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Name: William Shung
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Visitors to Canada Emergency Medical Insurance Claim Examples

Every year we welcome countless visitors to Canada. These visitors may be visiting for various reasons under a variety of visas. The most common reasons and visa used to visit Canada include:

Tourists and family visits (single or multiple entry visas)
Parents and grandparents (multiple entry or super visas)
Students (IEC visa or student visas)

These visitors are not covered under Canada’s universal health care system – meaning the Canadian government does not pay for any hospital or medical services which are used by visitors due to a medical emergency.

The Government of Canada and all provinces/territories advise visitors to Canada to purchase the necessary emergency medical coverage they require while visiting. Read more about why you need travel insurance the next time you visit Canada.

Below we share some real-life claims to illustrate the importance of purchasing adequate emergency medical insurance when visiting Canada.

Claim #1

A 74-year-old visitor to Canada insured was experiencing back pain three months after his coverage start date. He went to a walk-in clinic for medical attention and was diagnosed with sciatica. The Physician prescribed 10-days of anti-inflammatory medication and recommended physiotherapy. The claims documents supported the condition as a new, unforeseen condition occurring after the effective date.

The following expenses were paid:

the Physician visit,
the prescribed medication, and
the policy maximum of $500 for physiotherapy.

Claim #2

A 30-year-old insured purchased the Travelance VTC Essential Plan more than one year after his arrival to Canada. As the policy was purchased after arriving in Canada, a waiting period of 24 hours is applied for injury and 7 days for sickness. The claim documents were submitted and the information indicated the insured sustained an injury causing damage to his teeth, three days after the start date of the policy. The Claims Department requested the medical records, which confirmed the injury occurred outside the waiting period.

The following expenses were paid:

the initial consultation,
root canal, and
crowns up to the benefit maximum of $2000.

Claim #3

A 65-year-old visitor to Canada began experiencing symptoms of a urinary tract infection, two months after the start of the policy. She purchased the Essential Plan with coverage for $25,000. She received treatment in the emergency room and was prescribed medication for the infection. The blood work revealed the insured had diabetes. The insured was referred to a physician for treatment of the diabetes. At this follow-up visit, medication was prescribed.

The insured submitted a claim, and the following expenses were paid less the deductible:

services in the emergency room,
the follow up visit, and
medication costs (up to the 30-day supply).

Claim #4

A 59-year-old patient purchased a Travelance VTC Essential Plan. During the period of coverage, the insured began experiencing high blood pressure. The medical records showed the insured suffered from hypertension and was on prescribed medication for this condition previously.

The claim was denied, as there is no coverage under the Essential Plan for any pre-existing condition that exists during the 180-day period prior to the start date.

Since the insured was on medication for high blood pressure during this period, the condition is considered pre-existing and therefore not covered by the policy.

Claim #5

A 64-year-old visitor to Canada insured who purchased the Essential policy with coverage for $25,000, was a passenger in a car, when the car was t-boned by another car. Ambulance and Police attended the scene, and the insured was transported to the hospital. The insured sustained multiple fractures and internal injuries. The insured underwent multiple scans to assess the injuries and had surgery to repair a broken leg. She was hospitalized for a week.

The policy is secondary to other coverage including auto insurance coverage. The claim was submitted first to the auto carrier as the primary insurer. The Assistance Company stayed in touch with the family during the hospitalization, and after discharge, the family followed up with claims documentation to the Claims Department. The Claims Department confirmed the insured was eligible for the policy they purchased.

The policy provided coverage for expenses not covered by the auto policy including scans and tests up to the policy maximum of $25,000.

Claim #6

A 53-year-old visitor to Canada insured who sought medical attention for abdominal pain and was diagnosed with gallstone pancreatitis. She had purchased a VTC Premier Plan with coverage for $100,000. She was hospitalized for 12-days and underwent multiple surgeries due to complications. The Assistance Company managed the medical case. The procedures the insured had were emergent and deemed medically necessary. During the Assistance Company’s management of the case, the insured’s history of Coronary Artery Disease and a lung condition for which an inhaler was prescribed for use on a daily basis was noted. The Assistance Company alerted the hospital and the insured that the insured did not appear to be eligible for coverage. The Medical Eligibility Questionnaire completed at the time of purchase asks about the insured’s history relating to these conditions. The insured answered ‘no’ to the questions relating to her medical history. She should have answered ‘yes’ to these questions based on her medical history. This history made the insured ineligible for coverage, and the claim was denied. The family appealed this decision noting that while the insured was prescribed an inhaler for daily use, the insured did not follow the prescribed treatment. This did not impact the eligibility review because the fact is, it was prescribed for daily use even if the insured did follow the recommended treatment.

