| Reduce
Risk
Before sponsoring any potential 457 visa employee,
careful medical screening is essential to identify any existing
ailments and conditions, which may preclude them or an accompanying
family member from obtaining health insurance in Australia.
Every health insurer will provide a firm ruling
on the coverage of an existing ailment or condition
Every health fund
policy contains an existing ailment clause.
It may be called the existing ailment or pre-existing condition
clause, but in every policy it is intended to exclude ailments,
conditions, injuries, illness and treatment of which the employee
was aware at the time of joining the health fund. The usual time
limit is the 6 months prior to joining the fund.
Here is an example of the screening questions asked
by Australian Health Insurance when employees apply for cover. Where
an existing condition e.g. asthma is fully covered, AHI endorses
the policy to show there is 100% cover.
Pre-Existing Ailments Declaration
Please complete this declaration on behalf of yourself and any accompanying family members. Claims arising from Pre-Existing Ailments are not covered under this policy.
"A Pre-Existing Ailment is an ailment, illness or condition, the signs or symptoms of which, in the opinion of a Physician appointed by the Health Fund, existed at any time during the 6 months prior to joining the Health Fund, or upgrading to a higher level of cover."
You must disclose if:
- you, or any accompanying family member, are aware of any signs or symptoms of any ailment, illness, condition, or disability that has occurred in the last 6 months.
- you, or any accompanying family member, have an implant of any kind.
- you, or any accompanying family member, had medical and/or hospital treatment within the last 6 months.
- you, or any accompanying family member, were prescribed drugs or received any other treatment of any kind (including physiotherapy or chiropractic) within the last 6 months.
If you do not disclose all relevant information at the time of applying to join the Health Fund, we may refuse to pay your claim, or may treat the policy as never having existed. Should any decision need to be made about a claim for what may be a Pre-Existing Ailment, the Health Fund will appoint a Medical Arbiter to make a decision based on the information available.
Many Pre-Existing Ailments are fully covered. Where we offer to cover a Pre-Existing Ailment then your policy is endorsed to confirm you are fully covered and your policy is renewable.
Where we offer a policy which excludes a Pre-Existing Ailment, your policy is endorsed to confirm you are fully covered for all other Illness or Injury and your policy is renewable.
Pre-Existing
Ailment
Relationship e.g. self, spouse, partner, child:
________________________________________
________________________________________
Description
of ailment, illness, condition, injury, implant or
physical disability of which you are aware e.g. knee
injury, heart pacemaker:
________________________________________
________________________________________
Medical
treatment, chiropractic, physiotherapy or any other
treatment received during the past 6 months:
________________________________________
________________________________________
Attach
copies of available medical reports:
________________________________________
________________________________________
Prescribed
drugs taken in the past 6 months:
________________________________________
________________________________________
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Where a Sponsor
chooses to self-insure
it is important to have in place checks and balances to control
employees who decide to have a “health holiday”
and undergo expensive cosmetic surgery or unnecessary medical
treatment.
Unfortunately
there are medical clinics adept at disguising the treatment received.
Even the best regulated health funds are tricked into paying for
treatments excluded under their policy wording.
Except in the
case of accidents and other emergencies it is important to
require prior approval for all hospital admissions and specialist
treatment.
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