Allianz Global Assistance

Benefits

Emergency Hospital
The insurer agrees to pay for hospital accommodation, including semi-private room, and for reasonable and customary services and supplies necessary for your emergency care during confinement as a resident in-patient.

Emergency Medical
The insurer agrees to pay for the following services, supplies or treatment, when provided by a health practitioner who is not related to you by blood or marriage:

• The services of a legally licensed physician, surgeon, or anesthetist.
• Follow-up visits when declared necessary by the attending physician at the time of the emergency. Follow-up visits must occur during the period of coverage and be directly related to the emergency. The emergency must occur during the period of coverage and have been reported to Allianz Global Assistance.
• Diagnostics, lab tests and/or X-ray examinations as ordered by a physician for the purpose of diagnosis.
• Up to a combined maximum of $10,000, for all of the following:
  • The use of a licensed local land or sea ambulance to the nearest hospital. If an ambulance is necessary but is unavailable, the insurer will reimburse up to $100 for taxi expenses.
  • Private duty services of a registered graduate nurse (who is not related to you by blood or marriage) when ordered by a physician approved in advance by Allianz Global Assistance.
  •  When ordered by a physician, rental of crutches, wheelchair or hospital-type bed (standard nonelectric model only), not exceeding the purchase price; the cost of splints, trusses, braces or other approved prosthetic appliances; initial purchase of casts; artificial limbs, eyes or other approved prosthetic or medical appliances when approved in advance by Allianz Global Assistance.
  • When ordered by a physician, oxygen and rental of equipment for its administration.
  • When ordered by a physician, blood and blood plasma, except when donated.
• The services of the following legally licensed practitioners when ordered by the attending physician as treatment for a covered sickness or injury:
  • chiropractor;
  • Osteopath;
  • podiatrist/chiropodist;
  • Naturopath;
  • acupuncturist;
  • Physiotherapist.
    
    Not to exceed $600 per profession in any consecutive 12-month period.
• Emergency out-patient services provided by a hospital.
• When not hospitalized as an in-patient, drugs or medications that require a physician’s written prescription, not exceeding a 30-day supply. The morning after pill is limited to one prescription per period of coverage.

Transportation of Family or Friend
The insurer agrees to pay up to a maximum of $5,000 for the cost to transport up to two bedside companions (your family member or close friend) by round-trip economy class (using the most direct route) if:

• You are hospitalized due to a covered sickness or injury, and the attending physician advises that your family member or close friend’s attendance is necessary; or
• The local authorities legally require the attendance of your family member or close friend to identify your remains in the event of your death due to a covered sickness or injury.

Benefits are payable only when approved in advance by Allianz Global Assistance.

In addition, the insurer agrees to reimburse up to a maximum of $1,500 for the following expenses incurred by your family members or close friend(s) after arrival:

• Commercial accommodation and meals; and
• Essential telephone calls; and
• Taxi fares.
  Expenses must be supported by original receipts from commercial organizations.

Return of Deceased (Repatriation)
In the event of your death due to a covered sickness or injury, the insurer agrees to reimburse:

• Up to $15,000 for costs incurred to prepare and return your remains in a standard transportation container to your country of origin; or
• Up to $5,000 for cremation or burial of your remains at the place of death.

The cost of a funeral service, corn or urn is not covered.

Dental
The insurer agrees to reimburse:

• up to $5,000 for emergency treatment or services to whole or sound natural teeth (including capped or crowned teeth) which are damaged as a result of an accidental blow to the face; and
• Up to $600 for the immediate relief of acute dental pain caused by other than a direct blow to the face and for which you have not previously received treatment or advice; and
• Up to $100 per tooth for dental and/or oral surgical procedures which are necessary for the extraction of impacted wisdom teeth.

Reimbursement will not exceed the minimum fee specified in the Canadian Dental Association schedule of fees of the province or territory where treatment was received.

Treatment relating to any dental claim must begin within 48 hours after the onset of the emergency and must be completed within the period of coverage and prior to your return to your country of origin.

