Group Benefits Plan Information

Charges, as described in the Covered Expenses section, that are incurred outside the province of residence or outside Canada will be payable, less the amount payable by the Provincial Plan.

Medical Emergency ~100% of expenses to a lifetime maximum of CDN $5,000,000

Medical Referral ~ 50% of expenses to a maximum of CDN $3,000 every 3 calendar years.

Please carefully read the Covered Expenses section and the Special Definitions that apply to the travel health benefit, as well as the exceptions.

The following terms apply for the purposes of medical Treatment provided outside of the insured person’s province/territory of residence.

Hospital

A Hospital is an institution that is licensed as an accredited hospital that is staffed and operated for the care and Treatment of in-patients and out-patients. Treatment must be supervised by Physicians and there must be registered nurses on duty 24 hours a day. Diagnostic and surgical capabilities must also exist on the premises or in facilities controlled by the establishment.

A Hospital is not an establishment used mainly as a clinic, extended or palliative care facility, rehabilitation facility, addiction treatment centre, convalescent, rest or nursing home, home for older adults or health spa.

Medical Condition

Any disease, illness or injury (including symptoms of undiagnosed conditions).

Medical Emergency

A sudden and unforeseen Medication Condition that requires immediate Treatment. A Medical Emergency no longer exists when the evidence reviewed by Manulife indicates that no further Treatment is required at destination or the insured person is able to return to their province/territory of residence for further Treatment.

Physician

A Physician is a person licensed in the jurisdiction where the services are provided, to prescribe and administer medical Treatment.

Reasonable and Customary Charges

Charges incurred for drugs, services and supplies that are comparable to what other providers charge for similar drugs, services and supplies in the same geographical area.

The lowest of:

a) the prevailing amount charged in the absence of insurance for the same or comparable drug, service or supply in the same geographical area in which the charge is incurred, as determined by Manulife; or

b) the amount shown in the applicable professional association fee guide; or

c) the maximum price established by law; or

d) the amount as determined by Manulife as reasonable to be charged for the drug, service, or supply.

Stable

A Medical Condition is considered Stable when in the 90 days prior to departure all of the following statements are true:

1. there has not been any new Treatment prescribed or recommended, or change(s) to existing Treatment, and
2. there has not been any change to any existing prescribed drug, or any recommendation or starting of a new prescription drug, not including regular changes in medication that are made as part of an ongoing treatment or a reduction in medication due to an improvement in the medical condition, and
3. the Medical Condition has not become worse, and
4. there have not been any new, more frequent or more severe symptoms,
5. there has been no hospitalization or referral to a specialist, and
6. there have not been any tests, investigation or Treatment recommended, but not yet complete, not any outstanding test results, and
7. there is no planned or pending treatment.

All of the above conditions must be met for a Medical Condition to be considered Stable.

Treatment, Treat, Treated

A procedure prescribed, performed or recommended by a Physician for a Medical Condition. This includes but is not limited to prescribed medication, investigative testing and surgery.

Medical Emergency (see definition for description of what this is)

Charges incurred for the following medical treatment given outside the insured person’s province/territory of residence:

a) treatment required as a result of a Medical Emergency arising during the first 60 days while temporarily outside the province of residence provided that the insured person who receives the Treatment is also covered by the Provincial Plan during the absence from the province of residence, up to the Out-of Canada Maximum indicated in the Coverage limits for Travel.

b) referral outside of Canada for medical Treatment which is available in Canada, up to the referral outside of Canada for medical Treatment which is available in Canada, up the Referral outside Canada maximum.

If, while outside Canada on referral for medical Treatment, the insured person required Treatment for a Medical Condition which is related directly or indirectly to the referral Treatment, the total expenses payable for all Treatment are subject to the Referral outside Canada maximum indicated in the Coverage limits for Travel.

Medical Referral  (see definition section for description of what this is)

For all Treatment given outside of Canada, other than emergency medical Treatment, Manulife:

i.) requires that it be recommended as necessary by a Physician practicing in Canada, and

ii.) suggests that a detailed Treatment plan be submitted with cost estimates before Treatment begins.

