Sam is confused by what constitutes a pre-existing condition for her travel insurance.
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Q. Sam
My husband and I are considering booking an overseas trip for October this year. When it comes to travel insurance, though, we are a bit confused around how the pre-existing health conditions work. We both have high blood pressure, my husband suffers from a bad back, and I have a fatty liver. Do we have to declare all of these things? Will they still be covered if we suffer from health problems on our trip?
A. First of all, we need to define what a pre-existing medical condition is.
A pre-existing medical condition in travel insurance is a diagnosed medical condition that you or any insured person has had, or has received any form of medical advice, treatment or medication for in a specified time period before you bought your travel insurance policy.
Most insurers will cover a condition as long as it hasn’t resulted in treatment within the specified time period before booking a trip. However, this time period can vary between insurers, with some requiring up to five years or more. Additionally, while government insurance contract regulations state that a person is only subject to coverage for conditions they were experiencing six months before the contract was entered into, insurers can exempt themselves from this rule by simply informing the policyholder of the relevant provisions in writing. In other words, they can bury an exclusion or limitation in the product disclosure statement (PDS) which can sometimes be up to 30,000 words long.
It is my understanding that most insurers would cover a condition if it hadn’t led to treatment in the two years before you booked your trip, but others may specify a longer time. This makes it especially important to thoroughly check your product disclosure statement to ensure you are completely covered.
There are a few companies with standard travel insurance packages that include a range of pre-existing medical conditions.
High blood pressure, being relatively common, may well be included in one of these packages. So may your husband’s back.
Pretty much every travel insurance company will offer travel insurance that includes some pre-existing conditions, although one policy may not cover both of your health conditions. So, you’ll have to do your research to find the best one for you.
Check the insurer’s PDS for a specific list of conditions. If a condition is not listed as automatically covered then you may be able to apply to the insurer to cover your condition.
How are pre-existing conditions assessed?
Most Australian insurers use a risk rating system provided by insurance technology firm Verisk to assess pre-existing medical conditions. This system assigns a risk factor to each condition on a list, and depending on how high the risk factor is, the insurer may choose to rule out cover or charge an extra premium.
What if you can’t get cover?
If you’re denied cover for your pre-existing medical condition, or if you can’t afford the extra premium, you can still buy a travel insurance policy. However, you will not be covered for any claim that arises because of your pre-existing medical condition. Smartraveller research found that more than two in three people (67 per cent) may not have travel insurance for their condition.
Have you ever had to make a travel insurance claim for a health issue on a trip overseas? Was it easy or difficult? Which insurer did you use?
Also read: Why skipping travel insurance is a bad idea
