Every year Canada welcomes roughly 30 million visitors who come for various reasons under a variety of visas. Visitors to Canada are not covered under our country’s universal health care system, and without adequate emergency medical insurance, they may be left with expensive unexpected medical bills, which may be financially crippling. That is why all travellers are urged to purchase the appropriate emergency medical coverage they require while visiting. THIA member Travelance Insurance has been sharing some real-life claims that it has received so that you, as a consumer, can understand both how travel health insurance can give you peace of mind and the limits of its coverage.

Case #1

A 65-year-old visitor to Canada began experiencing symptoms of a urinary tract infection two months after the start of her policy, which offered coverage for $25,000. She received treatment in the emergency room and was prescribed medication for the infection. The blood work revealed the insured had diabetes so she was referred to a physician who provided treatment and a prescription for medication.

Outcome: The following expenses were paid, minus the deductible:

• services in the emergency room,
• the follow-up visit, and
• medication costs (up to the 30-day supply).

Case #2

A 53-year-old visitor sought medical attention for abdominal pain and was diagnosed with gallstone pancreatitis. She had purchased a visitors to Canada plan with coverage for $100,000 including some coverage for pre-existing conditions. She was hospitalized for 12 days and underwent multiple surgeries due to complications. The procedures were emergent and deemed medically necessary. While the claim was being managed, the claims assistance firm noted the insured's history of coronary artery disease and a lung condition for which a daily inhaler had been prescribed. The company alerted the hospital and the insured that she did not appear to be eligible for coverage because she had answered ‘no’ to questions about these conditions in her medical history questionnaire when she purchased the insurance and she should have answered ‘yes’ based on her medical history. This history made her ineligible for coverage, and the claim was denied. The family appealed this decision noting that while the insured was prescribed an inhaler for daily use, she did not follow the prescribed treatment. This did not impact the eligibility review because she was prescribed it for daily use even if she did not follow the recommended treatment.

Outcome: These two conditions in the medical conditions table rendered the insured ineligible for this policy, and the expenses related to the hospitalization were not covered, even though they were unrelated to her reason for claiming. This is because she was not eligible to purchase the policy in the first place. Her premium was refunded as she was not eligible for the policy and the insured was responsible for her medical costs.

Case #3

A 71-year-old who purchased a visitors to Canada plan with coverage for $100,000 was hospitalized after complaints of chest pain and shortness of breath. She was diagnosed with a heart attack and was transferred to a specialized hospital for left heart catheterization and multiple stent placements. She was then transferred back to the original hospital where she developed pneumonia and complications. The assistance company managing the case ensured treatment was appropriate and her resulting hospital costs were $78,000. The assistance company recommended she return to her home country to continue treatment (once she was stable and able to do so) due to limited coverage and expected continued treatment. The insured agreed. Her flight home required a medical escort and claims documents submitted by the family were deemed payable.

Outcome: The insured's deductible was waived due to her hospitalization for longer than 72 hours. As her condition was not pre-existing, there were no applicable exclusions and she was eligible for the policy she purchased. The hospital bill and return home expenses were paid up to the policy maximum of $100,000.

Travelance will share more case studies on visitor to Canada claims next month.

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