Confused - PEC Exclusion Waiver & Look-Back

[breezer]

I am pretty confused right now. If I fully meet the pre-existing condition exclusion waiver, do I also have to meet the look-back?

 

Here's my situation: My heart problem has been has been great for almost six months with no procedures, doctor appts, or change in meds. My last procedure (heart catheterization for which they found nothing) was on July 20, 2011. Was given a new med on July 13, 2011 which I never had to use. I want to book a cruise for October 2012 and buy insurance immediately after booking. Can I go ahead today or tomorrow and book without worrying if the insurance company has a 6-month look back?

 

Also, do I understand correctly that anything that might happen after I buy the insurance has no bearing on pre-existing condition or look-back even if the event might be heart-related?

 

Thanks.

[cruiseco]

I am pretty confused right now. If I fully meet the pre-existing condition exclusion waiver, do I also have to meet the look-back?

 

Here's my situation: My heart problem has been has been great for almost six months with no procedures, doctor appts, or change in meds. My last procedure (heart catheterization for which they found nothing) was on July 20, 2011. Was given a new med on July 13, 2011 which I never had to use. I want to book a cruise for October 2012 and buy insurance immediately after booking. Can I go ahead today or tomorrow and book without worrying if the insurance company has a 6-month look back?

 

Also, do I understand correctly that anything that might happen after I buy the insurance has no bearing on pre-existing condition or look-back even if the event might be heart-related?

 

Thanks.

 

The "look back period" is just one part of the plan's definition of a pre-existing medical condition. Some plans look back 60 days from the policy purchase date, some use six months, some use a year or more. Here's one example:

 

""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."

 

But for argument's sake let's completely ignore the "look back period" issue all together and concede that you do indeed have a heart-related pre-existing medical condition. As long as you meet the plan's requirements to be eligible for their waiver of that exclusion, the "look back period" thing doesn't matter diddly squat from then on. Here's the waiver from that same policy:

 

"Waiver of the Pre-Existing Condition Exclusion

 

The Pre-Existing Condition Exclusion is waived provided you meet all of the following requirements:

 

1) the payment for this plan and enrollment form is received within 21 days of the initial Covered Trip deposit/payment for your Covered Trip; and

2) you are not disabled from travel at the time you makes your plan payment; and

3) you insure all prepaid Covered Trip costs that are subject to cancellation penalties or restrictions; and also insures within 21 days of the payment for those arrangements the cost of any subsequent arrangements added to the your Covered Trip."

 

So if you meet all three of those conditions the "look back period" will never be an issue for you. That waiver completely gets rid of the pre-existing condition exclusion including any reference to a "look back period."

 

As to question #2, if you've met the three requirements to get the pre-existing condition exclusion waived, even if you have the exact same heart problem flare up and cause you to cancel/interrupt the trip ans/or require medical care during the trip there's no pre-existing medical condition worries -- you've made that whole issue go away, including the "look back period" section. They may deny your claim for another reason (maybe you've been smoking meth on the cruise and it set off a heart attack) but they can't deny it based on some sort of pre-existing condition reasoning.

[breezer]

Thank you so much for responding. Your explanation certainly made it all much clearer for me to understand. Thanks again for your help.

[hal2008]

The "look back period" is just one part of the plan's definition of a pre-existing medical condition. Some plans look back 60 days from the policy purchase date, some use six months, some use a year or more. Here's one example:

 

""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."

 

But for argument's sake let's completely ignore the "look back period" issue all together and concede that you do indeed have a heart-related pre-existing medical condition. As long as you meet the plan's requirements to be eligible for their waiver of that exclusion, the "look back period" thing doesn't matter diddly squat from then on. Here's the waiver from that same policy:

 

"Waiver of the Pre-Existing Condition Exclusion

 

The Pre-Existing Condition Exclusion is waived provided you meet all of the following requirements:

 

1) the payment for this plan and enrollment form is received within 21 days of the initial Covered Trip deposit/payment for your Covered Trip; and

2) you are not disabled from travel at the time you makes your plan payment; and

3) you insure all prepaid Covered Trip costs that are subject to cancellation penalties or restrictions; and also insures within 21 days of the payment for those arrangements the cost of any subsequent arrangements added to the your Covered Trip."

 

So if you meet all three of those conditions the "look back period" will never be an issue for you. That waiver completely gets rid of the pre-existing condition exclusion including any reference to a "look back period."

 

As to question #2, if you've met the three requirements to get the pre-existing condition exclusion waived, even if you have the exact same heart problem flare up and cause you to cancel/interrupt the trip ans/or require medical care during the trip there's no pre-existing medical condition worries -- you've made that whole issue go away, including the "look back period" section. They may deny your claim for another reason (maybe you've been smoking meth on the cruise and it set off a heart attack) but they can't deny it based on some sort of pre-existing condition reasoning.

 

 

thnx

[mellerswa]

I am pretty confused right now. If I fully meet the pre-existing condition exclusion waiver, do I also have to meet the look-back?

 

Here's my situation: My heart problem has been has been great for almost six months with no procedures, doctor appts, or change in meds. My last procedure (heart catheterization for which they found nothing) was on July 20, 2011. Was given a new med on July 13, 2011 which I never had to use. I want to book a cruise for October 2012 and buy insurance immediately after booking. Can I go ahead today or tomorrow and book without worrying if the insurance company has a 6-month look back?

 

Also, do I understand correctly that anything that might happen after I buy the insurance has no bearing on pre-existing condition or look-back even if the event might be heart-related?

 

Thanks.

 

I would call the insurance company in questions and ask about the look-back, but you may want to be aware of the fact that most insurance companies will take into account the pre-existing conditions of relatives when deciding whether or not to pay out a claim without a PEC waiver.

 

So if Aunt Jane, who has been sick for the past 5 months, passes away or takes a serious turn for the worse and you have to cancel your cruise, without a PEC waiver most insurance won't pay.