Health and Insurance

As we embark on another year of retirement it is important to “plan ahead” with respect to travel arrangements. Before engaging in any travel outside Ontario, its a wise and prudent move to contact Mondial Assistance Toll-free 1-800-249-6556 before leaving the province. Any questions you may have regarding your travel destination can be resolved prior to your departure. Mondial Assistance is available 24 hours 7 days a week.

The following numbers will prove useful, should emergencies arise during your travel.

Toll free from Canada and the United States: 1-800-249-6556

Toll free from Mexico: 00-1-800-514-3702

Toll free from the Dominican Republic: 1-888-751-4403

Toll free from al other countries that participate in Universal International Toll free*: 800-9221-9221

This includes the following:

*Argentina, Australia, Austria, Belgium, Canada, China, Columbia, Costa Rica, Denmark, Finland, France, Germany, Hungary, Ireland, Israel, Italy, Japan, Korea (South), Luxembourg, Macao, Malaysia, Netherlands, New Zealand, Norway, Portugal, Singapore, South Africa, Spain, Sweden, Switzerland, Taiwan, United Kingdom.

A collect cal from any other country: 519-742-6683

Your Group Insurance Benefits

For the first time ever, the senior population is expected to outnumber that of children under the age of 15 at some point between 2015 and 2021. In addition, over one-quarter of Canadians provided care to a chronically ill, disabled or aging family member or friend in the last 12 months. (Statics Canada) Here is the question. Caregivers need help – Who helps the helper? Did you know that we have a new enhancement in our Extended Health Care Benefits? That enhancement, Eldercare Select, answers many caregiving challenges faced by our members. It offers:

As well, there is support for several key areas. These include the following.

To learn more about this enhancement be certain to mark your calendar for the Annual Meeting on October 15. Jason Hutton of First Health Care will address our group on this new addition to our Extended Health Care Benefits.

RTO/ERO’s Extended Health Care (EHC) Plan

Most members and dependents participating in RTO/ERO’s Extended Health Care (EHC) Plan know that they automatically have $1,000,000 per person/trip travel coverage under this Plan. Are you as familiar with the details of your coverage, what services are available prior to your trip, and what to do in a medical emergency?

If you participate in the RTO/ ERO EHC Plan, you have coverage for an unlimited number of trips, each up to 62 days in duration. This includes trips outside of Canada, or simply outside of your province of residence, and coverage is available under RTO/ERO’s Supplemental Travel Plan for longer trips.

As part of the Out-of-Province/ Canada travel benefit under the EHC Plan, there’s coverage for:

Emergency medical expenses – hospital, physician and lab costs, air ambulance – to enable you to return home, additional hotel and meal expenses – during a hospitalization, transportation to the bedside – to bring a family member to the hospital if you are travelling alone, return of dependent children (including grandchildren) with an escort – should (grand)children need to come home during your medical emergency, repatriation – should your remains need to be returned, vehicle return – if you are brought home by air ambulance or by commercial flight with an escort, your vehicle will also be brought home, guide dog return – if you are brought home by air ambulance or by commercial flight with an escort, your guide dog will also be brought home, emergency accidental dental – for emergency dental expenses related to an accident, and Trip cancellation/interruption and delay!

In addition, you have the ability to access the following services in an emergency:

Emergency message centre – to relay messages to your family at home,

Emergency legal referral – any legal costs would not be covered,

Emergency translation services – to help you communicate,

Lost document and ticket replacement – any costs to replace these documents would not be covered.

What should you do before you travel?

Become familiar with your insurance coverage and the limitations of RTO/ERO’s policy. If you’re travelling with a medical condition, make sure you meet the stability requirements under RTO/ERO’s EHC Plan. The intent of the EHC Plan is to cover sudden and unforeseen medical emergencies. An emergency related to that condition while on your trip would not be covered. We would suggest that you contact the RTO/ERO travel assistance provider, Mondial Assistance (formerly named World Access Canada), as you may be eligible for trip cancellation coverage.

Check your trip dates. The out of- province/Canada travel benefit under the RTO/ERO EHC Plan includes coverage for trips up to 62 days in duration. This coverage begins on the day you leave your province of residence. This is important to remember, as travellers can be caught off guard, if travelling first to a location outside of their home province, then outside of Canada. An example is someone travelling from their home in Ontario to Manitoba for seven days before heading out on their bus trip into the United States, scheduled to last for 60 days. In total, this is deemed as 67 days of consecutive travel, which is over the 62 days permitted on any one trip under the EHC Plan. To ensure coverage for the entire duration of the trip, the Member should purchase an additional five days of coverage under the RTO/ERO Supplemental Travel Plan.

Let your travelling companion know where you keep your RTO/ERO Group Benefits ID Card and the Out-of-Province/Canada travel booklet, in case they need to contact Mondial Assistance on your behalf in an emergency.

Before you travel, you can call Mondial Assistance for pre-trip planning assistance. Mondial is able to provide you with useful information such as travel advisories for the region(s) to where you are travelling, required inoculations and visa requirements. They can also advise you how to call them from a particular country and provide you with the international phone number(s) for the different countries you will be visiting. Mondial offers assistance 24 hours a day, seven days a week, 365 days a year – they never close.

In a Medical Emergency

In a life-threatening medical emergency, seek immediate medical attention. When you get to the hospital (or as soon as is reasonably possible within 48 hours), contact Mondial Assistance. In other situations, contact Mondial Assistance before you seek medical attention.

A few things you’ll be asked when you speak with a Mondial Assistance representative:

Details of the emergency and the type of assistance you require;

Member’s full name, group/plan number, certificate number;

Patient’s name; Patient’s provincial health insurance number.

They can assist you by offering a referral to an appropriate facility and making the billing arrangements with the provider to ensure you receive appropriate care, and that you’re not out-of-pocket for these expenses. Mondial’s in-house registered nurse support, along with on-call physicians 24 hours per day allows for real-time monitoring of emergency medical care.

Mondial’s role at the onset of a medical emergency is to ensure that you are receiving appropriate care. Their first priority is the wellbeing of the patient – an approval for a medical procedure is based on medical need. During this time, they will be in contact with your treating physician(s), your family, and your physician in Canada – especially if you need to come home for continuing care.

Once the medical emergency is over, Mondial’s priority becomes claims adjudication. You’ll receive forms to sign so that Mondial can perform the claims adjudication, you’ll also need to send in receipts for any eligible out-of-pocket expenses you may have, and you’ll need to provide proof of departure.

Mondial will request medical records and itemized bills from the treating facilities, physicians, and labs, as well as the medical records from your physicians in Canada. Obtaining this information takes time – sometimes months – and this can be a source of anxiety for members. Mondial requires the medical records to determine whether the medical emergency is sudden and unforeseen according to RTO/ERO’s policy. You may want to consider phoning your physician to expedite the process. The itemized bills are needed for two reasons. First, they need to ensure that RTO/ERO is only being billed for the services that were provided to you, and second, Mondial recovers a portion of these expenses from the government health insurance plans. No matter what kind of trip you’re planning, you may benefit from the coverage and protection of the RTO/ERO Out-of-Province/Canada Travel policy. If ever in doubt, contact Mondial Assistance. Their contact information is listed on the back page of the RTO/ERO Group Benefits Booklets.

Source: Article courtesy of Johnson Inc.