INSURANCE POLICY FOR EMERGENCY HEALTHCARE
PLEASE READ THIS POLICY CAREFULLY
This insurance is designed to cover losses arising from sudden and unforeseeable circumstances. Coverage is subject to certain limitations and exclusions, including but not limited to a pre-existing
conditions exclusion which applies to medical conditions, treatment, and/or symptoms that existed and were not stable in the three months prior to Your Effective Date.
This document becomes a contract when You enroll and pay the full premium
10 DAY RIGHT TO EXAMINE Please take the time to read Your Policy and review all of Your coverage. If You have any questions You may contact guard.me. You may cancel this Policy within 10 days
of purchase and receive a full refund if You have not departed from Your Home Country (or a Canadian already returned to Canada) and there is no claim in process.
ramedical provider.
Medically Necessary means those services or supplies which are provided to You that are
our Emergency Sickness or Injury and that are necessary for the
relief of acute pain or suering, or to identify or treat Your Emergency Sickness or Injury; or with
respect to Hospital services, those which cannot safely be provided to You as an out-patient.
Medication means a drug which is considered MEmergency Injury or Sickness and which is available only with a prescription provided by a Physician
DEFINITIONS
Whenever used in this Policy or any amendment, the following terms shall be capitalized and
have the meaning specied below.
Accident/Accidental means a sudden, unexpected, unforeseeable, unavoidable external
event, leading directly and independently of all other causes, to bodily Injury to an Insured
during the Coverage Period.
Application means Our form You complete and submit to request insurance under this
Policy. The Application forms part of the contract of insurance and some terms are dened
in the Application, and some are dened in the Denitions section of this Policy.
Benefit Maximum means the amount stated as the limit payable for any particular benet
and applies to services received during the Coverage Period. Regardless of the number
of policies issued in a 365 day period, Benefit Maximums do not renew for subsequent
Coverage Periods until:
a) 365 days have elapsed from the Effective Date of the original policy purchased and on
on the anniversary date every year thereafter; or
b) The Effective Date of a new Coverage Period providing it is more than 365 days after
the Effective Date of the original Coverage Period on the rst policy.
Claim Administrator means Travel Healthcare Insurance Solutions Inc. (T.H.I.S.)
Corrective Device means a device that is required by You on the advice of a Physician
to correct a debilitating physical impairment and without which it would be a physical
impossibility for You to continue Your studies or Your teaching responsibilities at the
educational institution in which You are enrolled or are teaching. “Corrective Devices”
include prosthetic limbs, wheelchairs, seeing-eye dogs, and hearing aids, but do NOT
include eyeglasses.
Coverage means the emergency benefits described herein. Coverage is effective
throughout the world however Coverage in Home Country is limited; please refer to
Excursion or Coverage in Home Country - Canadians (see Benets),and Exclusion #6.
Coverage Period means the period of time during which You are insured for the benets
provided by this Policy, starting from 12:01 a.m. on the Effective Date until 12:00 midnight on
either the date (a) specied as the Termination Date on the Application; or (b) of termination
of any extension of this Policy. If You return to Your Home Country for any reason other than
Excursion or Coverage in Home Country - Canadians (see Benets), coverage terminates
effective the date of Your Return to Your Home Country. The maximum Coverage Period
including extensions is 365 consecutive days from the Effective Date.
Dentist means a qualied doctor of dentistry lawfully licensed to practice dentistry in the
place where dental services are performed, but does not include the Insured or a relative of
the Insured.
Effective Date means the date Your coverage under this Policy begins. Coverage begins on
the latest of the date and time, (a) the required premium is paid, or (b) the date You request
as the Start Date on Your Application or (c) the date You leave your Home Country or (d) for
returning Canadians, the date you return to Canada.
Eligible means a person under 65 years of age travelling outside his/her Home Country
(or a Canadian returning to Canada) as a student, faculty, teacher, chaperone, participant in
educational/business/cultural exchanges, along with the Insured’s spouse, parents and
dependents over the age of 15 days and under 19 years.
Emergency means any unexpected Sickness or Injury rst occurring during the Coverage
Period, which requires immediate Medical Treatment to relieve acute pain and suffering.
Home Country means the country where the Insured permanently resides.
Hospital means a facility which primarily treats patients on an inpatient basis, is licensed as
a Hospital by the jurisdiction where treatment is provided, provides 24 hour a day nursing
services by registered or graduate nurses, has a staff of one or more Physicians available 24
hours a day, provides organized facilities for diagnosis and surgical procedures, maintains
.
X-ray equipment and operating room facilities, is not primarily a clinic, nursing, rest or
convalescent home or similar establishment and is not, other than incidentally, a location for
the treatment of alcoholism or substance abuse.
