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
All dollar maximums outlined in this booklet are claimable unless
specifically identified as a payable maximum.
|The $100 deductible on EHB will be removed and the drug card added. Prescription Drugs are reimbursed at 75% and all other non-drug EHB items are reimbursed at 100%
||The maximum amount of benefits payable for a Member or Dependent is $1,000,000 per lifetime.
|With respect to Out of Country/Canada
Emergency expenses, there is an overall
maximum of $5,000,000.
||Covered from birth to age 21 or to age 25
if in full-time attendance at a school or
university, or to any age if handicapped.
See General Information for more details.
means a charge for any service and/or supply included in this booklet
as a benefit that:
It does not include any payment to a pharmacy or a practitioner
(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. Pharmacare's low cost
alternative and reference based pricing will not be applied unless
specified in this booklet.
- is assessed as a customary charge, medically necessary for health
care and maintenance, or to maintain or restore teeth, and
- was ordered or referred by a physician or dentist, unless otherwise
specified in the benefit description, and
- is not a cost normally paid (in whole or part) or provided by a
government plan or any other provider of health coverage, and
- is incurred while your coverage is valid. An expense is "incurred"
on the date the service is provided or the supply is received.
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
means an individual who is currently licensed, certified, or registered to
practice a profession in the area where the care or service is provided.
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.
In-Province Eligible Expenses
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.
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
- charges for a licensed ambulance service to and from the nearest
Canadian hospital equipped to provide the type of care essential to
- air transport will be covered when time is critical and the patient's
physical condition prevents the use of another means of transport;
- emergency transport from one hospital to another, only when the
original hospital has inadequate facilities; and
- charges for an attendant when medically necessary.
Prescription drugs and medicines dispensed by a licensed pharmacist
or a physician, in a quantity we consider reasonable:
- drugs and medicines which legally require a prescription from a
physician or dentist;
- insulin preparations for diabetics;
- vitamin B12 for the treatment of pernicious anemia; and
- allergy serums when administered by a physician.
Below is a list of Paramedical Service's covered by the plan if performed by a licensed, certified or registered practitioner:
|c) massage practitioner
|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 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.
Charges for eye examinations up to $85 per covered person every 24
Medical Aids and Supplies
Charges for the following services and supplies:
- testing supplies, needles, and syringes for diabetics;
- oxygen, blood, and blood plasma;
- ostomy and ileostomy supplies;
- surgical stockings to a maximum of 2 pair per calendar year;
- walkers, canes and cane tips, crutches, splints, casts, collars, and
trusset, but not elastic or foam supports;
- 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
- stump socks;
- one mastectomy brassiere per breast prosthesis to a maximum of
2 per lifetime;
- wigs and hairpieces required as a result of medical treatment or
injury to a lifetime maximum of $500;
- 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
- 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
Standard Durable Medical Equipment
Pre authorization is required from the Plan for expenses in excess of
- 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.
- 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.
- Reimbursement on rental equipment will be made monthly and will
in no case exceed the total purchase price of similar equipment.
- Standard durable equipment includes:
- 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
- medical monitors including heart and blood glucose monitors,
and cardiac screeners;
- bi-osteogen systems (when recommended by an orthopedic
surgeon) and growth guidance systems;
- breathing machines and appliances including respirators,
compressors, percussors, suction pumps, oxygen cylinders,
masks, and regulators;
- insulin infusion pumps for diabetics when basic methods are
- transcutaneous electric nerve stimulators (TENS), when
prescribed for intractable pain; and
- 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.
Out-of-Province Non-Emergency Eligible Expenses
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.
Out-of-Province Emergency Eligible Expenses
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.
|Emergency Air Transportation
||Reasonable & Customary Costs
$1,500.00 combined maximum.
||30 day supply per Prescription
|Private Duty Nurse
|Return of Deceased
||up to $5,000
|Transportation to Bedside
||Economy Round-trip Airfare
Plus up to $150 per day to $3,000
|Return of Traveling Companion
|Treatment of Dental Accidents
||up to $2,000
|Meals and Accommodation
||up to $150 per day, to $3,000 per Trip
||up to $250
The Policy covers expenses that are:
subject to the Overall Maximum per Insured Person specified in the
Schedule of Benefits.
- incurred outside the province or territory of residence of the
- 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
- 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.
- 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.
- Physician Charges: Charges for treatment by a Physician.
- 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.
- 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.
- 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.
- Ambulance Services: When reasonable and Medically Necessary,
licensed ground ambulance service to the nearest medical facility.
- 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
- 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.
- Emergency Air Transportation: When approved and arranged in
advance by Global Excel:
- air ambulance to the nearest appropriate medical facility or to
a Canadian Hospital for immediate Emergency treatment;
- transport on a licensed airline with an attendant (where
required) to return you to your province or territory of
residence for immediate Emergency treatment.
