Health Insurance Waiting Periods

[rev87]

Hoping someone may have a bit more knowledge in this area than what i can find online! I've searched AAM but haven't come across the same query..

If you were to get ill during the waiting period, will this condition be covered for procedures after the waiting period has expired? i.e A family member was admitted to A&E over the weekend & has been told they need to be referred to a cardiac specialist. They have 3 weeks remaining on their health insurance waiting period & we are wondering will any procedures be covered if they go private after this remaining 3 weeks has expired? There were no previous symptoms of this or any conditions before this visit to A&E

 

[Brendan Burgess]

A very interesting question.

Here is what the HIA says

I would have assumed that she got sick during the 26 weeks, so treatment during the 26 weeks is not covered.

But I assumed that treatment after the 26 weeks is covered. Although I am not sure.

The illness did not commence before she joined so she is not in the 5 year category.

Having said that, most people could defer treatment for 26 weeks if it were covered, so I guess it probably refers to treatment (anytime) for an illness which occurred during the first 26 weeks. But if the condition persists, when does cover come into effect? 5 years?

Brendan

 

[rev87]

Thanks for the reply Brendan,

Yes it's a very interesting question, surprised i could find no other discussions around it on the forum.

On paper, the illness commenced after joining so it should not be classed as a pre-existing condition.

Laya's T&C's say:How long before you can make a claim for any new disease, illness or injury which began or the symptoms of which began after membership started?
26 Weeks

I know insurer's can be difficult at times so hoping to have an understanding before they're called! Better to be armed with knowledge!