Certificate of Insurance Issued to: Urban School Insurance Consortium
Group Reference Number: FCM 1041455
Effective date: September 1, 2011
Table of contents
Contact information Keep these numbers handy when you travel. You can contact us at the following numbers or visit us at www.oneworldassist.com Notice: In the event of a claim, please contact the school board. Customer service From Canada & USA 1-800-663-5389 From Mexico 001-800-514-9976
* To use the global toll-free service when you are travelling outside North America and Mexico, you must first dial the international access code (see list below) to reach Canada, then enter our 11-digit toll-free number. For example, if you are in Australia, dial 0011 + 800-663-00399.
** If you are unable to use the global toll-free service and access codes shown above (subject to change without notice), please call us collect. You can complete your call by speaking immediately with a Canadian operator using one of the Canada Direct access numbers listed on our website at or with the assistance of a local operator. Tell the Canadian or local operator you wish to make a collect call to Canada at 604-276-9900. Some restrictions may apply depending on the country from which the call is originating. How to claim Claims procedures and payment of benefits
For information on how to contact us, please refer to Contact Information above.
Applicable to all claims
1. In the event of a claim, please contact the school board. 2. Any notices of claim should be promptly sent by the school board to: OneWorld Assist 11th Floor, 6081 No. 3 Road Richmond, BC Canada V6Y 2B2
Any cost incurred by OneWorld Assist in obtaining further documentation required to confirm eligibility of your claim is the responsibility of the claimant.
3. Claim Forms will be provided to the claimant by the school board for completion and return to OneWorld Assist. It is the responsibility of the
claimant and/or school board to complete and/or produce any documentation required by OneWorld Assist to enable them to process and confirm the eligibility of the claim.
4. All required documentation must be received within one year from the date of loss. Failure to do so will result in the denial of the claim.
5. To qualify for reimbursement, original itemized receipts must be provided as support for all eligible expenses. If original, itemized receipts are
not provided, the expense will not be reimbursed.
6. To receive benefits, any requested supporting documentation must be submitted along with the notice of claim.
Applicable to trip cancellation/trip interruption insurance 1.
To receive benefits, the following documents must be submitted along with the notice of claim: a)
The original unused airline ticket and/or all additional travel tickets purchased to return home or to rejoin the tour.
Itemized travel agency dated invoices showing full payment, taxes and premiums paid for your trip.
A statement from the travel agency/airline/tour operator documenting refunds provided for cancelled or unused tickets and/or cancelled or unused land and sea services.
If the claim occurred prior to departure, a medical certificate provided by the physician at the time of consultation prior to the departure date and time, stating the diagnosis, date of onset of the condition, dates and type of treatment, and the reason why travel was not possible.
If the claim occurred after the trip began, a medical certificate provided by the attending physician at the place where the illness occurred, stating the diagnosis, date of onset of the condition, dates and type of treatment, and the reason why it was medically necessary to return home earlier or later than the originally scheduled return date.
Applicable to baggage insurance
If baggage is lost or stolen, proof of loss (copy of notice and/or police report) is necessary to substantiate claim.
If baggage is damaged, a written estimate to repair damaged luggage from a repair shop of your choice (if under $25, please have repairs completed and forward the invoice to us) is necessary to substantiate claim.
3. If baggage is delayed, proof of delay is required and copies of itemized and dated receipts for personal necessities are necessary to
This certificate includes the terms of the travel insurance. This document contains clauses that may exclude or limit coverage. Please read it carefully.
This group policy has been issued to the policyholder by Industrial Alliance Pacific Insurance and Financial Services Inc. (IAP) and Lloyd’s Underwriters to cover various expenses as set outherein. This group policy is administered by Travel Underwriters. Assistance services and insurance claims applicable to this certificate are administered by OneWorld Assist. All italicized words have the meanings set out in the Definitions section. Whenever a reference to the masculine gender appears in this certificate, it will also be construed to include the feminine gender.
In consideration of the payment of the applicable premium to Travel Underwriters, the company hereby agrees to provide insurance in accordance
with the terms and conditions herein. All the limits of Insurance under each benefit are per person, per trip, unless otherwise stated.
Validation of coverage Insured persons of a participating school board of the policyholder will be enrolled for coverage under this group policy and this certificate when the school board makes application for Option 3 Coverage underwritten by IAP and the required premium is paid. Eligibility An individual is eligible for coverage if:
He has not yet reached the age of 70 years.
He is a student of a participating school board of the policyholder; or,
He is a chaperone appointed by a participating school board of the policyholder to travel with students.
Foreign exchange and international students are not eligible for this Insurance. Trip cancellation/trip interruption insurance—multi trip annual o
Trip cancellation means an event occurring prior to the insured person’s departure date, causing the insured person to cancel his trip.
Trip interruption means an event occurring while on a trip causing the insured person to interrupt or disrupt his trip as originally scheduled or to return earlier or later than his return date.
Period of coverage
Coverage takes effect on the later of September 1 at 12:01 AM or the date the participating school board’s application for Option 3 Coverage underwritten by IAP is received and expires at 12:01 AM on the next following September 1. Coverage for each trip commences at the time of booking each trip. Coverage terminates on the date of the cause of cancellation if a trip is cancelled prior to the contracteddeparture date, or on the date when the insured person returns to his home province, whichever first occurs. Coverage is only applicable for school mandated trips outside of Alberta.
