How health history and genetic test results can shape life, travel and health insurance in Australia

A changing landscape for genetic information and insurance

Australians applying for insurance are often asked to share health information, but the rules differ sharply depending on whether the product is life insurance, travel insurance or private health insurance. A key shift is now underway for life insurance: 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 takes effect (expected in about six months), it will apply to all new life insurance contracts. The change is significant because it targets how insurers use certain kinds of genetic information in underwriting. At the same time, it does not rewrite the disclosure obligations that apply when people are asked questions during an application, nor does it automatically extend to travel insurance or private health insurance.

For consumers, the practical question is not only “What will insurers be allowed to do?” but also “What do I need to tell them?” and “What happens if I get it wrong?” The answers vary by product type, and there are also areas that still need clarification—particularly around how private health insurers may treat some genetic findings.

What the new life insurance law is designed to stop

The new legislation will prohibit life insurers from using “protected genetic information” in underwriting. In this context, underwriting refers to the process some insurers use to assess the risk an applicant brings as an insured person, based on information collected through questions in the application process.

“Protected genetic information” includes health information that predicts or infers a person’s risk of future disease based on genetic test results. In plain terms, if someone has taken a genetic test that indicates a higher risk of developing a disease in the future, life insurers will not be able to deny cover or charge higher premiums on that basis once the law is in force for new contracts. A commonly understood example is a genetic result that predicts a higher risk of cancer.

However, the definition is not unlimited. The legislation’s protection does not include an applicant’s actual diagnosis, even if that diagnosis was made using a genetic test. It also does not include family history of disease. Those distinctions matter because they shape what information life insurers can still legally consider when assessing an application.

Life insurance: risk-rated products and broad health questions

Life insurance is usually risk-rated (with some exceptions, such as certain group insurance arrangements through superannuation). Risk-rated insurance means different people can receive different terms based on their risk profile. Those terms can include different premium costs, exclusions for certain conditions, or rejection of an application.

Because underwriting is central to life insurance, applicants can be asked detailed questions about medical history. Life insurers can ask about the medical history of the applicant and their first-degree relatives—parents, siblings or children. Importantly, the questions are not limited to conditions that are currently symptomatic. Any medical history at any stage may be treated as relevant to underwriting.

Even with the upcoming ban on using protected genetic information, life insurers will still be able to consider:

• Actual diagnoses, including those identified through genetic testing
• Family history of disease, including diagnoses in first-degree relatives

This means that while predictive genetic test results will be off-limits for life insurers under the new law (for new contracts once it begins), other health-related information can still influence the underwriting decision.

Disclosure and “good faith”: why accuracy matters in life insurance

When applying for life insurance, applicants must answer in “good faith.” This includes a requirement to not make a misrepresentation about matters relevant to the application. The practical implication is that if an insurer asks a question that is relevant to underwriting, the applicant is expected to answer honestly and accurately.

There are serious consequences for concealing health information or deliberately misleading an insurer about health history. This is described as “fraudulent nondisclosure” and can lead to policies being voided—meaning the policy has no effect at all. In that situation, premiums paid over time can be forfeited.

For consumers, the key takeaway is that the new restrictions on genetic discrimination in life insurance do not remove the need to respond carefully to application questions. The prohibition is about how insurers can use protected genetic information in underwriting, not about whether applicants should answer questions truthfully.

Travel insurance: still risk-rated, and not covered by the new ban

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 to apply exclusions. Unlike private health insurance, travel insurance underwriting is typically more individualised, reflecting the insurer’s assessment of the traveller’s health risks.

Crucially, travel insurance will not be subject to the new laws, which are restricted to life insurance. That means travel insurers are legally allowed to consider genetic test results to assess a person’s future risk of disease as part of underwriting.

In practice, when people apply for travel cover, insurers will mainly ask about personal medical history, including pre-existing conditions and procedures the person has had. Family history may become relevant in certain circumstances, such as where the applicant has a hereditary medical condition.

For travellers who have undertaken genetic testing, this creates a different environment than life insurance under the new legislation. Even after the life insurance restrictions begin, travel insurers may still be able to treat predictive genetic information as relevant to underwriting decisions.

Private health insurance: community-rated premiums, but waiting periods can apply

Private health insurance in Australia operates under a different model: it is community-rated. Community rating pools risk across groups rather than underwriting individuals. 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.

