An Overview of Benefits
|The following Summary of Benefits merely provides you with an overview of the Benefits provided. You must refer to the policy document for the specific details of coverage. This insurance is designed to cover losses arising from sudden and unforeseeable circumstances. It is very important that you read and understand the terms of your policy as the coverage contains provisions relating to eligibility, pre-existing conditions, limitations and exclusions. Emergency Medical Expenses are covered up to the limit set out in the policy for each benefit.|
|Maximum Sum Insured:||Up to $2,000,000 for coverage outside of Canada and up to $200,000 for coverage in Canada|
|Emergency Hospital:||Up to the maximum aggregate limit you selected for Semi-private, or intensive care hospital accommodation if required|
|Emergency Medical: includes:||Licensed local air, land and/or sea ambulance to the nearest hospital; Services of physician, surgeon, anesthetist, Diagnostics, lab tests and/or x-rays; Private duty services of a registered graduate nurse up to $10,000 and rental of medical appliances.|
|Diagnostic rays & Laboratory services||Up to $10,000|
|Drugs or Medications:||As required for the treatment of your emergency, up to $5,000 or 30 day supply|
|Professional Services:||50% of the cost of Physiotherapist, chiropractor, chiropodist, osteopath, podiatrist when ordered by the attending physician (up to $5,000)|
|Emergency Air Transportation / Return home||Payment for the cost to transport you by air ambulance when pre-approved, up to $25,000|
|Transportation of Children, Dependents, Family or friends:||Up to $2,000 to transport dependents and up to $1,000 for one family member or close friend and up to $1,500 for meals and accommodation|
|Follow-up Visits:||As many as are required to treat the emergency|
|Emergency Dental:||For emergency treatment caused by an accidental blow to the face, up to the limits set out in the policy|
|Emergency Assistance:||Assistance service in an emergency as set out in the policy|
|Subsistence Allowance, Meals, Accommodation Out of Pocket expenses:||Up to $1,500 as set out in the policy|
|Emergency Return Home:||The additional cost of one-way economy transportation up to the limits set out in the policy if unable to drive|
|Major Event Return Home:||Up to $3,000 for the cost to return to Canada upon the occurrence of one of the events if approved for travelers outside of Canada|
|Return of Deceased:||The cost to prepare return your body in the case of death, up to $5,000 including $500 for the cost of an URN or temporary casket|
|Pre-existing Conditions:||Will be covered according to the terms and conditions of the policy and the application for insurance|
|Waiting Period:||A waiting period will apply if the insurance is purchased after the departure date for your trip|
|Limitations Exclusions||Your policy contains limitations and exclusions. Please refer to policy for a complete list of the limitations and exclusions|
|Deductible Options:||The Deductible chosen on the application for insurance that applies to the policy is displayed on the policy receipt.|
You are eligible for coverage if on the Effective Date:
1. You are at least 15 days old and you are age 89 or under and not insured or eligible for benefits under a Canadian Government Health Insurance Plan; and
2. You are currently in good health and know of no reason why you would require Treatment during Your Insured Trip; and
3. You are not residing in a nursing home, rest home, convalescent home, rehabilitation Centre or home for the aged unless you receive written approval from the Company.
Limitations and Exclusions:
WHAT IS NOT COVERED FOR: HEALTH INSURANCE
No coverage shall be provided under this contract and no payment shall be made for any Loss resulting in whole or in part from, or contributed to by, or as a natural and probable consequence of, any of the following excluded risks:
1. Any Pre-existing Condition, unless You have been approved for Pre-existing Condition coverage and received a Policy Receipt from the Company. The Pre-existing Condition exclusion will apply to a loss or expenses resulting from a medical condition and a loss to Treat symptoms that existed on or prior to Your Effective Date, unless You have selected underwriting to cover Your Pre-existing Conditions and paid the corresponding additional premium.
Any condition that was not Stable at any time during the 365 days immediately before the Effective Date unless You have paid the additional premium required to reduce the Period of Stability; or
Any condition listed under “Exclusions” on Your Policy Receipt; or
Any condition listed under “Notes” on Your Policy Receipt as an excluded condition; or
Check to see how this exclusion applies in Your policy and how it relates to Your Effective Date, date of purchase and Termination Date. In the event of an accident, Injury or Sickness, Your prior medical history will be reviewed when a claim is reported. You must notify the Company prior to any Treatment. Your policy may limit benefits should You not contact the Company within a specific time period.
2. Diabetes: if You have been previously diagnosed with diabetes, Treatment for cardiovascular or cerebrovascular conditions is not covered (excluded) unless You have disclosed Your complete medical history, submitted it for underwriting approval and obtained an endorsement issued by the Company to cover Your specified Pre-existing Conditions
3. Any loss, Sickness or Injury which occurred outside of Canada or any loss, Sickness or Injury occurring while this policy is not in effect;
4. Hospital or Treatment, where this policy is specifically purchased to obtain such services, whether or not authorized by a Physician;
5. Expenses incurred as a result of asymptomatic or symptomatic HIV infection, Acquired Immune Deficiency Syndrome (AIDS), AIDS related conditions (ARC) or the presence of HIV, including any associated diagnostic tests or charges or other sexually transmitted disease
6. A Sickness, Injury, or related condition during a Trip
a. with the knowledge that You will require or seek Treatment or surgery for that Sickness, Injury, or related condition, or
b. for the purpose of obtaining Treatment or surgery.
7. Non-Emergency Treatment or investigation, check-ups, cosmetic surgery, chronic care, rehabilitation, or any complications directly or indirectly related thereto, or Treatment which can be reasonably delayed until You can return to Your Country of residence by the next available means of transportation. The delay to receive Treatment in Your Country of residence has no bearing on the application of this exclusion.
