1. Hospital Accommodation
(a) Reasonable and customary costs up to the ward rate or coronary care or intensive care unit where medically necessary.
(b) Medical treatment on an outpatient basis in a hospital.
2. Physician Charges
(a) The services of a legally licensed physician, surgeon, or anesthetist.
(b) When declared medically necessary by the attending physician at the time of the emergency, additional follow-up visits, provided they are directly related to the emergency and the emergency has been reported to the Assistance Company.
Laboratory tests and X-rays prescribed by the attending.
physician due to an emergency.
Note: This policy does not cover magnetic resonance imaging (MRI), cardiac catheterization, computerized axial tomography (CAT) scans, sonograms, ultrasounds, or biopsies unless such services are approved in advance by the Assistance Company.
4. Private Duty Nursing
The professional services of a registered private nurse (other than by an immediate family member) as the result of a covered emergency, when medically necessary while hospitalized, when ordered by the attending physician and approved in advance by the Assistance Company.
5. Ambulance Services
When reasonable and medically necessary, licensed ground ambulance service (also covers taxi fare in lieu of ground ambulance) to the nearest hospital.
6. Prescription Drugs
Up to a 30-day supply per prescription, unless you are hospitalized, drugs, serums and injectables that can only be obtained upon medical prescription, that are prescribed by a physician and that are supplied by a licensed pharmacist when required as a result of an emergency. This benefit does not cover drugs, serums and injectables necessary for the continued stabilization of a chronic medical condition, except in case of emergency.
Note: To file a claim, you must provide original receipts issued by the pharmacist, physician, or hospital, indicating the total cost, prescription number, name of medication, quantity, date and name of the prescribing physician.
7. Medical Appliances
When prescribed by a physician and approved in advance by the Assistance Company, minor appliances such as casts, splints, canes, slings, trusses, braces, crutches and/or rental of a wheelchair.
8. Paramedical Services
Treatment provided by a paramedical practitioner up to a maximum of $500 per practitioner classification, provided such treatment is prescribed by a physician and approved by the Assistance Company.
To be eligible for coverage under this plan, on the effective date the applicant must:
1. be a visitor to Canada, a person with a Canadian work visa or super visa, an immigrant to Canada or a Canadian resident, who is not eligible for a provincial or territorial government health insurance plan in Canada.
2. be at least 15 days old on the application date.
3. not have been diagnosed with a terminal illness; or not have been diagnosed with stage 3 or 4 cancer; or
4. not have been diagnosed with or have required medical treatment for kidney disease requiring dialysis; or
5. not have been diagnosed with or have had an episode of congestive heart failure; or
6. not have had a lung condition for which, in the last 12 months, you have been prescribed or used home oxygen; or
7. not have received or is awaiting a bone marrow or major organ transplant.
When coverage is purchased after your arrival in Canada, the following waiting periods apply:
(a) Age 85 or under:
i. If age 85 or under and coverage is purchased within 30 days after arrival in Canada, then in respect of any sickness, you will not be entitled to receive reimbursement for sickness or symptoms which manifested or were contracted or treated within 48 hours following the effective date of this policy,
ii. If age 85 or under and coverage is purchased more than 30 days after your arrival in Canada, then in respect of any sickness, you will not be entitled to receive reimbursement for sickness or symptoms which manifested or were contracted or treated within 7 days following the effective date of this policy.
(b)Age 86 or over:
If age 86 or over and coverage is purchased at any time after your arrival in Canada, then in respect of any sickness, you will not be entitled to receive reimbursement for sickness or symptoms which manifested or were contracted or treated within 15 days following the effective date of this policy.
(c) The waiting period may be waived if:
i. this policy is purchased on, or prior to, the expiry date of an existing JF Optimum Plus Visitor Insurance policy already issued by the Administrator Company to take effect on the day following such expiry date, provided no increase in the Sum Insured option or rate schedule change is applied for;
ii. the Administrator Company specifically waives or modifies the waiting period in writing; or
iii. you have coverage with another insurer during the first part of your trip in Canada, and you are purchasing this insurance after your arrival in Canada and there will be no gap in your coverage, you may request to have the waiting period waived. You must provide proof satisfactory to the Administrator Company that you have other coverage in force prior to purchasing this policy and receive written approval from the Administrator Company.
Stable Pre-Existing Medical Condition Coverage
(d) Stable pre-existing medical condition(s) are only covered if you paid the required premium for the stable pre-existing medical condition coverage option on the application date.
(e) Pre-existing medical condition(s) are not covered for insureds age 86 or older.
2. Expiry Date Coverage under this plan terminates on the earliest of:
(a) 11:59 p.m. (local time) on the expiry date indicated on the application or policy confirmation.
(b) 11:59 p.m. (local time) on the date calculated by the Administrator Company, due to an incorrect premium payment.
(c) the date you become eligible for a provincial or territorial insurance plan in Canada; or
(d) the date and time you leave Canada with no intention to return to Canada during the policy period.
(e) the date and time you arrive in your country of origin for a temporary return to your country of origin with the intention of returning to Canada during the policy period (coverage ceases and resumes when you return to Canada provided you are still eligible for coverage, premium will not be refunded or reissued).
1. You have 10 days after purchase to return this policy for a full refund, provided your coverage has not started and you have not experienced an event that would cause you to submit a claim. Please refer to the sections of the policy that explain when coverage starts.
2. If termination of your policy is requested because you must return to your country of origin prior to your scheduled return date, a partial amount (less an administration fee of
$40 per insurance policy) of the premium paid may be refunded, provided no claim has been incurred at any time during your trip.
