TRAVELLER Travel Insurance
Applicants 60 + years of age must answer the following questions to determine
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
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
Applicant : Name
Province of residence
Newfoundland and Labrador
Prince Edward Island
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
** If you are topping-up your existing policy, please provide the details in
section Notes below.
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:
Lung conditions (including asthma)
Heart conditions/disease (Do
not include aspirin, hypertension (high blood
pressure) and high cholesterol medication)
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
Within the 24 months prior to the date of application, have you had
a heart attack, stroke and/or transient ischemic attack
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)
conditions/disease (include aspirin)
conditions/disease (including asthma)
(controlled by medication or diet)
(also known as high blood pressure)
(gastro-esophageal reflux disease)
2 or more
ever been diagnosed with ANY medical conditions that are not listed
in the previous questions, for which you currently receive medical
treatment includes medication that you take or have been ordered to
take by a physician, not including a minor ailment.)
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)
The following definitions are for
general information only. Please consult your physician for more detailed
information about your medical conditions.
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.
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
Also known as Gastro-Esophageal
Reflux Disease (GERD). It results from chronic exposure of the esophagus to
acid coming up from the stomach (reflux).
Any abnormal condition of the
heart, heart disease or cardiopathy.
Elevated fat content in blood.
Also known as high blood pressure. For example,
blood pressure above 140/90 for more than 6 months.
Can be an infection within the
kidney itself. Urinary Tract Infections (UTI) are not considered Kidney
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.
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.
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
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".
: 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.
: 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.
February 20, 2019