AIG Emergency Out of Province Medical Coverage
Policy No. SRG 9148885
Coverage for Emergency Out of Province Medical treatment is provided by AIG Insurance Company of Canada for insured employees (plan members) and spouses under age 80. If the insured employee turns 80 prior to the spouse, the coverage will terminate for both at that time. Eligible dependent children of the insured employee are covered as per the terms of this policy. Please see the definition of “Dependent Child” for more details.
An International Identification Card should be taken with you when travelling out of your province of residence. If you do not have this card, please contact your plan administrator, Leslie Wells at 709-747-2249 ext 308 or [email protected]
In an Emergency, Here’s What To Do
Telephone the Travel Assist Coordination Centre at these numbers:
US & Canada 1 877 204-2017 (toll free)
Outside US & Canada 0 715 295-9967 (Collect)
An operator will ask the following:
The Insured Employee’s name and the patient’s name, location and the details of the emergency.
The group name of the policy: Newfoundland Plumbers and Pipefitters Local Union 740 Welfare and Pension Trust Funds
The Policy Number: SRG 9148885
AIG Insurance Company of Canada
120 Bremner Boulevard, Suite 2200
Toronto, Ontario M5J 0A8
Claims submitted later than one year from the date of the accident or the injury will be denied.
How It Works
Here’s What You Get
Guaranteed Acceptance – As long as an Insured Person’s health is stable, coverage is provided regardless of his or her health history.
“Insured Person” means you, the Insured Employee, or your eligible dependents, if any.
“Spouse” means a person who is under the age of 80 and who is either legally married to you, or if there is no such person, is a person who, although not legally married to you, has been cohabitating with you for a period of at least one year and is publicly represented as your domestic partner in the community in which you reside.
“Dependent Child” means a person who is either your natural child, adopted child or step-child or a child to whom you are in loco parentis and who is (i) under 19 years of age, unmarried and dependent upon you for maintenance and support and not employed for more than 25 hours per week; or (ii) under 25 years of age, unmarried and enrolled in post-secondary education and dependent upon you for maintenance and support and not employed for more than 25 hours per week; or (iii) by reason of mental or physical infirmity is incapable of self-sustaining employment and who is considered your Dependent Child within the terms of the Income Tax Act (Canada).
“Injury” means bodily injury which is sustained as a direct result of an unintended and unanticipated accident, occurring anywhere in the world outside of the Insured Person’s province of residence, that is external to the body and that occurs while the Insured Person’s coverage under this Plan is in force and which causes a loss covered by this Plan.
“Sickness” means the onset of sickness or disease requiring medical treatment, care or advice while an Insured Person is travelling anywhere in the world outside of his or her province of residence and which causes a loss covered by this Plan.
“Emergency” means medical treatment or surgery for an unforeseen Sickness or Injury which makes it necessary to receive immediate treatment from a Physician or Surgeon for the immediate relief of an acute symptom of which upon the advice of a Physician or Surgeon cannot be delayed until the Insured Person returns to his or her province of residence.
“Hospital” means an incorporated or licensed hospital having accommodation for resident bed patients, laboratory, registered graduate nurses always on duty and an operating room on the premises where surgical operations are performed by legally qualified Physicians or Surgeons, but in no event shall this include a convalescent or nursing home or home for the aged or health spa.
“Physician” or “Surgeon” means a medical doctor, other than the Insured Person or a member of the Insured Person’s immediate family, who is licensed to administer medical treatment and prescribe drugs in the place where he or she provides medical services. The following are not considered to be Physicians: naturopath, herbalist and homeopath.
“Totally Disabled” means the complete inability of the Insured Person, as a result of Sickness or Injury, on medical evidence, as certified by a legally qualified Physician, to continue his or her duties or activities and to continue the trip or vacation.
“Vehicle” means a passenger automobile or truck with a factory rated load capacity of 2500 pounds or less, or a motorcycle or a self-propelled mobile home designed and used for recreational purposes. Such vehicle must be insured for public liability and property damage for at least the minimum amount required by law in the Insured Person’s recognized province of residence.
Period of Coverage
Emergency Coverage for Hospital, Medical and Therapeutic Services
Emergency Medical and Therapeutic Services
the services of a legally qualified Physician or Surgeon (who is not an immediate family member),
laboratory tests and X-ray examinations ordered by a legally qualified Physician or Surgeon for the purpose of diagnosis,
the services of a registered graduate nurse (who is not an immediate family member), up to a maximum of 50 nursing shifts at the reasonable and customary fee, but not to exceed $100 per shift per occurrence,
rental of crutches or Hospital type bed, or the cost of splints, canes, slings, trusses, braces or other prosthetic appliances approved by the Insurer,
the services of a legally qualified Physician who is an anaesthetist,
drugs or medicines that require a legally qualified Physician’s or Surgeon’s written prescription,
services of a chiropodist, chiropractor, osteopath, physiotherapist or podiatrist (who is not an immediate family member) up to a maximum of $500 for each class of practitioner per occurrence,
expenses for accidental Injury to natural and sound teeth (capped or crowned teeth are considered whole or sound natural teeth) which requires treatment by a legally qualified dentist or dental surgeon within 30 days from the date of the Insured Person’s accident, not to exceed in the aggregate the amount of $2,000 as the result of any one accident,
out-patient services provided by a Hospital.
