Ontario is about to scrap out-of-country emergency health care coverage

Travelling to the U.S.? Here’s what you need to know

The Star Vancouver

When Toronto resident Jill Wykes had a health scare over a racing heartbeat in Florida a few years back, the $3,000 hospital bill for a two-hour visit and three tests added insult to illness.

Fortunately, the seasoned snowbird had a comprehensive travel health insurance policy that paid the full tab.

But the incident, which turned out to be nothing serious, served as a reminder that medical emergencies can happen any time, anywhere.

Buying enough travel insurance to cover all eventualities becomes even more important for Ontario residents when the province scraps its out-of-country coverage of emergency health care expenses on Jan.1.

Until Dec. 31, OHIP will continue to pay up to $400 per day for emergency in-patient services and up to $50 per day for emergency outpatient and doctor services. Starting next year though, that coverage stops.

A new program will provide kidney dialysis patients with $210 toward each treatment — actual prices in the U.S. range from $300 to $750 — but travellers will be on the hook for everything else.

The province says it’s cancelling the existing “inefficient” program because of the $2.8-million cost of administering $9 million in emergency medical coverage abroad each year. OHIP’s reimbursements also tended to offset only a fraction of the actual expenses.

Without private insurance, travellers can face “catastrophically large bills” for medical care, warns Ministry of Health spokesperson David Jensen, who “strongly encourages” people to purchase adequate coverage.

Health care south of the border, in particular, costs an arm and a leg. On average, fees in the U.S. are double those of other developed countries, according to the International Travel Insurance Group.

The insurance provider cites an array of costs, including: ambulance, $500 and up; ER visit, $150 to $3,000; hospital stay, $5,000 per day; MRI, $1,000 to $5,000; X-ray, $150 to $3,000; hip fracture, $13,000 to $40,000.

The monetary ouch factor can be especially painful for snowbirds, who are flocking to warm spots like Florida, Arizona and Texas in growing numbers as baby boomers reach retirement age.

But a significant number of vacationers of all ages are putting their financial health at risk.

According to a recent survey by InsuranceHotline.com, 34 per cent of Canadian respondents said they were unlikely to buy travel insurance, often in the mistaken belief their province would cover them. And 40 per cent had unrealistic expectations of health care costs, thinking, for example, that emergency medical evacuation would be under $2,000. In reality, the service can cost tens of thousands of dollars.

Jill Wykes and her husband Pierre Lepage leave nothing to chance during winters in Sarasota, Fla., an annual trek since 2011 when she retired as a travel industry executive.

The couple, now in their 70s, purchase a multiple-trip plan with a 60-day top-up for their four-month sojourn, which includes driving there and back and flying home for two short visits. Her policy costs about $900 while his is $1,600, because he falls into an older age bracket. They’re each covered for up to $5 million.

Wykes, a blogger and editor of, snowbirdadvisor.ca, calls it “foolish” to travel anywhere without health insurance and advises against thinking “you would just drive or fly home if you were sick.” The financial fallout from an accident or sudden illness “can quickly rise into six figures” in the U.S., she adds.

Anne Marie Thomas of InsuranceHotline.com, which provides free quotes for all types of insurance, echoes Wykes’s advice.

“Now, more than ever, you need travel insurance because there will be zero coverage (as of Jan. 1),” she says.

There’s no one-size-fits-all policy and insurance can cover everything from trip cancellation or interruption to lost baggage and medical costs, Thomas explains, so it’s important to match your needs and situation. A sunseeker driving south, for instance, wouldn’t need trip cancellation.

Okanagan woman fights for prompt insurance payout after serious overseas accident

The excerpted article was written BY

A Lake Country woman said she went into shock immediately after she was in a severe accident in Indonesia, but it was the pain that followed while she was waiting in the emergency room for her insurance coverage to kick in that was most agonizing.

Brittany Roth was exploring a small island near Bali on the back of a scooter when the road made a sharp turn.

“My left knee clipped a jagged rock wall and tore me off the bike,” she said.

Brittany said she looked down and saw an exposed kneecap, a foot that was ripped open and her leg covered in blood.

“I looked at my friend and I said, ‘We have to call travel insurance now’,” she said. “I know you have to call the insurance company before you make a claim or it’s void.

An ambulance then rushed her to a local medical clinic, but her injuries were too severe for staff to treat.

Brittany said she was told she needed to catch a boat back to the main island before sundown.

But despite her insurance coverage, she had to pay up first.

“The way that it works in Bali unfortunately, is the care is really, really good, but until you can pay the bill, you don’t get treatment,” Brittany said. “So they said, ‘we need a credit card now or you’re on your own for the night.’”

