Introduction
When you are traveling, pre-existing medical conditions can be of big concern. Most travel insurance plans usually exclude any claims arising from pre-existing medical conditions. However, with careful planning and if certain conditions are met, you may be eligible for the pre-existing conditions waiver. In other words, exclusions for pre-existing conditions would be waived under certain circumstances and you would get coverage for pre-existing conditions related claims which could be for trip cancellation, trip interruption and medical claims. Such waiver would be very helpful to those travelers who have chronic but well-managed medical conditions who would be able to travel worry-free knowing that their pre-existing conditions could be covered. Pre-existing condition exclusions and waivers usually apply to you, your traveling companion and non-traveling family members as well. You may not know medical conditions of your family members and the chances are even less that you would know the medical conditions of your traveling companion's family members. Therefore, having a pre-existing condition waiver is very helpful.
Definition
Even though the exact definition of pre-existing conditions varies in different products, this is a representation of the language used in one of the policies:
Pre-Existing Condition:
An illness, disease, or other condition during the sixty (60) day period immediately prior to the Effective Date for which You, a Traveling Companion, or a Family Member booked to travel with You:
- exhibited symptoms that would have caused one to seek care or treatment; or
- received a recommendation for a test, examination, or medical treatment; or
- took or received a prescription for drugs or medicine.
Item (3) of this definition does not apply to a condition that is treated or controlled solely through the taking of prescription drugs or medicine and remains treated or controlled without any adjustment or change in the required prescription throughout the sixty (60) days period before the Effective Date.
Please note that this definition is only for the trip cancellation insurance, and is NOT applicable to travel medical insurance which has an entirely different definition.
The Affordable Care Act (ACA), also called Obamacare, requires pre-existing conditions be covered. However, the ACA does not apply to travel insurance.
The pre-existing condition exclusion usually does not apply to repatriation of mortal remains, loss of checked luggage, baggage delay, AD&D (Accidental Death and Dismemberment) or Collision Damage Waiver.
Eligibility
The pre-existing condition exclusion can be waived if:
- You purchase the travel insurance on the date of the initial initial trip deposit or within 7-30 days of the same, depending upon the specific policy. Such duration of 7-30 days after your initial trip deposit is called an advantage period. Some policies may also offer this waiver as long as you buy the insurance prior to making the final trip payment.
- You purchase the insurance for the full cost of your trip, as it is required by most plans. Some companies require you to insure only the prepaid, non-refundable trip costs. In the later case, if you add any subsequent arrangements to the same trip, you would need to include them in the trip cost by the date of payment or deposit for such additional arrangements. Do not round down the trip cost as it will disqualify you for the pre-existing conditions waiver.
- You are medically stable to travel when travel insurance is purchased.
- You must cover the entire length of your trip, and not just a portion of it.
As long as the above conditions are met there is usually no additional paperwork required, nor is there any additional fee for this benefit. Even if you are traveling within the advantage period, you may still have the pre-existing condition waiver.
However, it is important to note:
- Certain medical conditions would still be excluded such as pregnancy, and mental or emotional disorders.
- Some policies may provide a reduced medical maximum for pre-existing condition related claims.
- Some policies may not provide a pre-existing conditions waiver if the trip cost is very high, such as over $50,000.
- Even with the pre-existing conditions waiver, all losses caused by pre-existing conditions may not be covered. For example, if your loss could have been reasonably foreseen at the time of purchasing the insurance it may not be covered.
Look-back period
This is a duration anywhere between 60 to 180 days prior to the effective date of the travel insurance. Depending upon the specific insurance policy, the administrator will review, or "look back" at, your medical records to determine if the claim was due to any pre-existing conditions.
If you had symptoms and/or were treated or had a change to your prescription medications during the look-back period, those medical conditions would be considered pre-existing conditions.
If you were medically stable during the look-back period, then your medical conditions would not be considered pre-existing conditions for travel insurance exclusion purposes.
Medically Stable
You could be considered medically stable if, during the look-back period, your medical condition did not change or become worse in any manner, you were not diagnosed with any new medical conditions, you didn't go through any treatment, you were not prescribed any new medications, there were no changes in your prescription medications, you had no pending or initiated treatments, scans, or test results.
Examples
Even though insurance policies vary and the specific scenarios differ, the examples below should help you understand how the pre-existing condition exclusion and waiver may apply:
- While you are traveling abroad, your non-traveling eligible family member who suffered from a pre-existing condition passes away. If that person was medically stable, if you had a pre-existing conditions waiver, then you could be covered for trip interruption benefits to cut short your trip.
- You have a pre-existing medical condition that has a sudden recurrence for which you need medical treatment. You could be covered if you were either medically stable during the look-back period or you had a pre-existing condition waiver. Without any of that, your medical claim would be denied.
- You have high cholesterol or high blood pressure for which you take daily medication as prescribed by your physician. There have been no changes to your medication and you didn't seek any additional medical treatment during the look-back period. If your condition is considered medically stable, then your pre-existing medical conditions could be covered.
- If you have diabetes and your insulin dosage changes often, you probably would not be considered medically stable. Therefore, you could be covered for the pre-existing conditions only if you qualify for pre-existing condition waiver and you purchase a travel insurance plan that included the coverage.
- You had a heart attack five years ago, now you are on regular medication and medically stable. You should generally be covered for such pre-existing conditions.
Conclusion
Purchase travel insurance as close to initial trip payment as possible and get the pre-existing conditions waiver.