All Inclusive Plan

 

TIC TRAVEL INSURANCE PLANS

 

EFFECTIVE JULY 2011

 

TIC Travel Insurance Coordinators Ltd. administers this policy.

 

Co-operators Life Insurance Company insures the benefits available under this policy except for benefits related to property, which is provided by the Sovereign General Insurance Company.

 

 

RIGHT TO EXAMINE POLICY

Please review this policy before you travel to ensure it meets your needs.

Refunds before the Effective Date

For all plans other than the All-inclusive Package Plan, you have 10 days after purchase to return this policy for a full refund. Please refer to the sections of this policy that explain when coverage starts.

Refunds after the Effective Date

For refunds after coverage has started, refer to the Refunds section of this policy.

 

TABLE OF CONTENTS

 

Summary of Benefits

Emergency Hospital & Medical Insurance for Canadians

Accidental Death & Dismemberment

Flight Accident

Trip Cancellation & Interruption

Baggage

Definitions

General Provision

Refunds

Claims Procedures

Statutory Conditions

Emergency Procedures

 

 

IMPORTANT NOTICE

 

Please read your policy carefully before you travel.

To help you better understand your policy

Key terms in this policy are printed in italics and are defined in the Definitions.

 

What am I covered for?

Travel insurance is intended to cover losses arising from sudden, unexpected, and unforeseeable circumstances.

Coverage is different for each plan; to find out what your coverage is, please read the section titled Benefits under the name of the plan(s) you have purchased.

 

What is not covered?

Travel insurance does not cover everything. Your policy has exclusions, conditions and limitations. You should read your policy carefully before you travel, so that you are aware of, and understand, the limits of your coverage.

You may not have coverage for costs incurred due to pre-existing medical conditions or symptoms that began before the effective date of your policy. You should review this and all other exclusions that apply to your plan.

 

Are the costs of my trip arrangements covered?

The costs of your travel arrangements are covered when you purchase coverage under the Trip Cancellation & Interruption plan. Details of your coverage will be shown in your confirmation of coverage.

The benefits payable under this policy are limited to the travel costs that are non-refundable. You may ask your travel supplier or agent for details about your non-refundable travel costs.

The non-refundable amount will be assessed on the date the Insured Risk (reason for cancellation) occurred, regardless of the date you actually cancelled your trip with your travel supplier or agent.

 

What if I have an emergency?

You must notify TIC Emergency Assistance (toll free 1-800-995-1662 or worldwide collect 416-340-0049) within 24 hours of admission to a hospital and before any surgery is performed.

 

Limits on Coverage

If you fail to do so without reasonable cause, then TIC will reduce the benefits payable to you under this policy by 20%.

 

How do I make a claim?

To apply for benefits under this policy, you will need to send a completed claim form (with all original bills attached) to TIC. Please take care in filling out the form, as any missing information may cause delay.

 

Is my personal information protected?

We are committed to protecting the privacy, confidentiality and security of the personal information we collect, use and disclose. Your personal information, including your medical history, will be collected, used and disclosed only for the purpose of providing you with the requested insurance services. For a copy of TIC’s privacy policy, please contact us or visit our website www.travelinsurance.ca.

 

I want to stay longer. Can I purchase further coverage?

Yes, you can, subject to policy terms and conditions. Just call your agent or TIC (during business hours) before coverage under your policy expires.

To be eligible for further coverage, you must be in good health and you must not have incurred any losses during the first period of coverage.

Travel Assistance

TIC or Co-operators Life Insurance Company will use their best efforts to provide assistance for a medical emergency arising anywhere in the world. However, TIC, Co-operators Life Insurance Company, and their agents will not be responsible for the availability, quantity, quality, or results of any medical treatment received, or for the failure of any person to provide or obtain medical services.

 

Extended Absence from Canada

The provincial and territorial government health insurance plans limit the time a person can be out of Canada and still remain eligible for coverage. Check your province’s health plan for details.

