SSQ INSURANCE COMPANY INC. EXPATRIATE INSURANCE. for Employees of POLICY N O 1SF80

Transcription

1 SSQ INSURANCE COMPANY INC. EXPATRIATE INSURANCE for Employees of HER MAJESTY THE QUEEN IN RIGHT OF CANADA AS REPRESENTED BY THE CHIEF OF DEFENCE STAFF IN HIS NON-PUBLIC PROPERTY CAPACITY, THROUGH THE VICE PRESIDENT, HUMAN RESOURCES, STAFF OF THE NON- PUBLIC FUNDS, CANADIAN FORCES POLICY N O 1SF80 This Booklet/Certificate is an important document. Please keep it in a safe place.

2 2 This booklet is an outline of SSQ Insurance Company Inc. s Expatriate insurance program offered to Employees of the Policyholder. It is designed to help you learn more about the coverage offered under this insurance program. This booklet should be kept for future reference. The Expatriate #1SF80 group insurance program s Master Application, endorsements and attached papers, if any, and the entire contract of insurance, all referred to hereafter as the Policy, set forth the terms and conditions of the insurance program. All rights and obligations are determined in accordance with the Policy, not this booklet. For exact provisions of coverage offered, please contact your Human Resources department.

3 2 SPECIFIC PROVISIONS 1. Name of Policyholder HER MAJESTY THE QUEEN IN RIGHT OF CANADA AS REPRESENTED BY THE CHIEF OF DEFENCE STAFF IN HIS NON-PUBLIC PROPERTY CAPACITY, THROUGH THE VICE PRESIDENT, HUMAN RESOURCES, STAFF OF THE NON-PUBLIC FUNDS, CANADIAN FORCES 2. Description of Eligible Persons: The following classes of persons are eligible: Class I: All eligible employees who enrol in the Employee Only Plan Class II: All eligible employees who enrol in the Employee and Family Plan "Employee" means a Canadian expatriate employee of the Policyholder under the age of seventy (70) who is hired in Canada by the Policyholder, whose place of permanent posting is outside their countryof residence and who is eligible or ineligible under both a Canadian federal and/or provincial health and hospitalization insurance plan and the Policyholder's other group hospital and medical insurance plans. for a minimum of one (1) year immediately before a loss is incurred under the policy. Only one (1) individual will qualify as a spouse. "Dependent Child" means a natural child, adopted child, stepchild or child who is in a parent-child relationship with the Insured Employee. The child must reside with the Insured Employee, be eligible or ineligible under both a Canadian federal and/or provincial health and hospitalization insurance plan and the Policyholder's other group hospital and medical insurance plans solely by reason of losing permanent resident status, unmarried, dependent upon the Insured Employee for maintenance and support and: a) under twenty-one (21) years of age, or b) under twenty-five (25) years of age (twenty-six (26) in the province of Quebec) and in attendance at an Institution for Higher Learning on a full-time basis, or c) by reason of mental or physical infirmity, is incapable of self- sustaining employment and is totally dependent upon the Insured Employee for support within the terms of the Income Tax Act. "Institution for Higher Learning" is limited to universities, colleges, CEGEPs and trade schools. "Employee Only Plan" means a plan which provides insurance to the Employee only. "Employee and Family Plan" means a plan which provides insurance to the Employee and his/her Spouse and/or Dependent Children. "Spouse" means an individual under the age of seventy (70) residing with the Insured Employee, who is a Canadian expatriate and eligible or ineligible under both a Canadian federal and/or provincial health and hospitalization insurance plan and the Policyholder's other group hospital and medical insurance, and: a) to whom the Insured Employee is legally married, b) with whom the Insured Employee has continuously cohabited in a conjugal relationship

