Travel medical insurance

Essentials

• Risk of serious illness or injury = Low
• Potential financial loss = Catastrophic
• Do you need travel medical insurance? = Yes 
• Understand precisely what is covered and what is not — Pay careful attention to what is covered (and under what circumstances) and what is not covered.
• Find out if any exclusions apply to you — Be absolutely certain about exclusions, especially pre-existing medical conditions, high-risk activities and medical problems brought about by your own behavior.
• Decide on a deductible and/or co-insurance rate — Estimate how to benefit from lower or higher deductibles and/or co-insurance.
• Check to see if you have existing health insurance — You might have some from home that can be continued or extended. Be careful: it is likely not enough.
• Make a successful claim — Insurers analyze large claims, looking for ways to deny or reduce them. Know how to make a claim that will be paid.

the Big Picture

Let us be clear: you need international travel medical insurance. If you get just one type of coverage, get medical. Why? For independent travelers, the most potent combination of risk and expense is serious illness or injury. A bit of bad luck can ruin you financially if you are not covered.

Travel medical insurance covers:

• New illnesses & injuries that arise during your trip only.

It does not cover some situations unless you buy a rider to include:

• New illness arising from pre-existing conditions.
• Injury from “high risk” activities.

It does not cover:

• Ongoing treatment for pre-existing conditions.
• Check-ups and other preventative and health maintenance procedures (take care of those before leaving on your trip).
• Treatment for injury sustained from your own voluntary actions (due to overconsumption of alcohol, for example).

Are there any situations where you don’t need to buy medical coverage?

• You already have sufficient cover — In rare occasions, you may have sufficient coverage from home that still applies abroad. Check carefully. Most home policies do not cover you abroad at all or, if they do, severely limit time abroad and/or coverage limits.
• You are immortal — Some travelers (usually young, healthy and low budget) attempt to economize by assuming that they’ll pay out-of-pocket to see a doctor about a stomach upset or to get a couple of stitches. They also trust that a major illness or severe injury will not befall them. It’s true that the probability of illness is less than for older or infirm travelers. But the probability of injury tends to be higher, because young people often do more physical (and high risk) activities and suffer more frequent lapses in judgment. Even if you never do “adventure sports,” you could be legally crossing a street when you’re hit by a vehicle. By the time you’re discharged from the hospital, you could owe $150,000 (or more!) It’s even possible that local authorities will confiscate your passport until someone pays your bills.

Factors that influence your risk of medical expenses

The type of trip you take and where you go has a direct bearing on the risk of medical expenses and the scale of those expenses:

• Poor country or rich country — The poorer the country and the farther from urban areas you go, the higher your risk.
• Your travel style — Budget travelers may face more risk from inadequate food hygiene, dangerous public vehicles, rooms with mosquitoes and other hazards.
• Number of road transport legs — The more transport legs you take, especially by road, the higher your risk. Road accidents are the No. 1 cause of traveler injury.
• High-risk activities — Some experiences also have higher risk of injury: scuba diving, trekking and adrenalin sports all put your body at more risk than touring museums or shopping.
• Countries with costly treatment — Rich countries have high, sometimes astronomical medical costs.
• Trip duration — The longer your trip, the higher your risk.

Quality features of medical travel insurance

There’s no straightforward grid for evaluating travel medical insurance. That’s because people have different needs. See how these factors fit for you.

Coverage

Travel medical insurance should include at least the following core expenses:

• 24/7 emergency contact — This is mandatory any time you end up in serious trouble. Quality may vary, especially if you’re heading off the usual traveler routes.
• Referral to local medical help — Your insurer should be able to refer you to a local doctor, dentist, specialist, clinic or hospital (for procedures covered by the policy). Translation services should also be available to assist with treatment or health facility administration processes.
• Treatment — Services include consultation and treatment by a doctor, dentist or specialist, laboratory costs related to diagnosis and treatment and medicines prescribed by that doctor, dentist or specialist. For smaller procedures, you may pay yourself and seek reimbursement.
• Hospitalization — Your insurer will either pay the bill directly or guarantee payment. This is essential for large expenditures that you cannot possibly pay yourself. 
• Monitoring & communication — If you’re hospitalized, your insurer should monitor your condition. If you are unable to communicate with home yourself, your insurer should maintain contact with someone at home that you specify in your policy application.