Inbound means an Eligible Insured whose Home Country is not Canada and who is
temporarily residing in Canada. Inter-provincial travel is covered.
Injury means bodily harm to an Insured due to an Accident that first occurs during the
Coverage Period.
Insured, You or Your means any Eligible person who submits an application and
corresponding payment for coverage under this Policy, and receives acceptance of coverage
from Our Plan Administrator in the form of a conrmation or a valid policy ID card.
Insurer, We, Us, Our means Old Republic Insurance Company of Canada.
Medical Treatment means medical advice, consultation, care, service or diagnosis provided
by a Physician or eligible paramedical provider.
Medically Necessary means those services or supplies which are provided to You that are
required to identify or treat Your Emergency Sickness or Injury and that are necessary for the
relief of acute pain or suffering, or to identify or treat Your Emergency Sickness or Injury; or
with respect to Hospital services, those which cannot safely be provided to You as an
outpatient.
Medication means a drug which is considered Medically Necessary for the treatment or relief
of an Emergency Injury or Sickness and which is available only with a prescription provided
by a Physician or Dentist.
Paramedical Provider means a person who has met the professional and legal requirements
necessary to provide the services of a chiropractor, osteopath, naturopath, acupuncturist,
chiropodist or podiatrist but does not include the Insured or a relative of the Insured. A referral
from a medical doctor is NOT required.
Plan Administrator means Travel Healthcare Insurance Solutions Inc. (T.H.I.S.)
Physician means a qualied doctor of medicine lawfully licensed to practice medicine in the
place where medical services are performed, but does not include the Insured or a relative
of the Insured.
Psychiatrist means a qualied doctor of psychiatry lawfully licensed to practice psychiatric
medicine in the place where psychiatric services are performed, but does not include the
Insured or a relative of the Insured.
Psychologist means a qualified doctor of psychology lawfully licensed to practice
psychology in the place where psychological services are performed, but does not include
the Insured or a relative of the Insured.
Reasonable and Customary means the amounts usually charged for treatment, services or
supplies to provide the appropriate level of care for the severity of the Emergency condition
being treated, in the geographical location where the treatment, services or supplies are
being provided.
Sickness means the sudden onset of a disease or illness that rst occurs while this insurance
is in effect, and is serious enough for You to seek Emergency Medical Treatment.
Termination Date means the date Your coverage under this Policy ends. Coverage ends on
the later of the date (a) specified as the Termination Date on the Application; or (b) of
termination of any extension of this Policy. If You return to Your Home Country for any reason
other than as defined in Excursion or Coverage in Home Country - Canadians
(see Benets), coverage terminates effective the date of your Return to Home Country.
INSURING AGREEMENT
If an Eligible Insured suffers an Emergency Injury or Sickness during the Coverage Period,
We will pay the benets stated in this Policy, subject to all of its terms, conditions, limitations,
exclusions and other provisions, for Reasonable and Customary Expenses that are incurred,
to the lesser of the Benet Maximum for that particular benet, or to the Policy maximum of
$2,000,000 All Benet Maximums contained in this Policy are per Insured for the duration of
the Coverage Period unless otherwise specied and are stated in Canadian Dollar currency.
It is a condition precedent to coverage under this Policy that at the Effective Date the Insured
is not aware of any existing medical condition which might require the Insured to incur any
medically related expenses during the Coverage Period.
BENEFITS
The benefits in this Policy are not subject to any deductible. Benefits are paid based on
Reasonable and Customary charges for services provided during the Coverage Period
up to the Benefit Maximum unless otherwise specified. Your insurance covers up to
$2,000,000 in total benefits for the following Medically Necessary services required to
treat an eligible, new emergent medical condition that first begins after the Effective
Date of Coverage. These Medically Necessary services include reasonable follow-up
visits, tests and surgeries until the initial emergency is resolved, and the condition is
stabilized.
Hospital Services • Charges made by a Hospital for semi-private room and board and other
necessary services and supplies, including drugs administered, while conned to a Hospital
for medical reasons; no limitation on number of days; private room where medically required
as determined and approved by the Claim Administrator. For Exceptional Hospitalization
Benefit, see below; Charges for Medical Treatment provided on an Emergency in patient
or out-patient basis; Charges for anaesthesia or blood products and the administration of
such products. Any surgical procedure requires prior written approval from the Claim
Administrator, unless a delay will be life threatening.
Physician’s Fees • All charges made by a Physician for professional services or Medical
Treatment;
Psychiatric Fees • When provided on an in-patient basis following an Emergency, fees
billed separately for the services of a Psychiatrist will be paid to a lifetime maximum of
$10,000. For Outpatient Psychiatric care, see Psychotherapy below.
