An Overview of Benefits

1. Emergency Hospital
We agree to pay for hospital accommodation, including semi-private room, and for reasonable and customary services and supplies necessary for your emergency care during confinement as a resident in-patient.

2. Emergency Medical
We agree to pay for the following services, supplies, or treatment, resulting from a covered sickness or injury, when provided by a health practitioner who is not related to you by blood or marriage:
(a) The emergency services of a legally licensed physician, surgeon, or anesthetist.
(b) Follow-up visits as prescribed by the attending physician at the time of the emergency. Follow-up visits must occur during the period of coverage and be directly related to the emergency. The emergency must occur during the period of coverage and have been reported to AGA. Follow-up treatment needed as a result of any sickness or injury that took place while you were in your country of origin during the period of coverage will be covered only on prior approval by AGA. On-going expenses resulting from such sickness or injury will not be covered, unless approved in advance by AGA. AGA reserves the right, as reasonably required and at its expense, to transport you to your country of origin following an emergency.
(c) Diagnostics, lab tests and/or X-ray examinations as ordered by a physician for the purpose of diagnosis.
(d) The services of the following legally licensed practitioners for treatment of a covered sickness or injury:
i. chiropractor;
ii. osteopath;
iii. podiatrist/chiropodist;
iv. physiotherapist, when ordered by the attending physician;
   v. acupuncturist. Not to exceed $500 per profession.
(e) Private duty services of a Registered Nurse when approved in advance by AGA. Not to exceed $10,000.
(f) The use of a licensed local air, land, or sea ambulance (including mountain or sea evacuation) to the nearest hospital, when reasonable and necessary.
(g) Rental of crutches or hospital-type bed, not exceeding the purchase price; and the cost of splints, trusses, braces or other approved prosthetic appliances approved in advance by AGA.
(h) Emergency out-patient services provided by a hospital.
(i) When not hospitalized as an in-patient, drugs or medications that require a physician’s written prescription, not exceeding a 30-day supply, to a maximum of $1,000

3. Out-of-Pocket Expenses
In the event you (or your insured travelling companion) are confined to hospital on the date on which you are scheduled to return home, we agree to reimburse up to $150 per day to a maximum of $1,500, or up to
a maximum of 10 days, for the following expenses incurred by you or any insured travelling companion:
(a) commercial accommodation and meals; and
(b) child care costs for children under age 18, or physically or mentally handicapped travelling companion(s) who rely on you for assistance; and
(c) essential telephone calls; and
(d) taxi fares. We will only reimburse these expenses if you or your travelling companion have actually paid for them. Expenses must be supported by original receipts from commercial organizations.

4. Transportation of Family or Friend
We agree to pay up to a maximum of $3,000 for the cost to transport one family member or close friend to your bedside by round-trip economy class (using the most direct route) if:
(a) you are hospitalized due to a covered sickness or injury and the attending physician advises that your family member or close friend’s attendance is necessary; or
(b) the local authorities legally require the attendance of your family member or close friend to identify your remains in the event of your death due to a covered sickness or injury.
Benefits are payable only when approved in advance by AGA. In addition, we agree to reimburse up to a maximum of $1,000 for the following expenses incurred by your family member or close friend after arrival:
(a) commercial accommodation and meals; and
(b) essential telephone calls; and
(c) taxi fares.
Expenses must be supported by original receipts from commercial organizations.

5. Return of Deceased (Repatriation)
In the event of your death due to a covered sickness or injury, we agree to reimburse:
(a) up to $10,000 for costs incurred to prepare and return your remains in a standard transportation container to your country of origin; or
(b) up to $4,000 for cremation or burial of your remains at the place of death. The cost of a coffin or urn is not covered.

6. Dental
We agree to reimburse:
(a) up to $4,000 for emergency treatment or services to whole or sound natural teeth (including capped or crowned teeth) which are damaged as a result of an accidental direct blow to the face; and
(b) up to $500 for the immediate relief of acute dental pain caused by other than a direct blow to the face and for which you have not previously received treatment or advice. Reimbursement will not exceed the minimum fee specified in the Canadian Dental Association schedule of fees of the province or territory where treatment was received. Treatment relating to any dental claim must begin within 48 hours after the onset of the emergency and must be completed within the period of coverage and prior to your return to your country of origin. Treatment must be performed by a legally qualified dentist or oral surgeon.

7. Emergency Transportation
When necessary, we agree to transport you to your country of origin when immediate medical consultation is required due to a covered emergency sickness or injury. Any emergency transportation such as air ambulance, one-way economy airfare, stretcher and/or a medical attendant must be pre-approved and arranged by AGA.