Treatment must be performed by a legally qualified dentist or oral surgeon.

Emergency Transportation / Return Home
When necessary, the insurer agrees to transport you to the nearest appropriate medical facility or to your country of origin when immediate medical consultation is required due to a covered emergency sickness or injury.

Any emergency transportation such as air ambulance, one- way economy airfare, stretcher and/or a medical attendant must be pre-approved and arranged by Allianz Global Assistance.

Maternity
The insurer agrees to reimburse the costs incurred by the mother for pre-natal care, miscarriage, or related complications.

The amount payable for all eligible expenses under this benefit is limited to $1,000 for expenses incurred in any consecutive 12-month period starting on the date the first pregnancy-related expense is incurred.

The expected delivery date must be more than 10 months after the effective date. For multiple Allianz Global Assistance administered policies with no lapse in coverage, the expected delivery date must be more than 10 months after the effective date of the initial policy purchased.

There is no coverage for a newborn under this policy.

Note: Your newborn may be covered under their own policy once they are at least 15 days old if the premium is accepted by Allianz Global Assistance or its representative and written approval is given by Allianz Global Assistance.

Physical Examination
The insurer agrees to reimburse up to $250 for one routine examination by a physician, including any related tests and laboratory fees.

This benefit is limited to one visit in any consecutive 12-month period, provided coverage with Allianz Global Assistance has been purchased for a minimum of 12 consecutive months with no lapse in coverage.

Eye Examination
The insurer agrees to reimburse the services of a registered optometrist for diagnostic procedures to determine the presence of any observed abnormality in the visual system.

This benefit is limited to one visit in any consecutive 12-month period, provided coverage with Allianz Global Assistance has been purchased for a minimum of 12 consecutive months with no lapse in coverage.

Tutorial Services
If, as the result of a covered sickness or injury, the attending physician expects that you will be hospitalized or confined to your home for 30 or more consecutive school days, the insurer agrees to reimburse up to $20 per hour to a maximum of $500 for the costs of a qualified private tutorial service arranged by your school.

Accidental Death & Dismemberment
Subject to the policy terms and conditions, the insurer agrees to pay up to the sum insured indicated on your confirmation of coverage, for loss of life, limb or sight resulting directly from accidental injury, occurring during the period of coverage, except while boarding, riding in, or alighting from a common carrier.

The maximum amount payable for all losses related to one covered event under all Accidental Death & Dismemberment Coverage under all policies issued by the insurer and administered by Allianz Global Assistance is $10 million.

Benefits are payable according to the following schedule:

• 100% of sum insured resulting from the same accidental injury for loss of:
  • life; or
  • Entire sight of both eyes; or
  • Both hands; or
  • Both feet; or
  • One hand and entire sight of one eye; or
  • one foot and entire sight of one eye.
• 50% of sum insured resulting from the same accidental injury for loss of:
  • entire sight of one eye; or
  • One hand; or
  • one foot.

Loss of hand or hands, or foot or feet means severance through or above the wrist joint or ankle joint, respectively. Loss of eye or eyes means total and irrecoverable loss of the entire sight.

Only one amount is payable (the largest) if you suffer more than one of these losses. This benefit is not subject to coordination of benefits.

Exposure and Disappearance
If you are exposed to the elements or disappear as a result of an accident, a loss will be covered if:

• As a result of such exposure, you suffer one of the losses specified in the schedule of losses above; or
• Your body has not been found within 52 weeks from the date of the accident. It will be presumed, subject to evidence to the contrary, that you suffered loss of life.

Specific Conditions
1. In the event of a medical emergency, you must notify Allianz Global Assistance within 24 hours of admission to a hospital and before any surgery is performed.

Limits on Coverage
If you fail to do so without reasonable cause, then Allianz Global Assistance will pay 80% of the claim payable. You will be responsible for the remaining 20% of the claim payable.

