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Pre-Exisiting Look Back Period - Part Deux


ccrain
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On the upcoming cruises we did not purchase insurance at time of booking. So in looking at lookback periods, I noticed something interesting.

 

The lookback period effective date, in all policies I reviewed, is DIFFERENT from the cancellation period effective date.

 

I looked at half a dozen major policies and the look back period for pre-existing effective date was the first day of travel NOT the date of purchase, which is the effective date for cancellation insurance.

 

So basically on a cruise in which final payment is due 90 days prior to embarkation, the look-back period includes that future 90 days when you purchase on or around final payment. This means, basically, that if you have any condition discovered in that 90 days that might need treatment while on the cruise, you should cancel to avoid the potential argument over pre-existing.

 

Yes, there are a couple of policies that offer the pre-existing waiver if you purchase on final payment, but they have other warts as well such as secondary medical and lower coverages.

 

Just wondered if anyone else's interpretation of this is similar to mine?

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Yes, I believe you are correct. We had a trip booked and a serious medical issue arose between the purchase of insurance and final payment. When I checked our policy carefully, the "effective date for all other coverages" (except cancellation) was the first date of travel, NOT date of purchase.

 

I had goofed and put in $0 cost - wanting to insure only medical and evacuation - and to my chagrin learned that $0 cost invalidated the pre-existing condition coverage. If I had put in $1 we would have been covered! We have cancelled the trip and have lost the insurance premium.

 

I think trip insurance is a minefield of gotchas!

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Yes, I believe you are correct. We had a trip booked and a serious medical issue arose between the purchase of insurance and final payment. When I checked our policy carefully, the "effective date for all other coverages" (except cancellation) was the first date of travel, NOT date of purchase.

 

I had goofed and put in $0 cost - wanting to insure only medical and evacuation - and to my chagrin learned that $0 cost invalidated the pre-existing condition coverage. If I had put in $1 we would have been covered! We have cancelled the trip and have lost the insurance premium.

 

I think trip insurance is a minefield of gotchas!

 

Some travel insurance policies (e.g., ours with Travel Insured) allow one to transfer the policy ONCE to another trip, within some specified period of time (maybe 1 year? I forget.).

 

But there cannot have been any claim or loss.

 

You might want to double check if your policy has this feature.

 

GC

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Thanks for the suggestion - but it'll be a while before we can plan another trip. And, maybe with that $0 trip cost that particular policy might not cover PEC even if transferred, Fortunately it is only a loss off $106.

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  • 3 months later...

I know I’m late to the party, but I just found this thread while browsing through the topics on this thread.

 

It started me thinking. Wow! I didn’t know that was the way it worked.

 

So I went to insuremytrip to read the certificate of a random policy - just one - not a full on research project, but I’m quessing the language is standard.

 

Here is what I found.

 

Effective date is defined as something like - not quoting exactly - 12:01 PM on the day after the company receives payment. Cancellation coverage begins on the effective date.

 

The look-back period for pre-existing conditions is based on the effective date. For this policy it was 60 days prior to the effective date, but it varies to as much a 180 days. So if you had to cancel for a medical reason, the company would look at your medical history for the defined period. If your history is clear or not related to the reason for cancellation, you are covered.

 

A new medical condition that arises after the effective date is not pre-existing because it did not exist before your coverage began. You can cancel or even If you have to file a claim for an illness while traveling, the look back is still based on the effective date, and I found only one definition for that.

 

It does go on to say that all other coverage (besides cancellation) begins on the day of travel. That seems rather obvious. You are not covered for other hazards until you actually start your trip.

 

There are lots of knowledgable people on this forum, and many of them have first-hand experience. If I have mispoken, please chime in.

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I know I’m late to the party, but I just found this thread while browsing through the topics on this thread.

 

It started me thinking. Wow! I didn’t know that was the way it worked.

 

So I went to insuremytrip to read the certificate of a random policy - just one - not a full on research project, but I’m quessing the language is standard.

