health
benefits

Extended Health

• For Employees and Eligible Dependents
• Definitions
• In-Province Eligible Expenses
• Vision Care
• Out-of-Province Non-Emergency Eligible Expenses
• Out-of-Province Emergency Eligible Expenses
• Benefit Summary
• Exclusions
• General Provisions and Limitations
• International Assistance Service
• Definitions
• Claims
• Exclusions
• Claims

For Employees and Eligible Dependents
The Extended Health Care (EHC) Benefit is designed to help you pay for services and supplies incurred by you and your Dependents, when not provided under a government health plan or by a tax supported agency.

All dollar maximums outlined in this booklet are claimable unless specifically identified as a payable maximum.

Eligible Expense
means a charge for any service and/or supply included in this booklet as a benefit that:

1. is assessed as a customary charge, medically necessary for health care and maintenance, or to maintain or restore teeth, and
2. was ordered or referred by a physician or dentist, unless otherwise specified in the benefit description, and
3. is not a cost normally paid (in whole or part) or provided by a government plan or any other provider of health coverage, and
4. is incurred while your coverage is valid. An expense is "incurred" on the date the service is provided or the supply is received.

Physician
means an individual who is duly qualified and licensed to practice medicine or surgery, or both, in the area where the service is provided, but excludes a physician residing with or related to you or your Dependents.

Practitioner
means an individual who is currently licensed, certified, or registered to practice a profession in the area where the care or service is provided.

Accidental injury
means caused by a direct external blow to the mouth or face resulting in immediate damage to the natural teeth or prosthetics and not by an object intentionally or unintentionally being placed in the mouth.

The EHC benefit covers reasonable and customary charges for the following services and supplies when medically necessary, and prescribed, ordered, or referred by a physician. Unless otherwise indicated, the maximums included here are on a per person basis.

Hospital
The additional charge for a semi-private or private room accommodation in a hospital or the extended care unit of a hospital. Charges for rental of a telephone, television, or similar equipment are not covered.

Emergency Ambulance

1. charges for a licensed ambulance service to and from the nearest Canadian hospital equipped to provide the type of care essential to the patient;
2. air transport will be covered when time is critical and the patient's physical condition prevents the use of another means of transport;
3. emergency transport from one hospital to another, only when the original hospital has inadequate facilities; and
4. charges for an attendant when medically necessary.

Prescription Drugs
Prescription drugs and medicines dispensed by a licensed pharmacist or a physician, in a quantity we consider reasonable:

1. drugs and medicines which legally require a prescription from a physician or dentist;
2. insulin preparations for diabetics;
3. vitamin B12 for the treatment of pernicious anemia; and
4. allergy serums when administered by a physician.

Paramedical Practitioners

Below is a list of Paramedical Service's covered by the plan if performed by a licensed, certified or registered practitioner:

a) acupuncturist
b) chiropractor
c) massage practitioner
d) naturopath
e) physiotherapist
f) podiatrist
g) psychologist
h) speech language pathologist
i) On a physical referral private duty care by a registered nurse for a person with an acute condition in the person’s home or in a hospital in the patient’s province of residence.

Excludes x-rays, appliances and tray fees.

Professional sources from these Paramedical practitioners will be covered to a combined maximum of $1,500.00. This means that you will be able to spend the full entitlement on one type of service or spread it over a number of services throughout the year.

Dental Accident
Dental treatment by a dentist, which is required, performed, and completed within 52 weeks after an Accidental injury which occurred while covered under this EHC plan, for the repair or replacement of natural teeth or prosthetics. Payment will be based on Fee Schedule. No payment will be made for temporary, duplicate, or incomplete procedures, or for correcting unsuccessful procedures.

Eye Examinations
Charges for eye examinations up to $85 per covered person every 24 months.

Medical Aids and Supplies
Charges for the following services and supplies:

1. testing supplies, needles, and syringes for diabetics;
2. oxygen, blood, and blood plasma;
3. ostomy and ileostomy supplies;
4. surgical stockings to a maximum of 2 pair per calendar year;
5. walkers, canes and cane tips, crutches, splints, casts, collars, and
trusset, but not elastic or foam supports;
6. rigid support braces and permanent prostheses (artificial eyes, limbs, larynxes, and mastectomy forms). Myoelectrical limbs are excluded, but the Plan will pay the equivalent of a standard prostheses;
7. stump socks;
8. one mastectomy brassiere per breast prosthesis to a maximum of 2 per lifetime;
9. wigs and hairpieces required as a result of medical treatment or injury to a lifetime maximum of $500;
10. one pair of custom fitted orthopedic shoes or orthotics per person prescribed by a physician or podiatrist and replacements thereof when necessitated by normal wear and tear; and
11. hearing aids and repairs to a maximum of $600 in a 60-month period for adults and $800 in a 60-month period for Dependent Children up to 21 years of age. Batteries, recharging devices, and other such accessories are covered. Replacement will be covered only when the hearing aid cannot be repaired satisfactorily.