4 3 3. Coverage (Per Insured Person): Medical Reimbursement Expense $ 1,000,000 Accidental Dental Treatment Included Evacuation Benefit $ 300,000 Emergency Treatment Included Maternity Expense Included Vision Care Included Basic Dental Included Major Restorative $ 1,000 Orthodontic Care $ 2,500 Repatriation Benefit $ 15,000 Emergency Air Transportation Benefit $10,000 Family Transportation & Accommodation Benefit $ 15,000 Return of Vehicle Benefit $ 1,000 Rental Expense Benefit $ 200 Hotel Convalescence Benefit $ 1,000 Coinsurance : Medical Reinbursement Benefit 100 % Dental reimbursement Benefit Basic Dental Benefit 90% Major Restorative 50% Orthodontic Care 50% Deductible None 4. Maximum Limit of Indemnity: The combined maximum for all expenses incurred for any one Accident, Sickness or Disease under: Medical Reimbursement Expense Benefit Accidental Dental Treatment Benefit Emergency Treatment Benefit Maternity Expense Benefit Vision Care Benefit $ 1,000, Effective Date of Individual Insurance: Insurance as to each eligible person becomes effective: A With respect to any Employee who is eligible for this insurance on the Effective Date of the Policy, on the latest of: (1) such effective date; (2) the date of the Employee's departure from Canada for the purpose of assuming the posting; or (3) the date the Policyholder advises in writing that coverage should commence. B With respect to any Employee who becomes eligible for this insurance after the Effective Date of the Policy, on the latest of: (1) the date the Employee becomes eligible for insurance hereunder; (2) the date of the Employee's departure from Canada for the purpose of assuming the posting; or (3) the date the Policyholder advises in writing that coverage should commence. C With respect to Spouse or Dependent Child, on the latest of : (1) the effective date of the Insured Employee's insurance hereunder; (2) the date the Spouse or Dependent Child becomes eligible for this insurance; or (3) the date of the Spouse's or Dependent Child's departure from Canada to reside with the Insured Employee in the place of permanent posting as stated under Item 2 of the Specific provisions. 6. Effective Date of the Policy: 12:01 a.m., Standard Time, April 1 st 2018 at the address of the Policyholder.

5 4 MAIN PROVISIONS Definitions Wherever used in this policy: "Accident" means any unlooked for mishap or untoward event which is not expected or designed. "Accommodation" means lodging in the vicinity of the Hospital where the Insured Person is confined. "Airfare" means the regular fare charged for an economy class seat on a regular flight by a domestic or international scheduled air carrier, which holds an operating certificate issued by Transport Canada or by a similar governmental authority having jurisdiction over such air carrier in the country of its certification. "Disease" means any unhealthy condition of the body or any part thereof occurring while this policy is in force as to the Insured Person whose disease is the basis of claim and for which expenses are incurred in the Insured Employee's place of permanent posting as stated under Item 2 of the Specific provisions. "Emergency" means unexpected and not preplanned. "Fare" means the regular fare charged for: 1) an economy class seat on a regular flight by a domestic or international scheduled air carrier, 2) a coach seat on a passenger train, 3) a regular seat on a passenger bus or 4) an economy class seat on a boat, where each of these carriers must hold an operating certificate issued by Transport Canada or by a similar governmental authority having jurisdiction over such carrier in the country of its certification. "Hospital" means an institution licensed as a hospital, which is open at all times for the care and treatment of sick and injured persons, has a staff of one (1) or more Physicians available at all times and which continuously provides twenty-four (24) hour nursing service by graduate registered nurses. It provides organized facilities for diagnostics and surgery, is an active treatment hospital and not primarily a clinic, rest home, or nursing home.. For the purposes of this definition, Hospital will include a facility or part of a facility used for rehabilitative or convalescent care provided service is ordered by a physician, subject to a maximum of one hundred and twenty (120) days. "Immediate Family Member" means a person at least eighteen (18) years of age, who is the son, daughter, father, mother, brother, sister, son-in-law, daughterin-law, father-in-law, mother-in-law, brother-in-law, sister-in-law, (all of the above include natural, adopted or step relationships), spouse, grandson, granddaughter, grandfather or grandmother of the Insured Person. "Injury" means bodily injury caused by an Accident occurring while this policy is in force as to the Insured Person whose injury is the basis of claim and resulting directly and independently of all other causes in loss covered by this policy, provided such injury is sustained and for which expenses are incurred in the Insured Employee's place of permanent posting as stated under Item 2 of the Specific provisions. In no event shall Injury mean Sickness or Disease howsoever caused unless caused by an Accident. "Insured Person" means the Insured Employee, the Insured Spouse or the Insured Dependent Child. "Motorized Vehicle" means a passenger car, station wagon, van, jeep-type automobile, truck, ambulance or any type of motorized vehicle used by municipal, provincial or federal police forces. "Nurse" means a graduate registered nurse (R.N.) or nurse who is licensed to practise nursing service by a governmental agency having jurisdiction over such licensing. Nurse is neither the Insured Person himself nor an Immediate Family Member. "Physician" means a doctor of medicine (other than the Insured Person or an Immediate Family Member) who is licensed to practise medicine by: 1) a recognized medical licensing organization in the locale where the treatment is rendered, provided he is a member in good standing of such licensing body, or 2) a governmental agency having jurisdiction over such licensing in the locale where the treatment is rendered. "Regular Care and Attendance" means observation and treatment to the extent necessary under existing standards of medical practice for the condition requiring such treatment or causing Hospital confinement.

