What is classified as a pre-existing condition?

Pre-existing conditions are classed as any ailment, illness or condition with any signs or symptoms in the 6 months before signing up for hospital cover or upgrading existing cover.

If you need to go into hospital in the first 12 months of taking out or upgrading hospital cover, then your health fund needs to check whether you’re being treated for something that was evident before you joined.

How are pre-existing conditions assessed?

Pre-existing conditions are determined on the basis of symptoms, not necessarily diagnoses. We’ll send some paperwork for both your doctor and treating specialist to complete. The paperwork tells us about the condition being treated and when the symptoms first became obvious. If they started before you signed up with us it means your condition will be called ‘pre-existing’ even if you hadn’t been diagnosed yet.

Will my pre-existing condition change my waiting periods?

Yes. For services that relate to your condition, the waiting periods will be extended, generally to 12 months. This applies to both new members and members upgrading their cover.

These extended waiting periods are set by the government, so we can’t waive or shorten them.

How do pre-existing rules apply to dental?

Great question. The answer is only moderately complicated.

Any dental work you have done will be covered by your extras. Any other costs associated with being in hospital are covered by your hospital cover.

If you’re admitted to hospital for dental work (e.g. wisdom teeth removal), your extras cover may pay the dentist if you have served your waiting period, but stuff like hospital accommodation, theatre fees, anaesthetist and other costs fall within your hospital cover and are subject to the pre-existing condition rule.