- 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:
The Insurer will only reimburse covered expenses evidenced by
- 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
- identify the deceased Insured Person prior to the release of
the body, where necessary.
- 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.
- 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.
- 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
- 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.
- 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.
- 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
The Policy does not cover losses or expenses related in whole or in
part, directly or indirectly, to any of the following:
- Treatment or services normally covered or reimbursable under a
Government Health Insurance Plan or under other insurance you
- 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.
- Any Trip booked or commenced contrary to medical advice or after
you are diagnosed with Terminal illness.
- Any medical condition for which, prior to departure, medical
evidence suggests a reasonable expectation that treatment or
hospitalization could be required while traveling
- 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.
- 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.
- 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.
- Magnetic resonance imaging (MRI), computerized axial
tomography (CAT) scans, sonograms or ultrasounds and biopsies
unless such services are authorized in advance by Global Excel.
- 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).
- A disorder, disease, condition or symptom that is emotional,
psychological or mental in nature unless hospitalized.
- Emergency air transportation and/or car rental unless approved
and arranged in advance by Global Excel.
- Treatment not performed by or under the supervision of a
Physician or licensed dentist.
- 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.
- War, invasion, act of a foreign enemy, declared or undeclared
hostilities, civil war, rebellion, revolution or military power.
- 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.
- Committing or attempting to commit an illegal act or a criminal act.
- Suicide (including any attempt thereat) or self-inflicted injury,
whether or not you are sane.
- Service in the armed forces.
- 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).
- Loss or damage to eyeglasses, sunglasses, contact lenses, or
prosthetic teeth, limbs or devices and resulting prescription
- 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.
- Upgrading charges and cancellation penalties for airline tickets,
unless approved in advance by Global Excel.
- The cost of any airline ticket covered under the Policy where your
ticket may be exchanged or used for the same purpose.
- Crowns and root canals.
- 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
General Provisions and Limitations
- 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
- Transfer or Medical Repatriation: During an Emergency (whether
prior to admission or during covered hospitalization), the Insurer
reserves the right to:
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.
- transfer you to one of Global Excel's preferred health care
- return you to your province or territory of residence
- 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.
- 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.
- 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.
- 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
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
- 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.
- 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
- 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
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
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.
- 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
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
- 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.
- 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.
- Evidence of Age: The Insurer reserves the right to request proof
of age of any Insured Person.
- Assignment: Benefits under the Policy may not be assigned.
- 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.
- 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.
- 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
International Assistance Service
Global Excel is available to take your calls 24 hours a day, 7 days a
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
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.
"Accident" means a fortuitous, sudden, unforeseen and unintentional
event exclusively attributable to an external cause resulting in bodily
"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
"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
"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
"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
"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
"Medically Necessary", in reference to a given service or supply,
means such service or supply:
- is appropriate and consistent with the diagnosis according to
accepted community standards of medical practice;
- is not experimental or investigative in nature;
- cannot be omitted without adversely affecting the condition of the
Insured Person or quality of medical care;
- 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
"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.
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
- 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;
- 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
- 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
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.
You are responsible for providing all the documents outlined below and
for any charges levied for these documents. To file a claim, you must:
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.
- 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);
- 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;
- 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;
- provide proof of the departure date(s) and return date(s);
- provide written proof of claim within ninety (90) days of the date of
receipt of services covered under the Policy;
- provide additional information pertinent to your claim, as may be
required by Global Excel after receipt of your claim;
- 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
- return the unused portion of your air ticket to Global Excel if the
Emergency Air Transportation benefit is used.
Any information not provided may result in a delay in processing your
All pertinent documents should be sent to:
Global Excel Management Inc
73 Queen St.
®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)
The following are not included as Eligible Expenses under your EHC
- any other item not specifically included as a benefit;
- 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
- 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
- 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;
- allergy testing unless rendered by a naturopath;
- 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;
- 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;
- 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;
- 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;
- expenses incurred, outside your province of residence, due to
elective treatment and/or diagnostic procedures, or complications
due to such treatment;
- 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;
- charges incurred outside your province of residence for continuous
or routine medical care normally covered by the government plan
in your province of residence;
- transportation charges incurred for elective treatment and/or
diagnostic procedures or for health or health examinations of any
- expenses of a Dependent hospitalized at the time of enrolment;
- services performed by a physician who is related to or residing with
you or your Spouse;
- fees for ambulance services when an ambulance is called but not
- ambulance charges for work-related illness or injury assessed by
the Workers' Compensation Board to be your employer's
- retroactive coverage and payment of any expense, including
expenses that receive special authorization from Pharmacare.
- 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.
- 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.
- 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.
- Accumulate receipts and when reasonable reimbursement is due,
submit a claim as follows:
- Obtain a claim form from the Plan Administrator or the Union
- 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).
- 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.