News of the Coronavirus (COVID-19)

News of the Coronavirus (COVID-19) has been dominating the headlines. Although the risks remain low in Canada, we do want to keep you informed.

COVID-19 is a respiratory illness caused by a virus that can be similar to the common cold, but some cases are more severe. Most people infected are likely to fully recover, just as they would from the flu.

People may be at greater risk if they have recently travelled to regions where there are currently outbreaks of the virus, or if they come into contact with someone who has the virus.

The most common symptoms are fever, cough, and shortness of breath. Symptoms typically appear within 2 to 14 days after exposure.

The virus is spread from person to person primarily through coughing and sneezing. Washing hands, cleaning commonly touched surfaces, and avoiding close contact with people showing symptoms are the best ways to prevent the illness from spreading.

There is no vaccine for COVID-19 at this time.

Most carriers are handling COVID-19 claims as follows:

For healthcare services and supplies incurred in Canada, standard healthcare contracts do not exclude coverage for a particular illness.

Out–of-country emergency care and travel assistance:
Standard contracts have out-of-country emergency care coverage. It covers expenses for healthcare services and supplies for a sudden, unexpected injury or an acute episode of disease. Travel assistance provides assistance for medical emergencies while travelling for vacation, business, or education. To be eligible for out-of-country emergency care and travel assistance, the plan member must be covered by their home province’s government health plan or the government coverage replacement plan sponsored by the employer.

NOTE: When a city is in lockdown, carriers may not be able to give assistance as officials may refuse entry. When a country issues evacuation notices assistance is left with the Canadian Embassy.

Prescription drugs:
For plan sponsors that have optional vaccine coverage under their group contract, any vaccine with a drug identification number (DIN) will be covered.

When a plan member can’t work because of a COVID-19 diagnosis or COVID-19-like symptoms, carriers will assess their eligibility for benefits the same way they do other illnesses. If a plan member is under quarantine related to COVID-19 and can’t be at work, carriers will assess their eligibility for benefits based on the terms of the contract.

This is an evolving situation and carriers will review the circumstances of each inquiry or claim on its own merit and the terms of the applicable group contract.

Carriers handle COVID-19 related claims the same way they handle other claims: based on the contract provisions applicable to that specific plan member.

For the latest information regarding COVID-19 we encourage plan sponsors and members to view the Government of Canada’s website:

DBA Team

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