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Allianz Global Assistance

Contents

Overview:

Allianz Global Assistance (AGA) administers this policy. Allianz Global Assistance is the registered business name of AZGA Service Canada Inc. and AZGA Insurance Agency Canada Ltd.
Underwritten by CUMIS General Insurance Company, a member of The Co-operators group of companies.

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Please review this policy to ensure it meets your needs. Refunds before the Effective Date You have 10 days after purchase to return this policy for a full refund. Please refer to the sections of the policy that explain when coverage starts.

Refunds after the Effective Date For refunds after coverage has started, refer to the Premium Refunds section on page 23 of this policy.
IMPORTANT NOTICE: This policy contains a provision removing or restricting the right of the insured person to designate persons to whom or for whose benefit insurance money is to be payable.
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BENEFITS:

1. Emergency Hospital
We agree to pay for hospital accommodation, including semi-private room, and for reasonable and customary services and supplies necessary for your emergency care during confinement as a resident in-patient.

2. Emergency Medical
We agree to pay for the following services, supplies, or treatment, resulting from a covered sickness or injury, when provided by a health practitioner who is not related to you by blood or marriage:
a) The emergency services of a legally licensed physician, surgeon, or anaesthetist.
b) Follow-up visits as prescribed by the attending physician at the time of the emergency. Follow-up visits must occur during the period of coverage and be directly related to the emergency. The emergency must occur during the period of coverage and have been reported to AGA.
Follow-up treatment needed as a result of any sickness or injury that took place while you were in your country of origin during the period of coverage will be covered only on prior approval by AGA. On-going expenses resulting from such sickness or injury will not be covered, unless approved in advance by AGA. AGA reserves the right, as reasonably required and at its expense, to transport you to your country of origin following an emergency.
c) Diagnostics, lab tests and/or X-ray examinations as ordered by a physician for the purpose of diagnosis.
d) The services of the following legally licensed practitioners for treatment of a covered sickness or injury:
i. chiropractor;
ii. osteopath;
iii. podiatrist/chiropodist;
iv. physiotherapist, when ordered by the attending physician;
v. acupuncturist.
Not to exceed $500 per profession.
e) Private duty services of a Registered Nurse when approved in advance by AGA.
Not to exceed $10,000.
f) The use of a licensed local air, land, or sea ambulance (including mountain or sea evacuation) to the nearest hospital, when reasonable and necessary.
g) Rental of crutches or hospital-type bed, not exceeding the purchase price; and the cost of splints, trusses, braces or other approved prosthetic appliances approved in advance by AGA.
h) Emergency out-patient services provided by a hospital.
i) When not hospitalized as an in-patient, drugs or medications that require a physician’s written prescription, not exceeding a 30-day supply, to a maximum of $1,000.

3. Out-of-Pocket Expenses
In the event you (or your insured travelling companion) are confined to hospital on the date on which you are scheduled to return home, we agree to reimburse up to $150 per day to a maximum of $1,500, or up to a maximum of 10 days, for the following expenses incurred by you or any insured travelling companion:
a) commercial accommodation and meals; and
b) child care costs for children under age 18, or physically or mentally handicapped travelling
companion(s) who rely on you for assistance; and c) essential telephone calls; and
d) taxi fares.
We will only reimburse these expenses if you or your travelling companion have actually paid for them. Expenses must be supported by original receipts from commercial organizations.

4. Transportation of Family or Friend
We agree to pay up to a maximum of $3,000 for the cost to transport one family member or close friend to your bedside by round-trip economy class (using the most direct route) if:
a) you are hospitalized due to a covered sickness or injury and the attending physician advises that your family member or close friend’s attendance is necessary; or b) the local authorities legally require the attendance of your family member or close friend to identify your remains in the event of your death due to a covered sickness or injury.
Benefits are payable only when approved in advance by AGA.
In addition, we agree to reimburse up to a maximum of $1,000 for the following expenses incurred by your family member or close friend after arrival:
a) commercial accommodation and meals; and
b) essential telephone calls; and
c) taxi fares.
Expenses must be supported by original receipts from commercial organizations.

5. Return of Deceased (Repatriation)
In the event of your death due to a covered sickness or injury, we agree to reimburse:
a) up to $10,000 for costs incurred to prepare and return your remains in a standard transportation container to your country of origin; or
b) up to $4,000 for cremation or burial of your remains at the place of death.
The cost of a coffin or urn is not covered.

