Acute Onset of Pre Existing Conditions Explained

In order 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 is always recommended to review individual plan definitions in the Description of Coverage for specific details.

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 at the time of application or within a period of time immediately preceding the travel insurance plans certificate effective date. It is important to note that most travel insurance policies do not provide coverage for pre-existing conditions.

An acute onset of a pre-existing condition is defined as a sudden and unexpected recurrence of a pre-existing condition that occurs spontaneously and without advance warning (either in the form of physician recommendations or symptoms), is of short duration, is rapidly progressive and requires immediate medical attention.

The above definition does not cover all the aspects of an acute onset of a pre-existing condition. Many insurance buyers believe the misconception that any sudden manifestation of symptoms is covered under acute onset of pre-existing conditions coverage, when in fact the occurrence must meet specific guidelines to be considered an acute onset and many of these guidelines vary by plan.

For example, if a medical condition like cancer has existed in a person for some time before the insurance policy was bought, and was diagnosed at the time the person had a medical incident, he or she may not qualify for acute onset of pre-existing condition coverage.

Keep in mind that travel insurance is designed to provide coverage for emergencies, accidents and any new and unexpected injury or illness that may occur while abroad. It is not meant to replace the domestic or preventative care the insured would receive at home for existing conditions. If the traveler is in poor health or at high risk for a medical event, it is likely best for them to refrain from travel.

Certain scenarios might further help understand the terms of this coverage. Let's take the example of Mr. Smith. He suffers from a heart ailment and had a heart attack in the past. The doctor has advised him to manage his conditions with medication, exercising daily and not participating in any stressful activities that can worsen his condition. Let's assume he has a sudden heart attack. He may not be covered under acute onset of pre-existing conditions if he finds himself in the following scenarios:

Scenario 1
Scenario 1

He participates in adventurous sports activities like bungee jumping. If he is rushed to the hospital complaining of heart-related issues during or after the activity, he may not be covered under acute onset of pre-existing conditions coverage because he violated certain conditions and precautions associated with heart ailments.

Scenario 2
Scenario 2

Mr. Smith misses his medication, or takes half of the recommended dosage, or does not take regular dosage, he may not covered under acute onset of pre-existing conditions because he failed to follow the recommendations prescribed by his physician.

Scenario 3
Scenario 3

Mr. Smith does not follow recommended exercise regimen, general health and diet guidelines.

In all the above scenarios, Mr. Smith failed to follow the guidelines and take adequate precautions to manage his pre-existing condition.

If Mr. Smith had followed the recommended guidelines from his physician, like following a proper diet and exercise routine, taking his medication as directed and refraining from adventurous sports activities that cause over-excitement, he would be more likely to be eligible for acute onset coverage. However, it is important to note that just because a condition is under control does not mean coverage is guaranteed, and every individual situation is different. Additionally, it is always up to the attending physician to determine if the incident can be categorized as an acute onset of a pre-existing condition.

Finally, in order to be eligible for acute onset of pre-existing coverage the insured has to take responsibility to keep the pre-existing condition under control. The insured may be eligible for acute onset of pre-existing condition coverage if he or she suffered a sudden and severe manifestation of pre-existing condition in spite of all the efforts to manage it. The medical conditions, doctor's diagnostic reports, and tests must satisfy the insurance benefit guidelines in order to receive coverage.

Disclaimer

Information provided here is high level, provided for your convenience and information purpose only. Please review the Evidence of Coverage and Plan Contract (Policy) for a detailed description of Coverage Benefits, Limitations and Exclusions. Must read the Policy Brochure and Plan Details for complete and accurate details. Only the Terms and Conditions of Coverage Benefits listed in the policy are binding.