Income protection with pre-existing conditions – yes, you can get it.

What is a pre-existing medical condition?

A pre-existing medical condition is a health issue you knew about before kicking off or renewing your insurance. It generally refers to things you've been diagnosed with, whether it's something you're currently managing or an older condition that's been treated in the past.

Let's take a look at a few common pre-existing conditions that insurers will consider when you apply for income protection:

It's important to understand that the pre-existing conditions covered for income protection can always vary between providers. Each insurer has its own definitions of various conditions and a list of what is covered in its product disclosure statement (PDS). For example, Medibank says an acute stroke is only counted if the impairment lasts longer than 24 hours and doesn't involve the retina.

Be sure to read your insurer's PDS to have a clearer picture of what you are and aren't covered for.

How does income protection cover pre-existing conditions?

When you apply for income protection with a pre-existing condition, insurers will usually have a few requirements to be approved and make a claim.

Typically you'll have to answer a range of questions about your health, such as when you were diagnosed, your current lifestyle habits, and whether you have any family history. Some insurers like Noble Oak may also ask you to provide medical records or undergo a medical examination.

Depending on your answers, it can affect your policy in the following ways:

• Coverage with specific exclusions for your conditions. This means if you make a claim because you're unable to work due to your pre-existing conditions, you might not qualify for the benefits.
• Coverage with waiting periods on your condition. Your policy might have a waiting period to cover pre-existing conditions. During this time, which can differ between policies, you won't be able to claim benefits for those conditions. Once the waiting period is over, your coverage for pre-existing conditions kicks in.
• Cover with higher premiums. Known as loading, these are extra fees insurers will put on your premium to cover the higher risk associated with a pre-existing condition. These can be quite high and can make your cover a lot more expensive.

What isn't classified as a pre-existing condition?

There are a few conditions that most insurers don't classify as pre-existing conditions, which include:

When you're choosing between income protection options, it's always good to check the policy details or talk directly with providers, so you know what information you do and don't need to disclose.

Do I need to disclose the details of my pre-existing medical condition or health issue?

Yes. It's essential to be upfront and honest with your provider about any pre-existing condition so that your income protection policy is tailored specifically to your needs.

If you withhold information, your insurer will have the right to deny any claim that comes as a result of your condition and refuse to provide you with cover.

Expert insight: Why is it difficult to get income protection with a pre-existing condition?

"There are many things that could knock you out of the workplace for a time, so insurance companies will be very cautious to offer income protection insurance to anyone with a difficult medical background.

If you could imagine the types of things that would stop you from working for 6-12 months – a car accident, a fall on the sports field, chronic fatigue, glandular fever, long COVID, the list goes on. This is especially difficult for those that have a history of mental health issues – even minor.

The silver lining with income protection and pre-existing medical conditions is that the insurer is more likely to exclude a medical condition rather than flat out refuse to insure you. This means while you're not covered for your particular ailment, you're still covered for all other events and illnesses."

Brenton Tong

Managing director and senior financial adviser, Financial Spectrum

How to apply for income protection insurance with an existing condition

You have a few options to apply for income protection with a pre-existing condition, these include:

• Apply like normal and disclose your condition: You won't be guaranteed cover, and it will be up to the individual insurer if they approve your application. To account for the added risk, some insurers might increase your premium or exclude your condition from the policy.
• Opt for a policy that covers the condition after a waiting period: It can help your chances of being covered if your condition is already included in an insurer's income protection policy. However, most providers will still ask for your medical records or for you to complete a medical examination. It's also not a guarantee, and if your condition is severe there's a chance you can be refused cover. However, insurers are more likely to exclude a medical condition from your policy than refuse you from cover outright.
• Seek advice from a financial advisor or insurance broker: This can really help you get a sense of your coverage needs and understand the options out there. If you heavily rely on your ability to work or have a tricky health condition, having professional advice on the matter can be a big plus.

No matter how you choose to apply for income protection, it's always a great idea to check what's out there and compare policies. This can not only save you money on premiums but also guide you to an income protection policy that best fits your needs.

Is it possible to apply for income protection with no medical examination?

Yes, you can. Applying for income protection without a medical exam can make things quicker, but insurers might play it safe. They may tweak the policy terms to cover the extra risk because there's no medical check-up.

