Assurance pour les Visiteurs au Canada : Les Conditions Préexistantes sont-elles Couvertes?

Il existe trois types de polices d’assurance (soins médicaux d’urgence) que les visiteurs au Canada peuvent acheter (polices à court terme ou exigences de super visa) :

  1. une assurance QUI NE COUVRE PAS les frais médicaux découlant d’une maladie qui peut être liée à un problème de santé préexistant; ou
  2. Assurance qui COUVRE les frais médicaux découlant d’une maladie soudaine et imprévue qui peut être liée à un état de santé préexistant STABLE.
  3. Assurance qui couvre UNIQUEMENT les frais médicaux découlant de CERTAINES maladies liées à une affection préexistante STABLE (à condition que la maladie ne soit pas liée à une affection pulmonaire, cérébrovasculaire ou cardiovasculaire préexistante (y compris un accident vasculaire cérébral et cardiaque).

Certaines entreprises (comme l’Assurance voyage Manuvie ou Destination Canada) offrent à la fois 1) et 2) ci-dessus. D’autres compagnies n’offrent qu’une seule police qui inclut la couverture 2) pour des conditions stables jusqu’à un certain âge (49, 59, 69 ou 79 selon la compagnie), mais la couverture n’en offre que 3) après cet âge (ou aucune couverture du tout).

Le problème avec la catégorie 3) ci-dessus est qu’elle ne convient qu’aux voyageurs qui ont certains types de problèmes de santé préexistants...et NON aux personnes qui ont des problèmes d’hypertension/tension artérielle, de diabète, de cholestérol/problèmes circulatoires.  Il peut être difficile pour les nouveaux acheteurs de la couverture VTC (ou même les voyageurs qui renouvellent la couverture et qui pensent qu’ils achèteront la même police que l’an dernier) de prêter attention à ces DÉTAILS IMPORTANTS lorsqu’ils font un achat.

Nous recommandons toujours de nous parler de la situation de santé d’une personne avant d’acheter une couverture VTC si des problèmes de santé préexistants doivent être couverts, afin que nous puissions utiliser notre expérience et notre connaissance des politiques pour vous aider (1-888-888-0510).

Bien qu’il soit toujours préférable d’avoir une couverture pour les affections préexistantes, si une personne n’a pas d’antécédents médicaux, la catégorie 1) ci-dessus sera tout aussi efficace que la catégorie 2) ou 3) — et habituellement moins coûteuse.

L’assurance voyage est conçue pour vous aider à vous protéger contre les risques de circonstances soudaines, imprévues et imprévues, comme les blessures accidentelles et les maladies imprévues. Ainsi, les problèmes de santé qui existent déjà et qui pourraient raisonnablement nécessiter des soins médicaux pendant votre voyage seront exclus de la couverture d’assurance-maladie de vos visiteurs au Canada. Autrement dit, les frais médicaux liés à l’entretien, à la surveillance ou au traitement continus d’une maladie (chronique) ne seront pas couverts — par l’une des polices offertes par une compagnie d’assurance canadienne. Si nous pouvions offrir aux clients la possibilité de choisir ce type de couverture, nous le ferions (même si ce serait coûteux), mais les entreprises canadiennes n’offrent pas ce type de couverture aux visiteurs au Canada.

Chaque compagnie d’assurance utilise des définitions différentes de ce qu’est un état « stable », ou des termes comme « état de santé préexistant », « changement de traitement », etc. Habituellement, les compagnies exigeront qu’un état de santé soit stable pour 90, 120 ou 180 jours avant l’entrée en vigueur de la politique. En général (nous examinerons la formulation exacte ci-dessous), pendant cette période de stabilité de 90/120/180 jours, la condition ne peut pas avoir présenté de nouveaux symptômes, il ne peut y avoir aucun changement dans le traitement médical, aucun changement (haut ou bas) dans les médicaments, ou aucun nouveau diagnostic. Certaines compagnies offrent des exceptions pour les médicaments qui nécessitent des changements de routine (comme la warfarine, la coumadine ou l’insuline).