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

2. In accordance with the Privacy Information notice on page 16, you authorize Allianz Global Assistance to communicate with your health care provider including any hospital or physician to manage your emergency.

3. Allianz Global Assistance reserves the right, as reasonably required and at its expense, to transfer you to any hospital or to transport you to your country of origin following an emergency.

If you refuse to be transferred or transported when declared medically ft to travel, any continuing costs incurred after your refusal will not be covered and the payment of such costs becomes your sole responsibility.

Coverage ceases upon your refusal and no coverage will be provided to you for the remainder of the period of coverage.

4. General Provisions of this policy apply.

Exclusions

IS1 Pre-existing Conditions Exclusion

Benefits are not payable for costs incurred due to any sickness or injury or medical condition, whether or not diagnosed by a physician:

1. For which you exhibited signs or symptoms; or
2. For which you required or received medical consultation or treatment; and
3. Which existed prior to the effective date of your coverage.

IS2 benefits are not payable for any sickness or injury when you knew, or for which it was reasonable to expect, before the effective date, that you would need or be required to seek treatment for that sickness or injury.

IS3 benefits are not payable for costs incurred due to any treatment, investigation or hospitalization which is a continuation of, or subsequent to, emergency treatment of a sickness or injury, unless approved in advance by Allianz Global Assistance.

IS4 benefits are not payable for any costs incurred due to any sickness for which signs or symptoms occurred within 48 hours after the effective date, except when applying for coverage:

1. Before the expiry date of your existing Allianz Global Assistance administered policy; or
2. Prior to the date you exit your country of origin.

IS5 benefits are not payable for costs incurred due to any loss incurred outside of Canada when you have not spent the majority of the period of coverage in Canada.

IS6 benefits are not payable for costs incurred due to any loss incurred inside your country of origin.

IS7 benefits are not payable for costs or losses incurred due to:

1. Your emotional or mental disorders resulting from any cause, including but not limited to anxiety or depression; or
2. Your suicide or attempted suicide; or
3. Your intentional self-infected injury.

IS8 benefits are not payable for costs incurred due to pregnancy, abortion, miscarriage, childbirth or complications thereof except as specifically provided under Maternity.

IS9 benefits are not payable for costs incurred due to loss, death or injury, if at the time of the loss, death or injury, evidence supports that the loss was in any way contributed to by:

1. Your abuse of alcohol during your trip; or
2. Your chronic use of alcohol or drugs before or after the efective date; or
3. Your use or consumption of cannabis products during your trip; or
4. Your use of prohibited drugs or any other intoxicant; or
5. Your non-compliance with prescribed treatment or medical therapy before or after the effective date; or
6. Your misuse of medication before or after the efective date.

IS10 benefits are not payable for costs incurred due to injury resulting from training for, competing or participating in:

1. Motorized speed contests; or
2. High-risk activities; or
3. Stunt activities; or
4. Professional sport activities.

IS11 benefits are not payable for costs incurred due to sickness or injury resulting from a motor vehicle accident where you are entitled to receive benefts pursuant to any policy or legislative plan of motor vehicle insurance, except when such benefits are exhausted.

IS12 benefits are not payable for costs incurred due to any sickness, injury or medical condition when a trip is undertaken for the purpose of securing medical treatment.

IS13 benefits are not payable for costs incurred due to your travelling against the advice of a physician or any loss resulting from your sickness or medical condition that was diagnosed by a physician as terminal prior to the effective date of this policy.

IS14 benefits are not payable for costs incurred due to any treatment which can be reasonably delayed until you return to your country of origin (whether or not you intend to return), unless approved in advance by Allianz Global Assistance.

IS15 Benefits are not payable for costs incurred due to any medical consultation that is non-emergency, ongoing elective or the consequence of a prior elective procedure, except as specifically provided under Physical Examination and Eye Examination.

IS16 Benefits are not payable for costs incurred due to hospitalization or services rendered for general health examinations or check-up purposes except as provided under Physical Examination.

