Are your employees planning to travel outside of the country?
Your group plan’s out-of-country coverage is designed to provide benefits during a medical emergency while you or your dependants are temporarily outside Canada for business, education or vacation. The definition of an out-of-country medical emergency will depend on the specific terms of each group plan. These are some examples of what might be considered a medical emergency:
A sudden, unexpected injury
An acute episode of a medical condition that was not identified or being treated prior to departure from Canada
An unexpected and unforeseen acute episode of a previously identified medical condition that was stable and controlled at the time of departure from Canada
In assessing whether a previously identified medical condition is stable and controlled at the time of departure, the insurer may consider whether, within three months prior to your departure:
You’ve had any new medications or changes in dose
Your doctor has prescribed or recommended any medical, surgical or diagnostic procedures for you
Your medical condition has worsened
Out-of-country coverage generally covers expenses associated with the initial treatment of a medical emergency, such as doctor fees, lab fees and hospital fees. Here are some examples of out-of-country expenses that may not be covered:
Non-emergency care or follow-up care after the initial emergency treatment
Expenses related to pregnancy or delivery after the 34th week of pregnancy or at any time prior to the 34th week if the patient’s Canadian physician considers the pregnancy to be high-risk
Continued medical care following an emergency outside Canada if the patient’s medical condition permits a return to Canada for treatment
How out-of-country coverage differs from travel assistance
Out-of-country coverage is sometimes confused with travel assistance. These are two separate types of coverage. Out-of-country coverage provides benefits for the medical costs associated with a medical emergency, such as doctor, hospital and lab fees.
Meanwhile, your plan’s travel assistance coverage includes such services as 24-hour-a-day, seven-day-a-week access to co-ordinators who can direct you to an appropriate healthcare facility or assist with travel arrangements following a medical emergency. Most plans do not include coverage for trip cancellation, trip interruption or loss or damage of baggage.
In case of medical emergency
If you experience a medical emergency while outside Canada, call the number on your travel assistance card (if your group plan provides travel assistance service). The assistance company will help arrange for appropriate medical care, verify your insurance coverage and provide necessary assistance, such as flight, hotel accommodation and vehicle return.