6 5 "Residence" means the primary dwelling in the place of permanent posting as stated under Item 2 of the Specific provisions of which the Insured Person is an occupant and the premises on which it is situated. "Sickness" means an impairment of normal physiological function and includes illness and infection occurring while this policy is in force as to the Insured Person whose sickness is the basis of claim and for which expenses are incurred in the Insured Employee's place of permanent posting as stated under Item 2 of the Specific provisions. "Trip" means travel outside the Insured Employee's place of permanent posting as stated under Item 2 of the Specific provisions, undertaken by the Insured Person, which commences on the date of departure from such place and continues until the return date to such place, subject to a maximum duration of thirty (30) consecutive days. The male pronoun will be construed as the feminine when the person is a female. Medical Reimbursement Expense Benefit A. When by reason of Injury, Sickness or Disease, an Insured Person requires medical or surgical treatment and incurs eligible expenses as described in this section; the Insurer will reimburse the reasonable and necessary charges for services or supplies received by the Insured Person in accordance with the following: 1. Hospital charges including those for room and board, up to and including the private accommodation level; 2. Hospital charges for out-patient services when medically required; 3. expenses for the services of a Nurse ordered or prescribed by a Physician, provided the Nurse does not ordinarily reside in the Insured Person's Residence, subject to a maximum of twenty-five thousand dollars ($ 25,000) per Accident, Sickness or Disease; 4. charges for prescription drugs, sera and vaccines, obtainable only upon a written prescription by a Physician or legally qualified dentist and dispensed by a registered pharmacist or Physician, but excluding any charges made for the administration of injectable drugs, sera and vaccines, subject to a dispensing maximum of one hundrd and eighty (180) day supply; 5. expenses charged for the services of a licensed professional physiotherapist for physiotherapy treatment ordered or prescribed by a Physician, provided such physiotherapist does not ordinarily reside in the Insured Person's Residence and is not an Immediate Family Member, subject to a maximum of one thousand dollars ($ 1,000) per calendar year; 6. expenses for a licensed ground ambulance service or, when recommended by a Physician, by any other conveyance licensed to carry passengers for hire, to or from the nearest Hospital which is equipped to provide the required treatment, subject to a maximum of one thousand dollars ($ 1,000) per Accident, Sickness or Disease; 7. expenses incurred for the following: a) blood plasma, whole blood or oxygen, including the administration thereof; b) x-rays and laboratory examinations which are required for diagnostic purposes, including ammograms, scanners and MRIs; c) artificial limbs, eyes or other prosthetic appliances, subject to a maximum of two thousand dollars ($ 2,000) per calendar year; d) rental or purchase of casts, cervical collars, crutches, trusses, splints, orthotics and braces (except dental braces and splints) or orthopaedic shoes (limited to three hundred dollars ($ 300) per pair and to a maximum of one (1) pair per Insured Person per calendar year), including any fee charged by a Physician for designing, constructing, fitting or applying such device, subject to a maximum of two thousand dollars

