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Effective May 30, 2007, RBC Travel Insurance Company has changed its name to RBC Insurance Company of Canada. Please note that this change does not affect the terms of your travel insurance coverage.
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Out of Province/Country Emergency Medical & Travel Assistance Insurance
RBC Royal Bank® Visa* CreditLine for Small Business™ Out of Province/Country Emergency Medical Insurance Certificate of Insurance
Introduction
IMPORTANT – PLEASE READ: This Certificate of Insurance is a valuable source of information and
contains provisions that may limit or exclude coverage. Please read this Certificate of Insurance,
keep it in a safe place and carry it with you when you travel.
RBC Insurance Company of Canada (the "Insurer") has issued group insurance policy U-1014451-A to
Royal Bank of Canada ("RBC Royal Bank"), to cover emergency medical expenses incurred by
covered persons while outside their Canadian province or territory of residence. This Certificate
of Insurance summarizes the provisions of this group insurance policy.
All italicized terms have the specific meaning explained in the "Definitions" section of this
Certificate of Insurance.
WHAT TO DO IN A MEDICAL EMERGENCY?
If you have a medical emergency, you must call Assured Assistance Inc. (Assured Assistance) before
you receive emergency services. Of course, if your medical condition prevents you from calling, we
understand - you must call as soon as medically possible or, as an alternative, someone else may
call on your behalf (relative, friend, nurse or doctor).
Assured Assistance can be contacted by calling:
1-800-426-5333 toll-free from the US & Canada, or
(905) 816-2582 collect from anywhere in the world
If you do not call Assured Assistance or if you choose to seek care from a non-approved medical
service provider, you will be responsible for a portion of your medical expenses as outlined under
"Limitations of Coverage".
DEFINITIONS
Throughout this document, all italicized terms have the specific meaning explained below.
Cardholder means a person to whom RBC Royal Bank has issued an RBC Royal Bank® Visa* CreditLine for Small Business™ card, and who has chosen the Travel Benefits Package.
Covered person means any cardholder who is under the age of 65 and has a valid government
health insurance plan. A covered person may be referred to as "you" or "your" or "yourself".
Departure point means the province or territory you depart from on the first day of your
intended trip.
Emergency services means any treatment, surgery or medication that:
- is required for the immediate relief of an acute symptom; or
- upon the advice of a physician cannot be delayed until you return to Canada, and has to be received during your trip because your medical condition prevents you from returning to Canada.
The emergency services must be ordered by or received from a physician or received in a hospital
during your trip.
Government health insurance plan means the health insurance coverage that Canadian provincial
and territorial governments provide for their residents.
Hospital means an institution licensed to treat patients on an in-patient, out-patient and
emergency basis, which has an operating room and laboratory, and which is operated under the
supervision of a staff of physicians. It does not include any establishment which is licensed or used
principally as a clinic, extended or palliative care facility, rehabilitation facility, convalescent, rest
or nursing home, home for the aged, health spa or addiction treatment centre.
Hospitalization means a stay of at least 48 hours in a hospital for emergency medical treatment,
which cannot be postponed.
Medical condition means accidental bodily injury or sickness (or a condition related to that
accidental bodily injury or sickness), including disease, acute psychoses and complications of
pregnancy occurring within the first 31 weeks of pregnancy.
Medical emergency means any unexpected or unforeseen sickness or bodily injury that occurs
during the period of coverage and makes it necessary for you to receive immediate treatment
from a physician or to be hospitalized.
Mountain climbing climbing means the ascent or descent of a mountain requiring the use of
specialized equipment, including crampons, pick-axes, anchors, bolts, carabiners and lead- or top-rope
anchoring equipment.
Physician means someone who is not you or a member of your family who is licensed to prescribe
drugs and administer medical treatment (within the scope of such license) at the location where
the treatment is provided. A physician does not include a naturopath, herbalist or homeopath.
Prescription drugs means drugs and medicines that can only be issued upon the prescription of a
physician or dentist and are dispensed by a licensed pharmacist.
Stable means any medical condition or related condition (including any heart condition or any
lung condition) for which there have been:
- no new treatment or new prescribed medication, and
- no change in treatment or change in prescribed medication (including the amount of medication to be taken, how often it is taken, the type of medication or change in treatment frequency or type) and
- no new symptom, more frequent symptom or more severe symptom experienced and no test result showing a deterioration, and
- no hospitalization or referral to a specialist (made or recommended) or the results of further investigation not yet completed, for that medical condition or related condition (including any heart condition or any lung condition).
