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• Choose the highest deductible available from an insurance carrier. Canadians are conditioned to think they must have no out-of-pocket expenses regardless of how small the claim. Since small claims are relatively expensive to process, you'll pay through the nose for a low or no-deductible policy. You'll pocket big savings by sharing a small amount of risk, while limiting your exposure to smaller bills. If an insurer offered you a six-month, maximum $4,750-of-expenses-covered medical policy for $392, you'd think it was outrageous, yet at least one major insurance carrier will offer you a $392 (45 percent) reduction from an $873 premium if you take a $5,000 deductible rather than a $250 deductible. A difference of only $4,750 more in total coverage costs you $392! Other insurance plans provide similar savings if they offer a choice of deductibles.

• Review the "exclusions" clause of your policy very carefully. Many policies will exclude coverage for any prior medical condition or pre-existing condition, as insurance companies like to call them, which means any condition that has been treated by a doctor within the past year (or some other specified time period). If you had a bypass operation several years ago and have an annual checkup by your doctor, any hospital stays that are even remotely related to your heart may not be covered.

• If you have a pre-existing medical condition, look for a policy that will at least provide you with emergency coverage for that illness up to a specified dollar amount. If you are uncertain how your pre-existing condition will be covered, pick up the telephone and call the underwriting department of the company in question and ask to be medically underwritten so that your conditions and the coverage for them will be spelled out in advance, eliminating surprises. Be absolutely clear and honest about any conditions or treatment you have had or are currently having, and do not be tempted not to mention a pre-existing condition when signing up for travel insurance. A five-minute telephone call may save you thousands of dollars. Be very leery of insurance companies that don't complete some form of medical underwriting using detailed questioning in their applications. These companies are the most likely to decline claims related to pre-existing conditions, as they try to do their underwriting after a claim is made. On the surface, such plans may appear to be easy to qualify for, but you may be denied coverage later. There is definitely an inverse relation between the difficulty and detail required in the application form and the number of claims paid - the harder it is to get through the detailed application, the more likely your claim will be paid once you are accepted for coverage.

• Talk with friends and other travellers who have made a claim through the insurance carrier you are considering, to see whether they were treated fairly and if their claims were paid on time.

• Don't expect miracles from insurance companies when submitting claims. Most companies will pay only according to the letter of the policy and they have highly structured claims systems to prevent fraud. Some companies pay only after the provincial plans have paid their portion of the claim. Only British Columbia, Ontario, and Quebec allow insurers to bill them directly on your behalf. With payments from Ontario and some other provinces running many months behind, payment from private carriers will, as a consequence, also be slow. The better travel insurance carriers will pay your claims quickly, without waiting for provincial plans to pay up.

• Look for a few of the better travel insurance carriers that have set up claims-paying offices and have negotiated payment schedules with hospitals in the more heavily populated winter visitor areas in the United States. This will often mean much faster claims processing. Instead of you paying the hospital and waiting months for reimbursement, you pay nothing and the carrier pays the hospital directly. This valuable service is worth asking for when shopping for travel insurance.

• Some provinces have reduced the repatriation allowance for Canadians returning to Canada for further medical treatment. It currently costs about $15,000 to fly a patient back to his or her home province from the Sunbelt. Check your policy to see whether you are covered for the portion your provincial plan won't pick up.

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