 

Here is what I found.

 

Effective date is defined as something like - not quoting exactly - 12:01 PM on the day after the company receives payment. Cancellation coverage begins on the effective date.

 

The look-back period for pre-existing conditions is based on the effective date. For this policy it was 60 days prior to the effective date, but it varies to as much a 180 days. So if you had to cancel for a medical reason, the company would look at your medical history for the defined period. If your history is clear or not related to the reason for cancellation, you are covered.

 

A new medical condition that arises after the effective date is not pre-existing because it did not exist before your coverage began. You can cancel or even If you have to file a claim for an illness while traveling, the look back is still based on the effective date, and I found only one definition for that.

 

It does go on to say that all other coverage (besides cancellation) begins on the day of travel. That seems rather obvious. You are not covered for other hazards until you actually start your trip.

 

There are lots of knowledgable people on this forum, and many of them have first-hand experience. If I have mispoken, please chime in.

 

This is actually similar to how *we* have always understood the coverage. I just looked again, and it says:

 

"“Pre-Existing Condition” means an illness, disease, or other condition during the 60 day period immediately prior to the date Your coverage is effective..."

 

and

 

"Coverage begins at 12:01 a.m. on the day after the date the appropriate premium for this Policy for Your Trip is received by the Company or its authorized representative prior to the scheduled departure time on the Scheduled Departure Date of Your Trip. This is Your “Effective Date”"

[bolding added]

 

Basically, as we understand it, once you have paid and you and the insurer are "locked in", there are no additional pre-existing conditions. IF something then happens health-wise, well, that's why one took out the travel insurance...

And it can't cover anything prior to payment, as that's sort of like knowing the house has a little fire in the corner, so 'time to get insurance...", etc.

 

BUT CHECK THE TERMS OF *YOUR* SPECIFIC POLICY!

 

GC

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Thanks for the confirmation.

 

I think the OP was confused by the language that describes when the coverage kicks in. Those are different, but there is only one effective date for look back.

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Right.

 

If OP is reading, perhaps you could post the *exact quotes* and name the policy (perhaps give a link)?

 

For all we know, there *are* policies that are something like what OP posted, although it doesn't quite make sense... how helpful is some "pre-existing condition" coverage would be the way OP described it - which was, of course OP's point!

That *would* be important to realize!

 

GC

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No problem. Let me show you a couple of examples from the actual insurance certificates.

 

Travelex:

 

When Coverage Begins

Trip Cancellation and Cancel for Any Reason coverage will be effective at 12:01

a.m. (Standard Time) on the date following payment to the Company of any

required plan cost.

Car Rental Collision coverage will take effect when the Insured signs the rental

agreement and takes possession of the rental vehicle provided the required

plan cost has been paid on or before the date the rental agreement has been

signed.

All other coverages will begin on the later of:

(a) 12:01 a.m. (Standard Time) on the scheduled Departure Date shown on

the travel documents; or

(b) the date and time the Insured starts his/her Trip.

 

(l) PRE-EXISTING MEDICAL CONDITION EXCLUSION: The Company will

not pay for any loss or expense incurred as the result of an Injury,

Sickness or other condition (excluding any condition from which death

ensues) of an Insured, Traveling Companion, Business Partner or

Family Member which, within the 60 day period immediately preceding

and including the Insured’s coverage effective date caused the

individual to incur charges, receive medical treatment, consult a health

professional or take prescription drugs.

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Nationwide:

 

Effective Date means 12:01 A.M. local time, at Your location, on the day after the required premium for such coverage is received by the Company or its authorized representative.

 

Pre-Existing Condition means an illness, disease, or other condition during the sixty (60) day period immediately prior to the Effective Date for which You, a Traveling Companion, or a Family Member booked to travel with You: 1) exhibited symptoms that would have caused one to seek care or treatment; or 2) received or received a recommendation for a test, examination, or medical treatment; or 3) took or received a prescription for drugs or medicine. Item (3) of this definition does not apply to a condition that 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 sixty (60) day period before the Effective Date.

