An Overview of Maximum Benefits
|BENEFIT SECTIONS||BENEFIT AMOUNT|
|1.||EMERGENCY MEDICAL||Plan Limit|
|Emergency Medical Expenses||Included|
|Emergency Return Home||Included|
|Repatriation of Remains||$10,000|
|Cremation/Burial at Destination||$4,000|
|3.||Accidental Death & Dismemberment||Up to $100,000|
All of the following restrictions apply:
(1) You must be over 14 days old and under 86 years of age during the entire Period of Coverage.
Ages 70 to under 86 years of age during the entire Period of Coverage may only purchase Plan Limits up to $100,000.
(2) You do not have a Medical Condition for which a Physician has advised You against travel before Your Period of Coverage.
(3) You do not have a surgically untreated aneurysm.
(4) You have never been diagnosed with or received Treatment for:
(a) Pancreatic or liver cancer, or any type of metastasized cancer.
(b) A kidney condition requiring dialysis.
(c) A bone marrow or organ transplant.
(d) Congestive heart failure.
A Terminal Sickness.
(5) At time of purchase of this Policy, you do not reside in a nursing home, assisted living home, convalescent home, hospice or rehabilitation Centre.
(6) You do not require assistance with Normal Daily Activities. This does not apply to children under 12 years of age.
(7) You have not taken (or have been prescribed) oral steroids or used home oxygen to treat a lung condition in the 12 months before Your Start Date.
(8) In the 12 months immediately prior to Your Start Date You have not been:
(a) diagnosed with or received Treatment for any two conditions listed in the Medical Conditions Table.
(b) Admitted to hospital for any one condition in the Medical Conditions Table
What’s Covered in The Emergency Medical Coverage Plan
You are covered up to the Plan Limit which is the overall benefit limit for the entire Period of Coverage. Certain sections below have a specified benefit limit for an eligible Emergency medical expense as described.
1. Emergency Medical Expenses: a Physician orders or prescribes the following as Medically Necessary for the diagnosis or Treatment of Your Emergency Sickness or Injury:
(a) the services of a Physician, surgeon or in- Hospital duty nurse.
(b) Hospital semi-private accommodation where available.
(c) transportation by a professional ambulance company to and from a Hospital.
(d) diagnostic testing including but not limited to sonograms, electrocardiograms, computerized axial tomography (CAT scan) and magnetic resonance imaging (MRI). The Company must pre-authorize all diagnostic tests.
(e) medical equipment purchased or rented for therapeutic purposes. The Company must pre- authorize this benefit.
(f) prescription medications dispensed by a licensed pharmacist. Coverage after an Emergency Treatment includes up to a 30-day supply of this prescribed medication up to a maximum of $1,000, per occurrence.
(g) If the attending Physician prescribes follow-up visits after an eligible Emergency Treatment, this benefit includes up to one follow-up visit to a maximum of $1,000. Follow-up visits must be scheduled during the Period of
Coverage. The Company must pre-authorize this benefit.
● With respect to the Emergency medical expenses described above, You or someone acting on Your behalf are required to immediately contact the Emergency Assistance Provider at the telephone numbers provided on page 9 of this Policy before admission to Hospital or within 24 hours after a life or organ- threatening Emergency. Failure to do so will result in You being responsible for 20% of any eligible expenses incurred.
● The Company must pre-authorize all diagnostic laboratory procedures, x-rays, surgeries, and rental or purchase of therapeutic supplies.
2. Emergency Return Home: if You have a medical Emergency, the Company, in consultation with its medical advisors, the Emergency Assistance Provider and the local attending Physician, may determine that You should be transported back to Your Home Country for continued Treatment. The Company will then arrange to transport You there with proper medical supervision if needed and will pay the following expenses up to the maximum benefit amount:
(a) the extra cost of a one-way Fare via a commercial airline by the most direct route back to Your Home Country; or
(b) the cost to accommodate a stretcher to transport You on a commercial airline by the most direct route back to Your Home Country, if a stretcher is Medically Necessary plus the cost of a round-trip Fare, reasonable meal and overnight accommodation expenses and professional fees for the services of a qualified medical attendant (other than a Family Member) to accompany You, if Medically Necessary or required by the airline; or
(c) the cost of transportation by air ambulance if Medically Necessary.
● Emergency Return Home - this Policy will cover the cost to transport You via a licensed airline, with accompaniment if Medically Necessary. The Company must pre-authorize all transportation costs for Emergency return home.
With respect to items #1 and #2 above, the Company reserves the right to return You to Your Home Country before any Treatment or following Emergency Treatment for Sickness or Injury, if the medical evidence obtained from Our medical advisor and Your local attending Physician confirms that You are able to return to Your Home Country without endangering Your life or health. If You decide not to return to Your Home Country after the Company recommends it, Your Policy will no longer cover any Emergency expenses and all coverage will end.
