What kind of medical insurance should I buy to cover my condition?

I had a problem with my heart, I think it was angina, about four years ago. Nothing since and I just had an appointment with my heart specialist and he says I’m fine. No change of pills for two years. What kind of medical insurance should I buy? I’m 58 years old and planning on taking a cruise in the spring.

Answer : If your heart condition is stable and you have had no change in medication for two years and have no other health problems, you should have no problem finding insurance. But make sure you have a plan that covers “stable” pre-existing conditions and if you are asked medical questions, which is likely, make sure you disclose the details of your angina, what medications you are taking and their dosages. Then get an endorsement that says you are covered for your angina. If you fail to disclose anything about your health on a medical questionnaire—even if it has nothing to do with a medical emergency you may encounter—your entire policy might be voided and you might be disqualified from coverage. If you are going on a cruise, your best bet is to insure with a travel insurance specialist that offers at least $1 million, will repatriate you to a hospital at home if medically required (evacuation to a nearby hospital is not good enough), and has an emergency service you can access 24/7 no matter where you are, even at sea. Most insurance plans offered by cruise lines are not good enough.


Question from multiple elderly Canadian travellers:

Canadian travel insurance is too expensive. These companies need more competition. Why can’t we buy insurance from American insurers if we are traveling to the United States? Couldn’t they offer a better deal in their own country?

Milan says…
You would think so. But the short answer is NO. First of all, most American-licensed companies can only sell to American residents. You need insurers who are not only licensed to sell in your home province, but who have out-of-country travel plans that are supplemental to the benefits offered by your provincial health insurance which pays some—albeit quite little—of the cost of your emergency medical care in foreign hospitals. Your Canadian plans can also file for reimbursement from your provincial health insurance, and are prepared to repatriate you to a hospital back in Canada by air ambulance or commercial flight if medically necessary and not just evacuate you to a nearby hospital and leave you to your own devices to get back home. Getting a hospital bed in Canada is no easy task so you need so you need an assistance service that normally deals with Canadian hospitals. In short, Canadian travel insurance is designed specifically for Canadian travelers in foreign countries and covers only emergency medical

care. American travel plans are designed for Americans who have more limited basic health insurance coverage. And as for the cost, unless you’re very, very sick, or very, very old, Canadian travel insurance, is a bargain.

What Does Travel Health Insurance Cover?

Though there are minor variations from policy to policy, whatever is necessary to treat your medical emergency abroad is pretty well covered in policies issued by most Canadian travel insurance companies. This includes:

  • 24-hour emergency assistance hotline you can call from anyplace in the world for advice and assistance in handling a medical emergency. This will be staffed by the insurer’s emergency assistance service, which will be supervised by qualified medical professionals.
  • Inpatient or outpatient hospital and doctors’ fees (including specialists), intensive care, surgery, lab tests, anesthesia, blood, room and board, in-hospital drugs, medically necessary special duty nursing.
  • Outpatient hospital, clinic, or lab services – though there may be some limitations. This could vary from policy to policy. Check it out.
  • Some policies may cover limited chiropractor or therapist or other allied professional services but don’t take that for granted. Check your policy out first.
  • In addition, most policies will cover your air evacuation to a hospital if you’re in an area without appropriate medical services, such as a remote island or resort, or repatriation to a hospital in Canada under certain conditions. If, after your emergency is stabilized, the assistance service determines it’s safe for you to be transferred to a Canadian hospital for further treatment or management, they have the right to transfer you at their cost. This may include medical evacuation by air ambulance or by regularly scheduled airline (possibly with a qualified attendant). If you decline their recommendation, they can end their coverage.
    On the other hand you may want to be air evacuated back to Canada but they may prefer to keep you where you are. That’s up to them, and those decisions are not always done for clinical reasons but for economic ones. Medical Air repatriation is no free ticket home. Arrangements like these are complex and they can only be made by your emergency assistance service in coordination with your attending hospital, the air ambulance service, and the hospital receiving you in Canada (provided a bed has been reserved in your name—often with the help of your family physician). If you want your insurer to pay for this (at $15,000 to $25,000 within North America) you better let your emergency assistance service do it.
  • If, alas, you die while abroad, your policy will likely cover the return of your remains to your next of kin’s funeral director of choice, but this includes only the basics: no fancy caskets, flowers, or organ music. This too is best handled by your insurer as different countries and states have their own regulations and requirements about transporting the dead.
  • Most policies also provide benefits to allow family or a relative to travel to your hospital bedside if you are traveling alone or otherwise need assistance.
  • Most Canadian travel policies also offer options for baggage loss or damage, trip interruption or cancellation (with limitations you should read about in the section on Trip Cancellation), return of your auto or recreational vehicle if you have an emergency and can’t drive home on your own, other roadside assistance services which may also be duplicated by your auto club memberships.

For Medical Emergencies Only

If you are a Canadian resident planning on traveling out of the country—even for one day—supplemental health insurance is absolutely essential because your provincial health insurance does not cover you while out of the country—not to any meaningful extent. Travel health insurance is as important as your passport, and it requires your full attention and care when buying. There is no single plan that is appropriate for everyone. Such a thing doesn’t exist. And the wrong plan can be worse than none because you could be paying for something that would leave you without protection when you need it most.

First of all, understand that the out-of-country insurance available to Canadians is not a substitute for your provincial health plan but a supplement to it. Its benefits are limited. Its purpose is to cover unexpected medical emergencies while you are traveling out of the country. That it does well and at a fair price. But it is not comprehensive health care. It does not cover elective services, non-emergencies, or services for conditions you planned to have treated before leaving the country.

Until 1991, when Canadian provinces cut back foreign hospital payments for their traveling residents, out-of–country travel medical insurance was relatively simple and cheap. Basically, it covered supplemental items like upgraded rooms, private nursing, television and telephone charges, certain special needs, and repatriation if necessary, but the high costs of hospital and doctors’ services were still largely paid by the provinces. When these were cut back, private insurers were left with covering the differences, and the costs of providing insurance skyrocketed.

Unlike the European Union, whose member countries provide limited reciprocal healthcare services to each other, Canada has no reciprocal arrangements with any other country. And unlike the United States where many private insurance plans offer some limited out-of-country coverage, Canada’s provincial plans cover only a small fraction of such services. Provincial governments only pay from $75 to about $400 a day for out-of-country hospital care. Yet in the United States, costs ranging from $5,000 to $10,000 a day are quite normal, leaving patients, or their insurers, responsible for the difference.

The bottom line is that hospitals are businesses, and adequate health insurance is the way to protect yourself in this very expensive market.

To keep their premiums affordable and to cover a rapidly-growing market, insurers have developed many different plans, tailoring benefits, exclusions, special circumstances and eligibility requirements to the needs of all travelers of all ages, not just the young and super-healthy. Virtually all of these health plans are encompassed in broader travel insurance policies that also cover trip cancellation benefits, lost baggage, legal aid while traveling, and a myriad of other travel services. But here we concentrate on the health benefits because those are the costs that can wipe out your life savings or worse.

What Is a Medical Emergency?

Canadian travel insurers interpret this generously. This is how the Travel Health Insurance Association of Canada defines emergency: “an unforeseen illness or injury which requires immediate treatment to prevent or alleviate existing danger to life or health…” Not all insurers use this definition, but generally they interpret emergency quite liberally and don’t limit it to something that is life-threatening. The best rule is: contact your emergency assistance service hotline and let them guide you. Most plans require you to contact them when you have an emergency, usually within 24 hours. If not, your benefits may be reduced. The reason they do this is that they can make a quick assessment and refer you to the nearest, appropriate medical service. On the other hand, if it’s an emergency requiring 911–call and get to the nearest hospital, get into treatment, then call your emergency assistance service with the details and they will instruct you further.

