Allianz Global Assistance

Important Notice

Please read your policy carefully.

  • Travel insurance is designed to cover losses arising from sudden and unforeseeable circumstances due to an emergency.
  • It is important that you read and understand your policy as your coverage may be subject to certain limitations or exclusions.
  • Costs incurred in your country of origin are not covered.
  • Your insurance contains pre-existing condition exclusions for travellers of any age. These exclusions apply to medical conditions and/or signs or symptoms that existed on or before your departure date or effective date. Check to see how this applies in your coverage and how it relates to your departure date, purchase date and effective date.
  • In the event of an accident, injury or sickness, your prior medical history may be reviewed when a claim is reported.
  • In the event of a medical emergency, you must notify AGA Emergency Assistance (toll-free 1-800-995-1662 or worldwide collect 416-340-0049) within 24 hours of admission to a hospital and before any surgeryis performed. Failure to notify AGA Emergency Assistance as required will delay the processing and payment of your claim and may limit the amount of your claim payment.
  • If you are ineligible for coverage, our only liability will be to refund any premium paid. Please check your confirmation of coverage to ensure you have the coverage options you require. Payment will be limited to the coverage options you selected and paid for at the time of application. You will be responsible for any expenses that are not payable by us.
  • If you have a change in your health between the date you apply for coverage and the effective date, you must contact your insurance representative to fully understand how your change in health affects your coverage under this policy. Failure to do so may limit the amount of your claim payment or result in your claim being denied. If you have been medically underwritten, you will also need to complete a new medical questionnaire.

To help you better understand your policy

Key terms in this policy are printed in bold italics and are defined in the Definitions section on page 14.

What are you covered for?

To find out what your coverage is, please refer to your confirmation of coverage and read the section titled Benefits.

What is not covered?

Travel insurance does not cover everything. Your policy has exclusions, conditions and limitations. You should read your policy carefully so that you are aware of, and understand, the limits of your coverage.

How do I make a claim?

Notify AGA as soon as possible in the event of an emergency.

Where possible, AGA will arrange to pay the provider directly.

To submit a claim under this policy, you will need to send a completed claim form (with all original bills and receipts from commercial organizations attached) to AGA. Please take care in filling out the form, as any missing information may cause delay. See Claims Procedures on page 24 for details.

What if my travel plans change?

You must contact your insurance representative to make any changes to your insurance.

I want to stay longer. Can I purchase further coverage?

Yes, you can, subject to policy terms and conditions. Just call your insurance representative or AGA (during business hours) before coverage under your policy expires. See Extending Your Trip on page 19 for details.

Travel Assistance

AGA will use its best efforts to provide assistance for a medical emergency arising anywhere in the world. However, we, AGA and their agents will not be responsible for the availability, quantity, quality, or results of any medical treatment received, or for the failure of any person to obtain medical service.

Eligibility

1. Coverage is NOT AVAILABLE to any individual who, as of their effective date:

a) has been diagnosed with a terminal illness; or

b) has been diagnosed with stage 3 or 4 cancer; or

c) has received treatment for any cancer (other than basal or squamous cell skin cancer or breast cancer treated only with hormone therapy) in the past 3 months; or

d) requires assistance with activities of daily living as the result of a medical condition or state of health.

2. To be eligible for coverage you must, as of the effective date:

a) be at least 15 days old and not more than 89 years old; and

b) not be insured or eligible for benefits under a Canadian government health insurance plan; and

c) be in good health at the time you purchase your policy and on the date you exit your country of origin, and know of no reason to seek medical consultation during the period of coverage.

Start of Coverage

Coverage starts on the effective date.

Waiting Period

Coverage for losses resulting from any sickness will begin 48 hours after the effective date if you purchase your policy:

a) after the expiry date of an existing AGA administered policy; or<./p>

b) after you exit your country of origin.

Any sickness that manifests itself during the 48-hour waiting period is not covered even if related expenses are incurred after the 48-hour waiting period.

End of Coverage

Coverage ends on the expiry date.

Insuring Agreement

In consideration of the application for insurance and payment of the appropriate premium, and subject to the terms, conditions, limitations, exclusions and other provisions of this policy, we will pay the reasonable and customary costs for eligible expenses incurred during the period of coverage while outside your country of origin, up to the amounts specified in this policy, in excess of any deductible and the amount allowed and/or paid for by any other insurance plan(s).

Payment is limited to the amounts specified under each coverage option. Some benefits are subject to advance approval by AGA.

