TD Insurance. Travel Medical Insurance Certificate of Insurance IMPORTANT NOTICE PLEASE READ CAREFULLY

Transcription

1 TD Isurace Travel Medical Isurace Certificate of Isurace Issued by: TD Life Isurace Compay ( TD Life ) uder Group Policy Number TI002 (the Group Policy ) to The Toroto- Domiio Bak (the Policyholder or TD Caada Trust ). Alliaz Global Assistace provides admiistrative ad adjudicatio services uder the Group Policy. IMPORTANT NOTICE PLEASE READ CAREFULLY The coverage described i this Certificate of Isurace (Certificate) is desiged to cover losses arisig from sudde ad uforeseeable circumstaces oly. It is importat that you read ad uderstad this Certificate before you travel as your coverage may be subject to certai limitatios or exclusios. WARNING: This Certificate may ot provide coverage for Medical Coditios ad/or symptoms that existed o or prior to the date of departure ad that were ot accurately disclosed ad/or updated as required uder this Certificate. It is importat that you uderstad how this applies i this Certificate ad how it relates to your erollmet, your departure date or your Effective Date. I the evet of a accidet, ijury or sickess your prior medical history may be reviewed whe a claim is reported. You are required to otify our Admiistrator prior to Treatmet. Beefits may be limited should you ot cotact our Admiistrator withi the time period specified uder Sectio 14 Geeral Coditios: Proof of loss ad timely reportig, page. If filig a claim, you will be asked to provide all origial medical bills ad prescriptio receipts ad proof of paymet for ay Eligible Expeses. PLEASE READ THIS CERTIFICATE OF INSURANCE CAREFULLY BEFORE YOU TRAVEL. If you have ay questios or eed clarificatio, call What to do i a emergecy All medical emergecies must be reported to our Admiistrator immediately. Please see sectio 11: What to do i a Medical Emergecy. Sectio 1: Summary of Beefits Limits You have purchased TD 55+ Exteded Stay Travel Medical Isurace ( 55+ Exteded Stay ): Beefits Maximum Beefit Limits Referece Page Medical Emergecy Coverage ad Up to $5,000,000 7 other beefits Private Duty Nursig Up to $5,000 7 Professioal Fees (Physiotherapist, Chiropractor, etc.) Up to $300 per professio Accidetal Detal Up to $2,000 8 Emergecy Retur Home Oe-way ecoomy air fare 8 Bedside Compaio Beefit Roud trip ecoomy air fare ad up to $1,500 for meal 8 ad accommodatio for the bedside compaio Travellig Compaio Beefit Oe way ecoomy air fare 8 Meals ad Accommodatio Up to $3,500 8 Icidetal Hospital Expeses Up to $500 8 Retur ad Escort of Childre Oe way ecoomy air fare ad escort if required by airlie 9 Pet Retur Up to $500 9 Vehicle Retur Up to $2,000 9 Retur of Deceased Up to $10,

2 Sectio 2: Defiitios I this Certificate, the followig words ad phrases show i italics have the meaigs show below. As you read through the Certificate, you may eed to refer to this sectio to esure you have a full uderstadig of your coverage, limitatios ad exclusios. Admiistrator meas the compay we select to provide medical ad claims assistace, claims paymet, admiistrative ad adjudicatio services uder the Group Policy. Applicatio meas the iformatio you provide icludig the medical questios, ad your aswers to those questios that form: w part of your Applicatio; w icludes the questios asked ad aswers give i coectio with requests to exted a Coverage Period; w is part of your isurace cotract ad is used to process your request for isurace. Certificate meas this Certificate of isurace. Certificate Holder meas the TD Bak Group customer who has applied, ad has bee accepted uder the TD 55+ Exteded Stay pla. Certificate Number meas the uique idetifier that you receive whe you buy this isurace. Coverage Period meas the Medical Emergecy Coverage Period ad is defied i Sectio 10: Medical Emergecy Coverage Period. Covered Trip meas a trip: w made by you outside your provice or territory of residece; w that has a miimum duratio of 30 days. Ad begis o the later of: your Effective Date, show i the Applicatio or most recet Declaratio of Coverage; the date you actually depart o the Covered Trip; Ad eds o the earlier of: your scheduled expiry date, show i the Applicatio or most recet Declaratio of Coverage; the date you actually retur; the date this Certificate termiates. NOTE: Check with your Govermet Health Isurace Pla (GHIP) for regulatios regardig extedig your coverage whe leavig your provice or territory for a specific legth of time. All GHIPs have differet maximum coverage limits o the umber of days allowed outside of the provice or territory before coverage will cease. NOTE: Covered Trips do ot iclude trips take for the purpose of commutig to or from your usual place of employmet. NOTE: The departure date couts as oe full day. Declaratio of Coverage meas the documet our Admiistrator seds to you whe you eroll for coverage uder the Group Policy. It icludes your Certificate Number ad cofirms the coverage you have purchased. 2

