Benefits
1. Hospital.
The insurer agrees to pay for hospital accommodation (private room for Enhanced or Deluxe, semi-private
room for Standard) and for reasonable and customary services and supplies necessary for your care during
confinement as a resident in-patient.
2. Medical
The insurer agrees to pay for the following services, supplies or treatment, when provided by a health
practitioner who is not related to you by blood or marriage:
a) The services of a legally licensed physician, surgeon, anaesthetist or registered graduate nurse.
b) The services of the following legally licensed practitioners when ordered by the attending physician as
treatment for a covered sickness or injury:
i. Physiotherapists; or
ii. Acupuncturist; or
iii. Naturopath.
Not to exceed $500 per profession for Standard, $1000 per profession for Enhanced, or $2000 per
profession for Deluxe.
c) The services of the following legally licensed practitioners for treatment of a covered sickness or injury:
i. Chiropractor; or
ii. Podiatrist; or
iii. Osteopath.
Not to exceed $500 per profession for Standard, $1000 per profession for Enhanced, or $2000 per
profession for Deluxe.
d) Diagnostics, lab tests and/or X-ray examinations as ordered by a physician for the purpose of diagnosis.
e) The use of a licensed local air, land, or sea ambulance (including mountain or sea evacuation), to the nearest
hospital when reasonable and necessary.
f) Rental of wheelchair, crutches or hospital-type bed, not exceeding the purchase price; and the cost of
splints, trusses, braces or other prosthetic appliances approved in advance by Allianz Global Assistance.
g) Private duty nursing services of a registered nurse or registered medical attendant. Must be pre-approved by
Allianz Global Assistance.
h) Out-patient services provided by a hospital.
i) Generic drugs or medications purchased after the effective date that require a physician’s written
prescription, not exceeding a 90-day supply unless you are hospitalized as an in-patient. Brand-name drugs
or medications are covered up to the generic equivalent when the generic is not available or the physician
indicates no substitutions. Prescription drugs or medications are covered in full while you are hospitalized.
The amount payable is limited to $10,000.
3. Return of Deceased (Repatriation)
In the event of your death due to a covered sickness or injury, the insurer agrees to reimburse:
a) Up to $10,000 for costs incurred to prepare and return your remains to Canada in a standard transportation
container; or
b) Up to $4000 for cremation or burial of your remains at the place of death.
The cost of a coffin or urn in not covered.
4. Dental
The insurer agrees to reimburse:
a) Up to the maximum amount shown in the Summary of Benefits, for treatment or services to whole or sound
natural teeth (including capped or crowned teeth) which are damaged as a result of an accidental blow to the
face; and
b) Up to $500 for the immediate relief of acute dental pain caused by other than a blow to the face.
Treatment relating to any dental claim must begin within 48 hours after the onset of the emergency, and must be
completed during the period of coverage.
Treatment must be performed by a legally qualified dentist or oral surgeon.
Dental conditions for which you have received treatment or advice in the 180 days prior to the effective date are
not covered.
5. Emergency Transportation
The insurer agrees to transport you to the nearest appropriate medical facility or to a Canadian hospital when
necessary continuing medical care is required and is not covered under the policy according to exclusion
EXP10.
Any emergency transportation such as air ambulance, one-way economy airfare, stretcher, and/or a medical
attendant must be pre-approved and arranged by Allianz Global Assistance.
6. Return Home
The insurer agrees to reimburse up to $5000 for the additional cost of one-way economy transportation by the
most direct route to Canada:
a) For you and one family member, if you are permanently unable to perform activities of daily living as the
result of a covered sickness or injury; or
b) For you and one family member, if you require long-term chronic care; or
c) For you, if the Department of Foreign Affairs and International Trade of the Canadian Government issues an
advisory to avoid non-essential travel or all travel to your destination after the effective date or after your
departure date to that destination.
Transportation must be pre-approved and arranged by Allianz Global Assistance.
7. Attendant
The insurer agrees to reimburse up to$500 for an attendant (who is not related to you by blood or marriage) to
care for any family members (under age 18, or physically or mentally handicapped and reliant on you for
assistance), if you are hospitalized for 48 hours or more as a result of a covered sickness or injury.
This benefit is payable only when approved in advance by Allianz Global Assistance.
8. Transportation of Family or Friend
The insurer agrees to pay up to a maximum of $3000 for the cost to transport up to two bedside companions
(your family member or close friend) 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 closed 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 Allianz Global Assistance.
In addition, the insurer agrees to reimburse up to a maximum of $1000 for the following expenses incurred by
your family member(s) or closed friend(s) 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.
