Pre-Existing Conditions

tripsense-travel-insurance-medical-pre-exsisting-conditionsA pre-existing condition is a condition that is known at the time you purchase insurance.

Let’s think of the most extreme example.  You’ve just been diagnosed with a terminal illness and you decide to get life insurance.  Obviously, it’s too late – they won’t sell it to you, and even if you don’t tell them about your new diagnosis, when it comes time to collect, your beneficiaries will not get a cent because they will investigate before they pay the claim and find out that it was known at the time you bought the insurance.

With travel insurance, it’s the same thing.  If any of the covered risks are KNOWN at the time you purchase the insurance, it won’t be covered and the claim will be denied.  Let’s look at some common ones.

You have a very sick family member

Your parent or immediate family member had heart surgery a few months ago and is now recovering nicely at home.  You’ve been through the mill helping out and checking in, bringing meals and giving emotional support.  The worry and stress has you wanting to take a vacation.  You purchase cancellation insurance because maybe something will happen and you don’t want to lose all that money.

This risk is KNOWN at the time you buy the insurance and won’t be covered.  It doesn’t mean it never will be covered because your family member had a heart attack.  Pre-existing conditions can be covered if they are STABLE AND CONTROLLED – and this carries a specific definition of time and conditions that may differ on the age of the person in question and the type of coverage you purchase.

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What is STABLE & CONTROLLED then?

Each insurance policy is different, and the policy type and price will make a difference.  But let’s look at one example where the person in question has a pre-existing condition and have been out of the hospital for 3, 6, or 12 months (depending on the plan).  They have had no relapses.  They have had no INCREASE or DECREASE or change in medication.  This is the big thing – oftentimes medication is tweaked after hospitalization, and each time medication is changed it introduces new risk.  The time frame restarts again even if the patient is doing well and medication is reduced!  The patient must be free of any evidence that there are complications or new problems during this period of time.

If you or someone in your immediate family has a pre-existing condition, you should look carefully at the clauses in the policy that apply.  Package insurance (with cancellation and other coverage) often has less onerous conditions around this than medical only.

Does it mean that someone with a pre-existing condition cannot get insurance at all?

No, some pre-existing conditions will allow for a higher premium because they are not as risky – this often occurs with longer term illnesses that are not likely to flare up and result in unexpected emergency medical care.  For higher risk coverage, it’s possible to still be covered by purchasing an “underwritten policy”.  This is essentially a detailed medical questionnaire which can only be filled out by the person themselves and is sent to the insurance company for review.  Based on the specific answers to the questions, a premium is offered for coverage.  It is very important to answer these questions accurately and even have them reviewed by the attending physician because in the event of a claim, if the doctor contradicts the questionnaire answers, the claim could be denied.

If you fill out medical questionnaires annually, please read them carefully – there are limits of number of years since surgeries for example, where after a certain period of time coverage is denied.  Example, if you had heart by-pass more than ten years ago, often they will not cover it on general policies.  You forget about it because you feel perfectly healthy, but the insurance company sees increased risk.

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Other non-medical pre-existing conditions

It goes back to the same concept of being KNOWN at the time of purchasing the insurance.  If you are in the midst of a lawsuit and court dates are about to be decided, you may not get away with making a claim for being subpoenaed, especially if you are a litigant.

It’s tricky enough for us to wade through the pre-existing conditions exclusions of our own Manulife policy; finding, reading and interpreting your own credit card coverage (or trusting their call centre staff) is another matter.

So, if there’s a pre-existing condition, why would I still buy insurance?

Just because one risk is not covered, doesn’t mean that there are not other risks that could disrupt your vacation or put you in need of medical care.  Even if the pre-existing condition is not covered, one can still slip and fall, or another member of the travelling party could find themselves in need of coverage.

Our Concierge Plan has “Change of Mind” coverage, which while limited (it won’t cover your entire loss), it will give you some protection even for a pre-existing condition – because you can claim for ANY reason – including “I just don’t feel like going”.

Supplier Cancellation Waivers (not insurance) can afford some protection with respect to pre-existing conditions.  These waivers are similar to change of mind, and often will not result in refunds, but they will allow for example, postponing a trip to a later date (waiving change or cancellation fees), applying a credit towards a new trip, and other options.  Be careful as they often will have limitations of application within close proximity to departure – ie, they are not valid within 7 or 48hrs of departure, etc.