Did you know that if you need to see a doctor in Florida, you could be handed a bill for $1,200? OHIP would pay $50.12 of it — the price of the visit if it had happened in Ontario. An overnight stay in hospital could cost $10,000 in the U.S. OHIP would pay $400 if you were in a cardiac ward or ICU. A good reason to buy travel insurance. But even extra coverage won't help if it's decided what ails you is a 'pre-existing' condition.

Going south this winter?
Here's what Snowbirds need to know about health insurance

Some who love Ontario’s waterfront lifestyle try to extend the boating, golfing and patio season by joining the annual Snowbird migration to the southern United States, Mexico and the West Indies for the winter months.  

If you’re among them, chances are you know it’s important to buy travel health insurance for that trip South. So before you leave, you fill out the questionnaire and buy a package that covers your upcoming vacation.  

Then the stomach pains hit. A visit to the doctor reveals the beginning of gall bladder problems. But you really don’t want to miss that trip to the southern United States. Instead of getting treatment, you and your spouse head out in the RV and make it half-way to your destination when the pain becomes unbearable.  

In hospital, they say you need emergency surgery. The bill comes in for $117,000.   But you’ve got insurance, so everything’s fine, right?  


Canadian Snowbird Association executive director Lawrence Barker tells MyNewWaterfrontHome.com that an association member recounted that very experience not long ago. And because the doctor’s findings weren’t revealed to the insurer — even though the traveller had already purchased a policy — the gall bladder became a non-reported, pre-existing condition.  

That’s fraud.  

The Conference Board of Canada says 85 per cent of Canadians purchase supplemental private health insurance coverage for their trips south. That sounds like a lot, but you might wonder: What’s wrong with the other 15 per cent?  

Buying private health insurance for a trip outside Canada just makes sense. You never know what emergency will befall you and, in the United States especially, medical bills can mount quickly.  

'Private health insurance is essential for any trip outside Canada'

The Snowbird had the right idea about buying insurance because just like all provincial health care plans, OHIP doesn’t do a lot to cover you outside Canada. The mistake was made when they didn’t get back to their insurer with news about the gall bladder.  

“Private health insurance is essential for any trip outside Canada,” says Barker. “Something could happen even on a cross-border shopping trip,” or during a night out in Detroit or Buffalo for a hockey game or a concert. And unless your vacation is covered through your place of employment or through extended benefits after retirement, you need that extra policy.  

Essentially, OHIP will only pay up to what the procedure or service would have cost in this province. That is a fact that becomes particularly critical if you’re travelling in the United States.  

If you need to see a doctor in Florida, you could be handed a bill for $1,200. OHIP would pay $50.12 of it — the price of the visit if it had happened in Ontario. An overnight stay in hospital could cost $10,000 in the U.S. OHIP would pay $400 if you were in a cardiac ward or ICU.  

Keep in mind, too, that OHIP does not pay for ambulance service, transportation costs, prescriptions or out-of-hospital food, accommodation and drugs.  

OHIP is the first to advise that anyone who plans a trip outside the country should purchase supplemental private health insurance. The provincial plan also says that once you have purchased that insurance, make sure you know the rules — including what’s covered and what’s not.  

To help you plan your trip ...

Here are some issues you need to think about when deciding what type of supplemental insurance you’ll need:  

Do all insurers charge the same?  
As for any kind of insurance, rates can vary widely among insurers.  

Take, for example, the case of Jim, a 70-year-old man, and his 65-year-old wife, Mary, who plan to spend five weeks in Florida. Jim suffered a heart attack a few years ago and takes three daily medications to keep his condition under control. To the insurer, Jim has a pre-existing heart condition.  

Naturally, Jim wishes to be covered for this pre-existing condition, just in case something goes wrong while he is away.  

Mary was diagnosed with, and treated for asthma, also a few years ago. But with the two medications she takes, Mary’s condition is under control and she is confident that she won’t require any treatment while she is away.  

Using one of the websites available to compare premiums among five potential insurers, Jim and Mary learn that three companies won’t even insure Jim, for any price. Mary’s coverage will be in the $150 range for their five-week vacation.  

But do they want to take the chance of Jim going South without coverage? What are the alternatives?

Two other companies agree to cover both Jim and Mary, but due to Jim’s history of heart troubles, one will charge $713 for the two of them, while the other will offer coverage for $797. It seems expensive, but at least the couple can travel safe in the knowledge that if something goes wrong, they’ve got the insurance they need.  

Should I get single-trip or annual coverage?  
Travellers should determine whether it is more economical to purchase single-trip insurance or an annual policy, based on their unique circumstances. Generally, if you’re just going for a few days, a single-trip policy is best, while if you plan several trips outside the country during the year, an annual policy would be less expensive.  

Keep this in mind if you like to go cross-border shopping, visit friends or family, or take in the odd entertainment or sports event. But in some cases, a traveller might pay less by purchasing an annual plan that covers them for 30 or 60 days a year, than they would if they bought a single-trip plan. Compare both.  