3. Emergency Dental: a licensed dentist or dental surgeon orders the following:
(a) Treatment or repair of natural or permanently attached artificial teeth which become damaged due to Accidental Injury to the head or mouth. We will reimburse You for Reasonable and Customary expenses up to a maximum of $2,000 for any one Injury.
(b) Treatment to relieve acute pain and suffering not related to an Accidental Injury up to a maximum of $300, per occurrence.
4. Repatriation: in the event of Your death during Your Period of Coverage, the Company will reimburse the reasonable costs actually incurred:
(a) for the preparation and repatriation of Your body or ashes to Your Home Country up to a maximum of $10,000; or
(b) for the cremation or burial at the place of death up to a maximum of $4,000.
• No benefit is payable for the cost of a headstone, casket, urn and/or funeral service expenses
5. Identification of Remains: in the event of Your death during Your Period of Coverage, if someone is legally required to identify Your remains before Your body is released, expenses will be reimbursed for:
(a) a round-trip economy airfare for someone to travel via the most direct route to the place where Your remains are located; plus
(b) up to $450 for commercial accommodation and meals.
• The Company must pre-authorize and arrange this benefit.
A. Refund of Premium: Other than the “10 Day Right to Examine” on page 1, and provided that you have not reported a claim under this Policy, a refund for unused days will be allowed. The following administration fees will be deducted from Your refund if You:
(a) cancel Your policy due to a denial of Your travel visa (no fee will be deducted);
(b) cancel Your policy before Your Start Date due to You no longer being eligible (no fee will be deducted).
(c) cancel Your Policy before You leave Your Home Country for other than “a)” or “b)” above ($250 fee will be deducted).
(d) cancel Your Policy before Your Expiry Date to return to Your Home Country or if You become insured under a Canadian federal, provincial, or territorial health/medical plan ($50 fee will be deducted); or
(e) cancel Your Policy and decide to stay in Canada ($250 fee will be deducted).
A request for refund must be submitted to Your broker within 30 days from the requested cancellation date. All requests for refunds must be accompanied with the following applicable documentation:
(a) evidence that You have been denied a travel visa.
(b) evidence that Your trip was cancelled before You departed Your Home Country.
(c) evidence to prove Your date of return to Your Home Country.
(d) evidence that You have become insured under a Canadian federal, provincial, or territorial health/medical plan.
(e) evidence that You have decided to seek alternative health protection while staying in Canada.
If a claim is received after a request for premium refund has been processed, you will be financially responsible for paying the claim and the Company will forward the claim to You for settlement.
B. Date Changes: Any requests for a date change after Your Start Date other than an extension of Your Period of Coverage may incur an administration fee of $50.
Assignment of Benefits: Where the Company has paid expenses or benefits to You or on Your behalf under this Policy, the Company has the right to recover, at its own expense, those payments from any applicable source or any insurance policy or plan that provides the same benefits or recoveries. This Policy also allows the Company to receive, endorse and negotiate eligible payments from those parties on Your behalf. When the Company receives payment from any other insurer, or any other source of recovery to the Company, the respective payor is released from any further liability with respect to the claim.
Autopsy: In the event of Your death, the Company may request an examination or autopsy subject to any applicable laws relating to autopsies.
Concealment and Misrepresentation: The entire coverage will be void, if before, during or after a loss, any Material Fact or circumstance relating to this Policy has been concealed or misrepresented.
Conformity with Existing Laws: Any provision of this Policy which is in conflict with any Canadian federal, provincial or territorial law where this Policy is issued is hereby amended to conform to the minimum requirements of that law. In all other respects, the terms and provisions of this Policy shall apply.
Contract Changes: This Policy is a legal contract between You and Us. It, including any endorsements and attached papers are the entire contract. No change in this Policy is valid unless approved in writing by one of Our officers. No agent or broker has the right to change this Policy or to waive any of its provisions. Currency: All premiums and benefits under this Policy are payable in Canadian currency based on a) the rate of exchange set by any chartered bank in Canada on the last date of service, or b) on the date the payment is issued to the provider of service.
Coordination of Benefits: The benefits in this Policy are secondary to those available under any other coverage You may have including but not limited to government health insurance, group or personal accident and sickness insurance, extended health or medical care coverage, any automobile insurance or benefits plan, homeowner, tenant or other multi-peril insurance, credit card benefit insurance, and other travel insurance.
Limitation of Liability: The Company’s liability under this Policy is limited solely to the payment of eligible benefits, up to the maximum amount stated in this Policy for any loss or expense. The Company upon making payment under this Policy does not assume any responsibility for the availability, quality, results or outcome of any Treatment or service, or Your failure to obtain any Treatment or service covered under the terms of this Policy. Regardless of how many valid Visitors to Canada policies You have purchased with the Company, the maximum amount for which You can be covered is limited to $150,000.
Medical Examination: The Company reserves the right to have You medically examined in the event of a claim.
