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On a recent trip to Bali, David Menadue discovered that, for people with HIV, it pays to be clued up about travel insurance.
As a 65th birthday present to myself — I made it! — I recently booked a flight to Bali with a friend. Aaahh, two weeks of lying in the sun, reading books and admiring the locals. At least that was the plan. Unfortunately, not long into the trip I had a medical event. At first I thought it was the result of consuming a piece of bad fish: the ubiquitous ‘Bali Belly’. A friend recommended we head to the International SOS Clinic in Seminyak as they apparently know how to cure such things fairly quickly. That's where my dramas really began.
During a check-up, doctors noticed an irregularity with my bloods — possibly indicating a heart attack. After being presented with a bill for $450, I was referred to the cardiologist at nearby Siloam Hospital. At this stage, my mind turned to travel insurance.
My insurance company is aware of my HIV status and has agreed to cover me as long as I won't be claiming for an HIV-related illness. (While an argument could be made by a hard-nosed insurer that cardiac issues could be related to HIV, this company had not made it an issue in the past.) I get my friend to contact the company and I'm assured that I will be covered if a cardiac event has happened in Bali as long as there is no evidence of any cardiac symptoms to that date. I am detailing my experience here as I think many HIV-positive people who have other co-morbidities may find tips on travel insurance helpful.
Some travel insurance companies offer cover from date of purchase of the policy; some only offer it from the date of leaving the country. Also, some will allow cover for up to six months after return if a link to an incident while on your trip can be established.
A representative from the insurance company rings me on my first day in Siloam Hospital and proceeds to reassure me that they will do their best to process the claim before I leave as it will likely be "pretty pricy". (The hospital charges inflated prices as it is geared particularly for Westerners who have some kind of insurance.) I tell the rep that the cardiologist wants me to be an inpatient for five days while they administer blood thinners to enable me to fly back to Australia as planned. I'm not unduly upset about this because I’m being thoroughly checked out; I’m put through scans, ultrasounds, X-rays and multiple blood tests — the whole caboodle.
I have given my insurance company the names and phone numbers of three of my doctors, including my cardiologist, who can all verify that there was no pre-existing cardiac condition before the date of my policy purchase. Three days into my hospitalisation and I get another call from the company saying my GP has given insufficient information to verify this.
Me: "What information did he provide?"
Company: "Four pages of summaries of your health."
Me: "My GP has gone to the trouble of writing four pages of summary on my health and that is insufficient?"
Company: "We require two years of your medical records."
Me: "Well, try the others and get back to me."
In the meantime, I email those doctors myself and inform them about what is going on so they will be prepared. By day four of hospitalisation, they have not heard anything. On the day I am to be discharged I hear from the company that my other doctors have not gotten back to them in time. "Because you only just contacted them, maybe?" I reply.
There is every likelihood that your travel insurance company will not settle your costs with an overseas supplier in a timely way so you'd better hope there is something left on your credit card! They will prefer that you pay upfront and they will reimburse you once they have done an investigation.
My claim, which includes the costs of re-routing my travelling companion from his planned flight back to Adelaide so as to accompany me back to Melbourne as my cardiologist recommended, comes close to $5,000. Whether or not I am reimbursed remains to be seen. But enough of my travails.
The main issue that people with HIV worry about with travel insurance is pre-existing conditions. Some travel insurance companies have automatic exclusion policies for HIV or AIDS while others — such as Covermore — have moved with the times and will cover you if you have HIV, or even if you have pre-existing AIDS illnesses (as long as you don't intend to claim if an AIDS-defining illness occurs during the insurance cover). If you want cover for this possibility, you will have to pay an extra premium.
I checked QBE Insurance's exclusion policies, too. They provide cover to a number of credit card travel insurance policies such as the one offered with the NAB Platinum Premium Visa Card. If you purchase your travel with at least $500 on the card, you get automatic travel insurance protection. However, almost all pre-existing medical conditions are not covered by this card. But while there is a specific exclusion for coverage of anyone with an AIDS-defining illness, HIV itself is not mentioned. A QBE representative told me that insurance would be granted if you have a pre-existing condition but only on the condition you weren't going to claim for it. In other words, only new medical conditions or other non-medical travel claims could be covered.
Check the Product Disclosure Forms (PDFs) for each travel insurance policy you take out to see if they will provide cover for pre-existing conditions and if they will still cover if you don't intend to claim for that condition. Some companies will cover pre-existing conditions for an extra premium. Be prepared for extra medical costs though if you end up ill with the condition.
Some countries still discriminate against the HIV-positive traveller even though many (such as the United States and China) have reversed their travel bans in recent times. Singapore, for example, requires a mandatory HIV test if you are intending on staying for longer than 30 days. Also, many Middle Eastern countries have restrictions on HIV-positive people, but mainly if you are intending on living or working there for long periods.
If travelling to certain countries and you become ill, you might be able to take advantage of Reciprocal Health Agreements. Such agreements mean that our government has an arrangement to provide citizens of these signatory countries with essential treatment and, in return, these countries are obliged to provide the same to Aussies when travelling. These countries include New Zealand, the United Kingdom, Ireland, Italy, Finland, Sweden, and Belgium. The same applies in the Netherlands, although you need to apply for an eligibility form before you travel if you are thinking you may require medical assistance there.
1. Always carry your prescriptions and a doctor's letter with you. The doctor's letter should contain the words, "These medications have been prescribed for a medical condition," which is usually sufficient.
2. Keep the HIV medications in their original bottles and do not attempt to hide the containers. If you do, customs officials might think they are contraband. Injectable medications must have the medication with them so as to justify bringing in empty syringes.
3. Don't advertise the fact that you are HIV-positive. Even a red ribbon might attract the attention of some customs officials.
4. If you encounter problems, ask for a private screening to protect your confidentiality or ask for a supervisor.
5. Whentravelling with treatment, pack enough medications in your carry-on luggage so that you don't miss a dose. Remember to adjust dosing for time-zone changes. Take your prescriptions with you just in case you run out as overseas pharmacists may still fill a script for you if you do.
6. Talk to your doctor about vaccinations and prophylactic medications if you are travelling to areas where malaria, yellow fever or other bugs are prevalent. People with HIV should not take live vaccines such as those offered by some clinics for yellow fever.
Don't let any of the above put you off travelling. Travel can do wonders for your health and wellbeing. Just plan a little beforehand, check your insurance, and make sure to research some of the policies of the countries you plan to visit. Bon voyage!