How much coverage should I pay for?  
Coverage packages usually come in amounts of $1 million, $2 million or $5 million. You might assume the lower-valued package will save you a lot of money, but premiums often vary little between the lowest and the highest amount. For peace of mind, you might want to go with the $5-million coverage.   

Be aware, too, that you might have automatic coverage through your credit card. But it’s likely to be for a limited time only and, if your visit extends longer, you’ll need to arrange additional coverage.  

That raises another issue: if your trip coverage is split between two insurers and you develop a condition during the coverage period of the first, that condition becomes “pre-existing” for the purposes of the second insurer.  

Deductible or non-deductible?  
Standard deductible amounts normally range from $100 to $500. On many policies, you can buy out that deductible portion, reducing your cost to zero, by paying a surcharge that ranges from 10 per cent to 15 per cent of the premium.  

Be careful about the wording of your policy, however. The deductible statement will either say the amount is per claim or per policy. If you’re going to buy a policy with a deductible portion, make sure it’s per policy. Otherwise, you’ll be charged a new deductible amount each time you make a claim.  

Do I need to fill out a questionnaire?  
If you’re age 55 or older, you will likely be required to fill out a medical questionnaire before purchasing your policy. Your responses will determine your rate category, with health issues such as heart, cancer, high blood pressure and your smoker status affecting what you pay.  

Be honest with your answers. You might be tempted to skim the truth to save some money on the premium, but if you make a claim and it’s discovered your responses weren’t accurate, your coverage could be voided. Remember the experience of that Snowbird with the gall bladder problems.  

Normally, a pre-existing condition is determined to be stable if you have not changed medications, dosages or treatments for a certain number of months or years. But each insurer has its own definition for what constitutes a pre-existing condition and a stable condition. Check with the insurer before you sign off on your responses to the questionnaire.  

If you have trouble knowing how to answer a question, consult your doctor.  

What about my kids? Do they need insurance, too?  
Older Canadians aren’t the only ones who need travellers’ health insurance. On the Travel Health Insurance Association (THIA) website, president Martha Turnbull says don’t forget that children travelling with their families and young people travelling on their own also need to be prepared for unexpected emergencies.  

THIA is the national organization that represents travel insurers and brokers, underwriters, re-insurers, emergency assistance and air ambulance companies, as well as allied services in the travel insurance field.

“The risks are too great not to have proper insurance,” says Turnbull. She says children are prone to accidents, fevers, gastric upsets or other sudden illnesses, and a trip to the emergency room can cost thousands of dollars.  

Turnbull points out that travel insurers will not only arrange proper care, they can pay to have holidaying young people sent back home. Without insurance, air ambulances from the southern U.S. back to Canada can cost you $25,000 or more.  

And for young people, not only are premiums inexpensive (less per day than the price of a burger and fries), they’re easy to obtain, often not requiring the filling out of the questionnaire older Canadians face.  

How do I make a claim?  
Each insurer will provide you with a coverage card and a phone number to call in case of a medical emergency. The insurer co-ordinates your treatment and in many cases, the bill will go directly to the insurer.  

If you need to report to a small clinic or doctor’s office, however, that might not be the case. Be prepared to pay the bill yourself, then submit your receipts to the insurer for reimbursement.  

Regardless, keep your insurance card on hand at all times and don’t forget, at the first possible moment, call your insurer, or have someone call on your behalf.  

I’m going away for five months and my drug prescriptions are only renewable for 90 days. What do I do?  
Ontario allows you to obtain a “vacation supply” of your medication of up to 212 days (about seven months).  

Where can I find a supplemental health insurer?  
There are many sources for travel health insurance. You can pick insurance up online, or at your bank, credit card company, insurance broker or automobile club.  

I’ve heard health care is cheap in Mexico. Do I need to buy coverage if that’s my destination?  
According to International Living, the magazine and website for people who want to live, travel and invest abroad, an average visit to the doctor — even a specialist — will be about $25 U.S. An overnight stay in a private hospital room could run $35. And in major Mexican cities, you can get high-quality care for serious medical emergencies.  

But what about getting there? You’ll either be driving — or flying — across the U.S. Check with your insurer. They might sell endorsements that provide coverage for the in-transit portion of your trip only.

But be aware, if you get there and need evacuation back home, how will you pay? If you’re really ill, airlines can deny you access for the trip home — even if you think you can “buck up” for the long flight.   Supplementary insurance can still be your best bet.  

How can I compare rates?  
On the Internet, you can visit www.travelinsurancequotes.ca  

Will my OHIP coverage run out if I’m away too long?  
As long as your primary place of residence remains in Ontario, you can travel outside the country for a total of 212 days in any 12-month period. Exceptions that allow longer stays are if you are studying, working or performing charitable work outside the country, but that must be approved prior to your departure.  

MyNewWaterfrontHome.com — October 2010