What is the best health fund for pre-existing conditions?

What Is The Best Health Fund For Pre-Existing Conditions?

A pre-existing condition is an ailment, illness or condition where, in the opinion of a medical practitioner appointed by your health care provider, the signs or symptoms of a condition existed during the six months before you first joined hospital cover or upgraded to a higher level of hospital cover.

Your health insurance company will assess whether in the six months prior to joining or upgrading your current level of hospital cover, the signs or symptoms of the condition were evident to you or would have been evident to a reasonable general practitioner.

Bronze Hospital & Bronze Extras Set Benefits

Entry level hospital cover. Includes preventative dental and optical.
$ 20.35*
per week
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Bronze Hospital & Silver Extras Set Benefits

Entry level cover. Cover for a range of popular services that suit your lifestyle.
$ 24.35*
per week
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Silver Hospital Plus & Bronze Extras Set Benefits

Moderate cover. Includes private hospital with some exclusions. Includes cover for preventative dental.
$ 29.90*
per week
Select

Bronze Hospital & Bronze Extras Set Benefits

Entry level hospital cover. Includes preventative dental and optical.
$ 20.35*
per week
Select

Bronze Hospital & Silver Extras Set Benefits

Entry level cover. Cover for a range of popular services that suit your lifestyle.
$ 24.35*
per week
Select

Silver Hospital Plus & Bronze Extras Set Benefits

Moderate cover. Includes private hospital with some exclusions. Includes cover for preventative dental.
$ 29.90*
per week
Select

* The price shown is per week and applies to a Single living in VIC with a $500 excess. It excludes LHC loading and includes a Base Tier Government Rebate.

Choose your own extras provider.*

*With GMHBA, you have the choice to use any extras provider with professional qualifications recognised by GMHBA.

If your condition or illness is determined to have met the pre-existing condition definition, a 12 month waiting period applies from the date of joining or upgrading your level of hospital cover. Your health insurance company will not pay hospital benefits for treatment for the condition during this waiting period. It is therefore very important to find the best health fund policy if you have a pre-existing condition.

Pre-Existing Condition Rule

The pre-existing condition rule applies the same way across all health funds. Similar to waiting periods, the pre-existing condition rule exists to keep health cover fair. Otherwise it could be possible for people who are knowingly unwell to join a health fund and claim for a planned procedure and leave. It is this type of claiming behaviour that makes health insurance more expensive for everyone.

Your treating doctor and specialist will be asked to complete a form which will provide information about your signs and symptoms. This information will be used by your health insurance company’s appointed medical practitioner to decide if your ailment, illness or condition is a pre-existing condition.

Waiting Periods for Pre-Existing Conditions

Once a member has been on their hospital policy for a continuous period of 12 months, the pre-existing condition waiting period no longer applies and the member is entitled to the full benefits under their policy.

If you're going to hospital and have less than 12 months membership on your current level of hospital cover, or if you have recently resumed your cover after a period of suspension, the pre-existing condition waiting period will apply to you. It may also apply if you have decreased your level of hospital excess in the last 12 months.

You must wait 12 months from the date of joining your health insurance company for benefits to be paid for treatment for that condition. Benefits will not be payable on procedures undertaken before 12 months of active membership.

If you are an existing customer who has upgraded hospital cover

You must wait 12 months from the effective date of your policy change or upgrade for the higher benefits to be paid for that condition. If you have at least 12 months membership in total across both your old and new hospital cover, you are entitled to the benefits that are payable on your previous hospital cover. If your previous hospital cover excludes benefits for that condition, you must wait 12 months from the date of change or upgrade for benefits to be paid for that condition.

How will it affect my health insurance policy?

If your condition is considered to be pre-existing, your health fund will impose a 12 month waiting period before you can claim for benefits relating to that condition. If you need to be admitted to hospital for a condition that you think may be pre-existing, check with your health fund in advance to ensure you’ll be covered for your medical treatment.

Will I pay more for my health insurance if I have a pre-existing condition?

No, you won’t. Even if you have a pre-existing condition, you can purchase any health insurance policy at the same price as anyone else, and you can claim as soon as your waiting periods have been completed.

GMHBA offers the some of the best health funds that include both hospital and extras. If you require further information on any of your medical conditions you can contact us and speak to one of our experienced staff.