Pre-existing Health Conditions: Everything You Need to Know

Pre-existing Health Conditions: Everything You Need to Know

If you are an individual who has a pre-existing medical condition, there can be some uncertainty when purchasing a travel medical insurance plan. It can be confusing to understand what may be covered or what most likely will not be covered under your policy. While most travel medical or visitors insurance policies do not coverage pre-existing conditions, there are some plans which offer limited pre-existing conditions coverage or coverage for the acute onset of pre-existing conditions.

Understanding pre-existing condition exclusions and coverage can help you ultimately decide on the best travel medical insurance plan and save yourself frustrations in the claims process later on.

What Is a Pre-existing Condition?

Generally, pre-existing health conditions include all such medical or physical conditions that an individual had before the start date of their insurance policy, including high blood pressure, diabetes, AIDS, pregnancy, and any such condition, whether known or unknown. However, each visitor insurance plan has its own definition of what is considered a pre-existing condition, so it is important to read your policy documents carefully.

Travel Insurance Explained: Pre-Existing Conditions from VisitorsCoverage on Vimeo.

Any injury, illness, or medical condition that meets any of the following criteria may be considered a pre-existing condition under visitors insurance:  

  • Condition that requires you to seek medical advice, diagnosis, care, or treatment before the effective date of coverage under the policy. 
  • Condition for which manifestation, medical advice, diagnosis, care or treatment was recommended, received, or noticed prior to the effective date of coverage under the policy.

Who Determines Whether a Condition is Pre-existing?

The insurance company evaluates the attending physician's statement, past and present medical records, history, and nature of treatment to determine if the condition is pre-existing. Learn more about the process and if/when you should contest a denial.

What Pre-existing Conditions Are Not Covered?

Most visitors insurance plans or travel medical insurance plans do not cover medical care related to pre-existing conditions as they have a pre-existing condition exclusion. However, coverage depends on your individual policy, as some plans do offer limited pre-existing conditions coverage or coverage for the acute onset of pre-existing conditions.

It’s impossible to say what type of conditions are or aren’t covered under visitors insurance because the coverage decision is ultimately made by your insurance company based on a number of factors including medical records and history. However, a good rule of thumb is if had a particular health condition prior to the effective date of your travel insurance policy, medical care related to that health condition will likely not be covered under a visitor insurance plan.

Why Pre-existing Conditions Are Not Covered by Most Visitor Insurance Plans

Travel or visitor insurance plans are short terms plans. The polices are meant to cover an insured person for any new conditions that may occur after the policy effective date. The insurance company will not cover for conditions the traveler knowing will have to undergo while traveling outside of their home country such as check-ups, dialysis and any other known and scheduled treatments and services.

Travel Insurance That Covers Pre-existing Conditions

While limited, there are visitors insurance plans that offer coverage for eligible medical care in relation to pre-existing health conditions should your condition worsen unexpectedly during your travels.

Pre-existing Medical Conditions Waiver

If you are a traveler with a pre-existing condition, you may want to consider a policy that includes a pre-existing medical conditions waiver. A pre-existing condition waiver allows you to cancel or interrupt your trip, or receive medical treatment, s long as the incident or sickness is tied to a pre-existing condition.

Does Visitors Insurance Cover Regular Checkups or Planned Surgeries?

No, preventative care services like checkups are not typically covered under visitor insurance plans. Also, any known or preplanned treatment and services prior to the effective date of your visitor insurance policy such as surgeries are not likely to be covered.

What is the Acute Onset of a Pre-existing Condition?

An acute onset of a pre-existing condition is generally classified as an unexpected and sudden recurrence of a past pre-existing condition. The pre-existing condition must not be currently suffered from and must not be a chronic condition in most cases. An attending physician will determine whether or not a condition is considered acute or chronic.

Acute onset of pre-existing conditions benefits covers necessary emergency care for any medical emergency that's life-threatening or requires immediate medical treatment. It may also cover you for emergency medical transportation, emergency room costs, surgery, medications, etc. depending on the plan benefits you choose.

The definition of the acute onset of a pre-existing condition may vary from plan to plan, so it’s important to read your policy’s documentation to understand what is considered an acute onset.

Navigating Travel Insurance With a Pre-existing Condition

It can be confusing to find travel insurance with a pre-existing condition, however, there are options for you available. If you have a pre-existing medical condition and are looking at visitors insurance options, take a look at those that offer some kind of pre-existing condition coverage. Additionally, understanding your policy’s benefits and exclusions can help you better prepare for dealing with your pre-existing condition during your travels and what will and won’t be covered under your plan. 

Read more about pre-existing conditions or speak to our Customer Success Team if you need assistance or have any additional questions.