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Does Visitors to Canada Medical Insurance Cover Pre-Existing Conditions?

 

A pre-existing medical condition is any disease, illness, medical issue, or injury, including symptoms of undiagnosed conditions, that exists on or before the effective date of the policy or departure from the home country, depending on the plan. This can include conditions such as high blood pressure, diabetes, heart conditions, lung disease, among others.

 

Canadian insurance companies offer Visitors to Canada Medical insurance plans WITH and WITHOUT coverage for pre-existing medical conditions.

 

VTC Insurance without Coverage for Pre-existing Conditions

If you purchased a plan without coverage for pre-existing medical conditions, only NEW unexpected accident or sickness requiring immediate treatment in Canada, will be covered. Minor sicknesses such as cough, colds, body aches, infections, and other health issues requiring medical consultations and immediate treatment are covered up to the sum insured as it is outlined in the policy.

 

VTC Insurance with Coverage for Pre-existing Conditions

Unexpected complications of a pre-existing medical condition and emergencies related to such conditions may also be covered under this policy, provided certain requirements are met.

Stability Requirements

To be covered under this policy, a pre-existing condition must remain STABLE within a specified STABILITY PERIOD preceding the policy effective date or departure from the home country, depending on the plan.

STABILITY PERIOD can be 90 days, 120 days, 180 days, and 365 days, depending on the plan and your age.

If your medical condition does not meet the standard stability requirements, you can opt the 7-day Stability Period Rider with TuGo Visitors insurance, or the 30-day Stability period with the TrueNorth Visitors plan, available at an additional cost.

Definition of Stable

Definition of STABLE may be different with various insurance plans. But, basically, a pre-existing medical condition is considered STABLE, if there has been no change to your health and treatment  within a stability period before the policy effective date:

no change in medication (increase, decrease, stopping, new medications),

Diabetes: Adjusting the regular insulin dosage to manage diabetes is usually not considered a change, provided the insulin was not initially prescribed during the stability period.

no new symptoms, 

no new treatment or tests,

no new medical consultation or referral to a specialist,

no hospitalization,

no new diagnosis.

Routine monitoring of a pre-existing condition during the stability period  is not considered a change provided this condition is not worsening and no change in treatment is recommended.

 

Excluded pre-existing conditions  

Some insurance plans may exclude certain medical conditions from coverage, and it is also important to review and understand any other limitations or exclusions concerning pre-existing conditions which may be outlined in the policy.

 

Eligibility Requirements for Any Visitors Insurance Plan

To purchase any Visitors to Canada Medical Insurance policy, you must meet the eligibility requirements. Some Visitors insurance policies may have eligibility requirements that involve health-related inquiries. This means that specific medical conditions might disqualify you from purchasing this policy.

Ensure that you are eligible for the chosen insurance plan before proceeding with the purchase.

 

 

How to Choose the Right Visitors to Canada Medical Insurance Plan

1)  Eligibility

Make sure that you qualify for the policy.

You're eligible to buy Visitors to Canada medical insurance if you meet the outlined eligibility requirements, and any new condition or injury needing immediate medical attention will be covered based on the policy's terms, conditions, and exclusions. However, your pre-existing medical conditions might not be covered.

 

2)  Coverage for pre-existing medical conditions

If you want your pre-existing  medical condition to be covered, select a plan which includes coverage for pre-existing medical conditions.

Verify that your pre-existing condition meets the stability requirements stated in the policy and is not excluded from coverage.

 

Please note that Visitors to Canada insurance covers losses resulting from sudden, unexpected and unforeseen situations such as sickness, injury, or complication of a stable pre-existing medical condition that may happen during the policy period. Ongoing care, medications prescribed before the policy effective (start) date are not covered.

 

3)  How Much You Will Pay

The cost of your insurance will depend on:

Age of the visitor,

Amount of coverage (aggregated policy limit),

Deductible (Deductible means the portion of eligible expenses you must pay from your own pocket when a claim occurs. The higher deductible the less premiums),

If the policy includes coverage for pre-existing medical conditions, or not,

Plan details, benefit limits covered under different insurance policies,

Some plans require a medical questionnaire to determine the cost of insurance.