That does not mean every consumer pays exactly the same amount. Premiums can vary based on where a person lives, and depending on the level of cover (commonly described as gold, silver or bronze).

While community rating limits the use of individual risk factors in pricing and acceptance, private health insurers can still take risk into account through waiting periods. Waiting periods do not affect the cost of premiums, but they can delay when a policy will cover treatment for certain conditions.

If a person has an existing medical condition, a health insurer can offer a policy but not cover treatment for that condition until the person has been insured for a set period. For most pre-existing conditions, the waiting period can be 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” in health insurance

In private health insurance, a pre-existing condition has a specific definition. It is:

“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 two practical implications. First, it focuses on whether signs or symptoms existed in the six months before the person became insured, rather than whether the person had a diagnosis years earlier. Second, the decision is ultimately made by a medical practitioner appointed by the insurer—not by the applicant and not necessarily by the applicant’s own doctor.

As a result, consumers are generally expected to disclose any condition for which signs or symptoms existed in the six months before the application. The definition also suggests that childhood conditions that no longer have signs or symptoms are not captured in the same way.

Because the insurer’s appointed medical adviser makes the final call, uncertainty can arise in borderline situations. The practical guidance in such cases is to answer questions honestly and, where uncertainty exists, provide supporting letters or evidence from a doctor.

The unresolved question: how health insurers treat predictive genetic results

One area that needs clarification relates to genetic testing and private health insurance waiting periods. The situation is relatively straightforward when a genetic test is used to diagnose a condition that has signs or symptoms: in that case, the genetic test and the condition are part of the applicant’s health information, and the insurer can apply a waiting period consistent with the rules for pre-existing conditions.

The more complex scenario is when a genetic test indicates a risk of future disease but the person does not currently have signs or symptoms of the disease. A widely cited example is a 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 because they carry the variant.

However, the concern is that health insurers could categorise such a genetic finding as a pre-existing condition and apply a 12-month waiting period for preventive care. Preventive care in this context could include procedures undertaken to reduce risk, such as a preventive mastectomy.

This is described as a murkier area where regulatory clarification would be helpful. The underlying tension is that community rating prevents insurers from charging more or denying cover based on genetic risk, but waiting periods can still shape access to benefits for certain kinds of care—especially where the insurer considers the matter to fall within the pre-existing condition framework.

Putting it together: the same health detail can mean different things

Consumers often assume that a single piece of health information—such as a recent operation, a family history of illness, or a genetic test result—will be treated consistently across insurance products. In reality, the same detail can have very different consequences depending on the type of insurance:

• Life insurance is usually risk-rated, and underwriting can consider personal medical history and first-degree family history. The new law will stop life insurers from using protected genetic information (predictive results) for new contracts once it takes effect, but it does not stop insurers from considering actual diagnoses or family history.
• Travel insurance is risk-rated and will not be covered by the new life insurance genetic protections. Travel insurers can legally consider genetic test results when assessing future disease risk, and they commonly focus on personal medical history, with family history relevant in some hereditary circumstances.
• Private health insurance is community-rated, so insurers cannot deny cover or charge higher premiums based on health risk factors, including personal or family history. But insurers can apply waiting periods, including up to 12 months for pre-existing conditions as defined by signs or symptoms in the prior six months, assessed by the insurer’s appointed medical practitioner.

If you disagree with an insurer’s decision: complaint pathways

Disputes can arise over premiums, exclusions, or whether a claim is covered—particularly where underwriting and disclosure intersect. If a consumer has a dispute and the insurer has not adequately addressed it, different complaint pathways apply depending on the product:

• For life insurance or travel insurance, complaints can be made to the Australian Financial Complaints Authority.
• For private health insurance, complaints can be made to the Commonwealth Ombudsman.

Key points to remember when applying

Across all product types, the safest approach is to treat application questions as important and to answer them honestly. The consequences of misleading disclosure can be especially severe in life insurance, where fraudulent nondisclosure can void a policy and lead to forfeited premiums.

At the same time, consumers should be aware that the rules are not uniform. The forthcoming life insurance ban on using protected genetic information is a targeted reform: it changes what life insurers can do with predictive genetic results in underwriting for new contracts, but it does not remove the relevance of diagnoses or family history, and it does not apply to travel insurance. In private health insurance, community rating limits pricing and acceptance decisions based on health risk, but waiting periods—and how certain genetic findings are classified—remain a critical practical issue where clearer guidance may still be needed.