Trip cancellation due to Family Member - Life threatening definition??

[Straitlover]

I haven't called the insurance co yet because I don't want to give them any info to deny or cancel my policy. I thought someone here might know. My mother's cancer has flared back up, and we think she is going to have to have more surgery, radiation and possibly go back on chemo. She is not in immediate danger of dying, but I have to take her to her appointments, and she really doesn't need to be alone while under treatment. I won't know for a few more days when all this is going to start, and our trip starts at the end of August.

 

My policy under trip cancellation for family members says it must be life threatening. Does that mean immediate danger of dying only?

[klfrodo]

The insurance company would probably require a physician certifying that death is imminent and that your presence is required.

That's also assuming that you purchased insurance that waives any pre-existing conditions

[sirwired]

Look again. Under most policies, I don't believe it has to be life-threatening. Post the insurer, policy name, and your state, and we can help you look it over. I believe the key is for the family member to reasonably require your care. Bonus points if you can get her doctor to write a note to that effect.

 

Here's what you should collect (preferably prior to cancelling) so you can prove the cancellation was "reasonable" and coverable:

 

- Get the doctor to state (or preferably write) a statement that your mother requires your care, which will commence on such-and-such date. Given that she's going to be going on chemo, that shouldn't be too much of a stretch.

- If you don't have a pre-ex waiver, and the pre-ex exclusion applies to all family members, you'll need her medical records during the pre-ex exclusion period (showing she received no active treatment or med changes during the exclusion period), along with a statement from her doctor saying she was in remission up until your booking date.

 

When it comes to claim time, don't be shy in sending them records. When I had to cancel to give my folks a hand after my Dad's triple-bypass, not only did I send in the dinky little one-page form and medical records release, I sent in sections from his chart with the highlights circled. (Like the surgical referral letter after a failed stent operation stating that immediate surgery was recommended.) Don't drown them with paperwork, but try to answer every question the adjuster might have before they ask it. (No, they don't need x-rays, MRIs, or tables of blood test numbers; the insurance adjusters aren't doctors. Written summaries are fine.)

 

Adjusters are not generally evil people, especially if you purchased from a reputable company; they are looking to see if your claim falls under a policy exclusion. If it doesn't, they really just need to be able to justify paying your claim to the reviewer at the underwriting company. (The people you'll be working with works for the insurer, which is different from the entity that the money to pay claims comes from.)

[klfrodo]

Look again. Under most policies, I don't believe it has to be life-threatening. Post the insurer, policy name, and your state, and we can help you look it over. I believe the key is for the family member to reasonably require your care. Bonus points if you can get her doctor to write a note to that effect.

 

Here's what you should collect (preferably prior to cancelling) so you can prove the cancellation was "reasonable" and coverable:

 

- Get the doctor to state (or preferably write) a statement that your mother requires your care, which will commence on such-and-such date. Given that she's going to be going on chemo, that shouldn't be too much of a stretch.

- If you don't have a pre-ex waiver, and the pre-ex exclusion applies to all family members, you'll need her medical records during the pre-ex exclusion period (showing she received no active treatment or med changes during the exclusion period), along with a statement from her doctor saying she was in remission up until your booking date.

 

When it comes to claim time, don't be shy in sending them records. When I had to cancel to give my folks a hand after my Dad's triple-bypass, not only did I send in the dinky little one-page form and medical records release, I sent in sections from his chart with the highlights circled. (Like the surgical referral letter after a failed stent operation stating that immediate surgery was recommended.) Don't drown them with paperwork, but try to answer every question the adjuster might have before they ask it. (No, they don't need x-rays, MRIs, or tables of blood test numbers; the insurance adjusters aren't doctors. Written summaries are fine.)

 

Adjusters are not generally evil people, especially if you purchased from a reputable company; they are looking to see if your claim falls under a policy exclusion. If it doesn't, they really just need to be able to justify paying your claim to the reviewer at the underwriting company. (The people you'll be working with works for the insurer, which is different from the entity that the money to pay claims comes from.)

 

Well Sirwired

I knew I should have just kept my mouth shut. :D

Your post gives good information towards the possibility of a favorable outcome.

[cruiseco]

Look again. Under most policies, I don't believe it has to be life-threatening. Post the insurer, policy name, and your state, and we can help you look it over. I believe the key is for the family member to reasonably require your care.

