Hospital Medical Care Visitors to Canada Insurance (HMC)

Eligibility

A Person Insured is not eligible for any coverage under the contract if, as of the Effective Date, any of the following apply to a Person Insured, even if disclosed on the Application:

●  They are travelling or planning to travel to Canada against the advice of a Physician;

●  They have received a Terminal Prognosis;

● They are experiencing new or undiagnosed signs or symptoms of a Sickness for which they reasonably expect may require Treatment while the contract is in force, or otherwise have a reasonably foreseeable need for Treatment while the contract is in force;

● In the 3 years prior to the Effective Date, they have received Treatment for aplastic anemia, hemolytic anemia, sickle cell anemia, or anemia requiring blood transfusions or bone marrow transplants, or have received Treatment in a Hospital for anemia through iron supplements;

● They have had a bone marrow transplant, stem cell transplant or an organ transplant (but excluding cornea transplants);

●  In the 6 months prior to the Effective Date, they have been Hospitalized for a Sickness;

● They are residing in a nursing home, rest home, convalescent home, rehabilitation centre or home for the aged;

● Except as required by minors due to their age, they require assistance with any activities of daily living (i.e., bathing, eating, using a toilet, taking medication(s) or getting into or out of a chair or bed); or

● In the 12 months prior to the Effective Date, they have:

• been prescribed home oxygen (including an oxygen concentrator) or prednisone for a lung condition or heart condition;

• had pulmonary fibrosis or cystic fibrosis;

• used nitroglycerine in any form (spray, patch, or pill) for a heart condition for the relief of angina or chest pain, or had heart condition with an ejection fraction of less than 40%; or

• had any aneurysm that is not surgically repaired.

If you need coverage for pre-existing medical conditions, you have to complete the HMC Medical questionnaire to determine your eligibility, and the cost of your insurance will depend on your medical history.

IMPORTANT EXCLUSION: Diabetes: If the Person Insured has diabetes as a Pre-Existing Condition, Treatment of any cardiovascular or cerebrovascular conditions is not covered (Exclusion #3).

 

Age. The applicant has to be at least 15 days old and no older than 89 years of age on the policy effective date. Pre-existing condition coverage is available for applicants up to 79 years of age.

 

Amount of coverage (Sum Insured): $10,000, $25,000, $50,000, $100,000, $150,000, $200,000

 

Deductible applies per insured per emergency: $100, $250, $500, $1,000, $5,000, $10,000

 

Waiting period.

If You purchase this policy after the Person Insured’s arrival in Canada, there is no coverage for any Emergency caused by an Injury or Sickness that began within 5 days following the Effective Date (the “Waiting Period”).

 

The Waiting Period is waived if the Person Insured is covered by another Canadian travel insurance contract and the coverage under the other Canadian travel insurance contract does not end before the Effective Date of this contract.

 

Family plan is available. Family includes you and/or your spouse and your child(ren) when your names appear on the application or confirmation of insurance. Coverage dates are the same for all family members. All family members must live at the same address while in Canada. No coverage for pre-existing medical conditions

 

Travel worldwide

You may take trips outside of Canada, including to your Country of Residence, during the Policy Period without canceling this contract.

 

Expenses incurred outside of Canada are not covered, unless they are incurred while in direct transit (including layovers) to or from Canada, an emergency happened while the policy is in effect

 

Extending Your Visit

You may apply for an Extension of your health insurance coverage provided you have not incurred a claim in the period prior to the Effective Date of the Extension you wish to purchase. Coverage will be extended at the option of the Company.

Extension coverage will be void and of no force or effect if a claim has occurred in the period immediately prior to your application for Extension coverage.

Your request for the Extension must be received prior to the expiry date of your existing coverage.

 

Premium Refunds

Full refund:

A full refund is not available if your request is made after the policy effective date.

