- To Be Eligible, You Must:
- You Are NOT Eligible If:
- Eligibility
- General Exclusions and Limitations:
- Waiting Period Exclusion:
- Limits on Costs and Claims:
- Non-Emergency or Unauthorized Treatments:
- Pre-Existing Conditions & Planned Treatment:
- Risky or Extreme Activities:
- Mental Health, Suicide, Illegal Acts:
- Substance Use, Pregnancy, and Children:
- Coverage Violations:
- Other Risk-Related Exclusions:
- Administrative or Non-Emergency Issues:
- Limitations and Exclusions
To Be Eligible, You Must:
- Be at least 15 days old and under 89 years of age on the departure date.
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Be able to travel independently, meaning:
You do not require assistance with activities of daily living (eating, bathing, dressing, toileting, mobility). - Not reside in a nursing home, long-term care facility, or rehabilitation center.
You Are NOT Eligible If:
- You are travelling against a physician’s advice.
- You have a life expectancy of 6 months or less.
-
You have:
Used or been prescribed home oxygen in the past 24 months.
Been prescribed or recommended dialysis in the past 12 months. - You have ever received or are awaiting an organ transplant.
-
You have ever had metastatic cancer (including positive lymph nodes), or:
Received chemotherapy (any form except topical cream) in the last 6 months. - You have been diagnosed with or treated for Congestive Heart Failure.
Eligibility
- Are travelling against the advice of a physician;
- Have been diagnosed with or been given a life expectancy of 6 months or less;
- Have been prescribed and/or used home oxygen within the past 24 months
- Have been prescribed or recommended the use of dialysis in the last 12 months;
- Are under 15 days old, or are age 89 years or older;
- Reside in a nursing home, home for the aged, other long-term care facility or rehabilitation center; or 7. Require assistance with activities of daily living.
- Are awaiting or received an organ transplant
- Have ever had any cancer with metastasis (which includes positive lymph nodes), or undergone chemotherapy (of any form, except cream) in the last 6 months
- Have been diagnosed with or treated for Congestive Heart Failure
General Exclusions and Limitations:
- Not covered unless a pre-existing condition waiver is purchased and the condition is stable for:
- Age 0–74: 180 days (option to reduce to 90 days)
- Age 75+: 365 days (option to reduce to 180 or 90 days)
- Age 0–74: 180 days (option to reduce to 90 or 30 days)
- Age 75+: 365 days (option to reduce to 180, 90, or 30 days)
2. Waiting Period Exclusion:
- No coverage for any sickness that begins during a policy’s waiting period—even if expenses occur later.
3–6. Limits on Costs and Claims:
- Charges exceeding “reasonable and customary” costs.
- Claims above your policy's maximum limit.
- Claims with inaccurate application information or if you’re ineligible.
- 30% co-insurance penalty if you don’t contact the insurer within 24 hours of hospitalization (unless medically impossible).
7–9. Non-Emergency or Unauthorized Treatments:
- Elective/cosmetic procedures, or non-urgent ongoing care.
- MRIs, CT scans, biopsies, surgery, etc., without prior authorization from the Assistance Centre.
10–11. Pre-Existing Conditions & Planned Treatment:
- No coverage for:
- Known need for treatment before the trip
- Conditions with symptoms that would lead a prudent person to seek care before departure.
- Travel against a physician's advice.
- Medical issues treated or started during trip breaks or side-trips.
12. Risky or Extreme Activities:
- Includes rock/mountain climbing, aerial activities, scuba (if not certified), racing, and pro sports.
13–15. Mental Health, Suicide, Illegal Acts:
- No coverage for:
- Suicide or self-harm.
- Mental/emotional disorders (unless hospitalized).
- Criminal or illegal behavior.
- Ignoring prescribed treatment.
16–18. Substance Use, Pregnancy, and Children:
- Injuries related to:
- Alcohol or drug use (including high blood alcohol content
- Pregnancy, childbirth, complications.
- Birth defects in children under 2 years old.
19–21. Coverage Violations:
- Not authorized by the insurer or recommended post-treatment repatriation ignored
- Treatment could reasonably be delayed until return to your home country.
