Did you know that the Province of Ontario provides some Out-of-Country medical benefits?
Most people I know believe when you travel out of Canada and don’t buy travel insurance, you are on your own for any expenses. This thinking is almost, albeit not quite, accurate. The coverage is woefully inadequate, when compared to costs often associated with even the simplest care outside Canada. This is especially true since the vast majority of Canadian travel is to the United States. The Ontario Provincial government provides up to $400 daily for acute care coverage, and $50 a day for outpatient services.
This said, the Ontario Provincial government has recently announced their intention to eliminate the existing coverage for out of country care. The logic used by the province is that the administration of the plan is very expensive, outweighing the benefits provided. There are approximately $9M in claims processed each year, but the cost of administering these claims is $2.8M, this is a 31% administrative rate. For a group of this size, this is an appalling administration fee! Further, the $9M in claims processed account for only 5% of the overall cost of these claims.
These statistics reiterate the fact that coverage amounts provided by Ontario’s program are inadequate. Individuals would need to buy their own protection regardless, of the program’s existence.
What Does This Change Mean?
From a coverage perspective, this doesn’t mean much. Just as before, if you were travelling out of Province, you should purchase travel insurance.
What will this change mean for Out-of-Country premiums? Well, using the math indicated above this will likely drive an increase of about 5% for your coverage cost. This is the percentage of the claims that are currently being paid by the government, that will now need to be covered privately. This additional cost will likely be picked up by the insurers, and passed along to the companies paying the bills.
How Should You Proceed If You Have a Claim?
It would be timely to review how company benefit plan members should be processing claims when they leave the country.
Under the current system with most carriers, there’s a 1-800 number to call if you’re outside the country and you need medical help. If you call that number, with very few exceptions, you’ll never have to take your wallet out of your pocket. You’ll just get your medical care and come home. The insurance company will take care of everything.
If you find yourself in need of medical care out of country, remember:
Make sure to involve the insurer before paying any costs out of pocket! In most cases when you pay the bill yourself, this will dramatically increase the time frame for re-payment. The process then becomes that you must submit bills to OHIP first, and then wait for adjudication before submitting them to your insurer. Ultimately you will get re-reimbursed, but it will take somewhere between four and six months!
The takeaway here:
This government change really doesn’t mean much. If you are leaving the province, make sure that you buy Out-Of-Province coverage, or if it is included in your group plan make sure you bring the contact information with you. Then, if you have a claim, make sure to call the number as soon as possible!
Steve Low, President of Zarmac Benefits Inc.