Travel insurance is complex. Indeed, the UK’s Financial Ombudsman Service – the body that deals with consumer complaints about dealings with the financial industry – reportedly regards travel insurance as one of “the most complex financial products an individual may buy.”
That assessment is based on the fact that travel insurance is very much a multifaceted thing. When you buy a travel policy, you are actually purchasing cover for several things at once – trip cancellations, missed departures, luggage and personal items, medical treatment costs.
It’s also based on the fact that the FOS deals with a lot of complaints about travel insurance, and specifically around insurance companies not paying out when customers believe they should. Certainly there are situations where insurers decline claims when the customer is entitled to their money. But equally, a lot of complaints about unpaid claims stem from misunderstandings about what is and is not covered – and also about what will and will not invalidate a claim.
One of these grey areas – and one that can potentially cause the most trouble for travellers – concerns the rules around declaring medical conditions before you buy a policy.
In short, the golden rule is that, if you have a known medical condition at the time you buy a travel insurance policy, you must tell your insurer about it. This is to give them the opportunity to change the terms of cover (which usually means charging more) or to decline to sell you a policy at all. If you don’t declare a medical condition, your insurer is entitled to void any policy they sell to you.
That said, not declaring a medical condition doesn’t always mean your claims will be turned down. There are circumstances where it may be deemed not your fault that you didn’t declare a condition, or that it isn’t relevant to your claim anyway. But these decisions would have to go to arbitration.
Let’s dig a little deeper into the process.
Why do I have to declare my medical conditions?
All travel insurance policies include medical cover. But on most policies, this is designed to insure you for accidents and medical emergencies only – so injuries, catching a nasty bug, food poisoning, sunstroke, that kind of thing. In fact, most policies clearly state that pre-existing medical conditions are not included.
That’s because, simply, insuring people with medical conditions carries more risk. You’re more likely to need medical assistance while you’re travelling, so you’re more likely to make a claim for medical expenses.
Some insurers are happy to take on this extra level of risk, but have special medical travel insurance policies to do so. Yes, they cost more, but the best ones will also provide full financial protection for any and all treatments related to your condition. As medical treatment for specific conditions is often even more expensive than general care (which, when things like surgery and hospital stays are involved, is plenty expensive enough), this is a protection you can’t really afford to be without.
Other insurers are more reluctant to take on the extra risk that known medical conditions represent, and will decline to insure some or all of them. This has in the past caused travellers a lot of heartache and frustration when they are left wondering where they can get insurance from after rejection. But recent changes to the industry code now require insurance companies to tell customers where they can get cover if they decline to sell them a policy.
The long and short of all of this is that declaring pre-existing medical conditions is as much about getting you the right type of cover as it is allowing insurers to avoid risk.
What do I have to declare?
This is where a lot of confusion creeps in for travellers – and why sometimes you may get a claim approved even if you haven’t declared a condition.
Does a cough you have had for a few weeks count as a ‘pre-existing medical condition’ even if you’ve seen your doctor about it and they haven’t prescribed any medication? What about treatment you had for a serious illness a few years ago but have had no symptoms since? What if you have had tests for something before you go away but no diagnosis?
The difficulty for customers is that rules on what you should declare change from provider to provider. The only real way you can find out is by asking them specifically. But in general, most insurers require disclosure of any history of cardiovascular or heart disease, even if it happened years before.
Aside from that, a working rule of thumb is to declare any consultations, diagnoses, treatments etc you’ve had in the past two years. Some insurers will say that certain things (e.g. a one off chest infection not related to an ongoing condition like asthma or COPD) are not relevant and say you can buy a standard policy. But it’s better to be safe and give the insurer all relevant information than find out you’re not insured when you need to make a claim.
What if I need medical treatment after not declaring a medical condition?
If you need medical treatment while abroad and subsequently submit a claim against your travel insurance for the costs, your insurer will look into your medical background. If they discover you have a medical condition that you didn’t declare, in most cases they will refuse