You can never be reminded too many time…too many people tend to wait until the last minute to get travel insurance and don’t take the time to find out exactly what the policy covers or what to do once they are in another country and need to go to a hospital. Remember, your travel card is not a credit card…you can’t just give it to any medical professional anywhere in the world and expect full payment. You, or a member of your family/a person you are travelling with MUST call the numbers on the card to ACTIVATE the claim on your behalf.
Note, you can not leave the country seeking medical care or treatment. Most policies require no change in a person’s health for at least 60-days prior to travelling. Even a change of medication, higher or lower, may mean a person’s health is not stable and therefore any resulting “medical situation” runs the risk of being denied. The U.S., where many Canadian snow birds spend the winter, is the world’s most expensive health-care system. A significant medical emergency can cost US$10,000 a day.
The customer has the responsibility to provide accurate information, understanding their policy, travelling with proof of insurance and the importance of notifying the travel insurance provider when a claim situation arises.
A recent Travel Health Survey found that less than 47% of travelers actually review the policy even though 23% of the same have incurred an out-of-country medical claim.
The most common reason for a claim denial is medical non-disclosure.
Diagnostic tests or prescription changes
A claim can be denied if a physician orders you a diagnostic test or prescribes a change in medication prior to travelling. A pre-existing condition needs to be stable for a period of time as specified in the policy, meaning no change in health or even a change of meds (dosage or type). Even a blood test that indicates a change in health status could compromise medical stability, and as a result their coverage.
Travelling while pregnant
Most travel health insurance policies do not cover women more than 31 weeks pregnant.
An injury or illness that occurs with high blood alcohol levels can lead to a claim being denied.
What constitutes an extreme sport?
Some policies consider hiking a form of mountaineering. Buying the wrong policy can be costly as a broken leg can cost up to $10,000 per day (and much more if there are complications) for medical treatment in the United States.
The examples below, help to illustrate why a claim may not be payable according to the policy:
Not a Sudden and Unforeseen Event
Emergency Travel insurance is designed to provide coverage against sudden and unforeseen events. This means the traveler had no way of knowing the emergency sickness or injury was going to happen.
If there is medical evidence to show the insured experienced symptoms prior to the effective date of coverage and within the stability period (for policies with coverage for pre-existing conditions) then there would be no claim payable.
A Pre-Existing Condition
Generally speaking, a pre-existing condition is a medical condition (other than a minor infection) which existed prior to the effective date of coverage and includes a medically recognized complication or recurrence of a medical condition. The definition of a pre-existing condition may vary depending on the insurance company.
While you may feel fine, your medical records may not support your claim. If you are not sure about your medical history, consult your primary care physician.
Policy exclusions are provisions within the insurance policy which eliminate or restrict coverage for certain types of risk. Exclusions may apply to the benefits, and other areas, of an insurance policy.
Various activities may be excluded or limited under your travel insurance policy. Before purchasing an insurance policy, make sure the activities you’ve planned for your vacation are covered. Take a few minutes to review and understand the policy wording. Contact your licensed insurance broker or the insurance provider for clarification.
Many emergency medical travel insurance policies allow a maximum amount of coverage for certain benefits. These limits may be per claim or over the entire duration of the policy.
Understanding the benefit limits of your policy will help you to understand how much coverage you are eligible for, for each benefit, under your policy. Each policy will have an overall limit and may include sub-limits for some categories of coverage.
When purchasing a travel insurance policy, it is imperative to provide complete and accurate medical history and to take the time to read and make sure you understand your policy.
Understanding the policy will help to make sure you’ve purchased a policy, which meets your needs. So, in the event of a sudden and unforeseen medical emergency, you won’t have to worry about how you will pay for the expenses.
Disclaimer: Please note that the information provided, while authoritative, is not guaranteed for accuracy and legality. The site is read by a world-wide audience and employment, taxation, legal vary accordingly. Please seek legal, accounting and human resources counsel from qualified professionals to make certain your legal/accounting/compliance interpretation and decisions are correct for your location. This information is for guidance, ideas, and assistance.