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
Max $3,000 (Pre-Approval Required)
Laboratory Diagnostics / X-Ray
Covered
Prescription Medications
Max $500 OR a 30 day Supply
Dental Pain Relief
Max $300
Emergency Dental Repair
Max $3,000
24-hour Emergency Assistance Center
Included
ambulanceTransportation
Covered
Emergency Home Return / Evacuation
Included
Repatriation of Remains
Max $10,000
Cremation / Burial
Max $2,500
Stable Pre-existing Medical Conditions Coverage
Included, if Selected
Private Duty Nurse / Medical Attendant
Max $5,000
Rental / Purchase of Medical Appliances
Max $5,000
Side-Trips Benefit (with in Canada and outside of Canada)
Included

Enhanced Benefits

Emergency Services of Chiropractor, Chiropodist, Physiotherapist, Osteopath, or Podiatrist
Max $300/Category
Accidental Death
Max $50,000
Double Dismembernent
Max $50,000
Single Dismembernent
Max $25,000
Bedside Companion Accommodation / Transportation
N/A
Meals and Accommodation / Hospital Allowance / Out-of-pocket Expenses
N/A
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
Max $50,000
Trip-Break Benefit
Included

To be eligible for coverage, on the effective date, you must:

1. Be a visitor to Canada or a person in Canada under a valid work or student visa, a Canadian or an immigrant not eligible for benefits under a government health insurance plan; and

2. Be at least 15 days of age and less than 90 years of age (less than 70 years of age for Premium plan); and

3. Not be travelling against the advice of a physician and/or not have been diagnosed with a terminal illness; and

4. Not be experiencing new or undiagnosed signs or symptoms and/or know of any reason to seek medical attention; and

5. Not require assistance with daily living activities (dressing, bathing, eating, using the toilet or getting in or out of a bed or chair).

For more information, please review the Policy Wording.

CLAIMS PROCEDURES

If you have selected the monthly payment plan option, the full policy premium will become due and payable when a claim is submitted. Your claim will not be processed until the full premium has been paid. The insurer may deduct any premium due from any claims paid.

The insured person is responsible for providing all the documents outlined below and levied for these documents.

To file a claim, the insured person must submit:

a) a fully completed Claim Form (provided by the Assistance Company upon notification of claim);

b) all original itemized bills from the medical provider(s) stating the patient’s name, diagnosis, all dates and type of treatment, and the name of the medical facility and/or physician;

c) original prescription drug receipts (not cash receipts) from the pharmacist, physician or hospital showing the name of the prescribing physician, prescription number, name of preparation, date, quantity and total cost;

d) a copy of your airfare ticket and passport confirming travel dates and entry into Canada. For side trips, proof of both departure from and return to Canada. The type of proof depends on whether you travelled via airline or car. (for example, copies of airline tickets, itinerary, boarding passes, gas receipts, hotel receipts, meal receipts, toll highway receipts, original duty-free shop receipts.)

e) Written proof of claim within 90 days of the date of receipt of services covered under this policy;

f) Additional information pertinent to the insured person’s claim, as may be required by the Assistance Company after receipt of the claim;

g) The unused portion of the insured person’s air ticket to the Assistance Company if the Emergency Transportation benefit is used.

Berkley Insurance Company reserves the right to exclude costs incurred on all invoices submitted, which cannot be verified by the insurer.

All pertinent documents should be sent to the Assistance Company.

Ardent Assistance Inc.

25 Millard Ave West

Second Floor,

Newmarket,

Ontario L3Y 7R6

For more information, please review the Policy Wording.

Refunds

1. If cancellation of your policy is requested before the effective date, the full premium paid will be refunded less any applicable administration fee. If the policy were purchased for a Super Visa application, satisfactory proof from Citizenship and Immigration Canada that your Super Visa was denied would be required before the refund being accepted and processed.

2. The premium paid (less any administration fees) may be partially refunded for the unused portion of the premium if termination of your policy is requested because you must return to your country of origin before your scheduled return date, or you become eligible and/or covered under a government health insurance plan during the coverage period.

3. No refund will apply to any insured who has incurred a claim under this policy. If the policy has been issued under family rates, no refund will apply if any family member has incurred a claim under this policy.

Note: Requests for refunds must be received in writing by your broker or sales agent no later than 60 days from the date you became eligible and/or covered under a government health insurance plan, or the date of your early return, or the expiry date of your policy. Once your broker or sales agent receives satisfactory proof (e.g. airline ticket/boarding pass, customs/immigration stamp) of your early return or proof of the date you became eligible and/or covered under a government health insurance plan, your refund will be calculated from that date. Otherwise, the calculation of such refunds will be based on the postmarked date of your written request. A premium refund request will be considered only if no claim has been paid or is pending. No refund will be issued if the amount of premium to be reimbursed is less than $20 per policy.

For more information, please review the Policy Wording.

This policy does not cover losses or expenses related in whole or in part, directly or indirectly, to any of the following:

1. Any sickness, injury or medical condition that existed before the effective date if you have selected and paid for Plan 1 as indicated on your Confirmation of Insurance. If you have selected and paid for Plan 2 as indicated on your Confirmation of Insurance, there is no coverage for any sickness, injury or medical condition that existed before the effective date, other than:

a) Up to Age 69: Any sickness, injury or medical condition that was stable in the 90 days before the effective date.

b) Age 70-84: Any sickness, injury or medical condition that was stable in the 180 days before the effective date provided you have accurately answered no to all questions on the medical declaration. If any question on the medical declaration is answered yes, there is no coverage for any sickness, injury or medical condition that existed before the effective date, whether or not stable.

