Emergency Travel Medical Benefit

You’ve heard about the expense associated with medical care if you travel outside of Canada. PlanDirect makes it easier to have the travel medical coverage you need by offering an Emergency Travel Medical Benefit option that provides 30 consecutive day multi-trip coverage if you’re under age 65, or 15 consecutive day multi-trip coverage if you’re between age 65-70. With competitive rates and the convenience of having one less arrangement to make the next time you travel, this option is an excellent addition to your PlanDirect coverage.

The Emergency Travel Medical Benefit provides up to $1 million coverage per trip for a medical emergency when you’re outside Canada.

Most emergency medical expenses incurred within Canada but outside your home province are covered by your provincial plan. We recommend that you check your provincial plan coverage before incurring medical expenses outside your province.

Emergency treatment

This option covers basic emergency medical treatment, services and supplies, including:

• Treatment by a physician
• Hospital accommodation
• Medical services and supplies, such as anesthesia, blood, casts and dressings
• Prescribed drugs when provided on an in-patient or outpatient basis
• Ambulance service
• Dental accident treatment

An exception applies to medical conditions and/or symptoms that existed before any trip.

Assistance services

The Emergency Travel Medical Benefit also gives you access to Emergency Travel Assistance when travelling anywhere outside Canada, within Canada if you're more than 500 kilometres from home. Service is available 24 hours a day, 7 days a week.

Assistance coordinators can help you locate hospitals, clinics and physicians who can provide appropriate medical care, qualified legal assistance, local interpreters and appropriate services for replacing lost passports. Other emergency services include:

• Hospital admission assistance
• Assistance for unattended children
• Return of vehicle
• Medical evacuation
• Family member travel assistance.

The Emergency Travel Medical Benefit is available if you are between age 50 and 69.

Extra value benefits

To help provide you with comprehensive protection, this option covers the cost of pre-paid travel expenses that are not refundable or recoverable from another source, under certain circumstances, when:

• Your trip must be cancelled for medical reasons
• You must return home because of a medical emergency
• You must return home because a close family member has died or has an unforeseeable sickness or injury requiring intensive care treatment

Detailed coverage information

Throughout this section, “you” and “your” refer to the proposed owner of the PlanDirect policy.

Definitions

Emergency medical treatment – medical treatment immediately required for the relief of an injury or an acute episode of sickness.

Medical emergency – any injury or sickness, which arises suddenly, cannot reasonably be anticipated and requires emergency medical treatment.

Non-emergency treatment or surgery means:

• Any treatment or surgery not required for immediate relief of acute pain or suffering or which could reasonably be delayed until you return home, including periodic check-ups or examinations and regular care for chronic conditions
• Any treatment you receive outside of Canada following emergency medical treatment, including follow-up visits and rehabilitation, if your medical condition permits you to return home
• Any treatment or surgery for a medical condition where the medical condition would not have prevented you from returning home for treatment or surgery
• Any medical or hospital services for which you specifically travelled to obtain, whether or not on the advice of a physician

Additional information

Benefits payable for emergency medical treatment and emergency medical assistance services are limited to customary charges for the service or supply provided.

The following services and supplies are covered when provided during a covered trip. The provision of these services and supplies must be related to emergency medical treatment resulting from a medical emergency.

Emergency medical treatment

Ambulance services

• Ambulance services, including air ambulance, to the nearest centre where essential treatment is available
• Where air ambulance service is required, coverage for a medical attendant is also included, if required
• We must pre-approve and arrange air ambulance services

Hospital services

• Hospital in-patient services and supplies, including room and board and general nursing care while confined to a hospital semi-private room, ward, coronary care unit or intensive care unit for acute care
• Surgery
• Hospital outpatient services and supplies

Physician services – the services of a licensed physician

Emergency dental treatment – Benefits payable for emergency dental treatment provided for treatment to a sound natural tooth, required as a result of a blow from an external force, are limited to $1,000 per covered trip, and, for a reason other than a blow from an external force, are limited to $200 per covered trip.

Private duty nursing services – We’ll pay for a professional nurse, who is not a member of the insured’s family, when provided during hospital confinement for emergency medical treatment, when ordered by a physician.

Miscellaneous services and supplies – The following miscellaneous services and supplies are covered when provided on an in-patient or outpatient basis:

• Anaesthesia and its administration
• Diagnostic X-ray and laboratory examination
• Whole blood, blood plasma and blood products
• Oxygen and its administration
• Casts, dressings, crutches, canes, slings and splints
• Prescription drugs requiring a prescription by law
• Rental of medical appliances, a hospital-type bed, wheelchair, crutches, braces, etc. (not to exceed the cost of purchase)

Emergency medical assistance services

If we’ve given prior approval, we will pay for, or reimburse expenses for, the following emergency medical assistance services resulting from a medical emergency, where arranged by the assistance centre.

Medical evacuation and repatriation

We cover:

• Transportation to the nearest hospital where treatment is available or to a hospital in Canada
• Coverage for a medical attendant, if required

We reserve the right to transfer you to another hospital or return you to your home province or territory. If you refuse the transfer request, we will be absolved of any further liability for that medical emergency.

Return home

• We cover your return home by economy seating—or by upgraded seating or air ambulance if medically necessary—as well as additional seats for a stretcher, if required.
• If you’re hospitalized and unable to accompany home any other insured person who is on a covered trip with you, we cover a one-way economy flight for each such insured person to return home.
• Return or round trip transportation for an attendant for you if you’re unable to travel alone may be covered, if we consider it necessary.
• Benefits under the return home provision are limited to $5,000 per insured per covered trip.