Automobile Return Benefit
Out-of-Pocket Expense Benefit
Family Transportation Benefit
Extended Coverage After Termination
Emergency Transportation Benefit
Pays up to $5,000 per occurrence for the use of ground ambulance.
Pays up to $50,000 per occurrence if the medical condition of an Insured Person requires air transportation to the nearest Hospital or for the Insured Person to be returned to his or her province of residence. This service must be coordinated and approved by Travel Assist.
Exclusions and Limitations
• Injuries received while the Insured Person is participating in any maneuvers or training exercises of the armed forces, national guard or organized reserve corps of any country or international authority;
• pregnancy, miscarriage, voluntary termination of pregnancy, childbirth or their complications except that in the case of an unexpected pregnancy complication occurring before the end of the seventh month;
• Sickness or Injury where the trip is undertaken for the purpose of securing medical treatment or advice for such Sickness or Injury;
• dental surgery or cosmetic surgery unless such surgery is a result of a covered Injury;
• any Sickness or Injury if at the time of the Sickness or Injury, the Insured Person is under the influence of drugs, alcohol (blood level in excess of 80 mg of alcohol per 100 ml of blood) or other intoxicant (unless administered on, and in strict accordance with the advice of a legally qualified Physician);
• emotional or mental disorders unless the Insured Person is confined to a Hospital;
• Sickness or Injury due to participation in professional sports;
• treatment or services that contravene any GHIP plan in Canada;
• expenses incurred on an elective (non-emergency) basis;
• suicide or any attempt at suicide while sane or insane;
• intentionally self-inflicted Injury or any attempt at intentionally self-inflicted Injury, while sane or insane;
• an act of declared or undeclared war, civil war, rebellion, revolution, insurrection, military or usurped power or confiscation or nationalization or requisition by or under the order of any government or public or local authority;
• any services or supplies provided by an Insured Person or one of the Insured Person’s immediate family members;
• a Sickness or Injury that, at the time of departure, might reasonably be expected to require an Insured Person to undergo treatment, surgery or hospitalization;
• any service, treatment, surgery or stay in Hospital not required for the immediate relief of acute pain or suffering or which is not medically necessary;
• any treatment or surgery which reasonably could be delayed until the Insured Person returns to his or her province of residence;
• anticipated medical treatments required on an ongoing basis or for continued stabilization of a medical condition known to the Insured Person prior to departure;
• that portion, if any, of any expenses for treatment, advice or hospitalization which are not reasonable and customary.
Emergency Travel Assistance
• help you locate the most appropriate medical facility for the Insured Person;
• confirm coverage with AIG Insurance Company of Canada and assure the Hospital that the Insured Person is covered;
• guarantee payment for hospitalization, if necessary;
• arrange for admission to a Hospital;
• provide translation services;
• contact the Insured Person’s own doctor for recommendations, when required;
• contact the Insured Person’s family and employer, when required;
• arrange for/co-ordinate emergency medical evacuation;
• co-ordinate the Insured Person’s return home
• The date the plan is terminated;
• The premium due date if premiums are not paid when due by the employee’s employer;
• The date you no longer satisfy the definition of an Insured Employer, or, for an eligible dependent, the date such dependent no longer satisfies the definition of Spouse or Dependent Child, as applicable;
• The first day of the month following the date the employee no longer belongs to an eligible class of members.
When an Insured Employee turns age 80, this coverage ceases for such Employee as well as his/her eligible dependents. Coverage for a Spouse may terminate sooner if he or she attains age 80 before the Insured Member’s coverage terminates. Similarly, coverage for a dependent child will cease once he or she no longer satisfies the applicable criteria provided within the definition of Dependent Child.
Group Benefits Information
RX/Extended Health Policy and Carrier Number
Active/Retired Policy#: 00551000; Carrier#: 07
Card Provider: Express Scripts Canada
Dental Policy and Carrier Number
Active/Retired Policy#: 00551000; Carrier#: 610158
Card Provider: Express Scripts Canada/Manions
This number can be found on your card under your name.
Emergency Out of Province Medical Coverage is provided through AIG for insured members under age 80.
In an Emergency, Travel Assist must be contacted immediately: 1-877-204-2017 (Canada & US), 0-715-295-9967 (collect – outside Canada/US).
Group Policy Name: Newfoundland Plumbers & Pipefitter Local 740 Benefit Trust Fund
Policy Number: SRG 9148885
Struggling with Substance Abuse?
The RDTC/NLBTC Members’ Trust provides members with a substance abuse and rehabilitation program at no direct cost to the member.
Contact the Plan Administrator, John Horgan, for immediate, confidential help: 1-844-726-2778, [email protected]
Member and Family Assistance Program
Life happens. Let us help.
Your MFAP is a confidential, no cost, support service that can help you find solutions to all kinds of challenges at any age and stage of life.
Call for confidential and immediate support with your work, health and life at:
1-866-448-9444. Visit their website at workhealthlife.com and search: RDTC / NLBTC Members Trust