Going it alone and making your own hospital arrangements, “authorizing” treatments or other procedures, or failing to notify your emergency assistance service of your emergency as soon as you can is a high risk game. Your assistance service is there to see you get appropriate care and for that they have to be notified right away. In the great majority of cases the medical director of your assistance service will let your attending physicians and staff do what they think appropriate. But there are times when attending staff may want to do procedures that may not be necessary at the time, or could wait until you are transferred to a Canadian hospital if transfer is necessary. In that case the medical director must give approval for such a procedure to be done. And if not, and you choose to go ahead, you may very well have to pay that part of the bill. All insurers require you to notify them of any major medical emergency needing treatment. For minor conditions, such as those in a walk-in clinic, it’s ok to have them done and file later for reimbursement. But you need all of the proper paperwork and clear identification of what was done, where, was a doctor involved and what was the outcome. But if in doubt, why not call and advise the assistance service? That’s what your cell phone is for.

What Is Not Covered?

If anyone selling you travel health insurance tells you you’re covered for everything, walk away. You’re not.

Travel health insurance covers unexpected, unforeseen emergencies, not continuing care, preventive services, routine check ups, maintenance care for a condition already stabilized, chronic care services, elective or non-emergency services or diagnostic services unrelated to your emergency.

No nose jobs or tummy tucks. No hip or knee replacements. No organ transplants. No cardiac bypass that can safely be deferred until you return or are repatriated home. In general, if it can be safely delayed until you get home, it will be. Travel health insurance is supplemental to your provincial insurance plan, it’s not a substitute for it. If it were, most Canadians couldn’t afford it.

If you can be safely discharged from hospital after treatment of an emergency you will be, and that is the end of your coverage for that particular condition or conditions related to it. You can then either go home or risk “going bare” for that condition. For example: if you have a heart attack, your insurance will cover your emergency and the treatment required to stabilize you until it’s safe for you to leave the hospital or be transferred to a hospital at home for further treatment. But that’s where coverage ends for that particular event. You will not be covered for continuing care of your heart or for a recurrent attack.

Even in policies that claim to cover pre existing conditions, pre-existing conditions are not covered unconditionally. There are limitations, and most will require that the pre-existing conditions being “covered” have been stable and controlled for a certain period of time before the policy goes into effect. That may be 30 days, 90 days, one year, maybe longer. It depends on the condition, the policy, the terms of the medical underwriting. This differs from plan to plan. You need to be acutely aware of the conditions of coverage and especially what the insurer means by terms like “stable” and “controlled”, “treatment”, “investigation”. Normally if a condition has been treated by a physician, has developed symptoms, or has required a change of medication—either type or dosage—within the specified time period, it will be considered unstable and not covered. See the section on Pre-existing conditions.

Most policies will not cover you for special risk circumstances such as skydiving, mountain climbing, shark hunting, professional scuba diving, professional sports, anything of a high risk nature. Tell your insurer if you plan to do any of those things and then get a written statement verifying that you are covered in case of such mishap. Note also that there are insurers who specialize in high risk coverage of that sort.

Neither will you be covered for suicide or any emergencies resulting from alcohol or other drugs nor if you are caught in a war zone or civil disturbance, riot, insurrection or act of terrorism.

Are Pre-existing Conditions Ever Covered?

Though there are almost as many definitions of “pre-existing condition” as there are policies, a pre-existing condition generally means any medical condition, diagnosed or not, which exhibited symptoms, or was treated or investigated by a physician or required medication within a specified period prior to the date of insurance. That period could be 30 days, 90, or a year—it depends on the policy. So if you have been experiencing sharp abdominal pains for two or three weeks before leaving on your vacation, but your gall bladder was not removed until after you arrived in Florida, that’s a pre-existing condition, whether or not it was diagnosed or treated by your family physician.

It’s not necessary for a formal diagnosis with clinical terminology to be recorded in a doctor’s notes for a pre-existing condition to be recognized. Common sense has a role to play in such determinations too.

Pre-existing conditions may or may not be covered, depending on the type of policy you buy. Some simply state that pre-existing conditions are Not Covered. Period. Or they may specify no coverage of pre-existing conditions that occurred within the past five years, or one year, or 90 days, or ever. Plans for people without pre-existing conditions are the cheapest, especially for super healthy people who never see a doctor except for a routine physical. But for the rest of us there are plenty of other options.

Many plans say they will cover pre-existing conditions. But don’t take that at face value. Read the fine print. Nobody covers pre-existing conditions unconditionally.

Insurers who say they cover pre-existing conditions will do so only if those conditions are stable and controlled. This is how the Travel Health Insurance Association defines this term:
“Stable and Controlled means the medical condition is not worsening and there has been no alteration in any medication for the condition or its usage or dosage, nor any treatment, prescribed or recommended by a physician, or received, within the period specified in this policy before the trip in question.” Whew!

In short, any pre-existing condition that exhibited symptoms, required treatment or a change of medication prior to the effective date of your insurance will very likely be considered “unstable” and will not be covered. Even a change of dosage of the same drug may be considered an instability, so be watchful and understand what your physician is prescribing for you. Usually, shifting from a trade product to a generic of the same strength should not adversely affect your stability status. But if your insurer gives you a problem on that point, you have justification for a complaint. (We’ll deal with complaints later).

What About Those In Less Than Perfect Health?

Because the Canadian travel market is expanding so rapidly, travel health insurers have developed an astonishing array of products for those with diagnosed health conditions and the expanding population of elderly. No travel health insurer wants to be locked out of the buoyant snowbird market, for example, not with between 500,000 and 600,000 of them heading out of the country each winter and with at least 80 percent of them buying supplemental health insurance.

On the one hand insurers don’t want to take undue risks by underwriting clients who are likely to expire in the tropical sunset-although dead clients are often cheaper to underwrite than ones who linger too long in hospital. But neither do they want to miss out on their market share. And so they have become very creative in providing plans for clients with more complicated health profiles.

The means to this end is called “medical underwriting” and it refers to basing risk (and premium price) on your specific health characteristics. To qualify, you must complete a health questionnaire, and this can be a daunting experience. Some questionnaires are pages long and are studded with ambiguity, opacity, contradiction and medical and even legal jargon. But it’s the only way insurers have of digging out the information about an applicant’s health.

Believe it or not: some applicants lie. Others just forget. And some just don’t know everything that’s in their medical record-either because their doctor didn’t tell them (thinking it wouldn’t make a difference to their care) or they didn’t understand what their doctor told them, or they didn’t think it relevant to the question being asked. All of these situations can be problematic because insurers have to know an applicant’s medical history in order to asses the risk they are undertaking (and the premium they should charge). It’s not up to you to determine what is or is not relevant. It’s up to you to answer the questions factually.

Question: Have you ever had symptoms, been investigated, or had treatment for a heart murmur? If you answered No or left it blank because a few years ago your doctor said no treatment was necessary and you need not worry about it, you made a serious mistake. The answer was clearly Yes, but you thought that since no treatment was necessary it was irrelevant. That’s the kind of omission that could negate an expensive hospital claim. If the answer was “I’m not sure” then you should have asked your doctor.

Remember, when asked to complete a questionnaire, whether by phone, online or by hand, you’re not being asked to offer your opinions, but to provide facts. The underwriters will determine what is or is not relevant. Sometimes they too ask a lot of irrelevant or obscure questions, but you have to answer factually, however silly the question may sound to you.

There are also many instances, particularly among the elderly, where applicants truly don’t know or don’t remember everything that’s in their medical record. But where coverage depends on that knowledge, it’s best to ask the family physician for help. Even if you have to pay a fee for that help-which is only reasonable-having accurate information from your medical record will protect you in the end.

Credit Cards Are No Substitute for Travel Medical Insurance

Don’t count on credit cards to cover your medical expenses while travelling abroad—not unless you have supplemental health insurance specifically written into your policy.

The days of automatic travel health coverage by even the most basic credit cards are long over. Now, only the higher-end cards, mostly those with annual fees, offer medical benefits as part of their travel insurance, although most will offer optional medical and evacuation or repatriation benefits from established travel insurers for an additional fee.

