Read the small print: some health insurance excludes ‘pandemics’

The fever, nausea and loss of appetite Vlastimil Gajdoš felt on his wedding day was not a mere case of cold feet.

Gajdoš, 65, fell ill in Honolulu in March after arriving with his bride-to-be from the Czech Republic. He and Sylva Di Sandro, 58, intended to marry and honeymoon on the island.

While they did tie the knot, they also engaged in serious battle with the novel coronavirus. He was in the hospital for two weeks, some of it in intensive care, on a ventilator. Like many visitors to the US, aware that healthcare prices can be higher than back home, Gajdoš purchased a travel insurance plan that covered up to $300,000 in medical expenses.

But after Gajdoš was diagnosed with Covid-19 and his wife called to check whether his care would be covered, the newlyweds discovered a catch: the insurer said it would not pay up front. And it would consider reimbursing the couple only after Gajdoš was released from the hospital.

“I was really afraid that they [doctors] would not give him any assistance if they were not sure that this would not be covered,” said Di Sandro, who had only a mild case and was not hospitalized.

The coronavirus pandemic has wreaked havoc on the travel industry – including insurance companies. Even beyond the current crisis, travelers should pay careful attention to the fine print on coverage policies.

Many plans offer healthcare coverage in case a person needs medical attention during a trip. But policies vary tremendously by company – containing limits on payouts, co-payments and circumstances, such as whether they cover an evacuation.

Most travel insurance plans contain exclusions for known or “foreseen events”, said Kasara Barto, a spokesperson for Squaremouth, an online service that allows travelers to compare insurance options.

A regular insurance policy might not cover a mountaineering accident while climbing Everest, for example.

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Also common is the pandemic exclusion, in which the insurer will not pay for a traveler’s medical expenses if they are related to an outbreak such as the coronavirus.

Language on exclusions can be vague, which could make it difficult for travelers to decipher whether their policy will pay for care related to Covid-19, industry experts said. To make matters worse, some policies don’t specifically name a pandemic as a circumstance that is covered or excluded – nor how they assess the start and end of a pandemic period.

The World Health Organization declared the spread of the coronavirus a pandemic on 11 March. Travelers who purchased plans after that date should make sure they have medical coverage for Covid-19, said Christopher Mosley, a lawyer who specializes in insurance litigation at the law firm Sherman & Howard.

However, that cutoff date might be earlier in some policies. Some insurers considered Covid-19 a risk in certain areas as early as January, Mosley added.

The risk is perhaps highest for foreigners visiting the US, which has the highest healthcare costs in the developed world. Many of the national health systems in European countries will treat foreigners for free or for much lower rates.

Foreign embassies are stepping in to help their citizens in the US decipher insurance policies. In a notice, the Slovenian embassy in Washington DC specifically mentioned the high cost of healthcare when advising citizens traveling in the US to check whether their insurance covers pandemics.

The Czech Republic intervened in Gajdoš’ case and at least one other time recently on behalf of citizens with health insurance problems, said Zdeněk Beránek, the deputy head of mission for the Czech embassy in Washington, DC.

“This is not the cheapest country in the world when it comes to healthcare,” Beránek said, “so you better be careful.”

Given the chaos of the pandemic, some insurers are choosing to stop selling travel insurance policies altogether – including LV, a company based in the United Kingdom.

But others, such as Allianz, are expanding benefits to include care for Covid-19, according to a press release.

Gajdoš and Di Sandro reached out to the embassy and his employer for help after his travel insurer denied him coverage. The employer pledged to help him if his plan did not cover his hospital stay, he said, but the government intervention worked. The insurer ultimately agreed to cover Gajdoš’s expenses.

The couple would not disclose the final tally for Gajdoš’s hospital stay, but a typical 10-day course of treatment in an intensive care unit can run into several hundreds of thousands of dollars.

He was discharged from the Queen’s medical center on 8 April, grateful for the care. Gajdoš said his insurer’s actions caught him off guard. He intentionally purchased a more expensive policy with the expectation that they would receive help, not pushback, from the plan.

“You don’t have the energy,” Gajdoš said. “You are oriented on fighting for your life.”

Kaiser Health News (KHN) is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente.

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