What is a pre-existing condition?

We know – there’s plenty of jargon involved when it comes to private health insurance. One of the most common questions we get is about pre-existing conditions.

A pre-existing condition is an illness or condition for which, in the opinion of a medical advisor appointed by Westfund, signs and symptoms existed during six months before the date you joined Westfund or upgraded to a higher level of cover. A 12-month waiting period applies to all new members for hospital costs relating to the treatment of pre-existing conditions. It's important to note that the only exceptions to this are treatments for hospital psychiatric services, rehabilitation and palliative care, which have a 2 month waiting period.

Planning on hospital treatment before this period ends? You’ll need to ask your GP and surgeon/specialist to complete a Medical Practitioner Certificate regarding ‘Pre-Existing Conditions' form. This certificate helps Westfund determine the level of benefits that will apply when hospitalisation is required for members who have: 

  • Been with Westfund for less than 12 months or;
  • Transferred or upgraded to a higher level of cover with Westfund less than 12 months ago.

Once this period is over, you’re entitled to the full benefits available under your cover.