Exceptional Hospitalization Benefit • If you are admitted to Hospital for suicide,
attempted suicide, self-inflicted injuries, mental or emotional disorders (including but
not limited to stress, anxiety, panic attacks, depression, eating disorders/weight problems),
or psychiatric treatment, we will pay up to a lifetime aggregate limit of $50,000 for medical
and/or psychiatric treatment received while you are in Hospital resulting from one or more
of these causes.
Psychotherapy • Up to $1,000 Benet Maximum for charges for out-patient care, including
psychiatric and psychological counselling.
X-rays, Laboratory and Diagnostic Tests • Charges for technical and interpretative
services. Prior written approval is required from the Claim Administrator for all major
diagnostic testing, including but not limited to magnetic resonance imaging (MRI) and
computer axial tomography (CAT) scans.
Prescription Medication • Limited to a 30-day supply of any one type unless prescribed
while a Hospital in-patient.
Private Duty Nursing Care • Up to $15,000 Benefit Maximum for the services of a
Registered Nurse, Registered Nurse Assistant or Home Care Worker, but does not include
the Insured, a relative of the Insured, or someone who normally resides with the Insured,
when ordered by the attending Physician.
Physiotherapy and Speech Therapy • Up to $1,000 Benet Maximum for charges made
by a physiotherapist or a speech therapist unless provided while a Hospital in-patient.
Medical Equipment and Supplies • Payable only if required as the result of a covered
Sickness or Injury. Purchase of medical supplies, including dressings and prosthetic
appliances; Rental charges for wheelchairs, crutches, Hospital-type bed or other appliances,
not to exceed purchase price. Up to $200 Benet Maximum for prescription glasses or contact
lenses, or up to $300 Benet Maximum for hearing aids. Up to $300 Benet Maximum for
custom orthotics, or up to $800 Benet Maximum for custom knee braces.
Emergency Transport • The full cost of licensed ambulance service to the nearest Hospital
when Medically Necessary; Emergency transfers between Hospitals when ordered by the
attending Physician, including user fee; OR, taxi fare to or from a Hospital or medical clinic
for eligible medical care to a maximum $100.
Paramedical Services • Up to $500 Benefit Maximum per Paramedical Provider
(chiropractor, osteopath, naturopath, acupuncturist, chiropodist, or podiatrist) for all services,
including x-rays.
Accidental Dental Care • Up to $4,000 Benet Maximum for Emergency dental treatment
to repair or replace natural or permanently attached articial teeth as the result of an Injury
caused by an Accidental blow to the mouth. Up to $500 Benet Maximum for emergency
repairs to articial teeth including bridges and denture plates. Treatment must take place
within 90 days of the Accident. Expenses incurred as a result of chewing Accidents or Injury
due to placing an object to or in the mouth are not payable.
Emergency Dental Care • (a) Up to $100 Benet Maximum per tooth to extract impacted
wisdom teeth or, (b) when a minimum of 6 months consecutive coverage has been
purchased, up to $600 Benet Maximum for Emergency dental treatment for the immediate
relief of pain and suffering, including root canals and wisdom teeth.
Wart Treatment • Charges for treatment of any type of warts up to $500 Benet Maximum.
Pregnancy Coverage • Where pregnancy commences after the Effective Date of this
Policy, serious complications due to pregnancy are covered up to a maximum $25,000.
Serious complications do not include normal conditions of pregnancy including but not
limited to morning sickness, spotting, ultrasounds, blood and urine testing, including testing
for gestational diabetes.
Annual Physician Visit • When a minimum of 6 months consecutive coverage has been
purchased, We will pay up to a total of $150 Benet Maximum for one visit to a Physician in
Canada for a non-emergency exam and associated tests, and for one consultation session
and prescription of the ‘morning-after-pill’.
Eye Exams • When a minimum of 6 months consecutive coverage has been purchased,
Up to $100 Benet Maximum for one non-emergency eye exam performed in Canada by a
licenced Optometrist. Note: the cost of glasses or contact lenses is NOT covered.
Excursion • Travel outside Canada (other than to Your Home Country) is covered subject
to the following conditions (a) more than 50% of the total Coverage Period must be spent in
Canada and (b) travel to the United States is limited to 30 days per trip. Expenses will not be
paid when incurred in Your Home Country “except where the trip to Your Home Country is
expressly taken in order to participate in a school-organized sporting or extra-curricular event,
or when claimed under the Coverage in Home Country – Canadians” benefit (see below).
Coverage in Home Country - Canadians • For Canadians returning to Canada, coverage
for a maximum 90 days is available during the Coverage Period until provincial healthcare
becomes available.
