Basic Benefits

Covid-19 coverage
Covered
Ambulance Services / Transportation
Covered
Emergency Hospitalization
Up to Coverage Amount
Services of a Physician, Surgeon, etc.
Up to Coverage Amount
Emergency Medical Care
Up to Coverage Amount
Walk-in Clinic Visits
Covered
Follow Up Treatment
Covered
Laboratory Diagnostics / X-Ray
Covered
Prescription Medications
Max $1,000 OR a 30 day Supply
Dental Pain Relief
Max $500
Emergency Dental Repair
Max $4,000
24-hour Emergency Assistance Center
Included
ambulanceTransportation
Covered
Emergency Home Return / Evacuation
Max $3,000
Repatriation of Remains
Max $12,000
Cremation / Burial
Max $5,000
Stable Pre-existing Medical Conditions Coverage
Covered
Private Duty Nurse / Medical Attendant
Max $10,000
Rental / Purchase of Medical Appliances
Covered
Side-Trips Benefit (with in Canada and outside of Canada)
Included

Enhanced Benefits

Emergency Services of Chiropractor, Chiropodist, Physiotherapist, Osteopath, or Podiatrist
Max $500/Category
Accidental Death
Up to Coverage Amount
Double Dismembernent
Up to Coverage Amount
Single Dismembernent
Up to 50% of the Coverage Amount
Bedside Companion Accommodation / Transportation
Max $3,000
Meals and Accommodation / Hospital Allowance / Out-of-pocket Expenses
Max $1500/$150 Per Day
Maternity Benefits / Delivery Coverage
N/A
Pregnancy Complications Coverage
N/A
Physical Examination (Non-emergency)
N/A
Eye Examination (Non-emergency)
N/A
Vaccines (Non-emergency)
N/A
Child Care / Escort Expenses
N/A
Psychiatric / Psychological
N/A
Return of a Vehicle
N/A
Sports Injuries Coverage
Not for Hazardous Sports
Flight / Travel Accident
N/A
Trip-Break Benefit
Included

Eligibility Requirements:

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 daily living activities as the result of a medical condition or state of health.

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 when 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.

Start of Coverage

Coverage starts on the effective date.

Waiting Period

Coverage for losses resulting from any sickness will begin 48 hours after the effective date if you purchase your policy:

a) after the expiry date of an existing AGA administered policy; or

b) after you exit your country of origin.

Any sickness that manifests itself during the 48-hour waiting period is not covered even if related expenses are incurred after the 48-hour waiting period.

End of Coverage

Coverage ends on the expiry date.

For more information, please review the Policy Wording.

Claims Procedures 

Claims forms are available by calling AGA’s Claims Department.

SEND YOUR CLAIMS TO:

Allianz Global Assistance Claims Department

P.O. Box 277

Waterloo, Ontario N2J 4A4

Canada

Collect worldwide: 416-340-8809

Toll-free Canada/USA: 1-800-869-6747

1. Notice of Claim. Claims must be reported within 30 days of occurrence.

2. Proof of Claim. Written proof of claim must be submitted within 90 days of occurrence.

3. Any costs incurred for documentation or required reports are your or the claimant’s responsibility.

4. To submit your claim, fill out the claim form completely and include all original bills. Incomplete information will cause delays.

5. All eligible claims must be supported by original receipts from commercial organizations.

When submitting your hospital or medical claim, please include:

1. A fully completed and signed claim form with all original bills and receipts.

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 completing the certificate is not a benefit under this insurance.

3. For physiotherapy visits, a letter from the referring physician recommending a referral to the physiotherapist.

4. Any other documentation that may be required and/or requested by AGA.

Important Note

• In the event of a medical emergency, AGA must be notified within 24 hours of admission to the hospital and before any surgery is performed.

Limits on Coverage

• If you fail to do so without reasonable cause, then we 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 us.

 

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

1. A fully completed and signed claim form completed 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 (in the event of death).

5. The Medical Certificate completed by the attending physician or hospital medical records.

6. Any other documents requested by AGA after an initial review of the claim.

 

For more information, please review the Policy Wording.

Premium Refunds

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

Refunds are payable when:

1. The entire trip is cancelled before the effective date.

2. You return to your country of origin before the expiry date, without intending to return to Canada. Refunds are not payable for time spent in your country of origin between visits to Canada.

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 departures 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 Notes

Premium refunds, regardless of payment method, must be obtained from the agent where coverage was originally purchased unless purchased directly from AGA.

There will be no refund of the premium if a claim has been made.

Refunds are payable from the date AGA 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. The refund will be calculated based on the date AGA receives the refund request.

A refund fee may apply.

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

For more information, please review the Policy Wording.

VTC1 Pre-existing Conditions Exclusion

a) 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.

b) If you are 60 to 79 years of age 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 condition;

• stroke or mini-stroke ( TIA- transient ischemic attack).

ii. Benefits are not payable for costs incurred due to or resulting from any pre-existing condition not listed under i) unless it was stable during the 180 days immediately before the effective date.

c) If you are 80 to 89 years of age on the effective date:

Benefits are not payable for any pre-existing condition unless you have completed a Medical Questionnaire, have been approved in writing by AGA and have paid the required premium.

VTC2 Benefits are not payable for costs incurred due to any treatment, investigation or hospitalization which is a continuation of, or after, emergency treatment of a sickness or injury unless approved in advance by AGA.

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:

a) before the expiry date of your existing AGA administered policy; or

b) before 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 most 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:

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.

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:

a) your intoxication or abuse of alcohol; or

b) your use of prohibited drugs, or any other intoxicant; or

c) your non-compliance with the prescribed treatment or medical therapy; or

d) your misuse of medication.

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

a) motorized speed contests; or

b) stunt activities; or

c) professional sports activities; or

d) high-risk activities.

VTC10 Benefits are not payable for costs incurred due to sickness or injury resulting from a motor vehicle accident. You are entitled to receive benefits according 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 to secure 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 before 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 AGA.

VTC14 Benefits are not payable for costs incurred due to any medical consultation that is non-emergency, on-going, and 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 any loss incurred in a city, region, or country when, before the effective date, the Department of Foreign Affairs, Trade and Development of the Canadian Government issued a written warning to avoid all travel, or to avoid non-essential travel, to that city, region, or country.

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

a) act of war; or

b) kidnapping; or

c) act of terrorism caused directly or indirectly by nuclear, chemical or biological means; or

d) 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:

a) protests; or

b) armed forces activities; or

c) a commercial sexual transaction; or

d) the commission or attempted commission of any criminal offence; or

e) 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.
For more information, please review the Policy Wording.

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