Waiting Periods for Pre-Existing Conditions

Claire Small's picture
Authored by Claire Small
Posted Thursday, October 10, 2019 - 10:45am

If you have a pre-existing condition, it may affect how and when you’re able to receive private insurance in some countries. This can be dispiriting if you really need to seek medical treatment; however, there are other options out there that aren’t privatized or restrictive. If you’re looking for health insurance no waiting period, there are options out there. It’s a good idea to understand the current legislature surrounding pre-existing conditions, too, since that will help you make a more informed decision when choosing your private health care provider.

Understanding pre-existing conditions

Pre-existing conditions are any ailment or illness that has had its underlying symptoms evident for a period of at least six months prior to your insurance coverage beginning. Some of the most common pre-existing conditions include sleep apnea, pregnancy, and diabetes, although there are dozens of potentially qualifying conditions. Pregnancy is its own case altogether in terms of how it is treated in regards to insurance, but it’s important to note that in order to qualify as a pre-existing condition, there doesn’t need to be an official diagnosis. At the same time, however, just because your family has a history of a medical condition does not mean that you have that condition as a pre-existing condition. Instead, doctors and insurers look for symptoms which would be reasonable to notice, such as shortness of breath, joint pain, or frequent headaches. These issues, when checked by a medical professional, would be able to lead to a diagnosis of an underlying condition, which would qualify as pre-existing. 

Why an insurance company would want a waiting period

As a result of 2007’s Private Health Insurance Act in Australia, insurers are allowed to limit how long you must wait to receive treatment for a pre-existing condition. This limit, which is generally imposed for up to twelve months, is in place in order to protect insurers. For example, if you thought that you might have a pre-existing condition, and there wasn’t a limit, you would most likely wait until you suspected an issue before you took out a health insurance policy. However, one of the main reasons that the privatized health care system works the way that it does is because people buying into its plans are not necessarily going to need intensive medical treatment regularly. Healthy, able-bodied individuals who have insurance ultimately help drive the cost down for those with pre-existing conditions who really need insurance in order to afford medical treatment or prescriptions. These rulings also apply for currently insured individuals who are looking to upgrade their insurance plans.  

As you can tell, the health insurance industry is complex, with some regulations benefiting insurers and others benefiting consumers. When it comes to pre-existing conditions, it’s crucial that you have an understanding of how the laws in your country of residence operate, so that you can be sure to seek the right insurance. This is especially true if you suspect that you might have a chronic illness like arthritis, depression, diabetes, or high blood pressure. If you’ve just switched to a private health insurer and have a pre-existing condition, it’s important to note that you can still be treated during a waiting period using a public option. That being said, you may want to shop around for health insurance options with no waiting period if your pre-existing condition requires costly, regular maintenance. Even common conditions, like arthritis, can wind up being costly if necessary drugs or routine screenings aren’t covered by insurance. While waiting periods help to protect insurers, as a consumer it’s vital that you have a gameplan if you’re going to need ongoing medical care during a waiting period.