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For the Period Beginning On or After August 1, 2019

This document and the confirmation of coverage make up the policy. Take the time to read this document as it contains important information about the coverage. Bold words have a specific meaning which we define in Section I. Definitions. If you have any questions, please call us at 1-800-463-5437. We are happy to help.

A. 10 day free look

The policy may be cancelled within 10 days of purchase for a full refund if there is no claim in process.

B. Who is eligible for coverage?

To be eligible for this coverage, the student must be:
a)more than 6 months old; and
b)less than 27 years old; and
c) live in Canada, except in the province of Quebec.

If the student is 14 years old or more at any time during the Coverage Period, they must be a full-time student in the 12 months prior to a claim. Full-time student is defined as being enrolled in a minimum of 3 courses at the same time during any 4-month period.

C. Coverage Period

Coverage under the policy begins on the date when we or our authorized representative receive the completed application and the
premium.

Coverage ends on the earlier of:
a) the expiration date shown on the confirmation of coverage; or
b) the date the insured is no longer eligible based on Section B.

The policy is in effect 24 hours a day, 7 days a week during the Coverage Period.

D. What we cover

We provide the benefits described in the policy if the insured is injured due to an accident during the Coverage Period. The Critical
Illness Benefit (see Benefit G5) applies whether or not an accident happens. The Travel Benefit (see Benefit G7) only applies if the
insured is covered under the Platinum Plan and is 20 years old or less at the time of a claim. All the benefits are subject to the Exclusions
in Section E, the Conditions and Limitations in Section F and the Exclusions Applicable to the Travel Benefit in Section H.

E. Exclusions

The policy does not cover:

  1. Intentionally self-inflicted injuries;
  2. Sickness, except under the Counselling Benefit (see Benefit G3), the Critical Illness Benefit (see Benefit G5) and Travel Benefit (see Benefit G7);
  3. The purchase, repair or replacement of eyeglasses, contact lenses, orthotic devices, trusses, braces or prescription medication except
    as we describe in Section G;
  4. Losses caused directly or indirectly, in whole or in part if the insured:
    a) commits a crime or malicious act;
    b) uses drugs, alcohol or medication.

In addition, exclusions that apply to the Travel Benefit (Benefit G7) under the Platinum Plan are in Section H.

F. Conditions & Limitations

  1. The insured can only be covered under one plan with us. Benefits will only be paid under one policy.
  2. The benefits we pay under the policy are in excess of the insured’s coverage from any other source.
  3. Except for the “10 Day Free Look” under Section A, there are no premium refunds.
  4. The policy only covers the insured if they attend school in Canada.
  5. If the insured files a claim with us, we have the right to have a physician approved in our sole discretion examine them.
  6. If the insured files a claim with us, we are automatically subrogated to their right to collect from third parties and can act on their behalf to enforce this right.
  7. If the insured files a claim for similar benefits with us and another excess insurer, we coordinate the payment of benefits with the other insurer to settle the actual eligible loss.
  8. The policy is subject to the statutory conditions of the Insurance Act of the province or territory where the insured lives. If the policy and the Insurance Act disagree, the Insurance Act prevails.

