Benefits – Excess Medical/Hospital Expense – Accident & SicknessWhen as a result of an injury or sickness the insured requires necessary services of a physician, registered nurse, physiotherapist, hospital, x-ray clinic, laboratory, ambulance or emergency medical return to the outbound point of departure, the Insurer will pay the actual expenses incurred not to exceed the maximum sum stated on the individual certificate.
Hospital services shall include all necessary services provided normally by a duly registered and licensed hospital excluding services of a nursing home, rest home, or by other non-hospital institutions.
Coverage is provided only for expenses incurred by Canadian Residents which are in excess of the benefits available under any Canadian Federal or Provincial Hospital and/or Medical Plan regardless of whether or not the insured is enrolled in such a plan.
Blanket Dental Accident Reimbursement
When an injury to whole or sound teeth including filled or restored teeth requires and receives dental treatment commencing within 30 days of the date of the accident the Insurer shall pay for the necessary expenses for such treatment rendered within 52 weeks of the accident. The following provisions apply:
a) Any payments made under this section shall not exceed the amount specified in the Schedule of Fees in effect at the time of the accident as published by the Dental Association of the Province in which this document of insurance is issued.
b) Capped or crowned teeth shall be deemed as whole or sound teeth.
c) No benefit will be payable for expenses of dental treatment incurred for the cost of replacement, adjustment or repair of artificial teeth or dentures (except as otherwise provided herein), any orthodontic treatment; any dental treatment provided solely for cosmetic or esthetic reasons.
Interruption Insurance
Out of Pocket Expenses: In the event covered injury or sickness causes an insured’s delay in returning to the point of departure beyond the return date, the Insurer will pay for reasonable out-of-pocket expenses incurred by the insured up to the per diem amount specified in the individual certificate, not to exceed the maximum applicable benefit for all such expenses.
Trip Interruption: If, after the outbound departure, the insured is obliged to leave the tour upon a physician’s advice due to covered illness or injury, the Insurer will pay for the cost of one-way economy class transportation to rejoin the ongoing tour or to original point of departure.
Repatriation Expense: In the event of covered death of the insured, occurring after the originating flight date, the Insurer will pay the cost of the actual expense incurred for conveyance of the body and ashes of the insured person, to the outbound point of departure, not to exceed the applicable maximum benefit.
Limitations and Exclusions:
This insurance does not provide expenses incurred directly or indirectly as a result of:
- a) Injury or sickness for which medical hospital benefits are provided under any other insurance policy or plan except for the excess not covered under such other insurance;
- b) Maintenance Therapy for pre-existing medical conditions;
- c) Dental, Chiropractic or any other health services not mentioned specifically in Excess Medical/Dental Expenses;
- d) Suicide or self destruction, intentionally self inflicted injuries or any attempt thereat;
- e) Declared or undeclared war, civil war, riot, insurrection, invasion or any act thereof;
- f) An illegal act by the insured or beneficiary;
- g) Participation in armed forces training exercises or maneuvers;
- h) Participation in sport, not listed within policy.
- i) A payment which contravenes any plan or any government or political subdivision or law of Canada.
More information including a collection of Frequently Asked Questions and the actual claim forms can be found online at http://insurance.basketballmanitoba.ca.
