Manulife Insurance – Eligibility Requirements

To be eligible, for coverage:

  1. You must not be:
  • Travelling against medical advice
  • Diagnosed with a terminal illness (life expectancy under 2 years)
  • On kidney dialysis
  • Using home oxygen within the last 12 months
  • Diagnosed with Alzheimer’s disease or any form of dementia
  • Under 30 days old or over 85 years old
    • (Note: If applying for $150,000 coverage, you must be under 70)
  • Living in a long-term care facility, nursing home, or rehabilitation center
  • Needing help with activities of daily living (e.g., eating, bathing, dressing)

Pre-Existing Condition Rules

  • Plan A: No coverage for any condition that existed in the 180 days before the start of your insurance
  • Plan B: No coverage for unstable pre-existing conditions in the 180 days prior to the effective date

Eligibility

Who can apply?
  • Visitors to Canada;
  • Canadians who are not eligible for benefits under a government health insurance plan;
  • Persons who are in Canada on a work visa or Parent and Grandparent Super Visa; or
  • New immigrants who are awaiting Canadian government health insurance plan coverage.
Eligibility requirements

You are not eligible for coverage under this policy if any of the following apply to you:

  • you are travelling against the advice of a physician;
  • you have been diagnosed with a terminal illness with less than 2 years to live;
  • you have a kidney condition requiring dialysis;
  • you have used home oxygen during the 12 months prior to the date of application;
  • you have been diagnosed with Alzheimer’s disease or any other form of dementia;
  • you are under 30 days or over 85 years of age (over 69 years of age for $150,000 Emergency Medical coverage);
  • you reside in a nursing home, home for the aged, other long-term care facility or rehabilitation centre;
  • you require assistance with activities of daily living.

What else you need to know when applying for coverage:

  1. Coverage must not exceed 365 days.
  2. Application for insurance may be made before or after you arrive in Canada.
  3. Plan B applicants 40 years of age or over must complete the medical questionnaire.
  4. A waiting period will apply, except in the case of injury, if you purchase this insurance after your arrival in Canada or after the expiry date of ann existing Visitors to Canada policy issued by us. Please review the waiting period definition.
  5. You may not be covered under more than one plan during your trip.
  6. A $75 deductible applies to each claim made under this policy, unless you chose the option of no deductible, $500, $1,000, $2,500, or $5,000 deductible per claim in your application for insurance, and paid the applicable premium. The deductible amount is the amount of covered expenses that you are responsible for paying per person per emergency medical claim. Your deductible amount is in Canadian dollars. The deductible amount is shown on your confirmation.
  7. Under Plan A, no benefits are payable for a pre-existing condition that existed within the 180 days prior to your effective date of insurance. Please refer to the section “What is not covered under Emergency Medical Insurance?”.
  8. Under Plan B, no benefits are payable for a pre-existing condition that is not stable within 180 days of the effective date. Please refer to the section “What is not covered under Emergency Medical Insurance?”.

Manulife – What Is Not Covered (Key Exclusions)

🔔 Pre-existing & Waiting Period Conditions

  • Any illness that begins during the waiting period
  • Plan A: No coverage for any medical condition that:
    1. Existed or was treated/advised within 180 days before the effective date
    2. Involved nitroglycerine for angina or oxygen/Prednisone for lung conditions
  • Plan B: No coverage for any condition not stable in the 180 days prior
  • No coverage for hospitalizations (2+ consecutive days or more than once) in the past 12 months due to a pre-existing condition

🔖 Benefit Limits & Admin

  • Charges exceeding reasonable/customary local rates
  • Charges over the maximum insured amount
  • Claims based on false application info or failure to meet eligibility
  • Only 80% of costs will be paid if you don’t call the Assistance Centre within 24 hours of hospitalization (unless impossible due to your condition)

🚫 Non-Emergency or Continued Care

  • Treatment that is not an emergency
  • Ongoing care for a condition that’s no longer an emergency (as decided by Manulife)
  • Diagnostic tests or surgeries (e.g. MRI, CAT scan, biopsy, heart surgery) unless pre-approved (except immediate hospital emergencies)
  • Conditions where you knew or should’ve known treatment would be needed during the trip
  • Medical issues from side-trips outside Canada beyond the allowed period

✨ Activities & Behavior Exclusions

  • Injuries from:
    1. Mountain or rock climbing
    2. Skydiving, hang gliding, other air sports
    3. Motorized racing
    4. Professional participation in sports/scuba/snorkeling
  • Self-inflicted injuries, unless tied to a mental illness
  • Criminal acts
  • Not following prescribed treatment
  • Conditions linked to intoxication or substance abuse
  • Minor mental/emotional disorders
👨‍🩺 Pregnancy & Newborns
  • No coverage for:
    1. Routine prenatal care
    2. Pregnancy/childbirth within 9 weeks of due date
    3. A child born during the trip
  • For children under 2: No coverage for birth defect–related conditions
🔐 Procedural/Policy Violations
  • Services needing pre-authorization that were not approved
  • Care after Manulife has advised you to return home
  • Injuries while piloting or learning to pilot an aircraft
  • Conditions arising between back-to-back policies (consecutive policy overlap gap)
  • Follow-up care outside Canada for issues that occurred in Canada
  • Illnesses contracted in regions under a Government of Canada travel advisory
  • Acts of war or terrorism

What is not covered under Emergency Medical Insurance?

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.
  5. Covered expenses that exceed the reasonable and customary charges that normally apply where the medical emergency occurs.
  6. Covered expenses that exceed the maximum insured amount available under the plan you have purchased.
  7. Any expenses or benefits if the information provided on the application for insurance is not truthful and accurate or you did not meet the eligibility requirements under this coverage.
  8. Covered expenses that exceed 80% 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 20% co-insurance does not apply).
  9. Any treatment that is not for an emergency.
  10. 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.
  11. 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.
  12. 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.
  13. Any emergency and non-emergency medical services for any injury that occurred or sickness that started or was treated during any trip break (Benefit #13) that you have taken or after the number of days permitted for your side-trip outside of Canada.
  14. An emergency resulting from mountain climbing requiring the use of specialized equipment, including carabiners, crampons, pick axes, anchors, bolts and lead-rope or top-rope anchoring equipment to ascend or descend a mountain; rock-climbing; parachuting, skydiving, hang-gliding or using any other air-supported sporting device;s participating in a motorized speed contest; or your professional participation in a sport, snorkeling or scuba-diving when that sport, snorkeling or scuba-diving is your principal paid occupation.
  15. Self-inflicted injuries, unless medical evidence establishes that the injuries are related to a mental health illness.
  16. Committing or attempting to commit a criminal act.
  17. Not following a recommended or prescribed therapy or treatment.
  18. Any loss, injury or death related to intoxication, the misuse, abuse, overdose, or chemical dependence on medication, drugs, alcohol or other intoxicant.
  19. Any loss resulting from your minor mental or emotional disorder.
  20. a) Your routine prenatal care;
    b) Your pregnancy or childbirth or complications thereof when they happen in the 9 weeks before or after the expected date of delivery;
    c) Your child born during your trip.
  21. For insured children under 2 years of age, any medical condition related to a birth defect.
  22. 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.
  23. Any emergency that occurs or recurs after our medical advisors recommend that you return home following your emergency treatment, and you choose not to.
  24. Any death or injury sustained while piloting an aircraft, learning to pilot an aircraft or acting as a member of an aircraft crew.
  25. For consecutive policies with no interruption in coverage 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.
  26. Any follow up visits outside Canada when the emergency occurred in Canada.
  27. 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 to or due to the reason for the Travel Advisory.
  28. Any act of war or act of terrorism.