What is an Existing Medical Condition?

What is an Existing Medical Condition?

“Existing Medical Condition” means a disease, illness, medical or dental condition or physical defect that, at the Relevant Time, meets any one of the following:

  1. Has required an emergency department visit, hospitalisation or day surgery procedure within the last 12 months.
  2. Requires:
    1. prescription medication from a qualified medical practitioner;
    2. regular review or check-ups;
    3. ongoing medication for treatment or risk factor control; or
    4. consultation with a specialist.
  3. Has:
    1. been medically documented involving the brain, circulatory system, heart, kidneys, liver, respiratory system or cancer; or
    2. required surgery involving the abdomen, back, joints or spine that required at least an overnight stay in hospital.
  4. Is:
    1. chronic or ongoing (whether chronic or otherwise) and medically documented;
    2. under investigation;
    3. pending diagnosis; or
    4. pending test results.

“Relevant Time” in respect of:

  1. Single Trip policies means the time of issue of the policy.
  2. Annual Multi-Trip policies means the first time at which any part of the relevant trip is paid for or the time at which the policy is issued, whichever occurs last.

Pregnancy

The following restrictions apply to all pregnancies and any claim arising from pregnancy:

  • No cover available if there has been complications with this or any other previous pregnancy.
  • No cover available if you have a multiple pregnancy e.g. twins or triplets.
  • No cover available if the pregnancy was medically assisted e.g. using assisted fertility treatment including hormone therapies or IVF.
  • Cover is only provided for serious, unexpected pregnancy complications that occur up until the 24th week of pregnancy i.e. up to 23 weeks, 6 days. Gestational age is measured in weeks and days and is calculated from the last known date of Your menstrual period or calculated from staging ultrasound.
  • Childbirth is not covered.
  • Costs relating to the health or care of a newborn child are not covered, irrespective of the stage of pregnancy when the child is born.

“Relevant Time” in respect of:

  1. Single Trip policies means the time when the policy is issued.
  2. Annual Multi-Trip policies means the first time when a part of the relevant trip is paid for or the time when the policy is issued, whichever occurs last.

What does this mean?

Expectant mothers should consider if Our products are right for them when travelling after 20 weeks gestation as costs for childbirth and neonatal care overseas can be expensive.

For assistance or if you wish to discuss other policy cover options, please contact us.

IMPORTANT TRAVEL INSURANCE INFORMATION

This page has important travel insurance information, that must be read before you buy and a submit form to be completed and submitted.

The contents of this page include:

PLEASE NOTE:

Please read the following important information from Cover More and complete their declaration and select the Submit Form, below.

This is general advice and does not take into account your financial situation, needs or objectives. You need to read the Product Disclosure Statement carefully to decide what type and level of cover suits you.

Statement:

You have a duty to take reasonable care not to make a misrepresentation when entering into this contract of insurance.

It’s important you understand you’ve answered our questions for yourself and anyone else that you want to be covered by this insurance.

You must take reasonable care to give a true and accurate account of matters. Your response should tell us everything that you know about the question.

If you’ve made a misrepresentation to us, we may cancel your contract or reduce the amount we will pay you if you make a claim, or both. If your misrepresentation is fraudulent, we may refuse to pay a claim and treat the contract as if it never existed.

I’m an Authorised Representative of Cover-More and receive a commission for the sale of insurance. This is explained in the combined FSG and PDS. The PDS explains how Cover-More collects and uses personal information that you share about yourself or others. Cover-More’s Privacy policy is available on its website. You have a 21 day cooling-off period, if you decide not to proceed with this insurance.

The combined PDS and FSG also contains information about the insurer Zurich Australian Insurance Limited, Cover-More, and Cover-More’s internal dispute resolution procedures.

By entering this contract of insurance today, please confirm you understand what I’ve advised you of, and confirm that the information you have provided in response to the questions asked, is true and accurate.

Duty to take reasonable care not to make a misrepresentation:

This is a consumer insurance contract under the Insurance Contracts Act 1984 (Cth) (Act).

Under the Act, you have a duty to take reasonable care not to make a misrepresentation to us.

  • This duty applies whenever you enter into, renew, extend or vary this contract of insurance. In all cases, we will ask you questions that are relevant to our decision to insure you and on what terms.
  • It is important that you understand you are answering our questions in this way for yourself and anyone else that you want to be covered by the contract.
  • When you answer the questions, you must give a true and accurate account of matters. Your response should tell us everything that you know about the question because your response is relevant to whether we offer you insurance and the terms we offer you.
  • A misrepresentation made fraudulently is made in breach of the duty to take reasonable care not to make a misrepresentation.

Circumstances relevant to your duty:

Whether or not you took reasonable care not to make a misrepresentation will be determined with regard to all the relevant circumstances.

If we know, or ought to know about your particular characteristics or circumstances, we will consider these to determine if you took reasonable care not to make a misrepresentation to us.

