Emergency Travel Assistance
Emergency Travel Assistance
If you have OMA Health benefits (including OPIP) you are covered for $2-million emergency out-of-country / out-of-province medical coverage for the first 90 days of travel if you are under age 70 and for the first 30 days of travel, if you are age 70 or over.
Effective October 3, 2016 this coverage will be provided through AZGA Service Canada Inc. (Allianz Global Assistance). Coverage will remain the same; all that has changed is the provider delivering the emergency travel assistance service. This is a high level overview of the Out of Province/Out of Country Travel Emergency coverage; for more details please call the Sun Life Customer Care Centre at 1.800.361-6212.
As a physician, you know the value of having the right protection when travelling – from anti-viral shots to stomach medication to sunscreen. But it's just as critical to protect your finances, especially considering the staggering costs of a medical emergency outside your home province or your home country. Emergency travel insurance makes a world of sense for both you and your loved ones. After all, travel is meant to enhance your lifestyle, not drain the funds you rely on to maintain it.
No line-ups and instant issue. Get your Medi-Passport card today.
A medical emergency while travelling can be unexpected and costly but with the emergency medical coverage under the Health and Health Plus benefit you're covered for:
- 100% of the cost of emergency services while outside your home province
- lifetime maximum of $2,000,000 per insured person
- coverage for pre-existing medical conditions with no exclusions
- coverage for the first 90 days of travel if under age 70
- coverage for the first 30 days of travel if age 70 or over
An emergency means an acute illness or accidental injury that requires immediate, medically necessary treatment prescribed by a doctor.
Emergency services are any reasonable medical services or supplies, including advice, treatment, medical procedures or surgery, required as a result of an emergency. If an insured person (you or your eligible dependents) has a chronic condition, emergency services do not include treatment provided as part of an established management program that existed before leaving your province of residence.
Your travel benefits and Medi-Passport are in effect only if you are covered by health benefits provided by OMA Insurance. Your spouse and children are also covered provided they are dependants under your health plan.
What to do in a medical emergency:
- You, or someone with you, must call the Allianz Global Assistance 24-hour operations centre before receiving medical care.
In the event of a medical emergency, contact Allianz Global Assistance:
In Canada or the USA call toll free: 1.800.511.4610
Elsewhere in the world call collect: 1.519.514.0351
- Have your member number ready
Give Allianz Global Assistance the information on your travel card and describe the situation. Stay in touch with Allianz Global Assistance throughout the emergency, until they confirm that you no longer need to do so. Be sure to give them your hospital, hotel or another telephone number so they can stay in touch.
What is covered?
Your travel benefit covers you for emergency medical services, including:
- Services and supplies while in hospital
- Outpatient and physicians' services
- Ground ambulance service to the nearest hospital
- Transportation to the province where you live for medical treatment, as appropriate
- Hotel accommodation and meals if you have been released from hospital but Allianz Global Assistance determines you are not yet able to travel
With Medi-Passport, you're also covered for additional support services:
- Hotel accommodation and meals, if your return trip is delayed by a medical emergency involving a covered family member travelling with you
- Replacement transportation tickets if you lose the use of your return ticket due to an emergency
- Return home of unattended dependent children, if you are hospitalized
- Visit by an immediate family member, if you are hospitalized for more than seven consecutive days, and you are travelling alone, or you are travelling only with a covered child who is under the age of 16 or mentally or physically handicapped
- Return of the remains to your home province, in the event of death
- Return of your personal or rented car
- Help with arrangements for replacing lost or stolen travel documents and luggage
Your Dependent Student Studying outside of CanadaUnder OMA Health benefits, your dependent children who are studying at an accredited learning institution outside of Canada are covered for emergency medical coverage for 12 months.
Insured members must provide Sun Life with details of the dependent's study plans (e.g. place, duration, copy of the offer letter). Sun Life will then review these details, whether the student is approved or declined an Explanation of Benefits statement will be sent.. The extension terminates once the student returns to Ontario and Sun Life would need to be advised by the member again for the following year as extensions are reassessed on an annual basis.
