Pre-Existing Medical Conditions – Understanding them.

In my 45+ years of travel insurance experience I’ve often had the question asked of me as to what is considered a pre-existing medical condition? And how can I get coverage for them?

The answer to those questions are fairly easy to understand if you look at the particular company’s definition of pre-existing conditions or their pre-existing conditions exclusion (yes they all have them) and read them very literally. The following is a typical pre-existing conditions exclusion:

“Pre-Existing Condition” means an illness, disease, or other condition during the 180 day period immediately prior to your effective date for which you or your Traveling Companion, Business Partner or Immediate Family Member scheduled or booked to travel with you:

1. received, or received a recommendation for, a diagnostic test, examination, or medical treatment; or

2. took or received a prescription for drugs or medicine.

Item (2) of this definition does not apply to a condition which is treated or controlled solely through the taking of prescription drugs or medicine and remains treated or controlled without any adjustment or change in the required prescription throughout the xx day period before coverage is effective under this policy.

The number of days that a company will look backwards from your coverage effective date for “package” plans varies from a low of 60 days to a high of 180 days and up to 3 years for the travel medical plans. If you read the above provision carefully you’ll see that sections 1 & 2 are very specific and will exclude from coverage any condition that meets this definition. It does have one exemption and that deals with the taking of a prescribed medication for a controlled medical condition and where the medication does not change during the entire time period. If it does not change (for better or worse) and if the condition is controlled throughout the entire period than it would be considered pre-existing and therefore not covered.

The above definition is fairly standard in most travel insurance policies however, they do change and you should always read the exact definition for the plan that you are thinking of buying.

Most “packaged” travel insurance plans offer a “waiver of pre-existing conditions” as an inducement to buy the insurance early. Since the vast majority of trip cancellation claims are caused by the accident, illness, or death of a family member and a large portion of those claims could be traced to what would be considered a pre-existing medical condition than it makes sense to buy a plan with this feature.  The “waiver of pre-existing conditions” is a time sensitive benefit that is only available if you purchase your coverage within the required time period.  This time sensitivity is the most talked about feature of the “waiver” however, most plans also have two other provisions that are equally as important:

  • you and your traveling family members must be physically able to travel on the day you buy the insurance; and
  • you must insure your trip’s value to the full, prepaid value which includes all prepaid travel arrangements.  For this last condition make sure you don’t round your trip value down and don’t exclude any portion of your trip.  Some travelers have excluded a part of their trip because they already purchased travel insurance for that part (airline tickets) however, that places them in non-compliance with this last condition and makes them ineligible for the “waiver”.

Note: this article was updated as of June 9, 2014.