What is Out of Country coverage?

Out of Country coverage (sometimes referred to as OoC, Out of Province or OoP) is a benefit that provides protection for employees that travel outside of their home province or outside of Canada. Depending on the insurance carriers plan design options, OoC will either be bundled with another product (such as EHB) or sold as a standalone benefit.

It is important to stress that Out of Country is not the same as trip insurance. It only covers medical emergencies and will not pay for cancelled flights, hotel stays as a result of delays or lost luggage. The definition of ‘medical emergency’ varies from carrier to carrier, but it typically means unexpected illnesses or accidental injuries. There may be pre-existing condition exclusions. It is important to review the conditions of your out of country coverage before heading overseas as resolving issues while someone is out of the country can be extremely challenging.

Out of Country components:

Unlike other group benefits, there are relatively few choices regarding Out of Country, with each carrier offering a limited selection of options. However, there are components that should be compared between each carriers OoC offering as these variables can have a significant effect on the coverage available:

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Number of days covered:

There may be a choice regarding the number of days the out of country benefit covers, but even a standard offering will cover the vast majority of trips. Between 60 and 120 days is the usual amount of days covered. Note that these are typically consecutive days (not annual limits) but there may be rules around what constitutes a continuation of the same journey. For example, returning to your home province for 24 hours but then leaving again may be considered a continuation of the previous trip.

Note that both business and personal travel is covered, and if you have family OoC coverage your eligible dependants are likely also covered under your OoC benefit.

Typically the only employees that run the risk of exceeding the number of days trip limit is business owners that are snow birds (i.e. living overseas for extended periods during the Winter). These employees should confirm that their OoC coverage will cover the duration of their time overseas or purchase additional insurance to fill any gaps in coverage.

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Students studying overseas:

Extended OoC coverage may be available for students that are studying overseas, but these are typically considered on a case by case basis. Approval should be confirmed with the groups insurance carrier before the student leaves the country. Restrictions often apply, for example coverage may only apply while the student is studying and may not cover any travel they do before or after their courses. There may also be restrictions around which educational institutions and/or countries are covered. It is worth stressing again that the Out of Country benefit only covers medical emergencies.

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Lifetime Maximum:

Out of country typically operates on a lifetime maximum basis. These maximums can be extremely high (in the millions of dollars) or sometimes even unlimited. Note that there may be other restrictions or limitations regarding what is and isn’t covered, and for how much. It is worth comparing the specifics of each carriers offerings to understand which would provide the most comprehensive coverage.

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Termination Age:

The age at which employees are no longer covered by the OoC benefit. 75 is the standard OoC term age, but some carriers may offer a higher termination age or a choice of OoC termination ages, with higher OoC rates for older employees.

Note that as with other benefits the Termination Age is applied to the employee. Dependant spouses that exceed the termination age remain covered as long as the employee is under the termination age. This can be particularly important for OoC coverage.

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Travel Assistance:

The Out of Country benefit often includes a travel assistance portion, which assists employees that are injured or sick while overseas. This assistance can include everything from locating appropriate care facilities nearby, pre-paying medical bills or helping to rearrange transport back to Canada.

It is highly recommended that employees contact the travel assistance provider as soon as possible once a claim incidence has occurred, to help ensure that the claims process is a smooth one for all parties. The number is usually found on the employees benefit card.

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Coinsurance & Deductible:

As Out of Country coverage is intended to cover emergencies only (ie not a planned spend) they usually have 100% coinsurance, meaning the claimant is not expected to cover any % of the overall costs. For the same reason OoC usually has a $0 deductible.

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Rates:

Out of Country rates are most commonly based on a flat amount, with certificates with single coverage paying around half as much as those with family coverage. OoC is not an experience rated benefit, it is a pooled benefit. However unlike other pooled benefits OoC is pooled from first dollar, meaning that all claim amounts are pooled and none of the cost is passed on to the policyholder.

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Key Provisions:

• Pre-existing condition/Stability clause: Out of Country is intended to cover unexpected medical emergencies. For this reason there is typically pre-existing conditions or stability clauses in the OoC benefit. These can limit or prohibit OoC claims related to a known medical condition. For example, if an employee had a heart attack, and 2 weeks later went overseas on holiday and had another heart attack, this is unlikely to be covered by the OoC benefit due to this clause. This does not mean that this employee could not claim for a different medical emergency, nor does it mean they can never claim for heart related conditions again – the stability clause will outline how long an employee must be symptom and treatment free before their condition is considered ‘stable’.One common ‘condition’ caught up in the pre-existing clauses is pregnancy. There are often guidelines around at what point in a pregnancy Out of Country would no longer cover the birth of the child. This is a particularly important provision to understand as the cost of delivering and caring for a premature child while overseas can run in to hundreds of thousands of dollars.
• High risk activities: Another common exclusion is activities deemed to be high risk. A full list of these will be included in the OoC contract, but common exclusions include heli-skiing, motor sport racing or competitive sports that you are paid to compete in.