You will be responsible for any expenses that are not payable by us.

Summary of Benefits

Accidental Death & Dismemberment …. up to sum insured
Emergency Hospital & Medical …………. up to sum insured
Included in the overall maximum:
Emergency Hospital …………………………. up to sum insured
Emergency Medical ……………………….. up to sum insured
Emergency Transportation ……………… up to sum insured
Accidental Dental …………………………………………. $4,000
Attendant ………………………………………………. up to $500
Chiropractor, osteopath, podiatrist/chiropodist,
physiotherapist or acupuncturist ……. $500 per profession
Dental Emergency ……………………………………. up to $500
Emergency Return Home ……………………….. up to $3,000
Out-of-Pocket Expenses …………………………. up to $1,500
Return of Deceased …………………………….. up to $10,000
Transportation of Family/Friend ……………… up to $3,000

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 anaesthetist.

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.

6 1A016PL-0316

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.

Specific 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.

The amounts payable for each eligible claim under
(a) and (b) above are in excess of all other sources of recovery and shall be reduced on a pro rata basis, so that the total amount paid for all such claims shall not exceed the respective aggregate limit which will be paid after the end of the calendar year and after completing the adjudication of all claims relating to act(s) of terrorism.

7. General Provisions of this policy apply. Refer to page 19.

Exclusions

VTC1 Pre-existing Conditions Exclusion

a) 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.

b) 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.

c) 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.

Definitions

Accident(al) means a sudden, unexpected, unforeseeable, unavoidable external event and excludes disease or infections.

Act of terrorism means an act, including but not limited to the use of force or violence and/or the threat thereof or commission or threat of a dangerous act, of any person or group(s) or government(s), committed for political, religious, ideological, social, economic or similar purposes including the intention to intimidate, coerce or overthrow a government (whether de facto or de jure) or to influence, affect or protest against any government and/or to put the civilian population, or any section of the civilian population, in fear.

Act of war means any loss or damage arising directly or indirectly from, occasioned by, happening through or in the consequence of: war; invasion; acts of foreign enemies; hostilities or warlike operations (whether war is declared or not) by any government or sovereign, using military personnel or other agents; civil war; rebellion; revolution; insurrection; civil commotion assuming the proportions of or amounting to an uprising; military or usurped power.

Activities of daily living means eating, bathing, using the toilet, changing positions (including getting in and out of a bed or chair) and dressing.

Aggregate limit means the total number or the maximum value of insured losses resulting from any one accident or event causing loss.

Commercial accommodation means an establishment providing short-term accommodation for paying guests, licensed under the law of its jurisdiction, which provides proof of commercial transaction.

Country of origin means the country in which you maintained a permanent residence prior to entry into Canada or the country which issued your passport. For Canadian passport holders without a permanent residence, country of origin means the country you departed from before arriving in Canada.

Deductible means the dollar amount for which you are responsible before any remaining eligible expenses are reimbursed under this insurance. It is retroactive to the effective date and applies once during the period of coverage. Your deductible is indicated on your confirmation of coverage.

Dependent children means your unmarried children who are:

  • a) financially dependent on you; and
  • b) at least 15 days of age and no more than 21 years of age.

Effective date means the later of:

  • a) the date and time the completed application and premium are accepted by AGA or its representative; or
  • b) the date indicated as the effective date on your confirmation of coverage; or
  • c) the first time you exit your country of origin.

If you purchase your policy after you have exited your country of origin, any sickness that manifests itself during the first

48 hours after the effective date is not covered even if related expenses are incurred after the 48-hour waiting period.

Emergency means a sudden, unforeseen sickness or injury occurring during the period of coverage while you are outside your country of origin, which requires immediate intervention by a physician or legally licensed dentist and cannot reasonably be delayed. An emergency is deemed to no longer exist when medical evidence indicates that you are able to continue your trip or return to your place of ordinary residence or country of origin. Costs incurred in your country of origin are not covered.
Expiry date means the earlier of:
Expiry date means the earlier of:

  • a) the date indicated as the expiry date on your confirmation of coverage; or
  • b) the date you become eligible for coverage under a Canadian government health insurance plan.

Family member means your spouse, parent, brother, sister, legal guardian, step-parent, step-child, step-brother, step-sister, aunt, uncle, niece, nephew, grandparent, grandchild, in-law, ward, natural or adopted child.

