What is a pre-existing medical condition for travel insurance? What you do and don’t need to declare to your insurer and airline

Peter is an Aussie in his mid-50s and while travelling in Switzerland in 2024 he developed severe chest pain. An ambulance was called, he was hospitalised and diagnosed with a heart attack. He subsequently made a claim against his travel insurance policy, amounting to several thousand dollars.

His insurer set their sleuths to work, requesting medical reports from the Swiss hospital and obtaining permission to access his Australian medical records and medication history. They discovered long-standing hypertension, a history of high blood pressure and ongoing prescription medication.

As a result, the insurer denied the claim on the grounds that Peter had failed to disclose a pre-existing condition related to the claim. According to Peter, he believed his health problems were under control and didn’t need to be disclosed, but his insurer disagreed, and Peter was left thousands of dollars out of pocket.

Pre-existing medical conditions are easily overlooked, especially when they’re relatively minor, or they happened months or years earlier and have been remedied. They’re also likely to add to the cost of a travel insurance policy, but failure to declare them is one of the main reasons medical claims are denied.

What is a pre-existing medical condition?

It might sound obvious, but the definition includes anything that existed, was investigated or showed symptoms before you bought the policy. If you saw a doctor with a problem, were diagnosed, took medication, had tests or were awaiting results before you purchased travel insurance, that’s a pre-existing condition. Since travel insurance is intended to protect against unforeseen events, a pre-existing condition implies a higher likelihood of a claim against your policy, and therefore it needs to be disclosed.

What pre-existing medical conditions do I really need to divulge? Acne?

Yep, acne is listed as a pre-existing medical condition. Do you need to disclose it? Definitely not, unless it could conceivably lead to a claim. Insurers don’t expect you to list every minor cough or cold, but there’s a fine line between conditions that must be declared and those that can be left off. If it’s medically significant, ongoing, recently treated or could reasonably lead to a claim, you need to declare it.

In general, you don’t need to admit to hay fever, occasional headaches, mild eczema, injuries with no ongoing symptoms and acne. Conditions you must declare include cancer, heart disease, stroke, diabetes and chronic kidney, lung or liver disease. There is also a grey zone, those conditions that might need to be declared depending on their severity and when they occurred, such as asthma. This includes any medical problem that is ongoing or monitored, or for which regular medication is required. It can also include psychological conditions such as anxiety or depression.

As a rule of thumb, declare it if you’ve seen a doctor about a specific problem in the past 12 months, if you take regular medication, if it’s ongoing or recurring or if it could possibly relate to a claim. Don’t worry if it’s minor, if no treatment or follow-up is needed and if it has no realistic chance of causing a claim.

Can an insurer find out about a pre-existing condition that I failed to disclose?

If you make a substantial claim for medical expenses, it’s almost certain your insurer is going to investigate whether your claim relates to a pre-existing condition. Your medical records will most likely tell the story, and when you make a claim your insurer will usually require your consent to access records and reports from treating doctors. That could include your GP, any specialist visited, hospitals you attended and Medicare records.

If your claim relates to treatment overseas, your insurer may also contact the hospital or clinic where you were treated, and doctors take a full record of existing conditions, medications and prior diagnoses. Doctors will often ask what medications you’re taking, and pain meds or bone-strengthening drugs are strong indications of an underlying condition.

You also need to immediately disclose any condition that has arisen after you’ve already purchased your travel insurance. Depending on the condition, this might mean you need to take out additional cover before you travel.

Bottom line, if you have a pre-existing medical condition that you fail to disclose and if a subsequent investigation reveals that condition as a contributing factor in an insurance claim, expect your insurer to walk away.

What if I have a pre-existing condition and don’t want to pay for insurance cover?

Many pre-existing conditions will increase the cost of a travel insurance policy, sometimes dramatically. Insurers will usually allow you to declare a pre-existing condition but choose not to cover it, which reduces the premium while providing cover for unrelated issues. This might sound risky, but there are some medical conditions that might have little chance of resulting in a medical claim, even when they’re serious, such as non-metastatic cancer that has stabilised. Even though this needs to be disclosed, it’s unlikely to cause problems, even on an extended overseas trip.

If you choose to forgo cover for a pre-existing condition, consider carefully what you’re giving up and the chances that this might exclude you from compensation for vital medical assistance.

What about airlines?

Airlines are also interested in your health, and that includes pre-existing medical conditions. If you’re suffering from a contagious disease, require medical equipment during your flight or if you’re 28 weeks or more pregnant, they want to know. Qantas has a website titled “Fitness to fly” with a list of the conditions that might be a concern. If any of those conditions apply, your doctor will need to complete a Travel Clearance Form, to be submitted at least five days before departure. That can be a problem if you are diagnosed with something shortly before you fly (for example, the airline’s policy says you can’t fly within 48 hours of a severe asthma attack if it required hospitalisation). The airline’s policy might also be at odds with your own medical advice – your doctor might be OK with you flying, but the airline may have a different view.