The Pre-Existing Conditions exclusion is waived if You (a) enroll in this Policy within final Trip payment; (b) purchase this Policy for the full cost of Your Trip; and © are medically able to travel on the Effective Date.

 

My note - Nationwide is very straightforward in its definitions. Although they do have the added stipulation of purchasing the policy for the full cost of your Trip....

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RoamRight:

 

Effective Date” means the date and time Your coverage begins, as indicated in Section IV-Coverage Provisions, When Coverage Begins and Ends.

 

When Coverage Begins:

Trip Cancellation, Optional Cancellation For Any Reason:

Coverage begins at 12:01 a.m. at Your location on the day after the date the required premium for this policy to cover Your Trip is received by RoamRight. This is Your “Effective Date” and time for Trip Cancellation, Optional Cancellation For Any Reason.

 

Trip Interruption and Missed Connection: Coverage begins when You depart on Your first scheduled Travel

Arrangement (or if You must use an alternate travel arrangement after Your Scheduled Departure Date to reach Your Trip destination, on the Scheduled Departure Date) for Your Trip. This is Your “Effective Date” and time for Trip Interruption and Missed Connection.

 

All Other Coverages: Coverage begins at 12:01 AM on the date when You depart on the first Travel Arrangement (or alternate travel arrangement if You must use an alternate Travel Arrangement to reach Your Trip destination) for Your Trip. This is Your “Effective Date” and time for all other coverages.

 

“Pre-Existing Condition” means an illness, disease, or other condition during the 180 day period immediately prior to the Effective Date of Your coverage for which You or Your Traveling Companion, Business Partner or Family Member: 1) received or received a recommendation for a 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 Your coverage is effective under this policy.

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TravelSafe:

 

SECTION III. Insuring Provisions

Your Term of Coverage:

For Trip Cancellation: Coverage begins on Your “Effective

Date” which is at 12:01 a.m. on the date the appropriate cost

for this policy for Your Trip is received and ends at the point

and time of departure on Your Scheduled Departure Date.

 

For Travel Delay: Coverage is in force while en route to and

from and during the Trip.

 

For all other coverages: All other benefits begin on 12:01

a.m. on Your Scheduled Departure Date. Coverage ends at

the point and time of return on Your Scheduled Return Date.

In the event the Scheduled Departure Date and/or the

Scheduled Return Date are delayed, or the point and time

of departure and/or point and time of return are changed

because of circumstances over which neither the Travel

Supplier nor You have control, Your term of coverage shall

be automatically adjusted in accordance with the Travel

Supplier’s notice to Us of the delay or change.

 

“Pre-Existing Condition” means any injury, sickness or condition (including any condition from which death ensues)

of You, Your Traveling Companion, or Your or Your Traveling

Companion’s Family Member traveling with You which

within the 60 day period prior to the effective date of Your

Trip Cancellation coverage under the Policy: (a) manifested

itself, became acute or exhibited symptoms which would

have caused one to seek diagnosis, care or treatment;

(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 © required medical treatment or treatment

was recommended by a Legally Qualified Physician.

 

My note - This one, while a bit obtuse, is at least reasonably clear.

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TripAssure:

 

Effective Date” means the date and time Your coverage begins, as indicated

in Section IV, Coverage Provisions, When Coverage Begins and Ends.

 

When Coverage Begins:

Trip Cancellation: Coverage begins at 12:01 a.m. at Your location on the

day after the date the required payment for this plan to cover Your Trip

is received by TripAssure. This is Your “Effective Date” and time for Trip

Cancellation.

 

Trip Interruption and Missed Connection: Coverage begins when You

depart on Your first scheduled Travel Arrangement (or if You must use

an alternate travel arrangement after Your Scheduled Departure Date to

reach Your Trip destination, on the Scheduled Departure Date) for Your

Trip. This is Your “Effective Date” and time for Trip Interruption and Missed

Connection.

