Who Is Eligible for Coverage?
All of the following restrictions apply:
1.You must not have a Medical Condition for which a Physician has advised You against travel before
Your Period of Coverage.
2.You must be over 14 days old and under 85 years of age during the entire Period of Coverage.
Ages 15 days to under 70 years of age during the entire Period of Coverage may purchase Plan Limits of $100,000 or $300,000;
Ages 70 to under 85 years of age during the entire Period of Coverage You may only purchase the $100,000 Plan Limit.
3.You must not be eligible for benefits under any Canadian federal, provincial or territorial government health insurance plan.
4.Prior to Your Period of Coverage:
a.)You have not been diagnosed with a Terminal Sickness;
b.)You have never been diagnosed with or received Treatment for:
i.)congestive heart failure;
ii.)Acquired Immune Deficiency Syndrome (AIDS) or Human Immunodeficiency Virus (HIV);
iii.)Alzheimer’s or any type of dementia;
iv.)pancreatic or liver cancer, or any type of metastasized cancer; or
v.)a condition requiring a bone marrow or organ transplant.
c.)You do not reside in a nursing home, assisted living home, convalescent home, hospice or rehabilitation centre;
d.)You do not require any assistance with Normal Daily Activities. This does not apply to children under 12 years of age.
5.)In the 12 months immediately prior to Your Period of Coverage, You have not been diagnosed with or received Treatment for:
a.)a lung condition requiring the use of home oxygen;
b.)a kidney condition requiring dialysis.
6.)At time of purchase of this Policy, You are not aware of needing any medical Treatment during Your Period of Coverage.
If You do not meet the eligibility requirements listed above, Your insurance is void and the Company’s liability is limited to a refund of the premium paid.
PERIOD OF COVERAGE
Start Date – When Coverage Begins
Coverage under this Policy begins on the latest of the following:
a.)Your Departure Date;
b.)Your Policy purchase date; or
c.)The effective date shown on Your Policy Confirmation.
Benefits under this Policy are subject to the following conditions:
a.)if Your Start Date is Your Departure Date, You must be scheduled to arrive in Canada within
48 hours after You leave Your Home Country. If You are scheduled to arrive in Canada more than 48 hours after You leave Your Home Country</>, coverage only begins on the date and time You arrive in Canada;
b.)if Your Start Date is after Your Departure Date,the following Waiting Periods will apply:
i.)24 hours for an Injury;
ii.)48 hours for a Sickness if Your Start Date is within 30 days of Your Departure Date;
iii.)48 hours for a Sickness if You are continuing coverage from an existing policy with no gap in coverage;
iv.)7 days for a Sickness if Your Start Date is more than 30 days from Your Departure Date.
When Coverage Ends
Your coverage ends on the earliest of the following:
1.)The date and time You cancel Your insurance;
2.)The date You become eligible for coverage under any Canadian federal, provincial or territorial government health insurance plan;
3.)The date You return to Your Home Country;
4.)The Expiry Date as shown on Your Policy Confirmation.
Automatic Extension of Coverage
Your coverage will be extended automatically beyond the Expiry Date shown on Your Policy Confirmation in the following cases:
1.If Your scheduled Common Carrier is delayed, then Your coverage will be extended for up to 72 hours; or
2.If You, Your Travelling Companion, or a Family Member travelling with You are in Hospital on or before Your Expiry Date,then Your coverage will be extended until the Hospital stay ends plus up to 5 days after discharge while outside Your Home Country; or
3.If You, Your Travelling Companion, or a Family Member travelling with You are unable to travel for a medical reason that does not need hospitalization but is documented by a Physician in Canada, then coverage will be extended for up to 3 days.
Extending Coverage After Arrival In Canada
To extend Your Period of Coverage after arrival in Canada, contact Your agent.
We will extend Your Coverage under this Policy beyond Your Expiry Date if:
1.)You have not reported a claim;
2.)You agree that expenses related to Medical Conditions present on the date You apply for an extension will not be covered;
3.)Your Policy is in force when You request an extension; and,
4.)You pay the additional required premium.
In all other cases the Company must approve Your coverage extension. Coverage cannot be extended beyond 18 months from Your original Start Date.
You must disclose all medical information otherwise the coverage extension is void.
