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Tour+Med Visitors Travel Insurance
Underwritten by
LS-Travel Insurance Company
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Tour+Med Visitors insurance offers two emergency medical plans
to meet different coverage needs. You can choose a plan that excludes coverage for
pre-existing medical conditions, or a plan that provides coverage for emergency
medical expenses related to stable pre-existing medical conditions.
Who Can Apply
● travelers visiting Canada;
● foreign workers holding a work permit;
● Canadians, immigrants or
permanent residents awaiting coverage under a provincial health
insurance plan;
● Super Visa applicants
and holders.
What coverage you will
have
Eligibility
You
are not eligible for coverage under TourMed Visitors
insurance policy if
:
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You have been diagnosed with a Terminal illness or require palliative care;
●
Your Physician has recommended that You do not travel;
● You require assistance with any]activities of daily living (eating, dressing,
changing positions (including getting in and out of a bed or a chair), and personal hygiene);
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● You have a degenerative neurologic
condition or a degenerative muscular condition;
●
You have ever undergone or are waiting for an organ transplant (heart, lung, liver, kidney, pancreas, bone marrow);
●
You have ever been diagnosed with heart failure, cardiomyopathy, or pulmonary edema;
●
You ever had lung cancer, pancreatic cancer or liver cancer, any cancer with metastasis
(which includes positive lymph nodes), or if You have had any Treatment for cancer in the
12 months before the Effective Date (except basal cell and squamous cell skin cancers);
●
You have a respiratory condition that has required, in the 24 months before the Effective
Date, more than 2 separate treatments of Prednisone or other oral steroids;
●
You have a Medical Condition that, in the 24 months before the Effective Date,
has required home oxygen or dialysis.
Amount of coverage
The maximum amount payable is based on the plan you have
purchased. The amount of coverage available: $50,000, $100,000, $150,000, or $300,000
(Canadian funds).
Age. Cost of this insurance depends on your
age on the policy effective date.
You must be under age 81 on the effective date of your insurance. Min age is 3 months.
Deductibles
Deductible means the portion of eligible expenses you must pay
from your own pocket when a claim occurs. The higher deductible,
the less insurance cost.
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Deductible
Options |
$0 |
$250 |
$500 |
$1,000 |
$2,500 |
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Applicable
Savings |
0 |
10% |
15% |
20% |
25% |
The full amount of the deductible applies on a per Event basis.
When to Purchase This Insurance
You can purchase a Visitor travel insurance policy:
• Before Your arrival in Canada (not more than 6 months before the requested Effective Date)-,
• Before the expiration of another insurance policy covering You in Canada, that You hold with
another insurance company;
• After Your arrival in Canada (a Waiting Period of 7 days applies and You could be required to
provide proof of Your arrival date in Canada).
Waiting period
A Waiting Period of 7 days beginning on the Effective Date is
applicable if You:
• Purchase this insurance after Your arrival in Canada;
• Purchase this insurance after the Expiration Date of your
existing policy issued by the TourMed Travel,
• Purchase this insurance after the termination of any other existing medical
coverage (satisfactory proof of the previous protection could be required in the case of a claim);
• Change from a Visitor to Canada policy that does not cover Pre-existing Medical Conditions
to a policy that covers them;
• Reduce the deductible;
• Increase the amount of coverage.
During the Waiting Period, premiums are payable and the Insured Person
is covered in case of Accident or Injury occurring during this Waiting Period,
but not in case of sickness (if the Medical Condition began before
the Effective Date or during the Waiting Period), even if costs are incurred after the Waiting Period has ended.
Insurance coverage for side-trips outside Canada
This insurance provides coverage while travelling outside Canada (excluding Your Home country), as
long as each Side-Trip originates and terminates in Canada. Any side Trip outside Canada must meet all of the following conditions:
• The Trip must not be in Your Country of Residence,
• The Trip must begin and end in Canada, during the Policy Period,
• The Trip outside Canada must be of 15 days or less;
• The total length of all Your side Trips outside Canada made during the Policy Period must
not exceed 49% of Your total stay in Canada
During your coverage period, if you take a Side-Trip outside of Canada that is longer
than that permitted in this policy, your Visitors to Canada coverage will be suspended
for the remainder of your Side-Trip but your coverage will not be terminated.