If a trip has already been booked when a participating school board of the policyholder purchases this Insurance, the effective date must be the same as the application date. If a trip has not yet been booked when a participating school board of the policyholder purchases this Insurance, the effective date may differ from the application date. Covered risks
insured person’s sickness, injury, death or quarantine.
2. Sickness, injury, death or quarantine of the insured person’s immediate family.
Quarantine, death or hospitalization of host at final destination.
Sickness or injury of the insured person’s immediate family who is at the final destination.
The legal adoption of a child by the insured person when the actual date of that adoption is scheduled to take place during a trip.
A natural disaster, which renders the insured person’s principal residence uninhabitable or school board facility inoperative.
An unforeseeable event completely independent of any intentional or negligent act that renders the insured person’s principal residence uninhabitable or school board facility inoperative.
Delay of a connecting common carrier due to weather conditions, earthquakes, volcanic eruptions, mechanical failure of the common carrier, a traffic accident, or an emergency police-directed road closure.
Delay of a private automobile resulting from mechanical failure of that automobile, weather conditions, earthquakes, volcanic eruptions, a traffic accident, or an emergency police-directed road closure.
10. An accident on the way to the departure point involving a private passenger automobile in which the insured person is a passenger or
driver; or common carrier in which the insured person is a passenger (police report required).
11. A formal written travel advisory and/or travel warning issued by the Department of Foreign Affairs and International Trade Canada (DFAIT)
or Public Health Canada (PHC), recommending that, on the contracted dates, the insured person avoids all or non-essential travel to the contracted destinations, provided such travel advisory/warning was issued after the date the trip is booked or after the date this Insurance is purchased, whichever occurs later, and is still in effect on the insured person’s scheduled departure date.
schedule change of the airline carrier that is providing transportation for a portion of the insured person’s trip, causing the insured person insured person being summoned to police, fire or military service (active or reserve).
14. The cancellation or delay of the insured person’s common carrier, due to weather conditions, earthquakes or volcanic eruptions, for a
period of at least 30% of the total duration of the trip, when the insured person chooses not to continue with the trip.
insured person’s job transfer that results in the relocation of the insured person’s principal residence of at least 160 km and within 30
days of departure or return (self-employment not applicable).
insured person being subpoenaed, after the trip is booked or after the date this Insurance is purchased, whichever occurs later, for
jury duty, as a witness, or required to appear at a court proceeding during the period of travel (excluding law enforcement officers).
17. Involuntary loss of the insured person’s or his spouse’s permanent employment provided the insured person or his spouse has been
continuously employed by the same employer for more than one year prior to the date the trip is booked or prior to the date this Insurance is purchased, whichever occurs later.
Applicable to trip cancellation only (coverage for prior to departure)
18. The non-issuance of the insured person’s travel or student visa (not including an immigration or employment visa) for reasons beyond the
insured person’s control, provided the insured person was eligible to make such an application.
insured person’s or the insured person’s immediate family member’s pregnancy, being diagnosed after the date the trip is booked or
after the date this Insurance is purchased, whichever occurs later, if the insured person’s trip is scheduled to take place in the nine weeks before or after and including the expected date of delivery.
20. Complications of the insured person’s or the insured person’s immediate family member’s pregnancy, occurring within the first 31 weeks of
21. Cancellation of the insured person’strip as a result of instructions by the union that teachers not participate in such trips.
Sum insured prior to departure—$5,000 Sum insured after departure—$25,000
Trip cancellation before departure Benefits, as outlined below, are payable if cancellation of the insured person’s trip results in unexpected travel costs as a result of covered risks 1 to 21. The sum insured amount is an aggregate limit per insured. 1.
Reimbursement of non-refundable prepaid airfare and/or other prepaid travel arrangement costs that cannot be recovered from another source. Note: if the insured person chooses not to cancel his trip, reimbursement of the change fee charged by the transportation supplier when such an option is available to the insured person.
Trip interruption after departure Benefits, as outlined below, are payable if interruption of the insured person’strip results in unexpected travel costs as a result of covered risks 1 to 17.
The sum insured amount is an aggregate limit per insured. Sum insured payable up to the maximum limit of $25,000 or the amount listed in this Insurance, whichever is less. 1. Reimbursement
insured person’s non-refundable, unused prepaid airfare costs; or,
The cost of a one-way economy airfare to the original contracteddeparture point to return earlier or later than the contractedreturn date; or,
An airline seat upgrade when medically necessary to the original contracteddeparture point to return earlier or later than the contractedreturn date. This benefit is payable only when pre-approved and arranged by OneWorld Assist.
2. Reimbursement of the insured person’s non-refundable unused prepaid travel arrangements excluding the cost of unused prepaid transportation back to the original contracteddeparture point.
3. Reimbursement of the insured person’s non-refundable unused prepaid airfare costs when the trip is interrupted after arrival at the destination, excluding reimbursement of the cost of unused prepaid transportation back to the original contracteddeparture point.