The bottom line is that you cannot take for granted that your credit card will pay your medical expenses in case of accident or illness abroad. You must have such assurance in writing and you must know what you have and what you need to have. And don’t accept “emergency or medical assistance” as a substitute. Such services only help you get emergency services. They don’t pay the bills.

Here are some tips and guidelines we suggest you follow.

Know the benefits and limits of any travel insurance you buy. Don’t count on the word of a travel agent or tour operator who says, “You’re fully covered, don’t worry about it.”

Make sure you qualify. Many credit card companies limit their coverage to younger and middle-age groups. If you’re over 55, or a snowbird, make sure your age group is covered.

Be aware of pre-existing conditions exclusions. Many basic credit card plans do not cover pre-existing conditions. So if you have any kind of medical history, or if you have been treated, or have taken any medications, or been investigated for any symptoms or conditions in the past year or less (some policies will even go back farther than a year), tell your insurer and make sure you know what is covered and what is not. Fortunately, most full-service travel insurers can offer you underwritten coverage based on your health status. But you’ll have to answer health questions candidly, accurately, and fully.

Related: What About Those in Less than Perfect Health?

Plan your time of travel. As a rule, credit card travel plans only cover you for a limited time, say 15 or 30 days, though some may go a little longer. And many will not extend that time, especially if you have some pre-existing conditions. Here it gets tricky, as some will not allow you to “top up” or extend your coverage beyond their stated limits with any other insurer. So if you are in the Bahamas and you decide to stay beyond your allotted 15 days, if you call your credit card company to get an extension, you may be denied.

Combining your short-term credit coverage days with longer-term stand-alone travel insurance can be tricky. I know of many frequent travellers, such as snowbirds leaving the country for up to six months, who try to save money by using their credit cards to cover the first 15 or 30 days of their trip. It doesn’t always work, and you better know that ahead of time. For example, if you come down with an illness on the 28th day of your first 30-day plan, you not only run out of benefits after that, but your illness becomes a pre-existing condition for your add-on plan and you can be disqualified from coverage. That happens more than you think. The best way to go? Leave your credit card for purchases, and take a stand-alone, dedicated travel health insurance plan from one of the established travel insurance companies to cover you from day one of your trip. It’s easier, safer, and you’ll probably end up with far more comprehensive coverage.

What is adequate medical coverage for international travel? Whether it’s a guided tour, independent travel, a cruise trip, or a weekend jaunt across the border, you need the following:

  • At least $1 million in medical emergency coverage. And be sure you understand what is covered, what is left for you to cover, and what your responsibilities are in case of emergency. Many insurers require you to call your assistance service within 24 hours of an emergency. Remember also that this is not a blank cheque for you to spend as you wish. Your insurer’s representative will determine what is medically necessary and will very likely fly you home by air ambulance rather than let you soak up $1 million in hospital services. But you need it anyway. Nowhere in the world is top-quality medical care cheap, and that is the only kind of care you want.
  • Repatriation to a hospital close to your home if medically necessary. Evacuation to the most appropriate hospital chosen by your insurer is not good enough. You need to get home and air ambulances are not cheap.
  • Direct payment of hospital and medical bills by your insurer. You don’t want to be stuck with a $50,000 hospital charge on your credit card—if you’re lucky enough to have one that goes that high.
  • 24/7 access to an emergency assistance service that can help you get the services you need and will monitor and consult with the medical professionals caring for you.
  • Where do you find these plans? In the United States, visit the Full Members section of the US Travel Insurance Association website. In Canada, visit the Members Section of the Travel Health Insurance Association website. And in the UK and Europe, where travel insurance is a fact of life, media ads for travel insurance are everywhere.

What Types of Plans Are There?

There are hundreds of different travel health insurance plans available. Each has its own individual characteristics so you need to ask questions about what you are buying. But they fall into just a few major categories.

The first is the Single Trip plan which covers you for one specific trip with designated beginning and ending effective dates. You apply for each trip individually and if medical questions or health issues are involved, you treat each application as a new and distinct contract. Don’t expect your insurer to go digging back in old files to research medical data you provided on a previous application. The Single Trip plan is most appropriate for people who travel only once or twice a year and know well in advance when they will be doing so. It’s also most appropriate for people taking longer trips, such as snowbirds going away for several months.

The Annual or Multi Trip plan is for more frequent travelers as it allows you to sign up once and make as many trips out of the country as you wish over the course of the year. Usually, the plan specifies a maximum number of days per each trip segment, but it allows the flexibility of doing trips at the last moment without going through separate insurance application processes. And leaving travel insurance until the last possible moment is always a bad idea as it doesn’t give you the time to read over the policy and to question its limitations and exclusions. One thing to be careful of, however, is that if you become ill or have an accident during one of those segments, that may become a pre-existing condition for the next segment and could put you at risk for an unexpected exclusion. If that happens, contact your insurer immediately and have your medical status adjusted.

Many employee, pension or retirement group plans may also include some out-of-country health care coverage. Make sure you see the fine print about what these benefits include as they generally have limits on the length of time they will cover you and the dollar amounts of coverage. Some of these plans provide a limited “bank account” of benefits e.g. 40 days or $100,000 or more. But once the benefit s are used up they are not replenished, or you may have plan does replenish but only up to a limit. Make sure you know what your plan does.
Many Canadians ho have such plans use them as a coverage base and then add top ups from commercial insurers. Before you do this make you know if your employer plan allows top ups. Not all do. And be clear about the risks. For example, if you want to top up an existing 40-day group benefit plan, the additional retail plan will cover you only from day 41. If you have a medical emergency during those first 40 days, your group plan will be liable. But that emergency may then be considered a pre-existing condition for the retail plan that only goes into effect on day 41, and so you may not be covered. You may find yourself caught in conflicts between your insurers.

Patching together plans is a risky business. Sometimes you may be better off buying a longer term retail plan that covers you from day one and leaving your group or employee plan for shorter trips that won’t exceed the plan’s limits. It may also be cheaper.

Credit Card companies offer limited out- of- country coverage as part of their premium price. Understand what those limitations are. Don’t assume they all offer the same benefits and make sure you know what those limitations are-maximum number of days covered, dollar limitations, and particularly health and pre-existing conditions requirements. You should assume that if you are not asked any health questions, you will not be covered for any pre-existing conditions. Read what I have to say about pre-existing conditions before you take that risk.

How Do You Know Which Plan Is Right For You?

The plan that’s right for you is the one that fits your age, the length of time you will be traveling, where you will be traveling, what you’ll be doing (climbing mountains or sky-diving), what you can afford, and most important, your individual health profile. The healthiest people usually get the cheapest plans. Remember, first and foremost, this is a restricted health policy and coverage is based on the insurer’s accurate knowledge of your health status and your own compliance with the terms as they are written in the policy. The fine print may be dense and interminable, but it rules. I have seen some travel policies that go on for more than 50 pages. And though you keep hearing “Read The Fine Print”, who are we kidding? But Please, at least read the summary of Covered Benefits and also Exclusions, and read carefully the definitions of Pre-existing Conditions, Stable and Controlled, Treatment, Trip Interruption and Cancellation conditions, and if you complete a medical questionnaire-read it all.

Misunderstanding questions about your health, not revealing pertinent health facts, “shading” the truth about your health so as to qualify for a lower premium category, failing to understand the terms of the contract with the insurer, or not complying with the policy requirements account for the vast majority of claims denials by insurers.

To make sure you get the best policy for your individual needs, start out by buying from an insurer, broker or agent that specializes in travel health insurance and doesn’t simply sell it as an adjunct to other coverages just to make a few extra dollars in commissions. If you have any doubts about who you are dealing with, ask if your agent, broker or the company issuing the policy is a member of the Travel Health Insurance Association of Canada. They should be. Sometimes you will see the THIA logo stamped on the policy. That’s a good endorsement. THIA is a professional group with established standards and educational programs for its members.

