When an insured person incurs eligible expenses as described in this section, the insurer will reimburse the reasonable and customary costs up to $5,000,000 CAD , subject to all policy limitations, exclusions and provisions. However, certain expenses, as specified below, are covered only with the prior approval of the Assistance Company.
1. Hospital Accommodation:
a) Charges up to the semi-private room rate charged by the hospital. If medically necessary, expenses for treatment in an intensive care or coronary care unit are also covered.
b) Emergency-room fees.
c) Emergency out-patient services provided by a hospital when medically necessary.
2. Medical Services: Medical treatment by a legally licensed physician, surgeon, anesthetist or registered graduate nurse (other than an immediate family member of the insured person).
3. Diagnostic Services: Laboratory tests and x-rays that are ordered by the attending physician and that are part of the emergency medical treatment. This policy does not cover magnetic resonance imaging (MRI), cardiac catheterization, computerized axial tomography (CAT) scans, sonograms or ultrasounds and biopsies unless such services are approved in advance by the Assistance Company.
4. Prescriptions: Drugs, including injectable drugs and sera, that can only be obtained upon medical prescription, that are prescribed by a physician and that are supplied by a licensed pharmacist when medically necessary for emergency medical treatment, except when needed to stabilize a chronic condition or a medical condition which an insured person had before the trip. This benefit is limited to a 30-day supply per prescription, unless the insured person is hospitalized.
5. Private Duty Nurse: When approved in advance by the Assistance Company and prescribed by an attending physician, the professional services of a registered private duty nurse (other than an immediate family member) as the result of a covered emergency when medically necessary and while hospitalized or in lieu of hospitalization.
6. Paramedical Services: When approved in advance by the Assistance Company, the services (including x-rays) of a licensed chiropractor, physiotherapist, podiatrist or osteopath to a maximum of $500 per insured person, per profession listed above.
7. Dental: When performed by a legally qualified dentist or oral surgeon, emergency treatment:
a) up to $5,000 to repair or replace whole or sound natural teeth or permanently attached artificial teeth damaged as a result of an accidental blow to the face; and
b) up to $500 for emergency dental treatment for relief of dental pain caused other than by a blow to the face and for which you have not previously received treatment or advice.
8. Medical Appliances: When approved in advance by the Assistance Company, and prescribed by the attending physician, minor appliances such as crutches, casts, splints, canes, slings, trusses, braces, walkers and/or the temporary rental of a wheelchair, not exceeding the purchase price.
9. Ambulance Services: Licensed ground ambulance service (includes taxi fare in lieu of ambulance) to the nearest medical facility in an emergency.
10. Transportation to Bedside: When approved in advance by the Assistance Company, single round-trip economy airfare plus up to $150 per day to a maximum of $3,000 for the cost of meals and commercial accommodation for one person of your choice to:
a) be with you if you have been hospitalized as the result of a covered emergency. To be payable, this benefit requires that you eventually be hospitalized as an in-patient for at least 3 consecutive days and that the attending physician provide written certification that the situation was serious enough to warrant the visit; or
b) identify the deceased insured person prior to the release of the body, where necessary.
11. Emergency Air Transportation: a) air ambulance to the nearest appropriate medical facility or to a Canadian hospital for immediate emergency medical treatment;
b) transport on a licensed airline with an attendant (when required) for your emergency return to your province or territory of residence in Canada for immediate medical attention;
c) the fare for additional seats to accommodate a stretcher to return you to your province or territory of residence in Canada;
d) up to the cost of a one-way economy airfare to return you to your province or territory of residence in Canada;
e) up to $5,000 for your emergency evacuation from a mountainous area, the sea or other remote location to the nearest, most reasonably accessible medical facility or hospital.
12. Repatriation of Remains: In the event of your death as a result of a covered accident or unforeseen sickness:
a) up to a maximum of $10,000 toward the actual cost incurred for the preparation of remains and transportation to your permanent residence in Canada; or
b) up to $5,000 for cremation and/or burial at the place of death. The cost of the casket, urn or funeral is not covered.
13. Meals and Accommodation: Up to $150 per day to a maximum of $3,000 for your commercial accommodation, meals costs for your dependents up to age 18 upon a physician’s advice:
a) you or your travel companion are hospitalized on the date you are scheduled to return to Canada; or
b) you or your travel companion are transferred to a different hospital in another city for emergency medical treatment.
14. Hospital Allowance: Up to $50 per day to a maximum of $500 for incidental expenses billed by the hospital such as telephone, television or internet charges while you are hospitalized.
15. Return and Escort of Children: When approved and arranged in advance by the Assistance Company, up to economy airfare to return accompanying dependent children to the departure point in the event that you are returned to Canada under the Emergency Air Transportation benefit or Repatriation of Remains. The insurer will also pay for an escort to accompany the dependent children.
16. Return of Travel Companion: When approved in advance by the Assistance Company up to single one-way economy airfare to for a travel companion to return to Canada if the insured person is returned to Canada under the Emergency Air Transportation benefit or the Repatriation of Remains benefit.
17. Pet Return: When approved and arranged in advance by the Assistance Company, up to $500 for the cost of returning your accompanying dog(s) or cat(s) to your province or territory of residence in the event that you are hospitalized due to a covered sickness or injury or returned to Canada under the Emergency Air Transportation benefit or the Repatriation of Remains benefit.
18. Vehicle Return: When approved and arranged in advance by the Assistance Company, up to $4,000 for the cost of returning your vehicle to your residence or to a commercial rental agency in the event that you are unable to return a vehicle to its point of origin due to a covered emergency during your trip.
19. Excess Baggage Return: When approved and arranged in advance by the Assistance Company, up to $500 for the cost of returning your excess baggage to the departure point in the event that you are returned to Canada under the Emergency Air Transportation benefit.
20. Return to Original Trip Destination: up to $5,000 for one-way economy airfare to return you and one travel companion to the original trip destination in the event that you are returned to Canada under the Emergency Air Transportation benefit.
a) Any sickness, injury or medical condition (other than a minor ailment) that was not stable:
I. In the 90 days prior to the effective date if you are less than 60 years of age; or
II. In the 180 days prior to the effective date if you are between 60 and 74 years of age travelling for no more than 31 days; or
III. In the 90 days prior to the effective date if you qualify for Rate Category 1 or 2; or
IV. In the 180 days prior to the effective date if you qualify for Rate Category 3; or
V. In the 365 days prior to the effective date if you qualify for Rate Category 4 or 5; or
b) Any sickness, injury or medical condition (other than a minor ailment) that existed prior to the effective date if you qualify for Rate Category 6.
Rate category is determined based on your answers to the health question on application, this information can be found on your policy confirmation.Please refer to policy wording for full details.