Do US Travel Insurance Companies Really Cover Pre-Existing Medical Conditions?
When you are choosing a travel medical insurance policy for a trip to USA, one of the most important things to consider is that whether the insurance policy covers pre-existing medical conditions or not. Unfortunately, most travel insurance plans automatically exclude coverage for the most common pre-existing medical conditions.
A pre-existing medical condition can be any illness, injury or other medical conditions that has been diagnosed, treated or prescribed medication for prior to the individual’s travel insurance plan becoming effective. There might be cases where the travel insurer agrees to cover such conditions but at a higher premium than for those without pre-existing conditions
What are Pre-existing Conditions?
There are times travellers are confused with the term “pre-existing condition,” leading to unsuccessful claims. A pre-existing condition simply means a change in your health that has been documented by a medical professional in your medical record. This includes diagnostic tests and examinations or medical recommendations for the same, treatments, or changes in prescription medications.
Generally, travel insurance companies consider a person to have a pre-existing condition if they have been diagnosed for an illness, disease or injury, which has not been “stable” during the “look-back” period. Here “stable” means that the medical condition has seen no change and hasn’t worsened. In other words, it means that there have been no new treatments or diagnoses, no new prescribed medications, and no scans or test results. There should also be no initiated or pending treatments.
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The Look-back Period
The look-back period generally ranges between 60 and 180 days prior to the date on which the travel insurance becomes effective. When you make a claim, the policy administrator will review your medical records from this duration to ascertain if the claim was due to a pre-existing condition. In case you had certain symptoms and/or received treatment for the same or if your prescription medications had changed during this period, then the condition will be considered pre-existing.
Pre-Existing Condition Waiver
A Pre-Existing Condition Waiver acts as a shield against exclusions based on pre-existing conditions. In other words, it prevents the travel insurance company from taking your recent medical history into consideration when you claim for benefits under your policy. Without this waiver, the company may look back into your medical records from the past 2-6 months and deny your claim if they find some relevant information.
Pre-existing condition waiver works for common ailments, such as high blood pressure and asthma, as well as serious medical conditions, such as heart problems and cancer. If you visit a doctor while travelling and the visit is related to a stable health issue from recent past, this waiver will eliminate the pre-existing condition exclusion and save you from being responsible for the medical bill.
A pre-existing condition waiver can be secured if the pre-existing conditions are stable, the insured is medically fit to travel and if the travel insurance is bought soon after making the initial trip deposit.
Acute Onset of Pre-existing Medical Conditions
There are insurers who provide travel medical insurance plans that cover pre-existing conditions. But, the coverage is provided only in cases of acute onset. If there is an outbreak or recurrence of a stable pre-existing condition, without any advanced warning, and the insured needs immediate medical care, the insurance plan covers the associated expenses.
Keep in mind that the treatment should occur within 24 hours of the onset of the condition.
Chronic/congenital pre-existing conditions that slowly worsen over time are NOT considered acute onset.
Travel Insurance Plans that Cover Acute Onset of Pre-Existing Medical Conditions
If you are planning to travel overseas in the near future, consider this list of the travel insurance plans that do offer coverage for pre-existing medical conditions.
Inbound USA insurance plan by Lloyd’s of London covers visitors travelling to USA and provides coverage while the visitor remains in the country. It is a basic level travel medical insurance plan, providing limited medical services at a low cost. The plan pays a fixed, pre-defined amount for each incident. The advantage is that you are allowed to seek medical care from any doctor or hospital you choose. The cover is provided for 5 to 364 days, with coverage of up to $130,000 for acute onset of a pre-existing medical condition.
Another option by Lloyd’s of London, Inbound Guest is also a limited coverage plan. Coverage is provided from 5 to 180 days and you are allowed to visit any doctor. In case of an acute onset of a pre-existing condition, you can get benefits of up to $120,000 with this plan.
Safe Travels for Visitors to the USA
Safe Travels for Visitors to the USA is offered by GBG Insurance Limited. Coverage is provided for 5 to 365 days, but there is a list of doctors and hospitals within the plan’s PPO network that you need to seek treatment from so that your expenses are covered by the plan. The unexpected recurrence of a pre-existing condition is covered up to the policy maximum.
Sirius International’s Visitors Care plan is another excellent option under the limited coverage bracket. Coverage is provided from 5 days to 12 months and here too, you need to seek treatment from within the insurance company’s PPO network so that you can access your medical care benefits. Acute onset of pre-existing conditions is covered under this plan.
VisitorSecure is another plan by Lloyd’s of London that pays a fixed amount equal to the policy maximum for every incidence of a pre-existing condition. There is no requirement to follow a PPO network. You can visit any doctor. For pre-existing conditions, the plan provides coverage of up to $100,000.
Cover America – Gold
Cover America – Gold is a comprehensive coverage plan from Lloyd’s of London, with many unique features and benefits. The plan provides 100% coverage up to the policy maximum if you opt for a hospital from its extensive PPO network. In case you choose an out-of-network plan, you are covered for 80% of the expense for the first $5,000 and 100% after that. You can get coverage of up to $125,000 for acute onset of pre-existing conditions. Additional features include $20-$25 co-pay for urgent care consultation, limited benefits for loss of passport, amusement park accidents coverage, cruise coverage, border entry protection, etc.
Patriot America Plus
Patriot America Plus from Sirius International covers up to the policy maximum for both regular medical conditions and acute onset of pre-existing conditions for those below 70 years of age. Coverage is from 5 to 365 days and there is a PPO network you need to choose from for treatment. In case you seek treatment from an out-of-network hospital, you will be covered for 80% of your medical expenses for the first $5,000 and 100% after that.
Liaison Travel Economy
For medical care through PPO network hospitals, Liaison Travel Economy pays 80% of the expenses up to the first $5,000 and 100% after that, while for out-of-network hospitals, the coverage is 70% till $5,000 and 100% after that. Up to $15,000 coverage is provided for acute onset of pre-existing conditions. It also provides an Rx discount card that helps you get a variety of prescription medication at discounted prices. Coverage is provided from 5 to 364 days.
Liaison Travel Choice
Liaison Travel Choice pays 90% for the first $5,000 and 100% after that for in-network hospitals and 80% for the first $5,000 for out-of-network hospitals. Acute onset pre-existing coverage is up to $30,000. It also includes a free Rx discount card.
Liaison Travel Elite
Liaison Travel Elite pays 100% up to policy maximum if you choose to seek treatment from within their PPO network. For out-of-network medical care, it pays 90% up to the first $5,000 and 100% after that. Coverage provided for acute onset of pre-existing conditions is $50,000. The plan covers you from 5 days to 3 years (1092 days) and includes a free Rx card for discounted prescription medication.
Atlas America from Lloyd’s of London provides 100% coverage up to policy maximum for both in-network and out-of-network medical care. Acute onset of pre-existing conditions is covered as well. Coverage is provided from 5 to 364 days.
Patriot Platinum pays 100% of the medical expenses during travel, up to the policy maximum if you seek treatment from within their PPO network. For out-of-network, it pays 90% for the first $5,000 and 100% after that. Those under 70 years of age are provided coverage up to $1,000,000 for acute onset of medical conditions, with varying age limits.
Tourists visiting the US or travelling from the US to another country should be extra careful while selecting a travel medical insurance plan. Make sure you have thoroughly studied the policy document and understand everything related to coverage before you buy a policy. Otherwise, you might end up paying a big medical bill due to a simple misunderstanding.