Compare Pre-Existing Conditions coverages

Allianz:

–  Age 59 years or under on the effective date: Benefits are not payable for costs incurred due to or resulting from your medical condition or related condition that was not stable at any time during the 90 days immediately before the effective date.
– Age 60 to 89 years on the effective date: Benefits are not payable for costs incurred due to or resulting from your pre-existing medical condition or related condition that was not stable at any time during the 180 days immediately before the effective date.

STABLE describes any medical condition or related condition, including any heart condition or lung condition, for which:
a) there has been no new treatment; and
b) there has been no change in treatment or change in treatment frequency or type; and
c) there have been no signs or symptoms or new diagnosis; and
d) there have been no test results showing deterioration; and
e) there has been no hospitalization; and
f) 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:
  a) Routine (not prescribed by a physician) adjustment of insulin to control diabetes provided the insulin was not first prescribed during the stability period.
  b) 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.
c) A minor ailment, which describes a sickness or injury during the stability period which ended more than 30 days prior to the effective date and which did not require:
               i. treatment for a period longer than 15 consecutive days; or
  ii. more than one follow-up visit to a physician; or
iii. hospitalization, surgery, or referral to a specialist.
The following conditions are NOT considered stable:
a) any lung condition for which you were prescribed or are taking prednisone;
b) any heart condition for which you were prescribed or are taking nitroglycerin.

Manulife:

Manulife will not pay any expenses relating to:
Plan A:
a) any medical condition, diagnosed or undiagnosed, which existed or for which you sought or received medical advice, consultation, investigation, or for which treatment was required or recommended by a physician, within the 180 days prior to the effective date.
b) 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
c) any lung condition, if in the 180 days before the effective date, you required treatment with oxygen or Prednisone for a lung condition.
Plan B:
a) pre-existing condition that is not STABLE in the 180 days before the effective date of insurance;
b) 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
c) any lung condition if, in the 180 days before the effective date, you required treatment with oxygen or Prednisone for a lung condition.
Plan B applicants 40 years of age or over must complete the medical questionnaire.
Plan A and B – Expenses for a pre-existing condition for which you were hospitalized either more than once, or for at least two consecutive days, in the 12-month period before your effective date of insurance.

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 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 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 or further testing, and there has been no testing for which the results have not yet been received.
Change in medication means the medication dosage, frequency, or type has been reduced, increased, or stopped, and/or new medication/s has/have been prescribed. The following is not considered a change in medication: a) a change from a brand-name drug to an equivalent generic drug of the same dosage; b) 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.

Destination Canada:

–  If at the time of application, you are 59 years of age or under and selected Option 1: Pre-existing medical conditions are covered provided that those medical conditions have been stable in the 90 days immediately before the effective date.
–  If at the time of application, you are between 60 and 69 of age or under and selected Option 1: Pre-existing medical conditions are covered provided that those medical conditions have been stable in the 120 days immediately before the effective date.
–  If at the time of application, you are between 70 and 79 of age or under and selected Option 1: Pre-existing medical conditions are covered provided that those medical conditions have been stable in the 180 days immediately before the effective date.
– If at the time of application you are 79 years of age or under and selected Option 2 at the time of application: All pre-existing medical conditions will be excluded from coverage.
– If at the time of application you are 80 years of age or over: All pre-existing medical conditions will be excluded from coverage.

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.
Medical consultation means any medical services obtained from a physician for a sickness, injury or medical condition, including but not limited to any or all of: history taking, medical examination, investigative testing, advice or treatment, and during which a diagnosis of the medical condition need not have been definitively made. This does not include routine annual medical check-ups where no medical signs or symptoms existed or were found during the check-up.
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

TuGo:

TuGo will not be liable to provide coverage or services, or to pay claims for expenses incurred directly or indirectly as a result of:
– 59 years and under on the application date – any medical condition which is not stable in the 90 days before the effective date of the policy.
– 60 to 69 years on the application date – any medical condition which is not stable in the 120 days before the effective date of the policy. A medical questionnaire is required.
– 70 to 85 years on the application date – any medical condition which is not stable in the 180 days before the effective date of the policy. A medical questionnaire is required.
– 86 years and over on the application date – any medical condition which is not stable in the 365 days before the effective date of the policy. A medical questionnaire is required.
– If you are 79 years and under, you can add an optional Unstable Pre-existing Medical Conditions Coverage to your policy to cover pre-existing conditions provided they were stable on or within the 7 days before the effective date of the policy (Subject to policy exclusions, terms and conditions).