If you exceed your province’s limits, you will not be eligible for coverage under this policy.

 

Summary of Benefits

All-inclusive Package Plan

Coverage includes:

 

Emergency Hospital & Medical for Canadians	$5 million
Trip Cancellation & Interruption	Select Plan
Accidental Death & Dismemberment	$10,000
Flight Accident	$50,000
Bagage	$500

 

Emergency Hospital & Medical Insurance for Canadians

Hospital confinement and Medical Services.............. $5 million

Included in the overall maximum of $5 million:

Hospital confinement and Medical Services	$5 million
Accidental Dental	$3,000
Ambulance Services	up to overall maximum
Attendant	up to overall maximum
Chiropractor, osteopath, chiropodist, podiatrist or acupuncturist	$300 per profession
Cremation at place of death	$4,000
Dental Emergency	$500
Emergency Trasnportation	up to overall maximum
Identity Fraud Recovery	$5,000
Meals and Accommodation	$3,000
Pet Return	$500
Physiotherapist	$300
Perscription Medication	$500
Return of Deceased	$10,000
Return to Original Trip Destination	$5,000
Return of Travelling Companion	up to overall maximum
Return of Vehicle or Watercraft	$3,000

 

 

Accidental Death & Dismemberment

For losses other than as a result of a Flight Accident.

Sum insured............... indicated on confirmation of coverage

Flight Accident

For losses as a result of a Flight Accident.

Sum insured............... indicated on confirmation of coverage

 

Trip Cancellation & Interruption

Select Plan

Prior to Departure	sum insured
After Departure	unlimited
Default Protection	$3,500 (aggregate limit applies)
Return of Deceased	$10,000
Cremation at Place of Death	$4,000
Out of Pocket Allowance	$600
Baggage Delay	$200
Meals and Accommodation	$1,000
Tour Operator	$1,000

 

Baggage

Sum insured	indicated on confirmation of coverage
Baggage	up to sum insured
Personal Currency	$100
Wheelchair	$100
Injury of accompanying cat or dog	$200
Travel Documents	$100

 

 

 

 

 

 

 

 

 

DEFINITIONS

 

Accident(al) means a sudden, unexpected, unforeseeable, unavoidable external event.

Act of terrorism means an act, including but not limited to the use of force or violence and/or the threat thereof or commission or threat of a dangerous act, of any person or group(s) or government(s), committed for political, religious, ideological, social, economic or similar purposes including the intention to intimidate, coerce or overthrow a government (whether de facto or de jure) or to influence, affect or protest against any government and/or to put the civilian population, or any section of the civilian population, in fear.

Act of war means any loss or damage arising directly or indirectly from, occasioned by, happening through or in the consequence of: war; invasion; acts of foreign enemies; hostilities or warlike operations (whether war is declared or not) by any government or sovereign, using military personnel or other agents; civil war; rebellion; revolution; insurrection; civil commotion assuming the proportions of or amounting to an uprising; military or usurped power.

Activities of daily living means eating, bathing, using the toilet, changing positions (including getting in and out of a bed or chair) and dressing.

Aggregate limit means the total number or the maximum value of insured losses resulting from any one accident or event causing loss.

Application date (applicable to Trip Cancellation & Interruption and All-inclusive Package Plans only) means the date you apply and pay for this insurance in conjunction with the initial non-refundable costs associated with booking your trip.

Business meeting means a meeting scheduled before the application date between companies with unrelated ownership, pertaining directly to your full-time employment or professional association, and required by your employment.

Canadian resident means a person legally authorized to reside in Canada and who maintains a permanent residence in Canada to which they will return after their trip.

Country of origin means the country in which you maintained a permanent residence prior to entry into Canada.

Default means a complete cessation of operations as a result of a bankruptcy of a contracted travel supplier.

Dependent children means your unmarried children who are:

a) financially dependent on you;

b) at least 15 days of age; and

c) age 21 or under.

