Unlike domestic U.S. health plans under the Affordable Care Act (ACA) or public healthcare systems in many countries, which guarantee coverage to citizens and residents, most global health and travel insurers medically underwrite applications. This means they review your health history before approving coverage and may limit or exclude benefits for pre-existing conditions.
Insurers often do this to manage financial risk and keep premiums affordable. However, each insurer evaluates risk differently, so your options will depend on your medical history and the type of insurance you choose. Global health insurers may offer limited coverage, exclusions, or increased premiums after underwriting. In contrast, travel medical insurers often exclude pre-existing conditions altogether or only provide benefits for acute onset, which we’ll explain below.
Talk to an Expert
Our licensed international insurance advisors can help you understand your options, explain how medical underwriting works, and guide you to the best plan for your needs.
A pre-existing condition includes any illness, injury, or symptom you had before your insurance policy started, even if it was undiagnosed.
Many international insurance plans can cover minor or well-managed pre-existing conditions, though they may apply exclusions or charge higher premiums (rate-ups).
Global insurers use medical underwriting to assess your health history and decide what coverage, exclusions, or premium adjustments apply.
Most travel medical insurance plans only cover the acute onset of a pre-existing condition, meaning sudden, unexpected emergencies, not ongoing care.
To improve your chances of getting coverage, apply early, fully disclose your health history, and
A pre-existing condition refers to any illness, injury, or medical issue that was present before your international insurance coverage begins. Conditions can include chronic illnesses like diabetes, asthma, or heart disease, or even past surgeries and ongoing medications.
International insurers typically use one of the following standard definitions:
Objective Standard
This is a condition for which you received diagnosis, treatment, or medical advice before the policy’s start date.
This definition is fact-based and straightforward; if your medical records show prior care, the insurer considers it pre-existing.
Prudent Person Standard
Under this standard, a condition may be considered pre-existing even if it was never formally diagnosed or treated, as long as symptoms were present and a reasonable person would have sought medical attention.
For example, if you experienced recurring chest pain before purchasing insurance, but didn’t seek medical attention, the insurer may still classify it as a pre-existing condition, even without a formal diagnosis.
If you also failed to disclose those symptoms on your application, the insurer could treat it as non-disclosure, potentially leading to a policy cancellation and denial of related claims.
Pre-Existing Conditions in Global Health Plans
International health insurance plans are designed for long-term international living and are usually medically underwritten, meaning insurers review your health history to assess risk. As a result, coverage for pre-existing conditions in international health insurance plans is not guaranteed.
Depending on your condition, the insurer may approve your application with a higher premium, exclude the condition, or deny coverage altogether.
Understanding medical underwriting is essential to finding the right plan and setting realistic expectations.
Why Do Insurers Limit Pre-Existing Condition Coverage?
Insurers limit or exclude pre-existing conditions to manage financial risk. People with these conditions are more likely to need expensive care.
To offset this, insurers may:
Increase premiums (rate-ups)
Impose waiting periods
Add exclusionary riders
Decline high-risk applicants
Limiting or excluding coverage enables insurers to keep premiums affordable for healthy individuals while offering long-term international coverage.
Pre-Existing Conditions and Medical Underwriting
When you apply for an international health plan, an underwriter reviews the medical history you provided in your application. This process determines whether the insurer will cover your pre-existing condition and at what cost.
Types of Medical Underwriting in Global Insurance
Global insurers use different approaches to evaluate pre-existing conditions. Choosing the right underwriting type can affect coverage, premiums, and exclusions.
Full Medical Underwriting (FMU)
FMU is the most common approach for international private medical insurance (IPMI) plans.
What it means: You complete a detailed medical questionnaire during the application process.
What the insurer does: A medical underwriter reviews your history and decides how to handle any disclosed conditions.
Possible outcomes: The insurer may accept the application with full coverage, approve it with a higher premium (rate-up), approve it with specific exclusions, or decline it altogether.
Best for: Applicants with relatively stable or minor pre-existing conditions who want clarity before their coverage begins.
Moratorium Underwriting
Moratorium underwriting is most commonly used in international plans among insurers based in the U.K. and the European Union.
