Pre-existing Medical Conditions

Travel Insurance and Pre-Existing Medical Conditions

Answering the questions concerning travel insurance and pre-existing medical conditions such as  "Does travel insurance cover pre-existing medical conditions?", "Which travel insurance covers pre-existing medical conditions?", and "What travel insurance policies are best for pre-existing medical conditions?" and more.

 As we get older, the chances of getting a pre-existing medical condition increases. According to a 2017 Gallup poll, 1 in 4 Americans have a pre-existing medical condition. One of the top reasons that travel insurance claims are denied is due to pre-existing medical conditions. With more Americans traveling each year and with more travelers aging, the amount of travelers with pre-existing medical conditions has risen. Through this article we hope to give you a better understanding of how travel insurance policies define pre-existing medical conditions, how they are applied to the travel insurance policies, and how you can get coverage for them.

It is important to state up front that Pre-Existing Medical Conditions are excluded from most coverages in travel insurance policies. That being said there are ways to get pre-existing medical conditions covered(waived in insurance speak) and we will look at those ways as we get further into the article.

What is a Pre-Existing Medical Condition?

Most travel insurance companies define a pre-existing medical condition in a similar fashion. In most cases pre-existing medical conditions are injuries or a sickness that exist prior to you purchasing the insurance. Any injury or sickness that you’ve sought medical treatment for, or have had a referral to seek medical treatment for, or have exhibited symptoms for which you should be seeking medical treatment for would be considered a pre-existing medical condition and excluded from the policy. 

A Pre-Existing Medical Condition is

• Any sickness or injury that someone has:

  • Sought medical treatment for; or

  • Been referred for medical treatment; or

  • Have exhibited symptoms for which should be medical treated

A concern that many travelers have is how long the travel insurance policy will look back into their medical history. Thankfully, none of the travel insurance plans look back indefinitely into someone’s medical history when determining whether or not you have a pre-existing medical condition. The amount of time that travel insurance companies look back into someone’s medical history is known as the Pre-Existing Medical Conditions Period.  

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What is a Pre-Existing Condition Period?

This is how far back the travel insurance policy will look into someone’s medical history.  How far depends on the type of policy you’re looking at, whether it’s a comprehensive package policy (the ones that include trip cancellation/interruption) or the Travel Medical plans.  

For the travel insurance policies with trip cancellation/interruption coverage, the pre-existing medical conditions period ranges from 60 to 180 days depending on the policy.  With some of the travel medical plans, the pre-existing medical conditions period can range up to 3 years. The less they look back into someone’s medical history, the better it is for you.

This look back period starts the day you’ve purchased the insurance with most plans. So any injury or sickness that someone has sought medical treatment for, had a referral to seek medical treatment for, or has exhibited symptoms for which they should be seeking medical treatment for during the Pre-Existing Medical Conditions Period would be considered a pre-existing medical condition and excluded.  Treatments, referrals or symptoms that existed prior to this period are not considered pre-existing medical conditions.

The Pre-Existing Medical Condition period is:

• How far the travel insurance policy looks back into someone’s medical history prior to purchasing the insurance

How far do they look back?

• 60 to 180 days with Comprehensive Package plans

• Up to 3 years with Travel Medical plans

Who does the Pre-Existing Medical Conditions Exclusion Apply To?

With comprehensive package policies, the exclusion applies to the insured, insured’s traveling companion, and immediate family members of the insured or traveling companion. Policies are almost evenly divided on whether or not the exclusion extends to non-traveling family members. This is an important point if you're concerned about an elderly family member who is not traveling and who has a pre-existing medical condition. If you are, then you should pick a plan that offers a pre-existing medical conditions waiver, or doesn’t apply the pre-existing medical conditions exclusion to immediate non-traveling family members.

With Travel Medical plans, the pre-existing medical condition exclusion applies only to the insured.

The Pre-Existing Medical Condition Exclusion applies to the following people:

• Comprehensive Package Plans - the insured, traveling companions, and immediate family members

  • Some plans apply to both traveling and non-traveling family members

• Travel Medical Plans - only the insured.

How Do I Cover Pre-Existing Medical Conditions?

Is there any way you can get coverage for pre existing medical conditions? YES, there is. With the trip cancellation/interruption plans, there are usually two exceptions to the pre-existing medical conditions exclusion:

• You purchase a plan that offers a Pre-Existing Condition Waiver, which usually have 3 conditions you need to meet in order to qualify for it:

  • it requires you to purchase the plan within 14-21 days from your first trip payment; and 
  • insure to the full trip cost; 
  • You are physically fit to travel when you buy the insurance

• If you don't qualify for the waiver most plans exclude from the pre-existing conditions exclusion(yes an exclusion in an exclusion) the taking of a prescribed medication for a condition that is controlled throughout the pre-existing condition period. Most comprehensive package plans will not exclude taking a prescribed medication for a controlled condition as long as the condition and the medication have both remained unchanged during the entire period.