Trip means travel outside your Canadian province or territory of residence.
WHEN DOES COVERAGE BEGIN AND END?
This insurance provides coverage whenever you leave your province or territory of residence.
You will be covered for the first 31 consecutive days of a trip, including the date you leave on your
trip and the date you return from your trip. Coverage automatically extends beyond the 31-day
limit as follows:
- When you are hospitalized due to a medical emergency beyond the 31-day limit, your coverage will remain in force during your hospitalization and up to 5 days following your discharge from hospital.
- Coverage is automatically extended for up to 5 days when you must delay your return beyond the 31-day limit due to a medical emergency.
- Coverage is automatically extended for up to 72 hours when the delay of a plane, bus, ship or train in which you are a passenger causes your trip to extend beyond the 31-day limit.
COVERAGE ENDS AT THE EARLIEST OF:
- the date you return to your province or territory of residence;
- the date your RBC Royal Bank® Visa* CreditLine for Small Business™ account is cancelled;
- the date your RBC Royal Bank® Visa* CreditLine for Small Business™ account is 60 days past due;
- the date you have been absent for more than 31 consecutive days from your province or territory of residence;
- the date you attain age 65;
- the date the cardholder attains age 65; or
- the date the group insurance policy terminates.
WHAT RISKS ARE INSURED?
This insurance covers reasonable and customary expenses, in excess of any medical expenses
payable by your government health insurance plan or any other insurance plan, for emergency
services medically required during your trip as a result of a medical emergency.
WHAT ARE THE BENEFITS?
-
Hospital & Medical Expenses
Covers the cost of a medical emergency including hospital, surgical and medical treatment. Eligible
expenses include the following when ordered by a physician during your trip :
- hospital room and board, up to semi-private or the equivalent,
- treatment by a physician or surgeon,
- out-patient hospital charges,
- x-rays and other diagnostic tests,
- use of an operating room, intensive care unit, anesthesia and surgical dressings,
- prescription drugs except when you need them to continue to stabilize a chronic medical condition or a condition which you had before your trip,
- local ground ambulance service (or local taxi fare in lieu) to a hospital, physician or medical service provider in a medical emergency ,
- the lesser of the rental or purchase of a hospital-type bed, a wheelchair, brace, crutches and other medical appliances, and
- the cost for the professional services of a registered private nurse while you are hospitalized, to a maximum of $10,000, when these services are recommended by a physician and approved in advance through Assured Assistance.
-
Emergency Dental Expenses
Covers the cost of the following dental expenses when ordered by, or received from, a
licensed dentist:
- the repair or replacement of natural teeth or permanently attached artificial teeth required as the result of an accidental injury to the mouth, to a maximum of $2,000. Dental treatment must be received within 90 days of the injury.
- treatment, during your trip, for the emergency relief of dental pain, to a maximum of $200.
-
Physiotherapy and Other Professional Services
Covers the cost for professional services of a physiotherapist, chiropractor, osteopath, chiropodist or
podiatrist to a maximum of $250 per profession, when ordered by a physician during your trip.
-
Emergency Air Transportation or Evacuation
Covers the cost of the following, when medically required and approved in advance and arranged
through Assured Assistance:
- the extra cost of a one-way economy air fare on a commercial flight by the most direct route to the point of departure to receive immediate emergency medical attention; or
- a stretcher fare on a commercial flight by the most direct route to the point of departure, if a stretcher is medically necessary; and
- a return economy air fare on a commercial flight and the usual fees and expenses for a qualified medical attendant to accompany you, when the attendant is medically necessary or required by the airline; or
- air ambulance transportation if it is medically essential.
-
Return of Deceased
Covers:
- the return of your remains in the common carrier's standard transportation container to your departure point, and up to $3,000 for the preparation of your remains and the cost of the common carrier's standard transportation container; or
- the return of your remains to your departure point, and up to $2,000 for the cremation of your remains where your death occurred; or
- up to $3,000 for the preparation of your remains and the cost of a standard burial container and up to $2,000 for the burial of your remains where your death occurred.
If someone is legally required to identify your remains, this insurance covers the cost of a round-
trip economy class transportation by the most cost effective route and up to $300 for meal and
hotel accommodation expenses for that person. That person is covered under the terms of your
insurance during the period in which he or she is required to identify your remains, but for no
longer than 3 business days.
