Is your medical condition stable enough to be covered by your group insurance “Out of Country” benefit?
While many group insurance companies do not have a pre-existing condition clause, they do require you to be medically stable when you travel out of the country. This benefit is designed for emergency situations or accidental injuries that occur while away and not intended to include treatment for conditions you already have.
What does medical stability mean? If prior to leaving the country you were seeking medical consultation, had diagnostic tests or change in your medication, an insurance company could determine that a pre-existing condition was not stable prior to departure. The period of stability that a carrier requires may range from zero to 90 days depending on the insurance carrier. If you are hospitalized for that condition, any related expenses may not be covered under your “Out of Country” group benefit. Travellers on long term disability, a leave of absence, or in late stage of their pregnancy should also consult with their insurance carrier prior to leaving the country to make sure they too will be covered.
Take the following two examples for comparison of stability:
Mary is a diabetic. She takes insulin and checks her blood daily but has been stable for months. Mary sees her physician monthly and has complete blood workup at each visit. She has been working and her regular treatment has not changed. Three days into her Mexican vacation, Mary has a sugar or insulin reaction that requires hospitalization. This would be considered an emergency and all expenses would be covered.
Bob, also a diabetic, has been visiting his physician because of fluctuating blood sugar levels. Three days after arriving in Florida, he has a sugar or insulin reaction and is hospitalized. Covered would be denied by some insurers based on the fact his condition was not stable at the time of his departure. Had Bob tripped and broke his ankle; this would be covered as it would have been deemed accidental and not a result of an unstable condition.
- If you are hospitalized out of country, your insurance carrier needs to be notified immediately or they can reduce or deny reimbursement of expenses.
- Always read the small print prior to departure, especially the exceptions section of your group insurance travel benefit. Also, be aware that some group travel plans have maximum dollar limits and limit the number of days of travel duration from the date you leave your province, ranging from 60 to 180 days.
- Speak with your group insurance specialist prior to travelling, if you have questions about your own situation.