Tired of the snow? Time to get away?

Emergency travel medical insurance is included in most employer-sponsored employee benefit plans.  Eligible employees and their dependents would be afforded this coverage as long as they were insured under the Extended Health Care benefit.  Coverage is provided for medical emergencies while travelling outside an employee’s home province for a specified duration of time, as indicated in the insurance contract; usually anywhere from 60 to 180 days per trip. Coverage under the provincial medical plan is required to be maintained in order for this Emergency Travel benefit to be in effect.

It is important to note that this coverage is for emergency medical treatment only.  An emergency is usually defined as a sudden, unexpected injury or acute episode of disease demanding immediate medical attention that could not have been reasonably anticipated based on the insured’s prior medical condition.  Some insurance companies will include further policy provisions with regard to a stability period, whereby any pre-existing condition must be considered ‘stable’ for a stated period of time prior to travel; anywhere from 90 to 180 days.  Employees should review the terms of the Emergency Medical Travel benefit in their benefit booklets for clarification.   As well, this benefit will not provide for coverage of regular or ongoing medical treatment of a medical condition.

It is important for employees to understand that if they have been diagnosed with any type of illness or disease, they should discuss their travel plans with their doctor to explicitly confirm that they are medically cleared for travel and any recent changes in health, change in medication, or treatment of an existing condition should be discussed.  It would be recommended that the doctor document the pre-travel visit and their clearance for travel in your medical file.

Emergency Services covered under this benefit typically include:

  • Services and supplies while in hospital
  • Outpatient and physician services
  • Ground ambulance service to the nearest hospital
  • Transportation to the employee’s home province for medical treatment, as appropriate

Every insurer uses a global travel assistance provider that co-ordinates care and provides concierge services in the case of an emergency.  They can:

  • Refer the insured to physicians, pharmacists and medical facilities
  • Confirm the coverage and benefits
  • Facilitate payments to a hospital or medical provider whenever possible
  • Monitor the medical situation if an employee or one of their family members is hospitalized

Additional support services may be provided for the employee and/or family members in the event of a medical emergency.  It is important to check these details within your plan’s booklet, and these services may include:

  • Hotel accommodation and meals if the return trip is delayed by a medical emergency
  • Replacement transportation tickets if the original ticket is unusable due to an emergency
  • Return of remains in the event of death
  • Return of personal or rental vehicles

It is a good idea to remind your employees of how this coverage works.   Most importantly, it is recommended that you advise employees that while travelling at any time, they should carry their emergency travel medical card with them.  If an employee does not have a card, they can be ordered from the insurance carrier and in many cases printed off the insurer’s website, or they are often available on the insurance carrier’s app.

In the event of a medical emergency while travelling, the insured should contact the emergency assistance number (as indicated on their benefit card) immediately or as soon as they are able; alternatively have someone they are travelling with do so on their behalf.  The travel assistance provider will be able to guide the insured through any concerns they may have, as well as confirm with hospitals or other medical professionals of the coverage available to avoid any delays in treatment. If they are admitted to hospital, the travel assistance provider will discuss treatment and arrange for payment with the hospital directly.  In some instances, the travel assistance provider may also recommend transfer to a different medical facility based on the circumstances.

However, employee’s can expect that if they see a doctor for minor treatment, they may have to pay for services up-front and submit the receipt for reimbursement when they return home.

There are many instances whereby someone may not be afforded or eligible for an employer-sponsored Extended Health Care benefit, including Emergency Travel Medical insurance; such as, over-age dependents, elderly parents, travel duration exceeding stated limit in contract, and contract lifetime maximum  being reached.  If additional insurance is necessary, ZLC Financial can help to arrange the purchase of coverage as needed.  When looking to purchase additional insurance, some provisions to consider are:

  • Pre-existing condition coverage – as long as individuals meet the requirements for stability of any medical conditions, they may purchase coverage.
  • Individuals over age 60 – they are required to answer a medical questionnaire.  As we have seen on news reports, if they fail to answer the questionnaire with 100% accuracy due to something like a childhood illness, claims end up being declined, sometimes leaving them with medical bills in the hundreds of thousands of dollars.  Coverage is available that will cover claims in the event there was an issue with the medical questionnaire, with a $10,000 deductible over and above the regular policy deductible, rather than leaving the entire claim to be paid by the claimant.
  • Deductibles – these can keep the overall cost of the insurance low, but individuals need to keep in mind that the deductible will be an out-of-pocket expense for them.
  • Plan maximums – these can start as low as $250,000, but medical costs can quickly add up.  It’s important to consider a reasonable maximum.

Each organization’s needs are unique and warrant a customized solution.  We would be pleased to discuss your specific situation with you to identify the best strategy with respect to your employee benefits program.  Should you have any questions on the above, please don’t hesitate to contact me or a member of our  team.

At ZLC Financial we are not the world’s biggest benefits advisor but we are large enough to have the best people, resources and clients in Western Canada.  Our goal is to work with you to find a better way for your employee benefits plan.  We provide this value to you by leveraging one of the most skilled benefits teams in the city – over 200 years of experience within our team of 11 employee benefits specialists.  We have been working with businesses ranging from 4 to over 7,000 employees for the past 30 years.

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