Hospital/Medical Coverage

Coverage under this provision is available on an "Emergency" basis only. It provides benefits for covered losses resulting from injury or sickness occurring during the first 90 consecutive days of a trip outside of the province of residence, subject to the following exclusions, limitations and provisions. An eligible Spouse and each eligible Dependent Child is insured for the same coverage as the Member. In no event will coverage extend beyond age 80.

When injuries or sickness result in Emergency Hospital confinement or require Emergency medical or therapeutic services as listed below, benefits will be paid to a maximum of $5,000,000.00, for the actual expenses incurred outside the province of residence, that exceed the amount which is payable with respect to such expenses under any government hospitalization or medical care plan in Canada, or if an Insured Person is not covered under any such plan, to the extent they exceed any amount which would be payable with respect to such expenses under the government hospitalization or medical care plan if he or she were covered under any such plan.

Benefit maximum amount reduces as follows:
Under age 75 - $5,000,000 lifetime maximum;
Age 75 to age 80 - $1,000,000 lifetime maximum.

Emergency Medical Assistance Benefit

Obtaining the services you need is fast and easy. By calling the toll-free numbers provided below, you have access to multilingual operators 24 hours a day, 7 days a week. A Wallet Card showing these phone numbers and your policy number is available from the Administrative Agent’s Office. The Insurer must be notified within 48 hours from the time of the incident.

In an Emergency, Here's What to Do

Emergency Hospital Confinement

If you are confined as a resident inpatient in a Hospital, reimbursement will include those reasonable and customary charges made by the Hospital for services rendered and supplies provided, including semi-private accommodation, to the extent that they are Medically Necessary.

In the event that an Insured Person is confined to Hospital at the end of his or her trip outside the province of residence and thus prevented from returning to the province of residence, insurance will continue for the period of such confinement, but in no event for more than 12 months from the date the first covered expense was incurred.

Extended Coverage After Termination

In the event of the delayed arrival of a common carrier or hospitalization of the Insured Person this benefit will automatically be extended at no charge;

1. 24 hours in the event of a delayed common carrier,
2. the period of hospitalization plus 72 hours after the Insured Person is released from hospital.

Emergency Medical and Therapeutic Services

Benefits are payable for reasonable and customable charges to the extent they are Medically Necessary, for the following:

• The services of a legally qualified Physician or surgeon (other than an Immediate Family member of the Insured Person);
• Laboratory tests and X-ray examination ordered by a legally qualified Physician for the purpose of diagnosis;
• The services of a registered graduate nurse (other than an Immediate Family member of the Insured Person), up to a maximum of 50 nursing shifts at a fee, but not to exceed $100.00 per shift;
• Rental of crutches or Hospital type bed, or the cost of splints, canes, slings, trusses, braces or other approved prosthetic appliances;
• The services of a legally qualified anaesthetist;
• Drugs or medicines that require a legally qualified Physician's written prescription;
• Services of a Chiropodist, Chiropractor, Osteopath, Physiotherapist, or Podiatrist (other than an Immediate Family member of the Insured person) up to a maximum of $300.00 for each class of practitioner;
• Expenses for accidental injury to natural and sound teeth (capped or crowned teeth are considered whole or sound natural teeth) which requires treatment by a legally qualified dentist or dental surgeon within 30 days from the date of the accident, not to exceed in the aggregate the amount of $2,000.00 as the result of any one accident;
• Out-patient services provided by a Hospital.

Repatriation Benefit

If an Insured Person suffers Injury or sickness resulting in Loss of Life and:

• Such Loss of Life occurs outside his or her province of residence; and
• Such Loss of Life occurs within 365 days of the date of the accident causing the Injury or sickness causing Loss of Life. The Insurer will pay the actual expenses incurred for preparing the deceased Insured Person for burial or cremation and shipment of the body to the city of residence of the deceased Insured Person. The maximum amount payable for Repatriation is $15,000.00 per Insured Person.

Identification Benefit

If an Insured Person suffers Injury or sickness resulting in Loss of Life and the Insured Person’s body requires identification, the Insurer will pay the reasonable and necessary expenses actually incurred by one member of the Immediate Family for:

• Commercial lodging and board while en route and/or during the stay in the city or town where the body is located (not to exceed a maximum duration of three consecutive nights); and
• Transportation by the most direct route to the location.

This benefit is payable only if the body is located outside the said Immediate Family member’s normal province of residence and the identification of the body is requested by the police or similar law enforcement agency having authority over such matters.

Payment will not be made for ordinary living, travelling or clothing expenses, other than as specifically stated above. If transportation occurs in a vehicle or device other than one operated under the license for the conveyance of passengers for hire, the reimbursement of transportation expenses will be limited to a maximum of $0.20 per kilometre travelled.

The benefit is payable only once in connection with Injuries, sickness and Losses suffered by any one Insured Person, regardless of the number of policies providing coverage for this benefit for such Insured Person, that may be issued by the Insurer. The maximum amount payable for Identification Benefit is $10,000.00, per Insured Person.

Trip Interruption Benefit

If your scheduled departure is delayed for at least 12 hours due to sickness or hospitalization as provided by the Plan, or due to sickness or hospitalization of your covered travelling companion, the Company will reimburse you up to a maximum of $500 for the extra cost of your one-way economy/charter air fare via the most cost-effective itinerary to your next scheduled travel destination or original departure point of the same trip.

