What Your Policy Does NOT Cover
All policies have exclusions, you must be aware of them.
Travel medical insurance provides coverage for losses from unexpected, sudden, medical emergencies due to an accident or a sickness. There are some circumstances in which you will have an accident or get sick and NOT be covered by your policy. The exclusions vary by policy so read your policy to be sure. The exclusions can be found in your policy in sections such as, “Exclusions,” “What Is Not Covered,” “General Limitations,” and “General Provisions.” Here is a summary of some (but not all) of the things NOT covered by most policies:
1. Unstable pre-existing condition
If you have a pre-existing medical condition, regardless of whether or not it appears on the medical questionnaire, it must meet the required stability period as stated in the policy. Stability periods are typically 90, 180, and 365 days but they vary by policy. You should read the definition of “stable” in your policy. Typically, to be considered stable prior to travel, you cannot have any change to your pre-existing medical condition and you cannot have any change in the treatment of that condition. Your stability will be affected if, in the required stability period, you are prescribed new medication, a change in the type of medication, a change in the dosage, or a change in the frequency you take your medication. This applies to a decrease or stoppage of a medication because you’re getting better. A change is a change and this affects your stability and whether or not the medical condition will be covered.
New symptoms, diagnostic tests, and undiagnosed medical conditions all affect your stability. For example, undiagnosed chest pains will be considered a heart condition until a heart condition is ruled out. If your medical file indicates you delayed medical treatment because you were about to travel or you require diagnostic tests or surgery in the future, your condition will not be covered.
2. Abuse of prescribed medication.
This includes failure to take your prescribed medication or taking the wrong dosage.
3. Abuse alcohol, drugs, or other intoxicants.
For example, if you’re over the legal limit for alcohol use, even if you are in your own home, and you have an accident, sickness, or injury, you will not be covered by most policies.
4. Suicide, attempted suicide, or self-inflicted injuries.
5. Emotional, psychological, or mental disorders or symptoms.
This usually includes anxiety and depression.
6. Criminal acts.
For example, you commit a felony and have a medical emergency. None of us intend to commit a felony but consider this scenario: You’re driving somewhere in a hurry, you go through a yellow light turning red, and you hit a pedestrian. In your attempt to miss the pedestrian, you crash your car and are injured. If you’re charged with careless or dangerous driving, you may not have coverage.
7. High-risk activities.
Most policies list activities that you cannot participate in if you want to have coverage for an accident or sickness. These activities include body contact sports, parachuting, parasailing, hang gliding, mountaineering, bungee jumping, and scuba diving.
8. Travel to some countries , regions, or cities in the world.
If, prior to your departure, a travel warning is issued by the Government of Canada (Global Affairs, Foreign Affairs, Trade and Development Canada) to avoid travel to a country, region or city, you should change your travel plans. If you elect to travel there and you have an accident, sickness, or injury, that is related to the reason for which the warning was issued, you will not be covered.
9. Your refusal to be medically evacuated to Canada.
If you have a medical emergency and the assistance company elects to return you to Canada for treatment, you must agree to return to Canada. If not, all further medical expenses will be your responsibility.
10. Recurrence or complication of a medical condition.
If you have a claim while travelling, once your condition is successfully treated, or are out of the hospital, and you no longer need medical care, a recurrence or complication of the condition will probably not be covered. The assistance company involved with your initial claim will inform you that coverage for that condition will terminate and you will be advised to return to Canada. If you elect to stay out of Canada, and there is a recurrence or complication, there will be no coverage.