Definition of Pre-Existing Condition - Do You Have to Know About It?

Let me preface my question by saying I always buy cruise insurance, and I buy it right after I've booked and put down the deposit.

I found out at the age of 64 that I have not one, but two, congenital heart defects. Obviously this condition has existed since birth. :p Suppose at the age of 60 I was sailing but hadn't purchased insurance within the window for pre-existing condition coverage. I have a heart attack or stroke, and the doctor determines it was brought on by the undiagnosed congenital heart defects. Would cruise insurance cover it? Do you have to be aware that a pre-existing condition, in fact, exists?

Roz

This is tricky for a couple of reasons. Most PEC conditions are defined by ‘having seen a doctor’ or ‘for which a reasonable person would have seen a doctor’. What you describe could be reasonably outside of those two limits in the past.....but that brings us to part two of the trickiness.

ALL travel insurance is based on good faith by both the insurance company and the purchaser. You do not have to undergo a medical exam to purchase insurance and be covered. Meaning that you cannot get an exact answer as to whether a situation will or will not be covered until you file a claim and an underwriter reviews it.

Which means nobody can really say one way or the other in advance. The best that we can hope for is to guesstimate what might happen based on past claim history. In your case, now that you know of these congenital heart defects, the real question is for your doctor; “how likely are they to contribute to a future medical problem?”. And if the answer is anywhere in the ‘they could’ or higher range, make certain to purchase insurance with PEC coverage in the future. (Which wasn’t your hypothetical question, but is what you have usually done in the past.)

Q. What is a Pre-Existing Medical Condition?

A. Any injury, illness, sickness or medical condition of an Insured or Family Member which either manifests itself or exists during the 60, 90, 180 or 365 days immediately preceding the day you buy Travel Insurance, unless the condition is controlled through the taking of prescription drugs or medication and remains controlled throughout the 60, 90, 180 or 365 day period. A pre-existing condition has manifested itself when medical care, treatment or diagnosis has been given. Any adjustment of a prescription causes that condition to be defined as a Pre-Existing Medical Condition, too.

This information provided by tripinsurancestore

https://tripinsurancestore.com/travel-insurance-frequently-asked-questions/#j

Thanks to both of you for your replies. This gets even more interesting. Since childhood, some doctors told me I had a heart murmur, but said it "was nothing". Some doctors couldn't hear it at all, and some of them would roll their eyes :rolleyes: as if to imply I was making it up.

Fast forward to when I was 64 and got a new internist. He didn't like what he heard and ordered an echocardiogram. That's when the heart defects were discovered. So I wonder if simply having "heart murmur" in my medical records would preclude coverage. There was no diagnosis of what was causing the heart murmur.

I guess the moral of the story is just go ahead and purchase insurance with pre-existing condition coverage and hope for the best.

Roz

Thanks to both of you for your replies. This gets even more interesting. Since childhood, some doctors told me I had a heart murmur, but said it "was nothing". Some doctors couldn't hear it at all, and some of them would roll their eyes :rolleyes: as if to imply I was making it up.

 

Fast forward to when I was 64 and got a new internist. He didn't like what he heard and ordered an echocardiogram. That's when the heart defects were discovered. So I wonder if simply having "heart murmur" in my medical records would preclude coverage. There was no diagnosis of what was causing the heart murmur.

 

I guess the moral of the story is just go ahead and purchase insurance with pre-existing condition coverage and hope for the best.

 

Roz

I'm not a doctor, but I did stay at a Holiday Inn Express :')

I would think that a "heart murmur" is not a medical diagnosis of a disease in and of itself but rather a symptom of nothing or a symptom of something to be determined by a medical professional.

https://www.mayoclinic.org/diseases-conditions/heart-murmurs/symptoms-causes/syc-20373171

Then again, I agree with your last statement. When in doubt, just get the insurance in time to cover pre-existing conditions. Claims agents can be persnickety when it comes to denying claims. Who wants to fight over what the definition of "Is" is?

