2013-2014 Pol i cy

Underwritten by:
Assistance & Claims Administered by:
Global Excel Management Inc.
Sold through:
Travel Insurance Office Inc.
and
First World Underwriting Agents
(in Manitoba & British Columbia)
www.Vacat ionInsurancePlan.com
2
Table of Cont ent s
Sect ion Page(s) g ( )
1 Medical Emergency Phone Numbers... 3
2 Important Notices Regarding This Policy.... 4
3 Obtaining a Refund.............. 5
4 Insurance Agreement........... 6
5 Deductible............................................... 6
6 Eligibility Criteria for All Persons......... 7
7 Additional Eligibility Criteria (for Persons Age 55 and Over)........ 8
8 Plan Qualication Medical Questions (for Persons Age 55 and Over)........... 9-10
9 Claim Payment Commitment........... 11-12
10 Types of Coverage
Single Trip Coverage................... 13
Top-Up Coverage..................... 13
Multi-Trip Annual Plan Coverage.............. 14
Family Coverage....................... 14
11 Changes in Your Health Prior to Travel...................... 15
12 Temporary Return to Canada While on a Trip....................... 15
13 Optional Extension of Coverage..................... 16
14 What Is Covered By This Policy
Benets at the Onset of the Emergency................. 17-18
Benets Pertaining to a Dental Emergency......................... 18
Benets Pertaining to Your Emergency Return to Canada...................... 19
Benets Pertaining to Your Delayed Return To Canada......... 20
Benets Pertaining to Preparation and Return of Remains....... 20
15 International Assistance Services Provided by Global Excel.................. 21
16 Contacting Global Excel as Soon as Reasonably Possible.............. 22
17 Claims Procedures............... 23
18 Claims Administration...................... 24
19 What is Not Covered by This Policy
Pre-existing Medical Condition Exclusions................... 25
Optional Stability Upgrades................................................. 26-27
Other Exclusions.......... 28-29
Your Actions That Incur Medical Expenses................. 30
Your Refusal to Return or to be Transferred or Repatriated.......... 31
Medical Expenses Incurred after the Emergency has Ended............ 31
20 Statutory Conditions................................................... 32-33
21 General Provisions..................................... 34-35
22 Denitions..................... 36-39
23 Identication of the Insurer........... back cover
3
Sect ion 1 Medical Emergency Phone Numbers
From Canada and U.S., call 1-800-715-8833
From Mexico, call 001-800-514-7798
From Aust ralia, call 1-800-002-554
From t he Dominican Republic, 1-888-751-4335
From anywhere else, call collect +819-566-8839
In t he event of an emergency during a covered t rip, you must call
Global Excel Management Inc. ( t Global Excel ), before seeking t reat ment . ll
If it is not reasonably possible for you t o cont act u Global Excel before seeking
t reat ment , due t o t he nat ure of your emergency, you must have someone else
call on your behalf or r you must call as soon as medically possible. Failure t o do
so limit s benet s payable t o:
in t he event of hospi t al i zat i on, 80% of eligible expenses, based on
reasonable and cust omary cost s, t o a maximum of $25,000; and
in t he event of an out pat ient medical consult at ion, a maximum of one
visit per sickness or s injury. r
You will be responsible for t he payment of any remaining charges. u
4
Sect ion 2 Import ant Not ices Regarding This Policy
IT IS IMPORTANT THATYOU CAREFULLY READ AND UNDERSTAND THIS POLICY U
BEFORE YOU TRAVEL. U
This policy cont ains a provision removing or rest rict ing t he right of t he insured t o d
designat e persons t o whom or for whose benefit insurance money is t o be payable.
Certain words that have been italicized have a specic meaning and are
dened in Section 22 Denitions, on pages 36-39.
All amounts indicated are in Canadian currency (CAD), unless indicated otherwise.
Travel insurance is designed to cover losses arising from sudden and
unforeseeable circumstances. It is important that you read and understand
your policy before you travel, as your coverage may be subject to certain
limitations and exclusions.
A pre-existing medical condition exclusion may apply to medical conditions
and/ or symptoms that existed prior to your trip. Check to see how this
applies inyour policy and how it relates to your depar ture date, date of
application or effective date.
Coverage is valid subject to the completion of the Vacation Insurance Plan
Emergency Medical Travel Insurance Application (included in this policy for y
reference on pages 7-10) and the payment of the required premium before
your depar ture date from Canada. e
In the event of a sickness or injur y, yy your prior medical history will be reviewed
after a claim has been reported.
Coverage will be null and void if the required premium is not received, if a
cheque is not honored for any reason, if credit card charges are invalid or if
no proof of your payment exists. r
If, while on a covered trip, you return u home or to Canada for any reason, e you
must contact Travel Insurance Office Inc. to discuss how your coverage may r
be affected.
If your health changes or does not remain r stable between the date e you
complete and submit the Application and your effective date, r you must review u
the medical questions on the Application by contacting
Travel Insurance Office Inc. to re-assess your eligibility. r
See Section 11 Changes in Your Health Prior to Travel, on page 15. r
5
Sect ion 3 Obt aining a Refund
Refunds are issued on the same day your written request is received and in the r
same form of payment that you used to purchase the coverage. u
There are no administration fees or service charges.
Cancellat ion of coverage: g You may cancel u your coverage and receive a full refund r
prior to the effective date of coverage. Your written request must be postmarked r
prior to the effective date shown on your Policy Receipt and t you do not require u
medical proof justifying why you are cancelling u your coverage. r
Ret urning t o Canada earlier t han planned: g p If you are returning earlier, before u your
return date and if you have not incurred a claim or no claim is pending, u you may u
receive a refund for the unused days of coverage. Your written request must be r
postmarked within 30 days of your return to Canada and include proof of r your early r
return to Canada such as an airline ticket or a credit card receipt showing the date
andyour signature. If r you do not have proof of u your return, the refund will be based r
on the postmark date of your written request. r
Depart ing Canada lat er t han planned: p g p If you are departing from Canada later than u
your scheduled r depar ture date and e you want u your policy to begin on a different date, r
you may receive a refund for the unused days of coverage. To obtain a refund u you
must telephone Travel Insurance Ofce Inc. no later than the next business day
after the depar ture date shown on e your Policy Receipt to provide t your new dates of r
coverage. You must send a letter conrming u your new dates of coverage. r
Mult i -Trip Annual Plans: p The premium paid is non-refundable after the effective date
of coverage, but additional days of coverage may be refundable.
To obt ain a refund you have t hree opt ions: u
1. MAIL your written request to: r Travel Insurance Of fice Inc.
190 Bullock Dr Suit es 1 & 2
Markham ON L3P 7N3
2. FAXyour written request to: 1-888-360-4833 r
3. EMAIL your request to: r VIP@TravelInsuranceOf fice.com
6
Sect ion 4 Insurance Agreement
This policy offers coverage to a maximum of $5 million CAD per insured person,
per trip, for reasonable and customary costs incurred by s you (less any applicable u
deductible) for an e emergency occurring while y you are travelling outside u your home
province for the benets outlined in Section 14 What Is Covered By This Policy, e
on pages 17-20. We will pay such eligible expenses, subject to all terms and e
conditions indicated in the policy, only in excess of those reimbursable under any
group, individual, private or public plan or contract of insurance, including any
auto insurance plan and your Canadian provincial or territorial government health r
insurance plan (GHIP).
Sect ion 5 Deduct ible
There is no deductible for persons 54 and under. There is a $250 U.S. e
deductible per e insured person, per trip, for persons 55 and over, unless you
chose a different deductible when you purchased this policy. The e deductible
is shown onyour Policy Receipt. The t deductible cannot be changed after e your
effective date.
7
Sect ion 6 Eligibilit y Crit eria for All Persons
The following eligibility criteria must be met to purchase this policy:
a) You must be a Canadian resident and be covered by the government health u
insurance plan (GHIP) of your Canadian province or territory of residence for r
the entire duration of your trip; r
b) You must not be travelling against the advice of a u physician or have been n
diagnosed with a terminal illness or s metastatic cancer;
c) You must not have a kidney disease requiring dialysis; u
d) You must not have been prescribed or used home oxygen during the u
12 months prior to your depar ture date; and ;
e) You must never have been diagnosed with AIDS (Acquired Immune Deciency u
Syndrome) or HIV (Human Immunodeciency Virus).
If you do not meet the Eligibility Criteria, u you do not qualify for this insurance and u
cannot purchase this policy. If you have purchased coverage, coverage is void and u
you should request a refund of premium. See Section 3 Obtaining a Refund, on u
page 5.