Standard Durable Medical Equipment
Pre authorization is required from the Plan for expenses in excess of $5,000

1. Charges for standard durable medical equipment when rented from a medical supplier. If unavailable on a rental basis, or required for a long-term disability, purchase of these items from a provider may be considered.
2. Repairs to purchased items. The Plan will replace the item when it can no longer be made functional. Request may be made for trade in or return of replaced equipment.
3. Reimbursement on rental equipment will be made monthly and will in no case exceed the total purchase price of similar equipment.
4. Standard durable equipment includes:
   1. manual wheelchairs, manual type hospital beds, and necessary accessories — electric wheelchair and hospital beds will be covered only when the patient in incapable of operating a manual wheelchair, otherwise the Plan will pay the manual equivalent;
   2. medical monitors including heart and blood glucose monitors, and cardiac screeners;
   3. bi-osteogen systems (when recommended by an orthopedic surgeon) and growth guidance systems;
   4. breathing machines and appliances including respirators, compressors, percussors, suction pumps, oxygen cylinders, masks, and regulators;
   5. insulin infusion pumps for diabetics — when basic methods are not feasible;
   6. transcutaneous electric nerve stimulators (TENS), when prescribed for intractable pain; and
   7. transcutaneous electric muscle stimulators (TEMS) required when, due to an injury or illness, all muscle tone has been lost.

Charges for the purchase and/or repair of eye wear when prescribed by a physician or optometrist to a maximum of $600 in a 24-month period. Charges for non-prescription eye wear are not covered. Laser Eye Surgery is an eligible item under the Vision Care Benefit entitlement.

The Plan will reimburse you for non-emergency Eligible Expenses incurred by you and your eligible Dependents while traveling outside your province of residence subject to the Deductible, in-province reimbursement percentage, and maximums. The Plan will not reimburse any expenses payable or provided under a government plan.

Travel insurance is designed to cover losses arising from sudden and unforeseeable circumstances occurring while you are temporarily outside your province or territory of residence. It is important that you read and understand your plan before you travel. In the event of any discrepancy between the provisions of a booklet or other document you hold and the provisions of the Policy, the provisions of the Policy shall govern. The Insurer has contracted Global Excel Management Inc. (called "Global Excel") to provide medical assistance and claims services under the Policy.

Coverage Period: 60 days per trip
IN THE EVENT OF AN EMERGENCY,
YOU MUST CALL GLOBAL EXCEL IMMEDIATELY:
From Canada & USA: 1-866-870-1898
From Anywhere: +(819) 566-1898

Globel Excel must be contacted before you seek medical treatment. If your condition renders you unable to do so, then someone else must contact Global Excel immediately for you. Do not assume that someone will contact Global Excel on your behalf. It remains your responsibility to ensure that Global Excel has been contacted prior to receiving medical treatment or as soon as reasonably possible.

If you incur any expenses without prior approval by Global Excel, such expenses will be covered, except where the Policy expressly requires the prior approval or authorization of Global Excel, on the basis of the Reasonable and Customary Costs that would have been payable for such expenses by the Insurer in accordance with the terms and conditions of the Policy. Such expenses may be higher than this amount, therefore you will be responsible for paying any difference between the amount you incur and the Reasonable and Customary Costs reimbursed by the Insurer.

The Policy covers expenses that are:

• incurred outside the province or territory of residence of the Insured Person;
• Medically Necessary;
• Reasonable and Customary Costs;
• incurred as a result of an Emergency due to sudden and unforeseen Sickness and/or Injury occurring during the Coverage Period;
• in excess of those covered by the Government Health Insurance Plan or other insurance under which you may have coverage; and
• legally insurable;

In the event of an Emergency, the following benefits are payable under the Policy. However, certain expenses, as specified below, are covered only if you obtain the prior approval of Global Excel.

