A pre-existing ailment, illness or condition is one where, after examining evidence, a medical adviser, or other relevant health care practitioner appointed by Queensland Country Health would consider that signs or symptoms would have been in existence at any time during the six months preceding the application for membership or upgrade of cover. You may have pre-existing condition, ailment or illness without being aware of it. In these cases, there is a 12 month waiting period before you are entitled to claim benefits for treatment. It is not necessary for the signs or symptoms to have been diagnosed by a doctor when a member joined or upgraded their level of cover.

Surgery for assisted fertility programs such as IVF or GIFT, Sterilisation or Vasectomy are elective and attract a 12 month waiting period.