Travel insurance is insurance that is intended to cover medical expenses, financial default of travel suppliers, and other losses incurred while travelling, either within one’s own country, or internationally. Temporary travel insurance can usually be arranged at the time of the booking of a trip to cover exactly the duration of that trip, or a “multi-trip” policy can cover an unlimited number of trips within a set time frame. Coverage varies, and can be purchased to include higher risk items such as “winter sports”. Usually, travel insurance can also provide helpful services, often 24 hours a day, 7 days a week.
“A journey is like marriage. The certain way to be wrong is to think you control it.” (John Steinbeck)
The most common risks that are covered by travel insurance are:
- Medical emergency (accident or sickness)
- Emergency evacuation
- Repatriation of remains
- Return of a minor
- Trip cancellation
- Trip interruption
- Accidental death, injury or disablement benefit
- Overseas funeral expenses
- Lost, stolen or damaged baggage, personal effects or travel documents
- Delayed baggage (and emergency replacement of essential items)
- Flight connection was missed due to airline schedule
- Travel delays due to weather
Some travel policies will also provide cover for additional costs, although these vary widely between providers. In addition, often separate insurance can be purchased for specific costs such as:
- Pre-existing conditions (e.g. asthma, diabetes)
- Sports with an element of risk (e.g. skiing, scuba diving)
- Travel to high risk countries (e.g. due to war, natural disasters or acts of terrorism)
- 3rd party supplier insolvency (e.g. the hotel or airline to which you made non-refundable pre-payments has gone into administration)
- Pre-existing medical conditions
- War or terrorism – but some plans may cover this risk, and some do cover for acts of terrorism
- Injury or illness caused by alcohol or drug use
Usually, the insurers cover pregnancy related expenses, if the travel occurs within the first trimester. After that, insurance coverage varies from insurer to insurer.
When you travel, remember that a foreign country is not designed to make you comfortable. It is designed to make its own people comfortable.” (Clifton Fadiman)
Medical Emergency Travel Insurance
Emergency health services are those given in connection with an acute, unexpected condition, illness, disease or injury that arises outside Canada and requires immediate treatment. Travel medical insurance is designed to reimburse you for emergency hospital/medical expenses incurred, over and above those the Ontario Health Insurance Plan (OHIP) will cover, while travelling outside of Canada.
While supplementary travel medical insurance policies vary greatly from insurance company to insurance company, most generally include coverage for the following emergency health care services:
- hospital room accommodation,
- incidental expenses related to your hospital stay,
- outpatient services,
- licensed physician’s fees,
- prescriptions and/or medical, therapeutic or diagnostic treatments prescribed by a licensed physician,
- medical appliances (e.g., splints, casts, crutches, canes, slings, trusses, walkers and the temporary rental of a wheelchair) when prescribed by a licensed physician,
- emergency dental care, and
- ambulance and air ambulance medical evacuation services.
Without supplementary travel medical insurance, you could be exposed to considerable financial obligations
Illness can strike and accidents can happen, even during a very short business or recreational trip. Any time you leave Canada without supplementary travel medical insurance – even just for a few hours – you’re taking a risk. While your Ontario health card entitles you to certain out-of-country emergency health care services when outside Canada, this coverage is limited.
If you are injured or become ill while travelling outside Canada and do not have supplementary travel medical insurance, you will be responsible for paying for those emergency health care services that are not otherwise covered by OHIP. The same rule applies to your young family members should they need out-of-country medical care on a vacation or school trip. It is, therefore, wise to consider purchasing supplementary travel medical insurance coverage before you leave.
OHIP for Ontarians Travelling Outside Canada
If you are a resident of Ontario and you are insured under OHIP, you are entitled to very limited funding for a certain range of medical services when you are travelling outside of Canada. For this reason, you are strongly advised to purchase additional health insurance every time you leave Canada and ensure that the supplementary insurance you have purchased provides adequate coverage.
While you are out of Canada OHIP covers
OHIP will pay very limited amounts for physician services and hospital/health facility services, and only if certain conditions are satisfied. Under Ontario’s Health Insurance Act and regulations, physician services are subject to different conditions than hospital services. OHIP will pay only for insured, emergency out-of-country health services that are rendered to an insured person. To qualify as an ’emergency’ there are a number of criteria that must be satisfied. These criteria are set by regulation and include the conditions listed below that must be met:
- the treatment must be medically necessary,
- the treatment must be performed at a licensed hospital or licensed health facility,
- the treatment must be rendered in relation to an illness, disease, condition or injury that: is acute and unexpected, and arose outside of Canada, and requires immediate treatment.
These provisions are intended and designed to provide a very limited amount of funding for the medical treatment of insured residents of Ontario if they incur an unexpected illness, disease, condition or injury while they are outside of Canada. If the illness, disease, condition or injury arises before you leave Canada, or if it is not acute or unexpected, no payment can be made.
OHIP does not cover:
- treatment that is medically unnecessary
- health services that are rendered at a facility that is not a licensed hospital or licensed health facility
- treatment that is generally accepted by the medical profession in Ontario, as being experimental, or for research or for part of a study
- treatment rendered for an illness, disease condition or injury that arose inside Canada
- ambulance services or transportation costs
- other services specifically set out in the regulations as uninsured or otherwise not listed as insured.
How much will OHIP pay?
The amount that OHIP pays is set by regulation. The amount paid for out-of-country health services is very limited and usually will not be sufficient to cover the full cost of the services rendered. OHIP covers only very limited amounts for hospital, health facility and physician services.
- For physician services, OHIP will pay the actual cost billed by the out-of-country physician(s) or the cost of the same physician service(s) in Ontario, whichever is less. Physician services in Ontario are usually rendered at a significantly lower cost than those billed at out-of-country health facilities. Please note that out-of-country health facilities and physicians usually bill separately.
- For outpatient emergency room services, OHIP will pay $50 Canadian (CDN) per day.
- For inpatient services, OHIP will pay $200 CDN per day. If the services are inpatient services rendered in an operating room, coronary care unit, intensive care unit, neonatal or pediatric special care unit, then OHIP will pay at the higher rate of $400 CDN per day for hospital services.
- For outpatient dialysis services, OHIP will pay $210 CDN per day.
The “per day” rates listed above cover all hospital inpatient services including, but not limited to, accommodation, meals, prescription drugs, surgically implanted devices and nursing services.
Note: OHIP does not pay for ambulance services, transportation costs, or out-of-hospital food/accommodation/drugs or prescriptions.
You should obtain additional insurance coverage for your absence from Canada
The Ministry of Health and Long-Term Care of Ontario strongly recommends you, whether you are absent from Canada for a few minutes or for an extended time, to purchase additional health insurance every time you leave Canada to cover any expenses in excess of the limited funding provided by OHIP. OHIP does not insure or pay for all out-of-country medical services. Also, the amount of funding provided by OHIP will not usually cover the full cost of any health services that you do obtain outside of Canada. You should therefore, buy supplementary health insurance from a private insurance company to provide you with additional coverage for your trip. It is also recommended that you understand the terms and conditions of the additional insurance coverage you have purchased and the implications of any pre-existing health conditions on your insurance coverage.