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Manjit Kaur Bola

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Health insurance covers up to $200000. Please read the policy before filling out the application.

This product is underwritten by Industrial Alliance Insurance and Financial Services Inc.
What is your birth date? 

STEP 1: TRAVEL AND TRIP INFORMATION

Effective Date of this policy
Termination Date of this policy
OR Duration of coverage days
Coverage Details:    
Application Type? A monthly billing option is only available for Super Visa, Visitor (365 days minimum).
For shorter trips, select Visitor, Immigrant, Returning Canadian.



Note: Super Visa requires a single application for each party.

Note: This applies only if you are a student registered at a Canadian School.
Health Coverage? (Choose the desired limit)  
Do you want Accidental Death coverage? (optional) starting from $22.50 to $60.75 depending on age
Allowances:    
Have you purchased a policy from us last year?
 
Is your travelling companion insured by us? (Receive a 5% allowance.)
Companion's name:
     
Have you been fully vaccinated for COVID-19?
(the answer to this question determines COVID-19 related coverage)
Yes: Coverage up to $200,000 for the costs of medical care provided by hospitals and physicians
No: Losses related to Covid-19 are not covered

STEP 2 : ELIGIBILITY:

You must meet the Eligibility Requirements set out below to be eligible for coverage under this policy. You are eligible for coverage if:
  1. You are at least 15 days old and You are age 89 or under and not insured or eligible for benefits under a Canadian Government Health Insurance Plan; and
  2. You know of no reason why you would require medical attention during your trip; and
  3. In the 12 months prior to the effective date you have not:
    1. been prescribed home oxygen or prednisone for a lung condition or a heart condition or had Pulmonary Fibrosis or Cystic Fibrosis;
    2. used nitroglycerine in any form (spray, patch or pill) for a heart condition for the relief of angina or chest pain, or have a heart condition with an ejection fraction of LESS THAN 40%;
    3. had any aneurysm that is not surgically repaired;
    4. required assistance with any activities of daily living (bathing, eating, using a toilet, taking medication(s) or getting into or out of a chair or bed);
  4. You have not had a Bone Marrow transplant, stem cell transplant or an organ transplant except a cornea transplant.
I have read the Eligibility Requirements above. I understand them, and declare that I am eligible. I acknowledge that any policy and coverage provided to me on the basis of the answers given will be deemed null and void if any answer is not correct.

I confirm I am eligible.

STEP 3 : MEDICAL QUESTIONNAIRE - You MUST answer all questions, as your answers form the medical statement and become part of the policy. You must click Yes for any condition that you had symptoms, been investigated for, received consultation or Treatment for, or had a change in medication or a change in Treatment for, been Hospitalized for or been diagnosed with.
  1. Check whether the stability clause is based on the Effective Date or the Application Date.
  2. If you have been prescribed medicine or a course of care by a doctor or have sought care from a licensed practitioner, you will be considered to have received treatment for a medical condition or injury.
  3. Certain underwriting rules may exclude a condition or reject the application.
  4. The policy is void if there is a material mistake in the medical statement.

 
1) Have you had CIRCULATORY, VASCULAR OR BLOOD DISORDERS in the last 3 years?:
Medications  Stable and Controlled for"Stable and Controlled" means that within the stability period prior to the application date:
  1. there is no new treatment; and
  2. there has been no change in treatment or change in treatment frequency or type; and
  3. here have been no new signs or symptoms or new diagnosis; and
  4. there have been no test results showing deterioration; and
  5. there has been no hospitalization; and
  6. there has been no referral to a specialist (made or recommended) and you are not waiting surgery or the results of further investigations performed by any medical professional.
 
 
a) High Blood Pressure (Hypertension) or Low Blood Pressure (Hypotension)
 
b) Vascular Disease (PVD) or Artery Disease (PAD)
 
 
2) Have you ever had symptoms or diagnosis for HEART OR CARDIOVASCULAR conditions?:
Medications  Stable and Controlled for"Stable and Controlled" means that within the stability period prior to the application date:
  1. there is no new treatment; and
  2. there has been no change in treatment or change in treatment frequency or type; and
  3. here have been no new signs or symptoms or new diagnosis; and
  4. there have been no test results showing deterioration; and
  5. there has been no hospitalization; and
  6. there has been no referral to a specialist (made or recommended) and you are not waiting surgery or the results of further investigations performed by any medical professional.
 
 
a) Cardiomyopathy, Congestive heart failure or water on the lungs or the use of Lasix or Furosemide
 
b) Any other heart or cardiovascular condition, heart attack, surgery, angioplasty, stent, by-pass, pacemaker, irregular rhythm, valve disorder, coronary artery disease or chest pain investigated by a doctor
 
 
3) Have you ever had symptoms or diagnosis for STROKE, CEREBROVASCULAR OR NEUROLOGICAL conditions?:
Medications  Stable and Controlled for"Stable and Controlled" means that within the stability period prior to the application date:
  1. there is no new treatment; and
  2. there has been no change in treatment or change in treatment frequency or type; and
  3. here have been no new signs or symptoms or new diagnosis; and
  4. there have been no test results showing deterioration; and
  5. there has been no hospitalization; and
  6. there has been no referral to a specialist (made or recommended) and you are not waiting surgery or the results of further investigations performed by any medical professional.
 
