Insurance Insights

Pre-existing Conditions Plainly Explained

Understanding Pre-existing Conditions in International Health Plans

One of the Key Elements of an Insurance Policy is the Definition and Coverage of a Pre-existing Condition

We know that the decision to live outside your home country is not one that you take lightly or without research. Our perspective is that you need all that information you can get as you protect your health.

What is a pre-existing condition?

Every insurance company defines a pre-existing condition a bit differently in their policy wording. Generally it is said to be a condition, illness, injury, or a condition, where you have received advice or sought out counsel, gotten treatment, therapy, taken on a special diet, or have shown symptoms prior to the start date of a policy.  The prefix “pre” is the indicator that it began prior to the start date of the policy.

An insurance policy has to bring in enough money to cover the potential expenses/costs that it can incur during your commitment to pay the premiums.

Examples of a pre-existing condition?

If you had back pain prior to the start of the policy, then it would be a pre-existing symptom/condition. Diabetes, depression, sleep apnea, pregnancy, etc. are obvious examples, yet anything you have taken medication for or had symptoms of even if you have not sought treatment has been a pre-existing issue.

What is a lookback period for a pre-existing condition?

It’s often seen as not fair for an insurance company to exclude an issue yet the cost of care would be much higher than the price paid for the policy if the condition were included in most cases so a ‘lookback period’ is the amount of time the policy says it looks historically at your health. For example, if a policy has a two year lookback it says if you have had the condition during the last 24 months then it is an excluded condition but once 24 months of no issue/condition have passed then it is a covered condition.

Do Travel Insurance or an International Health Insurance policy cover pre-existing conditions?

The simple answer is usually not on individual plans, but at times it will to a limited degree (acute onset).

Why would a policy exclude pre-existing conditions?

The likelihood that the cost of care would exceed the cost of the policy is high so the condition is excluded.  

What does medical underwriting mean and why does it affect insurability?

The process of gathering your health history, prescriptions taken, treatments and diagnoses received and family history to determine the level of risk and financial commitment that an insurance company is undertaking in caring for you with their policy is called medical underwriting. The results of this data collection and evaluation is what is used for a decision on whether the policy will be standard issue (no exclusions, unless issue later discovered by non-disclosure in the application), if flexible underwriting is utilized for conditional coverage (limitations of coverage) or if no policy is issued (denied coverage). Policies such as the World Explorer travel insurance and Nomad Health Insurance int'l medical insurance plans do not have medical underwriting, but the policy is issued immediately with a two year lookback period.

What is flexible underwriting for conditional coverage?

If the medical underwriting team determines that they will issue the policy with the condition that a particular issue will be excluded completely or for a period of time then they have utilized some flexibility in the underwriting process. Often an issue such as behavioral health will be excluded for a period of five years when there has been a diagnosis of depression but the health insurance will cover all else.

Is pregnancy considered a pre-existing condition?

In most cases maternity benefits come with a waiting period and pregnancy is considered a pre-existing condition on international health plans and travel insurance policies. Due to the potential for complication and the rising costs of childbirth the waiting period is either 10 months, 12 months, or 24 months so that they have collected enough premium from you to cover the cost of birth.

A condition is being excluded, should I just go without insurance then?

Since we are complex beings with much more to treat than the item that is being excluded it is still vital to get health insurance to transfer the financial risk of the other potential issues that could arise from accident or illness during the coverage period.

What is an acute onset of a pre-existing condition?

A sudden and unexpected outbreak or recurrence of a pre-existing condition which occurs: (1) spontaneously and without advance warning in the form of physician recommendations or symptoms, is of short duration, is rapidly progressive, and requires emergency medical care; and (2) after the policy start date; and (3) before the age indicated in policy summary. Treatment by a physician must be obtained within the twenty-four (24) hours beginning on the date and at the time of the sudden and unexpected outbreak or recurrence by some travel insurance policies and limited benefits are included at times, such as with the World Explorer plans from Insured Nomads.

Do Group Plans have Pre-Existing Condition Exclusions?

At times, a group policy will have a two year exclusion of pre-existing conditions or will be priced so that pre-existing conditions are covered when the group plan is designed.

Still have questions? Ask your broker that told you about Insured Nomads or contact us directly for a no obligation consult.