Chapter 8 Flashcards
Travel Insurance
Why do people need travel plans?
Many people believe their provincial or territorial health plans will cover them for medical and other expenses incurred regardless of where they become ill or are injured. Unfortunately, this is only partially true
While provincial and territorial medical plans have reciprocal agreements, identify four costs that may not be covered under all plans
- Ambulance charges
- Family visitation
- Repatriation; or
- Return of vehicle
Provincial or territorial health plans will respond regardless of the period of time a resident is away from the home - True or False?
False
When an accident or illness occurs outside of Canada, provincial or territorial plans only pay the plans’ fee regardless of
- The fees charged where the injury or illness occurred; or
- Any other costs incurred
Travel policies are available for clients who travel either for:
- Pleasure or
- Business
These (travel) policies may be purchased for:
- Individuals only, or to
- Include coverage for family members as well
Policies (travel) can be purchased to provide coverage on:
- Single trips ranging from two weeks up to 180 days; or
- Coverage can also be purchased on multiple trips lasting up to 30 or 45 days, occurring any time within a year from the date of policy issue
Major Sections of the Policy
Although no standard policy exists, identify five major sections usually found in a travel policy
- Insuring Agreement
- Term of Insurance
- Definitions
- Policy Coverage & Limitations
- Additional Exclusions & Limitations
Insuring Agreement
Identify two requirements before an insured can qualify for coverage
- A permanent resident of Canada; and
- Covered under the provincial or territorial health care plan
Term of Insurance
Identify the earliest of when coverage will terminate for other than annual policies
The return date shown on the application, but no later than the number of days shown in the application after the departure date shown in the application
Term of Insurance
Identify the earliest of when coverage will terminate for annual policies
The date the insured returns to the province or territory of residence, which is 30 days after the departure date
Define “Insured”
An Insured Applicant, his spouse and any Dependent Children
Define “Insured Applicant”
A Canadian resident under age 65, insured under the government health insurance plan of his Province or Territory of Residence, who has been named on an invoice/application issued by his broker
Define “Spouse”
The legal spouse of the Insured Applicant residing in Canada, provided there is no legal separation in effect, or an individual of the opposite sex who has been residing with the Insured Applicant for a period of at least one year
Define “Dependent Child or Children”
Any natural child, step child, legally adopted child or legal ward of the Insured Applicant, residing in Canada
Who is:
- 20 years of age and under, unmarried and receiving full support and maintenance from the Insured Applicant and residing with the Insured Applicant; or
- Less than 26 years of age, unmarried and receiving full support and maintenance from the Insured Applicant for reason of full time attendance at a Canadian accredited institute, college or university; or
- Receiving full support and maintenance from the Insured Applicant by reason of mental or physical infirmity
Define “Extended Family”
The dependent child, spouse, parent, guardian, brother, sister and grandparent of the Insured Applicant or spouse
Define “Accident”
An unforeseen and unintended occurrence due to external, violent, sudden, fortuitous causes beyond the Insured’s control
Define “Injury”
Bodily injury caused by an accident occurring while the Insured is insured hereunder
Define “Sickness”
Bodily sickness or disease, contracted and commencing after the policy is issued and while the policy is in effect
Define “Hospital”
What is not considered a hospital?
An institution operated pursuant to law for the care and treatment of sick and injured persons with organized facilities for diagnosis, major surgery and 24 nursing service
Does not include a convalescent or nursing home, home for the aged, health spa or a facility for the treatment of alcoholism, drug addiction or mental illness
Define “Supervised Condition”
A diagnosed medical condition, illness or injury for which you require any diagnostic testing, investigation or referral not yet complete, or for which the results are still not known that requires constant consistent treatment and is controlled with medication without change for:
- At least three months preceding the date of departure if you are under the age of 60; or
- At least six months preceding the date of departure if you are age 60 or over; or
- If you have taken medication for a cardiac condition or related condition at any time within six months
Define “Traveling Companion”
The person(s) who is sharing the same travel arrangements with the Insured
Define “Professional Sport”
Any sport for which a participant is receiving any remuneration including but not limited to sponsorship, endorsements or other monetary compensation
Define “Whole or Sound Teeth”
Whole in appearance whereby some part is natural (cannot be artificial teeth). Capped or crowned teeth are considered to be whole or sound. Teeth that have received a root canal are considered sound