1. Hospital Accommodation: Room and board costs up to the semiprivate room rate charged by the Hospital. If Medically Necessary, expenses for treatment in an intensive or coronary care unit are also covered. If coverage terminates for any reason during your Hospital stay, benefits continue until discharge, to a maximum of one year. In no case will expenses for In-patient stays be covered for a period greater than 365 days per Insured Person.
2. Physician Charges: Charges for treatment by a Physician.
3. Diagnostic Services: Laboratory tests and x-rays prescribed by the attending Physician and that are part of the Emergency treatment. The Policy does not cover magnetic resonance imaging (MRI), cardiac catheterization, computerized axial tomography (CAT) scans, sonograms or ultrasounds and biopsies unless such services are authorized in advance by Global Excel.
4. Paramedical Services: The services (including x-rays) of a licensed chiropractor, physiotherapist, podiatrist or osteopath, to the maximum specified in the Benefit Summary section of the Schedule of Benefits, per Insured Person, per profession listed above, when approved in advance by Global Excel.
5. Prescriptions: Drugs, including injectable drugs, and sera that can only be obtained upon medical prescription, that are prescribed by a Physician and that are supplied by a licensed pharmacist when Medically Necessary for Emergency treatment, except when needed to stabilize a chronic condition or a medical condition which you had before your Trip. This benefit is limited to a 30-day supply per prescription, unless you are hospitalized.
6. Ambulance Services: When reasonable and Medically Necessary, licensed ground ambulance service to the nearest medical facility.
7. Medical Appliances: When approved in advance by Global Excel, minor appliances such as crutches, casts, splints, canes, slings, trusses, braces, walkers and/or the temporary rental of a wheelchair when prescribed by the attending Physician, obtained outside your province or territory of residence and Medically Necessary.
8. Private Duty Nurse: The professional services of a registered private nurse, when Medically Necessary and while hospitalized, to the maximum specified in the Benefit Summary section of the Schedule of Benefits, per Insured Person, when approved in advance by Global Excel.
9. Emergency Air Transportation: When approved and arranged in advance by Global Excel:
   1. air ambulance to the nearest appropriate medical facility or to a Canadian Hospital for immediate Emergency treatment;
   2. transport on a licensed airline with an attendant (where required) to return you to your province or territory of residence for immediate Emergency treatment.
10. Transportation to Bedside: When approved in advance by Global Excel, a single round-trip economy airfare from Canada plus up to the amounts specified in the Benefit Summary section of Schedule of Benefits for the cost of meals and commercial accommodation for one of the following: Spouse, parent, child, brother, sister or business partner, to:
    1. be with you if you are traveling alone and have been hospitalized as the result of an Emergency. To be payable, this benefits requires that you eventually be hospitalized as an Inpatient for at least three (3) consecutive days outside your province or territory of residence and that the attending Physician provide written certification that the situation was serious enough to warrant the visit, or
    2. identify the deceased Insured Person prior to the release of the body, where necessary.
    The Insurer will only reimburse covered expenses evidenced by original receipts.
11. Return of Traveling Companion: If you are returned to your province or territory of residence under the Emergency Air Transportation benefit or the Return of Deceased benefit, the Insurer will reimburse the cost of a single one-way economy airfare for a traveling companion to return to Canada, when approved in advance by Global Excel.
12. Treatment of Dental Accidents: To the maximum specified in the Benefit Summary section of the Schedule of Benefits per Insured Person for Emergency dental treatment to repair natural, vital and sound teeth or permanently attached artificial teeth provided the Injury was caused by an external, accidental blow to the mouth or face. You must consult a Physician or dentist immediately following the Injury. Treatment must begin during the Coverage Period and be completed prior to returning to your province or territory of residence. An accident report is required from a Physician or dentist for claims purposes.
13. Meals and Accommodation: To the maximum specified in the Benefit Summary section of the Schedule of Benefits per Participant, for the cost of commercial accommodation and meals for the Participant and/or any of his/her Dependents when their Trip is extended beyond the last day of the scheduled Trip due to the Sickness and/or Injury suffered by an Insured Person. This benefit must be authorized in advance by Global Excel. The fact that you are unable to travel must be certified by the attending Physician and supported with original receipts from commercial organizations.
14. Vehicle Return: To the maximum specified in the Benefit Summary section of the Schedule of Benefits if neither you, nor someone traveling with you, are able to operate your Vehicle, whether owned or rented, during your Trip due to Sickness and/or Injury. Arrangements and payment will be made for the return of the Vehicle to your home in your province or territory of residence or the nearest appropriate rental agency. Benefits will only be payable for a single person to return the Vehicle when approved and/or arranged in advance by Global Excel. This benefit does not cover wages lost by the person driving your Vehicle. The Insurer will only reimburse covered expenses evidenced by original receipts.
15. Return of Deceased: To the maximum specified in the Benefit Summary section of the Schedule of Benefits towards the cost of preparation and transportation of the deceased Insured Person to their province or territory of residence in the event of death due to Sickness and/or Injury.

    In the case of cremation and/or burial at the place of death of the Insured Person, this benefit is limited to $2,500.

    The cost of the casket or urn is not covered.

16. Incidental Expenses: To the maximum specified in the Benefit Summary section of the Schedule of Benefits for your out-of pocket expenses such as telephone charges, television rental and parking while you are hospitalized for an Emergency and the expenses are incurred as a direct result of such hospitalization. The Insurer will only reimburse covered expenses evidenced by original receipts.

The Policy does not cover losses or expenses related in whole or in part, directly or indirectly, to any of the following:

