International Students to Canada

Travel Insurance

Travel with confidence

Welcome to your travel insurance policy Please note that key terms are printed in italics throughout
You put all the plans in place for a good trip, and made the remainder of this policy and are defined in the Definitions
your well-being a priority by choosing travel insurance. section on page 10 of your policy. Referring to the
Allianz Global Assistance is there to support you should an definitions will help you to better understand your policy.
unexpected emergency happen with 24/7 assistance, medical
monitoring and guided care from our experienced in-house This policy contains a provision removing or
team and network of trusted physicians and hospitals. restricting the right of the insured person to
designate persons to whom or for whose benefit
Take the time to get to know your policy before you leave insurance money is to be payable.
on your trip and talk to your insurance representative if:
• there is anything you do not understand, This policy must be accompanied by a Confirmation of
Coverage to complete the contract.
• you have questions about this policy,
• your travel arrangements change, or
• you have a change in health.

Important Notices

Please read your policy carefully. Travel insurance is designed to cover losses that are sudden and unforeseen. It does
not cover every situation and expense. Your coverage is subject to certain conditions, limitations and exclusions. It is
important for you to read and understand your policy before you travel.

• Costs incurred in your country of origin are not covered.

• Your insurance contains pre-existing condition exclusions. These exclusions apply to medical conditions and/or
symptoms that existed on or before your departure date or effective date. Check to see how this applies in your
coverage and how it relates to your departure date, purchase date and effective date.

• In the event of an accident, injury or sickness, your prior medical history may be reviewed when a claim is reported.

• If you are ineligible for coverage, the insurer’s only liability will be to refund any premium paid. Please check your
confirmation of coverage to ensure you have the coverage options you require. Payment will be limited to the
coverage options you selected and paid for at the time of application. You will be responsible for any expenses
that are not payable by the insurer.

Underwritten by CUMIS General Insurance Company, a member of The Co-operators group of companies.
Administered by Allianz Global Assistance, which is a registered business name of AZGA Service Canada Inc.
Allianz Global Assistance provides claims and travel assistance services on behalf of the insurance company.

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 Who to Contact and When

24/7 Emergency Assistance Medical Monitoring and Assistance

Please contact Allianz Global Assistance before You can rely on Allianz Global Assistance 24 hours a day, 7
seeking treatment. Medical availability and quality days a week. Allianz Global Assistance has an experienced
varies around the world. Our agents are available in-house medical team and a worldwide network of trusted
24/7 and equipped to provide you with a referral to physicians and hospitals ready to help when an unexpected
the nearest available medical facility, advocate on sickness or injury arises.
your behalf and ensure you receive the right care for Allianz Global Assistance will attempt to arrange direct
your situation. billing with the medical facility whenever possible. Some
facilities require payment up front and you may have to
In a serious medical emergency, get to a hospital and have pay for your treatment. Be sure to keep all your original,
someone call on your behalf within 24 hours of admission itemized receipts.
and before any surgery is performed.
Allianz Global Assistance provides the following services
If you fail to notify Allianz Global Assistance without during an unexpected sickness or injury:
reasonable cause, the insurer will only pay 80% of the
eligible expenses. You will be responsible for paying the • From the first point of contact, ensuring you receive
remaining 20%. the of right level of medical attention,
• A referral to the closest appropriate medical
provider,
Toll free Canada/USA 1-800-995-1662
• Virtual care from qualified physicians in real-time
Toll free worldwide 00-800-842-08420 or via video or tele-conferencing, if appropriate for the
situation,
Country code • Monitoring the status of your medical case,
+ 800-842-08420
(Outside Canada/USA) • Communicating with you and others you request
such as your family, your physician, travel supplier,
If unable to contact us through the toll free numbers or consulate, and
• Coordinating Emergency Transportation
Call collect 416-340-0049 arrangements related to your medical emergency
as described below.
International operator assistance may be required, Allianz Global Assistance will make commercially
depending on where you are calling from. Collect calls will reasonable efforts to provide these services during a
be accepted. covered unexpected sickness or injury.

Right to Cancel

Please review this policy when you receive it to

ensure it meets your needs. If you are not completely
satisfied with this policy, you may cancel it within
10 days of purchase for a full refund of premium
(premium is the amount you paid for this policy),
provided you have not left on your trip and have not
experienced an event that would cause you to submit
a claim.

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How to navigate this policy
Consider this page your home base which provides you with an overview of this policy. From here you can easily explore the
sections below by clicking on the topic you want to read more about.

Once you jump to your chosen section you can either continue to scroll and explore, or simply click on the

TABLE OF CONTENTS

button located on the bottom right of each page which will bring you back to this table of contents.

Table of Contents
Important Notices 1

Who to Contact and When 2

24/7 Emergency Assistance 2
Medical Monitoring and Assistance 2
Right to Cancel 2

Coverage Details 4
Eligibility 4
Insuring Agreement 4
Summary of Benefits 5
Description of Coverage 5
Benefits: What’s Covered 5
Specific Conditions 7
Exclusions: What’s not Covered 8

Claims Procedures 10

Definitions 10

Legal Information 13
General Provisions 13
Premium Refunds 15
Statutory Conditions 16
Privacy Information Notice 17
Contact Information 18
 Coverage Details

What am I covered for? e) be in good health at the time you purchase your
policy and on the effective date, and know of no
To find out what your coverage is, please refer to your reason to seek treatment or medical consultation
confirmation of coverage and read the section titled Benefits. during the period of coverage.
What is not covered?
Start of Coverage
This policy does not cover everything. Your policy has
exclusions, conditions and limitations. You should read your Coverage starts on the later of:
policy carefully when you receive it, so that you are aware of,
a) the date indicated as the effective date on your
and understand, the limits of your coverage.
confirmation of coverage; or
How do I make a claim? b) the first time you exit your country of origin.
Notify Allianz Global Assistance as soon as possible in the
event of an emergency. Where possible, Allianz Global Waiting Period
Assistance will arrange to pay the provider directly.
Coverage for losses resulting from any sickness will begin 48
To submit a claim under this policy, you will need to send hours after the effective date if you purchase your policy:
a completed claim form (with all original bills attached) a) after the expiry date of an existing Allianz Global
to Allianz Global Assistance. Please take care in filling out Assistance administered policy; or
the form, as any missing information may cause delay. See
b) after you exit your country of origin.
Claims Procedures on page 9 for details.

