Travelers who have had claims denied become enraged because they believe they have been duped (see Five “Loopholes” and How to Avoid Them).
Understanding what is and is not covered can help you prevent frustration. The policy certificate contains this information, which you should study throughout your free look period.
Travel insurance does not cover cancellations for ‘everything’
Cancellation and interruption coverage is provided by travel insurance, however the reason for the cancellation matters because not everything is covered.
A list of covered causes for trip cancellation is included in most travel insurance policies. You will not be covered if your cause is not in the list.
Any cancellations due to medical reasons must be approved and documented by a physician. You can’t just cancel a trip because a family member is sick; you’ll need to take them to the doctor and have him or her make that decision.
Pre-existing conditions require special attention
A pre-existing condition is anything that occurred (or began to occur) before you were covered by insurance.
The travel insurance company will review your medical records if you seek a claim due to a medical issue. They’ll have to figure out when and whether this condition started. If they go back and see no evidence of the condition, it was not a well-known one. If they notice that you have been diagnosed with the disease, it will be considered a pre-existing illness, and coverage would be rejected.
Pre-existing condition waivers have been produced by travel insurance providers to give coverage in certain scenarios.
Travel insurance policies have a list of ‘exclusions’
Every travel insurance policy has a list of exclusions, or situations in which coverage is not given. This is a detailed list of reasons that should be carefully read to avoid misunderstandings.
- Expenses incurred as a result of a pre-existing medical condition (although you can purchase a waiver if you have a pre-existing condition and get coverage).
- Changing your mind or realizing you can’t afford to travel (although you can get ‘cancel for any reason’ insurance and cancel a vacation before it begins).
- Losses incurred as a result of winning tickets or tours as an award or redeeming frequent flier or credit card miles (although some plans will reimburse the re-deposit fee for frequent flyer programs)
- Medical tourism, often known as medical tourism, is a type of travel when the objective of the journey is to acquire medical care outside of your native country (although Seven Corners offers a medical procedure insurance for complications due to medical treatment received outside the borders).
- Bad weather (but if you get ‘cancel for any reason’ coverage, you can cancel your trip before it starts if you feel you won’t enjoy it because of the weather).
- Skydiving, scuba diving, bungee leaping, heli-skiing, and other high-risk activities (although some plans offer coverage for high-risk activities as an optional add-on).
- Losses resulting from declared or undeclared wars, military activities, civil unrest, and riots.
- Losses caused by venereal disease, the AIDS virus, pregnancy (excluding pregnancy complications), or abortion.
- Anxiety, sadness, neurosis, or psychosis are all examples of mental, psychological, or nervous diseases that cause losses.
- Losses resulting from the insured purposefully inflicting bodily injury, including suicide.
- Losses suffered by the insured while legally inebriated or under the influence of drugs.
Additional exclusions related to the plan can be found in the policy, certificate, or description of the plan.
Can travel insurance companies check medical records?
It’s standard practice for your insurance provider to ask for medical information when you get travel insurance. Underwriters will utilize the information you provide to determine the amount of risk.
Your insurance provider may want more extensive medical information from your GP to ensure you’re granted the correct level of coverage or to determine whether they’re willing to insure you or process a claim.
Typically, a provider will not request to examine your medical records, but some may request to review them to ensure that the information you’ve provided in your application is correct.
According to the Financial Ombudsman, concerns concerning how insurance companies treat people with pre-existing diseases are a “repeated subject.”
What happens if you don’t declare medical conditions for travel insurance?
If you’re not sure whether you need to reveal a previous medical condition, it’s best to err on the side of caution and notify your insurer so you can be sure you’ll be covered while you’re abroad.
What medical conditions do you have to declare for travel insurance?
Respiratory diseases, heart, liver, kidney, brain or circulation disease or damage, diabetes, strokes or central nervous system disorders, and terminal illnesses are all medical conditions that must be disclosed when getting travel insurance estimates.
Any serious psychological or mental health issues, such as anxiety or depression, should also be disclosed.
In general, you must declare any medical condition for which you have received treatment in a hospital (inpatient or outpatient), clinic, or GP surgery in the previous five years, or if you have had surgery. In this time, you should also declare any medical conditions for which you have been prescribed medicine.
What if you develop a new medical condition after taking out travel insurance?
If you are diagnosed with a new medical condition after purchasing travel insurance, you should notify your insurance provider as soon as possible because this will be deemed a change in your health status.
What happens if you don’t declare medical conditions for travel insurance?
If you don’t tell your travel insurance company about a medical condition you have, you might not be protected if you need to file a claim. As a result, it’s critical to disclose any medical issues you may have, even if they may be managed with medicine.
If you require medical treatment while abroad, this might be quite pricey, as costs can often run into hundreds of pounds. As a result, you should look for a travel insurance policy that covers you for medical situations for at least £10m or £15m. Your policy should also provide sufficient coverage to pay you if you have to cancel your trip due to a medical emergency.
