endorsement 2017-1 forming part of the travel insurance contract issued … · 2019-01-15 ·...
TRANSCRIPT
ENDORSEMENT 2017-1 FORMING PART OF THE TRAVEL INSURANCE CONTRACT ISSUED TO THE POLICYHOLDER.
It is hereby agreed and stipulated that for all contracts issued as of September 27, 2017, the Visitors to Canada travel insurance policy is modified as follows.
01C
BV
019
5A
(2
018
-05
)
Amendment 1The following definition is added to the Definitions section of your contract:
Country of permanent residence: means the country in which the covered person permanently resided right before entering Canada.
Amendment 2The Side-Trips Outside of Canada clause is added to the Conditions of the contract:
Side-Trips Outside of Canada The insurance coverage remains valid when the covered person takes a side-trip outside of Canada under the following conditions:
• Trips outside of Canada must not exceed 30 days at a time.
• Each side-trip must begin and end in Canada.
• The covered person is not travelling to his/her country of permanent residence.
• The duration of all side-trips combined does not exceed 49% of the period of coverage of the contract.
WARNINGWhen a side-trip exceeds 30 days, only the first 30 days of the trip will be covered. Starting on the 31th day, the insurance coverage will be suspended with no premium refund for the remainder of the side-trip. The coverage will resume when the covered person returns to Canada. We will not reimburse any claim arising from an illness, accident, injury or symptoms that occurred while the insurance coverage was suspended.
Should the total duration of the side-trips exceed 49% of the period of coverage, the contract will be considered null and void in it’s entirety.
Amendment 3The Validity of the contract clause is modified as follows:
Validity of the contractThe insurance will be valid only when purchased and paid for in full before the effective date of the contract. Also, the duration of all side-trips outside Canada combined must be less than 50% of the period of coverage of the contract.
Amendment 4The text What is covered of the Emergency Medical Care benefit is modified as follows:
What is coveredBenefits will be paid for reasonable and customary expenses incurred following an emergency resulting from an accident or sudden illness which
occurs on a trip during the period of coverage. Eligible treatments are limited to what is declared urgent and necessary for the stabilization of the medical condition.
The benefits provided by this coverage are granted once the deductible has been paid. The deductible is that part of the eligible expenses under this policy that must be paid by the covered person before the Insurer pays a claim. The deductible applies after any benefits covered under governmental programs offered in Canada or in the covered person’s country of permanent residence have been paid. The deductible amount is indicated on the insurance certificate and applies per trip per covered person.
The insurance applies to trips taken in Canada and to side-trips taken outside of Canada, as long as all side-trips meet the conditions stipulated under the Conditions – Side-Trips Outside of Canada clause of your contract.
Amendment 5Exclusions 14 and 23 of the Other exclusions of the contract have been modified as follows:
14. Care or treatments received in Canada or in another country while on a side-trip when such care or treatments could have been obtained in the covered person’s country of residence without endangering the life or health of the covered person (with the exception of expenses for immediately necessary treatment following an emergency resulting from an accident or sudden illness). Under this exclusion, the fact that the treatment available in the country of residence of the covered person could be of lesser quality than treatment available in Canada or in another country does not in itself constitute a danger to the covered person’s life or health.
Without restricting the generality of this exclusion, no benefits are available under this plan for residents of other countries travelling primarily or incidentally to seek medical advice or treatment, even if such a trip is recommended by a physician.
23. Services or treatments received within your country of permanent residence during the period of coverage.
Amendment 6The following exclusion is withdrawn from the Other exclusions of the contract:
22. Treatments received outside the borders of Canada and the United States.
Amendment 7The following exclusion is added to the Other exclusions of your contract:
25. Fees incurred following an illness, accident, injury or symptoms that occurred during a side-trip while your insurance coverage was suspended.
Intended for all persons covered by this contract.
All other policy provisions remain unchanged.
Sylvain CharbonneauPresident and Chief Executive Officer
11Q
VV
018
5A
(2
018
-05
)
VISITORS TO CANADA
DISTRIBUTION GUIDE AND TRAVEL INSURANCE POLICY
®/MD Registered trademarks of the Canadian Association of Blue Cross Plans, licensed to the Canassurance Hospital Service Association, an inde pendent member carrying on business as Blue Cross® Canassurance® in Ontario, Québec and Atlantic Region.
®† Blue Shield is a registered trade-mark of the Blue Cross Blue Shield Association.
DISTRIBUTION GUIDE ANDTRAVEL INSURANCE POLICY
Blue Cross® Travel Insurance
Name of productVisitors to Canada
Type of productIndividual Travel Insurance Policy
InsurersCanassurance Hospital Service Association550 Sherbrooke Street West, Suite B-9Montreal, Quebec H3A 3S3Telephone: 514-286-8400Fax: 514-286-8358
Canassurance Insurance Company550 Sherbrooke Street West, Suite B-9Montreal, Quebec H3A 3S3Telephone: 514-286-8400Fax: 514-286-8358
The address of your distributor is found on theback cover of this brochure.
Responsibility of the Autorité des marchés financiers
The Autorité des marchés financiers does not express anopinion as to the quality of the products offered in this guide.The Insurer is solely responsible for any discrepanciesbetween the wording of the guide and the policy.
1
11QV
V018
5A (2
018-05
)
DISTRIBUTION GUIDETABLE OF CONTENTS
Why a distribution guide? 3
Your insurance contract 3
The Insurer 3
Description of Visitors to Canada Insurance 3
Definitions 3
1- Types of benefits or services offeredA) Emergency Medical Care Benefit 6
- Benefit exclusions, limitations or reductions 9B) CanAssistance Travel Assistance Benefit 13
2- Summary of applicable conditionsA) Eligibility 14B) Maximum sum insured 15C) Payment of the insurance premium 15D) Validity of the insurance contract 15E) Beginning and end of the insurance contract 15F) Extending the insurance contract 16G) Trip break 17H) Reimbursement of the insurance contract 17I) Cancelling the insurance contract 18J) Coordination of benefits 18K) Subrogation 18L) Concealment, fraud or attempted fraud 18M) Governing law and jurisdiction 19
3- ClaimsA) Submitting a claim 19B) The Insurer’s response period 19C) Appealing the Insurer’s decision and recourse 20
Supplementary information 21
Similar products 21
Notice of cancellation of an insurance contract 23
Note: words in bold and in italics in the text are found under“Definitions” on pages 3 to 5.
2
11QV
V018
5A (2
018-05
)
WHY A DISTRIBUTION GUIDE?The purpose of this guide is to describe the travel insurancebenefits. It gives you simple and concise information to help youbetter understand the benefits. You can then judge for yourselfwhether this product is right for you in the absence of aninsurance advisor.
The guide also provides you with a summary of the mainexclusions and restrictions of the policy.
YOUR INSURANCE CONTRACTThe insurance certificate attests the coverage amountselected, the product purchased and determines the benefitscovered by this contract as well as the particular medicalconditions specifically excluded from this contract.
The policy defines the various types of benefits and combinedwith your insurance certificate, constitutes your TravelInsurance contract.
These documents contain clauses which may limit theamounts payable. Please read them carefully.
THE INSURERInsurer means:- Canassurance Hospital Service Association (non-profit
mutual benefit association) for visitors in Ontario and Quebec;- Canassurance Insurance Company for visitors in other
provinces.
DESCRIPTION OF VISITORS TO CANADAINSURANCEDefinitions: here are a few definitions to help you understandthe policy.
Accident: an unintentional, sudden, fortuitous and unforeseeableevent due exclusively to an external cause of a violent nature andinflicting, directly and independently of all other causes, bodilyinjuries during the period of coverage.
Age: refers to the age of the covered person at the time thepresent contract is purchased.
CanAssistance: means the company authorized by the Insurerto provide assistance services to covered persons.
Contract holder: means the person designated as such on theinsurance certificate.
3
11QV
V018
5A (2
018-05
)
Covered person: means the persons whose names appear inthe “Covered Persons” section of the travel insurancecertificate.
