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
A 12 month waiting period applies to pregnancy related services, as well as surgery for assisted fertility programs such as IVF or GIFT, sterilisation or vasectomy.
Other hospital admissions, such as for surgical extractions, also attract a 12 month waiting period.
The 12 month waiting period for the treatment of a pre-existing ailment can also apply to extras services.