How your health and genetic results can affect life, travel and health insurance in Australia
Why your health details matter differently across insurance types
When you apply for insurance, the questions you are asked — and the consequences of your answers — depend heavily on the type of product. Life insurance and travel insurance generally involve underwriting, where the insurer assesses the risk you bring as an insured person. Private health insurance in Australia works differently, using a community-rated model that pools risk across groups rather than pricing each person based on individual health risk.
That distinction is especially important as Australia prepares to introduce legislation that will restrict how life insurers can use genetic test results. The changes are designed to prevent discrimination based on certain genetic information, but they do not apply across all insurance products. Understanding what is covered by the new rules, what is not, and what you still need to disclose can help you avoid disputes later.
New limits on life insurers’ use of genetic test results
The Australian parliament is set to pass legislation to ban life insurers from using genetic test results to discriminate against people applying for life insurance. Once the law comes into effect (expected in about six months), it will apply to all new life insurance contracts. These include death cover, income protection, disability cover, and trauma or critical illness cover.
The change focuses on what the legislation calls “protected genetic information” in underwriting. In practical terms, this means life insurers will be prohibited from using health information that predicts or infers someone’s risk of future disease based on genetic testing. For example, if you took a genetic test that suggested a higher future risk of cancer, the insurer would not be allowed to deny cover or charge higher premiums on that basis.
However, the boundary of what is protected is crucial. The definition does not include an actual diagnosis, even if that diagnosis was made through genetic testing. It also does not include family history of disease. Those two categories can still be taken into account by life insurers when underwriting. So if you, a parent, a sibling, or a child has been diagnosed with a condition such as cancer, that information may still legally influence the terms you are offered.
How underwriting works in life insurance
Underwriting is the process some insurers use to assess risk. During an application, insurers typically ask a range of questions to gather information relevant to that assessment.
Life insurance is usually risk-rated (with an exception in some cases of group insurance through superannuation). Risk-rated pricing means people with different risk profiles can be offered different terms. Those terms may include:
- different premium costs
- exclusions for particular conditions
- cover being declined altogether
Life insurers can ask about the medical history of an applicant and their first-degree relatives (parents, siblings, or children). This is not limited to conditions that are still causing symptoms. Any medical history at any stage can be treated as relevant to underwriting.
Your duty to answer honestly — and the consequences of getting it wrong
When applying for life insurance, you must answer in “good faith”. This includes a requirement to not make a misrepresentation about matters relevant to your application.
Failing to disclose health information, or deliberately misleading an insurer about your health history, can be treated as “fraudulent nondisclosure”. The consequences can be severe. A policy may be voided — meaning it has no effect at all — and premiums paid over time may be forfeited.
The practical takeaway is that the application process is not just a formality. The information you provide can affect whether you are covered, what you pay, and whether a claim is paid later.
What changes — and what does not — under the new life insurance law
For people planning to take out life insurance after the new law takes effect, the key change is that predictive or inferential genetic test results (protected genetic information) should not be used against them in underwriting for new contracts.
But the law does not remove the role of health history and family history in underwriting. Even with the new protections, life insurers can still consider:
- your actual diagnosis (including a diagnosis reached via genetic testing)
- your family history of disease
This distinction can be confusing in real life, because genetic testing can be used for different purposes. Some tests are used to diagnose an existing condition. Others are used to estimate future risk. The new rules target the latter category for life insurance, but do not override the insurer’s ability to consider diagnoses and family history.
Travel insurance: still risk-rated, and not covered by the new genetic rules
Travel insurance is also risk-rated. Travel insurers can ask for health information when deciding whether to offer cover, what it will cost, and whether certain conditions will be excluded.
Importantly, travel insurance will not be subject to the new laws restricting the use of genetic information. The new legislation is restricted to life insurance. This means travel insurers are legally allowed to consider genetic test results that assess future risk of disease as part of underwriting.
In most cases, travel insurers will focus mainly on your personal medical history, including pre-existing conditions and procedures you have had. Family history may become relevant in certain circumstances, such as where you have a hereditary medical condition.
Because travel cover can involve underwriting decisions tied to health information, it remains especially important to answer questions carefully and honestly. The specific questions asked, and how they are framed, will guide what you need to disclose.