IS17 Benefits are not payable for 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.

IS18 Benefits are not payable for costs incurred due to learning or educational assessments.

IS19 Benefits are not payable for costs incurred due to any rehabilitation or convalescent care.

IS20 Benefits are not payable for costs incurred due to dental or cosmetic surgery, except as specifically provided under Dental.

IS21 Benefits are not payable for costs incurred due to holistic treatment.

IS22 Benefits are not payable for costs that exceed the reasonable and customary rate for the area where the treatment or services are being performed.

IS23 Benefits are not payable for costs incurred due to treatment or services that contravene, or are prohibited by, legislation under a provincial or territorial hospital/medical plan.

IS24 Benefits are not payable for costs incurred due to any sickness or injury when such sickness or injury occurs in a city, region, or country for which the Canadian Government issued a written warning prior to the efective date to avoid all travel, or to avoid non-essential travel, to that city, region, or country, and such sickness or injury is related to or due to the reason for the warning.

IS25 Benefits are not payable for costs incurred due to any:

1. Act of war; or
2. Kidnapping; or
3. Act of terrorism caused directly or indirectly by nuclear, chemical or biological means; or
4. Riot, strike or civil commotion; or
5. Unlawful visit in any country; or
6. Participation in the commission or attempted commission of any criminal offence.

IS26 Benefits are not payable for costs incurred due to any nuclear occurrence, however caused.

IS27 Benefits are not payable for costs incurred due to being an occupant of an aircraft, either as passenger or crew, except while being transported under the terms of the Emergency Transportation/Return Home benefit, or while boarding or alighting from an aircraft.

IS28 Benefits are not payable for costs incurred due to dental care, services or supplies, except as specifically provided under Dental.

IS29 Benefits are not payable for eye glasses, contact lenses, hearing aids and/or prescriptions for any of these items, unless required as the result of an injury.

IS30 Benefits are not payable for costs incurred due to the purchase of:

1. 1. Medications or drugs not approved for use by the appropriate government authority; or
   2. Patent or proprietary medications when a generic equivalent is available in the marketplace; or
   3. Vitamins or vitamin preparations; or
   4. Drugs or medications which can be purchased over the counter without a physician’s written prescription; or
   5. Acne medications; or
   6. Nicotine resin products; or
   7. Dietary supplements or weight loss products; or
   8. Quantities of any drug or medication which exceed a 30-day supply within one month prior to the expiry date; or
   9. Contraceptives prescribed for any purpose, with the exception of the morning after pill, which is limited to one per period of coverage; or
   10. Contraceptive consultation or testing; or
   11. Fertility drugs or testing; or
   12. Drugs, medications, or other costs paid for by any other agency; or
   13. Experimental drugs or preventative medications; or
   14. Drugs purchased prior to the effective date; or
   15. Vaccines or vaccinations.

Claims

If you require medical care while travelling, it is critical that you contact Allianz Global Assistance before seeking treatment. In a severe medical emergency, get to a hospital immediately and have a family member or friend call Allianz Global Assistance on your behalf within 24 hours of admission and before any surgery is performed.

Claims for out-of-pocket expenses can be submitted through the secure Allianz Global Assistance. Claims Portal: www.allianzassistanceclaims.ca for the most efficient claims experience.

IMPORTANT:

Notice of Claim. Claims should be reported as soon as reasonably possible, within 30 days of occurrence, and in no event later than one (1) year after the date of occurrence.

Proof of Loss. Written proof of loss should be submitted as soon as reasonably possible, within 90 days of occurrence, and in no event later than one (1) year after the date of occurrence.

All eligible claims must be supported by receipts from commercial organizations and medical documentation regarding your treatment. Other documentation may be required and/or requested by Allianz Global Assistance.

Any expenses for documentation or required reports are your responsibility.

Incomplete information when submitting your claim will cause delay.