AccessAbility - Corrective Device Defect, Malfunction and Theft Protection • If, while
this policy is in effect, a Corrective Device required by You is stolen and not recovered, or
suffers a malfunction or defect which becomes apparent while You are covered under this
Policy and which renders Your required Corrective Device unusable, we will pay up to $1,000
Benet Maximum to replace or repair Your Corrective Device. We do not pay for defects or
malfunctions which are covered by the manufacturer’s warranty.
Trauma Counselling • If an Insured suffers a covered loss listed in the Schedule of Losses,
(other than loss of life – see below) within 90 days from the date of an Accident which
occurred during the Coverage Period, We will pay up to 6 sessions of trauma counselling.
Accidental Death and Dismemberment • If an Insured dies or suffers a permanent disability
as a result of a covered Accident, Injury, Sickness or event, within 90 days from the date of an
Accident which occurred during the Coverage Period, We will pay according to the following
Schedule of Losses up to $50,000 Benet Maximum. If the total claims against Us for the
same Accident exceed $1,250,000, Our liability for that Accident will be limited to $1,250,000
which will be shared proportionately among all claimants who are persons insured under
guard.me. Benets are payable to the Insured. In the event of the Insured’s death, benets
are payable to the beneficiary noted by the Insured. If a beneficiary is not otherwise
designated by the Insured, benefits will be paid to the first of the following surviving
preference beneciaries:
1. the Insured’s spouse;
2. the Insured’s child or children jointly;
3. the Insured’s parents jointly if both are living, or the surviving parent if only one survives;
4. the Insured’s brothers and sisters jointly; or
5. the Insured’s estate.
Schedule of Losses
Loss of Life....................................................... $50,000
Loss of Two or more Members......................... $50,000
Loss of Sight of both Eyes............................... $50,000
Loss of One Member and Sight of one Eye......$50,000
Loss of One Member.........................................$25,000
Loss of Sight of one Eye...................................$25,000
“Loss of Member” means severance of hand or foot at or above the wrist or ankle joint
respectively or complete irreversible paralysis.
“Loss of Sight” must be complete and irrecoverable.
DISAPPEARANCE -If an Insured disappears and after a suitable period of time it is
reasonable to believe that such Insured has died as a result of Bodily Injury, the Death Benet
shall become payable subject to a signed undertaking that if the belief is subsequently found
to be wrong such Death Benet shall be refunded to Us.
EXPOSURE - Injury of an Insured as a direct result of unavoidable exposure to the elements
shall be deemed to have been caused by Bodily Injury, and benets will be paid as per the
Schedule of Losses, above.
COMMON CARRIER – In the event of the Insured’s death as a result of an Injury caused
while riding as a fare-paying passenger on (a) any form of public transportation or (b) on a
scheduled ight on an airplane or helicopter, the benet increases to $100,000.
The following benefits are covered with the prior approval from the
Claim Administrator. The maximum amount payable for the following transportation
benefits cannot exceed $300,000 in total per Coverage Period.
Air Evacuation • The cost of transporting You to the nearest Hospital or to a Hospital in
Your Home Country, if Medically Necessary, either:
a) as a stretcher fare on a regular scheduled ight, including economy return fares for
qualied medical attendants (not a relative) and their associated fees and expenses; or
b) by appropriately equipped air ambulance, including associated fees and expenses for
a qualied crew.
Land ambulance costs at each end of the flight or connecting flights are included. The
attending Physician must certify that the Insured is medically fit for the type of transfer
selected.
Family Transportation and Subsistence Allowance • If You have no family members within
500 kilometres of Your location while You are outside Your Home Country and You are
Hospitalized and Your Hospitalization is expected to last a minimum of 7 days, or in the event
of the death of the Insured, We will pay up to $5,000 towards the cost of round-trip
transportation based on the lowest available fare for the most direct route for two persons
nominated by You to travel to Your bedside. We will also pay up to $1,500 for commercial
accommodation and meals for a maximum period of 10 days for these two persons.
BENEFITS (cont’d)
The attending Physician must certify that the situation is serious enough to warrant the visit.
Submit all bills and receipts to the Claim Administrator.
Repatriation or Burial of Deceased • If death occurs during the Coverage Period as a result
of a covered Injury or Sickness, We will pay either (a) up to $15,000 towards the reasonable
and necessary costs for the preparation and return of the Insured’s remains to the Insured’s
Home Country in a standard transportation container or (b) up to $5,000 for the cost of
preparing the remains, cremation or burial, and a burial plot in the location where death
occurs. The costs for a cofn, urn, headstone or funeral are excluded .
