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TRAVELLER Travel Insurance


Medical Questionnaire

Applicants 60 + years of age must answer the following questions to determine insurance rate.

If you have any doubt about your medical condition (s) as it relates to the following questions, you should consult your physician for advice before completing this medical health questionnaire (Important!*).


Eligibility. You are eligible for coverage if:
1. You are a Canadian resident  covered by a provincial health insurance plan for the entire trip length
2. You are not traveling against a physician's advice; or
3. You have not been diagnosed with a terminal condition (
means that a physician has given the applicant a terminal prognosis with a life expectancy of 12 months or less, or when the applicant is receiving palliative care)

I confirm that I understand and meet eligibility requirements above : YES      NO



Applicant : Name         Age         Province of residence       


Single-Trip Medical Plan             Annual Multi-Trip Medical Plan*        Total Number of days per trip    

* For Annual Multi-trip plans, you can choose 5, 10, 20, 35, 60, 95, 125, 155 & 182 days per trip

**  If you are topping-up your existing policy, please provide the details in section Notes below.


View Medical Definitions

Question 1

At the time of application, how many medications in total do you take or have you been ordered to take by a physician for one or more of the following medical conditions:

This medical question is specifically asking for the total number of medications being taken by the applicant for Lung conditions(include asthma), Diabetes and Heart conditions/disease. Click here to see examples.

3 or more medications    

2 medications 

1 medication  



Question 2

Within the 24 months prior to the date of application, have you had a heart attack, stroke and/or transient ischemic attack (mini-stroke, TIA)? 






Question 3

At the time of application, how many of the following medical conditions are you receiving medical treatment for?

(Medical treatment includes medication that you take or have been ordered to take by a physician)

Heart conditions/disease (include aspirin)

Lung conditions/disease (including asthma)

Diabetes (controlled by medication or diet)

Hypertension (also known as high blood pressure)


Bowel obstruction

Peptic ulcer

GERD (gastro-esophageal reflux disease)

Kidney infections

Kidney stones

Kidney failure



  2 or more medical condition  

   1 medical condition 



Question 4

Have you ever been diagnosed with ANY medical conditions that are not listed in the previous questions, for which you currently receive medical treatment?    

(Medical treatment includes medication that you take or have been ordered to take by a physician, not including a minor ailment.)





Question 5

Have you used any tobacco products in the past 12 months? 





Important!* If you qualify for the coverage selected but fail to answer truthfully and accurately any question asked at the time of the application, any claim will be subject to an extra deductible of $15,000 USD in addition to any other applicable deductible amount. No future coverage will be provided under this Policy unless you pay any additional premium reflecting true and accurate answers to those questions.



(Please enter your phone number, if you want an insurance broker call you)



Your E-mail   





The following definitions are for general information only. Please consult your physician for more detailed information about your medical conditions.

Bowel Obstruction

Bowel obstruction is a mechanical blockage of the intestines, preventing the normal transit of products of digestion.


Any malignant growth or tumor caused by abnormal and uncontrolled cell division; it may spread to other parts of the body through the lymphatic system or the blood stream.

Diabetes A chronic condition where the body is unable to produce insulin and properly regulate or maintain sugar (glucose) level in the blood. Includes Type 1 diabetes mellitus, (insulin dependent or juvenile type) and Type 2 diabetes, (adult-onset or noninsulin-dependent diabetes mellitus -NIDDM), which is the most common form of diabetes.


A condition in which pouch-like bulges or pockets (diverticula), most commonly in the wall of the large intestine, become inflamed or infected. It is an inflammation of a diverticulum.


Also known as Gastro-Esophageal Reflux Disease (GERD). It results from chronic exposure of the esophagus to acid coming up from the stomach (reflux).

Heart Conditions/Disease

Any abnormal condition of the heart, heart disease or cardiopathy.

High Cholesterol

Elevated fat content in blood.


Also known as high blood pressure. For example, blood pressure above 140/90 for more than 6 months.

Kidney Infections

Can be an infection within the kidney itself. Urinary Tract Infections (UTI) are not considered Kidney Infections.

Lung Conditions/Disease

Any abnormal condition of the lungs, affecting the lungs or associated airways. Most commonly applicable to lung infection such as pneumonia, Chronic Obstructive Pulmonary Disease (COPD), bronchial asthma, etc.

Medical Condition

Any condition of the body or mind that causes discomfort, dysfunction, or distress to the person affected. Sometimes the term is used broadly to include injuries, disabilities, syndromes, symptoms, deviant behaviours, and atypical variations of structure and function of the human body.


Includes medication that requires a prescription from a physician or other registered medical practitioner and medication purchased over the counter as per the physician′s advice or other registered medical practitioner′s advice.

Minor ailment

Means a condition which does not require the use of medication for a period of greater than 30 days, which did not require follow-up or referral visit to a physician, or other registered medical practitioner or which did not require hospitalization or surgical intervention.

Peptic Ulcer

An erosion in the lining of the esophagus, stomach, or small intestine, usually caused in part by the corrosive action of gastric acid.


Any reasonable medical, therapeutic or diagnostic measure prescribed by a medical physician or other registered medical practitioner in any form including prescribed medication, reasonable investigative testing, hospitalization, surgery or other prescribed or recommended treatment directly referable to the condition, symptom or problem including referral to a specialist. This includes medication that you take or have been ordered to take by a physician.


Not a medical term. Examples are cigarettes, cigars, cigarillos, chewing tobacco, pipe, snuff. Marijuana comes under the class of "drug" or "substance".


QUESTION 1 : Examples

Example1 : Applicant is taking 4 different medications in total: 2 medications are taken for a heart condition, and 2 medications are taken for diabetes. The applicant would answer that they are taking 3 or more medications.

Example2 : For the past few years, Frank has been taking 2 prescribed medications: one for high blood pressure and one for high cholesterol.

Last fall, Frank had a massive heart attack, and was prescribed 4 additional medications, including:

2 high cholesterol medications for his heart condition,

2 high blood pressure medications for his heart condition.

Based on the information provided, none of Frank's medications would be counted under Question #1 because they are either high cholesterol medications or high blood pressure medications. Frank would select "None" and proceed to Question #2. High cholesterol medications and high blood pressure medications are not counted under Question #1, regardless of the condition they're treating.

However, Frank has been prescribed cholesterol medications for his heart condition, which means he is getting treatment for this condition and  has to disclose this condition in question 3.


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Revised: April 09, 2019