|
|
|
|
||
Insure? Not Sure? |
|
Topics in this Section |
About Private Health InsurancePage | 1 | 2 | 3 | 4 | 5 | 6 | 7 | Standard waiting periods for pre-existing ailment/s or illnessWhen you decide to take out or upgrade private health insurance, you may already be unwell. You may have what is referred to as a pre-existing condition or illness. Under the Private Health Insurance Act, a health insurer may impose a 12-month waiting period on benefits for hospital treatment where it should have been reasonably apparent to either the contributor or a medical practitioner who conducts an examination, that there was a pre-existing condition in the six months prior to joining a hospital table or upgrading to a higher level of cover. For psychiatric, rehabilitation and palliative care, the waiting period is 2 months. It is important to check this with your health insurer prior to your admission to hospital. Remember, your health insurer will need at least a week or so to advise you about whether the pre-existing condition 12-month waiting period applies. Even if you are already ill, health insurers must allow you to purchase any type of cover. If an insurer refuses you membership, this may be an offence under the Private Health Insurance Act 2007.
What is the exact definition of a pre-existing condition?A pre-existing condition is a condition, illness or ailment, the signs or symptoms of which, in the opinion of a medical practitioner appointed by the health insurer, existed at any time during the 6 months prior to the member becoming insured under the policy. In forming an opinion about whether or not an illness was pre-existing, the health insurer appointed medical practitioner who makes the decision, must take into account information provided by your own doctor. If you require hospital treatment, but you have less than 12 months membership on your current hospital table, a 12-month waiting period could apply if your condition was determined to be pre-existing (for psychiatric, rehabilitation and palliative care, the waiting period is 2 months). Waiting periodsWhen you join a health insurer or increase your level of cover, you may have to wait some time before your insurance becomes effective. This protects you and others with your insurer, by ensuring no contributor makes a large claim shortly after joining an insurer, and then drops their membership. This ‘hit and run’ behaviour would result in increased premiums for everyone. You should note that for benefit limitation periods you can remove the benefit limitation period if you transfer to another policy without a benefit limitation. There is usually no waiting period if you need hospital or medical treatment because of an accident that happens after you join the insurer. The Government sets the maximum time that health insurers are able to make members wait until they can claim benefits for hospital treatment. These maximums are:
The Government does not regulate waiting periods for benefits payable under general treatment (previously known as ancillary or extras) cover. These waiting periods are set by individual health insurers and you should make sure you are aware of general treatment benefit waiting periods that apply to your insurer. |
|
| Home | About Us | Circulars | Contact Us | Gap Products | Health Funds | Industry Statistics | News & Updates | Publications | Standards & Legislation | Forms |
|
| Copyright
| Privacy Statement | Disclaimer
| |
Private Health Insurance Administration CouncilSuite 16, Level 1, 71 Leichhardt Street, KINGSTON ACT
2604 |
|
|
Last modified: 22 July, 2005 |
