Understanding Pre-existing Medical Conditions.

In my 42+ years of travel insurance experience I’ve often had the question asked of me as to what is considered a pre-existing medical condition? And how can I get that exclusion waived?

The answer to those questions are fairly easy to understand if you look at the particular company’s definition of pre-existing conditions or their pre-existing conditions exclusion (yes they all have them) and read them literally. The following is a typical pre-existing conditions exclusion:

“Pre-Existing Condition” means an illness, disease, or other condition during the XX day period immediately prior to your effective date for which you or your Traveling Companion, Business Partner or Immediate Family Member scheduled or booked to travel with you:

1. received, or received a recommendation for, a diagnostic test, examination, or medical treatment; or

2. took or received a prescription for drugs or medicine.

Item (2) of this definition does not apply to a condition which 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 xx day period before coverage is effective under this policy. 

The xx indicates the number of days that a company will look backwards from your coverage effective date. This time period usually varies between 60 to 180 for most vacation type of plans and up to 3 years for the travel medical plans. If you read this provision carefully you’ll see that sections 1 & 2 are very specific and will exclude from coverage any condition that meets this definition. It does have one exemption to the definition and that deals with the taking of a prescribed medication for a controlled medical condition and where the medication does not change during the entire time period. If it does change (for better or worse) or if the condition is not controlled throughout the entire period than it would be considered pre-existing and therefore not covered.

The above definition is fairly standard in most travel insurance policies however, they do change and you should always read the exact definition for the plan that you are thinking of buying.

Using time lines has always helped me understand pre-existing medical conditions and how they are excluded from travel insurance policies and has been helpful whenever I’ve trained travel insurance claim adjusters.

Most “packaged” travel insurance plans offer a “waiver of pre-existing conditions” as an inducement to buy the insurance early. Since the vast majority of trip cancellation claims are caused by the accident, illness, or death of a family member and a large portion of those claims could be traced to what would be considered a pre-existing medical condition than it makes sense to buy a plan with this feature.

article courtesy of John W. Cook from QuoteWright.com