From snowbirds to spring breakers, many Canadian travellers don't know enough about what their insurance covers while they are abroad.
While travel insurance can protect against unexpected illness and injury costs, including hospital stays, physician's fees and wheelchairs, there's misinformation and confusion among travellers as to what their policies cover.
There's a spotlight on the industry because of the so-called "million-dollar baby." One Saskatchewan mother is facing $950,000 in medical bills after an early emergency delivery of her daughter in Hawaii, and the subsequent recovery care she required, The Canadian Press reported. The mother's insurer allegedly declined to pay the claim because of a pre-existing medical condition, even though a physician reportedly said the condition was unrelated.
An insurance claim like this is extremely rare, according to those in the industry, but the conflict highlights the need for consumers to be deeply familiar with both their health and their insurance policy ahead of any travel. They should also be aware of available resources to help resolve disputes.
About 40 per cent of travelling Canadians don't know what kind of travel insurance they've purchased, according to Will McAleer, vice-president of the Travel Health Insurance Association of Canada (THIA), which represents insurers, brokers and other professionals in the field. Young voyagers may be more at risk, since older travellers – particularly snowbirds on longer journeys – tend to be well-educated, Mr. McAleer said.
Mr. McAleer said there are three things all travellers need to understand before they embark: their health, their trip and their policy.
When it comes to that last factor, the key risk most policies won't cover is unstable pre-existing medical conditions – which are any conditions known to a person, for which they've sought treatment from a licensed physician.
Broadly, this means travellers are often on the hook for any emergency expenses that stem from a medical issue diagnosed within three to four months before the trip, or a longer-term condition that has changed. A pre-existing condition could also include a medication change in the six to eight months prior to the person travelling.
Individual policies have different exemptions when it comes to pregnancy and childbirth, participation in extreme sports or exotic activities such as scuba diving, substance abuse and acts of war. Some countries are hard to obtain travel insurance for, and many policies won't cover costs of healing from self-inflicted wounds.
Many Canadians are also unaware what their provincial health-care plan will cover when they travel, according to THIA. Across Canada the short answer is: not much.
The Ontario Health Insurance Plan (OHIP), for example, will pay for just 7 to 9 per cent of a hospitalization abroad, to a maximum of $400 a day. Some provinces cover far less.
THIA's member surveys show that more than 95 per cent of the more than 103,000 claims are paid each year by Canadian insurers. But if a consumer is denied, there is help available to Canadians outside of the courts.
The OmbudService for Life & Health Insurance (OLHI) is a not-for-profit group funded by life and health insurance companies, but provides independent, free dispute resolution services between consumers and insurers. It's also an information resource for people with insurance-related questions for those looking for coverage.
Only about 8 per cent of OLHI disputes involve travel insurance, and 31 per cent of all their complaints are settled in favour of the consumer, said Andrea Zviedris, spokeswoman for OLHI. "In all cases where we've made a final settlement recommendation in favour of the consumer, that recommendation has been accepted by the insurer."
But consumers need to ask more questions ahead of their travel, Ms. Zviedris said. "We're finding a lot of consumers don't understand that they also have a duty to provide information to the insurer and sometimes they might be leaving out critical information when applying. It's not necessarily purposeful, of course."
And the industry wants to educate Canadians on the insurance options available to them when they travel. "We're redeveloping our website to put more out there for consumers," said THIA's Mr. McAleer, saying the association has evolved to be more focused on connecting with consumers.