Emergency Travel Insurance for Short-Term Trips CCCC offers emergency health insurance coverage for members who are travelling outside of Canada on short-term trips (under 45 days). This program provides excellent coverage for churches and agencies that are organizing short-term mission trips. The premium is $1.50 per person per day subject to a $15.00 minimum per person. To enrol in the program, you must belong to a CCCC member organization; fulfill the eligibility requirements (listed below); complete and submit an Application Form. ELIGIBILITY You are eligible for coverage if you are a resident of Canada who is under age 70 and covered under your provincial health insurance plan; you are in good health and are not applying for coverage with the intention of travelling for health reasons; you authorize the release and exchange of health, claim, or other personal information between the member organization, insurer, and plan administrator. Coverage applies for a specified period of time, commencing upon your scheduled date of departure and ceasing upon your scheduled date of return. In no event shall this coverage apply beyond 45 days of travel. Only those persons who are on record with the plan administrator at the time of loss are eligible under this plan. If it is determined that coverage was sought and obtained for the purpose of travelling for health reasons and receiving benefits under this plan, all coverage will be rendered null and void and the insurer reserves the right to recover from you or your estate any amounts paid due to misrepresentation of these facts. If you are under age 18, your parent or legal guardian must be aware of the terms and conditions of coverage. In addition, you must be travelling with a parent, legal guardian, or authorized group leader while insured. By accepting coverage under this plan, all conditions of coverage are acknowledged and agreed to. Page 1 of 5
PROCEDURE FOR CONFIRMING COVERAGE You must call the assistance provider immediately upon admission to a hospital and/or before incurring medical expenses (unless you are incapacitated and unable to do so). The assistance provider must pre-approve all treatment and care that is rendered in hospital. If you require emergency medical transportation and/or evacuation, the assistance provider will make arrangements for both the transportation and direct payment to the service provider. The insurer reserves the right to return you to Canada or to move you to any other facility where appropriate treatment and care is available, inside or outside that country. Failure to call the assistance provider prior to receiving treatment and care or your refusal to be repatriated or moved will result in unpaid claims and a loss of coverage. The assistance provider is American International Assistance Services (AIAS). They answer calls 24 hours a day to confirm coverage and provide other important travel related services, including payment assistance for eligible expenses in excess of $200 if required to guarantee payment prior to admission to hospital or receiving treatment. When you contact AIAS, you will need to provide your Policy Number and Provincial Health Insurance Plan Number. If you are hospitalized, AIAS will follow your progress to ensure you receive the best available treatment and to communicate with your family and physician. ELIGIBLE EXPENSES If you require emergency medical treatment outside Canada, 100% reimbursement will be made for eligible expenses not covered under your provincial health insurance plan. If you are hospitalized on the date your coverage would otherwise cease, coverage continues for 24 hours after discharge to return to Canada. Reimbursement of eligible expenses shall be based on the usual, reasonable, and customary charges for expenses incurred as a result of an injury or illness, less any amounts payable under a provincial health insurance plan, private health plan, credit card plan, or any other plan you are covered under at the time. All of the dollar amounts under this plan are stated in Canadian dollars, and reimbursement of eligible expenses is subject to a lifetime maximum of $1,000,000. Semi-Private Hospital Coverage includes semi-private accommodation in a public general hospital and outpatient treatment and care in a hospital or clinic, including services and supplies rendered. Professional Services Professional medical and surgical services rendered by a legally and duly qualified physician, surgeon, or anaesthetist for treatment in a hospital or clinic Professional nursing services rendered by a registered graduate nurse for treatment in a hospital or residence, up to a maximum 50 shifts at $100 each Page 2 of 5