Dependent child: refers to a child of the contract holder, hisspouse, or both, over 30 days old, who is dependent on thecontract holder, who is not married, and who is:- under 21 years of age, or;- under 25 years of age and attends an educational institution
full-time as a duly registered student, or;- physically or mentally handicapped.
Effective date: means the date indicated on the insurancecertificate.
Expiry date: means the date indicated on the insurancecertificate.
Hospital: refers to a place licensed as an accredited hospitaloffering care and treatment to in-patients or out-patients, has a graduate nurse always on duty, a laboratory,and an operating room where surgical operations are performedby a legally qualified surgeon. In no event shall the term“hospital” mean any hospital or institution or part of suchlicensed hospital or institution used primarily as a clinic,continued or extended care facility, convalescent home, resthome, health spa, or treatment centre for drug addicts oralcoholics.
Hospitalization: refers to admission to a hospital to receiveshort-term care as a bedridden patient for a minimum stay of 18 hours. Eligible short-term care comprises preventive care,medical diagnosis and medical treatment (including surgery) foran acute illness and does not include convalescent care andphysical or mental rehabilitation. In the case of day surgery, thehospital stay is equivalent to 18 hours of hospitalization.
Illness: refers to a deterioration in health or a disorder of theorganism certified by a physician.
Insurance certificate: refers to the document certifying theexistence of a contract and on which the following elements areprimarily specified: the covered persons, the contract number,the product, the dates of coverage, the selected benefits and thesums insured.
Member of the immediate family of the covered personrefers to:The spouseA child of the covered person or the spouseThe father or mother.
4
11QV
V018
5A (2
018-05
)
Physician: means a person who is not related in any way to thecovered person and who is legally authorized to practicemedicine on the premises where medical services are provided.
Period of coverage: refers to the time between the effectivedate and the expiry date of the contract indicated on theinsurance certificate.
Pre-existing conditions: refers to a health condition alreadyexisting at the purchase date or at the effective date of thecontract. Pre-existing conditions are subject to exclusions.Benefit exclusions are grounds for claim refusal (exclusion orrestriction).
Regular check-up: means a periodic consultation with aphysician scheduled in advance during which no new symptomor worsening of existing symptoms is reported by the coveredperson and no new anomaly is certified by the physician.
Spouse: means the person to whom the contract holder ismarried or the person who has been living permanently with thecontract holder for at least one year.
Sudden illness: means a unexpected and unforeseen illness forwhich initial symptoms (certified or not by a physician) appearafter the effective date of the insurance.
Terminal stage: means the period when a cure for an illness isno longer possible or when the illness resists any curativetreatment and death is bound to happen within a more or lessshort delay.
Travelling Companion: means the person who plans, leaves andreturns with the covered person on the same trip.
Treatment: means surgery, prescription drugs, therapy,consultations with physicians or other health professionals andany other type of method used to treat the covered person.
5
11QV
V018
5A (2
018-05
)
1- TYPES OF BENEFITS OR SERVICES OFFEREDVisitors to Canada Insurance offered by Blue Cross TravelInsurance is a travel insurance product.
Make sure that you have received a copy of theinsurance certificate specifying the sum insured youhave selected.
A) Emergency Medical Care Benefit
Benefits will be paid for expenses incurred following anemergency resulting from an accident or suddenillness that occurs on a trip during the period ofcoverage.
Expenses are covered up to the chosen amount ofcoverage mentioned on your insurance certificate.
Eligible costs are limited to what is declared urgent andnecessary for the stabilization of the medical condition.
This benefit does not cover non-urgent care, such asregular check-ups with a physician, prescription refills orfollow-up visits for a chronic or stabilized condition.
The benefits provided by this coverage are in addition toand not a substitution for benefits granted bygovernment programs: the Insurer does not reimbursewhat is paid by the governments.
Eligible costs come under 3 categories: • Hospitalization, medical and paramedical expenses• Transportation expenses• Subsistence allowance
6
11QV
V018
5A (2
018-05
)
Hospitalization, medical and paramedicalexpensesHospital expenses Cost for a semi-private room
when your condition requireshospitalization.
Physicians’ fees Reasonable and customaryexpenses for physicianservices without exceeding themaximum rates prescribed bythe local government authoritywhere services were rendered.
The following professional Private care from a registered fees when they are nurse during the hospitalizationprescribed by the physician period.and are required for your medical condition Services of a physiotherapist,
chiropractor, osteopath orpodiatrist (maximum $300 perprofession).
Diagnostic expenses and Charges for laboratory tests medical appliances when and X-rays.prescribed by the physician
Rental cost of crutches, canesor splints and the rental cost ofwheelchairs, orthopedic corsetsand other necessary medicalappliances.
Drugs Drugs prescribed as part of anemergency treatment.
Dental care Up to a maximum of $2,000when healthy, natural teeth aredamaged due to external injury.
Up to $300 for any emergencydental treatment excludingroot canal treatments.
7
11QV
V018
5A (2
018-05
)
Transportation expensesAmbulance or taxi service The cost of ambulance or taxi
service to get to the nearestappropriate medical facility.
Repatriation to the residence Costs incurred for repatriation following the authorization to your residence in order to of the attending physician get immediate medical care.and CanAssistance
The cost of repatriation of atravelling companion ormembers of your immediatefamily who are also coveredunder this contract when theyare unable to return by themeans of transportation initiallyplanned.
Return of the deceased Cost of preparing and returning following the death of the the deceased body (excluding covered person the cost of the coffin) to the
departure point at the place ofresidence (maximum $10,000)orthe cost of cremation or burialon site excluding the cost ofthe urn, coffin or gravestone(maximum $4,000)When a family member orfriend is required to go on siteto identify the deceased:- The total cost of round-tripeconomy-class transportationby the most cost-effectiveroute.
- Up to $300 for the cost ofaccommodation and meals ina commercial establishment.
8
11QV
V018
5A (2
018-05
)
Subsistence allowanceAccommodation and meal When your return is delayed costs in a commercial because of bodily injury or establishment illness for which you are the
victim yourself or which affectsyour travelling companion oran accompanying member ofyour immediate family(maximum $100 per day / maximum $1,000 in total).
Benefit exclusions, limitations or reductions
WARNING
Exclusions relating to the Emergency MedicalCare benefit
Exclusions relating to pre-existing conditions
1. Intended for all persons covered by this contract
a) All of the following cardiovascular conditions arenot covered: bypass, angioplasty, defibrillator,heart attack, aortic aneurysm, angina, valvularheart disease, peripheral vascular disease, heartrhythm disorders (arrhythmia, tachycardia,bradycardia): - when the covered person has already undergone
a procedure, consulted a doctor, been diagnosed,treated, hospitalized, or when the covered personhas been prescribed or taken medication linkedto one of these conditions, or;
- when a doctor has recommended that thecovered person receives treatment, be tested,take medication or undergo a procedure linkedto one of these conditions.
b) All of the following neurological conditions are notcovered: stroke (cerebrovascular accident) or TIA(transient ischemic attack):
- when the covered person has already undergonea procedure, consulted a doctor, been diagnosed,treated, hospitalized, or when the covered personhas been prescribed or taken medication linkedto one of these conditions, or;
9
11QV
V018
5A (2
018-05
)
- when a doctor has recommended that thecovered person receives treatment, be tested,take medication or undergo a procedure linkedto one of these conditions.
c) All of the following pulmonary conditions are notcovered: chronic bronchitis, emphysema, cysticfibrosis, COPD (chronic obstructive pulmonary disease).
- when the covered person has already undergonea procedure, consulted a doctor, been diagnosed,treated, hospitalized, or when the covered personhas been prescribed or taken medication linkedto one of these conditions, or;
- when a doctor has recommended that thecovered person receives treatment, be tested,take medication or undergo a procedure linkedto one of these conditions.