Detailed Medical Questionnaire means the form entitled Detailed Medical Questionnaire which contains detailed questions about your health. This form must be completed correctly and accurately, signed and dated by you, and submitted with your application. Your answers at the time of completion determine the terms of coverage and/or the premium that apply to you.

Effective date means the date and time coverage starts, as indicated under the Effective Date provision of each plan purchased.

Emergency means a sudden, unforeseen sickness or injury occurring during the period of coverage, which requires immediate intervention by a physician or legally licensed dentist and cannot reasonably be delayed. An emergency is deemed to no longer exist when medical evidence indicates that you are able to continue the trip or return to your place of ordinary residence in Canada or country of origin.

Expiry date means the date and time coverage ends, as indicated under the Expiry Date provision of each plan purchased.

Family member means your legal or common-law spouse, parent, brother, sister, legal guardian, step-parent, step-child, step-brother, step-sister, aunt, uncle, niece, nephew, grandparent, grandchild, in-law, ward, natural or adopted child.

High-risk activity(ies) mean(s) heliskiing, ski jumping, skydiving, sky-surfing, scuba diving (except if certified by internationally recognized and accepted program such as NAUI or PADI, or if diving depth does not exceed 30 meters), white water rafting (except grades 1 to 4), street luge, skeleton activity, mountaineering, or participation in any rodeo activity.

High-risk pregnancy means a pregnancy involving a medical condition that puts the mother, the developing fetus or both at a higher than normal risk of developing medical complications during or after the pregnancy and birth. These medical conditions include pre-eclampsia, eclampsia, hypertension, Rh incompatibility, gestational diabetes, or placenta previa.

Hospital means a facility incorporated or licensed as a hospital by the jurisdiction where such services are provided and which has accommodation for resident in-patients, a laboratory, a registered graduate nurse and physician always on duty and an operating room where surgical operations are performed by a physician. In no event shall this include a convalescent or nursing home, home for the aged, health spa, or an institution for the care of drug addicts, alcoholics or persons suffering from mental or nervous disorders.

Identity fraud means the act of someone knowingly transferring or using, without lawful authority, your means of identity which constitutes a violation of federal law or a crime or offence under any applicable federal, provincial, state, territorial or local law.

Injury means sudden bodily harm, which is directly caused by or resulting from an accident, being a sudden and unforeseen event, excluding bodily harm that results from deliberate or voluntary action, and independent of sickness and all other causes.

Insured person means an eligible person named on the application, who has been accepted by TIC or its authorized representative, and has paid the required premium for a specific plan of insurance.

Insurer means Co-operators Life Insurance Company, except in respect of all property insurance, where the insurer is The Sovereign General Insurance Company.

Key employee means your business partner or employee whose continued presence is critical to the ongoing affairs of the business during your absence.

Medical consultation means any medical services obtained from a licensed medical practitioner for an ailment, sickness or medical condition, including but not limited to any or all of: history taking, medical examination, investigative testing, advice or treatment, and for which a diagnosis of the condition need not have been definitively made. This does not include regular medical check-ups where no medical signs or symptoms existed or were found during the check-up.

Mountaineering means the ascent or descent of a mountain requiring the use of specified equipment including crampons, pick axes, anchors, bolts, carabiners and lead-rope or top rope anchoring equipment.

Nuclear, chemical or biological means the use of any nuclear weapon or device or the emission, discharge, dispersal, release or escape of any solid, liquid or gaseous chemical agent and/or biological agent, including the resultant contamination where:

• Nuclear means any occurrence causing bodily injury, sickness, disease, or death, or loss of or damage to property, or for loss of use of property, arising out of or resulting from the radioactive, toxic, explosive, or other hazardous properties of source, special nuclear, or by-product material.

• Chemical agent means any compound which, when suitably disseminated, produces incapacitating, damaging or lethal effects on people, animals, plants or material property.

