Top-Up Insurance

Spring 2016 CSANews Issue 98  |   Posted date : Jul 15, 2016.Back to list

Bird talk - Le Jaseur
As a result of a recent medical trauma, I have discovered a disturbing aspect of the use of top-up insurance. In the event of a medical incident occurring late on the last day of primary insurance, it will probably not be covered by the primary insurer if treatment is not sought until the next day. On the other hand, Medipac insurance will not cover the incident based upon the fact that it occurred before midnight on the last day prior to the top-up period. In my case, the situation was resolved favourably as it was minor and actually occurred after midnight, but I would like to hear your comments on this issue. What would happen, for example, in the event of a major automobile accident that occurred at 11:30 p.m.

Chris H.
Ottawa, ON

Response:
Ed.: A great question! So let’s read the Medipac policy

“This policy covers Reasonable and Customary Charges incurred by You outside Your province or territory of principal residence; that result from a Medical Emergency occurring during the period of coverage (as explained below); and that You incur for Medically Necessary Medical Treatment.

Your insurance begins at 12:01 a.m. on Your Effective Date of Insurance and ends on the earlier of: (a) 11:59 p.m. on the scheduled return date set out in Your Application for insurance; (b) the date You return to Canada for any medical reason. Once treatment ends You may apply to Medipac Assist to have Your policy reinstated.”

This clearly states that the medical emergency must “occur” during your policy coverage period for expenses to qualify. So, in your example, the accident at 11:30 p.m. would be the responsibility of the primary insurer. If your primary insurer refuses coverage in this situation, Medipac would undoubtedly pay your claim and seek restitution from the offenders. This has actually happened to Medipac several times and is very unfair to policyholders; the insurers do always pay us back…eventually.
Just as an aside. What happens at exactly 12:00 midnight? Since most policies are written in this manner, I would suggest that the bills be split evenly between the two insurers.

Back to list | More articles