What if my travel plans change?

Note: Any sickness that manifests itself during the
You must contact your insurance representative to make any 48-hour waiting period is not covered even if related
changes to your insurance. expenses are incurred after the 48-hour waiting period.
I want to stay longer. Can I extend my coverage?

Yes, you can, subject to policy terms and conditions. Just call End of Coverage
your insurance representative or Allianz Global Assistance
(during business hours) before coverage under your policy Coverage ends on the earlier of:
expires. See Extending Your Trip on page 14 for details. a) the date indicated as the expiry date on your
Assistance confirmation of coverage; or
b) the date you become insured under a Canadian
Allianz Global Assistance will use their best efforts to provide government health insurance plan.
assistance for a sickness or injury arising anywhere in the
world. However, Allianz Global Assistance, the insurer, and Insuring Agreement
their agents will not be responsible for the availability,
quantity, quality, or results of any medical treatment In consideration of the application for insurance and
received, or for the failure of any person to provide or obtain payment of the appropriate premium, and subject to the
medical services. terms, conditions, limitations, exclusions and other provisions
of this policy, the insurer will pay the reasonable and
Eligibility customary costs for eligible expenses incurred during the
period of coverage while outside your country of origin, up to
To be eligible for coverage, you must: the amounts specified in this policy.
a) be a student; or
Payment is limited to the amounts specified under each
b) be a dependent child or the spouse of an eligible coverage option. Some benefits are subject to advance
insured student; and approval by Allianz Global Assistance.
c) as of the effective date, be less than 60 years of age;
and You will be responsible for any expenses that are not
payable by the insurer.
d) not be insured or eligible for benefits under a
Canadian government health insurance plan; and

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Summary of Benefits Benefits: What’s Covered

Sum insured ........................................................................... $5 million Emergency Hospital

Emergency Hospital confinement The insurer agrees to pay for hospital accommodation,
and Medical Services ......................... up to overall maximum including semi-private room, and for reasonable and
customary services and supplies necessary for your
Chiropractor, osteopath, podiatrist/chiropodist, naturopath,
acupuncturist or physiotherapist .......... $600 per profession emergency care during confinement as a resident in-patient.

Ambulance Services ................................ up to overall maximum Emergency Medical

Prescription Medication ........................... up to a 30-day supply The insurer agrees to pay for the following services, supplies
or treatment, when provided by a health practitioner who is
Transportation of Family or Friend .................................... $5,000 not related to you by blood or marriage:
Return of Deceased ................................................................ $15,000 a) The services of a legally licensed physician, surgeon,
or anaesthetist.
Cremation at place of death ................................................ $5,000
b) Follow-up visits when declared necessary by the
Dental (accident) ...................................................................... $5,000 attending physician at the time of the emergency.
Follow-up visits must occur during the period of
Dental (other than direct blow to face) ................................ $600
coverage and be directly related to the emergency. The
Dental (wisdom teeth) ............................................ $100 per tooth emergency must occur during the period of coverage
and have been reported to Allianz Global Assistance.
Emergency Transportation/
Return Home ......................................... up to overall maximum c) Diagnostics, lab tests and/or X-ray examinations as
ordered by a physician for the purpose of diagnosis.
Maternity ................................ up to $1,000 per 12-month period
d) Up to a combined maximum of $10,000, for all of the
Physical Examination ....................... $250 per 12-month period following:

Eye Examination ......................... one visit per 12-month period i. The use of a licensed local land or sea ambulance
to the nearest hospital. If an ambulance is
Tutorial Services ............................................ $20/hour up to $500 necessary but is unavailable, the insurer will
reimburse up to $100 for taxi expenses.
Accidental Death & Dismemberment .................. up to $15,000
ii. Private duty services of a registered graduate
Description of Coverage nurse (who is not related to you by blood or
marriage) when ordered by a physician approved
in advance by Allianz Global Assistance.
1. Subject to the terms, conditions, limitations, exclusions
and other provisions of this policy, the insurer will pay the iii. When ordered by a physician, rental of crutches,
reasonable and customary costs incurred unexpectedly wheelchair or hospital-type bed (standard non-
as a result of your sickness or injury occurring as a electric model only), not exceeding the purchase
result of an emergency during the period of coverage price; the cost of splints, trusses, braces or other
while outside your country of origin, up to the amounts approved prosthetic appliances; initial purchase
specified in this policy. of casts; artificial limbs, eyes or other approved
prosthetic or medical appliances when approved
2. Costs incurred outside of Canada other than in your in advance by Allianz Global Assistance.
country of origin are covered provided the majority of the
period of coverage is spent in Canada. In addition, trips iv. When ordered by a physician, oxygen and rental
to the United States are limited to 30 days per period of of equipment for its administration.
coverage. v. When ordered by a physician, blood and blood
plasma, except when donated.
3. Your policy will remain in effect while you are in your
country of origin, however costs incurred in your country e) The services of the following legally licensed
of origin are not covered. practitioners when ordered by the attending physician
as treatment for a covered sickness or injury:
4. If you have been returned to your country of origin under
the Emergency Return Home benefit, this policy will expire. i. chiropractor;
ii. osteopath;
iii. podiatrist/chiropodist;
iv. naturopath;

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 v. acupuncturist; Dental
vi. physiotherapist. The insurer agrees to reimburse:
Not to exceed $600 per profession in any consecutive a) up to $5,000 for emergency treatment or services to
12-month period. whole or sound natural teeth (including capped or
f) Emergency out-patient services provided by a hospital. crowned teeth) which are damaged as a result of an
g) When not hospitalized as an in-patient, drugs accidental blow to the face; and
or medications that require a physician’s written b) up to $600 for the immediate relief of acute dental
prescription, not exceeding a 30-day supply. The pain caused by other than a direct blow to the face
morning after pill is limited to one prescription per and for which you have not previously received
period of coverage. treatment or advice; and