4. Reimbursement of a one-way economy airfare or transportation costs to catch-up to a tour as originally booked or a one-way economy airfare or transportation costs to the insured person’s next travel destination if a portion was missed.
5. Up to the limit of $350 per day, subject to a maximum of $1,500, for the insured person’s reasonable out-of-pocket expenses for commercial accommodation, meals, internet, telephone and facsimile charges and taxi expenses.
In the event the insured person returns to his home province from a trip before the scheduled return date as a result of:
Hospitalization (including home-based palliative care)or deathof a family member not travelling with the insured person after his departure
b) A natural disaster rendering the insured person’s principal residence uninhabitable after his departure date. The company will reimburse up to a maximum of $2,500 for the cost of a one-way economy airfare to travel back to the insured person’s original travel destination point provided the return takes place within the period of coverage.
Conditions In addition to the General Conditions, the following conditions apply: 1. When the reason for cancellation occurs prior to departure, the insured person or an authorized representative of the participating school board
Contact the travel agent or airline on the day the reason for cancellation occurs or on the next business day; and,
OneWorld Assist within the same period. Claim payment will be limited to the cancellation penalties specified in the trip contracts
which are in effect at the time the cause of cancellation occurs.
2. No claims will be considered unless the original unused transportation ticket(s) are provided to OneWorld Assist.
3. If the insured person’strip is cancelled because of sickness or injury, the patient must consult a physician on or before the departure date and
time, and prior to the date and time of cancellation. If the insured person’strip is interrupted or delayed for sickness or injury, the patient must consult a physician on or before the date and time of interruption or delay. In either case the insured person must provide a medical certificate completed by the physician that includes: a complete diagnosis, the date of onset of the condition, the dates and type of treatment, and the medical necessity of cancelling, delaying or interrupting the insured person’s trip. If a physician was not consulted as required or if the insured person cannot provide the complete written certificate, the claim will be denied. The claim must also include original unused tickets, copies of substitute transportation tickets and travel agent or tour operator invoices (if applicable).
4. If the insured person’s return home is delayed for more than 10 days beyond the scheduled return date, benefits will be payable only upon
satisfactory proof that the delay resulted from the insured person’s hospital confinement, or hospital confinement of a family member travelling with the insured person.
The authorized representative of the participating school board of the policyholder or if the insured person had left enough travel time to comply with the travel provider’s recommended check-in time prior to departure;
The insured person’strip, whether booked online or through a travel agent, meets the minimum connection times approved by the applicable travel provider.
6. The insured person’s trip must start and end within the Period of Coverage of this certificate, unless authorized by Travel Underwriters.
7. No chaperone, parent or student can decide to cancel their individual participation in the trip due to speculations that a labour dispute or school
board ruling may occur at a later date, and subsequently receive compensation for costs due to the cancellation under the Insurance. This is regardless of whether or not the trip was later cancelled.
8. Payments by the students to the tour operator after a tour is cancelled due to a union mandated labour dispute or school board ruling will only be
covered if the student had a contractual obligation to make the payment to the tour operator.
Exclusions In addition to the General Exclusions, this Insurance does not cover loss caused by or arising from: 1. A trip for which Insurance is purchased after the diagnosis of a terminal condition.trip for which Insurance is purchased after the insured person has been advised by a physician not to travel.
Cancellation or interruption caused by or related to a circumstance known to the insured person or the participating school board of the policyholder prior to the date the trip is booked or prior to the date this Insurance is purchased, whichever occurs later, and which may eventually prevent or interrupt travel as booked.
An early or late return due to sickness or injury, unless ordered in writing by the attending physician or unless returning to the insured person’s home province to seek immediate medicaltreatment.
pre-existing condition affecting the insured person, the insured person’s immediate family member, or host at destination, employer or key
employee, unless the pre-existing condition was stable:
During the 60 days prior to the date the trip is booked when the Insurance is purchased prior to the booking date; or,
During the 60 days prior to the date this Insurance is purchased when the Insurance is purchased after the date the trip is booked.
The non-issuance of a travel or student visa due to late visa application.
Refundable tickets, if, as result of a trip cancellation, an airline refunds the amount paid for the purchase of a ticket by the insured person and does not charge the insured person any cancellation penalties. This Insurance will not provide reimbursement for any amounts that are refundable by the airline.
Travel arrangements for which no premium was paid before departure.
Cancellation or interruption due to sickness or injury when a physician has not been consulted, or has not advised against travel on or before the insured person’s departure date and time or date and time of interruption or delay.
