Can Insurance Deny Care Based on Pre Existing Conditions
Pre-Existing Conditions & Travel Insurance
Last updated on 02/04/2021
The topic of pre-existing conditions is one of the most frequent inquiries our Customer Care team receives, so we know it's on the minds of many customers. Having an existing medical condition is very common. It's important to consider any pre-existing conditions you may have when making decisions about travel health insurance. Even if a close family member is not traveling with you but has a pre-existing condition, it's important to be aware of how it can affect travel insurance coverage before you purchase a plan.
What is a Pre-Existing Condition?
"Pre-existing condition" is a tricky term that often confuses travelers and can lead to an unsuccessful claim. In plain language, a pre-existing condition is any change in your health documented in your medical record by a medical professional including any treatments, diagnostic tests or examinations, medical recommendations for tests or examinations, or a change in prescribed medication.
In general, most travel insurance companies will consider you to have a pre-existing condition if you have a diagnosed illness or medical concern that has not been "stable" within a defined look-back period. "Stable" means that the condition has not changed or worsened in any way – no new diagnoses or treatments, no new medications, no treatments of any kind, and no pending or initiated treatments, scans, or test results. If you or a close family member have a pre-existing condition, there is an additional time-sensitive benefit known as a Pre-Existing Condition Waiver that you may want to consider.
Travel Coverage for Pre-Existing Medical Conditions
Emergency medical coverage is automatically included on all comprehensive travel insurance plans. This emergency medical coverage can work in conjunction with your health insurance, or in place of it, to help reimburse the cost of emergency medical care while traveling.
What's even better — the majority of comprehensive travel insurance plans will also cover pre-existing medical conditions. And, there's no additional charge.
However, in order to get coverage for pre-existing conditions, you must qualify and obtain a pre-existing medical conditions waiver.
What is a Pre-Existing Medical Conditions Waiver?
This waiver acts as a shield and prevents your travel insurance company from considering your recent medical history when processing a medical claim. Without a waiver, the insurance company may look back in your recent medical records and use any relevant information to deny your claim.
So, if you must visit the doctor or hospital while you're traveling, and it happens to be related to a stable health problem from your recent past —from common ailments, like asthma and high blood pressure to more serious conditions like cancer or heart attacks — a waiver will remove the pre-condition exclusion and trigger coverage to apply. This means you won't be responsible for a big medical bill and travel insurance will kick in.
Without the waiver, travel insurance will not pay any medical bills for treatment or claims linked to your recent medical past.
What is a Look-back Period?
When determining the result of a claim, the travel insurance company will "look back" at the medical records of the traveler or non-traveler to whom the claim refers. The period of time for this medical review that is specified will vary by plan and provider; typically within 60-180 days prior to purchasing a comprehensive plan. In order to have an approved claim, the condition must have been stable within the look back period. "Stable" means that the condition has not changed or worsened in any way – no new diagnoses or treatments, no new medications, no treatments of any kind, and no pending or initiated treatments, scans, or test results.
If you do not have a plan that includes the Pre-Existing Condition Waiver, your travel insurance company will have the right, should you file a claim, to look back into your medical history – or the medical history of pertinent family members – up to the defined period of time stated in the plan to determine whether or not the incident is related to a pre-existing condition. If the claim is related to the pre-existing condition, the claim will most likely not be covered. For travelers without stability in their health conditions, a Pre-Existing Condition Waiver may be the best option to avoid a denied claim.
Qualifying for a Pre-Existing Medical Conditions Waiver
To qualify for a waiver in order to bypass the look-back period, policyholders must meet a few requirements.
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Age: No age limit for a waiver on the majority of plans.
Cost: No additional premium for a waiver.
Health: Traveler must be medically fit to travel. Any pre-existing medical conditions must be stable.
Timing: Must buy travel insurance early, soon after making an initial trip deposit
Accuracy: Trip cost must be accurate.
Generally, If you're medically fit to travel, purchase insurance early, and insure the total cost of your trip — you'll automatically qualify for a waiver. And, if you were wondering if age is a factor, you'll be happy to know that the majority of travel insurance plans on InsureMyTrip.com have no age restrictions when it comes to emergency medical coverage for pre-existing medical conditions.
