Richard Albert, President Norfolk Mobility

Group Inc.

Most people think that only long term expatriate assignments present problems in the area of group medical insurance. However, group insurance for rotational and short term travelers is an area of growing concern. 

What is the problem?

Most insurers only offer ‘emergency medical care’ outside Canada, because staff will be covered by various provincial medical plans for most basic medical, surgical and hospital services. As a result, group insurers only expect claims for supplementary expenses like ambulance, massage therapy and prescription drugs (in some provinces), plus a small amount of out-of-country exposure from vacation travel.

This coverage does not then anticipate the covered person working outside Canada for extended periods. In these situations, the provincial medical care provider normally pays what they would have been required to pay had the service been rendered in Canada. However, out-of-country costs for physician’s services, diagnostic procedures and hospital room and board typically outstrip the levels of payment that the provincial plans provide. The group benefits provider may elect to pay some or all or the remaining claim, but only under certain circumstances.

• The worker has been outside Canada for more than 60 consecutive days (the ‘short term’ assignment worker) or more than 60 days in the last 180 (rotators) .
  
• The service was not considered ‘emergency’, and we have certainly seen partial reimbursements where the insurer felt the charges exceeded ‘reasonable and customary’ standards.
  
• The claimant was being treated for an unstable ‘pre-existing condition’ and should not, in the eyes of the insurer, have ventured outside Canada.
  
• The country to which the rotational or short term assignee is sent is declared a war zone or the site of current civil unrest.
  
• The losses result from acts of war or terrorism.

So what is the solution?

1. Arrange with your insurance company for extended coverage for the entire duration of the foreign assignment:
   
   • Establish claims reimbursement on the basis of a ‘first-dollar’ plan. In other words, the insurance company would adjudicate claims as though provincial medical did not exist, and would apply to those entities for any reimbursement they are willing to make.
     
   • Negotiate coverage in all countries where you operate, regardless of local circumstances.
     
   • In order to ensure you negotiate the cover you need for your employees, carefully review time limits out-of-country, reimbursement maximums, evacuation limits, residency requirements and policy exclusions.
   
   
2. If the above cannot be negotiated, seek a blanket supplement to your group medical plan, underwritten without geographical or occupational limits and not excluding pre-existing conditions.
   
   • The supplement would automatically take the position of first payer after you are outside Canada for a specified period of time.
     
   • The plan administrator would subsequently recover whatever they could from provincial health and your group insurance provider.
     
   • The cost is reasonable and coverage is readily available from specialty underwriters like Lloyds, London.