You may submit the required information by fax (416.340.2998) or email to email@example.com.
Travel Exclusions and Limitations
Sun Life Financial will not pay any benefit or accept any liability for claims relating to services that are not immediately required or which could reasonably be delayed until you return to the province where you live, unless your medical condition reasonably prevents you from returning to that province prior to receiving the medical services.1
- services relating to an illness or injury which caused the emergency, after such emergency ends
- continuing services, arising directly or indirectly out of the original emergency or any recurrence of it, after the date the Company or Allianz Global Assistance, based on available medical evidence, determines that you can be returned to the province where you reside, and you refuse to return
- services which are required for the same illness or injury for which you received emergency services, including any complications arising out of that illness or injury, if you had unreasonably refused or neglected to receive the recommended medical services.
- where the trip was taken to obtain medical services for an illness or injury, services related to that illness or injury, including any complications or any emergency arising directly or indirectly out of that illness or injury.
Limits on emergency travel assistance coverage
Allianz Global Assistance reserves the right to suspend, curtail or limit its services in any area, without prior notice, because of:
- a rebellion, riot, military up-rising, war, labour disturbance, strike, nuclear accident, terrorism or an act of God,
- the refusal of authorities to permit Allianz Global Assistance to fully provide service to the best of its ability during any such occurrence.
1 If you are uncertain about your coverage please contact the Sun Life prior to travel. For a complete list of Exclusions &Limitations including Liability payment please visit mysunlife.ca or review your Certificate.
Payments for Emergency Services
When Allianz Global Assistance pays providers
When you contact Allianz Global Assistance before seeking emergency help, normally Allianz Global Assistance verifies your coverage and arranges for the service provider (e.g., a hospital) to bill them directly. Allianz Global Assistance is also able to guarantee payment or advance money directly to a service provider. Sun Life Assurance Company of Canada will then reimburse Allianz Global Assistance for the eligible amount. Sun Life Assurance Company of Canada and Allianz Global Assistance also liaise with most provincial health plans and coordinate benefits with any other insurers involved.
You will also be asked to sign an authorization form allowing the insurers to recover any amounts payable by your provincial health plan.
If you pay medical expenses yourself
If, after obtaining confirmation from Allianz Global Assistance that you are covered and a medical emergency exists, you will be reimbursed for services and supplies that you paid for and that are covered by this plan. In this situation, you should do the following:
- Keep all receipts.
- Always obtain a fully itemized bill for any hospital treatment.
- Within 30 days of your return home, complete an Extended Health Care Claim form, include original receipts and any itemized bills, and send directly to Allianz Global Assistance at:
You don't have to send claims for physicians' or hospital fees to your provincial health care plan first. Sun Life Assurance Company of Canada and Allianz Global Assistance co-ordinate the whole process with most provincial plans and all insurers, and send you a cheque for the eligible expenses. This way, you receive your reimbursement faster. Allianz Global Assistance will ask you to sign a form authorizing them to act on your behalf.
When Allianz Global Assistance advances money to service providers, there are some situations when it will be necessary for you to reimburse the insurer for any amounts that:
- are paid for services or supplies that are not covered by your plan,
- exceed the maximum amount of your coverage under your plan, and
- you are responsible for including deductibles and the percentage of expenses you have to pay under your plan.
How to make a claim
In order for a claim to be processed for Out of Province/Out of Country expenses the following is required:
- Sun Life Extended Health Care Claim Form.
- Original itemized bills with proof of payment for expenses. Please keep copies of all bills for your records.
- Medical Records associated with the claim submission.
- In order to prove your departure and return dates please provide any supporting originals such as gas receipts, airline tickets, letter from your employer and/or credit card statements
- Completed and signed HIPAA Privacy Form and Provincial or Territorial Health Insurance Plan Form