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OLHI OLHI – OmbudService for Life & Health Insurance | Resolution of your Canadian Insurance Concerns | OLHI

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A lay person’s guide to travel insurance

Points of fact and advice:

  1. Selection of policy:

Per trip

Annual

Bank card

Part of extended health care benefit (group)

 

  1. Whatever your policy – READ IT CAREFULLY. And if there is anything you don’t understand – ASK. Don’t assume anything.

 

  1. Obtain qualified advice on what kind of coverage to buy.

 

  1. Avoid buying at the last minute when you are pre-occupied with your travel arrangements.

 

  1. Cheapest is not always the best in the long run.

 

  1. Understand that all travel insurance claims are underwritten at claim time – you don’t know that you have a valid claim until it has actually been admitted and paid. Having paid a premium and having a policy does not mean that you are insured. Remember that.

 

  1. Application:

a.) Read the application VERY CAREFULLY. If there is anything you don’t fully understand, ASK.

b.) Select a realistic spectrum of coverage – don’t stint.

c.) Preferably have the health questions completed by your attending physician – his/her fee may be the cheapest best investment you have ever made – a claim in a US hospital could be for $200,000 or more.

 

  1. Health history – do not, repeat not, attempt to determine what you think may or may not be relevant to the insurer – declare everything – even how often you break wind. ☺

 

  1. Understand the concept of risk from the insurer’s point of view – insurers do not pay a claim on a barn that is already smouldering when the policy is taken out – it’s called selection against the insurer.

 

  1. Common reasons why your claim may not be paid:

 

  • That means something you did not tell the insurer that the insurer has determined was material to the risk, meaning that if it had known that fact, it would not have issued the policy or would have charged a higher premium. What you did not tell the insurer does NOT have to be related to the claim that the insurer is denying. However, whatever the insurer determines is material of the risk has to be within your knowledge at the time of application – in other words you can’t not declare something that you don’t know about. Just be sure that you really didn’t know about it – don’t let your physician’s clinical notes make a liar out of you. Oh yes, the insurer will check those out.

 

  • Pre-existing condition. (Think of the smouldering barn.) A pre-existing condition is one that existed before the date that insurance commenced. Some policies will cover pre-existing conditions under conditions that the insurer will specify, the most common one at least that it has to be “stable” according to the insurer’s definition of “stable” – see below.

 

  • “Stable condition”. Insurers will define in the policy what that is – read that definition very carefully. If you can’t meet that test, don’t try to wing it – take my advice – stay at home.

 

  • Uncompleted tests or investigations. If your physician or specialist has recommended a test of any kind to investigate a possible medical condition, that has not been completed at the commencement of insurance (and the possibility of such medical condition therefore remains a question mark), your claim may be denied, depending on the wording of the policy, whether it proves to be relevant to the claim that is actually incurred or not.

 

  • Change in health condition prior to the commencement of insurance (departure), and not declared to the insurer. Again, that can be any change in health condition. So even if it is just a nosebleed, or a touch of indigestion, or just seems to be a sniffle of a cold or a persistent cough, call the insurer and tell them. For all you know, it could be something that can land you in hospital a week into your trip. Oy veh.

 

  • When a claim is incurred you must notify the insurer or the insurer’s claim administrator at the time that the insured service is about to be incurred, or the claim may be denied even if it is in all other respects perfectly eligible. Instructions on whom and where to call are always written into the policy or are a part of the travel coverage that you have. Most insurers of a travel insurance benefit will have provided a travel card – at the time of claim that card or your policy is more important than your passport.

 

  • It is axiomatic that the insurance has to be in force at the time of the claim – if you bought 30 day coverage, and you decided to extend your stay and your claim occurs on the 32nd day, you are sheer out of luck.

 

  • There are other exclusions and conditions of which you are well advised to take note, but the ones above are the most frequent causes of claim denials. Trust me.

 

Bon voyage.

 

 

 

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