Acute Onset of Pre-Existing Conditions Explained

To understand acute onset of pre-existing conditions, you need to first understand the difference between a pre-existing condition and an acute onset of a pre-existing condition. Definitions may vary by plan, and it's always recommended to review individual plan definitions in the Description of Coverage for specific details.

It is up to the policy provider during the claims process to determine the final outcome of whether your specific condition will be covered under your policy. Please go over any questions or concerns with your policy’s customer service to answer any questions you may have. Also, should something happen, make sure to keep any and all paperwork and documentation from the doctors that have treated you.

What is the Difference Between Pre-existing and Acute Onset of Pre-existing Conditions?

A pre-existing condition is defined as an injury, illness, sickness, disease, or other physical, medical, mental, or nervous condition, disorder or ailment (whether known or unknown) that, with reasonable medical certainty, existed prior to or at the time of applying for travel medical insurance. Most travel insurance policies don't cover pre-existing conditions.

The acute onset of a pre-existing condition is one where you know you have a condition you have been treated for in the past, but then you experience a very sudden, unexpected health issue that came out of nowhere and you need immediate treatment. You must be treated within 24 hours of onset of symptoms.

For example - you are currently dealing with kidney stones that have not passed yet and you purchase travel insurance, then proceed on your trip. Even though they are painful and you may eventually need medical attention, this is pre-existing and most likely not be covered.

If however, you have not had any recent problems with kidney stones and then suddenly, out of nowhere, you have another kidney stone that causes extreme pain and you need to see a doctor, this may be considered an acute onset of a pre-existing condition. If you have a travel insurance policy that is currently in effect, this sudden health issue may be covered (final determination from the policy provider).

Examples of an acute onset of a pre-existing condition:

• You suffer from, and have been treated in the past for asthma. You use an inhaler or take medication for this condition either daily or as needed. As you are traveling, you have a sudden asthma attack, cannot breathe, and need to immediately be seen by a physician and are taken to urgent care or to a hospital to be treated. This may be considered an acute onset of a pre-existing condition.*
• Five years ago you suffered a heart attack. Since that time you have been healthy and are following doctor’s recommendations. While traveling, you suffer another heart attack. This can be an acute onset of a pre-existing condition, as you were treated before, but this is out of nowhere, sudden, and needs immediate attention.*

Examples of pre-existing conditions:

• You suffer from epilepsy. Due to the nature of this chronic disease, it is considered a pre-existing condition because a seizure is always a possibility at any given time. You may still need medical attention, however, even with an active travel insurance policy in place, this most likely will not be covered.*
• You are being treated for cancer. Before your policy was in effect, you were handling your treatments well. Then while traveling, you have a set back or different health issues occur due to the cancer diagnosis or treatments. This is pre-existing and most likely will not be covered.*
• You are pregnant. You decide to take a trip and purchase travel insurance. While traveling, there is an issue with the pregnancy or you go into labor. This is a pre-existing condition and most likely will not be covered.*

*Disclaimer: these are just examples and it will be up to the attending physician's medical report and the insurance company's claim department to determine whether a condition was deemed an actual acute onset or not.

Also, it should be noted that not all the examples described above would be covered as an acute onset.

We strongly recommend that you read the policy documents and understand the eligibility, coverage benefits and the limitations of any policy you're considering. Please reach out to clear up any confusion or questions you may have about what your policy covers.

Travel medical insurance is not meant to replace the domestic or preventative care insurance coverage that would allow their physician to treat them should they need treatment for their pre-existing conditions. If a traveler is in poor health or at high risk for a medical event, it's likely best for them to refrain from travel.