Who wants to fight over what the definition of "Is" is?

That last sentence made me laugh. ;)

If you think about it, your entire body is pre-existing.:cool:

Roz

So this discussion brings up a question, which I hope the original poster doesn't mind me posting. I have always thought it best to purchase insurance within 2 weeks of making a deposit so that PECs are covered. However, what happens if the insurance is purchased later? Does the insurance company look back at your medical records for the period specified as the lookback period to see if a PEC was identified? If so, will the claim usually be denied? In other words, not getting the waiver doesn't mean treatment for all conditions will be denied, will it? If you broke an ankle, for example, 2 years ago, would you be reimbursed if you broke one again?

So this discussion brings up a question, which I hope the original poster doesn't mind me posting. I have always thought it best to purchase insurance within 2 weeks of making a deposit so that PECs are covered. However, what happens if the insurance is purchased later? Does the insurance company look back at your medical records for the period specified as the lookback period to see if a PEC was identified? If so, will the claim usually be denied? In other words, not getting the waiver doesn't mean treatment for all conditions will be denied, will it? If you broke an ankle, for example, 2 years ago, would you be reimbursed if you broke one again?

Under normal circumstances, a broken bone in and of itself, is not a PEC. Now, if you have been diagnosed and are being treated for bone cancer or maybe even Osteoporosis and you break an ankle, then I would anticipate that this would qualify as a PEC.

I believe the look back period is looking changes in diagnostics, treatments, and/or changes in medications.

Since processing a recent claim, I did some research on the definition of PEC. For the insurance I used associated with my Chase Sapphire CC, they have a pretty extensive definition and I was happy to learn that some things are NOT considered PEC if it is controlled with medication for at least 90 days prior to your trip. I’m sure each insurance company has their own definition so I’d advise you read the definition of the insurance you choose to use prior to selecting the insurance.

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It's difficult, but I guess I'm going to have to read every word of each plan I'm halfway interested in to see if the insurance will cover anything but the really obvious stuff. One plan I looked at indicated there was no medical coverage for a "sudden recurrence," no matter whether you purchased the insurance in time to get the pre-existing condition waiver or not. The same plan didn't cover cancellation of the trip if your house burned down and you felt you should stay home to take care of things. One thing I wasn't sure about was airline tickets. If you want to purchase your own and are willing to take a chance that you can at least pay a fee and get re-routed home on the same airline, you apparently cannot omit flight costs when purchasing insurance or you could jeopardize something on your claim. At least that's what I was told for one policy.

It's a jungle out there.

If I may ask, what policy was it that would not cover a "sudden recurrence"? Seems to me that is the whole point of purchasing insurance that covers PEC - or am I missing something?

It was either the AIG Travel Guard Silver Plan or AIG Travel Guard Basic Plan that I asked about the other day. I was using insuremytrip. There was a dash beside "Sudden Recurrence" but then there was other language that indicated the plan DID cover pre-existing conditions. I used the Chat function to ask if a sudden recurrence was covered. The agent responded "No" and that sounded a little shaky, so I ruled that plan out.

I just went back on the insuremytrip site to use the chat function again - out of curiosity and because I didn't want to post anything on here that may not be accurate. This time, after several attempts, another agent was able to tell me sudden recurrence was only wording I will see on some plans, and that a sudden recurrence IS a pre-existing condition, but one that is completely unseen. At least with Travel Guard Silver, it is covered if you purchase the insurance within the PEC waiver time. While he didn't mention what happens if you don't purchase in time to get the waiver, I assumed there would be no coverage in that case. I never really nailed down a specific definition of a sudden recurrence, but perhaps there's a definition somewhere in the policy. I didn't look.

I should probably just stick to using tripinsurancestore. They have a limited number of policies for sale, and don't have an online chat function, but they're pretty good about answering questions. I feel fairly confident about purchasing from them, too.

Yeah, it sounds like the agent you were "chatting" with either did not understand your question or just didn't know his/her stuff. Agree about tripinsurancestore.