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

A major change for life insurance: genetic test results and underwriting

Australia’s 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, including death cover, income protection, disability cover, and trauma/critical illness cover.

For consumers, the headline is straightforward: life insurers will be prohibited from using “protected genetic information” in underwriting. In practical terms, this means a life insurer will not be able to deny you cover or charge you a higher premium simply because you took a genetic test that predicts a higher risk of a future disease (for example, a genetic result indicating a higher risk of cancer).

However, the details matter. The new restriction is focused on predictive genetic information—information that forecasts or infers a person’s risk of future disease based on genetic testing. It does not remove an insurer’s ability to consider other categories of health information that are already part of standard underwriting.

What counts as “protected genetic information”—and what does not

The legislation’s key concept is “protected genetic information.” This includes health information that predicts or infers someone’s risk of future disease based on genetic test results.

But there are important exclusions:

• Actual diagnoses are not protected. If a person has been diagnosed with a condition, that diagnosis can still be relevant to underwriting, even if the diagnosis was made via a genetic test.
• Family history is not protected. A person’s family history of disease can still be used by life insurers in underwriting. For example, if you or a sibling has been diagnosed with cancer, that information may still be legally taken into account.

This distinction is central to understanding what the new law changes—and what it does not. The law is aimed at preventing discrimination based on predictive genetic risk, not at removing insurers’ ability to assess risk based on a person’s own medical history or their family history.

Why underwriting and disclosure still matter for life insurance

Underwriting is the process insurers use to assess the risk an applicant brings as an insured person. When you apply for life insurance, you are typically asked a range of questions designed to gather information relevant to that risk assessment.

Life insurance is usually risk-rated (with the exception of some group insurance through superannuation). Risk-rating means people with different risk profiles can be offered different terms. Those terms may include:

• Different premium costs
• Exclusions for certain conditions
• Insurance being rejected altogether

Life insurers can ask about the medical history of an applicant and their first-degree relatives (parents, siblings, or children). This is not restricted only to conditions that are currently symptomatic. Any medical history at any stage may be considered relevant.

Applicants must answer in “good faith.” This includes an obligation not to make a misrepresentation about matters relevant to the application. The consequences of getting this wrong can be serious. Concealing health information from a life insurer, or deliberately misleading them about health history, may amount to “fraudulent nondisclosure.” This can lead to a policy being voided—meaning it has no effect at all—and premiums paid over time may be forfeited.

Even with the new genetic protections, the broader framework of disclosure and underwriting remains. The change is specifically about limiting the use of predictive genetic test results, rather than removing the need to answer underwriting questions honestly and fully.

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

The new legislation is restricted to life insurance. Travel insurance will not be subject to the new laws.

Like life insurance, travel insurance is risk-rated. Travel insurers can ask for health information when deciding whether to offer cover, what it will cost, and whether exclusions should apply. Because travel insurers are not covered by the new life insurance restrictions, they are legally allowed to consider genetic test results that assess future risk of disease as part of underwriting.

In practice, when applying for travel cover, insurers will mainly ask about your personal medical history. This can include 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.

The key point for travellers is that the legal position differs by product type. A consumer might assume the new protections around genetic test results apply broadly, but under the information available so far, they are limited to life insurance contracts.

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

Health insurance in Australia operates under a different model. It is community-rated, which means risk is pooled across groups of people rather than underwritten individually.

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 based on individual risk factors like medical history.

That said, health insurers can still take health risk into account through waiting periods. A waiting period does not change the cost of premiums. Instead, it affects when certain benefits become payable.

If you have an existing medical condition, a health insurer can offer a policy but not cover treatment for that condition until you have been insured for a set period. The maximum waiting periods described are:

• Up to 12 months for a pre-existing condition
• No more than two months for psychiatric, rehabilitative, or palliative care, even for pre-existing conditions

What is a “pre-existing condition” for health insurance purposes?

For 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.”

There are several practical implications embedded in that definition:

• The focus is on whether signs or symptoms existed in the six months before the person became insured.
• This does not include childhood conditions that no longer have signs or symptoms.
• The decision is ultimately made by a medical practitioner appointed by the insurer, not by you or your own doctor.

Because the insurer’s appointed medical adviser makes the determination, the safest approach is to answer questions honestly and to provide supporting letters or evidence from your doctor if there is any uncertainty about whether something should be disclosed or how it should be characterised.

Where genetic testing becomes unclear in health insurance

One area flagged as needing clarification is how genetic testing interacts with health insurance waiting periods.

If a person has had a genetic test to diagnose a condition with signs or symptoms, that information must be disclosed to a health insurer, and the insurer can apply a waiting period.

The more difficult scenario is where a genetic test indicates a risk of future disease, rather than confirming a current condition with signs or symptoms. An example given 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. Yet, the situation is described as “murkier” because 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 a preventive mastectomy. The point is not that this will always happen, but that the current framework leaves room for uncertainty about how insurers might apply the pre-existing condition definition to predictive genetic results. Regulatory clarification on this issue would be helpful.

Different insurance products, different rules: a practical comparison

For consumers trying to understand what needs to be disclosed and how decisions are made, it helps to compare the three product types side by side.

• Life insurance: Usually risk-rated. Insurers can ask about your medical history and first-degree relatives’ medical history. You must answer in good faith and avoid misrepresentation. New legislation will prohibit life insurers from using “protected genetic information” (predictive genetic test results) in underwriting for new contracts once the law takes effect.
• Travel insurance: Risk-rated. Insurers can ask about personal medical history, including pre-existing conditions and procedures. Family history may be relevant in some cases (such as hereditary conditions). Travel insurance is not covered by the new life insurance genetic restrictions, so travel insurers are legally allowed to consider genetic test results that indicate future disease risk.
• Health insurance: Community-rated. Insurers cannot deny cover or charge higher premiums based on personal or family medical history. Premiums can vary by location and level of cover. 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). Genetic testing raises unresolved questions when it indicates future risk rather than current disease.

Why “good faith” disclosure is still essential

Across insurance types, one consistent theme is that applicants are expected to answer questions truthfully and completely. For life insurance in particular, the consequences of deliberately hiding relevant health information can be severe, including a policy being voided and premiums forfeited.

Even where a product is community-rated (health insurance), the disclosure and assessment process still matters because it can affect waiting periods and when benefits become available. The definition of a pre-existing condition, and the fact it is assessed by an insurer-appointed medical practitioner, means that clear and accurate information can be important if questions arise later.

Where there is uncertainty—especially around how genetic information might be interpreted in health insurance—the prudent approach described is to answer questions honestly and provide evidence from your doctor to support your position if needed.

What to do if you disagree with an insurer’s decision

Disputes can arise about premiums, cover, or the way information has been assessed. If you have raised an issue with your insurer and it has not been adequately addressed, there are external complaint pathways available, depending on the type of insurance:

• Life or travel insurance: complaints can be made to the Australian Financial Complaints Authority.
• Health insurance: complaints can be made to the Commonwealth Ombudsman.

What remains to be clarified

The legislative change for life insurance provides a clearer rule about the use of predictive genetic test results in underwriting, but it does not eliminate the role of medical history, diagnoses, or family history. Travel insurance remains outside the new protections, meaning genetic test results can still be considered there. Health insurance is protected from risk-based pricing through community rating, but waiting periods and the definition of pre-existing conditions can still create practical consequences—particularly where genetic testing indicates future risk rather than current illness.

As the new life insurance legislation comes into effect and as questions around genetic testing and health insurance continue to be discussed, consumers will benefit from clearer regulatory guidance—especially on how predictive genetic results should be treated when someone is seeking preventive care.