What Every (Insured) Traveler Needs to Know about Pre-existing Conditions

16 April 2012

Travelers are unhappy when their insurance claim is denied due to a pre-existing condition.

This topic can be complicated, but we’ll make it easier to understand.

First, let’s start with a definition:

A pre-existing condition is any injury, illness, disease or other medical condition that occurs prior to the travel plan’s effective date and for which you had symptoms and sought diagnosis, medical treatment, and/or new prescription medications or a change in your current prescription.

Some travel insurance plans cover medical costs relative to pre-existing conditions by offering a waiver to the exclusion. Having pre-existing coverage means that the medical coverage provided by your policy is in effect because the pre-existing exclusion is waived.

Pre-existing conditions are initially an ‘exclusion’

Pre-existing medical conditions, or pre-ex, are automatically excluded from nearly all travel insurance plans.

Insurance companies need to exclude pre-existing conditions…otherwise you could wait until something goes wrong to buy insurance.

Travel insurance companies understand that medical conditions occur throughout your life, and they have designed a way to get coverage even if you have a pre-existing condition.

Many plans can cover Pre-ex with a waiver to the exclusion

You can get coverage for pre-existing conditions by purchasing the right plan.

Insurance companies have designed plans that allow you to have coverage even if you have a pre-existing condition.

They do this by adding a ‘waiver’ to the pre-existing condition exclusion.

This waiver overrides the exclusion, and essentially covers pre-existing conditions as long as certain conditions are met.

Specific conditions must be met

The pre-ex waiver has conditions that must be met for coverage to be valid.

1. You must be healthy, or ‘medically stable’, during the plan’s ‘look-back period’

Medically stable means that you have not had a new medical condition and no changes in prescription medications during the look-back period.

The look-back period is the amount of time (typically 90 days) prior to your travel policy’s effective date that the insurance company will review for evidence of pre-existing conditions should you file a claim.

2. You need to be healthy when you buy your insurance

Again, this is to prevent travelers from getting sick and trying to buy insurance after the fact.

3. You need to obtain confirmation from the insurance company (in writing) that you have cover for pre-ex conditions

If you declare your medical conditions to the insurer, they can make an informed decision and ensure peace of mind when you travel.

Medical records will be examined if there is a claim

If you file a claim, medical records will be examined during the claims process.

If your trip is cancelled due to the health of a covered family member, for example, their medical records will be examined for evidence of a pre-existing condition.

This is an important part of the claims process and it cannot be avoided.

Pre-ex affects both medical and cancellation coverages

This is a critical factor to pre-ex coverage: pre-ex affects both your medical and your trip cancellation coverage.

For example, if you have to cancel your trip because a covered family member is ill due to a pre-existing condition, you must have a plan with cancel for any reason coverage to be able to cancel your trip and get your money back.

What is the ‘Look-back Period’ and ‘Medically Stable’?

The look-back period is the amount of time prior to your travel policy’s effective date that the insurance company will review for pre-existing conditions if you end up filing a claim. If you were medically stable during the look-back period, it is not considered a pre-existing condition.

The term medically stable means that you’ve had no new medical condition and no prescription medication changes during the look-back period. You must be medically stable when you purchase the travel plan and if a claim is made.

So, what qualifies as a pre-existing condition?

SituationIs this a pre-existing condition?
You have high cholesterol. You’ve been under medical care and have been prescribed medication. There have been no changes to your medication and you have not sought additional medical treatment during the look-back period.No, because you were considered medically stable throughout the look-back period. Your travel medical coverage will be in effect without having to purchase a pre-existing condition waiver.
Your daughter has type 1 (juvenile) diabetes. She’s doing well, but her insulin requirements fluctuate on a daily basis. This is normal for diabetics.Yes, because insulin is medication and the fact that the does changes often means she’s not considered medically stable. You’ll need to purchase the pre-existing coverage waiver to have medical coverage on your trip.