Any disclosed medical condition can affect life insurance premiums or terms. Insurers may apply a premium loading, exclude the specific condition, or in some cases decline cover. The outcome depends on the condition, its severity, treatment, and the insurer's underwriting guide.
Loadings and exclusions sit on the Policy Schedule per individual application, not in the PDS. Each panel insurer underwrites differently, so the same applicant may receive different outcomes across the 9 panel insurers. The framework below is general guidance.
How insurers assess medical conditions
During underwriting, you complete a personal statement and answer questions about your health history, current conditions, medications, family history, and lifestyle. The insurer may also request a Medical Attendant's Report (MAR) from your GP or specialists, a blood test or nurse-conducted health check, or a Personal Medical Attendant statement.
The insurer compares your declared health against their underwriting manual and produces one of four outcomes:
- Standard rates: cover offered at the standard premium for your age, gender, and smoker status.
- Premium loading: extra premium charged as a percentage of the standard rate. Often expressed as 50%, 100%, 150%. A 50% loading means you pay 1.5x the standard premium.
- Exclusion: cover offered at standard rates but with the specific condition (or related events) excluded. For example, a melanoma history may produce an exclusion for any skin-cancer-related death claim.
- Decline: cover not offered. The applicant can apply to other insurers (each underwrites independently).
Conditions commonly assessed
Cardiovascular
- Hypertension (high blood pressure): mild and well-controlled often standard; moderate or uncontrolled often loaded.
- High cholesterol: usually standard if well-controlled.
- Previous heart attack, stent, or cardiac surgery: loading typical; older events with strong recovery often loaded modestly.
- Atrial fibrillation: assessed case-by-case.
Cancer history
- Stage and tumour type drive the outcome. A successfully treated early-stage cancer with 5+ years clear may attract a modest loading or standard rates after a longer interval.
- Higher-stage cancers may require a longer clear period before standard cover is available.
- Some cancers (notably aggressive haematological cancers) may produce an exclusion or decline.
Diabetes
- Type 1 (insulin-dependent): typically loaded, with the size depending on age at onset, HbA1c control, and any complications.
- Type 2 (non-insulin and lifestyle-controlled): often modest loading or standard with strong control.
- Recent diagnoses may require a longer settling period before terms are offered.
Mental health
- Mild depression or anxiety treated and stable: often standard or modest loading.
- More significant or recurrent mental illness: loaded; some cover may carry mental-illness exclusion clauses.
- Active treatment with stable outcomes is usually viewed more favourably than untreated history.
Other conditions
- Obesity (high BMI): often loaded above stated thresholds.
- Sleep apnoea: assessed on severity and treatment compliance (CPAP).
- Asthma: well-controlled mild asthma often standard.
- Kidney or liver disease: loaded; severity and trend matter.
- Autoimmune conditions (lupus, rheumatoid arthritis, multiple sclerosis): loaded; outcome varies widely by condition and stability.
- Neurological conditions: assessed case-by-case.
Panel underwriting cite
Loadings and exclusions are documented on the individual Policy Schedule after underwriting, not in the PDS. The PDS sets out the duty to take reasonable care not to make a misrepresentation (covered below). Adviser guides for NEOS Protection, Encompass Protection, and Futura Protection flag that hazardous occupations may attract a per-mille loading on top of standard rates.
See AIA Priority Protection PDS (Version 32, 9 November 2025), Section 10 (Duty to take reasonable care not to make a misrepresentation), and TAL Accelerated Protection PDS (12 December 2024), Section 5 (Your Duty to take reasonable care not to make a misrepresentation). Each PDS sets out the framework; the actual loading or exclusion is on your Policy Schedule.
Why comparing across the panel matters
Each panel insurer has its own underwriting guide. The same applicant with the same medical history may receive a 100% loading from one insurer, a 50% loading from another, and standard rates with an exclusion from a third. For a meaningful medical history, applying to multiple insurers across the panel through a broker is the practical way to find the most favourable outcome.
The duty to take reasonable care not to make a misrepresentation
Under Insurance Contracts Act 1984 s20B (effective 5 October 2021), you must take reasonable care not to make a misrepresentation when answering the insurer's questions. A misrepresentation can include omitting material information when asked.
If the insurer later discovers a misrepresentation, ICA s28A-D sets out the proportionate remedies:
- For non-fraudulent misrepresentation, the insurer may treat the policy as if it had never been entered into (if it would not have entered into the contract had it known the truth), reduce the sum insured proportionately, or impose an exclusion. The remedy must be proportionate.
- For fraudulent misrepresentation, the insurer may avoid the policy entirely under ICA s28(2).
- AFCA can review insurer decisions on misrepresentation remedies.
Common considerations
- Answer the insurer's questions accurately and completely. A loading is much better than a declined claim years later.
- A pre-existing condition does not automatically mean no cover. Most conditions are insurable at some price or with some exclusion.
- Get the underwriting decision in writing. The Policy Schedule sets out the exact loading, any exclusion, and the cover terms.
- Reapply after material health improvements. A 100% loading at age 35 because of recent weight gain may be reviewable downward at age 40 after sustained loss.
- ASIC MoneySmart at moneysmart.gov.au provides consumer-facing guidance on what to expect during underwriting.
Regulator anchor: Insurance Contracts Act 1984 s20B (duty to take reasonable care not to make a misrepresentation, effective 5 October 2021); ICA s28A-D (insurer remedies, proportionate); ICA s28(2) (fraudulent misrepresentation remedy); AFCA (afca.org.au) for dispute resolution on underwriting outcomes.