Persons Age 0-54 g
If you are u age 54 and under on the date r you apply for coverage, and u you meet u
the Eligibility Criteria for All Persons (above), you qualify for u Plan 1 and 1 you do u not
have to complete the Medical Questionnaire section of the Vacation Insurance
Plan Emergency Medical Travel Insurance Application. y
Persons Age 55 and Over g
If you are age 55 and over on the date u you apply for coverage, and u you meet the u
Eligibilit y Crit eria for All Persons (above), you must also: u
Meet the Addit ional Eligibilit y Crit eria (for Persons Age 55 and Over)
on page 8.
Determine the plan for whichyou qualify by answering the u Plan Qualicat ion
Medical Quest ions (for Persons Age 55 and Over) on pages 9 10 and
adding up the points scored. The plan for which you qualify can be found by u
referring to the Plan Qualicat ion Table (for Persons Age 55 and Over) on
page 10. If you purchase online, answer the Medical Questions to determine
the plan for which you qualify.
The completed and signed Vacation Insurance Plan Application and Medical
Questionnaire (or online Application and Medical Questions) is essential
to the appraisal of the risk by Royal & Sun Alliance Insurance Company of
Canada and is the basis of and forms part of your contract. If there are any r
incomplete or inaccurate answers or concealment relating to an essential
component of the contract, we will void this policy and e your premium will r
be refunded, regardless of whether the incorrect answer to any question
is related or not related to the cause of your claim, whether it would have r
renderedyou ineligible for coverage, or if it would have only resulted in a higher u
applicable premium.
8
Sect ion 7 Addit ional Eligibilit y Crit eria
(for Persons Age 55 and Over)
For persons age 55 and over, all of the following additional eligibility criteria must
be met:
You are not currently taking a water pill (excluding a water pill taken for high blood u
pressure only);
You are not currently taking Lasix or Furosemide for any condition; u
You do not have an Aneurysm of 4 cm or more that remains surgically unrepaired; u
You have never had a Bone Marrow transplant or an Organ transplant (excluding u
corneal transplant);
You have not had Heart by-pass surgery more than u 12 years prior to your
depar ture date (use the date of the most recent bypass); e
You have not had Heart angioplasty or stent placement more than u 12 years prior
to your depar ture date (use the date of the most recent angioplasty or stent e
placement);
During the 5 years prior to your depar ture date you have not been diagnosed with or u
treated for Congestive Heart Failure; d
During the 12 mont hs prior to your depar ture date:
You have not been diagnosed with or treated for a new Heart condition or a u
Heart condition that required hospitalization, a change in medication or a new
medication;
You have not had a Lung condition that required u hospitalization or treatment n
with Prednisone (Deltasone or other generics) or have used or been prescribed
home oxygen;
During the 12 mont hs prior to your depar ture date, you have not been diagnosed u
with or treated for 3 or more of the following conditions: d
Diabetes (treated with oral medication or insulin) d
Any Heart condition (including stent placement, pacemaker and/ or debrillator)
Peripheral Vascular Disease (PVD: narrowing or blockage of any blood vessel)
High Blood Pressure
Stroke or Mini-stroke (CVA/ TIA)
Lung condition (including any prescription for puffers/ inhalers) excluding lung
cancer or a minor ailment.
If you do not meet the Additional Eligibility Criteria (for Persons Age 55 and Over) u
you do not qualify for this insurance and cannot purchase this policy. If u you
have purchased coverage, coverage is void and you should request a refund of u
premium. See Section 3 Obtaining a Refund, on page 5.
9
Sect ion 8 Plan Qualicat ion Medical Quest ions
for Persons Age 55 and Over
For persons age 55 and over, your answers to the following medical questions on r
the Application (or online) determined the plan for which you qualied for. u
During the 10 years prior to your depar ture date, have you been diagnosed with u
or treated for a Heart condition (including stent placement, pacemaker and/ or
debrillator)?
A Yes answer t o t his quest ion means you scored 5 point s.
During the 5 years prior to your depar ture date, have you been diagnosed with or u
treated for Diabetes (treated with oral medication or insulin or controlled by diet)
or Glucose intolerance (pre-diabetes)?
A Yes answer t o t his quest ion means you scored 5 point s.
During the 5 years prior to your depar ture date, have you been diagnosed with or u
treated for Stroke or Mini-stroke (CVA/ TIA)?
A Yes answer t o t his quest ion means you scored 5 point s.
During the 5 years prior to your depar ture date, have you been diagnosed with or u
treated for Peripheral Vascular Disease (PVD: narrowing or blockage of any blood
vessel)?
A Yes answer t o t his quest ion means you scored 5 point s.
During the 5 years prior to your depar ture date, have you been diagnosed with u
or treated for Lung condition (such as any prescription for puffers/ inhalers)
excluding lung cancer or a minor ailment? tt
A Yes answer t o t his quest ion means you scored 5 point s.
During the 5 years prior to your depar ture date, have you been diagnosed with or u
treated for Dementia or Alzheimers disease?
A Yes answer t o t his quest ion means you scored 5 point s.
During the 5 years prior to your depar ture date, have you been diagnosed with or u
treated for Cancer (excluding basal or squamous cell skin cancer or breast cancer
treated only with Tamoxifen, Femara or Arimidex)?
A Yes answer t o t his quest ion means you scored 5 point s.
During the 2 years prior to your depar ture date, have you been diagnosed with or u
treated for any of the following:
Chronic bowel disease (such as but not limited to Crohns disease or
Ulcerative colitis)?
Gallbladder disease (including stones)? Not applicable if your gallbladder has r
been removed.
Gastrointestinal bleeding, Bowel obstruction or have had Bowel surgery?
Kidney disease (including stones), Liver disease or Pancreatitis?
A Yes answer t o one or more part s of t his quest ion means you scored a t ot al
of 5 point s for t his quest ion.
10
Sect ion 8 Plan Qualicat ion Medical Quest ions
for Persons Age 55 and Over (continued)
Have you ever been diagnosed with or r treated for any of the following conditions:
Heart condition (including stent, pacemaker and/ or debrillator)?
Stroke or Mini-stroke (CVA/ TIA)?
A Yes answer t o one or more part s of t his quest ion means you scored 1 point .
Has it been more than24 mont hs since your last r regular check-up with a physician? nn
A Yes answer t o t his quest ion means you scored 1 point .
During the 12 mont hs prior to your depar ture date, have you been diagnosed with or u
treated for High Blood Pressure?
A Yes answer t o t his quest ion means you scored 1 point .
During the 12 mont hs prior to your depar ture date, have you been diagnosed with or u
treated for High Cholesterol?
A Yes answer t o t his quest ion means you scored 1 point .
If you purchased Vacat ion Insurance Plan online, your answers t o t he Medical
Quest ions det ermined t he plan for which you qualied.
Plan Qualicat ion Table for Persons Age 55 and Over Q g
Tot al
Point s
You Qualify for u Pre-exist ing St abilit y Period
0 Plan 1
90 Days/ Optional Stability Upgrades
30-Days or 7-Days
1 Plan 2
90 Days/ Optional Stability Upgrades
30-Days or 7-Days
2 - 4 Plan 3
90 Days/ Optional Stability Upgrades
30-Days or 7-Days
5 - 9 Plan 4
365 Days/ Optional Stability Upgrades
180-Days or 7-Days
10 or more Plan 5
365 Days/ Optional Stability Upgrades
180-Days or 7-Days
11
Sect ion 9 Claim Payment Commit ment
Vacat ion Insurance Plan Emergency Medical Insurance, underwrit t en by y
Royal & Sun Alliance Insurance Company of Canada and of fered t hrough
Travel Insurance Ofce Inc., will approve t he payment of any eligible claim
as long as you acknowledged and accept ed t he following in t he Agreement , u
Underst anding and Aut horizat ion sect ion of t he Applicat ion. (Please nd t he
Agreement , Underst anding and Aut horizat ion below for your reference). Not e
t hat we will approve payment for all eligible expenses aft er receiving all t he
necessary document s and informat ion as specied in Sect ion 17 - Claims
Procedure on page 23.
Agreement , Underst anding and Aut horizat ion g , g
1. I am a Canadian resident and will be covered by the government health
insurance plan in my province or territory of residence for the entire duration
of the trip(s) for which I am purchasing this insurance.
2. I understand that the answers on my Vacat ion Insurance Plan Emergency
Medical Insurance Medical Questionnaire are relevant to the risk and
constitute the basis of my insurance. The information I have provided on
this Application and Medical Questionnaire is true and accurate. Where I
was unsure of my medical history as it relates to the medical questions, I
have veried it with my physician. I personally provided the answers on this
Medical Questionnaire and I warrant that all information disclosed herein is
correct and complete.
3. I have answered the medical questions by checking either the No or Yes
box. If I completed a paper application and underlined or circled words, or
made any other markings, this does not affect my No or Yes responses.
If I checked both the No and Yes boxes in error, I have circled and
initialed the box that is the intended response.
