OSHCstudents – You have pre-existing conditions and you may wonder if these are covered by your private health insurance or not. Let’s find out the cover for pre-existing conditions.
What is a pre-existing condition?
A pre-existing condition is defined as any ailment, illness, or condition where, in the opinion of a medical adviser appointed by the health insurer, the signs or symptoms of that illness, ailment or condition existed at any time in the period of 6 months ending on the day on which the person became insured under the policy. The pre-existing condition waiting period applies to new members and members upgrading their policy to any higher level benefits under the new policy.
Health cover for pre-existing conditions
All insurance plans must cover treatment for pre-existing medical conditions.
- No insurance plan can reject you, charge you more, or refuse to pay for essential health benefits for any condition you had before your coverage started.
- Once you’re enrolled, the plan can’t deny you coverage or raise your rates based only on your health.
- Under the Private Health Insurance Act 2007, a health insurer may impose a 12 month waiting period on benefits for hospital treatment for pre-existing conditions.
- Once a member has been on their hospital policy for a continuous period of 12 months, the pre-existing condition waiting period no longer applies and the member is entitled to the full benefits under their policy.
- The exceptions to the 12 month waiting period for pre-existing conditions are psychiatric care, rehabilitation and palliative care. These services have a two month waiting period, even if pre-existing.
- In some cases, you may be able to access an exemption to the two month waiting period for upgrading psychiatric benefits
Exception: grandfathered plans don’t have to cover pre-existing conditions
Grandfathered plans don’t have to cover pre-existing conditions or preventive care. If you have a grandfathered plan and want pre-existing conditions covered, you have 2 options:
- You can switch to an insurance plan that will cover them during Open Enrollment.
- You can buy an insurance plan outside Open Enrollment when your grandfathered plan year ends, and you’ll qualify for a Special Enrollment Period.
You are international students or foreigners arrive to Australia, or Australian citizens traveling abroad who are looking for OSHC, OVHC, travel insurance, please contact OSHCstudents Team at email: firstname.lastname@example.org and our partners for further information and assistance.