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Travel insurance for pre-existing medical conditions

Need some advice on pre-existing medical conditions and travel? Here is what you need to know:

Share your thoughts, questions and experience about travel insurance and pre-existing conditions below.

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I have had a medical condition (Cardiomyopathy) for some 20 years, and in that time have traveled to more than 40 countries. I regularly take multiple medications, and I am no longer young. That said, my cardiologist (who is the only one with a finger on the pulse) is comfortable with my traveling and does not feel that I am in any danger of coming home in a body bag. Nevertheless, it is almost impossible to find any company prepared to provide travel insurance.

We live in an aging society, and increasing numbers of us are experiencing similar health issues. We should be able to obtain travel insurance, albeit at an increased premium.

The problem is, insurance companies assess risks by algorithm rather than physical examination; they trust computer projections rather than trained medical experts. My readiness for travel should be assessed by my doctor rather than by a formulaic computerised equation.

I would like to see a Choice investigation of the processes and policies applied by insurance companies when travel insurance risk is assessed. Currently the basic premise is “reject anything which could conceivably result in a claim”. This is not only immoral, it is against the fundamental principle of risk sharing.

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@boblorel, sad to hear you have had problems, but appears you have accepted some risk to still enjoy travelling to your ‘hearts content’. Have you tried getting a TI policy which excludes anything relating to your condition?

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There’s no problem obtaining insurance which doesn’t cover my pre-existing conditions - but what would be the point? I should be able to travel and have the peace of mind that comes with insurance, including those conditions which arose prior to traveling. The concept of insurance is that everyone pays so that unforeseen situations are protected against. If a medical professional states that the risk is low, then insurance companies should accept that risk for an increased premium.
As it stands, insurance companies simply exclude risks that mean that there is any possibility of having to pay out.

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That is certainly the theory, at least outside the board room.

Inside the board room there are only a few issues. Profits, bonuses, and dividends as with any business.

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The point would be to protect you against anything which is not related to a pre-existing condition. This could include accidents/injury which could arise while travelling, theft of property or personal effects, emergency evacuation/repatriation to Australia in the case of serious injury or death, rental car insurance, cancellation or delays to your trip outside your control (e.g. natural disasters), third party insurance just in case you injure someone else accidentally, and the list goes on.

While I can understand your dilemma, I suspect that most travel insurance companies exclude a range of pre-existing conditions because they don’t want to be responsible for those who may try and flaunt the system by taking a holiday to another country so that they can have care they would pay for in Australia (e.g. to bypass elective surgery waiting times in Australia or to have medical intervention quicker than in the public system - those without private health insurance, or to have treatment which one may think is better in another country). The same pre-existing exclusions apply to private health insurance as one could take a policy out, undergo very expense treatment as soon as the policy cover commences, and then terminates the policy shortly after completion of the treatment.

The Insurance Industry Ombudsmen has some information on pre-existing conditions which may be of interest. It can be found here and is why private health insurance companies can insist on waiting periods of 12 months for pre-existing conditions. As most travel insurance currency is 12 months or less, it could easily be argued that they restriction on pre-existing meets the 12 month period outlined in the link.

I suspect that if insurance (both travel and private health) did not have pre-existing condition exclusions, there would be many would take advantage of this and it would increase the cost of polices for all.

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The main point I am making is that assessments based on algorithms should not be the primary arbiter of who is insured and who is not. My cardiologist has definitive information based on years of facts, and if he considers travel too risky, then he says so - based on knowledge rather than software. He has me taking multiple medications because he knows that it is a strategy that works - thus I am still alive 20 years later and still able to travel. The computer looks at the number of medications and throws its electrons in the air in fright! Having a machine overrule a trained specialist makes no sense.

I appreciate all the benefits of taking insurance for other risks, but I simply would not travel without cover for my heart - the risk would be too great. Healthy people wouldn’t (shouldn’t) travel without travel insurance, and those who take a punt often end up bankrupt as a result. We can all insure our houses and cars even though they might have high risk factors involved. That’s not an option with me for travel insurance.

I am not alone, and in the future the numbers of ageing and medically compromised individuals will be far greater. There needs to be a better way of assessing who is a major risk, based on a human essessment, and who is simply a theoretical risk as judged by a computer. When you reach my age you may well wish that someone had challenged insurance companies today.

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You have answered your own question in relation to why travel insurance companies don’t want to provide cover. They possibly also would assess the risk as being to great.