These two conditions in the medical conditions table rendered the insured ineligible for the policy, and the expenses related to the hospitalization were not covered, even though they were unrelated to her reason for claiming. This is because she was not eligible to purchase the policy in the first place.

Her premium was refunded as she was not eligible for the policy and the insured was responsible for her medical costs.

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Claim #7

A 56-year-old visitor to Canada insured who sustained a fractured leg when she tripped while on a walk during her coverage period. She was insured under a VTC Essential Plan with coverage for $100,000. The family promptly notified the Assistance Company and an assistance case was opened. She did not require surgery, however, remained hospitalized for 16-days during her coverage period. The family kept the insured hospitalized for rehab care, even though they were informed that rehab care would not be covered. They were informed that acute care to treat an urgent and emergent condition is covered under the policy, but not rehab care. The hospital bill was $83,000.

The family submitted a claim for the full hospital cost. The insured was eligible for the policy she purchased.

The policy provided coverage for hospital costs and associated covered expenses for urgent and emergent care for $41,000.
The outstanding balance of $42,000 was the patient’s responsibility.

Claim #8

A 64-year-old visitor to Canada insured was diagnosed with COVID-19/pneumonia during his coverage period. He was insured under a Premier Plan with coverage of $100,000. His family contacted the Assistance Company. He was hospitalized, transferred to another hospital for ICU care, then back to the original hospital when he was stable. The Assistance Company oversaw his care ensuring it was appropriate.

In total his hospital stay was 24-days. His daily hospital rate not including labs, tests, or investigations was $4,100 per day. The bills exceeded $200,000

He was eligible for the policy he purchased, his claim was paid for policy maximum of $100,000.

Claim #9

A 71-year-old visitor to Canada insured who purchased the Premier Policy with coverage for $100,000, was hospitalized after complaints of chest pain and shortness of breath. She was diagnosed with a heart attack. She was transferred to a specialized hospital for left heart catheterization and multiple stent placements. She was then transferred back to the original hospital where she developed pneumonia and complications. The case was managed by the Assistance Company ensuring treatment was appropriate. Her hospital costs were $78,000. The Assistance Company recommended she return to her home country to continue treatment (once she was stable and able to do so) due to limited coverage and expected continued treatment. The insured agreed. Her return flight home required a medical escort. Claim documents were submitted by the family and the claim was deemed payable.

The insured’s deductible was waived due to her hospitalization in excess of 72 hours. The insured’s condition was not pre-existing, there were no applicable exclusions and she was eligible for the policy she purchased.

The hospital bill and return home expenses were paid up to a policy maximum of $100,000.

Claim #10

A 68-year-old visitor to Canada insured who had purchased a Premier Plan for a period of six months of coverage. She extended her policy before the expiry date of her original policy for an additional three months of coverage. Three days after her extension, she experienced difficulty breathing and was diagnosed with a spontaneous pneumothorax. Her medical history was obtained by the Assistance Company. It was determined that at the time she extended her policy, she had no symptoms of this condition. The Assistance Company followed up with her care during her three-day hospitalization.

Her hospital stay in a ward bed was $5,100 per day. She submitted claim documentation and it was determined that she was eligible for the policy she purchased. The following expenses were paid:

Her hospitalization was $24,000.
Her follow up care was paid to the maximum benefit of $3,000.

What Does Travelance offer for Visitors to Canada?
Travelance offers two plans for emergency medical insurance for visitors to Canada, to help financially protect against sudden and unforeseen medical emergencies while visiting Canada. Coverage is available from 15 days to 85 years of age, up to a maximum of 558 days.

Visitors to Canada Emergency Medical Insurance Essential Plan – This plan is for individuals who are in good health and are seeking an affordable plan option.

Visitors to Canada Emergency Medical Insurance Premier Plan – This plan builds on the VTC Essential Plan, providing additional and updated coverages, as well as offering some coverage for pre-existing conditions.
To learn more about the plans available and to compare coverage options, visit: https://www.travelance.ca/products/visitors-canada-insurance/

Both plans are super visa eligible!
When purchased according to current Canadian Government requirements, both plans fulfill the requirements of the mandatory insurance requirements of the super visa.

Call your licensed insurance broker for a quote!
To learn more about how purchasing a Travelance Visitors to Canada Emergency Medical Insurance can help financially protect you against sudden and unforeseen medical emergencies, contact your licensed insurance broker, today!

Looking for a licensed insurance broker in your area?