• Biological agent means any pathogenic (disease-producing) micro-organism(s) and/or biologically produced toxin(s) (including genetically modified organisms and chemically synthesized toxins) which cause illness and/or death in humans, animals or plants.

Period of coverage means the period from the effective date to the expiry date as indicated in this policy and for which premium has been paid.

Physician means a person other than you, who is legally qualified and licensed to practice medicine or perform surgery in the location where the services are performed, and is not related to you by blood or marriage.

Pre-existing medical condition means a sickness, injury or medical condition, whether or not diagnosed by a physician:

a) for which you exhibited signs or symptoms; or

b) for which you required or received medical consultation; and

c) which existed prior to the effective date of your coverage.

Reasonable and customary means the services customarily provided or the costs customarily incurred for covered losses, which are not in excess of the standard practice or fee in the geographical area where the services are provided or costs are incurred for comparable treatment, services or supplies for a similar sickness or injury.

Sickness means any illness or disease.

Spouse means a person who is legally married to you, or has been living in a common-law relationship (either opposite sex or same sex) with you for a continuous period of at least one year and who resides in the same household as you.

Stable means a pre-existing medical condition that:

a) did not require, or was not referred for any medical consultation;

b) did not require a change in type or dosage of medication.

Terminal means a sickness or medical condition for which a physician gave a prognosis of eventual death or for which palliative care was received, prior to the effective date.

Travel supplier means a tour operator, travel wholesaler, airline, cruise line, provider of ground transportation or provider of commercial accommodation to you that is contracted to provide travel services to you and that is licensed, registered or otherwise legally authorized to operate and provide travel services.

Travelling companion means a person who has prepaid shared accommodation or transportation with you. (Maximum of 5 persons including you.)

Treatment means a medical, therapeutic or diagnostic procedure prescribed, performed or recommended by a physician including, but not limited to, prescribed medication, investigative testing or surgery.

Trip means a period during which you are travelling outside of your province or territory of residence, or country of origin, and for which coverage is in effect.

We, us and our means TIC Travel Insurance Coordinators Ltd., The Sovereign General Insurance Company and Co-operators Life Insurance Company.

You or Your means the insured person.

 

 

GENERAL PROVISIONS

Assignment

Any benefits payable or which may become payable under this policy cannot be assigned by you, and the insurer is not responsible for and will not be bound by any assignment entered into by you.

Automatic Extension of Coverage

1. Coverage will be automatically extended for up to 72 hours in the event of a delay during the period of coverage of the conveyance in which you are riding or are scheduled to ride as a passenger. The delay must be due to circumstances beyond your control and the conveyance must be scheduled to arrive during the period of coverage. Additional premium will not be required.

2. Coverage will be automatically extended for up to 5 days, if medical evidence supports that you are medically unfit to travel due to a covered sickness or injury on or before the coverage expiry date.

3. If you are hospitalized at the end of the period of coverage, as a result of a covered injury or sickness, this coverage will be extended to you and your travelling companion(s) remaining with you when reasonable and necessary, during the period of hospital confinement, plus 72 hours after release to travel home.

Benefit Payments

Unless otherwise stated, all provisions in this policy apply to each insured person during one period of coverage. Benefits are only payable under one policy for each insured person during the period of coverage. If more than one TIC policy is in effect at the same time, benefits will only be paid under one insurance policy, the one with the greatest sum insured. Benefits are only payable for the plans and the specific sum insured selected, paid for and accepted by TIC at the time of application. Any benefits payable do not include interest charges. Benefits payable as a result of your death will be payable to your named beneficiary or to your Estate.

Claim Submission

You or the claimant, if other than you, shall be responsible for the verification of:

1. Any medical costs incurred; and shall obtain itemized accounts of all medical services which have been provided.

2. Any payment made by a provincial or territorial hospital/ medical plan, or, if you are not covered or are not eligible for coverage, verification of any payment that would have been made.

3. Any payment made by any other insurance plan or contract.

4. Providing substantiating medical documentation from your province, territory or country of residence, at the request of TIC.