1. Treatment or services normally covered or reimbursable under a Government Health Insurance Plan or under other insurance you might have.
2. Any condition that existed prior to departure unless such preexisting medical condition has been stable (i.e. no change in symptoms, no hospitalization, no change in condition, no new prescription drugs or prescribed change in treatment or medication) immediately prior to departure for the Pre-existing Condition Stability Period specified in the Schedule of Benefits.
3. Any Trip booked or commenced contrary to medical advice or after you are diagnosed with Terminal illness.
4. Any medical condition for which, prior to departure, medical evidence suggests a reasonable expectation that treatment or hospitalization could be required while traveling
5. Treatment, surgery, medication, services or supplies that are not required for the immediate relief of acute pain and suffering or that you elect to have provided outside your province or territory of residence when medical evidence indicates that you could return to your province or territory of residence to receive such treatment. The delay to receive treatment in your province or territory of residence has no bearing on the application of this exclusion.
6. Treatment or surgery during a Trip when the Trip is undertaken for the purpose of securing or with the intent of receiving medical or Hospital services, whether or not such Trip is taken on the advice of a Physician.
7. Cardiac catheterization, angioplasty, and/or cardiovascular surgery including any associated diagnostic test(s) or charges unless approved by Global Excel prior to being performed, except in extreme circumstances where such surgery is performed on an Emergency basis immediately upon admission to Hospital.
8. Magnetic resonance imaging (MRI), computerized axial tomography (CAT) scans, sonograms or ultrasounds and biopsies unless such services are authorized in advance by Global Excel.
9. Hospitalization or services rendered in connection with general health examinations for check-up purposes, treatment of an Ongoing Condition, regular care of a chronic condition, home health care, investigative testing, rehabilitation or ongoing care or treatment in connection with drugs, alcohol or any other substance abuse or non-compliance with any prescribed medical therapy or treatment and medical treatment of an acute Sickness and/or Injury after the initial Emergency has ended (as determined by the Medical Director of Global Excel).
10. A disorder, disease, condition or symptom that is emotional, psychological or mental in nature unless hospitalized.
11. Emergency air transportation and/or car rental unless approved and arranged in advance by Global Excel.
12. Treatment not performed by or under the supervision of a Physician or licensed dentist.
13. Treatment or hospitalization of mother or child as a result of pregnancy, miscarriage, childbirth or complications of any of these conditions occurring in the four (4) weeks before or after the expected delivery date.
14. War, invasion, act of a foreign enemy, declared or undeclared hostilities, civil war, rebellion, revolution or military power.
15. Terrorism or by any activity or decision of a government agency or any other entity to prevent, respond to or terminate terrorism except for ensuing loss or damage which results directly from fire or explosion. Such loss or damage is excluded regardless of any other cause or event that contributes concurrently or in any sequence to the loss or damage.
16. Committing or attempting to commit an illegal act or a criminal act.
17. Suicide (including any attempt thereat) or self-inflicted injury, whether or not you are sane.
18. Service in the armed forces.
19. Participation in any sport as a professional athlete (for which you are remunerated), or in motorized or mechanically-assisted racing or speed contests (defined as an organized activity of a competitive nature in which speed is a determining factor in the outcome of the event).
20. Loss or damage to eyeglasses, sunglasses, contact lenses, or prosthetic teeth, limbs or devices and resulting prescription thereof.
21. The replacement of an existing prescription whether by reason of loss, unless otherwise specified elsewhere in the Policy, renewal or inadequate supply or the purchase of drugs and medications (including vitamins) which are commonly available without a prescription or which are not legally registered and approved in Canada or which are not required as a result of an Emergency.
22. Upgrading charges and cancellation penalties for airline tickets, unless approved in advance by Global Excel.
23. The cost of any airline ticket covered under the Policy where your ticket may be exchanged or used for the same purpose.
24. Crowns and root canals.
25. Treatment or services received in the province where you attend school or work on a full-time basis or in your home country, if you are a foreign student studying in Canada or a non-resident working in Canada.

1. Notice to Global Excel: In the event of a Sickness and/or Injury likely to give rise to an Emergency, you must give immediate notice to Global Excel. Failure to do so may limit the benefits payable under the Policy. If you incur any expenses without prior approval by Global Excel, such expenses will be covered, except where the Policy expressly requires the prior approval or authorization of Global Excel, on the basis of the Reasonable and Customary Costs that would have been payable for such expenses by the Insurer in accordance with the terms and conditions of the Policy. Such expenses may be higher than this amount, therefore you will be responsible for paying any difference between the amount you incur and the Reasonable and Customary Costs reimbursed by the Insurer.
2. Transfer or Medical Repatriation: During an Emergency (whether prior to admission or during covered hospitalization), the Insurer reserves the right to:
   1. transfer you to one of Global Excel's preferred health care providers, and/or
   2. return you to your province or territory of residence
   for the medical treatment of your Sickness and/or Injury where this poses no danger to your life or health. If you choose to decline the transfer or return when declared medically stable by the Medical Director of Global Excel, the Insurer will be released from any liability for expenses incurred for such Sickness and/or Injury after the proposed date of transfer or return. Global Excel will make every provision for your medical condition when choosing and arranging the mode of your transfer or return and, in the case of a transfer, when choosing the Hospital.
3. Limitation of Benefits: Once you are deemed medically stable to return to Canada (with or without medical escort) either in the opinion of the Medical Director of Global Excel or by virtue of discharge from a medical facility, your Emergency will be deemed to have ended, whereupon any further consultation, treatment, recurrence or complication related to the Emergency will no longer be eligible for coverage under the Policy.
4. Misrepresentation and Non-Disclosure: Your entire coverage under the Policy shall be voidable if the Insurer determines, whether before or after loss, that you or the Policyholder have concealed, misrepresented or failed to disclose any material fact or circumstance concerning the Policy or your interest therein, or if you or the Policyholder refuse to disclose information or to permit the use of such information, pertaining to any of the Insured Persons under the Policy. Consequently and following a loss, no claim shall be payable by the Insurer and you shall be solely responsible for all expenses relating to your claim, including medical repatriation costs.
5. Subrogation: If you suffer a loss covered under the Policy, the Insurer is granted the right from you to take action to enforce all your rights, powers, privileges, and remedies, to the extent of benefits paid under the Policy, against any person, legal person or entity which caused such loss. Additionally, if no fault benefits or other collateral sources of payment of medical expenses are available to you, regardless of fault, the Insurer is granted the right to make demand for, and recover, those benefits. If the Insurer institutes an action it may do so at its own expense, in your name, and you will attend at the place of loss to assist in the action, in addition to providing the Insurer all information, cooperation and assistance the Insurer may reasonably require. If you institute a demand or action for a covered loss, you shall immediately notify the Insurer so that the Insurer may safeguard its rights.