 

Travel Delay: Coverage begins after You have traveled 100 miles or more

from home en route to join Your Trip. This is Your “Effective Date” and time

for Travel Delay.

 

All Other Coverages: Coverage begins when You depart on the first Travel

Arrangement (or alternate travel arrangement if You must use an alternate

Travel Arrangement to reach Your Trip destination) for Your Trip. This is

Your “Effective Date” and time for all other coverages.

 

“Pre-Existing Condition” means an illness, disease, or other condition

during the 60 day period immediately prior to the Effective Date of Your

coverage for which You or Your Traveling Companion, Business Partner or

Family Member scheduled or booked to travel with You:

1) received or received a recommendation for a 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 60 day period before Your coverage is

effective under this plan.

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So of the five policies I picked from Insuremytrip, 3 of which I've actually purchased in the past, two are very clear that the pre-existing coverage look back is from the date of purchase. 1 policy is subject to interpretation - which of course is what lawyers want - and two are pretty clear in the plain text saying that the pre-existing look back for medical benefits on the trip actually starts from the day the trip starts.

 

So having dealt with multiple lawyers and insurance companies over the past 10 years and knowing that each side will 'spin' the wording to benefit their client, I want travel insurance policies with the clearest wording to my advantage in the look back period issue.

 

Just another point in making sure you READ the actual policy certificate and not count on the 'brochure' wording or even what people post on cruise critic! Including ME!

 

And this doesn't even start to address the other issues of travel insurance like secondary benefits, "Usual and Customary", "suitable necessary medical treatment", etc. So far I've only had to deal with cancellations and not medical during a cruise. But as we all get older, and travel more often and for longer duration, the chances of a medical issue popping us becomes more and more likely.

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I am new to this also, and my question is pre-exisiting condition. Does this mean that if you have cancer and are in remission you are not covered even with purchasing before final payment date?

 

Hi Somedayhas arrived, and welcome to CruiseCritic.

 

I've written a reply but NOT yet posted it, and I might not, as I am not an "expert". I have my own theory about how it would work for your situation, at least with our Travel Insured policy (the specific type we get; they have more than one, I think).

 

I STRONGLY suggest that you CALL Steve at

www.TripInsuranceStore.com

 

He owns the company; they are travel insurance brokers, and handle policies from several vetted insurers (each with more than one type of policy, I think).

HE will either know the answer, or call one - or more - of the insurers to clarify if there is a policy for "you". (Your situation is hardly unique these days, thank goodness for modern medicine!)

 

IF he finds a policy that works for you, please have him highlight the EXACT SECTION that pertains to your situation being "covered".

With insurance, one does NOT want to be needing to say, "...but someone told me..."

 

It would be nice if you report back, given that others *are* in similar situations.

 

Our "CC email address" is right below this, in our signature section, if you want to write to us directly for more help.

But the bottom line is that we would only be giving our opinion or some advice, and you cannot rely upon us for any guarantees, obviously.

However, we DO try to help.

Why?

Because WE learned of travel insurance *here*.

And on our FIRST (and very expensive - for us at that time!) cruise/land trip, we therefore took out travel insurance. And... less than 2 weeks from when we were to depart, DH had a medical emergency, and the *only* traveling we did for the next couple of months was back and forth for medical care, tests, etc.!

And yes, Travel Insured refunded everything we had prepaid, all of which was, at that late date, totally NON-refundable.

And we've since had some other claims, ALL paid with no nonsense by Travel Insured. And getting claims paid with "no nonsense" IS a huge part of travel insurance!

We owe a huge debt (we know the exact dollar amount ;)) to CC for the encouragement about buying travel insurance!

 

Somedayhas arrived: Please make sure you understand the difference between "purchasing before final payment" and "purchasing within the 10-20 day window after FIRST payment/deposit", depending upon WHICH policy you have.

