Do I have to report the claim?
Any reported claim on a policy may make it difficult or impossible to get a refund of premium if you return to your country of origin early. Therefore, if you have a claim and there is a good chance you will leave Canada before your policy expiry date, you may choose not to report the claim – especially if you have a high deductible on your policy. However, you do so at your own risk; claims reported late may not be accepted. If there is a chance that your small claim may develop into something bigger, we suggest you report it as soon as possible so that required follow-up, continuing treatment and/or complications can be considered for payment.
Do I have to have a claim form completed?
Anytime you are treated by a doctor, dentist or healthcare practitioner and plan to claim the expense, you MUST have a claim form completed by the attending physician. The claim form has two sides – one the claimant completes and one the physician completes. If you fail to have the medical service provider complete the form when you’re first treated, you will have to return to that physician later to have the form completed. Any charges incurred for the cost of completing the claim form will not be reimbursed under the policy, but when the form is completed during the initial visit, you will not usually be charged for it.
Do I have to pay the bills or will the company pay directly?
The Visitor to Canada Insurance plan is a reimbursement plan. This means that you pay the bills yourself and then seek reimbursement from the insurance company. However, on inpatient hospital claims, the insurance company will attempt to make arrangements for the hospital to bill them directly so that you do not have to pay large expenses yourself. Whether or not the hospital will directly bill the insurance company depends on several factors:
- The length of your stay: If you are in and out of hospital within a couple of days, the hospital may insist that you pay yourself before they will discharge you.
- The complexity of your claim: More complex claims may require medical history from your home country and/or additional medical reports from the attending physicians here in Canada (to verify eligibility or to rule out questions about pre-existing medical conditions). Sometimes these necessary steps mean that the insurance company is not able to immediately verify whether or not the claim will be payable. If there is any doubt about whether the claim will be payable, the facility will often require you to pay your bill and you must submit the paid bills to the insurance company so you can be reimbursed.
- The facility you are treated in: Some facilities demand that a deposit is paid by nonresidents before they will proceed with major medical procedures. In these circumstances, contact the Emergency Assistance company to discuss your circumstances. In some cases, we may be able to arrange to advance the required deposit on your behalf. If the claim ends up being denied, you would have to repay that deposit.
Who does the insurance company send the cheque to?
Normally, we pay the insured person who has received the medical treatment. If this insured person wants to designate that payment to be made to the sponsor, this must be indicated on the claim form