VTC Insurance: Pre-existing Medical Conditions & Stable Periods

Seguro para visitantes en Canadá: ¿Están cubiertas las enfermedades preexistentes?

Existen tres tipos de pólizas de seguro (médico de urgencia) que los visitantes de Canadá pueden contratar en las compañías de seguros canadienses para protegerse contra gastos médicos imprevistos (pueden ser pólizas de corta duración para las vacaciones en Canadá o pólizas de larga duración, de un año o más, para las estancias en el extranjero). Experiencia internacional Visado de trabajo para Canadá o requisitos para del Super Visa):

1. Un seguro que NO cubra los gastos médicos derivados de una enfermedad que pueda estar relacionada con CUALQUIER afección médica preexistente; o 
2. Seguro que SÍ cubre los gastos médicos derivados de una enfermedad repentina e inesperada que puede estar relacionada con una enfermedad preexistente ESTABLE.
3. Seguro que SÓLO cubre los gastos médicos derivados de ALGUNAS enfermedades relacionadas con una afección médica preexistente ESTABLE (siempre que la enfermedad no esté relacionada con una afección pulmonar, cerebrovascular o cardiovascular (incluidos el derrame cerebral y el corazón) preexistente).

Algunas compañías (como Manulife Travel Insurance o  Destination Canada) ofrecen tanto el punto 1) como el 2). Other companies offer only one policy that includes coverage 2) for stable conditions up to a certain age (49, 59, 69 or 79 depending on the company), but then the coverage only offers 3) after that age (or no coverage at all).

The problem with category 3) above is that it will only be suitable for travellers with certain type of pre-existing medical conditions...and NOT people with hypertension/blood pressure issues, diabetes, cholesterol/circulatory issues.  It can be difficult for first time buyers of VTC coverage (or even travellers renewing coverage and thinking that they'll just buy the same policy that they had last year) to pay attention to these IMPORTANT DETAILS when making a purchase.

We always recommend speaking to us about a person's health situation before purchasing VTC coverage if pre-existing medical conditions need to be covered, so we can use our experience and policy knowledge to be of assistance (1-888-888-0510). For more information on VTC Coverage and pre-existing medical conditions, visit our Visitors to Canada blog.

While it is always better to have coverage for pre-existing conditions, if a person does not have a past medical history, category 1) above will be just as effective as category 2) or 3)  — and usually less costly.

Travel insurance is designed to help you protect against the risk of sudden, unplanned, and unforeseen circumstances such as accidental injury and unexpected illness. So medical conditions that already exist and can be reasonably expected to require medical attention during your trip will be excluded from coverage under your visitors to Canada health insurance. Simply put, medical expenses for ongoing maintenance, monitoring or treatment of an ongoing (chronic) condition will not be covered — by any of the policies offered by any Canadian insurance company. If we could provide the option for customers to choose that kind of coverage we would (even though it would be costly), but Canadian companies don't provide that type of coverage for visitors to Canada.

Each insurance company uses different definitions of what a 'stable' condition is, or for terms like 'pre-existing medical condition', 'change in treatment', etc. Usually, companies will require a medical condition to be stable for 90, 120 or 180 days before the policy coming into effect. Generally (we will look at exact wording below), during that 90/120/180 day 'stability period', the condition can not have exhibited new symptoms, there can be no changes in medical treatment, no changes (up or down) in medication, or no new diagnoses. Some companies offer exceptions for medications that require routine changes (like warfarin, coumadin, or insulin).

As with all insurance contracts, coverage is based on, and created from a collection of definitions (and exclusions), so it is important to review exact policy wordings (see below) to ensure that the policy offers coverage that fits the traveller's medical situation...(this is where BestQuote Travel Insurance Agency's experience and policy knowledge are well worth using). 

