Medical Insurance

Medical Insurance is a program designed for visitors and new immigrants for the first three months in Canada. This program covers all the health expenses for a person that is residing in Canada and does not have the free government coverage. (OHIP – Ontario Health Insurance Program).

The most important aspect of medical insurance is to choose the right coverage amount. It varies from 10 to 150 thousand dollars. If our visitors are over the age of 70, the maximum coverage is a $100,000.

Why is it so important to chose the right coverage amount? The insurance contract covers things such as: visiting a therapist or a specialist, drug coverage, medical tests or examination, emergency services, hospital stay and operations. In other words, any expense associated with a trauma or a sickness. The important thing is that while the insurance company will cover all the associated expenses, but only maximum to the amount of coverage chosen. If the coverage chosen by you is insufficient, the difference would have to be paid by you.

Below is an estimate of what expenses you may run into.

Visiting a therapist may cost 70-90 dollars. Medications will cost tens or even hundreds of dollars. Analysis and diagnostics are also not thousands. But if you have to turn to a hospital, the costs will increase. For example: an overnight hospital stay for a new immigrants costs approximately $1,300. For visitors with no status, the same night will cost anywhere between $2,300 to $4,000. Cost of an operation involving incisions starts at $17,000. Ambulance and emergency services may cost $600-$800, if not more, depending on severity of the problem. Appendicitis on a new immigrant, an incident from over 10 years ago, resulted in first fee of $8,000 and a later fee of $14,000. 7 years ago, a client with a stroke had to be hospitalized for 8 days to be brought out of a critical condition and to be sent back home. The bill was approximately $22,000. Of course, in our practice we have seen even more severe cases, but it is rare.

So, of course, it is important for a family to take coverage amount choice very seriously. The choice depends on the financial situation and a personality. If the person is young and does not foresee any serious trouble, maybe just a flue or a small fracture, then $10,000 may be enough coverage. However, if our visitor, in their retirement, has to spend a few days in a hospital, the $10,000 will run out very quickly. I believe that older people should consider higher coverage amount, $25,000 or even $50,000. Obtaining a SuperVisa requires a $100,000 coverage.

The other important factor in choosing the right coverage amount is the length of stay in Canada. If the person is here for a month, a 25 or 50 thousand coverage may be enough, but if the stay is a few months, $25,000 may be insufficient. For example, we had an insured female that has an insurance claim for approximately $20,000 and a month later she had another, unrelated, issue that was requiring an insurance payout of another $20,000. Insurance coverage that you chose is in effect for the duration of the contract. Therefore, the longer the person is staying in the country, the more attention needs to be paid to the coverage amount, as the coverage amount will remain the same through the duration of the contract.

We work with a variety of insurance companies and try to find you the best available option. Our job is to find a contract that has the best price with the best coverage, that also includes coverage on expenses, related to worsening of pre-existing conditions.

Below is a table with prices offered by the 21st Century Travel Insurance Limited. The company offers the following conditions: children under 21 are included in the contract free of charge, doctor visits per issue are not limited. Information on other companies can always be obtained from us by phone or in person.

Cover / Age Cost per Day, $* All rates in this table DO include coverage for “Stable Chronic Conditions”
< 25 26-34 35-39 40-54 55-59 60-64 65-69 70-74 75-79 80-85 86+
        $10,000 1.87 2.04 2.09 2.26 2.37 3.37 3.61 5.50 6.71 10.07 n/a
        $15,000 2.28 2.36 2.47 2.62 2.95 3.76 4.50 6.85 7.95 11.32 n/a
        $25,000 2.30 2.52 2.62 2.98 3.10 4.15 4.95 7.40 9.10 13.75 n/a
        $50,000 2.75 2.85 3.05 3.40 3.67 5.05 5.60 8.57 11.25 16.50 n/a
        $100,000 3.50 3.75 4.00 4.90 5.25 6.60 7.50 10.90 13.40 20.00 n/a
        $150,000 4.10 4.57 5.00 5.81 6.67 8.80 11.55 n/a n/a n/a n/a

* $50 Deductible ($500 at age 86 and over).

Rates effective October, 2016.

For insured ages 60 to 65 a Medical Declaration Questionnaire has to be filled out prior to buying a policy.

The table shows a per day price, per person, in Canadian dollars. The length of coverage does not provide discounts. If for example we calculating the price of insurance for a family of 5 (3 children), we take the per day insurance price for the oldest member of the family and multiply it by 2, which will be the total cost of family coverage per day. We then multiply this number by the length of stay in Canada.

If the age of your visitors exceeds 60 but they have not had any health issues in the past, you can get insurance that includes coverage on any new health problems and use the prices shown in the second table. For those age 86 and over, the Medical Declaration Questionnaire has to be filled out.

