Pre-Existing Conditions and Stability in Travel Insurance

/Pre-Existing Conditions and Stability in Travel Insurance
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Pre-Existing Conditions and Stability in Travel Insurance

Should you travel?

Deciding when and if you are well enough to travel when you have health concerns or after having had a health issue, is a discussion for you and your doctor. Once it’s been decided that you are well enough to travel, determining the type of insurance required and what is covered can be a daunting task. While this blog is not intended to replace the expert advice of an insurance broker, it may help you gain a better sense of the questions to ask and answers to expect.

Pre-existing Conditions: Excluded or not?

The term pre-existing condition is widely used and generally applies to a medical condition that is known prior to the effective date of coverage. Pre-existing conditions can be excluded from coverage but this depends on the type and specifics of the condition, the insurer and the stability. Just because you have an existing condition doesn’t necessarily mean you are permanently excluded from coverage.

How can “Stability” affect coverage?

Stability refers to the status of a condition and is a key factor in determining the insurability of certain pre-existing conditions. Stability is defined as the period of time your condition has remained unchanged prior to the effective date of coverage and is a measure of the likelihood of reoccurrence or complication from that condition. An unstable condition is identified if there is a planned or actual change in treatment by your physician in the form of recommendations, tests or medication alterations of type or dosage.

How can a Pre-Existing condition become insurable?

A simple example: Following a heart attack, Mr. X has a procedure to have a stent inserted in the problem artery. The heart attack and associated medical procedure now represent a pre-existing condition and the policy excludes heart-related medical costs. However, after a defined period (example: six months), the patient has fully recovered from the procedure and remained stable. Under this policy, his heart-related medical costs could again be covered under the policy.

A stable condition implies the chances of a relapse are not very high. The defined period for a condition to be declared “Stable” can vary from one condition to another and would restart any time there are changes as defined above.

Timing, sometimes, is everything

Pre-existing conditions, stability and the timing relative to the policy/trip effective date make things even more complicated. Insurance policies use the phrase “prior to the effective date of coverage” to define this timing. This term and how it applies to your situation can affect your coverage.

Here are a few examples:

  • You are planning a trip in six months. While planning the trip you also purchase travel insurance. Your application includes your medical status at the time of purchase. If in the lead up to your trip your medical situation changes, it may be considered a pre-existing condition since the effective date only begins on your departure.
  • You have an annual travel insurance policy, you plan to take 3 trips during the year. You take the first trip, but between the first and the second trip your medical situation changes. Even though you have an annual policy, each trip has its own effective date so while you didn’t have a pre-existing condition on the first trip, you do during the second.
  • You have a group benefits policy that provides for 60 days “out-of-country” coverage. Your trip will be for 75 days. You decide to buy Travel insurance for the additional 15 days. While you are away, during the first 60 days, you have an accident or become ill requiring medical care. This change in your medical status becomes a pre-existing condition for the extension policy (additional 15 days) and is automatically excluded for coverage on your 15 day extension policy.

What if I don’t disclose a pre-existing condition or change in Stability?
An insurance company can deny a claim if the application information was inaccurate or incomplete even if the claim is unrelated to a pre-existing condition.

Here are a few tips to avoid unpleasant situations and surprises:

  • Answer application questions truthfully and completely.
  • During the term of your policy report any changes in your medical condition.
  • When in doubt, ask your broker, your best resource to help you navigate the terms and conditions of your insurance policy.

Bon Voyage!

2018-07-06T09:13:09+00:00

About the Author:

Ogilvy Insurance