If you are a visitor to Canada or an International Experience Canada (IEC) visa holder and want to understand how to make a travel insurance claim, we've got you covered!
Get the answers to many frequently asked questions about claiming, including when you can claim on your travel insurance, what documents you need for a health insurance claim, how long an insurance claim takes, and more, starting with what a visitor insurance policy typically covers.
What is Typically Covered by a Visitors to Canada Insurance Policy?
Visitors to Canada and IEC insurance policies typically do not provide the same coverage as the governmental health care plan you have in your home country. Visitors to Canada insurance policies are intended for accidents and emergencies, not non-emergency or routine care situations.
Though visitor policies are for emergencies, there are insurance plans suitable for a range of people, including:
Insurance policies covering stable pre-existing medical conditions
Insurance policies with coverage for winter sports
If you do not have an insurance policy for your visit to Canada, you can use an insurance comparison tool to generate a quote and quickly compare travel insurance options.
Travel Insurance Claims
We are going to cover the entire travel insurance claim process. Highlighting information such as when you can claim, how long you have to make a claim, what the required documents are for a claim, how long it may take for you (or your treatment centre) to receive a claim payment, and if it is possible to cancel an insurance claim.
Making a Travel Insurance Claim
1. When can you make a claim on your travel insurance?
Your travel insurance does not cover all situations. There will be exclusions, conditions, and limitations. You must read and understand your policy to know what is included and excluded in your insurance.
Many visitors to Canada or IEC insurance policies do not cover:
Injuries as a result of drinking or taking drugs
Reckless behaviour resulting in an injury
Normal pregnancies
Regular check-ups
Sports injuries (unless you buy a policy covering that sport)
Pre-existing medical conditions (unless you buy a policy covering your stable pre-existing medical conditions)
Your visitors to Canada or IEC insurance policy is for sudden and unexpected situations, not follow-up, routine or recurrent care. So treatment or surgery which could reasonably be delayed may not be covered in the event of a claim.
If you have a medical emergency and need help, medical treatment or hospitalization, you, or someone on your behalf, must contact claims assistance as soon as possible, ideally before seeking treatment.
Where to go for treatment
In Canada, there are different treatment centres that you can visit, depending on the nature of your medical issue.
2. Where to go for treatment?
In Canada, there are different treatment centres that you can visit, depending on the nature of your medical issue.
| Treatment Centre | When to go there | Medical Examples |
|---|---|---|
Walk-in Clinic | When you are experiencing a minor or mild health issue. | Cold
Flu
Minor cuts and bruises
Upset stomach
Infection
Rashes |
Urgent Care Clinic | When you have a non-life-threatening condition that requires prompt attention.
You may be referred to an urgent care clinic if a walk-in clinic cannot address your condition. | Sprains and strains
Fractures
Mild difficulty breathing (including mild asthma attacks)
Cuts that may require stitches
Severe sore throat or cough
Urinary tract infections |
Hospital/Emergency Rooms (ER) | For critical, life-threatening conditions. | Chest pain or pressure
Head injuries
Seizures
Pneumonia
Severe pain
Foreign object in your body
Burns
Compound fractures
Sudden, severe headache
Sudden paralysis or weakness
Moderate or severe difficulty breathing |
Emergency rooms (ERs) in Canada have long wait lines; it could take up to 22 hours or more to wait for a hospital bed, depending on your condition. Hospitals are also more expensive than walk-in clinics.
Here are some fees taken from an Ontario hospital for non-residents in 2024:
Hospital Inpatient Fees (Intensive Care - Room Charges Per Day) - $13,506
Day Surgery Fees - From $3,336 to $43,935
CT Scan - $2,568
If there is any possibility your claim might not be covered, you should opt for a walk-in or urgent care clinic rather than a hospital.
What about online healthcare consultations?
Recently, some Canadian IEC policies, available through BestQuote Travel Insurance, have begun to include Maple telehealth, a telehealth consultation service, making health consultations easier and with less out-of-pocket costs. On October 01, 2024, BestQuote’s MedEC policy will include Maple telehealth as part of its policy benefits. If you purchase a MedEC policy after this date, you will be able to use Maple’s easy-to-use service up to three times a year for many purposes, such as getting a prescription, a note from a doctor, or medical advice without the high costs and wait times of a physical medical centre.