Insurance companies are about making money and staying in business, so they can sell more policies to make more money. They don’t accept unacceptable risks as this impacts on their business models and every other policy holder.

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I think you misunderstand. We do not (generally) live our lives without insurance. We insure our cars, our houses and with everything there is risk. I would not drive my car without insurance - the risk is too great. The insurance companies, however, will offer insurance without even seeing my car. They know the make, the model and the general condition, but they do not know much about me as the driver, a major factor in the potential for accidents. Sure they make some adjustment for age, but they issue policies nonetheless. There’s a lot of money in it.

With travel insurance, they are quite happy to issue policies provided they know the risks, and you will say that is why they do not insure people with pre-existing conditions. However, they do not really know the risk because they do not know me or my health. They make assumptions instead. What I am saying, is that they should be required to assess that risk by availing themselves of the information I could provide. Discrimination takes many forms, and we have laws to prevent that. I am suggesting that this is another form of discrimination. You may not see that because you are not the one being discriminated against. Unfortunately, that is the nature of discrimination - those who are not effected do not see it as discrimination. Perhaps when (if) you find yourself wanting to travel but a computer rules you as uninsurable, you might reconsider.

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No, it is similar to travel insurance. One has a duty to disclose information which may affect insurance risks. See this. Based on this information, a car insurance company can refuse cover.

It isn’t discrimination, but possibly risk management to limit their exposure to potential liabilities.

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An insurer can refuse car insurance, but cannot know if a driver is basically a hoon, and thus a greater liability. One man’s risk management is another’s discrimination. While health insurance can refuse to pay out on pre-existing medical issues, that only applies for the first 12 months - after that we are all entitled to be insured and to claim.
I suspect your views on this issue will remain unchanged as long as you regard it as a moral and justifiable approach for insurers to make business decisions based purely on the bottom line. However, what I am suggesting is that insurances should be available to all just as they generally are in other fields. You don’t see it as discriminatory, but that’s because you are prioritising the profit and loss statement over the fairness to all approach. You are also not the one being discriminated against, and that of course is the easier roads to travel. Perhaps you would also prefer to see the national disability insurance scheme discontinued due to a lack of profitability?
It is actually quite possible to insure people with health issues provided that a sensible approach is adopted. It can be done, but insurers choose not to do so. In a more equitable society both the business needs of the insurer and the needs of clients can both be accommodated.

In the US car insurance companies are most interested in driving record to rate you and insure or decline you with claims history secondary. Here they are only interested in claims history; they do not seem to care about hoons who do not make claims since anyone who does not make a claim is good business.

@boblorel, you have put an interesting proposition on the table. You are correct that at least in the western world insurance is basic to protect our financial lives. As a senior myself, I have long been aware that travel insurance, new credit, and other common bits of life would be and are increasingly difficult and expensive to obtain as our milestones are hit.

An underlying question is not discrimination per se, but taking on personal responsibility or demanding society share your personal risk tolerance as with NDIS, general insurances, etc. But then you wrote you could get travel insurance excluding heart conditions but why as it would serve no purpose. It would cover for a multitude of travel issues and even health related so long as they could not be traced back to your heart. So your position seems one-sided although understandable. We are all meeting a world that is increasingly about ‘me, my, mine and work out your own problems’. It is an ugly kind of world in my view, but roughly 50% of the electorates in most western societies are voting for parties that lean that way, such as our libertarian coalition.

Although you seem happy to take risk on advice, the human condition is complex and medical events happen. What you reference as discrimination seems reasonable for an insurance company operating as a business to decline to underwrite your personal risk tolerance for your condition because medical and evacuation expenses, especially in the USA, can be breath taking. nb. My late brother was a ‘sick puppy’ for years and every time he went into hospital the bill (paid 80% by US Medicare and supplementary insurances, 20% by him) was in the $USD200,000-400,000 range for just a few days. He was fortunate he had sufficient resources! You used the example of how private insurance has to cover pre-existing conditions after 12 months. Perhaps a travel insurer could cover pre-existing conditions for the first 30 days, but would seriously ill people take advantage? Or cover those conditions after 30 days away? What purpose then as most travel for weeks not months… I trust you see the points I am attempting to make, and am not being argumentative.

