A pre-existing ailment, illness or condition is one where signs or symptoms of a condition were present at any time during the six months prior to joining Territory Health Fund or upgrading your cover, that requires hospital treatment. You may have a pre-existing condition, ailment or illness without even being aware of it.

If it’s determined that a pre-existing condition was present (by a Territory Health appointed medical practitioner), you'll need to serve a 12 month waiting period before claiming benefits for treatment. It isn’t necessary for the signs or symptoms to have been diagnosed by a doctor at the time you join or upgrade your cover.

The 12 month waiting period for pre-existing ailments can be applied to all hospital (or hospital substitute) treatments that we pay benefits for. There are a couple of exceptions; a two month waiting period applies to the following services:

  • Approved psychiatric treatment
  • Approved rehabilitation treatment
  • Palliative care

The 12 month waiting period for the treatment of a pre-existing ailment can also apply to extras services.