Overview
Important Information
Eligibility
Coverage
Lifetime Maximum
Benefits
Limitations
Exclusions
When a Medical Emergency Occurs
Benefit Termination

Travel Emergency Medical

Overview - Travel Emergency Medical Benefit

If you have an accident or become ill outside of your province of residence, your provincial health care program may not cover all your medical bills, even when travel is within Canada. The Travel Emergency Medical benefit has been designed to cover many of the types of expenses that can occur when a medical emergency occurs while away from home.

When a Travel Emergency Medical benefit is provided there are some provisions which are very important and which could jeopardize claim payment. Because of their importance some of these items are noted here. The Travel Emergency Medical benefit:

  • If your scheduled trip is more than the allotted number of days, this coverage is null and void for the ENTIRE trip
  • Excludes claims related to pregnancy or pregnancy complications which occur within eight weeks of the expected due date;
  • Excludes claims related to a medical condition for which you received medical treatment or required medication during the three months preceding the date you left home. This includes changes in medication, frequency and usage and/or dosage when maintenance medications have been prescribed for a controlled and medically-supervised condition;
  • Limitations to the maximum amount payable, as a result of a medical emergency, may occur if notification is not provided within 48 hours of confinement to hospital or emergency surgery.

Please refer to the Exclusions and Limitations sections below for complete details. These are also contained in the Travel Emergency Medical Coverage Summary issued by the provider, iA Financial Group, and which you are encouraged to read carefully before you travel and perhaps include with your passport and important papers while travelling.

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Important Information

  1. The following information outlines the benefits for which you may be eligible and does not create or confer any contractual or other rights. All rights with respect to benefits will be governed by the Master Group Policy issued by Industrial Alliance to AFBS. In the event of any variation between this description and the provisions of the Policy, the latter will prevail.
  2. Members who may be traveling outside their province of residence and who need to renew their coverage in order to ensure continuing access to the Travel Emergency Medical benefits are reminded that this coverage can only be put in place once any renewal request and premium payment has been received by AFBS.
  3. There are maximum amounts payable on many of the benefits outlined below. Prior to traveling it is important that you determine whether the coverage provided meets your needs. Further, this is an emergency medical benefit only. This benefit does not include trip cancellation, lost/delayed baggage or other additional protection. Some Members may wish to purchase these independently.
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Eligibility

If you are insured for benefits with the Arts & Entertainment Plan®, reside in Canada and will be under age 85 for the duration of your Benefit Year you are eligible to participate in the Travel Emergency Medical benefit. If you insure your dependant(s) they are also eligible to participate provided an insured spouse/partner is under age 85 for the duration of your Benefit Year.

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Coverage

Coverage commences automatically upon leaving your province of residence for scheduled trips of 60 days or less in duration to the participant under age 80 and 30 days or less in duration to the participant age 80 but under age 85. There are no limits to the number of trips taken during the course of the year.

Please note that any person outside of the province of residence for a scheduled duration in excess of 60 days with respect to the participant under age 80, and 30 days with respect to the participant age 80 but under age 85; is not covered under this insurance.

Benefits offered under this insurance cannot be used as an extension, or be extended by any other policy or private hospitalization plan.

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Lifetime Maximum

There is a lifetime maximum of $1,000,000.00 (One Million) payable for each insured person while this Policy remains in place.

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Benefits

Reimbursement Maximum/incident
Excess Hospital Benefit
Emergency hospital expenses incurred including standard semi-private accommodation during confinement
Excess Medical Benefits
The reasonable and necessary expenses following treatment or services on an emergency basis for:
  1. Out-patient room charges;
  2. Treatment by a physician or surgeon;
  3. X-rays and laboratory examinations (when required for diagnostic purposes);
  4. Rental of crutches or appliances or the cost of splints, trusses or braces; and
  5. Treatment by a physiotherapist while hospitalized and up to a maximum of three treatments for the duration of any one trip when recommended in writing by the attending physician.
Prescription Drug Reimbursement
Reimbursement of prescription drugs or medications on an emergency basis and as prescribed by the attending physician. (Oral contraceptives, patent medicines, vitamins, repeat prescriptions, maintenance and chronic care drugs are excluded.)
Accidental Dental Expense
If an injury is sustained to a whole or sound tooth due to a force or blow that is external to the mouth.
$2,000
Evacuation
Transportation, medical services and supplies necessary for emergency evacuation. All arrangements must be recommended by the attending physician, certifying that the severity of the injury or sickness warrants the emergency evacuation. Pre-approval by Industrial Alliance is required prior to evacuation.
$80,000
Special Transportation
Stretcher accommodation on a regularly scheduled airline in order to return to the province of residence during an emergency evacuation.
$5,000
Attendant Transportation
If recommended by the attending physician, or if required by the air carrier’s regulations, the presence of a medical attendant during the emergency evacuation will be reimbursed the reasonable and necessary expenses for round trip airfare plus one day accommodation and board.
$5,000
Ambulance Expense
Ground or air ambulance to the nearest medical facility qualified to provide the necessary emergency services
Ground - $5,000
Air - $5,000
Repatriation
When a covered medical emergency results in death, the reasonable and necessary expenses incurred for the transportation of the body to the province of residence, including the preparation of the body for transportation
$3,000
Board, Lodging and Travel Expenses
When hospitalized for at least five days, reasonable board, lodging and extra travel expenses for other insureds who remain with you will be paid, or If you require the attendance of an immediate family member their expenses for return economy airfare and up to $100/day accommodation for a maximum of 20 days are eligible for reimbursement.
$3,000
Trip Interruption
Reimbursement of non-refundable, pre-paid travel costs or the cost of travel to rejoin a tour or group when a trip is interrupted as a result of a medical emergency.
$1,000
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Limitations

