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Medical Declaration

All applicants of age 55 to 85 on the effective date are required to complete the medical declaration for the Enhanced Plan.

Please answer the following yes/no questions:

A. Within the past 12 months, and in relation only to the medical conditions listed below, have you:

  1. been newly diagnosed with; 
  2. been prescribed any new medication or any change in medication for;
  3. had any new or change in treatment, including investigation or testing (do not count regular scheduled maintenance investigations or testing); 
  4. been referred to a specialist for; or 
  5. been hospitalized or seen in the emergency department of a hospital for:

Any of the following medical conditions:​ (a) a heart condition   (b) a lung condition (c) shortness of breath (d) chest pain  (e) stroke, or mini-stroke or TIA (Transient Ischemic Attack)?

 

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B. Have you had a heart bypass, heart valve surgery or angioplasty more than 10 years ago (use the date of the most recent procedure)?

 

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C. Within the past 12 months have you:

  1. been treated for and/or been diagnosed with internal bleeding; or
  2. been admitted to hospital for a gastrointestinal disease or disorder; or
  3. received treatment including investigation or testing where the results indicate either a new diagnosis of cancer or that cancer has returned or spread (except basal cell and squamous cell skin cancer or breast cancer treated only with hormonal therapy)?

 

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D. Within the past 12 months have you been prescribed or taken any of the following:

  1. prednisone for any lung condition; or
  2. any form of nitroglycerin for the relief of angina pain (including on an “as needed” basis)?

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E. Within the past 12 months have you been prescribed or taken medications for both diabetes and a heart condition?

(Answer No if you are medicated for one but not both of these conditions. Medication prescribed solely for the control of blood pressure is not a medication for a heart condition.

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Medical Declaration

This Medical Declaration must be completed by the applicant(s) between 70 and 84 years of age as of the effective date of coverage and are applying to purchase coverage for pre-existing medical conditions that have been stable in the 180 days prior to your effective date.

Please answer the following yes/no questions:

Q1. Was your most recent heart bypass, heart angioplasty (including stent placement) or heart valve surgery more than 10 years prior to your effective date?

 

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Q2. Have you been diagnosed with a heart condition as well as diabetes and/or hypertension (high blood pressure)? Answer NO if you have only diabetes/hypertension and do not have a heart condition.

 

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Q3. Have you ever had or are you awaiting a bone marrow or organ transplant?

     

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    Q4. In the 24 months prior to your effective date have you been diagnosed with or treated for:

    a. Congestive heart failure?

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    b. A lung condition with prednisone or other oral steroid medication (not including puffer) or home oxygen?

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    c. Kidney or liver failure?

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    d. Peripheral vascular disease?

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    Q 5. In the 12 months prior to your effective date have you been diagnosed with or been treated for:

    a. Angina, chest pain or a heart attack?

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    b. Stroke, transient ischemic attack (TIA) or mini-stroke?

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    c. Cancer (excluding basal or squamous cell skin cancer or breast cancer treated only with hormone therapy)?

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    d. Internal bleeding?

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    You are eligible for insurance plan if you have none of the following conditions:

    • are travelling against the advice of a physician.
    • have been diagnosed with a terminal illness with less than 2 years to live.
    • have been diagnosed with or received treatment within the past 2 years for pancreatic, lung, brain or liver cancer.
    • have ever been diagnosed with any type of cancer that has spread from one part or organ of the body to another (metastatic cancer).
    • have had or are waiting for an organ or bone marrow transplant (excluding corneal transplant).
    • have ever been diagnosed with Congestive Heart Failure.
    • have been prescribed or used home oxygen in the last 12 months.
    • require kidney dialysis.
    • reside in a nursing home, or long term care facility.
    Are you eligible?

    To be eligible for coverage, on the effective date, you must:

    • be a visitor to Canada or a person in Canada under a valid work or student visa, a Canadian or an immigrant not eligible for benefits under a government health insurance plan; and

    • be at least 15 days of age and less than 90 years of age; and

    • not be travelling against the advice of a physician and/or have not been diagnosed with a terminal illness; and

    • not be experiencing new or undiagnosed signs or symptoms and/or know of any reason to seek medical attention; and

    • not require assistance with the activities of daily living (dressing, bathing, eating, using the toilet or getting in or out of a bed or chair); and
    • have not been diagnosed or treated for pancreatic, liver, lung, brain or any kind of metastasized cancer; and

    • have not been diagnosed or treated for kidney condition requiring dialysis within the last 24 months; and

    • have not been diagnosed or treated for bone marrow or organ transplant within the last 24 months; and

    • have not been diagnosed for terminal sickness with less than 2 years to live; and

    • have not taken home oxygen in the past 12 months prior to the effective date

    Are you eligible?