3 Child(re) meas your childre or gradchildre who are: w umarried; w depedet o you for fiacial maiteace ad support; ad w uder 22 years of age, or w uder 26 years of age ad attedig a istitutio of higher learig, full-time, i Caada, or w metally or physically hadicapped ad who are your atural, adopted or step- childre/gradchildre ad who are depedet o you for support. NOTE: A Child does ot iclude a child who is bor while the child s mother is outside of her provice or territory of residece durig the Covered Trip. Such a child will ot be isured with respect to that trip. Dollars ad $ mea Caadia dollars. Effective Date meas the date your Certificate takes effect. It is the date show o your most recet Declaratio of Coverage. Eligible Expeses meas Eligible Medical Emergecy Expeses. Eligible Medical Emergecy Expeses are defied i Sectio 5: What your isurace covers Medical Emergecy Coverage, Limitatios ad Exclusios. Govermet Health Isurace Pla ( GHIP ) meas a Caadia provicial or territorial govermet health isurace pla. Group Policy meas the Group Policy TI002 issued by TD Life Isurace Compay to The Toroto-Domiio Bak. Hospital meas: w a istitutio that is accredited ad licesed by the appropriate authority as a hospital to treat patiets o a i-patiet, out-patiet ad emergecy basis; or w the earest medical facility that has bee approved i advace by our Admiistrator. EXCLUSION: Hospital does ot iclude chroic care, covalescet, rehabilitatio or ursig home facilities. Hospitalized or Hospitalizatio meas to be a i-patiet i a Hospital. Immediate Family Member meas your: w Spouse, parets, step-paret, gradparets, atural or adopted childre, step-childre or legal ward, gradchildre, brothers, sisters, step-brothers, step-sisters, auts, ucles, ieces, ephews; ad w mother-i-law, father-i-law, brothers-i-law, sisters-i- law, sos-i-law, daughters-i-law; ad w your Spouse s gradparets, brothers-i-law ad sisters-i-law. Isured Perso meas a perso: w who is eligible to be isured uder this Certificate; w for whom the required premium has bee paid; ad w o whom isurace has bee issued uder the Certificate. Medical Coditio meas a irregularity i your health which required or requires medical advice, cosultatio, ivestigatio, Treatmet, care, service or diagosis by a Physicia. Medical Emergecy meas ay uforesee illess or accidetal bodily ijury that happes durig a Covered Trip that requires immediate emergecy medical Treatmet by a Physicia. 3

4 Medical Emergecy Beefit meas, subject to the Maximum Beefit Limits described i Sectio 5: What Your Isurace Covers less all amouts payable uder a GHIP or ay group or idividual health plas or isurace policies. Medical Emergecy Coverage Period is defied i Sectio 10: Medical Emergecy Coverage Period. Physicia meas a physicia or surgeo who is registered or licesed to practice medicie i the jurisdictio where he or she provides medical advice or Treatmet ad who is ot related to you by blood or marriage. Pre-Existig Coditio meas a Medical Coditio: w for which symptoms appeared i the Pre-Existig Coditio Period; w that was ivestigated, diagosed or Treated durig the Pre-Existig Coditio Period, where Treatmet icludes medicatio; or w for which further ivestigatio was recommeded or prescribed, or for which a chage i treatmet was recommeded (icludig a chage i medicatio or dosage) durig the Pre-Existig Coditio Period. Pre-Existig Coditio Period is the period of time that eds immediately before the Coverage Period begis. Residet of Caada ad/or Caadia Residet is ay perso who: w has lived i Caada for a total of 183 days withi the last year (the 183 days do ot have to be cosecutive); or w is a member of the Caadia Forces. For a more detailed explaatio, please visit the Caada Reveue Agecy website. Reasoable Charges meas charges icurred by you for a Medical Emergecy that are comparable to what other providers charge for comparable treatmet, services or suppliers i the same geographical area. Spouse meas: w the perso you are legally married to; or w the perso you have lived with for at least oe (1) year ad publicly refers to as his or her domestic parter. Stable meas the Medical Coditio is ot worseig ad there has bee o alteratio i ay medicatio for the coditio or its usage or dosage, or ay Treatmet prescribed or recommeded by a Physicia or received withi the period specified i this Certificate. Travellig Compaio meas ay perso who travels with you durig the Covered Trip ad who is sharig trasportatio ad/or accommodatio with you. Treated or Treatmet meas ay medical, therapeutic or diagostic procedure prescribed, performed or recommeded by a Physicia, icludig but ot limited to prescribed medicatio, ivestigative testig ad surgery. The term Treatmet does ot iclude the ualtered use of prescribed medicatio for a Medical Coditio which is Stable. Trip Extesio is defied i Sectio 3: Eligibility - Who Ca Apply for Coverage. You, your ad yours mea the Isured Perso. We, us, our ad ours mea TD Life Isurace Compay. 4

5 Sectio 3: Eligibility Who ca apply for coverage You may apply for Coverage if: w You are at least 55 years old o the Effective Date of your 55+ Exteded Stay pla; w You are a Residet of Caada; w You are covered uder a GHIP; w You are a TD Bak Group customer; w You are i Caada whe you eroll i the coverage; w You have aswered medical questios to determie whether you are eligible for this coverage; w the iformatio you provide i your Applicatio is true ad complete; ad w You eroll i the isurace o earlier tha 120 days before the Effective Date of your 55+ Exteded Stay. You are ot eligible for Coverage if: w i the past 5 years you have bee diagosed with, bee treated for, bee prescribed or take medicatio for Demetia or Alzheimer s disease; w you have bee diagosed with a termial illess for which a Physicia has estimated you have less tha 6 moths to live; w you have bee advised by a Physicia ot to travel at this time; w i the last 12 moths you have bee prescribed or take home oxyge for a lug coditio; w durig the last 12 moths prior to the date of this Applicatio you have bee hospitalized as a ipatiet or i the emergecy departmet for a heart coditio; w durig the last 12 moths prior to the date of this Applicatio you have had a stroke or trasiet ischemic attack (TIA) or mii stroke; w you require kidey dialysis. Eligibility for the Trip Extesio Coverage If you have already purchased the 55+ Exteded Stay pla, you ca apply to exted the period of coverage if you meet the applicable eligibility criteria described i this sectio, except that: w you do ot have to be i Caada whe you buy this extesio of coverage; ad w you ca apply either before or after you depart o your Covered Trip as log as: you have ot suffered a Medical Emergecy before your Applicatio for this extesio of coverage; you apply before 11:59 p.m. EST o the date o which the origial coverage termiates; ad the Covered Trip is from 30 days but o loger tha the maximum umber of days allowed uder your GHIP for travel outside of Caada. NOTE: w There will be a additioal premium for the extesio of coverage. w The date of departure couts as oe full day whe you are calculatig the legth of your trip. 5

