Pre Existing Conditions and Exclusions

I am often asked; “why is there such a big difference in premiums between companies and their long-term international medical plans?

Long-term policies will have some type of medical underwriting or approval based on your health status. One of the primary differences is how a company determines, excludes and or covers “pre-existing” conditions.

First Example:  Some companies offer plans with very good benefits coupled with low premiums.  In this example the company most likely undergoes very limited medical underwriting or review at the time of application.

In this case the company will most likely underwrite and investigate every claim to determine if the medical services provided are from a “pre-existing condition.”  The verbiage below is the actual wording of an International medical insurance company:

It is any medical condition, sickness, injury, illness, disease, mental illness, or mental nervous disorder, regardless of the cause, including any congenital, chronic subsequent, or recurring complications or consequences related thereto or resulting therefrom that with reasonable medical certainty existed at the time of application or any time during the 12 months prior to the coverage start date of this policy, whether or not previously manifested, symptomatic, known, diagnosed, treated or disclosed.

This specifically includes but is not limited to any medical condition, sickness, injury, illness, disease, mental illness, or mental nervous disorder, for which medical advice diagnosis, care or treatment was recommended or received or for which a reasonably prudent person would have sought treatment during the 12 months immediately preceding the coverage start date of this policy.

The above verbiage is very unsettling. This is an example of a company who can dispute or deny just about any claim that is reviewed.

Second Example:  more reliable companies will go through a bit heavier underwriting and review before the application is approved.  If approved the new member knows they will not be scrutinized every time they have a claim.

The GeoBlue Xplorer long-term medical plan does not cover services for treatment of a medical condition for which medical advice, diagnosis, care, or treatment was recommended or received during 180 days immediately preceding the member’s eligibility date.

Although, the 180-day pre-existing conditions period can be reduced or eliminated if you have been covered by a creditable group or individual health insurance plan.

The GeoBlue clause above is much more reasonable and fair.

Ultimately, how a company views pre-existing conditions will determine the quality of a policy.

The last thing you want as a policy holder is to have a claim declined when you need them the most.  Only to find out, they determined the claim was a pre-existing condition you didn’t even know you had.

 

For a person or family needing a long-term international medical plan, be sure to look into, or ask about the pre-existing condition coverage and exclusions clauses and definitions. It will help with your decision.

Also, companies who do not medically underwrite at the time of application, will generally go through a medical review at the “time of claim,” which means they will look at your health history and determine if the current claim is the result of a pre-existing condition.  It they believe it is, the claim will most likely be denied.

On the other hand, companies that underwrite before the policy is approved, generally to not go through a medical review at the time of claim and the claims are typically processed quite quickly.

Please feel free to contact me anytime with questions regarding international medical companies, plans, or any of the above mentioned clauses and definitions.

John Conner
916-682-1117
john@johnconner.com

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Author: John Conner

Medicare and International Medical Insurance options.