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Out of Province/Country Emergency Medical Insurance

RBC Royal Bank Visa Platinum Preferred 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:

1-800-533-2778 toll-free from the US & Canada, or
905-816-2581 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.

Applicant means a person who has signed and submitted an application as the applicant for an RBC Royal Bank Visa Platinum Preferred card and in whose name the card account is established.

Cardholder means any person (includes applicants, co-applicants and authorized users), to whom RBC Royal Bank has issued an RBC Royal Bank Visa Platinum Preferred card.

Covered person means any of the following persons who are under the age of 65 and have a valid government health insurance plan: the applicant, the cardholder, the cardholder's spouse, or a dependent child who travels with or joins the cardholder or the cardholder's spouse on the same trip. A co-applicant or an authorized user to whom RBC Royal Bank has issued an RBC Royal Bank Visa Platinum Preferred card is a covered person in his/her own right. A covered person may be referred to as "you" or "your" or "yourself". A co-applicant's or authorized user's spouse and/or dependent child are not eligible for this insurance. The spouse and/or dependent child of the cardholder are no longer covered when the cardholder turns the age of 65.

Departure point means the province or territory you depart from on the first day of your intended trip.

Dependent child means a dependent unmarried natural, adopted, step or foster child of the cardholder who is covered under a government health insurance plan and is:

under 21 years of age, or
under 26 years of age if a full-time student, or
mentally or physically handicapped and incapable of self-sustaining employment and totally reliant on you for support and maintenance.

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 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.

Spouse means the person who is legally married to you, or has been living in a conjugal relationship with you for a continuous period of at least one year and who resides in the same household as you.

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 investigations 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 Platinum Preferred account is cancelled;
the date your RBC Royal Bank Visa Platinum Preferred 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.
Return of Dependent Children
If dependent children insured under your insurance travel with or join you during your trip, and you are hospitalized for more than 24 hours, or you must return to Canada because of your medical emergency covered under this insurance, this insurance covers, when arranged and approved through Assured Assistance, the extra cost of one-way economy transportation by the most cost effective route to the dependent children's point of departure and the cost of return economy transportation for an escort, when an escort is deemed necessary by the carrier.

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:
1. any heart condition has not been stable; or
2. 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:
1. any lung condition has not been stable; or
2. 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 offence.
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:
1. had caused your physician to advise you not to travel, or
2. 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.

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For your claim to be reviewed, 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:

Submission of claims must be made to the Claims Centre
Service	Contact
Address	RBC Insurance Claims Centre PO Box 97, Station A Mississauga, ON L5A 2Y9
Phone	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 document. 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.

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