Other coverage is often bundled with the core services. Depending upon your situation, some could be very helpful.

• Emergency evacuation — In many policies, emergency medical evacuation (not natural disaster or political evacuation) is included in a single type of coverage with a high coverage limit. In other policies, it’s listed separately.
• Coverage for children at no extra cost — This is a very nice feature for traveling families as it can save a big amount over insuring each child separately.
• Return of minor children to your home if you are hospitalized — This, too, is a boon to families, since it can cost a lot, especially if a young child requires a chaperone to get home.
• Extra medical coverage — More comprehensive medical policies may include specialized services, including: counseling after an assault or mugging, daily emergency cash allowance while you are in hospital, physiotherapy or chiropractic treatment, treatment by an acupuncturist or osteopath and more.
• Non-medical travel insurance coverage — Any of the following could appear in a medical plan: trip cancellation, baggage loss, AD&D or term life.
• Return of your body in event of death — This coverage is quite common in medical plans.
• Extension of coverage upon your return home — Coverage of medical expenses in your home country is critical if you cannot resume your regular home insurance the day after you arrive home. More on this below.

What’s not included

• Medical issues you had before you were insured — Insurance does not extend to treatment or prescriptions for pre-existing conditions. Get all your prescriptions filled before you go.
• Self-induced conditions — Any illness or injury caused by your own decisions may not be covered. That includes pregnancy, sexually transmitted diseases, getting injured while under the influence of intoxicants and more.  See “Exclusions” below.
• Emergency evacuation — As noted above, emergency medical evacuation is sometimes bundled with premium medical insurance. If it’s not but you need it, you’ll have to get it separately.
• Mental illness — We don’t know why mental illness is not covered, except that perhaps diagnosis and treatment are difficult to establish.
• Dental work — The only dental work covered is for repair from an injury. Considering the potential costs, the coverage limit for dental is not much. Coverage dose not include adjustment or repair of dental devices like braces and dentures. Take care of regular dental before you go.
• Optical examination and corrective lenses — If  you think you need your eyes checked, get an optical appointment at home before you go. 
• General medical check-ups — Especially if you haven’t had a check-up in a long time, if you’re older or given to illness, get a thorough check-up before you leave home.
• Non-prescription drugs — These are all at your expense. Even if a doctor writes a prescription, if the drug is not usually a prescription drug at home, insurance will not cover it.
• Cosmetic or other elective treatments — Sorry, your nose job isn’t covered.

Exclusions

You need to understand what the insurer is not willing to cover. There will be a section in the policy on “Exclusions” that lists specifics. Look for these types of exclusions, if they apply to you:

• Pre-existing medical conditions — If you have any medical condition that is under a doctor’s care, whether it is being treated or not, check whether it is on the list.
• High-risk activities — Insurers exclude all sorts of sports and other activities. Some of them seem harmless enough, such as trekking or even bicycling, but they could be in the list. Many “adrenalin sports” are completely out, with no rider available.
• Self-induced medical conditions — Where your own decision leads to injury or illness, you may not be covered.
• Geographic exclusions — Some countries, notably the United States, are excluded because of the cost of medical treatment. You need a separate policy or rider to include them. Other countries are excluded whenever your home country issues an “avoid all travel” advisory against going there.

In some cases, you can buy a rider or add-on that will include one or more exclusions. But there are some exclusions that no insurer will cover. If you are considering a rider, check that the added cost does not make the policy uncompetitive compared to other options.

More on pre-existing medical conditions

A “pre-existing” health condition is defined as any medical condition that exhibited symptoms, or had diagnosed and treated immediately prior to your application for insurance.

IMPORTANT: check the policy you are considering for the exact definition.

