Insured Services / Exclusions
Subject to the "policy terms" "we" will reimburse "you" for
eligible expenses incurred by "you", that are in excess of any sums which "you"
are legally entitled to recover under the terms of any health insurance plan or
any other valid and collectible policy of insurance and "your" "deductible
amount", for:
1. "emergency"
treatment provided by a "physician". "Emergency" "insured services" shall also
include the cost of standard "hospital" ward accommodations but does not
include the cost of services provided by a convalescent home, nursing home,
home for the aged or health spa.
2. medical,
"hospital" or out-patient services, except when expressly prohibited by legislation.
3. private
duty registered nursing or licensed home care providers and rental of a
"hospital" bed, wheelchair, crutches, splints, canes, slings, trusses or braces
or other prosthetic appliance up to $5,000 following "emergency" "insured
services" when prescribed in writing by a "physician".
4. treatment,
provided by a "health-care practitioner" up to $1,000, provided such treatment
is prescribed by a "physician".
5. diagnostic
treatment including x-rays, ultrasounds, and laboratory tests requested by a
"physician", up to the aggregate policy limit while "hospitalized" for a period
of 24 hours or more or up to $1,000 when these "insured services" are provided
on an outpatient basis.
6. the
use of a licensed ambulance service for "emergency" transportation.
7. Prescription
medications while "you" are an in-patient in a "hospital", or up to $500 when
these medications are prescribed on an outpatient basis. "We" will not
reimburse "you" for any medications that can be purchased over-the-counter
without a prescription.
8. in
the event of "your" death, up to $5,000 for the cost of preparing "your" body
for burial, transportation (including a standard shipping container normally
used by the airlines) to "your" "country of origin", and the cost of preparing
related legal documentation. In no event will "we" pay for the cost of the
purchase of a coffin. In the event that "your" body is cremated or "you" are
buried in Canada or the United States, the most "we" will pay for this "insured
service" is $1,500.
9. the
extra cost via the most cost-effective itinerary of economy airfare to return
"you" to "your" "country of origin" including, if medically necessary or
required by the airline, stretcher fare and/or the return economy fare and
reasonable fees and expenses of a medical attendant. To be eligible for this
benefit, "your" treating "physician" must recommend that "you" return home
because of "your" medical condition or "our" medical advisors recommend that
"you" return home after "your" "emergency" treatment. Such costs must be
pre-authorized and arranged by "us" following "emergency" "insured services" covered
under this policy.
10. up to $1,000 for
treatment to natural teeth and repairs to dentures or other dental devices if
such treatment is necessitated by a direct unintended or unexpected blow to
"your" face.
11. "emergency" treatment
(excluding fillings" to natural and permanently attached artificial teeth when
such treatment is necessitated by a cause other than a direct unintended or
unexpected blow to "your" face up to a per insured maximum of $300 during any
twelve (12) month period.
12. obtaining "hospital",
medical or "health-care practitioner" records, or a medical report from a
"physician" or "health-care practitioner" provided "we" request the record or
report. Under no circumstances will "we" reimburse "you" for the cost of
completing the claim form.
ACCIDENTAL DEATH AND DISMEMBERMENT
Under
Accidental Death & Dismemberment "we" will cover the following benefits:
1. Up
to $10,000 if an "injury" causes "you" to die, to become completely and
permanently in both eyes; or to have two of "your" limbs fully severed above
"your" wrist or ankle joints, within 365 days of the accident.
2. Up
to $5,000, if an "injury" causes "you" to become completely and permanently
blind in one eye; or have one of "your" limbs fully severed above a wrist or
ankle joint, within 365 days of the accident.
3. If
"you" have more than one "injury" during "your" trip, "we" will pay the
applicable insured sum only for the one accident that entitles "you" to the
largest benefit amount.
