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Common exclusions and limitations in visitors insurance policies in Canada

SUMMARY

Visitors to Canada should consider purchasing insurance to cover medical expenses, which can be a substantial financial burden for non-residents. However, visitor insurance policies often have exclusions and limitations, such as pre-existing conditions, non-emergency procedures, mental health care, high-risk activities, and more. Understanding these common exclusions and limitations in a visitor insurance policy is crucial for making informed decisions. 

By Ripenjeet Sandhu
Insurance Advisor, LLQP
11 min read
IN THIS ARTICLE

Medical treatments are usually expensive in Canada, especially for foreigners, since they aren’t covered under the country’s provincial healthcare plan. Visitors’ health insurance provides comprehensive coverage for visitors to Canada. However, like all insurance policies, visitor insurance comes with specific exclusions and limitations that anyone visiting the country needs to understand.

This blog will cover the most common exclusions and limitations in a visitor insurance policy in Canada, helping you make an informed decision when choosing the right plan.

What does visitor insurance cover in Canada?

Visitor insurance in Canada offers emergency medical protection for non-residents during their trip. Typically, this insurance provides coverage for some crucial healthcare requirements, such as:

  • Hospital stays
  • Emergency doctor visit
  • Ambulance services
  • Prescription medications
  • Evacuation and repatriation
  • Paramedical services
  • Other emergency treatments like dental or AD&D

The breadth of coverage ensures that visitors can enjoy their time in Canada with peace of mind, knowing they are safeguarded against the high healthcare costs in the event of unforeseen medical emergencies.

Why is visitor to Canada insurance important for non-residents?

Visitors to Canada insurance is essential for non-residents because Canada’s public healthcare system does not cover non-residents, international students, or temporary workers. 

Without this insurance, a simple doctor’s visit or a walk-in clinic could be anywhere from $100 to $600, while an emergency room or hospitalization could be as high as $6,000 per day!

Having a comprehensive visitor insurance policy ensures that non-residents have access to quality care without the fear of exorbitant bills.

Learn more about the importance of health insurance for visitors to Canada
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What are the typical exclusions in a visitors’ health insurance?

While visitor insurance provides essential coverage, several health conditions are not included. Understanding these exclusions can help avoid surprises and ensure adequate preparation for any medical situation.

1 Pre-existing conditions in visitor insurance policy

Various insurers provide the option to choose between two types of plans – one that covers stable pre-existing health conditions and another that doesn’t. The plans without pre-existing conditions have those health conditions as an exclusion, which will not be covered in the policy.

A pre-existing condition is any medical condition for which the visitor has received treatment or medication during a specific period before the policy’s effective date, such as chronic illnesses, heart disease, or diabetes. 

Plans that cover pre-existing conditions have higher premiums and have certain requirements like age and stability period of the condition.

2 Non-emergency procedures and visitors to Canada insurance

Since health insurance for tourists is for emergency medical only, it does not cover non-emergency procedures. This includes planned surgeries, routine check-ups, preventive care, elective surgeries (such as liposuction, cosmetic surgery, etc), holistic procedures, or any treatment that is not considered medically necessary.

3 Anything outside the “Usual, Customary, and Reasonable” in visitor insurance policy

Visitor insurance policies often exclude expenses that are not considered “usual, customary, and reasonable.”

What is meant by “Usual, Customary, and Reasonable”?

“Usual, Customary, and Reasonable” also known as UC&R refers to the standard amount that hospitals commonly charge for a particular service within a specific geographic area. 

Insurance companies maintain a database of UC&R for various provinces and review the claims based on it. If the claim is excessively higher than the standard cost of the treatment, they will not provide coverage for it.

For instance, if the cost of a kidney stone surgery is around $1,000 in Ontario as per the UC&R rate and your hospital charges $2,000 for the same procedure, you’ll not receive coverage for the treatment.

