Does that mean I have to stay him in the snow?
Not entirely. But you have to look at your options carefully. Here’s the way it works. If you recently had a heart bypass, most insurers will require at least one year of “stability” before they will cover you, which does not mean your doctor saying it’s OK for you to travel, or you testifying that you feel great and you walk three miles a day. It means meeting certain criteria like having no change of medication (type or dosage), no symptoms, no medical intervention other than just monitoring, nothing on that chart that suggests the need for further investigation. Some may give you a shorter stability period but will cover only for other, unrelated conditions, not your heart—or anything related to it—which covers a lot of territory.

I also suggested to a couple who have a winter home in Arizona that they might want to look at air ambulance plans as an option—but they must realize their limitations. They must be prepared to shoulder a good deal of cost of there is a heart-related emergency.

Air ambulance plans bought on a six-month or one-year enrollment basis are quite cheap and they do guarantee to get you to a hospital at home—but they too have pre-existing conditions limitations and they don’t operate like taxi cabs. You can’t just call them and say, I’m not feeling too well, will you fly me home?

They operate mostly on a hospital-to-hospital basis, so your emergency has to be serious enough for you to be hospitalized first and then a determination is made if you really need the air ambulance to get you home. If not, and you can do it on your own, or with trained assistance, that’s the way it will be done. And you will have to pay the initial costs of your hospital admission up to that point. So it’s not the same as insurance, but thousands of travelers use such services and are very satisfied with them because they do preclude the need for you to endure a long confinement if instead, once you are stabilized, you can be flown home. That’s a big advantage.

There are always options to almost any situation. But sometimes you just have to be patient.

Answer: Two recent visitors to this site, Noel and Bob, asked essentially the same question and they were wise in doing so because many of these so called extended plans are not designed for repeated or long term out-of-country travel. What’s worse, is that they don’t clearly define the limitations of their coverage and they can leave the snowbird retiree high and dry should they encounter a serious medical emergency abroad.

In Noel’s case, his employee benefits insurance administrator at Manulife couldn’t give him a satisfactory answer about the extent of his travel insurance benefits: nothing that satisfied him anyway. The administrator just wasn’t a specialist in travel insurance. I’ve heard the same complaint from others. He would have liked to use the plan as a basis for his coverage, topping it up with supplementary single trip insurance as that might have saved him money. He opted instead for buying full service travel insurance created for snowbirds from Day One and left his employee benefits plan for another day. A wise choice. Many employee and pension plans have quite a few limitations, but even if they were extensive enough, if the administrator can’t give you a clearly written contract telling you what is or is not covered, Stay Away.

With Bob, who was a retired provincial civil servant, it was only after several extended trips that he realized his plan covered him for only 40 consecutive days per trip. He didn’t know that. Again, there was no clear detailed explanation of benefits. He too, has now gone to the full-service travel insurance marketplace for coverage from Day One.

That’s not to say you can’t get good “top up” insurance for retiree or civil service pension plans. You can. Some of them are specifically crafted to tie in with these plans so there are no gaps. But you have to be careful. Not all plans interlock. Some do not allow “top ups.” Make sure both your primary and your secondary insurers know your intention and can give you written assurance of the extent of your coverage—nothing less than $1 million, assurance of repatriation to a hospital at home if medically necessary, 24/7 contact numbers, and direct payment to the hospitals and doctors treating you abroad.

From Ross

Answer: Yes, and it is available from several Canadian travel insurers. Ask for it if you’re sure you won’t be travelling to the U.S. For example, for short-term coverage for Canadians, the Non-USA travel insurance Plan (worldwide excluding USA) by T.I.C. (Travel Insurance Coordinators) costs $1.15 per day for an individual up to 30 years of age, whereas the USA plan (worldwide including USA) costs $1.75 for the same age bracket. But be careful.

If your travel takes you to the Caribbean, or Central America or Mexico or if you’re going on a cruise, and you suffer a life-threatening medical emergency and you have to be evacuated to the closest hospital, which may well be in the U.S., you may get stuck with a huge hospital bill that the insurer is not responsible for. And whatever plan you buy, make sure it provides repatriation to a hospital at home as a benefit—not just evacuation to the closest available hospital.