Heart condition includes angina or chest pain, arrhythmia, arteriosclerosis, atrial fibrillation, congenital heart defect, congestive heart failure, cardiomyopathy, carotid artery occlusion, heart attack (myocardial infarction), heart murmur, irregular heart rate or beat, any other condition relating to the heart or cardiovascular system.

High-risk activity(ies) mean(s) any skiing out of bounds, heliskiing, ski jumping, skydiving, sky-surfing, scuba diving (except if certified by internationally recognized and accepted program such as NAUI or PADI, or if diving depth does not exceed 30 meters), white water rafting (except grades 1 to 4), street luge, skeleton activity, mountaineering, or participation in any rodeo activity.

Hospital means a facility incorporated or licensed as a hospital by the jurisdiction where such services are provided and which has accommodation for resident in-patients, a laboratory, a registered graduate nurse and physician always on duty and an operating room where surgical operations are performed by a physician. In no event shall this include a convalescent or nursing home, home for the aged, health spa, or an institution for the care of drug addicts, alcoholics or persons suffering from mental disorders.

Injury means bodily harm, which is directly caused by or resulting from an accident, being a sudden and unforeseen event, excluding bodily harm that results from deliberate or voluntary action, and independent of sickness and all other causes.

Insured person means an eligible person named on the application, who has been accepted by AGA or its authorized representative, and has paid the required premium for a specific plan of insurance.

Lung condition includes chronic obstructive pulmonary disease (COPD), bronchial asthma, asthma, chronic bronchitis, emphysema, tuberculosis, pulmonary fibrosis.

Medical consultation means any medical services obtained from a licensed medical practitioner for a sickness, injury or medical condition, including but not limited to any or all of: history taking, medical examination, investigative testing, advice or treatment, and during which a diagnosis of the medical condition need not have been definitively made. This does not include regular medical check-ups where no medical signs or symptoms existed between check-ups or were found during the check-up.

Mountaineering means the ascent or descent of a mountain requiring the use of specified equipment including crampons, pick axes, anchors, bolts, carabiners and lead-rope or top rope anchoring equipment.
Nuclear, chemical or biological means the use of any nuclear weapon or device or the emission, discharge, dispersal, release or escape of any solid, liquid or gaseous chemical agent and/or biological agent, including the resultant contamination where:

  • Nuclear means any occurrence causing bodily injury, sickness, disease, or death, or loss of or damage to property, or for loss of use of property, arising out of or resulting from the radioactive, toxic, explosive, or other hazardous properties of source, special nuclear, or by-product material.
  • Chemical agent means any compound which, when suitably disseminated, produces incapacitating, damaging or lethal effects on people, animals, plants or material property.
  • Biological agent means any pathogenic (disease-producing) micro-organism(s) and/or biologically produced toxin(s) (including genetically modified organisms and chemically synthesized toxins) which cause illness and/or death in humans, animals or plants.

On-going expenses means any treatment, investigation or hospitalization which is a continuation of, or subsequent to, emergency treatment of a medical condition.

Period of coverage means the period from the effective date to the expiry date as indicated on your confirmation of coverage and for which premium has been paid. As selected and paid for at the time of application, the maximum period of coverage cannot exceed 365 days.

Physician means a person other than you, who is legally qualified and licensed to practice medicine or perform surgery in the location where the services are performed, and is not related to you by blood or marriage.
Pre-existing condition means a sickness, injury or medical condition, whether or not diagnosed by a physician:

  • a) for which you exhibited signs or symptoms; or
  • b) for which you required or received medical consultation; and
  • c) which existed prior to the effective date of your coverage.

Professional means you are considered professional by the governing body of the sport, earn the majority of your income from such activity, and are paid for your participation whether you win or lose.

Reasonable and customary means the services customarily provided or the costs customarily incurred for covered losses, which are not in excess of the standard practice or fee in the geographical area where the services are provided or costs are incurred for comparable treatment, services or supplies for a similar sickness or injury.

Sickness means any illness or disease.

Signs or symptoms means any evidence of disease experienced by you or recognized through observation.

Spouse means a person who is legally married to you, or a person who has been living with you in a common-law relationship for a period of at least 12 consecutive months.
Stability period:

  • a) if you are age 59 or under, is the 90 days immediately before the effective date.
  • b) if you are age 60 to 79, is the 180 days immediately before the effective date.

