Allianz Global Assistance

Benefits

– Maximum benefits: $25,000; $50,000; $100,000 and $500,000.
– Hospital emergencies: up to the amount of the insurance contracted for semi-private accommodation
– Physicians, surgeons and anesthesia services
– Private services of a registered nurse up to $10,000*
– Diagnosis: laboratory tests and X-ray examinations ordered by a doctor.
– Transportation by ambulance: licensed local air, land or sea ambulance (including mountain or sea evacuation) to the nearest hospital, when reasonable and necessary.
– Emergency air transportation: such as air ambulance, one-way economy airfare, stretcher, and/or a medical assistant to transport you to your home country due to a covered emergency illness or injury*
– Medical Device: Rental of crutches or hospital-type bed, not to exceed the purchase price, and the cost of splints, trusses, braces, or other approved prosthetic devices*
– Follow-up visits as prescribed by the treating physician at the time of the emergency. Follow-up visits must occur during the coverage period and be directly related to the emergency. The emergency must occur during the coverage period and AGA has been notified.
– Prescription Drugs or Medicines: One month’s supply, up to a maximum of $1,000.
– Professional medical services referred by a physician (care received from a licensed physical therapist, chiropractor, osteopath, chiropodist, podiatrist, and acupuncturist) up to $500 per profession.
– Accidental Dental: Up to $4,000 for repair or replacement of sound or whole natural teeth damaged by an accidental blow to the face.
– Dental Emergencies: Up to $500 for immediate relief of acute dental pain, other than that provided by Accidental Dental.
– Family or Friends Transportation: Up to $3,000 for inexpensive round-trip transportation to transport a close family member or friend to your bedside when directed by an attending physician OR to identify your remains in the event of your death. Up to $1,000 for lodging, meals, essential phone calls, and taxi fares incurred by your family member or close friend after arrival. *
– Meals and lodging in the event you or your insured travel companion are hospitalized on the date you are scheduled to return home: up to $150 per day up to a maximum of $1,500, or up to a maximum of 10 days for commercial lodging. , meals, childcare costs, essential phone calls and taxi fares incurred by you or any insured traveling companion.
– Emergency Return Home: Up to $3,000 for the cost of inexpensive one-way transportation to your home country if the covered illness or injury requires your immediate return home during the coverage period. This benefit also includes an additional insured family member. *
– Return of the Deceased (Repatriation): In the event of death from a covered condition, up to $10,000 is provided to return the body home, or up to $4,000 for cremation or burial at the place of death. The cost of a casket or urn is not covered.
– Accidental Death and Dismemberment: up to a maximum of the insured sum indicated in your confirmation of coverage, for accidental loss of life, physical integrity or sight (excluding flight accident).
– Act of terrorism: if you suffer a loss due to an act of terrorism, the insurer will pay up to the aggregate limit described in the insurance policy.
– Flight Coverage to/from Canada: Coverage begins on the later of: a) the date and time AGA or its representative accepts the completed application and premium; or b) the date indicated as the effective date on your confirmation of coverage; or c) the first time you leave your country of origin. The coverage expiration time is the time within the Canadian time zone where the coverage was purchased.
* Subject to prior approval by AGA

Exclusions

VTC1 Pre-existing Conditions Exclusion

• If you are 59 years of age or under on the effective date: Benefits are not payable for costs incurred due to or resulting from your medical condition or related condition that was not stable at any time during the 90 days immediately before the effective date.
• If you are 60 to 79 years of age on the effective date: Benefits are not payable for costs incurred due to or resulting from your pre-existing medical condition or related condition that was not stable at any time during the 180 days immediately before the effective date.

VTC2 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.

VTC3 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:

• before the expiry date of your existing Allianz Global Assistance administered policy; or
• prior to the date you exit your country of origin.

VTC4 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.

VTC5 Benefits are not payable for costs incurred due to any loss incurred inside your country of origin.

