Do Travel Insurers Cover Pre-existing Conditions?

Given that most people have some health imperfections, it would be unreasonable—and bad business—if travel insurers precluded all pre-existing conditions from coverage.

High blood pressure, high cholesterol, irregular heartbeat, circulatory issues, and many other symptoms and conditions that can be controlled and stabilized by medications and periodic physician assessments. These types of things are routinely covered in travel insurance policies—if the insurers are made aware of them before issuing the policy, and if the insured customers understand the limitations placed on that benefit and coverage.

In covering pre-existing conditions, the most important thing insurers need to know is whether or not they are stable, how long have they been stable and what medications and treatments they have required to keep them stable. Essentially, what risk are insurers undertaking in covering them?

This leads to the biggest question of all: what is “Stable,” anyway?

Many Canadians, before leaving on longer trips, visit their family physicians for a checkup and, hopefully, are given a “clean bill of health” to travel. That’s a good thing. But the family physician’s “okay” is not the same as is the definition of “Stable” in the policy or the application for coverage. They serve different purposes and it’s important to know the difference.

Family physicians often don’t reveal everything that’s in their medical records to their patients: they may not want to unnerve them needlessly, perhaps there’s an issue that’s too complicated to explain quickly and may not require immediate intervention, or maybe the doctor just doesn’t want to spoil his or her patient’s vacation for something that doesn’t appear urgent.

As a result, most travel insurers are pretty precise in defining Stable—in objective, measurable terms that can be documented over specified periods of time (e.g., 365, 90, 30 days) prior to the date of coverage:

Have there been any new or recurring symptoms? Has a doctor determined that the condition is worsening? Has a doctor treated, investigated or prescribed or changed (i.e. increased or decreased) medication(s) for the condition or related conditions? Has the patient been referred for consultation to a specialist or tests, or is awaiting the results of a test? Has the patient complied with all of the doctor’s directions, taken their medications as prescribed, followed up on visits and referrals? Failure to comply with doctors’ orders is justification in itself for denial of a claim.

Any of these situations, or others listed in the insurer’s definitions, can be considered an “instability”.  There may be indication that some form of medical intervention might be necessary within the term specified by the policy.

The customer can be certain that to effectively determine the pre-existing nature of their conditions and their stability (according to the insurer’s definition of “Stable”); claims examiners will requisition all of the medical records and charts from their physicians, including lab tests and hospital records, to determine what visits they have had with their doctors, the purposes of those visits, their changes in medication, treatments given and tests provided, as well as observations their doctors may or may not have passed on to them.

It may seem like an inconvenience to read through similar listings in varying policies and applications, but most of these questions require only a “Yes” or “No” answer. Yet to medical underwriters, such information can be vitally important in accurately assessing the risk they are taking in insuring the customer. They have no other source of medical knowledge about that applicant.

Once they have that information they can offer coverage that is appropriately suited to each applicant to provide the peace of mind that travel insurance was designed for.

Trained and experienced agents selling travel insurance products are acutely aware of the need to help applicants understand and comply with pre-existing and “Stable” conditions requirements. They can be your best source for understanding those elements of the policy that are most pertinent to your needs, and helping you make sure you’re in compliance with the “fine print.”

 

Do you have questions about your stability status? Call an expert agent today.

Leave A Reply