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Taking the Mystery Out of Out of Country Coverage…Part 2…Pre-existing Conditions

The area that creates the most controversy and media attention are pre-existing conditions and travel.  When you hear the stories in the media, it is prudent to remember that the Insurance Company is unable to provide their side of the story due to the Privacy Act.

I will make it very simple, if you have to call me and state your case 99.9% of the time I will tell you not to travel.  How many listen to these words of advice?  Probably not many.

I had one case where a surgery was completed and the Doctor approved the travel and when they were on the flight things went wrong and once they arrived at their destination the surgery needed to be completed again.  This also meant that the person could not fly home for at least a month.

While the Insurance Company was investigating the pre-existing condition, the insured paid for the surgery.  Luckily, they were reimbursed for the surgery and hospital stay.  They had to stay an extra couple weeks for recovery which was not covered under the Out of Country plan.

Your Doctor approving your travel does not always mean that your pre-existing condition will be covered.  The reason behind this is most Doctors are not clear on the wordings in your Employee Benefit Contract.

Most contracts will outline the following definition in their contract:

Stable will mean that, during the three month period before the departure date, the Person Insured has not:

  • Received Medical Care for the medical condition or been under evaluation for new symptoms or conditions uncovered in a medical examination;
  • Experienced a worsening or increased frequency of symptoms or examination finding related to the medical condition (diagnosed or undiagnosed), if the Person Insured has been seen by a Physician or other health care professional;
  • Been prescribed medication or been recommended a change in Medical Care related to the medical condition by a Physician or other healthcare professional, including changes in medication that are made as part of an ongoing Medical Care but not, including a reduction in medication (prescribed or non-prescribed) due to an improvement in the medical condition;
  • Been admitted to or received Medical Care at a hospital for the medical condition; or
  • Been advised of future non-routine tests, investigations, surgery or new Medical Care planned for a pre-existing medical condition or future medical appointment planned with respect to an undiagnosed medical condition.”

I would like to thank Empire Life for working with me on the Out-of-Country Blog.  Although most of the Insurance Companies operate under the same guidelines, I recommend that you check with your Insurance Company and get the responses in writing.

Please contact me with any questions or further clarification required.

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