VTC6 Benefits are not payable for costs or losses incurred while sane or insane due to:

• your emotional or mental disorders resulting from any cause, including but not limited to anxiety or depression; or
• your suicide or attempted suicide; or
• your intentionally self-inflicted injury.

VTC7 Benefits are not payable for costs incurred due to pregnancy, abortion, miscarriage, childbirth or complications thereof.

VTC8 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 medical condition causing the loss was in any way contributed to by:

• your intoxication or abuse of alcohol; or
• your use of prohibited drugs, or any other intoxicant; or
• your non-compliance with prescribed treatment or medical therapy; or
• your misuse of medication.

VTC9 Benefits are not payable for costs incurred due to injury resulting from training for or participating in:
motorized speed contests; or

• stunt activities; or
• professional sport activities (Professional means you are considered professional by the governing body of the sport, earn the majority of your income from such activity, and are paid for your participation whether you win or lose); or
• high-risk activities. High-risk activity(ies) mean(s) any skiing out of bounds, heliskiing, ski jumping, skydiving, sky-surfing, scuba diving (except if certified by internationally recognized and accepted program such as NAUI or PADI, or if diving depth does not exceed 30 meters), white water rafting (except grades 1 to 4), street luge, skeleton activity, mountaineering, or participation in any rodeo activity. Mountaineering means the ascent or descent of a mountain requiring the use of specified equipment including crampons, pick axes, anchors, bolts, carabiners and lead-rope or top rope anchoring equipment.

VTC10 Benefits are not payable for costs incurred due to sickness or injury resulting from a motor vehicle accident where you are entitled to receive benefits pursuant to any policy or legislative plan of motor vehicle insurance, except when such benefits are exhausted.

VTC11 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 or advice.

VTC12 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.

VTC13 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) by the next available means of transportation, unless approved in advance by Allianz Global Assistance.

VTC14 Benefits are not payable for costs incurred due to any medical consultation that is non-emergency, on-going, elective or the consequence of a prior elective procedure.

VTC15 Benefits are not payable for costs incurred due to hospitalization or services rendered in connection with general health examinations for check-up purposes, treatment of an on-going condition, regular care of a chronic condition, home health care, investigative testing, rehabilitation, or on-going care or treatment in connection with drugs, alcohol or any other substance abuse.

VTC16 Benefits are not payable for costs incurred due to any rehabilitation or convalescent care.

VTC17 Benefits are not payable for costs incurred due to dental or cosmetic surgery.

VTC18 Benefits are not payable for costs incurred due to naturopathic or holistic treatment.

VTC19 Benefits are not payable for costs that exceed the reasonable and customary rate for the area where the treatment or services are being performed.

VTC20 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.

VTC21 Benefits are not payable for costs incurred due to, contributed to by, or resulting from any sickness or injury when such sickness or injury occurs in a city, region, or country for which Global Affairs Canada issued a written warning to avoid all travel, or to avoid non-essential travel, to that city, region, or country, before the later of:

• the effective date of your policy, or
• the date you depart for the destination under advisory, and such sickness or injury is due to, contributed to by, or resulting from the reason for the warning.

VTC22 Benefits are not payable for costs incurred due to any:

• act of war; or
• kidnapping; or
• act of terrorism caused directly or indirectly by nuclear, chemical or biological means; or
• riot, strike or civil commotion; or
  e) unlawful visit in any country.

VTC23 Benefits are not payable for costs incurred due to any nuclear occurrence however caused.

VTC24 Benefits are not payable for costs incurred due to the participation by you, a family member or travelling companion in:

• protests; or
• armed forces activities; or
• a commercial sexual transaction; or
• the commission or attempted commission of any criminal offence; or
• the contravention of any statutory law or regulation in the area where the loss occurred.

VTC25 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 or Emergency Return Home benefits, or while boarding or alighting from an aircraft.

