When participating in or organizing an education abroad program, understanding the complexities of insurance, especially concerning pre-existing conditions, is essential. Because these products are only designed to provide add-on coverage for a short time, and they are not covered by laws like the Affordable Care Act, trip insurance or travel medical insurance may only cover pre-existing conditions in limited situations if at all. In this article I cover the following.
- How these plans may define pre-existing conditions
- Any rules for a pre-existing condition to be covered
- The degree of coverage available
Travel Medical Insurance Versus Trip Insurance
Travel medical insurance, also known as travel health insurance, tends to offer a more comprehensive level of medical coverage on travel. It is different from trip insurance, which offers a limited amount of medical coverage while ensuring other risks like trip cancellation, interruption, Delay as well as theft or damage of personal belongings.
Both types of plans can offer a level of coverage for health or trip-related concerns that may arise, even when connected with a pre-existing condition.
Key Insurance Concepts for Prospective Participants
Pre-Existing Condition
Many plans define a pre-existing condition as any medical condition, injury, or illness that began before travel started. It could be any condition for which
- treatment or medication was recommended, or
- the traveler experienced symptoms, or
- the dosage of a medication was modified or a medication was prescribed
Look-Back Period
The time before a trip during which a pre-existing condition starts is called the look-back period. The length of the look-back period depends on the insurance plan. Though it tends to be 30, 60, 90 or 120 days before the policy’s start date.
Does taking a medication mean one has a pre-existing condition?
A traveler may have a medical condition for which they are taking a medication, but this alone does not make it a pre-existing condition. If the type of medication or the dosage of the medication has not changed during the look back period, it may not necessarily be treated as pre-existing. Changing from a brand name to a generic medication may not count either.
That means that a disability/Medical condition that has not produced any of the aforementioned situations during the look back period before the start of a trip may not necessarily be considered a pre-existing condition. In that situation, the chronic condition would likely be covered just as any other medical need.
Alliance Global Assistance recommends speaking with a representative to clarify whether a chronic condition would be considered pre-existing.
It is important to keep in mind that travel or trip insurance products are designed to cover additional risks connected with travel, so the available coverage would not substitute one’s existing coverage for health or personal possessions.
If A Chronic Condition is Considered a Pre-Existing Condition by an Insurance Plan
Pre-Existing Condition Exclusion Waiver
In the event that a disability or chronic condition is considered to be a pre-existing condition for the purposes of an insurance plan, a traveler may obtain a waiver of the coverage exclusion for pre-existing conditions.
Some plans may include a provision that allows a participant to receive coverage for a pre-existing condition if coverage is initiated a certain number of days before the start of travel, typically defined as when the individual starts incurring travel expenses. This may range anywhere from 11 to 20 days though it varies from plan to plan.
Pre-Existing Condition Exclusion Waiting Period
Many policies include a pre-existing condition exclusion waiting period.
- This is the length of time after the start date of the insurance policy that an individual must wait before any pre-existing conditions are covered.
- This waiting period is often longer for individually purchased policies or policies with less comprehensive coverage.
Medical Travel Insurance
Even when there is coverage for a pre-existing condition, that coverage may not be as comprehensive as one’s primary insurance plan.
Coverage for Unforeseen Changes
Policies tend to limit coverage to the unexpected reoccurrence or aggravation of a condition.
- Examples of unforeseen changes related to a disability might include a need for counseling, or treatment for conditions such as a bladder infection, asthmatic attack, blood clot, pressure sore, or an adverse reaction to a medication.
- Chronic Health conditions that gradually deteriorate over time do not count.
- To receive coverage, a case would need to be made to explain why the change was unexpected.
- The existence of a disability must be clearly distinguished from the cause of an illness or injury abroad that is related to the environment (e.g., climate, activity, food) or from difficulty accessing care abroad that makes the condition worse.
- A person with a pre-existing condition has to have the ability to travel in order to receive coverage under many policies. It is a good idea to get a doctors letter confirming this before committing to travel.
Routine Treatment
Travel health insurance plans typically do not cover routine treatment for a pre-existing condition.
Trip Insurance
Using Travel Insurance Benefits
Most travel insurance plans include added benefits that can be valuable:
- They may cover lost or damaged luggage.
- A 24-hour traveler hotline can assist with airline claims for damaged medical equipment (like a wheelchair broken in flight), locate rentals abroad, and coordinate repair services.
Group Coverage
Large program providers and institutions may have the opportunity to secure more expansive coverage for their participants. Organizations and institutions can negotiate most short-term duration accident and sickness group policies.
Negotiable Options for Group Policies
Providers can negotiate options to:
- Remove exclusions for pre-existing conditions (or other exclusions such as for mental health conditions).
- Reduce the time period used to define pre-existing conditions.
- Offer limited coverage up to a certain maximum dollar amount for medications.
- Specify coverage in the case of an emergency to stabilize a pre-existing condition.
Steps Travelers Can Take
Even when larger programs can negotiate better plan terms, coverage for pre-existing conditions may still be limited to acute flare-ups rather than on-going treatment. If a program participant is expecting to need care while abroad for a medical condition, they probably will not be able to count on their program provider’s group plan.
Primary Health insurance Plan
Many primary health insurance plans, including those that universities make available to students, offer coverage abroad. Sometimes a student might find that third-party education abroad provider travel medical coverage does not support them to continue treatment abroad, but that the insurance through their home university does.
Host Country Healthcare
For longer stents abroad, a traveler may obtain coverage through a host country nationalized healthcare scheme. I know that this has happened in Japan and France. A traveler may have to pay a small monthly premium and wait several weeks for coverage to start.
Self-Insure
Typically only applicable in countries where healthcare costs are lower, program participants may find that they can pay their medical costs out of pocket.
Travel Home for Coverage
In a worst case scenario, a traveler may take advantage of those Home visits for continuing treatment.