For policies with coverage of $100,000 or over and with a duration of one year:
1. If cancellation is requested prior to the effective date of your policy, you must provide evidence of a Super Visa rejection letter from the government for a full premium refund. No refund will be made if the primary reasons of rejection are due to the following:
a. you did not complete the medical examination.
b. you did not complete and interview.
c. you did not provide required documents needed for the Super Visa application
2. If termination of your policy is requested after the effective date, you must provide evidence of a boarding pass and e-ticket from the airline for a partial premium refund. There must be no claims incurred at any time during the policy period. An administration fee of $40 per insurance policy applies.
Limitations and Restrictions:
1. Pre-Approval of Surgery, Invasive Procedure, Diagnostic Testing and Treatment The Assistance Company must approve in advance any surgery, invasive procedure (including, but not limited to, cardiac catheterization), diagnostic testing or treatment prior to you undergoing such procedure. It remains your responsibility to inform your attending physician to call the Assistance Company for approval, except in extreme circumstances where such action would delay surgery required to resolve a life-threatening medical crisis.
2. Notice to the Assistance Company You must contact the Assistance Company prior to seeking medical treatment. If it is not reasonably possible for you to contact the Assistance Company prior to seeking treatment due to the nature of your emergency, you must have someone else call on your behalf or you must call as soon as medically possible.
3. Limitation of Benefits
Once you are deemed medically stable to return to your country of origin (with or without a medical escort) in the opinion of the Assistance Company or by virtue of discharge from hospital, your emergency is considered to have ended.
There is no coverage for any further consultation, treatment, recurrence, or complication related to the emergency under this policy unless it occurs after you have been deemed medically stable for at least 120 days from the date the initial emergency is considered to have ended.
To be deemed medically stable you must meet the following requirements:
• there has been no new treatment.
• there have been no signs or symptoms or new diagnosis; and
• there has been no hospitalization; and
• there has been no referral to a specialist (made or recommended) and you are not awaiting surgery or the results of investigations performed by any medical professional.
4. Benefits Limited to Reasonable and Customary Cost
If you pay eligible expenses directly to a health service provider, these services will be reimbursed to you on the basis of the reasonable and customary costs that would have been paid directly to the provider by the Assistance Company. Medical charges you pay may be higher than this amount; therefore, you will be responsible for any difference between the amount you paid, and the reasonable and customary costs reimbursed by the Insurer.
5. Benefits Limited to Incurred Expenses
If any of the benefits are duplicated under a similar benefit or under another insurance coverage in this policy or another policy issued by the Insurer, the maximum you are entitled to is the largest amount specified under any one benefit or insurance coverage. The total amount paid to you from all sources cannot exceed the actual expenses you incur.
6. Availability and Quality of Care
The Insurer, the Administration Company, the Distribution Company or the Assistance Company and their agents will not be responsible for the availability, quality, quantity, or results of any medical treatment received, or for the failure of any person to provide or obtain medical services.
7. Transfer or Medical Repatriation
During an emergency (whether prior to admission, during a covered hospitalization or after your release from hospital), the Assistance Company reserves the right to: (
a) transfer you to one of its preferred health care providers, and/or
(b) return you to your country of origin, for medical treatment of your sickness or injury without danger to your life or health. If you choose to decline the transfer or return when declared medically stable by the Assistance Company, the Insurer will be released from any liability for expenses incurred for such sickness or injury after the proposed date of transfer or return.
The Assistance Company will make every provision for your medical condition when choosing and arranging the mode of your transfer or return and, in the case of a transfer, when choosing the hospital.
1. Pre-existing medical conditions exclusion Important: Check the special note on your confirmation of insurance to see which plan you selected.
a. If you selected and paid for coverage “Including stable pre-existing medical condition coverage”:
Benefits are not payable for costs or losses incurred due to, contributed by, or resulting from pre-existing medical condition(s) that are not stable pre-existing medical conditions.
b. If you selected and paid for coverage “Excluding stable pre-existing medical condition coverage”: Benefits are not payable for costs or losses incurred due to, contributed by, or resulting from any. pre-existing medical condition.
c. If you are 86 years of age or older: Benefits are not payable for costs or losses incurred due to, contributed by, or resulting from any. pre-existing medical condition.
|JF Insurance Agency Group Inc.|
|Effective October 01,2019 JF OPTIMUM PLUS VISITOR PLAN|
|Rate Schedule 1- Daily Rates pre-existing conditions coverage option|
|$25,000 $50,000 $100,000 $150,000 $200,000 $300,000|
|Age / Coverage Amount||$10,000||$15,000||$25,000||$50,000||$100,000||$150,000||$200,000||$300,000|
|Rate Schedule 2 - Daily Rates|
|Without pre-existing medical conditions coverage option|
|Age 85 and under: $0 Deductible Age 86 and older: $500 Deductible|
|Age/ Coverage Amount||$10,000||$15,000||$25,000||$50,000||$100,000||$150,000||$200,000||$300,000|
|0 to 25||$1.14||$1.43||$1.55||$1.70||$2.28||$2.72||$3.40||$4.41|
|Deductible Options:||(Not Available to Age 86 and older)|
|$100 Deductible||5% Discount|
|$1,000||Deductible 20% Discount|
|$2,500 Deductible (Disappearing) Applies to $25,000 Policy Limit only||30% Discount Any Age - Per Person - Per Claim|
|$2,500 Deductible (Disappearing) Applies to $50,000 Policy Limit only||25% Discount Any Age - Per Person - Per Claim|
|$3,000 Deductible||30% Discount|