4 Diagnostic tests covered in health insurance for visitors

Many visitor insurance policies limit or exclude coverage for diagnostic tests unless they are directly related to a covered emergency. This means that tests for routine monitoring of a condition or tests deemed unnecessary by the insurer may not be covered.

Some routine diagnostic tests that are generally not covered by visitor insurance policies include magnetic resonance imaging (MRI), computerized axial tomography (CAT) scans, ultrasounds, biopsies, etc.

These tests may only be covered in extreme scenarios for example, if the tests are performed immediately after an emergency hospitalization.

5 Pregnancy and maternity care under visitors to Canada insurance

Except for emergencies, pregnancy, and maternity care are typically excluded from visitor insurance policies unless explicitly stated otherwise. 

Even in cases where some coverage is provided, it is usually limited to emergency situations related to pregnancy and does not cover regular prenatal or postnatal care.

6 Mental health care and visitors' health insurance

Mental health services, including counseling, therapy, and psychiatric care, are often excluded from visitor insurance policies. If coverage is provided, it is usually limited to emergency psychiatric care.

7 Drugs and alcohol-related illnesses and injuries in visitors to Canada insurance

Incidents or illnesses resulting from chronic usage of drugs, alcohol, or other narcotics are generally excluded from visitor insurance coverage.

This includes injuries sustained while under the influence and severe medical conditions that may have been linked to drug or alcohol abuse even before the commencement of the coverage period.

8 Self-inflicted injuries as a part of medical insurance for visitors

Self-inflicted injuries, including those resulting from attempted suicide or any form of self-harm, are typically excluded from visitor insurance policies. These exclusions also extend to injuries sustained from reckless behavior or intentional harm. 

Some insurance companies may provide partial coverage if there is medical evidence that the injury was a result of a mental health illness.

9 High-risk activities and health insurance for visitors

High-risk activities such as extreme sports (skydiving, scuba diving, bungee jumping), motor racing, and mountaineering are often excluded from visitor insurance coverage. 

However, Tugo offers a Sports and Activities Coverage add-on that can provide substantial coverage if you participate in some high-risk activities. The company is willing to cover reasonable and customary expenses if an acute medical emergency arises while participating in activities listed within its benefits section.

These include high-risk adventures like mountaineering, paragliding, scuba diving, white water sports, boxing, snowboarding, downhill mountain biking, and more.

Read our recommendations for the Best Medical Insurance for Visitors to Canada

Other common exclusions for visitors to Canada health insurance

  • War and terrorism: Injuries or illnesses resulting from acts of war or terrorism are typically not covered
  • Ignoring medical advice: Any emergency that occurs or recurs after medical advisors recommend that the foreigner return home following emergency treatment and the visitor chooses not to, is excluded
  • Non-compliance with prescribed treatment: Not following recommended or prescribed therapy or treatment can void coverage
  • Aviation-related activities: Any death or injury sustained while piloting an aircraft, learning to pilot an aircraft, or acting as a member of an aircraft crew is excluded
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What are the limitations of visitors’ insurance policies?

In addition to exclusions, visitor insurance policies also come with certain limitations such as coverage limits, waiting periods, restrictions on specific health conditions, or limitations when it comes to partner hospitals that restrict the scope of coverage.

  • Coverage limits: There are often maximum amounts the insurance will pay for a covered medical service. Coverage limits can range from $150,000 in the case of Manulife to $500,000 in the case of Allianz or Tugo. Companies like RIMI-Secure Travel and MSH International offer coverage as high as $1,000,000. Once this limit is reached, the visitor must cover any additional costs
  • Waiting periods: Most insurance companies have a waiting period on their visitor health insurance policy that generally varies from 48 hours to 8 days. However, the waiting period does not apply to claims related to accident/injury – clients are covered for accidents/injuries from the moment of purchase, except for Travelance which imposes a 24-hour waiting period for accident/injury as well.
  • Restrictions on specific ailments: Policies may limit coverage for certain conditions or treatments, particularly if they are deemed high-risk or require specialized care
  • Limited network hospitals: Some insurance plans only cover treatment at specific hospitals or clinics within a designated network. Seeking care outside this network may result in reduced coverage or a complete denial of claims

What medical conditions should be mentioned when getting visitor health insurance for parents in Canada?