Transportation of Family or Friend c) up to $100 per tooth for dental and/or oral surgical
procedures which are necessary for the extraction of
The insurer agrees to pay up to a maximum of $5,000 for the impacted wisdom teeth.
cost to transport up to two bedside companions (your family
member or close friend) by round-trip economy class (using Reimbursement will not exceed the minimum fee specified
the most direct route) if: in the Canadian Dental Association schedule of fees of the
province or territory where treatment was received.
a) you are hospitalized due to a covered sickness or
injury, and the attending physician advises that Treatment relating to any dental claim must begin within
your family member or close friend’s attendance is 48 hours after the onset of the emergency and must be
necessary; or completed within the period of coverage and prior to your
b) the local authorities legally require the attendance return to your country of origin.
of your family member or close friend to identify your
Treatment must be performed by a legally qualified dentist
remains in the event of your death due to a covered
or oral surgeon.
sickness or injury.
Emergency Transportation / Return Home
Benefits are payable only when approved in advance by
Allianz Global Assistance. When necessary, the insurer agrees to transport you to the
nearest appropriate medical facility or to your country of
In addition, the insurer agrees to reimburse up to a maximum origin when immediate medical consultation is required due
of $1,500 for the following expenses incurred by your family to a covered emergency sickness or injury.
members or close friend(s) after arrival:
a) commercial accommodation and meals; and Any emergency transportation such as air ambulance, one- way
economy airfare, stretcher and/or a medical attendant must be
b) essential telephone calls; and pre-approved and arranged by Allianz Global Assistance.
c) taxi fares.
Maternity
Expenses must be supported by original receipts from
commercial organizations. The insurer agrees to reimburse the costs incurred by the mother
for pre-natal care, miscarriage, or related complications.
Return of Deceased (Repatriation)
The amount payable for all eligible expenses under this
In the event of your death due to a covered sickness or injury, benefit is limited to $1,000 for expenses incurred in any
the insurer agrees to reimburse: consecutive 12-month period starting on the date the first
a) up to $15,000 for costs incurred to prepare and return pregnancy-related expense is incurred.
your remains in a standard transportation container The expected delivery date must be more than 10 months
to your country of origin; or after the effective date. For multiple Allianz Global
b) up to $5,000 for cremation or burial of your remains at Assistance administered policies with no lapse in coverage,
the place of death. the expected delivery date must be more than 10 months
after the effective date of the initial policy purchased.
The cost of a funeral service, coffin or urn is not covered.
There is no coverage for a newborn under this policy.

Note: Your newborn may be covered under their own policy

once they are at least 15 days old if the premium is accepted
by Allianz Global Assistance or its representative and written
approval is given by Allianz Global Assistance.

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Physical Examination ii. one hand; or

The insurer agrees to reimburse up to $250 for one routine iii. one foot.
examination by a physician, including any related tests and Loss of hand or hands, or foot or feet means severance through
laboratory fees. or above the wrist joint or ankle joint, respectively. Loss of eye or
This benefit is limited to one visit in any consecutive 12-month eyes means total and irrecoverable loss of the entire sight.
period, provided coverage with Allianz Global Assistance has Only one amount is payable (the largest) if you suffer
been purchased for a minimum of 12 consecutive months more than one of these losses. This benefit is not subject to
with no lapse in coverage. coordination of benefits.
Eye Examination Exposure and Disappearance
The insurer agrees to reimburse the services of a registered If you are exposed to the elements or disappear as a result of
optometrist for diagnostic procedures to determine the an accident, a loss will be covered if:
presence of any observed abnormality in the visual system.
a) as a result of such exposure, you suffer one of the
This benefit is limited to one visit in any consecutive 12-month losses specified in the schedule of losses above; or
period, provided coverage with Allianz Global Assistance has b) your body has not been found within 52 weeks from
been purchased for a minimum of 12 consecutive months the date of the accident. It will be presumed, subject to
with no lapse in coverage. evidence to the contrary, that you suffered loss of life.
Tutorial Services
Specific Conditions
If, as the result of a covered sickness or injury, the attending
physician expects that you will be hospitalized or confined 1. In the event of a medical emergency, you must notify
to your home for 30 or more consecutive school days, the Allianz Global Assistance within 24 hours of admission to
insurer agrees to reimburse up to $20 per hour to a maximum a hospital and before any surgery is performed.
of $500 for the costs of a qualified private tutorial service
arranged by your school. Limits on Coverage

Accidental Death & Dismemberment If you fail to do so without reasonable cause, then Allianz
Global Assistance will pay 80% of the claim payable. You
Subject to the policy terms and conditions, the insurer agrees will be responsible for the remaining 20% of the claim
to pay up to the sum insured indicated on your confirmation payable.
of coverage, for loss of life, limb or sight resulting directly
You will be responsible for any expenses that are not
from accidental injury, occurring during the period of
payable by the insurer.
coverage, except while boarding, riding in, or alighting from
a common carrier. 2. In accordance with the Privacy Information notice on
page 16, you authorize Allianz Global Assistance to
The maximum amount payable for all losses related to one communicate with your health care provider including
covered event under all Accidental Death & Dismemberment any hospital or physician to manage your emergency.
Coverage under all policies issued by the insurer and
administered by Allianz Global Assistance is $10 million. 3. Allianz Global Assistance reserves the right, as
reasonably required and at its expense, to transfer you to
Benefits are payable according to the following schedule: any hospital or to transport you to your country of origin
a) 100% of sum insured resulting from the same following an emergency.
accidental injury for loss of:
If you refuse to be transferred or transported when
i. life; or declared medically fit to travel, any continuing costs
ii. entire sight of both eyes; or incurred after your refusal will not be covered and the
payment of such costs becomes your sole responsibility.
iii. both hands; or
Coverage ceases upon your refusal and no coverage will
iv. both feet; or
be provided to you for the remainder of the period of
v. one hand and entire sight of one eye; or coverage.
vi. one foot and entire sight of one eye. 4. General Provisions of this policy apply. Refer to page 13.
b) 50% of sum insured resulting from the same
accidental injury for loss of:
i. entire sight of one eye; or