 

 Please call at 416-493-0101 or 1-877-443-0101 for for assistance, or  Ask Your Question ONLINE

 

 

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Explore How Various Visitors to Canada Insurance Policies

Cover Pre-existing Medical Conditions

  21st Century Travel Visitors to Canada Insurance (underwritten by Manulife Financial)

  Allianz Global Assistance Visitors to Canada

  Destination Travel Group Visitors to Canada Insurance

  Group Medical Services (GMS) - Immigrants & Visitors to Canada

  Manulife Visitors to Canada

  TrueNorth Visitors to Canada

  Travelance Visitors to Canada (Premier Plan)

  TuGo Visitors to Canada Insurance

Call us at 1-877-443-0101 (416-493-0101) for free consultation or ask your question ONLINE

 

 Allianz Global Assistance

Pre-existing Conditions Exclusion

a) If you are 59 years of age or under on the effective date:

Benefits are not payable for costs incurred due to or resulting from your medical condition or related condition that was not stable at any time during the 90 days immediately before the effective date.

b) If you are 60 to 89 years of age on the effective date:

Benefits are not payable for costs incurred due to or resulting from your pre-existing medical condition or related condition that was not stable at any time during 180 days immediately before the effective date

 

Stable describes any medical condition or related condition, including any heart condition or lung condition, for which:

a) there has been no new treatment; and

b) there has been no change in treatment or change in treatment frequency or type; and

c) there have been no signs or symptoms or new diagnosis; and

d) there have been no test results showing deterioration; and

e) there has been no hospitalization; and

f) there has been no referral to a specialist (made or recommended) and you are not awaiting surgery or the results of further investigations performed by any medical professional.

The following are considered stable:

a) Routine (not prescribed by a physician) adjustment of insulin to control diabetes provided the insulin was not first prescribed during the stability period. .

b) Change from a brand name medication to a generic medication provided the medication was not first prescribed during the stability period and there is no increase or decrease in dosage.

c) A minor ailment, which describes a sickness or injury during the stability period which ended more than 30 days prior to the effective date and which did not require:

i. treatment for a period longer than 15 consecutive days; or

ii. more than one follow-up visit to a physician; or

iii. hospitalization, surgery, or referral to a specialist.

The following conditions are not considered stable:

a) any lung condition for which you were prescribed or are taking prednisone;

b) any heart condition for which you were prescribed or are taking nitroglycerin.

 

2) Benefits are not payable for any costs incurred due to any sickness for which signs or symptoms occurred within 48 hours after the effective date, except when applying for coverage:

a) before the expiry date of your existing Allianz policy; or

b) prior to the date you exit your country of origin

 

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  21st Century Travel Insurance (underwritten by Manulife Financial)

The company will not reimburse you for Insured services or pay an Accidental Death and Dismemberment claim and/or any other expenses directly or indirectly from:

Basic Plan (no age limit)

- Any pre-existing medical condition.

Standard Plan (available for ages 55 to 85 on the policy effective date)

- Any pre-existing medical condition that exist in the 180 days prior to the policy effective date.

Enhanced Plan (for ages up to 85)

i) if you are under age 55

- Other than a stable chronic condition;

ii) if you are age 55 to 85

- Other than a stable chronic condition and you were eligible to purchase and paid the required premium for the Stable Chronic Condition Option (Medical Declaration is required).

 

Stable Chronic Condition means a pre-existing medical condition for which, in the 180 days prior to your effective date of insurance:

there have been no new symptoms or change in symptoms; and

existing symptoms have not become more frequent or severe; and

physician has not found that the medical condition has become worse;

no test findings have shown that the medical condition may be getting worse; and

a physician has not provided, prescribed, or recommended any new medication, or any change in medication; and

a physician has not provided, prescribed, or recommended any new treatment, or any change in treatment; and

there has been no hospitalization or referral to a specialist or specialty clinic; and

a physician has not advised referral to a specialist or further testing, and there has been no testing for which results have not yet been received.