6 Sectio 4: Medical Eligibility Medical evidece of isurability is required if you are: w 55 years of age or older w applyig for the 55+ Exteded Stay pla, or a extesio of the 55+ Exteded Stay pla, with a trip legth greater tha 30 days Failure to Disclose Impacts Your Beefits This Certificate is voidable by us ad o beefits will be payable if you: w fail to disclose all Medical Coditios, curret medicatios, prescribed medicatios ad periods of Hospitalizatio i respose to the medical questios asked; or w fail to fully, completely ad accurately aswer the medical questios asked i the telephoe iterview with our Admiistrator. This Certificate ad all coverage hereuder is voidable by us eve if: w the failure to disclose or misrepresetatio relates oly to the amout of premium that should have bee paid; w ay failure to disclose or misrepresetatio does ot relate to the cause of ay claim. NOTE: We may ivestigate the aswers provided to the health questios i the Applicatio at ay time, icludig at the time of claim. Obligatio to Update Medical Evidece You are required to cotact our Admiistrator if there is a chage i your medical status durig the period that starts immediately after erollmet, ad eds immediately prior to departure o the Covered Trip. A chage i medical status icludes: w ay Medical Coditio discovered; w ay symptoms that appeared relatig to a Medical Coditio; w ay Medical Coditio that was ivestigated, diagosed or treated; w ay further ivestigatio that was recommeded or prescribed relatig to a Medical Coditio; or w ay recommeded chage i Treatmet, icludig ew medicatio, or ay chage to medicatio or dosage. This Certificate is voidable by us i which case o beefits will be payable uder it, if you fail to cotact our Admiistrator as required. Amedig or Cacellig Coverage based o a Chage i Medical Coditio Where medical evidece is required, our decisio as to whether, ad o what basis, to isure you depeds o your coditio whe you leave o the Covered Trip. Therefore, if there is ay chage i your Medical Coditio, as described above uder Obligatio to Update Medical Evidece, before the Covered Trip begis, we may: w cacel your isurace for that Covered Trip; or w request a higher premium for you for that Covered Trip. If you do ot pay the additioal premium by the date that you depart, we will cacel your isurace for that Covered Trip. If we cacel isurace uder this provisio, we will refud ay premiums that were paid for the cacelled coverage. 6

7 Sectio 5: What your isurace covers Medical Emergecy Coverage, Limitatios ad Exclusios We will pay a Medical Emergecy Beefit for Eligible Medical Emergecy Expeses if you suffer a Medical Emergecy durig the Coverage Period for a Covered Trip. Medical Emergecy Coverage Eligible Medical Emergecy Expeses icludes: w Medical Emergecy Coverage up to $5,000,000 per Covered Trip. No overall maximum per policy year. w Hospital Beefit covered as part of the overall beefit. Attedace at a Hospital or appropriate medical facility for Treatmet as a i-patiet, out-patiet ad emergecy basis that has bee approved i advace by our Admiistrator. EXCLUSION: Chroic care, covalescet, ursig home facilities or rehabilitatio cetres. w Physicias bills w Private duty ursig Up to $5,000 for services performed ad supplies deemed ecessary by a registered urse. w Diagostic services Charges for diagostic tests, laboratory tests ad X-rays which are prescribed by the treatig Physicia; ad approved i advace by our Admiistrator if the tests ivolve: magetic resoace imagig (MRI); computerized axial tomography (CAT) scas; soograms; ultrasouds; or ay ivasive diagostic procedures icludig agioplasty. w Ambulace Charges for emergecy ambulace service to the earest approved Hospital w Air ambulace Charges for emergecy air ambulace oly if our Admiistrator determies that your physical coditio precludes the use of ay other meas of trasportatio ad: makes the determiatio before the service is provided; pre-approves the service; ad arrages for the service. w Prescriptios Reimbursemet of prescriptio drugs required for Treatmet of a Medical Emergecy while i Hospital EXCLUSION: Vitamis ad patet, proprietary ad experimetal drugs. w Professioal Fees Up to a maximum of $300 per professio for expeses icurred as a result of a covered Medical Emergecy which requires Treatmet by a licesed physiotherapist, chiropractor, chiropodist, podiatrist or osteopath. Treatmet must be required for the immediate relief of a acute symptom, or that, accordig to a Physicia, caot be delayed util you retur to your provice or territory of residece. Treatmet must be ordered by a Physicia durig the Covered Trip ad received by a licesed professioal as described uder this beefit. 7

8 w Accidetal detal Up to $2,000 for detal treatmet that is: required durig a Medical Emergecy Coverage Period; ad ecessary because of a blow to atural or permaetly istalled teeth which occurs as a result of a Medical Emergecy. LIMITATION: Treatmet for emergecy relief of detal pai is covered separately up to a maximum of $200. w Medical appliaces The cost of casts, crutches, trusses, braces, sligs, splits, medical walkig boots ad/or the retal cost of a wheelchair or walker: prescribed by a Physicia; ad required because of a Medical Emergecy. w Emergecy Retur Home The cost of a oe-way ecoomy fare plus a secod oe-way ecoomy fare, if required to accommodate a stretcher: if as a result of a Medical Emergecy, our Admiistrator determies that you should retur to their provice or territory of residece; ad our Admiistrator approves the trasportatio i advace. w Bedside Compaio Beefit The cost of oe roud-trip ecoomy airfare from their provice or territory of residece ad up to $150 per day, to a maximum of $1,500 for food ad accommodatio ad if you are Hospitalized because of a covered Medical Emergecy ad are expected to remai Hospitalized for at least three cosecutive days; ad our Admiistrator approves this beefit i advace. w Travellig Compaio Beefit The cost of a sigle oe-way ecoomy airfare for a Travellig Compaio to retur to his or her city of departure if: you have a Medical Emergecy that makes it ecessary for the Travellig Compaio to stay beyod their scheduled retur date; ad our Admiistrator approves the travel i advace. w Meals ad Accommodatio Up to $350 per day to a maximum of $3,500, for your : commercial accommodatios ad meals; essetial telephoe calls ad iteret usage fees; taxi fares (or retal car i lieu of taxi fares). If, upo a Physicia s discretio you, or your Travellig Compaio, are relocated to receive medical attetio, for a Medical Emergecy coditio covered uder this isurace; or you are delayed beyod your retur date i order to receive Medical Emergecy Treatmet; or your Travellig Compaio requires Medical Emergecy Treatmet for ay Medical Coditio covered uder this isurace. NOTE: Subject to both the advice of a Physicia ad the pre-authorizatio from our Admiistrator w Icidetal Hospital Expeses Up to $50 per day to a maximum of $500, for your icidetal hospital expeses (telephoe calls, televisio retal, parkig), while you are Hospitalized for at least 48 hours. 8