Manulife will then advise the Employee of any benefit that will be provided.

If, while outside Canada on referral for medical Treatment, the insured person required Treatment for a Medical Condition which is related directly or indirectly to the referral Treatment, the total expenses payable for all Treatment are subject to the Referral outside Canada maximum indicated in the Coverage limits for Travel.

Charges for the following are payable under this Covered Expenses:

• Physician’s services;
• Hospital room and board at standard Ward rates;
• the cost of special Hospital services;
• Hospital charges for out-patient Treatment;
• licensed ambulance services, including air ambulance, to transfer the patient to the nearest medical facility or Hospital where adequate Treatment is available; and
• medical evacuation for admission to a Hospital or medical facility in the province/territory where the patient normally resides.

Covered Expenses will be limited to Reasonable and Customary charges less the amount payable by the Provincial Plan, or which would have been payable had proper application been made.

All other charges incurred outside the province/territory of residence are payable under the appropriate Covered Expenses on the same basis as if they were incurred in the province/territory of residence.

a) 24-Hour Access

Multilingual assistance is available 24 hours a day, seven days a week, through telephone (toll-free or call collect), telex or fax.

b) Medical Referral

Referral to the nearest Physician, dentist, pharmacist or appropriate medical facility, and verification of insurance coverage, is provided.

c) Claims Payment Service

Payment and co-ordination of expenses will take into account the coverage that the insured person is eligible for under a Provincial/Territorial Plan and this Policy. If such payments are subsequently determined to be in excess of the amount of benefits to which the insured person is entitled, Manulife Financial shall have the right to recover the excess amount by assignment of Provincial/Territorial Plan benefits and/or refund from the Employee.

d) Medical Care Monitoring

Medical care and services rendered to the insured person will be monitored by medical staff who will maintain contact, as frequently as necessary, with the insured person, the attending Physician, the insured person’s personal Physician and family.

e) Medical Transportation

If Medically Necessary, arrangements will be made to transfer an insured person to and from the nearest medical facility or to a medical facility in the insured person’s province/territory of residence. Expenses incurred for the medical transportation will be paid, as described under Medical Services and Supplies – Out-of-Province or Out-of-Canada.

If Medically Necessary for a qualified medical attendant to accompany the insured person, expenses incurred for round-trip transportation will be paid.

f) Return of Dependent Children

If dependent children are left unattended due to the hospitalization of an insured person, arrangements will be made to return the children to their home. The extra costs over and above any allowance available under pre-paid travel arrangements will be paid.

If necessary for a qualified escort to accompany the Dependent Children, expenses incurred for round-trip transportation will be paid.

g) Trip Interruption/Delay

If a trip is interrupted or delayed due to an illness or injury of an insured person, one-way economy transportation will be arranged to enable each insured person and a Travelling Companion (if applicable) to rejoin the trip or return home. Expenses incurred, over and above any allowance available under pre-paid travel arrangements will be paid.

A Travelling Companion is any one person travelling with the insured person, and whose fare for transportation and accommodation was pre-paid at the same time as the insured person’s fare.

If the insured person chooses to rejoin the trip, further expenses incurred which are related directly or indirectly to the same illness or injury, will not be paid.

h) After Hospital Convalescence

If an insured person is unable to travel due to medical reasons following discharge from a Hospital, expenses incurred for meals and accommodation after the originally scheduled departure date will be paid, subject to the maximum of this provision.

i) Visit of Family Member

Expenses incurred for round-trip economy transportation will be paid for an Immediate Family Member to visit an insured person who, while travelling alone, becomes hospitalized and is expected to be hospitalized for longer than 7 days. The visit must be approved in advance by Manulife Financial.

j) Vehicle Return

If an insured person is unable to operate his owned or rented vehicle due to illness, injury or death, expenses incurred for a commercial agency to return the vehicle to the insured person’s home or nearest appropriate rental agency will be paid, up to a maximum of $1,000 (Canadian).