Private health insurance: community-rated, but waiting periods can still apply
Private health insurance in Australia is community-rated. That means risk is pooled across groups of people rather than assessed and priced at an individual level through underwriting.
As a result, health insurers cannot deny cover or charge a higher premium based on personal or family history of disease, or other health risk factors. Premiums can vary based on where you live and the level of cover you choose (such as gold, silver, or bronze), but not because an insurer has decided you personally are higher risk due to your medical history.
However, health insurers can still take risk into account using waiting periods. A waiting period does not change the cost of premiums, but it can delay when certain treatments are covered. If you have an existing medical condition, a health insurer can offer you a policy but not cover treatment for that condition until you have been insured for no more than 12 months. For psychiatric, rehabilitative, or palliative care, the waiting period is no more than two months, even for pre-existing conditions.
What counts as a pre-existing condition for health insurance
For health insurance purposes, a pre-existing condition is defined as:
“an ailment, illness or condition; and in the opinion of a medical practitioner appointed by the insurer […], the signs or symptoms of that ailment, illness or condition existed at any time in the period of 6 months ending on the day on which the person became insured under the policy.”
This definition has a few practical implications. It means you must disclose any condition for which signs or symptoms existed in the six months before your application. It does not include childhood conditions that no longer have signs or symptoms.
It also means the final decision about whether something counts as pre-existing is made by a medical practitioner appointed by the insurer — not by you, and not necessarily by your own doctor. Where there is uncertainty, the safest approach is to answer questions honestly and provide supporting letters from your doctor where needed.
Genetic testing and health insurance: an area that needs clarification
One aspect flagged as needing clarification is how genetic testing fits within private health insurance rules on pre-existing conditions.
If you have had a genetic test to diagnose a condition with signs or symptoms, you must disclose this to a health insurer, and the insurer can apply a waiting period.
But where a genetic test indicates a risk of future disease — rather than diagnosing a condition with current signs or symptoms — the situation is less clear. The example raised is the BRCA1 gene variant, which increases the risk of breast, ovarian, and prostate cancer. Medically, a person with a BRCA1 variant does not have signs or symptoms of cancer simply by having the variant. Even so, it is possible a health insurer could categorise this as a pre-existing condition and apply a 12-month waiting period for preventive care. That could include preventive procedures such as a preventive mastectomy.
This is a regulatory grey area where further clarification would be helpful, because it sits at the intersection of a symptom-based definition of “pre-existing condition” and a genetic result that may inform future risk and preventive decisions.
Common scenarios: what insurers may ask about
People often wonder whether a recent procedure or past medical issue needs to be disclosed. The answer depends on the insurance type and the questions asked.
- Life insurance: insurers can ask about your medical history and the medical history of first-degree relatives. This can include conditions from any stage of life, not just those with current symptoms.
- Travel insurance: insurers typically ask about your personal medical history, including pre-existing conditions and procedures you have had. In certain circumstances, family history may also be relevant.
- Health insurance: the key concept is whether signs or symptoms existed in the six months before you became insured, as assessed by the insurer’s appointed medical practitioner.
Across all types, the consistent theme is that you should respond truthfully and in good faith. The consequences of withholding information can be particularly serious in life insurance, where fraudulent nondisclosure can void a policy entirely.
If you disagree with an insurer’s decision
Disputes can arise about premiums, exclusions, or whether a claim should be paid. If you have raised an issue with your insurer and it has not been adequately addressed, complaint pathways differ depending on the product:
- For life insurance or travel insurance, you can complain to the Australian Financial Complaints Authority.
- For health insurance, you can complain to the Commonwealth Ombudsman.
What to keep in mind before you apply
The upcoming change to life insurance rules is significant, but it does not remove the need to understand how insurers classify information. Predictive genetic test results will be treated differently from diagnoses and family history in life insurance. Travel insurance remains able to consider genetic test results in underwriting. Private health insurance cannot price you based on your health risk, but waiting periods can still affect when you can claim for treatment — and genetic testing introduces uncertainty where results relate to future risk and preventive care.
Given these differences, the most practical approach is to read application questions carefully, answer honestly, and keep relevant medical documentation available in case an insurer requests clarification or a dispute later needs to be resolved.