Failure to provide substantiating documents shall invalidate all claims under this insurance.

Contract

The application, completed medical questionnaire, confirmation of coverage, this policy, any document attached to this policy when issued, and any amendment to the policy agreed upon in writing after it is issued, constitute the entire contract. Each policy or term of coverage is considered a separate contract.

TIC reserves the right to decline any application or any request for extensions of coverage. No condition of this policy shall be deemed to have been waived, either in whole or in part, unless the waiver is clearly expressed in writing and signed by TIC.

Coordination of Benefits

Coverage under this policy is in excess of all or any existing coverage concurrently in force held by or available to you, including but not limited to homeowners, tenants, multi-risk, any credit card, third-party liability, group or individual basic or extended health insurance, or any private or legislative plan of motor vehicle insurance providing hospital, medical or therapeutic coverage. TIC will coordinate all benefits in accordance with the Canadian Life and Health Insurance Association guidelines.

Reimbursement will not be made for any costs, services or supplies that are payable to you under a motor vehicle insurance policy or legislative plan pursuant to the no-fault benefits schedule under any Insurance Act, or for which you receive benefits from any other party pursuant to any policy or legislative plan of motor vehicle insurance.

You may not claim or receive in total more than 100% of the loss caused by the insured event.

If you are retired with an extended health plan provided by a former employer, with a lifetime limit of up to $50,000, TIC will not coordinate benefits with that provider.

Currency

All amounts stated in the policy including premium are in Canadian currency. At the option of TIC, benefits may be paid in the currency of the country where the loss occurred.

Governing Law

This policy will be governed by the laws of the Canadian province or territory in which you normally reside, or in the case of visitors to Canada, the Canadian province or territory where the policy was issued.

Language

The parties request that the policy and all related documentation be drawn in English. Les parties demandent que la présente police ainsi que toute documentation pertinente soient rédigées en anglais.

Limit on Liability

It is a condition precedent to liability under this policy that at the time of application and on the effective date, you are in good health and know of no reason to seek medical attention.

Misrepresentation or Nondisclosure

A failure to disclose or misrepresentation of any material fact by you, or fraud, either at the time of application or at the time of claim, shall render the entire contract null and void, and any claim submitted thereunder shall not be payable. Where there is an error as to your age, provided that you are within the insurable age limits, the premiums will be adjusted according to your correct age.

Premiums

The total premium amount is due and payable at the time of application. The premium is calculated using the most current rates for your age on the effective date.

Rights of Examination

The claimant shall provide TIC with the opportunity to examine you when and so often as it reasonably requires while a claim is pending. In the case of your death TIC may require an autopsy, subject to any laws of the applicable jurisdiction relating to autopsies.

Right to be Reimbursed

As a condition to receiving benefits under the policy, you agree to:

a) reimburse us for all emergency medical and hospital costs paid under the policy from any amounts you receive from a third party responsible for your injury or sickness whether such amounts are paid under a judgment or settlement agreement;

b) whenever reasonable, initiate a legal action against the third party to recover your damages, which include emergency medical and hospital costs paid under the policy;

c) include all emergency medical and hospital costs paid under the policy in any settlement agreement you reach with the third party;

d) act reasonably to preserve our right to be reimbursed for any emergency medical or hospital costs paid under the policy;

e) keep us informed of the status of any legal action against the third party; and

f) advise your counsel of our right to reimbursement under the policy.

Your obligations under this section of the policy in no way restricts our right to bring a subrogated claim in your name against the third party and you agree to cooperate with us fully should we choose to exercise our right of subrogation.

Time

Expiry time of coverage is the time within the time zone where you were residing when the application was made.

 

 

 

 

CLAIMS PROCEDURES

 

Claims forms are available online at www.travelinsurance.ca or by calling TIC Claims Department.

Claims can be reported on our website at: www.travelinsurance.ca

SEND YOUR CLAIMS TO:

TIC Claims Department

2100 – 250 Yonge Street

Toronto, Ontario, Canada M5B 2L7

Collect worldwide: 416-340-8809

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

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

2. 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 delay.