What does this mean as a traveler with a pre-existing condition? First, your insurance will not pay for ongoing treatment or drugs related to that condition. Second, the insurer will deny a claim for what it deems the medical consequences of your condition. Suppose you have high blood pressure (hypertension) and it is listed as an exclusion. If you then have a cardiac event during your travels that requires hospitalization and treatment, you may not be covered. This is a grey area, since the causal relationship between your pre-existing hypertension and a cardiac event may not be direct. But you don’t want to end up in a fight with a lawyered-up insurance company.

• What are the pre-existing conditions? — The policy will have a list. But what if your exotic condition isn’t on it and there’s a risk of a “related” medical event during your travel? Contact the insurer and get a response in writing. You can probably expect something like, “Oh, yeah. We intended to exclude that.” If so, ask about inclusion in a rider.
• Look-back period — The insurer will want to know about any pre-existing conditions during a “look-back” period. This period is counted backwards from the policy’s effective date, normally 90 to 180 days. Pre-existing conditions that have been treated and stable the entire time will not likely affect the policy. But something as innocuous as a change in prescription for a pre-existing condition can affect your coverage. Do not omit to state any changes, however minor, in your policy application or a later claim could be denied.
• Policy extension — If you develop a new condition during your period your medical coverage is active, it will be considered pre-existing if you want to extend your policy beyond it’s current expiry date.

A common solution to pre-existing conditions is to buy a rider to cover it. Not all conditions can be covered this way, but many can. You might have to shop around to find an insurer who covers your condition and does so at a reasonable price.

What if you have a pre-existing condition where the rider for inclusion is hugely expensive or you can’t find an insurer that will cover it? Keep in mind that the insurance underwriter’s actuaries have deemed your condition extremely risky. So, if the rider is costly, shop around for a better deal, but get the rider. If none of the insurers will cover you, we’re sorry about your dire condition, but it might be too risky to travel now. Maybe your condition will improve in time and then you can travel. You don’t want to head out anyway and then find yourself in a foreign hospital facing ruinous bills.

More on high-risk activities

Maybe you don’t plan to do “adventure sports” during your trip, but it’s the nature of independent travel to make up your trip as you go. What happens if a great opportunity to do something “risky” comes along? If you get injured, your medical insurance may not apply because that activity is listed in the exclusions of the policy.

You can split your activities into three categories:

• Insured — These are no-risk or low-risk activities. If you’re on a stroll through the fields, fall into a ditch and break your ankle, you’re covered.
• Excluded, but can be included with a rider — There are lots of activities that are listed as exclusions, but can be included by paying extra for a rider. Note that the cost increase for your policy may be substantial, even to the point of making the policy uncompetitive compared to alternative policies with similar high-risk coverage.
• Excluded forever — The risks are so high that no insurance company will ever cover them, rider or not. Think base jumping, cave diving, running with the bulls and expeditions to the remote tundra.

Every medical insurance policy will list specific exclusions. If you don’t see your planned activity there, don’t assume it’s covered. Some innocuous activities are excluded by tight-fisted insurance companies who think that such activities as trekking and bicycling are high risk. Many will exclude injury from amateur sports, unless it is specifically covered. If you think an activity you plan is even remotely risky, contact the insurer to find out for sure. Get it in writing. They’ll probably say it’s excluded but can be covered in a rider. It will cost you more, but that’s better than getting injured and then having your claim rejected.

You never know when the opportunity might arise to do something really cool, but maybe a bit risky. Do you pay extra for the rider to insure against possible injury?

• No —  You don’t anticipate doing anything that your insurer regards as risky. When you find yourself deciding to do one incredible thing that’s not covered by your policy — the bungee jump at Victoria Falls! — you have to decide whether or not to accept the risk.
• Maybe — You’re open to adventure wherever and whenever the opportunity arises. You might do high-risk activities a few times… or maybe more. Who knows?
• Yes — You’re an adrenalin junky who’s always up for bungee jumping, snow boarding or diving with the sharks.

