While many visitors insurance plans can offer coverage for the acute onset of pre-existing conditions, most do not provide coverage related to pre-existing conditions themselves.
As many people purchase visitors insurance for parents or elderly relatives visiting them in the USA, the option to have pre-existing condition coverage is preferable. Luckily, Visitors Protect insurance can offer coverage for pre-existing conditions in certain situations.
However, this does not mean that all pre-existing conditions are covered in every situation, or that the insurance will pay to the policy maximum for care related to pre-existing conditions. In order to help you understand the benefits and exclusions, we offer the following FAQ.
What is as a pre-existing condition?
A pre-existing condition is generally defined as any medical condition that existed before the effective date of the policy. Examples could be conditions such as hypertension, cancer, diabetes, or epilepsy.
What requirements must my parent/relative meet to be eligible for coverage of pre-existing conditions with Visitors Protect?
The insured must be determined to be medically fit for travel. If you attempt to submit a claim close to the travel date and it is determined that the insured was not medically fit for travel, the claim could be denied. Before traveling to the USA, it might be helpful to get a doctor’s certificate stating that the person is medically fit for travel.
The insured also cannot be traveling to the USA solely for the purpose of medical treatment. If it is discovered that this is the case, some or all claims could be denied.
Finally, coverage for pre-existing conditions can only be provided for those conditions or treatments that are not excluded from coverage by the policy.
What pre-existing conditions are excluded from coverage by Visitors Protect?
Visitors Protect will not provide coverage for pre-existing conditions related to urinary tract infection (UTI) for the first 90 days of the effective date that requires treatment of the insured person in a hospital as an inpatient.
Visitors Protect also does not provide coverage for charges related to maternity and newborn care, mental or nervous disorders, preventative care including routine physical examinations and immunizations, elective treatment, or investigational/experimental surgeries or treatment. For a complete list of exclusions, please read the plan’s certificate wording.
If my father has been previously diagnosed with atrial fibrillation (AFib) and the doctor orders an echocardiogram or other testing related to his AFib, would it be covered by the insurance?
So long as your father is determined to have been medically fit to travel, the plan could provide coverage in accordance with the schedule of benefits for pre-existing conditions.
If my mother has been diagnosed with cancer and wants to come to the USA for treatment, would it be covered as a pre-existing condition?
No. The insurance does not cover pre-existing conditions in situations where the insured is traveling to the US solely for the purpose of medical treatment.
My father is very sick and wants to travel to the US to attend an important family event. If he suffers an illness due to one of his pre-existing conditions, would the insurance cover it?
The insurance will only provide coverage for pre-existing conditions if he is determined to have been medically fit for travel. If you submit a claim and it is determined that your father was not medically fit for travel, the claim could be denied.
What is the out-of-pocket cost for the treatment of pre-existing conditions with Visitors Protect insurance?
With Visitors Protect, there is a deductible of $1,500 per illness or injury for care related to pre-existing conditions. This means that you would have to pay $1,500 to satisfy the pre-existing condition deductible before the insurance begins to pay anything. The regular plan deductible is waived and no coinsurance applies for care related to a pre-existing condition.
What is the maximum amount the insurance will pay for care related to a pre-existing condition?
If the insured is age 69 or younger, the plan would pay a maximum limit of $25,000 for care related to eligible pre-existing conditions. If the insured is age 70 or older, the plan would pay a maximum limit of $20,000.
Even if you have purchased coverage with a policy maximum of $250,000 for your 65-year-old father, the plan would only cover a maximum of $25,000 for care related to pre-existing conditions.
More Information
Before purchasing any visitors insurance plan, be sure to read and understand the certificate wording so you are aware of all coverage details and exclusions. If you have further questions regarding what is covered, please contact our office.
Please note that the examples in this article are purely hypothetical scenarios, and presented for informational purposes only. The final determination of coverage eligibility will be made by the claims department of the insurance company’s plan administrator after the claim has been submitted along with the attending physician’s statement and medical records. Insubuy, LLC, its agents, affiliates, and employees are not responsible for any disputes related to the hypothetical situations described above. All claim adjudication will be in accordance with the provisions of the insurance policy.
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