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

 

When submitting your Emergency Hospital & 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. Completed appropriate provincial government health insurance plan forms; see claim form for details.

5. For Multi-trip Plans, proof of original departure from and return to your province or territory of residence.

6. Any other documentation that may be required and/or requested by TIC.

 

Important Note

• In the event of a medical emergency, TIC must be notified prior to any surgery being performed or within 24 hours of admission to hospital.

Limits on Coverage

• If you fail to do so without reasonable cause, then TIC will reduce the benefits payable to you under this policy by 20%.
  
  

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

1. A fully completed and signed claim form 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.

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

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

 

When submitting your Flight Accident claim, please include:

1. A fully completed and signed claim form (completed by either you, or in the case of death, by the appointed executor/executrix).

2. A copy of flight itinerary.

3. A copy of incident report from airline or airport.

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

5. The death certificate (in the event of death).

When submitting your Trip Cancellation & Interruption claim, please include:

a) Trip Cancellation, Interruption and Delay

i. A fully completed and signed claim form. Incomplete forms will be returned and will delay processing of your claim.

Both you and the claimant (if other than you) must sign the Authorization and Certification.

ii. A Medical Certificate completed by the treating physician. A copy of the patient’s/deceased’s medical records may be required.

iii. If cancellation is due to death, copy of death certificate.

iv. If cancellation is due to any reason other than sickness, injury or death, please contact the TIC Claims Department for detailed claims requirements.

b) Prior to Departure (in addition to the requirements for item a) above)

i. Itemized copy of the invoice confirming the amount paid for your trip, including the cost of airfare, hotel, taxes, service fees and any other expenses.

ii. Proof of payment such as: a credit card statement, a copy of a cancelled cheque, or a copy of the official receipt issued by the travel agency.

iii. Statement of refund from the travel supplier or agent if applicable.

iv. Original unused airline tickets and any other original travel documentation (if you did not get a refund from any other source).

c) After Departure (in addition to the requirements for item a) above)

i. Original unused airline ticket and passenger coupon of the new replacement ticket purchased to return home.

ii. If only a change-fee was charged, receipt showing the amount charged.

iii. For an unused tour, a copy of the original invoice, breakdown of unused tour cost, and a copy of the travel itinerary.

iv. Any original receipts for out-of-pocket expenses incurred due to interruption or delayed return.

v. Any other documentation to support your claim.

 

Important Note

If an insured trip must be cancelled, the travel supplier or agent must be notified on the day (or the next business day) that the cause of cancellation occurs. Benefits are limited to the amounts that are non-refundable, at the occurrence date of the Insured Risk that was the cause for cancellation, regardless of the date the trip is cancelled.

 

When submitting your Baggage claim, please include:

1. A completed and signed claim form with a brief explanation of the incident leading to the loss.

2. An itemized list detailing the value of all lost or stolen items, together with proof of ownership such as receipts, photos, credit card statements, owners manuals, etc.

3. Copy of correspondence from any other source which may cover this loss, confirming payment or denying liability.

4. Copy of airline tickets and itinerary confirming departure and return dates.

5. Any other documents to support your claim.

 

Important Note

Immediately notify the airline, bus, railroad, hotel or other authorities where the theft occurred and obtain an official report. A police report is required in the event of stolen baggage or personal effects.

 

 

STATUTORY CONDITIONS

Notwithstanding any other provisions herein contained, this contract is subject to the Statutory Conditions in the Insurance Act respecting contracts of Accident and Sickness Insurance. For Québec residents, notwithstanding any other provisions herein contained, this contract is subject to the mandatory provisions of the Civil Code of Québec respecting contracts of Accident and Sickness Insurance.

In witness whereof, CO-OPERATORS LIFE INSURANCE COMPANY has caused this policy to be signed by its COO and Senior Vice President.