Pre-existing conditions
(only applies to hospital cover)
A pre-existing condition is any ailment, illness or condition that you had signs or symptoms of (in the opinion of a medical practitioner appointed by the health insurer) that existed at any time during the 6 months before you joined a hospital cover or upgraded to a higher hospital cover. It's not necessary that you or your doctor knew what your condition was or that the condition had been diagnosed. A condition can still be classed as pre-existing even if you hadn't seen your doctor about it before joining hospital cover or upgrading to a higher hospital cover.
If you’re new to health insurance and have a pre-existing condition, you’ll need to serve a 12-month waiting period (under Hospital cover, not Extras) before we’re able to cover the condition. If you’ve got health insurance with another fund and have served all of your waiting periods with them, you’ll be covered straight away and won’t have to re-serve your waits if you move to a similar or lower level of cover with Peoplecare.
Waiting periods
All health funds have waiting periods. In short, a waiting period is how long you need to wait after taking out your cover before you can receive benefits for services or items covered. You aren’t able to claim on treatments you receive during this waiting period. Your cover description has a full list of all the waiting periods.
If you’ve switched to us within 30 days of leaving another fund, we’ll recognise any waiting periods you served with them once we’ve got your transfer certificate (as long as you were on a similar or higher level of cover). Call us on 1800 808 690 (Peoplecare members) or 1800 808 700 (non-members) for details.
Following is an outline of our waiting periods.
| Waiting period | Hospital cover |
|---|---|
| No waiting period | Hospitalisation related to an accident |
| No waiting period | Services covered by your old fund (if you transfer straight to a similar level of cover with us and have already served your waiting periods) |
| 1 day | Ambulance |
| 2 months | Health programs |
| 2 months | Hospital substitution programs |
| 2 months | Rehabilitation, psychiatric services and palliative care (even for pre-existing conditions) |
| 2 months | All other services, except for those listed below |
| 12 months | Pregnancy and birth |
| 12 months | Assisted reproductive services |
| 12 months | Pre-existing conditions (except rehab, psych and palliative) |
Please note that not all items are listed and other waiting periods may apply. Please contact the fund for more information.
| Waiting period | Extras cover |
|---|---|
| No waiting period | Services covered by your old fund (if you transfer within 30 days to a similar level of cover with us) |
| 1 day | Ambulance |
| 2 months | General dental, pharmacy, physiotherapy, chiropractic, podiatry & complementary therapies |
| 2 months | Pre/post-natal services (including midwifery) |
| 2 months | All other services, except for those listed below |
| 6 months | Optical |
| 6 months | Health management programs |
| 12 months | Major dental |
| 24 months | Laser eye surgery & hearing aids |
If you're upgrading your extras cover, waiting periods still apply for the services that you weren't previously covered for.
Transferring from another health fund
If you transfer to us from another fund where you had similar or higher cover and you’ve finished your waiting periods, you won’t have those waiting periods again. This means you can claim straight away for the things you were already covered for.
On the other hand, if your old cover had lower limits or benefits than your new one, you’ll have waiting periods before you can claim more than you were covered for before.
For more information on waiting periods and pre-existing conditions, visit privatehealth.gov.au