Gold Deluxe

Travel Guard

Gold Deluxe All Inclusive Package

 

444100 P1-P3 04/12; 444105 P1 04/12

 

 

PRIVACY PRINCIPLES

We abide by these Privacy Principles and want You, Our policyholders, insureds and claimants (referred to as “Customers” or “You”), to be aware of how and why We handle personal information. We work hard to respect and maintain Your privacy. However, the very nature of Our business is such that the collection, use and disclosure of personal information are fundamental to the products and services We provide.

These Privacy Principles apply only to the product or service Our Customers have obtained or the insurance Policy under which the Customer is seeking or receiving benefits. As a worldwide leader in the delivery of insurance products and services, the member companies of Chartis Inc. offer numerous products and services to many types of consumers and clients in many different countries around the world. Therefore, differing Chartis Inc. companies may adopt differing privacy practices to fit their own jurisdiction and business requirements.  The Global Privacy Notice, located at www.travelguard.ca, may also be applicable to Our Customers as We conduct Our business.

For the purposes of these Privacy Principles personal information means information that identifies an individual. For example: an individual’s name, birth date, address, age, health and financial information is personal information which We may collect, use and in certain circumstances, where necessary, disclose, in the course of providing insurance services and carrying on business.  Personal information does not include the name, business title, address, phone or fax number of an employee of an organization.

These Privacy Principles may be modified from time to time. An individual may obtain Our most up to date version located at www.travelguard.ca or by contacting us at:

The Privacy Officer
C/o Chartis Insurance Company of Canada
145 Wellington Street West
Toronto, Ontario  M5J 1H8
1-800-387-4481

 

Table of Contents

SCHEDULE OF BENEFITS
WARNING: THIS POLICY INCLUDES RESTRICTED BENEFITS
IMPORTANT INFORMATION
I. DEFINITIONS
II. SPECIFIC DETAILS OF YOUR INSURANCE
III. EMERGENCY MEDICAL COVERAGE
IV. TRIP CANCELLATION, INTERRUPTION AND TRIP DELAY COVERAGE
V. FLIGHT ACCIDENT AND TRAVEL ACCIDENT COVERAGE
VI. BAGGAGE AND PERSONAL EFFECTS COVERAGE
VII. OPTIONAL CRUISE AND TOUR PROTECTOR COVERAGE
VIII. OPTIONAL EXPANDED BENEFITS COVERAGE
IX. OPTIONAL GOLF PROTECTOR, SKI PROTECTOR AND BUSINESS PROTECTOR COVERAGE
X. FEATURES AND SERVICES TO SERVE YOU BETTER
XI. GENERAL CONDITIONS
XII. MAXIMUM LIMITS OF LIABILITY
XIII. GENERAL EXCLUSIONS
XIV. CLAIM PROCEDURES AND CUSTOMER SERVICES INQUIRIES
XV. SERVICES AND CONSIDERATIONS THAT PUT YOU AND YOUR FAMILY FIRST

 

SCHEDULE OF BENEFITS

All Coverage is per person

Maximum Benefit Limit

100% of Trip Cost	Trip Cancellation	Eligible Benefits	Return of Remains
Eligible Benefits	Trip Interruption	Eligible Benefits	Return to Trip Destination
Eligible Benefits	Trip Delay	Eligible Benefits	Bedside Companion Travel & Subsistence
$400	Change of Mind	Eligible Benefits	Emergency Dental for Injury & Sickness
$2,000	Schedule Change	$750	Hospital Expense ($75 per day)
$1,500	Vacation Rain Check	Eligible Benefits	Return of Travelling Companion
Eligible Benefits	Supplier Default	Eligible Benefits	Next Occupancy
$1,000	Baggage and Personal Effects	Eligible Benefits	Emergency Professional Services
$400	Baggage Delay	Eligible Benefits	Return of Dependent Children
$100,000	Flight Accident	Eligible Benefits	Return of Vehicle
$50,000	Travel Accident	$1,000	Pet Coverage
$40,000	Non – GHIP Emergency Medical Expenses	Included	LiveTravel
Eligible Benefits	Emergency Medical Expenses	Included	24 Hour Emergency Assistance
Eligible Benefits	Emergency Evacuation	Included	Concierge Service

 

Optional Coverage:

 Applicable only if appropriate additional plan cost has been paid.

 

Eligible Benefits: Please refer to the specific benefit with the policy wording for coverage limits.

I. DEFINITIONS

We attach very specific meanings to the following words when they appear in this Policy. We have capitolized these words when they are used as a defined term.

Accident/Accidental: A sudden, unexpected, unintended, unforeseeable, external event, occurring during an InsuredTrip that independently of any other cause, results in Injury (or damage, if the context relates to property loss or damage).

Accidental Death and Dismemberment (AD&D): Accidental death meaning bodily Injury caused by an accident which results in death if the Injury, accident and death occur while You are on a Trip. Accidental dismemberment meaning one (1) of (i) the actual severance of a limb above Your ankle or wrist joint; or (ii) the complete loss of eyesight in both eyes and/or hearing in both ears.

Business Meeting: A meeting (not including legal proceedings) arranged prior to Your Risk Date between companies with unrelated ownership which pertains to Your full-time occupation or profession and which was the sole purpose of Your Trip.