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 Exclusions: What’s not Covered b) your chronic use of alcohol or drugs before or after
the effective date; or
IS1 Pre-existing Conditions Exclusion c) your use or consumption of cannabis products during
your trip; or
Benefits are not payable for costs incurred due to any
sickness or injury or medical condition, whether or not d) your use of prohibited drugs or any other intoxicant; or
diagnosed by a physician: e) your non-compliance with prescribed treatment or
a) for which you exhibited signs or symptoms; or medical therapy before or after the effective date; or
b) for which you required or received medical f) your misuse of medication before or after the
consultation or treatment; and effective date.
c) which existed prior to the effective date of your IS10 Benefits are not payable for costs incurred due to injury
coverage. resulting from training for, competing or participating in:
IS2 Benefits are not payable for any sickness or injury when a) motorized speed contests; or
you knew, or for which it was reasonable to expect, before b) high-risk activities; or
the effective date, that you would need or be required to
seek treatment for that sickness or injury. c) stunt activities; or
d) professional sport activities.
IS3 Benefits are not payable for costs incurred due to
any treatment, investigation or hospitalization which is a IS11 Benefits are not payable for costs incurred due to
continuation of, or subsequent to, emergency treatment of sickness or injury resulting from a motor vehicle accident
a sickness or injury, unless approved in advance by Allianz where you are entitled to receive benefits pursuant to any
Global Assistance. policy or legislative plan of motor vehicle insurance, except
when such benefits are exhausted.
IS4 Benefits are not payable for any costs incurred due to
any sickness for which signs or symptoms occurred within IS12 Benefits are not payable for costs incurred due to
48 hours after the effective date, except when applying for any sickness, injury or medical condition when a trip is
coverage: undertaken for the purpose of securing medical treatment.
a) before the expiry date of your existing Allianz Global IS13 Benefits are not payable for costs incurred due to
Assistance administered policy; or your travelling against the advice of a physician or any loss
b) prior to the date you exit your country of origin. resulting from your sickness or medical condition that was
diagnosed by a physician as terminal prior to the effective
IS5 Benefits are not payable for costs incurred due to any date of this policy.
loss incurred outside of Canada when you have not spent the
majority of the period of coverage in Canada. IS14 Benefits are not payable for costs incurred due to any
treatment which can be reasonably delayed until you return
IS6 Benefits are not payable for costs incurred due to any to your country of origin (whether or not you intend to return),
loss incurred inside your country of origin. unless approved in advance by Allianz Global Assistance.
IS7 Benefits are not payable for costs or losses incurred due to: IS15 Benefits are not payable for costs incurred due to any
a) your emotional or mental disorders resulting from medical consultation that is non-emergency, ongoing elective
any cause, including but not limited to anxiety or or the consequence of a prior elective procedure, except as
depression; or specifically provided under Physical Examination and Eye
Examination.
b) your suicide or attempted suicide; or
c) your intentional self-inflicted injury. IS16 Benefits are not payable for costs incurred due to
hospitalization or services rendered for general health
IS8 Benefits are not payable for costs incurred due to examinations or check-up purposes except as provided under
pregnancy, abortion, miscarriage, childbirth or complications Physical Examination.
thereof except as specifically provided under Maternity.
IS17 Benefits are not payable for treatment of an ongoing
IS9 Benefits are not payable for costs incurred due to loss, condition, regular care of a chronic condition, home health
death or injury, if at the time of the loss, death or injury, care, investigative testing, rehabilitation, or ongoing care
evidence supports that the loss was in any way contributed or treatment in connection with drugs, alcohol or any other
to by: substance abuse.
a) your abuse of alcohol during your trip; or

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IS18 Benefits are not payable for costs incurred due to IS30 Benefits are not payable for costs incurred due to the
learning or educational assessments. purchase of:

IS19 Benefits are not payable for costs incurred due to any a) medications or drugs not approved for use by the
rehabilitation or convalescent care. appropriate government authority; or
b) patent or proprietary medications when a generic
IS20 Benefits are not payable for costs incurred due to dental equivalent is available in the marketplace; or
or cosmetic surgery, except as specifically provided under
Dental. c) vitamins or vitamin preparations; or
d) drugs or medications which can be purchased over the
IS21 Benefits are not payable for costs incurred due to counter without a physician’s written prescription; or
holistic treatment.
e) acne medications; or
IS22 Benefits are not payable for costs that exceed the f) nicotine resin products; or
reasonable and customary rate for the area where the
treatment or services are being performed. g) dietary supplements or weight loss products; or
h) quantities of any drug or medication which exceed
IS23 Benefits are not payable for costs incurred due to a 30-day supply within one month prior to the expiry
treatment or services that contravene, or are prohibited by, date; or
legislation under a provincial or territorial hospital/medical
plan. i) contraceptives prescribed for any purpose, with the
exception of the morning after pill, which is limited to
IS24 Benefits are not payable for costs incurred due to any one per period of coverage; or
sickness or injury when such sickness or injury occurs in a city, j) contraceptive consultation or testing; or
region, or country for which the Canadian Government issued
a written warning prior to the effective date to avoid all k) fertility drugs or testing; or
travel, or to avoid non-essential travel, to that city, region, or l) drugs, medications, or other costs paid for by any
country, and such sickness or injury is related to or due to the other agency; or
reason for the warning. m)experimental drugs or preventative medications; or
IS25 Benefits are not payable for costs incurred due to any: n) drugs purchased prior to the effective date; or
a) act of war; or o) vaccines or vaccinations.
b) kidnapping; or
c) act of terrorism caused directly or indirectly by
nuclear, chemical or biological means; or
d) riot, strike or civil commotion; or
e) unlawful visit in any country; or
f) participation in the commission or attempted
commission of any criminal offence.

IS26 Benefits are not payable for costs incurred due to any
nuclear occurrence, however caused.

IS27 Benefits are not payable for costs incurred due to

being an occupant of an aircraft, either as passenger or
crew, except while being transported under the terms of the
Emergency Transportation/Return Home benefit, or while
boarding or alighting from an aircraft.

IS28 Benefits are not payable for costs incurred due to dental
care, services or supplies, except as specifically provided
under Dental.

IS29 Benefits are not payable for eye glasses, contact lenses,
hearing aids and/or prescriptions for any of these items,
unless required as the result of an injury.

