Latest on preexisting-condition clause


Editor’s note: Continuing to up­date his information on travel medi­cal insurance (see May ’95, pg. 46), Wayne offers the following.

This article is meant to help you choose a travel-insurance policy that has a lenient “pre­existing” medical condition clause. There are major dif­ferences among the available policies.

Look for “the clause”

To begin, the most important com­ponent in the paragraph describing the prexisting-condition clause is the text that defines the period within which coverage is allowed for a preexisting medical condition (including complications of an acci­dent) that is “controlled and stable.”

Policy variations

All of the 1995 overseas medical and trip-cancellation policies that were reviewed for this report (with two exceptions: TravMed and Wallach & Company’s Health Care Abroad) provide some allowance for preexisting medical conditions that are “stable” and “controlled” by medication.

However, there has to have been no change in the medical condition and no change in the amount of any medication.

The shorter the time period dur­ing which you might have to prove “control,” the better. Coverage re­gardless of preexisting condition is best.

Even if vouhave not seen a doctor for a problem, the language will prevent payment if “there exist symptoms which would cause a rea­sonably prudent person to seek di­agnosis, care or treatment.”

Use insurers’ toll-free numbers to receive their brochures that com­pletely describe services provided and costs.

60 days’ controlled condition required

The following travel insurance companies use the more tolerant “60 days’ controlled condition” lan­guage in their policies: Travel As­sure (800/228-9792), Travel Guard (800/626-1300), Access America (800/284-8300), Carefree Travel (800/323-3149), CSA Travel Protec­tion (800/348-9505), Travel Insur­

ance PAK (800/243-3174) and American Express (800/756-2639, or 800/756-AMEX).

The following cruise lines’ insur­ance packages also use the more tolerant “60 days’ controlled” lan­guage: Clipper Cruise Line, Royal Viking Line, Royal Caribbean Cruise Line, Epirotiki Lines, Costa Cruise Lines, Norwegian Cruise Line, Princess Cruises, Crystal Cruises, Carnival Cruise Lines and Regency Cruises. (You’ll be offered an insurance package with the cruise description brochure.)

90 days’ controlled condition required

The following insurance company and cruise lines require “90 days’ controlled medical condition”: Travel Assistance International (800/821-2828) and Radisson Dia­mond Cruises, Bergen Line and Cunard.

No preexisting conditions allowed

The following two travel insur­ance companies require 180 days of no preexisting medical prob­lems or treatment and do not allow coverage for a condition that is controlled by medication: TravMed (800/732-5309) and Wallach & Company’s Health Care Abroad (800/237-6615).

These two companies will not pay for claims related to conditions that have been treated within the last six months, or if you are on some kind of regular medication.

Emergency evacuation services

A few companies supply only emergency medical evacuation (ex­tremely rare but potentially quite expensive) but do not pay for ac­tual medical treatment costs. Use the toll-free numbers to get brochures that describe the variety of other services supplied.

This type of coverage is of interest if you already have adequate over­seas medical cost coverage with your normal health insurance policy. (Your normal health insurance policy probably does not supply much in the way of medical evacua­tion coverage.)

These three companies supply emergency medical evacuation:

International SOS Assistance (800/523-8930) provides evacuation service to an adequate medical fa­cility (including back home, if nec­essary) regardless of preexisting conditions. Individual cost is $40 for one to 14 days and $275 for one year.

Traveler’s Emergency Network, or TEN (800/275-4836, or 800/ASK- 4-TEN), has recently canceled their preexisting-condition language and now (again) provides their services

The cost for a comprehensive pack­age of services, including medically required emergency evacuation (in­cluding all the way back home, if necessary), is $30 per year for indi­viduals and $50 for a family.

• Divers Alert Network, or DAN (800/446-5397), which was initially established to supply insurance cov­erage to scuba divers, provides any­one with medical evacuation coverage regardless of preexisting medical conditions for an entire year for $25 (or family coverage for $35).

DAN’s text is as follows: “A DAN member” (through Assist America) “traveling more than 100 miles from home. . . can be evacuated from anywhere in the world to an appro­priate medical facility in the event of an accident or illness” (but not necessarily all the way back home).

DAN does offer medical payments coverage but only for diving-related accidents.

Check on your existing coverage

You may find that the expense of additional travel medical insurance is not necessary (this coverage is usually “secondary,” that is, they pay only what your normal health insurance does not).

Before your trip, check with your regular health insurance provider to see what they provide in the way of medical expenses overseas. Most will at least reimburse for medical expenses.

Blue Shield, for example, has a long list of overseas hospitals that will admit members under the same conditions as at home.

Find out what you are expected to do regarding receipts and treatment records. Most policies (including supplemental travel insurance poli­cies) require prompt initiation of treatment for an illness or accident. Don’t wait until you get home to see a doctor.

Many credit cards, especially “Gold” cards, have “hotline” phone numbers that provide emergency assistance overseas. 

Medicare does not provide anv coverage beyond North America, but most “Medigap” policies do; they pay 80% after a $250 deductible.