2. For persons under the age of 55: In addition to the exclusions mentioned under point 1, during the 3 months prior to the effective dateof coverage, any illness, injury or condition related toa medical condition for which the covered person:
- consulted a physician (other than for a regularcheck-up), or;
- was hospitalized, or; - was prescribed or received a new treatment, or; - received a change in an existing treatment, or; - was prescribed or has taken a new medication,
or; - received a change in existing medication1
(including usage or dosage), or; - has taken nitroglycerin for a heart condition.
3. For persons aged 55 and over: In addition to the exclusions mentioned under point 1, during the 6 months prior to the effective dateof coverage, any illness, injury or condition related toa medical condition for which the covered person:
- consulted a physician (other than for a regularcheck-up), or;
- was hospitalized, or; - was prescribed or received a new treatment, or; - received a change in an existing treatment, or; - was prescribed or has taken a new medication,
or; 10
11QV
V018
5A (2
018-05
)
- received a change in existing medication1
(including usage or dosage), or; - has taken nitroglycerin for a heart condition.
1 The Insurer does not consider a change in existingmedication the following elements:• the routine adjustment of insulin or Coumadin®;• a change from a brand name medication to ageneric brand medication, provided the dosage isthe same;
• Aspirin® taken for non-prescribed medicalpurposes;
• decrease of the dosage of cholesterol medication;• hormone replacement therapy;• vitamins and minerals and non-prescriptionmedication;
• creams or ointments prescribed for cutaneousirritations.
In addition, the Insurer does not cover the costs incurred forthe following causes:1. Any state or condition for which symptoms were
ignored or for which medical advice was not followedor the recommended investigations, treatments, testsor procedures were not carried out before the effectivedate of the contract.
2. Pregnancy, delivery and complications arisingtherefrom.
3. Accident sustained by the covered person whileparticipating in:- a sport for remuneration;- a sporting event where money prizes are awarded;- a motor vehicle competition;- any kind of speeding event (except for amateurathletic activities which are non-contact and engagedin by the covered person solely for leisure or fitnesspurposes);- a dangerous or violent sport with a high level ofdanger and involving one of the following elements:speed, height, high level of physical effort, highlyspecialized material, stunts, physical contacts.As an example, the following sports are not covered:off-track snow sports, horse jumping obstacles, rockclimbing or mountain climbing, parachuting, gliding orhang-gliding, skydiving, bungee jumping, canyoning,etc.
11
11QV
V018
5A (2
018-05
)
4. Abuse of medication, alcohol, or use of drugs. Drivinga motor vehicle under the influence of drugs or with analcohol level exceeding 80 milligrams per 100millilitres of blood (0.08).
5. Trip undertaken for the purpose of receiving medical orparamedical care.
6. Suicide, attempted suicide or self-inflicted injury.7. War (declared or not) or insurrection. Perpetration of or
attempt to perpetrate a criminal act.8. Mental, nervous, psychological or psychiatric
problems, unless the covered person is hospitalized forthat specific reason.
9. Hospitalization in a long term care hospital or in therehabilitation department of a hospital, or in extendedcare homes or spas.
10. Care, treatments, products or services other thanthose declared by the appropriate authorities to berequired for the treatment of the injury or illness orstabilization of the medical condition.
11. Custodial care or services rendered for theconvenience of the patient
12. Care or treatments for cosmetic purposes.13. Care or treatments received in Canada or the United
States when such care or treatments could have beenobtained in the covered person’s country of residencewithout endangering the life or health of the coveredperson (with the exception of expenses forimmediately necessary treatment following anemergency resulting from an accident or suddenillness). Under this exclusion, the fact that the treatmentavailable in the country of residence of the coveredperson could be of lesser quality than treatmentavailable in Canada or the United States does not initself constitute a danger to the covered person’s life orhealth.
14. Care or treatments that are not covered undergovernment programs where services were rendered.
15. Care or treatments such as those rendered by anacupuncturist, a homeopath or a naturopath.
16. Even when prescribed, the following products areexcluded: natural products, vitamins, processed foodand supplements, creams, oils, shampoos, soaps,lotions and generally any drug available over thecounter.
12
11QV
V018
5A (2
018-05
)
17. Failure of the covered person to communicate withCanAssistance in the event of medical consultation orhospitalization.
18. Once the contract has been extended, any medicalcondition that arose during the initial period ofcoverage will be excluded as of the date of theextension.
19. Examinations or tests required as part of animmigration application.
20. Eyeglasses and hearing aids. 21. Treatments received outside the borders of Canada and
the United States. 22. Services or treatments provided in the United States to
a permanent resident of the United States.23. For children under the age of 2, costs related to a
medical condition resulting from a congenitalmalformation or congenital disease, as well as relatedhealth problems, whether diagnosed or not.
B) CanAssistance Travel Assistance BenefitAssistance services are included with the benefitsdescribed in this guide. You may contactCanAssistance, whose experienced agents can be ofgreat help with:• referral to an appropriate physician, clinic or
hospital;• follow-up of the medical file, at destination;• communication with the family physician;• services of an interpreter;• coordination of the repatriation of the covered
person and dependent children;• referral to legal counsel in the event of a serious
accident;• information about embassies, consulates, vaccines,
etc.;• transmission of important messages;• assistance in the event of loss or theft of documents
or credit cards.
CanAssistance is under no circumstance responsiblefor the expenses related to the services describedabove.
In the event of an emergency, you must contactCanAssistance before incurring any fees, otherwiseyour claim could be refused.
13
11QV
V018
5A (2
018-05
)
2- SUMMARY OF APPLICABLE CONDITIONS
A) EligibilityTarget clienteleThis product is offered to:• immigrants or permanent residents awaiting eligibility
for the government health insurance plan or to personswho completed the procedures for obtainingimmigrant or permanent resident status;
• foreign workers in Canada who possess a workpermit;
• foreign students in Canada who possess a studypermit;
• Canadian citizens returning home after a longabsence;
• visitors to Canada.
FeaturesIn order to be eligible for the Visitors to Canada insurance,covered person must not:
1. Have received medical advice not to travel;2. Suffer from an illness in a terminal stage;3. Suffer from kidney failure treated through dialysis;4. Have been diagnosed with or treated for a metastatic
cancer;5. Have been diagnosed with, had treatments or taken
medication for cancer in the past 12 months (with theexception of basal cell carcinoma);
6. Suffer from heart failure or cardiomyopathy;7. Be waiting for an organ transplant for one or several of
the following: kidneys, lungs, liver, heart, bone marrowor pancreas;
8. Have used home oxygen or taken cortisone pills for apulmonary condition in the past 24 months.
Age limitCovered persons must be a minimum of 31 days oldand a maximum of 79 years old at the time of theinsurance purchase.
Geographical areaThe insurance applies to trips made in Canada and in theUnited States. As a condition for the coverage to apply inthe United States, the places of departure and return must
14
11QV
V018
5A (2
018-05
)
be in Canada and the duration of trips in the United Statesmust be shorter than the duration of trips in Canada.
The insurance does not cover a permanent resident of theUnited States who, during the period of coverage as avisitor to Canada, returns to the United States and thereincurs hospitalization, medical and paramedicalexpenses.
B) Maximum sum insured According to the coverage amount you chose, as shownon your insurance certificate.
C) Payment of the insurance premiumThe premium must be paid in a single installment asindicated on your insurance certificate. It must bepaid in full before the effective date of the contract.
D) Validity of the insurance contractThe insurance is valid only when purchased and paidfor in full before the effective date of the contract.
E) Beginning and end of the insurance contract If the insurance is purchased prior to your arrival inCanada, the contract begins on the latest of the followingdates:• the effective date of the contract;• the date of arrival in Canada from the country of
residence;• the day following the termination date of a similar
coverage in Canada by virtue of another insurancecontract.
If the insurance is purchased after your arrival in Canada:• the insurance is effective as of the date of purchase.
However, the contract will include a 4-day waitingperiod from the date of purchase during which thecovered person is insured only in case of accidentor injury. During this waiting period, the coveredperson is not insured in case of illness. If an illnessoccurs during the waiting period, the illness will beconsidered as a pre-existing condition and will besubject to the Exclusions relating to pre-existingconditions of the contract.