 
a) Stroke, Cerebrovascular accident (CVA), Mini Stroke, Transient ischemic attack (TIA)CVAs are caused by a blood clot interrupting the blood flow to the brain (ischemic CVA) or by the rupture of a blood vessel or of an aneurysm (haemorrhagic CVA). Since the interruption is prolonged, the client could be left with permanent sequels. Anomalies will appear on cerebral imaging (scans, MRIs etc). A TIA is a sudden neurological deficiency, which disappears in less than an hour and leaves no traceable imaging anomalies. A TIA is an early sign of a potential cerabrovascular accident (CVA), which does leave permanent lesions.
 
b) Other Cerebrovascular or Neurological conditions or disorders
 
 
4) Have you had RESPIRATORY OR LUNG conditions in the last 3 years?:
Medications  Stable and Controlled for"Stable and Controlled" means that within the stability period prior to the application date:
  1. there is no new treatment; and
  2. there has been no change in treatment or change in treatment frequency or type; and
  3. here have been no new signs or symptoms or new diagnosis; and
  4. there have been no test results showing deterioration; and
  5. there has been no hospitalization; and
  6. there has been no referral to a specialist (made or recommended) and you are not waiting surgery or the results of further investigations performed by any medical professional.
 
 
a) Any chronic respiratory condition, lung disorder or lung surgery. (not including Asthma or minor ailments)
 
 
5) Have you had KIDNEY, GASTRO-INTESTINAL, DIGESTIVE OR LIVER conditions in the last 3 years?:
Medications  Stable and Controlled for"Stable and Controlled" means that within the stability period prior to the application date:
  1. there is no new treatment; and
  2. there has been no change in treatment or change in treatment frequency or type; and
  3. here have been no new signs or symptoms or new diagnosis; and
  4. there have been no test results showing deterioration; and
  5. there has been no hospitalization; and
  6. there has been no referral to a specialist (made or recommended) and you are not waiting surgery or the results of further investigations performed by any medical professional.
 
 
a) Chronic Kidney Disease, Chronic Renal Failure, Pancreatitis, Hepatitis or Cirrhosis of the liver
 
b) Other gastro-intestinal/liver/kidney conditions
 
 
6) Have you had DIABETES in the last 3 years?:
Medications  Stable and Controlled for"Stable and Controlled" means that within the stability period prior to the application date:
  1. there is no new treatment; and
  2. there has been no change in treatment or change in treatment frequency or type; and
  3. here have been no new signs or symptoms or new diagnosis; and
  4. there have been no test results showing deterioration; and
  5. there has been no hospitalization; and
  6. there has been no referral to a specialist (made or recommended) and you are not waiting surgery or the results of further investigations performed by any medical professional.
 
 
a) Diabetes prescribed insulinIf insulin and oral medications are taken, both conditions (Diabetes with insulin and Diabetes with medication) have to be checked.
 
b) Diabetes prescribed medication (not insulin)If insulin and oral medications are taken, both conditions (Diabetes with insulin and Diabetes with medication) have to be checked.
 
c) Diabetes without medication or impaired glucose toleranceThere is no surcharge for this condition.
 
 
7) Have you ever had CANCER?:
Medications  Stable and Controlled for"Stable and Controlled" means that within the stability period prior to the application date:
  1. there is no new treatment; and
  2. there has been no change in treatment or change in treatment frequency or type; and
  3. here have been no new signs or symptoms or new diagnosis; and
  4. there have been no test results showing deterioration; and
  5. there has been no hospitalization; and
  6. there has been no referral to a specialist (made or recommended) and you are not waiting surgery or the results of further investigations performed by any medical professional.
 
 
a) Leukemia or Lymphoma or Multiple Myeloma
 
b) Have you had any other form of Cancer and not including basal cell or squamous cell skin cancer
 
c) In the 6 months prior to the effective date have you had chemotherapy or radiation therapy for cancer or malignant tumour(s)
 
 
8) Do you have any OTHER RISK FACTORS you would like to be covered?:
Medications  Stable and Controlled for"Stable and Controlled" means that within the stability period prior to the application date:
  1. there is no new treatment; and
  2. there has been no change in treatment or change in treatment frequency or type; and
  3. here have been no new signs or symptoms or new diagnosis; and
  4. there have been no test results showing deterioration; and
  5. there has been no hospitalization; and
  6. there has been no referral to a specialist (made or recommended) and you are not waiting surgery or the results of further investigations performed by any medical professional.
 
 
a) Have you had symptoms, been referred to a specialist or specialty clinic or required treatment or prescription medication or surgery for any other medical or physical disorder or condition not referred to above - list them in the note section
 
b) Syncope or dizzy spells or fainting that was reported to a doctor or hospital
 
c) In the 6 months prior to the effective date have you had two or more falls that were reported to a physician
N/A  N/A   
d) In the 6 months prior to the effective date have you received advice/treatment for a medical emergency in a hospital for any of the conditions listed above
N/A  N/A   
Notes
Please enter any additional, pertinent information and any other information relating to your health here: (500 characters)

Key Terms Used in this Application and Policy

Answers on the application: Each condition requires the applicant to answer either "Yes" or "No" depending on whether the applicant has had such a condition, including symptoms or investigation or consultation concerning a certain condition. If the condition has been specifically ruled out and no further follow-up action has been or needs to be taken then the applicant can answer "No" to the condition. If the applicant answers "Yes" to any condition, the applicant must state how many medications they are taking for that condition and for how long the condition has been stable. This information will help to determine if the client can be covered for their condition. If a client has too many medications for major conditions they may be excluded from coverage.

