Group Health Insurance – Out of Country

Most healthcare benefit plans include the out of country/travel assistance benefit coverage for covered employees. This type of coverage provides insurance to employees while traveling for either personal or business reasons. Out of country benefits are paid for an employee if it is required due to a medical emergency that occurred while a covered person was traveling outside of the country for a maximum time (typically 60 to 120 days) per trip. There are variations in group contracts on what the definition of medical emergency is, however in general, it is one that results from an accidental injury or illness. Coverage for out of country expenses vary by insurer and can include:
 
  • Treatment provided by a physician
  • Diagnostic x-rays and laboratory services
  • Hospital accommodation
  • Medical and paramedical supplies and services provided during hospitalization
  • hospital and nursing services and medical supplies provided on an out-patient basis
Most plans include a lifetime maximum of $1,000,000 for out of country expenses. In addition to medical services provided, other items that are covered include ambulance services and referral medical care.
 
Ambulance services - Includes transportation by a licensed ambulance company to the nearest center where treatment is available
 
Referral medical care - Some plans provide care outside of the country for medical services not available in the country provided that the covered individual is referred by an attending physician. This coverage is typically subject to prior approval from the insurance company.
 
Travel Assistance
 
Employers are exposed to significant financial risk for employees' out of country medical expenses, as the cost of medical care can be significantly more expensive than the same services in Canada. This type of risk is controlled by managed care networks specialized in travel assistance benefits (discounted fees for increased volume). These organizations enable employers to provide cost effective out of country health coverage to their employees.
 
Under a travel assistance benefit, a covered person will be provided with a travel assistance card to carry with them when they travel abroad. In the case of illness or injury, the covered person contacts the service provider who, in turn, arranges appropriate treatment to be provided through its preferred provider network. Typically, services covered under a travel assistance benefit include the following:
 
  • 24 hour telephonic access to a representative using the provider's card
  • assistance in locating the most appropriate medical facility given the illness or injury
  • guaranteed payment for emergency medical treatment
  • arrangement for admission to a hospital
  • contact with the covered person's doctor for advice and with the insured's family and employer
  • assistance coordinating an emergency evacuation
  • arrangement of a return trip home for the insured and any covered dependents
  • arrangements for a family member to visit a covered person traveling alone and hospitalized for a minimum number of days (typically 7 days)
  • meals and accommodation for the visiting family member limited to a maximum dollar amount
  • repatriation of the remains of a covered person who dies while out of country

Category: Group Benefits