Travel health insurance is a specialized product and it requires specialized knowledge. For example, there are many travelers who will spend hours investigating the hotels and side trips they have purchased in a guided tour of Europe, but will simply accept the travel agent’s word that their medical policy add-on will “cover everything,” without even reading it. One thing you can be sure of: No Policy Covers Everything.

How Much Does Insurance Cost?

You may as well ask how much a car or a pair of shoes cost. If you’re healthy, young, traveling for only a couple of weeks and need no pre-existing coverage you might be able to buy insurance for less than $3 a day. If you’re 65, traveling for 90 days and in reasonable health for your age (perhaps taking medication for high blood pressure or some chronic condition that is under control) you might pay twice that. Still not bad, when you consider how much Americans pay for their private health insurance. If, on the other hand, you’re 82, have a medical history, are being treated for an existing condition and are about to leave on a 186-day winter snowbird vacation in Florida, you could pay $20 a day—or more. The bigger the risk, the more you pay. Your neighbour may be the same age as you, but because of the number and types of medications he takes, he might pay 50 percent more than you for a policy of the same duration.

Shop around. The more estimates you get (but make sure all your estimates are based on the same facts) the better price you may get. Comparing one plan that offers first dollar coverage with another that has a $500 deductible doesn’t make much sense. Some plans do charge less than others. Some insurers concentrate their products on snowbirds. others on short term, frequent, or business travelers. Find the plan that fits you best, but don’t try to cut corners by buying a plan that doesn’t fit your age, or health profile. It’s not worth saving a few dollars now only to have your claim denied later because you “forgot” to disclose a pre-existing condition, or neglected to list all of your medications on your application. Check out the section on How To Find Savings to help lower your premiums.

Thanks to the strengthening loonie, Canadian insurers have more purchasing power in paying for healthcare services in the United States. This has helped keep premium prices quite stable over the past three or four years and the 2007-2008 winter travel season should be no exception.

How to Save on Premiums.

Before you think of cutting costs, make sure you have a plan that fits your needs and your health profile. A cheap plan that doesn’t cover you when you need it is worse than no plan at all. The cheapest plan is the one that covers no pre-existing conditions, but that’s only for the healthiest of people. If you qualify, you will save.

Consider deductibles. A deductible is the part you pay for a medical service before the insurance kicks in. Most insurers offer premium discounts for deductibles-the bigger the deductible the bigger the discount-sometimes 10 or 15 percent. Maybe more if the deductible is really significant. If you’re traveling on vacation you can probably afford at least a $50 or $100 deductible. That will get you a discount of several percent. If you don’t get sick, you’re not going to have to pay it and you’ll still get the discount. Find your comfort level and go for it.

Think about waiving coverage for some pre-existing conditions that are not likely to cause you a problem. Most plans ask if you want all your pre-exists covered. Maybe you don’t need them all covered. Weigh the risks.

If you travel frequently, especially on shorter trips, consider an annual or multi-trip plan that allows you to make an unspecified number of trips of a certain maximum duration each year. One application. One fee. Cheaper than multiple single trips. But be aware that if you should have a medical emergency during one of these trip segments, that becomes a pre-existing condition for your next segment and you have to call your insurer and adjust the terms of coverage-and the premium.

Check out if your insurer offers loyalty discounts for repeat business year after year.

Some plans will allow discounts if you have been claim- free for a number of years, even if you have been insured with someone else. You’ll need a letter from the previous insurer verifying your claim free status.

Consider joining affinity groups—membership organizations, fraternal societies, groups such as the Canadian Snowbird Association which have plans tailored to specific needs and profiles of their members usually at favorable rates. The CSA, for example, not only has travel insurance designed especially for its members, but it offers a whole range of travel benefits that are worthwhile even if you buy your insurance elsewhere.

If you can break up your trips you might get a savings. Insurers charge more per day for longer than for shorter trips. Example, you will likely pay more per day for a 180-day trip than for a 60-day trip. Common sense says that the longer you’re away from home the more likely you may have a medical problem while away from home. Think about breaking your snowbird vacation into two 90-day trips instead of one 180-day trip. You might also consider an annual policy multi-trip 90-day policy, which would be cheaper than a single 180-day trip.

Buying over the telephone

Unless you’re buying a basic No Pre-exist policy, or are in good health with a clean medical record, completing a medical questionnaire over the telephone is a tricky business. There are many questions about whether or not you have ever had any one or more of dozens of conditions e.g. fibromyalgia, urinary disorder, hiatus hernia, etc. etc. some of which require some thought or explanation. Did you understand the question? Did the agent speak clearly. Did the agent have an accent you had difficulty with? Did you understand the difference between osteoporosis or osteoarthritis? Did the question about bowel disorder refer to constipation or something more serious?

The greatest risk in doing telephone questionnaires is that you have no record of your responses. You have no assurance that your answers were taken down correctly unless your insurer confirms all of your answers with you, preferably on paper or online so you can verify their accuracy at your own speed, your pace and convenience. More insurers are providing this type of confirmation and it’s worth the extra effort. As an ombudsman reviewer I have seen many cases in which applicants said the insurer’s customer service agents recorded their information wrong. But without some backup, how can that be proven? If you can complete the questionnaire by your own hand or with the help of the agent, at your own pace, and with your physician’s help if needed, do it.

Do You Need Travel Insurance Within Canada?

Some travel insurers tell you that since not all provinces cover health services to the same extent, you should purchase travel insurance any time you leave your home province: just to be safe. For example, some provinces cover emergency ambulance fully, some cover it to a lesser extent, some not at all. Some cover services by chiropractors, physical therapists, other ancillary health providers, others don’t. Some cover certain drugs out of hospital, others don’t. So what should you do? It depends on your tolerance for risk. First of all understand that if you need emergency medical services in another province they will very likely be provided in a hospital. If not, you would probably travel home to be taken care of. And according to the portability provision of Canada’s medicare, almost anything that is medically necessary and is provided in hospital will be covered no matter which province you are in. In that case, maybe your ambulance ride may not be fully covered, or maybe your initial visit to a clinic may not be eligible, or some drug you were prescribed before you went to hospital might not be covered. But that’s about as bad as it’s going to get.

Insurance is usually seen as a safeguard against major loss that would really hurt you financially. So if you lie awake worrying about the possibility of losing $300 or $400 in some unforeseen accident, then maybe you should buy insurance. On the other hand you may not consider paying $100 to protect against the possibility that you might lose $300 somewhere down the road a good deal? That’s your call. But first, do the math.

The Whole Truth and Nothing But. The Risks of Non-disclosure

In completing a questionnaire for medical underwriting, you will very likely be asked to sign a declaration acknowledging that if you fail to answer any question accurately, truthfully and completely, the insurer can void your policy and deny any claim you make under it. And that holds whether or not the condition you failed to disclose had any relationship to the emergency that was treated.
Example: Your claim for kidney stone treatment is declined because you failed to disclose a history of diabetes (even though it was well-controlled by diet and medication). Why? Because your insurer would not have offered you coverage under the conditions or at the rates it did. It might have asked for more information about your diabetes and its severity. It might have declined you totally. And so the policy becomes null and void. It’s called Non-Disclosure and the laws uphold the insurer’s right to deny such a claim.

This makes it doubly important for you to reveal not only what you know, but what you might not know that has been written into your medical record. It’s a good idea if you see your doctor frequently for a variety of conditions to have your doctor look at the medical questionnaire and the way you’ve answered it before you submit it to the insurer. It may take a little more time and it may cost you a few dollars, but in the end you will have bought a lot of security.

Visitors To Canada Need Insurance

Your mother-in-law from Chicago is coming to visit. She has her U.S. Medicare. Does she need health insurance? Yes. Absolutely. U.S. Medicare does not cover out-of-country services except in some extremely limited circumstances. And this is not one of them. Also, though most private health insurance plans carried by Americans do contain some coverage for out-of-area services, many Americans do not have private health insurance and so if they have an accident or a medical emergency while visiting they will be in the same circumstances you might be if you were stranded without health insurance in the U.S. And don’t make the mistake of thinking that Canadian hospitals are more charitable than their American counterparts. Canadian hospitals charge much more for foreign patients than they do patients from other provinces. Any large Toronto hospital may well charge between $4,000 and $5,000 a day for services to a foreign patient. What’s more, they are not hesitant about demanding payment. And if the patient can’t put up a guarantee, maybe the patient’s relatives, like her Canadian son-in law, might.