Baggage insurance—multi trip annual Maximum sum insured – $1,500 per person Period of coverage This Insurance takes effect on the later of September 1 at 12:01 AM or the date the participating school board’s application for Option 3 Coverage underwritten by IAP is received and expires at 12:01 AM on the next following September 1. Coverage commences on the date and time the insured person leaves his home province for a trip. Coverage terminates on the date and time the insured person returns to his home province, except if the insured person’s trip is interrupted before the scheduled return date as a result of an event as mentioned in the Trip Link Benefit under the Trip Cancellation/Trip Interruption Insurance plan. In this case, the insured person’sInsurance will not terminate, however the insured person will not be covered while in his home province. There will be no refund for the number of days the insured person spends in his home province. Benefits Baggage and personal effects Lloyd’s Underwriters agree to pay for the loss, damage, destruction or theft of personal effects owned by the insured person while in transit, or while in any hotel or other building, en route anywhere in the world, on land or water or in the air. Currency Lloyd's Underwriters agree to pay for loss of currency through theft or robbery of personal currency (excluding unexplained disappearance; police report required), up to a limit of $100. Baggage delay Lloyd’s Underwriters agree to pay for personal necessities if the insured person’s baggage is delayed beyond 12 hours while en route and before returning to the original departure point, up to a limit of $200. Conditions 1. Notice of loss—If the insured property is lost or damaged through perils insured against, the insured person or an authorized representative of the participating school board must notify OneWorld Assist within 30 days of return from journey and take all reasonable measures to protect, save and/or recover the property, and promptly notify either police, hotel proprietors, steamship lines, railroad or station authorities, airlines or any other carrier or bailee in whose custody the property was at the time of loss, damage or theft. This coverage is conditional upon compliance with this clause. Payment of loss—Any claim hereunder for damage and/or destruction shall be paid immediately after presentation to OneWorld Assist of evidence substantiating such damage and/or destruction. Valuation—Lloyd’s Underwriters shall not reimburse beyond the actual cash value of the property at the time any loss or damage occurs. Reduction in amount of insurance—Upon the occurrence of any loss covered hereunder, the amount of insurance and the applicable limit is reduced by the amount of such loss.
Coverage for risk of loss of or damage to the insured person’s property for any single item is limited to not more than 25% of the sum insured per person per claim. Exclusions
In addition to the General Exclusions, the company will not be liable to provide coverage or services, or to pay claims for expenses incurred directly or indirectly as a result of: 1. Loss, damage or theft of animals; self-propelled conveyances of any kind or their equipment; trailers, boats, motors, aircraft or other
conveyances or their appurtenances; bicycles except while checked as baggage with a common carrier; household effects and furnishings; artificial teeth and limbs; hearing aids; eye glasses, contact lenses; money (except as provided for currency), securities, tickets and documents;
personal entertainment devices including but not limited to portable DVD players, mp3 players including but not limited to iPods, personal computers, software, pagers or cellular phones; professional or occupational equipment or property; antiques and collectors items; property illegally acquired, kept or stored, or transported; works of art, jewellery, furs, cameras or camera equipment.
Loss or damage caused by wear and tear, deterioration, moths or vermin.
Expenses incurred if other insurance policies, plans or contracts cover the loss. If, however, the loss exceeds the limits of the other policies, plans or contracts and if this Insurance covers losses and periods not covered by those other policies, plans or contracts, this Insurance shall then apply in excess of all other valid insurance.
Loss caused by theft from an unattended vehicle unless the vehicle was securely locked and displayed visible signs of forced entry.
Extensions and Refunds Extensions and refunds are not available. General exclusions In addition to the exclusions specified in each Insurance coverage, this Insurance does not provide payment or indemnity for expenses incurred directly or indirectly as a result of: 1. a) War, civil war, riot, rebellion, insurrection, revolution, invasion, hostilities or warlike operations (whether war be declared or undeclared), civil
commotion, overthrow of the legally constituted government, military or usurped power, explosions of war weapons, utilization of nuclear, chemical or biological weapons;
b) Death or disablement in any way caused by or contributed by radioactive contamination; or,
c) Any action taken in controlling, preventing or suppressing any, or all of a) or b) above.
2. The insured person’s suicide or attempt thereat, self-inflicted injury.
3. The insured person’s commission or attempted commission of any crime or offence.
b) Voluntary termination of pregnancy or resulting complications;
c) Childbirth, complications related to pregnancy or childbirth occurring within the nine weeks immediately before or after and including the expected date of delivery;
d) Medical treatment incurred by a newborn child following the unexpected birth during a trip.
5. Any medical condition or recognized complication of a condition, where the purpose of the trip is to seek medical treatment, advice or services,
and where the medical evidence indicates the medical treatment, advice or services received are related to that condition.
6. Injury or sickness while scuba diving unless the insured person is certified by an internationally recognized and accepted program (including but
7. The insured person’s participation in, training or practicing for any sport as a professional athlete or while participating in, training or practicing for
any motorizedspeed contest; rodeo, show jumping or horse racing.
8. Psychological disorders, emotional or mental disorders. Acute psychosis is not excluded unless drug or alcohol induced.
9. Ongoing care, rehabilitation or check-ups.
10. Medical treatment, services or supplies provided in a chronic care facility of a hospital or convalescent or nursing home, health spa, or
11. Elective (non-emergency) treatment or surgery.
12. Emergency Air Transportation unless pre-approved and arranged by OneWorld Assist.
13. Treatment or services that contravene any provisions of any government health care plan of the province or territory in which the insured person
14. The insured person’s abuse of (prior to or duringa trip), or intoxication due to alcohol, drugs or medication.
15. A condition arising out of or resulting from Acquired Immune Deficiency Syndrome (AIDS) or AIDS Related Complex (ARC) if the condition first
manifested itself prior to the effective date of coverage or if the condition arose out of Human Immunodeficiency Virus (HIV) which had first been diagnosed or that manifested itself prior to the effective date.