9 w Retur ad Escort of Childre If Childre or gradchildre are travellig with you or joi you durig your Covered Trip ad you are Hospitalized for more tha 24 hours or you must retur to your provice or territory of residece because of your Medical Emergecy covered uder this isurace, this isurace covers: the lesser of the cost of a oe-way ecoomy air fare o a commercial flight via the most cost effective route for the retur of those Childre to their provice or territory of residece or the cost icurred to chage the retur date of existig air fare o a commercial flight; ad the cost of a retur ecoomy air fare via the most cost effective route o a commercial flight for a escort, if the airlie requires that the Childre be escorted. w Pet Retur Cost of oe-way trasportatio up to a maximum of $500 to retur your domestic dog(s) or cat(s) to your provice or territory of residece if: your domestic dog(s) or cat(s) travel with you durig your Covered Trip ad you must retur to your provice or territory of residece because of your Medical Emergecy covered uder this isurace; ad our Admiistrator approves this beefit i advace. w Vehicle retur Up to $2,000 toward the cost of returig your vehicle to your provice or territory of residece or the earest vehicle retal agecy if: you are uable to retur the vehicle because of a Medical Emergecy; ad our Admiistrator arrages for the retur of the vehicle. w Retur of Deceased Up to $10,000 toward the cost for preparatio ad trasportatio of your remais from the place of death to your city of residece; or the burial or the crematio of your remais where your death occurred; ad oe roudtrip ecoomy airfare if: a Immediate Family Member is required to idetify or obtai release of the deceased; ad our Admiistrator approves this trasportatio i advace. EXCLUSION: The cost of a burial casket or ur. LIMITATIONS AND EXCLUSIONS Medical Emergecy Isurace Limitatios 1. Failure to report A Medical Emergecy must be reported to our Admiistrator withi 48 hours of admissio to Hospital, or as soo as is reasoably possible. Otherwise, the Maximum Beefit Payable will be reduced to 80% of the Eligible Medical Emergecy Expeses, to a maximum of $30, Geeral The beefits payable uder the Certificate will be the actual cost of Eligible Expeses less ay amouts recoverable uder your GHIP ad/or ay other isurace or health pla coverage you may have (as described uder Sectio 12: How to Make a Claim). 9

10 Medical Emergecy Isurace Exclusios 1. Reasoably foreseeable coditios We will ot pay ay expeses or beefits uder this Certificate relatig to a Medical Coditio: Whe you kew or for which it was reasoable to expect before you left your provice or territory of residece, or before the Effective Date of the Coverage Period, that you would eed or be required to seek Treatmet; ad/or For which future ivestigatio or Treatmet was plaed before you left your provice or territory of residece; ad/or which produced symptoms that would have caused a ordiarily prudet perso to seek Treatmet i the three (3) moths before leavig their provice or territory of residece; ad/or that had caused your Physicia to advise you ot to travel. 2. Medical Emergecy occurrig outside the Coverage Period We will ot pay a beefit with respect to a Medical Emergecy that occurs outside the Coverage Period. For example, o beefit will be paid with respect to a Medical Emergecy that occurs after 11:59 p.m. EST o the last day of the Coverage Period, if you have ot purchased Trip Extesio coverage. NOTE: The day of departure couts as a full day for this purpose. 3. Failure to trasfer to a appropriate facility for treatmet We reserve the right to trasfer you to a appropriate medical facility, or to your provice or territory of residece, for further Treatmet i cosultatio with your treatig Physicia. Refusal to comply with a arraged trasfer will release us from ay liability to pay ay expeses icurred after the scheduled trasfer date. 4. Recurrece A Medical Emergecy is cosidered to have eded whe medical evidece shows that you are able to retur to your provice or territory of residece. Ay subsequet Medical Emergecy caused by the same coditio will ot be covered after the iitial Medical Emergecy has eded if you choose ot to retur. 5. Failure to get advace approval Where we require that a Eligible Expese be approved i advace by our Admiistrator, we will ot pay a beefit for that expese if advace approval was ot obtaied. We will ot pay a beefit with respect to ay surgery or ivasive procedure that has ot bee approved i advace by our Admiistrator, except i extreme circumstaces where a request for advace approval would delay ecessary surgery i a life-threateig Medical Emergecy. 6. No-emergecy services We will ot pay a beefit with respect to o-emergecy, experimetal or elective Treatmet, such as cosmetic surgery, chroic care, rehabilitatio, or ay directly or idirectly related complicatios, icludig ay Treatmet, surgery or medicatio which medical evidece idicates that you could have retured to your provice or territory of residece to receive. 10