Summary of Visitors Insurance Stability Periods and Age Limits: 

We prefer not to summarize coverage because that can always lead to dismissing relevant information. All policies use their definition of stable and other terms that affect coverage. All policies are subject to certain eligibility questions which may further restrict coverage. Please look at the summary here for a quick reference, before looking at the specific wording below:

• Manulife Plan B covers conditions stable for 180 days before the effective date — up to age 85;
• Blue Cross covers conditions stable for 180 days before the effective date — up to age 79;
• Destination Canada's pre-existing medical conditions coverage uses a stability period of 120 days and is offered up to age 79;
• Travel Shield's Plan B covers conditions stable for 180 days, up to age 70; ages 71-80 only conditions that are not related to lung, cerebrovascular or cardiovascular conditions will be covered (180 days).
• GMS covers conditions stable for 180 days before effective date —  up to age 79;
• Imagine Financial's Discover Canada policy covers conditions stable for 90 days up to age 70; or 180 days for ages 71-80;
• Global Allianz Assistance Visitors Plan covers conditions stable for 180 days — up to age 59; for ages 60 to 79, stable conditions (180 days) are covered except any cardiovascular, cerebrovascular, lung or vein/artery disorder conditions; after age 79, there is no coverage for any illnesses related to pre-existing medical conditions.
• Travel Guard covers conditions stable for 90 days — up to age 49; for ages 50-74 there is no pre-ex coverage.
• RSA Visitors Plan 1 covers conditions stable for 120 days before effective date up to age 79;
• Travelance Premier Plan covers conditions stable for 180 days — up to age 69; for ages 70 to 79, stable conditions (180 days) are covered except any cardiovascular, cerebrovascular, or lung conditions;
• The Optimum Plus Visitors Plan includes coverage for pre-existing medical conditions that are stable for 120 days up to age 85; for ages 86 and older there is no pre-ex coverage.
• Travel Underwriters Ultimate Trip Guard policy covers conditions stable for 120 days — up to age 59; then, for ages 60-69 the stability period becomes 180 days; for ages 70 and older, there is no coverage for pre-existing medical conditions.  

Detailed Summary of Policy Wordings and Relevant Definitions 

Below are the exact policy wordings related to pre-existing medical conditions (along with relevant definitions) for most of the policies found in Canada: 

Manulife Visitors to Canada
The pre-existing condition exclusion that applies depends on your age and the plan you have qualified for as determined by the answers to the medical questions.
Plan A:
Up to age 85: We will not pay any expenses relating to a pre-existing condition for which medication has been taken, received or prescribed and/or treatment has been received in the 180 days before your effective date of insurance; any heart condition if, in the 180 days before the effective date, you require any form of nitroglycerine for the relief of angina pain; any lung condition if, in the 180 days before the effective date, you require treatment with oxygen or prednisone for a lung condition.
Plan B:
Up to age 85: We will not pay any expenses relating to a pre-existing condition that is not stable in the 180 days before your effective date; any heart condition if, in the 180 days before the effective date, you require any form of nitroglycerine for the relief of angina pain; any lung condition if, in the 180 days before the effective date, you require treatment with oxygen or prednisone for a lung condition.
ALL PLANS & ALL AGES:
Hospitalization for a pre-existing condition. We will not pay any expenses relating to a pre-existing condition for which you are hospitalized either more than once or for at least 2 consecutive days in the 12 months before your effective date.
Definitions:
Please refer to these definitions when completing the Medical Questionnaire.
Change in medication means the medication dosage or frequency has been reduced, increased, stopped and/or new medications have been prescribed. We do not mean a change from a brand-name drug to an equivalent generic drug of the same dosage, and a routine adjustment in the dosage of your medication, as a result of your blood levels only, if you are taking Coumadin (warfarin) or insulin and are required to have your blood levels tested regularly and your medical condition remains unchanged.
Effective Date means the date on which your coverage starts.
Hospital means a facility that is licensed as a hospital where in-patients receive medical care and diagnostic and surgical services under the supervision of a staff of physicians with 24-hour care by registered nurses. A clinic, an extended or palliative care facility, a rehabilitation establishment, an addiction centre, a convalescent, rest or nursing home, home for the aged or health spa is not a hospital.
Medical condition means accidental bodily injury, illness or disease; symptom(s); complication of pregnancy within the first 31 weeks of pregnancy; a mental or emotional disorder that requires admission to a hospital, or acute psychosis.
Pre-existing condition means a medical condition that exists before your effective date.
Stable — a medical condition for which:
1. There have been no new symptoms, and existing symptoms have not become more frequent or more severe or there have been no test results showing deterioration; and/or
2. A physician has not determined that the condition has become worse; and/or
3. A physician (or other medical professional) has not prescribed or recommended a change in medication taken or medical care received for that condition; and/or
4. A physician (or other medical professional) has not prescribed or recommended a change in treatment for that condition; and/or
5. There has been no admission to a hospital and/or you are not awaiting results of further investigation for that medical condition.
Treatment means a medical, therapeutic or diagnostic procedure prescribed, performed or recommended by a licensed medical practitioner, including but not limited to prescribed medication, investigative testing and surgery related to any illness, injury or symptom.

