MEDOC Plan Design

Current Underwriter (2019) – Royal & Sun Alliance Insurance Company of Canada

The MEDOC Plan provides Emergency Medical and Non-Medical Insurance benefits as indicated below. Emergency Medical Insurance benefits are available for trips taken outside your province or territory of residence. Unless otherwise stated, all dollar amounts shown under this insurance are in Canadian currency. All benefits are subject to Exclusions & Limitations as outlined in Section IV.

A 17-DAY PLAN

If you purchased the 17-day Plan, your coverage includes:

Up to a maximum aggregate of $5,000,000 Emergency Medical Insurance benefits per insured person, per policy year for an unlimited number of trips, outside of Canada, not exceeding 17 consecutive days. Trips taken outside of your province or territory of residence, but within Canada, can be of any duration within the policy year. Proof of departure from your province or territory of residence is required if a claim occurs.

Non-Medical Insurance benefits includes up to a maximum of $8,000 Trip Cancellation, Interruption & Delay Insurance benefits per insured person, per trip. This applies only to trips booked prior to your day of departure.

B 35-DAY BASE PLAN

If you purchased the 35-day Base Plan, your coverage includes:

Up to a maximum aggregate of $5,000,000 Emergency Medical Insurance benefits per insured person, per policy year for an unlimited number of trips, outside of Canada, not exceeding 35 consecutive days. Trips taken outside of your province or territory of residence, but within Canada, can be of any duration within the policy year. Proof of departure from your province or territory of residence is required if a claim occurs.

Non-Medical Insurance benefits includes up to a maximum of $8,000 Trip Cancellation, Interruption & Delay Insurance benefits per insured person, per trip. This applies only to trips booked prior to your day of departure.

C SUPPLEMENTAL PLAN

If you purchased the Supplemental Plan, your coverage includes:

The 35-day Base Plan and the additional coverage for a single trip in excess of 35 consecutive days outside Canada, as shown on your confirmation of coverage. The additional number of days must be purchased to cover the entire duration of your travel, starting from the time you leave Canada for a period of more than 35 consecutive days until you return to your province or territory of residence. Coverage is available up to the maximum number of days allowed under your Provincial or Territorial Health Insurance Plan in your province or territory of residence.

The entire duration of your Supplemental Plan single trip, as shown on your confirmation of coverage must occur between the day you leave Canada and the day you return to your province or territory of residence. Should your travel dates change prior to leaving Canada, you must contact the Administrator to ensure your coverage is valid for your trip.

The Supplemental Plan automatically includes the 35-day Base Plan coverage. The Supplemental Plan is not an add-on to the 35-day Base Plan and must be purchased separately.

When purchasing two or more Supplemental Plans, the full premium for all trips must be paid.

Up to a maximum of $8,000 Trip Cancellation, Interruption & Delay Insurance benefits per insured person, per trip. This applies only to trips booked prior to your day of departure.

Changing your Day of Departure or Day of Return

If there is a change in your day of departure or your day of return as indicated on your confirmation of coverage, you must contact the Administrator before your day of departure or if you have already left on a trip, before your current coverage expires. Evidence of your day of departure will be required at the time of claim. Unless specified otherwise, your coverage will begin and end as described in Section I. General Information, E. When does your coverage begin and end?

D DEDUCTIBLE OPTION

The deductible amount (if applicable) is based on the amount indicated in your confirmation of coverage. The deductible amount applies to each unrelated claim for any benefit paid under the Emergency Medical Insurance benefits only and not to Trip Cancellation, Interruption & Delay Insurance benefits.

If a deductible amount applies (as indicated on your confirmation of coverage), the expenses covered will be limited to the eligible expenses described in your policy, after the application of the deductible.

An optional deductible amount (if applicable) must be selected at the time of yourapplication for insurance or effective date. At the effective date of a new policy,the optional deductible amount may only be selected or changed within 60 daysfrom the first premium deduction for that policy year, provided no claim has beensubmitted or is pending.

E MEDOC Plan Health Options

The MEDOC Plan provides three Health Options: Optimum Health Option, Preferred Health Option and Standard Health Option.

The Health Option you qualify for is based on your answers to the Health Option Questionnaire and determines the Rate Schedule that applies to you at the time of your application for insurance or effective date. If your answers to the medical questions on the Health Option Questionnaire are not complete and accurate, the Insurer may void this insurance at its sole discretion.

Please note: at each effective date, coverage shall be issued at the Standard Health Option. If you wish to apply for the Optimum Health Option or the Preferred Health Option you must do so within 60 days of the first premium deduction date for that policy year.

All members automatically qualify for the Standard Health Option if they meet the eligibility requirements of this policy. To qualify for the Optimum Health Option or Preferred Health Option, the Health Option Questionnaire must be completed at each effective date. At each new effective date, coverage will be issued at the Standard Health Option rates applicable for the new policy year. An insured person has 60 days from the first premium deduction for that policy year to submit their completed Health Option Questionnaire and have their Health Option adjusted if they qualify for the Optimum Health Option or the Preferred Health Option. Confirmation of a change of Health Option shall be provided in writing by the Administrator and your premium rates shall be adjusted. Any insured person who had the option of submitting the Health Option Questionnaire and did not, automatically qualifies for the Standard Health Option.

Once you have accurately completed the Health Option Questionnaire and have qualified for either the Optimum or Preferred Health Option, you will continue to qualify for that option until the end of the policy year (August 31st), regardless of changes to your health during the current policy year.

NOTE: The Pre-existing Medical Condition Limitation applies to all insured’s under all Health Options. For Trip Cancellation, Interruption & Delay Insurance benefits, the Pre-Existing Medical Condition Limitation also applies to a family member, close business associate, caregiver, travelling companion or your travelling companion’s family member. Please refer to Exclusions & Limitations in Section IV.

The Supplemental Plan includes Base Plan coverage. 

Trip Cancellation, Interruption, & Delay

Up to maximum $8,000 per Insured Person, per trip available if the insured, the insured’s immediate or extended family member, close business associate or travelling companion suffers a medical emergency before or during the scheduled trip. This only applies to trips booked prior to your day of departure from your province or territory of residence.

Emergency Medical Expenses

Eligible expenses are in Canadian currency and include but are not limited to the following:

  • Emergency medical expenses for hospital, physician, surgical and medical treatment, drugs and medication, x-rays, and nursing services up to the amounts specified and a maximum aggregate of $5,000,000 per insured, per sickness or injury.
  • Air emergency transportation or evacuation.
  • Return of vehicle up to a maximum of $5,000.
  • Additional expenses for meals and accommodation up to $350 per day, maximum $3,500, which includes return of dependent child with escort transportation of a family member to the bedside.
  • Repatriation or Burial at place of death up to a maximum of $5,000.
  • Pet return up to a maximum of $500.
  • Emergency dental up to a maximum of $5,000.
  • Emergency relief of dental pain up to a maximum of $600.
  • Incidental hospital expenses up to a maximum of $250 provided hospitalized for 48 hours or more.

All expenses must be approved and arranged in advance by contacting Global Excel Management at the MEDOC Claims Assistance Centre.