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Here's How the Waiver of the Pre-Existing Medical Conditions' Exclusion Works in a Travel Insurance Policy
Carol G., Rockville, Maryland says, "Steve, I have really appreciated the service I received for figuring out if my son's pre-existing medical condition would be covered and advice on the best plan for us. I already did the comment form at your website and have written posts on some cruise and disney boards (we're doing a Disney cruise) about how happy I was with your service and recommended www.TripInsuranceStore.com. Thanks for all of your help."
Technically, all travel insurance policies exclude coverage for Pre-existing Medical Conditions. You can cover pre-existing conditions with any of our plans. You can waive the exclusion accociated with a Pre-existing Condition by following the rules below. |
Until there's a claim, everything is on the honor system. The insurance company assumes the travel insurance purchaser is following the rules, but they have no way of knowing if they are.
Instead, at claim time the travel insurance purchaser must prove everything including:
It's more accurate to say that the travel insurance purchaser has a conditional promise from the travel insurance company that they have certain benefits.
Lee S., Maine, writes:
I'm confused between the notion of waiving the pre-existing conditions exclusion with the requirement of being "medically stable". My reading of pre-existing conditions is that if I buy the travel insurance by the deadline, the insurer will waive asserting that "pre-existing conditions" caused the cancellation of the trip. How does it work? |
Pre-existing conditions coverage is complicated. Here's how pre-existing conditions, medically stable and the lookback period fit together:
Any medical condition (no matter how minor) existing in the 60, 90 or 180 day Lookback Period is defined as a Pre-Existing Condition if you've had symptoms, it's been treated, consulted on or had a change of medication during those 60, 90 or 180 days prior to buying the travel insurance. A Pre-Existing Medical Condition includes any condition that's been tested, treated, examined, consulted with, received advice on or had symptoms of. This also includes any adjustments or changes in any prescriptions or medication. If a pre-existing condition exists, then it has to be "medically stable". This means that the person with that pre-existing condition hasn't already taken a turn for the worse. Medically Stable also means that no medical condition is known, foreseen or expected to "take a turn for the worse". And the person must be able to travel when they buy the insurance. If the traveler has the pre-existing condition, they have to be able to travel when they get their travel insurance. Don't call us or order a policy if you're being treated now (and can't currently travel), yet your doctor says you'll be able to travel later. You will not be covered at all. Learn more about Medically Stable here. If the person has a stable pre-existing condition, then the only way the pre-existing condition exclusion can be waived is to buy the travel insurance by the deadline. Important: Keep in mind that the pre-existing condition exclusion is being waived when you buy the travel insurance by the deadline.
You Must Follow These Rules To Waive The Pre-Existing Medical Condition Exclusion
If you want to waive the pre-existing medical condition exclusion for cancellation, interruption & medical treatment, you have to fulfill these 4 requirements:
With 3 exceptions (CSA, HTH & Travelex), you have to insure at least your trip's full prepaid, non-refundable cost (you can't round it down). If you don't know your final trip cost, estimate it high to be safe. You can always lower to the correct trip cost prior to your departure date. If it drops you to a lower trip cost range, you'll get a partial refund. and The person with the medical condition has to be medically stable when you get your insurance. Some companies include the medical stability of non-traveling family members in their Pre-Existing Medical Condition wording while others do not include the medical stability of non-traveling family members:
CSA, HTH, Travelex & Travel Guard include the medical stability of non-traveling family members TravelSafe & Travel Insured do not include the medical stability of non-traveling family members in their Pre-Existing Medical Condition wording You must get your travel insurance in the first 14 or 21 days after your first trip payment date (Travelex, Travel Guard, Travel Insured and TravelSafe) or no later than 24 Hours after you make your final Trip payment for CSA & HTH and You have to cover your trip's full length.
In addition, you'll see that CSA, HTH, Travel Guard, Travel Insured and TravelSafe all include wording like "this is the first and only booking for this same destination and dates of travel" as a condition of waiving the pre-existing medical condition exclusion. The reason is that you cannot cancel your trip & re-book it to just reset your inital trip deposit date. Read Steve's Blog post to find out more.