Change in Prescribed Medication means the medication dosage or frequency has been reduced, increased, stopped and/or new medications have been prescribed.

Exceptions:

• an adjustment to the insulin or Coumadin (Warfarin) dosage you are currently taking provided it is not newly prescribed or stopped and there has been no change to your Medical Condition; and
• a change from a brand name medication to a generic brand medication (insofar as the dosage is not modified).

Common/Scheduled Carrier: Means an air, land, or sea conveyance operated under a license for the transportation of passengers for hire.

Confirmation of Coverage: Your most recent computer printout, printed form, electronic copy, invoice, or Policy document that sets out the product You have purchased and any optional add on coverage, if any, You have chosen.

Contamination: The act or process of rendering something harmful or unsuitable to people by nuclear and/or chemical and/or biological substances causing illness, Injury and/or death.

Cruise: Travel for which You have booked, prior to Your departure from Your Home Province, overnight accommodation arrangements on a seaworthy passenger vessel.

Departure Date: The date on which You are scheduled to leave Your Home Province on a Trip.

Departure Point: The city that You depart from Your Home Province on the first day of Your Trip.

Dependent Child and/or Dependent Children: Unmarried persons who are Your natural, adopted, step or foster children, dependent on You for support and care and less than 21 years of age, or full-time students less than 26 years of age, or mentally or physically incapable of self support. You must be the legal guardian of any foster children and they must reside at Your same address.

Depreciated Value: Means 90% of the original purchase price (original receipt required) if such item is 0 to 12 months old at the date of loss. Means 70% of the original purchase price (receipt required) if such item is 13 to 24 months old at the date of loss. Means 50% of the original purchase price (receipt required) if such item is 25 to 36 months old at the date of loss. Means 30% of the original purchase price (receipt required) if such item is 37 to 48 months old at the date of loss. Means 20% of the original purchase price (receipt required) if such item is 49 to 60 months old at the date of loss. Means nil if such items are more than 60 months old at the date of loss.

Emergency: An unforeseen occurrence of, symptoms of Sickness, or of Injury, that occurs during a Trip (or for trip cancellation, that occurs immediately prior to Your Trip), which requires immediate Treatment from a Physician or that requires Hospitalization, failing which there could be a serious impairment to Your health.

Emergency Dental Treatment: Immediate and medically necessary dental services or supplies provided by a licensed registered dentist, Hospital, or other licensed Provider, that is the result of an acute and unexpected condition that arose during a Trip.

Emergency Medical Treatment: Medically necessary services or supplies provided during a Trip by a licensed Physician, Hospital or other licensed Provider, that are required to treat any Injury or Sickness or other sudden, acute and unexpected condition that arose during the Trip, and that cannot be reasonably delayed until You return to Your Home Province without endangering Your health.

Expected Medical Treatment: Medical consultation or Hospitalization that Your prior medical history indicates as being probable or certain to occur.

Expiry Date: For each Trip, the first to occur of:

• the date You return to Your Home Province;
• the date You leave Your Home Province on a Trip plus the number of days that is Your selected Trip duration, including Your date of departure;

unless there has been an Automatic Extension of Coverage or Top-up, in which case the Expiry Date is the first to occur of:

• the date You return to Your Home Province; or
• the end of any extension of coverage determined in accordance with the Automatic Extension of Coverage Section or the Top-up Section of this Policy.

Follow-up Treatment: Treatment that continues beyond the initial Emergency.

Follow-up Visit: The re-examination of You to monitor the effects of earlier medical Treatment related to the initial Emergency, except while Hospitalized. Follow-up visit does not include further diagnostic or investigative testing related to the initial Emergency.

Government Health Insurance Plan (GHIP): Health insurance coverage that Canadian provincial or territorial governments provide for their residents.  

Home Province: Your Canadian province or territory of residence.

Hospital: A medical facility which is legally accredited to provide medical, diagnostic and surgical Treatment to in-patients during the acute phase of their Sickness or Injury, which is primarily engaged in the aforesaid activities and which operates under the supervision of a staff of physicians and has a registered nurse continuously on duty. A Hospital does not mean an institution licensed as a home for the aged, rest home, nursing home, convalescent hospital, health spa, and rehabilitation centre or Treatment facility for drug or alcohol abuse and/or addiction.

Hospitalization or Hospitalized: The state of being admitted to a Hospital and receiving Emergency Medical Treatment on an inpatient basis.

Immediate Family Member: Any one (1) or more of Your Spouse, natural, step, or adopted children, persons for whom You are the legal guardian, parents, parents-in-law, son-in-law, daughter-in-law, step-parents, sisters, brothers, sisters/brothers-in-law, step-sisters/brothers, grandparents, grandchildren, aunts, uncles, nieces, and nephews.

Injury: A bodily injury sustained during a Trip, which is caused, directly and independently of all other causes, by an Accident.

Insured: The person named as the ‘primary traveller’ and/or one (1) or more other person(s), if any, named as ’other travellers’ on the Confirmation of Coverage, each as the context requires.

Insurer: Chartis Insurance Company of Canada, 145 Wellington Street West, Toronto, ON, M5J 1H8. This Policy is administered on Our behalf by Travel Guard Group Canada, Inc. (Travel Guard Canada).

Key-employee: An employee whose continued presence is critical to the ongoing affairs of the business during Your or Your Travel Companion’s absence.