How Do You Become Insured
You become insured and this brochure becomes an insurance Policy:
- When You are named on a completed insurance Policy Confirmation; and
- When You pay the required premium on or before Your coverage Start Date.
SCHEDULE OF MAXIMUM BENEFITS
|EMERGENCY MEDICAL||Plan Limit|
|Emergency Medical Expenses||Included|
|Emergency Return Home||Included|
|Repatriation of Remains||$5,000|
|Cremation/Burial at Destination||$3,000|
Plan Limit means the maximum amount of coverage under this Policy purchased by You as shown on
Your Policy Confirmation.
NOTE:Please see the appropriate Policy section for any specific benefit limits.
When It Applies
If You have a medical Emergency or need help during Your Period of Coverage .
What We Provide – 24/7
1.)Worldwide multi-lingual medical and dental referrals. If You need care from a Physician, dentist or medical facility while You are travelling, We can help You find one.
2.)Advance payment to We will provide advance payment to a Hospital if it is required to secure Your admission for a covered Sickness or Injury. If We determine later that a Policy exclusion applies to Your claim, You will be required to reimburse Us for any payments We made on Your behalf.
3.)Monitoring of Treatment. If You are hospitalized, Our medical staff will stay in contact with You and the attending Physician caring for You. We can also notify Your family and Your doctor back home of Your Sickness or Injury and update them on Your status.
4.Transfer of insurance information to medical providers. If You need medical Treatment for an Injury or Sickness, We will obtain and relay coverage information to emergency medical providers, if available.
5.)Vaccine and blood transfers. If needed, We will coordinate the transfer of required blood or vaccine to You.
6.)Dispatch of doctors and specialists. If You need the care of a Physician or specialist, We will coordinate the appropriate dispatch.
7.)Transfer of medical records. If and when needed for Emergency Treatment, We will coordinate the transfer of available medical records and related information to the attending Physician.
8.)Updates to family, employer and home Physician. If You are hospitalized, We will provide appropriate medical condition updates to Your family, employer and/or personal doctor.
B.MEDICAL EVACUATION AND REPATRIATION SERVICES
All evacuation and repatriation services must be pre-approved and arranged by Us.
1.)Emergency medical evacuations. If Our medical team and the local attending Physician agree that the local care facility cannot treat Your Sickness or Injury, We will transport You to the nearest appropriate facility with accompaniment if needed.
2.)Transportation after stabilization. If You are medically stable and We determine that You should return to Your Home Country for continued medical Treatment, then We will arrange for the cost of a one way Fare to get You home (less any refunds from Your unused return trip tickets).
3.)Repatriation of mortal remains. We will arrange for the reasonable and necessary services to transport Your remains to Your place of residence.
What Happens When You Call For Assistance
- You will be referred to the most appropriate service provider for Your
- We will confirm that a Policy was issued.
- Before receiving all relevant medical information, We will handle Your Emergency as if You were eligible for benefits under this Policy. If We determine later that a Policy exclusion applies to Your claim, You will be required to reimburse Us for any payments We made on Your
- We will remind You that any services rendered are subject to the terms and conditions of this Policy. If We determine later that a Policy exclusion applies to Your claim, You will be required to reimburse Us for any payments We have made on Your
- If Your claim is payable We will arrange to have medical expenses billed directly to the Company where possible
What To Do When You Need Assistance
Always have Your Policy number or Policy Confirmation with You when You travel. Use the information below to contact Our assistance provider anytime, 24 hours a day, 7 days a week. If You place a collect call to the Emergency Assistance Provider as instructed below and it does not work, please dial direct and submit the charges incurred along with Your claim documents.
|USA & Canada||1-800-334-7787|
|Elsewhere Operator Assisted Collect 905-667-0587|
When You contact Our assistance provider, please give Your name, Your policy number, Your location and the nature of the Emergency .
Limitation on Emergency Assistance Provider Services
The Company and/or the Emergency Assistance Providerreserve the right to suspend, curtail or limit services in any area or country in the event of:
- rebellion, riot, military uprising, war; or
- labour disturbances, strikes; or
- nuclear Accidents , acts of God, or refusal by the authorities in the country where assistance is required, to permit the delivery of such services.
The Emergency Assistance Providerwill use its best efforts to provide the required services during any such occurrence.