15
11QV
V018
5A (2
018-05
)
• the insurance must be purchased within the 30 daysafter the latest of the following dates:- the date of arrival in Canada from the country of
residence; - the termination date of a similar coverage in
Canada by virtue of another insurance contract. Ifthis insurance is purchased after the effectivedate of another insurance contract with similarcoverage in Canada, proof of the latter is required.
Coverage ends on the first of the following dates:• the date you leave Canada to return to your departure
point;• at midnight on the expiry date that appears on your
insurance certificate.• upon refusal of a recommended repatriation by the
Insurer.
F) Extending the insurance contract The duration of your insurance contract can be extendedby the Insurer at the request of the covered person.
The contract can be extended if the request is madebefore it ends, if the covered person pays the additionalpremium and is still eligible for insurance.
If the covered person files a claim during the initialperiod of coverage, the Insurer’s approval is requiredto extend the contract. Once the approval to extendthe contract has been granted, any claim thatpertains to an event that occurred during the initialperiod of coverage will be rejected.
The insurance cost and conditions will be modified forthe entire length of the trip if they are different for thisreason.
Insurance contract benefits are automaticallyextended at no cost under the followingcircumstances:• extended 24 hours when the return is delayed due to
a delay by the carrier, a traffic accident or thebreakdown of a private vehicle returning to thedeparture point;
• extended for the duration of hospitalization of thecovered person and for the following 24 hours;
• extended up to 72 hours when return is delayed dueto an illness of the covered person that began within
16
11QV
V018
5A (2
018-05
)
17
11QV
V018
5A (2
018-05
)
the 24 hours preceding the return and that requiresemergency medical care.
G) Trip break – Exclusive to the Visitors toCanada product with a minimum stay of365 days You can return to your country of residence and comeback to Canada without terminating the insurancecontract.
During the period outside Canada, no insurancecoverage is valid and no premium refund is granted forthe days spent in your country of permanent residence.You must ensure you meet insurance eligibility criteriaeach time you intend to return to Canada.
If a change were to occur in your health while in yourcountry of permanent residence, you must contact theInsurer before returning to Canada: any change in yourhealth will be considered as a pre-existing conditionand will be subject to the Exclusions relating to pre-existing conditions clause of the contract.
H) Reimbursement of the insurance contract A $25 administration fee applies on all reimbursementsincluding requests made before the effective date of thecontract.
This fee is not applicable if you cancel your insurancecontract within 10 days following the purchase, asmentioned in paragraph I) “Cancelling the insurancecontract”.
If your stay in Canada ends earlier than expected oryou obtain coverage through a mandatoryinsurance:
- the premium may be reimbursed for the unused daysif no claim was filed during your trip;
- days are considered used once the contract iseffective.
Procedure:Contact the Insurer or your travel insurance distributor.Proof of your return may be requested.
Proof can be the return ticket to your country ofresidence or proof of a purchase indicating that youwere outside of Canada at the time of transaction (forexample: credit card receipt, gas receipt).
18
11QV
V018
5A (2
018-05
)
If you have no proof of your return, the postmark dateon the reimbursement request letter is considered as thereturn date and the reimbursement is calculated fromthe following day.
SEND YOUR REQUEST TO:Blue Cross Travel InsuranceTravel Administration 550 Sherbrooke Street West, Suite B-9Montreal QC H3A 3S3
I) Cancelling the insurance contractYou can cancel the insurance without any fee within 10 days of purchase provided your trip has not yetbegun. The Act respecting the distribution of financialproducts and services provides you with the ability tocancel your contract within the 10-day period.
To obtain the reimbursement of your premium beforeyour insurance begins, you can either:
• contact your distributor or call Blue Cross Travel Insurance Customer Service directly at 514-286-8403 for the Montreal area, and at 1-800-361-5706 for all other areas;
• send the Insurer by registered mail the Notice ofcancellation of an insurance contract, which you willfind on page 23.
J) Coordination of benefitsFees reimbursed by another Insurer or government plan– whether you have filed this type of reimbursementrequest or not - reduce the benefits payable according tothe Visitors to Canada product.
K) SubrogationIf you acquire a right of action against a third partyfollowing an accident, the Insurer is subrogated to yourrights up to the sum reimbursed by the Insurer.
L) Concealment, fraud or attempted fraud If you conceal or misrepresent or if you attempt a fraudeither at the time of the insurance application, or at thetime of claim or any other moment during the life of thecontract, the contract will be deemed void and never tohave existed.
M) Governing law and jurisdictionThis policy shall be governed by and interpreted underthe laws of the Canadian province or territory in whichthis policy was issued.
The parties abide to the jurisdiction of the Court of theCanadian province or territory in which this policy wasissued, and further agree that any action and proceedingbrought by either party to enforce this policy shall becommenced in said Canadian province or territory.
3- CLAIMS
A) Submitting a claimBefore undergoing a treatment covered underEmergency Medical Care benefit, it is very important tocontact CanAssistance beforehand so that theInsurer can preauthorize this treatment.
You must inform the Insurer within 30 days following theevent giving rise to the claim to validate your claim.
You must then send, within 90 days of the event, allinformation, and original, detailed receipts coveringhospital and medical services, if applicable, and allother services.
When a claim has been submitted, the Insurer reservesthe right to demand, at his expense, medical exams and,if the law permits, an autopsy in the event of a death.
You may contact Blue Cross Travel Insurance CustomerService department for a claim form at the followingnumbers:- Montreal area: 514-286-6690; - Other areas (toll-free): 1-800-387-2538.
B) The Insurer’s response periodThe Insurer has 30 business days following receipt of allnecessary documents to process your file to:i) pay you the benefit or to notify you that the payment
was made to the care or service provider (hospital,clinic, etc.), or;
ii) refuse the claim in writing and give the reason orreasons that justify this decision.
19
11QV
V018
5A (2
018-05
)
C) Appealing the Insurer’s decision and recourse
Should the Insurer refuse the claim, you may contest orask for a review of the Insurer’s decision. You must do soin writing and state your case or provide new documentsthat could alter the Insurer’s decision (ex: new documentfrom your treating physician).
Any request for review can be made within the 12 months following the Insurer’s refusal. Upon receiptof your request for review, the Insurer will acknowledgereceipt in writing without delay and will inform you of thepossible recourses. You must send your supportingdocuments to the claims department at the followingaddress:
Blue CrossReview Committee – Travel Claims550 Sherbrooke Street WestSuite B-9Montreal QC H3A 3S3
The Insurer has 4 months to advise you of the decisionin writing or by telephone following your appeal.
Moreover, you can request for your file to be transferredto the Autorité des marchés financiers at all times. Youcan also consult that organization or your own legalcounsel.
20
11QV
V018
5A (2
018-05
)
SUPPLEMENTARY INFORMATIONFor further information concerning your Visitors to Canada travelinsurance policy, you must first contact the Insurer at:- Montreal area: 514-286-8403; - Other areas (toll-free): 1-800-361-5706.
For any additional information on the obligations of the Insurer ordistributor, contact the Autorité des marchés financiers at:Autorité des marchés financiersPlace de la Cité, Tour Cominar2640 Laurier Blvd., 4th FloorQuebec, QC G1V 5C1Toll free: 1-877-525-0337Quebec City: 418-525-0337Montreal: 514-395-0337Website: www.lautorite.qc.ca
SIMILAR PRODUCTS Other insurance companies offer travel insurance products.Check whether you already have travel insurance coverage andwhether it contains any coverage exclusions, restrictions orreductions.
Notes
Beginning of coverage:
End of coverage:
Amount of coverage:
Premium:
Other:
21
11QV
V018
5A (2
018-05
)
22
11QV
V018
5A (2
018-05
)
Notice of cancellation of an insurance contractNotice given by a distributorArticle 440 of the Act respecting the distribution of financial productsand services.
THE ACT RESPECTING THE DISTRIBUTION OF FINANCIAL PRODUCTSAND SERVICES GIVES YOU IMPORTANT RIGHTS.
