Travel

No; there are differences between the travel coverage you had with your benefit plan and your individual Retiree plan. The most important difference is the stability clause that applies to the Retiree plan. This states that a claim will not be paid for services related to a medical condition that was not deemed stable 90 days prior to your trip departure date.

Alberta Blue Cross^® defines medical condition as a condition, illness or injury that exists prior to your date of departure for each trip and for which you have:

• presented or exhibited signs or symptoms;
• received a diagnosis;
• required or received medical consultation;
• taken or been prescribed medication;
• required treatment;
• had test results showing deterioration;
• had a medical investigation; regardless of whether a diagnosis has been given;
• been hospitalized; or
• been referred to a specialist, whether or not the medical condition, illness or injury had been diagnosed by a physician.

Alberta Blue Cross^® defines a medical condition as stable if you have not had any of the following:

• a new prescription drug or change in medication;
• a new medical treatment;
• a new diagnosis, treatment or evaluation of symptoms;
• a change in diagnosis or medical treatment;
• a medical consultation to investigate symptoms that remain undiagnosed;
• hospitalization related to any medical condition;
• a referral to a medical specialist or a specialty clinic (made or recommended) where there are no further investigations or results pending;
• in-hospital care or a referral to a specialist, including initial follow-up visits, tests or investigations related to the medical condition and pending results;
• a deterioration in your condition;
• new, more frequent or more severe symptoms; new test results or test results showing a deterioration or pending test results (other than routine tests as part of regular follow-ups); or
• investigations or future investigations initiated or recommended.

Not all changes to medication will be affected by the stability clause. The definition below is provided to help clarify some concerns.

Change in medication means any increase or decrease in dose, strength or frequency of a prescribed medication, as well as the addition or discontinuation of any medication. Any written prescription not filled is considered a change. The following are not considered to be new treatments or medication changes:

• routine (not prescribed by a physician) adjustment of insulin to control diabetes, provided the insulin was not first prescribed during the 90 days prior to your trip;
• a change from a brand-name medication to the generic form of the same medication, provided the dosage is the same;
• routine adjustment of Coumadin, Warfarin or other anticoagulant medications, except where newly prescribed or stopped;
• a change in aspirin taken for non-prescribed medical purposes;
• a decrease in the dosage of cholesterol medication;
• a dosage change of thyroid or hormone replacement therapy medication;
• creams or ointments prescribed for cutaneous irritations; or
• vitamins and minerals and non-prescription medications.

The 90-day stability clause applies at claim time. Alberta Blue Cross^® will determine if the claim relates to a medical condition, symptom or illness that you experienced 90 days prior to your trip departure date.

Consider the following examples:

1. You’ve been diagnosed with an ear infection and take medication for it within 90 days of your departure date. If, on the trip you get an ear infection, Alberta Blue Cross^® will not pay for this claim as it was related to the medical condition (ear infection) that you had fewer than 90 days prior to your trip departure date.
2. You were diagnosed and started taking medication for high blood pressure six weeks before you leave for your vacation to Mexico.
   • If, while on vacation, you faint and fall down as a result of your high blood pressure, Alberta Blue Cross^® will not pay any benefits relating to that claim. This could include costs associated with medication, a doctor’s visit or even a hospital stay. That’s because there was a new diagnosis and new medication for high blood pressure fewer than 90 days before your trip departure date, which means it would not be considered stable.
   • However, if you have had a change of medication for your high blood pressure eight months before your trip to Mexico and had no changes to the medication or treatment within the 90 days immediately preceding your departure date, you’re considered stable. A claim relating to high blood pressure while on your vacation would be paid in this circumstance.
3. A heart attack came out of nowhere. A stent was placed in one of your arteries and the prognosis is good. The doctor tells you to get back to golfing, your favorite past time. You plan to go to Arizona and escape the winter for a while. You leave within 90 days of your heart attack.
   • If you have a claim in Arizona relating to your heart, your claim will not be paid according to the 90-day stablility clause. The reason for this is that any claim relating to a medical condition that required a change of medication, had a new diagnosis or had an intervention (stent) fewer than 90 days before your trip departure date won’t be covered.
   • If your claim in Arizona is for pneumonia, this claim will be paid. This is because the claim incident isn’t related to the medical condition (heart attack) and treatment (surgery) you had prior to leaving your province or territory of residence.

Including a stability clause is a very common industry practice. It also allows Alberta Blue Cross^® to offer competitive pricing for our customers while at the same time ensuring the long-term sustainability of the plan.

Yes; being deemed medically stable to travel in a doctor’s opinion is not the same thing as meeting our definition of stable as it relates to coverage of a medical condition. Your medical condition may be considered stable from a medical point of view; however, due to the timing of the most recent change in symptoms, medications, treatment, requisition or recommendation for a test or procedure, that does not necessarily mean you’ll be covered in the event of an emergency relating to that condition. If a pre-existing medical condition is directly or indirectly related to the need for emergency medical care during your trip, we’ll access your medical records to confirm whether the medical condition in question met our definition of the 90-day stability period.

Yes; every travel plan you purchase or have through a benefit plan includes specific limitations and exclusions. It’s important, and your responsibility, to carefully read and understand your travel benefits.

Your travel benefits contain limitations and exclusions that could affect your coverage. Some exclusions include the following:

• medical conditions that aren’t stable;
• participation in high-risk activities or extreme sports;
• seeking treatment, medical consultation or a second medical opinion while travelling;
• travelling against medical advice; or
• travelling after receiving a terminal prognosis.

There is no termination date for travel coverage on the Retiree plan. Members have travel coverage for life.

Yes; you need to return to your province of residence for your travel-day limit to restart. Each trip length begins when you leave your province or territory of residence and ends when you return to your province or territory of residence (you can leave on a new trip immediately upon return). Alberta Health states that you need to be physically present in Alberta for at least 183 days in a 12-month period to remain eligible for your Alberta Health Care Insurance Plan coverage. Check with your province’s eligibility rules for out-of-province travel.

Depending on the level of Retiree plan purchased, travel coverage is as follows:

• Basic extended health benefits allow any number of trips to a maximum of 30 consecutive days per trip.
• Enhanced extended health benefits allow any number of trips to a maximum of 60 consecutive days per trip.
• Enhanced+ extended health benefits allow any number of trips to a maximum of 90 consecutive days per trip.
• Premium extended health benefits allow any number of trips to a maximum of 120 consecutive days per trip.

All plans cover emergency medical claims to a maximum of $5 million per participant per trip.

Yes; extensions can be purchased as long as you purchase an extension prior to the date your eligible trip limit is reached. Extensions can also be purchased prior to the departure date if you know the exact travel dates.

With a Retiree plan in place, you’ll receive a discount of up to 25 per cent on your travel rates, depending on which level of extended health coverage you selected.

An extension to an existing Alberta Blue Cross^® travel plan can only be purchased by phone. Please contact our Alberta Blue Cross^® travel specialists directly at 780-498-8550 or toll free at 1-800-394-1965 during our business hours (Monday to Friday from 8:30 a.m. to 5 p.m. MT). We are closed on weekends and statutory holidays.