SNOWBIRD PRE-EXISTING CONDITIONS

Travel Insurance & Pre Existing Conditions

How insurance companies deal with pre existing conditions is a source of confusion and frustration for many SnowBirds...and it's also a source of frustration for insurers.

This old joke is probably the simplest way of expressing pre existing conditions i.e. a medical condition that occurred before the policy started and re-occurred after the policy started

But there's nothing funny about falling on the wrong side of an insurance company's 'pre-ex' clause - that's how claims get declined.

The problem arises because, although the basic concept is simple, putting it into plain language is not. And, despite the efforts of insurers to issue understandable policies, as soon as it gets translated into 'legalese' or 'insurancese' it becomes incomprehensible.

Most people know to look in the 'exclusions' section of an insurance policy to see what is NOT covered, but few people take the next step and look at 'definitions'.

A typical pre-ex clause might read as follows:

Pre-Existing conditions are not covered with the exception of accidents or sicknesses that require emergency treatment and have been stable and controlled during the 90 day period immediately prior to the effective date.

Each of the  highlighted terms may mean one thing to you and I as ordinary citizens, but they are specifically defined terms in an insurance policy.

'Stable', for example, is a relative term and needs to be defined.. 

In plain English, 'stable' things don't fall over. So in regular language, could one argue that the very fact that you got sick from a pre-existing condition proves that it wasn't stable?

That's NOT what insurers are trying to say, which is why they go on to define 'stable' as clearly as they can.

If all of this is giving you a headache, you're not alone and there are some smart things you can do to protect yourself.

1. Use a travel insurance professional to help you understand the policy you are buying. (You can find many of them right here at Snowbird.Net.)

This service is free (they get paid a commission on sales) and they can help translate from 'insurancese' into the language that we ordinary mortals speak.

2. Use a well established insurer that abides by an industry standard. 

The Travel Health Insurance Association is trying to standardize certain terms like the ones above and they have guidelines as to how someone can appeal a decision if a consumer disagrees. Also the Canadian Life and Health Insurance Association provides guidelines as to how tricky issues like subrogation are dealt with.

3. Get it in writing. (You can use your Snowmail account to get the ball rolling)

A verbal agreement isn't worth the paper it's written on. Any reputable insurer will provide you with a written clarification of how your specific pre existing condition will be dealt with.

4. Shop around (the 'one stop shop' at Snowbird.Net can make this task easier)

Even for those with complex medical conditions, there is competition and what one company would consider high risk, another might see as low risk. (High Risk = High Price, Low Risk = Low Price)

And most importantly...

5. Tell the truth, the whole truth and nothing but the truth.

If you disclose everything, and the insurance company says, 'Yes, we will cover you' Then they are on the hook.

But if any material fact is held back, they have the right to turn down a claim.

Even though sometimes it might not look that way, insurers are not stupid. And when claims get big, they investigate.

Bottom line recommendation:

Get help (there's lots right here), use a well established company, get it in writing, shop around and do like your mother told you...always tell the truth.