16. Expenses incurred as a result of the insured person’s failure to accept or follow the physician’s advice, treatment or recommended treatment.
17. Unless otherwise stated in this Insurance (see General Condition, number 2), expenses incurred if other insurance policies, plans or contracts,
including any private or provincial automobile insurance, cover the loss. If, however, the loss exceeds the limits of the other policies, plans or contracts and if this Insurance covers losses and periods not covered by those other policies, plans or contracts, this Insurance shall then apply in excess of all other valid insurance.
General conditions Provisions and conditions 1.
Qualification, Misrepresentation and Fraud
The coverage under this Insurance shall be void if the insured person does not meet the eligibility requirements for the plan selected on the application for Option 3 Coverage underwritten by IAP. The eligibility requirements are material to the risk for which Insurance is sought. In addition, the coverage under this Insurance shall be void if, before or after any loss or claim, the insured person, the participating school board of the policyholder or the representative of either conceal, misrepresent or fail to disclose any material fact or commit any fraud or false swearing pertaining to the insured person or any claim.
Subrogation –If the insured person or the participating school board of the policyholder acquires any right of action against any person, firm or organization for loss covered hereunder, the insured person or the participating school board of the policyholder shall, if requested by the company, assign and transfer such claim or right of action to the company and will permit suit to be brought in the insured person’s or participating school board’s name under the direction and expense of the company. This right of subrogation is in addition to all other rights of subrogation existing under common law, equity or statute. The insured person or the participating school board shall do nothing after a loss to prejudice the company’s rights of subrogation. If the insured person or the participating school board makes any claim against a third party based on an event that led to any payment under this Insurance, the insured person or the participating school board will include the amount of that payment in the claim against the third party, and when the amount of that payment or portion thereof is recovered, that amount shall be held in trust for the sole benefit of the company and immediately remitted to the company.
Due Diligence –Insured persons and/or the participating school board of the policyholder must act at all times so as to minimize the costs to the company.
Currency – Any dollar amount expressed as a limit of coverage or benefit payable under this Insurance is deemed by the company to be in Canadian currency.
Duplication of Coverage – If the insured person or the participating school board of the policyholder is insured under more than one Insurance administered by Travel Underwriters and the policies are in effect at the same time, the total amount paid to the insured person cannot exceed his total expenses. Benefits are paid under the one Insurance with the greatest benefit limit.
The date and time of termination of coverage is based on the time zone of the province or territory the Insurance was purchased in.
The availability, quality, results or effects of any medical treatment assistance, hospitalization, transportation or the insured person’s failure to obtain any of the above, is not the responsibility of either the company or Travel Underwriters or any company or agency providing services on their behalf.
In the case of duplicate benefits in this Insurance claims are payable for one benefit only.
OneWorld Assist has been appointed by the company to be the sole provider of all assistance and claims processing services.
10. In the event of the insured person’s medical treatment or other circumstances that have led or may lead to a claim under this Insurance, the
insured person authorizes any hospital, physician or other person or organization that has records or knowledge of the insured person or his health, medical history or other information relevant to the claim to provide that information to the company or OneWorld Assist and authorize the company and OneWorld Assist to use and disclose that information for the purpose of determining whether any claim that may be made is covered by this Insurance or by another plan or Insurance.
11. If requested by the company or Travel Underwriters or OneWorld Assist the insured person must furnish or consent to the release of the insured person’s medical records for the relevant period prior to the effective date and/or during the term of the insurance required in order to determine if the claim is payable. Failure to produce these records will invalidate the insured person’s claim.
12. In the event of a claim, the insured person or the participating school board of the policyholder may be required to establish the date of
departure and initially planned date of return of the trip in order to comply with the terms of the Insurance.
insured person shall be responsible for the verification of any hospital and medical expenses incurred and shall obtain itemized accounts of
all hospital and medical services which have been provided.
14. The company shall not reimburse any expense incurred after a period of 365 days has elapsed following the date on which the loss first
occurred or the relevant emergency first occurred.
company and OneWorld Assist shall comply with all applicable privacy legislation and regulations.
16. If any of the terms or conditions of this Insurance are in conflict with the statutes of the province or territory in which this Insurance is issued, the
terms and conditions are hereby amended to conform to such statutes.
17. In the event of unresolved disputes respecting any claim or portion thereof, the following should be contacted: Travel Underwriters, 11th Floor,
6081 No. 3 Road, Richmond, BC Canada V6Y 2B2.
18. The law of the province or territory of Canada in which the insured person ordinarily resides will govern this Insurance, including all issues of its
interpretation and performance. Any legal action or other proceeding related to or connected with this Insurance that is commenced by the insured person or anyone claiming on his behalf or by an assignee of benefits under this Insurance must take place in the courts of the province or territory of Canada in which the insured person ordinarily resided or in which the participating school board of the policyholder purchased this Insurance, and no other court has jurisdiction to hear or determine any such action or proceeding.
