I'm a Canadian Visiting the Palm Springs Palm Desert Area for the Winter, What Should I do About My Health Insurance (Part 1)?

January 28, 2013
By Sanger & Manes, LLP on January 28, 2013 10:07 AM |

We will finish our entry on Canadians doing business in the United States shortly, but let's focus on health care for the moment.

Will Canadian Health Care Coverage Pay for Costs Incurred Outside the US?
Canadian provincial health care coverage may not pay for all the health care costs incurred outside the province or country, and the difference can be substantial. For example, B.C. pays $75 (Cdn) a day for emergency in-patient hospital care, while the average cost in the U.S. often exceeds $1,000 (US) a day, and can be as high as $10,000 (US) a day in intensive care. Reimbursement is made in Canadian funds and does not exceed the amount payable had the same services been performed in the province. Any excess cost is the responsibility of the beneficiary. For complete travel protection for emergency care resulting from an accident or sudden illness, additional medical insurance should be purchased from a private insurance company. This applies whether one is going to another part of Canada or outside the country, even for only a day

But There is Supplemental Insurance

In general, Canadian residents who have coverage with their government health plan and who apply for coverage prior to departing, are eligible for supplemental health insurance. Persons over age 60 may require a complete Health Declaration as part of their application. Check the inclusions, exclusions and limitations of the private insurance policy carefully. The policy should include emergency medical and dental coverage, including physician, dental and professional fees, hospital fees, nursing fees, drug costs, diagnostic services such as laboratory and X-rays, and incidental hospital expenses such as television. Ambulance service to the nearest hospital should also be included. If ambulance service is required while in another province or outside Canada, fees charged are established by the provider. Fees may range from several hundred to several thousand dollars.

Additional Provisions

Additional provisions to look for include repatriation costs to pay to return the insured to his home province for immediate medical attention, cost of returning the insured's vehicle and pet, and should an insured person pass away, the cost of repatriating the deceased. Some policies cover the cost of transportation for a family member or friend to visit a sick or injured person in the hospital. Also, check to see if the insurance provider will cover expenses up front, which is preferable, or whether the policy holder has to pay for hospital bills and then be reimbursed by the insurance provider.
Be aware, the insurance company is not your friend. Every claim is meticulously examined to find a reason to reject it. When applying for insurance, answer every question as accurately and honestly as possible. Any mistake on the initial application, no matter how innocent, can be a reason for the claim to be rejected. Disclose all medical conditions and medications. If there is confusion regarding a question, seek guidance from a health-care professional. A dangerous practice is to not disclose a doctor's recommended treatment or medication change as this could invalidate the policy. If a doctor recommends a treatment, and you do not comply, or recommends a change in medication, and you do not comply, the insurance provider will treat this as an unstable pre-existing condition and the claim will be rejected. Also, if there is a new medical condition or medication while an annual policy is in effect, it is best to inform the insurance provider to avoid a pre-existing condition label. As long as a reported pre-existing condition meets a minimum stability period, insurance will be issued.


We will discuss more, in Part 2....