A full refund of premium will be provided:

•  For policies which are returned within 10 days of purchase if the policy has not been used to obtain a Visa and it is returned before the Effective Date of the policy.

•  If You are cancelling your policy because your application for  Parent and Grandparent Super Visa was refused, and you provide proof of visa refusal (or rescinded application) with your request for a refund.

If you want to cancel your policy issued for  your application for  Parent and Grandparent Super Visa before your arrival in Canada without a visa denial letter, a $250 cancellation fee will apply.

Partial refund:

If termination of your policy is requested because you must return to your country of origin prior to your scheduled return date, or you become eligible and/or covered under a provincial or territorial government health insurance plan during the period of coverage, a partial refund of premium (less an administration fee ) may be refunded, provided no claim has been incurred at any time during your trip.

Important note:

•  There is no refund if you have a claim paid, pending, or declined.

•  You may withdraw your claim to allow you to get a refund upon payment of an administration charge of $200,00.

•  You must complete payment for the full year if You have a claim under the monthly payment plan.

Service fees and administrative charges are not refundable.

 

MEDICAL AND HOSPITAL BENEFITS

"Emergency" means an unexpected or unforeseeable Sickness or Injury which requires immediate  medical attention, Treatment or care for the immediate relief of acute symptom, which cannot be delayed until you return to your country of residence.

BENEFITS	DETAILS
EMERGENCY HOSPITAL	Hospital and Medical expenses resulting from a Medical Emergency. Expenses related to prescription medication in hospital are covered up to the aggregate limit of the policy.
Doctor’s visits	•   Physician costs coverage for new symptoms •   The cost of the Doctor’s visits to renew a prescription during the first six (6) months. Refills for medication You had before the Effective Date of this policy are not covered.
Prescription Medications (out-patient)	Up to the Sum Insured & limited to a 30-day supply.
Follow Up Treatment	All Reasonable follow-up Treatment is covered until the Emergency ended. A Recurrence is not covered
Diagnostic rays & Laboratory Services	•   Covered NOTE: Magnetic resonance imaging (MRIs), computerized axial tomography (CAT) scans, sonograms, ultrasounds and biopsies must be approved in advance by the insurer.
Local licensed Ambulance services	Up to $5,000
Private Duty Nurse	Up to $10,000
Necessary Medical Appliances	Up to $5,000
Services of chiropractor, osteopath, chiropodist, podiatrist, osteopath and physiotherapist	50% of the cost of the services / Up to $2,000 when referred by a physician to treat the Emergency event
Dental expenses	Up to $5,000 in the event of a sudden dental infection or damage to the sound natural teeth caused by an Injury to the mouth.
Out-of-pocket Expenses in Hospital	Up to $2,000 while hospitalized
Bedside Companion Transportation	Up to $2,000
Emergency Return Home, Airline or Air Ambulance	Up to $25,000
Repatriation / Cremation / Burial	Up to $10,000
Return of Dependents & Escort	Up to $3,500 for dependents & $3,500 for escort
Meals and Accommodation When Return Is Delayed due to a Medical Emergency of Your Family Member	$100 a day / Up to $2,000
Accidental Death insurance (optional)	Up to $25,000
Trip-Break Benefit	You may return to your country of normal residence or take short side trips outside of Canada without terminating your policy. However, this policy does not provide coverage outside Canada.
Payment to doctors and clinics	You may be required to pay the doctor because the doctor will not want to wait for the insurance process
Payment to Hospitals	Hospitals will be paid directly by the insurance company.

 

EXCLUSIONS and LIMITATIONS

Visitors to Canada medical insurance does not cover everything. This insurance has exclusions, conditions and limitations.

 

Pre-Existing Medical Condition  exclusion:

A Pre-existing medical condition(s) means a medical or physical condition, symptom, illness or disease, whether diagnosed or not, for which Treatment has been received or taken, or which exhibited signs or symptoms, at any time preceding Your Effective Date and includes a medically recognized complication or Recurrence of a medical condition.

