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Medi-Select Advantage® Travel Insurance is underwritten by Royal & Sun Alliance Insurance Company of Canada and administered by Expert Travel Financial Security (E.T.F.S.) Inc. ® The etfs logo and Medi-Select Advantage are registered trademarks of Expert Travel Financial Security (E.T.F.S.) Inc.
M E D I C A L Q U E S T I O N N A I R E G U I D E L I N E S H O W T O U S E T H E M E D I C A L Q U E S T I O N NA I R E G U I D E L I N E S
This guide is designed as a tool to help clarify the medical questionnaire and to answer frequently
asked questions about situations encountered while offering the Medi-Select Advantage product.
Under no circumstances should a broker or sales agent interpret a client’s health and/or
answer a question for the client.
This guide must never replace a physician’s answer to clarify a patient’s medical condition. When
in doubt about their health or medications, our clients should always be referred back to
their physician for further clarification and understanding of their medical condition.
W H E R E T O F I N D A N A N S W E R
TO FIND AN ANSWER TO YOUR QUESTION, note the section of the medical questionnaire where your question arose. In this guide, all questions are divided according to the section of the application to which they pertain. ARE YOU ELIGIBLE?
Under each section, you will find subdivisions by major condition groups. Example: CARDIOVASCULAR, PULMONARY, DIABETES, etc.
If this guide does not provide an answer to your question, please contact our Client Services team for further information. Our team has access to medical professionals who can provide support for our sales representatives. Client Services can be reached from 8:00 a.m. to 9:00 p.m., Monday through Friday, and from 9:00 a.m. to 5:00 p.m. on Saturday (ET) at: 1-888-830-7460
M E D I C A L Q U E S T I O N N A I R E G U I D E L I N E S ARE YOU ELIGIBLE?
TERMINAL ILLNESSES
Q: An applicant has been
A: YES, if the terminal illness means that the applicant has a medical
diagnosed with an INCURABLE
condition that causes a physician to estimate that he has less than six
DISEASE of which he will
months to live or for which he has received palliative care.
eventually die. Is this to be considered a “terminal illness”? Q: What is metastatic cancer?
A: Metastatic cancer, sometimes abbreviated as mets, is the spread of
a cancer from one organ (or part) to another non-adjacent organ (or
part). Only malignant tumour cells have the established capacity to
metastasize; when tumour cells metastasize, the new tumour is called
a secondary or metastatic tumour, and its cells are like those in the
original tumour. The most common places for the metastases to occur
are in the lungs, liver, brain, and bones.
DO YOU REQUIRE MEDICAL UNDERWRITING?
CARDIOVASCULAR
Q: Is an applicant eligible to purchase if he
A: YES. The applicant may qualify for the Advantage plan
underwent a CABG or heart angioplasty
since we take the most recent CABG or heart angioplasty into consideration to determine the applicant’s eligibility to be placed into one of our predetermined risk categories. Q: Is an applicant eligible to purchase if he
A: NO. He is not be eligible for a regular predetermined risk
underwent a CABG or heart angioplasty 10
category and must apply for the Medical Underwriting plan. years ago and is taking ASPIRIN only or no
medication at all?
Q: Is an applicant eligible to purchase one
A: NO. No matter which condition the applicant takes Lasix or
of our regular plans if he is currently taking Furosemide for, he needs to apply for the Medical LASIX OR FUROSEMIDE FOR HIGH
Underwriting plan. Other names for Lasix or Furosemide are BLOOD PRESSURE (HYPERTENSION)
Q: Is upkeep of a PACEMAKER, such as
A: Provided that the patient’s condition is stable, the
change of battery or model, considered an CHANGE OF BATTERY (battery pack) is a technical
procedure, therefore it is NOT considered as an unstable
heart condition.
However, the CHANGE OF THE PACEMAKER DEVICE is
considered as a change in the condition and requires 365
days of stability.
Heart failure (HF) is generally defined as inability of the heart to supply sufficient blood flow to meet the
body's needs.