More on self-induced medical conditions

No insurance company will cover your medical expenses if you are negligent or in any way responsible for your own condition. Examples:

• Injury caused or exacerbated by the consumption of intoxicants (legal or illegal). Party animals, take note!
• Injury sustained during a criminal activity. (You don’t have to be convicted. Your insurer can suspend your claim until your case is resolved.)
• Suicide attempts or other self-mutilation.
• Sexually-transmitted diseases.
• Pregnancy, childbirth or elective abortion.
• Consequences of elective procedures such as cosmetic or religious surgery.
• Injury sustained due to civil disturbances. (Presumably, you should not have been anywhere near such an event. If you stumble into one, you should get away immediately. If you’re just unlucky and get hurt, you can make a case.)
• Stupid stunts (even without consumption of alcohol) or other behavior where you put yourself at unnecessary risk.

If you get ill or injured as a consequence of your own bad judgment, you shouldn’t lie to your insurer about it. If they find out, you get zero and your entire policy is void. It’s also fraud and that’s a criminal offence. However, you should make an effort to influence the official reports that must accompany your claim. You want them to reflect as positively as possible about your role in the event that led to your illness or injury.

More on geographic exclusions

Travel to some countries may come with more costly premiums or not be covered at all.

Cost of treatment

You don’t know what illness or injury will befall you, but it is known that medical treatment, hospitalization and drugs are cheaper in some countries and astronomical in others, the United States most of all. That’s why many insurers offer at least two types of medical coverage, one that includes the whole world and another that specifically excludes North America (Canada is expensive, too) and sometimes Japan or other countries. So, if you don’t plan to visit expensive countries, you can save money by getting a policy that excludes them. If you do plan to visit and have a flexible insurance company, you can control this extra cost by informing your insurer of the dates you will require coverage there and request extended coverage only for those dates.

Travel advisory

Medical coverage is usually void for countries that your government advises you not visit. Reasons are either health related (such as countries struck by the Ebola virus in 2014) or security related (such as Iraq, Syria and Yemen at time of writing). Some countries may be on your government’s no-travel list because of deep political disagreements.

Coverage limits

Don’t try to save money by accepting a low coverage limit for medical. The majority of medical issues are minor — a bad digestive disorder or a couple of stitches. But anyone can be unlucky and end up with lengthy hospitalization and costly treatment. It’s impossible to know what a “worst case” medical emergency would cost abroad.

Some low-end “backpacker” policies have as little as $100,000 in medical cover. That’s not enough. Surgery and hospitalization in countries with good quality but “cheap” medical (such as India, Thailand, Ecuador or South Africa) can still exceed that. You can have $100,000 in coverage and still be wiped out financially from a traffic accident in Thailand that wasn’t your fault.

How much is enough? Many policies these days have $5 million (or £5 million). Some of these maximums include medical evacuation, but that’s still good cover, even for visiting the US. We can’t suggest a minimum because there are too many variables. Try to get a policy with generous medical limits at a reasonable price.

Deductibles & Co-insurance

Medical travel insurance comes with a deductible (“excess”), which is the part of the claim that you have to cover first, before your insurer pays the balance. You will end up covering the cost of minor medical treatment yourself.

Co-insurance is a percentage of the claim that you are responsible for, up to a prescribed maximum. If you have a large medical bill, co-insurance can saddle you with a major payment, so you may want to avoid policies that have co-insurance and stick with deductibles.

Some policies have a deductible only and some both deductible and co-insurance. Co-insurance only is rare. Since medical costs can be quite high, you need to know how much you could end up covering yourself and balance that against cost.

To see how this could work out, imagine two scenarios during your travels:

• $200 medical event — You got sick and had to see a doctor. You have bills for the consultation and prescription drugs totaling $200.
• $1,500 medical event — You slipped in that dirty hostel shower and broke your wrist. There was an ambulance, x-ray, setting and pain killers.
• $25,000 medical event — You were riding a rental motorbike at the beach and got hit by a car. You don’t really know what happened after that, but by the time you were discharged from the hospital, you had bills of $25,000.

What would your personal cost be with low or high deductibles? How about low or high co-insurance percentage. What if you have both?

When you look at a medical travel insurance policy, you can do the math to see what your maximum exposure could be under different scenarios. Then it’s up to you to decide what level of risk you’re comfortable with versus what you can afford.