Any payment on your trip is considered the first payment. This includes the tax you pay when you redeem frequent flyer tickets, refundable deposits or even a trip planning consultation fee if that fee is later credited toward your trip costs.
Your Deadline To Waive The Pre-Existing Medical Condition Exclusion
Provider (the link goes to our summary page) |
The deadline is how many days after your initial deposit? |
What day is counted as day one? |
What is the last day you can get pre-existing conditions coverage? |
CSA Freestyle & Freestyle Luxe Plans |
Prior to or within 24 Hours of your final trip payment date |
Not Applicable |
Prior to or within 24 Hours of your final trip payment date |
HTH Trip Protector & Trip Protector Preferred Plans |
Prior to or within 24 Hours of your final trip payment date |
Not Applicable |
Prior to or within 24 Hours of your final trip payment date |
TraveLite & Travel Plus Plans |
21 calendar days |
The day after you make your initial trip deposit |
Three calendar weeks later |
Travel Guard Plans |
14 calendar days |
The day you make your initial trip deposit |
Two calendar weeks later |
Travel Insured Comprehensive & Gold Plans |
14 calendar days |
The day after you make your initial trip deposit |
Two calendar weeks later |
TravelSafe |
14 calendar days |
The day after you make your initial trip deposit |
Two calendar weeks later |
Provider (the link goes to our summary page) |
The Lookback Period (calendar days) |
Maximum Trip Value for Pre-existing Condition coverage |
CSA Freestyle & Freestyle Luxe |
180 days |
$20,000 to $50,000 depending on insured's age |
HTH |
180 days |
$30,000 |
Travelex Lite |
90 days |
$30,000 |
Travelex Plus |
90 days |
$50,000 |
Travel Guard Cruise, Tour & Travel |
60 days |
$50,000 |
Travel Guard Protect Assist |
180 days |
$30,000 |
Travel Insured |
180 days |
$100,000 |
TravelSafe |
60 days |
$50,000 |
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Here's what the CSA Freestyle Luxe Plan Certificate of Coverage says:
Pre-Existing Condition
means any Injury, Sickness or condition of the Insured or Traveling Companion, or Family Member for which within the 180-day period prior to the Insured's Effective Date under this Policy which a) manifested itself, became acute or exhibited symptoms which would have caused one to seek diagnosis, care or treatment; or b) required taking prescribed drugs or medicine, unless the condition for which the prescribed drug or medicine is taken remains controlled without any change in the required prescription; or c) required Medical Treatment or treatment was recommended by a Legally Qualified Physician.
Pre-Existing Condition Exclusion
This exclusion applies to Trip Cancellation, Trip interruption, and Emergency Medical Expense Coverages. It applies to you and all family members.
A Pre-existing Condition, as defined in this policy. The Pre-existing Condition Limitation does not apply to: a) Emergency Medical Evacuation, Medical Repatriation and Return of Remains coverage, Accidental Death & Dismemberment (Coverage A), Baggage and Personal Effects, Baggage Delay and Collision Damage Waiver; or b) to coverage purchased prior to or within 24 hours of the final payment for the Covered Trip and if the Insured is medically able to travel when payment is made for the insurance;
Pre-Existing Condition Exclusion Waiver
CSA will waive the Pre-existing Condition exclusion if you meet the following requirements:
You must purchase the CSA Freestyle or Freestyle Luxe Plan plan prior to or within 24 Hours of your final Trip payment All insured travelers must not be disabled from travel at the time they pay their premium. The booking for this trip must be the first and only booking for this travel period and destination
Click here to go to our CSA Freestyle & Freestyle Luxe detailed description page
Click here to go to CSA Freestyle & Freestyle Luxe's secure online quote & order page |
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Here's what the HTH Trip Protector Certificates of Coverage say:
PRE-EXISTING CONDITION means an illness, disease, or other condition during the 180-day period immediately prior to your effective date for which you or your Traveling Companion or Family Member:
1. received, or received a recommendation for, a diagnostic test, examination, or medical treatment; or
2. took or received a prescription for drugs or medicine.