Extended stay – If you’re not able to return to your home province or territory by the originally scheduled date of return because you’re hospitalized on that date, we cover any unexpected additional hotel accommodations and meals incurred by you and by a person who accompanied you on the covered trip and who wishes to stay with you. This benefit is limited to $200 per day to a maximum of $2,000 per covered trip. Coverage begins on the day after the originally scheduled date of return.

Identification of deceased insured – If you die during a covered trip, we cover reasonable travel, hotel accommodation and meal expenses for one person to identify the remains. This benefit is limited to $5,000 per insured person.

Repatriation of deceased insured – If you die during a covered trip, we’ll cover the cost of services and supplies legally required for the preparation of the body and the cost for its return transportation to Canada. This benefit is limited to $5,000 per insured person.

Burial or cremation of deceased insured at the place of death – If you die during a covered trip, we cover the cost of services and supplies legally required for the preparation of your body for burial or cremation at the place of death. This benefit is limited to $3,000 per insured person. Your closest relative will make the decision whether to have your body buried or cremated or returned to Canada.

Transportation to bedside – If you are on a covered trip alone, are hospitalized and expected to remain in hospital for more than 7 consecutive days, we cover the cost for reasonable travel, hotel accommodation and meal expenses for one person to visit you. This benefit is limited to $5,000 per covered trip.

Trip cancellation – We will reimburse the cost of pre-paid travel expenses, which are not refundable or recoverable from any other source if, before a scheduled departure, you have to cancel a trip because of:

• Your death or the death of an extended family member occurring within 22 days of the scheduled departure date
• An injury or sickness, which did not result from a pre-existing condition, that caused you to be unable to start the trip; the attending physician must substantiate in writing that, prior to the scheduled departure date, he or she advised you to cancel the trip or that the injury or sickness made it impossible for you to start the trip
• Injury or sickness, which did not result from a pre-existing condition, of an extended family member which required immediate hospitalization with an expected stay of at least 3 days
• The enforceable call to jury duty or sudden and unexpected subpoena to act as a witness in a court of law during the trip

This benefit is limited to $2,500 per insured or $5,000 for all insureds per covered trip. To receive a benefit under the Trip Cancellation provision, you must notify us within 7 days of any cancellation in travel arrangements and send us satisfactory proof of the reason for cancellation within 7 days thereafter.

Trip interruption – If you have to end a covered trip and return to your home province or territory because of a medical emergency, we cover the cost of any non-refundable prepaid travel for you and for each insured person travelling with you who has to return home. This benefit is limited to $2,500 per insured person or $5,000 for all insured persons per covered trip.

If you don’t return home and opt to continue travelling after the medical emergency has ended, we cover the additional cost of travel for you and for each insured person travelling with you. If required, we will reimburse the additional cost for hotel accommodation and meals incurred by an insured person travelling with you on account of the interruption.

Benefits payable under the Trip Interruption provision are limited to $2,500 per insured or $5,000 for all insured persons per covered trip.

Unexpected return – If you must return to your home province or territory because an extended family member who is not on the covered trip with you is suffering from an unforeseeable sickness or injury requiring intensive care treatment or has died, we will reimburse the cost of any non-refundable prepaid travel expenses for each insured person who is on the covered trip. We’ll pay any extra cost for a one-way economy flight home. This benefit is limited to $5,000 per insured per covered trip.

Vehicle return – If, for medical reasons, you or anyone with you are unable to drive an automobile that you own or lease back to your home or to the place to which the automobile must be returned, we cover the cost of returning the automobile. This benefit is limited to $2,000 per covered trip.

If you don’t notify the assistance centre as required, we reduce the benefits payable under this option by 20%, up to a maximum of $10,000. This reduction in benefits payable does not apply if the total expenses incurred for medical services and supplies do not exceed $500.

Exceptions and limitations

Travel insurance is designed to cover losses arising from sudden and unforeseeable circumstances. Expenses arising from or related to pre-existing conditions are not covered.

The emergency travel medical benefit contains a pre-existing condition exclusion that applies to expenses incurred while out of Canada, due to any injury or sickness or change in medical condition that resulted in new symptoms or an increase in the frequency or severity of symptoms, or required medical attention or consultation, diagnosis or treatment, or hospitalization, or for which oxygen treatment was received or required or for which a change in treatment or medication (including dosage or usage) was received or required:

• For an insured under age 60 on his or her departure date: that resulted in new symptoms or an increase in the frequency or severity of symptoms, or required medical attention or consultation, diagnosis or treatment, or hospitalization, or for which oxygen treatment was received or required or for which a change in treatment or medication (including dosage or usage) was received or required in the 6 months (pre-travel period) prior to an insured’s departure date.
• For an insured age 60 and over on his or her departure date: that resulted in new symptoms or an increase in the frequency or severity of symptoms, or required medical attention or consultation, diagnosis or treatment, or hospitalization, or for which oxygen treatment was received or required or for which a change in treatment or medication (including dosage or usage) was received or required in the 365 days (pre-travel period) prior to an insured’s departure date.

The policy contains other limitations and exclusions common for this type of insurance. For example, there is no coverage for expenses incurred for non-emergency treatment, treatment if travel was undertaken against the advice of a physician, or if caused by participation in hazardous or professional sports activities.

It is important to read and understand your policy before you travel as your coverage may be subject to certain limitations and exceptions.

Termination age

This coverage is available only before age 70.