IMG Protection America vs. SRI Liaison International

[submittedviaemail]

I am considering buying either the IMG Passport Protection Plus or the Liaison International. I understand that neither of these plans covers pre-existing conditions. But it appears to me that the definition of "pre-existing conditions" is more favorable for policy holders in case of the Liaison International plan.

According to the policy wording for Liaison International, a pre-existing condition is "a condition that would have caused a person to seek medical advise, diagnosis, care or treatment...."

So, if there were a condition that "existed" (like say a tumor) at the time of application, but was not known to the insured person, for which there were absolutely no symptoms in the past (and therefore not requiring the person to seek medical advise), then such a condition does not fit the above definition of pre-existing condition.

However, under the policy wording of Passport Protection Plus, this condition would be considered pre-existing, because their definition of pre-existing conditions includes conditions "... whether or not previously manifested or symptomatic..."

So my question is: Is this analysis correct? If not, why not?

[insubuy]

Official answer from SRI



The client below only reference the first part of the Pre-existing condition definition. The second part reads as follows.



1.Any Injury or Illness which meets the following criteria: (a) condition(s) that would have caused a person to seek medical advice, diagnosis, care or treatment during the 36 months prior to the Effective Date of coverage under this Policy; (b) condition(s) for which manifestation, medical advice, diagnosis, care or treatment was recommended, received, or noticed during the 36 months prior to the Effective Date of coverage under this Policy;



The key word in this statement is manifestation which means An indication of the existence, reality, or presence of something.

If the tumor is present, with or without the client's knowledge, it would not be covered. For example, two weeks into the policy a tumor shows up. That tumor was there prior to the effective date. One year into the policy is a different situation. A doctor would make the determination at that point how long that tumor has been there, based on the stage of growth. That would allow us to determine whether it is covered or not.



That means, pre-existing conditions are not covered in any of the plans, no matter how it is worded.

[submittedviaemail]

I see. Thanks a lot for researching into this. Based on this, it appears that between the IMG passport protection plus and Liaison, the IMG plan is better for my needs.

I am still unsure about one thing: Most of the diseases that I can think of, that could possibly run a huge bill, don’t happen overnight. Tumor was one example I used in my previous emails. I chose that example because it is one of those things that could exist in your body for months without you even knowing about it. Other examples would be clogged arteries (=> heart attack), stroke, diabetes, kidney stones, appendicitis…. The list could go on and on… And looks like none of these things would be covered.

So, based on your experience, can you give me a few examples of diseases that these companies have actually paid claims for your clients in the past? I understand that accidental injuries would most likely be covered. But what are some of the non-accidental medical conditions that have a good chance of being covered?

I have purchased Liaison from you before on two occasions, each time for 6 months. My mother has always been in good health, and fortunately, we have never had to make a claim. But I purchased insurance precisely to protect myself from big ticket medical conditions like the ones I mentioned above. So now I am wondering what I am getting in return for these premiums, if so many big ticket conditions don’t have much chance of being covered. (I’d like to clarify that unlike some of the other posts in your forum, I am not looking for coverage for a medical condition whose existence I know about. I am looking for insurance to protect myself from the unknown.)

[insubuy]

Your most of the examples are quite right. Most of those things don't happen overnight. Appendicitis, as I have been told by claims dept, can happen at any time and may be covered.

Heart attack may happen from clogged arteries, high BP, but it may also happen from shock etc.

Therefore, it is difficult to predict in advance what exactly may happen to a particular person. It all depends upon attending physician reports, treatment taken and medical records created at the time of diagnosis and treatment. Insurance company's claim dept. decide based on that.



Claims are regularly handled by insurance companies and/or their administrators and due to privacy reasons, we are not allowed to look into it, unless some customer complains and provides us explicit authorization to allow us to discuss this with insurance company (Because we are broker, work for you and not for them). Therefore, most people that contact us are the ones whose claims are denied, and when we look at the medical records they provide, doctors' notes clearly indicate what is going on, how long they think it may be going on and so on. And almost all of them happen to indicate pre-existing conditions in such cases but in other cases, we try our best so that customer gets paid. Whenever people get paid directly, they simply don't bother to report us.


But still I know many people who been covered wide variety of problems: some examples are appendicitis, pneumonia, high fever that caused person to get hospitalized and eventually died. Minor illnesses and injuries/accidents, of course.



In addition, people also may get covered for heart attack, strokes, stones. But, as I described above, it all depends upon exact circumstances.



Examples I got from IMG:

>>>

The coverage is meant for acute type illnesses or disease and accidents, not for chronic illness or disease. The difference between acute and chronic is the answer to me: acute – disease having a rapid onset and of relatively short duration, chronic – a disease having a slow onset and lasting for a long period of time.



Some of the things we have covered would include but not be limited to the following: accidents (auto, slips and falls, bicycle, pedestrian hit by car, burns, cuts requiring stitches), food poisoning, regular poisoning, Hepatitis A (food born illness), concussion, contusion or hematoma, viral and bacterial diseases contracted while in the states and which are not related to any pre-x conditions (i.e. meningitis, west nile, pneumonia, e-coli), fractures, dislocation of bone or joint, appendicitis, dog bite, insect bites, snake bite, injury due to being a victim of a crime (mugging, car jacking, assault), acute infections (upper respiratory, urinary tract, ear infection, yeast), travelers diarrhea, sprains, strains, laryngitis, pharangitis, conjunctivitis, rhinitis, fever, bronchitis, croup, contact dermatitis, poison ivy dermatitis, cold, flu, mumps, measles, chicken pox.




I asked couple of other companies to give examples of disease/claims paid but I am yet to receive it.