I'm confused - pre-existing condition waiver

[Shmoo here]

I'm sure this question has been asked, and I did find some thread that addressed it, but I don't understand......

 

I'm sorry, but I need it in plain, single syllable english, please......

 

If I don't purchase my insurance within the 14 day period immediately following my initial payment, what, if anything, would be covered medically? Nothing? Or, if my medical issue isn't related to a pre-existing condition, would that be covered?

 

For example, say I take blood pressure medication, have done so for years, and there's been no change in my medication/condition. Then, on my trip, I fall and break my arm, or have an appendicitis attack. Or get food poisoning. Would that be covered?

[Hlitner]

You are asking excellent questions, but unfortunately there is no simple answer. Coverage and Exclusions for so-called pre-existing conditions vary between different policies. So if you do purchase a policy within their specified pre-existing coverage time frame, you really need to read the definitions, coverage and exclusions. And if you purchase after a pre-existing time frame our advice is the same. There just is not a single definition for "pre existing" condition...which is simply more of a catch-all term. A good starting place (within the policy) is the "definitions" section where there will be a very specific definition for what they consider a "pre existing" condition.

 

The good news is that there are many different policies on the market. It is often wise to shop around for a policy that best fits your own needs (do not get sucked in by a cruise line or travel agency selling one particular policy). You can look at web sites like insuremytrip.com or squaremouth.com. Some others here on CC recommend another broker which is called Trip Insurance Store....where "Steve" has previously impressed some CC posters with his insurance advice.

 

As to your examples, they are interesting. Assume you are on blood pressure meds, under control, but have had several fainting incidents (due to the meds). On a trip you happen to faint, fall, and break your arm. The insurance company might deny coverage saying it was a pre-existing condition (we would appeal this kind of ruling). But it is very unlikely they could argue that appendicitis is related. And food poisoning would also have no connection to blood pressure meds...and not be an issue.

 

But our standard advice (we spent over 30 years in the health insurance industry) is to always read a policy (before you purchase) and do not skip the so-called fine print. And if there is something you do not understand, call the insurance company and ask for a specific explanation (document the call) keeping in mind that if it is not in writing it is usually not binding.

 

Hank

Edited January 1, 2016 by Hlitner

[Underwatr]

The specific rules and requirements regarding pre-existing conditions are spelled out pretty clearly in the actual insurance contract. Since it varies by policy I always make it a point to review the contract language before deciding on a policy.

 

In general, an insurance plan will have language excluding conditions that exist at the time the contract is purchased. For example a contract I have in front of me says

 

The following exclusion applies to the Medical and

Dental, Trip Cancellation, Trip Interruption, and Travel

Delay coverages:

 

We will not pay for loss or expense caused by or incurred

resulting from a Pre-Existing Condition, as defined in the

Definitions section, including death that results there from.

 

Any place you see terms with initial capitals it indicates that the term is defined elsewhere in the contract. In this contract a Pre-Existing Condition is defined:

 

PRE-EXISTING CONDITION means a Sickness or Injury

during the 180-day period immediately prior to your

effective date for which you or your Traveling Companion:

(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.

 

So in this contract, the use of prescription drugs doesn't cause an issue regarding pre-existing conditions as long as that medicine has been taken (or prescribed) at the same strength throughout the entire exclusion period.

 

The exclusion applies to the specific condition. If you're on blood pressure or cholesterol medication, breaking your arm shouldn't be excluded (I don't know enough about how closely the insurer will look to determine whether an apparently unrelated accident might have been caused by changes to a medication such as blood pressure meds).

 

Different policies will have different exclusion lookback periods (like 90 or 365 days vs. 180) so that's another factor to look at when reviewing policies.

 

Finally, there's the question of when you have to buy the insurance to be covered under the pre-existing conditions waiver. Most policies that have a waiver will require you to buy within something like 10 to 14 days of initial payment. Again, you have to read the contract before buying to make sure that there is a waiver available and that you're buying within the defined period. At least one insurer (CSA) offers a pre-existing conditions waiver if the policy is purchased before or within 24 hours after final payment. But there are other stipulations in the waiver clause to be aware of:

 

This (pre-existing condition) Exclusion does not apply provided you meet the

following requirements:

a. coverage is purchased prior to or within 24 hours

of your final Trip Payment and

b. you are medically able to travel at the time the

coverage is purchased; and

c. you insure 100% of your prepaid Trip costs that

are subject to cancellation penalties or restrictions.

In my experience having the waiver up to final payment is likely to make the insurance cost significantly more than buying it at time of initial payment but sometimes there are good reasons not to buy insurance that early in the planning process if everything paid can be refunded until final payment.

 

Looks like Hlitner posted while I was composing & editing. I agree with what he says as well.