The most common causes of heart failure are hypertension (high blood pressure) and coronary artery disease (for example, a patient has had a heart attack). Other structural or functional causes of heart failure include the following: Heart failure can cause a large variety of symptoms such as shortness of breath (typically worse when lying flat, which is called orthopnea), coughing, ankle swelling and exercise intolerance. Heart failure
The major signs and symptoms of heart failure Treatment commonly consists of lifestyle measures (such as decreased salt intake) and medications.
EXAMPLES of MEDICATION TREATING CONGESTIVE HEART FAILURE: The clients will often be treated
with drugs such as Coreg, Lasix or Furosemide.
Other medications which can be given to treat CHF are vasodilators (e.g., Capoten/Captopril,
Lisinopril/Zextril/Prinivil, Lanoxin/Digoxin, Enalapril/Vasotec). These medications can be given to treat
other conditions such as angina or hypertension. When a client mentions one of these medications, please
make sure to clarify what condition the client is treated for. In case of doubt, you must refer the applicant
back to his physician for clarification of his medical condition.
Definition: CABG (Coronary Artery Bypass Graft): Is an open heart surgery that involves bypassing a
blocked artery with a graft (vein or artery). Angioplasty: Angioplasty is a medical procedure in which a balloon is used to open narrowed
or blocked blood vessels of the heart (coronary arteries) or the legs (PVD) or the kidney
arteries. It can be used as an alternative to open heart surgery.
Stent: In medicine, a stent is a man-made 'tube' inserted into a natural passage/conduit in the
body to prevent, or counteract, a disease-induced, localized flow constriction.
PULMONARY
Q: If an applicant was diagnosed and
A: YES. If the client was hospitalized for cancer of the lung he
treated for CANCER OF THE LUNG 7
is still eligible for a regular plan. The pre-existing medical months ago, is he still eligible to purchase? condition exclusion of the plan type he qualified for will apply.
However if the client required the use home oxygen as a
result of his cancer of the lung he is not eligible to purchase
any product under the etfs banner.
Q: Does an applicant have to answer
A: NO. The applicant can answer “NO” to the question as we
“YES” to Q7b (“Do you require Medical
are referring to Prednisone pills only (or other generics like
Underwriting?”) if he was prescribed a PUFFER WITH A STEROID COMPONENT
for a lung condition?

Definitions:
Lung condition: Any disease affecting the lung. Lung conditions can be acute or chronic.
Acute lung condition: Means of sudden onset and short duration.
Chronic lung condition: Means ongoing or recurring. With chronic lung conditions there is
recurring inflammation that can badly damage the lung and make the lung more susceptible
to acute infections. A person with chronic lung conditions can also have acute infections on
top of their chronic conditions.
Chronic bronchitis: Is defined as chronic cough and sputum production for at least 3
months a year for 2 consecutive years.
Home oxygen: ANY administration (prescribed or used) of oxygen therapy outside of the
hospital.
EXAMPLES of ACUTE LUNG CONDITIONS: pneumonia, bronchitis, etc. EXAMPLES of CHRONIC LUNG CONDITIONS: asthma, bronchiolitis, bronchiectasis, cystic fibrosis, chronic bronchitis, COPD, interstitial lung disease, pulmonary fibrosis, sarcoidosis, reactive airway disease, emphysema, lung cancer, etc. MISCELLANEOUS
Q: Does an applicant have to answer “YES” to the
A: NO. The question targets MAJOR ORGAN and BONE
questions pertaining to ORGAN TRANSPLANTS if
MARROW transplants. Cornea, skin and eardrum transplants
he has undergone ANY KIND OF TRANSPLANT?
are excluded, as are sex change procedures. Q: Would an applicant who is being treated with an
a) If the applicant is undergoing experimental treatment for a EXPERIMENTAL DRUG be covered?
condition listed in the “Are you eligible?” section, he does NOT
QUALIFY for the insurance.
b) If the applicant is undergoing experimental treatment for a condition other than those listed in the “Are you eligible?” section, he may purchase this insurance with an exclusion for this condition. NOTE: The applicant MUST submit documentation relating to
the treatment. Upon reviewing this information, the medical
team will determine coverage for the condition.
Q. Does a client who has an aneurysm of 3.0 cm
A: NO. A client who has an aneurysm that is 3.0 cm is not
which remains surgically untreated have to answer required to answer yes to question 5 of the “Do you require Definition: Experimental Treatment: To be part of a study for a drug not yet licensed for general use.
