If you are already unwell before you join or upgrade a health insurance policy, this is referred to as a pre-existing condition. Health funds define this as a condition, illness or ailment that, in the opinion of a medical practitioner appointed by your health fund, existed anytime during the 6 months before you took out hospital cover or upgraded to a higher level of health cover. The signs or symptoms of a pre-existing condition should have been reasonably evident at any time within that period, whether or not they were diagnosed by a doctor.
If a pre-existing condition is determined to exist, you will generally need to wait 12 months before you can claim on health insurance benefits relating to that condition. This applies the first time you take out hospital cover, and then for upgraded benefits if and when you upgrade your health cover. The exception to this rule is if the pre-existing condition relates to psychiatric care, rehabilitation and palliative care, in which case the maximum waiting period is only two months.
If you need to be admitted to hospital for a condition that was potentially pre-existing, it is very important to check with your health fund before undergoing treatment, as they will need time to advise you about whether the waiting period will apply to your health cover.
Even if you have a pre-existing condition, you are able to purchase any type of health insurance policy at the same price as everyone else. As soon as you have served any waiting periods, you will be entitled to claim the benefits of the health insurance policy you have chosen.