Medical Condition: An Injury or Sickness, including but not limited to disease, acute psychoses, and complications of pregnancy occurring within the first 31 weeks.

Medical Consultation: Any investigative medical service, including history-taking, examination, testing, advice, or Treatment by a Physician for a symptom, Sickness, illness, or disease that may or may not have been definitively diagnosed.

Medical Emergency: An unforeseen occurrence of, symptoms of Sickness, or of Injury, that occurs during a Trip (or for trip cancellation, that occurs immediately prior to Your Trip), which requires immediate Treatment from a Physician or that requires Hospitalization, failing which there could be a serious impairment to Your health.

Mental or Emotional Disorders: Emotional or anxiety states, situational crisis, anxiety or panic attacks, or other mental health disorders treated with tranquilizers or anxiolytic drugs. (Example: a mental or nervous health disorder like: anxiety, depression, neurosis, psychosis and others or any related physical complications).

Minor Ailment: Any Sickness or Injury which does not require: the use of medication for a period of greater than 15 days; more than one (1)Follow-up Visit to a Physician, Hospitalization, surgical intervention, or referral to a specialist; and which ends at least 30 consecutive days prior to the Departure Date of each Trip. However, a chronic condition or any complication of a chronic condition is not considered a minor ailment.

Mountain Climbing: The ascent or descent of a mountain requiring the use of specialized equipment, including but not limited to pick-axes, anchors, bolts, crampons, carabineers, and lead or top-rope anchoring equipment.

Physician: A medical doctor, other than Yourself, Your Immediate Family Member, Your Travel Companion or their Immediate Family Member, who is licensed to administer medical Treatment and prescribe drugs in the place where he or she provides medical services. The following are not considered to be Physicians: naturopath, herbalist, and homeopath.

Policy or Policies: This document, any riders or endorsements to this document, the application, any medical questionnaire if applicable, and the Confirmation of Coverage all of which form the entire contract.

Policy Purchase Date: The date You pay for specific insurance coverage which is listed on Your Confirmation of Coverage as plan start date.

Premium: The cost of Your insurance Policy plus any additional amounts required for any optional coverage You have purchased.

Prescribed Medication: A drug, medicine or medication only obtainable by the prescription of a licensed Physician for Emergency Medical Treatment or dentist for Emergency Dental Treatment, and dispensed by a licensed pharmacist.

Provider: The Hospitals, clinics, Physicians, and other medical service providers, the use of which must be approved by Us at the time of the Medical Emergency.

Recurrence: The appearance of symptoms caused by or related to a Medical Condition that was previously diagnosed by a Physician or for which Treatment was previously received.

Rental Car: An automobile rented by You from a commercial rental agency for Your personal use under a written rental agreement.

Return Date: Either the date of Your scheduled return to Your Departure Point as indicated on Your most recent Confirmation of Coverage or (ii) the date of Your actual return to Your Home Province.

Risk Date: Means Your Start Date.

Schedule Change - the later departure of an airline carrier causing You to miss Your next connecting flight via another airline carrier (or connecting Cruise ship, ferry, bus or train), or the earlier departure of an airline carrier rendering unusable the ticket You have purchased for Your prior connector flight via another airline carrier (or connecting Cruise ship, ferry, bus or train). Schedule change does not mean a change resulting from a supplier default, Strike or a labour disruption.

Sickness: An acute illness or unforeseen disease requiring Emergency Medical Treatment, Emergency Dental Treatment or Hospitalization due to the sudden onset of symptoms.

Spouse: The person legally married to You, or if there is no such person, the person who has been living with You in a conjugal relationship for at least one (1) year, regardless of gender.

Stable and Controlled: Any Medical Condition (other than a Minor Ailment) for which there has been no new Treatment or newly prescribed medication; no change in Treatment or Change in Prescribed Medication; no new, more frequent or more severe symptoms; no test results showing deterioration; no investigations initiated for symptoms whether or not Your diagnosis has been determined; no Hospitalization and no referral to a specialist.

Start Date: The date shown on Your most recent Confirmation of Coverage as the “plan start date”.

Strike means a stoppage of work:

(1) announced, organized, and sanctioned by a labour union and

(2) which interferes with the normal departure and arrival of Common Carrier.

This includes work slowdowns and sickouts. The Insured’s Trip cancellation coverage must be effective prior to when the strike is foreseeable. A strike is foreseeable on the date labour union members vote to approve a strike.

Subsistence Allowance: Expenses incurred as a result of Your emergency, including accommodation, meals, and essential telephone calls.

Travel Companion: The person with whom You are sharing travel arrangements and prepaid accommodation (to a maximum of three (3) people) in respect of a Trip.

Treatment: A medical, therapeutic or diagnostic procedure prescribed, performed or recommended by a licensed Physician, including but not limited to Prescription Medication, investigative testing, and surgery.

Trip:  Your travel for which coverage under this Policy has been purchased and is in effect. The purpose of the Trip is business or pleasure and is not to obtain health care or Treatment of any kind; the Trip has defined Departure Dates and Return Dates specified when the Insured applies.