11 Sectio 6: Limitatios ad Exclusios You ca fid limitatios ad exclusios that apply specifically to particular beefits i the descriptio of those beefits. I additio, for all beefits, this Certificate does ot cover ay Treatmet, services, or expeses of ay kid caused directly or idirectly as a result of the followig: 1. Failure to take medicatio as prescribed by your Physicia 2. Alcohol or drug abuse abuse or misuse of prescriptio ad over-the-couter medicatio, or alcohol, or use of illicit drugs 3. Itetioally iflicted ijuries itetioally iflicted ijuries; suicide or attempted suicide, committed while you are either sae or isae 4. Pregacy pregacy or childbirth withi ie weeks of expected delivery date; ay complicatio relatig to pregacy that occurs i the last ie weeks leadig up to the expected delivery date, or after the expected delivery date; ay child bor durig a Covered Trip 5. Hazardous activities recreatioal scuba divig (uless you hold a basic scuba desigatio from a certified school or licesig body), moutaieerig, bugee-jumpig, parachutig, parasailig, cave exploratio, hag glidig, skydivig or ay airbore activity i ay aircraft other tha a passeger aircraft that holds a valid certificate of airworthiess 6. Professioal sports or racig participatio i professioal sports or ay orgaized racig or speed cotests 7. Elective Treatmet Treatmet if you specifically purchased this isurace to obtai such treatmet whether or ot it was authorized by a Physicia 8. Commutig ay trip that is primarily for the purpose of commutig to or from your usual place of employmet 9. Travel advisories a specific or related Medical Coditio which you cotracted i a foreig coutry, regio or city if before you left your provice or territory of residece, a formal writte warig was issued by Foreig Affairs ad Iteratioal Caada, advisig Caadias ot to travel to that coutry, regio or city durig the time of your Covered Trip 10. War or terrorism ay act of war, whether declared or ot, hostile or warlike actio i time of peace or war, isurrectio, rebellio, revolutio, civil war, hijackig or terrorism 11. Paymet of beefit prohibited by Caadia law we will ot pay a beefit where the paymet of the beefit is prohibited by Caadia law or where Caada has siged a treaty or agreed to a sactio prohibitig such paymet 12. Metal disorders ay metal, ervous or emotioal disorders, icludig ay Medical Emergecy arisig from these disorders 13. Crime participatio i a crimial offece icludig drivig while impaired or over the legal limit 14. Misrepresetatio regardig ay Medical Coditio for which you gave us or our Admiistrator false or iaccurate iformatio about ay diagosis, Hospitalizatios, Treatmet, prescriptios or medicatios 15. Iaccurate evidece of isurability failure to provide accurate ad complete evidece of isurability as described i Sectio 4: Medical Eligibility 11

12 Sectio 7: Proof of Isurace It is importat to kow if you have isurace coverage. You will have coverage oce you complete all the followig steps: w meet the eligibility criteria for isurace uder Sectio 3: Eligibility Who Ca Apply for Coverage; w apply for isurace; w provide us with accurate ad complete evidece of isurace. See Sectio 4: Medical Eligibility; ad w pay the required premium at time of erollmet. Oce this is complete you will receive proof of isurace. What is Proof of Isurace? w A Declaratio of Coverage will be mailed or ed based o your preferred method of delivery. If mailed to your address, you are deemed to receive it five days after we mail it. If it is ed to you, the you are deemed to receive it the same day we sed it to the address you provide. Sectio 8: Whe your Certificate Termiates Your Certificate will termiate o the earliest of: w the scheduled retur date i your Applicatio or, if applicable, the most recet Declaratio of Coverage; w the date you retur to your provice or territory of residece from the Covered Trip; w the date you are o loger eligible for coverage; w the date your isurace is caceled because of a chage i Medical Coditio before departig o the Covered Trip; ad w the date your request to cacel your Certificate is effective. NOTE: Refer to Sectio 10: Medical Emergecy Coverage Period for details o Automatic Extesio of Certificate i a Medical Emergecy. Cacellig your 55+ Exteded Stay Pla All requests for cacellatio of the 55+ Exteded Stay pla must be made to our Admiistrator, i writig or by phoe (see Sectio 13: How to Cotact our Admiistrator). Cacellatios may take place: by phoe cacellatio will be effective o the date of your call; or by writte, mailed request cacellatio will be effective o the post-marked date of your request. NOTE: If you cacel your isurace, your premiums may be refuded as described uder Sectio 9: Premium Calculatios ad Premium Refuds. 12

13 Sectio 9: Premium Calculatios ad Premium Refuds Your premiums will be based o: w Your age as of the Effective Date of your Certificate; ad w the medical iformatio provided whe you apply; w premiums i effect at the time of your Applicatio; ad w the duratio of your Covered Trip. If you cacel your isurace, your premiums may be refuded as follows: w cacellatios before the Effective Date o your Applicatio or Declaratio of Coverage will receive a full refud; or w cacellatios after the Effective Date where o claim has bee opeed will receive a pro-rated refud less a $15 admiistrative fee. Sectio 10: Medical Emergecy Coverage Period Medical Emergecy Coverage Period The Medical Emergecy Coverage Period begis o the later of: w your Effective Date, show i the Applicatio or most recet Declaratio of Coverage; w whe you actually depart o the Covered Trip, ad eds o the earlier of: w your scheduled expiry date, show i the Applicatio or most recet Declaratio of Coverage; w the date you actually retur; w the date this Certificate termiates. The Medical Emergecy Coverage Period for the 55+ Exteded Stay pla will ot ed if you temporarily retur to your provice or territory of residece before the termiatio date of your 55+ Exteded Stay pla as described i Sectio 8: Whe your Certificate Termiates, provided that: w you have ot icurred or submitted a claim uder this Certificate or suffered a Medical Emergecy durig the Covered Trip or durig your temporary retur to your provice or territory of residece; ad w there has bee o chage i ay Pre-Existig Coditio (as defied i Sectio 2: Defiitios) durig the Covered Trip or durig the temporary retur to your provice or territory of residece; ad w your Medical Coditio has ot chaged durig your temporary retur to your provice or territory of residece; ad w you are fit to resume travel o your Covered Trip. Automatic Extesio of Certificate i a Medical Emergecy If you are sufferig from a Medical Emergecy o the date the Medical Emergecy Coverage Period would ed for ay reaso except cacellatio of the Certificate, the Medical Emergecy Coverage Period is automatically exteded to 72 hours immediately followig the ed of the Medical Emergecy. 13

