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Travel insurance is designed to pay for certain unexpected medical travel costs that may arise when you are travelling outside of Canada or your home province, over and above your provincial health insurance coverage, which may only pay some portion of these expenses.

note: your provincial government is first payer for health expenses. All supplementary insurance polices require your provincial plan coverage

to be in place. For more information on the Manitoba government coverage, visit the website www.manitoba. ca/health or call the number on the back of your Manitoba Health card 1-800-392-1207.

An advantage of joining RTAM is having access to one of the most comprehensive voluntary emergency medical travel insurance plans available in the marketplace to education sector retirees. The spring 2011 issue of KIT outlined the comprehensive features, including trip cancellation insurance, recent enhancements (a 62-day base plan and a $2 million lifetime maximum per insured), and what happens in the event of a medical emergency. Full Plan details for RTAM members are outlined in the Certificate of Insurance, as posted on the website www.johnson.ca/rtam. This article will expand on the claims submission process through both the RTAM Plan and Manitoba Health, in the event of a medical emergency by answering a series of questions:

1.Who are the RTAM group Benefits Program partners for emergency Medical Travel, and what is their role in the claim submission process?

The RTAM Benefits Committee has partnered with each of the following organizations to deliver to the RTAM Members valuable benefits services and support. In the order of contact in the event of a claim, the partners are Sigma Assistel, Desjardins Financial Security and Johnson Inc.

Sigma Assistel (Sigma) a whollyowned subsidiary of Desjardins Financial Security (DFS), and they are the assistance partner for the Travel benefit. Sigma is the members’ first point of contact in the event of an emergency. They open their claim file, verifying eligibility, referring them to the closest appropriate medical facility, and guiding them through their claim process. Sigma staff are available 24 hours a day, 365 days a year to assist you in the event of an emergency while you travel.

Desjardins Financial Security (DFS) is the insurer of RTAM's Emergency Medical Travel Insurance Plan. When notified of a Travel Claim by Sigma, DFS sends the member instructions and forms for completion of the claim submission process. DFS reimburses eligible expenses, and applies any benefits and policy limitations (as defined in the Certificate of Insurance). Because your provincial government is first payer for health expenses you incur while travelling, DFS integrates the reimbursement with the province.

Johnson Inc. (Johnson) assists members with the Travel claims process as needed - to clarify coverage, confirm eligibility, and communicate with Sigma and DFS regarding a specific situation. As group benefits consultant and plan administrator, Johnson advises RTAM on plan design, enrols RTAM Members in the Group Benefits Program and answers any inquiries members have.

2.When should I call sigma? Before, during and after a Travel emergency?

Before Travel Emergency Treatment - You should always call Sigma before you seek emergency medical treatment, (or in the event of a Trip Cancellation claim prior to departure or a Trip Interruption post departure). This call to Sigma’s 24-hour assistance centre will ensure you are directed to the nearest appropriate medical facility, your eligibility is verified, and that there are no delays in treatment. At the first onset of symptoms of an Emergency, contact Sigma. If you are unable to do so immediately because you are medically incapacitated, someone else (a family member, friend or travel companion) must contact Sigma within 24 hours or as soon as is reasonably possible. Otherwise, eligible expenses will be limited to $2,000. Note that a phone call to Sigma to report the claim will be considered “Notice of Claim” under the policy terms in the Certificate of Insurance.

During Travel Emergency Treatment – In the event of a medical emergency in travel for which you have already contacted Sigma, you must provide updates of any changes in your medical condition, or should additional testing/referrals be required.

After Travel Emergency Treatment – Once your assistance file is complete, claims issues should be addressed to the coordinates provided on forms provided by DFS. In the event no such forms are received, you should notify Sigma so the situation can be rectified.

3.What is the process for submitting and processing an emergency medical claim?

Although your provincial government is first payer for health expenses you incur while travelling, DFS will reimburse all of the expenses eligible under your contract so you will receive your reimbursement as soon as possible.

The goal of DFS and Sigma is to provide the best client service possible as RTAM’s emergency travel provider. When a member contacts Sigma, DFS sends claim forms immediately. Members are encouraged to return these forms and any required documents to DFS as soon as possible. Throughout the process, the member is supported by DFS call centre agents, who provide help on any claims related issue (completing the forms, inquiries, etc.).

When a claim or bill is received, DFS assessors make sure all required information is included. If more information is required, the assessor contacts the member or the third party to gather any additional information. All invoices and medical facility billings are reviewed by DFS assessors, and for complex situations, by the DFS medical director.

4.What claim forms must be completed and what receipts are required for payment of a claim?

For emergency health care expenses, the insured must complete a form called, "Claim Form – Expenses Incurred outside the Province of residence or country". This form will be provided by DFS as soon as a notice of a claim is submitted to Sigma and/ or DFS, within 30 days of the medical emergency. The claimant must also complete the Reimbursement Agreement. Depending on the medical emergency that occurred during the trip, DFS may ask for the claim form, "Attending physician's statement" to be completed by your physician (there is no need to complete this form unless instructed to do so by the insurer). For all out-of-pocket emergency medical expenses paid directly by the claimant, original bills and proof of payment will be requested.

For Trip Interruption or Trip Cancellation claims, the cancellation Insurance claim form will be provided by DFS as soon as a notice of a claim is submitted to Sigma and/or DFS. If the cancellation is the result of a medical problem or a natural death, the medical statement on the reverse side of this form must also be completed by the family physician. The claimant will have to provide the invoice from their travel service supplier with details of the intended travel arrangements. When applicable, you must provide DFS with the following information:

1) Documentary evidence of the emergency situation which caused the cancellation or delay; 2) Proof that a portion of the travel arrangement costs are non-refundable;

3) Any unused transportation tickets; 4) Any receipts for land arrangements and out-of-pocket expenses, 5) Any tickets or receipts for any extra transportation cost incurred

5.Why must I submit my claim to Manitoba health as well as to sigma/dFs?

As mentioned above, although your provincial government is first payer for health expenses you incur while travelling, DFS will reimburse all of the expenses eligible under your contract so you will receive your reimbursement as soon as possible. As DFS does not yet have an agreement with Manitoba Health to submit the claim to them on the insured member’s behalf, you must sign and return to DFS a Reimbursement Agreement form (provided to you with your Claim form). By signing this form, you agree to submit your original invoices to the Manitoba government and reimburse DFS any partial amounts you will receive from them. If you do not submit a claim to the government, DFS will ask you to reimburse to them the amount you would have received from the provincial government.

6.What would cause a delay in the payment of invoices due to us hospitals and when would collection agencies be involved?

Most US healthcare providers routinely bill international insurance companies at market rates for medical services. For this reason, all travel insurers, including DFS, negotiate lower reimbursement rates.

Billing practices vary by facility. While nearly all of these claims payment negotiations are smooth and prompt, on some rare occasions

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