Here you have an information advantage over your insurer and an opportunity to optimize your policy:

• When it’s good to reduce or minimize deductible & co-insurance — Your insurer will have knowledge about your age and recent medical history. They also know whether or not you intend to do high-risk activities, based on whether or not you got a rider for them. They then adjust the price of your policy (with any riders) to reflect that. But you know much more about your destinations, style and activities. If you think your travel will be relatively risky, you can choose to pay more for a minimum deductible or co-insurance percentage.

Duration, extension, coverage when you return home

You always buy a travel insurance policy for a set duration, starting on your day of departure and (usually) ending on your scheduled day of return home. But do you know how long your trip will be? If so, you can buy your policy for precise dates.

What if your return date is open? You can buy a policy that will definitely cover your entire longest possible duration, although you might end up paying for time you don’t use if you come back earlier. Alternatively, a few insurers allow you to extend your policy while still traveling. There’s still a maximum duration, often 2 years (expatriate insurance can go indefinitely). If you don’t know how long your trip will be, perhaps the best solution is to buy a shorter duration of a policy that can be extended.

The other issue is whether your home health insurance will start the day after you arrive home. If not, you need travel medical insurance that will continue to cover you at home. This is a problem only for long-term travelers. More on this below.

Coverage you already have

To keep the two types of coverage straight, “health insurance” refers to what you have at home, while “medical insurance” refers to what you need to travel.

You probably already have health insurance, either public or private. It may provide some coverage that can apply abroad, but it will likely be limited in duration and coverage limits. Carefully read the details of your home health insurance: you must understand all the terms and conditions, just as if it was a commercial policy you are thinking of buying. There may be a section pertaining to coverage outside the country, or that information may be scattered in different sections of the plan. Use our guidance for choosing a travel insurance policy, combined with the other issues described in this section to make sure you have the complete picture.

Public health insurance

All rich countries except the United States provide universal, single-payer health insurance. The US Affordable Care Act (“Obamacare”) mandates that residents must be insured, but the insurance is provided by private insurance companies.

Public health care is “lowest common denominator” coverage. The basic coverage is there — sometimes it’s really basic — but there’s none of the flexibility you need as a traveler. In fact, the coverage for independent travelers is almost entirely inadequate for many reasons. It might cover a minor doctor visit, but not surgery or hospitalization.

Some governments have reciprocal arrangements with other governments to cover medical services to each other’s residents:

• EU member states — EU residents have the European Health Insurance Card. EU residents carrying an EHIC are entitled to treatment for unplanned medical events in other EU countries, although benefits vary by country. Notably, treatment for pre-existing conditions is included, as is regular pregnancy care and unplanned childbirth.
• United Kingdom — Besides the EHIC, the UK has a set of non-EU reciprocal arrangements, including Australia, New Zealand, island nations under UK administration and many countries of the former Yugoslavia.
• Australia — Down Under has a few reciprocal agreements as well, mostly with northern European countries and, of course, New Zealand.
• Canada — Canada has no reciprocal agreements at all. This is because health insurance is a provincial responsibility and the provinces can barely manage reciprocal agreements among themselves, let alone with foreign governments. Indeed, Québec refuses reciprocal agreements with the other provinces and territories.
• United States — The US, lacking a public insurance system, has no reciprocal agreements.

Private health insurance

Even if your country or province has public health insurance, many residents choose to augment that level of care with private insurance.

• Group plan from your employer, union, professional association or membership group — This can be either primary coverage (common in the US) or secondary to public health insurance (other rich countries).
• Personal top-up plan — Where public or employer plans provide only basic coverage, many people buy private top-up insurance to broaden types of coverage (dental and drugs, for example) or increase coverage amount. Top ups may also be provided by employers or other groups you belong to.

Credit cards

Do not rely on credit card medical insurance as your sole coverage: it is entirely inadequate. Some premium credit cards have limited travel medical insurance, although you must buy at least the transport (flights) with the card. As always, read the terms and conditions carefully to understand what is on offer… and where the gaping holes are.