[Happy2cruise]

I too would suggest contacting tripinsurancestore.com and speaking with Steve or one of the knowledgeable reps personally. They are very helpful and can help you with the right answers and advice. Good Luck:)

[CruisingAlong4Now]

I second the suggestion that you call Steve at the trip insurance store dot com

[weatherboy80]

We just purchased trip insurance through AIG (travel guard) for our 10 night cruise in early March for DW and I. We made the final payment 2 weeks ago though.

 

We also found during the holidays (of course) that my mother-in-law now has a kidney infection and we are not entirely sure how serious it is at this point. It is related to a form of blood cancer that she has been battling for several years (successfully to this point anyways), but are not certain how that will progress in the near future and certainly the next few months.

 

Anyways, I was reading through the travel insurance waiver and noted a section discussing prw-exsisting conditions regarding non-traveling "family" members within a 180 day look back period so I was then curious to know if this would impact our policy? I then called TravelGuard and they will not cover her conditions unless she passes away :mad: It is really hard to predict what will happen in the next 2 weeks let alone 2 months from now, especially with long term illnesses like these ...

 

However, I have noted that CSA insurance does not look at the non-traveling family members for coverage. Should I look to them instead? I have a 15 day review period on the TravelGuard either way ...

 

https://www.squaremouth.com/travel-advice/travel-insurance-for-pre-existing-medical-conditions/

 

Thanks for the advice!

[Underwatr]

We had to initiate a CSA claim last week since my wife became ill on a QM2 cruise. So far very happy with their support, but I haven't actually begun the process of submitting receipts for reimbursement.

[weatherboy80]

I'm a bit confused now. I called CSA and they said they do not look at the non traveling family members to issue the policy but if we had to make a claim they would look at the "worsening" of a condition regarding that family member :confused:

 

Anyone have a similar experience with CSA?

Edited January 3, 2016 by weatherboy80

[weatherboy80]

Maybe I'll answer my own question?

 

The more I read about this the more I think CSA might be our better option going forward - noting the discussion about half way down in reference to a non traveling family member illness:

 

https://www.insuremytrip.com/learn/getting-help/index.html

[Underwatr]

I thought I had answered that question but it looks like not. Carefully read the Trip Interruption and Trip Cancellation sections of the contract. My CSA policy says the relative's condition has to occur after you buy the policy:

 

TRIP INTERRUPTION BENEFIT

...

Covered Events:

1. The Sickness, Injury or death of you, your Family

Member, your Service Animal or your Traveling

Companion.

The Sickness or Injury must first

commence while your Trip Interruption coverage

is in effect under the Policy,

must require the in-

person treatment by a Physician, and must be so

disabling in the written opinion of a Physician as to

prevent you from taking your Trip (either because

your condition prevents your travel, or because

your Family Member, Traveling Companion or your

Service Animal requires your care);

 

Similar language is in the Trip Cancellation section.

 

Like the policy you're considering, the Pre-existing condition section in mine only mentions the traveler but they catch pre-existing conditions of relatives in the language above (and also exclude relatives' pre-existing conditions from any available waivers in doing so).

Edited January 3, 2016 by Underwatr

[weatherboy80]

Curious what they would consider a long term illness like cancer that suddenly takes a turn for the worse or having various complications then? When I talked to TravelGuard they said something like cancer would not be coved since we were less than the 180 day look back period for that non traveling family member and they consider a worsening cancer a non stable condition. *Travelguard would cover us In the event of death though. *However, when I talked with CSA they said they would not look at those pre existing conditions ... But any foreseen worsening condition would be examined.

 

The biggest challenge for us has been extracting relevant information from my inlaws family on the true state of my mother in law. *We are out of town and unfortunately they aren't very open regarding their health so that makes it extremely diffulcult as well.

 

I guess worse case scenario is that god forbid we would have to cancel last minute and eat the cost of the cruise and travel insurance premium. *I also wonder if the cruise companies (Celebrity in this case) would ever allow us to exchange to a different cruise in this scenario by pleading our case? *

 

I know hindsight be what it is at this point - buy the insurance as soon as you make an initial deposit!

Edited January 3, 2016 by weatherboy80

[weatherboy80]

I wonder if csa would consider death to be unforeseen like travel guard does?

[Underwatr]

Interesting. Reading my CSA policy, I can't tell. It only mentions sickness and injury. Perhaps death would be an unforseen development where continued sickness or incapacitation due to an injury would be excluded if the onset was before the policy was purchased.