In addition to the General Exclusions and Limitations, under
Accidental Death and Dismemberment Insurance, "we" will not cover expenses or
benefits if "your" death or "injury" results directly or indirectly from:
1. Piloting
an aircraft, learning to pilot an aircraft, or acting as a member of an
aircraft crew;
2. An
illness or disease, even if the proximate cause of its activation or
reactivation is the result of an "injury";
If "your" body is not found within 12 months of the
accident, "we" will presume that "you" dies as a result of "your" "injuries".
Death benefits will be payable to "your" estate. Accidental Death and
Dismemberment benefits are in excess of the aggregate policy limit.
General Exclusions and Limitations
"we" will not reimburse "you" for "insured services" or pay
an Accidental Death and Dismemberment claim and/or any other expenses arising
after any applicable "waiting period", from:
1. any
sickness, disease or "injury" for which medication has been taken, received or
prescribed, and/or treatment has been received in the 180 days preceding the
"effective date".
Important Note regarding Exclusion #1:
a "stable chronic condition" is covered (Exclusion #1 will not apply) if "you":
i)
are under 60 years of "age" on the "effective date" of "your" coverage;
or
ii)
are 60 to 85 years of "age" on the "effective date" of "your" coverage,
completed the Medical Declaration and paid the required premium to purchase the
"stable chronic condition" option.
2. any
sickness, "injury", or symptom:
-
when "you" knew, prior to "your" "effective date", that "you"
would need or be required to seek treatment for that medical condition during
"your" trip; and/or
-
for which, prior to "your" "effective date", it was reasonable to
expect that "you" would need treatment during "your" trip; and/or
-
for which future investigation or treatment was planned prior to
"your" "effective date"; and/or
-
which produced symptoms that would have caused an ordinarily
prudent person to seek treatment in the 180 days prior to the "effective date";
and/or
-
that had caused "your" physician to advise you not to travel.
NOTE: Under Exclusion #1 and #2,
each time "you" purchase another policy from "us" because "you" are staying in
Canada longer, each new policy will have a new "effective date" and "you" will
not be covered under the new policy for any sickness, disease, symptom or
"injury" which had manifested itself in the 180-day period immediately
preceding that new "effective date". "You" will not be covered for any
sickness, symptom or disease suffered during any "waiting period".
3. intentional
self-injury, suicide or attempted suicide while sane or insane;
4. any
sickness, "injury" or death related to the misuse, abuse, overdose, or chemical
dependence on medication, drugs, alcohol, or other intoxicant, whether sane or
insane;
5. an
"emergency" resulting from: hang-gliding, rock-climbing, "mountaineering",
parachuting or skydiving; participating in a motorized speed contest; or "your"
professional participation in a sport, snorkelling or scuba-diving when that
sport, snorkelling or scuba-diving, is "your" principal paid occupation.
6. any
pregnancy that commences prior to the "effective date" of this policy; "your"
routine pre-natal care; "your" routine pregnancy or childbirth; complications
of "your" pregnancy or childbirth when they happen in the 9 weeks before or
after the expected date of delivery; or medical treatment or services provided
to "your" child born during "your" coverage period;
7. the
provision of "insured services" to children 30 days of "age" or younger;
8. an
"act of war" or an "act of terrorism" when "you" are outside of Canada and
covered under the insurance;
9. any
treatment that is elective, cosmetic and not for an "emergency" and/or general
health examinations or services;
10. a continuation of
treatment or service first recommended or prescribed by a "physician" or
"health-care practitioner" before the "effective date" of this policy or where
such "insured services" were first initiated prior to the "effective date" of
this policy or during the "waiting period";
11. prescription drugs or
medications, treatment, appliances or devices provided to monitor or maintain a
"stable chronic condition".
12. the repair,
replacement or purchase of eyeglasses, contact lenses or hearing aids;
13. "your" medical or
health assessment or any form of report or document supporting an application
to obtain immigrant status or extend "your" visa in Canada;
14. any medical treatment
outside of Canada when the "emergency" occurred in Canada.