Stable: a medical condition is considered stable when all of the following statements are true:
a) There has been no deterioration of the medical condition as determined by a physician or other registered medical practitioner, and
b) There have been no new symptoms or findings or more frequent or severe symptoms or findings, and
c) There has been no change in treatment by a physician or other registered medical practitioner or any alteration in any medication related to the medical condition, and
d) There has been no new treatment received, prescribed or recommended by a physician or other registered medical practitioner.
Alteration means the medication usage, dosage or type has been increased, decreased or stopped and/or a new medication has been prescribed. Alteration does not include:
a) Changes in brand to an equivalent name brand or to an equivalent generic brand of the same or equivalent usage or dosage; or,
b) Routine dosage adjustments within prescribed parameters for insulin or oral diabetes medication to ensure correct blood levels are maintained; blood sugar levels must be checked regularly and the medical condition must remain unchanged; or,
c) Routine dosage adjustments within prescribed parameters for blood thinner medication to ensure correct blood levels are maintained; blood levels must be checked regularly and the medical condition must remain unchanged; or,
d) A temporary stoppage of blood thinner medication up to a maximum of 24 hours if the stoppage is required for a surgery or a procedure; or,
e) Usage changes due to the combination of several medications into one; the medical condition must remain unchanged.

21st Century:

Enhanced Plan – coverage for stable pre-existing medical conditions
– If you are under age 55, the Enhanced Plan is available to you if you satisfy the Eligibility requirements and pay the appropriate premium.
– If you are age 55 to 85, the Enhanced Plan is available to you if you satisfy the Eligibility requirements, truthfully and accurately answer “No” to all questions on the Medical Declaration and pay the appropriate premium.
– If you are age 55 to 85 and you answer “Yes” to any question on the Medical Declaration, you are not eligible for the Enhanced Plan, but the Standard Plan is available to you under this policy if you satisfy the Eligibility requirements and pay the appropriate premium.
– If you are under age 86, the Standard Plan is available to you, without the completion of the Medical Declaration, if you satisfy the Eligibility requirements and pay the appropriate premium.
– Applicants age 86 and over or applicants of any age who do not satisfy the Eligibility requirements are not eligible to purchase this policy.

“Unstable Chronic Condition” means a pre-existing medical condition for which, in the 180 days prior to your effective date of insurance, any of the following apply:
– there have been new symptoms or change in symptoms; and
– existing symptoms have become more frequent or severe; and
– a physician has found that the medical condition has become worse;
– test findings have shown that the medical condition may be getting worse; and
– a physician has provided, prescribed, or recommended any new medication, or any change in medication; and
– a physician has provided, prescribed, or recommended any new treatment, or any change in treatment; and
– a physician has provided, prescribed, or recommended any investigative testing, other than regular scheduled maintenance investigations or testing;
– there has been hospitalization or referral to a specialist or specialty clinic; and
– a physician has advised referral to a specialist or further testing, and there has been testing for which results have not yet been received.
Change in medication means the medication dosage, frequency or type has been reduced, increased, stopped and/or new medication(s) has/have been prescribed Exceptions: the routine adjustment of Coumadin, Warfarin or insulin, as long as they are not newly prescribed or stopped and there has been no change in your medical condition; and, a change from a brand name medication to a generic brand medication of the same dosage.
21st Century will not cover any heart condition if, in the 180 days before the effective date, you required any form of nitroglycerine for the relief of angina pain.
21st Century will not cover any lung condition if, in the 180 days before the effective date, you required treatment with prednisone for a lung condition.

