The short answer
A pre-existing condition is anything you had symptoms of, sought advice about, or were treated for before your cover started — whether or not it was formally diagnosed. Insurers respond in one of four ways: accept at standard rates, load the premium, exclude that condition, or decline.
Outright declines are less common than people fear. Exclusions and loadings are the normal outcome, and they vary a lot between insurers for the same condition.
Last reviewed 2026-07-30
The four outcomes, in order of likelihood
| Outcome | What it means |
|---|---|
| Standard terms | Covered normally. Common for well-controlled or historical conditions. |
| Premium loading | Covered, at a higher price — often expressed as a percentage above standard. |
| Exclusion | Covered for everything except that condition and things related to it. |
| Decline | No cover offered. Least common, and often insurer-specific rather than universal. |
How the different covers treat them
Health insurance — the strictest
Pre-existing conditions are generally excluded, and for some categories permanently. Southern Cross operates a moratorium-style approach where qualifying pre-existing conditions may become covered after three years of continuous cover on some plans. nib applies waiting periods that typically run from 12 months to four years — but permanently excludes pre-existing cardiovascular, cancer, hip and knee, back, transplant and reconstructive conditions on its Premium and Standard Hospital covers.
Both positions are summarised from the insurers' published material as at July 2026; plans change and you should check the current policy document.
Life insurance — the most forgiving
Because it insures death rather than a specific illness, life cover is often available at standard or lightly loaded rates for conditions that would be excluded outright on a health policy. A well-managed condition with a good prognosis frequently gets standard terms.
Trauma and income protection — condition-specific
These sit in between. A history of back problems commonly draws a back exclusion on income protection; a history of depression or anxiety commonly draws a mental health exclusion or a shortened benefit period. Those exclusions are significant, because back conditions and mental health are two of the largest causes of long-term work absence in New Zealand.
A decline from one insurer is not a decline from the market.
The biggest risk is not applying. It is switching.
This deserves its own heading because it is the most expensive mistake in New Zealand health insurance.
Suppose you have held health cover for eight years and, in year four, developed a heart condition — covered, because it arose while you were insured. Then someone offers you a cheaper premium with a different insurer. If you switch, you are underwritten fresh. That heart condition is now pre-existing, and the new insurer will very likely exclude it — permanently.
You have saved $40 a month and lost cover for the one thing most likely to happen to you. This is not a hypothetical; it happens constantly, and it is a large part of why "just compare and switch" is bad advice on health cover in particular.
Non-disclosure: why over-disclosing is always right
You have a duty to disclose what you know when you apply. Insurers can decline claims where something material was not disclosed, even when it seems unrelated to what you are claiming for. People under-disclose for understandable reasons — they forget a consultation from six years ago, or they assume something minor does not matter.
The correct instinct is the opposite: disclose everything, let the underwriter decide what is material, and get the outcome in writing. A policy with a known exclusion you understand is worth far more than a policy that looks complete and quietly is not.
What to do if you already have a condition
- Apply anyway. The most common reason people have no cover is that they assumed they could not get it and never asked.
- Apply through someone who knows the market's appetites for your specific condition.
- Do not cancel existing cover until new cover is confirmed and you have compared the exclusions.
- Ask about review. Some loadings and exclusions can be reviewed after a period of stability — a few years without recurrence, or resolved risk factors. Almost nobody goes back and asks.
- Get whatever you can get. A policy with an exclusion still covers everything else, and everything else is most of what might happen to you.
Common follow-up questions
Is high blood pressure a pre-existing condition?
Yes, if you were diagnosed, treated or investigated for it before cover started. In practice well-controlled hypertension is one of the more insurable conditions — it commonly draws standard or lightly loaded terms on life cover, though it may attract exclusions relating to cardiovascular conditions on health cover.
What if I had something years ago and it resolved?
Disclose it anyway. A resolved condition with a clean history for several years frequently attracts standard terms — but it needs to be on the application, because a claim declined for non-disclosure of something that would have been accepted is the worst possible outcome.
Can an exclusion be removed later?
Sometimes. Insurers will occasionally review an exclusion or loading after a defined period of stability. It is not automatic and it will not happen unless someone asks on your behalf. Worth raising at every policy review.
Is endometriosis a pre-existing condition?
If it was diagnosed, investigated or symptomatic before cover started, yes. Gynaecological conditions are frequently excluded on health cover, and the treatment of them differs meaningfully between insurers — which makes it a case where where you apply matters more than usual.
Keep reading
This page is general information about how insurance works in New Zealand. It is not regulated financial advice and it does not take your situation into account. For advice about your own cover, talk to a licensed financial adviser.