G. Benefits

SCHEDULE OF MAXIMUM BENEFITS

BENEFIT SECTIONS PLAN BENEFIT MAXIMUM
PLATINUM GOLD SILVER
1. DEATH, DISABILITY, LOSS OF LIMB OR USE
Total and Permanent Disability $350,000 $150,000 $75,000
Loss of Limb or Loss of Use $150,000 $150,000 $75,000
Accidental Death $30,000 $20,000 $15,000
Double Benefit for Accidental Death $60,000 $40,000 $30,000
2. DENTAL TREATMENT
Treatment within 10 years of Accident Dental Association Fee Guide Dental Association Fee Guide Dental Association Fee Guide
Treatment after 10 years of Accident (per tooth) $1,650 $1,400 $1,250
Implants (up to 2 implants per accident) $2,000 $1,800 $1,500
Orthodontics $2,500 $2,500 $1,500
Dentures and removable teeth $500 $500 $500
3. MEDICAL TREATMENT AND TRANSPORTATION
Hospital room expense Full Cost Full Cost Full Cost
Ambulance Full Cost Full Cost Full Cost
Emergency taxi to nearest medical facility $350 $350 $350
Paramedical $800 $500 $500
Medical Devices $1,500 $1,500 $1,500
Counselling $1,000 $750 $750
Special Training $10,000 $6,000 $6,000
Confinement $30,000 $20,000 $20,000
Travel for Specialized Treatment $3,000 $3,000 $3,000
Travel for Parent/Guardian $1,000 $1,000 $1,000
Tutoring $6,000 $6,000 $6,000
4. FRACTURE OR DISLOCATION
Skull (depressed), Spine (3 or more vertebrae) $1,000 $750 $750
Skull (not depressed), Pelvis, Spine (1 or 2 vertebrae) $500 $250 $250
Hip, Femur, Shoulder, Humerus, Scapula $300 $200 $200
Collar bone (clavicle), Elbow, Knee Cap, Leg, Forearm, Hand, Wrist or Foot $250 $150 $150
Jaw (except the alveolar process), Sacrum, Coccyx, Sternum, $200 $150 $150
Two or more toes, fingers or ribs
One toe, finger, rib or any bone not specified above $150 $150 $150
5. CRITICAL ILLNESS
Nursing expenses $12,500 $9,000 $9,000
Accommodations, meals, laundry, parking $3,000 $3,000 $3,000
6. MEDICAL EQUIPMENT
Damage to eyeglasses and contact lenses $350 $300 $300
Eyeglasses and contact lenses needed due to injury Full Cost Full Cost Full Cost
Purchase of Prosthetic Device or Hearing Aids $5,500 $5,500 $5,500
Fix or Replace Prosthetic Device or Hearing Aids $500 $300 $300
Special Clothing $400 $400 $400
7. TRAVEL
Out of Province Emergency Medical Expenses $200,000 N/A N/A
Trip Cancellation $1,000 N/A N/A
Airflight Accidental Death $5,000 N/A N/A
Emergency Return Flight $1,000 N/A N/A
Repatriation or Burial $5,500 N/A N/A

1. DEATH, DISABILITY, LOSS OF LIMB OR USE

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 use 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 use of a limb, or 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

LOSS PLATINUM GOLD SILVER
Both hands or both feet at or above the wrist or ankle $150,000 $150,000 $ 75,000
One hand and one foot at or above the wrist or ankle $150,000 $150,000 $ 75,000
One hand or one foot at or above the wrist or ankle and the sight of one eye $150,000 $150,000 $ 75,000
Sight in both eyes $150,000 $150,000 $ 75,000
One arm or one leg at or above the elbow or knee or the hearing in both ears or speech $45,000 $ 45,000 $ 22,500
One hand or one foot at or above the wrist or ankle, or the sight in one eye $30,000 $ 30,000 $ 15,000
Thumb and index finger at or above the knuckle (metacarpal-phalangeal joint) $15,000 $ 15,000 $ 7,500
Part or all of one or more fingers or toes $ 1,500 $ 1,500 $ 750

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.

2. DENTAL TREATMENT

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.

3. MEDICAL TREATMENT AND TRANSPORTATION

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 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.

4. FRACTURE OR DISLOCATION

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.

5. CRITICAL ILLNESS

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:

AIDS (Acquired Immune Deficiency Syndrome) Leukaemia Poliomyelitis
Cancer Meningitis Rabies
Cardiomyopathy Multiple Sclerosis Scarlet Fever
Diphtheria Muscular Dystrophy Tetanus
Encephalitis Myocarditis Tularaemia
Haemolytic Uremic Syndrome (Renal failure caused solely by E-coli bacterial infection) Necrotizing Fasciitis Typhoid

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.

6. MEDICAL EQUIPMENT

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.

7. TRAVEL (PLATINUM PLAN ONLY IF THE INSURED IS 20 YEARS OLD OR LESS AT THE TIME OF A CLAIM)

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.

