Do you have a pre-existing medical condition? Find out if you can get travel insurance.
If you suffer from a pre-existing medical condition and are looking to take out travel insurance, it is crucial you find if and how the company covers the medical condition. Depending on the nature of the condition, the company will either automatically provide cover, provide cover at an additional rate or apply exclusions for the condition. If you do not declare your condition, it is likely the policy will be void in the event of a claim.
This article will take a look at the conditions that are and are not normally covered by travel insurance and how to go about obtaining cover for a pre-existing medical condition.
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A pre-existing medical condition is usually defined as:
- A medical condition or symptoms of a condition that you are aware of
- A medical condition for which you are having or have had treatment in the past
- A medical condition you are treating with prescribed medication
- A medical condition you previously had surgery for
How are different conditions classified?
- Conditions that are automatically covered normally not serious conditions such as asthma or gastric reflux.
- Conditions that are covered under certain conditions but require further assessment to determine the severity of the condition and any current treatment being prescribed.
- Conditions it does not cover under any circumstances. These are usually serious illnesses and diseases such as cancer or HIV.
Declaring your condition is part of your duty of disclosure to the insurance company. Failure to do so can lead to your policy being rejected if you have to claim.
The list below is of conditions generally covered automatically provided the condition has been stable for the last 12 months and there is no planned surgery for the condition.
- Bell’s Palsy
- Carpal Tunnel Syndrome
- Coeliac Disease
- Congenital Blindness
- Congenital Deafness
- Diabetes Mellitus (Type I and II)
- Dry Eye Syndrome
- Folate Deficiency
- Gastric Reflux
- Graves’ Disease
- Hiatus Hernia
- High Cholesterol
- High Blood Lipids
- Impaired Glucose Tolerance
- Insulin Resistance
- Iron Deficiency Anaemia
- Macular Degeneration
- Meniere’s Disease
- Pernicious Anaemia
- Plantar Fasciitis
- Raynaud’s Disease
- Sleep Apnoea
- Solar Keratosis
- Trigeminal Neuralgia
- Trigger Finger
- Vitamin B12 Deficiency.
If you suffer from any of the conditions listed below, you will be covered for any sections of the policy related to medical expenses/repatriation or trip cancellation/lost deposits.
- Conditions where you have been given a terminal or palliative prognosis with a shortened life expectancy
- If you require oxygen therapy or home oxygen for the journey
- Aids defining illness
- If you have had or are having an organ transplant in the future
If you suffer from any of the conditions listed below, you will need to declare these to your insurance company. The company will then assess the condition and determine if they can provide cover for that condition and/or journey.
- Cardiac or heart conditions
- Respiratory or lung conditions
- Metastatic or secondary cancer
- Dementia or memory loss
- If you require the accompaniment of a full-time minder
- Deep Vein Thrombrosis
- Heart problems (e.g. coronary angiography, pacemakers, etc)
- Any conditions requiring surgery in the last two years
- Certain kinds of diabetes
Whether your insurer covers your condition will depend on its severity, how recent it is and the extent to which it is being controlled by medication.
If your condition is not listed in the policy, you must declare it to your insurance company. The company will assess the condition and decide whether or not cover can be provided.
Typically you'll be asked:
- What is name of your condition?
- What medications have been taken in treatment of the condition?
- If you are treated for blood pressure or diabetes, what was the last reading?
- Have you changed your treatment medication recently, generally in the last 3 months?
- Have you seen a medical practitioner recently, generally in the last three months?
- Have you been admitted or undergone treatment in a hospital in the last 12 months?
- Are you currently awaiting a medical review or treatment?
- Have you smoked in the last 12 months?
What will happen if I don't declare my condition?
You will not be covered for any claims for losses that have occurred as a result of your condition. In some cases, your insurance provider can also choose to cancel your policy if they feel you have purposely withheld information that may increase the likelihood of a claim occurring.
So I will not be covered for other losses not related to my condition i.e. loss of luggage?
If the insurance company discovers known information has been withheld, yes they are in there right to avoid paying your claim.
