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 (Max 3 Visits)
Laboratory Diagnostics / X-Ray
Covered
Prescription Medications
Max $10,000 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
Included
Repatriation of Remains
Max $16,000
Cremation / Burial
Max $6,000
Stable Pre-existing Medical Conditions Coverage
Included, 180 Days Stability Required
Private Duty Nurse / Medical Attendant
Up to the Coverage Amount
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
Max $100,000
Double Dismembernent
Max $100,000
Single Dismembernent
Max $50,000
Bedside Companion Accommodation / Transportation
Airfare $3,000+ $1,000 Expenses
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
Max $3,000
Psychiatric / Psychological
N/A
Return of a Vehicle
N/A
Sports Injuries Coverage
Not for Hazardous Sports
Flight / Travel Accident
Included
Trip-Break Benefit
N/A

Who Is Eligible for Coverage?

All of the following restrictions apply:

1) You must be over 14 days old and under 86 years of age during the entire Period of Coverage. Ages 70 to under 86 years of age during the entire Period of Coverage may only purchase Plan Limits up to $100,000.

2) You do not have a Medical Condition for which a Physician has advised you against travel before Your Period of Coverage.

3) You do not have a surgically untreated aneurysm.

4) You have never been diagnosed with or received Treatment for:

a) Pancreatic or liver cancer, or any type of metastasized cancer;

b) A kidney condition requiring dialysis;

c) A bone marrow or organ transplant;

d) Congestive heart failure;

e) A Terminal Sickness.

5) At time of purchase of this Policy, You do not reside in a nursing home, assisted living home,

Convalescent home, hospice or rehabilitation Centre.

6) You do not require assistance with Normal Daily Activities. This does not apply to children under 12 years of age.

7) You have not taken (or been prescribed) oral steroids or used home oxygen to treat a lung condition in the 12 months before Your Start Date.

8) In the 12 months immediately prior to Your Start Date you have not been:

a) Diagnosed with or received Treatment for any two conditions listed in the Medical Conditions Table;

b) Admitted to hospital for any one condition in the Medical Conditions Table.

MEDICAL CONDITIONS TABLE

1. Coronary artery disease (including heart attack or angina)

2. Valvular heart disease (including stenosis, regurgitation or valve replacement)

3. Heart arrhythmia (including atrial flutter, atrial fibrillation, ventricular fibrillation or use of a pacemaker)

4. A lung or respiratory condition for which daily medication has been prescribed (including inhalers)

5. Diabetes requiring insulin

6. Stroke or mini-stroke (TIA)

7. Aneurysm

8. Blood clots

9. Gastro-intestinal bleed

If prior to Your Start Date, Your health changes and You no longer meet the eligibility requirements listed above, You must send a written request for refund.

If You do not meet the eligibility requirements, Your insurance is void and the Company’s liability is limited to a refund of the premium paid.

What to Do If You Have A Claim

To receive Treatment:

Contact the Emergency Assistance Provider. You or someone on your behalf must do this before receiving Treatment for Your medical Emergency. Failure to do so will result in you being responsible for 20% of any eligible expenses incurred. You or someone acting on your behalf, must authorize us to access all medical documentation from the Treatment provider at your location and your personal Physician(s) at home for the applicable pre-existing time period.

In order to qualify for coverage under this provision, you must submit to us with your claim:

1. The completed medical claim form;

2. Original receipts or other proofs of payment;

3. Detailed medical documentation; and

4. Any other information we deem necessary to properly adjudicate your claim.

Contact Us

Travel Claims Department

P.O. Box 557, Hamilton, Ontario L8N 3K9

Toll Free Fax: 1-866-551-1704

Toll Free Telephone

Canada & USA: 1-888-526-0111

Direct Dial Telephone 905-667-3391

If you experience an emergency or require medical assistance while you are travelling at any time call:

USA & Canada 1-800-334-7787

Elsewhere Operator Assisted Collect 905-667-0587

Direct Dial 1-905-667-0587

Email: assistance@oldrepublicgroup.com

How to Submit a Claim

You can download a claim form directly from our website: www.oldrepublicgroup.com/TAI or you can contact Us toll free at: 1-888-526-0111

To make a claim for benefits under this Policy:

          Submit Your claims forms within 30 days after the expense or loss is incurred or as soon as is reasonably possible;

          Written proof of the claim must be submitted within 90 days, but not later than 12 months after the date of the event or loss. Written Proof of a Claim shall include:

                 1. The completion of any claim forms furnished by the Company;

                 2. Original receipts;

                 3. A written report, complete with the diagnosis by the attending Physician, if applicable, and any other form of documentation deemed necessary by the Company to validate your claim.

