Pre-Exisiting Conditions

Pre-Existing Conditions in Global Travel Medical InsuranceInternational Insurance with Pre-Existing Conditions

We first should define exactly what it is we are talking about. “Any medical condition that the insured has prior to contracting for insurance coverage can be considered a pre-existing condition.”

What are Pre-existing Conditions?

According to Lisa Smith of Investopedia, there are two types of PreExisting Conditions; Most insurance companies use one of two definitions to identify such conditions. Under the “objective standard” definition, a pre-existing condition is any condition for which the patient has already received medical advice or treatment prior to enrollment in a new medical insurance plan. Under the broader, “prudent person” definition, a pre-existing condition is anything for which symptoms were present and a prudent person would have sought treatment.

What is the Acute Onset (or recurrence) of a Pre-Existing Condition?

The Acute Onset or Recurrence of a Pre-Existing Condition is the sudden and unexpected outbreak, or recurrence, of a Pre-Existing Condition which occurs without advance warning. It is typically of short duration, rapidly progressive, and requires immediate care. For coverage to be effective, the Acute Onset of a Pre-Existing Condition must occur after the effective date of the policy. Plans offering benefit will typically require that treatment be obtained within 24 hours of the sudden and unexpected onset or recurrence. Important: A Pre-Existing Condition that is chronic, a congenital condition, or that gradually becomes worse over time will not be considered Acute Onset. Further, plans would exclude coverage for known, scheduled, required, or expected medical care, drugs or Treatments existent or necessary prior to the Effective Date of coverage.

Do International Insurance Providers Cover Pre-Existing Conditions

International health insurance plans, expat plans, or global medical insurance typically will be medically underwritten. This means that a medical underwriter working for the insurance company will review your medical history and determine if they are able to insure you. They will typically either approve the application as is, limit or exclude the pre-existing condition, add a premium to cover the additional risks associated with the pre-existing conditions, or deny your policy. Unfortunately, the only way to know how your situation will be treated is to apply and have your application reviewed.

In some Global Medical Plans, you might see a clause like this in your policy:

This plan provides a $50,000 lifetime benefit for eligible pre-existing conditions that existed at or prior to the effective date, subject to a maximum of $5,000 per period of coverage after coverage has been in effect for 24 continuous months. This benefit is payable whether or not you have received consultation or treatment for the condition(s) during the 24-month period of continuous coverage.

What this means is that your pre-existing conditions will be subject to specific limitations and restrictions in regards to benefits available. In short, insurance underwriters are limiting their risks (and costs) by limiting the amount they will have to pay out for claims to cover known medical conditions. 

Some providers will grant coverage for pre-existing conditions after a lesser time period. Often, if you have “prior creditable coverage”, meaning another insurance plan in place at the time you apply for your new international plan, coverage for pre-existing conditions may be granted in even less time. Prior creditable coverage is determined by the insurer so be sure to inquire at the time of your application. Even with prior coverage, the medical underwriters will make a judgement on how to handle your application.

What About Pre-Ex Benefits for Short Term Travel Medical Plans

Short Term Travel Medical Plans are guaranteed issue plans, meaning you are eligible for them regardless of your medical history (no medical underwriting). A typical plan would cover a trip of 5 days to 6 months, up to a maximum of one year but can be renewable for up to 2-3 years.

Pre-existing conditions are typically excluded from coverage. Sometimes these plans do provide benefits for “acute onset of pre-existing conditions” (see definition above). A typical clause may read:

For US citizens up to age 65 with a primary health plan, Patriot Travel Medical will pay the Usual, Reasonable and Customary charges of a sudden and unexpected recurrence of a Pre-existing Condition (defined on the Exclusions page) up to the plan maximum. For those without a primary health plan, Patriot Travel Medical will pay up to a $20,000 lifetime maximum. For those age 65 and older, with or without a primary health plan, Patriot International will pay up to a $2,500 lifetime maximum. The primary health plan must have existed prior to the effective date and during coverage of the Patriot plan, and the Pre-existing Condition must be covered under the primary health plan. These terms are for US citizens.

In short, if you maintain an insurance plan in the US while abroad, this plan will provide benefits to the maximum, assuming you will likely return to the US for treatment and not expect the plan to pay out a significant sum. If you don’t maintain a US plan, benefits are limited to put a cap on the insurer’s risks.

Why do Insurers exclude Pre-Existing Conditions?

Customers with pre-existing conditions are seen as a higher risk who will potentially cost the insurer more in health care costs than someone who does not have the same conditions. To offset those risks, insurers either limit the benefits for those pre-existing conditions , increase the cost of insurance, exclude coverage altogether, and/or attach a rider that specifically excludes that pre-existing condition but allows the applicant to be approved otherwise.

If you have questions, please reach out to a licensed agent at International Travel Insurance Group to help make sense of this confusing topic.