Milan

Milan says…
You would think so. But the short answer is NO. First of all, most American-licensed companies can only sell to American residents. You need insurers who are not only licensed to sell in your home province, but who have out-of-country travel plans that are supplemental to the benefits offered by your provincial health insurance which pays some—albeit quite little—of the cost of your emergency medical care in foreign hospitals. Your Canadian plans can also file for reimbursement from your provincial health insurance, and are prepared to repatriate you to a hospital back in Canada by air ambulance or commercial flight if medically necessary and not just evacuate you to a nearby hospital and leave you to your own devices to get back home. Getting a hospital bed in Canada is no easy task so you need so you need an assistance service that normally deals with Canadian hospitals. In short, Canadian travel insurance is designed specifically for Canadian travelers in foreign countries and covers only emergency medical care. American travel plans are designed for Americans who have more limited basic health insurance coverage. And as for the cost, unless you’re very, very sick, or very, very old, Canadian travel insurance, is a bargain.

June
Answer : If your heart condition is stable and you have had no change in medication for two years and have no other health problems, you should have no problem finding insurance. But make sure you have a plan that covers “stable” pre-existing conditions and if you are asked medical questions, which is likely, make sure you disclose the details of your angina, what medications you are taking and their dosages. Then get an endorsement that says you are covered for your angina. If you fail to disclose anything about your health on a medical questionnaire—even if it has nothing to do with a medical emergency you may encounter—your entire policy might be voided and you might be disqualified from coverage. If you are going on a cruise, your best bet is to insure with a travel insurance specialist that offers at least $1 million, will repatriate you to a hospital at home if medically required (evacuation to a nearby hospital is not good enough), and has an emergency service you can access 24/7 no matter where you are, even at sea. Most insurance plans offered by cruise lines are not good enough.

Milan

Shirley
Answer: If your husband has no other problems besides his diabetes, which is “extremely well controlled” he should have no problem getting a medically-underwritten policy which is based on his health status at the time he applies. But it requires that he answer all medical questions completely and accurately. It would be best if his doctor look over the application and how he has answered it. Most Canadian insurers who specialize in travel health insurance plans will be able to accommodate him even at the age of 77, so long as he truly “Has no other problems.” It’s not surprising your former employer’s insurance would not offer coverage. You need a company that specializes in travel insurance, particularly one that has plans for snowbirds, who are traditionally older. There are plenty of good companies in Canada who can do that. Click on any of our advertisers for further information.

Milan

• 24-hour emergency assistance hotline you can call from anyplace in the world for advice and assistance in handling a medical emergency. This will be staffed by the insurer’s emergency assistance service, which will be supervised by qualified medical professionals.
• Inpatient or outpatient hospital and doctors’ fees (including specialists), intensive care, surgery, lab tests, anesthesia, blood, room and board, in-hospital drugs, medically necessary special duty nursing.
• Outpatient hospital, clinic, or lab services - though there may be some limitations. This could vary from policy to policy. Check it out.
• Some policies may cover limited chiropractor or therapist or other allied professional services but don’t take that for granted. Check your policy out first.
• In addition, most policies will cover your air evacuation to a hospital if you’re in an area without appropriate medical services, such as a remote island or resort, or repatriation to a hospital in Canada under certain conditions. If, after your emergency is stabilized, the assistance service determines it’s safe for you to be transferred to a Canadian hospital for further treatment or management, they have the right to transfer you at their cost. This may include medical evacuation by air ambulance or by regularly scheduled airline (possibly with a qualified attendant). If you decline their recommendation, they can end their coverage.
  On the other hand you may want to be air evacuated back to Canada but they may prefer to keep you where you are. That’s up to them, and those decisions are not always done for clinical reasons but for economic ones. Medical Air repatriation is no free ticket home. Arrangements like these are complex and they can only be made by your emergency assistance service in coordination with your attending hospital, the air ambulance service, and the hospital receiving you in Canada (provided a bed has been reserved in your name—often with the help of your family physician). If you want your insurer to pay for this (at $15,000 to $25,000 within North America) you better let your emergency assistance service do it.
• If, alas, you die while abroad, your policy will likely cover the return of your remains to your next of kin’s funeral director of choice, but this includes only the basics: no fancy caskets, flowers, or organ music. This too is best handled by your insurer as different countries and states have their own regulations and requirements about transporting the dead.
• Most policies also provide benefits to allow family or a relative to travel to your hospital bedside if you are traveling alone or otherwise need assistance.
• Most Canadian travel policies also offer options for baggage loss or damage, trip interruption or cancellation (with limitations you should read about in the section on Trip Cancellation), return of your auto or recreational vehicle if you have an emergency and can’t drive home on your own, other roadside assistance services which may also be duplicated by your auto club memberships.

First of all, understand that the out-of-country insurance available to Canadians is not a substitute for your provincial health plan but a supplement to it. Its benefits are limited. Its purpose is to cover unexpected medical emergencies while you are traveling out of the country. That it does well and at a fair price. But it is not comprehensive health care. It does not cover elective services, non-emergencies, or services for conditions you planned to have treated before leaving the country.