-
Additional Hotel & Meal Expenses
Covers the cost of up to $150 per day, to a maximum of $1,500, for meal and commercial
accommodation expenses covered persons have incurred after the date you are scheduled to return
to the departure point, when your return is delayed due to your medical emergency or when you
are relocated to receive medical attention.
-
Bringing Relative to Bedside
Covers the cost of round-trip economy class transportation by the most cost effective route, to have
someone visit you when you are hospitalized during your trip for more than 3 days. However, if you
are under age 21, or age 21 and over and physically handicapped and dependent on your bedside
companion for support, this insurance provides this benefit to you as soon as you are admitted to a
hospital. That person is entitled to a maximum of $300 for meal and hotel accommodation expenses
and is covered under the terms of your insurance during the period in which he or she is required at
your bedside. The visit must be approved in advance through Assured Assistance.
-
Return of Vehicle
Covers the reasonable costs for a commercial agency, when arranged and approved through Assured
Assistance, to return a vehicle to your residence or to a commercial rental agency, when you are
unable to return the vehicle due to a medical emergency. The vehicle can be a private passenger
automobile, self-propelled mobile home, camper truck or trailer home that you own or rent and
which you use during your trip.
LIMITATIONS OF COVERAGE
If you do not call Assured Assistance before you seek emergency services, or if you choose to seek care
from a non-approved medical service provider, you will be responsible for 20% of your medical
expenses covered under this insurance and not recovered from your government health insurance plan,
to a maximum of $25,000. If, after reimbursement by your government health insurance plan, your
claim exceeds $25,000, this insurance will pay 100% of any eligible expenses over and above $25,000.
Should your medical condition prevent you from calling Assured Assistance before seeking emergency
services, you must call as soon as medically possible or someone else may call on your behalf.
PRE-EXISTING CONDITION EXCLUSION
This insurance does not pay for any expenses incurred directly or indirectly as a result of:
- Your medical condition or related condition, if at any time in the 90 days before you depart on your trip, your medical condition or related condition has not been stable .
- Your heart condition, if at any time in the 90 days before you depart on your trip :
- any heart condition has not been stable ; or
- you have taken nitroglycerin more than once per week specifically for the relief of angina pain.
- Your lung condition, if at any time in the 90 days before you depart on your trip :
- any lung condition has not been stable ; or
- you have been treated with home oxygen or taken oral steroids (prednisone or prednisolone) for any lung condition.
GENERAL EXCLUSIONS
The Insurer will not pay for any expenses incurred directly or indirectly as a result of:
- Any medical condition for which:
- you are awaiting the outcome of medical tests, the results of which show any irregularities or abnormalities, or
- future investigation or treatment (except routine monitoring) is planned before your trip.
- The continued treatment, investigation, recurrence or complication of a medical condition following emergency services for that medical condition during your trip if the medical advisors of Assured Assistance determine that you were medically able to return to your province or territory of residence and you chose not to return.
- The treatment of any heart or lung condition following emergency services for a related or unrelated heart or lung condition during your trip if the medical advisors of Assured Assistance determine that you were medically able to return to your province or territory of residence and you chose not to return.
- Any services that are not emergency services.
- Routine care of a chronic condition.
- The following:
- routine pre-natal care,
- any medical treatment directly or indirectly related to pregnancy , occurring within 9 weeks before or after the expected date of delivery, or
- childbirth occurring within 9 weeks before or after the expected date of delivery .
- Any child born during the trip.
- Invasive testing or surgery (including cardiac catheterization and MRI) unless approved by Assured Assistance prior to being performed.
- Your participation as a professional in sports, participation as a professional in underwater activities, scuba diving as an amateur unless you hold a basic scuba designation from a certified school or other licensing body, participation in a motorized race or motorized speed contest, bungee jumping, parachuting, rock climbing, mountain climbing, hang-gliding or skydiving.
- Your committing or attempting to commit a criminal of fence.
- Your intentional self-injury, suicide or attempted suicide (whether sane or insane).
- Your chronic use of alcohol.
- Your abuse of medication, drugs or alcohol or alcoholism, or your non-compliance with prescribed medical therapy or treatment.
- Your mental or emotional disorders, other than acute psychoses, unless you are hospitalized (where permitted by law).
- Act of foreign enemies or rebellion, voluntarily and knowingly exposing yourself to risk from an act of war (declared or not) or voluntarily participating in a riot or civil disorder.
