Travel Health Insurance (Word Problems) Flashcards
Understanding Travel Health Insurance via word problems.
What does OHIP stand for?
Ontario Health Insurance Plan
Who is eligible to be covered by OHIP?
Ontario residents
When is someone eligible to be covered by OHIP?
After establishing a three month residency
How long will OHIP provide continuous coverage during a temporary extended absence?
212 days
How much will OHIP pay out of country?
Maximum daily payments for emergencies are $50 outpatient services, $200 inpatient care, $400 inpatient care in an operating room or specific specialty care units
What are the three ways to obtain Travel Health Insurance?
- Government Health Insurance Plans (GHIP)
- Group Insurance Plans
- Private Travel Plans
Who are the most common buyers of Group Insurance Plans?
Employers
What kind of costs does Travel Health Insurance pay for outside the insured’s country of residence?
Reasonable and customary costs
What are the two main types of Outbound Insurance policies that are available?
- Single Trip Daily Plan
- Multi-Trip Annual Plan
Who needs Expatriate Insurance?
Canadian citizen residing outside of Canada for an extended period of time
What is a Top-Up?
A Single Trip Daily Plan purchased when the duration of a Multi-Trip Annual Plan ends
When does Travel Health Insurance pay when other policies are available to provide coverage?
All other coverage is primary
When does coverage begin for a Single Trip Daily Plan?
When the insured leaves home
When does coverage begin for a Multi-Trip Annual Plan?
Every time the insured leaves home
When is the premium for a Travel Health Insurance policy required?
Before the policy is bound
When does coverage end for Single Trip Daily Plan?
Insured returns home or number of days purchased has expired
When does coverage end for annual Multi-Trip Annual Plan?
Every time insured returns home, number of days purchased has expired, policy term ends
How long is the automatic extension of the Travel Health Insurance policy?
72 hours
What are the three reasons an automatic extension will be granted?
Emergency involving the insured, common carrier delay, weather related delay
What is the maximum time a policy can be extended?
212 days total
Under what circumstances can a trip be extended?
If no new medical condition has developed
Who is Visitors to Canada Insurance for?
Landed immigrants, refugees, international students, and workers, or those visiting the country
What are two exclusions in a Visitors to Canada Insurance policy?
Pre-existing conditions and sickness within 48 hours
What is the requirement following a Travel Health Insurance claim?
Call Emergency Assistance Hot Line first
Who is a snowbird?
Canadian aged 55+ who spend 31+ consecutive nights outside Canada
Is there a limit on how much will be paid for private duty nursing?
Up to a stated maximum
What expenses will be paid when the insured dies on vacation?
Repatriation, cost to prepare body, cost to have someone identify and release body
Will Emergency Medical pay for the cost to bring the insured home because of an insured medical condition?
Yes
Will Emergency Medical pay to bring someone to the bedside of a hospitalized insured travelling alone?
Yes
Will Emergency Medical pay to return a child home if they are traveling with an insured that is hospitalized?
Yes
When does the policy provide Emergency Medical coverage?
When not covered in full by GHIP
What is covered under Excess Hospital & Medical?
Hospital accommodation and physician services
What is covered under Extended Health Care?
- Private duty nursing
- Prescribed medication
- Diagnostic tests
- Medical appliances
- Local and air ambulance
- The services of other medical professionals
What is covered under Emergency Dental?
Costs associated with a direct accidental blow to the mouth
What is covered under Coming Home?
Cost of being returned to your province for immediate medical attention at the recommendation of the attending physician
What does Out of Pocket Expenses pay for?
Costs of the insured and travelling companion when the insured is hospitalized such as:
- Telephone charges
- Meals
- Hotel stays
- Taxi trips
Is scuba diving covered?
No
What is a pre-existing medical condition?
A sickness, injury, or medical condition which existed on or prior to the effective date or any departure date
What makes a pre-existing medical condition unstable?
A sickness or injury that would cause an ordinarily prudent person to expect to need medical treatment or investigation following departure
What do the time periods used to determine stability rely upon?
Insured’s age
Is coverage available for medical expenses resulting from an unstable pre-existing medical condition?
No
Is diagnosis of a pre-existing medical condition necessary for the condition to be excluded as unstable?
No
How do travel insurers deal with and underwrite pre-existing medical conditions?
May require a deductible or charge additional premium
What coverage reimburses the traveler the non-refundable prepaid portions of a trip if it has to be cancelled due to a medical emergency prior to departure?
Trip cancellation
What coverage reimburses the traveler the non-refundable prepaid portions of a trip if it has to be cancelled due to a medical emergency in the midst of the trip?
Trip interruption
What does Flight Accident cover?
Death or loss of limb or sight due to an aircraft accident
What is covered under the Emergency Medical coverage?
- Excess Hospital & Medical - Pays for hospital accommodation and physician services in excess of the limit in which GHIP allows.
- Extended Health Care - Pays for private duty nursing (up to a stated maximum), prescribed medication, diagnostic tests, medical appliances, local and air ambulance, and the services of other medical professionals.
- Out of Pocket Expenses - Pays for additional costs of the insured and travelling companion when the insured is hospitalized such as telephone charges, meals, hotel stays, and taxi trips.
- Childcare Attendant - Pays for the cost of a child care attendant to care for the children who were accompanying the insured while travelling when the insured is hospitalized.
- Coming Home - Pays for the cost of being returned to your province for immediate medical attention at the recommendation of the attending physician.
- Emergency Dental - Pays for costs associated with a direct accidental blow to the mouth.
- Transportation to the Bedside - Pays for round trip economy airfare and accommodation for any one spouse, parent, child, or sibling to be with the insured who is hospitalized.
- Return of Deceased - Pays for repatriation of the insured’s body in a standard airline container, the cost to prepare the body, and to fly someone to legally identify and release the body.
What is a covered event for Trip Cancellation & Interruption
- A personal or family situation such as death or sudden medical emergency.
- Being called to service such as the military or jury duty/being subpoenaed.
- Being quarantined.
- Canadian government issues a travel advisory after insurance was purchased.
- Severe weather delays.
What does Baggage coverage cover?
Loss or damage or delay in baggage and property an insured uses on a trip
What else besides unstable pre-existing medical conditions may be excluded from the Emergency Medical portion of the travel policy?
- Any sickness or injury that occurs while the policy is not in effect.
- Any sickness or injury that does not relate directly to an emergency.
- Expenses due to trip interruption when caused by a situation that the insured knew before leaving would make it unlikely to complete the trip as booked.
- Expenses due to trip cancellation or interruption when the purpose of the visit was to visit a person who is ill.
- Medical treatment when the policy is sought specifically for the purpose of obtaining treatment, whether or not it is recommended by a physician.
- Pregnancy, childbirth, miscarriage, or any complications due to pregnancy occurring within eight weeks of the expected delivery date. Some policies totally exclude any costs related to pregnancy.
- Suicide or self-inflicted injury.
- War or terrorism.
- Any air travel, unless as a passenger in a commercial aircraft licensed to carry 6+ passengers.
- Continuing medical treatment if the insured is medically fit to return home.
- Expenses incurred if the insured chose to travel to a region where there is a travel advisory.
- Expenses incurred without promptly advising the Emergency Assistance Hot Line, unless the treatment is deemed critical, may result in reduction of benefits.
- Sporting Activity Exclusions (Falling, swimming, going under)
