The Out-of-Province Benefit is available only to members with Supplementary Coverage.
The benefit consists of the following components:
- Emergency Benefit while Travelling
- Emergency Travel Assistance Services
- Referral Benefit
Emergency Benefit while Travelling
Each participant is covered for eligible medical expenses incurred as a result of an emergency while travelling on vacation or on business. The maximum eligible expense per participant is $1 million (in Canadian dollars) per period of travel. Coverage is for 40 consecutive days, excluding any time out of the province for business on official travel status.
Eligible expenses mean the reasonable and customary charges in excess of the amount payable by a government health insurance plan, if they are required for emergency treatment of an injury or disease that occurs within 40 days of the date of departure from the province/territory of residence (excluding any time out of the province for business on official travel status).
Emergency Benefit Eligible Expenses
Services of a physician.
Medical evacuation, which may include ambulance services, when suitable care, as determined by Canada Life, is not available in the area where the emergency occurred.
Family assistance benefits up to a combined maximum of $5,000 for any one travel emergency, as follows:
- The maximum payable for dependant children under age 16 who are left unattended because the participant or the participant’s covered spouse is hospitalised and an escort (if necessary) is the cost of economy fare for return transportation.
- Return transportation if a family member is hospitalised and as a result the family members are unable to return home on the originally scheduled travel, and must purchase new return tickets. The extra cost of the return fare is payable, to a maximum of the cost of economy fare.
- A visit of a relative if the family member is hospitalised for more than 7 days while travelling alone. This includes economy return airfare, or other means of transportation when air travel is not possible, and meals and accommodations in commercial lodging to a maximum of $200 per day, for a spouse, parent, child, brother or sister. This benefit also covers expenses incurred if it is necessary to identify a deceased family member prior to release of the body.
- Meals and accommodations in commercial lodging if the participant or a covered dependant’s trip is extended due to hospitalisation of a family member. The additional expenses incurred by accompanying family members for accommodations and meals are provided to a maximum of $200 per day.
Public ward accommodation and auxiliary hospital services in a general hospital.
Return of the deceased in the event of death of a family member. The necessary authorisations will be obtained and arrangements made for the return of the deceased to the province/territory of residence. The maximum payable for the preparation and return of the deceased is $3,000.
One-way economy airfare, or other means of transportation when air travel is not possible, for the patient’s return to their province/territory of residence. The fare for a professional attendant accompanying the patient is also included where medically required.
Emergency travel assistance services
The PSHCP provides a toll-free number which gives you 24-hour access to a world-wide assistance network of professionals who offer help with medical, legal, or other travel-related emergencies.
Please note, however, that assistance services are not available in countries of political unrest. The list of countries, as maintained by the plan Administrator, will change according to world conditions.
Neither the plan Administrator nor the company providing the assistance network is responsible for the availability, quality, or result of the medical treatment received by the participant or for the failure to obtain medical treatment.
Emergency Travel Eligible Expenses
Advance payment on behalf of the participant or a covered dependant for the payment of hospital and medical expenses.
To arrange for advance payment of hospital and medical expenses, the participant must sign an authorisation form allowing the Administrator to recover payment from the provincial/territorial health insurance plan. The participant must reimburse the Administrator for any payment made on their behalf which is in excess of the amount eligible for reimbursement under the provincial/territorial health insurance plan and the PSHCP.
Transportation arrangements to the nearest hospital that provides the appropriate care or back to Canada.
Medical referrals, consultation and monitoring.
A message service for family and business associates; messages will be held for up to 15 days.
A telephone interpretation service.
Official travel status
Employees required to travel on “official travel status” for government business are covered under the Emergency Benefit while Travelling and are eligible to use the Emergency Travel Assistance Services during the entire period of “official travel status”. Although there is no time limit to be on “official travel status”, the $1 million (in Canadian dollars) benefit coverage limit still applies.
Referral services must be:
- performed when the participant physically leaves the province/territory of residence,
- following a written referral by the attending physician or nurse practitioner in the person’s province/territory of residence,
- for a service that is not offered in the person’s province/territory of residence.
Eligible expenses under this benefit will be limited to the reasonable and customary charges in excess of the amount payable by a provincial/territorial health insurance plan and to a maximum eligible expense of $25,000 per illness or injury.
Referral Benefit Eligible Expenses
Services of a physician or surgeon
Public ward accommodation and auxiliary hospital services in a general hospital
Laboratory services including those services which when ordered by and performed under the direction of a physician provide information used in the diagnosis or treatment of disease or injury. Services include, but are not limited to, blood or other body fluid analysis, clinical pathology, radiological procedures, ultrasounds, etc.
No benefit is payable for:
- Expenses incurred outside the Participant’s province/territory of residence if they are required for the emergency treatment of an injury or disease which occurred more than 40 days after the date of departure from the province/territory of residence, except as provided for Members who are on official travel status;
- Expenses incurred by a Participant who is temporarily or permanently residing outside Canada;
- Expenses for the regular treatment of an injury or disease which existed prior to the Participant’s departure from their province/territory of residence;
- Expenses incurred under any of the conditions listed under General Exclusions and Limitations in the Plan Provisions.