Health emergency while travelling: Are you covered? - Sherbrooke Record
By R. A. GarberEmergency medical insurance while travelling didn’t use to be a concern for me. But then I attended a retreat abroad where having such insurance coverage was obligatory. Piece of cake. I had a. . .
By R. A. GarberEmergency medical insurance while travelling didn’t use to be a concern for me. But then I attended a retreat abroad where having such insurance coverage was obligatory. Piece of cake. I had a supplementary health insurance plan from my job, which information I confidently submitted. A few years later, I discovered this plan had stopped covering travel emergency medical care when I turned 70. Oops!Last week, I told a visitor from British Columbia that Quebec medicare coverage was fully portable across Canada, just like that of other provinces. Then I read an article by Charles Shaver in The Record, and registered a similar “oops!”He wrote that “since 1984, the Quebec government has ignored Section 11 of the Canada Health Act, and is the only province that has refused to sign the Reciprocal Medical Billing agreement which covers out-of-province medical/surgical care for most Canadians. Physicians across Canada legally charge Quebecers as ‘non-residents of Canada’ with fees 2 to 5 times the rates in their provincial schedule of benefits. ”Clearly, I needed to take a closer look. What is, and is not, covered in ROC?At Quebec’s healthcare website (ramq. gouv. qc. ca), the warning is upfront and clear: Get private insurance coverage if you are travelling outside Quebec. This includes the Rest of Canada. Why? Because your Quebec health insurance card will, in most cases, get you only partial coverage. You would have to pay the total cost; you’d get only partly reimbursed later. How much you’d recover depends on several things. For example, to be eligible for coverage, Quebec residents may not be absent from Quebec for 183 days or more per calendar year, whether in another province or another country. If you are living here, but are from another country, you lose your eligibility for “the duration of an absence of more than 21 consecutive days. ”There are exceptions. RAMQ provides an online questionnaire to find out what rules apply to your situation. For residents, absences of 21 days or more, not counting travel days, should total less than 183 days per year. If you plan to be outside Quebec for longer, you need to inform RAMQ. (But once every seven years, you may exceed the 183-day limit without losing your eligibility. )Whether in a clinic or a hospital, services by doctors, dentists, and optometrists are covered if these are normally covered in Quebec, but only at the Quebec rates, even if you paid more. A professional may or may not accept your Quebec health insurance card. If they accept, RAMQ pays. If they refuse, you must pay their entire fee. You can apply to RAMQ for a reimbursement later, armed with a report and originals of your invoices and receipts. Why would a professional in Ontario, for example, not accept your Quebec health card? Because Quebec does not participate in the interprovincial reciprocal medical billing agreement, as Shaver noted last week. Also, because the Ontario Medical Association rates are considerably higher than the Quebec rates, the doctor would have to absorb a financial loss. While fees vary, for a simple doctor visit, you could pay $50 to $100, and be reimbursed only $30 to $45. But it is different for hospital services. These include nursing care, diagnostic procedures, a bed in a ward, and medications during hospitalization. RAMQ says “you are not required to pay for hospital services you receive, because their cost is paid in full by RAMQ under an interprovincial agreement regarding these services. ” Show them your health card. So that’s inside Canada. What about travelling in another country?What about outside Canada?Emergency medical coverage in another country is not dissimilar to other provinces. The biggest difference is that because of the monetary exchange rate and differences in health care systems, the fees charged may be much steeper than for similar services in Canada. Reimbursements by RAMQ do not exceed Quebec rates, even if you paid more. That makes supplementary private insurance even more important. If you have such coverage, you will ask the foreign service provider to submit the invoice to your insurance company. If you do not, you yourself must pay the fee, and apply to RAMQ for a partial reimbursement. See above for details. Hospital care (nursing, tests, a bed in a ward, medications) abroad works the same as in other Canadian provinces. For such services resulting from a sudden illness or accident, RAMQ reimburses a maximum of $100 Canadian per day in hospital, or $50 per day at a hospital outpatient clinic. For hemodialysis, reimbursement is up to $220 Canadian per treatment. The RAMQ website offers some telling examples of the gaps between the amount charged and the amount reimbursed by RAMQ. A doctor visit in Florida cost $262. 64 Canadian, of which RAMQ reimbursed $52. 53. The patient paid $210. 11. A three-day hospitalization in Florida cost $25,000 Canadian, of which RAMQ reimbursed $300. The patient paid $24,700. On top of this, $1,000 Canadian was charged for professional services, of which RAMQ reimbursed $435. For dessert, so to speak, the patient paid $565. In South Carolina, an eight-day stay in intensive care and professional services for pneumonia left another traveller with $36,133 in non-reimbursed costs. You get the picture. Another issue is that certain costs are not eligible for reimbursement. As mentioned above, this includes medical services not covered in Quebec. Also not covered are services by a health professional other than a doctor, dentist, or optometrist. A private or semi-private hospital room. Ambulance or other emergency transportation, whether by land or air. The cost of returning a patient to Quebec. Medications purchased outside Quebec, even if prescribed by a physician. See ramq. gouv. qc. ca for a detailed list of services covered, or not. Next stepsWell, I already know to ask the pharmacy before leaving for extra pills to cover my time out of province. But what about supplemental insurance coverage? I asked four of my friends, Quebecers and retirees all, what insurance they have when travelling. I was impressed when every single one said they had supplemental insurance plans, thanks to their erstwhile careers in government or business. If you do too, bully for you!I, on the other hand, had a career in the community sector. My coverage ceased at age 70, remember? So where do I find coverage now? Or do I stop travelling?I’ll share that journey with you next week. In the meantime, wherever you go, remember to show your health card, for what it’s worth. 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