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 Claims Procedures

If you require medical care while travelling, it is critical When submitting your Emergency Hospital & Medical
that you contact Allianz Global Assistance before seeking claim, please include:
treatment. In a severe medical emergency, get to a hospital
1. A fully completed and signed claim form with all original
immediately and have a family member or friend call
bills and receipts from commercial organizations.
Allianz Global Assistance on your behalf within 24 hours of
admission and before any surgery is performed. For more 2. Medical records including an emergency room report and
details, refer to Medical Monitoring and 24/7 Emergency diagnosis from the medical facility or a Medical Certificate
Assistance on page 2. completed by the treating physician. Any fee for completion
of the certificate is not a benefit under this insurance.
Claims for out-of-pocket expenses can be submitted
through the secure Allianz Global Assistance. Claims 3. Any other documentation that may be required and/or
Portal: www.allianzassistanceclaims.ca for the most requested by Allianz Global Assistance.
efficient claims experience. When submitting your Accidental Death & Dismemberment
claim, please include:

IMPORTANT: 1. A fully completed and signed claim form by either you,

or in the case of your death, by the appointed executor/
Notice of Claim. Claims should be reported as soon executrix.
as reasonably possible, within 30 days of occurrence,
and in no event later than one (1) year after the date 2. The police report including any witness statements.
of occurrence. 3. The coroner’s report.
Proof of Loss. Written proof of loss should be 4. The death certificate.
submitted as soon as reasonably possible, within 90
days of occurrence , and in no event later than one (1) 5. The Medical Certificate completed by the attending
year after the date of occurrence. physician or hospital medical records.
6. Any other documents requested by Allianz Global
All eligible claims must be supported by receipts from
Assistance after initial review of the claim.
commercial organizations and medical documentation
regarding your treatment. Other documentation may be
required and/or requested by Allianz Global Assistance.

Any expenses for documentation or required reports

are your responsibility.

Incomplete information when submitting your claim

will cause delay.

Definitions

Abuse of alcohol means your intoxication from alcohol Act of terrorism means an act, including but not limited
consumption (alcohol intoxication is determined either when to the use of force or violence and/or the threat thereof or
records indicate that you have reached or exceeded a blood commission or threat of a dangerous act, of any person or
alcohol level of 80 milligrams of alcohol per 100 millilitres of group(s) or government(s), committed for political, religious,
blood, or when records indicate that you were intoxicated ideological, social, economic or similar purposes including the
and no blood alcohol level is specified). intention to intimidate, coerce or overthrow a government
(whether de facto or de jure) or to influence, affect or
Accident(al) means a sudden, unexpected, unforeseeable, protest against any government and/or to put the civilian
unavoidable external event and excludes disease or population, or any section of the civilian population, in fear.
infections.

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Act of war means any loss or damage arising directly or Heart condition includes angina or chest pain, arrhythmia,
indirectly from, occasioned by, happening through or in arteriosclerosis, atrial fibrillation, congenital heart defect,
the consequence of: war; invasion; acts of foreign enemies; congestive heart failure, cardiomyopathy, carotid artery
hostilities or warlike operations (whether war is declared occlusion, heart attack (myocardial infarction), heart murmur,
or not) by any government or sovereign, using military irregular heart rate or beat, any other condition relating to
personnel or other agents; civil war; rebellion; revolution; the heart or cardiovascular system.
insurrection; civil commotion assuming the proportions of or
amounting to an uprising; military or usurped power. High-risk activity(ies) includes:
a) heli-skiing;
Commercial accommodation means an establishment
providing short-term accommodation for paying guests, b) any skiing or snowboarding out of bounds;
licensed under the law of its jurisdiction, which provides proof c) ski jumping;
of commercial transaction.
d) skydiving or sky-surfing;
Common carrier means a licensed carrier offering its e) scuba diving (except if certified by internationally
transportation services to paying passengers at published recognized and accepted program such as NAUI or
rates and scheduled times. PADI, or if diving depth does not exceed 30 meters);
Country of origin means the country in which you maintained f) white water rafting (except grades 1 to 4);
a permanent residence prior to entry into Canada or, if g) street luge, skeleton activity;
different, the country which issued your passport. If you have
h) mountain climbing, which means the ascent or
more than one passport, country of origin will be the country
descent of a mountain requiring the use of specified
you indicated as such when applying for this insurance.
equipment including crampons, pick axes, anchors,
Dependent children means your unmarried children who: bolts, carabiners and lead-rope or top rope anchoring
equipment; and
a) reside with you; and
i) rock climbing, which includes but is not limited to
b) are financially dependent on you; and bouldering, ice climbing, lead or top-rope, multi-pitch,
c) are at least 15 days old and no more than 21 years old. soloing, sport climbing, trad climbing or via ferrata.
Rock climbing does not include climbing artificial rock
Effective date means the later of: walls when using proper safety equipment under
a) the date indicated as the effective date on your supervision.
confirmation of coverage; or
Hospital means a facility incorporated or licensed as a
b) the first time you exit your country of origin. hospital by the jurisdiction where such services are provided
and which has accommodation for resident in-patients,
If you purchase your policy after you have exited your country
a laboratory, a registered graduate nurse and physician
of origin, any sickness that manifests itself during the first 48
always on duty and an operating room where surgical
hours after the effective date is not covered even if related
operations are performed by a physician. In no event shall
expenses are incurred after the 48-hour waiting period.
this include a convalescent or nursing home, home for
Emergency means a sudden, unforeseen sickness or injury the aged, health spa, or an institution for the care of drug
occurring during the period of coverage while you are outside addicts, alcoholics or persons suffering from mental or
your country of origin, which requires immediate intervention by emotional disorders.
a physician or legally licensed dentist and cannot reasonably
Injury means bodily harm, which is directly caused by or
be delayed. An emergency is deemed to no longer exist when
resulting from an accident, being a sudden and unforeseen
medical evidence indicates that you are able to continue your
event, excluding bodily harm that results from deliberate or
trip or return to your place of ordinary residence or country of
voluntary action, and independent of sickness and all other
origin. Costs incurred in your country of origin are not covered.
causes.
Expiry date means the earlier of:
Insured person means an eligible person who has been
a) the date indicated as the expiry date on your accepted by Allianz Global Assistance or its authorized
confirmation of coverage; or representative, and has paid the required premium for a
b) the date you become eligible for coverage under a specific plan of insurance.
Canadian government insurance health plan.
Insurer means CUMIS General Insurance Company, a
Family member means your spouse, parent, brother, sister, member of The Co-operators group of companies.
legal guardian, step-parent, step-child, step- brother, step-
Lung/respiratory condition includes asbestosis, bronchial
sister, aunt, uncle, niece, nephew, grandparent, grandchild,
asthma, bronchiectasis, chronic asthma, chronic bronchitis,
in-law, ward, natural or adopted child.
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chronic obstructive pulmonary disease (COPD), emphysema, Reasonable and customary means the services customarily
pulmonary embolism, pulmonary fibrosis, and tuberculosis. provided or the costs customarily incurred for covered losses,
which are not in excess of the standard practice or paid fee
Medical consultation means any medical services obtained in the geographical area where the services are provided
from a licensed medical practitioner for a sickness, injury or or costs are incurred for comparable treatment, services or
medical condition, including but not limited to any or all of: supplies for a similar sickness or injury.
history taking, medical examination, investigative testing,
advice or treatment, and during which a diagnosis of the Sickness means any illness or disease.
condition need not have been definitively made. This does
not include regular medical check-ups where no medical Signs or symptoms means any evidence of disease
signs or symptoms existed between check-ups or were found experienced by you or recognized through observation.
during the check-up.
Spouse means a person less than 60 years of age, who
Medical/Dental Association schedule of fees means the a) is legally married to you; or is
official schedule of fees published by the medical/dental
b) a person who has been living with you in a common-
association, society or college of the province or territory in
law relationship for a period of at least 12 consecutive
which the treatment or service occurred. If the province or
months.
territory does not publish an official schedule of fees, benefits
payable under this policy will be in accordance with the Stable describes any medical condition or related condition,
provincial medical/ dental association schedule of fees in including any heart condition or lung/respiratory condition,
Canada closest to where the treatment or service occurred. for which:
Necessary means medically required treatment for an a) there has been no new treatment; and
unexpected sickness or injury. b) there has been no change in treatment or change in
treatment frequency or type; and
Nuclear, chemical or biological means the use of any
nuclear weapon or device or the emission, discharge, c) there have been no signs or symptoms or new
dispersal, release or escape of any solid, liquid or gaseous diagnosis; and
chemical agent and/or biological agent, including the d) there have been no test results showing deterioration;
resultant contamination where: and
• Nuclear means any occurrence causing bodily injury, e) there has been no hospitalization; and
sickness, disease, or death, or loss of or damage to
property, or for loss of use of property, arising out of f) there has been no referral to a specialist (made or
or resulting from the radioactive, toxic, explosive, or recommended) and you are not awaiting surgery or
other hazardous properties of source, special nuclear, the results of further investigations performed by any
or by-product material. medical professional.