EXCLUSIONS
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18.
GENERAL POLICY LIMITATIONS
GENERAL CONDITIONS
a pre-existing condition which means a sickness, injury or other condition that was
causing signs or symptoms, and/or required medical advice or investigation, whether
a diagnosis was established or not, and/or any form of medical treatment provided by
a Physician or other Practitioner during the 3 month period immediately preceding the
Effective Date, or if upon the commencement of the coverage, a condition was known
or present such that costs could reasonably have been expected to be incurred. The
following does not constitute medical treatment for the purpose of this pre-existing
conditions exclusion:
a) the consistent use of medication, meaning that no change in medication, dosage
or usage, has been prescribed by a Physician or other Practitioner;
b) a check-up when the Physician or other Practitioner observes no adverse change
in a previously noted condition, symptom or problem;
Elective or non-Emergency Medical Treatment, including any treatment given to
maintain the stability of a chronic sickness or condition, including visits for the rell of
medication, tests or examinations forming part of a normal regime, or for treatment
of congenital or genetic disorders or conditions, or for treatment not required for the
immediate relief of pain and suffering, or that could reasonably be postponed until the
Insured returns to his/her Home Country (except as provided under the Annual
Physician Visit and Eye Exam Benefits);
any continuing treatment of an Injury or Sickness if the Claim Administrator has
requested that the Insured return to his or her Home Country following Emergency
Medical Treatment; If an Insured who has been evacuated or asked to Return Home
later returns to Canada to resume studies/teaching in the same or subsequent policy
years, the benets payable will be limited to a maximum of $10,000 for that Sickness
or Injury for which they returned Home;
medication commonly available without a prescription (including but not limited to
‘over-the-counter’ medications such as acetaminophen or cold/allergy remedies);
fertility drugs; contraceptives; erectile dysfunction drugs; anti-baldness drugs; smoking
cessation drugs; vaccinations, immunizations or injections; vitamin preparations or
supplements; or medication received on a preventive or maintenance basis;
plastic or cosmetic surgery except as a result of a covered Injury; substitution or
extraction of, or repairs to an existing prosthesis, (except as payable under the
Corrective Devices Benefit);
any expenses incurred outside the Coverage Period or while you are in Your Home
Country (except as provided under the Excursion or Coverage in Home Country-
Canadians Benefits); medical services for any injury that occurred or was treated , or
sickness that started or was diagnosed or treated in Your Home Country during the
Coverage Period;
normal pregnancy; normal childbirth; elective abortion;
the Human Immunodeciency Virus (HIV) or Acquired Immune Deciency Syndrome
(AIDS) or Aids Related Complex (ARC);
suicide, attempted suicide, self-inflicted injuries, mental or emotional disorders
(including but not limited to stress, anxiety, panic attacks, depression, eating disorders/
weight problems), or psychiatric treatment, (except as described in the Exceptional
Hospitalization Benefit, Psychiatrist’s Fees benefit, or Psychotherapy benefit);
Your actions while they are impaired or adversely inuenced by medication, drugs,
alcohol or intoxicants; any medical claims related to the use or misuse of drugs or
alcohol;
participation in professional sports or hazardous activities such as motorized contests
of speed, parachuting, skydiving, hang gliding, bungee jumping, cave exploring,
mountaineering, rock or cliff climbing, or scuba diving;
operating any type of aircraft or travelling as a passenger on any non-commercial ight;
operating any form of motorized transport on land or water without a licence valid for
the area where operating; travelling in or on a motorcycle, snowmobile, or any kind of
vehicle while racing or off-road, unless no roads exist in the area in question;
injury or sickness caused while You are training or serving in any capacity as a member
of any armed forces or while actively participating in any conict of war, or sustained in
criminal activity. However, if You sustain an Injury as a direct result of war-like actions
in which You were not an active participant and within 48 hours of the commencement
of such hostilities, any expenses incurred arising from such incident will be covered.
any interest, nance or late payment charge;
injury or sickness covered under any other form of insurance, indemnity or plan or that
is the liability of a third party;
injury or sickness while travelling to a destination for which the Home Country
Government has issued a travel advisory stating that travel to the destination should
not be undertaken;
travelling contrary to the medical advice of a Physician or Practitioner or for the
purpose of obtaining Medical Treatment or when a terminal prognosis was given to
the Insured prior to the Coverage Period.
any expenses incurred as a result of the Insured’s failure to accept or follow a
Physician’s advice, treatment or recommended treatment.
We reserve the right to arrange transportation to return You to Your Home Country following
an Emergency, either before or after You receive Medical Treatment, or Hospital or Medical
Services. If You decline to return when declared medically fit to travel by the Claim
Administrator, We will not pay for any continuing expenses, recurrence or complications
arising from or directly or indirectly related thereto.
