I am posting this in the touring section because although it is insurance related it is more pertinent to people planning a trip. Mods can move it as they see fit.
Due to a close call while in the USA I began asking some questions and came up with more questions not answers.
I am not an insurance agent / adjuster / underwriter and the following is subject to correction if any knowledgeable party can contribute appropriate information.
If you have a valid OHIP card and never plan on leaving Ontario you can pretty much ignore this post but check your own situation first.
While I refer mostly to travel to the USA it is also important to recognize that although all provinces must have Medicare, not all provincial policies are the same. A medical condition in another province may have serious costs but it is far less likely to cost you your house than a similar situation in the USA if you don’t have travel insurance. E.g. an ambulance ride in Ontario typically results in a patient charge of $45.00. Out of province it can be hundreds or thousands of dollars (Airlift).
The Big Difference in Concept
The most important thing that one must recognize about travel medical insurance is that it is different in concept than vehicle insurance.
When you apply for vehicle insurance they underwrite the policy before giving it to you. Any errors or omissions are dealt with before they hand you the policy and barring lunatic behavior, you know you are covered.
With travel insurance they take you at your word and only check the information if there is a claim. It is common for policies to state that if there is any error it nullifies the entire policy even if the claim is for an unrelated issue. It doesn’t matter if the error is a lie, misunderstanding or forgetfulness. If you fail to mention the sprained wrist you may not be covered for the $100,000.00+ appendectomy.
Read the Fine Print
If you are not a senior citizen a questionnaire is probably not required but coverage is not guaranteed due to exclusions.
A common one is “Travelling against the advice of a physician” or a somewhat related “Traveling when medical evidence says travel is ill advised”.
These exclusions exist in company travel insurance perks as well so read the policy.
The Questionnaire
If you have to fill out a questionnaire it is important to recognize that the person handling your questionnaire is not your family doctor and that the questions require yes / no answers.
E.g. “Have you in the qualifying period sought the services of a physician regarding a muscular skeletal issue?”
If you ask for a clarification they repeat the question. They do not negotiate an answer. If you answer “Yes” because of a sprained wrist you could be assigned the same risk factor as a person with osteoporosis. If you answer “No” you misinformed them.
If you have to fill out a questionnaire be aware that the insurers vary by great extremes. One I checked with went back 24 months for pre-existing conditions with no exceptions.
Another went back 12 months and had a “Minor ailment exception”. A minor ailment was one that didn’t require more than one follow-up visit to a doctor and no prescription lasting more than 15 days. The sprained wrist wouldn’t have come up on the radar. The policy premium was a fifth of the first example.
A third only did short term trip coverage and only asked a few questions. The premium wasn’t a game changer.
Coverage Chain of Command
OHIP is the first to pick up part of the tab but the coverage is pathetic. While a typical USA hospital cost is $10K to $15K per day OHIP only covers $200 for a ward and $400 for ICU.
Then your vehicle insurance medical benefits come into play if the treatment is due to a vehicle incident. You are covered if you are the driver, passenger or you are a pedestrian that is hit by a motor vehicle.
My agent informed me that my $829.00 a year medical premium only got me $50,000.00 in benefits. That’s $45K USD which may or may not pay for a broken arm. That is to be reviewed at renewal as it doesn’t show anywhere on the policy.
Your vehicle insurance doesn’t cover appendicitis, heart attack, kidney stones, falling down drunk walking back to the motel etc.
If you are planning one of those lifetime travel sabbaticals make sure your out of country limits are up to date.
Last in line is the travel insurance policy that picks up whatever falls between the cracks.
A few months ago CBC’s Marketplace did a number on the insurance industry regarding people that got hit with refused claims from travel insurance companies. In typical journalistic fashion they used vague numbers with little factual information.
I spoke with a representative of a travel insurance association and he admitted that there are no hard and cold statistics readily available. When I asked about numbers he quoted in a magazine article he said they just had to estimate.
Risk / Reward
This is a calculation only the individual can answer.
If there is a one in a thousand chance of needing medical care in the USA and one claim in a thousand is denied it works out to be a one in a million risk. Is it possible that you are of greater risk of a life changing event at home from texting drivers?