Definitions Accident and injury means physical injury to the insured person caused by violent external and accidental means requiring emergency medical treatment which occurred after coverage commenced. Acutemeans initial or emergency short course (not chronic) treatment phase of a sickness or injury. Alteration means the medication usage, dosage or type has been increased, decreased or stopped and/or a new medication has been prescribed. Alteration does not include: a)
Changes in brand due solely to the availability of the insured person’s usual brand or due to a change from a brand name medication to an equivalent generic brand medication of the same usage or dosage; and
The routine adjustment of the dosage within prescribed parameters to ensure correct blood levels are maintained when the insured person is taking insulin or oral diabetes medication or blood thinner medication such as Coumadin/Warfarin and the insured person’s blood levels must be checked regularly and the insured person’s condition remains unchanged; and
c) The usage changes due to the combination of several medications into one and the insured person’s condition remains unchanged.
Application means the printed form completed by an authorized representative of the participating school board of the policyholder indicating Option 3 Coverage underwritten by IAP. Application date means the date when the application form is received by IAP. Canadian resident means a person who is eligible for or has a provincial or territorial government health care plan in place and: a)
Is a Canadian citizen with a primary permanent residence in Canada; or,
Has landed immigrant status in Canada and a primary permanent residence in Canada.
Certificate means this certificate of Insurance. Common carrier means a boat, airplane, bus, taxi, train or other similar vehicle that is licensed, intended and used primarily to transport passengers for hire. Company means Industrial Alliance Pacific Insurance and Financial Services Inc. (IAP) and certain Lloyd’s Underwriters, severally and not jointly. Contracted means specified in the travel documents for the insuredtripwith respect to any destination, date and time/place of arrival or departure. Departure date means the date on which the insured person is scheduled to depart on a trip or the date of the insured person’s actual departure. Departure point means the place the insured person departs from on the first day of a trip. Designated representative means Travel Underwriters or IAP. Elective (non-emergency) treatment or surgery means any treatment, investigations or surgery either: a) not required for the immediate relief of acute pain and suffering; or, b) which reasonably could be delayed until the insured person returns to Canada; or, c) which the insured person elects to have provided during an insured trip following emergencymedical treatment of a medical condition or the diagnosis of a medical condition, which on medical evidence would not prevent the insured person from returning to Canada prior to such treatment or surgery. Emergency means an unforeseen sickness or injury, which requires immediate medical treatment to alleviate existing danger to life or health. An emergency no longer exists, when the medical evidence indicates that the insured person is able to continue the trip or return to his province or territory of ordinary residence. Once such emergency ends, no further benefits are payable in respect of the condition which caused the emergency. Emotional or mental disorder means an emotional upset or condition, state of anxiety, situational crisis, anxiety or panic attack, or other mental health disorders. Group policy means this group travel insurance policy issued by the company to the policyholder. Home province means the insured person’s province or territory of ordinary residence in Canada. Hospital means a legally constituted medical facility under the medical supervision of a physician, with either permanent facilities on the premises for surgery or a formal arrangement with another institution making such facilities available, and providing 24-hour nursing services. The term “hospital” does not include convalescent, nursing, rest or skilled nursing facilities, whether separate or a part of a regular general hospital, operated exclusively for the treatment of the aged or persons who are drug or alcohol abusers. Hospitalization or hospitalized means medical treatment in a hospital when admitted as an in-patient. Immediate family or family member means (whether by birth, adoption or marriage) the insured person’s legal or common-law spouse, parents, step-parents, brothers, sisters, in-laws, natural or adopted children, stepchildren, stepbrother or stepsister, grandparents, grandchildren, aunts, uncles, first cousins, or any individual of whom the insured person is a legal guardian. Insuredpersons means students and chaperones under age 70 of a participating school board of the policyholder as indicated on the school board’s current application on file with IAP and for whom the applicable premium has been paid, excluding foreign exchange and international students. Lloyd's Underwriters means certain Lloyd's Underwriters as identified in Agreement No. RC789111. Medical treatment means any reasonable medical, therapeutic or diagnostic measure prescribed by a medical physician or other registered medical practitionerin any form including prescribed medication, reasonable investigative testing, hospitalization,surgery or other prescribed or recommended treatment directly referable to the condition, symptom or problem including referral to a specialist. Medical treatmentdoes not include either: a) the unchanged use of prescribed drugs or medication for a stable condition, symptom or problem; or, b) a check-up where the physician observes no change in a previously noted condition, symptom or problem. Medically necessarymeans the medical service or product in question is necessary to preserve, protect or improve the insured person’s medical condition and well being. Motorized speed contest means a timed sporting event involving the use of motorized vehicles. OneWorld Assist means OneWorld Assist Inc. Physician means a medical practitioner who is registered and licensed to practice their medical profession in accordance with the regulations applying in the jurisdiction where the person practices. A physician must be a person other than the insured person or a family member. Policyholder means Urban School Insurance Consortium. Professional means a person receiving financial compensation from their participation in the sport or who is considered professional by the governing body of the sport they participate in. Pre-existing condition means a medical or dental condition, illness or injury for which medical consultation, diagnosis, and/or medical treatment has been received by a physician or dentistand includes a medical or dental condition which occurs or develops as a progressive consequence of a pre- existing condition. Recurrence means the appearance of symptoms caused by or related to a medical condition that was previously diagnosed by a physician or for which medical treatment was previously received. Return date means the date on which the insured person is scheduled to return from a trip or the date of the insured person’s actual return home. Schedule change means the later departure of an airline carrier causing the insured person to miss his next connecting flight, or the earlier departure of an airline carrier rendering unusable the ticket the insured person purchased for his prior connector flight via another airline carrier. Schedule change does not include a change resulting from a strike or labour disruption. Sickness means an acute illness requiring immediate emergencymedical treatment as a result of a sudden onset of symptoms. Spouse means the person the insured person is legally married to, or an individual the insured person has been living with for a minimum period of one year and who is publicly presented as the insured person’s spouse, regardless of sex. Stable means that within the period specified in this Insurance: a) There has been no deterioration of thecondition as determined by a physician, and b) There have been no new symptoms or more frequent or severe symptoms, and c) There have been no symptoms related to the condition that remain undiagnosed, and d) There has been no change in medical treatment or no alteration in any medication for the condition, and e) There has been no new medical treatment prescribed or recommended by a physician or received. Terminal condition means a medical condition that, in the opinion of a physician, indicates a restricted or shortened life expectancy.
