Wait List Insurance

Remove Yourself From The Medical Wait Line? Insurance can do that.

Planning ahead can help you access medical services faster when needed. 

You don't need to wait THAT long. When placed on a medical wait-list greater than 45 days, wait list insurance, (also known as medical access insurance) allows immediate access to diagnostic examinations, specialist consultations, and surgical procedures.

HealthSure, a medical access insurance product underwritten by Certain Lloyd's of London Underwriters and administered by MSH International (Canada) Ltd., covers the costs of, and speeds up your access to specialist appointments, diagnostic testing and/or surgery.

Benefits:

  • Lifetime benefit maximum of $1,000,000 CDN.
  • There is no medical underwriting or medical questionnaire;
  • No deductible or co-payments;
  • It will cover pre-existing conditions once the policy has been in effect for 24 consecutive months;
  • Approved travel expenses for diagnostics and surgery
  • Payments made directly to the service provider - its not a pay and then get reimbursed type policy.
  • Optional upgrade to include Guaranteed Issue Critical Illness insurance
  • HealthSure Basic provides expedited access to Specialist consultations in 10 Specialist categories:  
    + Cadiology
    + Ear, Nose and Throat
    + Gastroenterology
    + General Surgery
    + Neurology
    + Ophthalmology
    + Orthopaedics
    + Rheumatology
    + Spine Team
    + Urology

Eligibility to age 74:

A Client who, at the time of application, resides in Canada, is under Age 75 and covered under the provincial health insurance plan of their province of residence, is eligible to apply for HealthSure Premium Insurance which must include Critical Illness Insurance and a minimum of Medical Access Insurance – HealthSure Plus+, Single Plan coverage.

Provided a Client purchases Medical Access Insurance – HealthSure Plus+ on a Couple Plan or Family Plan basis, the Spouse is also eligible for Critical Illness Insurance.

For the purposes of this policy, Insured Persons shall also be considered as those persons who:

* Have completed and signed the application form in acceptance of the policy terms and conditions;

* Have paid the required premium or had such premium paid on their behalf by the policyholder.

a) Medical Access Insurance – HealthSure Plus+ Medical Access Insurance – HealthSure Plus+ is available on a Single Plan, Couple Plan, Family Plan or Single with Children Plan basis.

An eligible Client may apply for Medical Access Insurance – HealthSure Plus+: 

1) Under the Couple Plan or Family Plan for a Spouse, who at the time of application, resides in Canada, is under age 65 and covered under the provincial health insurance plan of their province of residence;

2) Under the Family or Single with Children Plan for a Dependent Child, who at the time of application, resides in Canada and is covered under the provincial health insurance plan of their province of residence.

Where a Client and Spouse are both eligible for ePlus Insurance as a Client, Medical Access Insurance – HealthSure Plus+ coverage is limited to one of the following options:

i) A Single Plan basis for both Clients; or

ii) A Couple Plan basis whereby only the oldest Client applies; or

iii) A Single with Children Plan basis for one Client and a Single Plan basis for the other Client; or

iv) A Family Plan basis whereby only the oldest Client applies.

b) Critical Illness Insurance

Critical Illness Insurance is available to all eligible Clients who enroll in a minimum of Medical Access Insurance – HealthSure Plus+, Single Plan coverage.

A Spouse of an eligible Client, who at the time of application, resides in Canada and is also under age 65, is eligible to apply for Critical Illness Insurance provided the Spouse is also enrolled for Medical Access Insurance – HealthSure Plus+ as a Spouse under the Couple Plan or Family Plan.

Where a Client and Spouse are both eligible for HealthSure Premium Insurance as a Client and the oldest Client has applied for Medical Access Insurance - HealthSure Plus+ in accordance with section a) ii) or iv) above, then the older Client must apply for Critical Illness Insurance as a Client, and the younger Client is limited to Critical Illness Insurance as a Spouse. 


Exclusions:

This Policy does not provide Medical Access Insurance Benefits for the following:

1. Services and supplies that are:

  • Not Medically Necessary;
  • Not recommended or approved by a Physician;
  • Not rendered within the scope of the Physician’s license;
  • Furnished by a government plan, Hospital or institution unless the Insured Person is legally required to pay for the services;
  • Charged in excess of the Maximum Amount Payable;
  • Provided without prior written Pre-Authorization by Us; or
  • Provided after the termination date of an Insured Person’s Medical Access Insurance, except as outlined under subsection 18 Effect on Claims of Termination of Insurance, under the heading General Policy Terms.

2. Injury or Sickness occurring during or arising from an Insured Person’s course of employment for which benefits are provided or payable under Workers’ Compensation or under any Act or Law which provides benefits for such Injury or Sickness  for which an Insured Person failed to file a claim for Workers’ Compensation benefits for which they were eligible.