4. I understand that, in the event of a claim, bothRSA and A Global Excel
Management Inc. will review my prior medical history by obtaining a copy of
my medical records and review them to verify that the answers I provided on
the Medical Questionnaire are true and accurate. I understand that if any of
my answers on the Medical Questionnaire are incorrect or incomplete, the
Insurer will void my policy and my claim will be refused, regardless of whether r
the incorrect or incomplete answer to any question is related to the cause of
my claim or would have rendered me ineligible or resulted solely in a higher
applicable premium.
5. I understand that any medical condition that I have, that may affect my
coverage, including those disclosed on the Medical Questionnaire, will
be subject to the Pre-Existing Medical Condition Exclusions as stated on
this Application and in the Vacat ion Insurance Plan Emergency Medical y
Insurance policy.
12
Sect ion 9 Claim Payment Commit ment (continued)
6. I understand the requirement to read the Vacat ion Insurance Plan
Emergency Medical Insurance y policy prior to my depar ture date. If I do not
receive a copy of the policy prior to my depar ture date, I will obtain a copy by
calling Travel Insurance Ofce Inc. during business hours (Monday to Friday
9:00 to 5:00) at 1-800-500-2947. Or, I will review the policy by visiting the
website at www.VacationInsurancePlan.com
7. I understand that, if my health changes or does not remain stable between e
the date of my Application and the depar ture date of any trip I take, I must e
notify Travel Insurance Ofce Inc. to determine whether or not my eligibility
or coverage will be affected. If I am no longer eligible for the insurance plan I
purchased and fail to contact Travel Insurance Ofce Inc., any claim will be
deemed invalid and my policy will be declared null and void.
8. I understand that the premium due is payable in full prior to my depar ture
date. If I do not pay the premium due in full for any reason, including a
returned cheque or a declined credit card, any claim will be deemed invalid
and my policy will be declared null and void.
9. I have read and understood the Important Notice About Your Personal r
Information and by making application for this insurance I agree to the
collection, use and disclosure of personal information as described in that
notice. I understand that the Insurer may investigate my claim. By signing r
this Medical Questionnaire, I also hereby direct and authorize any physician,
health care practitioner, hospital or other medical care facility, pharmacy, l
the Ministry of Health or any other person who has attended and examined
me or who has knowledge or records of me or my health, to furnish to
RSA and to its authorized administrator, A Global Excel Management Inc., l
any or all information with respect to my sickness, injur y, medical history, yy
consultations, medicines or treatment and copies of all hospital or medical l
records for the purpose of investigating my claim.
10. I understand the necessity of calling to obtain approval before seeking
medical attention in case of a claim or medical emergency. The toll free yy
telephone number can be found on my wallet card and in my insurance policy.
13
Sect ion 10 Types of Coverage
Single Trip Coverage g p g
This policy must be purchased prior to your departure from r your home province
or prior to your departure from Canada and the coverage period must be for the r
entire duration of your trip. r
If you purchase coverage for a single trip, this policy: u
a) provides coverage for a single trip outside of your home province; and ;
b) provides coverage for a maximum trip duration of 183 days (or any other
applicable number of days allowed inyour home province). Coverage can be r
extended beyond 183 days, up to 365 days if you provide written approval u
from your government health insurance plan (GHIP) prior to purchasing the r
coverage and you pay the applicable premium; and u
c) allows for optional extensions (see Section 13 Optional Extension of
Coverage, on page 16); and
d) has an effective date that begins on the later of:
the date you leave u your home province or Canada; or e
your effective date as indicated on r your Policy Receipt; tt
e) terminates on the earlier of:
the date you return to u your home province or Canada; or e
your expiry date indicated on r your Policy Receipt.
Top-Up Coverage p p g
If you choose to top-up another carriers insurance plan, u you may apply for single u
trip coverage starting on the day after the expiry date of the other carriers
insurance plan, providing you meet the following conditions: u
Your additional top-up coverage must be purchased for the entire number r
of remaining days of your trip; and r
Your top-up coverage must be purchased before r your depar ture date
from Canada.
It is your responsibilit y t o ensure t hat your ot her carrier s t ravel insurance r
cont ract allows a t op-up of it s insurance coverage.
14
Sect ion 10 Types of Coverage (continued)
Mult i-Trip Annual Plan Coverage p g
If your policy includes a Multi-Trip Annual Plan (as shown on r your Policy Receipt) tt
the Multi-Trip Annual Plan:
a) provides coverage for the rst 4, 9, 16, or 30 consecutive days (as indicated
on your Policy Receipt) of every trip taken out of tt your home province, between
the Multi-Trip Annual Plan effective date and the Multi-Trip Annual Plan
termination date (as indicated onyour Policy Receipt). No coverage is in effect tt
for a trip that started prior to the effective date of your policy; and r
b) offers unlimited travel within Canada (excluding your home province); and e
c) requires trips to be separated by a return to your home province or to anywhere r
in Canada, and a stay of at least 24 hours; and
d) does not require that you provide advance notice of the u depar ture date and e
return date of each trip. However, you will be required to provide evidence of u
your depar ture date and return date when ling a claim (e.g. airline ticket/ e
boarding pass or a credit card receipt issued in Canada and signed by you); u
and
e) cannot be used to top-up another Multi-Trip Annual Plan; and
f) cannot be used to top-up a trip outside of your home province that started prior e
to the effective date of coverage; and
g) coverage for each trip terminates on the earliest of:
the expiry date of your Multi-Trip Annual Plan as indicated on r your Policy
Receipt; tt
the date you return to u your home province or territory of residence; or e
the date you reach the maximum number of days outside of Canada allowed u
under the Multi-Trip Annual Plan, as indicated on your Policy Receipt.
Family Coverage y g
If your policy includes Family Coverage (as shown on r your Policy Receipt), tt
this policy:
offers coverage for your spouse and e your children; and
is available for applicants up to age 54; and
does NOT require child(ren) to complete the Application or Medical
Questionnaire, but all your child(ren) must meet the eligibility requirements; )
and
requires a payment of premium that is twice the premium of the oldest
insured person regardless of the health status of each n insured person; and
allows all insured persons to travel independently of one another under the s
Multi-Trip Annual Plan; and
in case of divorce, allows all insured person to remain covered until n your
coverage terminates, as shown on your Policy Receipt.
15
Sect ion 11 Changes in Your Healt h Prior To Travel
Single Trip, Top-Up and Family Coverage g p, p p y g
If your health changes or does not remain r stable between the date e you complete u
and submit the Application andyour effective date, r you must: u
Review the Eligibilit y Crit eria for All Persons, the Addit ional Eligibilit y Crit eria
(for Persons Age 55 and Over) and the Plan Qualicat ion Medical Quest ions (for
Persons Age 55 and Over) on pages 8-10 in this policy: and
Call Travel Insurance Office Inc. to re-assess your eligibility. r
Canada and U.S.: 1-800-500-2947 (Monday to Friday 9:00 to 5:00)
Toronto-Markham: 905-201-6875 (Monday to Friday 9:00 to 5:00)
If you remain eligible for coverage but do not qualify for the insurance plan u
you purchased, u you will have the option to cancel the policy and obtain a full u
refund or to purchase a plan for whichyou qualify for and pay the additional u
premium due.
If you become ineligible for coverage u we will void e your policy, and the premium r
paid will be refunded.
If you are no longer eligible for the insurance plan u you purchased, and u you fail u
to notify Travel Insurance Office Inc., your claim will be denied, r we will void e
your policy, and the premium paid will be refunded. This means no benets r
will be covered andyou will be responsible for all expenses relating to u your
sickness or s injur y, including repatriation costs. yy
Mult i-Trip Annual Plan Coverage p g
If your policy includes a Multi-Trip Annual Plan and r your health changes or does r
not remain stable after the effective date, e your eligibility will not be affected but r
coverage for your medical condition may be excluded (see Section 19 r Pre-Exist ing
Medical Condit ion Exclusions, on page 25).
Sect ion 12 Temporary Ret urn t o Canada While on a Trip
If you return to u your home province for a temporary visit prior to the termination e
date of your policy, r you must call u Travel Insurance Office Inc. during business
hours (Monday to Friday 9:00 to 5:00) to discuss how your coverage may r
be affected.
If you purchased single trip coverage and provided u you have not incurred a u
claim, your coverage may resume with no additional premium once r you leave u
your home province to resume e your trip. The premium for the number of days r
of your temporary return will not be refunded or reissued.
If you purchased both a Multi-Trip Annual Plan and top-up coverage, u you may u
be entitled to a partial refund on top up coverage. Call Travel Insurance
Office Inc. to discuss your travel plans and whether or not r you are entitled to u
a partial refund of premium.
If during your temporary visit r you are u treated or d you receive u medical treatment
for a medical condition (other than a minor ailment), tt your policy will terminate r
and you may be eligible for a refund (see Section 3Obtaining a Refund, on u
page 5).