What it means: Applicants do not need to disclose their full medical history upfront, but insurers automatically exclude any conditions you experienced in the five years before your policy begins.
What the insurer does: The insurer applies a general waiting period, typically 2 years.
Possible outcomes: If you remain free of treatment, medication, or symptoms, the insurer may begin covering your pre-existing condition(s).
Best for: Healthy individuals with no significant medical history who prefer a quicker application process and the potential for lower premiums without full medical disclosure.
Tell the Whole Story. Always submit your complete and honest medical history. Omissions or inaccuracies can void your coverage!
What Conditions Might Be Uncoverable?
Every insurer has different thresholds for what they will consider. Some high-risk or costly conditions may be excluded entirely or result in coverage denial.
Case Examples
Applicant Profile
Underwriting Outcome
Explanation
Healthy applicant with a past appendectomy
Accepted with full coverage
No ongoing risk or treatment needed; considered a resolved condition.
Applicant with insulin-dependent diabetes
Accepted with exclusion
Coverage approved, but all diabetes-related care is excluded.
Applicant with mild, controlled high blood pressure (Moratorium Underwriting)
Accepted with waiting period
The condition may be covered after 24 months of continuous coverage with no treatment changes or complications during that time.
Applicant with metastatic cancer
Declined
Condition presents high, ongoing risk and cost; insurer will not offer coverage.
Maternity and Pre-Existing Pregnancy
Insurers treat pregnancy as a pre-existing condition and typically exclude maternity coverage if the applicant is already pregnant when applying.
Some insurers offer maternity benefits, but usually impose a waiting period, often 10 to 12 months, before covering prenatal care, delivery, and postnatal treatment.
Protect Your Health Beyond Pregnancy.Even if your existing pregnancy isn’t covered, you can still obtain insurance for other health needs now and for post-delivery care. Securing a plan ensures protection against unexpected medical expenses and access to care after your baby is born.
Don’t wait until after the baby is born to purchase coverage. Newborns are not automatically eligible unless the parent already has coverage under a qualifying plan.
BCBS Global Solutions Outside US Select-Plan With No Maternity Waiting Period
The BCBS Global Solutions Outside U.S. Select plan (formerly GeoBlue Xplorer Select) offers maternity coverage with no waiting period, making it an excellent choice for individuals or couples planning to start a family abroad. However, to qualify for maternity benefits, the applicant must not be pregnant at the time of application.
Even if pregnancy has already begun, it’s still worth applying for this plan to ensure the spouse has comprehensive coverage and to secure future coverage for the newborn and other medical needs.
U.S. health plans regulated by the Affordable Care Act (ACA) must accept applicants regardless of pre-existing conditions and cannot charge more based on medical history.
International plans are different:
U.S. ACA Plans
International Plans
Coverage for Pre-Existing Conditions
Guaranteed
Varies by insurer; Medical underwriting required
Medical Underwriting
No
Yes
Plan Acceptance
Guaranteed Issue
Application may be declined
Premiums
Community-rated
Based on individual risk
Coverage Requirements
U.S. specific
Designed for international use
Since they operate across multiple jurisdictions, international insurers use medical underwriting to manage risk and keep premiums stable.
Tips for Applicants with Pre-Existing Conditions
Apply early to allow time for underwriting
Maintain continuous health coverage
Disclose your complete medical history
Work with an expert broker to find the right fit
Talk to an Expert
Our licensed international insurance advisors can help you understand your options, explain how medical underwriting works, and guide you to the best plan for your needs.
Most travel medical insurance plans exclude pre-existing conditions, especially when you received a diagnosis, treatment, or experienced symptoms before the policy start date.
However, a few plans offer limited acute-onset coverage, and one notable exception provides full coverage for eligible travelers with U.S. health insurance.
Travel Plans and Benefits for an Acute Onset of a Pre-Existing Condition
An acute onset of a pre-existing condition is an unexpected flare-up of a medical issue you had before your insurance coverage began.
For example, suppose you have a history of well-controlled asthma and experience a sudden, unexpected attack while backpacking in Sedona, Arizona.
In that case, your plan may cover emergency treatment under the acute-onset benefit. However, it won’t cover routine follow-up care, ongoing medication, or future asthma-related visits once the situation stabilizes.