Blue Cross: 
Coverage for medical condition(s) that existed before your effective date is subject to the following:
This policy does not provide coverage for any expenses related directly or indirectly as a result of:
a) Your medical condition and/or related condition and/or symptoms (whether or not the diagnosis has been determined) if at any time in the one hundred eighty (180) days preceding your effective date your medical conditions or related conditions and/or symptoms have not been stable;
b) if at any time in the one hundred eighty (180) days before your effective date:
i) any heart condition has not been stable;
ii) any lung condition has not been stable.
Definition:
Stable: Any medical condition or related medical condition for which:
a) there have been no new symptoms, more frequent or more severe symptoms;
b) there has been no change in treatment or change in medications;
c) there has been no deterioration of your medical condition;
d) there has been no hospitalization or referrals to a specialist including initial follow-up visits, tests or investigations booked in conjunction with a medical condition/symptom;
e) there is no further testing, treatment or investigation booked or results pending;
f) you have not experienced a symptom that remains undiagnosed;
g) no further medical treatment after departure would be anticipated.

Travel Guard Canada:
If you are under 50 years of age when your insurance starts your policy includes Medical Exclusion #1.
If you are 50 years of age or older when your insurance starts your policy includes Medical Exclusion #3.
ME#1: We do not cover any loss or expense related directly or indirectly to:
a. Your medical condition or any related condition if in the 90-day period immediately preceding your effective date that condition has not been stable and controlled.
b. Your heart condition if in the 90-day period immediately preceding your effective date:
i. you have had any heart condition that has not been stable and controlled; or
ii. you have been required to use, take, or been prescribed to take nitroglycerine in any form, more than once per a seven-day period.
c. Your lung condition if in the 90-day period immediately preceding your effective date:
i. you have had any lung condition that has not been stable and controlled; or
ii. required the use of home oxygen or had to take oral steroids; for example prednisone or prednisolone.
ME#3: We do not cover any loss or expense related directly or indirectly to:
a. Any medical condition for which you have taken medication, been prescribed medication, received treatment, experienced a deterioration of the condition or had cause to seek treatment at any time within the 180-day period immediately preceding and including your effective date and this exclusion applies whether or not the condition has been stable and controlled;
b. Your heart condition if in the 180-day period immediately preceding your effective date you have taken medication, been prescribed medication, received treatment, experienced a deterioration of the condition or had cause to seek treatment for any heart condition; or
c. Your lung condition if in the 180-day period immediately preceding your effective date you have taken medication, been prescribed medication, received treatment, experienced a deterioration of the condition or had cause to seek treatment for any lung condition.
Definitions:
Medical condition: An injury or sickness, including but not limited to disease, acute psychoses, and complications of pregnancy occurring within the first 31 weeks.
Stable and controlled:Any medical condition for which there has been no new treatment or newly prescribed medication; no change in treatment or change in prescribed medication; no new, more frequent or more severe symptom; no test results showing deterioration; no investigations initiated for symptoms whether or not your diagnosis has been determined; no hospitalization and no referral to a specialist.

GMS Visitors to Canada:
Coverage for medical condition(s) that existed before your effective date is subject to the following:
This policy does not provide coverage for any expenses related directly or indirectly as a result of:
a) Your medical condition and/or related condition and/or symptoms (whether or not the diagnosis has been determined) if at any time in the one hundred eighty (180) days preceding your effective date your medical conditions or related conditions and/or symptoms have not been stable;
b) if at any time in the one hundred eighty (180) days before your effective date:
i) any heart condition has not been stable;
ii) any lung condition has not been stable.
Definition
Stable: Any medical condition or related medical condition for which:
a) there have been no new symptoms, more frequent or more severe symptoms;
b) there has been no change in treatment or change in medications;
c) there has been no deterioration of your medical condition;
d) there has been no hospitalization or referrals to a specialist including initial follow-up visits, tests or investigations booked in conjunction with a medical condition/symptom;
e) there is no further testing, treatment or investigation booked or results pending;
f) you have not experienced a symptom that remains undiagnosed;
g) no further medical treatment after departure would be anticipated.