15. a mental or emotional
disorder (other than acute psychosis) that does not require admission to a
"hospital";
16. an "emergency" that
occurs or recurs after our medical advisors recommend that "you" return to
"your" country of origin and "you" choose not to;
17. any medical condition
"you" suffer or contract in a specific country, region or city outside of
Canada, while covered under the Territorial Limitation, if Foreign Affairs and
International Trade Canada, has issued a formal Travel Warning, before "you"
travel to that location, advising against all or non-essential travel to that
specific country, region or city. In this exclusion "medical condition" is
limited to medical condition(s) which result or arise from or are caused
directly or indirectly by any of the specified reasons for which the formal
Travel Warning was issued and includes complications arising from such medical
condition;
18. a criminal act or an
attempt to commit a criminal act.
Rates
Maximum
Coverage Period: For ages 85 and younger, coverage is available for up to
365 days under
one policy.
For age 86 and over, coverage can be purchased to insured up to the first 180
days following
the arrival
date. A "Waiting Period" may apply at any age; review the policy carefully for
complete
description.
"Extra
Injury Coverage" Additional $50,000 of coverage with the $100,000 option:
When you purchase
the $100,000
Aggregate Policy Limit ("APL"), a bonus $50,000 of additional coverage is
automatically
included for
eligible expenses incurred as a result of an injury.
$10,000
Accidental Death & Dismemberment: $10,000 Accidental Death and Dismemberment
coverage is automatically included for ALL applicants.
Companion Discount
A 5% discount for two or more applicants on the same policy.
Maximum two insureds over age 59 on the same policy.
|
Table 1 – STABLE CHRONIC CONDITION COVERAGE - $50
DEDUCTIBLE
|
|
Is Medical
Declaration
Required?
|
No Medical
Declaration Required
|
Medical Declaration
is Required
|
|
Aggregate
Policy Limit
|
Up to 25
Years of Age
|
Age
26 to 34
|
Age
35 to 39
|
Age
40 to 54
|
Age 55 to 59
|
Age
60 to 64
|
Age 65 to 69
|
Age 70 to 74
|
Age 75 to 79
|
Age 80 to 85
|
Age 86 & over
|
|
$10,000
|
$1.61
|
$1.72
|
$1.62
|
$1.91
|
$2.02
|
$2.97
|
$3.18
|
$4.67
|
$5.63
|
$7.57
|
N/A
|
|
$15,000
|
$1.99
|
$2.04
|
$2.14
|
$2.44
|
$2.60
|
$3.40
|
$3.98
|
$5.99
|
$7.04
|
$9.51
|
N/A
|
|
$25,000
|
$2.09
|
$2.25
|
$2.41
|
$2.76
|
$2.97
|
$3.98
|
$4.51
|
$6.47
|
$8.00
|
$11.09
|
N/A
|
|
$50,000
|
$2.41
|
$2.57
|
$2.68
|
$3.16
|
$3.37
|
$4.67
|
$5.30
|
$7.77
|
$10.06
|
$13.03
|
N/A
|
|
$100,000
|
$3.16
|
$3.48
|
$3.69
|
$4.67
|
$4.83
|
$5.83
|
$7.23
|
$9.84
|
$12.17
|
$16.50
|
N/A
|
|
$150,000
|
$3.45
|
$3.92
|
$4.35
|
$5.64
|
$6.30
|
N/A
|
N/A
|
N/A
|
N/A
|
N/A
|
N/A
|
|
Age means each
applicant’s age on the Effective Date of the policy.
|
|
Table 2 STANDARD
RATES – No Stable Chronic Condition Coverage. $50 Deductible ($500 over age
85)
|
|
Is Medical
Declaration
Required?