H. Exclusions Applicable to the travel benefit (G7)

The Travel Benefit (G7) does not cover:

  1. Pre-existing medical conditions (see definition in Section I);
  2. Medical conditions that would make a normally prudent person decide not to travel;
  3. Declared or undeclared war, hostile acts, civil war, riot, insurrection, invasion or terrorism;
  4. Taking part in military forces training, exercises or manoeuvres, professional sporting events or motorized races;
  5. Taking part in mountaineering, parachuting, skydiving, parasailing, bungee jumping, gliding or piloting an aircraft or professional underwater activities;
  6. Any claim that is against the law of a government plan or political subdivision in Canada;
  7. Pregnancy, miscarriage, childbirth or complications within 2 months of the expected delivery date;
  8. Trips taken to arrange or receive medical, hospital, or dental services;
  9. Expenses inside the province or territory where the insured lives;
  10. Any claim that happens more than 30 days after the insured leaves the province or territory where they live;
  11. Therapy for a medical condition the insured has;
  12. Hospital or medical services when there is no emergency; or
  13. Expenses where the insured is 21 years old or more at the time of a claim.

I. Definitions

Accident: an unexpected event that is beyond the insured’s control.

Company, our, us, we: Old Republic Insurance Company of Canada, Hamilton, Ontario.

Confirmation of coverage: the document that identifies the named insured.

Dentist: a person, other than a family member, who is legally qualified to practice dentistry in the place where services are provided.

Emergency treatment: any immediate medical care provided by a physician that is necessary to prevent or reduce existing danger to life or health.

Hospital, hospitalized: a licensed institution that is staffed and operated for the care and treatment of in-patients. Treatment must be supervised by physicians and registered nurses must be on duty 24 hours a day. A laboratory and an operating room must also exist on the premises or in facilities controlled by the establishment. A hospital is not an establishment used mainly as a clinic, extended or palliative care facility, rehabilitation facility, addiction treatment centre, convalescent, rest or nursing home, home for the aged or health spa.

Injury, injured: sudden bodily damage due to an accident causing the insured to seek emergency treatment.

Insured: the person whose name is on the confirmation of coverage, who is eligible for coverage and for whom the required premium has been paid.

Physician: a person, other than a family member, who is legally qualified to practice medicine in the place where medical services are provided.

Policy: this document and the confirmation of coverage which we issue when the required premium is paid.

Pre-existing medical condition: a medical or related condition for which treatment or prescribed medication was needed at any time in the 90 days before the insured’s trip began.

Scheduled airline: an airline with a license to transport fare–paying passengers. It has a regular published schedule and includes chartered flights or licensed tour companies.

Sick, sickness: an illness or disease that needs emergency treatment or hospital care. Sickness does not include emotional or mental disorders unless hospitalized.

Totally and permanently disabled: the insured cannot ever be employed.

J. How to Submit a claim

  1. Please find the policy number on the confirmation of coverage and write it on all correspondence with us.
  2. To obtain a claim form, download it directly from our website www.insuremykids.com or call us toll free at 1-800-463-5437.
  3. To file a claim under the policy with us:
    • We must be notified of the event that caused it within 60 days.
    • You must complete a claim form, attach a dental or medical report and submit them to us within 90 days of the event that caused it.
  4. Submit the claim form and reports to:
    Old Republic Insurance Company of Canada
    insuremykids Claims Department
    P.O. Box 557
    Hamilton, Ontario, L8N 3K9
    Or by email to IMKClaims@insuremykids.com
  5. We pay benefits to:
    • the insured; or
    • the insured’s estate; or
    • the insured’s parent or legal guardian if the insured is less than 18 years old.
  6. We evaluate claims based on the terms and conditions of the policy. If you do not agree with how we evaluated the claim, you have 2 years from the date the claim is payable or would have been payable to begin legal proceedings.

K. Privacy

The company is committed to protecting your privacy. Collecting personal information about you is essential to our ability to offer you high quality insurance products and service. The information provided by you will only be used 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. In the event that we must share your information with a third party who conducts business outside of Canada, there is a possibility that this information could be obtained by the government of the country in which the third party conducts business. We take great care to keep your personal information accurate, confidential and secure.

Our privacy policy sets high standards for collecting, using, disclosing and storing personal information. If you have any questions about the company’s privacy policy, please contact our Privacy Officer by phone at 905-523-5587 or by email at: privacy@oldrepublicgroup.com. To review our complete Privacy Policy please visit https://www.insuremykids.com/privacy-policy/.

Underwritten by
Old Republic Insurance Company of Canada

Paul M. Field, CPA, CA
President and Chief Executive Officer