2. Expenses related to a sickness or injury that would have caused an ordinarily prudent person to seek medical treatment, advice, diagnosis or care during the 90 day period immediately before the effective date.

3. Any medical treatment is not an emergency medical treatment for the immediate relief of acute pain and suffering, including any elective or cosmetic surgery or treatment.

4. Any sickness or injury that occurred before your policy's effective date when coverage has been extended after you arrived in Canada.

5. Any costs incurred outside of Canada after you exceed 30 consecutive days in any country other than Canada during the coverage period.

6. Any 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 a terminal illness before the effective date.

7. Any medical treatment which can reasonably be delayed until you return to your country of origin by the next available means of transportation, whether you intend to or not.

8. Any medical treatment of an ongoing condition, regular care of a chronic condition, home health care, investigative testing, rehabilitation, convalescent or ongoing care or medical treatment of an acute sickness and/or injury after the initial emergency has ended.

9. Non-compliance with any prescribed medical treatment or therapy.

10. Expenses incurred whereby this policy was purchased specifically to obtain medical treatment outside your country of origin, whether or not recommended by your attending physician.

11. Any medical treatment in your country of origin.

12. Any medical condition for which symptoms were present or for which you received medical treatment during a temporary visit to your country of origin during the coverage period.

13. Transplants include cornea or organ transplants, bone marrow transplants, artificial joints, prosthetic devices, or implants, including any associated charges. Implants required to stabilize an emergency medical condition may be covered if pre-approved by the Assistance Company.

14. The replacement of an existing prescription whether because of loss, unless otherwise specified elsewhere in this policy, renewal or inadequate supply or the purchase of drugs and medications (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 an emergency.

15. Loss or damage to hearing devices, eyeglasses, sunglasses, contact lenses, prosthetic teeth, limbs or devices, and resulting prescription.

16. Routine pre-natal care; your pregnancy or childbirth or complications thereof occurring in the 9 weeks before or after the expected delivery date except as provided in (Benefit #19- Maternity In Policy Wording)

17. For children under 2 years of age, any sickness or a medical condition resulting from or related to a congenital disability.

18. Expenses for any benefit or medical treatment require prior approval by the Assistance Company if such approval was not provided, except in extreme circumstances where such medical treatment is performed on an emergency basis immediately upon hospital admission.

19. A disorder, disease, condition or symptom that is emotional, psychological or mental in nature unless the insured is hospitalized or as provided in (Benefit #20 – Psychiatric/Psychological. in Policy Wording)

20. Loss, death or injury, if at the time of the loss, death or injury, evidence supports that you were affected by, or the medical condition causing the loss was in any way contributed to by, the use of alcohol, prohibited drugs or any other intoxicant.

21. Committing or attempting to commit an illegal act or a criminal act by an insured person.

22. Your suicide, attempted suicide or self-inflicted injury, whether the insured person is sane or insane.

23. Rock or mountain climbing, hang gliding, parachuting, bungee jumping, or skydiving; participation in any motorized race or speed contest; participation in any sport as a professional athlete (for which the insured person is remunerated) or scuba diving (except if certified by an internationally recognized and accepted programs such as NAUI or PADI, or if diving depth does not exceed 30 metres).

24. Death or injury sustained while operating or learning to operate an aircraft as a pilot or crew.

25. Travel to, from or through any country, region or city for which, before your departure date, the Canadian Government, or any department thereof, has issued a warning to avoid all travel or to avoid non-essential travel during the time of your trip if the loss is the result of the reason for which the warning was issued.

26. War, invasion, an act of a foreign enemy, declared or undeclared hostilities, civil war, riot, rebellion, revolution or military power or your unlawful visit in any country.

27. Contamination resulting from radioactive material or nuclear fuel or waste or the release of weapon(s) of mass destruction (nuclear, chemical or biological).

28. Service in, or training for, the armed forces, National Guard or organized reserve corps of any country or international authority.

The following additional exclusions are also applicable to the Accidental Death & Dismemberment Benefits.

29. Mental incapacity, whether the loss or claim results directly or indirectly from a disorder, disease, condition or symptom that is emotional, psychological or mental in nature.

30. Sustained while the insured is underdoing the medical or surgical treatment of any sickness, injury or medical condition.

31. Stroke or cerebrovascular condition, cardiovascular condition including, but not limited to, myocardial infarction or heart attack, coronary thrombosis and aneurysm.

32. Travel or flight in or on (including getting in or out of, or on or off of) any vehicle used for aerial navigation, if you are:

a) riding as a passenger in any aircraft intended or licensed for the transportation of passengers; or

b) performing, learning to perform or instructing others to perform as a pilot or crew member.

33. Infections of any kind regardless of how contracted, except bacterial infections directly caused by botulism, ptomaine poisoning or an accidental cut or wound independent and in the absence of any underlying sickness, injury or medical condition including but not limited to diabetes.

34. An act, attempted act, or omission has taken or made by you, or an act, attempted act or omission taken or made with your consent, to interrupt the blood flow to your brain or to cause asphyxiation to you, whether with intent to cause harm or not.

35. Natural causes.

For more information, please review the Policy Wording.

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