 

Original substantiating claims documentation must be provided, however, the Company may accept certified copies if the original documentation cannot be provided for a reasonable cause. Failure to provide applicable substantiation for a claim shall invalidate any claim under this Policy. All documents required to support or validate the claim, including English or French translations of such documents, must be provided free of expense to the Company.

 

 Claim Payments

We will pay covered claims, less any applicable Deductible, within 30 days of receiving all of the information we need to assess your claim accurately. We will pay eligible benefits to you or to any person or entity having a valid assignment to such benefits. In the event of your death, any balance remaining or benefits payable for loss of life will be paid to your estate, unless otherwise indicated.

Limitation of Action

If you have a claim in dispute under this Policy, You must begin any legal action or proceeding against the Company within 24 months following the date of the event which caused the claim. All legal actions or proceedings must be brought in the province of Ontario where the head office of the Company is located.

Refund of Premium:

Other than the “10 Day Right to Examine”, and provided that You have not reported a claim under this Policy, a refund for unused days will be allowed. The following administration fees will be deducted from Your refund if You:

a) cancel Your policy due to a denial of Your travel visa (no fee will be deducted);

b) cancel Your policy before Your Start Date due to You no longer being eliglible (no fee will be deducted);

c) cancel Your Policy before You leave Your Home Country for other than “a)” or “b)” above ($250 fee will be deducted);

d) cancel Your Policy before Your Expiry Date to return to Your Home Country or if You become insured under a Canadian federal, provincial or territorial health/medical plan ($50 fee will be deducted); or

e) cancel Your Policy and decide to stay in Canada ($250 fee will be deducted).

A request for refund must be submitted to Your broker within 30 days from the requested cancellation date. All requests for refunds must be accompanied with the following applicable documentation:

a) evidence that You have been denied a travel visa;

b) evidence that Your trip was cancelled before You departed Your Home Country;

c) evidence to prove Your date of return to Your Home Country;

d) evidence that You have become insured under a Canadian federal, provincial or territorial health/medical plan;

e) evidence that You have decided to seek alternative health protection while staying in Canada.

If a claim is received after a request for premium refund has been processed, You will be financially responsible for paying the claim and the Company will forward the claim to You for settlement.

Exclusions only Applicable to the Emergency Medical section of this Policy:

There is no coverage and no benefits will be payable for claims presented under this section resulting from:

    1. Pre-Existing Conditions or related Medical Conditions as follows:

      I. For ages 69 and under on the Start Date, any Pre-Existing Condition or Medical Condition that was not Stable and Controlled during the 180 day period immediately prior to Your Start Date.

     II. For ages 70 to 79 on the Start Date:  

 A) Any Pre-Existing Condition or Medical Condition that was not Stable and Controlled during the 180 day period immediately prior to Your Start Date; and,

B) Any of the following Pre-existing Conditions that existed during the 180 day period immediately prior to Your Start Date:

· Any heart condition including but not limited to heart attack, angina, arrhythmia or cardiac surgery;

· Any brain condition including but not limited to stroke, transient ischemic attack (TIA), mini-stroke, aneurysm or seizure;

· Any lung condition including but not limited to chronic obstructive pulmonary disease (COPD), asthma, chronic bronchitis or emphysema.

    III. For ages 80 and over on the Start Date, any Pre-Existing Condition or Medical Condition that existed during the 180 day period immediately prior to Your Start Date.