Most Canadian travel insurers have plans for visitors to Canada. And make sure coverage begins before your visitors arrive in Canada so that they are covered the moment they cross the border. Falling down stairs at the airport can be expensive. Also, plans bought after the traveler arrives in Canada are normally subject to a brief waiting period before coverage kicks in, perhaps 48 or 72 hours. This is to protect the insurer from being maneuvered into covering a person who came to Canada specifically to get emergency medical treatment. Be aware that visitors insurance is also subject to certain pre-existing conditions limitations, so know what you are buying. And if you’re thinking of bringing in a relative to have a coronary artery bypass operation they couldn’t afford to have in their native country, and have it covered by their new traveler’s insurance, forget it. That’s not what it’s for.

Do Expatriates, Employees or Students Need Different Plans?

If you are a student studying abroad, a company employee stationed out of Canada for extended periods, or a Canadian national permanently residing out of the country, you need supplemental insurance that goes beyond what is available to occasional or frequent travelers. Since you may no longer be eligible for provincial insurance, you may need coverage for preventive care, annual checkups, and routine medical visits. These are not covered by single trip or annual, multi-trip plans designed to cover medical emergencies.

If you are a student, expatriate or a posted employee, deal with insurers who specialize in products designed for you. And you need to shop carefully because even expatriate plans are no substitute for government health insurance. There are pre-existing conditions limitations you need to understand. For example, if you buy a 12-month policy, any illness or medical treatment you have during that time may be counted as a pre-existing condition when you reapply for new insurance the following year. That new policy is based on your medical status at the time you apply for the new policy, not when you applied the first time. And be careful when using the term “renewal.” Many agents call it that, but it isn’t. It’s a new policy. There are some multi-year policies that cover you for, say, five years based on your health at the time of application. They’re relatively expensive and many people are not willing to make such a long commitment, but if you’re going to be out of the country for longer than a year, know what you’re getting into when seeking coverage over the long term.

I know of many Canadians emigrating to the U.S. or some other country find these expatriate plans to be just the ticket to tide them over until they qualify for coverage in their adoptive country. But they have limitations. So be sure you know what they don’t cover. If moving to the U.S., where there is no government health insurance for people under 65, unless you are covered by an employer’s plan, insurance is very expensive and often hard to get. Until you get established, expatriate or international insurance offers a reasonable alternative. But get it before you leave.

If you are a student, be aware that more and more colleges in the United States are now requiring foreign students to have adequate health insurance in place, or to buy special insurance designed for that college. Be prepared to pay. Some colleges in Florida charge well over $1,200 annually, and plenty of co-payments and deductibles apply. Private colleges throughout the U.S. almost all require such insurance as a condition of enrollment. You may be best off buying insurance plans designed in Canada specifically for Canadians studying abroad.

Note also that if you are out of your normal province of residence for more than six months (seven in Ontario) you might lose your eligibility for even your basic provincial health coverage, although there are some dispensations for people who have legitimate reasons other than tourism, to be out of the country for extended periods. Though you may have lived in Canada all your life and paid all the taxes along the way, your medicare is not a birthright. If some bureaucrat in your provincial health ministry finds you have been spending more time out of the country than in during a calendar year, you could lose your provincial health insurance eligibility, and it could take you three months of residence back home to regain it. And you would have to verify that three months.

I’ve seen it happen. You’d think these bureaucrats had something better to do.

Do You Need Insurance for Cruises?

Many people taking their first cruise think they are going on an all-inclusive pre-paid vacation. Not so. It’s what you spend on board the ship that makes cruise line investors happy. And for medical services, you pay your way. The ship doctor you visit for a cut thumb or investigation of chest pain is an independent contractor and expects to be paid. And his rates are not cheap. Also, medical care on board any ship is strictly limited to minor emergencies or to keeping you stable until you can be offloaded at the next port. If that is a small island hospital in the Caribbean or the Mediterranean, you will have to pay those hospital bills then and there unless you had the foresight to buy a full service plan designed specifically for Canadians. A plan designed primarily for Americans—which is what most cruise lines sailing out of U.S. ports sell—can be totally wrong for Canadians whose government health insurance pays virtually nothing for out-of-country services. American plans are meant to supplement the private insurance that Americans have, not the government insurance that you carry at home. With cruise line insurance you will also have to arrange your own way home—by commercial carrier or air ambulance—and that is a very expensive, very complicated procedure for you to handle yourself. If you’re in a Caribbean island hospital and you’re heading back to, say, Calgary, air ambulance can run $25,000 or more. If you’re a stretcher case, you would likely have to buy at least six commercial airline seats and even then your choice is slight, as many airlines, including Air Canada, British Airways, and all of the major U.S. Airlines, no longer carry stretcher cases. And unless you have the appropriate medical documentation and have an admission reserved at a hospital at home, an air ambulance might not transport you either. Making such arrangements is no game for amateurs.

All major cruise lines offer some limited supplemental health insurance plans but they are not designed for Canadian travelers and they don’t take into consideration the out-of-country restrictions on emergency medical care that Canadian travelers face. Most cruise line benefit levels are too low—some limited to $10,000 or $20,000. That’s a drop in the bucket, especially if you have been evacuated to an American hospital. Cruise line insurance also limits evacuations to
“the nearest appropriate hospital.” That’s not nearly good enough. You need to have repatriation coverage that guarantees you a return all the way home.

Dealing with a medical emergency on land, within minutes or an hour of a well equipped hospital, is stressful enough. Doing so out at sea, hours away from land, is a formidable job best left to the professionals.

Some cruise lines and travel agents offer supplemental insurance plans provided by commercial insurance companies as add-ons. Those are better choices than the in-house plans offered by cruise lines, but the best choice for Canadian cruisers is a full service travel health insurance plan designed by Canadian insurers for the special needs of Canadian travelers. It’s the same kind you would buy if you were going to Disney World for a week. They offer adequate hospital and medical coverage, arrange for transportation from the most out-of-the way places, and get you back home to a hospital in your area with the least disruption if that is what you need.

And these plans are easily available—from the same people who sell you travel insurance for a land-based trip.

Trip Cancellation Has Its Limits

You prepay your airfare. You prepay your destination resort. And then to make sure your investment is covered, you buy trip interruption of cancellation insurance. Then at the last minute you decide you just don’t feel like going, so you cancel your trip and expect the insurer to recoup your payouts. But it doesn’t work that way.

Trip cancellation coverage is designed to cover the unexpected, the circumstances beyond your control: you or your travel companion becomes ill and can’t travel, a death in your immediate family or that of your companion; one of you is being transferred by your employer, your carrier can’t get you to your destination because of weather or earthquake and you would lose at least 30 percent of your vacation time, you’ve been called to jury duty, the Canadian government has issued a formal written warning against traveling to your destination, the destination to which you are heading is blown away in a hurricane. One major insurer lists 42scenArios under which your trip cancellation benefit would kick in. But not one for simply changing your mind about traveling. Also note that if you do cancel because of illness, and that illness is the result of a medical condition that pre-existed your purchase of cancellation insurance, you likely won’t be covered either. And that goes for your traveling partner too. Sounds bizarre? It happens. That’s why you must peruse trip cancellation insurance very carefully before you count on it to protect your pre-paid trips.

Who Pays The Hospitals and Doctors?

Most insurers will pay hospitals, doctors and other health care providers directly if you notify them promptly. If the amounts are small, you will be expected to pay the provider directly and file for reimbursement with the insurer. But don’t expect them to pay the bills blindly if you haven’t even notified them. And if some of these hospitals or doctors bill you later for extra fees, advise your insurer and let them handle it. Don’t be in a hurry to send your cheque. American hospitals are used to waiting and they usually settle for far less than they have billed. They also make a lot of mistakes.

