Tugo Visitors to Canada Medical Questionnaire
For Emergency Hospital & Medical Single-trip, Multi-trip, and All-inclusive plans. This questionnaire applies to ages 60 and over, travelling for any duration.
If you wish to issue a policy it MUST be returned to your travel insurance representative and completed on quicktic.
What do you need to know?
It’s important to answer the Medical Questionnaire correctly. If you qualify for the insurance but you or a representative buying insurance on your behalf inaccurately answer any of the Rate Qualification questions, a $15,000 USD deductible applies to any incident claimed, in addition to any other deductible you may have selected.
At the time of a claim, if the answers are not complete or accurate, coverage won’t be provided until you correct your answers and, if applicable, you pay any additional premium that may be required.
Q. When do you need to complete the Medical Questionnaire?
A. If you are 60 years of age or older, and are travelling for more than two days outside of your province/territory of residence, you must answer the Medical Questionnaire to purchase one of the following plans: • Multi Trip Annual Worldwide Medical • Single Trip Worldwide Medical • Single Trip Excluding USA Medical
Q. Why do you need to complete the Medical Questionnaire?
A. Your answers will determine the premium (cost) of your insurance.
Q. Does answering the Medical Questionnaire mean you’re covered for pre-existing conditions?
A. No, it determines the premium of your insurance. Details about Pre-existing Condition coverage are in the policy.
Q. Can a representative answer the Medical Questionnaire on your behalf?
A. Yes, but you should verify that the answers shown on the policy declaration are complete and accurate. If any of the answers are incorrect on your Medical Questionnaire, please let your agent know.
Q. What should you do if you don’t know how to answer a question?
A. Refer to the “Definitions” and the “What else do you need to consider?” sections. If you’re still unsure, talk to your physician for advice before completing the Medical Questionnaire.
Definitions
Alteration 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 due solely to the availability of your usual brand or due to a change from a brand name medication to an equivalent generic brand medication of the same usage or dosage; and
b) The routine adjustment of the dosage within prescribed parameters to ensure correct blood levels are maintained when you are taking insulin or oral diabetes medication or blood thinner medication such as Coumadin/Warfarin and your blood levels must be checked regularly and your condition remains unchanged; and
c) The usage changes due to the combination of several medications into one and your condition remains unchanged.
Remission
The decrease in or the disappearance of signs and symptoms of cancer and/or the removal of cancer as determined by your physician and noted in your medical records. Remission can be complete or partial. Complete remission means the disappearance of all signs or symptoms. Partial remission means a decrease in or disappearance of some, but not all, signs and symptoms.
What else do you need to consider?
The following information is for general reference only. You should consult your physician(s) for more detailed information about medical conditions that may affect you.
Atrial fibrillation
Atrial fibrillation is a type of arrhythmia. Choose this condition if you’ve been diagnosed specifically with atrial fibrillation and not any other type of arrhythmia or dysrhythmia.
Coronary Artery Disease (CAD)
Coronary Artery Disease can be caused by arteriosclerosis and/or atherosclerosis. If you’ve been diagnosed with CAD and arteriosclerosis and/or atherosclerosis, choose all these conditions.
Experimental treatment
If you’ve been diagnosed with a condition and are receiving experimental treatment for it, whether the experimental treatment has been approved by Health Canada or not, choose that condition.
Medical study
If you’ve been diagnosed with a condition and are participating in a medical study for it, choose that condition.
At the time of application, you are eligible for coverage if:
1. You know of no reason for which you may seek medical attention.
2. You are:
a) A foreign worker, international student studying in Canada or a visitor to Canada with valid legal status in Canada; or,
b) An immigrant awaiting provincial or territorial government health care coverage; or,
c) A Canadian returning to Canada from an extended leave who is eligible for but not yet covered by a provincial or territorial government health care plan.
3. You are not travelling against a physician or other registered medical practitioner’s advice.
4. You have not been diagnosed with a terminal condition.
5. You are not receiving palliative care or palliative care has not been recommended.
6. You do not have Chronic Obstructive Pulmonary Disease (COPD), including emphysema, requiring home oxygen.
7. You do not have pancreatic cancer, liver cancer or any type of cancer that has metastasized or that required a bone marrow transplant.
8. You do not have kidney disease requiring dialysis.
9. You have not had or are not waiting for an organ transplant.
10. You have not been diagnosed with congestive heart failure also known as pulmonary edema.
Your form entry has been saved and a unique link has been created which you can access to resume this form.
Enter your email address to receive the link via email. Alternatively, you can copy and save the link below.
Please note, this link should not be shared and will expire in 30 days, afterwards your form entry will be deleted.
Office Hours: 8:30-4:30 MT
Simpson Group Insurance Services
99 Evergreen Terrace SW
Calgary, AB, T2Y 2R7 Canada
Proud member of the Travel Health Insurance Association of Canada (THIA)
Site by Daniel
Office Hours: 8:30-4:30 MT
Simpson Group Insurance Services
99 Evergreen Terrace SW
Calgary, AB, T2Y 2R7 Canada
Proud member of the Travel Health Insurance Association of Canada (THIA)
Site by Daniel