Policy

a) Total and Permanent Disability

If the insured is injured due to an accident and is deemed totally and permanently disabled as a result of that accident, we will pay the benefit for the plan chosen one (1) year after the date of the accident and after a physician approved in the company’s sole discretion confirms that the insured is totally and permanently disabled due to the accident. If other benefits have been paid under the policy, we will subtract the amount paid for other benefits from the Total and Permanent Disability Benefit. If the Total and Permanent Disability Benefit is paid, no further benefits are payable under the policy. If the insured dies within one (1) year after the accident, the Total and Permanent Disability Benefit is not payable. If the insured is 21 years old or more at the time of the accident, the Total and Permanent Disability Benefit payable is $100,000 or the maximum benefit under the plan chosen, whichever is less.

b) Loss of Limb or Loss of Use

If the insured is injured due to an accident resulting in the loss of a limb, or loss of sight, hearing or speech within one (1) year, we pay the benefit described in the TABLE OF INJURIES subject to Conditions i) to v) below.
Conditions:

• If the insured has more than one injury from the same accident, we cover the one that pays the highest benefit only.
• If the insured dies within 90 days of the accident, there is no coverage under this benefit.
• If we pay other benefits under the policy, we subtract them from this benefit, except for prosthetic devices.
• A physician approved in the company’s sole discretion must confirm that the loss of sight, hearing or speech is permanent and continuous for at least one (1) year after the accident.
• If the insured is 21 years old or more at the time of the accident, we pay the maximum benefit under the plan chosen or $100,000, whichever is less.

TABLE OF INJURIES

c) Accidental Death

If the insured is injured and dies due to an accident, we pay the death benefit for the plan chosen. Benefits are payable if death occurs within one (1) year of the accident. If the insured is 21 years old or more at the time of the accident, the maximum benefit is $10,000.

d) Double Benefit for Accidental Death

If the insured is injured and dies due to an accident while riding in or getting in or out of a bus, streetcar, subway train or a vehicle owned or leased by a school, we pay double the Accidental Death Benefit listed above. Benefits are payable when death occurs within one (1) year of the accident. If the insured is 21 years old or more at the time of the accident, the maximum benefit is $20,000.

If the insured’s whole or sound teeth are injured due to an accident and the insured needs dental treatment within 60 days of the accident, we cover the cost. Also, if those whole or sound teeth need follow-up dental treatment, we cover the cost for 10 years following the accident.

If this is not enough time because the insured’s teeth are still developing, then the attending dentist must contact us within 90 days after the accident and report why the treatment will take longer to complete. After 10 years, we cover up to the amount stated in the Schedule of Maximum Benefits.

If the insured needs orthodontic treatment due to the dental injury, we cover it up to the amount stated in the Schedule of Maximum Benefits. The same time periods as above apply.

If the insured’s dentures or removable teeth are broken due to an accident and the insured needs treatment from a physician or dentist within 30 days of the accident, we cover the cost to fix or replace them up to the amount stated in the Schedule of Maximum Benefits.

Conditions:

• To evaluate a claim, we use the Dental Association’s Fee Guide for General Practitioners that is in effect at the time and place where the insured’s dentist provides treatment;
• If the insured has capped or crowned teeth, we consider them to be whole and sound teeth;
• If there is more than one treatment that is professionally acceptable, we cover the least expensive one only;
• If the insured needs dental implants due to an accident, we cover up to 2 implants per accident and pay up to the maximum amount as stated in the Schedule of Maximum Benefits per implant.
• If the insured is 21 years old or more at the time of the accident, we cover up to one (1) year of dental work;
• There is no coverage for routine dental visits or dental maintenance including but not limited to cleanings and fillings;
• There is no coverage for artificial teeth or dentures except as specifically provided;
• There is no coverage for cosmetic or aesthetic treatment.