There are many horror stories in the media about American hospitals demanding payment or credit card guarantees before treating your emergencies, and most are untrue. Such intimidation may be applied in some other countries, but wherever you are, notify your assistance company if you think you need hospi9tal services and let them refer you, if there is time. If not, go to the nearest hospital and have a companion, or the hospital itself, call your assistance service immediately. Some policies require you to call within a certain time, eg 24 hours. American hospitals, by law, must treat anyone who comes to their emergency room with a legitimate emergency whether they are insured or not. Notify your emergency assistance, and they will deal with payment issues. You won’t be held hostage and required to sign over the deed to your house.

How Much Will Insurers Pay?

Many policies emphasize that they provide $1 million, up to $5 million or even “unlimited” coverage. But that doesn’t mean you are getting a blank cheque to spend on health services and you should not count on them when comparing plans. All insurers have emergency assistance companies to monitor your care anywhere in the world, to consult with your attending physicians, and to make determinations about if and when it is safe to return you to a hospital at home, or to discharge you and allow you to make your own way home or to continue your vacation. You can be sure that if the emergency assistance medical director feels it is safe for you to be repatriated to a hospital in Canada rather than languish in a hospital bed in the sunbelt at several thousand dollars a day, you will be returned. If you refuse, your coverage for anything related to the medical emergency from that point on will likely be terminated.

US Hospitals Sue Insurers and Canadian Travellers for Underpaying Bills

Nov. 26, 2007

Canadian travellers and their out-of-country health insurers are being sued by American hospitals for underpaying their bills for emergency medical services provided in the United States. According to hospital cost-containment experts, the legal actions could lead to more foreign travellers being required to pay deposits directly to hospitals when treated, or being billed for remaining balances after they return home.

The hospitals, among them Holy Cross in Fort Lauderdale, FL, Palms of Pasadena in St. Petersburg, FL, Bay Medical Centre in Panama City, FL, and Edinburg Medical Center in Edinburg, TX, have named Royal & Sun Alliance Insurance Company of Canada and its emergency assistance and cost-containment representative Global Excel Management, based in Quebec, as defendants in actions brought to the Ontario Superior Court of Justice. The initial claims total well over $1 million US, but could soar to many multiples of that if the actions grow to class-action status in the US courts.

These and other hospitals contend that cost-containment companies representing foreign insurers routinely underpay and in some cases adopt a “take it or leave it” attitude to bills submitted for treating non-resident patients. Cost-containment companies, whose job it is to negotiate hospital fees for their foreign clients the way domestic insurers negotiate for American insurers, say tough bargaining is necessary as American hospitals routinely overcharge, over-treat, cost-shift, and generally charge whatever traffic will bear to remain profitable.

The truth lies somewhere in between. Though the vast majority of hospitals in the United States are non-profit institutions, they are required to keep a close eye on their bottom line as there is no government bailout if they lose money. And because of the large numbers of uninsured, approximately 5 to 6 per cent of hospital expenses on average are attributable to bad debt or uncollected bills.

All hospitals in the US are required by law to treat medical emergencies regardless of the patient’s ability to pay or whether or not the patient is insured. That does not mean, however, that they can’t ask a foreign patient for credit card approval to pay a deposit, at least until they can verify insurance coverage.

The result, according Dr. Colin Plotkin, a British Columbia-based cost-containment expert who negotiates settlements between US hospitals and foreign insurers, is that more and more Canadian travellers are likely to be faced with demands for up-front payments upon admission to US hospitals—and they are also more likely to be billed for outstanding balances left behind by cost-containment companies that sometimes pay only 15 to 30 per cent of a hospital’s submitted bill.

If you have been required to put up a deposit before treatment or have been balance billed by a US hospital when you thought your medical costs were going to be fully covered, we would like to hear from you. We want to stay on top of this situation.

Watch Out For This Travel Insurance Trap

With the growing popularity of annual multi-trip travel insurance, it’s especially important to know what you’re buying. If not, you could fall into a very expensive trap.

First of all let me make it clear: I think annual multi-trip insurance for people who travel frequently for relatively short periods and don’t always have the time to make laborious travel arrangements is a terrific product. It’s efficient. It’s cheaper than single trip insurance on a per diem basis, and it’s flexible. But understand its limitations. What types of plans are there?

All Canadian travel insurance is based on when you leave your home province, not necessarily when you leave the country. This is so because health care in Canada is a provincial jurisdiction, there are slightly different rules about coverage from province to province, and travel health insurance is a supplement to your provincial plan. This is no big deal for people buying single trip insurance. They usually know exactly when they’re leaving the country, when they’re coming back, and they pay for the number of days they will be out. When they order their insurance, they say “I will be leaving December 13, 2007 and returning April 24, 2008” or some such combination.

But people who buy multi-trip plans buy them for a certain number of days per travel segment, say 7 days or 15 or 30, and they don’t always know the exact dates they will be traveling ahead of time. What that means is that over the course of the year they can travel up to that maximum number of days on as many trips as they wish, the stipulation being that they must return to their home province for at least one day before they start the next segment. Note I said home province, and this is where being out of your home province and being out of the country are not necessarily the same thing.

For example, if you live in Nova Scotia and you stop off to visit family in Ontario for five days before flying to Arizona for a winter vacation, you really only have 25 days of coverage left in the U.S. out of your 30-day policy. And if you get sick in Arizona on the 26th day, you are out of luck and out of coverage. What counts is when you left Nova Scotia, not when you left Canada on the last leg of your trip. And if you think all that’s necessary for you to kick in your next 30-day segment is to go back to Canada, you’re wrong. You have to go back to your home province and stay at least one day there before you leave on your next trip. True, you’re not required to check in or check out with your insurer, when travelling so the insurer may not always be able to tell if you are in your 29th day of coverage or out of cover on your 35th day of travel. But if you do have an emergency, your insurer does have the right to ask you to prove when you left your province so they can verify your coverage. Receipts from motels, gas stations, credit card statements, passport stamps, usually will do.

If you need more days on one of your multi trips, you can call your insurer and ask to be topped up. But that costs extra. And if you have had some medical claim during the initial period of your coverage, that may be considered a pre-existing condition for your top up. So understand this basic principle about travel health insurance: it’s tied to your provincial government insurance. That’s what medicare is all about.

Thinking of Nesting in the South? Now’s The Time—But Be Careful

If you ever thought about buying a vacation home, condo, or golf villa in the US sunbelt for your own personal use or for renting out to friends or club mates, now is the time. But be careful.

While house property values have been soaring in most of Canada, they have been plunging mercilessly across the US, including the vacation sunbelt areas in Florida, Arizona, California, and south Texas. Over the past  year, average appraisal values have dropped at least 10 to 15 per cent in many of these areas, and inventories of unsold properties have piled up. The result—it’s a buyer’s market like no other—in which sellers, realtors, developers, and mortgage companies hurt by the recent sub-prime crisis are at your mercy.

Right now, both coasts in Florida, the central interior, and the panhandle areas are loaded with unsold condos and new subdivision villas, some of which developers started building during the boom years three years ago and are now sitting empty.

But despite the bargains available, you still have to be careful. For the time being, stay away from new development projects that have not yet been completed. Because of the financing crisis, some developers are walking away from projects they started in the boom years, leaving those who made substantial deposits on planned units in the lurch. Stick with up-and-running developments that boast decent occupancy rates and plenty of happy neighbours.

And watch out for variable rate mortgages with premiums that might increase while property values decrease. This market might drop even lower—which shouldn’t bother those in this for the long haul and whose mortgage rates are fixed and not subject to financing fluctuations. If you intend to use the property for the remainder of your retirement years, either on a full-time basis during the winter months or renting it out for part of that time, you will do well over the long haul. But if you’re thinking of flipping for a quick profit, forget it.