 

This is from the Travel Guard "Gold" plan (at least for my state -- CA)

 

"(a) Sickness, Injury or death of an Insured, Family Member, Traveling Companion, or Business Partner;

1) Injury or Sickness of an Insured, Traveling Companion or Family Member traveling with the Insured must be so disabling as to reasonably cause a Trip to be cancelled or interrupted, or which results in medically imposed restrictions as certified by a Physician at the time of Loss preventing your continued participation in the Trip.

2) If the Insured must cancel or interrupt his/her Trip due to Injury or Sickness of a Family Member not traveling with the Insured, it must be because their condition is life-threatening, as certified by a Physician or because they require the Insured’s care.

3) Injury or Sickness of the Business Partner must be so disabling as to reasonably cause the Insured to cancel or interrupt the Trip to assume daily management of the business. Such disability must be certified by a Physician."

 

I agree, the OP is probably not reading the full plan wording. Almost all include that second part " . . . or because they require the insured's care." But I have seen a couple of exceptions over the years especially with plans like the ones that are included with credit cards.

[Straitlover]

I have the same that cruiseco listed - Travel Guard Gold with the pre-exisiting waiver. I purchased it through insuremytrip.com . I am in NC. I looked again and saw the same that was posted about needing care.

 

In our cabin is me, my sister and her best friend. The way we handle my mother's treatments (she is 76 YO) is I take her to her appointments (I live in another town 75 miles away), and my sister who lives across the street from my mother handles the evenings and any emergencies. I assume if we cancel, only the two of us would be covered, correct? The third person did get the discounted fare, but we've just been taking the total and dividng it by 3 for the amount each of us are paying. So, what we would probably do is get what we can back and pay her all she's out and then split the difference.

 

I forgot to call and add our plane tickets heading down when I purchased them, so we would jsut be out that since I did nto choose a big enough policy coverage amount. I don't know if my sister's CC has any kind of travel protection (Carnival MC), so I'd have to check on that.

 

We're still waiting to decide, but the info you have given is very helpful. Thanks a lot!

[SuzanneSLO]

I have the same that cruiseco listed - Travel Guard Gold with the pre-exisiting waiver. I purchased it through insuremytrip.com . I am in NC. I looked again and saw the same that was posted about needing care.

 

In our cabin is me, my sister and her best friend. The way we handle my mother's treatments (she is 76 YO) is I take her to her appointments (I live in another town 75 miles away), and my sister who lives across the street from my mother handles the evenings and any emergencies. I assume if we cancel, only the two of us would be covered, correct? The third person did get the discounted fare, but we've just been taking the total and dividng it by 3 for the amount each of us are paying. So, what we would probably do is get what we can back and pay her all she's out and then split the difference.

 

I forgot to call and add our plane tickets heading down when I purchased them, so we would jsut be out that since I did nto choose a big enough policy coverage amount. I don't know if my sister's CC has any kind of travel protection (Carnival MC), so I'd have to check on that.

 

We're still waiting to decide, but the info you have given is very helpful. Thanks a lot!

 

There may be a bigger issue if you did not purchase coverage for your airfare. I beleive that TravelGuard Gold requires that you cover all non-refundable expenses in order to waive the pre-existing condition (PEC) exclusion. If this is the case for your policy and you did not buy enough insurance in a timely manner (for example, by increasing your coverage within 15 days of buying your nonrefundable airline tickets), then the PEC exclusion would not be waived.

 

If the PEC exclusion applies to a non-travelling relative under your policy (it does not in all policies but appears to apply to the TG Gold), you will need to determine if your mother had a PEC during the policy's look back period (which looks like it is 180 days prior to the time you bought the policy for the TG Gold ). As noted by SirWired above, you will need to show she received no active treatment or med changes during the look back period.

 

Best of luck to you and to your mother. -- Suzanne

[cruiseco]

There may be a bigger issue if you did not purchase coverage for your airfare. I beleive that TravelGuard Gold requires that you cover all non-refundable expenses in order to waive the pre-existing condition (PEC) exclusion. If this is the case for your policy and you did not buy enough insurance in a timely manner (for example, by increasing your coverage within 15 days of buying your nonrefundable airline tickets), then the PEC exclusion would not be waived.

 

Yep. Way too many people fail to do this and get claims denied because they didn't meet ALL of the plan's requirements. This is from the TG Gold plan:

 

"PRE-EXISTING MEDICAL CONDITION EXCLUSION WAIVER

 

The Insurer will waive the pre-existing medical condition exclusion up to a maximum of the first $30,000 of Trip Cost per person if the following conditions are met:

1. This plan is purchased within 15 days of making the Initial Trip Payment;

2. The amount of coverage purchased equals all prepaid, non-refundable payments or deposits applicable to the Trip at the time of purchase, and the cost of any subsequent arrangement(s) added to the same Trip are insured within 15 days of the date of payment or deposit for any subsequent Trip arrangement(s);

3. All Insured’s are medically able to travel when plan cost is paid."

[sirwired]

Here's to hoping your mother's cancer was in remission with no treatment adjustments within the pre-ex period. TravelGuard knows you aren't in the same state your cruise is departing from and they are going to ask how you planned on getting to the port.