TheEmergency Assistance Provider’s obligation to provide services described in this Policy is subject to the terms, conditions, limitations and exclusions set out in this Policy. The medical professional(s) suggested or designated by the Company or the Emergency Assistance Providerto provide services according to the benefits and terms of this Policy are not employees of the Company or the Emergency Assistance Provider. Therefore, neither the Company nor the Emergency Assistance Provider shall be held responsible or liable for any negligence or other acts or omissions on their part, nor for the availability, quality, quantity or results of any medical Treatment or service You may receive or Your failure to obtain or receive any medical Treatment or service.
When It Applies
If You have a medical Emergency while You are visiting Canada.
What We Cover
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 while admitted to hospital.
- 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 8 of this Policy before admission to Hospital or within 24 hours after a life or organ-threatening 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.)Repatriation: in the event of Your death during Your Period of Coverage, the Company will reimburse the reasonable costs actually incurred for the preparation and repatriation of Your body or ashes to Your Home Country up to $5,000;or up to $3,000 for the cremation or burial at the place of death.
- No benefit is payable for the cost of a headstone, casket, urn and/or funeral service expenses.
What We Exclude
There is no coverage and no benefits will be payable for claims presented under this section resulting from:
1.)Any Pre-Existing Condition or Medical Condition that was present on 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;
Any expenses incurred outside Canada except for Emergency expenses incurred en route to Canada after the date and time You leave Your Home Country provided coverage was purchased prior to arrival in Canada and You are scheduled to arrive in Canada within 48 hours of departure;
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, 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;
Transplants of any kind;
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.)Pregnancy, childbirth, complications of pregnancy or childbirth, or voluntarily induced abortion; or a child born during Your Period of Coverage.
14.)Your use of drugs, alcohol, or any medication that results directly or indirectly in the condition causing a claim;
15.)Your suicide, attempted suicide or any intentionally self-inflicted Injury;
16.)Your participation in Extreme Activities;
17.)Your participation in organized professional sporting activities;
18.)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);
19,)Your riding, driving or participating in races of speed or endurance;
20.)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;
21.)Fraud, concealment, or deliberate misstatement in relation to any matter affecting this insurance or in connection with the making of any claim hereunder;
22.)Your participation in a crime or malicious act;
23.)Your participation in a riot or insurrection;
24.)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;
25.)Act of Terrorism by nuclear means and terrorism by dissemination of biological, chemical and or bio-chemical agents and substances;
26.)Your participation in the armed forces;
27.)Orbital or sub-orbital flights;
28.)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;
29.)Contamination resulting from radioactive material or nuclear fuel or waste; or
30.)Any trip as a driver, operator, co-driver, crewmember, or passenger on any commercial vehicle used to carry goods for sale, resale or income.
What We Pay
You will be reimbursed for the Reasonable and Customary charges to treat an Emergency Sickness or Injury, less any applicable Deductible.Your Policy Confirmation shows the maximum benefit payable for this insurance.
What To Do If You Have A Claim
To receive Treatment:
Contact the Emergency Assistance Provider using the information in the Travel Assistance section on page 8. You or someone on Your behalf must do this before receiving Treatment for Your medical Emergency. Failure to do so will result in You being responsible for 20% of any eligible expenses incurred.
You or someone acting on Your behalf, must authorize Us to access all medical documentation from the Treatment provider at Your location and Your personal Physician(s) at home for the applicable pre-existing time period.
In order to qualify for coverage under this provision,
You must submit to Us with Your claim:
1.)The completed medical claim form;
2.)Original receipts or other proofs of payment;
3.)Detailed medical documentation; and
4.)Any other information We deem necessary to properly adjudicate Your claim.
GENERAL POLICY PROVISIONS
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 You leave Your Home Country for other than “a)” above ($250 fee will be deducted);
c.)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
d.)cancel Your Policy and decide to stay in Canada ($250 fee will be deducted).
A request for refund must be submitted to Your agent 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.
Despite any other provision contained in the contract, the contract is subject to the statutory
conditions in the Insurance Act respecting contracts of accident and sickness insurance.
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 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.
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.
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.
Accident means a happening due to external, violent, sudden or fortuitous causes beyond Your control which occurs during the Period of Coverage.
