Joe and Suzanne Lefebvre of Ontario bought a travel health policy in October 2010 specifically for an Alaskan cruise they would take the following May.
On the fourth day of the cruise, Joe, who was 80 at the time, had to be hospitalized in Fairbanks with pneumonia. Complications set in and he spent 15 days in the hospital, after which their insurer arranged to fly the couple to a hospital in London, Ont., near their home.
That was all the insurer would do for them. The company refused his claim because Joe had a heart condition, atrial fibrillation, which he hadn’t disclosed on the insurance application.
In its defence, the insurer said the application had read, “if you are unsure if you have ever had a heart condition, please consult your doctor.”
Joe did have atrial fibrillation, stemming from a blood clot in 2008. The questionnaire in the application he filled out had stated that insurance would be denied for pre-existing conditions that weren’t stable before a trip.
Because his pre-existing condition had been stable for three years at the time of his hospitalization, the Lefebvres had assumed they weren’t required to include it on the application.
Their request for a review led to another refusal. Joe and Suzanne were left to deal with a $107,000 medical bill.
In the world of travel insurance plans, the term “pre-existing conditions” is a very important.
According to an article on SnowbirdAdvisor.ca, every medical condition you have ever had, no matter how trivial, qualifies as a pre-existing medical condition. Any and every physical condition, symptom, illness or disease that you have sought treatment for could turn out to be a pre-existing condition that can absolve an insurer from paying out.
As well, if test results uncovered a new medical issue while applying for insurance, that issue would be considered a pre-existing medical condition and excluded under your policy.
However, there is a good part to this. Even if you have pre-existing medical conditions, you can still be covered if those conditions are stable and have been controlled for a minimum period of time when you apply for your policy. These periods are usually 90, 180 or 365 days, depending on the policy, your conditions and your age at the time you apply.
The assumption is that any changes to a pre-existing medical condition during that minimum period indicates that the condition is no longer stable.
As well, changes also include any new medication or even dosage changes to an existing medication used to treat a pre-existing medical condition.
Finally, how “stable” and “pre-existing condition” are defined and what exactly they mean can differ greatly from policy to policy.
The moral of the story? Know your medical history. Don’t be hasty in filling out the forms. Talk to your doctor about any pre-existing conditions. Get a list of prescriptions and procedures with dates. It’s easy enough to forget something that could be crucial in the event you have to collect on your policy.
Snowbirds should also remember that travel medical insurance exists to cover those procedures that are of an emergency nature. It does not cover elective or non-medically necessary procedures, though it might cover your travel expenses if you need to cancel your trip or come home early.
To be eligible for travel medical insurance you will generally need to:
- be covered by your provincial government health care plan for your entire trip
- apply for your insurance from within Canada before you leave for your trip
- purchase insurance for your entire trip
- not make any misrepresentations on your insurance application
Travel medical insurance providers aim to recover some of your medical expenses from your provincial government, so if you aren’t covered by your provincial health care plan, your snowbird medical insurance may be invalid or limited.
Your insurance coverage usually begins on the effective date, which simply means the date on which you actually depart on your journey to your winter nest.
At the other end of your trip is the expiry date. For single trip policies (you’re going there and will pretty much remain there until you return to Canada), your coverage will expire on the return date as you indicated on your application. For multi-trip policies (you’ll be back and forth a bit), your coverage expires on the last day of the policy term, usually 365 days after the effective date.
If you can’t return to Canada on your stated return date because of flight cancellations, weather or other specified reasons such as a medical emergency, your policy should extend the expiry date of your coverage from 24 to 72 hours. But again, read the fine print.
It’s the end of your trip and you want to stay just a little bit longer? Your policy should allow you to extend your coverage for an additional fee, subject to there being no change in your health or medication.
If you have to cancel your winter travel plans at some point after you purchase your travel medical insurance and before your departure date, your policy should have a provision that allows you to cancel it and receive a full refund, possibly minus an administration fee.