We may consider the following matters to determine if you took reasonable care not to make a misrepresentation to us:

  • the type of consumer insurance contract in question, and its target market
  • explanatory material or publicity produced or authorised by us
  • how clear, and how specific, the questions we asked were
  • how clearly, we communicated to you the importance of answering those questions and the
  • possible consequences of failing to do so
  • whether or not an agent/insurance broker was acting for you, or
  • whether the contract was a new contract or was being renewed, extended, varied or reinstated.
  • You are not to be taken to have made a misrepresentation merely because you: • failed to answer a question, or
  • gave an obviously incomplete or irrelevant answer to a question.

Consequences if you fail to take reasonable care and do make a misrepresentation:

If you do not take reasonable care when answering our questions and the result is you do make a misrepresentation to us, we may cancel your contract or reduce the amount we will pay you if you make a claim, or both.

If your failure to take reasonable care not to make a misrepresentation to us is fraudulent, we may refuse to pay a claim and treat the contract as if it never existed.

In this document the terms “we”, “us” or “our” refer to Zurich Australian Insurance Limited ABN 13 000 296 640, AFSL 232507.

World Events and Claims Advice:

When events occur that affect new policies or affect our policyholders travelling in the area, we post relevant travel insurance advisory information here.

If you are planning to travel to a region mentioned in our claims advice section or you are already there, read through the relevant documentation to find out how this could influence your travel plans and your travel insurance policy.

Note: past advice may still be relevant, so please ensure you review all advisories before purchase.

Ongoing Worldwide Advice:

Coronavirus (COVID-19)

Zika Virus

See below for more alerts that may be relevant to you.

2021: Current Updates:

Update: Coronavirus (COVID-19)

30 June 2021

Update: Coronavirus (COVID-19)

21 June 2021

Existing Medical Conditions and Pregnancy

“Do any travellers have an Existing Medical Condition or Pregnancy?”

We call an Existing Medical Condition (EMC) any disease, illness, medical condition, dental condition or physical defect that you have or have had – even if you’re cured, or if it’s under control or in remission.

Some existing medical conditions are automatically included.

For others, you need to complete an online medical assessment by telling us all your conditions. If your conditions are approved by us, you can then decide to buy the cover you need. An extra premium applies.

That’s why it’s important you carefully answer these questions to understand if any traveller has an Existing Medical Condition that requires an online assessment.

ONLINE MEDICAL ASSESSMENT (ONLY IF REQUIRED)

Please refer to the PDS for a list of conditions automatically covered for free. If the customer does need to apply for existing medical condition cover, the process is easy, and the assessment outcome can be generated on the spot! If required the customer can access the online portal and complete the assessment themselves.

Declaration Form

This form includes important information and the declaration that needs completed and submitted.

Name of Traveler

Insert Quote Number for the policy of your choice. PLEASE NOTE: All Cover-More Quotes before 20 April 2022 are now invalid due to new policy wording.

Select: Yes or No to the General Advice question, below

I have read the general advice warning and this statement to my customer(s) and confirm they are aware of their duty to take reasonable care not to make a misrepresentation, including the consequences of making a misrepresentation. *
My customer has confirmed the information they provided to the questions asked (including information about Existing Medical Conditions) is true, and that they have taken reasonable care not to make a misrepresentation when answering the questions. *
I have given my customer the Combined FSG/PDS (hard copy or email) and advised them of the latest travel alerts and advisories that may apply to their trip, and where they can find this. *
I advised my customer of all the options available to vary the cover on this policy (including Existing Medical Condition cover), and confirm that the options selected have been chosen by the customer. *
Are any travellers travelling for 2 or more nights on a cruise on the sea or ocean, or on a river outside of Australia? *
Do any travellers require luggage cover? *
Do any travellers require cover for snow skiing, snowboarding or snowmobiling? *
Do any travellers require Adventure Activity cover? (Surfing automatically covered) *
Do any travellers require Motorcycle/Moped Riding cover? *
In the last 12 months, has any traveller been hospitalised or treated in the emergency department, seen a specialist, or had day surgery? *
Is any traveller: •taking prescription or over the counter medication to treat, control or prevent their condition? e.g. insulin for diabetes, aspirin for strokes, Paracetamol for back pain •having regular check-ups? •under investigation, waiting on a diagnosis or surgery? *
Has any traveller got a chronic, ongoing or reoccurring condition? e.g. arthritis or back pain *
Has any traveller ever had a medical condition or required surgery involving any of the following? •Kidneys, Liver •Cancer (even if in remission) •Joint, back or spine •Brain e.g. Dementia, Epilepsy, head injury, Tumours •Any heart-related condition e.g. Angina, bypass surgery, heart attack, irregular heart rhythms, stents •Strokes e.g. clots, Deep Vein Thrombosis, mini strokes, Pulmonary Embolism •Respiratory system e.g. Chronic Bronchitis, COPD, Emphysema *
If any travellers are pregnant: •Have there been complications with this or a previous pregnancy? •Is it a multiple pregnancy e.g.twins or triplets ? •Was the conception medically assisted? e.g. using assisted fertility treatment including hormone therapies or IVF (Pregnancy cover is limited to unexpected complications up to the 24th week. Childbirth or care of a newborn is not covered) *
Is any traveller experiencing any signs or symptoms where a medical diagnosis has not been sought? e.g. chest pain, shortness of breath, a persistent cough or unexplained bleeding. *