Comme pour tous les contrats d’assurance, la couverture est fondée sur un ensemble de définitions (et d’exclusions), et il est donc important de revoir le libellé exact de la police (voir ci-dessous) pour s’assurer que la police offre une couverture qui correspond à la situation médicale du voyageur...(C’est là que l’expérience et les connaissances de BestQuote Travel Insurance Agency valent la peine d’être utilisées).


Résumé des Périodes de Stabilité et des Limites d’Âge de l’Assurance Visiteurs :

Nous préférons ne pas résumer la couverture, car cela peut toujours entraîner le rejet de renseignements pertinents. Toutes les polices utilisent leur définition de termes stables et autres qui ont une incidence sur la couverture. Toutes les polices sont assujetties à certaines questions d’admissibilité qui peuvent restreindre davantage la couverture. Veuillez consulter le résumé ci-dessous pour une consultation rapide, avant d’examiner le libellé précis ci-dessous :

  • Le Plan B de Manuvie couvre les conditions stables pendant 180 jours avant la date d’entrée en vigueur — jusqu’à l’âge de 85 ans;
  • La Croix Bleue couvre des conditions stables pendant 180 jours avant la date d’entrée en vigueur — jusqu’à l’âge de 79 ans;
  • La couverture de maladie préexistante de Destination Canada prévoit une période de stabilité de 120 jours et est offerte jusqu’à l’âge de 79 ans;
  • Le plan B de Travel Shield couvre les affections stables pendant 180 jours, jusqu’à l’âge de 70 ans; les affections de 71 à 80 ans seulement qui ne sont pas liées à des affections pulmonaires, cérébrovasculaires ou cardiovasculaires seront couvertes (180 jours).
  • GMS couvre les conditions stables pendant 180 jours avant la date d’entrée en vigueur — jusqu’à l’âge de 79 ans;
  • La politique Découvrir le Canada d’Imagine Financial couvre les conditions stables pendant 90 jours jusqu’à 70 ans; ou 180 jours pour les 71 à 80 ans;
  • Le plan visiteurs Allianz Global Assistance couvre les conditions stables pendant 180 jours – jusqu’à l’âge de 59 ans ; pour les personnes âgées de 60 à 79 ans, les conditions stables (180 jours) sont couvertes sauf les troubles cardiovasculaires, cérébrovasculaires, pulmonaires ou artériels ; après l’âge de 79 ans, il n’y a aucune couverture pour les maladies liées à des troubles médicaux préexistants.
  • Travel Guard couvre des conditions stables pendant 90 jours - jusqu’à 49 ans; pour les 50 à 74 ans, il n’y a pas de couverture pré-ex.
  • RSA Visitors Plan 1 couvre les conditions stables pendant 120 jours avant la date d’entrée en vigueur jusqu’à l’âge de 79 ans;
  • Le plan Premier de Travelance couvre les conditions stables pendant 180 jours - jusqu’à l’âge de 69 ans; pour les personnes âgées de 70 à 79 ans, les conditions stables (180 jours) sont couvertes, sauf les conditions cardiovasculaires, cérébrovasculaires ou pulmonaires;
  • Le plan Optimum Plus comprend une couverture pour les problèmes de santé préexistants qui sont stables pendant 120 jours jusqu’à l’âge de 85 ans; pour les personnes âgées de 86 ans et plus, il n’y a pas de couverture préexistante.
  • La police Travel Underwriters Ultimate Trip Guard couvre les conditions stables pendant 120 jours - jusqu’à 59 ans; ensuite, pour les 60 à 69 ans, la période de stabilité devient 180 jours; pour les 70 ans et plus, il n’y a pas de couverture pour les conditions médicales préexistantes.

 

Résumé Détaillé des Libellés des Politiques et des Définitions Pertinentes

Voici le libellé exact de la politique concernant les problèmes de santé préexistants (ainsi que les définitions pertinentes) pour la plupart des politiques au 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.


Pour des informations encore plus spécifiques, obtenez un devis instantané et regardez les caractéristiques du résumé ou lisez le libellé de la politique. Ou pour plus d’aide, appelez-nous, et nous serons heureux d’expliquer plus en détail 1-888-888-0510 sans frais.