When you’re getting medical insurance for parents in Canada, it’s essential to mention any chronic illnesses, past surgeries or hospitalizations, and even mental health conditions to ensure proper coverage. Key conditions that you must disclose include:

  • Chronic conditions: Conditions like diabetes, hypertension, asthma, or heart disease, which require ongoing treatment or medication
  • Recent surgeries or hospitalizations: Any surgeries, hospital stays, or significant medical procedures in the past year
  • Respiratory issues: Conditions like chronic obstructive pulmonary disease (COPD), bronchitis, or other breathing-related illnesses
  • Cardiac conditions: Heart conditions, including heart attacks, arrhythmias, or strokes
  • Kidney or liver diseases: Chronic kidney disease, liver conditions, or any issues requiring regular treatment
  • Mental health conditions: Depression, anxiety, or any psychological treatments that are ongoing
  • Cancer: Any history of metastatic cancer, including remission status
  • Bone or joint issues: Conditions like arthritis or recent bone fractures

Learn more about Super Visa insurance for parents and grandparents

Can you be refused visitor to Canada insurance?

Yes, you can be refused to avail the visitors to Canada insurance based on various factors, such as any undisclosed pre-existing medical conditions, high-risk health profiles, or advanced age. 

Insurers may also deny coverage if applicants have a history of severe illnesses or require ongoing treatment that poses a significant risk. Additionally, people who live in rehabilitation centers, or old age homes or require assistance with conducting day-to-day activity may also be denied coverage.

Tips for choosing the right insurance policy in Canada

Choosing the right visitor insurance policy in Canada is all about tailoring the coverage to fit your unique needs and circumstances. Start by assessing your personal health and any pre-existing conditions, as well as the activities you plan to enjoy during your stay.

Also, consider the length of your visit—whether it’s a short trip or an extended stay, having the right level of coverage can protect you from unexpected medical costs, giving you the freedom to explore Canada without financial worry.

To get a customized plan with the best prices, connect with an insurance expert at PolicyAdvisor. We’ll help you find a one-stop solution for all your visitors’ insurance needs!

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Frequently asked questions

What should visitors do if their insurance policy has a significant exclusion?

If a policy has a significant exclusion, visitors should consider purchasing supplemental coverage or a different policy that provides the needed protection. It is also advisable to review exclusions thoroughly before purchasing a plan.

Are there any policies that cover all types of medical care without exclusions?

No policy covers all types of medical care without exclusions. All insurance plans come with specific exclusions, but some may offer more comprehensive coverage than others. It is essential to compare policies and choose one that provides the best balance of coverage and cost.

How can visitors get coverage for high-risk activities?

Visitors participating in high-risk activities should look for specialized insurance plans that offer coverage for such activities. Some insurers such as Tugo provide optional add-ons to cover extreme sports or other high-risk activities.

What steps should be taken in case of a medical emergency if the insurance policy has limitations?

In case of a medical emergency, visitors should immediately contact their insurance provider to understand the coverage and limitations. They should also follow the prescribed steps in their policy for emergency situations to ensure maximum coverage and avoid claim denials.

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KEY TAKEAWAYS

  • Non-residents in Canada should have visitor insurance to avoid high out-of-pocket medical expenses, as they are not covered under Canada's public healthcare system
  • Visitor insurance policies typically exclude pre-existing conditions, non-emergency procedures, mental health care, high-risk activities, and more
  • Policies often have coverage limits, waiting periods, and restrictions on certain ailments or treatments
  • To find the best insurance, assess personal needs, consider the length of stay, and consult with insurance brokers to secure comprehensive and appropriate coverage

By Ripenjeet Sandhu
Insurance Advisor, LLQP

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