The applicant certifies that the statements made on this application are complete and accurate and in no way seeks the coverage herein applied for by other than totally honest representation.
The applicant agrees that the coverage for Travel Health Plan is effective only if this application and requisite Subscription are received on or prior to Departure Date herein given.
The applicant agrees coverage for Trip Cancellation benefits is effective only if this application and requisite Subscription are received prior to any cancellation penalties becoming chargeable or within 72 hours of initial deposit.
The applicant agrees coverage for Trip Cancellation benefits is effective only if this application and requisite Subscription are received prior to any cancellation penalties becoming chargeable or within 72 hours of initial deposit.
A participant will not be eligible for coverage under a Manitoba Blue Cross travel plan if they:
- are travelling outside Manitoba with the intent to seek medical advice, surgery, treatment or a second opinion, even if the trip is on the recommendation of a physician or other medical professional.
- have been advised by their physician or other medical professional not to travel.
- have had two or more major strokes. (Strokes that have resulted in symptoms that lasted for more than 24 hours.)
- require home oxygen.
- are receiving kidney dialysis.
- have received a terminal prognosis.
- have been diagnosed with Acquired Immune Deficiency Syndrome (AIDS).
Family coverage means the applicant, spouse, and any eligible dependents travelling with the applicant. (Under the Annual Travel Plan the spouse and eligible dependents do not have to be travelling with the applicant to be covered.)
Applicants age 55 to 74 agree that when covered by the Annual Travel Plan no trip shall exceed 32 days in duration, and cannot be extended by Manitoba Blue Cross or another carrier. Any extension purchased to extend coverage beyond the 32-day limitation will invalidate all coverage for that trip under the Annual Travel Plan.
Applicants under age 55 (on Effective Date of Term of coverage) covered by the Annual Travel Plan may extend their coverage with Manitoba Blue Cross only (maximum 30 days) on a per trip basis beyond the 32-day limitation. The total period of coverage may not exceed 62 days per trip. This coverage cannot be extended by Manitoba Blue Cross or another carrier beyond 62 days. Any extension purchased to extend coverage beyond the 62-day limitation will invalidate all coverage for that trip under the Annual Travel Plan.
The applicant agrees that coverage must be purchased prior to their departure from Manitoba and/or Canada and for the entire duration of their trip, which originates and terminates in Manitoba and/or Canada. For the Annual Travel Plan coverage must be purchased prior to the departure date from Manitoba, and all trips must originate and terminate in Manitoba.
The applicant agrees that any extension coverage must be with Manitoba Blue Cross and must be purchased from Manitoba Blue Cross or an authorized agent. Any extension coverage purchased from another carrier will invalidate all coverage for that trip.
Applicants age 55 to 74 who have answered a medical questionnaire agree to report to Manitoba Blue Cross any change in medical condition that would alter the answers to their medical questions prior to date of departure.
Pre-existing stability period: Manitoba Blue Cross is not liable to pay benefits for any services or charges resulting directly or indirectly from a pre-existing condition that was not stable:
- for the Travel Health Benefits on all plans (under age 55) during the 7-day period prior to the departure date of coverage for the trip in question.
- for the Travel Health Benefits on Silver, Annual and Tour Package Plans, (ages 55 and over) during the 365-day period prior to the departure date of coverage for the trip in question.
- for the Travel Health Benefits on Gold (ages 55-74) during the 90-day period prior to the departure date of coverage for the trip in question.
- for the Airfare and Holiday Cancellation Benefits during the 180-day period prior to the date of purchase of coverage for the trip in question. If the cause of cancellation is a pre-existing medical condition, benefits are only payable if the attending physician verifies that the condition was stable for at least the 180-day period prior to the purchase date of coverage.
The medical condition must be stable based on the definition of stable in the Terms and Provisions, regardless of the opinion (written or verbal) of the physician or any other person who may provide an opinion on the medical condition.