Finding the best travel insurance if you have medical conditions
- Do you have a pre-existing medical problem and need to travel? Get a quote from AllClear today for complete medical coverage while you’re gone.
The Financial Conduct Authority has authorized and regulated Telegraph Media Group Limited as an Introducer Appointed Representative of AllClear Insurance Services Limited.
Why would a travel insurance claim be denied?
Travel insurance will not cover any claims filed as a result of unlawful, fraudulent, or dishonest behavior. As part of an industry-wide fraud prevention and detection effort, travel insurance firms share information on such claims. Similarly, claims resulting from irresponsible behavior, such as unlicensed use of swimming pools or visiting restricted areas, are not covered by travel insurance. During your travels and at your chosen destination, you must follow all applicable rules and regulations.
How far back do insurance companies check medical records?
When it comes to medical data, how far back do life insurance companies go? A medical records request for life insurance normally focuses on the previous five to 10 years. The insurance company needs to know if you’ve had any recent illnesses or treatments.
What information can insurance companies access?
The types of information collected by life insurance companies are usually determined by the amount of coverage you want, the policy type, and the underwriting procedure they utilize. Your age and health may also play a role.
The most information is received from sources such as those listed below for fully underwritten policies. Many of these same sources are used in accelerated underwriting, with the exception of the medical exam. In addition, the simplified issue underwriting procedure may rely on limited third-party data.
Information From You
Prepare your coffee. According to the Society of Actuaries, a life insurance application might have up to 60 questions. You’ll be quizzed on your age, personal medical history and mental health, family medical history, and whether or not you use tobacco. There will also be inquiries into your driving record, harmful hobbies, and any prospective trip plans to dangerous regions.
To verify your identification, insurance providers will ask for personal information such as your Social Security number and birth date. They may also want to know your annual wage because it may limit the amount of insurance you may acquire based on it.
It’s critical to be truthful while answering questions. Keep in mind that insurers will double-check a lot of the information you provide with other sources. Incorrect responses may void your insurance policy in the future.
Electronic Health Records
Life insurance businesses have benefited from the availability of electronic health records. They can get rid of the outdated procedure of requesting an Attending Physician Statement (APS) on an applicant through phone or fax by accessing digital medical records. Firms that help insurers obtain medical records are known as records-request companies.
Your life insurance application will include a HIPAA-compliant consent form for you to sign if an insurer requests your medical records.
Since 2014, health-care providers have been obligated by federal law to keep electronic health records. Life insurers can use electronic health information to speed up the application process and, in some situations, eliminate the need for a medical exam.
Previous Life Insurance Applications
Individual health and life insurance applications are gathered by MIB Group. If you’ve ever applied for insurance with one of MIB’s member businesses, it’s likely that they have a record of you. Insurers can check to see whether your previous responses contradict what you’ve indicated on a new application. You can acquire a free copy of your MIB file.
MIB does not have information about your workplace’s group life or health insurance.
From Pharmaceutical Databases
Life insurance firms will find out if you’re taking medication for high blood pressure, diabetes, depression, or anything else. They check your prescription drug history using third-party companies like Milliman Intelliscript.
From a Life Insurance Medical Exam
A medical exam, also known as a paramedical exam, is usually required for a fully underwritten life insurance policy to identify if you have any medical issues that could affect the amount you pay.
Carriers like ExamOne and APPS are used by insurance companies to send a nurse or paramedical professional to your home or business. They’ll probably measure your height, weight, and blood pressure, as well as take blood and urine samples (which can detect nicotine and drug use, among other things).
Depending on your age or health, some insurers may require an EKG and/or cognitive assessment.
From Your Motor Vehicle Report
You’re submitting a life insurance application, not a car insurance application. So, why would an insurance company want to look into your driving history? You may be a higher risk as a policyholder if you have received speeding tickets or other offences such as DUIs.
From Your Credit
For life insurance firms, your credit may also appear to be an odd source of information. According to the Society of Actuaries, they may examine your credit. Credit scores can help determine your “mortality,” or life expectancy. LexisNexis, an analytics firm, sells its Risk Classifier score to life insurance, for example. Your credit, driving history, and other public records-based criteria are all factored into your score.
From Public Records
Insurers can look up your personal information in public records, find out what property you own, see whether you have a criminal past, and look for other information that might indicate you’re a riskier applicant.
From Financial Statements
Insurance companies may need more information to verify your financial condition if you apply for life insurance beyond a particular sum. Ameritas, for example, will demand to see tax returns or income statements, as well as a list of assets certified by an accountant, for applicants who seek a life insurance policy worth more than $5 million.
From Your Social Media Accounts
Anything you share on social media has the potential to backfire. Even when applying for life insurance, this is true. According to a poll conducted by Lewis & Ellis Actuaries and Consultants, most insurance firms scan social media sites as part of their underwriting process. The majority of people use Google, although some also use LinkedIn, Facebook, Instagram, or Twitter.
