Private Medical Insurance is designed to cover new eligible medical conditions that may arise after the start date of a policy. It is usually not possible to cover a pre-existing medical condition from the last five years prior to the start date of your health insurance policy. However, some insurance providers may be able to cover a pre-existing condition after a policy has been in place for two years, even if in that 2 year period there has been treatment, symptoms, medication or advice given.
John had knee ligament damage 18 months before he signed up for private medical insurance policy and his knee was still sore when his policy incepted. The health insurance policy has not covered John for anything related to his knee condition in the first two years. After the second anniversary of the policy, if John’s knee is still causing him problems, he could, upon a GP referral, be able to see a specialist and obtain private treatment for the condition*.
Sandra had fibromyalgia when she signed up for a private medical insurance policy. If she has any medical issues related to this condition in the first two years, these would not be covered. After two years, if she has any acute flare-ups related to this condition, the insurance provider could cover the costs of obtaining treatment privately*.
*subject to the terms & conditions of the policy
There are some ongoing conditions that will usually never be covered, such as diabetes, heart conditions, cancer and mental illness.
If you have an existing private medical insurance policy in place, it may be possible to switch providers and get a new cover under similar conditions as the old one, without any new medical exclusions.
As each pre-existing condition is dealt with on a case by case basis and is dependent on your medical history and your particular situation, we recommend talking to one of our health insurance advisers to find out what options are available.