Can you excuse yourself from the medical wait line?
Insurance can help you do that, for you and/or your family.
Planning ahead can help you access medical services faster when needed.
Now, Canadians don't need to wait THAT long. When placed on a medical waiting 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 Lloyd's 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.
- Lifetime benefit maximum of $1,000,000 CDN, payable for: surgical and related medical services; hospital and inpatient services; other health services (such as diagnostic procedures, support services and/or second opinions); and specialist consultations.
- 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 $25,000 Guaranteed Issue Critical Illness insurance.
- HealthSure Plus provides expedited access to Specialist Consultations in the following medical specialties:
- + Cardiology
+ Ear, Nose and Throat
+ General Surgery
+ Spine Team
Description of Coverage:
COVERED BENEFITS AND SERVICES
a) SURGICAL AND RELATED MEDICAL SERVICES
Surgical services and other medical care directly related to the approved surgery provided by an approved Physician in an approved Hospital, Outpatient Surgical Facility, or free-standing ambulatory surgical center, including services of an anesthesiologist and assistant Surgeons when required.
This includes pre-surgical consultations and/or tests to determine if the surgery is Medically Necessary.
b) HOSPITAL AND INPATIENT SERVICES
i) Hospital Accommodation
Room and board charges for up to semi-private room accommodation, unless the Hospital is a private facility which provides private room accommodation only, for Hospital confinement in relation to an approved surgery.
ii) Other Inpatient Services and Supplies
Medically Necessary services, supplies and prescriptions related to an approved surgery in an approved Hospital.
c) OTHER HEALTH SERVICES
i) Diagnostic Procedures
If approved by Us, Medically Necessary diagnostic procedures related to conditions or treatment not otherwise limited or excluded under the Policy. Covered diagnostic procedures are limited to the following:
- Magnetic Resonance Imaging (MRI)
- Computerized Axial Tomography (CAT or CT scans)
- Cardiac Catheterization
ii) Medical and Surgical Support Services
Once treatment for an Insured Person has been approved by MSH INTERNATIONAL (CANADA) LTD., We will assist in locating a provider and coordinate the required surgery or Diagnostic Procedure. Requests for a specific Hospital or Doctor may be considered and must be approved in advance by Us.
iii) Second Opinions
Once an Insured Person has been placed on a Surgical/Procedural Waiting List in Canada for a condition covered under this policy, the Insured Person may be eligible for a second opinion on the recommended surgery or Diagnostic Procedure at no cost to the Insured Person, subject to Pre-Authorization and approval by Us. If determined necessary by Us, We may require a second surgical opinion for any surgery or procedure.
iv) Accommodation and Meals for Family Members
When We determine that a patient requires travelling assistance for a covered surgery only, We may authorize reimbursement of the costs of commercial accommodation and meals for a Family Member, or other person approved by Us.
The maximum daily allowance will be the lesser of the total charges and $150 per day, subject to an overall maximum per person of $1,500 per Occurrence.
We will only reimburse covered expenses evidenced by original, itemized receipts.
v) Transportation for Covered Services
Transportation costs incurred by an Insured Person while travelling to and from the approved surgical facility, including transportation costs for a follow-up appointment with the performing surgeon, if required, will be reimbursed upon completion of an authorized surgery.
In addition, transportation costs incurred by a Family Member or other person providing travel assistance to the Insured Person, when approved in advance by Us, will also be reimbursed subject to the benefit maximum per Occurrence.
This benefit is calculated by measuring the round-trip travel distance from the Insured Person’s Canadian residence to the approved surgical facility, according to the most recent Rand McNally geographical data available to Us. The maximum benefit per surgery is calculated at the rate of 51.5 cents per kilometer up to a maximum benefit of $500 per Occurrence.
vi) Acquired Immune Deficiency Syndrome (AIDS) or AIDS Related Diseases
The Policy will provide coverage for treatment of AIDS or AIDS related diseases, when a positive HIV or Aids diagnosis is made after the effective date of an Insured Person’s coverage, up to $50,000 per Insured Person per lifetime for all such treatment in total.
d) SPECIALIST CONSULTATIONS:
If an Insured Person is referred by their General Practitioner (GP) to a Specialist Physician for assessment while insured under this Benefit, and the Specialist Physician confirms that the assessment cannot be provided within forty-five consecutive days of the referral by the GP, the Policy will pay Benefits for the cost of an assessment by a Specialist Physician approved by Us, subject to the following:
a) the referral by the GP is to a Specialist Physician in one of the following medical specialties:
Orthopaedics; Cardiology; Neurology; General Surgery; Gastroenterology; Ear, Nose and Throat; Ophthalmology; Urology; Rheumatology; Spine Team; and
b) the assessment is for the purpose of determining a condition which may result in a diagnostic test or surgical treatment.
MSH INTERNATIONAL (CANADA) LTD. will make the first available appointment with the appropriate Specialist Physician at the geographical location closest to the Insured Person and make every effort to schedule the special Physician assessment within twenty one (21) days from the referral by the GP and/or approval of the request.
Travel expenses to the Specialist Physician approved by Us are not included under this Benefit.
An Insured Person’s coverage under this Benefit will commence on the first of the month following 90 days from the Effective Date of an Insured Person’s HealthSure Plus coverage. No coverage will be provided for Specialist Physician referrals for new medical conditions made during this waiting period.
For an Insured Person who has HealthSure Plus Single Plan coverage, the Specialist Consultations Benefit provides for a maximum of two assessments per Insured Person per coverage period.
For an Insured Person who has HealthSure Plus Couple Plan, HealthSure Plus Single with Children Plan, or HealthSure Plus Family Plan coverage, the Limited Specialist Coverage Benefit provides for a maximum of three assessments in total for all Insured Persons per coverage period. Each assessment includes an initial and follow-up consultation.
A coverage period is defined as one Policy Year from the Effective Date of an Insured Person’s HealthSure Plus coverage.
Eligibility (to age 74):
A Member 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 Plus.
HealthSure Plus is available on a Single Plan, Couple Plan, Family Plan or Single with Children Plan basis.
An eligible Member may apply for HealthSure Plus Insurance for:
- a) a Spouse, 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;
- b) 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.
All family members (Member, Spouse and/or Dependent Children) must be insured for the same type of coverage (HealthSure Plus).
Where a Member and Spouse are both eligible as a Member, coverage under HealthSure Plus is limited to the Couple Plan or the Family Plan and only the oldest Member may apply for coverage.
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.