|
No Medical
Declaration Required - $50 Deductible
|
Medical
Declaration Required, $500 Deductible
|
|
Aggregate Policy Limit
|
Age 60 to 64
|
Age 65 to 69
|
Age 70 to 74
|
Age 75 to 79
|
Age 80 to 85
|
Age 86 and over
|
|
$10,000
|
$2.68
|
$2.87
|
$3.87
|
$4.55
|
$4.92
|
$9.46
|
|
$15,000
|
$3.07
|
$3.59
|
$4.88
|
$5.63
|
$6.38
|
$12.17
|
|
$25,000
|
$3.59
|
$4.07
|
$5.62
|
$6.16
|
$7.09
|
$14.33
|
|
$50,000
|
$4.21
|
$4.79
|
$6.68
|
$7.73
|
$8.98
|
N/A
|
|
$100,000
|
$5.27
|
$6.53
|
$8.47
|
$10.06
|
$11.36
|
N/A
|
|
$150,000
|
N/A
|
N/A
|
N/A
|
N/A
|
N/A
|
N/A
|
|
Age means each
applicant’s age on the Effective Date of the policy.
|
Family Rates (All family members must be under age 60):Charge
2x the oldest applicant’s total
Premium and list all "family" applicants on the application. A
"family" is defined as three or more of:
parents(s) or legal guardian(s) and their unmarried children under age
21 who are visiting Canada with
them and are dependent on them for their sole means of support.
Minimum Policy Premium is $25.00. Displayed premiums are per
person per day, and are subject to
change without notice.
Deductible Options
To Age 85 |
| $50.00 deductible | standard |
| 0 deductible | add 5% |
| $250.00 deductible | subtract 10% |
| $1,000.00 deductible | subtract 20% |
| $5,000.00 deductible | subtract 35% |
| $10,000.00 deductible | subtract 40% |
Age 86 and Over |
| $500.00 deductible | applies |
| $1,000.00 deductible | subtract 20% |
| $5,000.00 deductible | subtract 35% |
| $10,000 deductible | subtract 40% |
Disappearing Deductible
Once eligible expense claims exceed $2500.00 the deductible
disappears and the claim is paid from dollar one. This new deductible applies
on to policy limits of $25,000.00 or $50,000.00.
When you select the disappearing deductible your premium is reduced
by 30% on the $25,000.00 limit and 255 on the $50,000.00 limit. The
$2500.00 deductible applies to only sickness claims and not injury claims. It
is a per person per claim deductible and not a per policy deductible like the
regular $50.00 and $250.00 deductibles.
|
Did the claim
result from an injury or from a sickness?
|
Were the
expenses on the claim more or less than $2,500?
|
What is the
Deductible Amount?
|
|
Injury
|
More than $2,500
|
$0
|
|
Injury
|
Less than or equal
to $2,500
|
$0
|
|
Sickness
|
More than $2,500
|
$0
|
|
Sickness
|
Less than or equal
to $2,500
|
$2,500
|
RATE TABLE GUIDE
|
Age
|
Stable Chronic
Condition Coverage Option
|
Medical Declaration Required?
|
Premium
Table
|
Deductible
Amount ‡
|
|
Under 60
|
Automatically Included
|
No
|
Table 1
|
$50.00**
|
|
60 to 85
|
If Option Waived
|
No
|
Table 2
|
$50.00**
|
|
If Option Purchased
|
Yes
|
Table 1
|
$50.00**
|
|
86 and over
|
Not Available
|
Yes*
|
Table 2
|
$500.00
|
* For
age 86 and over, the applicant is NOT eligible for 21st Century’s
Visitors to Canada Insurance if there are any Yes answers on the Medical
Declaration.
** Other
Deductible Amount options of $0, and $250 are available up to age 85 as
indicated on reverse.
‡ The
Disappearing Deductible Option can be selected by an applicant of any age. See
details below.
What is
the Stable Chronic Condition Coverage Option?
This option is automatically
included for all applicants up to age 59, and can be purchased for ages 60 to
85 (providing the applicant is eligible). When the option is included or
purchased, exclusion 1 in the policy will not apply to eligible expenses
incurred, after any applicable waiting period, to respond to a stable chronic
condition (as defined in the policy).
Note: conditions that do not meet
the definition of stable chronic condition will be subject to the pre-existing
exclusion in the policy.