Make sure you have the right medical insurance coverage when traveling
Key Points
- Out-of-country medical insurance coverage is complex, so you may want to check out your medical insurance needs a few months before your trip.
- Check your potential sources of coverage.
- Ensure you get the necessary details from your provider by asking the right questions.
- Make sure you have the coverage you need.
If you’re preparing to winter in a warmer climate, or take long sojourns out of the country, don’t forget to carefully consider your medical insurance coverage. Medical insurance is complex, and most provincial medicare plans pay only a fraction of what U.S. hospitals charge, so it is important to make sure you have the coverage you need.
While many people automatically buy out-of-Canada medical insurance, it’s not always necessary. Here are some other potential sources of out-of-country medical coverage you may not be aware of:
- If you have group health insurance, either as an active employee or as a retiree, check your policy: Many group plans include out-of-Canada coverage. However, you still need to make sure your coverage applies to pleasure trips, and to find out if your plan has a lifetime maximum for claims.
- Some gold and platinum credit cards include out-of-Canada medical insurance — check the coverage limit and duration. You can buy more days, but often must do so before you leave. If you have two cards that each provide insurance, note that both plans start when you leave and both plans work simultaneously, not consecutively.
Checklist of essential questions
No matter what the source, check your coverage and find out the answers to these essential questions.
Are risky pur suits covered? Some activities, such as scuba diving, parasailing, and rock climbing, are often excluded.
Are pre-existing medical conditions covered? Definitions and exclusions vary widely. This is a huge source of insurer-claimant conflict.
What is the cap on benefits? Is it in Canadian or U.S. dollars? Is there a “subrogation” clause? Subrogation usually means a claim goes first to your employer or association plan (if you belong to one) and the travel insurer only pays what the other won’t. A major claim could mean trouble if your normal plan has a fairly low lifetime limit. Most, but not all, travel insurers don’t subrogate against plans with lifetime limits of $50,000 or less.
What is the length of the coverage? Can it be extended from outside Canada while you’re away?
What’s the procedure if you need medical care? Most insurers require you to call a hotline before non-emergency treatment. A “managed care” company then directs you to a hospital or doctor. For an emergency, you can go to the closest hospital, but the hotline must be called within 24 to 48 hours. The managed care firm will then oversee your treatment and may move you when it’s safe to do so.
Who pays the bills? Does the insurer pay the bills, or will you be reimbursed for costs? Reimbursement could take months, leaving you with significant out-of-pocket expenses in the meantime.