14 Sectio 11: What to do i a Medical Emergecy I a Medical Emergecy, you must phoe our Admiistrator immediately, or as soo as is reasoably possible. If ot, beefits will be limited as described i Sectio 5 uder Limitatios ad Exclusios, Medical Emergecy Isurace Limitatios: 1. Failure to report. Some expeses will oly be covered if our Admiistrator approves them i advace. You ca get help 24 hours a day, seve days a week by callig: From the U.S. or Caada , or From other coutries, call collect Our Admiistrator will verify whether coverage is i effect ad will direct you to the earest appropriate medical facility. Our Admiistrator will arrage for direct paymet to the medical services provider wherever possible ad maage the Medical Emergecy from the iitial report through to its coclusio. If a direct paymet caot be arraged, you may be asked to pay for services ad the submit a claim for reimbursemet of Eligible Expeses. NOTE: All paymets ad paymet guaratees are subject to the terms, coditios, limitatios ad exclusios of the Certificate. Sectio 12: How to make a Claim IMPORTANT NOTE: You must report your claim ad provide supportig documetatio to our Admiistrator as soo as possible ad o later tha oe (1) year after the date it occurred. Medical Emergecy Claim A Medical Emergecy should always be reported immediately, as described i Sectio 11: What to do i a Medical Emergecy or beefits will be limited. If you report the claim immediately If our Admiistrator guaratees or pays Eligible Expeses o behalf of you the you must sig a authorizatio form allowig our Admiistrator to recover those expeses: w from your GHIP; w from ay health pla or other isurace; w through rights you may have agaist other isurers or other parties (see Sectio 14: Geeral Coditios, uder Subrogatio ). If our Admiistrator pays Eligible Expeses that are covered uder other isurace or aother pla, you must help our Admiistrator to seek reimbursemet as required. You must also provide evidece of the actual departure date from your provice or territory of residece. If requested, you must also cofirm ay retur dates to your provice or territory of residece. NOTE: If our Admiistrator makes a advace paymet for expeses that are ieligible uder this Certificate, the you must reimburse us. If you do ot report the claim immediately If you icur Eligible Medical Emergecy Expeses without first cotactig our Admiistrator for assistace ad claim maagemet, you must first submit receipts ad other proof to: w GHIP; w the to ay group or idividual health pla(s) ad/or isurer(s). Eligible Medical Emergecy Expeses ot covered by a GHIP or other pla or isurace must be submitted to our Admiistrator with proof of: w claim, receipts ad paymet statemets; w the actual departure date from your provice or territory of residece (Proof icludes, but ot limited to, a flight itierary, gas receipts or toll-road receipts). See Sectio 13: How to Cotact our Admiistrator, uder Customer Service for iformatio o how to get a claim form. 14

15 Sectio 13: How to cotact our Admiistrator 24-Hour Emergecy Assistace Number To report a Medical Emergecy, you ca call our Admiistrator 24 hours a day, seve days a week: From the U.S. or Caada From elsewhere, call collect You ca also call this umber to apply for a extesio of coverage for a Covered Trip. Customer Service To obtai a claim form, cacel your isurace or for geeral iquiries, call our Admiistrator from 8 a.m. to 9 p.m. ET, Moday to Saturday toll-free at or or mail your request to: Re: TD Isurace Travel Medical Isurace Alliaz Global Assistace P.O. Box 277 Waterloo, Otario N2J 4A4 Fax: Sectio 14: Geeral Coditios Uless this Certificate or the Group Policy states otherwise, the followig coditios apply to your coverage. Proof of loss ad timely reportig If you are makig a claim, you must sed our Admiistrator the appropriate claim forms, together with writte proof of loss (e.g. origial ivoices ad tickets, medical ad/or death certificates as described i Sectio 12: How to Make a Claim) as soo as possible. I every case, you must report your claim withi oe (1) year from the date of the accidet or the date the claim arises. Review ad medical examiatio Whe a claim is beig processed, we will have the right ad the opportuity, at our ow expese, to review all medical records related to the claim ad to examie you medically whe ad as ofte as may be reasoably required. Beefit paymets This policy cotais provisios removig or restrictig the right of the group perso isured to desigate persos to whom or for whose beefit moey is to be payable. This meas that uder the Group Policy, you do ot have the right to choose a beeficiary who will receive ay beefits payable uder this Certificate. Beefits are payable to you or, o your behalf, to your medical provider. Subrogatio There may be circumstaces where aother perso or etity should have paid you for a loss but istead we paid you for the loss. If this occurs, you agree to co-operate with us so we may demad paymet from the perso or etity who should have paid you for the loss. This may iclude: w trasferrig to us the debt or obligatio owig to you from the other perso or etity; w permittig us to brig a lawsuit i your ame; w if you receive fuds from the other perso or etity, you will hold it i trust for us; w actig so as ot to prejudice ay of our rights to collect paymet from the other perso or etity. We will pay the costs for the actios we take. Other isurace If you have other isurace i additio to this Certificate, whether with us or with aother isurer, the total beefits payable uder all your isurace icludig this Certificate, caot be more tha the actual expeses for a claim. If you are also isured uder ay other isurace certificate or policy, we will coordiate paymet of beefits with the other isurer. 15

16 Legal actio limitatio period Every actio or proceedig agaist a isurer for the recovery of isurace moey payable uder the cotract is absolutely barred uless commeced withi the time set out i the Isurace Act or other applicable legislatio. All actios or proceedigs agaist us must be brought i the provice or territory i which the Certificate Holder was residet at the Effective Date of this Certificate ad will be govered by the laws of that provice or territory, without referece to its coflicts of law rules. False claim If you make a claim kowig it to be false or fraudulet i ay respect, you will ot be etitled to the beefits of this coverage or to the paymet of ay claim uder the Group Policy. Currecy All amouts show are i Caadia currecy. Access to medical care TD Life, TD Bak Group, our Admiistrator ad their affiliates are ot resposible for the availability, quality or results of ay medical Treatmet or trasport, or for your failure to obtai medical Treatmet. Group Policy All beefits uder this Certificate are subject i every respect to the Group Policy which aloe costitutes the agreemet uder which beefits will be provided. The pricipal provisios of the Group Policy affectig you are summarized i this Certificate. The Group Policy is o file at the office of the Policyholder ad upo request, you are etitled to receive ad examie a copy of the Group Policy. Relatioship betwee us ad the Group Policy Holder TD Life Isurace Compay is affiliated with The Toroto- Domiio Bak ( TD Bak ). This is the ed of your Certificate of Isurace. 16

