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.
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.
What is a Pre-Existing Condition Waiver?
Many travelers call to ask whether they can be covered by travel insurance even if they have a pre-existing medical condition. Fortunately, the answer is yes; it is possible to purchase travel coverage regardless of the medical history of you or a loved one. In some plans, a Pre-Existing Condition Waiver is included as one of the benefits when the plan is purchased within a specified time frame – usually 10-21 days after making your initial trip payment. You must also meet all other applicable eligibility requirements.
With a Pre-Existing Condition Waiver, you'll be eligible for travel insurance benefits should something related to your condition (or your family member’s condition) disrupt your trip. For example, you may be traveling abroad, and a family member at home who suffers from a pre-existing condition suddenly takes an unforeseen turn for the worse, making it necessary for you to cut your trip short. Your plan's trip interruption benefit would apply if you had the waiver in place. If you were traveling with a pre-existing condition of your own and suddenly had an unforeseen recurrence or relapse that required you to seek medical attention, your expenses could be covered under the guidelines set by the travel insurance company. Without the waiver, you would not be eligible for these benefits.
Eligibility requirements for the Waiver
As noted previously, a Pre-Existing Condition Waiver has specific eligibility requirements set by the travel insurance company. Most companies require that you buy your travel insurance policy within 10-21 days after making your first trip payment. You must also be medically able to travel on the day that you purchase your insurance. Most plans also require you insure your total prepaid, non-refundable travel arrangements made before departure.
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.