Here are a few Aussie income protection providers we found who offer cover without a medical check-up:

• Suncorp
• HCF
• AAMI
• Real Insurance
• Medibank

Most insurers will ask you to complete a health check-up when you apply for income protection. This is so your insurer can get the most accurate picture of your health and the level of risk it will take on if you're covered. This is a standard procedure and isn't something to be feared or a reason to lie to your insurer about any pre-existing condition.

FAQs

• Can you get income protection insurance with a pre-existing medical condition?

  Yes, it's possible! What specific conditions you can get income protection for will be on a case-by-case basis for each insurer.

  Having income protection with a pre-existing condition will affect your policy. This could mean higher premiums, mandatory wait times on claims, and your pre-existing condition is excluded from the claimable events on your policy.

• Why do income protection insurers ask about pre-existing conditions?

  It's a matter of risk for providers. There are many things that can leave you unable to work for a time, so insurance companies are cautious about offering protection insurance to anyone who has a difficult medical background.

  The silver lining is that insurers are more likely to exclude a medical condition rather than flat-out refusing to insure you. So if you're not covered for your particular pre-existing condition, you'll still be covered for other events and illnesses.

• How far back do insurers look when asking about pre-existing conditions?

  Most insurers ask about symptoms, diagnoses, treatment or medical advice from the past five years. For some serious conditions, such as cancer or heart disease, they may ask about your whole life. The exact period varies between insurers, so read each application question carefully.

• Does a condition count as pre-existing if it was never diagnosed?

  It can. Many insurers define a pre-existing condition to include symptoms you were aware of, or that a reasonable person would have noticed, even if a doctor never diagnosed them. If you've had symptoms you haven't seen a doctor about, mention them in your application.

• What happens if I forget to disclose something on my application?

  You have a duty to take reasonable care not to make a misrepresentation when you apply. If an insurer finds an innocent mistake within three years of your policy starting, it may be able to change your cover or cancel it. After three years, it generally can't cancel your policy for an innocent mistake. If the misrepresentation was fraudulent, the insurer can cancel your policy at any time.

• Can an exclusion on my policy be removed later?

  Sometimes. Some insurers will review an exclusion if you can show you've been free of symptoms and treatment for a set period, usually with a report from your doctor. Ask your insurer whether it reviews exclusions and what evidence it needs.

• Will my policy cover a condition I develop after taking it out?

  Yes. A condition that first appears after your cover starts isn't pre-existing, so it's covered under your policy's normal terms. If your policy is guaranteed renewable, your insurer also can't cancel it or change your terms because your health changes.

• Does income protection through super cover pre-existing conditions?

  Default income protection in super is often accepted automatically without health questions, but many funds limit cover for pre-existing conditions. For example, a fund may not cover a condition you already had until you've held the cover for a set period. Check your fund's product disclosure statement for the exact rules.

• Will switching income protection insurers affect cover for my conditions?

  It can. Any condition you developed while holding your current policy will count as pre-existing when you apply with a new insurer, so it could be excluded or attract a higher premium. Keep your current policy until your new one has been approved and has started.

• What can I do if I'm declined cover or offered a high premium?

  Underwriting rules vary between insurers, so you may get a better result by applying elsewhere. A broker or financial adviser can often get an indication of the terms you'd be offered before you formally apply. You can also check whether your super fund offers income protection, or ask your insurer to review your terms after a period of good health.

• Do I have to disclose genetic test results when applying for income protection?

  Under the Financial Services Council's moratorium on genetic testing, insurers can't use the results of a predictive genetic test for income protection cover of up to $4,000 a month. You also can't be asked to take a genetic test as part of your application.

• Will a mental health condition always lead to an exclusion?

  No. Insurers look at how recent the condition is, how severe it was and what treatment you've had. Depending on your history, you could be offered standard cover, a higher premium, a waiting period or an exclusion for mental health claims.

Written by

Cameron Thach

Writer

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With a background in writing across education, Web3, and finance, Cameron’s mission is to create content that speaks directly to readers in a way that’s easy to understand, helping them navigate complex topics with confidence. Cameron studied a Bachelor of Commerce, Economics and Marketing at Macquarie University, graduating in 2019. See full bio