This policy will not cover:

a) any heart condition if, in the 180 days before the effective date, you required any form of nitroglycerine for the relief of angina pain.

b) any lung condition if, in the 180 days before the effective date, you required treatment with prednisone for a lung condition.

 

Change in medication means the medication dosage, frequency or type has been reduced, increased, stopped and/or new medication(s) has/have been prescribed

Exceptions: the routine adjustment of Coumadin, Warfarin or insulin, as long as they are not newly prescribed or stopped and there has been no change in your medical condition; and, a change from a brand name medication to a generic brand medication of the same dosage.

 

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Manulife Financial

The company will not pay any expenses or benefits relating to:

Plan A 

a) any medical condition, diagnosed or undiagnosed, which existed or for which you sought or received medical advice, consultation, investigation, or for which treatment was required or recommended by a physician, within the 180 days prior to the effective date.

b) any heart condition if, in the 180 days before the effective date, you required any form of nitroglycerine for the relief of angina pain;
c) any lung condition, if in the 180 days before the effective date, you required treatment with oxygen or prednisone for a lung condition.

d) a pre-existing condition for which you were hospitalized either more than once, or for at least 2 consecutive days, in the 12-month period before your effective date of insurance.

 

Plan B 

a) a pre-existing condition that is not Stable in the 180 days before the effective date of insurance;
b) any heart condition if, in the 180 days before the effective date, you required any form of nitroglycerine for the relief of angina pain;
c) any lung condition if, in the 180 days before the effective date, you required treatment with oxygen or prednisone for a lung condition.

d) a pre-existing condition for which you were hospitalized either more than once, or for at least 2 consecutive days, in the 12-month period before your effective date of insurance.
 

STABLE medical condition means that all of the following apply:

you have not had any new symptom(s); and

existing symptom(s) have not become more frequent or severe; and

a physician has not determined that the medical condition has become worse; and

no test findings have shown that the medical condition may be getting worse; and

a physician has not provided, prescribed, or recommended any new medication, any change in medication; and

a physician has not provided, prescribed or recommended any new treatment or any change in treatment; and

there has been no admission to a hospital or referral to a specialty clinic or specialist; and

a physician has not advised referral to a specialist or further testing, and there has been no testing for which the results have not yet been received.

Change in medication means the medication dosage or frequency has been reduced, increased, or stopped, and/or new medication/s has/have been prescribed.

The following is not considered a change in medication:

a) the routine adjustment of Coumadin, warfarin or insulin (as long as they are not newly prescribed or stopped) and there has been no change in your medical condition;

b) a change from a brand-name drug to an equivalent generic drug of the same dosage

 

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►  Group Medical Services (GMS)

A Pre-Existing Medical Condition exclusion:

The company does not cover any expenses resulting from medical condition(s) which have not been STABLE for 180 days immediately prior to your effective date, including:

a. medical condition(s) for which you received medical treatment or medical consultation; and/or

b. undiagnosed medical conditions(s) related to symptoms for which you received medical treatment or medical consultation.

You must be STABLE based on the definition of STABLE in this policy, regardless of the opinion of your physician or any other person who may provide an opinion on your medical condition(s).

 

STABLE: a medical condition is stable if,

a.  you have no reason to expect medical treatment after your effective date for the medical condition or any symptoms ;

b.  in the 180 days before your effective date, you have not received new or different medical treatment for the medical condition;

c.  in the 180 days before your effective date, you have not had an alteration to an existing prescription drug or were prescribed a new drug for the medical condition;

d.  in the 180 days before your effective date, your medical condition has not become worse;

e.  in the 180 days before your effective date, you have not experienced new, more frequent or more severe symptoms;

f.  in the 180 days before your effective date, you have not had or needed medical consultation for undiagnosed symptoms;

g.   in the 180 days before your effective date, you have not needed in-hospital care; a referral to a specialist, or a follow-up visit; and

h.  in the 180 days before your effective date, you have not had tests or an investigation whether you know the results or not, related to the medical condition.