16
Sect ion 13 Opt ional Ext ension of Coverage
If you choose to extend u your trip beyond r your scheduled day of return, r you may u
apply for a policy extension for single trip coverage providing you meet the u
following conditions:
you remain eligible for insurance; and u
you have not experienced any changes in u your health since r your effective date r
or depar ture date; and ;
a claim has not been made under the initial policy for the specic trip. If a
claim has been made, an extension may be granted upon review from the
Insurer; and rr
the total trip duration outside your home province, including the extension,
does not exceed the maximum period of coverage for which you are eligible; u
and
your additional coverage may be purchased after the r depar ture date, but
before the expiry of prior coverage; and
your additional coverage must be purchased for the entire number of r
remaining days of your trip; and r
you must pay the required premium prior to the effective date of the u
extension; and
the cost of additional days of insurance will be calculated based on the total
trip duration, the age of the insured on the purchase date of the extension or d
top-up and using the premium schedule in effect at the time of the extension
or top-up is requested; and
A new Application may be required, please call your Vacation Insurance Plan r
Insurance agent for details.
If You Want t o Ext end u Your Coverage g r
Call Travel Insurance Of fice Inc.
From Canada and U.S.
Call t oll-free 1-800-500-2947
(Monday to Friday 9:00 to 5:00)
From everywhere else in the world y
Call collect 905-201-6875
(Monday to Friday 9:00 to 5:00)
17
Sect ion 14 What Is Covered By This Policy
This policy provides a maximum of $5 million CAD per insured person, per t rip n .
In order to be considered eligible expenses, many benets listed in this section
require the prior approval of Global Excel.
There is a $250 U.S. deductible per e insured person, per trip unless you chose u
a different deductible when e you purchased this insurance. The u deductible is e
shown on your Policy Receipt. The t deductible cannot be changed after e your
effective date.
Global Excel, RSA and A Travel Insurance Office Inc. are not responsible for the
availability, quality or results of any medical treatment or transportation, or t your
failure to obtain medical treatment or t hospitalization.
Benet s at t he Onset of t he Emergency g y
We cover: e
a) Ground Ambulance Services: The cost of licensed ground ambulance service
to the nearest hospital (also covers taxi fare in lieu of ground ambulance), if l
medically required.
b) Remot e Evacuat ion: your emergency evacuation from a mountainous area, y
the sea, or other such remote location to the nearest, most reasonably
accessible medical facility or hospital, to a maximum of $5,000. l
c) Hospit al p Accommodat ion: l The cost of care received in hospital up to the l
semi-private room rate (or an intensive or coronary care unit where medically
necessar y).
d) Physician y Fees: n The cost of care received from a physician. If hospitalized,
we also cover treatment for a disorder, disease, condition or symptom that is e
emotional, psychological or mental in nature.
e) Diagnost ic Services: g The cost of laboratory tests and x-rays prescribed by
the attending physician that are needed to diagnose n your condition. r Global
Excel must approve in advance any magnetic resonance imaging (MRI), l
computerized axial tomography (CAT) scans, sonograms or ultrasounds and
biopsies, in order for it to be covered under this policy.
f) Paramedical Services: When approved in advance by Global Excel,
services of a licensed chiropractor, chiropodist, osteopath, podiatrist or
physiotherapist, including x-rays, to a maximum of $300 per profession
listed.
18
Sect ion 14 What Is Covered By This Policy (continued)
g) Prescript ion Drugs: p g The cost of drugs, serums and injectables that can only
be obtained upon medical prescription, that are prescribed by a physician. Up
to a 30-day supply per prescription, unless you are u hospitalized. This benet d
does not cover drugs, serums and injectables needed to stabilize a chronic
condition or a medical condition which you had before u your trip. r
h) Medical Appliances: pp The cost of minor appliances such as crutches, casts,
splints, canes, slings, trusses, braces, walkers and/ or the rental of a
wheelchair when reasonable and medically necessar y.
i) Privat e Dut y Nursing: y g The services of a licensed private duty nurse while
you are u hospitalized, up to a maximum of $5,000 per d insured person, when
approved in advance by Global Excel.
j) Hospit al p Allowance: l Incidental hospitalization expenses; telephone, parking n
and television rental charges up to $250 per policy.
k) Out -of-Pocket Expenses: p When approved in advance by Global Excel, if a l
medical emergency prevents y you or u your insured travel companion from n
returning home on e your scheduled return or requires that r you be relocated for u
treatment, we cover all reasonable, necessary expenses, commercial lodging e
and meals, commercial automobile rental, or taxi transportation and parking
fees up to $150 per day to a maximum of $1,500 per policy.
l) Transport at ion t o p Your Bedside: r When approved in advance by Global
Excel, if l you are travelling alone and have been u hospitalized for at least 7 d
consecutive days, we will cover e you until u you are medically t to return u home:
a round-trip economy airfare from Canada and up to $150 per day to a
maximum of $1,500 per policy for the cost of meals and accommodation
for someone to be withyou;
for aninsured 20 years old or less, a bedside companion is available d
immediately upon hospitalization.
Benet s Pert aining t o A Dent al g Emergency g y
m) Treat ment of Dent al Acci dent s ii : The treatment for a dental emergency
incurred during your trip to a maximum of $2,000 to repair or replace r
sound natural teeth or permanently attached articial teeth that have been
injured because of an accidental blow to the face, provided you consulted a u
physician or a dentist that was ordered or prescribed immediately following n
the injur y. This benet excludes crowns and root canals. An yy accident report t
is required from the physician or dentist for claim purposes. n
n) Emergency g y Relief of Dent al Pain: y We cover up to $350 for each e insured
person for n emergency relief of dental pain at trip destination. This benet y
excludes crowns and root canals.
19
Sect ion 14 What Is Covered By This Policy (continued)
Benet s Pert aining t o g Your Emergency g y Ret urn t o Canada y
o) Emergency g y Air Transport at ion: p yy When approved and arranged in advance
by Global Excel: ll
air ambulance to a Canadianhospital for l medical treatment;
transport on a licensed airline with an attendant (when required) for
emergency return to y your home for immediate medical attention; e
the fare for additional airline seats to accommodate a stretcher to return
you to u your home; or ;
up to the cost of a one-way economy airfare to your home.
p) Qualied Medical At t endant : Q When approved and arranged in advance by
Global Excel, fees for a qualied medical attendant (other than an l immediate
family member) to accompany rr you to u your home when recommended by the e
attending physician. This includes return economy airfare and overnight
lodging and meals (where necessary).
q) Ret urn of Insured Travel Companion p : When approved in advance by Global
Excel, if you must return u home because of a covered medical e emergency and y
if you are travelling with a u travel companion, we cover the e travel companion
for the cost of a one-way economy airfare to returnhome if e you are returned u
under the Emergency Air Transportation or Preparation and Return of Remains y
benet. The insured travel companion must be insured under this insurance n
policy or another travel insurance policy underwritten by RSA and offered A
through Travel Insurance Office Inc.
r) Escort of Children (and Grandchildren): ( ) When approved in advance by Global
Excel, if you are u hospitalized or medically repatriated, d we cover: e
the cost of a one-way economy airfare for the return home of e your insured
children or grandchildren; or n
up to $1,000 for the services of a caregiver (other than an r immediate
family member) contracted by ) you for u your insured child(ren) or
grandchildren.
s) Vehicle Ret urn: e When approved in advance by Global Excel, if neither you, nor
someone travelling withyou, is able to drive your owned or rented r vehicle due e
to your medical r emergency, yy we cover up to $3,000 to return e your vehicle to e
your home or the nearest appropriate rental agency, excluding the rental cost. e
Benets will only be payable for one person to return the vehicle. This benet
does not cover wages lost by the person driving your vehicle.
t ) Pet Ret urn: If your cat or dog is travelling with r you during u your trip and r you
must return home due to e your medical r emergency or y repatriation, we cover up e
to $500 for one-way transportation to your home.
20
Sect ion 14 What Is Covered By This Policy (continued)
Benet s Pert aining t o g Your Delayed Ret urn To Canada y r
If you or u your travel r companion travelling with n you is unable to travel on u your
scheduled date of return home, we will automatically extend e your coverage r
without additional premium for up to 5 days, for the following reasons:
a) the delayed arrival or departure of a common carrier which you are travelling u
aboard causes you to miss u your scheduled return to r your home province; or ;
b) the vehicle in which e you are travelling in is involved in an u accident; or tt
mechanical breakdown that prevents you from returning to u your home
province; or ;
c) you or u your travel companion is unable to return n home because of a covered e
medical emergency for which y you are not able to travel, but u you are u not
hospitalized; or dd
d) if driving, a delay due to inclement weather prevents you to return u home.