Trip Cost: Is the dollar amount of Trip payments or deposits reflected on any required enrollment form which are subject to cancellation penalties or restrictions paid by the Insured prior to the Insured’s Trip Departure Date. Trip cost will also include the cost of any subsequent pre-paid payments or deposits paid by the Insured for the same Trip, after enrollment for coverage under this Policy provided the Insured amends their trip cost to add such subsequent payments or deposits and pays any required additional premium prior to the Insured’s Departure Date.

University Health Insurance Plan (UHIP): Provides insurance to pay the cost of the hospital and medical services that students or employees and their families at Ontario participating universities and affiliated colleges might need to maintain their health while in Canada.

Vehicle: A private passenger automobile, minivan, recreational vehicle, or camper truck, which You use during Your Trip exclusively as conveyance of passengers other than for hire. It can be either owned by You or rented by You from a rental agency.

We, Us, Our: Chartis Insurance Company of Canada, 145 Wellington Street West, Toronto, ON, M5J 1H8. This Policy is administered on Our behalf by Travel Guard Canada.

You, Yourself, Your: The person named as the ‘primary traveller’ and/or one (1) or more other person(s), if any, named as ’other travellers’ on the Confirmation of Coverage, each as the context requires.

WARNING: THIS POLICY INCLUDES RESTRICTED BENEFITS

1. This Policy covers losses resulting from unforeseeable and Emergency circumstances only.
2. A pre-existing condition exclusion applies to Medical Conditions and/or symptoms that existed prior to travel. There may be no coverage if You have a pre-existing condition.
3. You must contact Us before seeking medical attention and a failure to call will result in Your being responsible for 30% of any eligible expenses incurred unless Your Medical Condition prevents You from calling, in which case You must call as soon as medically possible or have someone call on Your behalf.
4. Our medical department must approve and arrange all surgery and heart procedures, (including, but not limited to, heart catheterization), in advance and a failure to call will result in Your being responsible not only for the amount of Your deductible, if applicable, but also for 30% of any eligible expenses incurred unless Your Medical Condition prevents You from calling, in which case You must call as soon as medically possible or have someone call on Your behalf.
5. If You choose not to receive Treatment or services from a Provider, as directed by Us, You will not only be responsible for the amount of Your deductible, if applicable, but also for 30% of any eligible expenses.
6. Your Emergency Medical and Dental Coverage is subject to an aggregate limit of $10 million CAD if You are 60 years of age or older. If You are less than 60 years of age on Your Policy purchase date, there is no such limit.
7. There are limits, limitations and exclusions that apply to all Insured persons
8. The coverage provided by this Policy shall be null and void for travel in, to, or through Cuba, because such travel is not serviced and supported by the Insurer's United States affiliates.
9. Read this Policy carefully.

 

IMPORTANT INFORMATION

This Policy covers losses arising from sudden, unexpected and unforeseeable circumstances only. Some words have very specific meanings that are set out in the Definitions Section. These words are capitalized in this Policy document when the Policy definition applies.

Along with this Policy document, You should have received a Confirmation of Coverage. The Confirmation of Coverage sets out details specific to the product You purchased and it is part of Your contract of insurance as is this document and Our medical questionnaire (if applicable). If You did not receive all of these documents, if any information contained in these documents is incorrect, or if You have questions regarding Your coverage, it is Your responsibility to contact Us at 1-866-878-0191. You should bring all of these documents with You when You travel.

 

II. SPECIFIC DETAILS OF YOUR INSURANCE

AM I ELIGIBLE?

Gold Deluxe All Inclusive Package

To be eligible for this coverage You must:

1. have purchased Your Policy prior to or on the same day as Your Departure Date;
2. have purchased Your Policy not more than 18 months prior to Your Departure Date;
3. have purchased coverage for the full duration of Your Trip;
4. have purchased Your Policy from Us for the full value of Your non-refundable prepaid travel arrangements;
5. be covered under Your GHIP for the full duration of Your Trip to be eligible for the maximum Emergency medical benefits; if You do not have GHIP coverage while on Your Trip, Your aggregate limit for all Emergency Medical Benefits will be limited to $40,000;
6. have correctly answered Our medical questionnaire if Your non-refundable prepaid travel arrangements exceed $20,000;
7. be less than 75 years of age at the time Your Policy is purchased and be;
   1. travelling for a maximum of 183 days if You are less than 60 years of age, or
   2. travelling for a maximum of 60 days if You are 60 years of age or older and less than 75 years of age.

 

Gold Medically Qualified Deluxe All Inclusive Package

To be eligible for this coverage You must:

1. have purchased Your Policy prior to or on the same day as Your Departure Date;
2. have purchased Your Policy not more than 18 months prior to Your Departure Date;
3. have purchased Your Policy  from Us for the full value of Your non-refundable prepaid travel arrangements;
4. have purchased Your Policy from Us for the full duration of Your Trip;
5. be covered under Your GHIP for the full duration of Your Trip to be eligible for the maximum Emergency medical benefits; if You do not have GHIP coverage while on Your Trip, Your aggregate limit for all Emergency Medical Benefits will be limited to $40,000;
6. be travelling for a maximum of 60 days and be:
   1. 75 years of age or older and have satisfied Our requirements based on the answers You have provided on Our medical questionnaire; or
   2. 75 years of age or older and less than 85 years of age and have chosen not to answer Our medical questionnaire and have paid the Premium from Rate Chart 5.

 

HOW DO I BECOME INSURED?