 

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►  TuGo Visitors to Canada insurance

The company will not be liable to provide coverage or services, or to pay claims for expenses incurred directly or indirectly as a result of:

 1)     a) For insureds who are 59 years and under on the application date

Pre-existing conditions that are not stable in the 90 days before the policy effective date,

b) For insureds who are 60 to 69 years on the application date .

Pre-existing conditions that are not stable in the 120 days before the policy effective date,

c) For insureds who are 70 - 85 years on the application date.

Pre-existing conditions that are not stable in the 180 days before the policy effective date,

d) For insureds who are 86 years and over on the application date.

Pre-existing conditions that are not stable in the 365 days before the policy effective date.

 

2) Conditions or any related conditions for which, prior to departure, testing or investigative consultation took place, was scheduled to take place or was recommended (not including routine check-up or routine monitoring for a medical condition), and for which results had not yet been received at the time of departure. This includes tests that were recommended or scheduled prior to departure, but had not yet taken place at the time of departure.

 

Unstable Pre-existing Medical Condition Coverage (Optional )

This Optional Coverage can be purchased as an endorsement to the Emergency Medical Insurance plan.

Eligibility: you must be 79 years and under at the time of the application date of this Policy.

Maximum limit: Up to the sum insured as indicated on the declaration. This coverage does not increase the maximum limits of the Emergency Medical Insurance plan stated in the Policy.

When this Optional Coverage is purchased, the insurer will pay for sudden and unexpected emergency medical condition incurred as a result of your pre-existing medical conditions that do not meet the stability requirements above but stable on or within the 7 days before the effective date of this Policy.

 

Pre-existing Condition means:

Any disease, illness or injury (including symptoms of undiagnosed conditions that exists on or before the effective date of the Policy.

 

Stable Condition

A medical condition is considered stable when all of the following statements are true:

There has been no deterioration of the medical condition as determined by a physician or other registered medical practitioner, and

There have been no new symptoms or findings or more frequent or severe symptoms or findings, and

There has been no change in treatment by a physician or other registered medical practitioner or any Alteration in any medication related to the medical condition, and

There has been no new treatment received, prescribed or recommended by a physician or other registered medical practitioner.

 

Alteration

The medication usage, dosage or type has been increased, decreased or stopped and/or a new medication has been prescribed. Alteration does not include:

a. Changes in brand to an equivalent name brand or to an equivalent generic brand of the same or equivalent usage or dosage; or,

b. Routine dosage adjustments within prescribed parameters for insulin or oral diabetes medication to ensure correct blood levels are maintained; blood sugar levels must be checked regularly and the medical condition must remain unchanged; or,

c. Routine dosage adjustments within prescribed parameters for blood thinner medication to ensure correct blood levels are maintained; blood levels must be checked regularly and the medical condition must remain unchanged; or,

d. A temporary stoppage of blood thinner medication up to a maximum of 24 hours if the stoppage is required for a surgery or a procedure; or,

e. Usage changes due to the combination of several medications into one; the medical condition must remain unchanged.

 

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►  Travelance (Premier Plan)

There is no coverage and no benefits will be payable for claims presented under this section resulting from:

1. Pre-Existing Conditions or related Medical Conditions as follows:

a) For ages 69 and under on the Start Date,

-  any Pre-Existing Condition or Medical Condition that was not Stable and Controlled during the 180 day period immediately prior to Your Start Date.

b) For ages 70 to 79 on the Start Date:

any Pre-Existing Condition or Medical Condition that was not Stable and Controlled during the 180 day period immediately prior to Your Start Date; and, 

any of the following Pre-existing Conditions that were present on Your Start Date:

▪ Any heart condition including but not limited to heart attack, angina, arrhythmia or cardiac surgery;

 Any brain condition including but not limited to stroke, transient ischemic attack (TIA), mini-stroke, aneurysm or seizure;

 Any lung condition including but not limited to chronic obstructive pulmonary disease (COPD), asthma, chronic bronchitis or emphysema.

c) For ages 80 and over on the Start Date,

-  any Pre-Existing Condition or Medical Condition that was present on Your Start Date.

 

Stable and Controlled means:

 - there has not been any new Treatment prescribed or recommended, or change(s) to existing Treatment (including a stoppage in Treatment); and

- there has not been any change to any existing prescribed drug including an increase, decrease, or stoppage to prescribed dosage), or any recommendation or starting of a new prescription drug.