If you or u your travel companion insured with n us is s hospitalized on d your scheduled r
date of return, we will automatically extend e your coverage without additional r
premium for the period of hospitalization, up to a maximum of 365 days,
until you or u your travel companion are medically n stable to return e home plus 5 e
consecutive days after discharge.
Benet s Pert aining t o Preparat ion and Ret urn of Remains g p
If you die during u your trip, r we cover expenses up to a maximum of $5,000 for the e
preparation of your remains; homeward transportation costs of r your remains; or r
cremation and/ or burial at the place of death.
The cost of the casket or urn is not covered by this benet.
If someone is legally required to identify your body because r you have died while u
on a trip, we cover the cost of a round-trip economy airfare from Canada and e
up to $150/ day to a maximum of $1,500 for meals and accommodation. The
person required at bedside or mandated to identify the deceased insured person
will be covered under the same terms and conditions of your policy. r
21
Sect ion 15 Int ernat ional Assist ance Services
Global Excel Emergency g y Call Cent re y
No matter where you travel, professional assistance personnel are ready 24 u
hours a day, 7 days a week to take your call. r Global Excel can also provide l you
with Canada Direct instructions and codes so that you deal only with Canadian u
telephone operators.
Referrals
Whenever possible, Global Excel will refer l you to a preferred medical provider u
(hospital, clinic and l physician) that is closest to where n you are staying. With a u
referral, it is less likely that you will have to pay for services out-of-pocket. u
Direct Billing g
Whenever possible, Global Excel will instruct the l hospital or clinic to bill l Global
Excel directly. l
Benet Informat ion
Explanation of your policy is available to r you and to the medical providers who u
are treating you.
Case Management g
Global Excel s experienced and professional team, available 24 hours a day,
7 days a week, will monitor the services given in the event of an emergency. If yy
necessary, Global Excel will help l you to return to Canada for the care u you need. u
Urgent Message Relay g g y
In the event of an emergency, yy Global Excel will contact your travel companion
and keep him/ her informed of your medical situation. r Global Excel will help l you
exchange important messages with your family. r
Int erpret at ion p
Global Excel can connect l you to a foreign language interpreter when required for u
emergency services in foreign countries. y
22
Sect ion 16 Cont act ing Global Excel as Soon
as Reasonably Possible
In the event of an emergency during a covered trip, y you must call u Global Excel
prior to seeking treatment. If it is not reasonably possible for you to contact u
Global Excel prior to seeking treatment, due to the nature of l your emergency, yy
you must have someone else call on u your behalf or r you must call as soon as u
medically possible. Failure to do so limits benets payable to:
a) in the event of hospitalization, 80%of eligible expenses, based on
reasonable and customar y costs, to a maximum of $25,000; and
b) in the event of an outpatient medical consultation, a maximum of one
visit per sickness or s injur y, you will be responsible for the payment of any u
remaining charges.
If You Have an u Emergency g y
From Canada and U.S., call 1-800-715-8833
From Mexico, call 001-800-514-7798
From Aust ralia, call 1-800-002-554
From t he Dominican Republic, 1-888-751-4335
From anywhere else, call collect +819-566-8839
Medical Procedures Requiring Prior Approval q g pp
Global Excel must approve in advance any surgery, invasive procedure, diagnostic l
testing or treatment (including, but not limited to, cardiac catheterization,
angioplasty or stent placement), prior to the insured undergoing surgery, d
procedure, diagnostic testing, treatment or charges except in extreme
circumstances where such surgery is performed on an emergency basis y
immediately upon admission to a hospital. Global Excel must approve in advance l
any magnetic resonance imaging (MRI), computerized axial tomography (CAT)
scans, sonograms or ultrasounds and biopsies.
It remains your responsibilit y t o inform your at t ending physician t o call Global
Excel for approval, except in ext reme circumst ances where such act ion would
delay surgery or t reat ment required t o resolve a life-t hreat ening medical crisis.
Non-Medical Expenses Requiring Prior Approval p q g pp
Global Excel must approve in advance any l emergency air transportation and/ or y
any upgrading charges and cancellation penalties for airline tickets.
Global Excel must approve in advance, all reasonable, necessary expenses l
incurred by you or an u insured travel companion insured with n us for commercial s
lodging and meals, commercial automobile rental, or taxi transportation and
parking fees up to $150 per day to a maximum of $1,500 per policy, if a covered
emergency causes y you to miss u your scheduled return or requires that r you be u
relocated for treatment.
23
Sect ion 17 Claims Procedures
If you have a medical u emergency and intend to le a claim, y you are responsible for u
providing all of the information and documents outlined below within 90 days of
receiving services, as well as for any charges levied for these documents:
a) Your policy number and the patients name (married and maiden, where r
applicable), date of birth and Canadian provincial or territorial government
health insurance plan (GHIP) number (including the expiry date or version code,
where applicable).
b) All original itemized bills from the medical provider(s) stating the patients
name, diagnosis, all dates and types of treatment, and the name of the
medical facility and/ or physician.
c) For prescription drugs, the original prescription drug receipts (not cash
receipts) from the pharmacist, physician, or hospital indicating the name of l
the prescribing physician, prescription number, name of the medication or
preparation, date, quantity and total cost.
d) If your coverage includes a Multi-Trip Annual Plan, proof of r your depar ture date
and return date such as an airline ticket/ boarding pass or a credit card receipt
issued in Canada showing the date and your signature.
e) A completed and signed Mandate/ Authorization Form which means the claim
form provided to you by u Global Excel when notice of claim has been given, l
which you must complete and sign for the purpose of allowing u RSA to recover A
payment from any other insurance contract or health plan (group, individual or
government).
f) For out-of-pocket expenses, an explanation of expenses accompanied by
original receipts.
g) If the Emergency Air Transportation benet is used, the unused portion of y your
air ticket.
Once Global Excel receives l your claim, r you may be required to provide additional u
information. Failure to submit required information will lead to a delay in
processing your claim. Incomplete documentation will be returned to r you for u
completion.
Mail all required documents to:
Global Excel Management Inc.
73 Queen Street
Sherbrooke QC J 1M 0C9
Canada
Or, you may mail all required documents to: u
Global Excel Management Inc.
P.O. Box 10
Beebe Plain, VT, 05823
USA
24
Sect ion 18 Claims Administ rat ion
Keeping p g You Informed About u Your Claim: r Global Excel will answer any questions l
you have about the eligibility of u your claim, its standard verication procedures r
and the way that your policy benets are administered. If r you have questions or u
want to follow-up regarding your claim, call r Global Excel during business hours l
(Eastern Time).
From Canada and U.S., call 1-800-336-9224
From anywhere else, call collect +819-566-8698
Ot her Insurance: This insurance is a second payor plan. For any loss or damage
insured by, or for any claim payable under any other liability, group or individual
basic or extended health insurance plan, or contracts including any private
or provincial or territorial auto insurance plan providing hospital, medical, or l
therapeutic coverage, or any other insurance in force concurrently herewith,
amounts payable hereunder are limited to those covered benets incurred
outside the province or territory of residence that are in excess of the amounts
for which you are insured under such other coverage. All coordination with u
employee related plans follows Canadian Life and Health Insurance Association
Inc. guidelines. If the lifetime maximum for all in-country and out-of-country
benets is over $100,000, RSA will coordinate benets only above this amount. A
In no case will RSA seek t o recover against employee relat ed A
plans if t he lifet ime maximum for all in-count ry and out -of-count ry
benet s is $100,000 or less.
Payment of Benet s: y All payments are payable to you or on u your behalf. In case r
of death of the insured person, benets are payable to the estate of the insured
unless another beneciary is designated in writing to Global Excel or l RSA.
Any claims paid to you will be payable in Canadian funds. If u you have paid a u
covered expense, you will be reimbursed in Canadian currency at the prevailing u
rate of exchange on the date that the claim payment is made to you. No sum
payable shall bear interest.
The total benets paid to you from all sources cannot exceed the actual expenses u
that you have incurred. u
25
Sect ion 19 What Is Not Covered By This Policy
Pre-Exist ing Medical Condit ion Exclusions g
The following exclusions are applicable to any medical conditionyou have, including u
any medical conditionyou have disclosed on the Application (if applicable). u
If you Qualify for the u Plan 1:
This policy does not cover losses or expenses caused directly or indirectly, in whole
or in part, by any sickness, injur y or medical condition (other than a y minor ailment) tt
that was not stable at any time during the e 90 days prior to eachdepar ture date.
See Additional Exclusions 1 and 2 below.
If you Qualify for the u Plan 2:
This policy does not cover losses or expenses caused directly or indirectly, in whole
or in part, by any sickness, injur y or medical condition (other than a y minor ailment) tt
that was not stable at any time during the e 90 days prior to eachdepar ture date.
See Additional Exclusions 1 and 2 below.
