Pre-existing Medical Conditions:  Insider Tips

Pre-existing Medical Conditions:  Insider Tips

Pre-existing Medical Conditions are a fact of life but do you know what you need to declare when applying for travel insurance?

All travel insurance policies have terms and conditions relating to pre-existing medical conditions and it is important you understand what is covered so there is no disagreement if you have to make a claim.

When it comes to pre-existing medical conditions, leisure travel insurance policies generally fit into one of three categories:

  1. No cover is provided for any claim related to or arising from a pre-existing medical condition. In this case, they are completely excluded from cover.
  2. Cover is provided for only certain listed pre-existing medical conditions. Claims which arise from other conditions are excluded.
  3. Cover is provided for certain listed pre-existing medical conditions but if you have any other conditions, you have the option to declare these at the time of application for the insurer to decide if they will offer cover.

Policy Type #1 – no cover for any pre-existing medical condition

The first policy type is great for travellers who have no pre-existing medical conditions whatsoever.  This type of policy will only respond to compensate you for medical expenses if you suffer an accidental injury or illness while travelling overseas.  If you need medical treatment for or related to a pre-existing medical condition, there will be no cover.

Policy Type #2 – cover for certain pre-existing medical conditions that are listed in the policy

The second policy type will only suit those travellers who have one (or more) of the listed pre-existing medical conditions.  With this policy type, there are usually certain provisos that you must satisfy for the automatic cover to be provided.

In the case of “automatically covered” conditions, there is usually a requirement that you haven’t been hospitalised within a certain timeframe (usually 2 years) and/or you haven’t received medical treatment for the condition within a certain period of time (usually the previous 90 days).  If you have a medical condition that is in the “automatically covered” list but you have recently been hospitalised or received medical treatment, this disentitles you to automatic cover for the condition.  Let’s look at Asthma as an example.

Many travel insurance policies provide automatic cover for Asthma provided you have not received hospital treatment in the past 2 years and/or consulted a doctor for the condition in the past 90 days.  There are usually some other criteria you must meet to be eligible for automatic cover of Asthma.  For instance, you must also be less than a certain age (usually 60 years old) and you must not use more than two medications to control the condition.

If you do not meet all the criteria for automatic cover of Asthma, you will not be covered in the event of a claim for treatment of this condition while travelling.  It is not a case of meeting one or two of the provisos – you must satisfy all of them to be eligible for cover.

Take care with this policy type if you have one pre-existing medical condition that is automatically covered and another condition that is not automatically covered.  If your chosen insurer will not allow you to apply for cover of the condition that is not automatically covered, this may produce a gap in your cover.

Policy Type #3 – option to declare pre-existing medical conditions when applying for cover

The third policy type provides you with more flexibility when it comes to finding a policy that will cover you for claims related to your past medical history.  It is important though that you get it right when declaring your past medical history and check to make sure what your chosen insurer expects you to declare.

If you have two medical conditions, one of which is automatically covered by the policy and one that is not, check to see if you need to declare both of your conditions as part of the application process.  It may be the insurer requires you to declare and undertake medical screening for all of your conditions – including the one that is automatically covered.

Many pre-existing medical conditions are related.  For instance, heart disease, blood pressure, cholesterol and diabetes can be “linked” conditions.  Having one of these conditions can also be a risk factor for the others.  Many travel insurance policies provide automatic cover for high blood pressure and/or cholesterol but not diabetes.  If you have high blood pressure and diabetes, please don’t assume that because high blood pressure is an automatically covered pre-existing medical condition, you only need to declare your diabetes.  Please check with your chosen insurer to make sure you are declaring your medical history in accordance with their underwriting requirements.  It is always best to make sure everything is declared to avoid distress and potentially disagreements if you need to make a claim.

Last words …

Tip #1

Travel insurers generally exclude cover for any condition where the traveller is undergoing or awaiting medical treatment of any kind.

So, if you have been referred to a specialist and are waiting for an appointment or you are receiving treatment at the time of applying for cover, the insurer will most likely decline to offer cover.  This is because the condition may not be stable and the risk is unable to be adequately assessed.  The insurer cannot make a judgement call on your medical status while you are still receiving or are awaiting medical investigation.  You should still be able to buy a travel insurance policy, but it will in all likelihood exclude cover for the condition that is receiving or awaiting treatment.

Tip #2

If you do decide to self insure your pre-existing medical conditions by not declaring them at the time of applying for insurance (or the insurer declines to cover them), you can still buy a policy and it should operate in all respects except for the (non-covered) pre-existing medical conditions.  For instance, if you were to suffer a bout of food poisoning, it is unlikely this would be related to your medical history and you should be able to claim for the cost of treatment.  Similarly if you were travelling as a passenger in a commercially licensed form of public transport which was involved in an accident causing you to sustain injury, this too should be covered. You should be able to claim the cost of medical treatment for your injuries because the accident is in no way related to your past medical history.

Tip #3

Taking medication for a condition does not mean you have been cured of the condition.  It means the condition is being managed with medication.  If you stopped taking the medication, the symptoms would likely return.  For instance, if you are taking medication to treat high blood pressure, this means you have controlled blood pressure; it does not mean the condition no longer exists.  So, if you are taking medication for any reason, declare this to your chosen travel insurer.  Similarly, if you have had surgery for a medical condition, you should still declare the condition that the surgery was performed to treat.  If you had a coronary stent inserted to treat heart disease, this does not mean the heart disease is cured, it means the stent is being used to treat / manage the condition.  You should declare any past surgical procedures and let the insurer decide if it is relevant to their decision to insure you.

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