A few honest questions

  • what price would you be willing to pay for travel insurance that included your heart condition?
  • why do you think that is a fair price?
  • what medical review would you be willing to undergo to override ‘the computer’ and at whose cost?
  • under the for-profit capitalistic system what is the insurance company’s responsibility to shareholders?
  • does your cardiologist have his/her own ‘skin’ in the game, unlike an insurance company that gave you cover, if you are travelling and have an episode?

Serendipitously there is an item in the press about Volvo thinking outside the box for ‘placing’ their cars. It caused me to have a deeper think about your post. It is a problem where individual ‘rights’ (is international travel insurance a right?) meet with individual responsibilities and costs. You call it discrimination while others call it risk management. It is a touch of discrimination as currently practised because it stops short of a physical exam (which is your original point), but at the same time, at what cost to a wider society to satiate an individual?

Perhaps Volvo will succeed with their novel approach, and similarly one day universal travel insurance for health might be part of medicare or become a long term subscription as with life insurance. Both interesting propositions, but if the medicare levy went up another 1/2% to cover travel how would the electorate respond? Perhaps wildly in favour, or not.

Once again, insurance is a business not a social movement, for better or worse.

My last comment is that you are 100% correct that those of us who do not meet with particular problems rarely equate them with discrimination, while those who do interpret them quite differently.

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You can get Travel Insurance for those with pre-existing conditions. Many actors who are getting old are covered under these policies to do the movies they are involved in, but the cost is at times earth staggeringly high. The movie industry though expects to recover these large costs by selling the end product. One such firm that will take high risk cases is Lloyds but the premiums are very high (probably much larger than the remaining cost of the holiday).

The insurance industry also has doctors who have given and continue to give expert advice of the risks involved, this helps the actuaries to develop the formula/charts/documents that they use to assess a Traveller’s risk profile and thus accept or decline a cover. Some, such as Lloyds, may cover a person but they require the person to have independent assessment/s to make the decision (at the person’s cost). This avoids any inference of “buddy behaviour” of the person’s normal health care team, this does not mean that a Doctor has or would act in this manner but it does avoid the risk.

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You can get it, but it’s extremely hard to track down. I have had to pay $2000 for a 3 weeks holiday, but mostly the companies look at the word “Cardiomyopathy” and that’s as far as they get. My issue is that it’s a little like saying you have cancer and making a blanket assumption. Every disease has a spectrum, and unless you actually look at individual specifics then essentially it’s a totally unfair and discriminatory process. If one has a life threatening disease, then there would be an expectation that the risk would be high. However, if the probability of actually dying is actually low, then that is what should be assessed - not a theoretical blanket approach but an individual assessment based on actual facts.

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Like others who have pointed this out above, no Insurance company has to take a risk they don’t like. Some are more broad in their acceptance some narrower. This includes even the case where you supply evidence as to your condition, if they have a policy of refusing even the small risk involved in a given disease they have that right, just as you have the right to accept their terms or refuse to use them.

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This is a good point as it is comparable to the situation you are in. One may get car insurance, but if they are hooning when an accident is caused, then cover won’t be provided. Car insurance policues have exemptions for such activities, for example, the NRMA car PDS states:

Vehicle use
We don’t provide cover if any of these applied when the incident happened:
the driver of your vehicle or a passenger was being wilful or reckless
your vehicle or anything it was towing:
– was in an unsafe condition
– was being towed illegally
_– exceeded the number of passengers or load limits recommended by your _
vehicle’s manufacturer
your vehicle was being used:
– for illegal purposes or in an illegal manner
_– to illegally carry or store explosives, flammable or combustible substances _
and liquids
– in a race, rally, trial, test or contest, or
– in a track day, drive day or similar organised event
your vehicle was left with a commercial dealer so they could sell it for you

These conditions are imposed to reduce insurance risks, that being payment of claims that could readily be avoided or are an unacceptable risk.

Likewise for pre-existing conditions, these can be excluded on the same basis. While travel insurance can be obtained (like car insurance), cover does not extent to pre-existing conditions (like someone who choses to hoon and case an accident/results in a claim).

My retired parents (mid to late 70s) take out travel insurancefor international travel and I am staggered at the costs. My father has been told that they are in the high age risk for claims and premiums reflect this. They also disclose medical history when taking out cover to ensure this history is not used to refuse any claim. While it may not be seen as fair, they pay for the risk they pose to the insurance company.