Limitation on Liability
The Insurer, the Plan Administrator and/or the Claim Administrator are not responsible for
the availability, quality or results of any Medical Treatment, or Your failure to obtain Medical
Treatment or transportation and shall not be held liable for any negligence, wrongful acts or
omissions of any service providers.
The Contract. The Application, this Policy, any document attached to this Policy when
issued, and any amendment to the contract agreed upon in writing after the Policy is issued,
constitute the entire contract, and no agent has authority to change the contract or waive
any of its provisions.
Waiver. The Insurer shall be deemed not to have waived any condition of this contract, either
in whole or in part, unless the waiver is clearly expressed in writing signed by the Insurer.
Copy of Application. The Insurer shall, upon request, furnish to the Insured under the
contract a copy of the Application.
Premium Payment. The full premium is due and payable when You apply for insurance. If
for any reason the premium paid for the coverage applied for is incorrect, We will a) charge
and collect the difference, or b) shorten the Coverage Period if an underpayment in premium
cannot be collected, or c) refund any overpayment. Coverage will be null and void if for any
reason Your payment is not honoured by the nancial institution. The premium is calculated
using the most current premium rates on the date You apply for coverage, for Your age on the
Effective Date. We reserve the right to decline any application for insurance.
Duplicate Contracts or Policies. In the event that more than one contract is issued to one
Insured, benets shall be limited to the maximum payable under one contract at any time, and
a refund for duplicate premiums will be issued.
Misrepresentation or Nondisclosure. All coverage under this Policy shall be void, if,
whether before or after a loss, the Insured has concealed or misrepresented any material fact
or circumstance concerning this coverage or subject thereof, or the interest of the Insured
therein, or in the case of any fraud or false swearing of the Insured.
Material Facts. No statement made by an Insured at the time of Application for this contract
shall be used in defence of a claim under or to avoid this contract unless it is contained in the
Application or any other written statements or answers furnished as evidence of insurability.
Governing Law. This Policy is governed by the laws of the Canadian province of Ontario
where this Policy was issued. Any action or proceeding against the Insurer for recovery of
claims under this Policy must be brought in the Canadian province of Ontario and must
commence within 2 years from the date on which the cause of action arose. Despite any other
provisions contained in this Policy, this Policy is subject to the statutory conditions of the
Insurance Act respecting contracts of accident and sickness insurance.
Benefit Payments. All benets are payable to You unless You assign Your right to payment
directly to the service provider or another named assignee. In the event of Your death all
benets are payable to the beneciary noted by the Insured. If a beneciary is not otherwise
designated by the Insured, benefits will be paid to the first of the following surviving
preference beneciaries:
1. the Insured’s spouse;
2. the Insured’s child or children jointly;
3. the Insured’s parents jointly if both are living, or the surviving parent if only one survives;
4. the Insured’s brothers and sisters jointly; or
5. the Insured’s estate.
Benet payments do not provide for the payment of any interest. This Policy contains a clause
which may limit the amount payable.
Currency. All premium amounts, Benefit Maximums and benefit payments are stated in
Canadian Dollar currency. For reimbursement purposes, the exchange rate on foreign
currency shall be the rate determined at the date the expense was paid and quoted by the
nancial institution selected by the Claim Administrator. At Our option We may pay a claim
for benets in the currency where the loss occurred.
Co-ordination of Benefits. The benefits in this Policy are payable in excess of those
available under any other valid and collectible insurance Policy or plan under which You are
entitled to claim including but not limited to, a government health insurance plan, group or
personal accident and sickness insurance or extended health/medical care coverage, any
automobile insurance or benets plan, homeowner, tenant, or other multi-peril insurance,
credit card benet insurance, and other travel insurance. Any payment made under this
Policy will be co-ordinated with any other plan providing similar coverage such that the total
benets payable under all policies or plans does not exceed 100% of the eligible expenses
incurred.
Rights of the Company and Claimant: When You purchase this Policy, You agree to provide
the Company with access to all pertinent records or information about You from any licensed
Physician, dentist, medical practitioner, Hospital, clinic, insurer, individual, institution or other
provider of service to determine the validity of any claim submitted by You or on Your behalf.
We will not pay for any expenses resulting directly or indirectly from:
GENERAL CONDITIONS (cont’d.)
Plan Administrator to Furnish Forms for Proof of Claim. Claim Forms are provided with
each ID Card issued, and are also provided to all schools and organizations. Where a Claim
Form is required, the Plan Administrator will provide one to the Insured by fax, email or mail.
