Eliminating the Confusion from Pre-existing Medical Condition Coverage in Travel Insurance.

We recently blogged about why travel medical insurance is a good idea, especially when traveling outside the United States. However, even when you purchase travel insurance with health coverage, it may not cover everything. If you have pre-existing medical conditions it may exclude you from certain types of travel medical coverage. In fact, pre-existing medical conditions are among the biggest “gotchas” in travel insurance and among the most confusing to navigate. Insurance typically only covers you for unknown risks at the time you buy the insurance. If you know that a risk already exists, that could affect your ability to travel, then you might not be covered for this risk.

Here are some things you need to know about pre-existing medical conditions as they related to travel insurance:

Many people believe that a pre-existing condition waiver covers all the people defined in a trip insurance policy, but this is not always the case.  Often language in the policy will state that preexisting condition waivers only affect the medical treatment coverage or cancellation coverage for the passengers who are being insured to travel. This is specifically defined in both the US Fire and Nationwide policies on TripInsurance.com, and pre-existing condition waivers are not applicable for your ailing family members who are not going on the trip. Read the policy language carefully!

Let me give you an example of how the pre-existing condition waiver can improve your trip insurance coverage. Let’s say you are diabetic, and you have been having trouble balancing your insulin, and have been treated by your doctor for this condition in the 90 days before you paid your initial trip deposit.  If you don’t have a pre-existing condition waiver in your trip insurance policy, then you are not covered for medical problems on your trip having to do with your diabetes. This includes any medical treatment or even medical emergency evacuation because this problem would be considered a pre-existing condition. If you have a pre-existing condition waiver, then medical treatments would be covered. Some policies include this pre-existing condition waiver as a feature of the policy, provided you buy the coverage within 14 days of paying your initial trip deposit.

Do you always need this kind of waiver? Say you have a diagnosed heart condition or are diabetic.  You are on prescribed medication, but your doctor has not had to change your medication in the last 90 days, and the condition is “under control.”  The ailment is probably not considered a preexisting condition; your medical condition is considered stable. So if you suffer a heart attack or have an insulin attack while traveling, it may be covered because this is a new and dramatic change in your health condition.

The determination of whether or not a medical condition is covered has a lot to do with your doctor’s reports, and whether your medical records show that you have been treated for the condition in the 90 days prior to the purchase of the travel insurance. The insurance company will try to ascertain whether you knew about the medical problem when you bought the insurance. If you buy within the 14 days of your initial deposit, and have a pre-existing condition waiver, then the claims process becomes a bit easier because it eliminates the debate as to whether the medical condition was a problem when you bought the insurance. Having the pre-existing condition waiver will save a lot of time processing your claim. Without it, the insurance company will have to request a copy of your medical records to investigate the claim. With the waiver, they don’t have to do the investigation, and may be able to pay the claim from the doctor’s bills you have submitted.

When it comes to processing travel insurance claims for pre-existing medical conditions there are two basic considerations: 1) was the traveler’s health stable? and 2) was there a downturn in health within 90 days prior to travel?

The overriding factor is whether or not you are physically fit to travel. A company won’t insure you if you are not fit to travel. A common example is a woman who will be late in her pregnancy by the time of the trip.  You can’t be covered under travel insurance unless you are considered medically fit to travel at the time of purchase, or don’t already know that you will have trouble traveling ( i.e pregnancy) by the time the trip starts.  If you have a relative who is ill and you want to purchase a trip to give them an incentive to recover, then you need to get cancel for any reason coverage because standard cancellation and medical insurance may not cover the loss.  If a dramatic change in the traveler’s medical condition affects the trip, you may not know if it will be covered by trip cancellation insurance until a claims adjuster gets a copy of the medical records from the doctor.

A pre-existing condition waiver does not affect coverage for family members that become ill and cause you to cancel your trip.  For example, if a parent is already in hospice at the time you buy your trip and the trip insurance and their medical condition gets worse, you are probably not covered for trip cancellation. If they pass away, you probably would be covered because death is generally always considered a dramatic change in health condition.

If you are worried about insuring yourself or a loved one because of a current health condition, always look for a policy that contains a pre-existing condition waiver, and always buy your insurance within 14 days of your initial trip deposit.  If you have any questions we have a staff of professionals available 24/7 to help you select a policy.

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