• The Act allows you to cancel an insurance contract you have justsigned when signing another contract, without penalty, within 10 days of signature. To do so, you must give the Insurer notice byregistered mail within that period. You must use the following model.
• Despite the cancellation of the insurance contract, the first contractentered into will remain in force. Caution, it is possible that you maylose advantageous conditions as a result of this insurance contract;contact your distributor or consult your contract.
• You may cancel your insurance contract at any time; but after the 10-day delay, penalties may apply.
For further information, contact l’Autorité des marchés financiers at :
Quebec 418-525-0337, Montreal 514-395-0337Toll free 1-877-525-0337
Notice of cancellation of an insurance contractTo: Canassurance Hospital Service AssociationP.O. Box 910, Station B, Montreal, Quebec H3B 3K8
Date: ________________________________________________(date of sending this notice)
Pursuant to section 441 of the Act respecting the distribution of financialproducts and services, I hereby rescind insurance contract
no.: ______________________________________________(contract number, if indicated)
Entered into on: _____________________________________(date of signature of contract)
In: ______________________________________________(place of signature of contract)
__________________________________________________(name of client, in capital letters) (client’s signature)
Sections 439, 440, 441 and 442 of the Act appear on the back of this notice
23
11QV
V018
5A (2
018-05
)
Art.439. A distributor may not subordinate the making of a contract tothe making of an insurance with the Insurer specified by the distributor.
The distributor may not exercise undue pressure on the client or usefraudulent tactics to induce the client to purchase a financial product orservice.
Art.440. A distributor that, at the time a contract is made, causes theclient to make an insurance contract must give the client a notice,drafted in the manner prescribed by regulation of the Authority, statingthat the client may rescind the insurance contract within 10 days ofsigning it.
Art.441. A client may rescind an insurance contract made at the sametime as another contract, within 10 days of signing it, by sending noticeby registered or certified mail.
Where such an insurance contract is rescinded, the first contract retainsall its effects.
Art.442. No contract may contain provisions allowing its amendment inthe event of rescission or cancellation by the client of an insurancecontract made at the same time.
However, a contract may provide that the rescission or cancellation ofthe insurance contract will entail, for the remainder of the term, the lossof the favourable conditions extended because more than one contractwas made at the same time.
24
11QV
V018
5A (2
018-05
)
11QV
V018
5A (2
018-05
)
Your
Travel Insurance Policy
26
11QV
V018
5A (2
018-05
)
This is your insurance policy. Read it carefully.The insurance certificate attests the coverage amount selected, theproduct purchased and determines the benefits covered by thiscontract as well as the particular medical conditions specificallyexcluded from this contract.
The policy defines the various types of benefits and combined withyour insurance certificate, constitutes your Travel Insurancecontract.
These documents contain clauses which may limit the amountspayable. Please read them carefully.
TABLE OF CONTENTSNotice regarding personal information 27
Definitions 28
Conditions 29
Benefits
• Emergency Medical Care 33- Exclusions and reductions of coverage 36
• CanAssistance Travel Assistance 39
Notice 40
How to reach us 41
In this document, the masculine gender is used solely forconvenience, and includes the feminine.
27
NOTICE REGARDING PERSONAL INFORMATION
By purchasing one of our insurance products, you are consenting to thecollection, use and disclosure of your personal information by Blue Cross®
for the purposes of appraising your insurance application, confirmingcoverage and assessing your claims.
Your insurance file will be maintained on a confidential basis at our offices.Your personal information will only be accessible by our employees andauthorized representatives who need access to your file for the purposes setout above.
Upon written notice, you will be entitled to access your personal informationcontained in your file and, if applicable, request that your file be updated orcorrected.
For additional information regarding the manner in which we collect, use,disclose and otherwise manage your personal information, please visit ourwebsite, or write to us at:
Compliance DirectorCanassurance Hospital Service Association and its subsidiaries1
550 Sherbrooke Street WestSuite B-9Montreal, QC H3A 3S3
1Canassurance Insurance Company and CanAssistance Inc.
11QV
V018
5A (2
018-05
)
28
11QV
V018
5A (2
018-05
)
DEFINITIONS Accident means an unintentional, sudden, fortuitous and unforeseeableevent due exclusively to an external cause of a violent nature and inflicting,directly and independently of all other causes, bodily injuries during theperiod of coverage.
Age means the age of the covered person at the time the present contractis purchased.
CanAssistance means the company authorized by the Insurer to provideassistance services to covered persons.
Contract holder means the person designated as such on the insurancecertificate.
Covered person means the persons whose names appear in the “CoveredPersons” section of the travel insurance certificate.
Dependent child means a child of the contract holder, his spouse, or both,over 30 days old, who is dependent on the contract holder, who is not married,and who is:
- under 21 years of age, or;- under 25 years of age and attends an educational institution full-time as
a duly registered student, or;- physically or mentally handicapped.
Effective date means the date indicated on the insurance certificate.
Expiry date means the date indicated on the insurance certificate.
Hospital means a place licensed as an accredited hospital offering care andtreatment to in-patients or out-patients, has a graduate nurse always onduty, a laboratory, and an operating room where surgical operations areperformed by a legally qualified surgeon. In no event shall the term“hospital” mean any hospital or institution or part of such licensed hospitalor institution used primarily as a clinic, continued or extended care facility,convalescent home, rest home, health spa, or treatment centre for drugaddicts or alcoholics.
Hospitalization means admission to a hospital to receive short-term care asa bedridden patient for a minimum stay of 18 hours.
Covered short-term care comprises preventive care, medical diagnosis andmedical treatment (including surgery) for an acute illness and does notinclude convalescent care and physical or mental rehabilitation.
In the case of day surgery, the hospital stay is equivalent to 18 hours of hospitalization.
Illness means a deterioration in health or a disorder of the organismcertified by a physician.
Insurance certificate refers to the document certifying the existence of acontract and on which the following elements are primarily specified: thecovered persons, the contract number, the product, the dates of coverage,the selected benefits and the sums insured.
Insurer means:
- Canassurance Hospital Service Association (non-profit mutual benefitassociation) for visitors in Ontario and Quebec;
- Canassurance Insurance Company for visitors in other provinces.
29
Member of the immediate family of the covered person means thespouse, father, mother and children (not necessarily dependent) of thecovered person, his spouse or both.
Period of coverage means the time between the effective date of thecontract and the expiry date indicated on the insurance certificate.
Physician means a person who is not related in any way to the coveredperson and who is legally authorized to practice medicine on the premiseswhere medical services are provided.
Regular check-up means a periodic consultation with a physicianscheduled in advance during which no new symptom or worsening ofexisting symptoms is reported by the covered person and no new anomalyis certified by the physician.
Spouse means the person united to the contract holder by marriage or aperson who has been living permanently with the contract holder for overone year. Following a separation of more than 3 months or dissolution of themarriage by divorce or annulment, this person will lose his status as spouse.
Sudden illness means a unexpected and unforeseen illness of which initialsymptoms (certified or not by a physician) appear after the effective date ofthe insurance.
Terminal stage means the period when a cure for an illness is no longerpossible or when the illness resists any curative treatment and death isbound to happen within a more or less short delay.
Travelling companion means the person who plans, leaves and returnswith the covered person on the same trip.
Treatment means surgery, prescription drugs, therapy, consultations withphysicians or other health professionals and any other type of method usedto treat the covered person.
CONDITIONS
Eligibility Target clienteleThis product is offered to:
- immigrants or permanent residents awaiting eligibility for thegovernment health insurance plan or to persons who completed theprocedures for obtaining immigrant or permanent resident status;
- foreign workers in Canada who possess a work permit;
- foreign students in Canada who possess a study permit;
- Canadian citizens returning home after a long absence;
- visitors to Canada.
Age limit Covered persons must be a minimum of 31 days old and a maximum of 79 years old at the time of the insurance purchase.