I suppose it is the same as a hoon or someone who has many car accidents, an insurance company can decide to refuse cover or increase premiums to cover the risk.

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Price? I already pay a premium. I paid $2000 for a 3 week holiday. That’s not a bad income for an insurer for 21 days. Whether fair or not, at least that is an option, whereas having no options excludes me from travel.

Medical review? I am regularly reviewed by a specialist at my cost, so the information is already available.

Insurers responsibility? To offer cover to all based on a non-computerised assessment, with loadings applied to higher risks. Health insurers are not allowed to exclude sick people, so why should they exclude them from travel insurance?

Skin in the game? Not applicable. The specialist is simply there to make an unbiased, objective assessment. There is no reason why they need to be financially involved. Specialists already provide such information across a broad spectrum of areas without having to be personally involved.

One reason is that they know the costs of treatment in Australia, but the economics around the world vary dramatically. Your $2,000 for 3 weeks was pretty special!

My experience from the US is that no matter how long and deep your doctors records go, an insurer will bring in their own, which was the underlying premise of my question.

My point was not that he should be contributing, but that if he is wrong he will feel quite badly, but an insurer pays. Therein lies a difference in the view from the specialists eyes and the actuaries eyes.

Thanks for the dialogue. It might not appear that way, but I am empathetic.

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Don’t forget, costs of medical treatment overseas is vastly more expensive than it is in Australia, as Australia has the medicare system to cover all permanent residents/residing citizens. This also includes rebates to specialists and most other services which means costs are subsidised by the taxpayer.

When travelling internationally, except for a few countries that provide some limited reciprocal arrangements, all costs must be funded by the patient…or where a patient has insurance, by the insurance company with excesses paid by the patient.

A relatively short hospital visit to get some tests or treatment can run into the $10Ks, if not 100Ks in countries like the US. If you need evacuation back to Australia (say as local medical services are unsatisfactory or due to likely extended stay in hospital for recovery), expect even higher costs.

You may believe that the risk of something going wrong on a 3 week holiday is low, but unless the risk is like any other traveller (where the risks would be close to zero if there was no similar pre-existing condition existed), then one could be expected to pay significantly more premium to cover the higher risk.

It is agreed that your own specialist may indicate that the risk is low in their opinion, but an insurance company is likely to only place limited weight to the specialist report. If a risk exists (like having a diagnosed and pre-existing medical condition), then an insurance company will factor these risks into a premium. If you (and potentially your specialists) are confident that the risk is near zero, you could ask your specialist to provide a personnel guarantee that nothing would happen on a holiday…something I am sure that they will be unwilling to do as they then could become liable should something then happen…and something they couldn’t guarantee. The insurance company possibly would be thinking likewise.

While I private travel regularly, I do cross my fingers that I never have anything which may affect my ability to travel or gain cost effective travel insurance. Having increased travel costs such as substantially higher travel insurance costs would impact significantly on my ability to travel to the extent that we currently do.

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Thanks for raising this topic, we often get requests to look into the process for assessment of pre-existing conditions. It’s frustrating for many people. It’s also something we talk about regularly at CHOICE and we agree it would be good to investigate and get a better understanding of how travel insurers assess pre-existing conditions.

All other events a travel insurer will or won’t cover are made transparent in their Product Disclosure Statement (at least as transparent as the wording allows). If we’re unsure about their interpretation, we often have case studies from the Financial Ombudsman Service to refer to, and the insurers themselves are usually happy to answer questions CHOICE poses to them about T&Cs.

But when it comes to pre-existing conditions, we’re in the dark as much as you are. The PDS may say it covers a pre-existing condition ‘subject to assessment’. But there is no transparency as to what happens in that assessment process.

As you suggest, it seems there are two or three suppliers industry wide of software programs that assess pre-existing conditions, such as http://www.healix.com/.

It would be good to get guidance on the logic that drives these programs for each insurer. The lack of transparency around process and pricing makes it difficult for people like yourself to shop around and compare insurers who may or may not cover your condition.

That lack of transparency fails the ‘fair market’ test. If there’s any industry ‘insiders’ who have more information on how the software that assesses pre-existing conditions works, please get in contact with us travel@choice.com.au

And for anyone else, please feel free to send us an account of your experience with the assessment of your pre-existing condition to travel@choice.com.au. We may not be able to do anything about it yet, but we will keep these on file as possible case studies to advocate for greater transparency in the industry.

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