It is important to note that in the above statement concerning comprehensive package plans, unchanged means absolutely no change.  If the medication dosage has been decreased during the pre-existing period, even though it was an improvement, it’s still a change in the medication. Also along these lines would be changing from a name brand medication to a generic one - the insurance companies consider that one a change as well. An important distinction to remember, this is a feature of the comprehensive package plans - not all travel medical plans have this exception. With these plans any medication taken, regardless of whether or not you are stable, is considered to be a form of medical treatment, and therefore a pre-existing medical condition - so be sure to read your policy carefully.

If the root cause of your claim is due to a pre-existing medical condition as defined in the policy and you did not qualify for a pre-existing medical condition waiver, then your claim will be denied.

Pre-Existing Medical Conditions and Comprehensive Package Plans

With the package policies, most commonly know as travel insurance for trip cancellation and trip interruption, what benefits are affected by pre-existing medical conditions? The answer is nearly all of them. The pre-existing medical conditions exclusion applies nearly to all coverages, namely trip cancellation, trip interruption, travel delay, medical and emergency medical evacuation.  

Comprehensive Package Policy Pre-Existing Medical Conditions Exclusions apply to the following benefits:

• Trip Cancellation/Trip Interruption

• Travel Delay

• Medical 

• Emergency Medical Evacuation(not all policies exclude pre-existing medical conditions from the emergency medical evacuation benefit)

Pre-Existing Medical Conditions and Travel Medical Plans

How do travel medical plans differ from the comprehensive package plans?  For starters, most of the travel medical plans have much longer pre-existing medical condition periods - up to 3 years in some cases. Also, most travel medical plans do not have the provision concerning prescribed medications and being medically stable. Most of them are more restrictive in how they define a pre-existing medical condition. However, we are beginning to see more of these plans offer coverage for the sudden or acute onset of a pre-existing medical condition.

Travel Medical plans

• Pre-existing conditions period up to 3 years

• Generally more restricting

• Some offer coverage for Acute Onset of a Pre-Existing Medical Condition

What is an Acute Onset of a Pre-Existing Condition?

Most plans define it as the sudden and unexpected reoccurrence of a pre-existing medical condition.  Depending on your age and whether or not you have a primary health care plan, the benefit amounts available to you for Acute Onset can be limited.  For example, depending on the policy, some plans restrict the amount of medical for insureds starting at ages 64 and up to anywhere from $2,500 to $100,000 of medical coverage.  Some of the plans do not offer coverage for Acute Onset of a pre-existing medical condition for travelers over 70, while other cap this off for travelers age 80 and over. Evacuation limits can also be affected for acute onset, in most cases, there will be a limit of $25,000.  While coverage for acute onset can work for some, these plans tend to better suit younger, long term travelers rather than older ones.  

Acute Onset

• Covers Acute Onset of a Pre-Existing Medical Condition

• Medical Limits can be limited

• Emergency Medical Evacuation can be limited

• Benefit amounts can be limited by the following

  • Ages 64 and older

  • Primary health insurance

• Better suited for younger travelers

What Travel Insurance is Best for Pre-Existing Medical Conditions?

Best Pre-Existing Medical Conditions Travel Insurance For Trip Cancellation and Trip Interruption - Comprehensive Package Policies

First, do you, any family members, traveling companions, family members of traveling companions, have any pre-existing medical conditions you're concerned with? Do they meet the definition of a pre-existing medical condition as stated in the travel insurance policy? If the answer is yes, then the best travel insurance plans to look at are those plans that offer the pre-existing medical conditions waiver. As long as you qualify for the waiver, pre-existing medical conditions would be covered, so be sure to start looking at those plans as soon as you make your initial travel deposit.

What if you are ineligible for the waiver? If it's an immediate family member who isn't going with you, look at those plans that don't apply the pre-existing medical conditions exclusion to immediate non-traveling family members. 

Best Pre-Existing Medical Conditions Travel Insurance For Travel Medical Policies

If you're a younger traveler, you can look at those plans that offer coverage for an Acute Onset of a pre-existing medical condition.  Travelers 64 and older would be better served with getting travel medical coverage through a comprehensive package policy.

How Travel Insurance Companies Determine Pre-Existing Medical Conditions

How do they determine if something is a pre-existing condition? It's actually very simple. Travel insurance claim personnel are trained to line up the important dates into a time line which will objectively tell them if the medical condition is pre-existing. The important dates include: 

• date of plan purchase,

• date pre-existing conditions period begins, e.g., plan purchase = June 1st, 2019 - 180 days = December 3rd, 2018.

• date of departure,

• date of first trip payment,

• date/s of treatment taken from Physician's statement (part of claim form), and

• date first symptoms appeared for current treatment taken from Attending Physician's statement.

If the dates of treatment or first symptoms fall between the date of plan purchase and the first day of the pre-existing period than the condition would be considered pre-existing.