[weatherboy80]

It's hard to tell as well - here is the response I got my a CSA Rep today:

 

Thank you for your email. Unfortunately, we are unable to make any type of determination of coverage at this time. Many details affect the outcome of a claim, so a Claims Representative always makes the final determination of coverage of all claim situations after a review of completed claim forms and supporting documentation. If you have any further questions, please contact our Customer Service Department at 800-348-9505, and a representative will be happy to assist you.

 

Regards,

CSA Travel Protection

 

Seems like a typical cut and paste email response.

 

Right now I've actually got 2 policies for our upcoming March cruise. I need to get rid of one of them :rolleyes: First is from TravelGuard and the other is now from CSA. I have ~11 days to cancel the first one and 8 more to cancel the CSA policy. My guess is either would be sufficient for all general cases, except that TravelGuard phone rep told me explicitly that death is always considered an unforeseen condition no matter what the cause, but that general illness (no matter how grave) would not.

Edited January 4, 2016 by weatherboy80

[weatherboy80]

Talked again with the folks at insuremytrip. Their suggestion, in our case, is to stick with TravelGuard if our primary concern is with death alone before or during our trip. As I pointed out TravelGuard will not cover us if we cancel to simply be by her side if her condition worsens. CSA, however, may be a better option if death is not the primary concern here, but we still maybe caught by the "The Sickness or Injury must first commence while your Trip Interruption coverage is in effect under the Policy" within the CSA cancellation section. So for example if she were relatively stable with her condition (remember the non pre-existing conditions for non-traveling family members), but caught phenomena or some other new grave illness we would likely be covered. If she were to pass related to the cancer alone then we would not. As per always, it a case by case review either way :confused:

[cruiz30]

So advice...

 

Final payment for my cruise is due Thursday. My mom has cancer and receiving chemo. She lives with me I am her primary caregiver. I would like to travel with my husband and children. Mom will be a home. I didn't purchase the insurance during the waiver period because I wasn't aware of the waiver issue. Just wondering how her pre existing condition would or wouldn't effect my policy.

[Underwatr]

The only policy I'm aware of with a pre-existing condition waiver at final payment for medical coverage is CSA but illness of a family member that exists at time of purchase isn't waived for cancellation or interruption coverage with CSA as we've discussed. Death might be a covered event but the language is vague.

 

(I'm assuming "North Jersey" in your info is Northern New Jersey since I'm only familiar with policies sold to US residents.)

[weatherboy80]

Underwatr is correct - so far in my case, which is very similar to yours (prayers to you and your family), the only company that said they will cover death no matter what is TravelGuard. I'm still trying to find out from CSA if they will cover death due to a prolonged illness for a family member - their language is certainly vague ...

[cruiz30]

Yes, I'm from New Jersey. So basically, there is no insurance that would cover my mom's pre existing condition at this point. :(

 

I guess I will be cancelling my cruise on Thursday.

[Underwatr]

Assuming you can get your money back it might be the best option at this point. I'm facing a similar issue with the cruises I've booked.

Edited January 6, 2016 by Underwatr

[weatherboy80]

Good luck! In our case we made the final payment (12/17/2015) a week before we knew the seriousness of my mother-in-law. Honestly, we still don't know how far along the cancer is or what the most likely prognosis is at this point either which still makes all of this very difficult. I guess If we would have known we would have canceled our simply moved the date, but right now just continuing to plan to go on our March cruise is our best bet. We are planning to travel to visit with her a couple times beforehand though and maybe get some more straightforward answers.

[cruiz30]

What are your thoughts about canceling my current reservation and rebooking in order to get pre existing condition waiver? I would have to pay an extra $200 for the cruise :(

[Underwatr]

The Trip Cancellation and Trip Interruption clauses might still require that the sickness or injury that you'd claim for not exist at the time you purchase the policy.

 

My CSA policy says the Preexisting Condition waiver applies to Cancellation and Interruption coverage but also specifies in those sections that the sickness or injury must first commence while the policy is in effect to be covered.

 

E.g., a reoccurrence less than 180 days from the last would be covered under the waiver but if she's already sick when you buy the policy it probably wouldn't be covered.

 

At least that's how I'm reading my CSA policy.

Edited January 6, 2016 by Underwatr

[weatherboy80]

Well in our case I would gladly take a $200 penalty or change in fare to be able to move or postpone our cruise. The doctors are now considering removal of her enlarged spleen for quality of life improvements supposedly in early Feb. With her myleofibrosis and now pending removal of the spleen that carries a pretty high risk! The planned cruise is not until March 4th so that still leaves a lot of time for things, both good and bad, to change.

[6rugrats]

What are your thoughts about canceling my current reservation and rebooking in order to get pre existing condition waiver? I would have to pay an extra $200 for the cruise :(

 

Don't believe this will work; it seems like insurance fraud. The insurance company will be able to find out you already had a booking. Advise you not go down this road.