What medical conditions does travel insurance really cover?

What medical conditions does travel insurance really cover?

Susan from Auckland*
"We had to make a claim for a huge medical bill from when we were travelling in the US, but our claim was rejected because my husband had an operation 2 years earlier."

Time and time again we receive feedback from customers who’ve had rejected claims with something to do with a pre-existing medical condition, and the majority of these rejections were because the insurer was not made aware of the condition before the start date of travel, or because the condition was never covered in the first place.

Travel insurance does cover medical conditions but like all insurances there are restrictions and exclusions set within the policy to keep premium costs lower for the consumer. Travel insurance prices are all based on risk assessment. Just as skydiving isn’t covered as it’s too risky to insure, the same goes for serious illnesses and injury. If travel insurers started to cover conditions such as heart disease or cancer then overall premiums for consumers would go through the roof. Insurers put restrictions on the higher risk illnesses to keep costs down for the average traveller.

Comparetravelinsurance.co.nz helps to explain which conditions are covered and why claims are rejected.

Natalie Ball, Director, Comparetravelinsurance.co.nz

“What travellers fail to realise is that any previous illness or injury is considered a pre-existing medical condition. If you want cover, you must disclose anything you have sought medical attention for in the past. Even something like a stomach ulcer from 10 years ago. Without doing so, your claim could be rejected as the insurer was not made aware of the condition in the first place.”

Ball suggests “If you’re finding it difficult to find cover for a particular condition, ensure you contact insurance companies with varying underwriters to research a good cross-section of the market.”

What is considered a pre-existing medical condition in travel insurance jargon?

A pre-existing medical condition is considered an ongoing medical or dental condition which you are aware of, or have symptoms of. A condition you are currently seeking medical treatment for, or have previously been treated for, by a medical professional. A condition you are taking medicine for currently or you’ve had surgery for, in the past 12 months. Pregnancy is also considered a pre-existing medical condition.

Typical pre-existing medical conditions are covered:

• Allergies including Rhinitis, Chronic Sinusitis, Eczema, Food Intolerance, Hay Fever

• Asthma – provided you have no other lung disease and are less than 60 years old (age may vary from insurer to insurer)

• Epilepsy – provided there has been no change in the last 12 months

• High cholesterol

• High blood pressure – provided you do not suffer from cardiovascular disease or diabetes

• Osteoporosis

• Cataracts, congenital blindness

• Congenital deafness

• Diabetes – provided you were diagnosed more than 12 months ago and have no kidney or eye complications, you do not suffer from hypertension or hypoglycaemia, and you are under 50 years of age (age may vary from insurer to insurer)

• Hernia

• Incontinence

Typical pre-existing medical conditions are not covered:

• Terminal illness with a life expectancy of under 24 months

• Chronic renal failure

• Congestive heart failure

• Aids

• Cancer

• If you’re awaiting surgery

• If you require oxygen for your holiday

• If you take blood thinning drugs

• Seizures in the past 12 months

• Recurring pain, including back pain, that requires ongoing treatment such as physiotherapy or a chiropractor

• Mental illness – including depression, anxiety, dementia

• Suicide

• Autism

• Fertility treatment

• If you are waiting for an organ transplant

• Alcohol or drug addiction

• Sexually transmitted diseases

• Pregnancy, if you’ve had complications, or went through IVF, childbirth also isn’t covered

You can still get travel insurance if you have a pre-existing condition

If you do suffer from a medical condition that’s not automatically covered, it doesn’t mean you’re unable to get travel insurance at all. Many conditions require a medical assessment before cover can be purchased. And/or you might be able pay a premium to cover your condition to out-way the additional risk.

If you are refused cover for your condition, you will still have all the other benefits of travel insurance and any medical claims that are totally unrelated to your pre-existing medical condition are ok. But you will not be covered for any claims arising from your refused pre-existing condition.

Typical situations and conditions you’ll need a medical assessment for:

• If you’ve had surgery in the last 2 years

• If you’ve experienced heart problems

• If you have a pacemaker

• If you’ve suffered from a stroke

• If you have HIV

• If you suffer from epilepsy, and you’re on two or more anti-convulsion medications

• If you have cystic fibrosis

• If you’ve had deep vein thrombosis

Your medical claim will also be rejected if:

• You were aware, before your journey commenced, that it might be cancelled, disrupted or delayed due to illness

• If injury or illness happens to a person over 85 years old (age will vary from insurer to insurer)

• If you do not disclose your pre-existing condition before the start date of travel

• If your pre-existing medical condition was deemed too risky to insure before your started your trip

Conclusion

Medical bills overseas regularly exceed tens of thousands of dollars and without travel insurance you could see your holiday end in financial ruin.

It’s important to remember that each underwriter has a different list of conditions that are covered, so it pays to shop around and compare different policies and insurers. And the best way to find out what each policy covers is to read the PDS in full.

ENDS

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