17 TD 55+ Exteded Stay Travel Medical Isurace Pla Privacy Agreemet I this Agreemet, the words you ad your mea ay perso, or that perso s authorized represetative, who has requested from us, or offered to provide a guaratee for, ay product, service or accout offered by us i Caada. The words we, us ad our mea TD Bak Group ( TD ). TD icludes The Toroto-Domiio Bak ad its world-wide affiliates, which provide deposit, ivestmet, loa, securities, trust, isurace ad other products or services. The word Iformatio meas persoal, fiacial ad other details about you that you provide to us ad we obtai from others outside TD, icludig through the products ad services you use. You ackowledge, authorize ad agree as follows: Collectig ad Usig Your Iformatio At the time you request to begi a relatioship with us ad durig the course of our relatioship, we may collect Iformatio icludig: details about you ad your backgroud, icludig your ame, address, cotact iformatio, date of birth, occupatio ad other idetificatio records that reflect your dealigs with ad through us details about your browsig activities, your browser or mobile device your prefereces ad activities. This Iformatio may be collected from you ad from sources withi or outside TD, icludig from: govermet agecies ad registries, law eforcemet authorities ad public records credit reportig agecies other fiacial or ledig istitutios orgaizatios with whom you make arragemets, other service providers or agets, icludig paymet card etworks referces or other iformatio you have provided persos authorized to act o your behalf uder a power of attorey or other legal authority your iteractios with us, icludig i perso, over the phoe, at the ATM, o your mobile device or through or the Iteret records that reflect your dealigs with ad through us You authorize the collectio of Iformatio from these sources ad, if applicable, you authorize these sources to give us the Iformatio. We will limit the collectio ad use of Iformatio to what we require i order to serve you as our customer ad to admiister our busiess, icludig to: verify your idetity evaluate ad process your applicatio, accouts, trasactios ad reports provide you with ogoig service ad iformatio related to the products, accouts ad services you hold with us aalyze your eeds ad activities to help us serve you better ad develop ew products ad services help protect you ad us agaist fraud ad error help maage ad assess our risks, operatios ad relatioship with you help us collect a debt or eforce a obligatio owed to us by you comply with applicable laws ad requiremets of regulators, icludig self-regulatory orgaizatios. Disclosig your iformatio We may disclose Iformatio, icludig as follows: with your coset i respose to a court order, search warrat or other demad or request, which we believe to be valid to meet requests for iformatio from regulators, icludig self-regulatory orgaizatios of which we are a member or participat, or to satisfy legal ad regulatory requiremets applicable to us to suppliers, agets ad other orgaizatios that perform services for you or for us, or o our behalf to paymet card etworks i order to operate or admiister the paymet card system that supports the products, services or accouts you have with us (icludig for ay products or services provided or made available by the paymet card etwork as part of your product, services or accouts with us), or for ay cotests or other promotios they may make available to you o the death of a joit accout holder with right of survivorship, we may release ay iformatio regardig the joit accout up to the date of death to the estate represetative of the deceased, except i Quebec where the liquidator is etitled to all accout iformatio up to ad after the date of death 17

18 whe we buy a busiess or sell all or part of our busiess or whe cosiderig those trasactios to help us collect a debt or eforce a obligatio owed to us by you where permitted by law Sharig Iformatio with TD Withi TD we may share Iformatio world-wide, other tha health-related Iformatio, for the followig purposes: to maage your total relatioship withi TD, icludig servicig your accouts ad maitaiig cosistet Iformatio about you to maage ad assess our risks ad operatios, icludig to collect a debt owed to us by you. to comply with legal or regulatory requiremets. You may ot withdraw your coset for these purposes. Withi TD we may also share Iformatio world-wide, other tha health-related Iformatio, to allow other busiesses withi TD to tell you about products ad services. I order to uderstad how we use your Iformatio for marketig purposes ad how you ca withdraw your coset, refer to the Marketig Purposes sectio below. Additioal Collectios, Uses ad Disclosures Social Isurace Number (SIN) If requestig products, accouts or services that may geerate iterest or other ivestmet icome, we will ask for your SIN for reveue reportig purposes. This is required by the Icome Tax Act (Caada). If we ask for your SIN for other products or services, it is your optio to provide it. Whe you provide us with your SIN, we may also use it as a aid to idetify you ad to keep your Iformatio separate from that of other customers with a similar ame, icludig through the credit gratig process. You may choose ot to have us use your SIN as a aid to idetify you with credit reportig agecies. Credit Reportig Agecies ad Other Leders For a credit card, lie of credit, loa, mortgage or other credit facility, merchat services, or a deposit accout with overdraft protectio, hold ad/or withdrawal or trasactio limits, we will exchage Iformatio ad reports about you with credit reportig agecies ad other leders at the time of ad durig the applicatio process, ad o a ogoig basis to review ad verify your creditworthiess, establish credit ad hold limits, help us collect a debt or eforce a obligatio owed to us by you, ad/or maage ad assess our risks. You may choose ot to have us coduct a credit check i order to assess a applicatio for credit. Oce you have such a facility or product with us ad for a reasoable period of time afterwards, we may from time to time disclose your Iformatio to other leders ad credit reportig agecies requestig such Iformatio, which helps establish your credit history ad supports the credit gratig ad processig fuctios i geeral. We may obtai Iformatio ad reports about you from Equifax Caada Ic., Tras Uio of Caada, Ic. or ay other credit reportig agecy. You may access ad rectify ay of your persoal iformatio cotaied i their files by cotactig them directly through their respective websites ad Oce you have applied for ay credit product with us, you may ot withdraw your coset to this exchage of Iformatio. Fraud - I order to prevet, detect or suppress fiacial abuse, fraud, crimial activity, protect our assets ad iterests, assist us with ay iteral or exteral ivestigatio ito potetially illegal or suspicious activity or maage, defed or settle ay actual or potetial loss i coectio with the foregoig, we may collect from, use ad disclose your Iformatio to ay perso or orgaizatio, fraud prevetio agecy, regulatory or govermet body, the operator of ay database or registry used to check iformatio provided agaist existig iformatio, or other isurace compaies or fiacial or ledig istitutios. For these purposes, your Iformatio may be pooled with data belogig to other idividuals ad subject to data aalytics. Isurace This sectio applies if you are applyig for, requestig prescreeig for, modifyig or makig a claim uder, or have icluded with your product, service or accout, a isurace product that we isure, reisure, admiister or sell. We may, collect, use, disclose ad retai your Iformatio, icludig health-related Iformatio. We may collect this Iformatio from you or ay health care professioal, medically-related facility, isurace compay, govermet agecy, orgaizatios who maage public iformatio data baks, or isurace iformatio bureaus, icludig MIB Group, Ic. ad the Isurace Bureau of Caada, with kowledge of your Iformatio. With regard to life ad health isurace, we may also obtai a persoal ivestigatio report prepared i coectio with verifyig ad/or autheticatig the iformatio you provide i your applicatio or as part of the claims process. With regard to home ad auto isurace, we may also obtai Iformatio about you from credit reportig agecies at the time of, ad durig the applicatio process ad o a ogoig basis to verify your creditworthiess, perform a risk aalysis ad determie your premium. 18