Professional dental services rendered by a legally and duly qualified dentist or dental surgeon as a result of accidental injury to natural and sound teeth (including crowns and capped teeth) when performed within 30 days of the accident in a hospital or dental office, up to a maximum of $2,000 per incident Medical Services & Supplies Travel by licensed land ambulance, or by licensed air ambulance if medically necessary, to the nearest appropriate medical facility or between facilities Laboratory tests and x -ray examinations performed by a legally and duly qualified doctor of medicine for diagnosis and treatment of an injury or illness Necessary services performed by a licensed physiotherapist, chiropractor, osteopath, chiropodist, or podiatrist, up to a maximum of $300 per practitioner Drugs and medicines legally requiring a written prescription by law, including syringes and needles, prescribed by a legally and duly qualified physician The rental of durable medical equipment, such as hospital beds, wheelchairs, crutches, canes, splints, slings, trusses, braces, and other approved supplies Family Transportation If you are confined to a hospital outside Canada for at least 5 consecutive days, the insurer will pay the necessary costs for round trip economy commercial transportation, or $0.20 per kilometre driven by the most direct route, for transportation to your bedside by a spouse, parent, sibling, or child over the age of 17 when recommended in writing by the attending physician. In addition, the cost of commercial meals and accommodation incurred by the person travelling to your bedside are also covered, up to a maximum of $100 per day for up to 20 days. Eligible expenses are subject to a combined overall maximum of $5,000. Emergency Evacuation If you are confined to a hospital outside Canada and the insurer requires you to return to Canada for treatment and care, or be moved to another facility where appropriate medical treatment and care is available, or if the attending physician certifies that the severity of your condition warrants emergency evacuation, reimbursement will be made for the cost of one way economy transportation by land, water, or air, plus the additional cost to accommodate a stretcher if required, to travel by the most direct route to the intended destination point. The insurer reserves the right to return you to Canada or to move you to any other facility where appropriate treatment and care is available, inside or outside that country. Failure to comply will result in unpaid claims and a loss of coverage. If the insurer or operator of the conveyance deems that you must be accompanied by a legally and duly qualified medical attendant, reimbursement will be made for the cost of round trip economy transportation and the usual and customary fee charged by the medical attendant, who is not a relative by birth or marriage, plus overnight hotel and meal expenses. Eligible expenses for an emergency evacuation are subject to a combined overall maximum of $25,000. Page 3 of 5
Repatriation Of Remains If you suffer a loss of life as a result of an injury or illness, the insurer will pay necessary costs for the preparation of your mortal remains for burial or cremation, and homeward transportation to your province of residence in Canada, up to a combined maximum of $5,000. Coverage excludes the cost of a burial coffin. LIMITATIONS & EXCLUSIONS Eligible expenses are limited to amounts in excess of Provincial Health Insurance Plan limits, and may not be eligible for reimbursement unless it contributes towards the cost. Eligible expenses do not include, and reimbursement will not be made for any the following, even if on the recommendation of a physician: treatment and care that is not medically necessary, does not require immediate attention, or could reasonably be delayed until your return to Canada treatment and care that is obtained on the referral of a physician, whether or not the treatment or care is available in your home province of residence treatment and care that is rendered in a chronic care or psychiatric hospital, chronic unit of a general hospital, long-term care facility, or nursing home treatment and care that is required for ongoing care, rest cures, health spas, check-ups, or deemed to be elective, cosmetic, or experimental in nature treatment and care for childbirth or pregnancy occurring within 8 weeks of the delivery date, determined from the date of your departure from Canada over-the-counter products, including laxatives, shampoos, cosmetics, atomizers, smoking cessation aids, first aid supplies, vitamins or patent medicines In addition to the above, eligible expenses do not include and reimbursement will not be made for losses that are caused by, as a result of, or connected with an act of declared or undeclared war or armed aggression, participation in a riot, or service in the armed forces of any nation or international authority an attempt at suicide or self-destruction or any self-inflicted injury while sane or insane, nor committing, attempting, or provoking any criminal offence high risk activities including any professional sports, sky diving, parachuting, hang gliding, stunt flying, bungi jumping, rock climbing, or speed contests REIMBURSEMENT OF EXPENSES If you have incurred out-of-pocket expenses, submit a claim form to the plan administrator within 30 days of returning to Canada. Attach all original itemized paid receipts showing your name, the provider s name and address, a detailed description of the services and supplies, dates expenses were incurred, and amount paid. It is recommended that you keep a copy of claim forms and receipts until you have been reimbursed, as receipts may become lost or misplaced. Page 4 of 5
OVERPAYMENT & SUBROGATION The insurer has the right to recover any overpayment of benefits that have been made, whether to you or for you, or to you on behalf of your eligible dependent, whatever the cause of such overpayment. If benefits are paid to a person who has a right to receive payment or recover damages from a person or organization arising from the same cause, the insurer will be subrogated to the rights of recovery of the person and the person will reimburse the insurer for benefits paid. Page 5 of 5