Stable describes any medical condition or related condition, including any heart condition or lung condition, for which:

  • a) there has been no new treatment; and
  • b) there has been no change in treatment or change in treatment frequency or type; and
  • c) there have been no signs or symptoms or new diagnosis; and
  • d) there have been no test results showing deterioration; and
  • e) there has been no hospitalization; and
  • f) there has been no referral to a specialist (made or recommended) and you are not awaiting surgery or the results of further investigations performed by any medical professional.

The following are considered stable:

  • a) Routine (not prescribed by a physician) adjustment of insulin to control diabetes provided the insulin was not first prescribed during the stability period.
  • b) Change from a brand name medication to a generic medication provided the medication was not first prescribed during the stability period and there is no increase or decrease in dosage.
  • c) A minor ailment, which describes a sickness or injury during the stability period which ended more than 30 days prior to the effective date and which did not require:

i. treatment for a period longer than 15 consecutive days; or

ii. more than one follow-up visit to a physician; or

iii. hospitalization, surgery, or referral to a specialist.
The following conditions are not considered stable:

  • a) any lung condition for which you were prescribed or are taking prednisone;
  • b) any heart condition for which you were prescribed or are taking nitroglycerin.

Terminal applies to a medical condition for which a physician gave a prognosis of eventual death or for which palliative care was received prior to the effective date.

Travelling companion means a person who has prepaid shared accommodation or transportation with you. (Maximum of 5 persons including you.)

Treatment means a medical, therapeutic or diagnostic procedure prescribed, performed or recommended by a physician including but not limited to prescribed medication, investigative testing or surgery.

Trip means a period during which you are travelling outside your country of origin and for which coverage is in effect.

We, us and our means CUMIS General Insurance Company, a member of The Co-operators group of companies.

You or your means the insured person.

General Provisions

Assignment

Any benefits payable or which may become payable under this policy cannot be assigned by you, and we are not responsible for and will not be bound by any assignment into which you have entered.

Automatic Extension of Coverage

1. Delay of conveyance. Coverage will be automatically extended for up to 72 hours in the event of a delay, due to circumstances beyond your control, of the conveyance in which you are riding or are scheduled to ride as a passenger. The delay must occur prior to the expiry date and the conveyance must be due to arrive prior to the expiry date.

Conveyance means a vehicle, airline, bus, train, or government-operated ferry system.

2. Medically unfit to travel. Coverage will be automatically extended for up to 5 days if medical evidence supports that you are medically unfit to travel due to a covered sickness or injury on or before the coverage expiry date.

3. Hospitalization. Coverage will be automatically extended during the period of hospital confinement, plus 72 hours after release to travel home, if you are hospitalized at the end of the period of coverage as a result of a covered injury or sickness. This coverage will be extended to your travelling companion(s) remaining with you
when reasonable and necessary, under their respective AGA administered policy.

Additional premium will not be required for any automatic extension of coverage.

Extending Your Trip

If you decide to extend your trip, you may apply for a new period of coverage provided you meet the Eligibility requirements on page 4 of this policy.

Each policy or period of coverage is considered a separate contract and all limitations and exclusions will apply.

Benefit Payments

Unless otherwise stated, all provisions in this policy apply to each insured person during one period of coverage. Benefits are only payable under one policy for each insured person during the period of coverage. If an insured person is recorded by us as having coverage under more than one of our policies at the same time, benefits will only be paid under one insurance policy, the one with the greatest sum insured. Benefits are only payable for the plans and the specific sum insured selected, paid for and accepted by AGA at the time of application, and indicated on your confirmationof coverage. Any benefits payable do not include interest charges. Benefits payable as a result of your death will be payable to your named beneficiary or to your Estate.

Claim Submission

You or the claimant, if other than you, shall be responsible for providing AGA with the following:

1. receipts from commercial organizations for all medical costs incurred and itemized accounts of all medical services which have been provided; and

2. any payment made by any other insurance plan or contract, including a government hospital/ medical plan; and

3. substantiating medical documentation, at the request of AGA.

Failure to provide substantiating documents shall invalidate all claims under this insurance.

Contract

The application, completed medical questionnaire, confirmation of coverage, this policy, any document attached to this policy when issued, and any amendment to the policy agreed upon in writing after it is issued, constitute the entire contract. Each policy or term of coverage is considered a separate contract.

We reserve the right to decline any application for coverage.

No condition of this policy shall be deemed to have been waived, either in whole or in part, unless the waiver is clearly expressed in writing and signed by us.