Auto-immune disorder includes acquired immune deficiency syndrome (AIDS) or human immunodeficiency virus (HIV), Grave's disease, Lou Gehrig's disease, multiple sclerosis, myasthenia gravis, sarcoidosis any location, scleroderma, systematic lupus erythematosis.

Blood Disorder includes anemia (other than vitamin B-12 deficiency anemia), hemochromatosis, idiopathic thrombocytopenic purpura (ITP), hemophilia, polycythemia vera, Sickle-cell anemia.

Deductible means the amount which the Insured must pay per claim before any remaining covered expenses are reimbursed under this policy. Your deductible is indicated on your confirmation of coverage and applies to each claim.

Emergency means an unexpected or unforeseeable sickness or injury which requires immediate medical attention or treatment to prevent or alleviate existing danger to life or health, or to relieve acute symptoms, that cannot be delayed until you return to your province.

High-risk activity(ies) includes skiing or snowboarding out of bounds, ski jumping, skydiving, skysurfing, scuba diving (except if certified by internationally recognized and accepted program such as NAUI or PADI, or if diving depth does not exceed 30 meters), white water rafting (except grades 1 to 4), street luge, skeleton activity, mountaineering, or participation in any rodeo activity.

Major organ means, heart, kidney, liver or lung.

Medical consultation means any medical services obtained from a licensed medical practitioner 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 condition need not have been definitively made. This does not include regular medical check-ups where no medical signs or symptoms existed between check-ups or were found during the check-up.

Minor Ailment means any sickness or injury which does not require:

  1. the use of medication for a period greater than 15 days;
  2. more than one follow-up visit to a physician;
  3. hospitalization, surgical intervention, or referral to a specialist; and
  4. which ends at least thirty (30) days prior to your effective date.
A chronic condition or any complication thereof is not considered a minor ailment; it is a pre-existing condition.

Other Cerebrovascular or Neurological conditions or disorders: includes Parkinson's disease, epilepsy, cerebral palsy, multiple sclerosis, brain injury or brain tumor, seizure disorder, Lou Gehrig's disease (ALS), Creutzfeldt-Jakob disease, Cushing's syndrome, Guillain-Barré syndrome (GBS), trigeminal neuralgia (TN or TGN).

Pre-existing condition means a medical or physical condition, symptom, illness or disease, whether diagnosed or not, for which treatment has been received or taken, or which exhibited signs or symptoms, at any time preceding your effective date and includes a medically recognized complication or recurrence of a medical condition but does not include a minor ailment.

Recurrence means the appearance of signs or symptoms caused by or related to a medical condition which was previously diagnosed by a physician or for which treatment was previously received.

Signs or symptoms means any evidence of disease experienced by you or recognized through observation.

Stable as indicated on your medical statement summary (if applicable), means that during the specified period:

  1. there has been no new treatment; and
  2. there has been no change in treatment or change in treatment frequency or type; and
  3. there have been no signs or symptoms or new diagnosis; and
  4. there have been no test results showing deterioration; and
  5. there has been no hospitalization; and
  6. there has been no referral to a specialist (made or recommended) and you are not awaiting the results of further investigations performed by any medical professional.
Exceptions:
  1. the routine adjustment of Coumadin, warfarin, or insulin (as long as the medication is not first prescribed or stopped during the 90 days prior to the effective date);
  2. change from a brand name medication to a generic medication provided the medication was not first prescribed during 90 days prior to the effective date and there is no increase or decrease in dosage;
  3. a minor ailment.

Stomach, bowel, digestive, gastrointestinal disorder includes any condition along the gastrointestinal tract (from the mouth to the anus) and can include (among others) esophagus disorder, stomach disorder, ulcer, hernia, irritable bowel syndrome (IBS), inflammatory bowel disease, gastrointestinal bleeds, gastritis, Chrohn's disease, Celiac disease, diverticulitis, ulcerative colitis, colitis, bowel obstruction, bowel resection or ostomy.

Exceptions: The following conditions are not subject to any surcharge but must be noted in the note section of the medical questionnaire:

  1. Gastroesophageal reflux disease (GERD); or
  2. removal of polyps during a routine colonoscopy where no signs or symptoms were present; or
  3. diverticulosis.

Terminal applies to a medical condition for which a physician gave a prognosis of eventual death or for which palliative care was received prior to the effective date.

Treatment means a medical, therapeutic or diagnostic procedure prescribed, performed or recommended by a physician including, but not limited to, prescribed medication, investigative testing or surgery.


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