Allianz Visitors to Canada:
Benefits are not payable for costs incurred for or as a result of:
a) If you are 69 years of age or under on the effective date:
Any pre-existing medical condition unless it was stable in the 180 days immediately before the effective date.
b) If you are 70 to 79 years of age on the effective date:
i. Any of the following pre-existing medical conditions, unless you have completed a Medical Questionnaire, have been approved in writing by AGA and have paid the required premium: • cardiovascular; • cerebrovascular; • respiratory; or
ii. Any other pre-existing medical condition not listed under b) i. unless it was stable in the 180 days immediately before the effective date;
c) If you are 80 years of age or over on the effective date:
Any pre-existing medical condition unless you have completed a Medical Questionnaire, have been approved in writing by AGA and have paid the required premium.
Definition:
Pre-existing medical condition means: Any sickness, injury or medical condition that has showed symptoms or required a medical consultation (even if the condition wasn’t diagnosed), or that you’ve been treated, hospitalized or prescribed medication for.
A medical consultation includes services performed by a physician for an ailment, sickness or medical condition, which may include taking a history of the problem, examining you, advising or treating you, or ordering tests to confirm a diagnosis or find out more.
Stable means a pre-existing medical condition that:
a) did not require, or was not referred for any medical consultation;
b) did not require a change in type or dosage of medication.

RSA Medi-Select Advantage:
This insurance does not cover losses or expenses caused directly or indirectly, in whole or in part, by:
1. Any sickness or symptoms which manifested or were contracted or treated within the first 48 hours following the effective date if you purchase this policy after your arrival in Canada.
2. Pre-existing Condition:
a) Any sickness, injury or medical condition for which:
i. you have had symptoms;
ii. you have been hospitalized;
iii. you have been prescribed medication (including prescribed as needed);
iv. you have taken medication; or
v. you have undergone a medical or surgical procedure, at any time in the 180 days before your effective date.
b) Your heart condition if, for any heart condition:
i. you have had symptoms;
ii. you have been hospitalized;
iii. you have been prescribed medication (including prescribed as needed);
iv. you have taken medication; or
v. you have undergone a medical or surgical procedure, at any time in the 180 days before your effective date.
c) Your lung condition if, for any lung condition:
i. you have had symptoms;
ii. you have been hospitalized;
iii. you have been prescribed medication (including prescribed as needed);
iv. you have taken medication;
v. you have undergone a medical or surgical procedure; or
vi. you have been treated with home oxygen or taken oral steroids (e.g. Prednisone), at any time in the 180 days before your effective date.
3. For insured children under two years of age: Any sickness or medical condition arising from or related to a birth defect.

TuGo Ultimate TG
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. Pre-existing Conditions as defined except as follows:
a) for persons 59 years and under, if Stable in the 120 days before the effective date of this Policy; or,
b) for persons 60 to 69 years, if Stable in the 180 days before the effective date of this Policy and the applicable optional coverage was purchased.

“Pre-existing Condition” means:
a) dental or medical condition, illness or injury that has been diagnosed, and for which you have consulted, or received dental or medical treatment before the effective date or the arrival date in Canada, whichever occurs later; or,
b) A dental or medical condition, illness or injury that has not yet been diagnosed, and for which you were experiencing symptoms before the effective date or the arrival date in Canada, whichever occurs later; or,
c) A medically recognized complication or recurrence of a medical or dental condition, illness or injury, whether the condition was diagnosed before the effective date or the arrival date in Canada, whichever occurs later.
“Medical Treatment” means any reasonable medical, therapeutic or diagnostic measure prescribed by a Physician 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. Medical Treatment does not include either:
a) the unchanged use of prescribed drugs or medication for a Stable condition, symptom or problem; or
b) a check-up where the Physician observes no change in a previously noted condition, symptom or problem.
“Physician” means a Physician, surgeon, radiologist, anesthesiologist, who is registered and licensed to practice his or her medical profession in accordance with the regulations applying in the jurisdiction where the person practices.
“Stable” means the medical condition is not worsening and there has been no alteration* in any medication for the condition or its usage or dosage, nor any Medical Treatment prescribed or recommended by a Physician or received, within the period specified in this Policy before the commencement date of a covered trip.
* Alteration includes an increase or decrease in medication dosage, usage or a change in medication type, but does not include changes in brand due solely to the availability of Your usual brand or due to government regulations regarding reference-based pricing.

For even more specific information, Get an Instant Quote and look at the summary features or ready the policy wording. Or for more help, just give us a call, and we'll be happy to explain in more detail 1-888-888-0510 toll free.