8. Emergency Return Home for You and One Family Member
If a covered sickness or injury requires you to be returned home during the period of coverage, we agree to reimburse up to $3,000 for the additional cost of one- way economy transportation by the most direct route for you and one insured family member to your country of origin when approved and arranged by AGA. Your coverage under this policy ceases once you have been returned to your country of origin under this benefit.

9. Accidental Death & Dismemberment
We agree to pay up to a maximum of the sum insured indicated on your confirmation of coverage, for loss of life, limb or sight resulting directly from accidental injury occurring during the period of coverage, except while boarding, riding in, or alighting from an aircraft.

Benefits are payable according to the following schedule:
  (a) 100% of sum insured resulting from the same
accidental injury for loss of:
   i. life; or
   ii. entire sight of both eyes; or
   iii. both hands; or
   iv. both feet; or
   v. one hand and entire sight of one eye; or
   vi. one foot and entire sight of one eye.
  (b) 50% of sum insured resulting from the same accidental injury for loss of:
   i. entire sight of one eye; or
   ii. one hand; or
   iii. one foot.
Loss of hand or hands, or foot or feet means severance through or above the wrist joint or ankle joint, respectively.
Loss of eye or eyes means total and irrecoverable loss of the entire sight.
Only one amount is payable (the largest) if you suffer more than one of these losses.
Exposure and Disappearance
If you are exposed to the elements or disappear as a result of an accident, a loss will be covered if:
  (a) as a result of such exposure, you suffer one of the losses specified in the schedule of losses above; or
  (b) your body has not been found within 52 weeks from the date of the accident. It will be presumed, subject to evidence to the contrary, that you suffered loss of life.


Special Conditions

1. In the event of a medical emergency, you must notify AGA within 24 hours of admission to a hospital and before any surgery is performed. Limits on Coverage
If you fail to do so without reasonable cause, then
we will pay 80% of the claim payable. You will be responsible for the remaining 20% of the claim payable.
You will be responsible for any expenses that are not payable by us.
The deductible is shown on your confirmation of coverage and applies once during the period of coverage.

2. We reserve the right, as reasonably required and at our expense, to transfer you to any hospital or to transport you to your country of origin following an emergency.
If you refuse to be transferred or transported when declared medically fit to travel, any continuing costs incurred after your refusal will not be covered and the payment of such costs becomes your sole responsibility.
Coverage ceases upon your refusal and no coverage will be provided to you for the remainder of the period of coverage.

3. Costs incurred outside of Canada other than in your country of origin are covered provided the majority of the period of coverage is spent in Canada.

4. Your policy will remain in effect while you are in your country of origin, however costs incurred in your country of origin are not covered

5. If you have been returned to your country of origin under the Emergency Return Home benefit, this policy will expire.

6. Act of Terrorism – Limits on Coverage and Aggregate Limit
When an act of terrorism directly or indirectly causes a loss that would otherwise be payable under this plan, other than Accidental Death & Dismemberment, subject to all other
policy limits, coverage will be provided as follows:
  (a) As a result of any one or a series of acts of terrorism occurring within a 72-hour period, the aggregate limit payable shall be limited to $2.5 million for all eligible insurance policies issued by us and administered by AGA, including this policy.
  (b) As a result of any one or a series of acts of terrorism occurring in any calendar year, the aggregate limit payable shall be limited to $5 million for all eligible policies issued by us and administered by AGA, including this policy.


Exclusions

Pre-existing Conditions Exclusion
  (c) If you are 59 years of age or under on the effective date:
Benefits are not payable for costs incurred due to or resulting from your medical condition or related condition that was not stable at any time during the 90 days immediately before the effective date.
  (d) If you are 60 to 79 years of age on the effective date:
   i. Benefits are not payable for costs incurred due to or resulting from any of the following pre-existing conditions, unless you have completed a Medical Questionnaire, have been approved in writing by AGA and have paid the required premium:
● heart condition;
● stroke or mini-stroke (TIA- transient ischemic attack).
   ii. Benefits are not payable for costs incurred due to or resulting from any pre-existing condition not listed under i) unless it was stable during the 180 days immediately before the effective date.
    (e) If you are 80 to 89 years of age on the effective date: Benefits are not payable for any pre-existing condition unless you have completed a Medical Questionnaire, have been approved in writing by AGA and have paid the required premium.

