Demystifying the concept of medical conditions

Travel insurance is a protection against health expenses abroad following an accident or sudden illness. This is insurance that covers the person’s health. Insurance’s aim is to warn us of future hazards. Therefore, there are restrictions on the medical conditions for people wishing subscribe a travel insurance. The proper term would be to talk to medical eligibility.

What is a condition of medical eligibility?

To obtain travel insurance that will cover you with the benefits offered by the insurance contract, everyone must first meet certain criteria relating to their medical conditions.
A condition of medical eligibility is a health condition for which you have had to be hospitalized or operated, or any condition for which you are being treated by prescribed medication.

Each insurer decides on conditions that it does not want to accept or that it wants to accept under certain conditions (prior condition of health, degree of medical disorder, medical stability, etc.). All insurance policies operate according to a principle. What is not excluded or subject to restriction in the insurance contract, is covered.

Should one infer that one can not be perfectly covered (100%) if a medical condition afflicts them? The answer is no. However, the requirements can vary greatly depending on the age, duration of the trip or the medical condition itself.

What are the medical conditions subject to exclusion or restriction?

As stated above, each insurer sets its own rules. There are very frequent exclusions, that is, those that prevent us from taking out travel insurance:

  1. Your doctor advises you not to travel;
  2. You are suffering from a terminal illness;
  3. You are suffering from metastatic cancer or certain specific cancers (e.g., pancreatic cancer or liver cancer);
  4. You have kidney problems requiring dialysis;
  5. You suffer from respiratory problems requiring oxygen at home;
  6. You have HIV or AIDS;
  7. You are afflicted with some sclerosis, cystic fibrosis, etc.;
  8. Your state is considered as disabled*.

* Recently, some insurers refuse disabled people, that is to say the people who need the help of someone else for activities of daily living or to move.

These systematic exclusions are very common but again, should be reviewed with your travel insurance broker. Some insurers have a list that may differ with varying exclusions. There are also additional medical conditions that are found with one insurer and not with another.

What if one of these conditions affects them?

Now look at the positive side. Even with a medical condition, be it cardiac, pulmonary, diabetic or other, you may be covered if your condition is consistent with the stability required by the insurer. Stability is the time between your last treatment, the last change in medication or last follow-up investigation in relation to your subscription date or date of travel departure. Attention must be given to the definition of medical stability given by each insurer.

By cons, we must also understand that if you have more than two or three major conditions in your file, it is quite possible that you are refused to take out any insurance coverage. It can also impose a large deductible of $5,000 or more, in the case of consultation on all of your medical records on a specific condition or only in the case of hospitalization.

When you purchase travel insurance, it is important to give as much information as possible. Obviously, they will not consider an operation for appendicitis that is 20 years old or even the removal of gallstones after a long time. By cons, surgery to the cardiac system (bypass surgery, angioplasty, valve change, etc.) should always appear in the file, regardless of how long the intervention occurred.

This is where a representative in insurance against sickness or accident is a valuable guide to help you in preparing your travel insurance policy.

What medical information should I know before contacting my broker?

To help your broker to find you adequate travel insurance, it is very important

– To know your list of prescription drugs (all drugs listed on your medical record);

– Why you take them (it controls what);

– To have a calendar of important dates of operation, consultation or hospitalization for health problems such as cardiac, neurological, pulmonary, etc.

Example: Bypass surgery or angioplasty more than ten or twelve years old is regularly checked and even excluded for long-term trips.

If you can accurately provide answers to the three points mentioned above, you are putting every chance on your side. In case of hesitation, check with your doctor, because any error or omission makes the contract null and void in its entirety. A simple consultation for influenza on your trip abroad or in another province may be refused by the insurance. Indeed, if there is an error in your record, for cholesterol, high blood pressure or other, even though the wrong state of health is not the reason for the medical claim, you will not be refunded.

Intentionally or unintentionally omitting medical conditions in your file may lead to the refusal of any medical claims.
A good knowledge of the contract conditions and a good statement of your medical conditions are the guarantee of a serene journey!