Here's more on those important qualifications:
Be medically fit to travel.
You 
must be medically fit to travel on the day the travel insurance plan is purchased in order to meet the health qualifications for a pre-existing medical conditions waiver. The waiver can also extend to others listed on the policy, so they must also be medically fit to travel.
If your doctor or insurance company believes you should avoid traveling for any medical reason, you will likely be disqualified for coverage. Also, if you have future plans to undergo treatments or surgery, this would be considered "foreseen" and the waiver would not cover you.
Buy travel insurance early.
If you wait too long, coverage for pre-existing medical conditions will no longer be available. You must buy travel insurance soon after your first trip payment/deposit in order to meet the deadline for qualification. Typically, the requirement is anywhere from 10-21 days after the deposit.
For example, if you put a 50% deposit down on a hotel room on November 1st. That would be considered your first trip deposit date. Soon after November 1st, you must buy travel insurance in order to be eligible for a pre-existing conditions waiver. Some companies require you to buy a plan as early as ten days after putting money down on your trip. So, in this scenario, you'd have to buy insurance by November 10th to qualify with some plans.
Tip: A pre-existing medical conditions waiver is considered a time-sensitive benefit. A time-sensitive benefit is an insurance term that indicates the coverage will no longer be available for those who wait too long to purchase.
Insure full cost of trip.
Finally, you must insure the entire cost of your trip to be eligible for the waiver. This includes any pre-paid, non-refundable travel arrangements. If you are having trouble calculating the trip cost, review the trip cost guide on our site.
Note: The pre-existing conditions waiver does not cost more. You just need to qualify.
Generally, travel insurance plans extend pre-existing medical condition waivers to all qualifying travelers — no matter their ages. However, a few plans do enforce age limits. If you have questions on age limits, talk with a licensed travel insurance agent at InsureMyTrip to review options.
If you meet all the requirements and want to purchase a travel insurance plan that includes coverage for health problems linked to your medical history, look for plans with a pre-existing medical conditions waiver included in the policy certificate and be sure to read all eligibility requirements.
Tip: an easy way to find these plans on InsureMyTrip.com is to click "Pre-Existing Conditions Waiver" filter on the left-hand side of the quote results screen, hit apply changes. Only plans that offer the waiver will be displayed. Read individual policy requirements to be sure you qualify.
Insurance companies can easily link any medical visit with a pre-existing medical condition. Even a blood test, change in medication, or a recommendation for a test is flagged as an indicator. That's why it's so important to obtain a waiver. It helps to maximize benefits. Even if you aren't concerned, having the waiver will speed up your claims process because they won't have to look through your past medical history.
Q: What if a non-traveling family member's health puts a trip in jeopardy?
A: The pre-existing condition exclusion and waiver may also apply to non-traveling family members. This varies by plan. It is important for customers to be aware of this in the event they may be concerned about having to cancel/interrupt their trip due to a non-traveling family member's medical issue.
Documentation for Claims Involving Pre-Existing Medical Conditions
Here are common travel insurance claims related to pre-existing medical conditions and expected documentation requirements:
Claim: Emergency Medical Care
Emergency medical care is required while traveling.
- Proper claim form
- Proof of trip
- Note from attending physician on the trip
- Copy of medical records
- Copy of medical bills
Claim: Trip Interruption
A medical emergency forces the traveler to cut the trip short and return home.
- Proper claim form
- Proof of trip
- Note from attending physician on the trip
- Copy of medical records
- Copy of medical bills
Claim: Trip Cancellation
A medical emergency of a traveler forces the traveler(s) to cancel a trip.
- Proper claim form
- Proof of trip
- Doctor's note
- Copy of medical records
- Copy of medical bills
Claim: Trip Cancellation
Medical emergency or death of a non-traveling family member forces the traveler(s) to cancel a trip.
- Proper claim form
- Death certificate or other medical documentation
- Proof of scheduled trip
Tip: In the event you must see a doctor when on a trip, contact your travel insurance company as soon as possible. They will walk you through how to start the claims process. They will likely need access to your medical records. In most cases, a user may have to pay out-of-pocket for emergency medical expenses and be reimbursed later by the insurance company.