Claims

You must notify AGA Emergency Assistance within 24 hours.
after admission to a hospital and before any surgery is performed. Failure to do so, without reasonable cause, will result in the reduction of eligible benefit amounts payable by 20%.
– Claims must be reported within 30 days of their occurrence.
– Written proof of claim must be submitted within 90 days of the incident.
– To submit your claim, please complete the claim form completely and include all original invoices. Incomplete information will cause delays. – Any costs incurred for the required documentation or reports are the responsibility of you or the claimant.
– Always make a copy of the documents you send.
SEND CLAIMS TO:
Allianz Global Assistance Claims Department
PO Box 277
Waterloo, ON, N2J 4A4

AGA’s claims and emergency assistance staff are available to assist you 24 hours a day, 7 days a week. AGA’s experienced multilingual staff checks hospital coverage, arranges for emergency medical evacuation, coordinates payments, and communicates with your GP and family members as needed. Call AGA Emergency Assistance or have someone call for you as soon as possible.

1-866-520-8823

Refunds

Refunds are paid when:
1. All travel is canceled prior to the effective date.
2. You return to your home country before the expiration date, with no intention of returning to Canada. No refunds are paid for time spent in your home country between visits to Canada.
3. You are insured under a Canadian provincial or territorial health/medical plan.
When you submit 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 a boarding pass or itinerary, or any other written proof of your early return to your country of origin; and 4. any other documentation that supports your request for reimbursement.

Important notes:
There will be no premium refund if a claim has been made. Refunds are paid from the date the request is received by AGA. Refunds for partial cancellations will be calculated by multiplying the daily premium by the actual number of days the policy was in force; if this amount is less than the required minimum premium, the minimum premium will be used. This amount is then subtracted from the total premium paid. The refund will be calculated based on the date the refund request is received by AGA. A refund fee may apply. Refunds will not be issued for amounts less than the minimum premium.

1-866-520-8823

Extensions

If you decide to extend your trip, you can apply for a new coverage period as long as you meet the eligibility requirements.
Each policy or coverage period is considered a separate contract and all limitations and exclusions will apply.

ADDITIONAL TRIPS:
Costs incurred outside of Canada, except in your home country, are covered as long as the majority of the coverage period is spent in Canada.
If you travel to your home country, your policy will remain in force, however costs incurred in your home country are not covered.
Country of origin means the country in which you had a permanent residence before entering Canada or the country that issued your passport. For Canadian passport holders without permanent residence, country of origin means the country from which you departed before arriving in Canada.

Eligibility

1. Coverage is NOT AVAILABLE to any individual who, as of their effective date:
   • a) has been diagnosed with a terminal illness; or
   • b) has been diagnosed with stage 3 or 4 cancer; or
   • c) has received treatment for any cancer (other than basal or squamous cell skin cancer or breast cancer treated only with hormone therapy) in the past 3 months; or
   • d) requires assistance with activities of daily living as the result of a medical condition or state of health. Activities of daily living means eating, bathing, using the toilet, changing positions (including getting in and out of a bed or chair) and dressing.
2. To be eligible for coverage you must, as of the effective date:
   • a) be at least 15 days old and not more than 89 years old; and
   • b) not be insured or eligible for benefits under a Canadian government health insurance plan; and
   • c) be in good health at the time you purchase your policy and on the date you exit your country of origin, and know of no reason to seek medical consultation during the period of coverage.

STABLE describes any medical condition or related condition, including any heart condition or lung condition, for which:

1. a) there has been no new treatment; and
2. b) there has been no change in treatment or change in treatment frequency or type; and
3. c) there have been no signs or symptoms or new diagnosis; and
4. d) there have been no test results showing deterioration; and
5. e) there has been no hospitalization; and
6. f) 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 considered stable:

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

The following conditions are not considered stable:

1. a) any lung condition for which you were prescribed or are taking prednisone;
2. b) any heart condition for which you were prescribed or are taking nitroglycerin.