3 Months pregnant will private insurance company will cover till OHIP active

[steerpike]

Here is what it said on my wifes private insurance (now expired because we have provincial healthcare now):

"12. Maternity Benefit
When the expected delivery date is more than 10 months after
the effective date of this policy and there is no lapse in coverage,
TIC will pay 80% of the costs per pregnancy incurred by the
2 global expatriate hospital & medical
mother and the newborn as the result of pregnancy, childbirth
or miscarriage, or complications related thereto, up to a total
maximum of either:
a) $5,000 for normal childbirth; or
b) $7,500 for caesarean section; or
c) $25,000 for medical complications related to childbirth.
Newborns are not covered under this policy other than as
specifically stated above. Newborns can be fully covered at
15 days of age if a completed application is accepted by TIC
or its representative and written approval is given by TIC."

It only gives you $5000 which probably won't cover the full cost of the childbirth. But it would help. It's TIC travel insurance.

 

[Rob_TO]

Here is what it said on my wifes private insurance (now expired because we have provincial healthcare now):

"12. Maternity Benefit
When the expected delivery date is more than 10 months after
the effective date of this policy and there is no lapse in coverage,
TIC will pay 80% of the costs per pregnancy incurred by the
2 global expatriate hospital & medical
mother and the newborn as the result of pregnancy, childbirth
or miscarriage, or complications related thereto, up to a total
maximum of either:
a) $5,000 for normal childbirth; or
b) $7,500 for caesarean section; or
c) $25,000 for medical complications related to childbirth.
Newborns are not covered under this policy other than as
specifically stated above. Newborns can be fully covered at
15 days of age if a completed application is accepted by TIC
or its representative and written approval is given by TIC."

It only gives you $5000 which probably won't cover the full cost of the childbirth. But it would help. It's TIC travel insurance.

Sounds very generous. And basically a 1 month wait from getting coverage, to when you can start trying. Would be a great policy if you got a 1 year or so coverage and could make sure you got pregnant asap after that waiting period! Was it a policy specific to people wanting pregnancy coverage?

Here is a typical snapshot of a bunch of travel insurance companies and their policies on pregnancy: http://www.travellersinsurance.ca/content/plans
As you can see all of them allow for emergency costs from pregnancy complications, but also ALL of them stop all pregnancy-related coverage completely around 9 weeks before the due date. So covering the actual delivery is out of the question.

TIC is on there too: " Pregnancy - Complications or childbirth are excluded after 32nd week of pregnancy ", but I guess you can customize the plan if needed at extra cost.

 

[screech339]

Here is what it said on my wifes private insurance (now expired because we have provincial healthcare now):

"12. Maternity Benefit
When the expected delivery date is more than 10 months after
the effective date of this policy and there is no lapse in coverage,
TIC will pay 80% of the costs per pregnancy incurred by the
2 global expatriate hospital & medical
mother and the newborn as the result of pregnancy, childbirth
or miscarriage, or complications related thereto, up to a total
maximum of either:
a) $5,000 for normal childbirth; or
b) $7,500 for caesarean section; or
c) $25,000 for medical complications related to childbirth.
Newborns are not covered under this policy other than as
specifically stated above. Newborns can be fully covered at
15 days of age if a completed application is accepted by TIC
or its representative and written approval is given by TIC."

It only gives you $5000 which probably won't cover the full cost of the childbirth. But it would help. It's TIC travel insurance.

Since TIC also listed that it won't cover baby delivery cost from 8 weeks before baby is due, I think the prenatal care listed in your policy is meant for very premature births. It doesn't make sense to offer prenatal care coverage but won't cover cost of delivery. This is why I assume that the policy will cover premature deliveries which falls under pregnancy complications category.

And you can bet the farm that insurance companies will use / find any excuse not to cover the pregnancy cost even if they did offer coverage. They will first use any wrong answers made on the medical questionnaire history to justify not paying it. Any excuse they can use to not pay they will use it. They will fight it tooth and nail to avoid paying the costly pregnancy issues.

Take a look at the news lately over travel insurance claims on the cbc news. There were 3 clients that were denied to claims due to "incorrect" yes and no answers on their medical questionnaire. 1 or 2 were claims totally unrelated to pre-existing condition and yet they were denied because they answered wrong on the forms.

Anyone who bought travel insurance should expect that they may have to fight tooth and nail to get their rightful claims.

 

[Rob_TO]

Since TIC also listed that it won't cover baby delivery cost from 8 weeks before baby is due, I think the prenatal care listed in your policy is meant for very premature births. It doesn't make sense to offer prenatal care coverage but won't cover cost of delivery. This is why I assume that the policy will cover premature deliveries which falls under pregnancy complications category.

Remember that terms and conditions are subject to change based on what specific policy you are getting. I just posted a very generic one, they may offer more customized plans with different conditions as well which is what he may have had.

But yes I agree, any pregnancy related claims should prepare to have to fight and show tons of additional proofs to get reimbursement.

 

[screech339]

Remember that terms and conditions are subject to change based on what specific policy you are getting. I just posted a very generic one, they may offer more customized plans with different conditions as well which is what he may have had.

But yes I agree, any pregnancy related claims should prepare to have to fight and show tons of additional proofs to get reimbursement.

Most medical offices probably won't accept travel insurance as they know they are not going to get the money so easy. So they want the money all up front and let you deal with the problem of getting the money back from insurance companies.

 

[Rob_TO]

Most medical offices probably won't accept travel insurance as they know they are not going to get the money so easy. So they want the money all up front and let you deal with the problem of getting the money back from insurance companies.

Right.
We ran into this at several places around Toronto. Emergency room or critical care centre will demand around $900 or so upfront no matter what your issue is and before they even let you see a nurse, just to account for any potential tests they might do. Doctors offices and labs also just take upfront payments (usually cash only).

However in emergencies that will cost a considerable amount, after the initial upfront payment the hospital will bill you later for the rest.