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Medical Emergency

A medical emergency is a sudden and unforeseen illness, injury, or medical condition that requires immediate medical attention to prevent serious harm, disability, or death. In the context of health and travel insurance, it refers to an unexpected situation where urgent care is needed while away from home or outside your province or territory of residence.

Medical emergencies include situations such as heart attacks, strokes, fractures, severe infections, or accidents that demand prompt medical intervention. Insurance coverage for emergencies ensures that necessary hospital, surgical, or physician services are provided without delay, often including ambulance transportation and emergency repatriation for travel plans. The goal of emergency coverage is to stabilize the patient and prevent the condition from worsening, not to treat ongoing or elective medical needs.

Example:

If you are traveling abroad and experience chest pain that turns out to be a heart attack, your travel medical insurance would cover emergency hospital and physician costs, as well as any necessary surgery or medical evacuation, subject to the terms of your policy.

What to Watch For:

Emergency coverage applies only to unexpected and urgent medical events, not to routine care or follow-up appointments. Insurers may deny claims if the condition existed before travel or if it was not stable according to the policy’s definition. Always review your plan’s stability and pre-existing condition clauses before traveling, and contact the insurer’s emergency assistance line as soon as possible when a crisis occurs.

Related Terms

Major Restorative

Major restorative coverage includes complex dental procedures designed to restore the function and appearance of teeth. Examples include crowns, bridges, onlays, dentures, and sometimes implants. These treatments are more extensive and expensive than basic restorative services such as fillings.

Material Facts

Material facts are the pieces of information that are essential for an insurer to accurately assess risk and decide whether to approve an application, determine premiums, or apply exclusions. These facts include any details that could influence the insurer’s decision to issue coverage or the terms of that coverage. Examples include medical conditions, medications, family health history, lifestyle habits, and participation in hazardous activities.

Medical Condition

A medical condition refers to any illness, injury, disease, disorder, or ongoing health issue that affects a person’s physical or mental well-being. In the context of insurance, the term includes both acute and chronic conditions, whether diagnosed, treated, or undiagnosed at the time of application or claim. Examples include high blood pressure, diabetes, asthma, depression, or past surgeries.

Medically Necessary

Medically necessary describes any service, treatment, or supply required to diagnose, treat, or manage a health condition, rather than for convenience, appearance, or personal preference. Insurers use this term to determine whether a claim qualifies for payment under your policy.

Medically Underwritten (MU)

Medically underwritten (MU) refers to the process used by insurers to evaluate an applicant’s health history before approving coverage and determining eligibility, premiums, and benefit limits. In a medically underwritten plan, you must answer health questions, disclose pre-existing conditions, and often complete a medical questionnaire or provide additional documentation

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