Out of Country Coverage - 14.02.2014

Many of us push away the winter blahs with trips to warmer climates. Planning for these getaways can be fun, but also a bit stressful when we think about all the preparation necessary before the trip. Packing lists are made and suitcases are pulled from the closet. We remember to pack our camera, sunscreen and favourite flip flips. What else should be on your packing list?

Aside from vital government documentation like a passport, it is easy to forget to pack important documentation such as your group benefits travel insurance information. Out of Country (OOC) coverage isn't normally top of mind, but remembering to pack OOC documentation could mean a world of difference if you have an unforeseen medical emergency while on your trip.

Insurance providers and benefits administrators report that Out of Country travel coverage is often misunderstood and top of the list in terms of frequently asked questions. Most plan sponsors offer travel coverage through their group extended health coverage, but it isn't something plan members carefully consider when planning a trip outside of Canada. 

If you have group benefits coverage with OOC travel coverage, it is helpful to read and understand the insurance policy especially for the limitations and exclusions. Insurance carrier call centers often get questions related to: the number of days of coverage, the definition of a sudden and unexpected emergency, preexisting conditions and coverage eligibility for a plan member during the third trimester of a pregnancy.

OOC coverage often is confused with travel assistance. They are different. OOC coverage provides benefits for medical costs associated with medical emergencies for you and your eligible dependents including the services of a physician, lab and hospital fees. "What is a medical emergency?" is the most frequently asked question. For Out of Country coverage, it depends on what's written in the group benefits plan. Most definitions include wording such as:

  • a sudden and unexpected injury;
  • an unforeseen medical condition or illness that wasn't preexisting or that the member received treatment for prior to leaving Canada (not a chronic condition);
  • an unexpected episode of a known medical condition that was stable and controlled before the member left Canada.

Travel assistance generally includes 24/7 access to travel support representatives. You get access to a coordinator who can recommend a healthcare facility, coordinate out of country payments with the Canadian government, keep your doctor in Canada informed of your progress, as well as make travel arrangements for you when you've experienced a medical emergency while outside of Canada.

Travel holds the possibility of creating wonderful experiences and great memories. An unforeseen medical emergency can be compounded with unnecessary stress if you don't remember to:

Pack your travel insurance documents and carry them in a safe place. Record the toll free number on your travel assistance card as well as your group benefits plan number and certificate number, provincial health insurance number, name, address and phone number of your family physician in Canada.

Have adequate coverage. Aside from your OOC coverage, will you need additional travel insurance? 

  • Generally not covered by OOC are diagnostic services, elective treatments, routine care, baggage insurance, trip cancellation, trip interruption and repatriation of the deceased. 
  • Also, plan members who travel outside of Canada are only covered for a limited number of days as per the Group Benefits plan. A common duration of OOC coverage is sixty days. If you need coverage beyond the specified day limit, additional coverage should be considered.

Understand how to submit a claim and who has the burden of proof. It is the plan member's responsibility to manage his OOC claim and sometimes completing the forms can be confusing. To facilitate the most efficient reimbursement process, insurance carriers generally ask plan members to submit their OOC directly to them. This allows for the carrier to coordinate payment with the provincial governments quickly and easily.

Know what to do if you or an eligible dependent has a medical emergency:

  • call the travel assistance provider number on your card immediately BEFORE seeking medical treatment;
  • if that isn't possible, call as soon as you can so that you avoid issues with coverage of medical costs.

When you're packing your bathing suit and a book to read at the beach, remember to pack your travel insurance documents including the toll free travel assistance number along with your group benefits plan and certificate number. If you have questions about Out of Country coverage or travel assistance, please call your designated insurance provider. 

For information about how we can help optimize your benefits plan, contact us. We're here to help so you can focus on what you do best.