9. Maternity
a) The insurer agrees to reimburse up to 80% of the costs incurred by the mother for pre-natal care, childbirth
or miscarriage, or related complications.
The expected delivery date must be more than 10 months after the effective date.
For multiple policies with no lapse in coverage, effective date for this benefit means the effective date of the
initial policy purchased.
b) The insurer agrees to reimburse up to 80% of the costs incurred for routine new-born nursing care up to 14
days following birth.
Newborns can be covered under their own policy at 15 days of age if a completed application is accepted by
Allianz Global Assistance or its representative and written approval is given by Allianz Global Assistance.
The amount payable for all eligible expenses under this benefit is limited to $5000 for the Standard
Option, $10,000 for the Enhanced Option, or $25,000 for the Deluxe Option.
10. Vaccines
The insurer agrees to reimburse up to $100 for vaccinations in any 12-month period, provided coverage has
been in effect for a minimum of 6 consecutive months with no lapse in coverage.
This benefit is not subject to any deductible.
11. Physical Examination
The insurer agrees to reimburse for one routine examination by a physician.
This benefit is limited to one visit in any consecutive 12-month period, provided coverage has been in effect for
a minimum of 9 consecutive months with no lapse in coverage.
This benefit is not subject to any deductible.
12. Accidental Death & Dismemberment
Subject to the policy terms and conditions, the insurer agrees to pay up to the sum insured shown in the
Summary of Benefits, for loss of life, limb or sight resulting directly from accidental injury occurring during the
period of coverage, except while boarding, riding in, or disembarking from a common carrier.
13. Common Carrier
Subject to the policy terms and conditions, the insurer agrees to pay up to a maximum sum insured shown in the
Summary of Benefits for loss of life occurring during the period of coverage while boarding, riding in, or
disembarking from a common carrier as a ticketed passenger.
The total aggregate limit for accidental injury under the Common Carrier benefit is $10 million.
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 loss of life; 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.
Additional Benefit for the Enhanced and Deluxe Options.
14. Eye Examination
The insurer agrees to reimburse for services of a registered optometrist for diagnostic procedures to determine
the presence of any observed abnormality in the visual system.
This benefit is limited to one visit in any consecutive 12-month period, provided coverage has been in effect for
a minimum of 9 consecutive months with no lapse in coverage.
Exclusions
EXP1 Pre-Existing Conditions Exclusion
Standard Option
Benefits are not payable for costs incurred due to any sickness or injury or medical condition, whether or not
diagnosed by a physician:
a) For which you exhibited signs or symptoms; or
b) For which you required or received medical consultation; and
c) Which existed prior to the effective date or your coverage.
Enhanced and Deluxe Options
Benefits are not payable for costs incurred due to or resulting from your medical condition or related condition
that was not stable at any time during the stability period.
EXP2 Benefits are not payable for costs incurred due to any sickness for which signs or symptoms occurred
during the 48 hours after the effective date, except when the application for this insurance is received:
a) Prior to your leaving Canada; or
b) Before the expiry date of your existing Allianz Global Assistance policy.
EXP3 Benefits are not payable for costs or losses incurred while sane or insane due to:
a) Your emotional or nervous disorders resulting from any cause, including but not limited to anxiety or
depression; or
b) Your suicide or attempted suicide; or
c) Your intentional self-inflicted injury.
EXP4 Benefits are not payable for costs incurred due to pregnancy, abortion, miscarriage, childbirth or
complications thereof, except as specifically provided under Maternity (Benefit 9).
EXP5 Benefits are not payable for costs incurred due to loss, death or injury, if at the time of the loss, death or
injury, evidence supports that the medical condition causing the loss was in any way contributed to by:
a) Your intoxication or chronic abuse of alcohol, prohibited drugs, or any other intoxicant; or
b) Your non-compliance with prescribed treatment or medical therapy; or
c) Your use of medication or drugs that have not been approved by the appropriate government authority; or
d) Your misuse of medication.
EXP6 Benefits are not payable for costs incurred due to injury resulting from training for or participating in:
a) Motorized speed contests; or
b) Stunt activities; or
c) Professional sport activities; or
d) High-risk activities.
EXP7 Benefits are not payable for costs incurred due to sickness or injury resulting from a motor vehicle
accident where you are entitled to receive benefits pursuant to any policy or legislative plan of motor vehicle
insurance, except when such benefits are exhausted.
EXP8 Benefits are not payable for costs incurred due to any sickness, injury or medical condition for which a
diagnosis need not have been made when travel is undertaken for the purpose of securing medical treatment or
advice, unless previously approved by Allianz Global Assistance.
