VTC Travel Insurance for Pre-Existing Conditions

Visitors to Canada Insurance: Are Pre-existing Conditions Covered?

There are three kinds of (emergency medical) insurance policies that visitors to Canada can purchase from Canadian insurance companies to ensure that they protect themselves against incurring unexpected medical expenses (these could be either short-term policies for vacations to Canada or longer duration policies of a year or more for International Experience Canada work visa or super visa requirements):

1. Insurance that DOES NOT cover any medical expenses that arise as a result of an illness that can be related to ANY pre-existing medical condition; or
2. Insurance that DOES cover medical expenses that arise from a sudden unexpected illness that can be related to a STABLE pre-existing medical condition.
3. Insurance that ONLY covers medical expenses that arise from SOME illnesses related to a STABLE pre-existing medical condition (as long as the illness is not related to a pre-existing lung, cerebrovascular or cardiovascular (including stroke and heart) condition.

Some companies (like Manulife Travel Insurance or Destination Canada) offer both 1) and 2) above. 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 types of pre-existing medical conditions and NOT people with hypertension/blood pressure, diabetes, cholesterol/circulatory issues. It can be challenging for first-time buyers of VTC coverage (or even travellers renewing coverage and thinking that they'll buy the same policy 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 assist (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 offer 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 comes into effect. Generally (we will look at the 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 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 specific eligibility criteria, limitations, definitions and exclusions, which may further restrict coverage.

While it is beyond the scope of this page to list all of the pre-existing conditions, limitations, definitions and exclusions of every policy offered on this website, we list some of the policy wording below - please refer to the policy wording for full details.

Please look at the summary here for a quick reference before looking at some of the particular wording:

• Manulife Plan B covers conditions stable for 180 days before the effective date — up to age 85.
• BlueCross covers conditions stable for 90 days up to age 54; or 180 days for ages 55+; stable conditions are covered except for any pre-existing cardiovascular conditions, neurological conditions, or pulmonary conditions.
• Destination Canada covers conditions stable for 120 days before the effective date and is offered up to age 79; no coverage for pre-existing conditions 80+.
• Travel Shield's Starr Plan covers conditions stable for 120 days before the effective date and is offered up to age 79.
• GMS covers conditions stable for 180 days before the effective date — up to age 79.
• MHS's Discover Canada policy covers conditions stable for 90 days up to age 70; or 180 days for ages 71-80.
• Allianz Global Assistance Visitors Plan covers conditions stable for 90 days up to age 59; or 180 days for ages 60-89.
• Travel Guard covers conditions stable for 90 days up to age 49; or 180 days for ages 50+.
• 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 for any cardiovascular, cerebrovascular, or lung conditions.
• JF Visitors Plan includes coverage for pre-existing medical conditions that are stable for 120 days before the effective date up to age 99.
• TuGo Visitors to Canada Plan covers conditions stable for 90 days up to age 59; then, for ages 60-69, the stability period becomes 120 days; then for ages 70-85, the stability period becomes 180 days; and for age 86+ the stability period becomes 365 days.

Below are the exact policy wordings related to pre-existing medical conditions (along with some relevant definitions) for some of the policies offered on this website:

Manulife Visitors to Canada - Pre-Existing Medical Condition Exclusion

We will not pay any expenses or benefits relating directly or indirectly to:

1. Any sickness that manifests during the waiting period even if related expenses are incurred after the waiting period.

2. For Plan A —

1. any medical condition, diagnosed or undiagnosed, which existed or for which you sought or received medical advice, consultation or investigation, or for which treatment was required or recommended by a physician, within the 180 days prior to the effective date;
2. any heart condition if, in the 180 days before the effective date, you required any form of nitroglycerine for the relief of angina pain; and/or
3. any lung condition if, in the 180 days before the effective date, you required treatment with oxygen or Prednisone for a lung condition.

3. For Plan B —

1. a pre-existing condition that is not stable in the 180 days before the effective date of insurance;
2. any heart condition if, in the 180 days before the effective date, you required any form of nitroglycerine for the relief of angina pain; and/or
3. any lung condition if, in the 180 days before the effective date, you required treatment with oxygen or Prednisone for a lung condition.

