Routine Care, Check Ups and Pre-Existing Conditions Coverage in Visitors Insurance

Some people residing in the U.S. have family living in another country; together, they decide when and how long the family member(s) will come to visit them in the U.S. When they are making arrangements for travel, they begin to look into visitors insurance for the visiting relatives. The U.S. resident has domestic health insurance provided by employer, which generally covers many of the conditions they would need as a resident of the U.S., visitors insurance is not the same type of coverage. Some people mistakenly assume that visitors insurance would work similarly and that it will provide coverage for everything but that is not the case.

What Does Visitors Insurance Cover?

As many people didn't purchase the visitors insurance when they moved to the United States, they wonder what is visitors insurance and what coverage it provides. Visitors insurance is a short-term international travel medical insurance that would generally cover any medical conditions, injuries or accidents, that may occur after the effective date of the policy. It is primarily designed to cover unexpected and primarily new medical conditions that may usually occur to a person who is traveling abroad.

In some plans, it may cover acute onset of pre-existing conditions that occur after the effective date of the policy up to some amount for the persons up to some age. However, most plans do not cover pre-existing conditions, and no plans will cover maternity, preventive checkups, routine visits, cosmetic surgery, elective surgery, birth control, immunization, dental, vision and so on.

Why So Many Things Are Excluded?

Compared to the domestic major medical insurance plans, the premium paid for visitors insurance plans costs significantly less. Most people don't realize that their employer pays a significant portion of their health insurance and they are may only be paying a small portion which is deducted from their paychecks. For any insurance plan, the more benefits provided and conditions covered, the higher the premium. E.g., if your car insurance covered routine items such as oil change, battery replacement, brake replacement, etc., it would cost a lot more.

The fundamental concept of the insurance is that a given insurance company charges a small amount of premium to many people and pays out large amounts to a few people who are owed payments for eligible expenses as per the rules of the insurance policy. Of course, the insurance company has to pay for their other expenses and they must make a profit to stay in business. If everyone who bought the insurance filed claims, the insurance company would run out of money and go out of business.

Example of Unreasonable Expectations

Just to illustrate what kind of requests or demands we occasionally receive from customers, we decided to look at recent call notes and found the following:

• Sister in law has come to the U.S. on visitors visa while she is 7 months pregnant. They would like to buy the insurance to cover the cost of delivery and new born care.
• Mother came to visit family in the U.S. a few weeks back. Now, she is having back pain and shoulder pain. Son would like to buy the insurance to show it to the doctor and get treatment such as physiotherapy and/or chiropractor.
• Visiting Parents have already been in the U.S. for the past 4 months. Now, the son would like to buy insurance only for father and only for 15 days, because he hurt his finger and they need to visit the emergency room.
• Father in India has stage 4 cancer and son is working in the U.S. on H1 visa. Son does not want to leave his job and the U.S. income to go to India and care for his father. Instead, he wants to bring his father to the U.S. for cancer treatment. He is looking for insurance that will cover this.
• Parents are visiting the U.S. and mother has arthritis. While they are in the U.S., the son would like to have his mother's knee surgery done and they are looking for insurance that covers it.
• Parents are currently in India, his father had a heart attack recently. The son would like to bring his father to the U.S. for heart surgery and he would like to buy insurance coverage because the medical treatment in the U.S. is very expensive.
• Parents are visiting in the U.S. for the past couple of months; both parents are healthy, so the son saw no need to buy them insurance. However, his mother slipped and fell down in the bathroom and needs urgent medical attention. Son would now like to purchase the insurance only for his mother. He does not see the need to buy the insurance for father because he is still healthy.
• A person who walks into our office is visiting from India. He would like to buy the insurance because he would like to get his eye retina checked up.
• Parents are visiting the U.S. Son would like to buy the insurance for a full body checkup, and to cover the cost of supplies for father's diabetes and prescription medicines for mother's blood pressure.
• Sister is visiting the U.S. from overseas and she is having mental problems. Sister would like to take her to a psychiatrist for mental checkup and would like to buy the insurance for the same.
• Uncle has been sick in his country for last year. Nephew would like to bring him to the U.S. for treatment and needs visitors insurance that covers all necessary treatments.
• A young parent just bought the visitors insurance and would like to get immunization coverage for his children.
• Person would like to buy visitors insurance because father needs angioplasty.
• Visiting mother has fallen sick and they are taking her to the emergency room in their car. Daughter would like to buy the insurance, make it effective immediately and fax the insurance card to the hospital emergency room so that by the time they reach the hospital, the payment is handled by the insurance company.
• Mother has been in the U.S. for the last 6 months. Now that she has a toothache and a headache, son would like to buy the insurance so that they can visit the dentist and physician first thing tomorrow.

It is simply not possible for the visitors insurance companies to provide coverage any of the above items from the small amount of premium they collect. If the visitors insurance companies decided to include coverage for some or all of the above situations, it would probably become mandatory for all visitors to purchase the insurance, the cost of the premium would be much higher than most are willing to pay, and it would be necessary to purchase for a much longer duration and likely on a continuously renewing basis. To say the least, visitors would be upset by such requirements and high costs.

Visitors Insurance is Not Medical Tourism

While the United States provides the best medical care in the world, such treatments are also the most expensive in the world. Visitors insurance is for unexpected situations that arise during travel and is not meant to be used as a medical tourism insurance policy. Many people try to buy visitors insurance to take advantage of the better healthcare provided in the U.S.; however, visitors insurance plans are not meant to cover conditions that are existing, expected or for planned treatment of such. The U.S. does not provide free healthcare to its citizens, so of course there is no free healthcare available to the visitors. Visitors traveling to the U.S. for medical treatment would need to come to the U.S. on a medical tourist visa with proof of their finances showing that they have enough money to pay out of their pocket for medical treatment in the U.S.

What is the Use?

Many people ask, "If visitors insurance does not cover XYZ, what is the use?" If you would like to buy visitors insurance to specifically cover XYZ, there is no use, because insurance company would end up paying more money in claims for sure than they would collect from you. The insurance company's position would be, "If we need to cover XYZ, we will lose too much money." because they would lose money for sure.

Visitors insurance can take away some of the risks, but it won't cover everything you may need or desire. In short, visitors insurance plans are primarily meant to cover unexpected situations that are either completely new or an acute onset of pre-existing conditions (if covered) and are not meant to cover routine maintenance of pre-existing conditions in most plans, preventive checkups, scheduled or expected treatment etc.