3. Injury or Sickness caused by:  an act of declared or undeclared war; service in the military forces of any country, including non-military units supporting such forces; the Insured Person committing or attempting to commit civil tort or an indictable offence, taking part in a riot (meaning the Insured Person is taking an active part in common with three or more others by using or threatening to use force or violence without authority of law).

4. Injury or Sickness, while sane or insane, resulting from or related to self-inflicted sickness or injury,  flagrant self-abuse such as continued behaviour contrary to a Physician’s recommendation, suicide, threatened suicide, alcohol abuse, or drug addiction or abuse.  This includes an accident where alcohol or drugs were involved; treatment related to any psychological, mental, Nervous or emotional disorders, treatment of any sexually transmitted disease, except as indicated under sub section 2 c) vi) in this section.

5. Procedures, devices, services, supplies, or drugs that We consider experimental or investigative in the area where service is received.

6. Plastic or cosmetic surgery, unless for reconstruction caused by a covered Injury, Sickness or a mastectomy.  Covered expenses are only payable if the Injury happens, or the Sickness is first diagnosed while insured by the Policy, and the covered expenses must be incurred while the Insured Person is insured under the Policy;

7. Treatment to remove a birthmark;

8. Services and supplies rendered to treat hair loss or to promote hair growth, including but not limited to hair transplants and wigs;

9. Routine physical exams, checkups, and related x-ray and lab expenses, drugs and medicines, except those prescribed in and taken home from the Hospital where permission was Pre-Authorized by Us;

10. Blood products storage where not necessary or not in conjunction with a scheduled covered surgery;

11. Blood products when replaced by donation;

12. Organ or tissue or transplants, including transplants for burns and related services, except corneal transplants;

13. The implant of an artificial organ or any service or supply in connection therewith;

14. Items or devices primarily used for comfort or commonly installed in homes, including but not limited to air purifier, humidifier, dehumidifier, whirlpool, air conditioning, water bed, exercise equipment or ultraviolet lighting;

15. Personal or home-based artificial kidney equipment;

16. Growth hormone treatment, regardless of the reason for prescription;

17. Foot care including but not limited to: shoe inserts, foot care related to corns, calluses, bunions, hallux valgus, flat feet, weak arches or weak feet;

18. Treatment or surgery of bony protuberance of the forefoot and toes, including misalignment of the same (e.g. bunions, spurs, hammertoes);

19. Any dental treatment or services;

20. Treatment of temporomandibular joint dysfunction, craniomandibular joint dysfunction, myofacial pain syndrome and all related conditions, orthognathic reconstructive surgery;

21. Private duty services of a health care provider;

22. Eye exams for corrective lenses, including contact lenses, eye glasses and their fitting, radial keratotomy, corneal modulation, refractive keratoplastry or any similar procedure, speech or vision therapy, including eye exercises, hearing exams, hearing aids and their fitting;

23. Emergency medical care provided through a public or private medical facility;

24. A Chronic Medical Condition;

25. A Related Medical Condition;

26. Sex change operations and complications from that surgery, artificial insemination, in-vitro or in-vivo fertilization, testing, treatment or medication for the primary purpose of achieving conception, maintaining pregnancy or preventing abortion,  infertility and impotency testing and treatment, abortion, voluntary sterilization, reversal procedures or sterilization;

27. Acupuncture, chelation therapy, or laetrile used in form or any derivative or variation thereof;

28. Treatment for weight loss, or  for exogenous or morbid obesity, including but not limited to: gastric bypass, gastric stapling, or balloon catheterization, liposuction or reconstructive surgery, any food supplement or augmentation, diet, health or exercise programs, health club dues, or weight reduction clinics;

29. Any treatment related to pregnancy or complications thereof;

30. Prosthesis, Corrective Devices and medical appliances which are not surgically required, unless necessitated by Injury, deformity or Sickness which occurs while the Insured Person is covered under the Policy;

31. Chronic Fatigue Syndrome including, but not limited to diagnostic workups;

32. Sclerotherapy, for the treatment of varicose veins of the extremities;

33. Any treatment relating to birth defects or congenital illnesses;

34. Services and supplies (including but not limited to splints and braces) prescribed or rendered solely to allow for participation in any sports related activity, or solely for strengthening, conditioning or maintaining a muscle, bone or joint function;

35. Injury or Sickness occurring while engaged in any hazardous, high risk or extreme sport activities including but not limited to: sky or scuba diving, parachuting, mountain climbing, ballooning, hang gliding, bungee cord jumping, stunt flying, crop dusting or the operation of an ultra light aircraft, racing of any form (other than on foot) and all professional sports.

36. Expense for which no benefit is specifically described in the Policy, in any amendment to the Policy, or an expense specifically excluded in the Policy.