When submitting your Emergency Hospital & Medical claim, please include:

1. A fully completed and signed claim form with all original bills and receipts from commercial organizations.
2. Medical records including an emergency room report and diagnosis from the medical facility or a Medical Certificate completed by the treating physician. Any fee for completion of the certificate is not a benefit under this insurance.
3. Any other documentation that may be required and/or requested by Allianz Global Assistance.

When submitting your Accidental Death & Dismemberment claim, please include:

1. A fully completed and signed claim form by either you, or in the case of your death, by the appointed executor/executrix.
2. The police report including any witness statements.
3. The coroner’s report.
4. The death certificate.
5. The Medical Certificate completed by the attending physician or hospital medical records.
6. Any other documents requested by Allianz Global Assistance after initial review of the claim.

Refunds

A full refund will be provided for policies which are returned within 10 days of purchase, as described in the section titled Right To Examine Policy.

Refunds are payable when:

1. The student fails to meet visa eligibility requirements.
2. You return to your country of origin prior to the expiry date, without intending to return to Canada, 30 days or more before the expiry date.
3. You become insured under a Canadian provincial or territorial health/medical plan.

When submitting your premium refund request, please include:

1. A fully completed and signed Refund Request Form; and
2. A copy of your confirmation of coverage; and
3. confirmation of your early departure such as boarding pass or itinerary, or any other written proof of your early return to your country of origin; and
4. Any other documentation to support your refund request.

Important Note

Premium refunds, regardless of method of payment, must be obtained from the representative where coverage was originally purchased unless purchased directly from Allianz Global Assistance.

There will be no refund of premium if a claim has been made. Refunds are payable from the date Allianz Global Assistance receives the request. Refunds for partial cancellations will be calculated by multiplying the daily premium by the actual number of days the policy was in effect; if this amount is less than the minimum premium required, the minimum premium will be used. This amount is then subtracted from the total premium paid.

Refund amounts less than the minimum premium will not be issued.

Extensions

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

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

2. Medically unfit to travel. Coverage will be automatically extended for up to 5 days if medical evidence supports that you are medically unfit to travel due to a covered sickness or injury on or before the coverage expiry date.
3. Hospitalization. Coverage will be automatically extended during the period of hospital confinement, plus 5 days after release to travel home, if you are hospitalized at the end of your trip as a result of a covered injury or sickness.

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

Eligibility

To be eligible for coverage, you must:

• be a student; or
• be a dependent child or the spouse of an eligible insured student; and
• as of the effective date, be less than 60 years of age; and
• not be insured or eligible for benefits under a Canadian government health insurance plan; and
• be in good health at the time you purchase your policy and on the effective date, and know of no reason to seek treatment or medical consultation during the period of coverage.

Student means a person:

• whose country of origin is not Canada and who is residing in Canada on a temporary basis; and
• who:
  1. is registered at a school, college, university or other governmentally accredited educational institution in Canada and attends classes as a full-time student, as defined by the institution; or
  2. remains in Canada for up to one year immediately after completion of studies as described above, and who is working or has applied to work in a field related to the studies completed. 

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

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

The following are also considered stable:

• Routine (not prescribed by a physician) adjustment of insulin to control diabetes provided the insulin was not first prescribed during the time period specified in the Pre-Existing Conditions Exclusion of this policy.
• Change from a brand name medication to a generic medication provided the medication was not first prescribed during the 90 days immediately before the effective date of this policy and there is no increase or decrease in dosage.
• A minor ailment, which describes a sickness or injury which ended more than 30 days prior to the effective date and which did not require:
  1. treatment for a period longer than 15 consecutive days; or
  2. more than one follow-up visit to a physician; or
  3. hospitalization, surgery, or referral to a specialist.

Spouse means a person less than 60 years of age, who

• is legally married to you; or is
• a person who has been living with you in a commonlaw relationship for a period of at least 12 consecutive months.

Dependent children means your unmarried children who:

• reside with you; and
• are fnancially dependent on you; and
• are at least 15 days old and no more than 21 years old.