Terrorist activity means an act, or acts, of any person, or group(s), committed for political, religious, ideological, ethnic or similar purposes with the intention to influence any government and/or, but not be limited to, the use of force or violence and/or the threat thereof. Furthermore, the perpetrators of terrorist activity can either be acting alone, or on behalf of, or in connection with any organization(s) or government(s). Travel Underwriters means North American Air Travel Insurance Agents Ltd. Trip means the period of travel outside the insured person’shome province for which prepaid travel arrangements have been contracted before the departure date and for which a premium under this Insurance has been paid. The trip must be school mandated and supervised. The trip commences when the insured person leaves on his departure date and ends when the insured person returns on his return date. Statutory conditions The contract This certificate, any document attached to this certificate when issued, and any amendment to the group policy agreed on in writing after the group policy is issued constitute the entire contract, and no agent has authority to change the contract or waive any of its provisions. Waiver The company is deemed not to have waived any condition of this certificate, either in whole or in part, unless the waiver is clearly expressed in writing signed by the company or Travel Underwriters. Notice and proof of claim Notice of a claim shall be given in accordance with the claims procedures clause set out in this certificate as soon as practical but in no case later than 30 days from the date a claim arises. You must also within 90 days from the date the claim arises under this certificate furnish such proof and additional information as is reasonably possible and if required by the company, furnish a certificate from a physician detailing the cause or nature of the sickness or injury for which the claim has been instituted. Rights of examination As a condition precedent to recovery of insurance moneys under this certificate, a)
the claimant must afford to the insurer an opportunity to examine the person of the person insured when and so often as it reasonably requires while the claim under this certificate is pending, and
in the case of death of the person insured, the insurer may require an autopsy subject to any law of the applicable jurisdiction relating to autopsies.
Limitation of actions An action or proceeding against the insurer for recovery of a claim under this certificate must not be commenced more than one year** after the date the insurance money became payable or would have become payable if it had been a valid claim. **Two years in Ontario, Saskatchewan and the Northwest and Yukon Territories, three years in Quebec and Nunavut. SUBSCRIPTION POLICY Applicable to all Sections of this certificate Excluding Baggage IN CONSIDERATION OF THE having paid or agreed to pay each of the INSURERS the required premium, hereinafter called “THE INSURERS”. THE INSURERS SEVERALLY AND NOT JOINTLY agree, each for the Sum(s) Insured or Percentage(s) and for the Coverage(s) Insured set against its name, and subject always to the terms and conditions of the certificate, that if a loss occurs for which insurance is provided by this certificate at any time while it is in force, they will indemnify the INSURED against the loss so caused; the liability of each insurer individually for such loss being limited to that proportion of the loss payable according to the terms and conditions of this certificate which the Sum Insured or the amount corresponding to the Percentage set against it bears to the total of the sums insured or of the amounts corresponding to the percentages of the sums insured respectively set out against the coverage concerned on the Policy Declaration. Wherever in this certificate, or in any endorsement attached hereto, reference is made to “The Company”, “The Insurer”, “This Company”, “we”, “us”, or “our”, reference shall be deemed to be made to each of the Insurers severally. This certificate is made and accepted subject to the foregoing provisions, and to the other provisions, stipulations and conditions contained herein, which are hereby specially referred to and made part of this certificate, as well as such other provisions, agreements or conditions as may be endorsed hereon or added hereto. SEVERAL LIABILITY CLAUSE PLEASE NOTE – This notice contains important information. PLEASE READ CAREFULLY
The liability of an insurer under this contract is several and not joint with other insurers party to this contract. An insurer is liable only for the proportion of liability it has underwritten. An insurer is not jointly liable for the proportion of liability underwritten by any other insurer. Nor is an insurer otherwise responsible for any liability of any other insurer that may underwrite this contract. The proportion of liability under this contract underwritten by an insurer (or, in the case of a Lloyd’s syndicate, the total of the proportions underwritten by all the members of the syndicate taken together) is shown in this contract. In the case of a Lloyd’s syndicate, each member of the syndicate (rather than the syndicate itself) is an insurer. Each member has underwritten a proportion of the total shown for the syndicate (that total itself being the total of the proportions underwritten by all the members of the syndicate taken together). The liability of each member of the syndicate is several and not joint with other members. A member is liable only for that member’s proportion. A member is not jointly liable for any other member’s proportion. Nor is any member otherwise responsible for any liability of