If you Qualify for the u Plan 3:
This policy does not cover losses or expenses caused directly or indirectly, in whole
or in part, by any sickness, injur y or medical condition (other than a y minor ailment) tt
that was not stable at any time during the e 90 days prior to eachdepar ture date.
See Additional Exclusions 1 and 2 below.
If you Qualify for the u Plan 4:
This policy does not cover losses or expenses caused directly or indirectly, in whole
or in part, by any sickness, injur y or medical condition (other than a y minor ailment) tt
that was not stable at any time during the e 365 days prior to each depar ture date.
See Additional Exclusions 1 and 2 below.
If you Qualify for the u Plan 5:
This policy does not cover losses or expenses caused directly or indirectly, in whole
or in part, by any sickness, injur y or medical condition (other than a y minor ailment) tt
that was not stable at any time during the e 365 days before each depar ture date.
See Additional Exclusions 1 and 2 below.
Addit ional Pre-Exist ing Medical Condit ion Exclusions Applicable t o Persons g pp
Purchasing a Mult i-Trip Annual Plan g p
This policy does not cover losses or expenses caused directly or indirectly, in whole
or in part, by:
1. your heart condition, if any heart condition was not r stable during the applicable e
pre-existing stability period before each depar ture date.
2. your lung condition, if r
a) any lung condition was not stable; or
b) you have been u treated with home oxygen or taken oral steroids d
(e.g., prednisone) for any lung condition, at any time during the applicable
pre-existing stability period before each depar ture date.
26
Sect ion 19 What Is Not Covered By This Policy (continued)
Opt ional St abilit y Upgrades: p y pg
30-Day St abilit y Opt ion
If you selected and purchased the 30-Day Stability Option at the time of Application,
as indicated on your Policy Receipt, the Pre-existing Medical Condition Exclusions for
the plan you qualied for shall be replaced with the following:
This policy does not cover losses or expenses caused directly or indirectly, in whole
or in part, by any sickness, injur y or medical condition (other than a minor ailment) tt
that was not stable at any time during the 30 days prior to each depar ture date.
See Additional Exclusions 1 and 2 below.
Addit ional Pre-Exist ing Medical Condit ion Exclusio g ns Applicable t o Persons pp
Purchasing g a Mult i-Trip Annual Plan p gg
This policy does not cover losses or expenses caused directly or indirectly, in whole
or in part, by:
1) your heart condition, if any heart condition was not stable during the 30 days
before each depar ture date.
2) your lung condition, if
a) any lung condition was not stable; or
b) you have been treated with home oxygen or taken oral steroids (e.g.,
prednisone) for any lung condition; at any time during the 30 days before
each depar ture date.
180-Day St abilit y Opt ion
If you selected and purchased the 180-Day Stability Option at the time of
Application, as indicated on your Policy Receipt, the Pre-existing Medical Condition
Exclusions for the plan you qualied for shall be replaced with the following:
This policy does not cover losses or expenses caused directly or indirectly, in whole
or in part, by any sickness, injur y or medical condition (other than a minor ailment) tt
that was not stable at any time during the 180 days prior to each depar ture date.
See Additional Exclusions 1 and 2 below.
Addit ional Pre-Exist ing Medical Condit ion Exclusions Applicable t o Persons
Purchasing a Mult i-Trip Annual Plan
This policy does not cover losses or expenses caused directly or indirectly, in whole
or in part, by:
1) your heart condition, if any heart condition was not stable during the 180 days
before each depar ture date.
2) your lung condition, if
a) any lung condition was not stable; or
b) you have been treated with home oxygen or taken oral steroids(e.g.,
prednisone) for any lung condition; at any time during the 180 days before
each depar ture date.
27
Sect ion 19 What Is Not Covered By This Policy (continued)
7-Day St abilit y Opt ion
If you selected and purchased the 7-Day Stability Option at the time of Application,
as indicated on your Policy Receipt, the Pre-existing Medical Condition Exclusions for
the plan you qualied for shall be replaced with the following:
This policy does not cover losses or expenses caused directly or indirectly, in whole
or in part, by any sickness, injur y or medical condition (other than a minor ailment) tt
that was not stable at any time during the 7 days prior to each depar ture date.
See Additional Exclusions 1 and 2 below.
Addit ional Pre-Exist ing Medical Condit ion Exclu g sions Applicable t o Person pp s
Purchasing a Mult i-Trip Annual Plan g p
This policy does not cover losses or expenses caused directly or indirectly, in whole
or in part, by:
1) your heart condition, if any heart condition was not stable during the 7 days
before each depar ture date.
2) your lung condition, if
a) any lung condition was not stable; or
b) you have beentreated with home oxygen or taken oral steroids (e.g.,
prednisone) for any lung condition; at any time during the 7 days before
each depar ture date.
The 7-Day Stability Period Upgrade Option offers up to a maximum of $250,000 CAD
for a pre-existing medical condition that was not stable at any time during the
applicable pre-existing medical condition exclusion period under the plan you
qualied for, provided that the sickness, injury or medical condition was stable on
your depar ture date and at all times during the 7 days prior to your e depar ture date.
Please note: Eligible expenses for pre-existing medical conditions that are stable
on your departure date and at all times during the applicable pre-existing medical
stability period required by the plan you qualied for are payable, up to the policy
maximum of $5,000,000 CAD.
28
Sect ion 19 What Is Not Covered By This Policy (continued)
Ot her Exclusions
These exclusions apply to all benets available under this policy. This policy does
not cover losses or expenses caused directly or indirectly, in whole or in part for:
a) Treatment, hospitalization, surgery, medication, services or supplies that
are not required for the immediate relief of acute pain or suffering, or
that you elect to have provided outside u your home province when medical e
evidence indicates that you could return to u your home province to receive e
such treatment. The delay to receive treatment in your home province has no e
bearing on the Application of this exclusion.
b) Treatment or services rendered in connection with general health
examinations for check-up purposes.
c) Treatment of an ongoing condition, regular care of a chronic condition, home
health care, investigative testing, rehabilitation or ongoing care or treatment
in connection with drugs, alcohol or any other substance abuse.
d) Elective and/ or cosmetic surgery or treatment whether or not for
psychological reasons.
e) Treatment for a sickness or s injur y which rst appeared, was diagnosed or y
received treatment after the depar ture date and prior to the effective date of e
the Single Trip Daily Plan if purchased as a top-up to another carriers travel
insurance product.
f) Treatment for any medical condition for which you incur a claim after u your
depar ture date and prior to the effective date of the extension, if the e
extension was purchased after your depar ture date.
g) Treatment not performed by or under the supervision of a physician or n
licensed dentist.
h) Expenses for which no charge would normally be made in the absence of
insurance.
i) Expenses incurred as a result of symptomatic or asymptomatic HIV infection,
HIV-related conditions and AIDS (Acquired Immune Deciency Syndrome),
including any associated diagnostic tests or charges.
j) Radiotherapy or chemotherapy.
k) A disorder, disease, condition or symptom that is emotional, psychological or
mental in nature unless you are u hospitalized.
l) Services provided by an optometrist or for cataract surgery.
m) Crowns and root canals.
29
Sect ion 19 What Is Not Covered By This Policy (continued)
n) Treatment or hospitalization of mother or n child(ren) as a result of pregnancy, )
miscarriage, childbirth or complications of any of these conditions occurring
in the nine weeks before and/ or after the expected delivery date.
o) The replacement of an existing prescription, whether by reason of loss,
renewal or inadequate supply, or the purchase of drugs and medication
(including vitamins) which are commonly available without a prescription or
which are not legally registered and approved in Canada or which are not
required as a result of a medical emergency. yy
p) The purchase or replacement cost (prescribed or not), loss or damage to
hearing devices, eyeglasses, sunglasses, contact lenses or prosthetic teeth,
limbs or devices and resulting prescription.
