In the event that services are necessary, or to establish a claim, the participant must call the assistance provider named on the reverse of the subscriber’s identification card. As a condition of coverage under this plan, notification of any hospitalization must be made within 24 hours for verification of eligibility and coverage.
There is no coverage for a pre-existing condition.
“Pre-existing condition” means any medical condition including illness, sickness, injury or symptoms, that required consultation, diagnosis, treatment and/or investigation in the 90 day period prior to departure from the province of residence, or for which a new medication was prescribed or a change was made in the dosage of a medication in the 90 days prior to departure from the province of residence.
Medavie Blue Cross will pay for the following services when they are:
- medically necessary;
- incurred on an urgent basis as a result of unforeseen illness or accidental injury occurring while you are travelling outside your province of residence or outside Canada;
- not covered or eligible for coverage by any government plan or program;
- non-elective services or services obtained on a referral basis.
Benefits are subject to all limitations, exclusions and maximum benefit limits.
Travel Health Benefits are available on the assumption that a participant is entitled to all benefits provided under government insurance plans for out-of- province services. Benefits are supplemental to government insurance and will not duplicate or substitute benefits available under government insurance plans. Medavie Blue Cross will not pay any Travel Health benefits unless the participant is covered by a government insurance plan for out-of- province services.
If following diagnosis or a period of treatment, it is determined, through appropriate medical evaluation, which a participant is able to return to Canada for such treatment, Medavie Blue Cross has the right to have the participant returned to Canada. If such determination is made and the participant or family member is duly informed and elects to obtain treatment outside Canada, the charges for such treatment will not be covered.
Your Travel Health Benefit Does Not Cover:
- Services, supplies and equipment related to all pre-existing conditions;
- Non-emergency services to monitor, stabilize or continue treatment of any existing medical condition;
- Services, supplies or equipment received by a participant who travelled outside the home province for the purpose of obtaining hospital treatment, medical treatment or advice;
- Services, supplies or equipment that were obtained outside the province of residence at a participant’s election, including surgery or other treatment known to be required, that could be deferred until return to Canada;
- Cardiac surgery, angioplasty or other cardiac procedures, unless approved by Medavie Blue Cross prior to being performed, except when such procedures are performed immediately following admission to hospital, on an emergency basis, to preserve life, when a delay in treatment would threaten life;
- Surgery for removal of cataracts;
- Services, supplies or equipment provided to a participant in relation to pregnancy, other than services related to a naturally occurring miscarriage or to a premature delivery occurring before two months of the expected date of birth;
- Services, supplies or equipment related to any malignant medical condition originally diagnosed or treated prior to departure from the usual province of residence, or the progression of such condition, are excluded, except that the initial diagnostic services and transportation expenses related to such condition will be covered if approved in advance by Medavie Blue Cross and the medical condition has been stable for 12 months prior to departure.
- Expenses in excess of $2 million Canadian per covered Participant, per incidence outside the province of residence.