When you return to Canada, your coverage will resume. If the total length of all Your
side Trips outside Canada exceeds 49% of your Policy Period, the
contract will be considered null and void.
Extending your trip
If your coverage period, as shown in your Policy Confirmation, is less than 365 days, you may extend
your coverage up to a total coverage period of 365 days.
Any Medical Condition for which the Insured Person was treated during the
initial period of the policy will automatically be excluded from the first day of the
extended coverage period.
The Insurer reserves the right to allow or deny extended
coverage on a case-by- case basis.
Automatic extension
• The Policy Period will automatically be extended for up to 72 hours at no extra charge
for a delay considered to be beyond the Insured Person’s control (e.g., Accident, Vehicle
breakdown). Should medical care become necessary during the 72-hour period, You must
provide the Insurer with supporting written evidence.
• If You are hospitalized beyond the Expiration Date due to a medical Emergency, Your coverage will remain in force for as long as You are hospitalized, and the 72-hour extension will
commence upon Your release. If Your travel companion is also insured under a policy issued
by the Insurer, the Insurer will also extend their policy at no extra charge. This applies to one
(1) travel companion.
Refunds
Non-departure
The request must be received prior to Your Departure Date from Your Country of Residence
otherwise it will be considered and administered as an early return request.
Administrative charges apply, and no refund will be made on amounts due of less than $25.
Early Return
a) No claim is either paid or pending.
b) No expense has been incurred by the Insurer for an Emergency return of the
Insured Person or his/her travel companion to their Country of Residence.
c) The Insurer must receive the request for refund and supporting documentation
(exhibiting the Insured Person’s name, the date and the location of the transaction) within 30 days
of returning to his/her Country of Residence. (Examples: credit card statement, credit card receipt,
written confirmation obtained at the border, plane ticket or boarding pass).
The premium refund will be calculated beginning on the day following Your return in
Your Country of Residence. Administrative charges apply,
and no refund will be made on amounts due of less than $25.
Summary of Benefits
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Benefit |
Benefit Limits
(per person, per policy) |
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HOSPITAL / MEDICAL EXPENSES
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The costs of Hospitalization in a semi-private room
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INCIDENTAL HOSPITAL EXPENSES
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Reimbursement of expenses associated with a covered Hospitalization
(telephone, television, parking etc.), subject to presentation of
original receipts, up to a maximum of CAN$100 per
Hospitalization. |
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PHYSICIANS’ FEES
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Reasonable and Customary Fees charged by Physicians |
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MEDICAL APPLIANCES
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Costs for the purchase or rental: splints, casts,
crutches, canes, slings, trusses, a walker or wheelchair, when prescribed by the attending Physician. |
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PRIVATE DUTY NURSING CARE AND HOME HEALTH CARE
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Up to a maximum of CAN $10,000 per Insured Person,
subject to the Emergency Assistance's approval. |
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DIAGNOSTIC SERVICES
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Laboratory tests and X-rays
required for the Treatment of an Emergency and when prescribed by the attending Physician.
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PRESCRIBED MEDICATION
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Cost of
Medication(s) prescribed by a Physician following a
covered medical Emergency. Payment of the prescription
will be valid for the initial 30 days after the onset of
the Emergency.
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EMERGENCY DENTAL CARE
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Treatment of an Injury causing damage to a natural and healthy tooth
resulting from an Accidental blow to the mouth, a fracture or a dislocation of the jaw.
The maximum benefit is $1,000 per Accident.
‣
Emergency. Immediate relief of acute
dental pain other than a direct blow to
the face and for which You have not previously received Treatment or advice - up to $500 |
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AMBULANCE SERVICES
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The cost of local ambulance services to the nearest qualified
medical facility in the case of an Emergency and for inter-Hospital transfers.
