What plan members need to know about out-of-country coverage

Many Canadians travel abroad for vacation, but what about for health reasons?

A March 2015 Fraser Institute report revealed that more than 52,000 Canadians travelled abroad in 2014 to seek medical treatment or diagnostic services. This stat shows a growing desire by Canadians to secure faster service and avoid deteriorating health given “longer than reasonable” wait times (9.8 weeks versus. the 6.5 weeks standard of care preferred by physicians after seeing a specialist).

Canadians are travelling abroad for other reasons, too, including the desire to work with physicians with better medical technologies and outcomes. Many are even referred to these clinics by their provincial public health care systems when they acknowledge a person’s particular situation is beyond local capabilities or capacities.

Read: Non-traditional approaches that get more bang for benefits bucks

These health services are being performed in the United States, Mexico and overseas, sometimes in very inviting climates that have a much warmer, sunnier environment that might promote more relaxed recuperation. This is known as medical tourism.

Several insured options are now available through group benefits advisors and insurance agents that provide protection against the high costs of obtaining this non-emergency, out-of-country (OOC) medical services. These products are becoming more popular as Canadians are recognizing the need for something more and service beyond the scope of their public healthcare system. These products have also become important tools for advisors who recognize the need to design a more comprehensive healthcare offering for their clients. But a new challenge is emerging.

Read: Passport to Health

We’ve got you covered…maybe
Canadians seeking medical treatment abroad are often accompanied by spouses or children who will help them recuperate, post-op. Group benefits advisors are now asking insurers to detail the levels of protection offered to members and their families when they travel abroad to obtain non-emergency treatment. Plan members must pay attention because not all OOC care is guaranteed.

Plan members must be made aware they need to consult their group OOC service providers to confirm their levels of coverage, if any. Many carriers will not cover an individual for emergency OOC care (even if the emergency is not related to the condition being treated) when traveling abroad for the purposes of seeking diagnostic or medical procedures and surgery of any kind. This is the case even when the member’s attending physician in his/her home province recommends travelling abroad.

Members will need to secure their own private emergency medical travel protection, be prepared to disclose the reasons for their travel and consider any possible coverage exclusion that might result from that necessary disclosure.

Read: Containing the costs of travel insurance

The news isn’t all bad. Spouses and dependent children covered under the member’s group emergency OOC plan will more than likely be covered by the group policy—they are not the ones travelling for the purposes of seeking this treatment.

Plan member’s need to ask the right questions before they leave Canada as medical tourists. Taking charge of your own medical outcomes is admirable. Doing so haphazardly and without all the facts is a potential disaster.