Aneurysm: An aneurysm is an abnormal widening or ballooning of a portion of an artery,
related to weakness in the wall of the blood vessel. Some common locations for aneurysms
include: aorta (the major artery from the heart), brain (cerebral aneurysm), leg (popliteal artery
aneurysm), intestine (mesenteric artery aneurysm), splenic artery aneurysm.
Pseudoaneurysm: Is known as a false aneurysm, this is a hematoma that forms as the result
of a leaking hole in an artery. Note that the hematoma forms outside the arterial wall, so it is
contained by the surrounding tissues. Also it must continue to communicate with the artery to
be considered a pseudoaneurysm. A pseudoaneurysm is usually as a result of trauma
(previous surgery for instance) whereas an aneurysm is usually from a congenital defect.
WHICH PLAN DO YOU QUALIFY FOR?
CEREBROVASCULAR & PERIPHERAL VASCULAR DISEASES
Q: If an applicant has a diagnosed
A: NO. For the purposes of emergency travel insurance we
CARDIOVASCULAR,
no longer consider taking Aspirin/Entrophen, or any other CEREBROVASCULAR OR PERIPHERAL
generic form of ASA, as being treatment for a diagnosis or VASCULAR CONDITION (e.g., MI, stroke,
history of cardiovascular or cerebrovascular conditions and of Fugax , etc.) and is taking
ASPIRIN/ENTROPHEN or BABY ASPIRIN
for a preventative reason (prescribed or
not), do we consider that he is being
treated for that condition? For example, the
applicant had a stroke 4 years ago and
started taking Aspirin 2 years later after
hearing that it would be good for him.
Q: If an applicant has been diagnosed
A: NO. When we speak of PVD, we refer specifically to
with, treated or hospitalized for, has been Peripheral Vascular Disease (see definition below). prescribed or taken medication for an
ANEURYSM, a STROKE (CVA), or a MINI-
We do not refer to aortic aneurysms (central and not
STROKE (TIA), does he need to answer
peripheral). We do not refer to the presence or absence of
“YES” to the question concerning
conditions such as CVAs or TIAs, although these may occur PERIPHERAL VASCULAR DISEASE?
as a result of carotid artery disease. We also do not refer to
venous problems of the legs, such as thrombophlebitis, deep
vein thrombosis (DVT) or varicose veins.
NOTE: The presence of conditions such as CVA or TIA will
be identified and captured under their own respective
questions within the application.
Q. Does a client who has been diagnosed
A: YES. A client who has been diagnosed with an Amaurosis
Fugax must answer yes to the questions pertaining to TIA. Definition: CVA (Stroke): A stroke is an interruption of the blood supply to any part of the brain. A stroke
is sometimes called a "brain attack." There are two kinds of strokes: 1. A blood vessel carrying blood to the brain is blocked by a blood clot. This is called an 2. A blood vessel breaks open, causing blood to leak into the brain. This is a hemorrhagic TIA (Mini-Stroke): A transient ischemic attack is a "mini-stroke" caused by temporary
disturbance of blood supply to an area of the brain, resulting in a sudden, brief decrease in
brain function. It lasts less than 24 hours; usually less than one hour.
PVD (peripheral vascular disease): This refers to diseases of blood vessels outside the heart
and brain.
Amaurosis Fugax (AF): Amaurosis fugax is loss of vision in one eye due to a temporary lack
of blood flow to the retina. Amaurosis fugax is thought to occur when a piece of plaque in the
carotid artery breaks off and travels to the retinal artery in the eye. Plaque is a hard substance
that forms when fat, cholesterol, and other substances build up in the walls of arteries. Pieces
of plaque can travel through the bloodstream. Vision loss occurs as long as the blood supply to
the artery is blocked
CARDIOVASCULAR
Q: Is a HEART MURMUR considered to
A: YES. However, an applicant with a heart murmur may now
answer “NO” to the relevant questions ONLY IF he meets
ALL of the following conditions:
1. His heart murmur was not diagnosed in the 2. He has not been treated, hospitalized, been prescribed and/or taken medication in the applicable period for his heart murmur. 3. His heart murmur did not require monitoring, follow- up visit(s) or consultation with a specialist in the applicable period. NOTE: Please remember that a heart murmur is still a heart
condition and if the applicant has been diagnosed with, been
treated for, been prescribed and/or taken medication or been
hospitalized for a heart murmur in the applicable period he
must answer “YES” to the relevant questions.