- Any portion of the benefits that require prior authorization and arrangement by Assured Assistance if such benefits were not pre-authorized and arranged by Assured Assistance.
- Any medical condition or related condition that arises during a trip you undertake with the knowledge, acquired prior to departure, that you will require or seek treatment or surgery.
- Any medical condition for which it was reasonable, prior to departure, to expect treatment or hospitalization during your trip.
- Symptoms which would have caused an ordinarily prudent person to seek treatment or medication in the 90 days before your trip.
- Treatment or surgery for a medical condition or a related condition which:
- had caused your physician to advise you not to travel, or
- you contracted in a country during your trip when, before your trip, the Canadian government had issued an advisory not to travel within that country.
- Any medical condition if the medical advisors of Assured Assistance recommend that you return to your country of residence following emergency services you have received, and you chose not to return.
- Ionising radiation or radioactive contamination from any nuclear fuel or waste which results from the burning of nuclear fuels; or, the radioactive, toxic, explosive or other dangerous properties of nuclear machinery or any part of it.
WHAT TO DO IF YOU HAVE A CLAIM?
If you call Assured Assistance at the time of the medical emergency as shown under "What to do in a medical emergency" you will receive the necessary claims assistance.
If you do not call Assured Assistance, you must notify the Claims Centre of your claim within 30 days
of the date medical or other expenses were first incurred.
For your claim to be paid, you must submit the following information:
- the completed claim form (contact the Claims Centre to obtain a claim form),
- original of all bills, invoices and receipts,
- any required government health insurance plan form,
- proof of any payment(s) or denial(s) made by other insurance plan(s), and
- a complete diagnosis from the physician(s) and/or hospital(s) who provided the treatment, including, where applicable, written verification from the physician who treated you during your trip that the expenses were medically necessary.
SUBMISSION OF CLAIMS MUST BE MADE TO THE CLAIMS CENTRE:
RBC Insurance
Claims Centre
PO Box 97, Station A
Mississauga, ON L5A 2Y9
1-800-464-3211
You must submit the information required for your claim within 90 days of the date medical or other
expenses were first incurred. If it is not reasonably possible to provide such information within 90
days, you must do so within one year or your claim will not be paid.
The Claims Centre will pay your claim or advise you of the decision not to pay your claim within 60
days of receiving all of the required information.
OTHER CLAIM INFORMATION
During the processing of a claim, the Insurer may require you to undergo a medical examination by
one or more physicians selected by the Insurer and at the Insurer's expense.
You agree that the Insurer and its agents have:
- your consent to verify your health card number and other information required to process your claim, with the relevant government and other authorities;
- your authorization to physicians, hospitals and other medical providers to provide to us, Assured Assistance and the Claims Centre, any and all information they have regarding you, while under observation or treatment, including your medical history, diagnoses and test results; and
- your agreement to disclose any of the information available under a) and b) above to other sources, as may be required for the processing of your claim for benefits obtainable from other sources.
After the Insurer pays your health care provider or reimburses you for covered expenses, it will seek
reimbursement from your government health insurance plan and any other medical insurance plan
under which you may have coverage. You may not claim or receive in total more than 100% of your
total covered expenses or the actual expenses which you incurred, and you must repay to us any
amount paid or authorized by the Insurer on your behalf if and when the Insurer determines that the
amount was not payable under the terms of your policy .
If you are retired and your former employer provides to you under an extended health insurance
plan, a lifetime maximum coverage of:
- $50,000 or less, we will not co-ordinate payment with such coverage;
- more than $50,000, we will co-ordinate payment with such coverage only in excess of $50,000.
If you are actively employed and your current employer provides to you under a group health plan, a
lifetime maximum coverage of:
- $50,000 or less, we will not co-ordinate payment with such coverage;
- more than $50,000, we will co-ordinate payment with such coverage only in excess of $50,000.
If you disagree with the claim decision of the Insurer, the matter will be submitted to arbitration
under the arbitration law in the Canadian province or territory in which you permanently reside. You
must begin arbitration proceedings to recover a claim within 12 months of the occurrence. If,
however, this limitation is invalid according to the laws of the Canadian province or territory where
you permanently reside, you must commence your claim within the shortest time limit permitted by
that province or territory . All arbitration proceedings must be brought in the Canadian province or
territory in which you permanently reside. Where requested by the Insurer, you consent to the
transfer of any proceedings to the province or territory where you permanently reside.
