A standard travel insurance policy will include coverage for pre-existing medical conditions, provided the policyholder meets the insurer’s stability requirements.
Unfortunately, each insurer defines stability in its own way—years after the Travel Health Insurance Association of Canada first tried to promote standard wordings. So we have compiled a list of the words insurers tend to use.
During a specified period, these health-related developments could void coverage for a pre-existing condition when travelling outside of Canada:
- Symptoms or signs of illness, whether new, more frequent, or severe
- New diagnoses or tests pointing to a deterioration in health
- New treatments, medical care, medications, dosages, or admissions to hospital
- Referral to a specialist, or a recommendation for treatments or tests
- A failure to act on the recommendation or referral, or a refusal to wait for test results before travelling
As a broker, you should expect your clients to question you about the rules. While all travel policies include a section of definitions, a common word like treatment may not be defined, and may not be clear to all readers.
A case study
A man is planning a trip and has purchased travel medical insurance. He develops chest pains and spends the night in a bed in an emergency ward. Tests reveal no heart or circulatory problems. Yet a doctor recommends a daily dose of children’s Aspirin and a visit to a family doctor. The family doctor suspects acid reflux. He prescribes medication for a month and orders tests that confirm his diagnosis. Later, he prescribes medication to use when necessary. The man decides on his own to consume less chocolate and coffee.
The acid reflux is now a pre-existing medical condition, for which he has been tested and has received a diagnosis. He has been treated for a month and given a further prescription. So he can postpone travel and buy a new policy once the required period of stable health has passed. Or he could travel as planned, and risk paying a medical bill if the symptoms recur while he is away. In that case, if he happens to slip and fall, his travel policy will cover him for this unrelated medical event.
Two travel policies make clear that their stability requirements differ for minor ailments. Travel Insurance Coordinators (requires Adobe Reader) and RSA Canada (requires Adobe Reader) policies would cover travel 30 days after a minor sickness or injury as long as it required medication for no more than 15 consecutive days, and the patient took no more than two visits to a family physician. Travel would not be covered if the illness or injury required hospitalization, surgery, or a referral to a specialist.
RSA and TIC plans will permit insured persons to have switched recently from a brand name to the same dosage of generic medicine, and to have adjusted a long-standing prescription for diabetes medication. RSA will also permit routine adjustments to Coumadin (a blood thinner that is also known as warfarin).
Be alert to subtle differences in the definitions of stable health. Do not assume all companies have the same wordings, or that policies will stay the same from year to year. Discuss current wordings with your clients, and stress the importance of matching the policy with their needs. Make sure to warn about the risk of travel if their health status changes.