Q: Is a MITRAL VALVE PROLAPSE
A: YES. However, an applicant with a mitral valve prolapse
may now answer “NO” to the relevant questions ONLY IF he
meets ALL of the following conditions:
1. His mitral valve prolapse was not diagnosed in the 2. He has not been treated, hospitalized, been prescribed and/or taken medication in the applicable period for his mitral valve prolapse (with the exception of preventative antibiotic treatment prior to any dentist consultation). 3. His mitral valve prolapse did not require monitoring, follow up visit(s) or consultation with a specialist in the applicable period. NOTE: Please remember that a mitral valve prolapse is still a
heart condition and if the applicant has been diagnosed with,
been treated for, been prescribed and/or taken medication or
been hospitalized for a mitral valve prolapse in the applicable
period he must answer “YES” to the relevant questions. Also
note that if the client suffers from symptomatic Valvular Heart
Disease, secondary to mitral valve prolapse, this condition is
considered a heart condition and must be declared on the
medical questionnaire.
Q: Do we consider PACEMAKERS,
A: YES. An applicant who has had a stent, pacemaker,
DEFIBRILLATORS, STENTS, SHUNTS
defibrillator, shunt or artificial valve inserted is considered as AND ARTIFICIAL VALVES as a
being under treatment for a medical condition. NOTE: Artificial hips and joints are NOT to be considered as
continuous forms of treatment.
Q: If an applicant has been diagnosed with
A: YES, as we assume that the applicant is being treated for
HIGH BLOOD PRESSURE (Hypertension)
both conditions. If he disagrees with this, the applicant must AND A HEART CONDITION but says that
submit (from his physician) documentation explaining that the he is only taking medication for high blood medication is prescribed for hypertension only. Upon pressure, does he have to answer “YES”
reviewing this information, the medical team will determine to questions pertaining to treated heart EXAMPLES of VARIOUS HEART CONDITIONS: Angina (chest pain), Myocardial infarction (heart attack), Atrial fibrillation, Arrhythmia (irregular heartbeat), Congestive heart failure, Valvular heart disease, Mitral valve replacement, Coronary artery disease, Sick sinus syndrome, Aortic sclerosis, Endocarditis, etc. PULMONARY
Q: If an applicant was diagnosed with
A: YES, since he has been prescribed a puffer*.
ASTHMA 11 years ago and has
*NOTE: Puffers are often prescribed on an “as needed”
continuously been prescribed a PUFFER,
basis; therefore, if the applicant is prescribed a medication, yet states that he NEVER USES IT, does
he is considered to be treated even though he may not use it. he have to answer “YES” to questions
pertaining to treated lung conditions?
Q: If an applicant is prescribed a PUFFER
A: YES. In these cases, we consider “allergies” as being
FOR ALLERGIES ONLY, does he have to
allergy-induced asthma, which is a lung condition. answer “YES” to questions pertaining to
treated lung conditions?
Q: Should an applicant who has suffered a
A: NO. Pulmonary embolism is a condition that occurs when
PULMONARY EMBOLISM answer “YES”
one or more arteries in your lungs become blocked. In most to our questions pertaining to LUNG
cases, pulmonary embolism is caused by blood clots that CONDITIONS?
travel to your lungs from another part of your body — most commonly, your legs. Q: If an applicant who DOES NOT HAVE
A: NO. The condition is considered to meet the definition of a
an underlying lung condition is prescribed puffers and/or antibiotics for a lung
condition for less than 15 days, but does
not require a follow up visit to a physician,
hospitalization and/or referral to a
specialist, and the treatment is completed
more than 30 days prior to departure, does
he still need to answer “YES” to the
question pertaining to lung conditions?