WHAT OTHER TERMS SHOULD YOU KNOW ABOUT?
- This insurance is classified as supplemental, in that it covers expenses in excess of expenses payable by any other insurance plan.
- When you contact Assured Assistance, they will, on the Insurer's behalf, refer you or may transfer you, when medically appropriate, to one of their recommended medical service providers. They will also request that the approved medical service provider bill the medical expenses covered under this insurance directly to the Insurer instead of to you.
- If you are eligible, from any other insurer, for benefits similar to the benefits provided under this insurance, the total benefits paid to you by all insurers cannot exceed the actual expense that you have incurred. We will coordinate the payment of benefits with all insurers from whom you are eligible for benefits similar to those provided under this insurance, to a maximum of the largest amount specified by each insurer.
- If you incur expenses covered under this insurance due to the fault of a third party, the Insurer may take action against the third party. You agree to cooperate fully with the Insurer or its agents and to allow the Insurer or its agents, at its/their own expense, to bring a lawsuit in your name against a third party. Where a third party is involved, an accident report is required before any claim payments can be made.
- All amounts are shown in Canadian dollars. If you have paid a covered expense, you will be reimbursed in Canadian currency at the prevailing rate of exchange quoted by RBC Royal Bank on the date the last service was rendered to you. This insurance will not pay for any interest.
- The Insurer, Customer Care Representatives/Coordinators of Assured Assistance and the Claims Centre, RBC Royal Bank and their agents are not responsible for the availability, quality or results of medical treatment or transportation, or your failure to obtain medical treatment.
- This Certificate of Insurance is the entire contract between you and the Insurer and is subject to the statutory conditions of the Insurance Companies Act of Canada and any governing provincial statutes concerning contracts of accident insurance.
- To substantiate a claim under this insurance, you must provide the requested/required documents. Failure to provide the requested/required documentation will invalidate your claim.
- The Insurer may, at its discretion, void this contract in the case of fraud or attempted fraud by you, or if you conceal or misrepresent any material fact or circumstance concerning this insurance contract.
YOUR PRIVACY MATTERS TO US
At RBC Insurance Company of Canada, we're committed to protecting your privacy. We respect your privacy and want you to understand how we safeguard your personal information.
How we collect your information
We collect and keep information about you, which is needed to provide the products and services you request. We collect information from you, either directly or through our representatives. We may also need to collect information about you from sources such as hospitals, doctors and other health care providers, the government (including government health insurance plans) and governmental agencies, other insurance companies, travel suppliers, law enforcement representatives, private investigators, your family and friends, and any references you provide.
How we use your information
We use your information to provide the products and services you request, which includes using it to evaluate insurance risk, manage and co-ordinate claims, reprice medical expenses, and negotiate payment of expenses to third parties. We may also share your information with others who work for RBC Insurance Company of Canada or other RBC Financial Group® companies, or with third parties, when it is necessary for the services we provide to you. Third parties may include other insurance companies, health organizations and the government (including government health insurance plans) and governmental agencies.
We may use your information internally, to prepare statistical reports that help us understand the needs of our customers and that help us understand and manage our business.
Other ways we may use your information
When you request products and services directly from RBC Insurance Company of Canada, there are other ways we may use your information. For example, we may use or share some of your information to help you find out about other products and services from RBC Insurance Company of Canada and other RBC Financial Group® companies. However, we will never use or share your health information for these purposes. To better manage your relationship with other RBC Financial Group® companies, and where the law allows us, we may consolidate the information we have about you with information held by the other group companies.
If, at any time, you decide that you do not want us to use your information as described above, please let us know by calling us at 1-800-464-3211.
Your right to access your information
You have the right to access the personal information that we have about you in your file. If we have information that is not correct, you can have it corrected.
To access your information or to ask us to correct your information, you can contact us at:
RBC Insurance Company of Canada
P.O. Box 97, Station A
Mississauga, Ontario L5A 2Y9
Phone: 1-800-464-3211
Fax: (905) 813-4701
If you would like more information about client privacy
RBC Financial Group publishes a brochure on client privacy. If you would like a copy of the brochure, you can contact us and we would be pleased to send one to you.
® Registered trademarks of Royal Bank of Canada. RBC and Royal Bank are registered trademarks of Royal Bank of Canada. Used under license.
* Registered trademark of Visa International Service Association. Used under license.
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