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

Relevant Manulife Definitions

Change in medication
Means the medication dosage, frequency, or type has been reduced, increased, or stopped, and/or new medication has been prescribed. The following is not considered a change in medication:

• A change from a brand-name drug to an equivalent generic drug of the same dosage; 
• 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 on a regular basis, and your medical condition remains unchanged.

Effective date
Means the date on which your coverage begins. Your coverage starts on the later of:

1. The effective date of insurance as shown on your confirmation; or
2. The time and date you arrive in Canada from home. Except in the case of an injury, the applicable waiting period applies to all claims if you purchased insurance after your arrival in Canada.

When coverage is purchased prior to leaving home with an effective date equal to the date and time you are scheduled to arrive in Canada, coverage will also be provided with no additional premium during your uninterrupted flight directly to Canada. An uninterrupted flight can include a stop-over provided you do not leave the airport.

Injury
Means sudden bodily harm that is caused directly by external and solely accidental means. Under Travel Accident Insurance, the injury must also be independent of sickness or disease..

Medical condition
Means sickness, injury, disease, or symptom(s); complication of pregnancy within the first 31 weeks of pregnancy.

Pre-existing condition
Means a medical condition that exists before your effective date of insurance

Sickness
Means illness or disease, or any symptom related to that illness and/or disease.

Stable medical condition means that all of the following apply:

• There have not been any new symptoms; and
• Existing symptoms have not become more frequent or severe; and
• A physician has not found 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, or any change in medication; and
• A physician has not provided, prescribed, or recommended any investigative testing, 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 specialty clinic or a specialist for further testing, and there has been no testing for which the results have not yet been received.

Treatment
Means hospitalization, prescribed medication (including prescribed as needed), medical, therapeutic, diagnostic or surgical procedure prescribed, performed or recommended by a licensed medical practitioner.

IMPORTANT: Any reference to testing, tests, test results, or investigations excludes genetic tests. “Genetic test” means a test that analyzes DNA, RNA or chromosomes for purposes such as the prediction of disease or vertical transmission risks, or monitoring, diagnosis or prognosis.

Waiting period
Means the 48-hour period following and including your effective date of insurance if you purchase your policy:

• after the expiry date of an existing Manulife Visitor to Canada policy; or
• after you arrive in Canada.

BlueCross Visitors to Canada - Pre-Existing Medical Condition Exclusion

A) Exclusions due to pre-existing medical conditions

No amount is payable, under the terms of this coverage, if the loss sustained or the costs incurred result directly or indirectly from one of the following causes:

1. For people of all ages:

All the conditions listed in one of the categories found in the adjacent column will be excluded if, for one of the conditions in this category:

• You have already undergone a procedure, seen the physician, been diagnosed, treated or hospitalized, or if you have received a prescription or taken a medication, or
• It has been recommended by a physician that you receive treatment, undergo tests, take medication or undergo a procedure.

2. For people aged 54 and under, during the 3 months preceding the effective date of coverage, in addition to the exclusions in point 1:

1. Any medical condition that affects you and that is not stable
2. Any heart condition for which you have used nitroglycerin

3. For people aged 55 to 79, during the 6 months preceding the effective date of coverage, in addition to the exclusions in point 1:

1. Any medical condition that affects you and that is not stable
2. Any heart condition for which you have used nitroglycerin

Relevant BlueCross Definitions

Accident
Means an event due to an external cause and of a violent nature which causes, directly and independently of any other cause, bodily injury while the insurance is in effect. The accident is always unforeseen, sudden, unintentional and does not in any way mean illness or infection.

Hospitalization
Means admission and stay in a hospital as a bedridden patient to receive acute care for a minimum period of 18 hours. Day surgery will always be considered a hospitalization, regardless of its duration. Hospitalization under no circumstance means convalescent care or physical or mental health rehabilitation.

Illness
Indicates a deterioration of health or a disorder of the organism observed by a physician.

Medical condition
Means a health issue, illness or injury (including symptoms of undiagnosed conditions).

Pre-existing medical condition
Means any existing medical condition when the coverage comes into effect or upon return to Canada after a Trip break.

