HCi Factsheet

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What is a pre-existing condition?

July 2024

A pre-existing condition is any illness, injury or ailment that you (or a person covered on your policy) had signs or symptoms of, during the six (6) months before taking out private health insurance with HCi.  Pre-existing condition rules also apply when adding a dependant to your policy, or when upgrading your HCi cover.

This includes both diagnosed and undiagnosed conditions, as well as chronic conditions that may have existed for a long time, whether or not you were aware of these.

However, risk factors (such as family history) are not counted as part of a pre-existing condition.

Like most private health insurers, HCi has a waiting period of twelve (12) months for pre-existing conditions. This means that you generally won’t be able to claim for treatment related to a pre-existing illness or condition for 12 months after joining HCi or upgrading your cover.

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Who determines if I have a pre-existing condition?

If you (or a person covered by your policy) require hospital treatment within the 12 month waiting period, we’re required to assess the existence of a pre-existing condition. This assessment will determine whether or not the treatment is covered by your policy at that time.

You can provide information to clarify if somebody covered by your HCi policy has a pre-existing condition or illness via our Pre-existing certificate form. Note that you will need to return two versions to us – one from your GP and one from your specialist or surgeon.

HCi uses an independent medical practitioner (not your doctor) to assess whether any signs or symptoms existed during the six months prior to taking out or upgrading your cover.  This evaluation usually takes up to ten (10) business days and we will advise you of the outcome once the determination is made.

You can also find out more about pre-existing conditions and the application of waiting periods on the Commonwealth Ombudsman’s website.

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If you have less than 12 months of HCi cover, please contact us before you plan a hospital visit so we can determine if a pre-existing condition waiting period applies.

HCi used its best endeavours to ensure this information was accurate at the time of publication. From time to time, circumstances relating to the subject matter may change which may impact the accuracy of the information. This information is also general in nature and does not take into account any specific health or financial situation. Before making any decisions in relation to this information, you should consider your own financial and health situation and seek professional advice. Health Care Insurance Ltd ABN 43 009 579 088. A Registered Private Health Insurer.

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