a) Hospital Room Expense

If the insured is injured due to an accident and is admitted to a hospital in Canada for more than 24 continuous hours within 30 days of that accident, we cover the cost of a private or semi-private room for up to one (1) year. We also cover up to $25 a day for television and Wi-Fi service. The insured must have Canadian government health insurance coverage to receive this benefit.

b) Emergency Transportation

If the insured is injured due to an accident and travels by ambulance to the nearest medical facility for help, we cover the cost. If the insured takes a taxi or another means of transport, we pay up to the amount stated in the Schedule of Maximum Benefits.

c) Paramedical

If the insured is injured due to an accident, and a legally qualified chiropractor, osteopath, physiotherapist, athletic therapist or registered nurse begins treating the insured’s injury within 30 days, we pay up to a maximum of $100 per visit up to the amount stated in the Schedule of Maximum Benefits for all providers. We do not cover massage therapy.

d) Medical Devices

If the insured is injured due to an accident and requires crutches, splints, an orthotic truss, a brace, prescription drugs, any type of cast or the rental of a wheelchair or hospital-type bed due to the accident, we cover up to the amount stated in the Schedule of Maximum Benefits. A splint, brace or orthotic device used for sports or non-therapeutic purposes is not covered.

e) Counselling

If the insured dies, loses a limb or the use of a limb, loses their sight, hearing or speech or are diagnosed with a Critical Illness and the insured’s physician recommends counselling for the insured, the insured’s parents, legal guardian and/or siblings, we cover up to the amount stated in the Schedule of Maximum Benefits for the services of a licensed psychologist.

f) Special Training

If the insured is injured due to an accident and needs special training to be employed, we provide coverage for up to 3 years after the accident. We cover up to the amount stated in the Schedule of Maximum Benefits, including $150 a day hotel and meals if the training is located more than 160 km from where the insured lives.

g) Confinement

If the insured is injured due to an accident and is continuously confined to hospital or to the insured’s home except for attending medical appointments, we pay $750 per month under the Platinum Plan and $500 per month under the Gold or Silver Plan. This benefit starts on the 31st day of continuous confinement under a physician’s care and ends when the insured’s continuous confinement ends or after 40 months, whichever comes first. We cover only one period of continuous confinement per accident.

h) Travel Expenses for Specialized Treatment

If the insured is injured due to an accident and within one (1) year needs specialized treatment that is located more than 160 km from where the insured lives, we cover their travel expenses up to the amount stated in the Schedule of Maximum Benefits. This benefit is limited to $60 a day.

i) Travel Expenses for Parent/Legal Guardian

If the insured is a patient in a hospital due to an accident and the attending physician recommends that the insured’s parent or legal guardian be with the insured, we cover the expense for them to travel on a common carrier up to the amount stated in the Schedule of Maximum Benefits.

j) Tutoring

If the insured is injured due to an accident and is continuously confined to hospital or to the insured’s home under a physician’s care for more than 30 days, we cover the cost of tutoring and equipment that the insured needs during the period of confinement up to the amount stated in the Schedule of Maximum Benefits. We pay up to $30 an hour for up to 6 months for a teacher to tutor the insured and the cost to rent necessary equipment and software that the school board recommends.

If the insured is injured due to an accident and fractures or dislocates a body part, we pay the benefit that corresponds to the injury as shown in the Schedule of Maximum Benefits. If they have more than one injury from the same accident, we cover the one that pays the highest benefit only.

If the insured is diagnosed for the first time with one of the following Critical Illnesses during the Coverage Period, we cover the cost of treatment and services listed below for up to 3 years from the physician’s first diagnosis.

