Private Health Insurance and Pre-Existing Conditions

Understanding Private Health Insurance and Pre-Existing Conditions

People with a pre-existing medical condition are often interested in Private Health Insurance. Private health insurance providers cater to anyone applying for cover with a pre-existing medical condition & whether this may affect the general terms.
Pre Existing Health Conditions That are of a Concern

Will a Private Health Insurance Policy Cover Any Pre-Existing Conditions?

Private health insurance providers will usually cover any pre-existing medical conditions, usually stated in terms of your policy.

However, it may affect how much you are charged for premiums every month.

If you have more than one type of pre-existing condition, then this might impact your ability to get private health insurance coverage at all! This means that if someone has been diagnosed with cancer or HIV, they may not purchase Private Health Insurance at all like these types of illnesses are considered ‘high risk.’

No wonder,

This can lead people who would otherwise qualify for Private Health Insurance to go without because their only option becomes state hospital care which does not provide specialist treatment.

Now is a good time for people who have an existing pre-existing condition, or those at risk of developing one currently, to consider taking Private Health Insurance.

What Is Classed as a Pre-existing Condition?

Some many diseases and disorders can lead to a person being considered as having a pre-existing condition1. Pre-existing conditions also include diabetes,

  • Heart disease,
  • Cancer (if not fully cured),
  • Blood pressure problems
  • Asthma

Private Healthcare Australia will consider any of these medical issues when looking at your application for cover. Still, there is no guarantee you would be accepted based on them alone.

When you apply for coverage, your private health insurance provider will consider the type of pre-existing condition and whether or not private treatment was received in the past year.

Are Pre-existing Chronic Conditions Covered?

A chronic condition is described as an illness, disease, or injury that lasts for more than a few weeks with no definite endpoint.

And the good news?

Chronic conditions, such as diabetes and heart disease are covered if they are stable. However, you will have to provide your insurer with a letter from the doctor who treated you, declaring that it was under control for 12 months before applying for cover.

Chronic diseases include:

  • Asthma
  • Diabetes
  • Multiple sclerosis2
  • Heart disease


If you are treated for a chronic condition, your private health insurer will not refuse cover. They should be more inclined to offer coverage as this indicates that you need ongoing medical treatment. The terms of the policy may vary depending on what type of coverage you apply for – so make sure to do your research first before signing any agreements!

What about Pre-existing Mental Conditions?

Private health insurance providers recognize these too; in some cases, they may offer waivers or exceptions from specific clauses accompanying policies such as exclusions for suicide attempts, self-injury, or substance abuse treatments/conditions (unless any other provisions do not allow this waiver).

If you have a pre-existing condition, there is no need to worry. Private health insurance companies recognize the risk of these conditions and cater to them as best they can – so be sure to compare different providers to find one that suits your needs most accurately!

Is Private Health Insurance That Covers Pre-Existing Conditions of My Treatment No Longer Required?

The types of private health insurance which cover pre-existing conditions will typically do so for some time after the original condition has been cured. This is because it could be possible that the ailment or complaint may reoccur in a different form, and these companies understand this risk.

Full medical underwriting involves the completion of a questionnaire by the applicant to assess their current and previous state of health, as well as any medical conditions that may be considered to have been cured. For example, if you are applying for Private Health Insurance with a pre-existing condition, your ailment has been fixed. This is because it could be possible that the disease or complaint may reoccur in a different form, and these companies understand this risk.

Best of all,

With moratorium underwriting, a person may apply for medical insurance without completing a complete medical declaration. This can be a challenging decision for anyone with a pre-existing condition.

The right thing you do is have an honest conversation with your insurance provider about the risks and whether or not they are willing to offer any waivers or exceptions. This will help keep things simple when it comes to going through the application process.

Common Questions

Will a Private Health Insurance Policy Cover Any Pre-existing Conditions?

Where Can I Find Policies for People with Pre-existing Health Conditions?

Which Health Insurance Provider Is Best for Pre-existing Conditions?

What Pre-existing Conditions Are Not Covered?

In conclusion

By now you should know that,

There are many ways that private health insurance providers cater to anyone who is applying for coverage with a pre-existing medical condition. Mind that the terms of your policy may be affected by this and will depend on your individual needs.

Regardless of your health condition, when applying for Private Health Insurance coverage, there are options available; so, make sure you think thoroughly before committing yourself to one company exclusively. This way, if a particular policy has clauses that exclude certain treatment areas, then you can find another company that might suit you better in fairness terms and price wise.


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