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FAQ about pre-existing conditions and visitor medical insurance
Q:
What are the pre-existing conditions?
A:
Even though the precise definition of pre-existing conditions vary among various insurance companies
and different insurance products, following is a general description:
A pre-existing condition is defined as any injury, illness, sickness, disease, or other physical, medical, mental or nervous condition, disorder or ailment that, with reasonable medical certainty, existed at the time of application or at any time during the X years prior to the effective date of the insurance, whether or not previously manifested or symptomatic, diagnosed, treated, or disclosed prior to the effective date, including any subsequent, chronic or recurring complications or consequences related thereto or arising therefrom.
Q:
Are any pre-existing conditions
covered? If not, how does the insurance company
determine whether something was pre-existing or not?
Is there any medical exam to be done in the home
country or in the United States after
arrival?
A:
Each insurance company has its own period through which
pre-existing conditions are not covered.
For Inbound USA and Inbound Immigrant from Seven Corners, pre-existing
conditions in the last 6 months (1 year for age 70+) are
NOT covered. Please see brochure for complete
information.
For Liaison International from Seven Corners, pre-existing conditions in last 3 years are NOT
covered.
For IMG products, pre-existing conditions in last 3 years are NOT covered.
For Travel Insurance products such as Visit USA and WorldMed,
pre-existing conditions in last 3 years are NOT
covered on medical expenses.
For HCCMIS Atlas products, pre-existing conditions in last 2 years are not covered
while in Citizen Secure products,
pre-existing conditions are covered same as any other injury or illness if disclosed
on the application and not excluded or limited by a rider.
For Global Underwriters(Diplomat) products, pre-existing conditions
in last 3 years are NOT covered.
There is no medical examination to be done in the
home country prior to arrival or in the United States
after arrival. God forbid, if you have some medical
problem after arriving in the U.S. and during the period of
your insurance coverage, the U.S. doctor where you
would go for treatment would be able to determine
whether any condition was pre-existing or not. He/she
would be able to tell the insurance company whether
some treatment might have been received before the
insurance coverage started.
Generally high blood pressure, diabetes, heart disease,
AIDS, pregnancy, cancer, cataract etc. would be considered pre-existing conditions
as it would not have occurred overnight after buying the
insurance plan. However, there is no fixed rule and it is
extremely difficult to tell what would be considered a
pre-existing condition and what not to be considered.
And we can't list each and every disease or medical condition as there could be potentially millions of combinations.
Even though various number of years are mentioned above for which
the pre-existing conditions are not covered, there are some
conditions that would not be covered no matter how long ago
it happened if you are still taking medications regarding that disease.
E.g., if the person had a heart attack 10 years back, he is
quite healthy now but if he is taking medications currently
for it (even if it is something like one Aspirin a day), the condition
would be considered existing even today and would not be covered.
For a limited coverage for pre-existing conditions, up to a limited amount, and in limited
circumstances, please look at
pre-existing conditions coverage.
Q:
My mother-in-law has diabetes and she
needs to take insulin injections every day. Is that
covered in visitor medical insurance?
A:
No. That would be considered as
pre-existing condition and hence would NOT be
covered. She is in the pre-existing condition
duration exclusion period as defined in the
policy. It is advisable to carry enough medications from the home
country itself before traveling.
Q:
My father needs bypass surgery (or cancer treatment or cataract surgery or any other medical treatment).
I would like to bring my
father to the USA to get the treatment done here as the facilities
are better in the USA. Can I buy health insurance to cover that?
A:
No. That would be considered a pre-existing conditions and
will NOT be covered.
Q:
My father needs to go for kidney
dialysis twice a week. Is that covered in visitor
medical insurance?
A:
NO. That would be considered a
pre-existing condition and hence would NOT be
covered. He is in the pre-existing condition
duration exclusion period as defined in the
policy.
Q:
What is the point of buying insurance if it does not cover pre-existing
medical conditions? These are the ones we need to get covered. Probability
of other illnesses is very low anyway.
A:
Even though the insurance will not cover pre-existing conditions, it will
cover other conditions that were not pre-existing or unrelated to pre-existing conditions.
Insurance companies work on a risk basis, the lower the probability of paying the claims,
the less premium they would charge. The higher the probability (generally in case of elders),
the higher the premium they would charge.
When the insurance companies know for sure that they will have to pay claims after
the person buys the insurance, they do not want to insure those conditions because that
is a clear loss of money for them, that they know about in advance.
The reason they charge something like $100/month and provide $50,000 coverage is all
because the probability of the insurance company having to pay even $100 to you is quite less.
You may be worried about the pre-existing conditions. However, you never know what may
happen in the future. And you are insuring yourself against the unexpected. A person may
contract any new health problem such as a weather change, allergies in a new place,
change of food, cold, fever, flu, diarrhea, pneumonia, food poisoning, snake bits, getting
hit by a car, falling in the snow, or any other small or big health problems like a urinary tract
infection, heart attack for reasons not related to pre-existing conditions. Therefore, it is
very advisable to buy health insurance for visitors to USA.