If you’re well qualified, another plus is benefitting from mortgage interest rates that are not far off their record lows of a few months ago. As non-US residents, you’ll likely pay a point or so higher than permanent residents (perhaps about 7 per cent), but by historical standards, that’s very attractive too.

Do the math. Tally up the renewed value of the loonie. Look at the existing market. A perfect storm like this doesn’t happen often.

Travellers Warned About Chikungunya, New Mosquito-Borne Hazard

Canadians travelling to the Indian subcontinent and exotic resorts in the Indian Ocean, Sub-Saharan Africa, Southeast Asia and the Philippines should be vigilant about the emergence of a new dengue-like virus, chikungunya. This illness produces a severe and painful arthritis that can last for weeks or months.

According to Canada’s leading tropical and travel medicine expert, Dr. Jay Keystone, chikungunya (no relation to chickens or bird flu) is a mosquito-borne virus that has spread throughout the Seychelles and the Indian subcontinent, and has even recently penetrated northeastern Italy, where more than 150 cases have been reported.

According to the European Centre for Disease Prevention, the spread of chikungunya in Italy, in the area of Ravenna, is the first local transmission of the virus in Europe and could presage a much broader spread of the disease throughout the continent.

Dr. Keystone, professor of medicine at the University of Toronto and staff physician at the Centre for Travel and Tropical Medicine, Toronto General Hospital, spoke about chikungunya at the annual general meeting of the Travel Health Insurance Association of Canada (THIA) on September 18. He said that unlike malaria, which is spread by night-biting mosquitoes, chikungunya is spread by mosquitoes during the day when people are out and active.

Dr. Keystone also told the THIA that malaria continues to be a persistent problem, particularly among Canadian residents returning home after visiting friends and family (VFRs) in countries where malaria is prevalent—especially the Indian subcontinent, Asia, and Africa. He noted that about half the cases of malaria encountered in Canada are brought in by VFRs, and that VFRs now make up about 40 per cent of Canadians who undertake international travel.

He emphasized that “fever in a returned traveller from a country where there is malaria is malaria until proven otherwise.”

Travellers to Dominican Republic Warned of Norovirus and Malaria

Travellers heading to the Dominican Republic this winter need to practice some preventive hygiene while enjoying the sun, sand, food, and drink, integral parts of their one- or two-week vacation package.


According to a DR liaison group set up by Canadian travel insurers, 56 Canadian tourists last year reported requiring treatment for what local health care agencies and government officials said was a norovirus. Because of the transient nature of the ailment, many more who contract norovirus simply don’t report it, but suffer nonetheless.

The norovirus, or Norwalk-like virus, results in a severe stomach flu or gastroenteritis, and can lay up its victims for one to two days with nausea, vomiting, diarrhea, and cramps. The virus, which is not susceptible to treatment by antibiotics, is highly contagious and has been experienced most frequently over the past several years on cruise ships, where thousands of people are kept in close contact with each other.

Norovirus is highly contagious and can be carried in food and beverages, on surfaces such as furniture, elevator buttons, door handles, improperly sanitized cutlery or glasses, as well as by direct contact with other people. The best protection is to wash your hands frequently, avoid handshakes, use hand sanitizers whenever you can, very carefully wash any fruits or vegetables you eat, and be vigilant of the sanitation, food, and beverage services around you. Remember that ice cubes don’t work as sanitizers.

The liaison group set up by the Travel Health Insurance Association of Canada has been working to improve the way insurers and health care agencies exchange information with clinics and doctors in the Dominican Republic, with the aim of standardizing data on the availability and costs of health services for Canadian and other tourists. Part of the problem in coordinating that information, say members of the working group, is that facilities catering to tourists are growing so rapidly throughout the island.

Because of the growing tendency by health clinics and doctors in the DR to require tourists to put up individual payment guarantees (e.g., credit card imprints) before providing services, the Department of Foreign Affairs and International Trade urges all Canadian travellers to have proof of current, adequate travel health insurance on hand for immediate verification.


Another concern to travellers is the persistence of malaria, particularly in La Altagracia province at the easternmost tip of the DR, which encompasses the Punta Cana and Bavaro area resorts.

The Public Health Agency of Canada (PHAC) recommends the malaria prophylaxis vaccination and the use of personal protective measures (e.g., repellants) against mosquito bites for all rural areas of the Dominican Republic and all areas in the province of La Altagracia, including tourist resorts.

While chloroquine is the malaria drug of choice for the Dominican Republic, atovaquone / proguanil (Malarone ®), doxycycline, and mefloquine are as effective as chloroquine and readily available.

PHAC also recommends that travellers planning trips to these areas visit physicians knowledgeable in travel and tropical medicine some six to eight weeks before departure, as vaccination must be started several weeks before travel and continue after a traveller returns home.

CSA Wins Clarification of Six-Month Canadian Snowbird Rule

Six months less a day: that’s the rule of thumb Canadian snowbirds can use in determining how long they are allowed to stay in the U.S. sunbelt during their winter vacations.

The ruling, which is not new but which is a clarification of existing border procedure, was issued to the Canadian Snowbird Association this summer by the U.S. Customs and Border Protection agency. The CSA had long sought official clarification of the so-called six months or 182-day rule which governed how long Canadians could be admitted to the U.S. under the B2 (visitors) visa. That rule has often been misinterpreted, by border agents as well as visitors, because 182 days does not always constitute six months: that depends on which months are being counted. And when purchasing out-of-country insurance, snowbirds have not always been clear exactly how many days they were allowed.

The letter to CSA President Gerald Brissenden, sent by Paul Morris, executive director of admissibility requirements for CBP, said it has been established practice to count ahead six months from the month of admission and subtract one day from the admission date. “For example, a person seeking a six month admission on June 15, 2007, would be granted an admission until December 14, 2007, which equates to 182 days.” If, using this formula, they travel during other months, they may be admitted for 183 days, or 181 days—depending on their months of travel.

“We believe that the current practice is the most efficient and practical means of calculation and is consistent with the intent of the statute,” wrote Morris. He added that clarification of the ruling would be “reinforced” with officers at ports of entry.

In expanding on the ruling, the CSA advised its members that its intent is to allow visitors to stay a maximum of six months per calendar year, and that they could not merely return to Canada for a short stay and return to the U.S. for another six months.

Canadians who stay in the U.S. longer than six months per year might find themselves subject to U.S. tax laws and consequences. They might also be disqualified from coverage by their provincial health insurance plan which requires them to be actual residents in their province for at a minimum of six months (five months in Ontario). If they are found out and disqualified by their province, they must wait at least three months for their coverage to be re-instated.

Still, despite all the furor about border security, the great majority of snowbirds entering the U.S. for their winter vacations are usually passed on through with little formality. Even the B2 visa is for Canadians mostly an artifact: usually just a verbal OK by the border agent and not an actual document.

High US Health Costs Not Likely to Allow Premium Reductions

Though the loonie has hit new 30-year highs against the US greenback this year, don’t expect to see any substantial reductions in out-of-country travel health insurance premiums this coming winter vacation season.

It’s true that currency exchange rates in the past have forced insurers into the unfavourable position of collecting their premiums in cheap Canadian dollars while paying out for medical emergencies in the United States in expensive US dollars. But that equation has changed a lot now that the two currencies are nearing par.

Some skeptics might say the near-parity negates insurers’ justification for charging as much as they do. Not really, as US health costs seem to know no boundaries and continue to rise faster than the cost of living, wage levels, the difference in exchange rates, or anything else measurable by statisticians. In 2006 the cost of health care in America amounted to over $7,000 per capita. In Canada that cost ran to $4,548.

I recently heard about a tourist from the UK who was diagnosed with an irregular heartbeat and treated at Holy Cross Hospital in Fort Lauderdale, Florida (for two nights), ending up with a $17,000 bill. Actually, that’s not an unusual hospital charge for high-tech cardiology. But the situation was made worse when the patient’s insurer found that he neglected to mention some pre-existing conditions when applying for insurance—this spiked his claim, leaving him liable for the whole bundle. (There’s a lesson here for all travellers thinking about ways to shave a few dollars off their insurance premiums.)