any other insurer that may underwrite this contract. The business address of each member is Lloyd’s, One Lime Street, London EC3M 7HA. The identity of each member of a Lloyd’s syndicate and their respective proportion may be obtained by writing to Market Services, Lloyd’s, at the above address. Although reference is made at various points in this clause to “this contract” in the singular, where the circumstances so require this should be read as a reference to contracts in the plural. Where LLOYD’S UNDERWRITERS are subscribing insurers to the group policy, the following applies to them: IDENTIFICATION OF INSURER/ACTION AGAINST INSURER This insurance has been entered into accordance with the authorization granted to North American Air Travel Insurance Agents Ltd. (The Coverholder) by the Underwriting Members of the Syndicates whose definitive numbers and proportions can be ascertained by the reference to the Agreement Number specified in the Policy Declaration (hereinafter referred to as “the Underwriters”). The Underwriters shall be liable hereunder each for his own part and not one for another in proportion to the several sums that each of them has subscribed to the said Agreement. In any action to enforce the obligations of the Underwriters they can be designated or named as “Lloyd’s Underwriters” and such designation shall be binding on the Underwriters as if they had each been individually named as defendant. Service of such proceedings may validly be made upon the Attorney In Fact in Canada for Lloyd’s Underwriters, whose address for such service is 1155, rue Metcalfe, Suite 2220, Montreal, Quebec H3B 2V6. NOTICE Any notice to the Underwriters may be validly given to North American Air Travel Insurance Agents Ltd. d.b.a. Travel Underwriters (The Coverholder).
Complaints under all Sections other than Baggage should be referred to the lead insurer IAP at 2165 West Broadway, P.O. Box 5900, Vancouver B.C. V6B 5H6 BAGGAGE SECTION ONLY THIS SECTION IS WRITTEN 100% BY LLOYD’S UNDERWRITERS IDENTIFICATION OF INSURER/ACTION AGAINST INSURER
This insurance has been effected in accordance with the authorization granted to the Coverholder by the Underwriting Members of the Syndicates whose definitive numbers and proportions can be ascertained by the reference to the Agreement Number specified in the Declaration Page (hereinafter referred to as “the Underwriters”). The Underwriters shall be liable hereunder each for his own part and not one for another in proportion to the several sums that each of them has subscribed to the said Agreement. In any action to enforce the obligations of the Underwriters they can be designated or named as “Lloyd’s Underwriters” and such designation shall be binding on the Underwriters as if they had each been individually named as defendant. Service of such proceedings may be validly made upon the Attorney In Fact in Canada for Lloyd’s Underwriters, whose address for such service is 1155 rue Metcalfe, Suite 2220, Montreal, Quebec H3B 2V6. In respect of Lloyd’s participation only, it is noted that for the purposes of the Insurance Companies Act (Canada), this document was issued in the course of Lloyd’s insurance business in Canada. International assistance services The following services will be provided to all Policyholders: 1. Toll-free help line 24 hours a day, every day (for medical emergencies only).
2. Vital communications link between claimant/hospital regarding insurance coverage and procedures.
3. Medical (physician and surgeon) consultative and advisory services including review of appropriateness and analysis of medical care.
4. Monitoring of progress during treatment and recovery.
5. Establishing contact with family, personal physician and/or employer as appropriate.
8. Special assistance respecting claims.
9. Management, arrangement and authorization of emergency medical evacuation.
10. Arrangement and coordination of repatriation of remains.
11. Interpretation of certificates of insurance.
12. Assistance in locating the nearest and most appropriate medical care.
13. Payment to hospitals and other medical providers for emergency medical expenses will be guaranteed where possible relieving claimant of credit responsibilities.
14. Travel arrangements assistance for family members.
15. Provision of medical assistant to travel with claimant when necessary.
16. In addition to physicians, hospitals/administrators and ambulance, arrangements and communications are concluded on your behalf with:
Consulates Travel Agents Embassies Tour Guides Airlines Police Foreign Affairs Department
17. Legal referral services in order to meet the legal needs of travellers.
To access this service, please refer to the Contact Information at the beginning of this certificate document.
Insurance is administered by North American Air Travel Insurance Agents Ltd. d.b.a. Travel Underwriters, a licensed insurance broker. 11th Floor – 6081 No. 3 Road, Richmond, BC Canada V6Y 2B2. Insurance is underwritten by Industrial Alliance Pacific Insurance and Financial Services Inc. and certain Lloyd’s Underwriters, severally and not jointly.
CONSENT FOR MICROWAVE THERMOTHERAPY TREATMENT FOR THE TREATMENT OF BENIGN PROSTATIC HYPERPLASIA CAUSING BLOCKAGE OF THE URINARY CHANNEL I, _______________________________, hereby authorize DRNAMES.HED, along with medical assistants under his/her control, to perform the American Medical Systems Microwave Thermotherapy for the treatment of Benign Prostatic Hyperplasia. This treatment will be
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