Coordination of Benefits

Amounts payable under this plan are in excess of any amounts available or collectible under any existing coverage concurrently in force held by or available to you.
Other coverage includes but is not limited to:

  • homeowners insurance;
  • tenants insurance;
  • multi-risk insurance;
  • any credit card, third-party liability, group or individual basic or extended health insurance;
  • any private or legislative plan of motor vehicle insurance providing hospital, medical or therapeutic coverage.

We will coordinate all benefits in accordance with the Canadian Life and Health Insurance Association guidelines.

Reimbursement will not be made for any costs, services or supplies that are payable to you under a motor vehicle insurance policy or legislative plan under any Insurance Act, or for which you receive benefits from any other party pursuant to any policy or legislative plan of motor vehicle insurance, until such benefits are exhausted.

You may not claim or receive in total more than 100% of the loss caused by the insured event.

Currency

All amounts stated in the policy, including premium, are in Canadian currency. If currency conversion is necessary, we will use the exchange rate on the date the service was rendered to you. At our option, benefits may be paid in the currency of the country where the loss occurred.

General Terms

Policy terms and conditions are subject to change with each new policy purchased, without prior notice, to reflect actual experience in the marketplace.

>Governing Law

This policy will be governed by the laws of the Canadian province or territory where the policy was issued.

Language

The parties request that the policy and all related documentation be drawn in English. Les parties demandent que la présente police ainsi que toute documentation pertinente soient rédigées en anglais.

Limit on Liability

It is a condition precedent to liability under this policy that at the time of application and on the effective date, you are in good health and know of no reason to seek medical attention.

Limitation of Action

Every action or proceeding against an insurer for the recovery of insurance money payable under the contract is absolutely barred unless commenced within the time set out in the Insurance Act (for actions or proceedings governed by the laws of Alberta, British Columbia, and Manitoba), the Limitations Act, 2002 (for actions or proceedings governed by the laws of Ontario), or other applicable legislation. For those actions or proceedings governed by the laws of Quebec, the prescriptive period is set out in the Quebec Civil Code.

Misrepresentation or Nondisclosure

Your failure to disclose or misrepresentation of any material fact, or fraud, either at the time of application or at the time of claim, shall render the entire contract null and void at our option, and any claim submitted thereunder shall not be payable.

Where there is an error as to your age, provided that your age is within the insurable limits of this policy, the premiums will be adjusted according to your correct age.

Premiums

The total premium amount is due and payable at the time of application. The premium is calculated using the most current rates for your age on the effective date of this policy as indicated on your confirmation of coverage.

A family rate is available. Family includes the applicant, age 59 and under, the applicant’s spouse, age 59 and under, and dependent children. The premium for family coverage is calculated at two times the premium for the eldest adult age 59 and under.

Rights of Examination

The claimant shall provide us with the opportunity to examine you when and so often as it reasonably requires while a claim is pending. In the case of your death, we may require an autopsy, subject to any laws of the applicable jurisdiction relating to autopsies.

Right to be Reimbursed (Subrogation)

As a condition to receiving benefits under the policy, you agree to:

  • a) reimburse us for all emergency medical and hospital costs paid under the policy from any amounts you receive from a third party responsible (in whole or in part) for your injury or sickness, whether such amounts are paid under a judgment or settlement agreement;
  • b) whenever reasonable, initiate a legal action against the third party to recover your damages, which include the emergency medical and hospital costs paid under the policy;
  • c) include all emergency medical and hospital costs paid under the policy in any settlement agreement you reach with the third party;
  • d) act reasonably to preserve our right to be reimbursed for any emergency medical or hospital costs paid under the policy;
  • e) keep us informed of the status of any legal action against the third party; and
  • f) advise your counsel of our right to reimbursement under the policy.

Your obligations under this section of the policy in no way restricts our right to bring a subrogated claim in your name against the third party and you agree to cooperate with us fully should we choose to exercise our right of subrogation.

Time

Expiry time of coverage is the time within the Canadian time zone where the coverage was purchased.

Premium 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 the remaining 20% 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.

6. Any other documents requested by AGA after initial review of the claim.

Privacy Information Notice

CUMIS General Insurance Company (the “insurer”) and the insurer’s insurance administrator, AGA, and the insurer’s agents, representatives and reinsurers (for the purpose of this Personal Information Notice collectively “we” “us” and “our”) require personal information including:

  • details about you including your name, date of birth, address, telephone numbers, e-mail address, employer, and other identification;
  • medical records and information about you;
  • records that reflect your business dealings with and through us.