Act of Terrorismor Terrorism means the unsanctioned and illegal use of violence (excluding general civil disturbance, rioting and act of war (declared or undeclared) or the intentional release of a biological material), which caused destruction of property, Injury or death for the express or implied purpose of achieving a political, ethnic or religious goal or result.
Caregivermeans the permanent full-time person entrusted with the well-being of Your dependent(s) and whose absence cannot reasonably be replaced.
Children means any insured unmarried person who is dependent upon You for support, is travelling with You or who joins You during Your Period of Coverage and is either: i) under 21 years of age; ii) under 26 years of age if a full-time student; or iii) of any age who is mentally or physically handicapped.
Common Carrier means commercial airline carrier, cruise ship, ferry, bus, train, taxi, limousine or other similar vehicle that is licensed, intended and used primarily to transport passengers for hire not including rented, leased or privately owned vehicles.
Company, We, Our, Usmeans Old Republic Insurance Company of Canada (In Quebec, Reliable Life Insurance Company), Hamilton, Ontario.
Contaminationmeans poisoning of people by nuclear, chemical and/or biological substances that cause Sickness or death.
Deductible means the amount of covered expenses per Emergency, under the Emergency Medical section of this Policy that You are responsible for paying before any remaining covered expenses are paid under this Policy. The amount of the Deductible for which You are responsible, is shown on Your Policy Confirmation. If You are Hospitalized for 72 consecutive hours, we will waive the first $250 of any Deductible.
Departure Datemeans the date You actually leave Your Home Country.
Emergency means an unforeseen Sickness or Injury that requires immediate Treatment to prevent or alleviate existing danger to life or health. An Emergency no longer exists when medical evidence indicates that You are able to return to Your Home Country or continue with Your visit in Canada.
Emergency Assistance Providerprovides the Emergency service 24 hours a day, 7 days a week , during Your Period of Coverage.
Expiry Datemeans the date coverage under this Policy ends as shown on Your Policy Confirmation.
Extreme Activities means participating in any of the following: bungee jumping, hang-gliding, hunting, mountain climbing, parachuting, paragliding, rock climbing (not mountaineering), scuba diving (unless qualified and not diving deeper than 130 feet), skydiving, spelunking, tall ship crewing.
Family Member means Spouse, parent, legal guardian, step-parent, grandparent, grandchild, in-laws, natural or adopted child, stepchild, brother, sister, stepbrother, stepsister, aunt, uncle, niece, nephew or an employed Caregiver for unmarried dependent Children under 16 years of age.
Faremeans the lowest single seat fare from any International Air Transportation Association carrier.
Home Countrymeans Your country of permanent residence.
Hospitalmeans a duly licensed facility which accommodates inpatient care, which has registered nurses on a full-time basis, a laboratory and an operating room where surgical operations are performed by qualified surgeons. Excluded are convalescent homes, rest homes, nursing homes, homes for the aged, drug and alcohol treatment centres, health spas or clinics or any facility not operated 24 hours per day under the supervision of a Physician.
Injurymeans sudden bodily damage caused by an Accident during the Period of Coverage.
Material Factmeans any fact that would cause Us to decline Your application for insurance or charge more premium than You have paid for the insurance Policy.
Medical Conditionmeans an irregularity in a person’s health which required or requires medical advice, consultation, investigation, Treatment, care, service or diagnosis by a Physician.
Medically Necessarymeans Treatment or services that are appropriate for the relief of Sickness or Injury in an Emergency, based on generally accepted professional medical standards.
Normal Daily Activitiesmeans eating, bathing, use of a toilet, getting in and out of a bed or chair, and dressing.
Physicianmeans a person, other than You, a Travelling Companion or a Family Member, who is qualified and legally licensed to practice medicine, perform medical Treatment and/or surgery within the scope of their licence in the place where the medical services are rendered.
Plan Limit means the maximum amount of coverage under this Policy purchased by You as shown on Your Policy Confirmation.
Policymeans this document and Your Policy Confirmation, which is issued in consideration of payment of the required premium.
Policy Confirmationconfirms the insurance coverage You have purchased, sets forth Your Policy purchase date, Your effective date and the Expiry Date of Your Period of Coverage and forms an integral part of the Policy contract.
Pre-Existing Conditionmeans a Medical Condition for which Treatment has been received or taken or which exhibited symptoms, prior to Your Start Date and within the period specified, and includes a medically recognized complication or Recurrence of a Medical Condition.