Her travelling companion called Brittany’s sister Brooke Roth in the middle of the night in Canada, asking for her credit card number.

“My sister said it was terrifying receiving the call, hearing me screaming in the background. She thought I was getting kidnapped, she didn’t know why I needed a credit card,” Brittany said.

Brooke said she tried to stay calm as she learned the details.

Brooke paid the bill, and Brittany was put on a spine board for transport to Bali.

Some locals and her travelling companion carried Brittany to the waiting boat.

“They had to go down really, really steep concrete stairs to get to the beach, and then they had to walk through the ocean, knee-deep through water to get me to this boat,” Brittany said.

When the 20-year-old arrived at the hospital in Bali, still in a bathing suit, she was met with another bill — this one for $12,000.

“I was there for about four hours,” Brittany said. “They had said, ‘Unless we receive payment in 15 minutes, I’m sorry, we have to let you go. We can’t keep you here anymore.’”

“We were terrified thinking that we might be on the street,” Brittany said. “I don’t know what to do with my leg. I can’t walk. I’m bleeding.”

Meanwhile, back in Canada, Brooke was in a bureaucratic battle with Pacific Blue Cross Insurance.

“It was really frustrating. We had the approval right in front of us, but it took them so long to send the confirmation to the hospital,” she said.

After hours on the phone, confirmation finally went through, and Brittany successfully underwent surgery.

She received 38 stitches, has a torn tendon and is now moving around with crutches.

The sisters are still waiting for their $3,500 back, and Brittany is out-of-pocket the $3,000 expense of flying home unexpectedly.

Friends have started a GoFundMe campaign to help Brittany recover some of her costs.

Pacific Blue Cross declined an interview, but emailed Global News a statement on Monday.

“All travel insurance policies require contact with the insurer as soon as possible after an event has occurred to ensure the best treatment for the insured individual and to properly facilitate the claim,” it said.

“We’re obligated to work within each country’s medical system; it is not uncommon for medical facilities to require confirmation of payment, which we appreciate is unpleasant when injured.”

The insurance company also said that it can’t address specific cases because of privacy concerns.

Global News

Big data opens up new horizons for insurance companies

Amid regulatory changes and insurtech competition, Canadian insurers find that a one-size-fits all approach in the millennial era won’t work anymore

TORONTO, Nov. 28, 2019 /CNW/ – With digital-savvy millennials now the world’s largest population segment and Gen Z following in their footsteps, Canadian insurance companies must rethink their business and harness big data to drive growth and profitability, finds a new KPMG in Canada report called Insurance frontiers: Here to horizon.

“The insurance industry will look radically different in 10 years from how it does today,” says KPMG’s Chris Cornell, Partner and National Insurance Sector Leader. “Forging a new path won’t be easy; insurers must digitize their operations, products, and processes, and use data-driven insights to address this seismic shift in customer dynamics. The one-size-fits-all approach won’t work anymore.”

As many as 86 per cent of chief executives at insurance companies around the world surveyed by KPMG are concerned over how millennials will change their business. Millennials aren’t following historical norms in terms of predicted life paths or milestones. Also, 84 per cent of Canadian millennials don’t trust traditional advertising and 95 per cent say the most credible source of product information is their friends.

Data allows insurance companies to know their customers in ways not previously possible, the report says. Big data can be used to inform assumption setting, better understand risk drivers, anticipated behaviours or events, make quicker underwriting decisions, and support strategies and decisions.

By using data analytics, social media listening, and artificial intelligence, insurance companies can make every customer ‘a segment of one’ with personalized care and customized insurance products, the report says.

“From the moment we’re born to the moment we die, we generate an enormous amount of data,” says Mr. Cornell. “Big data can open up new horizons for insurers. But, they must put into place much stronger data collection and analysis tools. This requires a total rethink of how to collect, store, analyze, and use data, not to mention how to ensure that it’s kept safe and secure.”

For example, by using data for predictive analytics, insurers can create more tailored, micro-insurance products to help companies better understand, manage, and respond to their unique risks, such as reducing fleet insurance premiums.

Released today at KPMG’s 28th annual insurance conference in Toronto, the report delves into five key trends that present risks and opportunities:

  • Seismic shift in customer dynamics
  • Business model disruption, innovation, and technological change
  • Focus on strategic alliances and partnerships
  • Game-changing regulations
  • Building a future-forward workforce

The report notes that while insurtechs have ratcheted up the pace of change, many are focused on enhancing or improving a segment of the insurance value chain rather than trying to disrupt the entire industry.

“Strategic alliances present a massive opportunity for Canadian insurers,” says Mr. Cornell.

