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• What is a pre-existing medical condition?
• Do health insurance policies cover pre-existing conditions?
• What types of illnesses are considered pre-existing conditions?
• What are the most common types of chronic conditions?
• Does a pre-existing condition mean I’ll pay more for health insurance?
• Can a health insurer refuse to provide cover if I have a pre-existing condition?
• Are there any exemptions from the waiting period for pre-existing conditions?
• Do the waiting periods start again if I switch policies?
• Frequently asked questions
• Looking for health insurance with a pre-existing condition?

Long story short

Pre-existing conditions affect hospital waiting periods

You’ll have a maximum 12-month waiting period before you can claim for pre-existing conditions on hospital cover.

You don’t need a diagnosis for a condition to be pre-existing

Signs or symptoms of a condition in the 6 months before joining a health policy can be enough for it to be seen as pre-existing.

Pre-existing conditions don’t exclude you from cover

All health funds must cover pre-existing conditions. Your health history won’t impact your policy premium, either.

What is a pre-existing medical condition?

A pre-existing medical condition is an illness, ailment or condition you showed signs or symptoms of in the 6 months before you joined or upgraded your health insurance. You don’t need to have known you had the condition beforehand – signs and symptoms are enough without a diagnosis. If need be, it comes down to the opinion of a medical practitioner chosen by your insurer.

Do health insurance policies cover pre-existing conditions?

All health funds must cover pre-existing conditions under Australian law to provide fair health coverage to everyone (this is known as the ‘pre-existing condition rule’). A health fund can’t deny you cover because of a pre-existing condition (or make you pay more for a policy because of it). However, you’ll likely have a waiting period capped at 12 months for claiming related treatments on your hospital cover. Once you’ve covered this waiting period, you’ll be able to claim treatments to help manage and ease your condition.

Roughly one in 2 Australians have a chronic health condition, while 8 in 10 have a long-term health condition, according to the Australian Bureau of Statistics. If you fall into either of these camps, you can still get health insurance.

What types of illnesses are considered pre-existing conditions?

Pre-existing conditions aren’t decided by the type of illness you have, just by whether you had it or signs of it before you took out your cover. So, if you had symptoms of them, both everyday manageable conditions, like asthma, diabetes or arthritis, and conditions requiring more intensive treatment and intervention, like osteoporosis, vascular disease and cancer, can be pre-existing conditions for you.

Is pregnancy treated as a pre-existing condition?

While pregnancy obviously isn’t a pre-existing condition in the same way asthma or heart disease is, it’s treated similarly, with insurers able to apply a 12-month waiting period for pregnancy, obstetrics and birth-related claims.

So, if you’re planning to grow your family and want to give birth privately, it’s a good idea to take out or upgrade to pregnancy cover before you start trying. With pregnancy and birth-related services covered, you can choose your own obstetrician so you have the same doctor by your side on this exciting journey.

Is mental illness treated as a pre-existing condition?

Mental health conditions like bipolar affective disorder, eating disorders, obsessive-compulsive disorder and post-traumatic stress disorder are treated as pre-existing conditions, but with a shorter maximum hospital cover waiting period of only 2 months. There’s a one-off exemption to this waiting period if you want to upgrade for fewer restrictions on psychiatric treatments, but you need to have already completed an initial 2-month membership on any hospital policy.

Mental health cover, which could reimburse some costs of mental health treatment and support, is available on some extras policies. Typically, out-of-hospital mental health services are covered under psychology extras, while in-hospital psychiatric treatment is found on hospital cover. Keep in mind that waiting periods for extras cover apply regardless of whether your mental illness is pre-existing or not.

Is my family history treated as a pre-existing condition?

No, your family’s medical history doesn’t count as a pre-existing condition. Assessments are based on your personal medical history, including recent hospital treatments and doctor’s notes about specific symptoms.

Your treating doctors, however, might ask about your family’s medical history to help speed up finding a diagnosis. Knowing your family’s medical history can also help you be more proactive in your own health decisions, like altering your diet if your family has a history of heart disease to minimise your chance of developing problems.

What are the most common types of chronic conditions?