Due to a close call while in the USA I began asking some questions and came up with more questions not answers.
I am not an insurance agent / adjuster / underwriter and the following is subject to correction if any knowledgeable party can contribute appropriate information.
If you have a valid OHIP card and never plan on leaving Ontario you can pretty much ignore this post but check your own situation first.
While I refer mostly to travel to the USA it is also important to recognize that although all provinces must have Medicare, not all provincial policies are the same. A medical condition in another province may have serious costs but it is far less likely to cost you your house than a similar situation in the USA if you don’t have travel insurance. E.g. an ambulance ride in Ontario typically results in a patient charge of $45.00. Out of province it can be hundreds or thousands of dollars (Airlift).
The Big Difference in Concept
The most important thing that one must recognize about travel medical insurance is that it is different in concept than vehicle insurance.
When you apply for vehicle insurance they underwrite the policy before giving it to you. Any errors or omissions are dealt with before they hand you the policy and barring lunatic behavior, you know you are covered.
With travel insurance they take you at your word and only check the information if there is a claim. It is common for policies to state that if there is any error it nullifies the entire policy even if the claim is for an unrelated issue. It doesn’t matter if the error is a lie, misunderstanding or forgetfulness. If you fail to mention the sprained wrist you may not be covered for the $100,000.00+ appendectomy.
Read the Fine Print
If you are not a senior citizen a questionnaire is probably not required but coverage is not guaranteed due to exclusions.
A common one is “Travelling against the advice of a physician” or a somewhat related “Traveling when medical evidence says travel is ill advised”.
These exclusions exist in company travel insurance perks as well so read the policy.
The Questionnaire
If you have to fill out a questionnaire it is important to recognize that the person handling your questionnaire is not your family doctor and that the questions require yes / no answers.
E.g. “Have you in the qualifying period sought the services of a physician regarding a muscular skeletal issue?”
If you ask for a clarification they repeat the question. They do not negotiate an answer. If you answer “Yes” because of a sprained wrist you could be assigned the same risk factor as a person with osteoporosis. If you answer “No” you misinformed them.
If you have to fill out a questionnaire be aware that the insurers vary by great extremes. One I checked with went back 24 months for pre-existing conditions with no exceptions.
Another went back 12 months and had a “Minor ailment exception”. A minor ailment was one that didn’t require more than one follow-up visit to a doctor and no prescription lasting more than 15 days. The sprained wrist wouldn’t have come up on the radar. The policy premium was a fifth of the first example.
A third only did short term trip coverage and only asked a few questions. The premium wasn’t a game changer.
Coverage Chain of Command
OHIP is the first to pick up part of the tab but the coverage is pathetic. While a typical USA hospital cost is $10K to $15K per day OHIP only covers $200 for a ward and $400 for ICU.
Then your vehicle insurance medical benefits come into play if the treatment is due to a vehicle incident. You are covered if you are the driver, passenger or you are a pedestrian that is hit by a motor vehicle.
My agent informed me that my $829.00 a year medical premium only got me $50,000.00 in benefits. That’s $45K USD which may or may not pay for a broken arm. That is to be reviewed at renewal as it doesn’t show anywhere on the policy.
Your vehicle insurance doesn’t cover appendicitis, heart attack, kidney stones, falling down drunk walking back to the motel etc.
If you are planning one of those lifetime travel sabbaticals make sure your out of country limits are up to date.
Last in line is the travel insurance policy that picks up whatever falls between the cracks.
A few months ago CBC’s Marketplace did a number on the insurance industry regarding people that got hit with refused claims from travel insurance companies. In typical journalistic fashion they used vague numbers with little factual information.
I spoke with a representative of a travel insurance association and he admitted that there are no hard and cold statistics readily available. When I asked about numbers he quoted in a magazine article he said they just had to estimate.
Risk / Reward
This is a calculation only the individual can answer.
If there is a one in a thousand chance of needing medical care in the USA and one claim in a thousand is denied it works out to be a one in a million risk. Is it possible that you are of greater risk of a life changing event at home from texting drivers?
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