Stable
Means a pre-existing medical condition that has remained unchanged for several months prior to the effective date of coverage.

For a pre-existing medical condition to be considered stable, it must meet all the following criteria:

1. No new medical diagnosis has been made
2. No new symptoms appeared and there was no worsening or increase in the frequency of existing symptoms
3. No hospitalization has taken place
4. No new medication was prescribed or recommended
5. No change of dosage1 was made to a medication already prescribed or recommended (dose increased or decreased, or consumption stopped)
6. No new treatment or medical test is pending or has been prescribed, ongoing or recommended
7. No ongoing treatment has been changed or discontinued
8. No prescribed or recommended treatment, nor medical advice has been ignored

We do not consider the following to be a change of dosage in existing medication:

• Routine insulin or Coumadin® adjustment
• Replacement of a medication by an equivalent generic brand if its dosage remains unchanged
• Decrease in dosage of cholesterol medication
• Adjustment to a hormone replacement therapy treatment
• Change in consumption of non-prescribed medication such as: Aspirin®, vitamins, minerals, etc.
• Use of cream or ointment prescribed for skin irritation

Treatment
Means a medical procedure prescribed, performed or recommended by a physician for a  medical condition. These are a few non-exhaustive examples: prescribed medication, investigative testing, surgery, etc.

Destination Canada Visitors to Canada - Pre-Existing Medical Condition Exclusion

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

1a) If at the time of application you are 79 years of age or under and selected Option 1 (with coverage for stable pre-existing conditions):

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

1b) If at the time of application you are 79 years of age or under and selected Option 2 (without coverage for pre-existing medical conditions):
Any pre-existing medical condition.

1c) If at the time of application you are 80 years of age or over:
Any pre-existing medical condition.

Relevant Destination Canada Definitions

Change in medication
Means the medication type, dosage, or frequency is reduced, increased, stopped, and/or new medications are prescribed.

Exceptions:

• Regular blood tests that result in routine adjustments of Coumadin, warfarin, or insulin as long as these medications are not newly prescribed or stopped; or,
• Changing from a brand name medication to the same dose of a generic medication.

Medical condition
Means sickness, injury, disease or symptom.

Pre-existing medical condition
Means any medical condition that exists prior to your effective date.

Signs or symptoms
Means any evidence of sickness experienced by you or recognized through observation.

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.

All of the above conditions must be met for a medical condition to be considered stable.

Treatment
Means medical, therapeutic or diagnostic procedure prescribed, performed or recommended by a physician including, but not limited to, prescribed medication, investigative testing and surgery.

Important: Any reference to testing, tests, test results, or investigations excludes genetic tests. “Genetic test” means a test that analyzes DNA, RNA or chromosomes for purposes such as the prediction of disease or vertical transmission risks, or monitoring, diagnosis or prognosis.

Travel Shield Starr Visitors to Canada - Pre-Existing Medical Condition Exclusion

We will not pay for any expenses relating to:

• A Pre-existing Condition that was not Stable in the one hundred twenty (120) days before your Effective Date;
• A heart condition, if, in the one hundred twenty (120) days before your Effective Date, any heart condition has not been Stable or you have taken any form of nitroglycerine for the relief of angina pain; or
• A lung condition, if, in the one hundred twenty (120) days before your Effective Date, any lung condition has not been Stable or you required treatment with oxygen or prednisone for any lung condition.

Relevant Travel Shield Starr Definitions

Injury or Injuries
Means accidental bodily harm to you unrelated to Sickness or any other cause and which occurs during a Trip.

Medical Condition
Means an irregularity in a person's health which required or requires medical advice, consultation, investigation, treatment, care, service or diagnosis by a Physician, and includes complications of pregnancy within the first thirty-one (31) weeks of pregnancy. 

Medical Treatment
Means any procedure which is medical, therapeutic or diagnostic in nature, which is Medically Necessary and which is prescribed by a Physician. Medical Treatment includes Hospitalization, investigative testing, surgery, prescription medication or other treatment directly related to the Sickness, Injury or symptom.

Physician
Means a medical doctor, other than you or your Immediate Family Member, who is licensed to administer Medical Treatment and prescribe drugs in the place where he or she provides medical services. Naturopaths, herbalists and homeopaths are not considered to be Physicians.  