Claim Forms are also available at our website: www.guard.me.
Rights of Examination. As a condition precedent to recovery of insurance money under this
contract, (a) the claimant shall afford to the Insurer an opportunity to examine the Insured
when and so often as it reasonably requires while the claim hereunder is pending. The phy-
sician and the location of such examination shall be at the Insurer’s discretion. The Insured
agrees to cooperate and to provide full details to the physician. This physician may, in con-
junction with input from the treating physician, make additional recommendations to assist in
recovery or cure. and (b) in the case of death of the person insured, the Insurer may require an
autopsy subject to any law of the applicable jurisdiction relating to autopsies.
Non compliance With Obligations. We may choose to limit or refuse payments when (a)
the Insured or the party concerned with the payment is negligent in the fullment of any ob-
ligation resting upon him/her and has thus harmed the interests of the insurer; (b) facts have
been incorrectly or insufciently provided, or have been misrepresented, or if false data has
been provided, (c) where an Insured suffers an Injury or Sickness, the Insured is required to
seek immediate medical treatment and to follow all doctors advice, prescriptions and orders.
Failure to comply may result in reduction or refusal of payments.
When Money Payable. All money payable under this contract shall be paid by the Insurer
within 90 days after it has received acceptable proof of claim.
Limitation of Actions. An action or proceeding against the Insurer for the recovery of a claim
under this contract shall not be commenced more than two years after the date the insurance
money became payable or would have become payable if it had been a valid claim.
1. You must call the Emergency Assistance Number shown below BEFORE admission to
Hospital as an in-patient and for prior written approval BEFORE any expenses are
incurred for the following:
• Major Diagnostic tests • Dental
• Surgery • Air Evacuation
• Family Transportation • Repatriation / Burial
2. Present Your guard.me I.D. Card to Your medical service providers.
3. Complete a claim form for EACH new Sickness or Injury when FIRST treated. Take it with
You on Your rst appointment if possible. You may photocopy a blank claim form for
future use or obtain forms from Your organization or from our website at www.guard.me
4. Within 30 days of the rst medical expense, log on to www.guard.me to le your claim
electronically or MAIL:
• Completed claim form
• Original itemized bills / receipts
• Include medical reports, emergency room report, history & physical, surgical, lab,
x-rays and discharge reports to:
guard.me Claims
80 Allstate PKY,
Markham, Ontario L3R 6H3
Remember to keep a copy for Your files.
5. For a death claim, the beneciary or other person entitled to claim must call Travel
Healthcare Insurance Solutions Inc. to report the claim. Details of claim must be
submitted with an original death certicate or other proof of death, acceptable to Us.
We will not accept liability for any claim submitted to Us more than 1 year after the date
the loss was incurred.
Claims cannot be considered unless the claim form is fully completed and signed by
the claimant and submitted with all the ORIGINAL required documentation which must
be provided free of expense to Us.
Payment will not be released until all original invoices and receipts are received by the
Claim Administrator.
Underwritten by:
Old Republic Insurance Company of Canada
100 King Street West, 11th Floor
Hamilton, Ontario CANADA
L8N 3K9
CLAIM PROCEDURE
The Company and Our Plan Administrator (collectively “We” “Our” in this privacy section) are committed to protecting Your privacy. When You bought Your Policy You gave
consent for Your personal data to be collected and processed by Us in accordance with this Privacy/Data Protection Notice. The information provided will be used only for determining
Your eligibility for coverage under the Policy, assessing insurance risks, managing and adjudicating claims and negotiating or settling payments to third parties. This information
may also be shared with third parties, such as other insurance companies, health organizations and government health insurance plans to adjudicate and process any claim. We collect and
process Your personal data in line with applicable Privacy and Data Protection legislation. We take great care to keep Your personal information accurate, confidential and secure. If
You have any questions about the Company’s Privacy Policy, please contact our Privacy Officer at (905) 523-5587 or by email to: privacy@oldrepublic-group.com.
Contact the 24 Hour Toll-Free Emergency Assistance Number at 1-888-756-8428 (North America) or collect (905) 731-8291
1. within 24 hours of admission to Hospital, or if incapacitated, as soon as reasonably possible;
2. for any benefit where prior approval is required;
3. for any Excursions, prior to incurring ANY medical expenses.
Failure to notify the Claim Administrator as required will limit Our liability to 90% of the eligible expenses incurred.