Most insurers limit acute-onset benefits based on the traveler’s age, the specific plan chosen, and whether the traveler has a primary health plan in their home country. These variables help insurers manage risk and determine the level of coverage available.
Acute-onset benefits cover short-term emergency treatment but exclude chronic or ongoing care related to the condition.
Travel Plans with Acute Onset Benefits
International Medical Group (IMG) provides emergency care coverage for travelers under age 70 who experience the acute onset of a pre-existing medical condition.
Travel Plan That Covers Pre-Existing Conditions in Full
Finding travel insurance that fully covers pre-existing conditions can be difficult, but the right plan ensures you are protected while abroad.
BCBS Global Solutions Single Trip Platinum – For US Citizens and Residents
Unlike most travel insurance plans, BCBS Global Solutions Single Trip Platinum offers coverage for pre-existing conditions without limitations, provided the traveler is a U.S. citizen or resident and maintains an active primary U.S. health insurance plan throughout the trip.
BCBS Global Solutions Single Trip Platinum is ideal for short-term travelers seeking comprehensive coverage, including coverage for pre-existing conditions.
Single Trip Platinum Travel Insurance
For U.S. citizens and residents up to age 95
Includes pregnancy coverage, baggage loss, trip interruption & more
Only a few international plans offer full coverage for pre-existing conditions.
For short-term travel, GeoBlue Voyager Choice covers U.S. citizens and residents who maintain a primary U.S. health plan.
For long-term expats, plans like Cigna Global and GeoBlue Xplorer may cover certain pre-existing conditions after underwriting or a waiting period.
It’s important to apply early and work with an advisor to understand your eligibility.
Some insurers require your condition to be stable for 6 to 12 months – meaning no symptoms, no treatment, and no medication changes – before they consider covering it. This stability period helps the insurer assess whether the condition poses an ongoing risk.
Remember that each insurer defines stability slightly differently, so you should clarify the specific requirements when applying.
Expert Tip: Providing detailed medical records showing your stability can strengthen your case.
It depends on the type of plan you have. Most travel medical plans only cover the acute onset of a pre-existing condition, an unexpected and sudden flare-up requiring emergency care.
Insurers typically do not cover ongoing treatment, routine management, or predictable complications.
For full coverage, you need a plan that explicitly includes pre-existing conditions, such as GeoBlue Voyager Choice (if eligible), or you may need to rely on your primary health insurance at home.
Most international health and travel insurance plans exclude maternity coverage if you’re already pregnant at the time of application.
However, you can still apply for a plan to cover other medical needs during your pregnancy and to secure coverage for your spouse and newborn after delivery.
Some expat health plans, like GeoBlue Xplorer Select, offer maternity benefits with no waiting period, but only if you are not pregnant when you enroll.
Planning ahead is critical if you’re thinking about starting a family abroad.
An acute onset refers to a sudden, unexpected flare-up of a pre-existing condition, such as a heart attack or asthma attack, that requires immediate medical attention.
A regular medical emergency could be any new illness or injury, such as a broken bone or a sudden infection while traveling.
Travel insurance often covers general emergencies but limits or excludes care related to known pre-existing conditions, unless it qualifies under the acute onset clause.
Understanding this distinction can help set realistic expectations for your coverage.
To protect your medical information, international insurers follow strict data privacy regulations, such as HIPAA (for U.S. insurers) or GDPR (for European insurers).
They only use your health details to assess your application or process claims and do not share your data across countries without your consent.
If you’re concerned about how your data is stored or used, you can request the insurer’s privacy policy for transparency.
Reputable insurers prioritize confidentiality and comply with global privacy standards.
Need Help?
Pre-existing condition rules can be complex and vary widely. Our licensed advisors can help you understand your options and guide you through the application process.
Talk to an Expert
Our licensed international insurance advisors can help you understand your options, explain how medical underwriting works, and guide you to the best plan for your needs.
Joe Cronin, President of ICI, is a leading expert in international health, life, and travel insurance. An MBA and founder of multiple global businesses, he helps expatriates and travelers access trusted, comprehensive insurance solutions worldwide.
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