In the case of confinement in a hospital or emergency surgery, iA Financial Group must be notified no later than 48 hours from the date of hospitalization or emergency surgery. Failure to notify iA Financial Group may limit coverage to a maximum of $10,000 for all expenses incurred.

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Exclusions

Travel Emergency Medical benefits will not be paid when a loss results from any of the following:

  • Pregnancy or complications thereof occurring within eight weeks of the expected due date;
  • Participation in professional sports, bodily contact sports, acrobatic or stunt flying, hang gliding, parachuting, skydiving, parasailing, rock climbing, mountain climbing, bungee jumping, scuba diving, or motorized speed contests; except while performing your occupation;
  • A pre-existing or related condition whereby you received medical treatment or required the use of medication during the three months preceding the date you left your province of residence. This exclusion does not apply if treatment was deemed, by the treating physician or health care provider, as a routine follow-up examination, nor shall it apply if your use of medication is for a controlled and medically supervised condition, which was not medically compromised and whereby there has been no change in either the medication or in the frequency and usage, or dosage within the three months prior to departure;
  • Any elective (non-emergency) treatment or surgery, (i) not required for the immediate relief of acute pain and suffering; (ii) which medically could be delayed until you return to your province of residence; (iii) which you elect to have rendered or performed outside your province of residence following emergency treatment for, or diagnosis of, a medical condition on which the medical evidence would not prevent you from returning to your province of residence prior to receiving such treatment or surgery;
  • Suicide or any attempt thereat or intentionally self-inflicted injury, while sane or insane;
  • The commission or the attempt to commit a criminal act;
  • Alcohol related illness or disease, or the abuse of medication, drugs, alcohol or other toxic substances, non-compliance with prescribed medical therapy or treatment. Alcohol abuse is defined as having a blood alcohol level in excess of 80 mg of alcohol per 100 ml of blood;
  • Mental or emotional disorders, unless hospitalized;
  • Declared or undeclared war or any act thereof;
  • Any loss as the sole result of the utilization of nuclear, chemical or biological weapons of mass destruction howsoever these may be distributed or combined;
  • Any ailment or condition for which the trip was taken for the purpose of securing or with the intent of receiving medical attention, prescription drugs or medicine or hospital services.
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When a Medical Emergency Occurs

If possible, before obtaining any medical service or advice, or within 48 hours thereafter contact:

Industrial Alliance Emergency Assistance Line
(open 24 hours a day, 7 days a week)
1-800-255-2008 or
Outside North America call collect to:
0 (305) 865-8895

At the time of the call you will require the following information:

Insurance Company: iA Financial Group

Policyholder: Actra Fraternal Benefit Society

Policy Number: 100009655

The information above is included on the Travel Emergency Medical Summary page issued by iA Financial Group and provided to you in your initial insurance package.

The operator will also want to know:

  • The name of the person calling, their telephone number and, if the call is not being placed by the injured or ill insured person, their relationship to the insured;
  • The full name and birthday of the injured or ill insured person and their location;
  • The name, location and telephone number of the hospital or treating physician;
  • The nature of the illness, injury or medical problem and to the extent possible the type of health needed.
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Benefit Termination

Member

Your access to Travel Emergency Medical benefits will cease:

  • When you are no longer eligible to participate in the Arts & Entertainment Plan®;
  • During any Benefit Year if you are not insured with the Arts & Entertainment Plan®;
  • Immediately when you move from Canada;
  • At the end of the Benefit Year prior to your 85th birthday. (Benefits are not available at any time during the Benefit Year in which you turn 85);

Dependants

  • Coverage for your insured dependants will terminate on the earliest of;
    • The date on which your coverage as a Member terminates;
    • The date on which (s)he is no longer considered an eligible dependant;
    • The end of the Benefit Year prior to their 85th birthday.
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