Q: If an applicant who DOES HAVE an
A: YES. If someone who is already being treated for or had a
diagnosis of a chronic lung condition develops an acute infection (e.g., pneumonia) on top of their chronic condition, condition for less than 15 days, but does or if they have an aggravation (flare-up) of their chronic not require a follow up visit to a physician, condition, they must to answer “YES” to a change in
condition and treatment. They also require 365 days’ stability specialist, and the treatment is completed to be covered. Because of their chronic lung disease, they
more than 30 days prior to departure, does will never be considered to have a minor ailment with
he still need to answer “YES” to the
regard to their lungs.
Q. Does an applicant who has been
A. NO. A client who has been diagnosed with cancer of
diagnosed with cancer of the lung have
the lung does not need to answer yes to a lung condition.
to answer yes to question 11 d lung
condition?
DIABETES
Q: Does an applicant who is CURRENTLY being
A: YES. The applicant is required to answer Q 11a pertaining
treated for Diabetes with an oral medication or insulin have to answer YES to the question pertaining to Diabetes treated with diet only? Q: If an applicant is only following a DIET TO
A: YES. The applicant must answer “YES” to the Q 11 a.
TREAT DIABETES, does he have to answer
“YES” to the Q 11 a?
Q: Does the applicant qualify for the same plan if
A: The applicant qualifies for the SAME PLAN whether he is
he is a diabetic treated WITH ORAL MEDICATION
taking oral medication or injectable medication. OR WITH INJECTABLE TREATMENT (i.e.,
Insulin)?
Q: For a diabetic applicant, if the hypoglycemic
A: NO. This is considered as a change in medication and
agent is CHANGED FROM ORAL (i.e., Diabeta or
therefore NOT considered STABLE.
Glucophage) TO INJECTABLE (Insulin) treatment,
is it CONSIDERED STABLE?
Q: If the INJECTABLE DIABETIC MEDICATION
A: YES. Regulation of injectable diabetic medication is not
(i.e., Insulin) is decreased or increased in dosage, considered a change in medication. However, if a NEW
is it considered STABLE?
INJECTABLE INSULIN is added, this is considered as a
change in medication and therefore NOT considered
STABLE.
Q: If an ORAL DIABETIC MEDICATION (i.e.,
A: A change in oral DIABETIC MEDICATION DOSAGE is
Diabeta, Metformin, etc.) is decreased or increased NOT considered a change in medication. However, if a NEW
or if there is a new oral diabetic medication added, ORAL MEDICATION is added, this is considered as a
is it considered STABLE?
change in medication and therefore NOT considered
STABLE.
Q: Can an applicant who has diabetes be
A: YES. If an applicant with Diabetes is prescribed Altace and
prescribed ALTACE as a PREVENTATIVE
has no history of cardiovascular or kidney conditions, we may MEASURE for cardiovascular or kidney protection?
consider the prescription as preventative only for those 2
conditions. However, if the applicant has any prior history of
a cardiovascular or kidney condition, or of any other condition
that would require the use of Altace, the medication will not
be considered as preventative.
Q: If a client has been diagnosed with Diabetes in
A: NO. If an applicant has a new diagnosis of Diabetes in the
the last 24 months and is only treated with diet, can last 24 months and is only treated with diet, he must answer “YES” to Q 11a as the diagnosis of Diabetes was made
within the 5 year timeframe of the question.
Q: Does a client who has been diagnosed with
A: YES. If an applicant has been diagnosed with glucose
glucose intolerance have to answer yes to any intolerance he must answer “YES” to Q 11 a pertaining to
Definition
Glucose Intolerance: Pre-diabetes or glucose intolerance is a condition where blood
glucose (blood sugar) levels are higher than normal but are not high enough to be called
Diabetes. Pre-diabetes or glucose intolerance can lead to Type 2 diabetes, heart disease
and stroke.
GASTROINTESTINAL
Q: Should POLYP REMOVAL be
A: NO. Polyp removal should not be considered as a bowel
considered as a BOWEL SURGERY?
surgery, nor should it be considered as a chronic bowel disease. However, if the polyp(s) caused GASTROINTESTINAL
BLEEDING, the applicant must answer YES to that question
OR if the polyp(s) was found to be CANCEROUS, the
applicant must answer “YES” to our question pertaining to
CANCER.
Q: If you are speaking to a francophone
A: He is actually referring to a GALLBLADDER ATTACK, not
applicant and he refers to a “CRISE DE
a liver condition. If he has been treated for the condition he FOIE”, what condition is he referring to?
would need to answer “YES” to the question pertaining to
treated gallbladder conditions.
