Underwritten by:
Administered by:
CUMIS General Insurance Company
P.O. Box 5065
151 North Service Road
Burlington, Ontario L7R 4C2
AZGA Service Canada Inc.
o/a Allianz Global Assistance
4273 King Street East
Kitchener, Ontario N2P 2E9
Your Group Insurance Plan
SUMMARY
This document summarizes the most often consulted elements of your group insurance
plan. Allianz Global Assistance hopes it will be useful to you and suggests that you
keep it for future reference.
Please note that this document is provided for information purposes only and in no way
constitutes your actual insurance policy, insurance master application, insurance booklet
or insurance certificate; nor does it affect the terms and provisions of the actual group
insurance policy or master application in any way. Conditions, limitations and
exclusions apply to certain benefits. For a complete description of coverage, applicable
limitations and exclusions, please refer to your group insurance policy and master
application. If there are any differences between this document and the policy or master
application texts, the policy and master application texts will take precedence. You are
entitled to consult the policyholder’s policy and master application and obtain copies.
This document describes the group insurance plan in force on November 1, 2016, for the
following participants:
Insured members of ARTA
(Group Policy no.: FC310040)
Group Policy no.: FC310040
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Emergency Out-of-Country Medical Benefit
Medical Reimbursement Expense Benefit
Hospital charges including those for room and board
Hospital charges for out-patient services when medically required
Services of a nurse ordered or prescribed by a physician
Charges for medically necessary prescription drugs, sera and injectables ordered or prescribed by a physician or
dentist
Maximum per Insured Person
Included in the $5,000,000 amount per
lifetime
$5,000 per calendar year
Included in the $5,000,000 amount per
lifetime
Services of a licensed or registered physiotherapist for physiotherapy treatment ordered or prescribed by a physician
Licensed ground ambulance service
X-rays and laboratory examinations which are required for diagnostic purposes; rental of wheelchair, crutches or
canes
Medical care and treatment rendered or surgical procedure performed by a physician
Services of a licensed anaesthetist when recommended by a physician
$250 per calendar year
Services of a licensed or registered chiropractor, chiropodist or podiatrist ordered or prescribed by a physician
Expenses for diagnostic X-rays and laboratory tests ordered by a chiropractor, chiropodist or podiatrist
$250 per calendar year
1 X-ray per practitioner
Emergency Dental Treatment Benefit
Injury to whole and sound teeth or artificial teeth due to a force or blow external to the mouth
Evacuation Benefit
Transportation to the nearest hospital by any conveyance (other than ground ambulance) licensed to carry passengers
for hire, including air ambulance provided the evacuation is recommended by the attending physician and approved
by the insurer
Transportation to the insured person’s province of residence by any conveyance (other than ground ambulance)
licensed to carry passengers for hire, including air ambulance provided the evacuation is recommended by the
attending physician and approved by the insurer
Transportation to the insured person’s province of residence in the event he is confined as inpatient in a hospital and
under the regular care and attendance of a physician, thus preventing him from returning to his province of residence
on the original scheduled return flight, provided the return ticket is non-changeable and non-refundable
Reasonable and necessary expenses actually incurred by a medical attendant or one immediate family member, who
accompanied the insured person, for a round trip airfare plus accommodation and board
Vehicle Return
Reimbursement of charges and arrangements, if an insured person is unable to operate his/her owned or rented
vehicle for the return of the vehicle to the insured person’s normal place of residence or to the nearest appropriate
rental agency
Repatriation Benefit
Reasonable and necessary expenses (including cremation) actually incurred for the preparation and transportation of
the body of the deceased insured person to the first resting place in the vicinity of the normal place of residence of the
deceased
Group Policy no.: FC310040
Included in the $5,000,000 amount per
lifetime
$2,000 per calendar year
Reasonable and necessary transportation
expenses
$5,000
$5,000
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Emergency Out-of-Country Medical Benefit
Family Transportation and Accommodation Benefit
In the event of a loss of life sustained by an insured person or if this person is confined as an inpatient in a hospital for
three or more consecutive days because of a medical emergency :
 Reasonable and necessary expenses incurred by any other insured persons or travelling companion for their
board, accommodation and transportation by the most direct route back to their normal place of residence; or
 Reasonable and necessary expenses incurred by an immediate family member or a family representative for
board, accommodation and one return fare for transportation by the most direct route to and from the normal
place of residence of the immediate family member or family representative to the confined insured person, if
such insured person had been travelling unaccompanied by a family member at the time he became
hospitalized.
Maximum per Insured Person
Included in the $5,000,000 amount per
lifetime
$0.35 per kilometre travelled if transportation
occurs in a motorized vehicle other than one
operated under a license for the conveyance
of passengers for hire
Trip Cancellation or Trip Interruption and Delay
The non-refundable portion of the pre-paid travel arrangements for trip cancellation, or the extra cost of a one-way
economy airfare to the departure point or to the destination point and any unused non-refundable land arrangements
for trip interruption and delay.
Return of Excess Baggage
In the event of an Insured Person’s return to their province or territory of residence for treatment or recovery, return of excess
baggage to the Insured Person’s province or territory of residence.
$10,000
$500
Return of Animal Companion
In the event of an Insured Person’s return to their province or territory of residence for treatment or recovery, return of an Animal
Companion to the Insured Person’s province or territory of residence.
$500
Additional Expenses
Reimbursement of charges, when a trip is delayed due to hospitalization of an insured person, for board, lodging or
similar expenses incurred by insured persons and/or travelling companions who remain with the hospitalized person.
Daily limit of $150 to a maximum of $3,000
Travel Assistance Services
TravelAssistance Program provided by AZGA Service Canada Inc. a/o Allianz Global Assistance.
Group Policy no.: FC310040
Included
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