Pre-existing conditions

What is classified as a pre-existing condition?

A pre-existing condition is basically any health issue that was already showing signs or symptoms before you joined or upgraded your hospital cover. If an independent doctor (one appointed by Frank and not your own) thinks it was around in the six months before you signed up or upgraded your cover and would have been evident to you or a reasonable medical practitioner, it will be deemed as pre-existing.

Pre-existing conditions have a 12-month waiting period.

If you need to go into hospital in the first 12 months of taking out or upgrading hospital cover, Frank needs to check whether you’re being treated for a pre-existing condition. This process can take some time and there’s a bit of paperwork involved, so make sure you allow for this before you agree to a hospital admission date.

How are pre-existing conditions assessed?

Pre-existing conditions are determined on the basis of symptoms, not necessarily diagnoses. We’ll send some paperwork for both your doctor and treating specialist to complete. The paperwork tells us about the condition being treated and when the symptoms first became obvious. If they started before you signed up with us it means your condition will be called ‘pre-existing’ even if you hadn’t been diagnosed yet. The paperwork will then be assessed by an external medical practitioner appointed by Frank, who will decide whether your condition is deemed pre-existing or not.

Will my pre-existing condition change my waiting periods?

Yes. For services that relate to your condition, the waiting periods will be extended to 12 months. This applies to both new members and members upgrading their cover.

What about emergency admissions?

In an emergency, we may not have time to determine if you’re affected by the pre-existing condition rule before your hospital admission. So, if you have less than 12 months membership on your current hospital cover you might have to pay for some or all of the hospital and medical charges if:

• you’re admitted to hospital and you choose to be treated as a private patient; and
• it is later determined that your condition was pre-existing.

This could lead to significant out-of-pocket expenses if you proceed with treatment.

How do pre-existing rules apply to dental?

Great question. The answer is only moderately complicated.

Any dental work you have done will be covered by your extras. Any other costs associated with being in hospital are covered by your hospital cover.

If you’re admitted to hospital for dental work (e.g. wisdom teeth removal), your extras cover may pay the dentist if you have served your waiting period, but stuff like hospital accommodation, theatre fees, anaesthetist and other costs fall within your hospital cover and are subject to the pre-existing condition rule.