A standard benefit in the healthcare portion of most group benefits plans is the emergency out of country coverage (OCC). The point of OCC is to cover the cost of emergency medical treatment incurred while an employee or their dependants are outside the country. It is in the category of catastrophic coverage.
What about OHIP coverage while outside Canada?
Government health plans, such as Ontario’s OHIP, pay about 5% of costs related to emergency medical expenses that may arise when Ontario residents travel abroad. The $50-per-day for out-patient treatment allowance comes up completely inadequate when the real cost can actually be as much as $3,500 or more, depending on the nature of the emergency. Insurance is vital to offsetting the real cost.
OOC policies define a medical emergency as any unforeseen or sudden illness or bodily injury that requires immediate medical treatment. Often restrictions include pre-existing conditions, injury due to impairment from alcohol or other substances, or injuries from risky activities such as mountain climbing.
For example:
A client travelling in Europe fell ill with meningitis. The OCC plan covered his hospitalization in France until he was stable enough to travel and then covered his flight home. He then continued his recovery in a Canadian hospital. The cost of diagnostic tests, treatment, hospital stay and return trip ran into the tens of thousands of dollars.
Another client travelled to Florida weeks after having had a heart attack. During the second week in Florida, he suffered another. The insurer determined that this was a pre-existing condition and, in fact, that he was not stable enough to have travelled in the first place. The claim was denied
Review travel benefits
Before travelling, it is important that employees and covered dependants review their Travel Benefits to be sure they understand what is covered and how to access it, if necessary. Individuals with existing medical conditions, particularly if there is a recent change to their condition or a change in medication, should consult their physician prior to travelling.
The amount of time an employee or dependant will be out of the country is another consideration. Most ASSOCIUM plans offer either a 60 or 90 day trip duration coverage. If a claim arises after that, the claim will be denied. Individuals may return to Canada prior to the expiry dates and “re-set” the coverage but it is important to understand that these plans are not intended to cover long term absences. If an extended absence is anticipated, it is advisable to purchase additional coverage from another source.
In Ontario, the government is planning to end the OHIP travel coverage altogether, which it says costs the Ontario government $2.8 million to administer and $9 million in claims payments. It is expensive to administer and completely inadequate on its own. This change further underscores the need for travellers to understand the nature of their existing (group) coverage and seek private coverage to fill any gaps.
For more information on your emergency out of country coverage (OCC), please review your benefits booklet or contact your ASSOCIUM service representative.
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