• Chemical agent means any compound which, when The following are also considered stable:
suitably disseminated, produces incapacitating, a) Routine (not prescribed by a physician) adjustment
damaging or lethal effects on people, animals, plants of insulin to control diabetes provided the insulin was
or material property. not first prescribed during the 90 days immediately
• Biological agent means any pathogenic (disease before the effective date of this policy.
producing) micro-organism(s) and/or biologically b) Change from a brand name medication to a generic
produced toxin(s) (including genetically modified medication provided the medication was not first
organisms and chemically synthesized toxins) which prescribed during the 90 days immediately before the
cause illness and/or death in humans, animals or plants. effective date of this policy and there is no increase or
Period of coverage means the period from the effective decrease in dosage.
date to the expiry date as indicated on your confirmation of c) A minor ailment, which describes a sickness or injury
coverage and for which premium has been paid. which ended more than 30 days prior to the effective
date and which did not require:
Physician means a person other than you, who is legally
qualified and licensed to practice medicine or perform i. treatment for a period longer than 15 consecutive
surgery in the location where the services are performed, and days; or
who is not related to you by blood or marriage. ii. more than one follow-up visit to a physician; or

Professional means you are considered professional by iii. hospitalization, surgery, or referral to a specialist.
the governing body of the sport and are paid for your
participation whether you win or lose.

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Student means a person: Terminal applies to a medical condition for which a physician
a) whose country of origin is not Canada and who is gave a prognosis of eventual death or for which palliative
residing in Canada on a temporary basis; and care was received prior to the effective date.

b) who: Treatment means medical, therapeutic or diagnostic

i. is registered at a school, college, university or other procedure prescribed, performed or recommended by a
governmentally accredited educational institution physician including, but not limited to, prescribed medication,
in Canada and attends classes as a full-time investigative testing or surgery.
student, as defined by the institution; or Trip means a period during which you are travelling outside
ii. remains in Canada for up to one year immediately of your country of origin and for which coverage is in effect.
after completion of studies as described above,
and who is working or has applied to work in a You or your means the insured person.
field related to the studies completed.

Legal Information

General Provisions Benefit Payments

Unless otherwise stated, all provisions in this policy apply to
Assignment each insured person during one period of coverage. Benefits
are only payable under one policy for each insured person
Any benefits payable or which may become payable under during the period of coverage.
this policy cannot be assigned by you, and the insurer is not
responsible for and will not be bound by any assignment If more than one Allianz Global Assistance administered
entered into by you. policy is in effect at the same time, benefits will only be
paid under one insurance policy, the one with the greatest
sum insured. Benefits are only payable for the plans and
Automatic Extension of Coverage
the specific sum insured selected, paid for and accepted by
1. Delay of conveyance. Coverage will be automatically Allianz Global Assistance at the time of application, and
extended for up to 72 hours in the event of a delay, due indicated on your confirmation of coverage.
to circumstances beyond your control, of the conveyance
Any benefits payable do not include interest charges.
in which you are riding or are scheduled to ride as a
Benefits payable as a result of your death will be payable to
passenger. The delay must occur prior to the coverage
your named beneficiary or to your Estate.
expiry date and the conveyance must be due to arrive
prior to the coverage expiry date.
Claim Submission
Conveyance means a vehicle, airline, bus, train, or
government-operated ferry system. You or the claimant, if other than you, shall be responsible for
providing Allianz Global Assistance with the following:
2. Medically unfit to travel. Coverage will be automatically
extended for up to 5 days if medical evidence supports 1. receipts from commercial organizations for all medical
that you are medically unfit to travel due to a covered costs incurred and itemized accounts of all medical
sickness or injury on or before the coverage expiry date. services which have been provided; and
3. Hospitalization. Coverage will be automatically 2. any payment made by any other insurance plan or
extended during the period of hospital confinement, contract, including a government hospital/ medical plan;
plus 5 days after release to travel home, if you are and
hospitalized at the end of your trip as a result of a
covered injury or sickness. 3. substantiating medical documentation, at the request of
Allianz Global Assistance.
Additional premium will not be required for any automatic
extension of coverage. Failure to provide substantiating documents shall invalidate
all claims under this insurance.