Reasonable and Customarymeans charges that are usually made by other providers of similar standing for residents in the locality where the charges are incurred, for comparable Treatment, services or supplies for a similar medical Emergency.
Recurrencemeans the appearance of symptoms caused by or related to a Medical Condition which was previously diagnosed by a Physician or for which Treatment was previously received.
Sicknessmeans an acute illness, acute pain and suffering or disease that requires Emergency medical Treatment or hospitalization due to the sudden onset of symptoms during the Period of Coverage.
Spousemeans the person who is legally married to You, or if not married to You, has been living in a conjugal relationship with You for a continuous period of at least one year.
Start Datemeans the date Your insurance coverage under this Policy begins (See Period of Coverage page 4).
Terminal Sicknessmeans a Medical Condition from which no recovery is expected and which carries a prognosis of death within 12 months of Your Start Date.
Travelling Companionmeans the person who is travelling with You during Your Period of Coverage up to a maximum of five persons, including You.
Treat, Treated or Treatmentmeans any medical, therapeutic or diagnostic procedure prescribed, performed or recommended by a Physician including but not limited to prescribed medication, investigative testing and surgery.
Waiting Periodmeans the period of time after the Start Date of Your Policy during which You are ineligible for benefits. If You become sick or injured during this period of time, Your Policy will not cover any expenses resulting from or related to this condition even if the Waiting Period is over.
You or Yourmeans a person who is eligible and named on the Policy Confirmation for insurance under this Policy and for whom the required premium has been paid.
In this Policy, words and terms denoting the singular shall be interpreted to mean the plural and vice versa, unless the context clearly indicates otherwise.
Travel Claims Department
P.O. Box 557, Hamilton, Ontario L8N 3K9
|Toll Free Fax:||1-866-551-1704|
|Toll Free Telephone|
|Canada & USA:||1-888-526-0111|
|Direct Dial Telephone||905-667-3391|
If You experience an emergency or require medical assistance while You are travelling at any time call:
|USA & Canada||1-800-334-7787|
|Elsewhere Operator Assisted Collect 905-667-0587|
How To Submit A Claim
You can download a claim form directly from Our website:
or You can contact Us toll free at: 1-888-526-0111
To make a claim for benefits under this Policy:
- Submit Your claims forms within 30 days after the expense or loss is incurred or as soon as is reasonably possible;
- Written proof of the claim must be submitted within 90 days, but not later than 12 months after the date of the event or loss.
Written Proof of a Claim shall include:
1.)the completion of any claim forms furnished by the Company;
3.a written report, complete with the diagnosis by the attending Physician, if applicable, and any other form of documentation deemed necessary by the Company to validate Your claim.
Original substantiating claims documentation must be provided, however, the Company may accept certified copies if the original documentation cannot be provided for a reasonable cause. Failure to provide applicable substantiation for a claim shall invalidate any claim under this Policy. All documents required to support or validate the claim, including English or French translations of such documents, must be provided free of expense to the Company.
We will pay covered claims, less any applicable Deductible, within 30 days of receiving all of the information We need to assess Your claim accurately.
We will pay eligible benefits to You or to any person or entity having a valid assignment to such benefits. In the event of Your death, any balance remaining or benefits payable for loss of life will be paid to Your estate, unless otherwise indicated.
Limitation of Action
If You have a claim in dispute under this Policy, You must begin any legal action or proceeding against the Company within 24 months following the date of the event which caused the claim. All legal actions or proceedings must be brought in the province of Ontario where the head office of the Company is located.
The Company is committed to protecting Your privacy. Collecting personal information about You is essential to Our ability to offer You high-quality insurance products and service. The information provided by You will only be used for determining Your eligibility for coverage under the Policy, assessing insurance risks, managing and adjudicating claims and negotiating or settling payments to third parties. This information may also be shared with third parties, other insurance companies, health organizations and government health insurance plans to adjudicate and process any claim. In the event that We must share Your information with a third party who conducts business outside of Canada, there is a possibility that this information could be obtained by the government of the country in which the third party conducts business. We take great care to keep Your personal information accurate, confidential and secure.
Old Republic Insurance Company of Canada In Quebec, Reliable Life Insurance Company
Paul M. Field, CPA, CA
President and Chief Executive Officer