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PARAMEDICAL FEES
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Fifty percent (50%) of the cost of
the services provided by a chiropractor, podiatrist or
physiotherapist (including X-rays prescribed by these professionals), up to CAN $300. |
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EMERGENCY TRANSPORTATION TO
THE INSURED PERSON’S BEDSIDE
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Round-trip economy airfare from the Country of Residence
to the Hospital where the Insured Person has been a patient for no less than seven
(7) consecutive days, will be reimbursed for one (1) Immediate Family member, as well
as reasonable and necessary expenses, up to a maximum of CAN $1,000. |
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EMERGENCY AIR TRANSPORTATION TO COUNTRY OF RESIDENCE
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In consultation with the attending Physician, the Emergency Assistance reserves
the right to allow that You continue to receive Treatment where You are Hospitalized,
to transfer You to another Hospital or that You be repatriated to Your Country of
Residence for continued Treatment. |
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RETURN OF DECEASED
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Up to a maximum of CAN $5,000, for the preparation and transportation of the remains
the Country of Residence, cremation or burial at the plaoe of death |
Exclusions and limitations. Visitors to Canada
medical insurance does not cover everything.
This insurance has exclusions, conditions and
limitations.
Pre-Existing Medical
Condition Exclusion
If the Pre-Existing
coverage was purchased, the insurer will not pay any expenses or benefits relating to
Any Pre-existing Medical Condition (except Minor Ailments) that has not been
Stable
and Controlled for a period of:
- three (3) months before the Effective Date (or before the
Departure Date in the case of a side Trip outside of Canada) for an Insured Person
aged
3 months to 59 years old, and
- six (6) months before the Effective Date (or
before the Departure Date in the case of a side Trip outside of Canada) for an Insured
Person aged 60 and over.
Stable and Controlled - Means any Medical Condition (other than a Minor Ailment)
for which all the following statements are true:
There has not been a ne/v diagnosis, any new Treatment prescribed or recommended, or
change(s) to existing Treatment (including a stoppage in Treatment), and
b) There has not been any change to any existing prescribed Medication (including an
increase, decrease, or stoppage to prescribed dosage, or any recommendation or
starting of a new prescription Medication (Exceptions: the routine adjustment of
Coumadin, Warfarin or insulin and the change from a brand name Medication to a generic brand
Medication of the same dosage), and
c) There has not been any new, more frequent or more severe Symptoms, and
d) There has not been any Hospitalization or referral to a specialist, and
e) There has not been any medical exam, investigative testing or test results showing deterioration: and
f) There has not been any Treatment recommended, planned or not
yet completed, nor any outstanding test results.
All of the above conditions must be met for a Medical Condition to be considered Stable and
Controlled.
Minor Ailment - Means any Medical Condition which does not require:
1) the use of Medication for a period greater than 15 days, or
2) more than one follow-up visit to a Physician, or
3) Hospitalization or a visit to a Hospital emergency room, or
4) surgical intervention, or
5) referral to a specialist.
To be considered a Minor Ailment,
the Medical Condition must end at least 30 consecutive days
prior to the Departure Date of each Trip.
Other Exclusions
• Covered expenses that exceed 70% of those normally paid under this insurance,
if you do not contact the Assistance Centre within 24 hours of Hospitalization,
unless your Medical condition makes it medically impossible for
you to call (in that case, the 30% co-insurance does not apply).
• Any Treatment that is not for an Emergency, including any
elective or cosmetic surgery or Treatment.
• The continued Treatment, Recurrence cr complication of a Medical Condition or any direct
or indirect complication that may occur, if the Medical Assistance determines that your
Emergency has ended.
• Magnetic resonance imaging (MRI), computerized axial tomography (CAT) scans, sonograms,
ultrasounds or biopsies, cardiac catheterization, angioplasty and/or cardiovascular surgery
including any associated diagnostic test(s) or charges unless approved in advance by
the Assistance Centre prior to being performed. All surgery must be authorized by ACM
prior to being performed except in extreme circumstances where surgery is
performed on an Emergency basis immediately upon admission to Hospital.
• A medical condition:
- when You knew, before you left Home, or before the Effective date of coverage, that
you would need or be required to seek Treatment for that Medical condition during
your Trip; and/or
- for which it was reasonable to expect before
you left Home or before Your Effective date of coverage, that
you would need Treatment during your Trip; and/or
- for which future investigation or Treatment was planned before You left Home; and/or
- which produced symptoms that would have caused an ordinarily prudent
person to seek Treatment in the 3 months before leaving Home; and/or
- that had caused Your Physician to advise You not to travel.
• Any Emergency and non-Emergency medical services for any Injury that occurred
or Sickness that started or was treated during any Trip break (Eligible expense #15)
that You have taken or after the number of days permitted for Your side-Trip outside of Canada.
