Which medical conditions does travel insurance really cover?

By Chris Chamberlin, September 1 2014

Travel insurance normally covers medical conditions, but like all insurances there are restrictions and exclusions set within the policies to keep the costs of premiums at a minimum.

Travel insurance prices are all based on risk assessment. Just as skydiving isn’t generally covered as it’s too risky to insure, the same goes for serious illnesses and injury.

If travel insurers started to cover conditions such as heart disease or cancer, it’s likely that overall premiums for consumers would go through the roof. Insurers put restrictions on the higher risk illnesses to keep costs down for the average jetsetter.

“What travellers fail to realise is that any previous illness or injury is considered a pre-existing medical condition,” suggests Natalie Ball, Director of Comparetravelinsurance.com.au.

“If you want cover, you must disclose anything you have sought medical attention for in the past. Even something like a stomach ulcer from 10 years ago. Without doing so, your claim could be rejected as the insurer was not made aware of the condition in the first place.”

What is considered a pre-existing medical condition in travel insurance jargon?

A pre-existing medical condition is considered an ongoing medical or dental condition which you are aware of, or have symptoms of, or a condition that you are currently seeking treatment for, or have previously been treated for, by a medical professional.

It can also be something that you’re currently taking medicine for or you’ve had surgery for in the past 12 months. Pregnancy is also considered a pre-existing medical condition.

Typical pre-existing medical conditions that are covered:

  • Allergies including rhinitis, chronic sinusitis, eczema, food intolerance, hay fever
  • Asthma – provided you have no other lung disease and are less than 60 years old (age may vary from insurer to insurer)
  • Epilepsy – provided there has been no change in the last 12 months
  • High cholesterol
  • High blood pressure – provided you do not suffer from cardiovascular disease or diabetes
  • Osteoporosis
  • Cataracts, congenital blindness
  • Congenital deafness
  • Diabetes – provided you were diagnosed more than 12 months ago and have no kidney or eye complications, you do not suffer from hypertension or hypoglycaemia, and you are under 50 years of age (age may vary from insurer to insurer)
  • Hernia
  • Incontinence

Typical pre-existing medical conditions that aren’t covered:

  • Terminal illness with a life expectancy of under 24 months
  • Chronic renal failure
  • Congestive heart failure
  • Aids
  • Cancer
  • If you’re awaiting surgery
  • If you require oxygen for your holiday
  • If you take blood thinning drugs
  • Seizures in the past 12 months
  • Recurring pain, including back pain, that requires ongoing treatment such as physiotherapy or a chiropractor
  • Mental illness – including depression, anxiety, dementia
  • Suicide
  • Autism
  • Fertility treatment
  • If you are waiting for an organ transplant
  • Alcohol or drug addiction
  • Sexually transmitted diseases
  • Pregnancy, if you’ve had complications, or went through IVF, childbirth also isn’t covered

Pre-existing medical conditions

If you do suffer from a medical condition that’s not automatically covered, it doesn’t mean you’re unable to get travel insurance at all. Many conditions require a medical assessment before cover can be purchased.

There might also be the option to pay a premium to cover your condition, which helps to outweigh the additional risk for the insurer.

Importantly, if you’re refused cover for your particular condition, all of the other benefits of travel insurance remain available to you, and any medical claims that are totally unrelated to your pre-existing medical condition are unaffected.

Of course, you won’t be covered for any claims arising from your refused pre-existing condition, but that’s to be expected.

Typical situations and conditions you’ll need a medical assessment for:

  • If you’ve had surgery in the last 2 years
  • If you’ve experienced heart problems
  • If you have a pacemaker
  • If you’ve suffered from a stroke
  • If you have HIV
  • If you suffer from epilepsy, and you’re on two or more anti-convulsion medications
  • If you have cystic fibrosis
  • If you’ve had deep vein thrombosis

Your medical claim will also be rejected if:

  • You were aware, before your journey commenced, that it might be cancelled, disrupted or delayed due to illness
  • If injury or illness happens to a person over 85 years old (age will vary from insurer to insurer)
  • If you do not disclose your pre-existing condition before the start date of travel
  • If your pre-existing medical condition was deemed too risky to insure before starting your trip

Finding the right cover

Medical bills overseas regularly exceed tens of thousands of dollars. Without travel insurance, your journey could end in financial ruin. 

It’s important to remember that each underwriter has a different list of conditions that are covered, so it pays to shop around and compare different policies and insurers.

Ball suggests that “if you’re finding it difficult to find cover for a particular condition, ensure you contact insurance companies with varying underwriters to research a good cross-section of the market.”

Regardless of the type or breadth of insurance you need, the best way to find out what each policy covers is to read the Product Disclosure Statement (PDS) in full before making a final call.

The document lists and explains every event, situation and condition that is insured by the policy, along with any applicable excesses, waiting periods and conditions that apply – making it a ‘must-read’ for any traveller.

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Chris Chamberlin

Chris Chamberlin is the Associate Editor of Executive Traveller and lives by the motto that a journey of a thousand miles begins with a single step, a great latte, a theatre ticket and a glass of wine!

wilsoni Banned
wilsoni Banned

Qantas - Qantas Frequent Flyer

28 Sep 2011

Total posts 321

"..you must disclose anything you have sought medical attention for in the past.."  What a joke. Can anyone seriously remember every medical event, big and small?  Yet the insurers can wriggle out if you saw a doctor 20 years ago, you've been fine ever since but something happens when you travel.  Surely it's time for legislation to regulate travel insurance and make the playing field more even. This is just corporate bastardry writ large.

12 Jun 2013

Total posts 744

When I buy travel insurance there's not even a box to type "Hey I had surgery eighteen months ago" into.

Now, I can of course see the value of sensible restrictions on pre-existing conditions, since I don't want my travel insurance to cover the nine-months-pregnant woman who just *happens* to go into labour while hanging around the waiting room of the Mayo Clinic, I would worry about travel insurance weaselling out of legitimate and unexpected medical emergencies that might arise while I'm travelling (especially in the US, where a hospital stay can easily cost you a three-bedroom house...)

Qantas - Qantas Frequent Flyer

23 Mar 2012

Total posts 210

Travel insurance is a wrought for people with a pre-existing condition. It seems that most companies disregard the medical reports completed by doctors who treat folk from day to day and rely on the medical advisors that have little to NO experience in treating some conditions. This is especially true when it comes to a condition like cystic fibrosis that vary rarely needs emergency treatment but insurers just refuse most applications on some ill defined risk...even for short trips of a week or 2. 

wilsoni Banned
wilsoni Banned

Qantas - Qantas Frequent Flyer

28 Sep 2011

Total posts 321

There are plenty of cases too where the insurer, for example, refuses a broken leg claim because years ago you saw a doctor for dizzy spells. He/she diagnosed a case of mild  ear infection that cleared up and hasn't occurred again, but the company says "our medical staff" (read a tame doctor with a medical degree from somewhere you've never heard of) think the fall that caused the leg break was due to your "pre-existing" condition.  How are they allowed to get away with this? It's a huge abuse of market power, because they write the policy conditions (which are much the same for every insurer) and you get no say and no choice.  Yet the ACCC and other relevant bodies are seemingly powerless.


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