What’s a pre-existing condition?
Simple Life won't cover you for any pre-existing conditions. In simple terms, a pre-existing condition means you aren't covered for any claim that’s caused directly or indirectly by any illness, injury, medical condition and/or symptoms that occurred in the five years before your cover start date.
Further explanation of what we mean by a pre-existing condition can be found in the Simple Life Product Disclosure Statement (PDS). To help give you some understanding of the pre-existing condition exclusion, here are five hypothetical examples we've put together for illustrative purposes:
October 2011: David’s doctor discovers he has a melanoma. David has it removed.
November 2013: David’s Simple Life application is accepted.
September 2014: David’s doctor diagnoses him with secondary cancer, which is related to the original melanoma
Potential outcome: David’s Simple Life claim would be declined due to the policy’s 5 year pre-existing condition exclusion
Reason: David’s secondary cancer was a result of the original melanoma, which was discovered within the 5 years before his Simple Life cover start date.
January 2011: Jane has a heart attack
December 2013: Jane’s application for Simple Life is accepted.
November 2016: Jane is diagnosed with liver cancer.
Potential outcome: Jane’s claim would be considered as part of the standard claims assessment process.
Reason: Jane’s liver cancer was first diagnosed after her Simple Life cover start date and isn't related to her heart attack.
February 2003: Steve has a serious skiing accident and breaks his pelvis, but makes a full recovery by 2005, which means he no longer has symptoms of the injury, requires medication or treatment for it.
January 2014: Steve’s application for Simple Life is accepted.
November 2017: Steve has a serious car accident and breaks his pelvis.
Potential outcome: Steve’s claim would be considered as part of the standard claims assessment process.
Reason: Steve’s broken pelvis in 2017 is unrelated to the injuries he sustained in the skiing accident in 2003.
February 2013: Katie gets a cold.
January 2014: Katie’s application for Simple Life is accepted.
November 2015: Katie has a stroke
Potential outcome: Katie’s claim would be considered as part of the standard claims assessment process.
Reason: Katie’s stroke is unrelated to the cold she had in the year before her Simple Life cover start date.
June 2013: Sean begins getting severe headaches, but he doesn't seek medical advice.
November 2013: Sean’s application for Simple Life is accepted.
January 2014: Sean is diagnosed with a brain tumour and is told he has fewer than 12 months to live. Doctors say his headaches were a symptom of the tumour.
Potential outcome: Sean’s claim would be declined, due to the policy’s 5 year pre-existing condition exclusion. Under Simple Life’s pre-existing condition exclusion, a terminal illness benefit won't be paid for an illness, injury, medical condition or related symptom for which a reasonable person in their circumstances should have been aware of, or would have sought medical help for.
If you have a pre-existing condition and want cover for that condition, you should consider whether Simple Life cover is appropriate for you and, if necessary, explore alternative insurance arrangements. If it applies to you, you might like to speak to a financial planner.
Important information: Please note these are examples only of the possible application of the Simple Life pre-existing condition exclusion to certain basic hypothetical scenarios. The examples are of a general nature only and don't take into account individual circumstances. Any claim under a Simple Life policy will need to be considered and assessed on an individual basis having regard to the particular facts of the claim, including the supporting medical and other evidence obtained during the claims assessment process.