Because the coverage for acute onset of pre-existing conditions (chronic and congenital conditions) is relatively new for visitors to United States and many people have questions and doubts about it, we would like to provide the following answers to some extent.
Please note that it is impossible to make a determination based on a hypothetical scenario and claims are always adjudicated based on the policy provisions. However, the questions below are answered to the best of our understanding based on our past experience. You can use this information to assist you in purchasing the best health insurance for visitors with pre-existing conditions.
Please note that your situation may not be as simple as described below and there may be many other factors. Final determination of medical expense eligibility will be made by the claims department AFTER the claim has been submitted (either by the provider directly or by the insured). The claims department will have the final authority to adjudicate the claim. Insubuy, LLC. or any of its agents, employees or affiliates would not be responsible for any disputes arising out of relying on this information as the examples below are simply generic illustrations and claim adjudication will be done according to the provisions of the insurance policy.
My parents are visiting United States and they have pre-existing conditions. Is there any coverage available for that?
Currently, pre-existing condition coverage in USA visitor insurance is only available with Visitors Protect insurance with certain restrictions.
You can get coverage for the acute onset of pre-existing conditions to a certain amount in many of the plans for the persons of below a certain age.
What exactly is an acute onset of pre-existing conditions?
An "Acute Onset of a Pre-Existing Condition" is a sudden and unexpected outbreak or recurrence of a Pre-Existing Condition(s) which occurs spontaneously and without advance warning either in the form of Physician recommendations or symptoms, is of short duration, is rapidly progressive, and requires immediate care. The Acute Onset of a Pre-Existing Condition must occur after the effective date of the policy. Treatment must be obtained within 24 hours of the sudden and unexpected outbreak or recurrence. A Pre-Existing Condition that is a chronic or congenital condition or that gradually becomes worse over time will not be considered Acute Onset. This benefit does not include coverage for known, scheduled, required, or expected medical care, drugs or Treatments existent or necessary prior to the Effective Date of coverage.
How is acute onset of pre-existing conditions different from pre-existing conditions?
Acute onset of pre-existing conditions is described as above.
My father got heart attack yesterday suddenly. Isn't that acute onset of pre-existing condition? Can I buy the insurance today to cover that?
Acute onset of pre-existing condition must occur after the effective date of the policy. If the person already had a heart attack before buying the insurance policy, it is considered a pre-existing condition. This is not to be confused with a heart attack in the past (such as few years ago) and another heart attack occurs suddenly after the effective date of the policy.
What are some of the examples of situations that might be considered acute onset of pre-existing conditions?
Even though each case and each scenario is different, just to get some idea, some examples are:
- Person has high blood pressure and/or diabetes and gets heart attack all of the sudden.
- Person has asthma and all of sudden gets an asthma attack.
- Person has diabetes and gets diabetes stroke all of sudden.
However, based on the medical records and the attending physician's report, the insurance company's claims department will determine whether a specific claim falls under acute onset of pre-existing conditions or not. Please do not assume that all of the cases described above will be covered under acute onset of pre-existing conditions.
What are some of the examples that are NOT acute onset of pre-existing conditions?
Even though each case and each scenario is different, just to get some idea, some examples are:
- Person has been complaining of small amount of chest pain for the past few days and now gets heart attack.
- Person's blood pressure has been rising for the past few days and now the person feels much sicker and would like to get the treatment.
What is the purpose of acute onset of pre-existing conditions coverage?
If some life-threatening emergency occurs all of sudden due to pre-existing conditions and you have to take treatment in the next 24 hours.
What is NOT the purpose of acute onset of pre-existing conditions coverage?
It is not meant to cover any routine maintenance related to pre-existing conditions such as diabetes supplies, kidney dialysis, blood pressure medicine, elective surgery, any foreseen treatment or anything that can reasonably be anticipated that it would be necessary. Of course, if you would like to get a second opinion about your sickness while you are visiting the USA, that is definitely not covered. These are some of the examples where the insurance company definitely is going to lose money and that is not the purpose of any insurance from anywhere. Even with acute onset of pre-existing conditions coverage, there must be an uncertainty about the likelihood of you needing the treatment after the effective date of the policy.
My mother has arthritis. Or my father has thyroid disease. Or my mother in law has back pain. Are those covered under acute onset of pre-existing conditions coverage?
While those diseases are not excluded under acute onset of pre-existing conditions coverage, it is very unlikely for the person to get an acute onset of any of those conditions, as per the definition above.
I have a specific question about my relative's medical condition. How can I know whether some specific scenarios would be covered under acute onset of pre-existing conditions or not?
You are welcome to discuss them with us. However, it is generally not possible to answer in Yes or No to such hypothetical scenarios. The determination is made by the claims department AFTER it already happens based on the attending physician reports and all the treatment and diagnosis records that are submitted. Each scenario is different and it is not possible to predict that scenario in advance.
But from your experience of processing a lot of similar cases, can you tell me the answer?
No, each specific scenario is different. What may be true for many others may not be the same for you, as there are many medical factors.
Can I talk to the claims department now to discuss more details about my situation?
No. Claims department have really nothing to discuss until you have the actual claim and they have your medical information available. No one can give you guaranteed answer for sure based on the hypothetical questions for something that may happen in the future.
Up to what age can I get the coverage for acute onset of pre-existing conditions?
Many plans will provide a good amount of coverage for persons below the age of 70, while a few others may provide a reasonable amount of coverage for persons until age 90.
What is the difference between 'acute onset of pre-existing conditions' and 'sudden and unexpected recurrence of pre-existing conditions'?
Please read the FAQ article about Sudden and Unexpected Recurrence of Pre-Existing Conditions FAQ below.
In short, the coverage under 'acute onset of pre-existing conditions' is a lot broader and covers under a lot more scenarios compared to the coverage under 'sudden and unexpected recurrence of pre-existing conditions'.
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