Health costs in Europe have also been rising steadily—more than 80 per cent since 1990 among the developed countries making up the Organization for Economic Cooperation and Development. Though per capita health costs in Canada are among the highest in the world, the costs in France, Germany, Norway, Switzerland, and Luxembourg are just as high or higher. So wherever you go, travel insurance is a necessity. It’s not just in the US that health care costs can ruin you.

I have also heard increasing reports of foreign hospitals—particularly in Mexico, and some in the US—demanding deposits or other forms of payment from Canadian patients, even though they are properly insured. Such cases need to be reported and investigated so they can be dealt with by insurers or their representatives. If you know of any such cases, drop me a comment and we can expose what’s going on.

Canadian Senior Travellers Save Provincial Health Treasuries a Bundle

Nearly one third of Canada’s 32 million people are baby boomers, aged 55 to 64, and nearing retirement. Many of them are looking at another 25 to 30 years of active, productive lives. Another 4.3 million (one out of seven) are at least 65, and their numbers can be expected to double in the next 25 years.

That’s the news out of Statistics Canada, and given the good health, improved agility, and longevity of seniors and boomers, it represents a potential tsunami coming into the leisure travel and tourism marketplace.

But it also represents a huge challenge to private health insurers called to cover the health bills when Canadians are stricken by medical emergencies abroad—whether Michigan, Albania, or Thailand. Publicly funded provincial health plans cover only a tiny share of a Canadian’s emergency medical bills while out of the country: a pittance. A $100 or $200 reimbursement on a per diem charge of $5,000 is hardly reimbursement. And before you groan about rapacious American hospitals, understand that a top line hospital in Toronto will do the same thing to foreigners unlucky enough to be stricken in Canada.

Every time a Canadian traveller has a medical emergency abroad, the cost is diverted away from Canada’s GHIP (government health insurance plans) and is financed by private insurers and the fees they collect from their customers—even though these customers have been paying taxes and contributing to the financing of GHIP most of their lives.

I am not aware of any studies that have quantified how much money is spent on emergency medical services rendered to Canadians out of the country, or even how many Canadians are treated abroad each year. But last year, Canadians made almost 23 million overnight trips out of the country—many of those covered by private health insurance. As an example, snowbirds (those 55 and over, travelling for at least 30 consecutive days) made an estimated 673,400 trips out of the country in 2005, according to Statistics Canada, and at least 85 per cent of them bought supplemental health insurance. Two years ago, the Conference Board of Canada valued the health portion of the Canadian single and multi-trip annual travel insurance market at over $360 million. And that’s very conservative; it doesn’t include the coverage provided by group policies such as credit card, employer, and pension plans.

Add to that the growing numbers of Canadians awakening to the possibility of medical tourism—a very different kind of trip which entails travelling abroad for procedures you can’t get in a reasonable time at home. While not covered by standard travel insurance, there are specialized private health insurance plans that may cover certain out-of-country treatments.

Provincial health ministries and finance ministers ought to be grateful that as many Canadians travel abroad as they do—especially seniors, who normally account for almost 45 per cent of the total health care spending in Canada.

Media Reports Dead Wrong About Travel Insurance

Earlier this year, newspapers in the CanWest chain carried a story headlined “Travel Insurance is a Waste.” The story was also picked up by radio stations across the country. The underlying claim was that travel insurance only duplicates the coverage most people have through other insurance (e.g., homeowners or medical), so in most cases, it is redundant.

What the CanWest and radio stories did not reveal, however, was that the original report appeared in an American newspaper. It was based on a magazine survey of American consumers and the use of private health insurance in the United States. The data, when applied to Canadians (whose health insurance does not cover them out of the country) couldn’t be more wrong, and it couldn’t be a more damaging piece of advice for the millions of Canadians who travel to foreign countries each year.

Carrying the story in Canada without even checking its applicability for Canadian readers was an irresponsible piece of journalism. Let’s hope Canadian travellers saw through it and used their better judgment. In fact, all provincial and federal governments strongly urge Canadians to buy private travel health insurance when they leave the country.

The point is that provincial health insurance covers such a tiny portion of out-of-country medical services (maybe 10 per cent) that it is almost irrelevant. Canadians travelling out of the country, therefore, are vulnerable to financial catastrophe if they have a serious medical emergency in the United States, Mexico, Europe, Dominican Republic, Asia—virtually anywhere they travel—if they don’t have the safety net of private supplemental health insurance. In the United States, where most people have only private health insurance, many of their plans provide for out-of-area (and out-of-country) emergency medical coverage. (Although most will not fly a patient back home by air ambulance, and many will require the traveller to pay any medical bills up front and seek reimbursement once home.) Consequently, travel health insurance is not considered as high a priority by Americans as it is for Canadians.

Among Canadian snowbirds, some of whom spend almost half of their lives out of the country, more than 80 per cent buy travel insurance and most would not dare leave the country without it. That’s only common sense, despite the media reports.

How NOT To Buy Travel Insurance

I’ve given you lots of Do’s about buying travel insurance. Now I give you some don’ts.
Don’t buy insurance on price alone. This is not a microwave oven with a given model number and price. Each policy is specific to the applicant. Your age, health profile, travel destination and purpose determines what you need in your policy. There are ways to keep your price down, and shopping around is fine. But first of all determine what you need, then do your shopping. And when comparing prices, which you should do, make sure you’re comparing equals Your neighbour’s plan may cost less, but is he younger? If he healthier or travelling for a shorter period? Does he have deductibles? Is his coverage package different? This is a product like any other and a Chevy will never be a Cadillac.

Don’t wait until the last minute to apply. This is one of the most important pieces of advice I can offer, especially if you are taking prescribed medications or have a medical history that requires you to see your doctor on a regular basis—that usually means most of us. Every insurer offers you time to inspect your policy before you finally commit. Inspect it, paying special attention to Benefits, Exclusions, and Definitions such as Pre-existing Conditions (and how that applies to your special case). If you filed a medical questionnaire by telephone, you’ll need time to verify all of the information was recorded accurately. Ask for a copy. And before you leave you want to have a letter from your insurer confirming that you have coverage on the basis of the information you have provided, for whatever conditions you have specified.

Don’t consider travel insurance a last minute add-on, like the extra jar of sun screen. Do it as early as you can. Snowbirds are old hands at this. Many buy “early bird” insurance several months before their departure to lock in rates before they go up. This is a great money saver. But if your health status changes in any way before your effective coverage date, you must notify your insurer and have your application altered. And that means any change, in symptoms, treatment, diagnosis, alteration of medication or dosage.

Don’t Buy A Policy Without Reading It First. It sounds so basic, But every day people buy insurance without knowing what they’re buying and many times freely admit they never read even the summary of their policy. At least read the summary and check out some of the definitions like pre-existing condition, stable and controlled, exclusions. Would you buy an airline ticket without knowing where your plane is going and when it’s taking off?

Don’t Buy From Someone Who Doesn’t Clearly Explain The Policy To You. Not all people know the travel insurance product they are selling. The best course is to buy from a company or agent that specializes in travel health insurance. If in doubt, buy from an agent who is a member of the Travel Health Insurance Association of Canada. Some will have that logo on their product. If not, ask.

Don’t Buy A Policy That A Salesperson Says Will “Cover Everything”. Such a policy doesn’t exist. The agent doesn’t know what they are selling. Walk Away.

Don’t Lie, Shade the Truth, Omit or Obscure Information That Might Invalidate Your Policy. Just because you get a policy handed to you doesn’t mean you are absolutely covered if the insurer later finds out you didn’t tell the whole truth. And if you are asked to provide medical information, make sure it is accurate and complete. If you’re not sure about something medical, ask your physician for help and make sure your doctor’s medical record supports your answers fully. The great majority of claims declined for medical reasons are justified denials and are caused by inaccurate, incomplete or misinterpreted information provided or omitted by the applicant.