Medical Records: In the event of a claim, you agree to provide access to and We reserve the right to review any and all medical records or documentation relating to Your claim(s) from any licensed Physician, dentist, medical practitioner, Hospital, clinic, insurer, individual, institution or other provider of service relating to the validity of Your claim.
Right of Recovery: In the event that You are found to be ineligible for coverage, a benefit is paid in error, payment is made in excess of the amount allowed under the provisions of this Policy, a claim is found to be invalid, or benefits are reduced in accordance with any Policy provision, the Company has the right to collect from You any amount which it has paid on Your behalf to medical providers or other parties or seek reimbursement from You, Your estate, any institution, insurer, or person to whom the payment was made.
Subrogation: If You suffer a loss caused by a third party, the Company has the right to subrogate Your rights of recovery against the third party for any benefits payable to or on Your behalf, and will, at its own expense and in Your name, execute the necessary documents and take action against the third party to recover such payments. You must not take any action or execute any documents after the loss that will prejudice the Company’s rights to such recovery.
Sworn Statements: We have the right to request that claims documents be sworn under oath and have you examined under oath in respect to any claim documents submitted.
There is no coverage, and no benefits will be payable for claims resulting from:
1. Pre-Existing Conditions or related Medical Conditions that existed during the 180-day period immediately prior to Your Start Date
2. Expenses related to a Sickness, Injury, or Medical Condition that in the opinion of Our medical director would have caused You to seek medical advice, diagnosis, care or Treatment, during the 180-day period immediately prior to Your Start Date.
3. Any expenses incurred outside the Period of Coverage.
4. Any expenses incurred outside Canada except for:
(a) if coverage is purchased prior to arrival in Canada, Emergency expenses incurred en route to Canada after the date and time You leave Your Home Country provided You are scheduled to arrive in Canada within 48 hours of departure.
(b) if coverage is in effect on the date You leave Canada, Emergency expenses incurred en route to Your Home Country after the date and time You leave Canada provided You are scheduled to arrive in Your Home Country within 48 hours of departure.
(c) Emergency expenses incurred during any side trip outside of Canada as described in Coverage for Side Trips Outside Canada on page 6.
(a) not required for the immediate relief of acute pain and suffering.
(b) which can reasonably be delayed until Your Policy expires or You return to Your Home Country.
(c) for follow-up Treatment (other than subsequent follow-up visits per benefit 1. g) on page 11), Recurrence of a Medical Condition or subsequent Emergency Treatment or hospitalization for a Medical Condition or related Medical Conditions for which You had received Emergency Treatment during Your Period of Coverage.
6. Transplants of any kind.
7. Expenses incurred whereby this Policy was purchased specifically to obtain Hospital or medical Treatment outside Your Home Country whether or not recommended by Your attending Physician.
8. The cost of replenishing any medication that was in use on Your Departure Date or for the maintenance of any course of Treatment that commenced prior to Your date of arrival in Canada.
9. Unless the Company pre-approves it, Emergency air transportation; surgery; diagnostic testing; cardiac procedures including but not limited to cardiac catheterization, angioplasty, or surgery.
10. Your mental, emotional or nervous disorders resulting from any cause, including but not limited to anxiety or depression.
11. Any Treatment or services performed by a Family Member.
12. Any elective medical Treatment.
13. Cataracts or any Medical Conditions resulting from their medical care.
14. Pregnancy, childbirth, complications of pregnancy or childbirth, or voluntarily induced abortion; or a child born during Your Period of Coverage.
15. Your use of drugs, alcohol, or any medication that results directly or indirectly in the condition causing a claim.
16. Your suicide, attempted suicide, or any intentionally self-inflicted Injury.
17. Your participation in Extreme Activities.
19. Your driving a motorcycle, moped, or scooter, whether or not You are driving on publicly maintained roads, driving off-road or on private property (unless You hold an applicable valid Canadian driver’s license);
20. Your riding, driving, or participating in races of speed or endurance.
21. Your piloting an aircraft or air travel on any air supported device other than as a fare-paying passenger on a flight operated by a Common Carrier;
22. Fraud, concealment, or deliberate misstatement in relation to any matter affecting this insurance or in connection with the making of any claim hereunder.
23. Your participation in a crime or malicious act.
24. Your participation in a riot or insurrection.
25. War or act of war (whether declared or undeclared), invasion, act of foreign enemy, hostilities, civil war, rebellion, revolution, insurrection or military uprising or usurped power.
26. Act of Terrorism by nuclear means and terrorism by dissemination of biological, chemical and or bio-chemical agents and substances.
27. Your participation in the armed forces.
28. Orbital or sub-orbital flights.
29. Events related to travel warnings issued by Foreign Affairs Canada prior to Your Start Date that were or continue to be in effect for Your country, region or city of destination during Your Period of Coverage, as reflected in Your travel itinerary.
30. Contamination resulting from radioactive material or nuclear fuel or waste; or
31. Any trip as a driver, operator, co-driver, crewmember, or passenger on any commercial vehicle used to carry goods for sale, resale, or income.