FeaturesIn order to be eligible for Visitors to Canada insurance, the covered personmust not:
1. Have received medical advice not to travel;
2. Suffer from an illness in a terminal stage;
11QV
V018
5A (2
018-05
)
30
11QV
V018
5A (2
018-05
)
3. Suffer from kidney failure treated through dialysis;
4. Have been diagnosed with or treated for a metastatic cancer;
5. Have been diagnosed with, had treatments or taken medication forcancer in the past 12 months (with the exception of basal cellcarcinoma);
6. Suffer from heart failure or cardiomyopathy;
7. Be waiting for an organ transplant for one or several of the following:kidneys, lungs, liver, heart, bone marrow or pancreas;
8. Have used home oxygen or taken cortisone pills for a pulmonarycondition in the past 24 months.
Effective date of coverageIf the insurance is purchased prior to the covered person’s arrival in Canada,the contract is effective on the latest of the following dates:
- the effective date of the contract;- the date of arrival in Canada from the country of residence;- the day following the termination date of a similar coverage in Canada
by virtue of another insurance contract.
If the insurance is purchased after the covered person’s arrival in Canada:
• the insurance is effective as of the date of purchase. However, the contractwill include a 4-day waiting period from the date of purchase during whichthe covered person is insured only in case of accident or injury. During thiswaiting period, the covered person is not insured in case of illness. Ifan illness occurs during the waiting period, the illness will be considered asa pre-existing condition and will be subject to the Exclusions relating topre-existing conditions of the contract.
• the insurance must be purchased within the 30 days after the latest of thefollowing dates:
- the date of arrival in Canada from the country of residence; - the termination date of a similar coverage in Canada by virtue ofanother insurance contract. If this insurance is purchased after theeffective date of another insurance contract with similar coverage inCanada, proof of the latter is required.
Termination date of coverageCoverage ends on the first of the following dates:
- the expiry date of the contract, or;- the trip return date, whether planned or premature.
Refund of premiumAny request for a refund of premium must be submitted to the Insurer’sauthorized agent from whom the insurance was purchased, before theeffective date of the contract.
Administrative fees of $25 per contract are deducted from any refund,including a refund due to cancellation of the contract before the effectivedate of the contract.
These fees are not applicable if you cancel the contract within 10 daysfollowing its purchase, as long as the trip has not started.
Following an early departure from Canada, or if you obtain coverage througha mandatory insurance, a refund could be made for the unused days,provided no claim was submitted. Days are considered used once thecontract is effective.
You must submit your request in writing accompanied by proof of yourdeparture date from Canada or the effective date of the mandatoryinsurance you are now covered by.
Unless the covered person presents proof to the contrary, the postmark onthe letter will be considered as the date of return and the refund will beeffective on the following day.
Contract extension Coverage under this contract may be extended as long as the additionalpremium is paid, and that the covered persons remain eligible forinsurance. If the extension or the coverage conditions of insuranceaffect the initial rate of the premium, the new premium will apply forthe entire duration of the contract.If the covered persons file a claim during the initial period of coverage,the Insurer’s approval is required to extend the contract. Once theapproval to extend the contract has been granted, any claim thatpertains to an event that occurred during the initial period of coveragewill be rejected.The contract holder must file a request for extension only prior to theend of the initial coverage period by contacting the Insurer.
Automatic extension of coverageAll coverage will automatically be extended free of charge:
a) up to 24 hours when the return home is delayed due to the carrier or asthe result of a traffic accident or mechanical failure of the private vehiclereturning to the departure point (claim must be supported bydocumentary proof);
b) during the period of hospitalization and the 24 hours which follow thedischarge from hospital of a covered person;
c) up to 72 hours when the return home is delayed due to a coveredperson’s illness occurring within 24 hours prior to the contracted returndate and requiring emergency medical care.
Trip break – Exclusive to the Visitors to Canadaproduct with a minimum stay of 365 daysCovered persons can return to their country of residence and come back toCanada without terminating the insurance contract.
During the period outside Canada, no insurance coverage is valid and nopremium refund is granted for the days spent in the country of permanentresidence. Covered persons must ensure they meet insurance eligibilitycriteria each time they intend to return to Canada.
If a change were to occur in a covered person’s health while in the countryof permanent residence, the covered person must contact the Insurer beforereturning to Canada: any change in the covered person’s health will beconsidered as a pre-existing condition and will be subject to the Exclusionsrelating to pre-existing conditions clause of the contract.
Validity of the contractThe insurance will be valid only when purchased and paid for in full beforethe effective date of the contract.
31
11QV
V018
5A (2
018-05
)
Repatriation of a covered personIn the absence of medical contraindication, the Insurer can requirerepatriation of any covered person or his transfer to other medical facilities.Refusal by the covered person cancels the coverage and theterminating notice to the contract holder shall be sufficient. There willbe no premium refund granted for early return in case the coveredperson refuses to be repatriated.
Settlement of claimsThe Insurer shall not assume responsibility under the contract unless thecovered person has contacted CanAssistance as stipulated in theEmergency Medical Care benefit and provides the Insurer with written noticeof the loss within 30 days of acquiring knowledge of it, and transmits to theInsurer within 90 days of the loss, original and detailed bills of the claimedexpenses, a proof of payment accepted by the Insurer, a medical certificategiving the complete diagnosis and confirming that the services included inthe claim have been rendered or that the covered loss did indeed occur, aswell as any other document or information of any nature required by theInsurer for the study of a claim.
The Insurer shall be entitled to have the covered person undergo examinationsfor claims adjustment purposes, and to have an autopsy performed in theevent of death as long as it is not prohibited by law. Expenses for thoseexaminations are the Insurer’s responsibility.
Method of paymentThe Insurer shall make any refund by means of a cheque in the name of theservice provider or the contract holder or his assignee, after receiving andassessing the relevant accounts and the necessary information pertainingthereto, in accordance with the terms and conditions provided. However, inall cases, the Insurer shall have the right to pay the service provider directly.
Any amount paid by the Insurer or on its behalf relieves the Insurer of allobligations to the extent of such amount.
When a refund for hospital, medical and assistance expenses is notrequested by the covered person, but is the object of a claim settlementbetween the Insurer and the service providers, the contract holder mustprovide any original document requested to enable the claim settlement,otherwise he becomes responsible for the payment of the amounts owed.
Coordination of benefitsBenefits under this contract cover only the excess costs which are notcovered by any other individual or group contract or by any law or publicinsurance.
If a covered person is entitled to similar benefits under any other individualor group contract, the benefits payable under this contract shall becoordinated so that the total payment from all coverages shall not exceedthe amount for which the claim is made.
SubrogationIf, in the event of loss or damage, the covered person shall acquire any rightof action against any individual or legal entity for loss covered under thiscontract, the Insurer shall be subrogated for all the covered person’s rightsof recovery to the amount paid by the Insurer. The covered person shall signand deliver the required documents to this effect and do whatever isnecessary to secure such rights. If the covered person reaches an
32
11QV
V018
5A (2
018-05
)
33
agreement or accepts payment from the third party liable for the losswithout the written consent of the Insurer, the latter shall be relieved of anyobligation toward the covered person.
Concealment, fraud or attempted fraudThis contract is void in the case of fraud or attempted fraud by the coveredperson, or if the covered person conceals or misrepresents any material factor circumstance concerning this insurance, either at the time of application tothe insurance, at time of claim or any other moment during the life of thecontract.
InterestNo sum payable under this contract shall bear interest.
CurrencyAll amounts of money mentioned in this contract, as well as sums payableunder this contract, shall be in Canadian dollars.
Modifications to the contractThe terms and conditions of this contract may not be modified unless agreedupon in writing by the contract holder and the Insurer. The Insurer’s waivingor omitting to require any provision in the contract to be executed orobserved must not be interpreted as the Insurer’s waiver of its right torequire any provision to be carried out or observed.
Governing law and jurisdictionThis policy shall be governed by and interpreted under the laws of theCanadian province or territory in which this policy was issued.
The parties abide to the jurisdiction of the Court of the Canadian province orterritory in which this policy was issued, and further agree that any actionand proceeding brought by either party to enforce this policy shall becommenced in said Canadian province or territory.
