conditions. Some policies permanently exclude pre-existing conditions, meaning they can never be covered at all (i.e. there may not be a waiting period).

If you purchase an OSHC or OVHC policy from us and don’t declare a pre-existing condition, your policy may be void if you make a claim for a pre-existing condition and its pre-existence is discovered. Alternatively, you might receive only partial payment for the claim. Furthermore, your claim, if investigated later.

Part of your agreement in accepting the terms and conditions is that you consent for your information to be obtained from medical practitioners you have seen for the particular ailment.

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