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Visitor Insurance Coverage for Pre-Existing Conditions

Last updated: May, 2018

Contents

Introduction

This in-depth InfoDesk article discusses visitor to Canada insurance coverage for medical costs resulting from pre-existing conditions.

What is a "Pre-Existing Condition"?

A pre-existing condition can be defined as any health condition or medical condition for which, prior to your effective date:

  1. You experienced symptoms or;
  2. You received medical attention or;
  3. You were hospitalized or;
  4. You were prescribed and/or take medication;
  5. You had a medical or surgical procedure.

Pregnancy Costs and Visitor Insurance Coverage

Pregnancy is considered a special pre-existing "condition" by insurance companies. Pregnancy related costs are never covered by visitor plans if the insured is already pregnant at the time of application.

However, there are specialty plans designed for visitors that plan on staying in Canada for an extended period of time that do cover pregnancy costs if the insured becomes pregnant after being insured (please contact us for more information).

When is a Pre-Existing Condition Covered?

Most visitor to Canada insurance plans either come with or without coverage for pre-existing conditions. This differs from travel insurance where coverage depends solely upon the stability of the pre-existing condition.

In other words, some VTC plans never cover costs due to a pre-existing condition, while other plans do cover these costs as long as the insured person qualifies for that plan.

In addition, for a pre-existing condition to be covered it must be considered "stable" for a given amount of time.

To summarize, a visitor to Canada insurance plan will cover the costs resulting from a pre-existing condition if and only if:

  1. The applicant applies for a plan that offers pre-existing condition coverage.
  2. The pre-existing condition has been considered stable by the insurance company for a minimum amount of time (differs between companies, see below).
  3. The applicant successfully answers all eligibility and medical questions (extra medical questions are often asked, depending on the age of the applicant e.g. 55 and older).

Note that some insurance carriers will not cover pre-existing conditions for older age brackets.

Eligibility & Medical Questions

All visitor to Canada plans have eligibility questions that determine plan eligibility. In addition there may be additional medical questions asked if you want pre-existing conditions covered, depending on the insurance company and plan.

Generally speaking we can say that visitor to Canada insurance coverage for pre-existing conditions is unavailable if you:

  • Have provincial healthcare coverage (exclusion from all VTC plans).
  • Have a terminal disease.
  • Are traveling against the advice of a doctor.
  • Have AIDS.
  • Have kidney disease.

Please use the following links for carrier-specific eligibility and medical questions. Note that not all questions are necessarily listed here due to coverage differences between VTC plans.

  1. Manulife Eligibility Questions
  2. Allianz Eligibility Questions
  3. RSA Eligibility Questions
  4. GMS Eligibility Questions

Stability Periods

For a pre-existing condition to be covered all insurance companies require that condition to be "stable" for a specified period of time prior to the effective date of the policy.

Each insurance carrier's definition of stable is different. However, we can generalize and state that a pre-existing condition is "stable" if that condition:

  1. Has not required ANY change in medication levels (includes decrease in medication).
  2. Hasn't required any new treatment.
  3. Hasn't shown any change in scope or severity.
  4. Has been treated as per a doctor's instructions.

The following are stability periods for all visitor to Canada insurance plans that we quote (note that our VTC quoting engine will display the exact stability periods for all quoted plans).

Manulife Visitor Insurance and Stable Pre-Existing Conditions

The required Manulife stability period for pre-existing condition coverage is 180 days.

"Stable medical condition" means that:

  • You have not had a new symptom(s); and
  • Existing symptom(s) have not become more frequent or severe; and
  • A physician has not found that your medical condition has become worse; and
  • No test findings have shown that your medical condition may be getting worse; and
  • You have not received, been prescribed, taken or had a physician recommend any new medication, or any change in medication; and
  • You have not received, been prescribed, or had a physician recommend any new treatment or any change in treatment; and
  • You have not been hospitalized or referred to a specialist or specialty clinic; and
  • Your physician has not advised you to see a specialist or to have further test results, and you have not undergone testing for which you have not yet received the results.

Allianz Visitor Insurance and Stable Pre-Existing Conditions

Allianz required stability periods are as follows:

  • Age 59 and under: 90 days of stability prior to the effective date.
  • Age 60 - 79: 180 days of stability prior to the effective date.
  • Age 80 - 89: No coverage for any pre-existing conditions unless the Medical Questionnaire is completed and approved in writing by Allianz.

Stable describes any medical condition or related condition, including any heart condition or lung/respiratory condition, for which:

  1. There has been no new treatment; and
  2. There has been no change in treatment or change in treatment frequency or type; and
  3. There have been no signs or symptoms or new diagnosis; and
  4. There have been no test results showing deterioration; and
  5. There has been no hospitalization; and
  6. There has been no referral to a specialist (made or recommended) and you are not awaiting surgery or the results of further investigations performed by any medical professional.

The following are considered stable:

  1. Routine (not prescribed by a physician) adjustment of insulin to control diabetes provided the insulin was not first prescribed during the stability.
  2. Change from a brand name medication to a generic medication provided the medication was not first prescribed during the stability period and there is no increase or decrease in dosage.
  3. A minor ailment that descibes a sickness or injury during the stability period which ended more than 30 days prior to the effective date and that didn't require:
    • Treatment for a period greater than 15 consecutive days or;
    • More than one follow-up to a physician or;
    • Hospitalization, surgery, or referral top a specialist.

The following conditions are not considered stable:

  • Any lung condition for which you were prescribed or are taking prednisone;
  • Any heart condition for which you were prescribed or are taking nitroglycerin

GMS Visitor Insurance and Stable Pre-Existing Conditions

The GMS required stability period is always 12 months.

A medical condition is considered stable if:

  1. you have no reason to expect medical treatment for the condition or any symptoms after the effective date;
  2. in the 12 months prior to the application date, you have not received any new or different treatments for the medical condition;
  3. in the 12 months prior to the application date, you have not had an alteration to an existing prescription drug, or were prescribed a new drug for the condition;
  4. in the 12 months prior to the application date, your medical condition has not worsened;
  5. in the 12 months prior to the application date, you have not experienced new, more frequent or more severe symptoms;
  6. in the 12 months prior to the application date, you have not had or required any medical consultation for some undiagnosed symptoms;
  7. in the 12 months prior to the application date, you have not needed in-hospital care; a referral to a specialist, or a follow-up visit; and;
  8. in the 12 months prior to the application date, you have not had tests or an investigation, whether you know the results or not, related to the medical condition.

RSA Visitor Insurance and Stable Pre-Existing Conditions

The RSA required stability period is 120 days.

Stable is defined as:

  1. A condition that is being treated and controlled by diet or consistent use of medication that's prescribed by a physician and for which, in the 120 days before the effective policy date, there has been:
    1. no hospitalization; and;
    2. no change in treatment, medication or dosage.
      Exceptions: a reduction in dosage or elimination of medication resulting from an improved health condition, approved by a physician, does not constitute a change in medication or dosage. A reduction or elimination of treatment resulting from an improved health condition, approved by a physician, does not constitute a change in treatment.
  2. A condition that existed for more than 120 days before the policy effective date and which did not require treatment, as determined by a physician, during the 120 days before the policy effective date.

Conclusion

Getting visitor to Canada insurance coverage for costs resulting from a pre-existing condition is possible if: your condition has been stable for a substantial period of time and; you can successfully answer all required eligibility questions for the VTC plan you would like.

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