ALLIANZ GLOBAL ASSISTANCE

Benefits

– Maximum benefits: $100,000; $150,000 and $300,000.
– 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

VTC Pre-existing Condition Exclusion1 a) If you are 59 years of age or younger on the effective date: Benefits are not payable for costs incurred due to or as a result of your medical condition or related condition that was not stable at any time during 90 days immediately prior to the effective date. . b) If you are between the ages of 60 and 79 on the effective date:
I. Benefits are not payable for costs incurred due to or resulting from any of the following pre-existing conditions, unless you have completed a Medical Questionnaire, have been approved in writing by AGA, and have paid the required premium: • heart problems; Heart condition includes angina or chest pain, arrhythmia, arteriosclerosis, atrial fibrillation, congenital heart defect, congestive heart failure, cardiomyopathy, carotid artery occlusion, heart attack (myocardial infarction), heart murmur, irregular heartbeat or heart rate , any other condition related to the heart or cardiovascular system. • stroke or mini-stroke (TIA- transient ischemic attack).
ii. Benefits are not payable for costs incurred due to or as a result of any pre-existing condition not listed in i) unless it has been stable for the 180 days immediately preceding the effective date.
c) If you are between the ages of 80 and 89 on your effective date: No benefits are payable for any pre-existing condition unless you have completed a Medical Questionnaire, been approved in writing by AGA, and paid the required premium.
VTC2 Benefits are not payable for costs incurred due to any treatment, investigation or hospitalization that is a continuation or subsequent to emergency treatment of an illness or injury, unless approved in advance by AGA.
VTC3 Benefits are not payable for any costs incurred due to any illness for which signs or symptoms appeared within 48 hours of the effective date, except when applying for coverage:
a) before the expiration date of your existing AGA-administered policy; or b) before the date of departure from their country of origin. VTC4 benefits are not payable for costs incurred due to any loss incurred outside of Canada when the majority of the coverage period has not been spent in Canada. VTC5 Benefits are not payable for costs incurred due to any loss incurred within your home country.
VTC6 Benefits are not payable for costs or losses incurred while sane or insane due to:
a) your emotional or mental disorders resulting from any cause, including, but not limited to, anxiety or depression; or b) your suicide or attempted suicide; or c) 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 by:
a) your intoxication or abuse of alcohol; or b) your use of prohibited drugs or any other intoxicant; or c) your failure to comply with prescribed treatment or medical therapy; or d) your misuse of medication.
VTC9 benefits are not payable for costs incurred due to injuries resulting from training or participation in:
a) motorized speed contests; or b) stunt activities; or c) professional sports activities (Professional means that you are considered a professional by the sport’s governing body, derive the majority of your income from such activity, and are paid for your participation, whether you win or lose); or d) high-risk activities. High Risk Activity(s) means any off-limits skiing, heli-skiing, ski jumping, skydiving, parachuting, scuba diving (except if certified by an internationally recognized and accepted program such as NAUI or PADI, or if the depth of diving is not exceeds 30 meters), rafting (except grades 1-4), street sledding, skeleton activity, mountain climbing, or participation in any rodeo activity. Mountaineering means the ascent or descent of a mountain that requires the use of specific equipment including crampons, pegs, anchors, bolts, carabiners, and lead rope or top rope anchoring equipment. VTC10 benefits are not payable for costs incurred due to illness or injury resulting from a motor vehicle accident in which you are entitled to benefits under any legislative motor vehicle insurance policy or plan, except where such benefits

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.

Elegibilidad

• La cobertura NO ESTÁ DISPONIBLE para ninguna persona que, a partir de su fecha de vigencia:
  1. haya sido diagnosticada con una enfermedad terminal; o 
  2. ha sido diagnosticado con cáncer en etapa 3 o 4; o 
  3. ha recibido tratamiento para cualquier tipo de cáncer (que no sea cáncer de piel de células basales o de células escamosas o cáncer de mama tratado solo con terapia hormonal) en los últimos 3 meses; o 
  4. requiere asistencia con las actividades de la vida diaria como resultado de una condición médica o estado de salud. Las actividades de la vida diaria incluyen comer, bañarse, ir al baño, cambiar de posición (incluso acostarse y levantarse de una cama o silla) y vestirse. 
• Para ser elegible para la cobertura debe, a partir de la fecha de entrada en vigencia: 
  1. tener al menos 15 días de edad y no más de 89 años; y
  2. no estar asegurado ni ser elegible para los beneficios de un plan de seguro de salud del gobierno canadiense; y
  3. gozar de buena salud al momento de adquirir su póliza y en la fecha de salida de su país de origen, y no tener motivos para consultar a un médico durante el período de cobertura.   

ESTABLE describe cualquier condición médica o condición relacionada, incluyendo cualquier condición cardíaca o pulmonar, para la cual:

• no ha habido un nuevo tratamiento; y
• no ha habido cambio en el tratamiento o cambio en la frecuencia o tipo de tratamiento; y
• no ha habido signos o síntomas o nuevo diagnóstico; y 
• no ha habido resultados de pruebas que muestren deterioro; y 
• no ha habido hospitalización; y
• no ha habido derivación a un especialista (hecho o recomendado) y no está esperando cirugía o los resultados de investigaciones adicionales realizadas por cualquier profesional médico. 

Se consideran estables:   

• Ajuste rutinario (no prescrito por un médico) de la insulina para controlar la diabetes, siempre que la insulina no haya sido prescrita por primera vez durante el período de estabilidad.
• Cambio de un medicamento de marca a un medicamento genérico siempre que el medicamento no haya sido recetado por primera vez durante el período de estabilidad y no haya aumento o disminución de la dosis.      
• Una dolencia leve, que describe una enfermedad o lesión durante el período de estabilidad que finalizó con más de 30 días de anticipación a la fecha de vigencia y que no requirió:
  1. tratamiento por un período superior a 15 días consecutivos; o 
  2. más de una visita de seguimiento a un médico; o 
  3. hospitalización, cirugía o derivación a un especialista. 

Las siguientes condiciones no se consideran estables:

• cualquier afección pulmonar para la que le recetaron o está tomando prednisona;
• cualquier afección cardíaca para la que le recetaron o está tomando nitroglicerina.