What is a pre-existing condition?

A pre-existing condition is a 12-month waiting period for hospital treatment relating to a pre-existing condition – it’s a rule that applies whether the ailment, illness or condition was known to the member or not.

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 six 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 existing members upgrading their cover. T

he test applied under the law relies on the presence of signs or symptoms of the illness, ailment or condition, not on a diagnosis (i.e. it’s not necessary for the member or their doctor to know what their condition is or for it to be diagnosed). In forming an opinion about whether or not an illness is a pre-existing condition, an HIF-appointed medical practitioner will take into account information provided by the member’s treating doctor.

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