VTC2 Benefits are not payable for costs incurred due to any treatment, investigation or hospitalization which is a
continuation of, or subsequent to, emergency treatment of a sickness or injury, unless approved in advance by AGA.
VTC3 Benefits are not payable for any costs incurred due to any sickness for which signs or symptoms occurred
within 48 hours after the effective date, except when applying for coverage:
  (a) before the expiry date of your existing AGA administered policy; or
  (b) prior to the date you exit your country of origin

VTC4 Benefits are not payable for costs incurred due to any loss incurred outside of Canada when you have not spent the majority of the period of coverage in Canada.

VTC5 Benefits are not payable for costs incurred due to any loss incurred inside your country of origin.

VTC6 Benefits are not payable for costs or losses incurred while sane or insane due to:
  (a) your emotional or mental disorders resulting from any cause, including but not limited to anxiety or depression; or
  (b) your suicide or attempted suicide; or
  (c) your intentionally self-inflicted injury.

VTC7 Benefits are not payable for costs incurred due to pregnancy, abortion, miscarriage, childbirth or complications thereof.

VTC8 Benefits are not payable for costs incurred due to loss, death or injury, if at the time of the loss, death or injury, evidence supports that the medical condition causing the loss was in any way contributed to by:
  (a) your intoxication or abuse of alcohol; or
  (b) your use of prohibited drugs, or any other intoxicant; or
  (c) your non-compliance with prescribed treatment or medical therapy; or
  (d) your misuse of medication.

VTC9 Benefits are not payable for costs incurred due to injury resulting from training for or participating in:
  (a) motorized speed contests; or
  (b) stunt activities; or
  (c) professional sport activities; or
  (d) high-risk activities.

VTC10 Benefits are not payable for costs incurred due to sickness or injury resulting from a motor vehicle accident where you are entitled to receive benefits pursuant to any policy or legislative plan of motor vehicle insurance, except when such benefits are exhausted.

VTC11 Benefits are not payable for costs incurred due to any sickness, injury or medical condition when a trip is undertaken for the purpose of securing medical treatment or advice.

VTC12 Benefits are not payable for costs incurred due to your travelling against the advice of a physician or any loss resulting from your sickness or medical condition that was diagnosed by a physician as terminal prior to the effective date of this policy.

VTC13 Benefits are not payable for costs incurred due to any treatment which can be reasonably delayed until you return to your country of origin (whether or not you intend to return) by the next available means of transportation, unless approved in advance by AGA.

VTC14 Benefits are not payable for costs incurred due to any medical consultation that is non-emergency, on-going, elective or the consequence of a prior elective procedure.

VTC15 Benefits are not payable for costs incurred due to hospitalization or services rendered in connection with general health examinations for check-up purposes, treatment of an on-going condition, regular care of a chronic condition, home health care, investigative testing, rehabilitation, or on-going care or treatment in connection with drugs, alcohol or any other substance abuse.

VTC16 Benefits are not payable for costs incurred due to any rehabilitation or convalescent care.

VTC17 Benefits are not payable for costs incurred due to dental or cosmetic surgery

VTC18 Benefits are not payable for costs incurred due to naturopathic or holistic treatment.

VTC19 Benefits are not payable for costs that exceed the reasonable and customary rate for the area where the treatment or services are being performed.

VTC20 Benefits are not payable for costs incurred due to treatment or services that contravene, or are prohibited by legislation under a provincial or territorial hospital/ medical plan.

VTC21 Benefits are not payable for costs incurred due to any loss incurred in a city, region, or country when, prior to the effective date, the Department of Foreign Affairs, Trade and Development of the Canadian Government issued a written warning to avoid all travel, or to avoid non-essential travel, to that city, region, or country.

VTC22 Benefits are not payable for costs incurred due to any:
  (a) act of war; or
  (b) kidnapping; or
  (c) act of terrorism caused directly or indirectly by nuclear, chemical or biological means; or
  (d) riot, strike or civil commotion; or
  (e) unlawful visit in any country.

VTC23 Benefits are not payable for costs incurred due to any nuclear occurrence however caused.

VTC24 Benefits are not payable for costs incurred due to the participation by you, a family member or travelling companion in:
  (a) protests; or
  (b) armed forces activities; or
  (c) a commercial sexual transaction; or
  (d) the commission or attempted commission of any criminal offence; or
  (e) The contravention of any statutory law or regulation in the area where the loss occurred. VTC25 Benefits are not payable for costs incurred due to being an occupant of an aircraft, either as passenger or crew, except while being transported under the terms of the Emergency Transportation or Emergency Return Home benefits, or while boarding or alighting from an aircraft.