Most travel insurers will cover pregnancy, providing it satisfies the following criteria:
- Your trip ends on or before your 26th week of pregnancy
- Claims are for unexpected complications only (not expenses related to childbirth)
- It does not involve IVF treatment
- It will not be a multiple birth (i.e. twins)
- Your trip is not for fertility treatment
- You have not experienced pregnancy complications in the past
- You are not travelling against your doctor’s advice
As pregnancy is classed by insurers as a pre-existing condition, you will need to declare it when applying for insurance, be medically assessed and pay a higher premium, due to the higher risk you represent to the insurer.
The majority of travel insurers will automatically cover diabetes, but the devil is in the detail, as each may require certain conditions to be met. For instance;
Even though Type 2 diabetes is a less serious form, if you have also had hypertension in the last 12 months, some insurers may exclude you from cover altogether
Because Type 1 diabetes requires stricter management, some insurers apply stricter cover conditions such as age limits.
The golden rule with diabetes, as with any pre-existing medical condition, is if you are unsure whether you are covered, declare it to your insurer at the time of applying. You may have to answer a few more questions and pay a higher premium, but it’s a small price to pay compared with receiving overseas medical bills that aren’t covered by your insurance.
Some people with pre-existing medical conditions assume that because they are travelling to a country that has a Reciprocal Health Care Agreement with Australia, they can bypass travel insurance and rely on that country’s public health system if their condition requires treatment.
Unfortunately, while RHCA countries do provide Australian travellers with subsidised health care, levels of cover differ and some costs aren’t covered at all, including:
- Treatment in a private hospital
- Treatment as a private patient in a public hospital
- Ambulance cover
- Medical evacuation to Australia
- Elective surgery
- Dental care
Travel insurance is vital when travelling overseas and the only time RHCA treatment should be viewed as a backup is if you have a pre-existing medical condition that no insurer will cover.
What is a pre-existing medical condition?
Any condition that you are aware of and have had treatment or surgery for in the past, are currently treating with medication, or have been hospitalised for in the past 90 days.
I went to the emergency department about my medical condition. Is this considered hospitalisation?
Yes, hospitalisation includes visits to day surgery and the hospital emergency department.
How long does a medical assessment take?
An online self-assessment can take as little as 10 minutes.
How long does it take to process my assessment?
Usually within 24 to 48 hours.
How much does it cost to cover my pre-existing condition?
It depends on your insurer, your condition and how much of a risk you represent.
What if I develop a new medical condition after I have purchased my policy?
As it developed after you bought your insurance, it is not considered a pre-existing condition and would therefore be covered according to the terms and conditions of your policy.
Can I apply for cover for a pre-existing medical condition from overseas?
No, you must apply while you are in Australia.
My insurer has refused to cover my pre-existing medical condition. Does this mean I can’t get travel insurance?
No, it simply means you won’t be covered for any expenses related to your condition.
If there is a problem with my pregnancy and my doctor advises against travel, will I be covered for trip cancellation?
It depends on your insurer. You may be able to claim if cancellation is due to unexpected complications with your pregnancy.
If I fall pregnant after I have bought my policy, will I still be covered?
Again it depends on your insurer, but normally if you inform them of the change in circumstances you may still be able to get cover for pregnancy.
Is asthma classed as chronic lung disease?
Only when you are more than 70 years of age.
My insurer refused to cover my condition. Does this mean I can’t get travel insurance?
No, it just means you won’t be covered if you develop any complications related to that condition.
Can I get travel insurance if I have suffered from cancer?
Yes, there are a handful of insurers who will provide cover for some cancers for a higher premium, providing certain conditions are met, such as being in remission for a certain period of time (i.e. 6 to 12 months).
What are pre-existing medical conditions? Why are some covered by travel insurance and some not? Hopefully this article has helped you answer these questions. There are many conditions which are automatically covered, there are insurers who will cover you for others not normally covered, provided you pay an extra fee, and that even if you can’t get cover, you can still get travel insurance and still be fully covered for every other eventuality, apart from an event related to your condition.
Picture: HOSPITAL LA MILAGROSA, licensed under Creative Commons Attribution-NonCommercial-ShareAlike 2.0 Generic (image cropped)