Pre-existing conditions: what are they?

Pre-existing condition is a term that's thrown around a lot when looking into health insurance. Understanding what it really means before taking out a health insurance policy will help to avoid headaches at claim time. To help with that, we've demystified the term so you can read through your next health insurance policy with eyes wide open.

Q1. What is a pre-existing condition?

A condition, or a sign or symptom of a condition that:

  • Was treated before you applied for health insurance
  • You knew about, whether or not you decided to seek medical advice or diagnosis before applying for health insurance
  • You've previously sought diagnosis for or asked for medical advice about (or a reasonable person would seek diagnosis or medical advice about)
  • Was identified in a diagnosis or medical screening, even if you didn’t know about it

Q2. Will my pre-existing condition be covered by health insurance?

Most health insurance policies don’t cover pre-existing conditions, but some may cover them after a set time from your join date. For example, AA Health covers most pre-existing conditions after 3 years. In some cases, certain pre-existing conditions may not be covered at all, like cancer, heart conditions, hip, knee and back conditions. That’s why it’s important to discuss your condition with an insurer and be clear about what is and isn’t covered before taking out cover.

For AA Health, you can find out what's on the list of pre-existing conditions that are never covered on the policy wording for Private Hospital Cover or Private Hospital and Specialist Cover.

Q3. What if I find out that I do have a pre-existing condition after taking out health insurance? Will I be covered for it?

The same logic would apply, where there would usually be a waiting period until your pre-existing condition was covered (for example, 3 years) unless the condition was on the list that would never be covered.

Q4. Do I have to pay more for health insurance in NZ if I have a pre-existing condition?

Many insurance products in New Zealand charge an additional premium to cover pre-existing conditions. AA Health is among the few providers that do cover pre-existing conditions after three years of continuous cover, although there are some pre-existing conditions that will never be covered.

Q5. I think I have cataracts. Will I be covered?

A cataract is a clouding of the lens in the eye that leads to a decrease in vision.

AA Health Everyday cover includes a yearly allowance for GP visits for an initial diagnosis.

If your cataract/s is not a pre-existing condition, then you'd be covered straight away. If you had cataract/s or signs and symptoms prior to joining, this would be considered pre-existing and a three-year waiting period will apply. After three years, AA Health Private Hospital and Specialist can cover opthalmologist/eye specialist examinations and treatment. And with the Private Hospital or Private Hospital and Specialist cover you would be covered for hospitalisation because of your cataract/s.

Q6. Are age-related degeneration of bones or other parts of the body considered pre-existing condition?

If signs or symptoms of degeneration of the body started before applying for health insurance, or related to a past injury/pre-existing condition, then it will be considered a pre-existing condition, where a waiting period would apply.

Q7. If I have been treated for a condition and am now in the clear, will I still need to report it as a pre-existing condition?


If you have a policy like AA Health Private Hospital and Private Hospital and Specialist cover you won’t be asked medical questions up-front when you join but must disclose pre-existing conditions or provide relevant medical notes if you need to make a hospital claim.

If you are looking at applying through another health insurer, you should disclose any conditions you've previously had when asked, even if you've had the all-clear from your doctor.

We hope this helps you feel more confident with your understanding of what pre-existing conditions are. If you have any questions on how AA Health covers pre-existing conditions specifically, call us at 0800 758 758 to talk with one of our friendly team members.

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