 

Option 1

No coverage for Any Pre-existing Condition. No medical questionnaire required. You must meet the Eligibility requirements.

Option 2

Medical questionnaire required. You have to accurately disclose your medical conditions in the medical statement on your application, and have been approved for Pre-existing Condition coverage.

This plan covers pre-existing medical conditions that were Stable at any time during the 365 days immediately before the Effective Date. You can reduce the Period of Stability to the 180 days or 90 days at additional cost.

However, there is no coverage for any loss or expense resulting from a medical condition for which has not been Stable and for which signs or symptoms existed within the 90 days prior to your policy Effective Date.

 

Stable or Stability means that during the period selected in your Application for Insurance, immediately preceding your Effective Date your condition is not worsening and there has been:

a) No change in signs or symptoms or the development of new signs or symptoms.

b) No reduction, increase or stoppage in medication dosage or its frequency.

c) No new medications prescribed.

d) You have not been hospitalized or required medical consultation (other than a routine examination);

e) No medical, therapeutic, or diagnostic procedure has been prescribed, received, or performed, or recommended by a Physician, including but not limited to investigative testing or surgery.

 

Some other exclusions:

This insurance does not cover losses or expenses caused directly or indirectly, in whole or in part, by the following excluded risks:

⁕ Expenses incurred as a result of asymptomatic or symptomatic HIV infection, Acquired Immune Deficiency Syndrome (AIDS), AIDS related conditions (ARC) or the presence of HIV, including any associated diagnostic tests or charges or other sexually transmitted disease;

⁕ Expenses arising from Sickness or Injury related to a change in a pre-approved Pre-existing Condition if you failed to notify the Company of that change prior to your Effective Date;

⁕ Major medical or surgical procedures which are not approved in advance by the Medical Director:

a) cardiac catheterization, angioplasty and/or cardio-vascular surgery including any associated diagnostic test(s) or charges unless approved in advance by the Company prior to being performed, except where such surgery is performed as a Medical Emergency immediately upon admission to Hospital;

b) magnetic resonance imaging (MRIs), computerized axial tomography (CAT) scans, sonograms, ultrasounds or biopsies unless approved in advance by the Company except where such tests are performed as part of a Medical Emergency Treatment protocol;

⁕ Surgery to correct vision or hearing unless caused by an accidental blow or services provided by a naturopath or services provided in a convalescent home, nursing home, rehabilitation centre or health spa;

⁕ Noncompliance with prescribed medical therapy or Treatment;

⁕ Childbirth, miscarriage, deliberate termination of pregnancy, routine prenatal care or any complications incident to pregnancy;

⁕ Mental, nervous or emotional disorders, misuse of medication, abuse of drugs or intoxicants;

⁕ Air ambulance services unless approved in advance and arranged by the Company.

 

Note: This is a summary of benefits. For the full details of coverage, eligibility, exclusions, limitations and claims procedure, please refer to the Policy Wording .

 

If you have questions about this insurance coverage, or need help to complete the application, or want to buy insurance over the phone, please call at 416-493-0101 (or 1-877-443-0101) or click here to ask your question online.   What to do if you need medical assistance 24/7 EMERGENCY ASSISTANCE If you need medical care, go to the nearest possible medical clinic. All minor Sickness such as cough, colds, body aches, diarrhea, infections, and other necessary consultations that may lead to more serious illness is covered up to the coverage limit. Emergency medical Treatment is covered in clinic, in hospital or by virtual consultations.   For Emergencies, Claims Assistance and General Inquiries regarding Your travel insurance, call at 1-833-370-8777 from Canada or the U.S.A. or 416-814-7615 (from other countries)   Failure to contact Trident Global Assistance within the first 48 hours of a visit to a Hospital, urgent care clinic, or a Physician (including virtual visits) as a result of an Emergency may result in a reduction in benefits under the contract.

 

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