Finally, emergency medical coverage that covers pre-existing medical conditions waiver is an important consideration when choosing travel insurance. It can help cover medical expenses for you and other travelers on your policy. In addition, it can provide added protection in the event you must have to cancel a trip due to the illness of a family member.
If you need further assistance, contact a licensed travel insurance agent at InsureMyTrip.
Pre-Existing Conditions for Non-Travelers
There are two ways in which the travel insurance companies may view pre-existing conditions for non-traveling family members when determining eligibility for a claim due to the cancellation or interruption of your trip because of a sudden illness in a family member at home. The plan certificate for each plan will outline this in detail.
Some travel insurance companies use the same limitation they do for travelers and apply the look-back period. This will exclude coverage for any condition that they received treatment, diagnostic testing or medication changes for during that time. Again, a Pre-Existing Condition Waiver can be obtained if the non-traveling family member is in stable health as of the purchase of the plan and other eligibility requirements are met. It is important to review the Pre-Existing Condition Waiver wording to make sure that it also applies to non-traveling family members in this case.
Another way travel insurance companies may cover trip interruption for the illness of a family member at home is "unforeseen worsening of the condition," which means that if it is unexpected that the non-traveling family member's health would take a turn for the worse (according to their medical records at the time of purchasing the plan), it is considered an unforeseen occurrence. This does not have an eligibility requirement, but the worsening of the condition must be unexpected according to the attending physician.
You can also review the plan certificate for the Pre-Existing Conditions exclusion. Specifically, if the plan states "family member booked to travel with you" in reference to a Pre-Existing Condition, then the company will look at the unforeseen worsening of the condition of a non-traveler. If the certificate does not state this, then the company will look at Pre-Existing Conditions for non-traveling family members the same as a traveler.
Pre-Existing Conditions for Canadian Travelers
Every plan we sell to Canadian travelers, whether it be for trip cancellation only or all-inclusive, includes an exclusion on pre-existing conditions. This means that the plan will not provide any benefits for a condition that falls under this exclusion, and how a plan defines existing conditions will change based on a traveler's age.
There are many factors taken into account when looking at emergency medical coverage, and it is best to call and speak with one of our licensed Canadian reps to find the best plan to fit your needs.
Common Questions Our Customers Often Ask About Pre-Existing Conditions
To make sure that you've done everything you can to protect yourself and your trip: do your research, be upfront with your travel insurance company about any conditions you think might apply, purchase your travel insurance plan as soon after paying your initial trip deposit as possible, and familiarize yourself with all the details of your plan before you depart. More specifically, understand this is a complicated component to travel insurance, and don't be afraid to ask questions! Here are some common questions travelers just like you ask.
Can you still find value in a plan if you have a pre-existing condition?
Absolutely! As we noted before, travelers with pre-existing conditions will be most interested in plans with Pre-Existing Condition Waivers included in them. Travelers who need the waiver will need to be timely when purchasing their policy, as all Pre-Existing Condition Waivers will only be available within a certain number of days from the first payment made towards the trip. If you are not within the timeframe to be eligible for the waiver, there may still be options. For example, if your last diagnostic test or change in medication was 90 days ago, we could find a plan that only looks back 60 days.
Is 'old age' a pre-existing condition?
The short answer is no. Age may affect other aspects of the travel insurance plan such as the amount of medical coverage available or the premium of the policy, but it does not directly apply to the pre-existing condition exclusion. The travel insurance company will review medical records for the person in question to evaluate the stability of the health conditions. These may not have any connection to age.
Is pregnancy a pre-existing condition?
No. Pregnancy is not a pre-existing condition; however, it is a foreseen condition. Normal, healthy pregnancy is never eligible for coverage under a travel insurance plan - even if the pregnancy did not exist before the purchase of a plan. If pregnancy complications prohibit travel by order of a physician, you may be eligible for trip cancellation or trip interruption coverage.
Can Insurance Deny Care Based on Pre Existing Conditions
Source: https://www.insuremytrip.com/travel-insurance-plans-coverages/pre-existing-conditions/