A Southern Cross Health Society policyholder has criticised the insurer for classifying her peri/menopause as a pre-existing condition, a move she describes as discriminatory. Southern Cross maintains its stance is consistent with underwriting policies aimed at protecting the broader membership base.
The 53-year-old woman, who requested anonymity, told Stuff that she was informed by Southern Cross that “any investigation or treatment related to perimenopause/menopause is not able to be covered.” This included consultations with an endocrinologist and related medical tests.
“Peri/menopause is a stage of life. It is not a condition, disease, or disorder. This is discrimination,” she said. “It is akin to excluding me for being female, or being of a certain age. It looks, smells, and feels like discrimination.”
She obtained her Southern Cross policy in April. Prior to that, she had begun hormone replacement therapy (HRT) for hot flushes, which is publicly funded. She also used medication for anxiety related to perimenopause but ceased usage before the policy was activated.
In an earlier phone call with a Southern Cross representative, she claimed it was agreed exclusions would apply only to her known symptoms at the time. She told Stuff that she accepted this position as reasonable. However, she later received correspondence from an underwriter stating that broader exclusions would apply to all menopause-related health events.
Andrea Brunner, chief operating officer for Southern Cross, said the insurer defines pre-existing conditions as “any health condition, sign, symptom, or event occurring or existing that the policyholder or dependant was aware of, or should reasonably have been aware of, before the policy start date.”
“Not all applicants experiencing peri/menopause will necessarily receive an exclusion,” Brunner said. “It is dependent on whether they are experiencing symptoms and/or receiving treatment at the time their policy is taken out.”
Brunner said the woman’s HRT use and ongoing symptoms constituted a pre-existing condition. That this “represents a risk relative to the potential for claims associated with ongoing medical consultations, prescriptions, or other charges.”
She also said that unrelated future conditions would remain covered and that exclusions could be reviewed if symptoms ceased and HRT treatment ended.
Southern Cross provided the woman with an audio recording of her initial policy discussion. Complaints against insurers can be filed with the Insurance and Financial Services Ombudsman Scheme, but a spokesperson said such cases fall outside its jurisdiction if they relate to a refusal to offer cover.
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