 

GC

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Hi Somedayhas arrived, and welcome to CruiseCritic.

 

I've written a reply but NOT yet posted it, and I might not, as I am not an "expert". I have my own theory about how it would work for your situation, at least with our Travel Insured policy (the specific type we get; they have more than one, I think).

 

I STRONGLY suggest that you CALL Steve at

www.TripInsuranceStore.com

 

He owns the company; they are travel insurance brokers, and handle policies from several vetted insurers (each with more than one type of policy, I think).

HE will either know the answer, or call one - or more - of the insurers to clarify if there is a policy for "you". (Your situation is hardly unique these days, thank goodness for modern medicine!)

 

IF he finds a policy that works for you, please have him highlight the EXACT SECTION that pertains to your situation being "covered".

With insurance, one does NOT want to be needing to say, "...but someone told me..."

 

It would be nice if you report back, given that others *are* in similar situations.

 

Our "CC email address" is right below this, in our signature section, if you want to write to us directly for more help.

But the bottom line is that we would only be giving our opinion or some advice, and you cannot rely upon us for any guarantees, obviously.

However, we DO try to help.

Why?

Because WE learned of travel insurance *here*.

And on our FIRST (and very expensive - for us at that time!) cruise/land trip, we therefore took out travel insurance. And... less than 2 weeks from when we were to depart, DH had a medical emergency, and the *only* traveling we did for the next couple of months was back and forth for medical care, tests, etc.!

And yes, Travel Insured refunded everything we had prepaid, all of which was, at that late date, totally NON-refundable.

And we've since had some other claims, ALL paid with no nonsense by Travel Insured. And getting claims paid with "no nonsense" IS a huge part of travel insurance!

We owe a huge debt (we know the exact dollar amount ;)) to CC for the encouragement about buying travel insurance!

 

Somedayhas arrived: Please make sure you understand the difference between "purchasing before final payment" and "purchasing within the 10-20 day window after FIRST payment/deposit", depending upon WHICH policy you have.

 

GC

 

Thanks for the advice. I am definitely going to call and see what I can find out.

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Ccrain

 

Are the bolded words, “This is your effective date” quoted in the policy in each section or is it your impression that each start of coverage indicates a new effective date?

 

It is logical that trip delay / interruption or medical do not start until you actually travel. Insurance can’t pay for something that hasn’t happened yet. It doesn’t necessarily mean that the effective date changes at every stage.

 

I still think that effective date means the defined time after the company receives payment. Your policy is in force at that point, and coverage is applied as the risk occurs.

 

I could certainly be wrong, so you have raised an important question. It underlines the need to read the policy and to ask a qualified broker for clarification.

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Ccrain

 

Are the bolded words, “This is your effective date” quoted in the policy in each section or is it your impression that each start of coverage indicates a new effective date?

 

It is logical that trip delay / interruption or medical do not start until you actually travel. Insurance can’t pay for something that hasn’t happened yet. It doesn’t necessarily mean that the effective date changes at every stage.

 

I still think that effective date means the defined time after the company receives payment. Your policy is in force at that point, and coverage is applied as the risk occurs.

 

I could certainly be wrong, so you have raised an important question. It underlines the need to read the policy and to ask a qualified broker for clarification.

 

The bold typeface is my highlighting the actual certificate words that are causing me concern or non-concern as the case may be...I have not edited them.

 

And yes, the plain language is clear on the two that concern me - the effective date of medical coverage is the day you depart. The effective date of cancellation insurance is the date of purchase. Since the pre-existing condition language uses the same terminology - Effective Date - I can only conclude that there are essentially TWO pre-existing condition Effective Dates - one for cancellation, one for medical treatment.

 

My concern with talking to a broker is that unless they can provide something in writing from the company, or themselves, anything they say is moot. This is purely a matter of contract law and even getting another lawyer's opinion on the matter would be pretty much a waste of money.

