Know Before You Go: Travel Insurance Coverage

Although emergency medical travel insurance is typically part of a group insurance health plan, not everyone is aware of what exclusions could restrict coverage for an insured individual. It is important that plan sponsors understand the details of their travel coverage and ensure the information is effectively communicated to their employees.

The contract will outline the length of coverage and if there are any overall dollar maximums, but it may not provide the necessary details to fully understand the plan’s coverage; as such, it is important that plan sponsors and employees ask the right questions.

Most employees assume their travel coverage offers protection regardless of where they travel or receive medical treatment, what they are doing at the time of the medical emergency and any pre-existing conditions*; but, that isn’t always the case.

The following are some key aspects of an emergency medical travel insurance plan that plan sponsors and employees should be aware of when understanding their coverage.

  1. Pre-existing medical conditions*
    Pre-existing conditions could exclude you from coverage under the emergency medical travel plan. Make sure you understand how a pre-existing condition is defined under your policy—would you be covered if your physician deemed you medically stable? In the case of an expecting mother, you need to understand what happens in the event that a pre-term delivery, a miscarriage or pregnancy complications occur while you were travelling. It is also important to know if the expecting mother is covered for any medical services related to her pregnancy after 30 weeks or 36 weeks or whether she is insured at all.
  2. High-risk activities
    Is a medical emergency excluded if you are participating in certain activities?  For example, would you be covered if the emergency is the direct result of a high-risk activities such as rock climbing, mountain biking, downhill skiing, parasailing, kite boarding or scuba diving? While enjoying the warm sun or the snow, you may not consider whether your travel coverage excludes these types of activities. Before you leave for your trip, be sure to check with your insurer whether coverage is excluded with these activities.
  3. Limitation on trip duration
    Check how long you can travel before your travel coverage expires. Some plans only offer coverage for trips less than 30 or 60 days. If you are going on an extended vacation, this is a very important question to ask.
  4. Are any destinations excluded?
    If you are travelling to a war zone, an area of civil unrest or any destination for which government travel warnings have been issued, coverage may be excluded. If there is any doubt that your destination may not be covered, it is recommended you contact your insurer before you depart to ensure you are covered while travelling.
  5. What do you need to do in the event of a medical emergency?
    It is very important to contact the travel insurer prior to receiving medical services to open the claim file. In addition, the travel insurer can immediately direct the insured to an approved medical facility, provide translation services and confirm the services provided with the insurance plan. If a claim file is not opened up immediately, you could risk receiving medical services from a provider that is not covered by the insurance plan or receiving services that are not insured by the plan.

Although a contract may provide many details of the emergency medical travel policy, plan sponsors should never assume that all medical services are insured or that there are no exclusions. Plan sponsors should know what they are paying for and they need to let their employees know what is—or isn’t—covered. At the very least, it is important to remind employees to look into the coverage before they leave on vacation and to contact their insurance provider should they have any questions.