Travel insurance: the five exclusions that surprise people most

Why exclusions are discovered too late

Travel insurance is bought in good spirits, between booking a ticket and packing. The contract, for its part, is rarely read. So exclusions are often discovered at the very moment you most need the coverage: in a hospital, abroad, with a bill to pay.

An exclusion is not an anomaly or a hidden trap. It is a situation the insurer chose not to cover, and wrote into the contract. The problem lies in the gap between what people imagine and what is written: you think you are covered “if there is a health problem”, while the contract says “unless…”.

This article presents five exclusions that regularly surprise travellers, and how to spot them before leaving. It contains no premiums and no amounts: these vary by product, age and destination.

An authorised person, registered with the Autorité des marchés financiers (AMF), can then apply these notions to your trip. This text does not replace reading your contract or personalised advice.

1. A pre-existing medical condition

This is the exclusion most often misunderstood. The contract generally requires your medical condition to be stable for a specific period before departure. Being stable, in the contract’s sense, does not mean “I feel fine”: it generally means no change in diagnosis, treatment or medication, and no new symptoms, during the set period.

If your condition is not stable, costs linked to that condition may be excluded, even if you correctly declared the diagnosis. Costs unrelated to it remain in principle covered, but the line between the two is sometimes disputed at claim time.

Before leaving, do this short exercise:

• list your current diagnoses, treatments and medications;
• find the definition of “stable” in the contract, and the period that applies;
• note any recent change, even a minor one, to your treatment;
• answer the medical questionnaire accurately.

An inaccurate or incomplete declaration can lead to a denial. If you are unsure on a point, ask before buying, in writing if possible.

2. Medical advice not followed

Travelling against your doctor’s advice, not following prescribed treatment or ignoring a follow-up instruction can lead to a denied claim. For the insurer, these are situations where the traveller’s own choice increased the risk.

This exclusion also reaches quieter cases. A test requested before departure that was not done, a medication you decide to stop without telling anyone, advice not to fly that you choose to set aside: each of these can be held against you at claim time.

A few habits:

• tell your doctor about your travel plans if your health is being monitored;
• take enough medication, in its original packaging;
• keep a written record of medical advice received before leaving;
• do not change a treatment without professional advice.

This is not meant to make you feel guilty: it is how contracts work. Insurance protects against the unexpected, not against a risk you chose to ignore. If your doctor advises against travelling, talk to the insurer before deciding, since cancelling the trip may fall under a different coverage.

3. Alcohol or drugs

An incident linked to alcohol or drug consumption can be excluded. The clause is often broader than people think: it may apply to an accident that seems to have no direct connection with consumption, as long as consumption is judged to have contributed to the event.

The contract may target alcohol, illegal drugs, but also some medications taken without following the prescription. The criteria vary from one insurer to another, and so does the way of proving or contesting the link.

What is useful to know:

• the clause generally describes a threshold or a notion of impaired faculties;
• the exclusion may apply to medical costs, repatriation or other coverages;
• it often targets the traveller, but may also affect an event caused with other people;
• medical and police reports may be requested when you claim.

You do not have to travel depriving yourself of everything, but you should know the rule. Read the clause before leaving, including for an accident that seems unrelated to any consumption, and keep in mind that a festive evening can have consequences for a claim you did not think was connected.

4. Risky activities

Extreme sports, climbing, diving, off-piste winter sports, riding a two-wheeled vehicle: many of these activities are excluded or require an endorsement, meaning additional coverage expressly added to the contract. An undeclared activity can lead to a denied claim, even if the injury occurred in another context the same day.

The difficulty is that the line is blurry for the traveller. Is a hike a risky activity? A boat excursion? A zip line? The answer depends on the contract’s wording, and is not always on the list you imagine.

Before leaving:

• list the planned activities, even those you are only considering;
• compare it with the exclusions and with the possible endorsements;
• ask in writing whether a specific activity is covered or not;
• check equipment, guide or skill-level requirements that condition the coverage.

If an activity idea comes up on site, the wisest precaution is to contact the insurer’s assistance line before doing it. A phone call can prevent an unpleasant surprise of several thousand dollars to pay out of pocket.

