With wait times growing exponentially for specialists, surgeries, and medical investigations across Canada, many Canadians are looking to other countries to obtain care faster. This is known as medical tourism, and it is becoming more common. For employers who offer an income loss benefit to their employees, such as a short- or long-term disability plan, or for employees relying solely on employment insurance benefits, there are important considerations which should be taken into account before an employee leaves the country for treatment. Not managing or documenting these situations properly could impact an employee's loss of earnings eligibility during their recovery time.
Travelling outside the country for non-emergency medical care is known as medical tourism.
Yes. Most policies have limitations on benefits being paid to employees who are out of the country unless there has been prior agreement to pay benefits during this period or require the third-party adjudicator to approve the travel. There may also be provisions around benefits only being payable for medically necessary procedures.
A standard disability policy includes the following language:
Some situations can arise while an employee is out of the country and suffers a medical condition, causing them to be disabled, e.g., broken leg, heart attack, emergency surgery, etc. In these situations, disability benefits (STD or LTD) or employment insurance (EI) could be approved for income loss benefits. Supporting medical information would be required to be submitted as per the client's policy. Disability benefits would often then start the day of their incident/illness/surgery, etc. (or after the appropriate qualifying period).
If you travel outside of Canada, you're not usually eligible to receive sickness benefits while outside Canada. However, you could be eligible if you're obtaining medical treatment that isn't readily or immediately available in your area of residence.
55 (1) Subject to section 18 of the Act,5 a claimant who is not a self-employed person is not disentitled from receiving benefits for the reason that the claimant is outside Canada.
Patients in Canada have the right to receive appropriate and timely care, and it's legal to travel abroad to access healthcare.
Disability benefits may be payable to employees in these situations if they meet the provisions of their policy. However, employers have valid concerns when it comes to employees choosing medical tourism as part of their treatment plan. There are always risks that employee absences will be prolonged either because of health complications or the decision to enjoy the "tourism" component of their travel.
When faced with a disability claim or absence for an employee seeking treatment out-of-country (or during a vacation), be sure to review policy language to confirm if benefits may be impacted when the employee is out of the country.
How is a medical tourism/out-of-country claim handled?
If all of the policy provisions are met, the claim will proceed as per normal processes while the employee remains totally disabled and compliant with the disability policy, including, where noted, participation in any rehabilitation (RTW or accommodation) planning. It will terminate at its natural conclusion or at such a time when the employee becomes non-compliant or no longer meets the policy terms and provisions.
It is important to ensure that staff are aware of the rules and policies around travelling out of the country and the impact it might have on their coverage or disability claim. Employees should seek approval for any out-of-country travel for medical reasons prior to leaving. Employers should ensure all policies are clear, written and shared so there are no surprises.
When there is a sudden illness or medical event for the duration of a vacation, the employee should be classified as 'on leave/disability/EI' from the date of disability. An employee on vacation is considered to be 'at work' as long as there is no break in their coverage for benefits. This may result in an employee 'getting back' any vacation time that wasn't taken because of a disability that occurred.
Medical tourism can offer quicker access to care, ultimately resulting in less lost time from work, but it is essential to understand the rules and implications. If you have any additional questions on how medical tourism may impact your employee benefit plan offerings, please reach out to a benefits consultant.