True Senior Guard Travel Insurance Plan

Eligibility and Medical Questionnaire

(applicants 60 + years of age must answer the following questions to determine insurance rate)

Applicant Information

Name of Applicant:
Age of Applicant:
Name of Co-Applicant:
Age of Co-Applicant:

Trip Information

Eligibility

You must meet the following eligibility requirements on the departure date of each trip .
You are eligible for coverage if:
a) You are a Canadian resident  covered by a provincial health insurance plan for the entire trip length;
b) You are not traveling against a physician's advice;
c) You have not been diagnosed with a terminal condition with a life expectancy of 6 months or less;
d) You do not require assistance with any activities of daily living (eating, dressing, personal hygiene).

I confirm that I understand and meet the eligibility requirements above
You are not eligible for True senior Guard Plan. To select the insurance plan best suited to your insurance needs, please complete online our General Medical questionnaire.

Rate Classification Questions

Do any of the following conditions apply to you?
Have you ever had lung cancer, pancreatic cancer, liver cancer or any cancer with metastasis (which includes positive lymph nodes)?
Have you ever undergone a major organ transplant (heart, lung, liver, kidney or pancreas)?
Have you had a Medical Condition that, in the 24 months before the Application Date, has required home oxygen or dialysis?
Have you had Treatment for heart failure or cardiomyopathy in the 12 months before the Application Date?
Have you had chemotherapy, immunotherapy or targeted therapy in the 12 months before your Application Date?
In the 12 months prior to and at the time of application, have you been diagnosed with, received a Treatment for, still receiving treatment for, or have you been prescribed, recommended or renewed Medication for the following conditions (INCLUDING Aspirin):
Osteoporosis
Bowel obstruction or bowel surgery
Cancer (excluding basal cell/squamous cell skin cancer)
Cholesterol
Diverticulitis / Diverticulosis
Dementia and/or Alzheimer's
Diabetes (treated with oral medications, injectables or insulin)
Gallstone(s)
Gastrointestinal bleeding
High Blood Pressure (HBP)
Heart condition(s)/disease treated with Medication
Heart condition(s)/disease treated with these specific treatments / surgeries, (REGARDLESS of when they occurred): angioplasty, stent, bypass, valvular surgery / procedure, pacemaker, defibrillator
Kidney disease (INCLUDING but not limited to: kidney stones & dialysis)
Liver disease
Respiratory condition(s)/disease (INCLUDING but not limited to: asthma and/or seasonal allergies)
Pancreatic Disease including pancreatitis
Parkinson's disease
Seizures and/or Epilepsy
Syncope (loss of consciousness)
Stroke (CVA) and/or mini-stroke (TIA) (INCLUDING aspirin)
Ulcerative Colitis, Crohn’s Disease (INCLUDING Stoma REGARDLESS of when the Treatment/surgery occured)
Has it been longer than 24 months since you last saw a Physician or nurse practitioner?
Have you used any tobacco, vapes or nicotine products in the past 24 months?
Coverage for pre-existing medical conditions
You can choose the stability period for coverage for pre-existing medical conditions. If you experience a change to your health or treatment within a stability period before your departure date, this condition will not be covered.
Stability period for pre-existing conditions (age 60 and over)
Stability period for pre-existing conditions (age 59 and less)
Stability period for pre-existing conditions (age 60 and over)
Stability period for pre-existing conditions (age 59 and less)

Submit your Questionnaire

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