BENEFITS
Emergency Medical Care Benefit
What is coveredBenefits are paid for reasonable and customary expenses incurredfollowing an emergency resulting from an accident or sudden illnesswhich occurs within the boundaries of Canada and the United States,during the period of coverage. Such expenses are limited to what isdeclared urgent and necessary for the stabilization of the medicalcondition. The benefits provided under this insurance are in addition to andnot a substitution of benefits granted by the government programs offeredin Canada or in the covered person’s country of residence.
The insurance applies to trips made in Canada and in the United States. Asa condition for the coverage to apply in the United States, the places ofdeparture and return must be in Canada.
11QV
V018
5A (2
018-05
)
34
The duration of trips in the United States must be shorter than the durationof trips in Canada.
The insurance does not cover the costs incurred in the United States by thepermanent resident of the United States who, during the period of coverageas visitor to Canada, returns to the United States and there incurshospitalization, medical and paramedical expenses.
BenefitsThe following benefits are provided for each covered person for thereasonable and customary charges listed below, subject to a maximumshown on the insurance certificate during the period of the contract, andprovided that these charges are not incurred before obtaining theapproval of CanAssistance.
NoticeFailure to contact CanAssistance in the event of medicalconsultation or hospitalization following an accident or suddenillness could result in refusal of the compensation requested.
The Insurer and CanAssistance are not responsible for the availability orquality of medical and hospital care rendered, or the lack thereof.
Hospitalization, medical and paramedical expensesHospitalizationHospitalization expenses for a semi-private room. Private room is not covered.
Physicians’ feesReasonable and customary expenses for physician services withoutexceeding the maximum rates prescribed by the local government authoritywhere services were rendered.
Medical appliancesThe purchase or rental cost of crutches, canes or splints, and the rental costof wheelchairs, orthopedic devices and other medical appliances whenprescribed by the attending physician.
Nursing careThe fees of a graduate nurse (other than a relative) for private care whilehospitalized and when medically necessary and prescribed by the attendingphysician.
Professional services (when prescribed as part of an emergencytreatment)Professional services by a physiotherapist, chiropractor, osteopath orpodiatrist when medically necessary and prescribed by the attendingphysician, up to a maximum of $300 per profession.
Diagnostic servicesThe charges for laboratory tests and X-rays when prescribed by theattending physician.
Drugs (when required as part of emergency treatment)The cost of drugs prescribed by a physician, except when they are requiredfor the continued stabilization of a chronic medical condition.
Dental careThe fees of dental surgeons for emergency dental care treatment, excludingroot canal therapy, up to $300 per trip and per covered person.
11QV
V018
5A (2
018-05
)
The fees of dental surgeons up to $2,000 per accident and per coveredperson for treatment necessitated by an external injury (not as a result ofintroduction of food or an object into the mouth), only when natural andhealthy teeth which have had no previous treatment are damaged or toreduce a fracture or dislocation of the jaw.
In all cases, treatment must begin during the period of coverage and endwithin 6 months of the accident. The covered person must submit to theInsurer an X-ray taken after the accident and before the treatment begins,showing the damages sustained.
Transportation expensesThe following services must be approved and planned byCanAssistance:Ambulance or taxi serviceLand or air transport costs to the nearest accredited medical facility,including inter-hospital transfer when the attending physician andCanAssistance determine that existing facilities are inadequate to treat orstabilize the patient’s condition.
Repatriation to the residenceThe cost of repatriation of the covered person to his residence by means ofappropriate transportation in order to receive immediate medical attention,following the authorization of the attending physician andCanAssistance.The cost of simultaneous repatriation of a travelling companion or anymember of the immediate family of the covered person who is also coveredunder this contract, if he is unable to return to the departure point by meansof the transportation initially planned for such return.
A round-trip ticket for a medical attendant is also covered.
Return of the deceasedUp to $10,000 for the cost of preparing and transporting the deceasedperson (excluding the cost of a coffin) to the departure point at the place ofresidence, or up to $4,000 for the cost of cremation or burial on site(excluding the cost of a coffin, an urn and a gravestone).
Also, when a family member or a friend of the deceased covered person isrequired to go to the place of death to identify the deceased, the Insurer willreimburse the following expenses:
1. The total cost of round-trip economy-class transportation by the mostcost-effective route.
2. Up to $300 for the cost of accommodation and meals in a commercialestablishment.
Subsistence allowanceUp to $1,000 ($100 per day for a maximum of 10 days) for the cost ofaccommodation and meals in a commercial establishment, when a coveredperson’s return must be delayed due to illness or bodily injury to himself orto an accompanying immediate family member or travelling companion.
35
11QV
V018
5A (2
018-05
)
What is not covered
Exclusions and reductions of coverage No benefits are payable if the loss sustained or the expenses incurred resultdirectly or indirectly from one of the following causes:
Exclusions relating to pre-existing conditions1. Intended for all persons covered by this contract
a) All of the following cardiovascular conditions are notcovered: bypass, angioplasty, defibrillator, heart attack, aorticaneurysm, angina, valvular heart disease, peripheral vasculardisease, heart rhythm disorders (arrhythmia, tachycardia,bradycardia):
- when the covered person has already undergone aprocedure, consulted a doctor, been diagnosed, treated,hospitalized, or when the covered person has been prescribedor taken medication linked to one of these conditions, or;
- when a doctor has recommended that the covered personreceives treatment, be tested, take medication or undergo aprocedure linked to one of these conditions.
b) All of the following neurological conditions are not covered:stroke (cerebrovascular accident) or TIA (transient ischemicattack):
- when the covered person has already undergone aprocedure, consulted a doctor, been diagnosed, treated,hospitalized, or when the covered person has been prescribedor taken medication linked to one of these conditions, or;
- when a doctor has recommended that the covered personreceives treatment, be tested, take medication or undergo aprocedure linked to one of these conditions.
c) All of the following pulmonary conditions are not covered:chronic bronchitis, emphysema, cystic fibrosis, COPD (chronicobstructive pulmonary disease).
- when the covered person has already undergone aprocedure, consulted a doctor, been diagnosed, treated,hospitalized, or when the covered person has been prescribedor taken medication linked to one of these conditions, or;
- when a doctor has recommended that the covered personreceives treatment, be tested, take medication or undergo aprocedure linked to one of these conditions.
2. For persons under the age of 55: In addition to the exclusions mentioned under point 1, duringthe 3 months prior to the effective date of coverage, any illness,injury or condition related to a medical condition for which thecovered person:
- consulted a physician (other than for a regular check-up), or;
- was hospitalized, or;
- was prescribed or received a new treatment, or;
- received a change in an existing treatment, or;
36
11QV
V018
5A (2
018-05
)
- was prescribed or has taken a new medication, or;
- received a change in existing medication1 (including usageor dosage), or;
- has taken nitroglycerin for a heart condition
3. For persons aged 55 and over: In addition to the exclusions mentioned under point 1, duringthe 6 months prior to the effective date of coverage, any illness,injury or condition related to a medical condition for which thecovered person:
- consulted a physician (other than for a regular check-up), or;
- was hospitalized, or;
- was prescribed or received a new treatment, or;
- received a change in an existing treatment, or;
- was prescribed or has taken a new medication, or;
- received a change in existing medication1 (including usageor dosage), or;
- has taken nitroglycerin for a heart condition.1 The Insurer does not consider a change in existing medication thefollowing elements:- the routine adjustment of insulin or Coumadin®;- a change from a brand name medication to a generic brandmedication, provided the dosage is the same;
- Aspirin® taken for non-prescribed medical purposes;- decrease of the dosage of cholesterol medication;- hormone replacement therapy;- vitamins and minerals and non-prescription medication;- creams or ointments prescribed for cutaneous irritations.
Other exclusionsNo benefits are payable under this benefit if the loss sustained or theexpenses incurred result directly or indirectly from one of the followingcauses:
1. Any state or condition for which symptoms were ignored or for whichmedical advice was not followed or the recommended investigations,treatments, tests or procedures were not carried out.