Coverage under this Policy will not come into effect until all of the following conditions have been satisfied:

1. Your name appears on the Confirmation of Coverage;
2. You have paid the required Premium on or before Your Start Date;
3. if applicable, You have truthfully and fully completed and submitted Our medical questionnaire and satisfied Our requirements based on the answers You have provided.

 

 

HOW DOES THE MEDICAL QUESTIONNAIRE AFFECT MY COVERAGE?

If You are 75 years of age or older at the time You purchase Your Policy You must complete Our medical questionnaire.  Each question on Our medical questionnaire assigns a point value for each yes answer.  Once Our medical questionnaire is completed the total point score will determine the medical exclusion that You qualify for and the Premium that You will pay.  The completed medical questionnaire forms part of Your Policy and will be reviewed should a claim arise.  If on Your medical questionnaire there is an incorrect answer the Policy is voidable and Premium will be refunded.

You can choose not to complete Our medical questionnaire if You are 75 years of age or older and less than 85 years of age and have paid the Premium from Rate Chart 5.

 

 

WHEN DOES MY INSURANCE START AND END?

For Trip Cancellation, Trip Interruption and Trip Delay coverage:

This Policy comes into effect on Your Start Date and ends the earliest of:

1. the day indicated as Your Return Date on Your Confirmation of Coverage;
2. the day You return to Your Home Province to end Your Trip;
3. the day You have cause to file a trip cancellation claim.

 

For Emergency Medical coverage:

This Policy comes into effect on Your Departure Date and ends the earliest of:

1. the day indicated as Your Return Date on Your Confirmation of Coverage;
2. the day You return to Your Home Province to end Your Trip;
3. the day You have cause to file a Trip Cancellation claim.

 

UNDER WHAT CIRCUMSTANCES CAN MY POLICY EXTEND?

Automatic Extension of Coverage

If You or Your Travel Companion are Hospitalized on Your scheduled Return Date Your coverage will automatically be extended at no additional Premium for the period of Hospitalization and up to 120 hours after discharge. If You have a Medical Condition rendering You medically unable to travel, on Your scheduled Return Date but You are not Hospitalized, Your coverage will be automatically extended for up to 120 hours after Your scheduled Return Date.

Coverage will automatically be extended for up to 72 hours when there is a delay of a Common Carrier on which You are pre-booked as a passenger.

Optional Policy Extension

If You choose to extend Your Trip, beyond Your scheduled Return Date and you have not made a claim nor is there reason to claim, You may apply for a Policy extension subject to the following conditions:

1. the request for an extension must be made and approved by Us prior to Your original Return Date;
2. You must pay the required additional Premium before Your original Return Date; and
3. You must have been eligible for the insurance that You seek to extend at the time of Your original booking and at the time of the request for the extension.

 

 

D.  Exclusions – Emergency Medical and Dental Coverage

These exclusions apply to the Emergency Medical and Dental Coverage set out in Section III, A. The additional exclusions set out in the General Exclusions Section of this Policy also apply.

Based on Your age and, when applicable, the answers You provided on Our medical questionnaire there are four (4) possible exclusion identifiers which can apply to Your Policy depending on the product selected.

These four (4) identifiers are GE, ME#1, ME#2, or ME#3.

 

Deluxe All Inclusive Package Ages 0-74		ME#1
Deluxe All Inclusive Package Ages 75 and older	Rate 1 Rate 2 Rate 3 Rate 4 Rate 5	GE ME#1 ME#2 ME#2 ME#3

 

Pre-Existing Condition Exclusion for Identifier GE

If Your exclusion identifier is GE only the exclusions set out in the General Exclusions Section of this Policy apply to Your Emergency Medical and Dental Coverage.

Pre-Existing Condition Medical Exclusion Identifier ME#1

If Your exclusion identifier is ME#1 Your Emergency Medical and Dental Coverage is subject to all of the exclusions set out in the General Exclusions Section of this Policy and the following exclusion:

ME#1. We do not cover any loss or expense related directly or indirectly to:

1. Your Medical Condition or any related condition if in the 90-day period immediately preceding Your Departure Date that condition has not been Stable and Controlled;
2. Your heart condition if in the 90-day period immediately preceding Your Departure Date:
     i. You have had any heart condition that has not been Stable and Controlled, or
     ii. You have been required to use, take, or been prescribed to take nitroglycerin in any form, more than  once per a seven (7) day period;
3. Your lung condition if in the 90-day period immediately preceding Your Departure Date:
      i. You have had any lung condition that has not been Stable and Controlled, or
      ii. You required the use of home oxygen or had to take oral steroids; for example prednisone or prednisolone.

Pre-Existing Condition Medical Exclusion Identifier ME#2

If Your exclusion identifier is ME#2 Your Emergency Medical and Dental Coverage is subject to all of the exclusions set out in the General Exclusions Section of this Policy and the following exclusion:

ME#2. We do not cover any loss or expense related directly or indirectly to:

1. Your Medical Condition or any related condition if in the 180-day period immediately preceding Your Departure Date that condition has not been Stable and Controlled;
2. Your heart condition if in the 180-day period immediately preceding Your Departure Date:
     i.   You have had any heart condition that has not been Stable and Controlled, or
     ii.  You have been required to use, take, or been prescribed to take nitroglycerin in any form, more than once per a seven (7) day period;
3. Your lung condition if in the 180-day period immediately preceding Your Departure Date:
     i   You have had any lung condition that has not been Stable and Controlled, or
     ii  You required the use of home oxygen or had to take oral steroids; for example prednisone or prednisolone.
   