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Coordination of Benefits Governing Law
With the exception of the Accidental Death and This policy will be governed by the laws of the Canadian
Dismemberment benefit, amounts payable under this plan province or territory where the policy was issued.
are in excess of any amounts available or collectible under
any existing coverage concurrently in force held by or Language
available to you.
The parties request that the policy and all related
Other coverage includes but is not limited to: documentation be drawn in English. Les parties demandent
• homeowners insurance; que la présente police ainsi que toute documentation
• tenants insurance; pertinente soient rédigées en anglais.

• multi-risk insurance;
Limit on Liability
• any credit card, third-party liability, group or
individual basic or extended health insurance; It is a condition precedent to liability under this policy that
• any private or legislative plan of motor vehicle at the time of application and on the effective date, you
insurance providing hospital, medical or therapeutic are in good health and know of no reason to seek medical
coverage. attention.

Reimbursement will not be made for any costs, services Limitation of Action
or supplies that are payable to you under a motor vehicle
insurance policy or legislative plan pursuant to the no-fault Every action or proceeding against an insurer for the
benefits schedule under any Insurance Act, or for which you recovery of insurance money payable under the contract
receive benefits from any other party pursuant to any policy is absolutely barred unless commenced within the time
or legislative plan of motor vehicle insurance, until such set out in the Insurance Act (for actions or proceedings
benefits are exhausted. (Does not apply to Accidental Death governed by the laws of Alberta and British Columbia), The
and Dismemberment benefits) Insurance Act (for actions or proceedings governed by the
laws of Manitoba), the Limitations Act, 2002 (for actions
You may not claim or receive in total more than 100% of the or proceedings governed by the laws of Ontario) The
loss caused by the insured event. Limitations Act (for actions and proceedings in the province
of Saskatchewan), or other applicable legislation. For those
Currency actions or proceedings governed by the laws of Quebec, the
prescriptive period is set out in the Quebec Civil Code.
All amounts stated in the policy including premium are in
Canadian dollars. At the option of Allianz Global Assistance,
benefits may be paid in the currency of the country where the Misrepresentation or Nondisclosure
loss occurred. Your failure to disclose or misrepresentation of any material
fact, or fraud, either at the time of application or at the time
Extending Your Trip of claim, shall render the entire contract null and void at the
option of the insurer, and any claim submitted thereunder
If you decide to extend your trip, you may apply for a shall not be payable.
new period of coverage provided you meet the Eligibility
requirements of the new policy. Where there is an error as to your age, provided that your
age is within the insurable limits of this policy, the premiums
If you have incurred a claim, Allianz Global Assistance will will be adjusted according to your correct age.
review your file before deciding on granting a new policy.

Each policy or term of coverage is considered a separate Premiums

contract.
The total premium amount is due and payable at the time
Allianz Global Assistance reserves the right to decline any of application. The premium is calculated using the most
request for new terms of coverage. current rates for your age on the effective date of this policy
as indicated on your confirmation of coverage.
General Terms
Rights of Examination
Policy terms and conditions are subject to change with each
new policy purchased, without prior notice, to reflect actual The claimant shall provide Allianz Global Assistance with
experience in the marketplace. the opportunity to examine you when and so often as it

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reasonably requires while a claim is pending. In the case Premium Refunds
of your death, Allianz Global Assistance may require an
autopsy, subject to any laws of the applicable jurisdiction A full refund will be provided for policies which are returned
relating to autopsies. within 10 days of purchase, as described in the section titled
Right To Examine Policy.
Right to be Reimbursed (Subrogation) Refunds are payable when:
As a condition to receiving benefits under the policy, you
1. The student fails to meet visa eligibility requirements.
agree to:
a) reimburse the insurer for all emergency medical and 2. You return to your country of origin prior to the expiry
hospital costs paid under the policy from any amounts date, without intending to return to Canada, 30 days or
you receive from a third party responsible (in whole more before the expiry date.
or in part) for your injury or sickness whether such 3. You become insured under a Canadian provincial or
amounts are paid under a judgment or settlement territorial health/medical plan.
agreement;
When submitting your premium refund request, please
b) whenever reasonable, initiate a legal action against
include:
the third party to recover your damages, which
include emergency medical and hospital costs paid 1. a fully completed and signed Refund Request Form; and
under the policy;
2. a copy of your confirmation of coverage; and
c) include all emergency medical and hospital costs
paid under the policy in any settlement agreement 3. confirmation of your early departure such as boarding
you reach with the third party; pass or itinerary, or any other written proof of your early
d) act reasonably to preserve the insurer’s right to be return to your country of origin; and
reimbursed for any emergency medical or hospital 4. any other documentation to support your refund request.
costs paid under the policy;
Important Note
e) keep Allianz Global Assistance informed of the status
of any legal action against the third party; and Premium refunds, regardless of method of payment, must
f) advise your counsel of the insurer’s right to be obtained from the representative where coverage was
reimbursement under the policy. originally purchased unless purchased directly from Allianz
Global Assistance.
Your obligations under this section of the policy in no way
restricts the insurer’s right to bring a subrogated claim in your There will be no refund of premium if a claim has been made.
name against the third party and you agree to cooperate Refunds are payable from the date Allianz Global Assistance
with the insurer fully should they choose to exercise their receives the request. Refunds for partial cancellations will be
right of subrogation. calculated by multiplying the daily premium by the actual
number of days the policy was in effect; if this amount is less
than the minimum premium required, the minimum premium
Sanctions
will be used. This amount is then subtracted from the total
Benefits are not payable under this policy for any losses or premium paid.
expenses incurred due to or as a result of your travel to a
Refund amounts less than the minimum premium will not be
sanctioned country for any business or activity that would
issued.
violate any Canadian or any other applicable national
economic or trade sanction law or regulation.

Time
Expiry time of coverage is the time within the Canadian time
zone where the coverage was purchased.

