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UNSTABLE PRE-EXISTING CONDITIONS

This insurance does not provide coverage for any Medical Emergency concerning, relating to, caused by or arising from any of the following:

1. Any Pre-Existing Condition that was not Stable and Controlled in the 90 days immediately prior to the Effective Date of Insurance or Your Trip Start Date. This includes any reaction that results from a change in medication prescribed for such a condition.

   "Pre-Existing Condition" means any medical or physical condition, symptom, illness or disease for which Medical Attention was received or for which an ordinarily prudent person would have sought Medical Attention prior to the Effective Date of Insurance or Your Trip Start Date.

   "Stable and Controlled" means:

   1. the medical or physical condition, symptom, illness or disease did not first manifest itself; and/or
   2. the medical or physical condition, symptom, illness or disease was not first investigated; and/or
   3. the medical or physical condition, symptom, illness or disease has not worsened; and/or
   4. no change in any medication or its usage or dosage occurred, was prescribed and/or recommended by a Physician; and/or
   5. no Medical Attention was received, prescribed or recommended by a Physician.

   "Medical Attention" means any medical, therapeutic or diagnostic procedure, service or supply that is prescribed, performed or recommended by a Physician, including but not limited to prescribed medication, investigative testing and surgery. Medical Attention does not include either the unchanged use of prescribed medication for a medical condition, symptom or problem which is Stable and Controlled; or a Routine Check-up.
   
   A change in medication does not apply to cholesterol lowering medication or to a change in any other medication from a brand name medication to a generic brand medication (insofar as the dosage is not modified). If You are taking Coumadin (warfarin) or insulin and are required to have Your blood levels tested on a regular basis and You are required to adjust the dosage of Your medication only to ensure correct blood levels are maintained, such a change is not considered to be a change in medication, provided Your medical condition remains unchanged.

2. Any medical or physical condition, symptom, illness or disease that, in the 12 months prior to Your Effective Date of Insurance or Your Trip Start Date, required: a) a total of three (3) or more Emergency Room visits, Hospitalizations, Day Surgeries or any combination of all three; and/or b) a single Hospitalization for more than 48 consecutive hours.
3. Any medical or physical condition, symptom, illness or disease for which treatment and/or investigation(s) was recommended but not received prior to Your Effective Date of Insurance or Your Trip Start Date.

GENERAL EXCLUSIONS
This insurance does not cover, provide services or pay expenses resulting directly or indirectly from:

4. War, whether declared or not, any act of civil war, rebellion, insurrection or terrorism, participation in a riot, civil commotion or demonstration or service in the armed forces of any country.
5. Suicide, attempted suicide or self-inflicted Injury.
6. (a) Normal pregnancy; (b) normal childbirth; or (c) any complication, condition or symptom of pregnancy occurring within the last 18 weeks before the expected date of delivery or 9 weeks after.
7. Any child born during a Trip.
8. A Trip made for the purpose of obtaining a diagnosis, treatment, investigation, surgery or palliative care, whether or not it was recommended by a physician.
9. Emotional, psychological or mental disease, disorder, condition or symptom.
10. Medical or surgical treatment which is not a Medical Emergency, is primarily cosmetic, or is experimental; or any complication of the foregoing treatment.
11. Any medical or physical symptom, illness or disease for which, prior to Your Trip Start Date, Medical Attention or a change in medication has been recommended or scheduled for a date after Your Trip begins
12. Expenses for which no charge would normally be made in the absence of insurance
13. Rehabilitation, the continued treatment, or complication of the medical condition which caused the Medical Emergency, once You are discharged from Hospital or once a Medical Emergency ends, as determined by the Company.
14. Any expenses incurred after the date on which You have declined an offer of repatriation and/or medical evacuation.
15. The commission or attempted commission of any criminal act by You.
16. Any treatment, services or supplies not Medically Necessary (as defined), or any medical procedures and/or tests (including but not limited to MRI, MRCP, CAT Scan, CT Angiogram, Nuclear Stress Test, Angiogram, Angioplasty or Cardiac Catheterization) not authorized by Medipac Assist in advance. All surgeries must be authorized by Medipac Assist prior to being performed except in extreme circumstances where surgery is performed on an emergency basis immediately upon admission to a Hospital.
17. Emergency medical relocation unless arranged and approved in advance by Medipac Assist.
18. Any treatment, services or supplies provided by a home for the aged, a rest home, health spa, nursing home, convalescent hospital, hospice, palliative care facility, a place for the care and treatment of drug addicts or alcoholics, custodial or educational facility, or any rehabilitation facility
19. Any Hospital/medical benefits if You are not covered under the Government Health Insurance Plan of Your Canadian province or territory of principal residence.
20. Any damage to or loss of: hearing aids, eyeglasses, sunglasses, contact lenses, artificial teeth or artificial limbs and resulting prescription thereof.
21. Non-compliance with or the refusal to accept recommended medical treatment or rehabilitation, the abuse of drugs or alcohol, or the abuse of prescribed medication (including non-compliance with or refusal to take prescribed medication), whether prior to or during Your Trip.
22. The regular treatment or regular care of a condition that existed prior to the Effective Date of Insurance.
23. A Heart, Lung, Liver, Kidney, Pancreatic or Bone Marrow Transplant.
24. A Medical Emergency that occurred during a Trip under the Annual Add-on for which proof of departure has not been provided
25. Any medical treatment or condition resulting from the practice or training for, or participation in, any high-risk sport, activity or behaviour, including but not limited to scuba diving, mountaineering, rock or precipice climbing, hang gliding, paragliding, sport parachuting, skydiving or bungee jumping.
26. Any medical treatment or condition resulting from the practice or training for, or participation in, a) any speed or endurance contest or b) any athletic or sport activity for remuneration or prize money.
27. Any medical or physical condition, symptom, illness or disease for which the results of any test(s) and/or investigation(s) were not available prior to the Effective Date of Insurance or Your Trip Start Date.
28. Any Medical Emergency that occurs in any city, region or country where the Government of Canada has issued a travel advisory to “avoid all non-essential travel” or “avoid all travel” prior to Your Effective Date of Insurance or Your Trip Start Date. For travel advisories due to COVID-19, this exclusion does not apply.
29. A COVID-19 test that is required by any body with appropriate authority (such as a government or transportation service) for entry or exit from a country or jurisdiction, to use its services, or for a COVID-19 test which is not considered a Medical Emergency.
30. A general health examination or check-up.