   

Pre-Existing Condition Medical Exclusion Identifier ME#3

If Your exclusion identifier is ME#3 Your Emergency Medical and Dental Coverage is subject to all of the exclusions set out in the General Exclusions Section of this Policy and the following exclusion:

ME#3. We do not cover any loss or expense related directly or indirectly to:

1. any Medical Condition for which You have taken medication, been prescribed medication, received Treatment, experienced a deterioration of the condition or had cause to seek Treatment at any time within the 180-day period immediately preceding and including Your Departure Date and this exclusion applies whether or not the condition has been Stable and Controlled;
2. Your heart condition if in the 180-day period immediately preceding Your Departure Date You have taken medication, been prescribed medication, received Treatment, experienced a deterioration of the condition or had cause to seek Treatment for any heart condition; or
3. Your lung condition if in the 180-day period immediately preceding Your Departure Date You have taken medication, been prescribed medication, received Treatment, experienced a deterioration of the condition or had cause to seek Treatment for any lung condition.

 

IV. TRIP CANCELLATION, TRIP INTERRUPTION AND TRIP DELAY COVERAGE

A.  Benefits – Trip Cancellation, Trip Interruption and Trip Delay Coverage

If You incur expenses due to a covered risk, on or after Your Start Date and prior to or on Your Expiry Date, while You are on a Trip, We provide coverage for the following covered benefits up to the specific benefit limits set out below. Benefit limits are for each Insured under this Policy. We do not pay more than the benefit limit.

 

 

 

IX. OPTIONAL GOLF PROTECTOR, SKI PROTECTOR AND BUSINESS PROTECTOR COVERAGE

If You wish to obtain this optional coverage You have to apply for it for each Trip and pay the required Premium.

A.  Benefits – Golf Protector, Ski Protector and Business Protector Coverage

If You incur expenses due to a covered risk, while You are on a Trip, for which You have purchased this coverage, We provide coverage for the following covered benefits up to the benefit limit.

XI. GENERAL CONDITIONS

All of the following conditions apply to all coverage under this Policy including optional coverage purchased.

1. Your coverage will be declared null and void if, for any reason:
   a.  the required Premium is not received by Us;
   b.  You are ineligible for coverage in accordance with any section of this Policy; or
   c.  You have incompletely or falsely provided information when purchasing your Policy or on Our medical questionnaire.
   
   
2. Canadian Currency: The benefit, benefit limits and all other amounts expressed in this Policy are expressed in Canadian currency, except any deductible which is expressed in US dollars. Where covered losses are billed in foreign currency, the rate of exchange is based on the rate effective on the date when We pay the claim. No sum payable shall bear interest. To facilitate direct payment to providers, We may elect to pay the claim in the currency of the country where the charges were incurred based on the rate of exchange established by any chartered bank in Canada:
   a.  on the last date of service; or
   b.  on the date the claim was incurred if a cheque is issued directly to Physicians, Hospitals or other medical Providers.
   
   
3. If You are covered under more than one (1) of Our Policies, or have similar coverage with another insurance company, the total amount paid to or for You will not exceed Your actual expenses and the maximum to which You are entitled is the largest amount specified for that benefit under any one (1) of Our Policies with the exception of the Flight Accident benefit which has a maximum payable of $100,000 if You are covered under more than one (1) of Our Policies providing that benefit.
   
   
4. The coverage outlined in this Policy is last payor only. If, at the time of loss, You have insurance from another source, or if any other party is also responsible, to pay for benefits also provided under this Policy, We will pay eligible expenses only in excess of those covered by that other insurance company or insurance companies or other responsible party or parties, including insurance plans provided through credit cards, third party liability, group or individual basic or extended health insurance plans or contracts including any private or provincial or territorial auto insurance plan, providing Hospital, medical or therapeutic coverage, or any third party liability insurance in force concurrently with this Policy.
   
   
5. In the event of a payment of a claim under this Policy, We have the right to proceed, in Your name, but at Our expense, against third parties who may be responsible for giving rise to a claim under this Policy. You will execute and deliver documents as necessary and co-operate fully with Us so as to allow Us to fully assert Our rights. You will do nothing to prejudice such rights.
   
   
6. We have full rights of subrogation; however, We do not subrogate against any retiree plan benefit if the lifetime maximum limits for all in-country and out-of-country medical benefits is $50,000 or less.
   
   
7. Notwithstanding any provision of this Policy, this Policy is subject to the statutory conditions of the Insurance Act applicable to contracts of Accident and Sickness insurance and the laws and regulations in Your Home Province. The laws and regulations of the province or territory in Canada in which You normally reside govern this Policy and any provision in this Policy which is in conflict with any such statute is hereby amended to conform to such statute.
   
   
8. Confirmation of Coverage: In the event that You are found to be ineligible for coverage or that a claim is found to be invalid or benefits are reduced in accordance with any Policy provision, We have the right to collect from You any amount which We have paid on Your behalf to medical providers or other parties.
   
   
9. Your Policy will be declared null and void in the case of fraud or attempted fraud by You, or if You conceal or misrepresent any material fact or circumstance concerning this insurance.
   