30
Sect ion 19 What Is Not Covered By This Policy (continued)
Your Act ions t hat Incur Medical Expenses p r
a) Non-compliance with any prescribed medical therapy or medical treatment (as t
determined by us) or failure to carry out a s physician s instructions.
b) Treatment or surgery during a trip when the trip is undertaken for the purpose
of securing or with the intent of receiving medical or hospital services, l
whether or not such trip is taken on the advice of a physician; or a sickness,
injur y or related condition for which it was reasonable to expect treatment or y
hospitalization during n your covered trip. r
c) Medication, drugs or toxic substance abuse or overdose (whether or not you
are sane); alcohol abuse, alcoholism or an accident while being impaired t
by drugs or alcohol or having an alcohol concentration that exceeds 80
milligrams in 100 milliliters of blood.
d) Committing or attempting to commit an illegal act or criminal act.
e) Suicide (including attempted suicide) or a self-inicted injur y whether or not y
you are sane. u
f) Participation in any sports as a professional athlete (a person who engages
in an activity as their main paid occupation) or any competitive motorized
sporting events, racing or motorized speed contests.
g) Self exposure to exceptional risk, hazardous pursuits or occupations or
ight accident (unless t you are travelling as a fare-paying passenger on a u
commercial airline).
h) Your participation in and/ or voluntary exposure to any risk from: war or act r
of war, whether declared or undeclared; invasion or act of foreign enemy;
declared or undeclared hostilities; civil war, riot, rebellion, revolution or
insurrection; act of military power; or any service in the armed forces.
i) A trip outside your home province on a commercial e vehicle for the purpose e
of delivering goods or carrying a load. This exclusion applies to the driver,
the operator, a co-driver, a crew member and any other passenger of the
commercial vehicle.
j) Sickness, injur y or medical condition y you suffer or contract in a specic u
country, region or area for which the Department of Foreign Affairs and
International Trade of the Canadian Government has issued an ofcial travel
warning, before your depar ture date, advising travellers to avoid non-essential
travel or to avoid all travel to that specic country, region or area. If the
Canadian Government issues an ofcial travel warning after your depar ture
date from Canada, e your coverage for r sickness, injur y or medical condition is y
limited to a period of 10 days from the date the travel warning was issued,
or to a period that is reasonably necessary to safely evacuate the country,
region or area. In this exclusion sickness, injur y or medical condition means y
any sickness, injur y or medical condition that is attributable to the reason y
for which the ofcial travel warning was issued or complications arising from
such sickness, injur y or medical condition. y
31
Sect ion 19 What Is Not Covered By This Policy (continued)
Your Refusal t o Ret urn or t o be Transferred or Repat riat ed p r
During an emergency (whether prior to admission, during a y hospitalization or after n
your release from the r hospital), ll Global Excel reserves the right to: l
a) transfer you to one of its preferred health care providers; and/ or u
b) return you to u your home province, for the medical treatment of t your sickness
or injur y without danger to y your life or health. r
If you choose to decline the transfer or return when declared medically u stable by e
us, we will be released from any liability for expenses incurred for such e sickness
or injur y after the proposed date of transfer or return. y Global Excel will make every l
provision for your medical condition when choosing and arranging r your transfer or r
return and, in the case of a transfer, when choosing the hospital.
Medical Expenses Incurred Aft er t he p Emergency g y has Ended y
Limitation of Benets
Once you are deemed medically u stable to return to e your province or territory of r
residence (with or without a medical escort) either in the opinion of Global Excel
or by virtue of discharge from hospital, your emergency is considered to have y
ended, whereupon any further consultation, treatment, recurrence or complication
related to the medical emergency will no longer be eligible for coverage under this y
policy.
Recurrence
Treatment of a sickness or s injur y after the initial medical y emergency has ended y
(as determined by Global Excel). ll
32
Sect ion 20 St at ut ory Condit ions
1. The Cont ract
The application, this policy, any document attached to this policy when issued
and any amendment to the contract agreed on in writing after this policy is issued
constitute the entire contract, and no agent has authority to change the contract
or waive any of its provisions.
2. Mat erial Fact s
No statement made by the insured or a person insured at the time of application
for the contract may be used in defence of a claim under or to avoid the contract
unless it is contained in the application or any other written statements or
answers furnished as evidence of insurability.
3. Not ice and Proof of Claim
1. The insured or a person d insured, or a beneciary entitled to make a claim, d
or the agent of any of them, must:
a) give written notice of claim to the insurer: rr
i. by delivery of the notice, or by sending it by registered mail, to the
head ofce or chief agency of the insurer in the province, or r
ii. by delivery of the notice to an authorized agent of the insurer in the r
province, not later than 30 days after the date a claim arises under
the contract on account of an accident or t sickness;
b) within 90 days after the date a claim arises under the contract on
account of anaccident or t sickness, furnish to the insurer such proof as r
is reasonably possible in the circumstances of:
i. the happening of the accident or the start of the t sickness,
ii. the loss caused by the accident or t sickness,
iii. the right of the claimant to receive payment,
iv. the claimants age, and
v. if relevant, the beneciarys age; and
c) if so required by the insurer, furnish a satisfactory certicate as to the rr
cause or nature of the accident or t sickness for which claim is made s
under the contract and, in the case of sickness, its duration.
2. Failure to give notice of claim or furnish proof of claim within the time
required by this condition does not invalidate the claim if:
a) the notice or proof is given or furnished as soon as reasonably possible,
and in no event later than one year after the date of the accident or the t
date a claim arises under the contract on account of sickness, and it is
shown that it was not reasonably possible to give the notice or furnish
the proof in the time required by this condition; or
b) in the case of the death of the person insured, if a declaration of d
presumption of death is necessary, the notice or proof is given or
furnished no later than one year after the date a court makes the
declaration.
33
Sect ion 20 St at ut ory Condit ions (continued)
4. Insurer t o Furnish Forms for Proof of Claim r
The insurer must furnish forms for proof of claim within 15 days after receiving r
notice of claim, but if the claimant has not received the forms within that time the
claimant may submit his or her proof of claim in the form of a written statement of
the cause or nature of the accident or t sickness giving rise to the claim and of the s
extent of the loss.
5. Right s of Examinat ion
As a condition precedent to recovery of insurance money under the contract,
a) the claimant must give the insurer an opportunity to examine the insured
person when and as often as it reasonably requires while a claim is pending,
and
b) in the case of death of the person insured, the insurer may require an
autopsy, subject to any law of the applicable jurisdiction relating to autopsies.
6. When Money Payable
All money payable under the contract must be paid by the insurer within 60 days
after it has received proof of claim.
34
Sect ion 21 General Provisions
1. Subrogat ion
If you suffer a loss covered under this policy, the Insurer is granted the right from r
you to take action to enforce all your rights, powers, privileges and remedies
upon making payment or accepting the claim to the extent of the incurred losses,
against any person, legal person or entity which caused such loss. Additionally, if
No Fault benets or other collateral sources of payment of expenses are available
to you, regardless of fault, the Insurer is granted the right to make a demand for, r
and recover those benets.
If the Insurer institutes an action, the r Insurer may do so at its own expense, in r
your name, andyou will attend at the place of loss to assist in the action. If you
institute a demand or action for a covered loss you shall immediately notify the
Insurer so that the r Insurer may safeguard its rights. r You shall take no action after
a loss that will impair the rights of the Insurer set forth in this paragraph and shall r
do such things as are necessary to secure the Insurer s rights. s
2. Misrepresent at ion and Non-disclosure
The completed and signed Application and Medical Questionnaire is essential to
the appraisal of the risk by the Insurer and is the basis of and forms part of r your
contract. Any erroneous responses thereon constitute material misrepresentation
or concealment relating to an essential component of the contract, that renders
your insurance void. Consequently and following a loss, no claim shall be payable
by the Insurer and r you shall be solely responsible for all expenses relating to your
claim, including repatriation costs.
The entire coverage under this policy shall be void if the Insurer determines, r
whether before or after loss, you have concealed, misrepresented or failed
to disclose any material fact or circumstance concerning this policy or your
interest therein, or if you refuse to disclose information or permit the use of
such information, pertaining to any of the insured persons under this contract of
insurance.
3. Arbit rat ion
Notwithstanding any clause in the present policy, the parties hereto undertake to
submit to an arbitration procedure, to the exclusion of the courts, any present or
future dispute relating to a claim. The arbitration proceedings shall be governed
by arbitration laws in force in the Canadian province or territory of residence of
the insured. The parties agree that any action will be referred to arbitration. d
4. Applicable Law
This contract of insurance is governed by the laws of your Canadian province or r
territory of residence. Any legal proceeding by you, your heirs or assigns shall be
brought in the courts of the Canadian province or territory of residence of
the insured.
35
Sect ion 21 General Provisions (continued)
5. Limit at ion Periods
Every action or proceeding against an insurer for the recovery of insurance money
payable under the contract is absolutely barred unless commenced within the
time set out in the Insurance Act (British Columbia, Alberta and Manitoba). Every
action or proceeding against an insurer for the recovery of insurance money
payable under the contract is absolutely barred unless commenced within the
time set out in the Limitations Act (Ontario), otherwise within two years from the
date of loss or such longer period that may be required under the law applicable
in your province or territory of residence. r
6. Waiver
The insurer shall be deemed not to have waived any condition of this contract, r
either in whole or in part, unless the waiver is clearly expressed in writing signed
by the insurer. rr
7. Copy of Applicat ion
The insurer shall, upon request, furnish to the r insured or to a claimant under the d
contract a copy of the application.
8. Import ant Not ice About Your Personal Informat ion r
Royal & Sun Alliance Insurance Company of Canada (we, us) and its
agents and representatives involved in the sale and administration of travel
insurance collect, use and in some instances when appropriate, disclose,
personal information for insurance purposes, such as administering insurance,
investigating and processing claims and providing assistance services.