Cover / Age Cost per Day, $* (All rates in this table DO NOT include the “Stable Chronic Condition” Option.)
60-64 65-69 70-74 75-79 80-85 86+
$10,000 3.04 3.26 4.46 5.28 6.66 10.71
$15,000 3.40 4.00 5.60 6.60 8.90 12.54
$25,000 3.75 4.45 6.66 8.07 10.06 14.76
$50,000 4.50 5.06 7.72 9.80 11.90 n/a
$100,000 5.90 6.75 9.80 12.10 14.00 32.00**
$150,000 8.00 10.50 n/a n/a n/a n/a

* $50 Deductible.

** Available for 365 days only to policyholders who hold a Parent and Grandparent Super Visa (PG-1 VISA) are age 86-89, and have been insured with 21st Century with an Aggregate Policy Limit of $100,000 within the 18 months preceding the purchase date of this policy.

For people ages 86 and over, standard Deductible will be $500.

The prices are fixed – it does not matter whether you buy insurance directly through the company or through a broker. The company only processes the contracts through licensed agents.

Let us see how this Insurance works. If a person becomes ill and needs to see a doctor, all the expenses including his visit to the doctor, tests, medicine the person has to pay by himself. After recovering, the person needs to have a claims form signed by the attending physician, attach all the receipts proving all the costs, and send all of this information to the company. The Company will reimburse all the expenses less 50 dollars (deductible) – our participating portion. Ending up in a hospital entails different costs, the expenses are dealt with directly between the hospital and the Company. You must remember to call the Company within 24 hours after you become ill or visit the doctor.

It is important to remember that if a person has to undergo a regular, planned medical exam, a treatment, or simply extend an existing prescription, such expenses will NOT be covered by the insurance company. This is considered to be maintaining an existing, stable medical condition. However, if the stable chronicle condition gets worse, the insurance company will cover all costs associated with re-stabilizing your health. Chronicle stable condition is when there is a health issue present, but there were no complications or dosage of prescribed medication had not had to be changed in the last 180 days. Simple example, a person is taking medication to control blood pressure for many years. If the person runs out of medication, the prescription needs to be extended, all costs associated with this extension, any doctor visits, tests, etc, will not be covered. However, if the condition is worsening and the prescribed medication or its dosage is no longer adequate maintain stable condition, all further expenses such as bringing back to the stable condition or increased dosage of medication will be covered.

With 21st Century, accidental coverage begins immediately upon contract completion, health insurance comes into effect 72 hours after contract is entered into.

$50 Deductible (your participation) is calculated through the whole coverage period. During process of getting insurance contract for all family members, each member has their own coverage, and therefore, $50 deductible is separate for each person. If you want to avoid the $50, please let us know during the contract processing. The company adds an extra 5% to the cost of the insurance.

Is there a discount available? Yes there is.

If there are 2 visitors, with 21st Century you receive a 5% discount on each insured individual.

If you choose a $250 deductible versus the standard $50. In this situation the company offers a 10% discount. Let’s see who might benefit from it. Elderly parents planning to live with you for a prolonged period of time. The insurance policy cost maybe into thousands. You know that the coverage is important and you need one. But at the same time, understand, that minor issues can be handled easily, but the major issues are the important ones. So your coverage amount is fairly high. This can go on for more than a year (for example under sponsorship). You decide that it will be beneficial to you to have an insurance policy with a $250 deductible, as, over time, the discount may very well cover the $250. We often have insurance to cover the possible risk. When you buy it – nothing happens. As always, things happen when you don’t have coverage…

If you wish to receive an even higher discount, you can look at other deductible options. The discount available is up to 40%.

Other questions that you may have:

Additional deductible options and resulting higher discounts.