 

So the bottom line for me is that I simply avoid those policies completely and go with policies that are clearer in their definition of Effective Date OR simply purchase policies that waive the pre-existing conditions even if I have to sacrifice Primary Coverage to do it.

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Ccrain

 

Are the bolded words, “This is your effective date” quoted in the policy in each section or is it your impression that each start of coverage indicates a new effective date?

 

It is logical that trip delay / interruption or medical do not start until you actually travel. Insurance can’t pay for something that hasn’t happened yet. It doesn’t necessarily mean that the effective date changes at every stage.

 

I still think that effective date means the defined time after the company receives payment. Your policy is in force at that point, and coverage is applied as the risk occurs.

 

I could certainly be wrong, so you have raised an important question. It underlines the need to read the policy and to ask a qualified broker for clarification.

 

I agree that there must be more to this, but *I* sure don't like the way those two sections are worded, which is why I wonder about how the entire policy is worded, as you suggest.

 

But even IF there is some intermediate wording that makes it "okay", I think this is terribly sloppy writing, and with contracts, that's NOT what one wants.

 

BTW: In general (and I've no doubt there would be exceptions) ambiguities in contracts tend to be (notice waffle wording please ;)) resolved in favor of the party that did NOT write the contract.

 

But challenging a dispute, as already mentioned, means... legal costs, at least most of the times.

 

I just don't like how the "ALL other coverages..." section looks...

[but were there more "other coverages" before that section??]

Unless I see more on a full Travelex policy, we'll *never* purchase from them.

No problem, however, as we are totally satisfied with Travel Assured!

 

GC

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Ccrain

 

You are right on all points. Roam Right and Travel Assure seem to play by different rules. Even if you ask an agent what it means, you are bound by the written policy and the company’s application of its terms. Absolutely correct to avoid such policies when there are plenty of other choices.

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This is what I received from an agent from a website that seems to be used by a lot of members here:

Most Comprehensive Plans will offer a waiver of pre-existing conditions if you meet the following conditions: You purchase the policy within 10 - 21 days of making your first trip payment; insure ALL prepaid non-refundable expenses prior to your departure date; and be medically fit to travel the day you purchase the policy.

He did state that through Nationwide cruise plans a waiver could be obtained.

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  • 2 weeks later...

It was stated that Nationwide says you must insure your whole trip. Does that mean your airfare also? I booked the cruise and would like to purchase insurance, but I have not booked air or pre-cruise hotel as of yet. Could someone clarify this for me? Thank you.

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It was stated that Nationwide says you must insure your whole trip. Does that mean your airfare also? I booked the cruise and would like to purchase insurance, but I have not booked air or pre-cruise hotel as of yet. Could someone clarify this for me? Thank you.

 

that is the one thing that bothers me about nationwide - that term is just too legal beagle for me. And for cruises with various penalty times and amounts, who knows?

 

I have simply insured the cost of the cruise, for which i have a receipt, because if I cancel at the last minute, I will just have to eat the airfare and other costs, but if I cancel within 2-3 weeks, I only have a 50% penalty or something like that and the difference will cover the airfare and other costs.

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It was stated that Nationwide says you must insure your whole trip. Does that mean your airfare also? I booked the cruise and would like to purchase insurance, but I have not booked air or pre-cruise hotel as of yet. Could someone clarify this for me? Thank you.

 

Yes, most plans require that you cover any and all nonrefundable costs of your entire trip to include airfare, car rental cost, hotel, etc.. Unless they are refundable.

if you purchase refundable airline tickets, you don't have to add them to your insurance. If your hotel rates allow you to cancel before arrival, you don't have to cover.

 

You do NOT have to pay for ALL the insurance all at once. You can book the cruise and buy insurance that only covers the deposit, then as you book more and/or pay more, you just call the insurance company and tell them your new costs and pay the increase. Or, you can just wait until a few days before you depart for the cruise and pay the new costs.

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