Q: Does an applicant treated for or
A: As it relates to the medical questions on the application,
diagnosed with DIVERTICULOSIS OR
DIVERTICULOSIS
DIVERTICULITIS
DIVERTICULITIS need to answer “YES” to
considered Chronic Bowel Diseases. Therefore, when your the CHRONIC BOWEL DISEASE
clients are completing the medical questions on the application and have had Diverticulosis or Diverticulitis, they
can answer “NO” to the question pertaining to treated
chronic bowel diseases. However, it is possible that severe
cases of Diverticular Disease can result in gastrointestinal
bleeding, bowel obstruction or bowel surgery. In such
cases, the applicant must answer “YES” to the relevant
question.
Q: Does an applicant treated for or
A: As it relates to the medical questions on the application,
diagnosed with IRRITABLE BOWEL
IRRITABLE BOWEL SYNDROME is NOT to be considered
SYNDROME (IBS) need to answer “YES”
as a Chronic Bowel Disease. Therefore, when your clients to the CHRONIC BOWEL DISEASE
are completing the medical questions on the application and have IBS, they can answer “NO” to the questions pertaining
to treated chronic bowel diseases. However, it is possible
that severe cases of IBS can result in gastrointestinal
bleeding, bowel obstruction or bowel surgery. In such
cases, the applicant must answer “YES” to the relevant
question.
Q: Does someone with HEPATITIS need
A: YES. Hepatitis is a liver condition and therefore, the
to answer “YES” to a LIVER CONDITION?
applicant must answer “YES” to the questions pertaining to
treated liver conditions.
Q: Does someone who has common bile
A: If the client has an episode of stones following the removal
duct stones after having his gallbladder of his gallbladder then he can answer “NO” to the question.
removed have to answer “YES” to the
NOTE: The client must have the required plan type stability in
order for the “stones” to be considered stable (please refer to Definition: Bowel obstruction: Involves a partial or complete blockage of the bowel that results in the
failure of the intestinal contents to pass through. EXAMPLES of CHRONIC BOWEL DISEASES: Crohn’s disease, Colitis, etc. EXAMPLES of CAUSES FOR GASTROINTESTINAL BLEEDING: Any of the chronic bowel diseases listed above, as well as polyps, stomach ulcers, esophageal varices or cancer of the intestines. Q: If an applicant had a LUMPECTOMY
A: YES. The applicant must answer “YES” to the question
OR MASTECTOMY (resection) and was
pertaining to treated cancer if the surgical treatment occurred Arimidex does she have to answer “YES”
If the surgical treatment occurred outside of the timeframe of the question and the applicant is currently treated with
Tamoxifen, Femara or Arimidex only, then the applicant may
answer NO.
Q: If the applicant Is taking an ANTI-
A: YES. If the applicant has been treated for the condition, he
CANCER DRUG to prevent recurrence of
must answer “YES” to the questions pertaining to treated
the cancer is this considered a “treatment”? Q. Does an applicant who has been
A. NO. A client who has been diagnosed with cancer of the
bowel or kidney or pancreas or liver is required only to kidney or pancreas or liver have to answer answer YES to question 11 f cancer.
Therefore, regardless of the location of the cancer the
applicant is only required to answer YES to the cancer
question.
Definition: Cancer treatment: The three most common types of cancer treatment are surgery,
radiotherapy and chemotherapy. Treatment is aimed at removing the cancer cells or destroying them in the body with medicines or other agents. Surgery is good if the tumour is localized and can be safely "cut out", but it may not be
possible if the cancer has spread to other areas of the body or if the tumour cannot be
removed without damaging vital organs.
Radiotherapy uses radiation in the forms of a special kind of x-ray, gamma rays or electrons
to damage cancer cells so that they cannot multiply.
Chemotherapy uses medicines to attack the cancer cells. This is used when the cancer has
spread to other areas in the body.
