What is Not Covered?

Applicable to All Coverage

In addition to the Exclusions specified in each Insurance coverage, this Insurance does not provide payment or indemnity for expenses incurred directly or indirectly as a result of:

1.      a)  war, civil war, riot, rebellion, insurrection, revolution, invasion, hostilities or warlike operations (whether war be declared or undeclared), civil commotion, overthrow of the legally constituted government, military or usurped power, explosions of war weapons, utilization of nuclear, chemical or biological weapons.

b)  death, disablement in any way caused or contributed by radioactive contamination.

c)  any action taken in controlling, preventing or suppressing any, or all of a) and b) above.

2.      Suicide, attempted suicide, or self-inflicted injury, or the commission or attempted commission of any criminal/criminal-like act by the Insured, an Immediate Family member or a Traveling Companion.

3.      Pregnancy, complications thereof, childbirth or complications thereof, occurring within the last 9 weeks immediately before or after the expected date of delivery or where the Insured Person is traveling against Physician’s advice.

4.      A trip that is undertaken:

a)      against Physician’s advice; or

b)      after diagnosis of a Terminal Condition.

5.      Any condition or recognized complication of a condition, where the purpose of Your trip is to seek Medical Treatment or advice for that condition, and where it can be reasonably shown that the Medical Treatment received is related to that condition.

6.      A medical condition for which hospitalization could have reasonably been expected.

7.      Injury while participating in professional sports.  Scuba diving unless designated by internationally recognized and accepted programs (NAUI, PADI).

8.      Psychotherapeutic treatment or rehabilitative treatment, psychological, mental or emotional disorders.

9.      Coverage commencing after the departure date from Canada unless authorized by Travel Underwriters.

10.  Any Elective (non-emergency) Treatment or Surgery. 

11.  Air ambulance unless arranged and pre-approved by the Company.

12.  Expenses incurred after Emergency Air Transportation, when the Emergency Air Transportation was not coordinated and arranged by World Wide Mediclaim Services Ltd.

13.  Treatment or services that contravene any provisions of any provincial Government Health Care Plan of the province or territory in which the Insured resides.

14.  Treatment, service or prescriptions required for ongoing care, check-ups, or provided in a psychiatric hospital, chronic unit of a general hospital, convalescent or nursing home, health spa, or rehabilitation centre.

15.  The consumption or abuse of any alcohol, drugs, or medication, or any event, act or omission caused or contributed to by an consumption or abuse of alcohol, drugs, or medication.

16.  A condition arising out of or resulting from Acquired Immune Deficiency Syndrome (“AIDS”) or AIDS related Complex (“ARC”) if the condition first manifested itself prior to the Effective Date of Coverage or if the condition arouse out of Acquired Human Immunodeficiency Virus (“HIV”) which had first manifested itself prior to the Effective Date.

17.  Any Medical Treatment which is a continuation of, or subsequent to an Emergency Sickness or Injury, unless You are declared medically unfit to return to Your province or territory of ordinary residence.

18.  Expenses incurred as a result of the Insured’s failure to accept or follow the Physician’s advice, treatment or recommended treatment.

19.  This Policy does not provide reimbursement for Eligible Medial Expenses or Additional Benefits once the Emergency ends and in the opinion of the attending Licensed Medical Physician or dentist You are able to travel home to Your province or territory of ordinary residence for all or part of treatment relating to that Emergency.

20.  Unless otherwise stated in this Policy (see General Condition, no 2) expenses if other insurance policies, plans or contracts, including any private or provincial automobile insurance, cover the loss.  If, however, the loss exceeds the limits of the other policies, plans or contracts in dollar or day value, this Insurance shall then apply in excess of all other valid insurance.

 

Exclusions Applicable to Emergency Excess Hospital/Medical Insurance

In addition to the General Exclusions this Insurance does not provide payment or indemnity for expenses incurred directly or indirectly as a result of:

1.  Any Pre-existing Conditions defined, except as follows:

Applicable to persons 55 years and under

a)      On trips 28 days and less, except for conditions where symptoms arose or medical consultation was required within 7 days prior to departure, with the exception of a Minor Ailment.

b)      On trips over 28 days, any condition which has remained Stable in the 90 days prior to the commencement date of a covered trip.

Applicable to persons 56 to 69 years

a)      On trips 14 days and less, except for conditions where symptoms arose or medical consultation was required within 7 days prior to departure, with the exception of a Minor Ailment.

b)      On trips over 14 days, any condition which has remained Stable in the 180 days prior to the commencement date of a covered trip.

Applicable to person 70 to 89 years

a)      On all trip lengths, Pre-existing Conditions must be Stable in the 365 days prior to the commencement date of a covered trip.

1.      Sickness when the appropriate and applicable discount for the Accident Only Coverage option is chosen as indicated on the Application/Declaration.

2.      A cardiovascular condition for persons 65 yeas and over if:

a)      You are taking a total of 3 or more medications that have been ordered by a Physician, other than medication taken for high blood pressure; and,

b)      One or more of these medications is related to a cardiovascular condition.

Medication taken for thyroid, glaucoma, allergies, eczema, heartburn, menopause, migraines, sleeping disorders or a Minor Ailment, are not considered unless these medications are taken as a result of a cardiovascular condition.

3.      Any condition(s) for which the Insured is registered on a Canadian hospital list waiting to receive treatment.

4.      Conditions or any related conditions for which, prior to departure, tests and investigative consultation took place, was scheduled to take place or was recommended, and for which results had not yet been received at the time of departure.

5.      Tests and investigative consultation including, but not limited to biopsies, except when performed at the time of Emergency Sickness or Injury.

6.      Loss of or damage to eyeglasses, contact lenses, prosthetic devices, hearing aids.

7.      Any subsequent claim of the same medical condition with respect to a Sickness or Injury which occurred:

Applicable to Single Trip Plan

During the effective term of this Insurance and for which a claim has already been paid or is pending and,

Applicable to Annual Plan

During a covered trip and for which a claim has already been paid or is pending.  On any subsequent covered trip, no coverage will apply unless such medical condition which required the medical attention has remained Stable as follows:

a)      In the 90 days prior to the commencement date of a covered trip for persons 55 years and under;

b)      In the 180 days prior to the commencement date of a covered trip for persons 56 to 69 years of age;

c)       In the 65 days prior to the commencement date of a covered trip for persons 70 to 89 years of age.

8.      The first $250 USD of the eligible expenses per Insured Person, per covered claim unless You have paid the zero deductible surcharge at the time of Application.  This exclusion applies to the portion of eligible expenses remaining after payment by Your provincial Government Health Care Plan or other insurance policies, plans or contracts, including private or provincial automobile insurance.  This exclusion does not apply to plan option  - Emergency Excess Hospital/Medical for travel within Canada.