Category: Exclusions
Most panel Trauma policies include a 90-day qualifying period at the start of cover for cancer, heart attack, stroke, and coronary artery bypass surgery. This is separate from the 14-day survival period, which applies after a Critical Illness Event occurs.
The two timing rules sit at different points in the policy life cycle. Both must be understood before assuming a claim will pay.
At the start of a new Trauma policy, the listed cancer, heart attack, stroke, and coronary artery bypass conditions are excluded for 90 days. Conditions outside this list are usually covered immediately, or after a much shorter period.
The 90 days is intended to discourage applications made after symptoms have begun. Three of the conditions (cancer, heart attack, stroke) are also the largest claim categories, so the qualifying period materially affects the insurer's risk pool.
| Insurer | Qualifying period | PDS reference | |---------|-------------------|---------------| | AIA | 3-month qualifying period for listed Crisis Events | AIA Priority Protection PDS (9 November 2025), Section 4, footnote | | Zurich | 90-day exclusion period for most Trauma conditions | Zurich Wealth Protection PDS (1 November 2025) | | TAL | 3-month qualifying period for Cancer, Heart Attack, Stroke, Coronary Artery Bypass | TAL Accelerated Protection PDS (12 December 2024), Section 2.3 | | OnePath | "Some insured trauma conditions have a 90-day" qualifying period | OnePath OneCare PDS (1 October 2025) | | ClearView | 90-day qualifying for listed events; trauma definitions updated 5 June 2025 | ClearView ClearChoice PDS (13 May 2024, Update 5 June 2025) | | NEOS | 90-day qualifying period for certain Critical Illness Events | NEOS Protection PDS (6 December 2024) | | Encompass | 90-day exclusion period for listed events | Encompass Protection PDS (26 September 2025) | | Acenda | 90-day qualifying period for listed Critical Illness Events | Acenda Insurance PDS (27 September 2025) | | Futura | 90-day qualifying period for listed Critical Illness Events | Futura Protection PDS (1 October 2025) |
This is a different rule. Once a Critical Illness Event has occurred, the insurer pays only if you survive for 14 days from the date of the event. If you do not survive 14 days, the Trauma benefit is not payable (though a Life cover Death Benefit may pay if you also held Life cover).
Cites:
Three scenarios show how the timing rules combine.
No benefit. The 90-day qualifying period excludes cancer claims at the start of cover. This applies even if the cancer was undetected at application time, because the rule is calendar-based.
The 90-day qualifying period is satisfied. The 14-day survival period starts from day 100 (the event date). If the insured survives to day 114 with permanent deficit confirmed, the claim is payable.
The 90-day qualifying period is satisfied but the 14-day survival period is not. Trauma benefit is not payable. If the insured also held Life cover, the Death Benefit pays on death.
If you are replacing comparable existing Trauma cover and cancel the previous cover at the same time, some panel insurers waive the 90-day qualifying period for the conditions you had served on the previous cover. This is described as a portability or continuation-of-cover provision. OnePath OneCare and several other panel insurers offer explicit waiver clauses for replacement of comparable cover. Confirm the exact waiver wording with the new insurer before cancelling the old policy.
Some confusion exists between the qualifying period (calendar-based, at policy start) and pre-existing condition exclusions (condition-based, lasting longer). The 90-day qualifying period applies regardless of whether the condition was pre-existing; it is a blanket exclusion of the listed conditions during the early policy life. Pre-existing condition exclusions are imposed at underwriting based on your declared medical history (see the previous FAQ in this corpus) and may last 5-10 years or be permanent.
Accidental injury, motor neurone disease, paralysis, multiple sclerosis, loss of limbs, and many other listed Critical Illness Events are typically not subject to the 90-day qualifying period. Cover for these events starts immediately upon policy commencement.
The specific list varies by insurer, so check the PDS section labelled "qualifying period", "exclusion period", or "waiting period" before assuming a particular condition is covered from day one.
This is general information, not personal advice.
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