Find out more about Maple and other telehealth services here.
3. Do you need to pay for the claim?
Whether you pay or not upfront depends on the nature of your claim. You should contact the insurance company before receiving treatment where possible.
With high-cost claims, the insurance company tend to organize payment with the medical provider. With low-cost claims, you typically pay and submit receipts with a claim form to the administrator.
4. Should you submit your claim?
It might not be worth it to submit a low-cost claim. Because once a claim has been opened and paid, you will no longer be eligible for future refunds like an early return if you return home early. Also, if you purchased a policy with a deductible (also known as excess) to reduce the cost of the policy, that will reduce the amount you can claim by the deductible amount.
We'll use an example to explain why it may not be worth it to submit a low-cost claim. Say you buy a two-year IEC insurance policy with a $100 deductible for $1750. After two months in Canada, you go to the walk-in clinic, get prescription medication, submit $210 in receipts, and receive a $110 refund. However, you decide to leave Canada later in the year. Because a claim was submitted, you are not eligible for an early return refund that could be $800+.
So, you might not want to submit a small claim, particularly if your insurance policy permits early return refunds. In fact, many IEC travellers and visitors to Canada use a higher deductible option on their policy. It helps save money upfront, and only 1 out of 7 people end up making a claim.
5. How long do you have to make an insurance claim?
You should contact the claims administrator as soon as medically possible. If you cannot contact claims assistance yourself, someone can contact them on your behalf.
Most policies require you to notify claims assistance within 24 hours of hospitalization or an ER visit and before surgery. If you do not notify claims assistance within 24 hours without reasonable cause, you may have a delay in payment or a reduction of the eligible benefits. Typically the reduction of eligible benefits is 20%, meaning you would be responsible for paying 20% of any eligible medical expenses incurred. You could also have limited or excluded benefits.
Some policies may deny your claim if you, or someone on your behalf, do not contact claims assistance before seeking treatment.
Once you have submitted a claim, your insurance policy will highlight how long you have to report the claim and submit written proof. In general, most claims must be reported within 30 days of occurrence. Written proof of a claim is typically required within 90 days of occurrence.
How to Make a Claim
1. What documents are required for a health insurance claim?
When you make an initial call to claim, you will be told what documents are required to submit for your claim. You should provide evidence of your accident or injury and fill out a claim form detailing the medical situation.
The evidence and forms that you need to submit are claim-dependent. They can include any of the following:
A fully completed claim form
Original, itemized bills from the medical provider with the patient information and details of the diagnosis
Original prescription drug receipts
A copy of your airfare ticket and passport confirming travel dates and entry into Canada (or proof of departure and return to Canada for side trips)
Written proof of the claim within 90 days
Additional information relevant to the claim as may be required
When you submit a claim, your claims assistance provider will tell you the required documentation. The documents and information required must be submitted within your claim time limits as detailed in your policy wording. If claim information is not provided in time, it will likely result in the non-payment of your claim.
2. How long does an insurance claim take?
We're sure you’re wondering how long does an insurance company have to investigate a claim in Canada.
In general, the insurance company may take up to 60 days after receiving proof of claim to pay you (or the service provider) or deny the insurance claim. This length of time could vary depending on the complexity of a claim.
However, if additional information is required or there is incomplete information, there will be a delay in processing your claim. It is also possible that your claim could be invalidated.
To avoid unforeseen delays, check regularly for correspondence and supply all applicable evidence and information alongside your claim forms within your policy claim time limits.
Cancelling an Insurance Claim
1. Can you get a refund after submitting a claim?
Most policies only allow you to cancel your insurance policy and request a premium refund if no claim has been paid or is pending.
If you are applying for a partial refund due to returning home early, for example, you may be able to apply to have your claim withdrawn.
2. Can you cancel an insurnace claim?
Most insurance policies consider a claim submitted when an insured person or a family member contacts claims assistance. You are more likely to be able to withdraw your claim and cancel your insurance policy if you are in the earlier stages of the claim, e.g., you have only initially called to report the claim, but the claim payment is not pending or paid yet. However, this is at the discretion of your insurance provider.