Travel insurance is not a substitute for your provincial medicare, and it’s not designed for the “medical tourist” who wants to avoid wait lists at home. It’s for accidents, unforeseen, unexpected emergencies; for treatment of illnesses and conditions you didn’t have before you left the country. As such it has many limitations. Understand them.
Too many people have unrealistic expectations of out-of-country health insurance and are upset and amazed that claims for what they think are legitimate medical services can sometimes be denied. When they are, they say nobody told them of the exclusions and limitations; they didn’t know they had a pre-existing condition. Why couldn’t they stay and have their bypass done in Florida or Arizona instead of being sent home to join a six-month wait list? Why couldn’t the insurer show some compassion for their “special” case?
The hard facts are these: provincial governments pay a pittance as their share of out of country hospital care. The insurer pays the rest. And if the insurer can get you home by air ambulance for $20,000 rather than pay $250,000 for a bypass, so be it.
Travel insurance is a business, paid for by your premiums. The dollars coming in by premiums have to more than match the dollars going out to foreign hospitals and doctors whose rate are multiples more than services cost at home. If insurers starting paying for unnecessary prolonged stays by patients who prefer to recuperate from their operation in the sunbelt rather than Sudbury in January, or if they covered any and all services for unstable pre-existing conditions, or if they forgave medically underwritten clients who “forgot” to mention that they had obstructive lung disease, the rates you pay for a weekend in Seattle or a winter in Texas would be many times higher than they are.
In the end, you’re paying for your neighbour’s hospitalization in a foreign country. That’s the equation.
To make the balance work, travel insurance has very generous benefits, but also a lot of exclusions and limitations, and it’s up to you to know them when you buy coverage, and especially when you answer medical questions that determine your eligibility for plan classifications. You have to know what a pre-existing condition is; how the insurer defines treatment, or stable; how long your conditions have to be stable before you travel. You have to be honest, complete and accurate when completing your application for insurance. You have to be prepared to have your doctor help you fill out that application if you have any questions about changes in your medications or ongoing tests or referrals to specialists.
Travel insurance has become a very specialized tool, crafted to fit your specific needs. It’s not a “mere” formality you buy and then forget about in case you might need it. It demands your attention.