What Is Not Covered?
12/27/07 • By Milan Korcok
If anyone selling you travel health insurance tells you you’re covered for everything, walk away. You’re not.
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.