Pre-existing Condition
Means a Medical Condition that existed before your Effective Date

Sickness
Means any disease, illness, or infection of an Insured Person during a Trip that requires Emergency Medical Care. 

Stable
Means that all of the following apply to your Medical Condition:

• There has been no new symptom;
• Any existing symptom has not become more frequent or severe;
• There has been no new Medical Treatment or prescribed medication;
• No test findings have shown that the Medical Condition may be getting worse;
• There has been no change in Medical Treatment or prescribed medication (including the amount, frequency or type of medication, and the frequency or type of Medical Treatment); and
• There has been no admission to a Hospital or specialty clinic or referral to a specialist, and there has been no testing for which the results have not yet been received. 

GMS Visitors to Canada - Pre-Existing Medical Condition Exclusion

The following expenses are not covered by this policy.

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

1. Medical condition(s) for which you received medical treatment or medical consultation; and/or
2. Undiagnosed medical condition(s) related to symptoms 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).

Relevant GMS Definitions

Alteration
An alteration to an existing prescription drug includes any of the following:

1. A new medication;
2. A change in medication type;
3. An increase or decrease in medication dose;
4. The discontinuation of a medication; or
5. An adjustment (stop and start) in an anticoagulation medication dosage due to surgery within 10 days prior to your effective date.

The following alterations resulting from the regular maintenance of a condition where there is no change in the condition are not considered an alteration:

1. A dosage adjustment for an anti-hypertensive or cholesterol lowering medication;
2. A change from a brand name medication to a generic brand medication of the same dosage;
3. If you are taking Coumadin/Warfarin for anticoagulation therapy and are required to have your blood levels tested on a regular basis (INR) and you are adjusting the dosage of your anticoagulation medication to ensure your INR is maintained within therapeutic range as directed by your physician(s); or
4. If you are taking insulin or oral anti-diabetic medication for diabetes and are required to have your blood levels tested on a regular basis and you are adjusting the dosage of your medication to ensure your blood glucose level is maintained within therapeutic range as directed by your physician(s).

Injury
is the impairment of your physical condition caused from a sudden and unforeseen accidental event that is independent from an illness or disease which includes but is not limited to a physical wound, fracture or blow to the body.

Medical condition(s)
Are any irregularities to your health such as an illness, injury or emotional, psychological or psychiatric condition(s):

1. For which you receive medical treatment or medical consultation;
2. Related to undiagnosed symptoms for which you received medical treatment or medical consultation; or
3. Related to undiagnosed symptoms which would have caused an ordinary person to seek medical treatment or medical consultation.

Medical consultation
A meeting with a physician to discuss and evaluate symptoms to diagnose a medical condition, illness or injury. It also includes meeting with a physician to evaluate your progress and/or medical treatment of a medical condition, illness or injury.

Medical treatment
Any medical, therapeutic or diagnostic measure prescribed or recommended by a physician in any form, including; prescription medication; investigative testing; in-hospital care; surgery; or other prescribed or recommended action directly referable to the applicable condition, symptom or problem.

Stable
A medical condition is stable if:

1. You have no reason to expect medical treatment after your effective date for the medical condition or any symptoms;
2. You have not received new or different medical treatment for the medical condition;
3. You have not had an alteration to an existing prescription drug or were prescribed a new prescription drug for the medical condition;
4. Your medical condition has not become worse;
5. You have not experienced new, more frequent or more severe symptoms;
6. You have not had or needed medical consultation for undiagnosed symptoms;
7. You have not needed in-hospital care; a referral to a specialist, or a follow-up visit; and
8. You have not had tests or further investigation, whether you know the results or not, related to the medical condition. 

For more specific information, get an instant quote, look at the summary features, or read the policy wording. For more help, give us a call. We'll be happy to explain in more detail 1-604-259-2544 (Vancouver), 1-647-799-2032 (Toronto), 1-403-800-1582 (Calgary), 0808-1693710 (from the United Kingdom),1-800-717-487 (from Australia), 0800-441219 (from New Zealand), or 1-888-888-0510 (toll-free in North America).