Insurance companies would benefit from stepping back and thinking about what the insurer of the future looks like without considering their current organizational structures, he says. “By envisioning what is possible, insurers can look at how third parties and strategic alliances could help them achieve that vision,” he adds.

When it comes to digital change, an astounding 87 per cent of insurance CEOs said they are directly involved in devising and leading technological change within their firm, finds the KPMG’s 2019 Global CEO Outlook. However, three-quarters (76 per cent) of insurance CEOs also admit they ignored insights from data analysis and computer-driven models because the findings were contrary to their own intuition and experience.

KPMG surveyed 1,300 CEOs in 11 countries and key industries, including 132 CEOs from insurance companies in the U.S., Europe, and Asia with revenues from US$500 million to over US$10 billion.

The report also urges insurance companies to act soon in order to ensure they’re ready in time for IFRS 17. Already deferred by one year, companies must comply by Jan. 1, 2022.

“Insurers need to build in enough time to test, analyze and compare results and make any necessary changes,” says KPMG’s Stephen Smith, Audit Partner in Financial Services. “One of the biggest issues is that it’s not scalable, making the transition complicated for larger companies with large, complex books of business. Small insurers, meanwhile, are finding the regulatory burden quite challenging to address given their more limited internal resources and operational flexibility.”

Access a full copy of the 2019 Canadian insurance industry opportunities and risks report at https://home.kpmg/ca/en/home/insights/2019/11/insurance-frontiers-here-to-horizon.html

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KPMG in Canada Website
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About KPMG in Canada
KPMG LLP, an Audit, Tax and Advisory firm (kpmg.ca) is a limited liability partnership, established under the laws of Ontario, and the Canadian member firm of KPMG International Cooperative (“KPMG International”). KPMG has over 7,000 professionals/employees in over 40 locations across Canada serving private and public sector clients. KPMG is consistently recognized as an employer of choice and one of the best places to work in the country.

The independent member firms of the KPMG network are affiliated with KPMG International, a Swiss entity. Each KPMG firm is a legally distinct and separate entity, and describes itself as such.

SOURCE KPMG LLP

Driver who wrecked his brakes to avoid clobbering a moose wins ICBC battle

Rhianna Schmunk · CBC News ·

Hurtling toward a burly moose on a remote stretch of highway in northern B.C., Ronald Driedger did what any driver with enough time would do: he slammed his brakes to the floor.

It wrecked his brakes but took the edge off what could have been a deadly collision: Driedger did hit the moose, but both driver and animal survived.

What followed was a year-long battle between Driedger and the Insurance Corporation of B.C. (ICBC) over the cost of the $1,700 brake repair.

Driedger argued he was covered, ICBC said he wasn’t.

After a flurry of emails and one showdown in B.C.’s Civil Resolution Tribunal, Driedger​​​​​​​ won.

Brakes couldn’t stop car ‘creeping forward’ after crash

A ruling posted online Tuesday said Driedger​​​​​​​ saw the moose along a highway near Smithers, B.C., northwest of Prince George, late in the evening on Aug. 3, 2018. The decision didn’t say how fast Driedger​​​​​​​ was going when his car hit the moose.

The animal survived and ran off. The 2008 Mazda 3 was still driveable but left with minor body damage, so Driedger​​​​​​​ filed a claim with ICBC.

“Over the next two days, he noticed his brakes were ‘soft.’ He had to pump the brakes repeatedly to stop fully. When the vehicle was stopped but in gear, the brakes could not keep the car from creeping forward,” the ruling read.

Driedger​​​​​​​ called ICBC four days after the crash to add brakes to his claim for the body damage.

The insurer denied his brake claim more than a week later, saying he hadn’t proved the damage was caused by anything other than wear and tear — which isn’t covered.

An estimator said the likely reason for the brake problem was that the master cylinder had failed. The cylinder creates the pressure that feeds brake fluid into the brake circuit.

An ICBC employee told Driedger​​​​​​​ master cylinders “rarely fail even under abusive driving conditions.”

“[The worker] concluded that ‘one simple panic stop should under no circumstances result in brake system damage.’ In other words, [the worker] did not believe that the hard braking before the collision caused the brake problem,” the ruling read.

Driedger​​​​​​​ appealed with ICBC and the issue then went to another committee within the insurer. That committee said the issue wasn’t with the master cylinder, but with a pre-existing fault that meant the brakes would have eventually failed under hard braking — even if Driedger​​​​​​​ didn’t know about i

Again, Driedger’s claim was denied. He filed a claim with the CRT, which handles small claim disputes in B.C.

ICBC asked for the claim to be dismissed, saying Driedger​​​​​​​ hadn’t proved the moose crash caused the brake failure. The tribunal sided with Driedger​​​​​​​.