Item 2 of this definition does not apply to a condition which is treated or controlled solely through the taking of prescription drugs or medicine and remains treated or controlled without any adjustment or change in the required prescription throughout the 180-day period before coverage is effective under this Policy.
There is no coverage for any loss due to injury, sickness or death of you or a family member, if, during the 180 days preceding and including the coverage effective date, there was medical care, advice, consultation or treatment received for the condition, or if symptoms of the condition were present, or if there was any adjustment of medication for the condition. This exclusion applies whether the condition was known to you or not, and whether the condition was diagnosed or not.
Pre-Existing Condition Exclusion Waiver. We (HTH) will waive the Pre-existing Condition exclusion if you meet the following requirements.
the payment for this plan is received prior to/or within 24 hours of your final payment for your Covered Trip; and you are not disabled from travel at the time you make your plan payment; and the booking for the Covered Trip must be the first and only booking for this travel period and destination.
Click here to go to our HTH Worldwide detailed description page.
Click here to go to HTH's secure online order page |
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Here's what the Travelex Certificate of Coverage says:
PRE-EXISTING CONDITIONS EXCLUSION
This exclusion applies to Trip Cancellation/Interruption and Emergency Medical Benefits. The program does not cover losses or expenses if they result from:
1. Any injury to You or Your Traveling Companion, Your Business Partner or Your Family Member occurring prior to and including the Effective Date;
2. Any sickness of You or Your Traveling Companion, Your Business Partner or Your Family Member occurring during the 90 days prior to and including the Effective Date for which treatment by a Legally Qualified Physician has been sought or advised or for which symptoms exist which would cause a prudent person to seek diagnosis, care or treatment.
If You have purchased a program where pre-existing conditions are waived, the Company covers these pre-existing conditions provided:
1. The protection plan was purchased within twenty-one (21) calendar days of the initial Covered Trip payment;
2. On the date of purchase of the protection plan, You were Medically Fit;
3. You had not filed a claim for Trip Cancellation/Interruption due to a sickness or injury within 90 days prior to the purchase of the protection plan;
4. You do not have a sickness excluded by General Exclusions “m)” and “n)”;
5. The pre-existing conditions exclusion applies to all amounts over the Maximum Waiver Amount shown on the Confirmation of Coverage except for Medical Evacuation/Repatriation benefits which are not subject to the Maximum Waiver Amount.
If You do not meet the above criteria, You will still be covered for Trip Cancellation/Interruption and Emergency Medical Benefits caused by reasons other than those related to the pre-existing condition.
Note this important wording on the Travelex Confirmation of Coverage (not in the Evidence of coverage): "The Maximum Waiver Amount for Medical Expense is $30,000 per person for the TraveLite plan" or "... $50,000 per person for the Travel Plus plan." What this means is that if you are buying a Travelex plan in the 21 day waiver period, your Pre-Existing Condition maximum limit is reduced to $30,000 per person for the TraveLite plan or $50,000 per person for the Travel Plus plan.
Also, you'll see that Travelex doesn't include the wording "this is the first and only booking for this same destination and dates of travel" as a condition of covering a pre-existing medical condition.
Travelex's Family Member definition says "provided the Family Member resides in the United States, Canada or Mexico". In other words, you are not covered if your Family Member resides outside the United States, Canada or Mexico
Click here to go to our Travelex detailed description page.
