Purchasing a travel medical insurance plan for your trip abroad is one of the best things you can do to protect yourself financially in the event of an unexpected illness or injury. As you compare plans and determine which is best for your needs, it’s important to also educate yourself about what exactly travel medical insurance covers and what it doesn’t, also referred to as exclusions. Exclusions are certain types of medical treatment or services that will not be eligible for coverage under your visitors insurance plan.
Due to the short-term nature of travel medical insurance policies, they aren’t designed to cover any and all medical treatment received during your travels. Instead, a travel medical insurance plan covers you for any new illnesses or injuries that occur after the start date of your policy to protect you if an unforeseen emergency happens in the midst of your trip. Since these plans are more limited in coverage in comparison to a domestic health insurance plan, there are some exclusions to be aware of that will help you better understand your travel medical insurance policy.
The coverage of treatment related to pre-existing conditions is the most common exclusion that is often ignored or misunderstood by travel medical insurance policyholders.
An attending physician will determine whether a condition was pre-existing with reasonable medical certainty, whether or not that condition was known or unknown to the policyholder.
Pre-existing condition exclusions include (but are not limited to):
- Pre-existing conditions prescriptions refill
- Hospitalizations related to pre-existing conditions
- Regulatory lab work for pre-existing conditions
- Treatment for genetic disorders
- Mental health
While pre-existing conditions are a common exclusion in travel medical insurance plans, some plans may offer coverage for the worsening of pre-existing conditions or the acute onset of pre-existing conditions.
Acute Onset of Pre-existing Conditions
The acute onset of a pre-existing condition is a sudden and unexpected recurrence of a pre-existing health condition that previously occurred but that is not a chronic condition, is not currently active, and no medications are being taken to control the condition.
There are some travel medical insurance plans which do offer coverage for treatment related to the acute onset of a pre-existing condition. However, it is best to review a plan’s coverage details to fully understand what this type of coverage entails.
Preventative Care or Routine Care
Any type of preventive health care or routine treatments are also excluded from most travel medical insurance plans. Travel medical insurance is designed to offer temporary coverage for unexpected illnesses or injuries, which is why routine or preventative care is excluded as it is considered non-emergency care that you would typically seek under your domestic health insurance plan back in your home country.
Preventative care and routine care treatments include (but are not limited to):
- Well visit checkups
- Vaccinations or immunizations
- Maternity care
- Standard vision care
- Routine dental services
- Maintenance medications
Elective treatments are also excluded, and are considered any type of treatment or services you seek that are elective in nature, meaning that you are choosing to receive the treatment, whether physician recommended or not, and while the treatment may be beneficial to you, it is not urgent or absolutely essential.
Example of elective treatments include (but are not limited to):
- Voluntary testing/lab work
- Second opinions
- Elective/planned surgery
- Medical equipment like hearing aide/BP machine
Dental and Vision
Both regular dental and vision care is excluded from travel medical insurance plan coverage. For dental services, visits such as dental cleaning, root canals, fillings, and any other dental procedures are not eligible for coverage. For vision, eye exams, prescription lenses or glasses, cataract or glaucoma surgery, and other standard vision-related visits are excluded.
However, in some cases, an emergency dental or vision treatment may be covered under some travel medical insurance plans. For example, an emergency eye injury or sudden eye pain that is not related to a corrective procedure could be considered a medical emergency. Additionally, a dental emergency such as a dental accident or sudden tooth pain may also be eligible under certain plans.
Another common exclusion in most travel medical insurance plans is travel-related expenses. For example, monetary expenses related to travel delay, trip cancellation, trip interruption, or lost luggage are often not covered. This may be surprising since you are purchasing a travel medical insurance plan, however, there are separate trip insurance plans on the market designed to cover non-refundable trip-related expenses.
Heart Attack or Stroke
A hospitalization due to a heart attack or stroke is also excluded from travel medical insurance plans. While this may be confusing as travel medical insurance does usually cover hospitalizations for emergencies, a heart attack or stroke is considered to be related to a pre-existing condition and therefore is excluded from coverage.
Pregnancy or Childbirth
Prenatal visits, childbirth, and any type of maternity care are all commonly excluded from travel medical insurance plans as treatment for pregnancy falls under routine care and therefore doesn’t apply under new illness or injury treatment coverage.
Since cancer is an illness that is considered a pre-existing condition, whether known or unknown to the policyholder, cancer treatments are exempt from eligible visitors insurance coverage.
Injuries Related to Extreme Sports
Any injury that is incurred during your travels while participating in extreme or hazardous sports is often excluded from travel medical insurance coverage. This includes activities such as bungee jumping, skiing or snowboarding, zip lining, riding motorcycles or scooters, and kayaking, among others.
Some travel medical insurance plans offer additional riders that can be added on to your plan that can cover medical expenses related to extreme or hazardous sports injuries, so if you are planning on participating in any of these activities during your travels, you may want to consider this add-on.
Home Country Coverage
Since travel medical insurance plans are primarily designed to provide medical coverage for those who are traveling to another country, any medical incidents that occur while in your home country would not fall under eligible international travel medical insurance coverage. However, there are some policies which offer a “benefit period” where coverage will continue for eligible reasons if they occur during the policy period. This specific clause may be included in your policy's description of coverage.
Understand Your Travel Medical Insurance Plan
While these are just some of the most common exclusions that are ignored when it comes to travel medical insurance, it is always best to review a plan’s details of coverage for more information regarding what is and isn’t covered. By educating yourself about what your plan can provide coverage for, you can avoid confusion or frustration during the claims process.