Until 1991, when Canadian provinces cut back foreign hospital payments for their traveling residents, out-of–country travel medical insurance was relatively simple and cheap. Basically, it covered supplemental items like upgraded rooms, private nursing, television and telephone charges, certain special needs, and repatriation if necessary, but the high costs of hospital and doctors’ services were still largely paid by the provinces. When these were cut back, private insurers were left with covering the differences, and the costs of providing insurance skyrocketed.

Unlike the European Union, whose member countries provide limited reciprocal healthcare services to each other, Canada has no reciprocal arrangements with any other country. And unlike the United States where many private insurance plans offer some limited out-of-country coverage, Canada’s provincial plans cover only a small fraction of such services. Provincial governments only pay from $75 to about $400 a day for out-of-country hospital care. Yet in the United States, costs ranging from $5,000 to $10,000 a day are quite normal, leaving patients, or their insurers, responsible for the difference.

The bottom line is that hospitals are businesses, and adequate health insurance is the way to protect yourself in this very expensive market.

To keep their premiums affordable and to cover a rapidly-growing market, insurers have developed many different plans, tailoring benefits, exclusions, special circumstances and eligibility requirements to the needs of all travelers of all ages, not just the young and super-healthy. Virtually all of these health plans are encompassed in broader travel insurance policies that also cover trip cancellation benefits, lost baggage, legal aid while traveling, and a myriad of other travel services. But here we concentrate on the health benefits because those are the costs that can wipe out your life savings or worse.

Going it alone and making your own hospital arrangements, “authorizing” treatments or other procedures, or failing to notify your emergency assistance service of your emergency as soon as you can is a high risk game. Your assistance service is there to see you get appropriate care and for that they have to be notified right away. In the great majority of cases the medical director of your assistance service will let your attending physicians and staff do what they think appropriate. But there are times when attending staff may want to do procedures that may not be necessary at the time, or could wait until you are transferred to a Canadian hospital if transfer is necessary. In that case the medical director must give approval for such a procedure to be done. And if not, and you choose to go ahead, you may very well have to pay that part of the bill. All insurers require you to notify them of any major medical emergency needing treatment. For minor conditions, such as those in a walk-in clinic, it’s ok to have them done and file later for reimbursement. But you need all of the proper paperwork and clear identification of what was done, where, was a doctor involved and what was the outcome. But if in doubt, why not call and advise the assistance service? That’s what your cell phone is for.

Travel health insurance covers unexpected, unforeseen emergencies, not continuing care, preventive services, routine check ups, maintenance care for a condition already stabilized, chronic care services, elective or non-emergency services or diagnostic services unrelated to your emergency.

No nose jobs or tummy tucks. No hip or knee replacements. No organ transplants. No cardiac bypass that can safely be deferred until you return or are repatriated home. In general, if it can be safely delayed until you get home, it will be. Travel health insurance is supplemental to your provincial insurance plan, it’s not a substitute for it. If it were, most Canadians couldn’t afford it.

If you can be safely discharged from hospital after treatment of an emergency you will be, and that is the end of your coverage for that particular condition or conditions related to it. You can then either go home or risk “going bare” for that condition. For example: if you have a heart attack, your insurance will cover your emergency and the treatment required to stabilize you until it’s safe for you to leave the hospital or be transferred to a hospital at home for further treatment. But that’s where coverage ends for that particular event. You will not be covered for continuing care of your heart or for a recurrent attack.

Even in policies that claim to cover pre existing conditions, pre-existing conditions are not covered unconditionally. There are limitations, and most will require that the pre-existing conditions being “covered” have been stable and controlled for a certain period of time before the policy goes into effect. That may be 30 days, 90 days, one year, maybe longer. It depends on the condition, the policy, the terms of the medical underwriting. This differs from plan to plan. You need to be acutely aware of the conditions of coverage and especially what the insurer means by terms like “stable” and “controlled”, “treatment”, “investigation”. Normally if a condition has been treated by a physician, has developed symptoms, or has required a change of medication—either type or dosage—within the specified time period, it will be considered unstable and not covered. See the section on Pre-existing conditions.

Most policies will not cover you for special risk circumstances such as skydiving, mountain climbing, shark hunting, professional scuba diving, professional sports, anything of a high risk nature. Tell your insurer if you plan to do any of those things and then get a written statement verifying that you are covered in case of such mishap. Note also that there are insurers who specialize in high risk coverage of that sort.

Neither will you be covered for suicide or any emergencies resulting from alcohol or other drugs nor if you are caught in a war zone or civil disturbance, riot, insurrection or act of terrorism.