   Notwithstanding any provisions in the Policy to the contrary, the Insurer's rights under this paragraph shall be governed by the laws of the state, province, or district where the loss occurs, or where benefits under the Policy are paid.

   You shall take no action after a loss that will impair the rights of the Insurer set forth in this paragraph and shall do all such things as are necessary to secure such rights.

6. Arbitration: Notwithstanding any clause in the Policy, the parties hereto undertake to submit to an arbitration procedure, to the exclusion of the courts, any present or future dispute relating to a claim.

   The arbitration proceedings shall be governed by the arbitration law in force in the Canadian province or territory of residence of the Participant. The parties agree that any action will be referred to arbitration.

7. Applicable Law: The Policy is governed by the law of the Canadian province or territory of residence of the Participant. Any legal proceeding by the Insured Person, his heirs or assigns shall be brought in the courts of the Canadian province or territory of residence of the Participant.
8. Other Insurance: If, at the time of loss, you have insurance from another source, or if there is any other party responsible for benefits provided under the Policy, the Insurer will pay covered expenses only in excess of those covered by that other insurer or other responsible party, including credit cards, private or public health plans, private or provincial auto plans, or any other insurance, whether collectable or not, which provides the Insured Person with some or all of the benefits and coverage provided under the Policy. If, however, that other insurance is also "excess only", the Insurer will co-ordinate payment of all eligible claims with that other insurer. All co-ordination follows the Canadian Life and Health Insurance Association guidelines. In no case, will the Insurer seek to recover against employment related plans if the lifetime maximum for all in country and out-of-country benefits is $50,000 or less.
9. Co-ordination and Order of Benefits: If a person has coverage under another plan that does not provide for co-ordination of benefits, that plan will be considered primary carrier and will be responsible for making the initial payment. If the other plan does provide for co-ordination of benefits, the order of benefit will be as follows:

   Participant and Dependent Spouse
   The plan insuring the Participant or the Participant's dependent Spouse as an employee/member pays benefits before the plan insuring the Participant or the Participant's Spouse as a Dependent.

   Dependent Child
   If the dependent child is insured as a Dependent under the Participant's and the Spouse's plans, benefits will first be payable under the plan of the parent whose birthday comes first in the calendar year. The balance of eligible expenses can then be submitted to the plan of the other parent.

   If both parents have the same birthday (month/day), the claims for children must be submitted to the plan in the alphabetical order of the parents' first names.

   When a person is insured under other group or individual policies or government plans, the benefits payable from all sources cannot exceed one hundred percent of expenses incurred.

10. Rights of Examination: To be entitled to payment of benefits provided under the Policy, the Participant, on his or her own behalf and on behalf of his or her Dependents hereby authorizes any physician, health professional, hospital, institution and any other organization to forward to the Insurer or its representatives, all information, reports or documents that they may require.

    The Participant hereby authorizes the Insurer to communicate directly with any physician, health professional, hospital, institution or other organization to obtain any information required for the assessment of claims and hereby relieves the persons concerned of all legal responsibility which could arise from the disclosure of such information.

    In the event of death, the Insurer will require that a death certificate be filed with the claim. Furthermore, the Insurer has the right to request an autopsy and review any autopsy report, if not prohibited by law.

11. Limitation of Actions: An action or proceeding against the Insurer for the recovery of a claim under the Policy shall not be commenced more than one (1) year (two (2) years in the Northwest Territories, three (3) years in the province of Quebec) after the date the insurance money became payable or would have become payable if it had been a valid claim.
12. Availability and Quality of Care: Neither the Insurer nor Global Excel shall be responsible for the availability or quality of any medical treatment (including the results thereof) or transportation at the vacation destination, or your failure to obtain medical treatment during the Coverage Period.
13. Evidence of Age: The Insurer reserves the right to request proof of age of any Insured Person.
14. Assignment: Benefits under the Policy may not be assigned.
15. When Money Payable: All money payable under the Policy shall be paid by the Insurer within sixty (60) days after it has received proof of claim.
16. Continuance of Individual Coverage during Absence from Work: If a Participant is absent from work due to disability, temporary lay-off, authorized leave of absence, strike or any other work stoppage, the insurance will be continued as long as the Participant remains covered under the Policyholder's basic group extended health care plan.
17. Examination of the Policy: The Policy, including any endorsements, will be kept at the office of the Policyholder. You may consult the Policy during the regular business hours of the Policyholder.



