Out-of-Country Travel Medical Insurance: Most Common Misinterpretations

Summer 1999 CSANews Issue 32  |  Posted date : Mar 02, 2007.Back to list

It still surprises us when people say that Medipac won't cover their pre-existing condition. The truth is, that we are one of the companies that will, if you are stable for an appropriate period. Our pre-existing period of three months (or 90 days) is probably one of the easiest for which to qualify in the industry, and most of the medical questions we ask are simply to determine what premium rate you will pay.

There is so much misunderstood information swirling around in the travel insurance field that we thought some answers to your most common problems might assist you, both before your purchase and during your trip.

When filling out your application, be sure all of your answers are correct. Check with your doctor if you are not certain of a reply. CHF (congestive heart failure) often referred to as water ON the lungs is one of the most misunderstood questions. If differences are found, Medipac will pro-rate your claim based on your proper premium. This could mean payment of only 50, 60, 80 per cent, etc. of your claim. Some companies will refuse coverage altogether and refund your premium.

A drug change between a brand-name drug and a generic substitute is still a drug change and is a pre-existing condition consideration. Call your insurance company before travelling and ask them for an advance ruling ­ they may waive this change.

Once you buy your insurance, if you have a medical problem or a drug change prior to leaving, you must call your insurance company and tell them. Your pre-existing conditions normally become effective on the day you leave ­ NOT on the day you bought your insurance. A lot of snowbirds with annual or multi-trip plans can get caught by this difference.

When buying "Top-Up" coverage, consider that for most plans the pre-existing conditions clauses applies up to the day your top-up policy starts, NOT the day you actually departed. In many instances, your top-up policy will actually be voided if you have a medical emergency under your underlying base plan during the first part of your trip. Our Superannuate Credit for government plans was designed to eliminate this and is strongly recommended.

If you are hospitalized, almost all plans have penalties if you don't call the emergency hot lines. That call can save you thousands of dollars. Some insurers will pay nothing if you don't call (unless you are totally incapacitated). Medipac will reduce your claim by 25 per cent which, again, is very lenient compared to many policies. There is also a hidden advantage to the call, as sometimes doctors will perform unnecessary tests and operations and a second opinion will usually prevent this predatory practice.

Many diagnostic tests also require insurance company pre-authorization and we have seen many snowbirds have to pay for their own MRIs, blood tests, etc.

If you must pay the bill yourself, immediately send the bill to your insurance company. There are many time limits on bill submissions, especially to the government health plans (GHIPs).

Send in your claim form immediately ­ any insurance company must have a claim form on file BEFORE they pay the bill.

When getting a receipt from a medical provider, request either a UB92 or a Form 1500. A cash register tape or a cash receipt alone is not acceptable to either the insurance company or your Government Health Insurance Plan.

One last thing - if you have a minor health problem, go to a doctor or a clinic rather than to an emergency department. There are new strains of "super bugs" lingering in some hospitals that are resistant to the usual antibiotic treatments.

And, by the way, if you have more questions, you know who to call.