Eligibility and Medical
Who can apply?
To be eligible for medical coverage you must:
a) be at least 15 days old and
no more than 89 years old;
b) be insured for benefits under a Canadian government
health insurance plan
during the entire period of coverage
Applicant : Name
Province of residence
Newfoundland and Labrador
Prince Edward Island
Traveling Worldwide excluding USA
Single-Trip Medical Plan
Annual Multi-Trip Medical Plan*
Total Number of days per trip *
For Annual Multi -trip plans, you can
choose 4, 8, 15, 35, 60 or 125 days per trip.
If you are topping-up your existing policy, please provide the details in section
View Medical Definitions
Do you qualify?
Section 1 - Eligibility
Please answer the
following medical questions to determine your eligibility
diagnosed with a terminal illness?
been diagnosed with stage 3 or 4 cancer, or
been diagnosed or received
for any cancer (other than basal cell
or squamous cell skin
cancer or breast cancer treated only with hormone therapy)
in the past 3 months?
with activities of daily living?
Have you been
prescribed or used home oxygen
for a lung/respiratory
condition during the previous 12
had your most recent
heart surgery more
than 12 years ago or less than 6 months ago ?
Have a diagnosed
unrepaired aneurysm of 4 centimeters or greater, measured in
either length or diameter?
received or are awaiting a bone marrow or had
a major organ transplant?
Have you been
diagnosed with or received
treatment for a kidney disease
ever been diagnosed with an auto-immune disorder
you ever been diagnosed with
congestive heart failure?
any of the medical questions in Section 1,
you are not eligible to purchase this policy.
Please continue to Section 2, if you have to answer NO to all
questions in Section 1.
What rate category do you qualify for?
Please answer all questions and
check Yes or No for each question (for applicants 60 -
89 years of age ).
Section 2 - Rate Table
Have you smoked tobacco
or used tobacco products in the last 5 years
In the 12 months before the date you apply for coverage,
a) been prescribed or
taken 7 or more medications excluding aspirin?
been prescribed or used prednisone for any lung/respiratory
c) used any form of nitroglycerine
(spray, patch or pill) for the relief of angina/chest pain?
been hospitalized (as an inpatient or in the emergency
department) for a heart condition?
e) had a stroke or mini-stroke
(TIA or transient ischemic attack)?
In the last 24 months have
you been diagnosed with or received treatment for a blood
have any of the following conditions, OR in the last 5 years, have
you been diagnosed with or had an investigation,
consultation , been prescribed
medication or received treatment for:
a) Artery or vein disorder?
(other than basal cell and squamous cell
skin cancer or breast cancer treated only with hormone
c) Diabetes (controlled
by oral medication or insulin)?
(including pacemaker or defibrillator,
even if the procedure was completed more than 5 years ago)
f) Stroke (CVA), mini-stroke
Do you have any of the following
conditions, or in the last 24 months, have you been diagnosed with or
had an investigation, medical consultation
, been prescribed medication or
a) Neurological disorder?
b) Digestive tract disorder?
c) Internal conditions?
d) High blood pressure treated with 3 or
Was your last medical check-up more than
18 months ago?
Do you have any of the following
conditions, OR in the last 12 months, have you been diagnosed with or
had an investigation, medical consultation, been prescribed medication or
a) High blood pressure (hypertension) treated with 1 or 2
b) Pre-diabetes (glucose intolerance) and diet-controlled
bone and joint disorder?
Option to exclude pre-existing
conditions from coverage:
(Not available if you answered YES to
questions 2 and 3
in Section 2 OR if you
answered NO to all questions.)
Do you want to exclude
all pre-existing medical conditions, regardless of whether
or not they are stable?
(Answering YES to this question
provides coverage only for new
medical conditions that arise during
(Please enter your phone number, if
you want an insurance broker call you)
Activities of daily living
means any of the following:
f) using the toilet;
g) changing positions (including getting in and out of a
bed or chair);
or vein disorder
includes aneurysm, atherosclerosis, blood clots, carotid artery stenosis,
deep vein thrombosis (DVT), peripheral vascular disease (PVD), varicose
includes acquired immune deficiency syndrome (AIDS) or human
immunodeficiency virus (HIV), Grave’s disease, Lou Gehrig’s disease,
multiple sclerosis, myasthenia gravis, sarcoidosis any location,
scleroderma, systematic lupus erythematosis.
includes anemia (other than vitamin B-12 deficiency anemia, hematochromatosis, idiopathic thrombocytopenic purpura
(ITP), hemophilia, polycythemia vera, Sickle-cell anemia.
includes cancer of the blood, bowel, brain, breast, colorectal, esophagus,
lung, ovarian or uterine, prostate, skin, stomach.
Digestive tract disorder
includes Crohn’s disease, bowel, colon and intestinal disorder,
diverticulitis, diverticulosis, esophagus disorder, hernia, stomach
disorder, gastroesophaegeal reflux disease (GERD), gastritis, inflammatory
bowel disease, irritable bowel syndrome (IBS), ulcer, ulcerative colitis.
includes angina or chest pain, arrhythmia, arteriosclerosis, atrial
fibrillation, congenital heart defect, congestive heart failure,
cardiomyopathy, carotid artery occlusion, heart attack (myocardial
infarction), heart murmur, irregular heart rate or beat, any other condition
relating to the heart or cardiovascular system.
includes ablation, angioplasty, heart bypass operation, implanted
defibrillator, implanted pacemaker, valve replacement (repair),
includes gallbladder disease, kidney disorder (including kidney stones),
liver disease, ovarian or uterine disorder, prostate or urinary disorder,
spleen and/or pancreatic disorder.
includes asbestosis, bronchial asthma, bronchiectasis, chronic asthma,
chronic bronchitis, chronic obstructive pulmonary disease (COPD), emphysema,
pulmonary embolism, pulmonary fibrosis, sleep apnea (using a CPAP machine),
means, heart, kidney, liver or lung.
means a sickness or injury which ended more than 30 days prior to the
effective date and which did not require:
a) treatment for a period longer than 15
consecutive days; or
b) more than one follow-up visit to a physician; or
c) hospitalization, surgery, or referral to a specialist.
means any medical services obtained from a licensed medical practitioner 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 condition need not
have been definitively made. This does not include regular medical check-ups
where no medical signs or symptoms existed between check-ups or were
found during the check-up.
Muscle, bone and joint
includes degenerative disc disease (DDD), fibromyalgia, herniated disc,
osteoporosis, osteopenia, rheumatoid arthritis, sciatica, scoliosis, spinal
includes Alzheimer’s disease or dementia, brain injury, brain tumor,
cerebral palsy, Creutzfeldt–Jakob disease, Cushing’s syndrome, epilepsy,
Guillain-Barré syndrome (GBS), Parkinson’s disease, seizure, trigeminal
neuralgia (TN or TGN).
means any evidence of disease experienced by you or recognized through
to a medical condition for which a physician gave a prognosis of eventual
death or for which palliative care was received prior to the effective
means a medical, therapeutic or diagnostic procedure prescribed, performed
or recommended by a physician including, but not limited to, prescribed
medication, investigative testing or surgery.
January 31, 2019