A complete guide to travel health insurance!
The Canadian Life and Health Insurance Association (CLHIA) produces consumer publications on life and health insurance designed to assist Canadian consumers in making informed choices for themselves and their families. For more information on CLHIA consumer guides visit http://www.clhia.ca/index_en_red.htm
The following information is a review of the supplementary health insurance Canadians need when they travel out of country or out of province. Tips are also included to help make the claims process as smooth as possible.
1. Why purchase travel health insurance?
All provincial health ministry’s strongly recommend that you consider other sources of coverage if you are leaving the country because provincial health coverage, in itself, usually is not adequate. If you are traveling within Canada, an inter-provincial agreement exists to provide coverage for you. Quebec participates in this agreement for hospital fees only, so Quebec residents traveling out of their home province should check their health insurance plan for limitations.
But, once you travel outside of Canada or even outside of your home province, coverage under your provincial health insurance plan is limited, and only a fraction of these expenses may be covered. The good news is that the difference can be made up by travel health insurance.
2. What is travel insurance?
Travel insurance in its broadest form is designed to pay for certain unexpected costs that may arise when
you are traveling. These can include emergency hospital/medical costs, trip cancellation, lost baggage and accidental death insurance. But, not all plans cover all of these components. For instance, the trip cancellation insurance you buy when you book your holiday may not include health insurance. Be sure you understand what type of protection you are buying, and whether it meets your needs.
3. Who provides travel health insurance?
The group health insurance that you have through your employer, union or professional association may cover out-of-country hospital/medical expenses. Check to see if it does and what limitations apply.
Each time you travel you can purchase coverage through companies offering individual travel insurance. For online travel insurance quote and policy application visit www.primelinkinsurance.ca
Some credit cards may provide some protection. Check the details and be aware of any specific restrictions (e.g., your travel arrangements, including any premiums, may need to be purchased with that credit card, the length of the coverage, etc). Credit cards often have other restrictions such as duration of travel and age.
Travel health insurance plans cover emergency care. Routine or elective treatment is usually not covered.
This refers to treatment you could have received in Canada, treatment you could have deferred until your return, and/or ongoing treatments you may need if you are out of the country for a lengthy period of time. Check your policy.
When completing the health portion of your travel insurance application form, make sure you list all medications that you take. If you are not completely sure about what to include, you can call your doctor for advice on how to proceed.
4. Questions you should ask
When purchasing travel insurance or evaluating any current coverage you may have (e.g., through group plans, credit cards, etc.), for your own peace of mind there are a few key questions you should ask. In the unlikely event that a health problem arises you will ensure that you have all the vital information at hand.
• If you decide to extend the length of your stay, can your policy be extended? How would this be done and what are the extra costs?
• Are there any restrictions on the maximum number of days of travel?
• What are the age restrictions if any?
• What types of restrictions and limitations does your policy have?
• What are the policy maximum limits?
• Does the policy deny benefits if your medical emergency arises because of a pre-existing condition?
• Does your insurance company have a toll-free telephone number for emergency assistance that you can reach from anywhere you travel?
• Are there exclusions that pertain to specific activities/events i.e., sports, war, suicide, substance abuse?
• What maximums, deductibles and/or co-insurance would apply in the event of a claim?
• What documentation is needed to submit a claim? What are the procedures?
• Does your policy provide for trip cancellation, baggage loss and other damages?
5. Read you policy carefully
Benefits will vary from policy to policy, so check and pay particular attention to possible restrictions and limitations, such as the following:
Pre-existing conditions – Some policies will not provide coverage for conditions that exist before your departure. This includes conditions for which you have seen a doctor or received other treatment recently.
Other policies may provide coverage for these conditions, but on a limited basis. If you currently have a condition that is stable or under control by medication, and you are medically fit to travel, check your policy to see if you would be covered were an emergency to arise (e.g., if you are on antihypertensive
medication and suffer a heart attack, if you have a mental disorder, or if you are in the latter stages of pregnancy).
Sports – Participation in high-risk activities such as extreme sports e.g., scuba diving, sky diving, etc., m may be excluded.
War – Policies may exclude coverage for injuries caused by war.
Destination – Before you travel, check for any travel advisories issued by either Foreign Affairs and International Trade Canada (http://www.voyage.gc.ca/countries_pays/menu-eng.asp) or the Public Health Agency of Canada (http://www.phac-aspc.gc.ca/tmp-pmv/pub-eng.php). Check you policy to see if there are any restriction for specific destinations may have some exclusion in your coverage.
Maximums – Maximums can vary from a few thousand dollars to unlimited coverage for hospital and medical expenses. Some policies cover only a certain percentage of costs. There also may be maximums related to age.
Duration – Many policies specify a time limit for coverage (e.g., 30 or 60 days). In some cases credit card coverage limits the total number of days to less than 20.
Suicide – Benefits for expenses incurred due to suicide or self-inflicted injuries are routinely excluded.
Substance abuse – Hospital and other medical expenses incurred as a result of drug or alcohol abuse are often excluded.
6. What should I do in the event of a claim?
Your holiday or business trip is interrupted by a sudden illness or accident and you are rushed to the local hospital.? Procedures can vary from policy to policy; it is important to check what procedures are required under your policy before starting your trip.
Make sure you file your claim promptly and take the necessary steps to obtain the information that you need to submit. Obtain all bills or medical evidence in English or French, if possible. Call the emergency assistance line if your policy provides one. In some cases, you may be required to call this number within 24 or 48 hours after the emergency occurs and to follow the advice of the assistance agency (e.g., about repatriation or transfer to another hospital) to retain coverage.
If you have a claim, notify your insurance company immediately (even if you are still waiting for appropriate documentation, or if your provincial health insurance plan has not yet paid). Submit your claim as soon as possible. There is often a limited time period for submitting claims.
You may have to pay up front, and then seek reimbursement from your provincial health plan and insurance company when you return home. In other situations, out-of-country hospitals may bill your provincial health insurance plan and/or your insurance company directly. This is especially valuable if you have incurred a substantial bill.
Normally you are required to submit your claim and all original receipts to your provincial health insurance plan first. Be sure to retain copies of everything. Then submit the outstanding bill, along with proof of payment from the provincial plan and copies of all receipts to your insurance company.
In some provinces, your insurance company may be able to submit your claim to the provincial health insurance plan on your behalf; check with your company.
If you have coverage through more than one policy, the first insurance company you call will ask you about additional coverage and may be able to coordinate the claim with the other insurance company(ies).
7. What to do if you’re not successful
Most claims are resolved successfully, but if your claim is turned down and you do not agree with the decision reached, you can appeal the decision, especially if you have new information to add to the file. If your appeal is turned down and you still believe the decision is unjust, you may wish to discuss your case with your insurer’s ombudsman/complaints department. If you are still unsuccessful, you can contact the OmbudService for Life and Health Insurance (see Consumer Assistance).
Before you leave home . . . purchase your travel insurance from Prime Link (www.primelinkinsurance.ca)
Mark Anevich
Travel Insurance Expert
LinkedIn Profile
DON’T FORGET:
• Your provincial health card
• Your travel insurance documents
• The emergency contact