These three types of cancer treatment are often done in combination; for example, surgical removal of a tumour followed up with radiotherapy or chemotherapy. MISCELLANEOUS
Q: When is an INFECTION considered to
A: An infection is always a condition. Every diagnosis in
medicine is a condition. What is important is to determine whether or not the condition meets the definition of a minor ailment. Q: Does an applicant have to answer
A: YES. The applicant does need to answer “YES” to
“YES” to any question if he only takes
question 14 b) as elevated cholesterol (Hyperlipidemia) is CHOLESTEROL MEDICATION?
Q: If an applicant does not meet the
A: NO. A new diagnosis or a change in medication for
stability requirement of his plan due to A
cholesterol occurring within the pre-existing stability period of the policy will not be used as a basis to deny coverage of new CHANGE IN CHOLESTEROL
or previously stable cardiovascular and cerebrovascular MEDICATION, will this have an effect on
his coverage for cardiovascular and cerebrovascular conditions? NOTE: A change in cholesterol medication is a change in
condition. The pre-existing condition clause still applies to the
condition that does not meet the stability requirement.
Q: Does an applicant need to answer
A: NO. The question targets cigarette smokers only.
“YES” to the questions pertaining to
smoking cigarettes if he has SMOKED
CIGARS, A PIPE, MARIJUANA OR IF HE
HAS CHEWED TOBACCO in the
applicable period?
Q: WHY are we ONLY TARGETING
A: Because cigarette smoking has a strong association with
CIGARETTE SMOKERS rather than users
the development of many of the major critical illnesses such as but not limited to heart disease, hypertension, stroke, mini-stroke, and peripheral vascular disease. Q: If an applicant goes from taking a
A: NO. A change in medication with the intent to combine
medication twice a day to taking it once a various doses of medication into one unique dose, all the day with no change in total dosage amount, while maintaining the same medication and prescription, is not to be considered a change in medication. medication? (e.g., a client taking 2 caplets of 20 mg daily sees his prescription modified to 1 caplet of 40 mg daily) Q: If an applicant does not meet the
A: NO. A new diagnosis or a change in medication for high
stability requirement of his plan due to a blood pressure (hypertension) occurring within the pre- CHANGE IN HIGH BLOOD PRESSURE
existing stability period of the policy will not be used as a (Hypertension) MEDICATION, will this have
basis to deny coverage of new or previously stable an effect on his coverage for cardiovascular cardiovascular and cerebrovascular conditions. NOTE: A change in high blood pressure/hypertension
medication is a change in condition. The pre-existing
condition clause still applies to the condition that does not
meet the stability requirement.
Definition
Carotid Artery Stenosis: Narrowing of the carotid arteries. These are the main arteries in the
neck that supply blood to the brain
Habitual smoker: We define a habitual smoker as someone who smokes one or more
cigarettes per week.
Alzheimer’s Disease: Accounting for 60% to 70% of senile dementias, Alzheimer’s disease is
a progressive mental deterioration manifested by loss of memory, inability to calculate,
deterioration of visual-spatial orientation, confusion and disorientation.
Dementia: Dementia is a deterioration of cognitive abilities that impairs the previously
successful performance of activities of daily living. The signs and symptoms that may be seen
are: memory problems and disorientation, aggression, sleep disturbance, incontinence,
constipation, wandering and falls, communication difficulties, depression, psychotic features,
failure to recognize family members and familiar surroundings and malnutrition. With patients
with dementia, infections, especially urinary tract infections and chest infections, tend to cause
rapid worsening of confusion.
Sleep Apnea: Sleep apnea is a sleep disorder characterized by pauses in breathing during
sleep. Each episode, called apneas, lasts long enough so that one or more breaths are
missed, and occurs repeatedly throughout sleep.
CPAP (continuous positive airway pressure): A CPAP machine is used mainly by patients
for the treatment of sleep apnea at home. The CPAP machine delivers a stream of
compressed air via a hose to a nasal pillow, nose mask or full-face mask, splinting the airway
(keeping it open under air pressure) so that unobstructed breathing becomes possible,
reducing and/or preventing apneas.
Regular check-up: Is any standard or customary medical examination unrelated to any
specific medical condition and is carried out for the purpose of screening, health monitoring or
preventive care and may include routine medical tests and investigations

Source: http://www.assurancevoyagersa.ca/msadocumentcenter/pdfs/1002MDGECA%200710000.pdf