Yes. A pre-existing condition does not automatically prevent cover, but it will affect the underwriting outcome and may result in a premium loading, an exclusion, or decline. Honest disclosure is the single most important step.
The Insurance Contracts Act 1984 s20B duty to take reasonable care not to make a misrepresentation (in force since 5 October 2021) means you must answer the insurer's questions truthfully and completely. The insurer assesses your specific condition, severity, treatment, and management against its underwriting guidelines.
What insurers consider for a pre-existing condition
- What the condition is: some conditions get standard rates with full disclosure; others attract loadings; a small number trigger exclusions or decline.
- How well controlled it is: a well-managed condition with regular medical review typically gets better terms than an unmanaged condition.
- How long ago it was diagnosed or treated: longer time without recurrence usually improves the assessment.
- Current symptoms and treatment: stable conditions on consistent medication score better than active or fluctuating conditions.
- Family medical history: hereditary patterns may compound the assessment.
Underwriting outcomes for pre-existing conditions
- Standard rates: minor or fully-resolved conditions often qualify (well-controlled asthma without recent hospitalisation, hypertension on long-term stable medication, fully-resolved skin lesions).
- Premium loading: moderate risk conditions add a percentage uplift to the standard rate. Common examples: moderate hypertension (50-100% loading), Type 2 diabetes well-controlled (50-100%), past depression with full recovery and no recent medication (varies).
- Specific exclusion: cover issued but the condition (or related claims) are excluded. Common examples: melanoma history with skin-cancer exclusion; previous mental health episode with mental-health exclusion on TPD; specific orthopaedic condition with related-claim exclusion.
- Decline: a small subset of conditions, particularly recent serious diagnoses, may not meet any panel insurer's appetite at this time. Re-application after a clear period may succeed.
Where each panel insurer documents the duty and loading framework
Loadings and exclusions are not published in the PDS itself; they appear on the Policy Schedule after underwriting. The duty to take reasonable care is documented in:
- AIA Priority Protection PDS (Version 32, 9 November 2025), Section 10.2: misrepresentation framework.
- Zurich Wealth Protection PDS (1 November 2025), duty section.
- TAL Accelerated Protection PDS (12 December 2024), Section 5: duty framework.
- OnePath OneCare PDS (1 October 2025), Application duty section.
- ClearView ClearChoice PDS (13 May 2024, update 5 June 2025): duty section.
- NEOS Protection PDS (6 December 2024), Important Information section.
- Encompass Protection PDS (26 September 2025), duty section.
- Acenda Insurance PDS (27 September 2025), duty section at pages 118-119.
- Futura Protection PDS (1 October 2025), duty section.
Underwriting appetite varies between insurers. Comparing across the 9 panel insurers for a specific condition often produces materially different outcomes. A broker can re-shop a declined or heavily-loaded outcome across the other panel insurers without you completing 9 separate applications.
Common condition categories and what to expect
- Heart conditions (hypertension, high cholesterol, past heart attack): standard rates possible for well-controlled cases; loadings or exclusions for active or recent events.
- Cancer history: depends on type, stage, and time since treatment. Some cancers underwritten standard after 5-10 years clear; others attract loading or exclusion.
- Diabetes (Type 1 and Type 2): Type 2 well-controlled often gets a loading; Type 1 typically attracts a larger loading and may trigger TPD or IP exclusions.
- Mental health (depression, anxiety, bipolar): variable. Time since last episode, ongoing medication, and severity all matter. Mental health is increasingly underwritten with more nuance than the historic blanket-exclusion approach.
- Musculoskeletal (back pain, joint conditions): standard or loaded for life cover; exclusions more common on TPD and IP for the specific body region.
- Sleep apnoea, asthma, autoimmune disease: condition-specific underwriting; well-controlled cases often progress with manageable loadings.
- Substance use history: depends on the substance, the time since cessation, and any related medical sequelae.
Documenting your condition for underwriting
Underwriters value evidence. If you can supply at application:
- Recent GP notes confirming the condition is stable
- Specialist report (cardiologist, oncologist, psychiatrist) confirming current management
- Current medication list with dosages
- Recent test results (blood pressure log, HbA1c, cholesterol, recent ECG)
- Treatment plan and review schedule
the underwriting outcome often improves relative to a bare disclosure with no supporting evidence.
Pre-existing condition cover through super
Super-held default cover (group insurance) typically uses simplified underwriting or automatic acceptance at default sum insured levels. This can be an option where retail cover is loaded or declined. Limitations: lower sum insured caps, more restrictive definitions, and pre-existing exclusions sometimes apply for the first 12 to 24 months. Check your fund's insurance guide.
What not to do
Do not omit, downplay, or misstate a condition. Insurer remedies under Insurance Contracts Act s28A-D apply on claim if a non-disclosed condition surfaces. For non-fraudulent misrepresentation, the insurer can reduce the sum insured proportionately, impose an exclusion, or treat the policy as if it had never been entered into. Fraudulent misrepresentation under s28(2) allows full avoidance.
Regulator anchor
The Insurance Contracts Act 1984 s20B and s28A-D govern the duty and remedies. Sensitive health information requires explicit consent for collection and processing under Australian Privacy Principle 3.3 (Privacy Act 1988). The Life Insurance Code of Practice 2019 binds all 9 panel insurers on claims handling. AFCA at afca.org.au is the external dispute pathway.