Visitors Insurance Calculator

Visitors Travel Insurance

First Date of Cover

Last Date of Cover

Duration

Traveller1

Family Coverage

Super Visa

Payments freqency

Plan

Policy Limit

Deductibles

User Name	Plan Name	With Pre-existing	Without Pre-existing

	Net	Tax	Adjustment	Total
		0.00 CAD	0.00 CAD

Health Information

1. Was your most recent heart bypass, heart angioplasty (including stent placement) or heart valve surgery more than 10 years prior to your effective date?

Yes No

2. Do you have both diabetes (for which you are taking medication) and a heart condition?

Yes No

3. Have you ever had or are awaiting a bone marrow or organ transplant?

Yes No

4. In the 24 months prior to your effective date have you been diagnosed with or treated for :

a) Congestive heart failure?

Yes No

b) A lung condition with prednisone (or other oral steriod medication) or home oxygen?

Yes No

c) Kidney or liver failure?

Yes No

d) Peripheral vascular disease?

Yes No

5. In the 12 months prior to your effective date have you been diagnosed with or been treated for:

a) A heart attack?

Yes No

b) Stroke, transient ischemic attack (TIA) or mini-stroke?

Yes No

c) cancer (excluding basal or squamous cell skin cancer or breast cancer treated only with hormone therapy)?

Yes No

d) internal bleeding?

Yes No

If any question on the medical declaration is answered yes, there is no coverage for any sickness, injury or medical condition that existed prior to the effective date, whether or not stable. ( Please Confirm that you agree to this condition ).