k) Identification of Deceased

If an insured person dies while travelling alone, expenses incurred for round-trip economy transportation will be paid for an immediate family member to travel, if necessary, to identify the deceased prior to release of the body.

l) Meals and Accommodation

Under the circumstances described in parts f), g), h), i), and k) of this provision, expenses incurred for meals and accommodation will be paid, subject to a combined maximum of $2,000 (Canadian) per Medical Emergency.

a) Return of Deceased to Province/Territory of Residence

In the event of the death of an insured person, the necessary authorizations will be obtained and arrangements made for the return of the deceased to their province/territory of residence. Expenses incurred for the preparation and transportation of the body will be paid, up to a maximum of $5,000 (Canadian). Expenses related to the burial, such as a casket or an urn, will not be paid.

b) Lost Document and Ticket Replacement

Assistance in contacting the local authorities is provided, to help an insured person in replacing lost or stolen passports, visas, tickets or other travel documents.

c) Legal Referral

Referral to a local legal advisor, and if necessary, arrangement for cash advances from the insured person’s credit cards, family or friends, is provided.

d) Interpretation Service

Telephone interpretation service in most major languages is provided.

e) Message Service

Telephone message service is provided for messages to or from family, friends or business associates. Messages will be held for up to 15 days.

f) Pre-trip Assistance Service

Up-to-date information is provided on passport and visa, vaccination and inoculation requirements for the country where the insured person plans to travel.

Manulife Financial, and the company contracted by Manulife Financial to provide the travel assistance services described in this Benefit, will not be responsible for the availability, quality, or results of any medical Treatment, or the failure of an insured person to obtain medical Treatment or emergency assistance services for any reason.

Emergency assistance services may not be available in all countries due to conditions such as war, political unrest or other circumstances which interfere with or prevent the provision of any services.

No Out-of-Province/Out-of-Canada Medical Emergency benefits are payable for expenses directly or indirectly related to:

a) any Medical Condition which is not Stable in the 90 days before the scheduled date of departure from the province/territory of residence;

b) self-inflicted injuries, unless medical evidence establishes that the injuries are related to a mental health illness;

c) further related medical Treatment if Manulife determines that the insured person should transfer to another facility or return to their home province/territory of residence for treatment;

d) tests, Treatment or surgery for which the insured person could have returned home, after Medical Emergency Treatment has started. This includes but is not limited to invasive or investigative testing, MRI, CT, surgery, cardiac catheterization, other cardiac procedures, transplant, and follow up appointments;

e) non-Emergency or elective Treatment (e.g. cosmetic surgery, chronic care, rehabilitation, or Treatment not immediately medically required, including any expenses for directly or indirectly related complications);

f) any claim, if the insured person is not covered under the Government Health Insurance Plan (GHIP) of their province or territory of residence for the entire duration of the trip. It is the insured person’s responsibility to check that they do have this coverage;

g) any charges incurred relating to a trip made for the purpose of obtaining a diagnosis, Treatment, surgery, investigation, palliative care, or any alternative therapy, as well as any directly or indirectly-related complication;

h) any Medical Condition or symptoms for which it is reasonable to believe or expect that Treatments will be required during the trip;

i) the continued Treatment, recurrence or complication of a Medical Condition or related condition, following Emergency Treatment during the trip, if Manulife determines that the Emergency has ended and the insured person is able to return to their province/territory of residence for further Treatment;

j) a Medical Condition that is the result of the insured person not following Treatment as prescribed, including prescribed prescription or over-the-counter medication;

k) any Medical Emergency related to a pregnancy, delivery, or complications of either, for insured persons who are pregnant and travelling within 4 weeks of the expected date of delivery;

l) a Medical Condition arising during the trip from, or in any way related to, the insured person operating a motor vehicle or watercraft of  any kind while impaired by a drug or any intoxicant or having a blood alcohol level of more than 80 mg of alcohol per 100 ml of blood.