8
3.
F
ailure to obtain advance approval
• Where an Eligible Medical Emergency Expense speciies that it must be approved in
advance by Our Administrator, if advance approval is not obtained, no beneit will be
payable for that expense.
• No beneit will be paid with respect to any surgery or invasive procedure that has not
been approved in advance by Our Administrator, except in extreme circumstances
where a request for prior approval would delay necessary surgery in a life-threatening
medical crisis.
4.
Treatment once it to transfer to another facility or return to Your home province or territory
If Our Administrator determines that You should transfer to another facility or return to
Your home province/territory of residence for Treatment, and You choose not to, beneits
will not be paid for further medical Treatment.
5. Ongoing Medical Emergency Treatment requires pre-approval (Investigations, Treatment
and surgery)
After Your Medical Emergency Treatment has started, Our Administrator must assess
and pre-approve additional medical Treatment. If You undergo tests as part of a medical
investigation, Treatment or surgery, obtain Treatment or undergo surgery that is not
pre-approved, Your claim will not be paid. This includes but not limited to invasive testing,
surgery, cardiac catheterization, other cardiac procedures, transplant, and MRI.
6. Non-Emergency Services
We will not pay a beneit with respect to non-Medical Emergency, experimental or elective
Treatment, including:
• cosmetic surgery, chronic care, rehabilitation including any expenses for directly or
indirectly related complications;
• placement of new crowns, bridges, dentures.
7. Recurrence or ongoing Treatment once Medical Emergency has ended
• We will not pay a beneit with respect to the continued Treatment, recurrence or
complication of a Medical Condition or related condition, following Treatment during
Your trip, if Our Administrator determines that Your Medical Emergency has ended.
•
We will not pay a beneit with respect to the continued Treatment, recurrence or
complication of a Medical Condition or related condition where Treatment was received
without notiication to Our Administrator and Your Medical Emergency has ended.
8. Failure to meet the requirement to be covered by a GHIP or Canadian Armed Forces
health care plan
We will not pay a beneit if You are not covered under the GHIP of Your province or
territory of residence prior to and for the entire duration of the trip. It is Your responsibility
to check that You do have this coverage. There is no coverage if You do not have a valid
GHIP. Members of the Canadian Armed Forces must have a valid health care plan in
Canada prior to and for the entire duration of the Covered Trip.
9.
T
ravelling for the purpose of obtaining Treatment
• We will not pay a beneit if a trip is made for the purpose of obtaining a diagnosis,
medical Treatment, surgery, investigation, palliative care, or any alternative therapy, as
well as any directly or indirectly related complication.
1
0. Trave lling when Treatment could be expected
•
We will not pay a beneit if any Medical Condition or symptoms for which it is reasonable
to believe or expect that Treatment or Hospitalization will be required during Your trip.
• We will not pay a beneit if any evident symptoms that would be reasonable to expect
You to investigate in the 3months prior to Your Departure Date on a Covered Trip.
11. Medical Emergency occurring outside the Coverage Period
We will not pay a beneit if a Medical Emergency that occurs before the Coverage Period
begins or after it ends:
• For an Insured Person 64years of age and under, this means, for example, that no
beneit will be paid with respect to any Medical Emergency if an Insured Person’s
Medical Emergency occurs after the irst 21days following an Insured Person’s
Departure Date from their province or territory of residence.
• For an Insured Person 65years of age or older, this means, for example, that no beneit
will be paid with respect to any Medical Emergency if an Insured Person’s Medical
Emergency occurs after the irst 4days following an Insured Person’s Departure Date
from their province or territory of residence.
For clarity, no beneit will be paid with respect to a Medical Emergency that occurs after
11:59p.m.ET on the last day of the Coverage Period, if You have not purchased top-up
coverage. Note: The day of departure counts as a full day for this purpose.