• Look for a plan that has a toll-free or collect emergency assistance telephone number manned by the insurance carrier itself, not by a third party. It can be very reassuring to have a 24-hour hotline that you can call if you need assistance or wish to verify coverages. Often hospitals will call this line for you and establish any necessary liaison between you and your insurance provider.
• Most companies have early-bird rates if you purchase your insurance well in advance of traveling. For example, major carriers will give you last year's rates before the new season's rate increases if you purchase before mid-August for upcoming winter travel. Rate increases for many years have been in the 10 percent range or higher, so these early-bird savings can be significant.
• Finally, review the policy's cancellation procedures. Many policies are canceled automatically the minute you use them if you don't return immediately to Canada after the treatment. For example, say you went to an emergency room when you thought you might be having a heart attack and it turned out to be indigestion. If you wanted to stay the rest of the winter in the Sunbelt like you had originally planned, you might find your insurance company canceling your policy automatically and leaving you without coverage for the remainder of your stay.
REMAINING IN THE UNITED STATES MORE THAN SIX MONTHS
There are currently no Canadian provinces that allow you to remain covered by provincial medicare plans after absences of longer than six months, except Manitoba, Ontario, and Newfoundland. Ontario and Manitoba allow seven months, and Newfoundland allows eight months of out-of-province travel. This is a real dilemma for those who want to remain in the United States for an extra month or two. Most travel insurance policies will cover you up to a maximum of six months (unless you are from Manitoba, Ontario, or Newfoundland) and will pay only if the provincial plan pays. There are several options for someone in this situation:
• Do nothing and hope the province will not find out that you were out of the province longer than you should have been. In the past this option would have been much less of a gamble, but with hungry provincial medical administrators looking to cut costs, we do not recommend this strategy.
• If you have a group insurance plan with your employer or even with your own corporation, the group insurance can normally be expanded to include coverage on a limited basis in the US. A US citizen or green card holder could possibly get on a group plan through a US employer.
• Find an insurance carrier that will cover you when medicare may not cover you, and for longer than six months at a time, or make a trip back to Canada to get an extended policy, keeping in mind that most travel insurance companies require you to have current valid provincial medicare coverage before they will pay claims. There are some international company policies available through brokers in Canada that offer such a policy, but now that the Ontario Health Insurance Plan allows seven months of travel, it is expected that other carriers will come out with extended coverage. See the next section of this chapter for information on insurance brokers.
• Purchase year-round insurance coverage that will cover you anywhere in the world for both emergency and non-emergency medical services. These high-deductible plans are discussed in the next section of this chapter. If you are in good health, these policies are very reasonably priced and give you access to any medical facility in the world. The benefits of using these year-round plans instead of travel insurance are invaluable to those that need to bypass a sometimes slow or insensitive Canadian medical system (as they cover visits to out-of-province or out-of-country facilities, which you may choose to use if there is a waiting list in the Canadian province or city where you are living). With several Canadian provinces now offering private clinics to supplement their healthcare systems, these year-round policies will give you insurance-paid access to more medical options.
• Become a resident of the United States if you are eligible (see Chapter 7) and enrol in an American health care plan. This will be discussed in the next section.
INSURANCE FOR CANADIANS MOVING TO THE UNITED STATES
There are a great many myths about Canadians finding effective and affordable medical insurance when they take up permanent residence in the United States. I have prepared plans for Canadians, both winter visitors and permanent residents, for a good number of years and have successfully discredited most of these myths. We have been able to develop a variety of alternatives that ensure Canadians receive the best of both medical systems.