International Assistance Service


Global Excel is available to take your calls 24 hours a day, 7 days a week.

Emergency Call Centre — No matter where you travel, professional assistance personnel are ready to take your call. Global Excel can also provide you with Canada Direct instructions and codes so that you only deal with Canadian telephone operators.

Referrals — Global Excel can refer you to the preferred medical providers (Hospitals, clinics and Physicians) that are closest to where you are staying. With a referral, it is less likely that you will have to pay for services out of pocket.

Benefit Information — Explanation of your coverage is available to you and to the medical providers who are treating you.

Medical Consultants — Global Excel's team of medical professionals, available 24 hours a day, will monitor the services given in the event of a serious Emergency. If necessary, Global Excel will help you return to Canada for the care you need.

Urgent Message Relay — In the event of a medical Emergency, Global Excel will contact your traveling companion to keep him/her advised of your medical situation and will help you exchange important messages with your family.

Interpretation Service — Global Excel can connect you to a foreign language interpreter when required for Emergency services in foreign countries.

Direct Billing — Whenever possible, Global Excel will instruct the Hospital or clinic to bill the Insurer directly.

Claims Information — Global Excel will answer any questions you have about the eligibility of your claim, standard verification procedures and the way that the benefits under the Policy are administered.




Definitions

"Accident" means a fortuitous, sudden, unforeseen and unintentional event exclusively attributable to an external cause resulting in bodily Injury.

"Actively at Work" means the employee is physically and mentally capable of doing each and every function of his/her occupation, on the basis of the minimum number of hours worked per week specified in the Schedule of Benefits. If an employee is not actively at work due to vacation, holidays, a non-scheduled working day, maternity or parental leave, then actively at work means the capability to perform the employee's normal duties at the employee's normal place of employment on the same basis as the employee who is actively at work.

"Coverage Period" means the number of consecutive days specified in the Schedule of Benefits during which you are covered under the Policy when you take a Trip and which is calculated as of the commencement date of your Trip.

"Dependent" means the Spouse and the unmarried child of the Participant or Spouse, who is under the age limit specified under General Information, is dependent on the Participant for support and is not employed on a full-time basis. A dependent child who is physically or mentally disabled and totally dependent on the Participant for support will continue to be eligible provided he/she was covered as a Dependent under the Policy before attaining such age limit.

"Emergency" means the occurrence of a Sickness and/or Injury during the Coverage Period that requires immediate Medically Necessary treatment for the relief of acute pain or suffering, other than experimental or alternative treatment, and such treatment cannot be delayed until your return to Canada.

"Global Excel" and "Global Excel Management Inc." mean the company appointed by the Insurer to provide medical assistance and claims services under the Policy.

"Government Health Insurance Plan" means the health care coverage provided by Canadian provincial and territorial governments to their residents.

"Hospital" means an institution which is designated as a hospital by law; which is continuously staffed by one or more Physicians at all times; which continuously provides nursing services by graduate registered nurses; which is primarily engaged in providing diagnostic services and medical and surgical treatment of a Sickness and/or Injury in the acute phase, or active treatment of a chronic condition; which has facilities for diagnosis, major surgery and in-patient care. The term Hospital does not include convalescent, nursing, rest or skilled nursing facilities, whether separate from or part of a regular general hospital, nor a facility operated exclusively for the treatment of persons who are mentally ill, aged, or drug or alcohol abusers.

"Immediate Family Member" means your Spouse, son, daughter, father, mother, brother, sister, stepson, stepdaughter, stepfather, stepmother, mother-in-law, father-in-law, son-in-law, daughter-in-law, brother-in-law, sister-in-law, grandson, granddaughter, grandfather or grandmother.

"Injury" means any unexpected and unforeseen harm to the body that is caused by an Accident, that you sustained during the Coverage Period and that requires Emergency treatment that is covered by the Policy.

"In-patient" means a patient who occupies a Hospital bed for more than twenty-four (24) hours for medical treatment and for which admission was recommended by a Physician when Medically Necessary.

"Insurer" means Royal & Sun Alliance Insurance Company of Canada.

"Medical Assistance Card" means the card provided to the Participant and on which the following information is shown: name of the Policyholder, Policy Number, Coverage Period per Trip and emergency telephone numbers.

"Medically Necessary", in reference to a given service or supply, means such service or supply:

1. is appropriate and consistent with the diagnosis according to accepted community standards of medical practice;
2. is not experimental or investigative in nature;
3. cannot be omitted without adversely affecting the condition of the Insured Person or quality of medical care;
4. cannot be delayed until the Insured Person returns to his or her province or territory of residence.

