Every year we welcome roughly 30 million visitors to Canada. These visitors may come for various reasons under a variety of visas. The most common reasons and visas used to visit Canada include:

• Tourists and family visits (single or multiple entry visas)
• Parents and grandparents (multiple entry or super visas)
• Students (IEC visa or student visas)

Visitors to Canada are not covered under our country’s universal health care system—meaning the Canadian government does not pay for any hospital or medical services that are used by visitors due to a medical emergency. Without adequate emergency medical coverage, visitors may be left with expensive unexpected medical bills, which may be financially crippling.

The Government of Canada and all provinces/territories advise visitors to Canada to purchase the necessary emergency medical coverage they require while visiting. Here, THIA member Travelance shares some real-life claims to illustrate the importance of purchasing adequate emergency medical insurance on your next trip.

Case #1

A 74-year-old visitor who had insurance began experiencing back pain three months after his coverage start date. He went to a walk-in clinic and was diagnosed with sciatica. The physician prescribed 10 days of anti-inflammatory medication and recommended physiotherapy. The claims documents supported the condition as a new, unforeseen condition occurring after the policy effective date. Because of this, these expenses that the visitor incurred were paid:

• the physician visit,
• the prescribed medication, and
• the policy maximum of $500 for physiotherapy.

Case #2

A 30-year-old visitor to Canada purchased an emergency medical insurance plan more than one year after his arrival in the country. Because the policy was purchased after arriving in Canada, waiting periods are applied: 24 hours for an injury claim and 7 days for a sickness claim. He submitted claim documents that indicated that he had sustained an injury causing damage to his teeth three days after the start date of the policy. The Claims Department requested the medical records, which confirmed the injury occurred outside the waiting period, so the following expenses were paid:

• the initial consultation,
• root canal, and
• crowns up to the benefit maximum of $2,000.

Case #3

A 56-year-old visitor sustained a fractured leg when she tripped while on a walk. She was insured under a plan with coverage for $100,000. The family promptly notified the assistance company. They were informed that acute care to treat an urgent and emergent condition is covered under the policy, but not rehab care. The visitor did not require surgery, however, she remained hospitalized for 16 days during her coverage period. The family kept her hospitalized for rehab care, even though they were informed that rehab care would not be covered. The hospital bill was $83,000.

The family submitted a claim for the full hospital cost. The insured was eligible for the policy she purchased, which provided coverage for hospital costs and associated covered expenses for urgent and emergent care, which amounted to $41,000. The rest of the cost ($42,000) was the patient’s responsibility.

Case #4

A 59-year-old patient with a visitor to Canada emergency medical insurance plan began experiencing high blood pressure during the coverage period. The medical records showed they had suffered from hypertension and were on prescribed medication for this condition previously.

The claim was denied, as the purchased plan did not provide coverage for any pre-existing condition that existed during the 180-day period prior to the plan’s start date. Since the insured was on medication for high blood pressure during this period, the condition is considered pre-existing and therefore not covered by the policy.

Travelance will share more case studies on visitor to Canada claims in two weeks.

Travelance is an insurance distributor dedicated to providing superior service and products to its clients. Travelance clients include policyholders, brokers, travel agents, and agencies.