19 We may use your Iformatio to: determie your eligibility for isurace coverage admiister your isurace ad our relatioship with you determie your isurace premium ivestigate ad adjudicate your claims help maage ad assess our risks ad operatios. We may share your Iformatio with ay health-care professioal, medically-related facility, isurace compay, orgaizatios who maage public iformatio data baks, or isurace iformatio bureaus, icludig the MIB Group, Ic. ad the Isurace Bureau of Caada, to allow them to properly aswer questios whe providig us with Iformatio about you. We may share lab results about ifectious diseases with appropriate public health authorities. If we collect your health-related Iformatio for the purposes described above, it will ot be shared withi TD, except to the extet that a TD compay isures, reisures, admiisters or sells relevat coverage ad the disclosure is required for the purposes described above. Your Iformatio, icludig health-related Iformatio, may be shared with admiistrators, service providers, reisurers ad prospective isurers ad reisurers of our isurace operatios, as well as their admiistrators ad service providers for these purposes. Marketig Purposes We may also use your Iformatio for marketig purposes, icludig to: tell you about other products ad services that may be of iterest to you, icludig those offered by other busiesses withi TD ad third parties we select determie your eligibility to participate i cotests, surveys or promotios coduct research, aalysis, modelig, ad surveys to assess your satisfactio with us as a customer, ad to develop products ad services cotact you by telephoe, fax, text messagig, or other electroic meas ad automatic dialig-aoucig device, at the umbers you have provided us, or by ATM, iteret, mail, ad other methods. With respect to these marketig purposes, you may choose ot to have us: cotact you occasioally either by telephoe, fax, text message, ATM, iteret, mail, or all of these methods, with offers that may be of iterest to you cotact you to participate i customer research ad surveys. Telephoe ad Iteret discussios Whe speakig with oe of our telephoe service represetatives, iteret live chat agets, or messagig with us through social media, we may moitor ad/or record our discussios for our mutual protectio, to ehace customer service ad to cofirm our discussios with you. More Iformatio This Agreemet must be read together with our Privacy Code. You ackowledge that the Privacy Code forms part of the Privacy Agreemet. For further details about this Agreemet ad our privacy practices, visit or cotact us for a copy. You ackowledge that we may amed this Agreemet ad our Privacy Code from time to time. We will post the revised Agreemet ad Privacy Code o our website listed above. We may also make them available at our braches or other premises or sed them to you by mail. You ackowledge, authorize ad agree to be boud by such amedmets. If you wish to opt-out or withdraw your coset at ay time for ay of the opt-out choices described i this Agreemet, you may do so by cotactig us at Please read our Privacy Code for further details about your opt-out choices. Last modified August

20 Complait hadlig process for TD Life Isurace Compay At TD Isurace we are committed to providig you with the best customer experiece we ca. If you have a cocer about TD Isurace or the service you have received we wat to work with you to resolve it as efficietly as possible. If a problem caot be resolved immediately, the followig steps are take to esure it is fixed as quickly as possible. Step 1: Cotact a TD Isurace Customer Service Represetative 120 Adelaide Street West, 2d Floor Toroto, ON M5H 1T1 Phoe: TD.IsuraceLifeAdHealth@td.com Step 2: Problem is referred to TD Isurace Customer Care If you are ot satisfied with the solutio offered i Step 1, the problem will be referred to the TD Isurace Customer Care Departmet for hadlig. TD Isurace Customer Care Departmet 120 Adelaide St W., PO Box 1 Toroto ON M5H 1T1 Phoe: tdiscc@td.com Step 3: Cotact the TD Isurace Ombudsma If your problem or cocer remais uresolved after you have followed Steps 1 ad 2, you may cotact the TD Isurace Ombudsma TD Isurace Ombudsma 3650 Victoria Park Ave, 9th Floor Toroto, ON M2P 3P7 ombudsma@tdisurace.com Please be sure to iclude your full ame, address, telephoe umber, policy ad/or claim umber i all iquiries. Step 4: Cotact OmbudService If your problem or cocer remais usatisfied after you have received the Ombudsma s fial positio letter, you may cotact the OmbudService for Life ad Health Isurace (OLHI): 401 Bay Street, Suite 1507 P.O. Box 7 Toroto, Otario M5H 2Y4 Phoe: or Fax: (0814)