Can insurance companies have access to protected health information?
The Privacy Rule requires HIPAA covered entities (health plans and most health care providers) to give individuals access to their protected health information (PHI) in one or more “designated record sets” kept by or for the covered entity upon request. This includes the right to see or get a copy of the PHI, or both, as well as the ability to order the covered entity to send a copy to a person or entity of the individual’s choosing. Individuals have the right to access this PHI for as long as it is kept by a covered entity, or by a business associate on behalf of a covered entity, regardless of when it was created, whether it is kept in paper or electronic systems onsite, remotely, or archived, or where the PHI originated (e.g., whether the covered entity, another provider, the patient, etc.).
Information Included in the Right of Access: The “Designated Record Set
Individuals have the right to access PHI in a secure environment “This is a defined record set.” A+ “45 CFR 164.501 defines a “designated record set” as a collection of records kept by or for a covered entity that includes the following:
- Individual medical records and billing records kept by or for a covered health care provider;
- A health plan’s or an insurer’s enrollment, payment, claims adjudication, and case or medical management record systems; or
- Other records that are utilized by or for the covered entity to make judgments about individuals, in whole or in part. Whether or not the documents have been used to make a choice regarding the specific individual requesting access, this last category covers records that have been used to make decisions about any individual.
Any item, collection, or grouping of information that includes PHI and is stored, collected, used, or distributed by or for a covered organization is referred to as a “record.”
Individuals have a right to a wide range of health information about themselves kept by or for covered entities, such as medical records, billing and payment records, insurance information, clinical laboratory test results, medical images such as X-rays, wellness and disease management program files, and clinical case notes, among other information used to make decisions about them. A covered entity is not required to provide new information, such as explanatory materials or analyses, in response to a request for access that does not already exist in the selected record set.
Information Excluded from the Right of Access
Because the information is not utilized to make judgments about individuals, an individual does not have the right to access PHI that is not part of a designated record set. This could include records of quality assessment or improvement, patient safety activity records, or records of company planning, development, and management that are used for business decisions rather than individual decisions. For example, a hospital’s peer review files or practitioner or provider performance evaluations, or a health plan’s quality control records used to improve customer service or formulary development records, may be generated from and include an individual’s PHI, but they may not be in the covered entity’s designated record set and therefore subject to individual access.
In addition, the right of access is expressly denied to two types of information:
- Psychotherapy notes are personal notes kept separately from the rest of the patient’s medical record by a mental health care professional for the purpose of documenting or analyzing the contents of a counseling session. 164.524(a)(1)(i) and 164.501 are found in 45 CFR 164.524(a)(1)(i) and 164.501.
- Information gathered in the course of, or in anticipation of, a civil, criminal, or administrative action or proceeding. See 45 CFR 164.524(a)(1) for more information (ii).
The underlying PHI from the individual’s medical or payment records, or other data used to generate the aforementioned sorts of excluded records or information, however, remains part of the designated record set and accessible to the individual.
What counts as a pre-existing medical condition for travel insurance?
Pre-existing medical issues are usually described as a sickness or injury that occurred before or at the time you purchased travel insurance. This encompasses both medical and non-physical ailments including cancer, diabetes, and respiratory problems, as well as mental illnesses like anxiety and depression.
What is classed as a pre-existing medical condition?
What are pre-existing conditions, and who are the people who have them? A pre-existing condition, to put it simply, is any health issue that a person has before to enrolling in health coverage. A pre-existing condition may be known to the individual for example, if she is already pregnant. People may also seek for coverage if they are unaware that they have an undetected ailment, such as tumor cells growing within them that will not be detected for months or years. A pre-existing condition could be minor, such as seasonal allergies or acne that can be managed with over-the-counter drugs. Diabetes, heart disease, or cancer, for example, could be more dangerous and require more expensive treatment.
What is considered pre-existing condition for travel insurance?
Pre-existing conditions are usually not covered by travel insurance carriers. These are some of the most common causes for travel insurance claims being denied.
According to travel insurance company Allianz Travel, a pre-existing condition is an injury, illness, or medical condition that caused someone to seek treatment, feel symptoms, or take medicine before purchasing the travel insurance policy.
According to Squaremouth, a travel insurance company, an insurer goes back 60 to 180 days before the policy was purchased to establish what qualifies as a pre-existing ailment. The disease will be regarded pre-existing if the traveler’s medical state changed during that time, such as a new diagnosis, a worsening in health, or the addition of new prescription medicine.
You don’t need an official diagnosis from a health care expert to have something recognized as a pre-existing condition for travel insurance purposes, according to Allianz Travel.
How do I contact Staysure?
Team for Travel Insurance Renewals Our renewals staff can help you renew or cancel your travel insurance policy by calling 0800 014 7808.