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Statutory Conditions 2. any payment made by any other insurance plan or
contract, including a government hospital/ medical plan;
and
Contract
3. supporting medical documentation, at the request of
The application, this policy, any document (including but not Allianz Global Assistance.
limited to the completed medical questionnaire, Confirmation
of Coverage) attached to this policy when issued and any If you do not provide the required supporting documentation,
amendment to the contract agreed on in writing after this your claim will not be paid.
policy is issued, constitute the entire contract, and no agent
has the authority to change the contract or waive any of its Failure to Give Notice and Proof
provisions.
Failure to give notice of claim or furnish proof of claim within
Allianz Global Assistance reserves the right to decline any the time prescribed does not invalidate the claim if:
application or any requests for extensions of coverage.
a) the notice or proof is given or furnished as soon as
reasonably possible, and in no event later than the
Waiver limitation period set out in The Limitations Act from the
date of the accident or the date a claim arises under
The insurer shall be deemed not to have waived any the contract on account of sickness or disability if it
condition of this contract, either in whole or in part, unless the is shown that it was not reasonably possible to give
waiver is clearly expressed in writing signed by the insurer. notice or furnish proof within the time so prescribed; or
b) in the case of your death, if a declaration of
Copy of Application presumption of death is necessary, the notice or
proof is given or furnished no later than the limitation
The insurer shall, upon request, furnish you or a claimant
period set out in The Limitations Act after the date a
under the contract a copy of the application.
court makes the declaration.

Material Facts
Insurer to Furnish Forms for Proof of Claim
No statement made by you or a person insured at the time
Claims forms are available by contacting Allianz Global
of application for the contract shall be used in defence of a
Assistance’s Claims Department and shall be furnished to
claim under or to avoid the contract unless it is contained in
you upon request, and no later than 15 days after receiving
the application or any other written statements or answers
notice of claim.
furnished as evidence of insurability.

Termination Rights of Examination

The claimant shall provide the insurer with the opportunity
You may at any time request that this contract be terminated
to examine you when and so often as it reasonably requires
and the insurer shall, as soon as practical after you make
while a claim is pending. In the case of your death, the insurer
the request, refund the amount of premium actually paid by
may require an autopsy, subject to any laws of the applicable
you that is in excess of the short-rate premium calculated to
jurisdiction relating to autopsies. The insurer shall bear the
the date of the request according to the table in use by the
costs of any examination or autopsy and shall provide copies
insurer at the time of the termination.
of the reports of any examination or autopsy to the insured or
Refer to Premium Refunds on page 15. the insured’s representative.

Notice and Proof of Claim When Money Payable

Please refer to the Claims Procedures on page 9. All money payable under this contract shall be paid by the
insurer within 60 days after Allianz Global Assistance has
You or the claimant, if other than you, shall be responsible for received proof of claim.
providing Allianz Global Assistance with the following:

1. receipts from commercial organizations for all medical

costs incurred and itemized accounts of all medical
services which have been provided; and

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Privacy Information Notice We reserve our right to collect personal information, necessary
for insurance purposes, from the following individuals:
• Individuals who apply for insurance products
Protecting your personal information
• Certificate holder and/or Policyholders
Protecting your personal information is a top priority. This
• Insureds and/or Claimants
Privacy Notice explains how and what types of personal
data will be collected, why it is collected and to whom it is • Family members, friends or travelling companions
shared or disclosed. PLEASE READ THIS NOTICE CAREFULLY. of a Certificate or Policyholder, Insured or Claimant,
in cases where you, for medical or other reasons,
CUMIS General Insurance Company (the “insurer”) and the cannot communicate directly with Us.
insurer’s insurance administrator, Allianz Global Assistance,
and the insurer’s agents, representatives and reinsurers (for
the purpose of this Privacy Notice collectively “We” “Us” and
Who will have access to your personal information?
“Our”) require your personal information. We disclose information for insurance purposes, to and with,
third parties such as, but not necessarily limited to, other Allianz
Personal information we collect group companies, health care practitioners and facilities in
Canada and abroad, government and private health insurers,
We will collect your personal information including but not family members and friends/ travelling companions of the
limited to: Certificate holder or Policyholder, Insured or Claimant and
• Surname, First name agencies. We may also use and disclose information from
Our existing files for insurance purposes. Our employees who
• Address require this information for the purposes of administering your
• Date of Birth insurance will have access to this file. Upon your request and
• Telephone numbers authorization, We may also disclose this information to other
persons. From time to time, and if permitted by applicable
• Email addresses law, We may also collect, use or disclose personal information
• Credit/debit card and bank account information in order to offer additional or upgraded products and
services (the “optional purposes”). In some instances We may
• Employment details including termination notices
additionally maintain or communicate or transfer information
and accepted offers of employment
to health care and other service providers located outside of
• Sensitive personal information such as: Medical Canada. As a result, personal information may be accessible to
information relating to your health status, excluding regulatory authorities in accordance with the law of these other
genetic test results jurisdictions.

How will we obtain and use your personal information? What are your rights in respect of your personal data?
This personal information is collected for the following When permitted by applicable law and regulations you have
insurance purposes when offering and providing insurance the right to:
and related services:
• Access your personal data held about you
• To identify and communicate with you
• Withdraw consent at any time where your personal
• To consider any application for insurance data is processed
• If approved, to issue a Policy or Certificate of Insurance • Update or correct your personal information so that it
• To administer insurance and related benefits is always accurate
• To evaluate insurance risk, manage and coordinate • Delete your personal information from our records, if it
claims, re-price medical expenses and negotiate is no longer needed for the purposes indicated above
payment of claims expenses • File a complaint with Us and/or relevant data
• To adjudicate claims and to determine eligibility for protection authority
insurance benefits
You may exercise these rights by contacting the Privacy
• To provide assistance services Officer at [email protected].
• For fraud prevention and debt collection purposes
• As required or permitted by law

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How long do we keep your personal data?
We will retain the personal information We collect for a
specified period of time and in a storage method appropriate
with legal and Our internal corporate requirements.
Personal information will be securely destroyed following the
expiration of the appropriate retention period. Individuals
have a right to request to access or correct personal
information We have on file by contacting the Privacy Officer
at [email protected] or by writing to:

Privacy Officer

Allianz Global Assistance

700 Jamieson Parkway
Cambridge, Ontario N3C 4N6 Canada

How can you contact us?

For information about how to obtain access to written
information about Our policies and procedures with respect
to service providers outside of Canada, please contact the
Privacy Officer at [email protected].

For a complete copy of Our Privacy Policy, please visit

www.allianz-assistance.ca.

How often do we update this privacy notice?

We regularly review this Privacy Notice. We will ensure the
most recent version is available on Our website,
www.allianz-assistance.ca.

Contact Information

Administrator:

Allianz Global Assistance

700 Jamieson Parkway
Cambridge, Ontario N3C 4N6
1-800-869-6747

Insurer:

CUMIS General Insurance Company

P.O. Box 5065, 151 North Service Road
Burlington, Ontario L7R 4C2
1-800-263-9120

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