Limitations of home health insurance

We are not aware of any home health insurance that does not suffer from one of these limitations:

• No travel coverage — Some public plans and private policies provide no coverage once you are outside the borders of your country. For example, US Medicare for seniors provides no coverage for travel.
• Short duration coverage — Among those public plans and private policies that offer travel coverage as an “extra,” the maximum duration of your trip can be short, as little as 30 days.
• Low coverage limits — Coverage limits for hospitalization and treatment are often low, insufficient to cover even modest claims. For example, most Canadian provincial health care plans offer just CAD 100 per day in hospitalization costs. But if you travel just over the border to the United States, hospitalization can easily cost USD 1000 per day. If you lack separate travel medical insurance, the difference is on you.
• Continuing enrollment or coverage at home while you travel — In public health schemes, you can remain enrolled at home for a defined period after you leave the country. Canadian provinces, for example, keep you covered for between 6 months and 212 days. US “Obamacare” requires you to retain coverage (and pay for it) for 330 days after leaving the country. Coverage at home is important for many commercial travel insurance policies. In the event of a serious and continuing health issue, the insurer wants to send you home and dump you on your home insurer with no break in coverage. It’s no surprise then, that many insurers refuse to sell travel insurance policies longer than 6 months to Canadians.
• Resumption of coverage upon your return home — Many public health plans (such as Canadian provincial schemes and the UK’s NHS) or government-mandated health insurance (such as “Obamacare”) require you to maintain domestic coverage while traveling, even though they provide very little or no coverage while you are abroad. In part, this is so that you can resume your home insurance immediately when you get back. If your trip is a long one, you can discontinue coverage after a specified number of months. But if you do, then you have to make a plan to be covered when you get home until you can get back on your home health plan. You may be able to extend some travel medical policies for a few months.

It’s vital that you understand what limitations apply to your health insurance. While your existing coverage can helpfully reduce your requirement for additional coverage, it does not eliminate it.

Issue: home insurance as primary cover

Since your home insurance will not likely be enough to cover costly medical expenses while you travel, you will have commercial medical travel insurance as well. But this presents a problem: your home insurance is considered primary coverage. What can happen with expensive hospitalization and treatment is this:

• You are presented with the bill.
• You have to submit it to your home insurer first.
• They take their sweet time determining what they will pay.
• Only then will your commercial insurer deal with the rest.

In practical terms, that means that you may have to pay a big bill up front, presumably using a credit card with a generous limit. Compare that with not having home insurance as primary coverage: your commercial insurance company gets involved directly with the medical services provider within the first 24 hours or so and you never have to deal with the bills at all.

Issue: coverage when you return home

This problem applies to Americans and Canadians. Britons and Australians have to be traveling for years before there’s an issue.

Who will insure you the day after your return back home? Given the huge potential cost of medical care, you don’t want any gap in coverage.

If you experience serious illness or injury while traveling and you will need ongoing costly care, travel insurers have a strategy: interrupt your trip and dump you back on your home health insurance provider as soon as possible. But will there be a home insurer to dump you on?

Most travel insurance ends the day you arrive home, so you need health coverage that starts the very next day. That won’t be a problem if you return before you are removed from enrollment in the health plan you were on before your trip. Be very sure you know how long that is! What is the exact expiry date? Can you request an extension of your enrollment?

• Australia — Lucky Aussies! Medicare coverage won’t expire unless you’re absent more than 5 years.
• United Kingdom — Lucky Brits, too. NHS kicks in as soon as you arrive home. Only long-term expats under retirement age are not eligible to nip back to the UK for some free service. Anyone returning with the intention of staying in the UK can get NHS services immediately.

Americans and Canadians… sorry. Your governments are not as generous to travelers.

Affordable Care Act (“Obamacare”) rules for travelers

At time of writing, Obamacare was under review, including possible revision or termination. 

