November is the time many Canadians start to plan their winter vacation. Of course when you travel outside the country (and even your province) your provincial health plan provides minimum coverage, and to play it safe you should have emergency medical insurance.
The supplementary medical plan you may have as part of your employee benefit package may provide some coverage for you, your spouse and your children up to a specified age. Also if you buy your airline tickets using a credit card you might have emergency medical coverage too, depending on the specific card, and then generally only up to age 65.
If you don't have either type of coverage or you're concerned that what you have might be inadequate, you can buy coverage online from a number of major insurance companies, including those owned by banks and those that have deals with auto clubs and a few retailers. You can also buy coverage from your travel agent. As well, some organizations catering to seniors offer plans that are tailored to their clientele.
If you fill out an application online without speaking with an agent, make sure you know what you are buying and what the policy's limitations are. To paraphrase what a provincial insurance regulator commented to me recently, these are good policies if you are in perfect health, take no medications and have never had to see a doctor.
If you don't fit that description, you should deal with an insurance agent who will walk you through the application and make sure you don't make any mistakes that could lead to a denied claim. Even if you go the online route, companies have a toll-free number to call to speak to an agent who will answer your questions and who will walk you through the application.
Put simply, the more medications you take, the more aches and pains you have, the more doctors who know you on a first-name basis, the more likely you should deal with an insurance agent who has extensive expertise in this area and who can recommend a policy that best fits your specific needs.
What you must understand is that you may not be covered if you failed to disclose a material fact on your application about your medical history. Unlike life insurance policies, which are underwritten -- your application is reviewed prior to acceptance and may require a medical -- travel insurance policy applications are reviewed only if you make a claim. As the medical questionnaire for one company states, "if you submit a claim under the policy, the insurer will review your medical history and your answers."
Indeed you may find out whether or not you have coverage only after you make a claim and the company reviews your application to determine whether you qualify. It may void the policy at its discretion and deny the claim.
This is a great business for the insurers. They may issue policies to people who don't really qualify, most of whom will never make a claim. Those who do make claims may find them denied. The companies meanwhile keep the premiums.
They key issues you or your agent will have to address are pre-existing conditions. These are medical conditions or symptoms that you have prior to making your trip -- high blood pressure, diabetes, heart condition, lung condition or cancer, to name a few. You must disclose anything and everything, and if you're not sure check with your physician. Depending on the specific policy, you will be covered for specific pre-existing conditions if they have been stable for a given period prior to your departure date. If there is a change in your health between the time you obtain the policy and your departure date, there is a change in insurability that should be disclosed to the insurance company. For example a change in your blood pressure medication after your arrange your insurance but before your departure probably means your condition is no longer considered stable. You should report it to the insurance company to determine if you are still covered, require a different policy or now have an exclusion.
As one company puts it, if you are no longer eligible for the insurance purchased and fail to contact the insurer, your claim will be denied, the insurer will void your policy and the premium will be refunded. In other words you won't have coverage and you'll be responsible for all expenses incurred.
You should also recognize that you won't be covered for symptoms for which you should have seen a doctor prior to buying the insurance. Similarly, you won't be covered for anything stemming from alcohol abuse or failing to take your medications or participating in hazardous sports as listed in the policy.
Before taking out any policy you should read it online and understand what protocols you must follow if you become ill or have an accident. Generally you are required to contact the insurer before seeking treatment. If you don't, the insurer may reduce your benefits, depending on the specific policy. This could mean that you have to pay a portion of the hospital bill that would otherwise have been paid by the insurer.
Insurers generally pay physicians and hospitals directly, provided you contacted the insurer in advance of seeking treatment. If you have to submit a claim for reimbursement of expenses you incurred prior to obtaining the insurer's approval, you should understand that you may be reimbursed only what the insurer would have paid. Of course if you have to submit a claim, make sure you obtain detailed receipts from the medical providers.
And read the fine print. One company's policy states that in determining the validity of a claim made by someone who may not have been eligible for coverage, it can obtain and review your medical records. It also states the company has the right to have you medically examined. It also says it has the right to request an autopsy where the law allows.
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