 

If Your health changes at any time between Your Date of Application and Your Effective Date of Insurance, You must contact Medipac at 1-888-633-4722 right away. A reassessment for Your eligibility and rate qualification will be required. Failure to contact Medipac may result in claim denial, or payment of only a portion of the Covered Expenses.

Individuals Excluded from Coverage
You cannot be covered by this policy, and all insurance coverage is null and void, and the liability of the Company will be limited to return of premium if:

1. Coverage is not purchased for the entire duration of Your Trip (unless otherwise expressly stated in this policy)
2. Coverage is applied for while outside Canada (with the exception of post-departure applications for extension of coverage).
3. Any material misrepresentation is made on the application or in connection with any claim for benefits under this policy.

and/or if between Your Date of Application and Your Effective Date of Insurance:

4. You had been diagnosed as having a terminal illness or had been advised by a Physician not to travel.
5. You had been diagnosed with pulmonary fibrosis or interstitial lung disease.
6. You had an organ or bone marrow transplant (excluding cornea or skin graft) or a blood disorder for which You received stem cell treatment.
7. You had been treated for, taken or been prescribed medication for, or been diagnosed with lung cancer, metastatic cancer or two (2) or more cancers (excludingbasal cell and squamous cell skin cancer).
8. You had a cardiac condition with an ejection fraction of less than 40% or a ventricular function grade of 3 or 4.
9. You had moderately severe or severe cardiac valve stenosis.
10. You had an aneurysm or dilated artery greater than 4.5 cm in size (diameter or width) which remains surgically untreated.
11. You underwent chemotherapy, immunotherapy or targeted drug therapy for cancer or malignant tumour(s).
12. You had surgery or stenting on any artery or had cardiac pacemaker implant surgery.
13. You had cardiac ablation, cardiac defibrillator implant surgery, coronary angioplasty and/or stent, coronary bypass surgery, cardiac valve replacement or repair, had a heart attack, a cardiac arrest or had an episode of congestive heart failure.
14. You had a stroke, a transient ischemic attack (TIA) or a ministroke.
15. You had any chronic lung disease (including emphysema, chronic obstructive pulmonary disease [COPD], chronic bronchitis, reactive airway disease or asthma) which caused You to be Hospitalized for more than 24 consecutive hours, or for which You had taken or been prescribed prednisone or Solu-Medrol.
16. You had taken or been prescribed home oxygen for any reason.
17. You had taken or been prescribed insulin or two (2) or more medications for diabetes and medication for a heart condition. The term “medication” includes nitroglycerin in any form.

If You are under the age of 56 and travelling for less than 41 days, items 4. to 17. do not apply

Misstatement
If You misstate Your response to any question in section A of the application, then this policy is null and void.

If You misstate Your response on the application to either the COVID-19 vaccine question or the question which asks if You have smoked cigarettes and, as a result, paid a lower premium than required, Your policy will provide reimbursement of only 75% of all Covered Expenses.

If You misstate Your response in any other section of the application and, as a result, paid a lower premium than required, this policy will cover only the proportion of Covered Expenses that the premium paid bears to the required premium. You will be responsible for the remaining portion of Covered Expenses.

Where the Company has incurred expenses on Your behalf, You irrevocably assign Your premium and any Government Health Insurance Plan payments to the Company; where the amount of premium is greater than the Company’s expenses, the difference shall be refunded to You.