Trips less than 330 days

Unfortunately, the Affordable Care Act makes your options narrow and, um, not so affordable. Under ACA rules, you must maintain “minimum essential coverage” for 330 days in any 12 month period. So, you have no choice but to pay to maintain your home health insurance coverage. You’ll be subject to the “individual mandate penalty” if you don’t. The only benefit for all that is having insurance as soon as you arrive back home. If your reason for return is recovery from a serious illness or injury you experienced abroad, you’re covered. By all means, try to go for cheap “minimum essential coverage” while you’re gone, but, as with travel insurance, make sure “minimum” is still good enough.

With few exceptions, Obamacare policies do not provide travel coverage. On the flip side, travel insurance doesn’t count as Obamacare “minimum essential coverage” either.

Trips longer than 330 days

Life gets much more complicated for Americans traveling long-term. For counting the 330 days, including splits between tax years and breaks back in the US, the IRS rules about residency apply.

If you don’t return before the 330 day deadline, your coverage will lapse and your previous insurer doesn’t have to take you back. When you return, you will have a 60 day window in which to get reinsured. A new insurer will want to know your medical history, so gathering your medical records and possibly getting an exam could delay your enrollment and cost you out-of-pocket. In the meantime, you’re not covered.

That lapse in coverage after 330 days might not be such a big deal, unless recovery from a serious illness or injury forces you back to the US after your Obamacare has expired. While insurers cannot discriminate about pre-existing conditions, no insurer will be keen to take you on if they have to assume a huge ongoing cost right from the get go. Expect some processes.

What does it all mean? You don’t have to worry about ongoing coverage when you return, as long as you keep paying the minimum premiums for minimum coverage.

Canadian provincial health care rules for travelers

 

Oh, Canada! Would that provincial health care was as helpful to travelers as British and Australian public health care. Alas, it’s not and it presents some gnarly issues for long-term Canadian travelers.

You have a choice between conventional travel insurance, which requires you to maintain your provincial coverage, or expatriate insurance, which does not.

Travel insurance conditions

While you’re enrolled, your provincial or territorial plan is your “primary” insurer, although coverage limits are too low to be relied upon solely. You will need private travel insurance to be covered adequately. All conventional travel insurance insurers are “secondary” insurers that require you to maintain your provincial coverage. The province pays first, before the travel insurer considers the balance of the claim.

The provincial plans will keep you enrolled for a limited time (183 to 212 days depending upon your province), although most provinces will entertain requests of up to 2 years. Restrictions apply, so check carefully.

If your trip is going to exceed the duration of your provincial coverage, you’ll have to switch from conventional travel insurance to expatriate insurance when the provincial coverage expires.

Expatriate insurance

If you’re going to be off provincial coverage because of the long duration of your trip or because you’re a resident of BC (see below), you’ll need expatriate insurance (normally limited to medical and emergency evacuation).

When you get back, your province of residence has to re-enroll you, but you could wait 1-3 months before they do. That could create a gap, during which you have no medical insurance. You might find some expatriate policy that carries over at home for a limited time OR you may have to buy “visitors” insurance to stay in your home province until the provincial health plan starts.

So sorry, BC residents!

There’s an old joke that “BC” means “bring cash” and it certainly applies to long term travelers from the province. BC residents are uniquely screwed charged for health care, incentivizing them to get expatriate insurance from the beginning. BC is the only province to bill health care premiums directly to its citizens. That makes the costs of conventional travel insurance plus BCMSP $900 per person per year more expensive than for any other Canadians. Suddenly, expatriate insurance looks pretty good.

More information by province or territory

Each province is different in its treatment of travelers. The links below provide summary information about how long you can be away (temporary absence) and what is covered while you are abroad. You may need to contact your provincial or territorial health plan for the specifics.

Alberta

British Columbia

Manitoba

New Brunswick

Newfoundland and Labrador

Nova Scotia

Northwest Territories

Nunavut — information is sparse. Contact the Department of Health for more.

Ontario

Prince Edward Island — information is sparse. Contact Health PEI for more.

Québec — temporary absence & coverage abroad

Saskatchewan — temporary absence & coverage abroad

Yukon

HELP! It’s hard for us to keep track of rules and changes in so many jurisdictions. If you’re aware of any changes (or anything we’ve got wrong), please let us know.

How to make a claim

Please read Travel insurance claims: how to get paid.