Of all the issues in travel insurance, pre-existing medical conditions seem to generate the most confusion. Three different readers have recently asked about this aspect of insurance:
"My husband and I will be traveling on a yacht for most of next year. Both of us have pre-existing heart problems (three and five years ago) but we're on medication and stabilized now. Can we get medical insurance to cover us?"
"If someone went on a trip two years ago, had a heart attack, and had a claim paid by his insurance company, can he qualify for travel insurance again? He is a diabetic and is taking insulin for it, but is in stable condition."
"In their waivers of the exemption for pre-existing conditions, are all insurance carriers bound by the 14-day rule or do some have other shorter windows?"
The short answer to the first reader is, "Yes, if you follow the fine print;" the answer to the second reader is, "I've never seen an application for travel insurance that asks for information about past illnesses or insurance claims;" and the answer to the third is, "Yes, some have windows shorter than 14 days." And although our readers' questions did not address the issue, the problems with pre-existing medical conditions apply to trip-cancelation, trip-interruption insurance, and emergency evacuation insurance as well as to medical coverages.
What Is a Pre-Existing Condition?
A basic principle in virtually all travel insurance policies is that the insurer will deny any medical claim based on a "pre-existing" medical condition. One typical insurance company describes a pre-existing condition as an illness or injury that you, a traveling companion, or family member were seeking or receiving treatment for or had symptoms of on the day you purchased your plan, or at any time in the 120 days before you purchased it. Specifically, the insurance would not pay off if you, a traveling companion or family member:
- Saw or were advised to see a doctor.
- Had symptoms that would cause a prudent person to see a doctor.
- Were taking prescribed medication for the condition or the symptoms, unless the condition or symptoms are effectively controlled by the prescription, and the prescription hasn't changed.
Those qualifications are pretty standard. The main variation is in the length of pre-purchase time: Some companies specify only 60 days rather than 120, but I've also seen others as long as 180 days.
Getting the Pre-Existing Denial Waived
Most issuers of travel insurance will waive the exemption for pre-existing conditions if you meet certain requirements. The same company cited above states that you, a traveling companion, or family member can have an existing medical condition and you will still be eligible for all coverage and assistance services, as long as:
- You purchase your insurance within 14 days of making your first trip payment or first trip deposit.
- You purchase trip-cancelation coverage that covers the full cost of all your nonrefundable trip arrangements.
- You are medically able to travel on the day you purchased the plan.
- The total cost of your trip is $50,000 per person or less.
As with the definition of conditions, those terms are typical. The main variation is that some companies establish a buying deadline as short as seven days; I've never seen any longer than 14 days.
In terms of language, some issuers are clearer than others about that full coverage requirement. The example I've cited clearly states that you have to buy insurance for all of the "nonrefundable" trip arrangements, while others omit "nonrefundable."
What to Do
I would guess that practically everyone over age 50 or so has at least one medical condition—as well as lots of younger people—that fits the insurance companies' definitions of a "pre-existing" condition. And keeping in mind that insurance companies love to nitpick claims and deny them if at all possible, make sure to comply with the fine print on those terms any time you buy travel insurance. Specifically, that means:
- Buy the insurance as soon as you make the initial payment.
- Insure the full value of your prepayments—even nonrefundable airline tickets from which you could recover at least part of the value. And make sure any policy you buy doesn't require that you include recoverable prepayments in your trip-cost figure.