Pre-Existing Condition Health Insurance
Compare health insurance for pre-existing conditions in one place here with Savvy.
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Many Australians live with a variety of pre-existing health conditions. However, under Australia’s ‘community-rated’ health system, that doesn’t mean they can’t access affordable health insurance. You can compare health cover policies in one place right here through Savvy.
We provide a quick and simple health insurance comparison service to help you find the health coverage you need. Within minutes, you could be looking at a range of health insurance policy quotes, which you’re able to compare side-by-side to find one that fits your needs from a panel of trusted insurers. Start comparing free, no-obligation quotes here through Savvy today.
What is a pre-existing health condition when it comes to health insurance?
On paper, a pre-existing health condition is any ailment or complaint that you’ve experienced or had symptoms of in the six months prior to buying a health insurance policy (or upgrading an existing policy). However, it’s not quite as simple as that, because what if you haven’t experienced any symptoms and don’t know you have the condition? Can it still be called a pre-existing condition if you don’t know about it?
What’s the definition of ‘pre-existing’?
The definition of what is a pre-existing condition is an important one, as under the Private Health Insurance Act 2007, a health insurer can ask you to wait for 12 months before claiming for any pre-existing condition when you first buy a new hospital insurance policy. For this reason, knowing what is and isn’t classified as a pre-existing condition becomes very important. Examples of common pre-existing conditions include:
- Allergies
- Diabetes
- Glaucoma
- Hypertension
- Sleep apnoea
- Migraines
How will my health insurer know if I have a pre-existing health condition?
The decision about whether a condition is pre-existing or not lies with your health insurance provider. If necessary, they will appoint their own doctor to assess the situation and decide if your condition did exist prior to you signing up for your health policy. However, this doctor will have to consider information provided by your own healthcare providers before making a decision. For example, if you are found to have an advanced cancer tumour, a medical specialist may determine the condition existed for a long time before its discovery. However, if you had no symptoms and were not aware of the issue, it may not be regarded as a pre-existing condition by your health insurer.
Because the issue of pre-existing conditions can take time to resolve, it’s important to have your health insurance in place (if possible) at least a year before you need hospital treatment. Savvy can help you compare a range of free health insurance quotes so you can get your health insurance sorted out without further delay.
Can I still get health insurance if I have a pre-existing condition?
Yes – you can still get health insurance if you have a pre-existing condition and you won’t have to pay any more for your health cover than the next person. In fact, under Australia’s ‘community-rated’ health insurance system, health insurers are not permitted to refuse to cover anyone just because they have a known health condition. In the same way, health funds can’t discriminate against anyone on the grounds of their age, gender or disability. Pre-existing conditions only affect the waiting periods you may have to serve before you can make a claim on your health insurance policy.
What are the waiting periods for pre-existing conditions?
There are two different types of health insurance available in Australia: hospital cover and extras cover.
- Hospital cover – assists with the costs of medical treatment if you are admitted to hospital
- Extras cover – provides benefits for treatment received that are provided in a non-hospital setting but not covered by Medicare, such as dental and physio treatments
Waiting periods which may apply if you have a pre-existing health condition vary depending on whether you have a hospital or extras policy. The waiting periods are:
Hospital cover waiting periods
- 12 months for any pre-existing conditions
- 12 months for pregnancy and childbirth services (obstetrics)
- 2 months for psychiatric care, rehabilitation and palliative care (even for a pre-existing condition)
- 2 months for all other conditions
Extras cover – common waiting periods*
- 2 months for general dental and physiotherapy
- 6 months for optical items (such as glasses and contact lenses)
- 12 months for major dental procedures (which may include extractions, crowns and bridges)
- 1, 2 or 3 years for some high-cost procedures such as orthodontics (which may include braces, aligners and teeth straightening procedures), hearing aids
*Waiting periods for extras cover aren’t regulated in the same way as those for hospital cover, so they may vary between health insurance providers. In some cases, certain waiting periods can be waived at the discretion of the fund
The good news is that once you’ve served a waiting period for a particular category of treatment, you may not have to serve that waiting period again, even if you swap health funds. This only applies to a switch from one fund to another where you buy an equiivalent level of cover. If you upgrade to a higher level of cover, which offers cover for clinical categories that you weren’t previously insured for, you may have to serve out those additional waiting periods before you can claim.
How do I compare health cover policies for people with a pre-existing health condition?
The areas to compare between health funds vary depending on the type of insurance you’re looking at.
Comparing hospital cover policies
These are some areas to look at when comparing hospital cover policies:
- What cover do you need? Does the policy provide cover for treatment areas you know you’ll need, particularly if you have any pre-existing conditions?
- What tier of hospital cover can you afford? You can choose between basic, bronze, silver and gold tier policies. It’s also important to consider costs between different policies, such as comparing one bronze policy against another
- What are the excess payments on offer, and what could you afford if you do get admitted to hospital? Excess payments can range from zero to a maximum of $750 for singles and $1,500 for couples or families
- Are there any co-payments required for hospital admission? Co-payments can range from zero to $100 a day, often capped at between $500 and $700
Comparing extras policies
Look at the differences between health insurers in these areas when comparing extras policies:
- Are there any special offers available? Special offers for new customers can include a waiver on waiting periods, so you may be able to claim straight away even if you have a pre-existing condition
- Choose the level of extras cover that offers the benefits you need – though these levels aren’t as tightly regulated, you can generally choose between cheaper and more expensive policies, with the latter typically being the most comprehensive in terms of coverage
- What are the policy limits for different categories of treatment? For example, a cheaper policy may offer a benefit limit of $100 for optical, whereas a more expensive comprehensive policy could offer $350 for optical benefits
- Are there free benefits which you may find useful and can save you money, such as no-cost dental check-ups or the first physio or chiro appointment offered at no out-of-pocket cost?
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Frequently asked questions about health cover for those with pre-existing conditions
Helpful health insurance guides
Looking for health insurance to cover your condition or treatment?
Read one of our helpful guides on a range of different ailments and potential hospital or extras treatments to help you find out if they're covered.
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