Click here for the TraveLite's secure online order page. Click here for the Travel Plus' secure online order page - the Travel Plus plan is not available to residents of Kansas and New York |
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Both Travel Guard plans have the same definition for a Pre-Existing Medical Condition:
PRE-EXISTING MEDICAL CONDITION EXCLUSION:
The Insurer will not pay for any loss or expense incurred as the result of an Injury, Sickness or other condition of you, traveling companion, business partner or Immediate Family Member which, within the 60 day period (Platinum plan) or the 180 day period (Gold plan) immediately preceding and including your coverage effective date: first manifested itself or had symptoms which would have prompted a reasonable person to seek diagnosis, care or treatment; or for which care or treatment was given or recommended by a Physician; or required the taking of prescription drugs or medicines, unless the condition for which the drugs or medicines are taken remains controlled without any change in the prescription drugs or medicines.
PRE-EXISTING MEDICAL CONDITION EXCLUSION WAIVER
If insurance was purchased within 14 calendar days of "initial trip payment", the Pre-Existing Medical Condition Exclusion will be waived. (Day one is the date the "initial trip payment" is received.) This is applicable to all coverages contained in the policy. In order to receive the waiver of Pre-Existing Conditions, the amount of Trip Cancellation coverage purchased must equal the full pre-paid nonrefundable portions of all trip arrangements.The Insured must be medically able to travel when he/she pays his/her premium. In the event that a claim is filed, the Injury or illness must be substantiated to Travel Guard's Claims Department.
The Exclusion for Pre-Existing Conditions will be waived if:
The Insured purchases the plan within 14 calendar days of making his/her "initial trip payment" The amount of Trip Cancellation coverage purchased must equal the full cost of all pre-paid non-refundable Trip arrangements; The booking for this Trip must be the first and only booking for this travel period and Destination; The Insured must be medically able to travel when he/she pays his/her premium.
Click here to go to our Travel Guard detailed description page.
Click here for the Cruise, Tour & Travel's secure online order page. Click here for the Protect Assist secure online order page |
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Pre-Existing Medical Conditions Exclusion
"Pre-Existing Condition" means any Injury, Sickness or condition of Yourself, a Traveling Companion or You and/or Your Traveling Companion's Family Member for which medical advice, diagnosis, care or treatment was recommended or received within the 180 day period ending on the Effective Date. Conditions are not considered pre-existing if the condition for which prescribed drugs or medicine is taken remains controlled without any change in the required prescription.
If you purchase the Travel Insured Comprehensive or Gold plan within 14 days of Your initial Trip deposit for Pre-Existing Condition Waiver:
The Pre-Existing Condition exclusion will be waived if the protection plan is purchased within 14 days of the initial Trip deposit (count the date you make your initial deposit as day #1), You purchase this policy for the full non-refundable cost of Your Trip, You are not disabled from travel at the time You pay the plan cost and this is the first and only booking for this same destination and dates of travel.
Click here to go to our Travel Insured detailed description page.
Click here to go to Travel Insured's secure online order page |
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A brief description is below. For complete coverage, terms, conditions and exclusions click here to view or download Travel Safe's Certificate / Policy.
Pay Your Premium within 14 Calendar Days of Your Initial Trip Deposit and ... The Exclusion for Pre-Existing Conditions will be waived if:
Your enrollment form and premium payment is received (or, if mailed, is post-marked) within 14 days of the date your initial Trip deposit is received; and You insure all prepaid Trip costs that are subject to cancellation penalties or restrictions and also insure within 7 days of the payment for those arrangements the cost of any subsequent arrangements (or any other arrangements not made through your travel agent) added to your Trip; and You are not disabled from travel at the time you pay your premium.
Coverage for Financial Insolvency is included under the Pre-Departure Trip Cancellation and Post-Departure Trip Interruption Benefits, if:
Your enrollment form and premium payment is received (or, if mailed, is post-marked) within 14 days of the date your initial Trip deposit is received.
Coverage for a Terrorist Act is included under the Pre-Departure Trip Cancellation and Post-Departure Trip Interruption Benefits, if:
Your enrollment form and premium payment is received (or, if mailed, is post-marked) within 14 days of the date your initial Trip deposit is received.
Click here to go to our Travel Safe detailed description page.
Click here to go to Travel Safe's secure online order page |
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