22–24. Other Risk-Related Exclusions:
- Piloting or learning to fly an aircraft.
- Claims from:
- Successive policy periods/extensions.
- Travel advisories in effect before departure.
- War, terrorism, armed forces activities.
25–32. Administrative or Non-Emergency Issues:
- Expenses due to entry/re-entry requirements (e.g. testing).
- Refusal of repatriation.
- Sickness during a temporary return to your home country.
- Diagnostic tests, observation, preventive care, elective surgeries, and similar services that aren’t emergencies.
Limitations and Exclusions
1. Exclusions due to pre-existing medical conditions: Any pre-existing conditions and/or symptoms unless the pre-existing coverage was purchased and the pre-existing condition meets the following guidelines:
i) 0-74 years of Age has a standard Stability of 180 days with option to buy down to 90 days
ii) 75+ years of Age has a standard Stability of 365 days with option to buy down to 180 days and 90 days
i) 0-74 years of Age has a standard Stability of 180 days with option to buy down to 90 days and 30 days
ii) 75+ years of Age has a standard Stability of 365 days with option to buy down to 180 days and 90 days and 30 days
NOTE: dates are based from the departure from Your home Country.
2. Waiting Period: Any Sickness that manifests during the Waiting Period even if related expenses are incurred after the waiting period.
3. Reasonable and customary: Covered expenses that exceed the Reasonable and customary charges that normally apply where the medical Emergency occurs.
4. Fee limit: Covered expenses that exceed the maximum insured amount available under the plan You have purchased.
5. Truthful and Accurate: Any expenses or benefits if any of the information provided on the application for insurance is not truthful and accurate or You did not meet the eligibility requirements under this coverage.
6. Treatment received without approval from the Assistance Centre: Covered expenses that exceed 70% of those We would normally pay under this insurance, if You do not contact the Assistance Centre within 24 hours of Hospitalization, unless Your Medical condition makes it medically impossible for You to call (in that case, the 30% co-insurance does not apply).
7. Experimental or optional treatment: Any Treatment that is not for an Emergency, including any elective or cosmetic surgery or Treatment.
8. Continuous Treatment: Continued Treatment of a Medical condition when You have already received Emergency Treatment for that condition during Your Trip, if Our medical advisors determine that the medical Emergency has ended.
9. Treatment received without approval from the Assistance Centre Magnetic resonance imaging (MRI), computerized axial tomography (CAT) scans, sonograms, ultrasounds or biopsies, cardiac catheterization, angioplasty and/or cardiovascular surgery including any associated diagnostic test(s) or charges unless approved in advance by the Assistance Centre prior to being performed. All surgery must be authorized by the Assistance Centre prior to being performed except in extreme circumstances where surgery is performed on an Emergency basis immediately upon admission to Hospital.
10. Exclusions due to pre-existing medical conditions: A medical condition:
- when You knew, before You left Home, or before the Effective date of coverage, that You would need or be required to seek Treatment for that Medical condition during Your Trip; and/or
- for which it was reasonable to expect before You left Home or before Your Effective date of coverage, that You would need Treatment during Your Trip; and/or
- for which future investigation or Treatment was planned before You left Home; and/or
- which produced symptoms that would have caused an ordinarily prudent person to seek Treatment in the 3 months before leaving Home; and/or
- that had caused Your Physician to advise You not to travel.
11. Trip Break: Any Emergency and non-Emergency medical services for any Injury that occurred or Sickness that started or was treated during any Trip break (Eligible expense #15) that You have taken or after the number of days permitted for Your side-Trip outside of Canada.
12. Activities:
a. Any accident or Medical Condition sustained while participating in: – professional or competitive sports, any race or speed contest, gliding, hang-gliding, rock climbing, mountain-climbing which involves the ascent or descent of a mountain requiring the use of specialized equipment including but not limited to crampons, pick-axes, anchors, bolts, carabiners and lead or top-rope anchoring equipment, mountaineering, spelunking, rafting, acrobatic skiing or snowboarding (including kitesurf), bungee jumping, parachuting or other aerial activities or underwater activities using a breathing apparatus (except snorkelling);
b.Any activities requiring that the insured person signs an accident waiver and release of liability form or any behaviour involving risk, including but not limited to not following security requirements, not obeying warning signs or being in restricted zones.