5. A destination under advisory

If the authorities advise against travel to a destination, coverage may be restricted or excluded, including for costs unrelated to the reason for the advisory. The Government of Canada’s travel advisories are public, and contracts often refer to them explicitly.

The timing of the advisory matters. An advisory issued before purchase does not have the same effect as one issued afterwards, and how it is handled depends on the contract: some allow you to cancel or interrupt the trip on specific conditions, others simply exclude the area concerned.

A few simple steps:

• check the official travel advisories before buying, then again before leaving;
• read what the contract provides if an advisory is issued after purchase;
• keep proof of the purchase date and the dates of your bookings;
• find out about stopovers, since they can also be affected.

A trip to a destination under advisory is not necessarily impossible to insure, but the coverage may be limited, or require a specific product. An authorised person can tell you what exists, without promising that an insurer will agree to cover you.

A hypothetical scenario

Picture a person we will call Inès, who is preparing a trip of several weeks. She is receiving treatment for a chronic condition and plans a few mountain excursions. She bought a package online and assumes the insurance “comes with” the ticket.

Before paying, she reads the exclusions. She sees that her condition must be stable for a specific period, and remembers that a dose of her treatment was adjusted recently. She also notes that mountain hiking might require an endorsement depending on the level.

She asks an authorised person to explain the definition of stability, to tell her whether her excursions would be covered, and to say from when the coverage starts. She also asks about the purchase date, since some coverages require buying soon after booking.

This scenario is fictional and guarantees no outcome. It illustrates an approach: list your situation, set it against the exclusions, then decide. Inès could have postponed her departure, changed her plans or chosen other coverage. Above all, she avoided leaving in the belief that she had protection her contract did not provide.

Mistakes to avoid

A few mistakes come up every travel season. Knowing them lets you avoid them without special effort.

• Assuming credit card or employer insurance covers everything, without reading its conditions.
• Counting on the public health plan as if it covered all costs abroad.
• Answering the medical questionnaire from memory or downplaying a recent change.
• Not declaring a planned activity because it seems harmless.
• Buying insurance long after booking, at the risk of losing some coverages.
• Leaving without noting the insurer’s assistance number or keeping the contract documents.
• Waiting until costs have been incurred before calling the insurer, when prior authorisation is sometimes required.

None of these mistakes is serious on its own, but they add up. A conversation with an authorised person, registered with the AMF, helps spot them before departure.

A good way to avoid them is to keep, on your phone and on paper, the assistance number, the contract number and a summary of the coverages. In a stressful situation, that saves precious time.

Questions to ask before buying

Here is a list to bring to the meeting or to put to the insurer. Each answer should be given to you in writing, or appear in the contract.

• How does the contract define the stability of a medical condition, and over what period?
• Which activities are excluded, and which can be added by endorsement?
• What does the clause say about alcohol, drugs and medication?
• What happens if a travel advisory is issued after purchase?
• When does the coverage start and when does it end?
• Must I call the assistance line before receiving care?
• Who advances the costs, and how does reimbursement work?
• Which coverages require buying soon after booking?

Add a question about your situation: do my existing coverages, through a credit card or an employer, overlap, and which one applies first?

An authorised person can answer these points using the actual contract. If an answer seems vague, ask for it in writing: clarity is part of the comparison between two products.

How CompareTaux can help

CompareTaux is a referral service. It displays no premiums, makes no automated decision and sells no product. You describe your trip and your situation in a short form, and your request is routed to an authorised person, registered with the AMF, who contacts you.

That person can present products from different insurers, read the exclusions with you and answer your questions. It is the person, not the website, who can give advice tailored to your situation.

You are under no obligation to follow through. If you want to check a person before speaking with them, the AMF register is public.

To dig deeper on your own, the AMF, the FCAC and the Office de la protection du consommateur offer independent, free and up-to-date information, notably on consumer rights and how to file a complaint.

Frequently asked questions

Sources

• Autorité des marchés financiers: public information
• Financial Consumer Agency of Canada
• Office de la protection du consommateur