The 3 most common chronic conditions in Australia are mental and behavioural conditions, back problems, and arthritis, according to the Australian Bureau of Statistics. In 2022, at least 14% of the population had one of these conditions. Other common chronic conditions were less common, affecting only 1% to 5% of the population.

Understandably, people aged 85 or over were more likely to have at least one of these conditions, but 28% of people aged 0–14 years had at least one of these conditions, too, according to the Australian Institute of Health and Welfare.

Health insurance could help treat and manage many of these conditions. For example, extras cover could help pay for psychologist sessions, physiotherapy appointments or medications not covered by the Pharmaceutical Benefits Scheme. Similarly, hospital cover could help cover diabetes pumps, joint replacements, heart surgery and cancer treatment. What health insurance can help with, of course, depends on a person’s policy.

Note: These figures reflect indicative chronic condition prevalence in Australia in 2022, based on data from the Australian Bureau of Statistics and rounded where appropriate. Data retrieved August 2026, based on data from 2022.

Does a pre-existing condition mean I’ll pay more for health insurance?

No, Australia’s community-rated private health system means that your premiums aren’t influenced by your health history or pre-existing conditions. This means that health funds can’t charge you more based on your health status or claims history. So, if you have a pre-existing condition, you’ll pay the same as anyone else for the same cover, although those pesky waiting periods will still apply.

Can a health insurer refuse to provide cover if I have a pre-existing condition?

No, Australian law makes sure that health funds can’t refuse you hospital cover, even if you have a pre-existing condition. Once you’ve served all your required waiting periods, you can claim for treatments under your policy.

But telling your insurer about a pre-existing condition doesn’t mean your policy will cover treatment for it. For example, you might have basic hospital cover, which doesn’t include treatment for the heart or vascular system. If you claim for a pre-existing heart condition or one that develops later, you won’t be covered unless you upgrade your policy to a higher level of cover (and satisfy those waiting periods on your upgraded cover, too).

So, it’s always a good idea to read your policy brochure to see what kind of conditions and clinical treatments are included in your coverage. If you’re concerned you might need treatment for something outside your cover, comparing options and upgrading your cover sooner rather than later could be a smart move.

Helpful tip

Researching your insurer’s network of preferred providers can help you find specialists who are experts in treating your condition. Some health fund networks include medical specialists with extensive experience in specific areas. Choosing these specialists can offer tailored care that better suits your needs while potentially lowering out-of-pocket costs, especially if they have ‘no-gap’ agreements with your insurer.

Dr. Jill Gamberg

GP, Coach and Lifestyle Medicine Physician

Are there any exemptions from the waiting period for pre-existing conditions?

While a maximum 12-month waiting period for pre-existing conditions is standard on hospital cover, psychiatric care, rehabilitation and palliative care only have a 2-month maximum waiting period, even with a pre-existing condition.

For psychiatric care, you can upgrade your cover from restricted benefits and avoid the usual 2-month waiting period if you apply for an exemption. You can only get this exemption once in your life and you’ll need to have held a lower form hospital cover for 2 months). There isn’t a similar exemption for rehabilitation or palliative care, though.

Do the waiting periods start again if I switch policies?

By law, you won’t have to re-serve hospital waiting periods you’ve already served when you switch insurers or choose a new policy.

But there are still some rules that you’ll need to follow to skip the waiting periods. You’ll need to make sure that your old policy is paid up to the date you switch. You also need to find out whether your new insurer allows short breaks in between coverage changes or insists on a seamless transition from old to new. If there’s a gap, you might need to re-serve some of those waiting periods, so it’s important to check this beforehand.

Keep in mind that the rules can also be a little different if you’re switching to a policy with extra benefits that weren’t included under your previous policy. In these cases, the insurer might get you to serve an additional waiting period before the extra benefits take effect.

Frequently asked questions

Looking for health insurance with a pre-existing condition?

Having a pre-existing condition doesn’t mean you’re left out in the cold when it comes to health insurance. A pre-existing condition also doesn’t exclude you from using iSelect’s services. We make it easy to compare a range of health insurance policies and providers to find cover that works for you, no matter your health history. Speak with one of our health insurance comparison experts on 1800 784 772 or use our online comparison tool today.