90-Day Provision (Enhanced and Standard Plans only): If you are advised by the Assistance Centre that your emergency has ended, and you are not required to return to your country of origin, you will have no further coverage under this policy for any insured services that are directly or indirectly related to ongoing treatment, recurrence or complication of that medical condition. However, if your claim is deemed to be payable under this policy then subject to the other terms, conditions and exclusions of this policy such medical condition will be covered again in the event of a subsequent emergency if, in the 90-days prior to that subsequent emergency:
– you have not had any recurrence, new symptom(s) or any complications;
– existing symptom(s) have not become more frequent or severe;
– a physician has not determined that your medical condition has become worse;
– no test findings have shown that your medical condition may be getting worse;
– a physician has not provided, prescribed, or recommended any new medication, or any change in medication;
– a physician has not provided, prescribed, or recommended any new treatment, or any change in treatment;
– there has been no hospitalization or referral to a specialist or specialty clinic;
– a physician has not advised referral to a specialist or further testing; and
– there has been no testing for which results have not yet been received.

Blue Cross:

The contract contains exclusions relating to pre-existing conditions.
1. For people of all ages: All of the following conditions listed in one of the categories below 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.
Caridovascular conditions: Angina; Angioplasty; Aortic aneurysm; Bypass surgery; Defibrillator; Heart attack; Heart rhythm disorders (arrhythmia, tachycardia, bradycardia); Peripheral vascular problems; Valvulopathy
Neurological conditions: Stroke (cerebrovascular accident); TIA (transient ischemic attack)
Pulmonary conditions: Chronic bronchitis; COPD (chronic obstructive pulmonary disease); Cystic fibrosis; Emphysema
2. For people age 54 and under, during the 3 months preceding the effective date of coverage, in addition to the exclusion in point 1:
a) Any medical condition that affects you and that is not stable
b) Any heart condition for which you have used nitroglycerin
3. For people age 55 to 79, during the 6 months preceding the effective date of coverage, in addition to the exclusions in point 1:
a) Any medical condition that affects you and that is not stable
b) Any heart condition for which you have used nitroglycerin

For a pre-existing 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 dosage* 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.

* Blue Cross does 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 Aspirin®, vitamins, minerals, etc.; Use of cream or ointment prescribed for skin irritation.

GMS:

GMS does not cover expenses resulting from medical condition(s) which have not been stable for one hundred and eighty (180) days immediately prior to your effective date, including:
a. medical condition(s) for which you received medical treatment or medical consultation; and/or
b. 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).

Stable: a medical condition is stable if:
a. you have no reason to expect medical treatment after your effective date for the medical condition or any symptoms;
b. you have not received new or different medical treatment for the medical condition;
c. you have not had an alteration to an existing prescription drug or were prescribed a new prescription drug for the medical condition;
d. your medical condition has not become worse;
e. you have not experienced new, more frequent or more severe symptoms;
f. you have not had or needed medical consultation for undiagnosed symptoms;
g. you have not needed in-hospital care; a referral to a specialist, or a follow-up visit; and
h. you have not had tests or further investigation, whether you know the results or not, related to the medical condition.
Alteration: An alteration to an existing prescription drug includes any of the following:
• a new medication
• a change in medication type
• an increase or decrease in medication dose
• the discontinuation of a medication; or
• an adjustment (stop and start) in an anticoagulation medication dosage due to surgery within ten (10) days before 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:
• a dosage adjustment for an anti-hypertensive or cholesterol lowering medication;
• a change from a brand name medication to a generic brand medication of the same dosage;
• 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
• 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).
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 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.

IMPORTANT NOTE: The product-related information on this website is for illustration purposes only. For complete benefits, terms, conditions, limitations and exclusions, please see the policy booklet at the download section below. Please read and understand your policy before you travel.