What Does the Term Pre-existing Condition Really Mean?

With American politicians struggling aggressively to reform their health care system, we have been hearing much about covering the “uninsured” and those with “pre-existing conditions”—concepts which to Canadians may seem alien.

In Canada, virtually all residents are covered from birth so there are no uninsured—with a few rare exceptions, but those numbers are minute. And since all medically-necessary services are covered by provincial health plans, “pre-existing condition” seems an abstract term.

But when Canadians travel out of the country, the term takes on life and meaning, as it is a crucial element in the validity of supplemental private travel insurance.

Actually, most private American health insurance plans include coverage for “out of area” services, and those cover pre-existing conditions. So the pre-existing conditions issue in the US is primarily focused on those who have no health insurance because they are unemployed or work for small businesses that don’t provide it as a benefit.

Essentially, all private travel insurance sold in Canada has limitations about covering medical emergencies that are related to conditions or symptoms that existed prior to the effective date of coverage, or some specified period before that date—say, 30 days, or 90, or 365.

In some policies, if those conditions or symptoms are known to the insurer they may offer some limited coverage depending upon the severity or type of symptoms. Or they may offer coverage for everything but those specific defined conditions.  But they must be told about the conditions or symptoms and they must specifically confirm their terms of coverage related to them when you buy your policy.

Some credit card plans, usually issued only for short time frames such as 15 or 30 days, will offer coverage but exclude any pre-existing conditions, period. And many will not cover older age groups, say 55 or older.  Make sure you ask.

If you’re looking for a standardized definition of pre-existing condition that will apply to you regardless of the plan you buy, you won’t find it. Travel insurers haven’t been able to write a definition they can all agree on. So whenever you buy trip coverage, discuss it with your insurer and make sure you understand it before you answer any health questions.

I suggest that if you buy your insurance from a travel agent, bank, auto club, or other affinity group, talk to an agent who specializes in travel insurance and can get into the details with you if you have health issues or are in the care of a physician for a new or recurring condition. Best if you can speak with a customer service agent representing the insurer directly.

 

What do you consider a “condition”?

Are high blood pressure, high cholesterol, diabetes, enlarged prostate, heartburn considered pre-existing conditions? Yes.  Will they disqualify you from coverage? Not necessarily—it depends on whether they are stable and controlled, how many medications you take, what your doctor is doing to treat you. In most cases you’ll be fine, just make sure you answer the health questions accurately.

Remember that private health insurers want to sell you policies. If they rejected everyone who was on high blood pressure or cholesterol medication, they wouldn’t be in business long. There are too many of us.

Just understand what it means. And if you read only one part of your travel policy, read the part on pre-existing conditions. Don’t skip that.

 

Are you ready to start investigating travel insurance plans that support your pre-existing condition? Contact us for a personalized walk-through of your options.

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