Within what time frame, after the insurance incident, is it necessary to submit a claim to receive a refund on medical expenses?
Within 30 days of the insurance incident, you have to contact the insurance company and inform them of the occurrence. Within 90 days of the insurance incident, a written claim needs to be submitted with all applicable documents, proving your expenses.
If the visiting individual, for one reason or another decides to return, is the refund available?
Yes. The insurance premium for the remaining time of the coverage will be returned to you, less $25 processing fee. You have to remember, however, that if you had a medical claim, that required a refund on medical expenses, there will be no refund on the premiums, regardless of how small the claim may have been. If an insurance incident occurred, you have already contacted the company for the refund of your expenses (have not yet received the refund) and at some point realized, that the insured is planning to return, you have to do the following. Either receive the refund on the insurance claim and not receive the refund on the unused portion of the policy, or cancel the claim (if it is significantly lower that the refund obtained through return of premium), and receive the sum, that you are entitled to when your visitor returns home. In order to cancel a yet unpaid claim a $200 fee applies.
To receive a refund, it is necessary to submit a written notice, indicating the reason for your decision, for example, early return of the visitors or obtained status in Canada, with which the insured will no longer require an insurance contract. Remember, supporting documents (tickets, person’s status, etc.) have to always be submitted along with the written notice to receive a return of premium.
Buying insurance prior to or after arrival of relatives?
For elderly people and small children it is best to buy insurance ahead of time, so that there is medical coverage from the moment they arrive, and not after 72 hours. These may be the crucial hours. No one knows how the elderly will handle the long flight. In our practice, there was an incident, where an elderly woman, right at Pearson Airport, encountered a femur fracture. Imagine how much this would cost the relatives, had they not purchased visitor’s insurance.
To process the contract ahead of arrival of your friends or relatives, you have to provide us with exact spelling of the visitors’ names, their dates of birth, arrival date, as well as information of hosts, Canadian address, your first and last name.
Is there a difference between paying for the whole visit and paying monthly?
If we are buying insurance monthly, we get uninterrupted insurance coverage, but it will still be a brand new contract every time, with the same questionnaire and conditions. Most important condition – pre-existing condition – no issues over past 180 days. So when we are getting the new contract for the next month, we may have to answer yes to the questions regarding past 180 days, and as a result, may get declined for the coverage all together, or obtain coverage with exceptions on covering the condition in question. Imagine a situation. Elderly person has insurance, plans to stay in the country for a long time and pays for coverage monthly, as it is expensive to pay for the whole time at once. Unfortunately, in the second month he experiences some blood pressure issues. He goes to see a doctor. Thankfully, everything is fine, the issue is resolved and the insurance company covers the expenses. But now, any thing associated with the blood pressure, will no longer be covered. What if he has a heart attack in 3 or 4 months? You would have to pay for all the expenses your self. Now its serious. Choosing proper length of coverage is very important.
How can a new immigrant process their medical insurance prior to arrival to Canada, to have the flight included as well?
Contact us via e-mail or over the phone. Provide us with all the necessary information and we will be to process the contract for you. The payment will be made using our resources and the confirmation of insurance coverage will be e-mailed to you. Upon arrival, you will get in touch with us, we will meet, hand you over the original and you will make the payment. The payment can be in cash, cheque or using a credit card.
If the person has been in Canada for over a month and now we decided to purchase insurance contract?
Here are the rules for the 21st Century company: if a person, wanting to obtain insurance, has resided in Canada for a period of more than 1 month, the insurance coverage on accidents (trauma) will be in effect immediately after the payment has been processed, but illness coverage will only come into effect after 7 days. If you really do not like this condition and you prefer to have illness coverage to come into effect after 2-3 days, let us know, we can process your insurance with another company, that will have no restrictions.
Is the flight to Canada and return flight covered?
Yes, the flight from country of origin to Canada and the return flights are covered, even if there is a layover in a third country.
If the person is ready to leave but the flight has been delayed for a day, is it necessary to purchase additional insurance?
No, the person will automatically be covered for 48 hours, if the flight has been delayed.
The whole family, with visitors is planning to go on a vacation, for example to Caribbean Islands, is it necessary to purchase additional insurance for the trip?
If during, while our visitors are in Canada, you would like to go on vacation to another country and than return to Canada, your visitors trip to another country will still be covered by the Canadian company. The company will cover all medical expenses that may come up when on a trip outside of Canada. The conditions are as follows: more than 50% of your insurance coverage period has to be spent in Canada and the length of a trip can not exceed 30 days. You can have multiple trips but in total these trips can not exceed 30 days.
Is dentist coverage included?
The contract specifies, that if there is an accidental damage to the face, that results in a need of dental work, this expense will be covered. It refers only to accidental cases. The company will also covers expenses associated with relieving tooth pain. Not fixing the issue, just relieving pain. Its important to understand this. If someone has a tooth ache, it means that the company will only cover a portion of the expenses. Usually, this requires check up of what happened, for example open up the tooth, relieve pain and put in new filling. In this case, the company will pay for the check-up, process of opening up the tooth and will only pay for the temporary filling. The company believes that – guests to Canada, are here temporarily, therefore the company will only pay for procedures to relive the pain, the visitor can than take care of the problem when they return home.
Does this insurance cover expenses associated with pregnancy and the delivery it self?
Previously, like other companies, nothing related to pregnancy was covered. Today, the conditions have been softened. The company will now cover any complications, that may occur prior to 9 weeks before the expected delivery date and beyond 9 weeks after the delivery. Important condition, the pregnancy has to start after the arrival to Canada. For example, a person is sponsoring a spouse. This process can take a long time. The spouse is residing in the country through the process, is allowed to. The spouse got pregnant and is experiencing strong toxicosis. The insurance company will cover all the expenses associated with this problem, in the periods described above.

To purchase this product, please contact our office. We are open 9 a.m. to 9 p.m., Monday through Friday. Occasionally, we are open on Saturdays, please try to call. A payment can be done using cash, cheque or credit card. Medical insurance can be purchased over the phone. This requires a full name of the person to be insured and their birthday. In such cases, payment can be made by credit card or a with a cheque.