8. Sickness or Injury when travel is booked or commenced contrary to medical advice, with prior knowledge of an Unstable Condition, or after determination of a Terminal Prognosis.
9. Major medical or surgical procedures, including but not limited to cardiac surgery, which are not approved in advance by the Medical Director.
10. Expenses arising from Sickness or Injury related to a change in a pre-approved Pre-existing Condition if You failed to notify the Company of that change prior to Your Effective Date.
11. Any Treatment, investigation, or hospitalization which is a continuation of or subsequent to a Medical Emergency, unless You are declared medically unfit to return to Your Country of residence by the Medical Director
12. Childbirth, miscarriage, deliberate termination of pregnancy or any complications incident to pregnancy;
13. Mental, nervous or emotional disorders, misuse of medication, abuse of drugs or intoxicants, any Sickness related to and/or induced by alcohol, medication, drug and/or toxic substance abuse, any accident related to and/or induced by an excessive consumption of alcohol (determined by a blood-alcohol level in excess of eighty (80) milligrams per one hundred (100) milliliters of blood) or Treatment therefor
14. Suicide or attempt thereat, or self-inflicted injury, whether sane or insane.
15. Sickness or Injury arising from civil disorders, war, or act of war, declared or not, or willful exposure to peril except in an attempt to save human life.
16. Committing or attempting to commit any criminal or illegal activity
17. Air travel other than as a passenger in a commercial aircraft with a seating capacity of six people or more, licensed to carry passengers for hire.
18. An automobile accident where You are entitled to benefits under an automobile insurance policy (including but not limited to no-fault benefits), or under an applicable insurance act.
19. Participation in sanctioned competitive sports, professional sports or, participation in aerobatic or stunt flying, hang gliding, mountaineering, skydiving, parachuting, bungee jumping, scuba diving without being properly certified, extreme fighting, any racing or speed contests unless the Company has accepted the risk and issued a Rider.
20. For children under two (2) years of Age: Any Sickness or medical condition related to a birth defect.
21. Treatment or surgery for a specific condition, or a related condition, which:
a. had caused Your Physician to advise You not to travel, or
b. You contracted in a country during Your Trip when, before Your Effective Date, a written formal notice was issued by the Department of Foreign Affairs and International Trade of the Canadian government, advising Canadians not to travel to that country, region or city.
22. Noncompliance with prescribed medical therapy or Treatment.
23. a. cardiac catheterization, angioplasty and/or cardio- vascular surgery including any associated diagnostic test(s) or charges unless approved in advance by the Company prior to being performed, except in extreme circumstances where such surgery is performed as a Medical Emergency immediately upon admission to Hospital.
b. magnetic resonance imaging (MRIs), computerized axial tomography (CAT) scans, sonograms, ultrasounds, or biopsies unless approved in advance by the Company.
c. The replacement of an existing prescription, whether by reason of loss, renewal or inadequate supply, or the purchase of drugs and medications (including vitamins) which are commonly available without a prescription or which are not legally registered and approved in Canada.
24. Services in connection with general health examinations, routine prenatal care, regular care of a chronic condition.
25. The continuing care and/or Treatment of an acute Sickness or Injury after the initial Medical Emergency has ended (as determined by Our Medical Director) or a medical consultation where the Physician observes no change in a previously noted condition, symptom, or complaint.
26. Medical care or surgery that is cosmetic in nature.
27. Cataract surgery or services provided by a naturopath or an optometrist or in a convalescent home, nursing home, rehabilitation Centre or health spa.
28. Air ambulance services unless approved in advance and arranged by the Company.
29. Damage to or loss of hearing devices, eye examinations, eyeglasses, sunglasses, contact lenses, or prosthetic teeth or limbs, and resulting prescription thereof.
You may apply for a refund if you become insured under a Canadian provincial or territorial health/medical plan as long as you are not required to maintain the coverage for work permit or other immigration purposes. Requests for premium refund will be considered, in the case of non-departure from your Country of residence due to a Medical Emergency, failure to meet visa requirements, or departure from Canada provided this policy is signed and returned to the Company and no claim has been paid or is pending on Your behalf. A full refund will be provided for policies which are returned within 10 days of purchase and before the Effective Date of the policy.
A refund will be calculated from the date of receipt of written notification, subject to an administration fee of 12% of refund calculated plus $25 per Application for Insurance and a minimum refund amount of $10 per policy.
Premium refunds, regardless of method of payment, must be obtained from the agent where coverage was originally purchased.
|This option does not provide coverage for any pre-existing medical conditions|
|Daily Rate - $0 Deductible. No Medical questionnaire required.|
|86 - 89||$10.26||$15.96||$17.24||$18.56||n/a||n/a|
RATE TABLE 2
|This option provides coverage for pre-existing conditions that were stable Over 365 days|
|Daily Rate - $0 Deductible. No Medical questionnaire required.|
|80-85||N/P||No||Pre-ex||Coverage||see||< rate table 1|
|86+||N/P||No||Pre-ex||Coverage||see||< rate table 1|
RATE TABLE 3
|This option provides coverage for pre-existing conditions that were stable between 180 days and 365 days excluding Heart & Stroke – A Medical Questionnaire is required|
|80-85||N/P||< no pre-ex|
|86+||N/P||< no pre-ex|
RATE TABLE 4
|This option provides coverage for pre-existing conditions that were stable between 90|
|to 180 days - excluding Heart, Stroke, Cancer and PVD. A Medical Questionnaire is required|
|80-85||N/P||< no pre-ex|
|86+||N/P||< no pre-ex|