For a limited coverage for pre-existing conditions, up to a limited amount, and in limited
circumstances, please look at
pre-existing conditions coverage.
Q:
I am willing to pay a higher premium, but could you suggest me the insurance
plan that would cover pre-existing conditions?
Q:
My father had a heart attack 8 years back. If he gets any heart related
sicknesses, will that be covered?
A:
According to most insurance companies' opinion, if he is taking any treatment or
any medications
currently (including any over the counter medicines), it will be considered
a
pre-existing condition, and it will not be covered. If not, at the time of the loss,
based on attending physician statement(APS), the claim adjuster will determine whether it will be covered or not.
Q:
I heard that if you don't sign any paper saying you are responsible for the medical expenses of your parents,
you can get away without paying the part of payment not covered by insurance. Is it true? If yes, then why should
we take insurance?
A:
That is really not true because of several reasons:
* For most of the relatives that visit you in the USA, you would have sponsored them. For that, you would have provided the I-134 form, Affidavit of Support, mentioning that you would take care of everything. It is possible to catch you based on that. (Some people argue that the I-134 is not legally binding affidavit of support. How is the hospital going to go to the USCIS/Dept. of State/Consulate and get all those documents? All these are very subjective and there is no precise answer for that. It is an open ended discussion.)
* More important than that, it is possible that some people might have got away without paying in earlier times. But once that happens in a given hospital, hospital administrators and their billing department get very smart. They don't want this to happen again. Therefore, many times, I have heard and seen for myself, that the hospitals ask for U.S. residents (who has SSN) to sign as a second guarantor, in case insurance does not pay or pays partially. Otherwise, they won't treat the patient.
And don't think you would be the first patient at a given hospital who did not have this experience or has not heard about this before. There will always be people ahead of you who did that somehow.
While it is true that everywhere in the U.S., it is a law that hospitals can't refuse the treatment in life threatening cases even if you don't have insurance, have no money or are illegal in the U.S. But that is not complete treatment, just the stabilizing treatment, which may be a very small fraction of the treatment you may need. And of course, that does not mean, it is free. They will come after you for that money for the treatment received. They may also be able to put the lien on the sponsor's property (car, house etc.) or get the sponsor's assets frozen until the debt is paid off. And of course, they won't give you full treatment if you can't pay or don't have insurance.
Now that leaves the cases where the hospital does not ask the U.S. resident to sign anything and it is not life threatening. That does not mean you can get away. As long as they have your address, hospitals and collection agencies will get after you and make you pay. I have also heard verbally and read in the discussion boards about the cases where the sponsor (of parents/in-laws or other relatives) was summoned by a sheriff (police) and had to appear in court and agree to pay all the expenses.
Q:
I want to invite my parents and they have pre-existing conditions. What is the solution?
A:
Unfortunately, there is no solution.
No insurance company will pay for it and when you invite them, you are simply taking the risk and be ready to pay the expenses yourself in case something related to a pre-existing condition occurs.
For a limited coverage for pre-existing conditions, up to a limited amount, and in limited
circumstances, please look at
pre-existing conditions coverage.
Q:
What if I can't afford to pay the high healthcare costs in the U.S. and no insurance will pay for pre-existing
conditions for visitors to USA?
A:
Well, that is the decision you need to make whether you really want to invite them to the U.S. in that case. Instead, consider visiting them in their country. This may sound harsh, but sorry, this is the reality.
Q:
My in-laws have high blood pressure and diabetes. I understand the no visitor medical insurance plan
is going to cover that and I am willing to take the risk. What precautions should I take for regarding their
health to minimize future potential problems?
A:
Blood pressure and diabetes are the 2 most common diseases older people visiting from India have. Most of the
time, such persons are in a good/stable health condition. However, they may require regular medications
and frequent check ups.
Ask them to get a thorough medical check up done before traveling to the USA. This is not required by the insurance
companies before you buy the insurance. However, it will be very helpful in discovering any unknown medical
issues, if any. It provides you with the peace of mind to travel without any worries if everything is fine.
Also, in case any of your relatives get into any new
medical conditions, it may be helpful to prove to the insurance companies that it was not a pre-existing
condition.
Carry a sufficient amount of medications from the home country before traveling to the USA. If you decide
to stay longer than earlier planned, and if you run out of the medications, you can also ask a relative
in your home country to send them by postal mail or courier, as long as they are not controlled drugs.
Persons suffering from high blood pressure and/or diabetes should consider self measuring equipments, available
in major pharmacy stores, online and wholesale places like Costco, Sam's Club etc. Most of them cost under
$50 to $100 and are very useful. You don't need to run to the doctor every time to get your blood pressure
checked. If any of the equipments require a doctor's prescription, you will have to pay for that doctor
visit yourself as that visit would be related to pre-existing conditions and not covered by any visitors
insurance plan. You should also be careful with your eating habits, changing weather, and allergies. It would be
helpful to walk every day and do some light exercises.
The host should not make hectic travel plans for their older visiting parents. At many tourist places,
there is a lot of walking to do for the site seeing. Keep their age in mind while making travel plans.
