What is a pre-existing condition?

A pre-existing condition is any illness, ailment or condition where, in the opinion of a medical advisor appointed by Australian Unity, the signs or symptoms have existed at any time during the six months up to and including the day on which you became insured under the policy—regardless of whether you were aware of it.

Depending on your level of Overseas Visitors Cover, you may still be able to claim on pre-existing conditions after having served a waiting period.

If you have Private Health Insurance (for Australian citizens and permanent residents), you can find out about pre-existing conditions here.

Working visa covers

Level of Cover Pre-existing condition waiting period
Budget Workers Cover 2 months for psychiatric, rehabilitation and palliative care; 12 months for all other pre-existing conditions
Mid Workers Cover
Workers Cover Plus

Non-working and working holiday visas

Level of Cover Pre-existing condition waiting period
Basic Visitors Cover No cover for pre-existing conditions
Mid Visitors Cover 24 months for all pre-existing conditions
Top Visitors Cover 12 months for all pre-existing conditions

Check your product fact sheet for full details about your selected cover.

Where applicable, the pre-existing condition waiting period applies to new members and to members upgrading their existing policy to a higher level (for example, to increase your level of hospital benefits). If you are upgrading your cover, you will still be entitled to the benefits payable under your previous level of cover while you are serving the waiting period for the higher benefits.

After you have held continuous hospital cover for the required waiting period, the pre-existing condition waiting period no longer applies and you are entitled to the full benefits under the policy.

Why is there a waiting period for pre-existing conditions?

If this waiting period didn’t exist, people could take out hospital cover or upgrade to comprehensive cover only when they knew or suspected that they might need hospital treatment and immediately make a hospital claim. If these new members then cancelled (or downgraded) their membership, their hospital costs would have to be paid for by the fund’s long-term members. Not only is this unfair to existing members, it could also lead a fund having to increase premiums.

Going to hospital during the waiting period?

For any hospital claim that might be related to a pre-existing condition, we may ask you to have a medical report completed by the first doctor you saw about the condition, such as your GP or specialist. We will then review the information and assess whether the treatment relates to a pre-existing condition.

To ensure you are not faced with any unexpected costs, you should always check that you will be covered before seeking hospital treatment. We recommend you download the Medical Report Form as soon as you know you need hospital treatment, and ask your doctor to complete it and return it to us as soon as possible. We need up to five working days to carry out the initial pre-existing condition assessment after receiving the report form.

To find out more about the pre-existing condition waiting period, call us on 13 29 39 or visit the Commonwealth Ombudsman website.