• An Emergency resulting from mountain climbing requiring the use of specialized equipment,
including carabiners, crampons, pick axes, anchors, bolts and lead-rope or top-rope
anchoring equipment to ascend or descend a mountain; rock-climbing; parachuting, skydiving,
hang-gliding or using any other air-supported sporting device; skiing or snowboarding out
of bounds, heli-skiing, ski jumping; participating in a motorized speed contest; white water
rafting (except grades 1 to 4), street luge, skeleton activity, rodeo activity; or
Your professional participation in a sport when that sport, snorkeling or scuba-diving
is Your principal paid occupation; or snorkeling or scuba-diving (unless certified by an
internationally recognized and accepted program such as NAUI or PADI and diving depth does not exceed 30 meters).
• Any loss Injury or death, whether the Insured Person is declared sane or insane, incurred due to:
a) Your emotional or mental disorders resulting from any cause, including but not limited to anxiety or depression; or
b) Your suicide or attempted suicide; or
c) Your intentionally self-inflicted Injury.
• Committing or attempting to commit a criminal or illegal act by You, a family member or travelling companion Your or beneficiary.
• Not following a recommended or prescribed therapy or Treatment.
• Any loss, Injury or death related to
intoxication, the misuse, abuse,
overdose, or chemical dependence on
medication, drugs, alcohol or other
intoxicant.
• Your routine prenatal care; pregnancy or childbirth or complications thereof
when they happen in the 9 weeks before or after the expected date of delivery; Your Child born during Your Trip.
• For insured Children under 2 years of Age, any Medical condition related to a birth defect.
• Any benefit that must be authorized or arranged in advance by the Assistance
Centre when it has given no authorization or made no arrangement for that benefit.
• Any Emergency that occurs or recurs after Our medical advisors recommend
that You return Home following Your Emergency Treatment, and You choose not to.
• Any death or Injury sustained while piloting an aircraft, learning to
pilot an aircraft or acting as a member of an aircraft crew.
• For consecutive policies and policy extensions: any Medical condition which first
appeared was diagnosed or for which You received medical Treatment, after the
scheduled Departure Date and prior to the effective date of the subsequent policy or insurance extension.
• Any follow-up visits outside Canada when the Emergency occurred in Canada.
• Any Medical condition You contract or suffer in a specific country, region,
or city when a Government of Canada Travel Advisory, issued before Your departure to
that country, region, or city advises Canadians to avoid all or non-essential travel
to that specific country, region or city. In this exclusion, “medical condition”
is limited, related or due to the reason for the travel advisory.
• Any Act of War or Act of Terrorism.
• Your participation in armed forces activities.
Please refer to the
policy wording for a full list of exclusions and limitations.
Note: The product-related
information is for illustration purpose only. Please
refer to the
Policy Wording for details on the coverage provided,
conditions, exclusions and claim procedure.
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What
to do if you need medical attention
In order to obtain medical services, You must call EMERGENCY ASSISTANCE for authorization:
Toll free: 1 833 204-7647 or
Collect: 1 514 657-2486
YOU MUST CALL THE EMERGENCY ASSISTANCE BEFORE OBTAINING ANY
TREATMENT.
If You do not call the Emergency Assistance before
receiving any Treatment, your claim could be denied. If exceptional circumstances prevent
you from calling the Emergency
Assistance before obtaining any Treatment, you or the person accompanying you must call
as soon as possible and provide proof of those exceptional circumstances.
You must accept the referral provided by the Emergency Assistance.
If you refuse the
medical provider or Hospital referral, your claim could be denied.
If you do not call Emergency Assistance before receiving any Treatment, or if
you refuse the
medical provider or Hospital referral, the Insurer reserves the right to limit the reimbursement
of eligible medical expenses to the lesser of:
• Charges that would have been incurred within its network of medical providers: and
• 70% of the eligible expenses incurred by the Insured Person, with an overall limit of 25,000 (this means that
your original coverage amount (see Your Travel Insurance
Confirmation for the amount) is reduced to $25,000).
You may be required to pay providers directly. Coordination of care
through the Emergency Assistance will expedite reimbursement.
To apply for benefits under this policy, you
will need to send a completed claim form (with all original
bills attached) to the Assistance Centre. Consult the claim guideline in your
Policy Wording (pg.
19).
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