"Ongoing Condition" means an acute Sickness and/or Injury that requires continuing care and/or treatment after the initial Emergency has ended as determined by the Medical Director of Global Excel.

"Participant" means an employee or a member whom the Policyholder identifies as being entitled to coverage under the Policy and for whom the Policyholder has paid the required premium.

"Physician" means a medical practitioner whose legal and professional standing within his or her jurisdiction is equivalent to that of a doctor of medicine (M.D.) licensed in Canada, who is duly licensed in the jurisdiction in which he or she practices, who prescribes drugs and/or performs surgery and who gives medical care within the scope of his or her licensed authority. A Physician must be a person other than you or your Immediate Family Member.

"Policy" means the group travel emergency medical insurance contract issued to, and on file with, the Policyholder, bearing the policy number specified in the Schedule of Benefits.

"Policyholder" means the company or organization specified in the Schedule of Benefits and to which the Policy is issued.

"Reasonable and Customary Costs" means costs that are incurred for approved, covered medical services or supplies that do not exceed the standard fee of other providers of similar standing in the same geographical area, for the same treatment of a similar Sickness and/or Injury.

"Sickness" means a disease or disorder of the body that results in loss while this coverage is in effect. The sickness must be sufficiently serious to prompt a reasonably prudent person to consult a physician for the purpose of medical treatment.

"Spouse" means the person to whom the Participant is legally married or with whom he or she has been residing for the cohabitation period specified in the Schedule of Benefits.

"Terminal Illness" means you have a condition that is cause for the Physician to estimate that you have less than six (6) months to live.

"Termination Age" means the age specified in the Schedule of Benefits at which the Participant's coverage terminates. Dependents beyond the Termination Age may be covered provided that the Participant has not yet reached the Termination Age.

"Terrorism" means an ideologically motivated unlawful act or acts, including but not limited to the use of violence or force or threat of violence or force, committed by or on behalf of any group(s), organization(s) or government(s) for the purpose of influencing any government and/or instilling fear in the public or a section of the public.

"Trip" means a journey that you undertake which commences on the date of your departure from your province or territory of residence and ends when you return to your province or territory of residence.

"Vehicle" means any automobile, station wagon, mini-van, sports utility vehicle (for on-road use), motorcycle, pick-up truck or a mobile home, camper truck or trailer home under 11 meters (36 feet in length), used exclusively for the transportation of passengers other than for hire, in which the Insured Person is a passenger or driver during the Trip.

"You", "Your" and "Insured Person" means any one of the Participant or the Participant's Dependents covered under the Policy.




Claims

Notice and Proof of Claim
In the event that Global Excel is not contacted immediately, the Insured Person, or a beneficiary entitled to make a claim, or the agent of any of them, shall:

1. give written notice of claim by delivery thereof or by sending it by registered mail to Global Excel not later than thirty (30) days from the date the claim arises under the Policy;
2. within ninety (90) days from the date a claim arises under the Policy, furnish Global Excel such proof of claim as is reasonably possible in the circumstances of the Emergency giving rise to the claim and the loss occasioned thereby, the right of the claimant to receive payment, his or her age and the age of the beneficiary, if relevant; and
3. if required by Global Excel, provide a satisfactory certificate stating the cause for which the claim is made and the duration of the disability, if applicable.

Failure to Give Notice of Proof
Failure to give notice of claim or furnish proof of claim within the prescribed period above does not invalidate the claim if the notice or proof is given or furnished as soon as is reasonably possible, and in no event later than one (1) year from the date of Injury or the date a claim arises under the Policy on account of Sickness if it is shown that it was not reasonably possible to give notice or furnish proof within the time so prescribed.

Insurer to Furnish Forms for Proof of Claim
Global Excel, on behalf of the Insurer, shall furnish forms for proof of claim within fifteen (15) days after receiving notice of claim, but where the claimant has not received the forms within that time he or she may submit his or her proof of claim in the form of a written statement of the cause or nature of the Emergency giving rise to the claim.

Claims Procedure
You are responsible for providing all the documents outlined below and for any charges levied for these documents. To file a claim, you must:

1. include the Policy number, the patient's name (married and maiden, if applicable), date of birth, and Canadian provincial or territorial Government Health Insurance Plan number with its expiry date or version code (if applicable);
2. submit all original itemized bills from the medical provider(s) stating the patient's name, diagnosis, all dates and type of treatment, and the name of the medical facility and/or Physician;
3. provide the original prescription drug receipts (not cash receipts) from the pharmacist, Physician or Hospital showing the name of the prescribing Physician, prescription number, name of preparation, date, quantity and total cost;
4. provide proof of the departure date(s) and return date(s);
5. provide written proof of claim within ninety (90) days of the date of receipt of services covered under the Policy;
6. provide additional information pertinent to your claim, as may be required by Global Excel after receipt of your claim;
7. sign and return the authorization form, provided by Global Excel, allowing the Insurer to recover payment from the Canadian provincial or territorial Government Health Insurance Plan. The Insurer will coordinate and pay your claim to the participating medical providers and where permitted, co-ordinate claims directly with the Canadian provincial or territorial Government Health Insurance Plan on your behalf; and
8. return the unused portion of your air ticket to Global Excel if the Emergency Air Transportation benefit is used.
All sums in the plan are in Canadian currency unless otherwise indicated. If you have paid a covered expense in a currency other than Canadian currency, you will be reimbursed in Canadian currency at the prevailing rate of exchange on the date that the claim payment is made. This insurance will not pay interest.