Refunds

A full refund will be provided for policies which are returned within 10 days of purchase, as described in the section titled Right To Examine Policy. Refunds are payable when:
1. The entire trip is cancelled prior to the effective date.
2. You return to your country of origin prior to the expiry date, without intending to return to Canada. Refunds are not payable for time spent in your country of origin between visits to Canada.
3. You become insured under a Canadian provincial or territorial health/medical plan.
When submitting your premium refund request, please include:
1. a fully completed and signed Refund Request Form; and
2. a copy of your confirmation of coverage; and
3. confirmation of your early departure such as boarding pass or itinerary, or any other written proof of your early return to your country of origin; and
4. any other documentation to support your refund request. Important Notes
Premium refunds, regardless of method of payment, must be obtained from the agent where coverage was originally purchased unless purchased directly from AGA.
There will be no refund of premium if a claim has been made. Refunds are payable from the date AGA receives the request.
Refunds for partial cancellations will be calculated by multiplying the daily premium by the actual number of days the policy was in effect; if this amount is less than the minimum premium required, the minimum premium will be used. This amount is then subtracted from the total premium paid. The refund will be calculated based on the date the refund request is received by AGA.
A refund fee may apply.
Refund amounts less than the minimum premium will not be issued


Claims Procedures


Claims forms are available by calling AGA’s Claims Department.
SEND YOUR CLAIMS TO:
Allianz Global Assistance Claims Department 250 Yonge Street, Suite 2100 Toronto, Ontario M5B 2L7 Canada Collect worldwide: 416-340-8809
Toll-free Canada/USA: 1-800-869-6747
1. Notice of Claim. Claims must be reported within 30 days of occurrence.
2. Proof of Claim. Written proof of claim must be submitted within 90 days of occurrence.
3. Any costs incurred for documentation or required reports are your or the claimant’s responsibility.
4. To submit your claim, fill out the claim form completely and include all original bills. Incomplete information will cause delay.
5. All eligible claims must be supported by original receipts from commercial organizations.

When submitting your hospital or medical claim, please include:
1. A fully completed and signed claim form with all original bills and receipts.
2. Medical records including an emergency room report and diagnosis from the medical facility or a Medical Certificate completed by the treating physician. Any fee for completing the certificate is not a benefit under this insurance.
3. For physiotherapy visits, a letter from the referring physician recommending a referral to the physiotherapist.
4. Any other documentation that may be required and/or requested by AGA.

Important Note
● In the event of a medical emergency, AGA must be notified within 24 hours of admission to hospital and before any surgery is performed. Limits on Coverage
● If you fail to do so without reasonable cause, then we will pay 80% of the claim payable.
● You will be responsible for any expenses that are not payable by us.

When submitting your Accidental Death & Dismemberment claim, please include:
1. A fully completed and signed claim form completed by either you, or in the case of your death, by the appointed executor/executrix.
2. The police report including any witness statements.
3. The coroner’s report.
4. The death certificate (in the event of death).
5. The Medical Certificate completed by the attending physician or hospital medical records.
Any other documents requested by AGA after initial review of the claim


Rates

Sum insured
Age$10,000 $25,000 $50,000 $100,000 $150,000 $300,000
0-25 $1.66 $2.15 $2.48 $3.26 $3.92 $6.34
26-34 1.76 2.32 2.65 3.58 4.16 6.58
35-39 1.88 2.48 2.76 3.80 4.62 7.04
40-54 1.98 2.87 3.26 4.85 5.80 8.64
55-59 2.10 3.09 3.48 5.02 5.89 9.08
60-64 3.20 4.29 5.04 6.23 7.41 10.78
65-69 3.43 4.86 5.72 7.73 9.20 12.80
70-74 5.04 6.99 8.29 10.42 12.40 19.08
75-79 6.01 8.47 10.65 12.87 15.32 22.81
80-84 5.21 7.50 9.50 12.02 14.31 21.31
85-89 6.12 8.81 11.17 14.13 15.75 29.32

Note: $20 minimum premium per policy
Family includes the applicant, age 59 and under, the applicant’s spouse, age 59 and under, and dependent children at least 15 days of age and no more than 21 years of age.
The premium for family coverage is calculated at two times the premium for the eldest adult age 59 and under.
Deductible Options for Additional Savings
$100 = 5% premium savings
$250 = 10% premium savings
$1,000 = 20% premium savings
$3,000 = 30% premium savings
Deductibles are applied per person per policy