Trip Mate ticBadCode


Travel Insurance Certificate
For

Globus
For Canadian Citizens or Residents Only
For a Printer Friendly/Acrobat version of this document, click here.

Download Acrobat Reader

Please Note: This plan may not be purchased after You have made final payment for Your Trip.


Co-operators Life Insurance Company
Administrative Office: 1920 College Avenue
Regina, Saskatchewan S4P 1C4
(Hereinafter referred to as “the Company”)
Plan Documents
Globus
Plan # F380G
This Plan Documents is a summary of the travel insurance benefits underwritten by Co-operators Life Insurance Company, herein referred to as the Company and also referred to as We, Us and Our.

Insurance provided by this Plan Documents is subject to all of the terms and conditions of the Group Policy. If there is a conflict between the Policy and this Plan Documents, the Policy will govern.
Schedule of Benefits
Benefit Maximum Benefit Amount
Accidental Death and Dismemberment
24-Hour Other Than Air Flight
Air Flight
 
$25,000
$100,000
Medical Expense/Emergency Assistance
Accident and Sickness Medical Expense
Emergency Dental Expense
Emergency Evacuation and Repatriation
One Call 24-Hour Assistance Services
 
$1,000,000*
$1,000
$50,000
Included
Trip Cancellation
Occupancy Upgrade
Trip Cost
Included
Trip Interruption
Occupancy Upgrade
Trip Cost
Included
Missed Connection $1,000
Travel Delay (Up to $100 Per Day) $1,000
Baggage and Personal Effects $2,500
Baggage Delay $250
* Medical Expense/Emergency Assistance Benefits of this plan are subject to a Maximum Benefit Limit of $25,000 for those persons who at the time of a covered Injury or Sickness do not have valid hospital and medical insurance under a Government Health Insurance Plan of a province or Territory of Canada.
The travel insurance (except Property risks) is underwritten by Co-operators Life Insurance Company, 920 College Avenue, Regina, Saskatchewan S4P 1C4.

Property risks are underwritten by The Sovereign General Insurance Company, 500 – 6700 Macleod Trail S.E., Calgary, Alberta T2H 0L3.
SECTION I. Coverages
ACCIDENTAL DEATH AND DISMEMBERMENT
24 Hour Other Than Air Flight: You are eligible for benefits 24 hours a day, up to the Maximum Benefit Amount, when You sustain an Injury during the Trip which results in any of the following losses within 180 days of the date of the Injury causing the Loss.

Air Flight: You are eligible for benefits, up to the Maximum Benefit Amount, when You sustain an Injury during the Trip which results in any of the following losses within 180 days of the date of the Injury causing the Loss: a) while riding solely as a passenger in an aircraft on a regularly scheduled airline flight or regularly scheduled charter flight; b) while riding as a passenger in any land or water conveyance provided at the expense of the air carrier as a substitute for an aircraft covered by this policy; c) while riding as a passenger in a vehicle licensed to carry passengers for hire, but only when going to an airport to board an aircraft on which You are covered by this policy or when leaving an airport after alighting from such an aircraft; or d) while upon airport premises designated for passenger use immediately before boarding or immediately after alighting from an aircraft on which You are covered by this policy.

Benefits will be paid as follows:
Loss: Percentage of
Principal Sum Payable:
Life 100%
Both Hands; Both Feet or Sight of Both Eyes 100%
One Hand and One Foot 100%
One Hand and Sight of One Eye 100%
One Foot and Sight of One Eye 100%
One Hand; One Foot or Sight of One Eye 50%

Loss of hand or hands, or foot or feet, means severance at or above the wrist joint or ankle joint, respectively.

Loss of eye or eyes means the total and irrecoverable loss of the entire sight thereof.

Only one of the amounts shown above (the largest applicable) will be paid for Injuries resulting from one accident.

The benefit for loss of: (a) two limbs; (b) both eyes; or (c) one limb and one eye is payable only when such loss results from the same accident.

The Principal Sum is shown in the Schedule of Benefits.
ACCIDENT & SICKNESS MEDICAL EXPENSE

For the purpose of this benefit:

“Covered Expense” means expense incurred for services and supplies: (a) listed below; and (b) ordered or prescribed by a Legally Qualified Physician as Medically Necessary for diagnosis or treatment; which is limited to:
1. The services of a Legally Qualified Physician;
2. Hospital or ambulatory medical-surgical center services (this will also include expenses for a cruise ship cabin or hotel room, not already included in the cost of Your Trip, if recommended as a substitute for a Hospital room for recovery of a Sickness or Injury);
3. Transportation furnished by a professional ambulance company to and/or from a Hospital; and prescribed drugs, prosthetics and therapeutic services and supplies.
Benefits will be paid for the Covered Expense incurred, up to the Maximum Benefit Amount, if You incur a Covered Expense as a result of a Sickness that first manifests itself during the Trip or Injury that occurs during the Trip.

Only Covered Expenses incurred within the 52 weeks following the date of the Sickness or Injury will be reimbursed. Expenses incurred after the 52 weeks following the date of the Sickness or Injury are not covered.

Benefits will include expenses incurred during the Trip for emergency dental treatment due to Injury not to exceed $1,000. Expenses for emergency dental treatment incurred after the Trip are not covered.

Benefits will not be paid in excess of the Usual and Customary Charges.

Advance payment will be made to a Hospital, up to the Maximum Benefit Amount, if needed, to secure Your admission to a Hospital, because of a covered Sickness or Injury. The Program Medical Advisor will coordinate advance payment to the Hospital.

These benefits will not duplicate any benefits payable under the policy or any coverage(s) attached to the policy.
MEDICAL EVACUATION AND
RETURN OF MORTAL REMAINS

When You suffer a loss of life for any reason or incur a Sickness or Injury during the course of a Trip, the following benefits are payable, up to the Maximum Benefit Amount.
1. Emergency Medical Evacuation: If the local attending Legally Qualified Physician and the Program Medical Advisor determine that transportation to a Hospital or medical facility is Medically Necessary to treat an unforeseen Sickness or Injury which is acute or life threatening and adequate Medical Treatment is not available in the immediate area, the Transportation Expense incurred will be paid for the Usual and Customary Charges for transportation to the closest Hospital or medical facility capable of providing that treatment.

If You are in the Hospital for more than 7 consecutive days and Your dependent children who are under 18 years of age and accompanying You on the Trip are left unattended, Economy Transportation will be paid to return the dependents to their home (with an atten