(If You require a routine adjustment to the dosage of Your prescription for Coumadin, Warfarin or Insulin (unless it is newly prescribed or stopped) to ensure correct blood levels are maintained, such a change is not considered an alteration in medication provided the condition remains unchanged); and

- the Medical Condition has not become worse; and

- there has not been any new, more frequent or more severe symptoms; and

- there has been no hospitalization or referral to a specialist; and

- there have not been any tests, investigation or Treatment recommended, but not yet complete, nor any outstanding test results; and

- there is no planned or pending Treatment

 

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►  Destination Visitors to Canada  

This policy will not provide coverage, provide services, or pay claims for expenses incurred directly or indirectly as a result of:

a) If you are 79 years of age or under on the application date and selected Option 1 at the time of application:

▪  Any pre-existing medical condition unless it was stable in the 120 days immediately before the effective date.

b) If you are 79 years of age or under on the application date and selected Option 2 at the time of application:

▪  Any pre-existing medical condition.

If you are 80 years of age on the application date:

▪  Any pre-existing medical condition.

 

Stable means a medical condition that is considered stable when all of the following statements are true:

1. There has not been any new treatment prescribed or recommended, or change(s) to existing treatment (including a stoppage in treatment); and

2. There has not been any change in medication (including increase or decrease of dosage), or any recommendation or starting of a new prescription drug, and

3. The medical condition has not become worse, and

4. There has not been any new, more frequent or more severe signs or symptoms, and

5. There has been no hospitalization or referral to a specialist, and

6. There have not been any tests, investigation or treatment recommended, but not yet complete, nor any outstanding test results, and

7. There is no planned or pending treatment

 

Medical consultation means any medical services obtained from a physician for a sickness, injury or medical condition, including but not limited to any or all of: history taking, medical examination, investigative testing, advice or treatment, and during which a diagnosis of the medical condition need not have been definitively made. This does not include routine annual medical check-ups where no medical signs or symptoms existed or were found during the check-up.

 

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►  TrueNorth Visitors Plan

If the Pre-Existing coverage was purchased, the insurer will not pay any expenses or benefits relating to any pre-existing conditions and/or symptoms unless the pre-existing condition meets the following guidelines: :

Standard and Enhanced Plans

i) For 0-74 years of age: a standard stability period is 180 days  with option of a 90-day stability period  at additional cost.

ii) For 75+ years of age: a standard stability is 365 days with options of a 180-day and a 90-day stability period at additional cost.

b) Gold and Platinum Plans

i) For 0-74 years of age: a standard stability period is 180 days with options of a 90-day and a 30-day stability period at additional cost.

ii) For 75+ years of age: a standard stability period is 365 days with options of a 180-day, a 90-day and a 30-day stability period at additional cost.

NOTE: dates are based from the departure from Your home Country.

 

STABLE describes any Medical condition or related condition for which:

a) there has been no new Treatment; and

b) there has been no change in Treatment or change in Treatment frequency or type; and

c) there have been no signs or symptoms or new diagnosis; and

d) there have been no test results showing deterioration; and

e) there has been no Hospitalization; and

f) there has been no referral to a specialist (made or recommended) and You are not awaiting the results of further investigations performed by any medical professional.

 

The following are considered STABLE:

Routine (not prescribed by a Physician) adjustment of insulin to control diabetes provided the insulin was not first prescribed during the time period specified in the pre-existing conditions exclusion as shown on Your Confirmation.

Change from a brand name medication to a generic medication provided the medication was not first prescribed during the time period specified in the pre-existing conditions exclusion as shown on Your Confirmation and there is no increase or decrease in dosage.

The routine adjustment of Coumadin or Warfarin provided the Coumadin or Warfarin was not first prescribed during the time period specified in the pre-existing conditions exclusion as shown on Your Confirmation.

A minor ailment

 

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NOTE: The product-related information is for illustration only. Please refer to the policy wording for the complete terms, benefits, conditions & exclusions.

 

 

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