“The brakes were damaged very close in time to the collision and in the same sequence of events. I find that whether there was a pre-existing issue with the brakes, as ICBC alleges, is not relevant,” wrote tribunal member Eric Regehr.

Regehr ordered the insurer to pay Driedger​​​​​​​ more than $1,900 in compensation. More than $1,700 was awarded to cover the brake repair, as well as additional reimbursement for interest and tribunal fees.

ICBC handled an average 2,900 crashes involving animals in the north central Interior of B.C. between 2013 and 2017.

The Wildlife Collision Prevention Program in B.C. says more than 10,000 wildlife vehicle collisions happen every year in the province, resulting in approximately 570 personal injuries and three deaths.

CBC News

Technology & societal changes driving unprecedented customization for consumers

Welcome to the era of ultra-personalized insurance.

CONTENT FROM INSURANCE TRENDS REPORT

New types of products and services are available to Canadians through a growing number of channels and, increasingly, consumers are purchasing insurance tailor-made for their personal needs.

While traditional policy categories and annual commitments still exist, insurers are launching innovative forms of insurance that break the historic mould, such as insurance that you activate and deactivate as warranted or premiums based on your behaviour – demonstrated by data – instead of your demographic risk profile.

Digital monitoring technologies and connectivity are fuelling much of the transformation. “All the sensors and connected devices in our homes, vehicles and fitness devices are generating tremendous amounts of data, and data is the new gold,” says Doug Grant, partner at Insurance-Canada.ca Inc., an organization that provides independent information about technology and the business of insurance. “Using analytics and AI, you can understand your customer much better and make them offers or add products they tell you they want.”

This wealth of data is allowing insurance companies to be more proactive in risk management, says Mr. Grant. Examples include vehicle telematics that reward safe drivers and premium reductions for homeowners who install sensors that warn of dangerous water leaks.

“The traditional model was based on the understanding that if something goes wrong, I will indemnify you for the loss,” he says. “With this shift, the insurer is giving you tools to reduce your risk, and both parties benefit when insurance claims are reduced.”

Personalization of insurance is enabling new forms of usage-based policies. That principle motivated CAA Insurance to take a non-traditional approach with the launch of Canada’s first pay-as-you-go auto policy, CAA MyPace.

“Our goal is to give the motorists who rely on our insurance choice and control over how they benefit, based on their lifestyle and their stage of life,” says Matthew Turack, president, CAA Insurance. “MyPace is most beneficial for people who don’t drive very much maybe because they use public transit for work or are retired. Motorists pay in increments of 1,000 kilometres driven.”

Low-mileage drivers with this policy are saving an average of 40 per cent in premiums, says Mr. Turack.

CAA is also a big provider of travel insurance via its Orion Travel Insurance Company, and innovation is happening in that sphere as well. For example, the company’s emergency medical travel insurance now offers policyholders virtual health-care services. “We’re providing the opportunity for people who get a minor ailment while travelling to get telemedicine, linking with a physician through a secure video link. It is another customized offering that responds to consumer needs.”

In addition to technology changes, insurance providers are also responding to significant societal change. As VP of Emerging Business Models at The Co-operators, Peter Primdahl works to identify opportunities for new types of policies and delivery channels.

“The nature of work is changing with the ‘gig economy,’ and consuming is changing – moving away from ownership to access,” says Mr. Primdahl. “Changes in the ways we live are creating new risks, and by addressing these and facilitating participation in this economy, we hope to help people improve their financial security in this new era.”

We’re providing the opportunity for people who get a minor ailment while travelling to get telemedicine, linking with a physician through a secure video link. It is another customized offering that responds to consumer needs.

— Matthew Turack president, CAA Insurance

The other shift is the fact that consumers are always connected and expect their insurance providers to be the same, he says. “We are now focusing more than ever on how our clients interact with us. While we continue to manage our core business, we are exploring a ‘test and learn’ approach to new products – releasing them to clients and inviting their feedback, making improvements as requested.”

This more experimental approach led to creation of a suite of digital products called Duuo by The Co-operators, he says. “We developed the first digital on-demand policy in Canada for short-term rental housing, an activity typically not covered by regular homeowner’s insurance. Users can pop in and out of the coverage – turning it on before their guests arrive and having it automatically turn off when they leave.”

The Co-operators responded to client requests with another novel product: on demand Rent My Stuff insurance for people renting out their equipment. “We’re encouraging our customers to continue to tell us how we can refine more of our products and client experiences to align with their lives,” says Mr. Primdahl.

Source:

The Globe and Mail

More than just the valet was keeping an eye on Kerry Charbonneau’s truck while he was away on vacation.

Read more

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