2. Pregnancy, delivery and complications arising therefrom.
3. Accident sustained by the covered person while participating in a sportfor remuneration or in a sporting event where money prizes areawarded to the winners, in any kind of motor vehicle competition orany kind of speeding event, in a contact sport, in a dangerous or violentsport such as but not limited to: off-track snow sports, horse jumpingobstacles, rock climbing or mountain climbing (grade 4 or 5 routesaccording to the scale of the Yosemite Decimal System – YDS),parachuting, gliding or hang-gliding, skydiving, bungee jumping,canyoning, and any sport or activity with a high level of stress and riskinvolved.
The restriction as for the speeding event does not apply to the amateurathletic activities which are non-contact and engaged in by thecovered person solely for leisure or fitness purposes.
4. Abuse of medication or alcohol, or use of drugs, use of experimentaldrugs or products or any other drug addiction, and any condition
37
11QV
V018
5A (2
018-05
)
arising therefrom, or driving of a motor vehicle while the coveredperson is under the influence of drugs or with an alcohol level of morethan 80 milligrams per 100 millilitres of blood (0.08).
5. Trip undertaken for the purpose of receiving medical and paramedical care.
6. Suicide, attempted suicide or self-inflicted injury of the coveredperson, whether sane or insane.
7. War, invasion, enemy acts, hostility between nations (whether or not waris declared), civil war, rebellion, revolution, insurrection, military poweror usurped power.
8. Perpetration of or attempt to perpetrate, directly or indirectly, acriminal act under any law.
9. Any condition resulting from a mental, nervous, psychological orpsychiatric problem, unless the covered person is hospitalized for thatspecific reason.
10. Any claim for patients in long term care hospitals, a rehabilitationdepartment of a public hospital, or in extended care homes or spas.
11. Any care, treatment, products or services other than those declared bythe appropriate authorities to be required for the treatment of theinjury or disease or stabilization of the medical condition.
12. Supportive care or services rendered for the convenience of thepatient.
13. Care or treatments for cosmetic purposes.
14. Care or treatments received in Canada or the United States when suchcare or treatments could have been obtained in the covered person’scountry of residence without endangering the life or health of thecovered person (with the exception of expenses for immediatelynecessary treatment following an emergency resulting from anaccident or sudden illness). Under this exclusion, the fact that thetreatment available in the country of residence of the covered personcould be of lesser quality than treatment available in Canada or theUnited States does not in itself constitute a danger to the coveredperson’s life or health.
Without restricting the generality of this exclusion, no benefits areavailable under this plan for residents of other countries travellingprimarily or incidentally to seek medical advice or treatment, even ifsuch a trip is recommended by a physician.
15. Care or treatments that are not covered under government programswhere services were rendered.
16. Care or treatments such as those rendered by an acupuncturist, ahomeopath or a naturopath.
17. Products listed below are not covered even when obtained by aprescription:
- processed food for infants, dietary or food supplements orsubstitutes of any kind, including protein, so-called “natural”products, multivitamins and drugs available over the counter (GPproducts), antacids, digestives, laxatives, antidiarrheals,decongestants, antitussives, expectorants and any other flu or coldmedications, gargles, oils, shampoos, lotions, soaps and all otherdermatological products.
18. Failure of the covered person to communicate withCanAssistance in the event of medical consultation or hospitalizationfollowing an accident or sudden illness.
38
11QV
V018
5A (2
018-05
)
19. Once the contract has been extended, any medical condition thatarose during the initial period of coverage will be excluded as of thedate of the extension.
20. Consultations or exams required for an immigration application.
21. Eyeglasses and hearing aids.
22. Treatments received outside the borders of Canada and the UnitedStates.
23. Services or treatments received within the United States by apermanent resident of the United States during the period of coverage.
24. For insured children under the age of 2, costs directly or indirectlyrelated to a medical condition resulting from a congenitalmalformation or congenital disease, as well as related healthproblems, whether diagnosed or not.
CanAssistance Travel Assistance BenefitThis benefit is offered free of charge with the purchase of the travelinsurance product included in this policy.
Medical assistanceIf, following an accident or sudden illness, the covered person mustconsult a physician or require hospitalization, he must contactCanAssistance immediately. CanAssistance will make the necessaryarrangements in order to provide the covered person with the followingservices:- for the State of Florida, direct the covered person to an appropriate
clinic or hospital member of the Preferred Patient Care network;- for the State of South Carolina, direct the covered person to an
appropriate clinic or hospital member of the Preferred Personal Carenetwork;
- for all other destinations, direct the covered person to an appropriateclinic or hospital and advance funds to the hospital if necessary;
- confirm the medical insurance coverage in order to avoid paying asubstantial deposit;
- provide the follow-up of the medical file and communicate with thefamily physician;
- coordinate the repatriation of the covered person to his country ofresidence, when necessary;
- coordinate the safe return home of dependent children if the parent ishospitalized;
- make the necessary arrangements for the transportation of a familymember to the patient’s bedside if the covered person is hospitalized forat least 7 days and if the attending physician advises such attendance;
- coordinate the return of the covered person’s road vehicle if he is unableto bring it back due to illness or accident.
CanAssistance is under no circumstance responsible for the expensesrelated to the services described above.
39
11QV
V018
5A (2
018-05
)
40
11QV
V018
5A (2
018-05
)
NoticeFailure to contact CanAssistance in the event of medicalconsultation or hospitalization following an accident or suddenillness could result in refusal of the compensation requested.
The Insurer and CanAssistance are not responsible for the availability orquality of medical and hospital care rendered, or the lack thereof.
General assistanceIn the event of any other emergencies, the covered person can contactCanAssistance in order to receive the following services:- toll-free assistance lines available 24 hours a day, 7 days a week;
- transmission of urgent messages;
- coordination of claims;
- services of an interpreter for emergency calls;
- referral to legal counsel in the event of a serious accident;
- settlement of formalities in the event of death;
- assistance in the event of loss or theft of identification papers;
- information regarding embassies and consulates.
Through CanAssistance, the Insurer may also provide pre-travel informationwith regard to visas and vaccines.
NOTICEAny notice to the Insurer may be validly forwarded to:
Canassurance Hospital Service AssociationP.O. Box 910, Station BMontreal, QuebecH3B 3K8
In witness whereof the Insurer has signed this contract which must bevalidated by an authorized representative.
Sylvain CharbonneauPresident and Chief Executive Officer
HOW TO REACH US
Travel Assistance LinesIf the covered person needs health care, he or a travellingcompanion must call CanAssistance immediately.
Canada, United States
1-800-361-6068 or 514-286-8411
Assistance agents offer the covered person 24-hour service, 7 days a week.
For better service, the covered person should give his name, thephone number where he is calling from and his contract number.
NoticeFailure to contact CanAssistance in the event of medicalconsultation or hospitalization following an accident orsudden illness could result in the compensation requestedbeing refused.
ExtensionTo obtain an extension, the covered person must contact the Insurerat:
Canada, United States
1-877-986-7681 or 514-286-7681
Settlement of ClaimsTo obtain a claim form, the covered person may contact ourCustomer Service Department at one of the following numbers:
1-800-387-2538 or 514-286-6690
41
11QV
V018
5A (2
018-05
)
1-800-361-6068 From Canada and the United States Du Canada et des États-Unis
514-286-8411 From elsewhere in the world, collect D’ailleurs dans le monde, à frais virés
Member of / Membre de
550 Sherbrooke Street West Suite B-9 Montréal (Québec) H3A 3S3
Your distributor
Detach this card and carry it with you at all times for the duration of your contract.
In case of emergency or should you require medical attention, please call the emergency telephone number(s) listed on the card as soon as possible.
11Q
VV
018
5A
(2
018
-05
)
Your Name Votre nom
Contract No. N° de contrat
Expiry Date Date d’expiration
1-800-361-6068 514-286-8411 From Canada and the United States From elsewhere in the world, collect Du Canada et des États-Unis D’ailleurs dans le monde, à frais virés
TRAVEL ASSISTANCE / ASSISTANCE VOYAGE