6. Dental
We agree to reimburse:
a) up to $4,000 for emergency treatment or services to whole or sound natural teeth (including capped or crowned teeth) which are damaged as a result of an accidental direct blow to the face; and
b) up to $500 for the immediate relief of acute dental pain caused by other than a direct blow to the face and for which you have not previously received treatment or advice.
Reimbursement will not exceed the minimum fee specified in the Canadian Dental Association schedule of fees of the province or territory where treatment was received. Treatment relating to any dental claim must begin within 48 hours after the onset of the emergency and must be completed within the period of coverage and prior to your return to your country of origin. Treatment must be performed by a legally qualified dentist or oral surgeon.

7. Emergency Transportation
When necessary, we agree to transport you to your country of origin when immediate medical consultation is required due to a covered emergency sickness or injury. Any emergency transportation such as air ambulance, one-way economy airfare, stretcher and/or a medical attendant must be pre-approved and arranged by AGA.

8. Emergency Return Home for You and One Family Member
If a covered sickness or injury requires you to be returned home during the period of coverage, we agree to reimburse up to $3,000 for the additional cost of oneway economy transportation by the most direct route for you and one insured family member to your country of origin when approved and arranged by AGA. Your coverage under this policy ceases once you have been returned to your country of origin under this benefit.

9. Accidental Death & Dismemberment
We agree to pay up to a maximum of the sum insured indicated on your confirmation of coverage, for loss of life, limb or sight resulting directly from accidental injury occurring during the period of coverage, except while boarding, riding in, or alighting from an aircraft.

Benefits are payable according to the following schedule: a) 100% of sum insured resulting from the same accidental injury for loss of:
i. life; or
ii. entire sight of both eyes; or
iii. both hands; or
iv. both feet; or
v. one hand and entire sight of one eye; or
vi. one foot and entire sight of one eye.
b) 50% of sum insured resulting from the same accidental injury for loss of:
i. entire sight of one eye; or
ii. one hand; or
iii. one foot.
Loss of hand or hands, or foot or feet means severance through or above the wrist joint or ankle joint, respectively. Loss of eye or eyes means total and irrecoverable loss of the entire sight.

Only one amount is payable (the largest) if you suffer more than one of these losses.
Exposure and Disappearance
If you are exposed to the elements or disappear as a result of an accident, a loss will be covered if:
a) as a result of such exposure, you suffer one of the losses specified in the schedule of losses above; or
b) your body has not been found within 52 weeks from the date of the accident. It will be presumed, subject to evidence to the contrary, that you suffered loss of life

Eligibility:

  1. 1. Coverage is NOT AVAILABLE to any individual who, as of their effective date:
    a) has been diagnosed with a terminal illness; or
    b) has been diagnosed with stage 3 or 4 cancer; or
    c) has received treatment for any cancer (other than basal or squamous cell skin cancer or breast cancer treated only with hormone therapy) in the past 3 months; or
    d) requires assistance with activities of daily living as the result of a medical condition or state of health.
    2. To be eligible for coverage you must, as of the effective date:
    a) be at least 15 days old and not more than 89 years old; and
    b) not be insured or eligible for benefits under a Canadian government health insurance plan; and
    c) be in good health at the time you purchase your policy and on the date you exit your country of origin, and know of no reason to seek medical consultation during the period of coverage.
  2. Start of Coverage
    Coverage starts on the effective date.
    Waiting Period
    Coverage for losses resulting from any sickness will begin 48 hours after the effective date if you purchase your policy:
    a) after the expiry date of an existing AGA administered policy; or
    b) after you exit your country of origin. Any sickness that manifests itself during the 48-hour waiting period is not covered even if related expenses are incurred after the 48-hour waiting period.
    End of Coverage
    Coverage ends on the expiry date.

Claims Procedures

Claims forms are available by calling AGA’s Claims Department.
SEND YOUR CLAIMS TO:
Allianz Global Assistance Claims Department 250 Yonge Street, Suite 2100 Toronto, Ontario M5B 2L7
Canada
Collect worldwide: 416-340-8809
Toll-free Canada/USA: 1-800-869-6747

1. Notice of Claim. Claims must be reported within 30 days of occurrence.
2. Proof of Claim. 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 hospital or 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. Any other documentation that may be required and/or requested by AGA.

Important Note
• In the event of a medical emergency, AGA must be notified within 24 hours of admission to hospital and before any surgery is performed.

Limits on Coverage
• If you fail to do so without reasonable cause, then we will pay 80% of the claim payable. You will be responsible for the remaining 20% of the claim payable.
• You will be responsible for any expenses that are not payable by us.

When submitting your Accidental Death & Dismemberment claim, please include:
1. A fully completed and signed claim form completed 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 (in the event of death).
5. The Medical Certificate completed by the attending physician or hospital medical records.
6. Any other documents requested by AGA after initial review of the claim.

 

Download:

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