Any information not provided may result in a delay in processing your claim.

All pertinent documents should be sent to:




Global Excel Management Inc
73 Queen St.
Sherbrooke, Quebec
J1M 1J3

®The logo is a registered trademark
of Global Excel Management Inc.:
the Global Excel logo.

Tel: 1-866-870-1898 (toll free) or (819) 566-1898 (collect)
during business hours (EST)




Exclusions

The following are not included as Eligible Expenses under your EHC plan:

1. any other item not specifically included as a benefit;
2. except as specifically included in this booklet: dentures or dental treatments, surgical lens implants, or examinations for the prescription or fitting of any of these, x-rays, hospital coinsurance, vitamin preparations, contraceptives, fertility drugs, erectile dysfunction drugs, medications used to treat or replace an addiction or habituation, support stockings, orthotics, arch supports, and professional services of physicians or any person who renders a professional health service in the patient's province of residence;
3. general anaesthetic, medications used to prevent baldness or promote hair growth, food and mineral replacements or supplements, HCG injections, drugs not approved for sale and distribution in Canada, and medications available without a prescription;
4. any drug, vaccine, item or service classified as preventive treatment or administered for preventive purposes, and which is not specifically required for treatment of an illness or injury;
5. allergy testing unless rendered by a naturopath;
6. personal comfort items, items purchased for athletic use, air humidifiers and purifiers, services of Victorian Order of Nurses or graduate or licensed practical nurses, services of religious or spiritual healers, occupational therapy, services and supplies for cosmetic purposes, public ward accommodation, rest cures;
7. charges for completion of forms or written reports, communication costs, delivery and mailing or handling charges, interest or late payment charges, non-sharable or capital costs levied by local hospitals, or charges for translating documents into English;
8. any payment to a pharmacy, a practitioner, or a physician (demanded or received by balanced billing, extra billing or extra charging) which represents an amount in excess of the schedule of costs prescribed by the government plan;
9. that portion of a claim normally covered by the government plan which has been refused on the basis that the claim was not submitted within the government plan's time limits;
10. expenses incurred, outside your province of residence, due to elective treatment and/or diagnostic procedures, or complications due to such treatment;
11. expenses incurred outside your province of residence, due to therapeutic abortion, childbirth, or complication of pregnancy occurring within 2 months of the expected delivery date;
12. charges incurred outside your province of residence for continuous or routine medical care normally covered by the government plan in your province of residence;
13. transportation charges incurred for elective treatment and/or diagnostic procedures or for health or health examinations of any kind;
14. expenses of a Dependent hospitalized at the time of enrolment;
15. services performed by a physician who is related to or residing with you or your Spouse;
16. fees for ambulance services when an ambulance is called but not used;
17. ambulance charges for work-related illness or injury assessed by the Workers' Compensation Board to be your employer's responsibility; or
18. retroactive coverage and payment of any expense, including expenses that receive special authorization from Pharmacare.



Claims
1. Because the Plan does not return receipts after the claim is processed, it is recommended that you keep a photocopy of the receipts that you submit to the Plan. You will receive a remittance statement for your records each time you submit a claim.
2. If you have Duplicate coverage, please review the Coordination of Benefits section under General Information. Two separate claim forms (one for the primary plan and one for the secondary plan) must be completed. The remittance statement from the first plan must be submitted to the second plan. Because claims information regarding the other plan is not retained by the Plan, be sure to provide information on the second plan on both claim forms. Incomplete claims will be returned for clarification.
3. Certain medical expenses are covered under the government plan. If you submit your claim to the Plan before you submit your claim to the government plan, the Plan will deduct any amounts the government plan would normally pay (e.g. Pharmacare expenses) from your EHC claim. The balance of the EHC claim is then paid according to the plan design.
4. Accumulate receipts and when reasonable reimbursement is due, submit a claim as follows:
   1. Obtain a claim form from the Plan Administrator or the Union Hall
   2. Follow the instructions on the claim form. To avoid delay in claims payment, please include original receipts and all other requested information with your claim. (Photocopies of receipts are acceptable only when accompanied by a claims payment statement from another carrier).
   3. We suggest you submit claims within 90 days from the date the expense was incurred. However, you must submit the claim form by June 30th of the year following the calendar year in which the expense being claimed was incurred. If not, your claim will not be paid under any circumstances. Example: Your claim must be received for your receipts for 2003 before June 30, 2004.