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With changes this year to Ontarians’ out-of-country health insurance coverage – and some public cases of tourists being denied coverage after getting sick abroad – travellers from Ontario could be wondering whether they have proper travel medical coverage.

Insurance providers are not surprisingly putting an emphasis on consumers, saying people routinely don’t report all their health considerations when filling out the forms. But consumer advocates say travel insurance can be confusing for even the most fastidious buyer; and that the scope of what counts as a pre-existing condition – something insurers can use as a basis of denying travellers a payout – is often significantly broader than customers realize.

“The pre-existing condition doesn’t have to be [directly related to] the event that takes place when you’re on vacation,” says Anna Szczurko, a partner with Siskinds law firm who works with people whose claims have been denied. “It could be something as simple as, you went to the doctor and found out your iron deficiency isn’t a problem any more. Would I think to put that down on my policy? Most people wouldn’t.”

As of Jan. 1, Ontario’s public health-care plan scrapped a program that paid up to $400 each day for high-level inpatient care for Ontarians abroad and $50 daily for emergency outpatient and doctor services, a change that pundits warn will likely lead to increased costs for private insurance. Health Minister Christine Elliott announced the cancellation last May, saying the province was spending $2.8-million on administration costs for $9-million in claims payouts each year, and that the coverage was a pittance compared with the total bills Canadians were facing abroad.

Meanwhile, stories of Canadians being denied reimbursement through their private travel coverage have peppered the news cycle. A man from Kitchener, Ont., who found out he had a brain tumour in Thailand in December was initially denied coverage after a hospital visit for the flu was flagged as a pre-existing condition. A Mississauga man who had a heart attack in Las Vegas last fall was billed the equivalent of $877,207 after his insurance company determined he wasn’t medically stable in the months leading up to his trip because of his use of home oxygen.

Will McAleer, executive director and past president of the Travel Health Insurance Association of Canada (THIA), said both sides have a responsibility to deal with each other fairly and honestly. In 2017, his organization released a “bill of rights and responsibilities” in an attempt to better educate consumers; the document says it’s up to travellers to provide accurate information and notify their insurer immediately if an emergency arises.

He says the organization is also working to ensure its members live up to their end of the rights and responsibilities, which includes ensuring “fair and prompt claims handling” and providing a process for consumers to escalate and appeal decisions with which they don’t agree.

Jeff Simpson, a THIA member from Calgary, says the organization has been pushing the industry to simplify and standardize terms so they are easier for customers to decipher. “Travel insurance is one of the last insurance markets that has very diverse levels of coverage, and the understanding of some of the key terms is quite different from company to company,” said Mr. Simpson, president of Simpson Group Insurance Services Inc.

Pre-existing conditions worth noting on a travel insurance application include any long-term ailments, such as heart disease or diabetes, or any recent doctor visits or changes to medication that fall within a policy’s “stability period,” a predetermined duration before the trip that is often 90 or 180 days.

Ms. Szczurko suggests applicants note minor ailments as well, such as cough, flus or headaches. She advises clients to buy a policy in which the underwriting is done ahead of time – so they know for sure they are covered.

Mr. McAleer advises consumers to be familiar with their coverage, and make sure they have insurance every time they leave Canada. He says provincial health coverage is unlikely to cover ever-rising costs of medical care abroad, a point driven home by the recent changes in Ontario.

Those changes may increase the cost of private coverage, he adds, but we likely won’t see rate hikes until summer, after the snowbird season has ended and insurers take stock of how much the changes affected them. He has seen reports that rates could rise as much as 7.5 per cent, but thinks that much of a hike is unlikely.

Another change some Canadians may have noticed is a request for more medical information up front – and higher travel insurance premiums – as they age. While a more complicated questionnaire starting at about the age of 55 has been a longstanding practice in the industry, some insurance companies are also making allowances on risk that they might not have before in order to cater to an aging travelling population, Mr. Simpson said.

One example is CAA Insurance’s new rider, released last summer, that allows customers to pay extra to have their pre-existing condition stability period reduced to seven days. Elliott Silverstein, director of government relations for CAA Insurance, said a non-smoking, 60-year-old client with diabetes or high blood pressure would pay from $45 to $60 more for a week-long trip.

“It’s something travellers had been looking for,” he added. “This is not the time you hold back details to save a few dollars. … If you are dealing with a pre-existing condition, you still have options.”

Editor’s note: An earlier version of this story said that the THIA's bill of rights and responsibilities came out last year. It was released in 2017.

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