 

As far as anybody else travelling with you... if they aren't on your policy, they are going to be on their own. TG will not pay the single supplement (or anything else) for somebody not listed on the policy. It's unlikely that a simple non-annual-fee affinity card will have insurance that will cover your trip.

[Straitlover]

The policy I bought does have all three of us listed. I just wasn't sure if one of us is not related if their part would be covered.

 

I bought $500 each for cancellation. Our cruise fare total is $927.00 Taxes and 5 days of prepaid gratuities bump up the total to $1374 total. If we cancel, what do we lose, just the $927 or the whole amount? If it's only the $927, then there would be plenty left to cover our flights down ($318 total, 106 each). I used Southwest RR points for our return flight, so I could just cancel those and get my points back.

 

She has not had any chemo since Dec 2011. The only changes in medication are for infections that she gets from time to time (compromised immune system) and they give her antibiotics for them.

 

We did get a better report today than we were expecting. Right now, no surgery will be needed and only 10 days of radiation that will be finished before we would leave. Hope to find out next week if and when we start back on the chemo. So, there may still be the chance to go.

[sirwired]

Pre-paid amounts must be insured if they are non-refundable. Are pre-paid gatuities non-refundable? I don't know the answer to that one. If they are refundable any time before departure then they don't have to be insured.

 

Generally your traveling companions listed on the policy are covered if anybody in your party has to cancel for a covered reason; check your policy for details.

[SuzanneSLO]

The policy I bought does have all three of us listed. I just wasn't sure if one of us is not related if their part would be covered.

 

I bought $500 each for cancellation. Our cruise fare total is $927.00 Taxes and 5 days of prepaid gratuities bump up the total to $1374 total. If we cancel, what do we lose, just the $927 or the whole amount? If it's only the $927, then there would be plenty left to cover our flights down ($318 total, 106 each). I used Southwest RR points for our return flight, so I could just cancel those and get my points back.

 

She has not had any chemo since Dec 2011. The only changes in medication are for infections that she gets from time to time (compromised immune system) and they give her antibiotics for them.

 

We did get a better report today than we were expecting. Right now, no surgery will be needed and only 10 days of radiation that will be finished before we would leave. Hope to find out next week if and when we start back on the chemo. So, there may still be the chance to go.

 

I would suspect that pre-paid gratuities would be refunded even if you cancelled at the last minute, but you should check the cruise lines policy.

 

Even though you purchased the same amount of insurance for each passenger, most company's do not aggregate the fares. So if the 1st and 2nd fare were $400 and the 3rd person was $127, then the 3rd person would have sufficent coverage but the first 2 would not once the $106 in airfare was added. It is likely, however, that all 3 of you have sufficient coverage and thus, coverage for PECs.

 

You should also be aware of the cutoff dates for increases in cancellation penalties.

 

With the more optomistic report you just received, now is obviously too soon to cancel. However, if you have to cancel, you may need to do it quickly because the insurance may not pay the additional loss if you could have cancelled when the penalty was 50% but you waited until it was 100%.

 

Best of luck to both you and your Mom -- Suzanne

[Straitlover]

The report was better than anticipated, so unless something happens between now and the end of the month, we will not have to cancel. No surgery, radiation will be finished several days before we leave, and hoping to hold off chemo until we get back (radiation dr said that should not be a problem).

 

Thanks again for all the info!

[Straitlover]

Well, spoke too soon. Her arm fractured 4 days sfter they said no imminent fracture. She entered the hospital 8/11, did surgery 8/14, still in the hospital as of today. Hoping to get her into short term rehab later this week.

 

If she will still be in rehab the week of the cruise, we will still go. However, instead of flying down 2 days early, we will proably drive down the day before (leave early in the AM, and we have 3 drivers, 700 miles). Our SW flights I can cancel and get the points back in my account. We would lose the $15 in booking fees and the $37.50 we paid for Early Bird. We would lose all of the Jetblue funds (around $318). I would have to check and see if we would get any of that back through insurance.

 

If she doesn't get approved for rehab or she is not there very long, we will have to re-evaluate at that time.