   
10. During the claims process, We may require You to have a medical examination by one (1) or more physicians chosen by Us and at Our expense.
    
    
11. We are not responsible for the availability, quality or results of any medical Treatment. We are not responsible for any transportation arranged by Us. We are not responsible for Your failure to obtain medical Treatment.
    
    
12. You must, at all times while You are covered under this Policy, act in a prudent manner so as to minimize costs to Us.
    
    
13. If Your health status changes (including a Change in Prescribed Medication or Treatment) prior to departure for any Trip, You must notify Us immediately. At Our sole discretion, We may opt to waive the exclusion that precludes Your unstable Medical Condition from coverage. This would allow You to continue with Your Trip and retain coverage for Your Medical Condition.
    
    
14. Any reference to age in this document is specific to Your age on the date You apply for insurance.
    
    
15. The coverage provided by this Policy shall be null and void for travel in, to, or through Cuba, because such travel is not serviced and supported by the Insurer's United States affiliates.
    
    

XII. MAXIMUM LIMITS OF LIABILITY

General Liability: Our liability under this Policy is limited solely to the payment of eligible benefits, up to the benefit limits specified herein, for any loss or expense.

XIII. GENERAL EXCLUSIONS

The following exclusions apply to all benefits available under this Policy, including all optional coverage purchased. In addition to any exclusion that apply to a specific benefit outlined within each section, We also do not cover any claim, loss or any expense related in whole or in part, directly or indirectly to:

1. expenses resulting from any Sickness, Injury or state of health prior to Your Policy purchase date that would cause Expected Medical Treatment or Hospitalization during Your Trip;
   
   
2.  reimbursement for expenses once the Emergency ends and in the opinion of the attending Physician or dentist, You are able to travel to Your Home Province for any further Treatment relating to the Sickness or Accident that led to the Emergency other than for a follow-up visit as listed under the benefits for Emergency Medical Treatment;
   
   
3. optional Policy extensions: Sickness or Injury which first appeared, was diagnosed or received medical Treatment after your Departure Date and prior to the Effective Date of the optional insurance extension;
4. any Treatment that is not Emergency Treatment. For example (and not inclusive of):
   1. expenses incurred for medication commonly available without prescription; vaccinations, injections or medication received on a preventative basis or for the maintenance of a Medical Condition; contraceptives; fertility medication; vitamin preparations; general physical examinations; or routine medical tests;
   2. transplants including but not limited to organ transplants or bone marrow transplants, artificial joints, or prosthetic devises/implants including any associated charges;
   3. expenses incurred for acupuncture or naturopathic or holistic Treatment;
5. ionizing radiation or radioactive Contamination from any nuclear fuel or waste which results from the burning of nuclear fuels, or, the radioactive, toxic, explosive or other dangerous properties of nuclear machinery or any part of it;
6. expenses incurred for any portion of benefits that require prior authorization and arrangements by Us if such benefits were not authorized and arranged by Us;
7. any Medical Condition if on Our medical questionnaire, there is an incorrect answer. In this case the Policy is voidable and Premium refundable;
8. more than one (1) Follow-up Treatment, Recurrence or complication of a Medical Condition or related condition, following Emergency Treatment of that condition during Your Trip if the medical department determines that You were medically able to return to Your Home Province and You chose not to return;
9. more than one (1)  Follow-up Treatment of any heart or lung condition, following Emergency Treatment for a related or unrelated heart or lung condition during Your Trip if the medical department determines that You were medically able to return to Your Home Province and You chose not to return;
10. any Medical Condition, if Our medical department recommends that You return to Your Home Province following Your Emergency Treatment, and You choose not to travel;
11. expenses incurred for Treatment or services that are prohibited under Your GHIP/UHIP;
12. expenses in excess of reasonable and customary rates where Treatment has occurred before You or someone on Your behalf has called Us;
13. any medical expense incurred while travelling in Your Home Province;
14. routine pre-natal care; a child born during Your Trip; childbirth or complications of childbirth; pregnancy or complications thereof within the nine (9) weeks before or anytime after the expected date of delivery;
15. Your Mental or Emotional Disorders;
16. Your committing or attempting to commit suicide or intentionally self-inflicted Injury (whether sane or insane);
17. any alcohol related Sickness, death, or Injury or the abuse of medication, drugs, alcohol or any other toxic substance during the Trip; Alcohol abuse includes having a blood alcohol level in excess of 80 milligrams of alcohol per 100 millilitres of blood;
18. a Trip undertaken in contravention of a Physician’s recommendation or after the manifestation of medical symptoms which would cause an ordinarily prudent person to seek medical advice or Treatment in the 90 days prior to Your Departure Date; or where a terminal condition prognosis has been diagnosed by any Physician;
19. a Medical Condition or related condition that arises during a Trip You undertake with the prior knowledge that You will require or seek Treatment or surgery for that Medical Condition or a related condition;
20. a Medical Condition for which future investigation or Treatment is planned before Your Departure Date. This does not include routine monitoring;
21. the commission of or Your direct or indirect attempt to commit a criminal act or Injury occurring while You are committing or attempting to commit a criminal act;
22. Your participation in rock or Mountain Climbing; participation in a motorized race or motorized speed contest; Your participation as a professional athlete in a sporting event;
23. operating or learning to operate any aircraft, as pilot or crew; performing employment duties on any aircraft or ship; or performing duties in any regular armed forces service;
24. expenses incurred if You travel to a country that The Department of Foreign Affairs and International Trade of the Canadian Government or Health Canada has advised travellers not to travel to during the time of Your Trip. This exclusion applies if the advisory is issued prior to Your Departure Date;
25. war (declared or not), acts of foreign enemies or rebellion;
26. interest on a payment or reimbursement;
27. expenses incurred relating to travel in, to, or through Cuba, because such travel is not serviced and supported by the Insurer's United States affiliates;
28. any Medical Condition, if prior to Your Departure Date, such Medical Condition renders You ineligible or causes You to qualify for a different rate. You must be and remain eligible and rate qualified under this Policy when You purchase and continuously until You take a Trip for coverage to come into and be in effect when You take a Trip