Typically, we collect personal information from individuals who apply for e
insurance, and from policyholders, insureds and claimants. In some cases s we
also collect personal information from and exchange personal information with
family, friends or travelling companions when a policyholder, s insured or claimant is d
unable, for medical or other reasons, to communicate directly with us.
We also collect and disclose information for the insurance purposes from, e
to and with, third parties such as, but not necessarily limited to, health care
practitioners and facilities in Canada and abroad, government and private health
insurers and family members and friends of policyholders, insureds or claimants. s
In some instances we may additionally maintain or communicate or transfer e
information to health care and other service providers located outside of Canada,
particularly in those jurisdictions to which aninsured may travel. As a result, d
personal information may be accessible to authorities in accordance with the law
of these other jurisdictions.
For more information about our privacy practices or for a copy of r our privacy r
policy, visit www.rsagroup.ca. g p
36
Sect ion 22 Denit ions
We attach very specic meanings to the following words when they appear in e
this policy. We have italicized these dened words throughout this document. e
Accident means a fortuitous, sudden, unforeseen and unintentional event t
exclusively attributable to an external cause resulting in bodily injur y. yy
Caregiver means a person r you have entrusted with the care of u your children on n
a permanent, full-time basis and whose services cannot reasonably be replaced.
Child(ren) means an unmarried child of the ) insured or his d spouse who is, at the e
date of purchase, dependent onyou for support and is: u
a) under 21 years of age;
b) a full-time student who is under 26 years of age; or
c) of any age with a permanent physical impairment or a permanent mental
deciency.
Deduct ible means the amount in U.S. dollars which the e insured person must pay n
before any remaining covered expenses are reimbursed under this policy. The
deductible applies once, per insured person, per trip. The deductible is shown
on your Policy Receipt. The deductible cannot be changed after t your effective r
date.
Depart ure dat e means the date e you leave u your province or territory of residence, r
on a trip for which insurance coverage is in effect.
Emergency means that y you require immediate u medical treatment for the relief of t
acute pain or suffering resulting from an unexpected and unforeseen sickness
or injur y occurring while on a trip and that such y medical treatment cannot be t
delayed until your return to r your home province or territory of residence. e
Global Excel Management Inc. or Global Excel means the company appointed l
by Royal & Sun Alliance Insurance Company of Canada to provide medical
assistance and claim administration services.
If You Have an u Emergency g y
From Canada and U.S., call 1-800-715-8833
From Mexico, call 001-800-514 -7798
From Aust ralia, call 1-800-002-554
From t he Dominican Republic, 1-888-751-4335
From anywhere else, call collect , +819-566-8839
37
Sect ion 22 Denit ions (continued)
Home or home province r means your province or territory of permanent r
residence in Canada. If you requested coverage to start when u you leave Canada, u
home means Canada.
Hospit al means an institution which is designated as a hospital by law; which is l
continuously staffed by one or more physicians at all times; which continuously s
provides nursing services by graduate registered nurses; which is primarily
engaged in providing diagnostic services and medical and surgical treatment
of a sickness or s injur y in the acute phase, or active treatment of chronic y
conditions; which has facilities for diagnosis, major surgery and inpatient care.
The term hospital does not include convalescent, nursing, rest or skilled nursing
facilities, whether separate from or part of a regular general hospital, nor a
facility operated exclusively for the treatment of persons who are mentally ill,
aged, drug or alcohol abusers.
Hospit alized or d hospit alizat ion means an n insured who occupies a d hospital bed l
for more than 24 hours for medical treatment and for which admission was t
recommended by a physician when n medically necessar y. yy
Immediat e family member means r your mother, father, sibling, r child, spouse,
grandparent, grandchild, aunt, uncle, niece, nephew, mother-in-law, father-in-law,
daughter-in-law, son-in-law, brother-in-law and sister-in-law.
Injury means an unexpected and unforeseen harm to the body caused by an y
accident, occurring while on a trip and requiring immediate t emergency treatment y
that is covered by this policy.
Medical t reat ment means any reasonable services and supplies which are t
medical, therapeutic or diagnostic in nature, which are medically necessar y and y
which are prescribed by a physician, hospital or other licensed provider. l
Medically necessary, in reference to a given service or supply, means such yy
service or supply:
a) is appropriate and consistent with the diagnosis according to accepted
community standards of medical practice;
b) is not experimental or investigative in nature;
c) cannot be omitted without adversely affecting your condition or quality of r
medical care;
d) cannot be delayed until your return to r your home province, territory of
residence or Canada.
38
Sect ion 22 Denit ions (continued)
Met ast at ic cancer means a cancer that has spread from its original site to one r
or more other area(s) of the body.
Minor ailment means any t sickness or s injur y which does not require the use of y
medication for a period greater than 15 days; more than one follow-up visit to a
physician, hospitalization, surgical intervention, or referral to a specialist; and
which ends at least 30 consecutive days prior to the depar ture date of each trip. e
However, a chronic condition or any complication of a chronic condition is not
considered a minor ailment.
Physician means a medical practitioner whose legal and professional standing n
within his jurisdiction is equivalent to that of a doctor of medicine (M.D.) licensed
in Canada, who is duly licensed in the jurisdiction in which he practices, who
prescribes drugs and/ or performs surgery and who gives medical care within the
scope of his licensed authority. A physician must be a person other than yourself
or an immediate family member. rr
Policy Receipt is the document t you receive from u Travel Insurance Off ice Inc.
conrming your coverage, plan name, r deductible, coverage period, travel dates
and whether or not a Multi-Trip Annual Plan is included. It also includes your
income tax receipt and wallet cards.
Reasonable and cust omary cost s means costs that are incurred for approved, s
eligible medical services or supplies that do not exceed the average
reimbursement the provider receives for all services rendered to its patients,
up to a maximum of 150%of the rate that would be applicable if the costs were
payable by U.S. Medicare.
Regular check-up means any standard or customary medical examination p
unrelated to any specic medical condition and which is carried out for the purpose
of screening, health monitoring or preventive care and may include routine medical
tests and investigations.
RSA, we, us, our, Insurer means Royal & Sun Alliance Insurance Company of r
Canada.
Sickness means a disease or disorder of the body which results in a loss while s
this coverage is in effect. The sickness must be sufciently serious to prompt
a reasonably prudent person to consult a physician for the purpose of n medical
treatment.
Spouse means the person to whom e you are legally married or with whom u you have u
been residing for at least the last 12 months.
39
Sect ion 22 Denit ions (continued)
St able means any medical condition (other than a e minor ailment) for which all the tt
following statements are true:
a) There has been no new diagnosis, treatment or prescribed medication;
b) There has been no change in treatment or change in medication, including the
amount of medication to be taken, how often it is taken, the type of medication
or change in treatment frequency or type. Exceptions: the routine adjustment
of Coumadin, Warfarin, insulin or oral medication to control diabetes (as long
as they are not newly prescribed or stopped) and a change from a brand name
medication to a generic brand medication (provided that the dosage is not
modied);
c) There have been no new symptoms, more frequent symptoms or more severe
symptoms;
d) There have been no test results showing deterioration; and
e) There has been no hospitalization or referral to a specialist (made or n
recommended) andyou are not awaiting results and/ or further investigations u
for that medical condition.
Terminal illness means that s you have a medical condition that is cause for a u
physician to estimate that n you have less than six months to live or for which u
palliative care has been received.
Travel companion means a person who is accompanying n you and is sharing travel u
arrangements withyou from u your point of departure on the covered trip, including r
accommodation and transportation if paid in advance of departure.
Treat ed means that d you have been u hospitalized, have been prescribed a d
medication (including prescribed as needed), have taken or are currently taking
medication, or have undergone a medical or surgical procedure.
Vehicle means any automobile, station wagon, mini-van, sports utility vehicle (for e
on road use), motorcycle, boat, pick-up truck or a mobile home, camper truck or
trailer home, used exclusively for the transportation of passengers other than for
hire, in which you are a passenger or driver during u your trip. r
You, your, yourself, insured, insured person(s) refers to any eligible person who )
is named on the Policy Receipt and all eligible t children if Family Coverage is n
purchased.
Sect ion 23 Ident icat ion of t he Insurer
Underwritten by:
Assistance and Claims Administered by:
Sold through:
Travel Insurance Office Inc.
and
First World Underwriting Agents
(in Manitoba & British Columbia)
Vacation Insurance PlanEmergency Medical Travel Insurance is y
underwritten by Royal & Sun Alliance Insurance Company of Canada and
is sold through Travel Insurance Office Inc. and First World Underwriting
Agents in Manitoba and British Columbia.
RSA and the RSA logo are trademarks owned by RSA Insurance A
Group plc, licensed for use by Royal & Sun Alliance Insurance Company
of Canada.
The Global Excel logo is a registered trademark of Global Excel l
Management Inc.