EXP9 Benefits are not payable for costs incurred due to your travelling against the advice of a physician or any
loss resulting from your sickness or medical condition that was diagnosed by a physician as terminal prior to the
effective date of this policy.
EXP10 Benefits are not payable for costs incurred due to:
a) Any treatment which can be reasonably delayed until you return to Canada (whether or not you intend to
return) by the next available means of transportation, unless approved in advance by Allianz Global Assistance; or
b) Any treatment which can be reasonably delayed until your government health insurance plan takes effect if
you are waiting for coverage under a government health insurance plan to take effective; or
c) Any treatment, investigation or hospitalization which:
i. Is a continuation of or subsequent to an in-patient hospitalization; or
ii. Exceeds 30 days following the initial day that necessary outpatient treatment of a covered sickness or
injury began;
Unless approved in advance by Allianz Global Assistance.
EXP11 Benefits are not payable for costs incurred due to any medical consultation that is elective or related to a
prior elective procedure, except as specifically provided under Physical Examination (Benefit 11) and Eye
Examination (Benefit14).
EXP12 Benefits are not payable for costs incurred due to cosmetic surgery unless such emergency surgery is a
result of a covered sickness or injury.
EXP13 Benefits are not payable for costs incurred due to holistic treatment.
EXP14 Benefits are not payable for costs incurred due to dental care, services or supplies, except as specifically
provided under Dental (Benefit 4).
EXP15 Benefits are not payable for eye glasses, contact lenses, hearing aids and/or prescriptions for any of
these items.
EXP16 Benefits are not payable for costs incurred due to the purchase of:
a) Medications or drugs not approved for use by the appropriate government authority; or
b) Vitamins or vitamin preparations; or
c) Drugs or medications which can be purchased over the counter without a physician’s written
prescription; or
d) Acne medications; or
e) Nicotine resin products; or
f) Dietary supplements or weight loss products; or
g) Quantities of any drug or medication which exceed a 30-day supply within one month prior to the expiry
date; or
h) Contraceptives prescribed for any purpose, contraceptive consultation testing; or
i) Fertility drugs or testing; or
j) Drugs, medications, or other costs paid for by any other agency; or
k) Experimental drugs or preventative medications; or
l) Drugs purchased prior to the effective date; or
m) Vaccines or vaccinations other than as provided under Vaccines (Benefit 10)
EXP17 Benefits are not payable for costs that exceed the reasonable and customary rate for the area where the
treatment or services are being performed, or costs incurred in Canada which exceed the applicable provincial
medical/dental association schedule of fees.
EXP18 Benefits are not payable for costs incurred due to treatment or services that contravene, or are
prohibited by, legislation under a provincial or territorial hospital/medical plan.
EXP19 Benefits are not payable for costs incurred in the USA or Mexico if coverage is purchased for Zone 2,
except for loss due to acute emergency hospital and other covered emergency costs due to sickness or injury
occurring during the period of coverage while you are travelling to or from Canada in transit through the USA
or Mexico for a period of up to 5 days.
EXP20 Benefits are not payable for costs incurred due to any loss incurred in a city, region, or country when,
prior to the effective date or departure date to that destination, the Department of Foreign Affairs and
International Trade of the Canadian Government issued a written warning to avoid all travel, or to avoid nonessential
travel, to that city, region, or country. If you are already at that destination on the date a warning is
issued, coverage will be provided for 5 days to allow you to leave for a safe location.
EXP21 Benefits are not payable for costs incurred due to any fraudulent, dishonest or criminal act by you, or
any person acting with you, or your authorized representative, whether acting alone or in collusion with others.
EXP22 Benefits are not payable for costs incurred due to any:
a) Act of war; or
b) Kidnapping; or
c) Act of terrorism caused directly or indirectly by nuclear, chemical or biological means; or
d) Riot, strike or civil commotion; or
e) Unlawful visit in any country.
EXP23 Benefits are not payable for costs incurred due to any nuclear, chemical or biological occurrence,
however caused.
EXP24 Benefits are not payable for costs incurred due to the participation by you, a family member or travelling
companion in:
a) Protests; or
b) Armed forces activities; or
c) A commercial sexual transaction; or
d) The commission or attempted commission of any criminal offence; or
e) The contravention of any statutory law or regulation in the area where the loss occurred.
EXP25 Accidental Death & Dismemberment benefits are not payable for losses incurred while being the
occupant of a common carrier, either as passenger or crew, or while boarding or disembarking from a common
carrier.
EXP26 Common Carrier benefits are not payable for losses incurred while being an on-duty crew member of a common carrier.
Please refer to the policy wording for a complete description of benefits, exclusions, limitations and conditions.