The Canada Health Act requires your provincial Health Insurance Plan to cover your medical costs in your province of residence only. While some of your provincial coverage may extend to medical emergencies incurred outside Canada, you may only be reimbursed for a fraction of the total cost.
For example, the Ontario Health Insurance Plan (OHIP) will only cover you up to a maximum of $400 per day for cardiac ICU care for an out of country claim. This pales in comparison to the more than $10,000 per day that a typical USA hospital would charge. Even something as simple as an emergency room consultation with a doctor in the USA could end up costing you $1,200 or more. OHIP would reimburse only about $40 of that cost.
Here are some real examples of out of country emergency medical costs not covered by provincial health benefits:
- While on vacation in Texas, Anna suffered a painful blood clot in her leg. Her bill for treatment was an even more painful $50,000 for a 5 day hospital stay.
- A Las Vegas vacation turned into a financial disaster for a BC man when a 10 day hospital stay for a serious case of pneumonia cost him over $140,000.
- During a Florida vacation, Bill suffered a heart attack and needed emergency surgery to remove five blockages in his heart. He now owes $346,000 for his treatment.
Purchasing Emergency Medical Travel Insurance is the best protection against the devastating cost of a medical emergency while traveling outside the country, but according to a recent survey more than two-thirds of Canadian travelers under the age of 55 don’t buy this protection. I suspect this has more to do with a lack of understanding of their risk than the cost of insurance. A lawyer under the age of 70 and working full-time can buy Emergency Medical Travel Insurance protection for only $50 per year or $75 per year for an entire family. That’s a small price to pay for a worry-free holiday.
However, before buying any Emergency Medical Travel Insurance policy, it’s extremely important to know of any contractual limitations that could impact your eligibility in the event of a claim. The most common is a pre-existing condition clause. A pre-existing condition is a health condition that was diagnosed prior to departure and any medical costs related to that condition are ineligible for benefits. Depending on the contract, the insurer may include anything diagnosed by a licensed physician from three to as much as eight months before you depart on your trip. It may also include medical conditions that have not been stable. This might sound harsh, but given the huge financial risk, this type of clause is necessary to protect the insurer against anti-selection.
Fortunately, most people do not have pre-existing health issues that could lead to a medical emergency. If you do have a health issue that could be a problem, there are some insurers willing to offer coverage subject to underwriting and an additional premium.
It’s extremely important to have the best insurance policy for your needs, but not everyone knows what to look for when purchasing Emergency Medical Travel Insurance. Here are the important things to know about any policy you are considering:
- Are you covered if you have a pre-existing condition?
- If you have a pre-existing condition, you should try to find an insurer that is willing to cover you for that illness. Please keep in mind that most insurers have not designed or priced their policies to allow for exceptions, so your options may be limited and expensive.
- Make sure your stay outside the country falls within the maximum number of days for your coverage. If coverage expires while you are travelling, it may not be possible to buy additional coverage until you return to Canada.
- Will you be responsible for any portion of the claim cost? You can save money by buying a policy that covers a percentage of the total, but given the potential size of the claims, a plan that pays 100% of the cost may end up saving you serious money.
- Make sure your travel insurance includes a worldwide, 24-hour/7-day emergency contact number with translation services for health care providers in your destination country.
- Ensure that the coverage includes emergency transportation costs back to Canada or a location with appropriate care.
- Look for coverage that includes emergency dental care.
- Make sure your policy does not exclude or significantly limit coverage for certain regions or countries you may visit.
If you have a credit card that offers Emergency Medical Travel Insurance, don’t assume that it is automatically included and provides adequate coverage. Some credit card companies charge an additional premium for travel insurance. Most also require that you use their card to pay for your travel arrangements. Verify the conditions, limitations and requirements before you rely on this coverage.
Taking the time to be sure you have the best protection for your needs will ensure a worry-free vacation.
Please note that our advice is not intended to replace that of a qualified insurance expert who has personally reviewed your specific benefits and insurance needs. To find your local CBIA Sales Representative, click here.