One of the benefits of retirement for
those who have planned prudently is the freedom and ability to travel
extensively. As with most worthwhile activities, travel offers both
benefits and risks. The primary risk is one known to every traveler,
but is one which is too often neglected or overlooked - the risk of
being stricken with a serous illness in another country.
we have seen a growing political debate in Canada over the state of
public health care and its future direction, most people make their
plans for foreign travel assuming that their public health insurance is
completely "portable". Others may obtain supplemental private health
insurance, without carefully reading and understanding the coverages
and the exclusions from coverage in a particular insurance contract.
discussion of this subject must begin with an understanding that (using
Ontario as the example) OHIP does not offer adequate protection for the
cost of medical services, particularly in the United States.
important precondition to any OHIP coverage for medical services
rendered abroad is that one must satisfy the 183 day residency
requirement. That is, a person must be physically present in Ontario
for at least 183 days in each year, and have his or her primary
residence in Ontario, in order to maintain eligibility to access OHIP
coverage. This requirement is subject to a grace period of 30 days, to
allow for unplanned necessary time outside of Ontario for those who
have consumed all or nearly all of the 183 day allowance.
OHIP coverages which are available for medical treatment outside
Canada, and the limits or caps on reimbursement, are set out in the
regulations passed under the Health Insurance Act. Those regulations
may be summarized as follows:
- Coverage for
either hospital or out-patient treatment is available only for
emergencies. That is, illnesses which are acute and unexpected. If the
illness is not in the nature of an emergency, or if it pre-dated the
departure from Canada, it is not covered.
- A wide range of
services are excluded from coverage, those being various therapies,
drug treatment outside of a hospital, and laboratory services.
the treatment is covered, and the "emergency" test is met, OHIP will
reimburse in accordance with certain limits. For hospital care,
reimbursement is limited to a maximum of $200 per day, or $400 per day
for certain types of care such as coronary or intensive care. The
limits on reimbursement often represent a small fraction of the daily
rates charged in American hospitals, which also charge for many
treatments and services beyond the daily bed rate.
respect to prescription drugs, there is no coverage for drugs purchased
outside Ontario by seniors covered by the Ontario Drug Benefits Plan.
It should be noted however that since early last year, seniors about to
embark on a lengthy trip can purchase a supplementary 100 day supply of
a medication before departing Ontario.
therefore, every prudent traveler should purchase supplementary health
insurance, so as to avoid the risk of being crippled financially by the
need for foreign medical care. It is by no means unheard of for an
emergency stay in an American hospital of something in the order of one
week to run up costs of $20,000 to $25,000, of which perhaps one-tenth
might be covered by OHIP.
securing private insurance can represent a critical financial decision,
the purchase is often made without any scrutiny of the specific
coverages offered, and more importantly, the stated exclusions from the
coverages. The same consumer who will engage in extensive research and
comparison shopping for an appliance or an automobile, will typically
purchase medical insurance without having the faintest idea what
coverages and exclusions the policy contains.
with the purchase of any important service, it is critical that the
individual read the policy, ask questions about provisions which are
not clear, and comparison shop. The adage that you get what you pay for
is probably never truer than in the purchase of private health
insurance. Because of the magnitude of the risk, the focus should be on
quality, and not on price.
It is also critical
that the application for coverage be completed with care. The insurer
treats the statements made on an application as representations it
relies upon to issue the policy. For example, if one were to fail to
truthfully answer questions on an application concerning a pre-existing
cardiac condition, a subsequent claim for coverage for emergency
cardiac care might well be denied.
don't leave home without supplementary health coverage, and make sure
that what you purchase is suited to your particular health needs.