The Company will also reimburse the additional and unplanned hotel and meal expenses, telephone calls and taxi fares up to a combined maximum of $300 per day to a maximum of 5 days.

In order to claim any of the above outlined expenses, original itemized invoices must be provided at time of claim.

The combined maximum amount payable for this benefit is $2,000 per Insured Person per incident.

Automobile Return Benefit

If Injury or Sickness results in an Insured Person becoming Totally Disabled and unable to continue his or her trip, the Insurer will pay the actual expense incurred for a commercial agency to return the Insured Person’s private or rental Vehicle used for the trip, to the Insured Person’s place of residence or nearest rental agency, up to a maximum of $5,000.00.

Out of Pocket Expense

The Insurer will pay up to $150.00 per day for reasonable and necessary commercial living expenses incurred by any Insured Person or their Insured Travel Companion if an Insured Person becomes Totally Disabled and cannot continue their trip, up to a maximum benefit of $1,500.00.

Family Transportation

If an Insured Person suffers Injury or sickness resulting in the Insured Person being confined to a Hospital located outside his or her permanent province of residence, the Insurer will pay the reasonable and necessary expenses actually incurred for the transportation of one member of the Immediate Family to such Hospital if:

• Confinement to Hospital occurs within 365 days of the accident causing the Injury or sickness; and
• Reimbursement of expenses are limited to the cost of one economy class return airfare via the most direct route, or the equivalent amount toward another type of common carrier transportation for such Immediate Family member, and incidental travel expenses up to a maximum of $250.00.

The maximum amount payable for Family Transportation for all injuries resulting from any one accident or sickness is $15,000.00 per Insured Person.

Emergency Transportation

Ground Transportation:

The Insurer will pay the reasonable and necessary charges for the use of a licensed ground ambulance to a maximum of $5,000.00 for any one Injury or sickness.

Air Transportation:

If an Injury or Sickness commencing during the course of a trip results in the Medically Necessary emergency air transportation of the Insured Person, the Insurer will pay benefits for covered expenses up to a maximum of $50,000.00. Air transportation must first be approved by the Insurer and it must be ordered by a legally licensed Physician who certifies that the severity of the Insured Person’s injury or sickness warrants the air transportation of the Insured Person and that such is Medically Necessary.

If due to the geographical area at the onset of the Medical Emergency an Air Ambulance is deemed necessary, the Insurer will pay the cost of a licensed air ambulance to transport the Insured Person to the nearest Hospital or medical facility where appropriate medical treatment can be obtained. Air transportation means:

a) The Insured Person’s medical condition warrants immediate transportation from the place where the Insured Person is injured or sick to the nearest Hospital where appropriate medical treatment can be obtained; or

b) After being treated at a local Hospital, the Insured Person’s medical condition warrants transportation to the place where he or she resides (provided such residence is located in the Canada) to obtain further medical treatment or to recover; or

c) Both a) and b) above.

Covered expenses are only those reasonable and customary expenses, up to the maximum, for transportation, medical services and medical supplies which are Medically Necessary and incurred in connection with the air transportation of the Insured Person. All transportation arrangements made for transporting the Insured Person must be the most direct and economical route. Expenses for special transportation must be recommended by the attending Physician, or required by the standard regulations of the conveyance transporting the Insured Person. Expenses for medical supplies and services must be recommended by the attending Physician. Air transportation means any land, water or air conveyance required to transport the Insured Person during air transportation. Special transportation includes, but is not limited to, air ambulance, land ambulances, commercial airlines and private motor vehicles.

Exclusions

There is no coverage under this policy and no payment shall be made for any loss resulting in whole or in part from, or contributed to by, or as a natural and probable consequence of any of the following excluded risks:

• Injuries received while the Insured Person is participating in any manoeuvres or training exercises of the armed forces, national guard or organized reserve corps of any country or international authority;
• Pregnancy, miscarriage, voluntary termination of pregnancy, childbirth or their complications except that in the case of an unexpected pregnancy complication of which occur before the end of the seventh month;
• Sickness or Injury where the trip is undertaken for the purpose of securing medical treatment or advice for such Sickness or Injury;
• Dental surgery or cosmetic surgery unless such surgery is a result of a covered Injury;
• Emotional or mental disorders unless the Insured Person is confined in a Hospital;
• Sickness or Injury due to participation in professional sports;
• Treatment or services that contravene any Government Health Insurance plan in Canada;
• Expenses incurred on an elective (non-emergency) basis;
• Suicide or any attempt at suicide while sane or insane;
• Intentionally self-inflicted Injury or any attempt at intentionally self-inflicted Injury, while sane or insane;
• An act of declared or undeclared war, civil war, rebellion, revolution, insurrection, military or usurped power or confiscation or nationalization or requisition by or under the order of any government or public or local authority;
• Any services or supplies provided by an Insured Person or an Immediate Family Member of the Insured Person;
• A sickness or Injury that, at the time of departure, might reasonably be expected to require an Insured Person to undergo treatment, surgery or hospitalization;
• Any service, treatment, surgery or stay in Hospital not required for the immediate relief of acute pain or suffering or which is not Medically Necessary;
• Any treatment or surgery which reasonably could be delayed until the Insured Person returns to his or her province of residence;
• Anticipated medical treatments required on an ongoing basis or for continued stabilization of a medical condition known to the Insured Person prior to departure;
• That portion, if any, of any expenses for treatment, advice or hospitalization which are not Reasonable and Customary.