13. Suicide, intentional injury, anxiety or depression: Any loss Injury or death incurred due to:
a) Your emotional or mental disorders resulting from any cause, including but not limited to anxiety or depression; or
b) Your suicide or attempted suicide; or
c) Your intentionally self-inflicted Injury.
14. Criminal act: Your, Your family member or travelling companion’s commission or attempted
commission of a criminal offence or illegal act based on the law where the cause of the claim occurred.
15. Medical recommendation: Not following a recommended or prescribed therapy or Treatment.
16. Use of drugs and other intoxicating substances: Any loss, Injury or death related to intoxication, the misuse, abuse, overdose, or chemical dependence on medication, drugs, alcohol or other intoxicant. Any injury resulting due to or relating to the consumption of Alcohol with a blood level or, or higher than, 80 milligrams in 100 milliliters of blood.
17. Pregnancy:
a. Your routine prenatal care;
b. Childbirth
c. Your pregnancy or childbirth or complications thereof
d. Your Child born during Your Trip
e. Termination of pregnancy
f. Assisted reproduction (procreation)
g. Any complication related to pregnancy or childbirth
18. Children: For insured Children under 2 years of Age, any Medical condition related to a birth defect.
19. Treatment received without approval from the Assistance Centre Any benefit that must be authorized or arranged in advance by the Assistance Centre when it has given no authorization or made no arrangement for that benefit.
20. Medical recommendation: Any Emergency that occurs or recurs after Our medical advisors recommend that You return Home following Your Emergency Treatment, and You choose not to.
21. Any treatment which can be reasonably delayed until you return to your country of origin (whether or not you intend to return) by the next available means of transportation, unless approved in advance by the Assistance Centre
22. Aircraft Any death or Injury sustained while piloting an aircraft, learning to pilot an aircraft or acting as a member of an aircraft crew.
23. Extending on another plan: For consecutive policies and policy extensions: any Medical condition which first appeared, was diagnosed or for which You received medical Treatment, after the scheduled Departure Date and prior to the Effective date of the subsequent policy or insurance extension.
24. Follow up visits Any follow-up visits outside Canada when the Emergency occurred in Canada.
25. Public notice with regard to travel: Any Medical condition You contract or suffer in a specific country, region, or city when a Government of Canada Travel Advisory, issued before Your departure to that country, region, or city advises Canadians to avoid all or non-essential travel to that specific country, region or city. In this exclusion, “medical condition” is limited, related or due to the reason for the travel advisory.
26. Act of war and civil unrest: Any Act of War or Act of Terrorism.
27. Armed Forces: Your participation in armed forces activities.
28. Exclusions due to pre-existing medical conditions: Any Medical Condition which first appeared, was diagnosed or for which You received medical Treatment, after Your Departure date and prior to Effective date
29. Expenses due to requirements for entry or re-entry on your trip: Any eligible expenses incurred due to requirements for entry or re-entry on your trip including but not limited to mandatory testing.
30. Refuse to be repatriated: If You refuse to be repatriated to your home country or to a medical provider referred by your insurer, your insurer has the right to cease the insurance
31. Temporary Return – Any sickness, symptom, or injury that presented, recurred or for which treatment was received during any temporary return to your country of origin during the period of coverage.
32. Any Treatment not authorized by the Emergency Assistance, or not considered to be an Emergency as defined in this policy. This includes but is not limited to:
a. – Blood tests (i.e., Coumadin), observation, exploratory and/or investigative tests or exams (i.e. MRI), check-ups, preventive or experimental Medications, vaccines, elective Treatments, cosmetic surgeries, eye treatment, dermatologist care, cardiac catheterization, angioplasty, colonoscopy, endoscopy, biopsy, cystoscopy, surgery and insertion, removal or adjustment of implants or care or services provided for the sole convenience of the Insured Person.
b. – Also, any Treatment that could reasonably be delayed until the Insured Person returns to his/her country of residence even if the perception is that the care may be of less accessibility and quality.