This personal information is collected for the following insurance purposes when offering and providing insurance and related services:

  • to identify and communicate with you;
  • to consider any application for insurance;
  • if approved, to issue a Policy or Certificate of insurance;
  • to administer insurance and related benefits;
  • to evaluate insurance risk, manage and coordinate claims, re-price medical expenses and negotiate payment of claims expenses;
  • to investigate claims and to determine eligibility for insurance benefits;
  • to provide assistance services;
  • for fraud prevention and debt collection purposes;
  • as required or permitted by law.

We only collect personal information necessary for insurance purposes from individuals who apply for insurance, from Certificate or Policy holders, insureds and claimants. In some cases we also collect personal information from members of a Certificate or Policy holder’s, insured’s or claimant’s family or their friends when they are unable, for medical or other reasons, to communicate directly with us. We also collect

and disclose information for the insurance purposes from, to and with, third parties such as, but not necessarily limited to, health care practitioners and facilities in Canada and abroad, government and private health insurers and family members and friends of the insured, Certificate or Policy holder or claimant. We may also use and disclose information from our existing files for the insurance purposes. Our employees who require this information for the purposes of their duties will have access to this file.

Upon your request and authorization, we may also disclose this information to other persons.

From time to time, and if permitted by applicable law, we may also collect, use or disclose personal information in order to offer additional or upgraded products and services (the “optional purposes”).

When an individual applies for, purchases, or is covered by one of our insurance policies or submits a claim for insurance benefits, he or she is presumed to consent to the personal information practices described in this notice. If an individual does not wish to have their personal information used for the optional purposes they need only notify AGA. A person may decline to have their information collected, used or disclosed for the insurance purposes but in that instance we will likely be unable to provide insurance and related services.

Personal information is maintained in the Policy or Policy holder’s, insured’s or claimant’s file that we establish and maintain in the offices of AGA. In some instances we may additionally maintain or communicate or transfer information to health care and other service providers located outside of Canada. As a result, personal information may be accessible to regulatory authorities in accordance with the law of these other jurisdictions. For information about how to obtain access to written information about our policies and procedures with respect to service providers outside of Canada, please contact the Privacy Officer at privacy@allianz-assistance.ca.

We will retain the personal information we collect for a specified period of time and in a storage method appropriate with legal and our internal corporate requirements. Personal information will be securely destroyed following the expiration of the appropriate retention period. Individuals have a right to request to access or correct personal information we have on file by contacting the Privacy Officer at privacy@allianz-assistance.ca or by writing to:

Privacy Officer

Allianz Global Assistance

250 Yonge Street, Suite 2100
Toronto, Ontario M5B 2L7
Canada

Fax: (416) 340-2707

For a complete copy of our Privacy Policy please visit ww.allianz-assistance.ca

Questions?

If you have any questions or concerns about our products, services, your policy, or claim please feel free to contact Allianz Global Assistance anytime:

Toll Free: 1-800-670-4426

Collect: (416) 340-1980

Statutory Conditions

Despite any other provision contained in the contract, this contract is subject to the statutory conditions in the Insurance Act respecting contracts of accident and sickness insurance. For Québec residents, notwithstanding any other provisions herein contained, this contract is subject to the mandatory provisions of the Civil Code of Québec respecting contracts of Accident and Sickness Insurance.

Administered by

AZGA Service Canada Inc.
o/a Allianz Global Assistance

250 Yonge Street, Suite 2100
Toronto, Ontario M5B 2L7
Canada

Underwritten by

CUMIS General Insurance Company

P.O. Box 5065, 151 North Service Road
Burlington, Ontario L7R 4C2
Canada

Emergency Procedures

In the event of a medical emergency, you must notify AGA Emergency Assistance (toll-free 1-800-995-1662 or worldwide collect 416-340-0049) 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.

AGA is here to help. AGA’s service is available 24 hours a day, 7 days a week. AGA Emergency Assistance also provides support and recommendations for non-medical emergencies, providing you with access to resources to help resolve any unexpected difficulties you encounter during your trip.

For 24/7 emergency assistance call
Allianz Global Assistance

Toll-free Canada/USA: 1-800-995-1662

Toll-free worldwide: 00-800-842-08420 or
Country code + 800-842-08420

If unable to contact AGA through the toll-free numbers call collect: 416-340-0049. International operator assistance is required. Please confirm how to call collect to Canada from your destination prior to departure.