XIV. CLAIM PROCEDURES AND CUSTOMER SERVICE INQUIRIES

By paying the Premium for this insurance, You agree that:

1. We may verify Your GHIP/UHIP and other information required to process Your claim, with government and other authorities;
2. physicians, Hospitals and other medical providers are authorized by You to provide to Us any and all information they have regarding You, while under observation or Treatment, including Your medical history, diagnoses and test results;
3. We may disclose the information available under 1) and 2) above and from other sources to such other persons, as may be required for the purposes of providing assistance about or processing Your claim for benefits; and
4. failure to complete the required claim form and authorization form in full will delay the processing of Your claim and could invalidate Your claim. We cannot process Your claim in full until all required documentation has been received by Our claims department.

 

All claim information should be sent to:

Travel Guard Canada

Attn: Claims Department

145 Wellington Street West, Toronto, ON M5J 1H8

To Claim For Emergency Medical and Dental Benefits:

You must notify Us at 1-866-878-0192 or collect at 416-646-3723 prior to any Emergency Medical Treatment and prior to any surgery, invasive procedure or Hospitalization. Our assistance co-ordinators will provide guidance. We will make every effort, although We cannot guarantee, to pay providers directly. You must provide Us with original receipts for incurred expenses including those for Subsistence Allowance expenses.

To Claim For Trip Cancellation, Interruption and Delay Benefits:

You must notify Us immediately of a cancellation, interruption or delay no later than the next business day following a cancellation, interruption or delay. You must provide:

1. proof of all non-refundable, prepaid deposits or payments;
2. completed documentation if a Medical Condition was the cause for cancellation;
3. complete unused transportation tickets and vouchers;
4. original receipts for Subsistence Allowance expenses;
5. original receipts for new tickets;
6. reports from police or local authorities documenting the missed connection or travel delay; and
7. invoices and original receipts from travel service providers.

To Claim For Change of Mind:

You must notify Us of Your cancellation of a scheduled Trip prior to Your Departure Date from Your Home Province because You have changed Your mind provided Your Trip has been paid in full.

To Claim For Baggage and Personal Effects Benefits:

You must notify Us immediately of the loss or damage to baggage or personal effects. You must also report the loss or damage to police, local or conveyance authorities, tour operator representatives, the hotel manager or official transportation representative and obtain a written report.

When filing Your claim You must submit:

1. a letter of coverage or denial from the transportation carrier and/or Your homeowner’s insurance company;
2. the written report regarding the loss or damage; and
3. original receipts or sales slips for all lost or stolen articles claimed and proof that You owned the articles.

Failure to submit the written report to Us with Your claim will result in the denial of Your claim.

To Claim For Golf Protector, Ski Protector, and Business Protector:

If You have purchased this optional coverage and You wish to submit a claim, You must notify Us immediately of the loss or damage. You must report loss or damage to police, local or conveyance authorities, tour operator representatives, the hotel manager or official transportation representative as soon as possible and obtain a written report. Failure to submit this written report to Us with Your claim will result in the denial of Your claim.

You must also submit a letter of coverage or denial from the transportation carrier and/or Your homeowner’s insurance company. As proof of loss value, We may, at Our option, request original original receipts, credit card original receipts or sales slips for all lost or stolen articles claimed. You must obtain a copy of the Physician’s report and diagnosis (applicable to refund of green fees or ski vacation Package refund only), and submit complete unused tickets and vouchers. For emergency courier fees, We will need a receipt of the imposed charges.

XV Services and considerations that put You and Your family first

Child Less Than 2 Years of Age (no seat):

The medical coverage as described in the medical section of this Policy will be extended at no additional Premium to Your child who is less than two (2) years of age but older than 15 days (excludes Children born during Your Trip) who does not occupy a seat, is Your Immediate Family Member living in the same household, and who travels with You during Your Trip.

Vacation Rain Check:

At Your request, We will provide You with a coupon for the amount of Your unused prepaid Trip cost sum Insured up to a limit of $1,500 if You have to interrupt Your Trip and You are forced to miss 75% of Your Trip due to the death or Hospitalization of a non-travelling family member, Your business partner, Your Key-employee, or Your caregiver. You must use the coupon for travel that occurs within 180 days following the date Your original Trip was interrupted and You must book the Trip through the same travel agency that booked the original Trip. The Vacation Rain Check is not available in conjunction with the Change of Mind™ benefit nor is it available if the travel agency named on the coupon is insolvent.