No benefits are payable if the loss sustained or the expenses incurred result directly or indirectly from one of the following causes:
Exclusions relating to pre-existing conditions
For persons under 61 years of age:
During the three months prior to the Effective date of coverage, any Illness, injury or condition related to a medical condition for which the Covered person:
consulted a Physician (other than for a regular checkup), or;
was hospitalized, or;
was prescribed or received a new treatment, or;
received a change in an existing treatment, or;
was prescribed or had taken a new medication, or;
received a change in existing medication (including usage or dosage).
For persons 61 years of age or over:
a) During the six months prior to the Effective date of coverage, any Illness, injury or condition related to one of the medical conditions listed below for which the Covered person:
consulted a Physician (other than for a regular checkup), or;
was hospitalized, or;
was prescribed or received a treatment, or;
was prescribed or had taken a medication for:
Cardiovascular conditions: myocardial infarction, angina, arrhythmia, pacemaker, defibrillator, congestive heart failure, bypass, angioplasty, valvulopathy or valve replacement, aortic aneurysm, heart transplantation, peripheral vascular disease;
Chronic obstructive lung conditions: asthma, emphysema, chronic bronchitis, lung transplantation;
Neurological conditions: cerebral-vascular Accident, transient ischemic attack;
Insulin-dependent diabetes: diabetes treated with insulin injections;
Kidney failure, kidney transplantation;
Gastrointestinal conditions: cirrhosis, hepatitis, ulcers, internal bleeding, liver transplantation, intestinal obstruction;
Cancer or malignant tumor.
b) During the six months prior to the Effective date of coverage, any other Illness, injury or conditions related to a medical condition for which the Covered person:
consulted a Physician (other than for a regular checkup), or;
was hospitalized, or;
was prescribed or received a new treatment, or;
received a change in an existing treatment, or;
was prescribed or had taken a new medication, or;
received a change in existing medication (including usage or dosage).
Other exclusions
Any state or condition for which symptoms were ignored or for which medical advice was not followed or the recommended investigations, treatments, tests or procedures were not carried out
Pregnancy and complications arising there from
Accident sustained by the Covered person while participating in a sport for remuneration, any kind of motor vehicle competition or any kind of speed contest, gliding or hang-gliding, mountain climbing (grade four or five routes, according to the scale of the Yosemite Decimal System—YDS), parachuting or skydiving, bungee jumping, canyoning and any extraordinary and uncommon sport with a high level of stress and risk involved
Abuse of medication or alcohol, or use of drugs or any other drug-addiction, and any condition arising therefrom, or driving of a motor vehicle while ability to drive is impaired by drugs or by alcohol with an alcohol level of more than 80 milligrams to 100 millilitres of blood
Trip undertaken for the purpose of receiving medical attention
Suicide, attempted suicide or self-inflicted injury of the Covered person, whether sane or insane
War, invasion, enemy acts, hostility between nations (whether or not war is declared), civil war, rebellion, revolution, insurrection, military power or usurped power, confiscation or nationalization or requisition or destruction of or damages to belongings due to any government or local or public authority
Perpetration of or attempt to perpetrate, directly or indirectly, a criminal act under any law
Any condition resulting from a mental, nervous, psychological or psychiatric problem, unless the Covered person is hospitalized for that specific reason
Any claim for patients in chronic care Hospitals or in chronic care units of public Hospitals, or in nursing homes or health spas
Any care, treatment, products or services other than those declared by the appropriate authorities to be required for the treatment of the injury or disease or stabilization of the medical condition
Custodial care or services rendered for the convenience of the patient
Care or treatments for cosmetic purposes
Care or treatments received in Canada or the United States when such care or treatments could have been obtained in the Covered person’s country of residence without endangering the life or health of the Covered person (with the exception of expenses for immediately necessary treatment following an emergency resulting from an Accident or sudden Illness). Under this exclusion, the fact that the treatment available in the country of residence of the Covered person could be of lesser quality than treatment available in Canada or the United States (except Hawaii) does not in itself constitute a danger to the Covered person’s life or health.
Without restricting the generality of this exclusion, no benefits are available under this plan for residents of other countries traveling primarily or incidentally to seek medical advice or treatment, even if such a trip is on the recommendation of a Physician.
Care or treatments that are not covered under government programs where such Hospital and medical costs are incurred
Care or treatments such as those rendered by a chiropractor, a podiatrist, an acupuncturist, a homeopath, a physiotherapist or a naturopath
Products listed below are not covered even when obtained by a prescription:
Processed food for infants, dietary or food supplements or substitutes of any kind, including protein, so-called natural products, multivitamins and drugs available over the counter (GP products), antacids, digestives, laxatives, antidiarrheal drugs, decongestants, antitussive drugs, expectorants and any other flu or cold medications, gargles, oils, shampoos, lotions, soaps and all other dermatological products
Failure of the Covered person to communicate with CanAssistance in the event of medical consultation or hospitalization following an Accident or sudden Illness
Repatriation authorized by the Insurer for medical reasons terminates the contract coverage from that moment on
Treatment required for immigration purposes
Eyeglasses and hearing aids
Services or treatments received in the State of Hawaii in the United States or outside Canada and the United States
Services or treatments received within the United States by a resident of the United States during the Period of coverage
Acts of Terrorism Where an Act of terrorism directly or indirectly causes a loss that would otherwise be payable under one of the covered risks in accordance with the terms and conditions of the policy, this insurance will provide coverage as follows:
The benefit payable is reduced to 50%.
The benefits payable shall be paid out of a fund and, where total claims exceed fund limits, eligible claims shall be reduced on a pro rata basis so that the maximum payment out of the fund for all policyholders shall be $5,000,000 (Canadian) per Act of terrorism or series of Acts of terrorism occurring within a 72 hour period.
The total maximum payment out of the fund for all policyholders shall be $10,000,000 (Canadian) per calendar year regardless of the number of Acts of terrorism.
If, in our judgment, the total of all payable claims for all policyholders under one or more Acts of terrorism may exceed the applicable fund maximum limits, your prorated claim will be paid after the end of the calendar year.
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