Am I covered if I have a pre-existing medical condition?

Got a pre-existing medical condition and wondering if it can be covered? Read on for the answers...

What’s covered

If you have a pre-existing medical condition, it will be automatically covered if you can meet the following requirements:

  • it’s one of the 23 listed automatically covered conditions; and
  • the specific requirements noted for that condition are met;and
  • you haven’t been hospitalised for any condition (and this includes day surgery or a visit to an Emergency Department) within the last 2 years.

See section ‘Health conditions and your policy’ in the policy wording for the list of these covered pre-existing medical conditions and specified requirements for each.

What is a pre-existing medical condition?

  • any chronic or ongoing medical or dental condition of which you are aware or any complication related to any such chronic or current condition;
  • any medical or dental condition, or related complication, the symptoms of which you are currently aware;
  • a medical or dental condition that is currently being investigated or treated, or has been investigated or treated in the 90 days prior to the issue date of your policy, by a health professional (including chiropractor, physiotherapist or dentist);
  • any medical condition, currently on-going or experienced at any time in the past, involving your back, neck, brain, heart, circulatory or respiratory system, or cancer;
  • any condition for which you take prescribed medicine;
  • any condition for which you see a medical specialist;
  • pregnancy (see article 'Am I covered if I'm pregnant'?); or
  • any condition for which you’ve had surgery, or any complication arising from any surgery you’ve had, at any time, for any reason.

Woah! Any surgery, any time for any reason? Yes, afraid so. Had a knee reconstruction 5 years ago? Sure you feel fine, but if it starts playing up while you’re away it’s probably not going to be covered.

Good and bad news

The good news:
There are those 23 pre-existing medical conditions such as coeliac disease, hypothyroidism and gastric reflux which are automatically covered by your policy.Not only are you covered in some circumstances if you have pre-existing conditions, but you’re also covered in relation to pre-existing conditions of people you’re travelling with and your close relatives who are not listed on your policy. For example, you’ve got a big trip booked and are covered by travel insurance, but before you leave your father has a sudden heart scare that puts him into hospital. Obviously your trip’s off, but you could make a claim for cancellation costs with us. Another example: you’re travelling with your best buddy, and his knee gives up and he has to return home. We understand that you need to cancel your trip, too, and we offer cover.

The bad news:
the terms and conditions about pre-existing medical conditions apply to them, too. If before you bought your policy your father had a heart condition, or your buddy had a knee reconstruction, those are pre-existing medical conditions and your cover is limited to $2,000. For claims involving someone who is not a close relative or a travelling companion, there is no cover

What’s not covered

Be sure to read the terms, conditions, limits and exclusions of the policy wording for what's covered and what’s not and as already mentioned, section ‘Health conditions and your policy’ for the detailed information on pre-existing medical conditions coverage. If you are unsure of cover, please contact us for help.

If your pre-existing medical condition is not on the list, sorry, but we can’t cover any expenses arising from, affected by or exacerbated by that excluded pre-existing condition.

But this doesn’t mean you can’t buy a policy with us! We’ll still cover you for any sudden illness or serious injury that is completely unrelated to an excluded condition.

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