2. Expenses related to a Sickness, Injury, or Medical Condition that in the opinion of our medical Director would have caused you to seek medical advice, diagnosis, care or Treatment, during the 180 day period immediately prior to Your Start Date;

3. Any expenses incurred outside the Period of Coverage;

4. Any expenses incurred outside Canada except for:

a) If coverage is purchased prior to arrival in Canada, Emergency expenses incurred en route to Canada after the date and time You leave Your Home Country provided You are scheduled to arrive in Canada within 48 hours of departure;

b) If coverage is in effect on the date you leave Canada, Emergency expenses incurred en route to Your Home Country after the date and time you leave Canada provided you are scheduled to arrive in Your Home Country within 48 hours of departure;

c) Emergency expenses incurred during any side trip outside of Canada as described in Coverage for Side Trips outside Canada

5. Treatment:

a) Not required for the immediate relief of acute pain and suffering;

b) Which can reasonably be delayed until Your Policy expires or you return to Your Home Country;

c) for follow-up Treatment (other than subsequent follow-up visits, Recurrence of a Medical Condition or subsequent Emergency Treatment or hospitalization for a Medical Condition or related Medical Conditions for which You had received Emergency Treatment during Your Period of Coverage;

6. Transplants of any kind;

7. Expenses incurred whereby this Policy was purchased specifically to obtain Hospital or medical Treatment outside Your Home Country whether or not recommended by your attending Physician;

8. The cost of replenishing any medication that was in use on Your Departure Date or for the maintenance of any course of Treatment that commenced prior to your date of arrival in Canada;

9. Unless the Company pre-approves it, Emergency air transportation; surgery; diagnostic testing; cardiac procedures including but not limited to cardiac catheterization, angioplasty or surgery;

10. Your mental, emotional or nervous disorders resulting from any cause, including but not limited to anxiety or depression;

11. Any Treatment or services performed by a Family Member;

12. Any elective medical Treatment;

13. Cataracts or any Medical Conditions resulting from their medical care;

14. Pregnancy, childbirth, complications of pregnancy or childbirth, or voluntarily induced abortion; or a child born during Your Period of Coverage.

Exclusions only Applicable to the Accidental Death & Dismemberment section of this Policy:

There is no coverage and no benefits will be payable for claims presented under this section resulting from:

1. Disease or any physical defect, infirmity or Sickness which existed before the commencement of Your Period of Coverage;

2. Any Injury sustained as a result of any type of employment or employment related activities; or

3. Any Act of Terrorism.

Exclusions Applicable to all sections of this Policy:

There is no coverage and no benefits will be payable for claims resulting from:

1. Your use of drugs, alcohol, or any medication that results directly or indirectly in the condition

Causing a claim;

2. Your suicide, attempted suicide or any intentionally self-inflicted Injury;

3. Your participation in Extreme Activities;

4. Your participation in organized professional sporting activities;

5. You’re driving a motorcycle, moped, or scooter, whether or not You are driving on publicly maintained roads, driving off-road or on private property (unless You hold an applicable valid

Canadian driver’s license);

6. Your riding, driving or participating in races of speed or endurance;

7. Your piloting an aircraft or air travel on any air supported device other than as a fare-paying passenger on a flight operated by a Common Carrier;

8. Fraud, concealment, or deliberate misstatement in relation to any matter affecting this insurance or in connection with the making of any claim hereunder;

9. Your participation in a crime or malicious act;

10. Your participation in a riot or insurrection;

11. War or act of war (whether declared or undeclared), invasion, act of foreign enemy, hostilities, civil war, rebellion, revolution, insurrection or military uprising or usurped power;

12. Act of Terrorism by nuclear means and terrorism by dissemination of biological, chemical and or bio-chemical agents and substances;

13. Your participation in the armed forces;

14. Orbital or sub-orbital flights;

15. Events related to travel warnings issued by Foreign Affairs Canada prior to Your Start Date that were or continue to be in effect for your country, region or city of destination during Your Period of Coverage, as reflected in your travel itinerary;

16. Contamination resulting from radioactive material or nuclear fuel or waste; or

17. Any trip as a driver, operator, co-driver, crew member, or passenger on any commercial vehicle used to carry goods for sale, resale or income.

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