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Because the coverage for acute onset of pre-existing conditions (chronic and congenital conditions) is relatively new for visitors to United States and many people have questions and doubts about it, we would like to provide the following answers to some extent.
Please note that it is impossible to make a determination based on a hypothetical scenario and claims are always adjudicated based on the policy provisions. However, the questions below are answered to the best of our understanding based on our past experience. You can use this information to assist you in purchasing the best health insurance for visitors with pre-existing conditions.
Please note that your situation may not be as simple as described below and there may be many other factors. Final determination of medical expense eligibility will be made by the claims department AFTER the claim has been submitted (either by the provider directly or by the insured). The claims department will have the final authority to adjudicate the claim. Insubuy, LLC. or any of its agents, employees or affiliates would not be responsible for any disputes arising out of relying on this information as the examples below are simply generic illustrations and claim adjudication will be done according to the provisions of the insurance policy.
Currently, pre-existing condition coverage in USA visitor insurance is only available with Visitors Protect insurance with certain restrictions.
You can get coverage for the acute onset of pre-existing conditions to a certain amount in many of the plans for the persons of below a certain age.
An "Acute Onset of a Pre-Existing Condition" is a sudden and unexpected outbreak or recurrence of a Pre-Existing Condition(s) which occurs spontaneously and without advance warning either in the form of Physician recommendations or symptoms, is of short duration, is rapidly progressive, and requires immediate care. The Acute Onset of a Pre-Existing Condition must occur after the effective date of the policy. Treatment must be obtained within 24 hours of the sudden and unexpected outbreak or recurrence. A Pre-Existing Condition that is a chronic or congenital condition or that gradually becomes worse over time will not be considered Acute Onset. This benefit does not include coverage for known, scheduled, required, or expected medical care, drugs or Treatments existent or necessary prior to the Effective Date of coverage.
Acute onset of pre-existing conditions is described as above.
Acute onset of pre-existing condition must occur after the effective date of the policy. If the person already had a heart attack before buying the insurance policy, it is considered a pre-existing condition. This is not to be confused with a heart attack in the past (such as few years ago) and another heart attack occurs suddenly after the effective date of the policy.
Even though each case and each scenario is different, just to get some idea, some examples are:
However, based on the medical records and the attending physician's report, the insurance company's claims department will determine whether a specific claim falls under acute onset of pre-existing conditions or not. Please do not assume that all of the cases described above will be covered under acute onset of pre-existing conditions.
Even though each case and each scenario is different, just to get some idea, some examples are:
If some life-threatening emergency occurs all of sudden due to pre-existing conditions and you have to take treatment in the next 24 hours.
It is not meant to cover any routine maintenance related to pre-existing conditions such as diabetes supplies, kidney dialysis, blood pressure medicine, elective surgery, any foreseen treatment or anything that can reasonably be anticipated that it would be necessary. Of course, if you would like to get a second opinion about your sickness while you are visiting the USA, that is definitely not covered. These are some of the examples where the insurance company definitely is going to lose money and that is not the purpose of any insurance from anywhere. Even with acute onset of pre-existing conditions coverage, there must be an uncertainty about the likelihood of you needing the treatment after the effective date of the policy.
While those diseases are not excluded under acute onset of pre-existing conditions coverage, it is very unlikely for the person to get an acute onset of any of those conditions, as per the definition above.
You are welcome to discuss them with us. However, it is generally not possible to answer in Yes or No to such hypothetical scenarios. The determination is made by the claims department AFTER it already happens based on the attending physician reports and all the treatment and diagnosis records that are submitted. Each scenario is different and it is not possible to predict that scenario in advance.
No, each specific scenario is different. What may be true for many others may not be the same for you, as there are many medical factors.
No. Claims department have really nothing to discuss until you have the actual claim and they have your medical information available. No one can give you guaranteed answer for sure based on the hypothetical questions for something that may happen in the future.
Many plans will provide a good amount of coverage for persons below the age of 70, while a few others may provide a reasonable amount of coverage for persons until age 90.
Please read the FAQ article about Sudden and Unexpected Recurrence of Pre-Existing Conditions FAQ below.
In short, the coverage under 'acute onset of pre-existing conditions' is a lot broader and covers under a lot more scenarios compared to the coverage under 'sudden and unexpected recurrence of pre-existing conditions'.
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