PRIVACY / DATA PROTECTION NOTICE
EMERGENCY PROCEDURES
03 2018 CANADA E
Termination by Insured. The Insured may terminate this contract at any time by giving
written notice of termination to the Plan Administrator acting on behalf of the Insurer, or by
delivery thereof to an authorized agent (e.g. school or organization). If this Policy is cancelled
prior to the Effective Date for medical reasons, the Insured or the Insured’s authorized agent
where applicable, will receive a full refund of premiums paid. If the Policy is cancelled for any
other reason, an administration fee of $25 may be charged. If this Policy is cancelled after the
Effective Date, We will refund the premiums paid for unused coverage less an administration
fee of $25, provided that no claims have been incurred or paid, or are pending. A waiting
period applies to all refunds.
Refunds. Other than the 10 Day Right to Examine, refunds are calculated on a pro-rata basis
from the date postmarked on Your written request or on the date such fax or e-mail request
is received by the Plan Administrator and are subject to a minimum refund amount of $10.
No refunds will be paid on Returning Canadians' 90-day GHIP replacement coverage. This
Policy is not transferable.
Termination by Insurer. (1) The Insurer may terminate this contract at any time by giving
written notice of termination to the Insured. Unused premiums will be refunded in the event
that no claims are paid or pending. (2) The notice of termination may be mailed to the Insured,
or sent by fax or email, or where the application has been sent by another party or agent,
that party or agent may be notied by mail, fax or email. (3) Where the notice of termination is
given, 5 days notice of termination shall be given, effective the date of mailing, fax or email.
Subrogation (Right of Recovery). If any benet paid to You or on Your behalf is in excess
of the amount allowed by the provisions of this Policy, or if payment is made due to a clerical
or administrative error, then We reserve the right to recover such amount from You or any
institution, insurer, or other organization or party to whom such payment was made. If any
payment is made under this Policy, then We have the right to proceed in Your name against
any third party that may be responsible for giving rise to a claim under this Policy. We or Our
designated representatives shall have full rights of subrogation. You shall not do anything to
prejudice such rights and shall co-operate fully with Us or Our designated representatives, by
agreeing to sign, execute and/or deliver such documents as are required to proceed against
any third party that may be liable.
Policy Extensions. The maximum Coverage Period available under this Policy, including
extensions, is 365 consecutive days from the Effective Date. Any request for an extension
must be made to the Plan Administrator no later than 7 business days immediately before
the Termination Date of Your existing coverage. Coverage for this Policy extension will be
void from inception if any payment is not honoured by Your nancial institution. The Plan
Administrator or the Insurer has the right to refuse any extension. If a claim has been received
for any Insured, an extension may be granted with an exclusion for the claimed condition.
Automatic Continuation of Coverage. If the Insured is unavoidably delayed for a reason
in no way attributable to the Insured, beyond the end of the Coverage Period, this Policy will
automatically remain in effect at no extra premium for a period not to exceed:
a) 72 hours, if delayed while travelling as a fare paying passenger in a licensed public
conveyance or by private vehicle and the delay is caused by mechanical breakdown, a trafc
Accident or inclement weather; or
b) the period of connement as an in-patient in a Hospital (unless said period of connement
is in excess of the maximum limitation for Psychiatric Hospitalization) OR the period during
which You are unable to travel on medical grounds (excluding psychiatric conditions)
acceptable to the Claim Administrator. Following discharge from Hospital or following
medical approval to travel, an additional 72-hour extension will be granted.
Notice and Proof of Claim. The Insured, or a beneciary entitled to make a claim, or the
agent of any of them, shall, (a) give written notice of the claim including a completed Claim
Form, and originals of all bills to the Claims Administrator or Plan Administrator, acting on
behalf of the Insurer by delivery thereof, or by sending it by mail, not later than 30 days from
the date that a claim arises under the contract on account of an Accident, Injury, Sickness
or disability; (b) within 90 days from the date a claim arises under the contract on account
of an Accident, Injury, Sickness or disability, furnish to the Claim Administrator or the Plan
Administrator such proof as is reasonably possible in the circumstances of the happening of
the Accident or commencement of the Injury, Sickness or disability, and the loss occasioned
thereby, the right of the claimant to receive payment, and (c) if so required by the Claim
Administrator or Plan Administrator, furnish a satisfactory certicate as to the cause or nature
of the of the Accident, Injury, Sickness or disability for which claim may be made under the
contract. This reference to ‘disability’ refers to benets payable under the Accidental Death
and Dismemberment Benet.
Failure to give Notice or Proof. Failure to give notice of claim or furnish proof of claim
within the time prescribed above does not invalidate the claim if the notice or proof is given or
furnished as soon as reasonably possible, and in no event later than one year from the date
of the incident or Accident or the date a claim arises under the contract on account of Injury,
Sickness or disability if it is shown that it was not reasonably possible to give notice or furnish
proof within the time so prescribed.