Q:
If my mother-in-law has diabetes and high blood pressure, won't any new medical conditions like
heart attack be considered pre-existing conditions as well? I guess the insurance company will try
to tie any new medical conditions with pre-existing conditions. If that is the case, why should I buy
visitors insurance?
A:
While it is possible that pre-existing medical conditions may cause some new medical conditions. If
that happens, then new medical conditions would also be not covered.
However, it is certainly possible that you may get into new medical conditions which are not related
to pre-existing conditions. And those will usually be covered.
Insurance company's claims department determines whether some conditions are pre-existing conditions
or not based on the attending physician statement, all medical records, and treatment records. Even many
insurance companies' claims department have doctors on staff to determine it medically.
Moreover, some companies like IMG use a completely independent peer review company in cases where claims
are disputed and appeals are filed. This is how the denials are overturned in some cases. This is
an important IMG behind-the-scenes service that most clients are not aware of.
(Earlier, we were not confident whether a peer review company was really independent from IMG as it was
hired by IMG. Therefore, we asked for the proofs and justifications for the same and we were finally
convinced that the other company was indeed independent. We were shown the certified statements from the
other company's doctor. It showed that the peer review works independently of IMG, when a claim was overturned then IMG promptly paid the claim.)
For a limited coverage for pre-existing conditions, up to a limited amount, and in limited
circumstances, please look at
pre-existing conditions coverage.
Q:
My sister is pregnant and I would like to invite her to the United States for delivery so that the
baby becomes a U.S. citizen. What kind of insurance plans are available for the maternity coverage?
A:
Unfortunately, there are no insurance products from any company anywhere that would cover maternity
expenses such as delivery if you are already pregnant.
You will need to pay for all the expenses yourself.
Q:
My father has pre-existing medical conditions. I understand that no insurance company will cover
pre-existing conditions for visitors to the United States. I can't afford the high cost of treatment
in the USA. Will the insurance company pay for sending him back to India in case he needs treatment
for pre-existing conditions?
Q:
My mother has diabetes and my father has high blood pressure. I completely understand that their daily
medications, insulin etc. will not be covered by the insurance. However, if an emergency arises because
of those conditions and they need to get admitted in the hospital, will the insurance plan at least cover
the emergencies?
A:
Complications or emergencies arising out of pre-existing conditions are also considered pre-existing
conditions.
For a limited coverage for pre-existing conditions, up to a limited amount, and in limited
circumstances, please look at
pre-existing conditions coverage.
Q:
My mother was diagnosed with breast cancer. She has already finished her chemotherapy treatment. However, she needs
to go through frequent check ups for monitoring purpose. Would that be covered?
A:
No. That would be considered as pre-existing conditions and not covered.
Q:
While looking at the
Patriot America brochure, I found that if the person
is below 70 years of age, and if I buy the insurance within 14 days of the initial trip deposit, the pre-existing conditions
would be waived. Could you please explain that?
A:
Patriot TRIP Lite is only for trip cancellation and that occurs before you start the trip.
Lets assume your father has a heart disease and is below 70 years of age. You buy Patriot TRIP Lite within 14 days of purchasing the air ticket to come to the USA. Your air ticket costs $1,500. Those tickets are non-refundable.
All insureds are medically able to travel in the date coverage is purchased.
Now, God forbid, lets assume that just a couple of days before coming to the USA, he gets a heart attack because of his pre-existing condition heart disease. Now, he is in the hospital and can't travel to the USA.
What will happen to the $1,500 he paid for his air tickets? Patriot TRIP Lite is the insurance to cover that air ticket cost or cancellation penalties.
Trip cancellation insurance starts from the next day of purchase and finishes the day the person starts his trip. After starting the trip, there is no trip to cancel and therefore there is no coverage. (If the person needs to go back to the home country early, lets say if their home is flooded or something, that is called trip interruption and not relevant to this discussion.)
In other words, it is an air ticket (or other pre-paid travel expenses) insurance for before starting the trip.
It does NOT cover anything at all if the insured needs medical treatment because of pre-existing conditions while in the USA.
Q:
I am seeking information about coverage for a particular health problem. Why is this not mentioned here?
A:
Please note that this web page is about FAQ (Frequently Asked Questions) and not the complete and exhaustive
list of all medical conditions
that people may have and the answers to coverage for that. This list of FAQ's is provided only for your convenience so that you get an overall idea and is not a legally binding contract, not an advertisement, and not any promise for any coverage. This web page does not list
the complete terms and conditions of any insurance plan as they are governed by the policy wording of each
insurance plan from a given insurance company and we have no control over it. If there is any discrepancy between anything mentioned here and the the policy wording of a specific plan, policy wording would override.
Important disclaimer: Please
note that we have tried to answer the questions to
the best of our knowledge. We make no guarantee of
the accuracy of these answers, as actual answers may
change from time to time as insurance companies
change their policies or because of any other reason.
We will not be liable in any case, for any problem
arising out of reading these questions and answers.
Please use this information at your own risk.
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