Critical Illnesses:

The following treatment and services are provided up to the amount stated in the Schedule of Maximum Benefits:

• a registered nurse;
• $125 a day for hotel, meal, laundry and parking expenses related to the Critical Illness if the physician recommends that the insured’s parent or legal guardian be with the insured while they are hospitalized.

a) Eyeglasses and Contact Lenses

If the insured is injured due to an accident and needs treatment from a physician within 30 days because they:

• damage or break their eyeglasses or contact lenses; or
• need eyeglasses or contact lenses for the first time

we pay up to the amount stated in the Schedule of Maximum Benefits to fix or replace them or to buy new ones. We do not cover the normal replacement of eyeglasses or contact lenses if a prescription changes or if they are lost.

b) Prosthetic Device and Hearing Aids

If the insured is injured due to an accident and a physician prescribes an artificial limb, artificial eye and/or hearing aid, we cover the purchase of the device within 3 years after the accident, up to the amount stated in the Schedule of Maximum Benefits. If the insured damages or breaks their artificial limb, artificial eye and/or hearing aid due to an accident, we cover up to the amount stated in the Schedule of Maximum Benefits to fix or replace it.

c) Special Clothing

If the insured is injured due to an accident and a physician recommends special protective clothing, we cover the cost up to the amount stated in the Schedule of Maximum Benefits.

a) Out-of-Province Emergency Medical Expenses

If the insured travels during the Coverage Period and is sick or injured outside the province or territory where they live and need emergency treatment, we cover it. If they are sick, it must not be due to a pre-existing medical condition. We cover emergency treatment from a physician, registered nurse, hospital, x-ray clinic, ground ambulance or up to $1,000 for reasonable alternative ambulance transport if needed. Wecover the cost of crutches, braces, splints, trusses or other prosthetic devices, emergency medicine, blood and/or plasma and the rental of a wheelchair and/or a hospital-type bed. Wedo not cover the services of a family member.

With respect to emergency treatment, the insured or someone with the insured must notify the emergency assistance provider right away. Our emergency assistance provider must approve all emergency treatment.

24-HOUR EMERGENCY ASSISTANCE
1-800-334-7787 (Canada/USA) or elsewhere
collect 1-905-667-0587

Once the emergency treatment is over, we have the right to return the insured to the place where the trip began. Based on medical evidence, if the attending physician says the insured is healthy enough to travel without danger to their life and health, we will proceed to make travel arrangements. If the insured refuses to be returned to the place where the trip began, all benefits stop immediately.

If we return the insured to the place where the trip began and the insured decides to go back to the trip destination or rejoin the trip or tour itinerary, the policy will not cover the insured.

The overall maximum under this benefit is $200,000 if the insured has government health insurance coverage and $5,000 if they do not.

The company and the emergency assistance provider we appoint are at your service according to the conditions, limitations and exclusions of the policy. The medical providers we suggest when contacted for help are not our employees. Neither we nor the emergency assistance provider are responsible for their negligence or other acts or omissions. Neither we nor the emergency assistance provider are responsible for the emergency treatment or service you receive or do not receive, or for its availability, quality, quantity or results.

b) Trip Cancellation

If the insured cancels their trip before it begins due to their sickness, injury or death, we pay $1,000 or the penalty to cancel within 72 hours of the physician’s order, whichever is less. We do not cover any other reason for cancellation. A physician must report in writing on the sickness or injury and the need to cancel the trip because of it. We do not cover cancellation due to emotional or mental disorders unless hospitalized.

c) Airflight Accidental Death

If the insured dies due to an airflight accident, within 90 days of that accident, we pay the Accidental Death benefit plus $5,000. The insured must be a fare-paying passenger on the flight of a scheduled airline. We do not cover pilots, operators or crew members.

d) Emergency Return Flight

If the insured needs to fly home while on their trip due to their sickness or injury, we pay for the unexpected flight to the place where the trip began. We do not cover any other reason for interrupting the trip. The attending physician must report in writing on the insured’s sickness or injury. We pay the lesser of: i) a one-way economy airfare; ii), the fee to change the existing ticket; or iii) $1,000. If the insured receives a refund on the existing ticket, we subtract the refund from the benefit we pay.

e) Repatriation or Burial

If the insured dies outside the province or territory where they live due to a reason that is covered under the policy, we pay to bring their remains back to the place where their trip began or to bury or cremate their remains at the place where they died. We do not cover the cost of a headstone, casket and/or funeral service.