7 6 ($ 2,000) for all expenses per calendar year; e) rental of a wheelchair, an iron lung and other durable medical equipment for temporary therapeutic treatment, subject to a maximum of five thousand dollars ($ 5,000) per Accident, Sickness or Disease; f) cost of elastic support stockings for varicose vein treatment, including pressure gradient hose, up to a a maximum of four pairs per Insured person er year; g) cost of intra-uterine devices (IUDs) when inserted by a physician; 8. expenses for medical care and treatment rendered or surgical procedure performed by a Physician; 9. expenses for the services of a licensed anaesthetist when recommended by a Physician; 10. expenses for the services of any of the following licensed practitioners, provided such practitioner does not ordinarily reside in the Insured Person's Residence and is not an Immediate Family Member, subject to a maximum of one thousand dollars ($ 1 000) per specialty per calendar year (such services do not require the recommendation of a Physician except as indicated below): a) acupuncturist b) chiropractor b) osteopath c) chiropodist or podiatrist d) licensed masseur, on the recommendation of a Physician e) speech therapist f) licensed psychologist and/or psychiatrist g) naturopath h) occupational therapist i) homeopath j) dietician k) audiologist Expenses for diagnostic x-rays and laboratory tests ordered by a chiropractor, osteopath, chiropodist or podiatrist will be allowed as expenses under the services of such practitioners, subject to a maximum of one (1) x-ray per practitioner for each Insured Person in any one (1) calendar year. B. The Insurer will also reimburse the reasonable and necessary charges for services or supplies received by the Insured Person in accordance with the following: 1. expenses for an annual health examination, not to exceed a maximum amount of four hundred dollars ($ 400) per Insured Person per year; 2. expenses for well-baby care, for a period of six (6) months after the birth of an Insured Dependent Child; 3. expenses for the administration of vaccines, anti-toxins, injections for immunizing against disease or poisons, not to exceed a maximum amount of one hundred twentyfive dollars ($ 125) per Insured Person per calendar year; 4. expenses for eye examination by a licensed ophthalmologist or optometrist to determine if purchase or replacement of eyeglasses or contact lenses are required, subject to not more than one (1) examination per Insured Person every two (2) calendar years. 5. cost of drugs for the treatment of infertility, when prescribed by a physician, up to a lifetime maximum amount of one thousand and two hundred dollars ($1,200) per Insured person; 6. cost of glucometers prescribed by a diabetologist or an internist, for insulindependents only; 7. diabetic supplies including test strips, clinitest, dextrose sticks or other home chemical testing agents subject to a maximum of one thousand dollars ($1,000) per insured person per year,

8 7 8. cost of supplies for colostomy or ileostomy and surgical bandages, when recommended by a physician; 9. cost of purchase or rental of wigs following chemotherapy, up to a maxmium amount of two hundred dollars ($ 200) per insured person per year; 10. cost of breast prostheses required as a result of surgery, up to a maximum amount of two hundred dollars ($ 200) per insured person per year ; and 11. cost of post-operative bras required as a result of surgery, up to a amximum of two bras per Insured person per year. Prescription Drug Reimbursement Expense Benefit The insurer will reimburse the reasonable and necessary charges for prescription drugs obtainable upon a written prescription by a Physician or a legally qualified dentist and dispensed by a registered Pharmacist, including preparation fees but excluding any delivery fees. Exception / prior approval drugs Prior approval by SSQ is required for some prescription drugs commonly referred to as exception or prior approval drugs. For these drugs to be covered, their use must meet all of the following conditions: Comply with the specific clinical criteria and directions for use determined by the government authorities Comply with the usage criteria suggested by the recognized appropriate medical and governmental authorities of the medical sector Comply with the necessary, customary and reasonable standards of practice generally accepted in the health care sector, including the ratio between their cost and their effectiveness. Accidental Dental Treatment Benefit When Injury to whole or sound teeth (capped or crowned teeth will, for the purposes of this policy, be considered whole and sound), due to a force or blow external to the mouth, requires treatment, replacement or x-rays by a legally qualified dentist or oral surgeon, the Insurer will pay the necessary expenses actually incurred by the Insured Person within fifty-two (52) weeks after the date of the Accident for such treatment or services, but not to exceed in the aggregate the amount of five thousand dollars ($ 5,000) as a result of any one (1) Accident. Evacuation Benefit If, as a result of Injury, Sickness or Disease, an Insured Person requires any of the following evacuations: 1. transportation by any conveyance (other than ground ambulance) licensed to carry passengers for hire, including air ambulance, from the place of Accident, Sickness or Disease to the nearest Hospital that is equipped to provide the required treatment (or medical facility or doctor s clinic, when warranted) provided the evacuation is recommended by the attending Physician and approved by the Insurer. 2. transportation to the Insured Person s permanent place of posting or to Canada (whichever is recommended by the attending Physician) 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 and the attending Physician certifies in writing that the Insured Person s medical condition after receiving treatment (including diagnostic testing) warrants the return to his permanent place of posting or to Canada for further treatment or to recover. 3. transportation to the Insured Person s country of posting (or Canada if recommended by the attending Physician) 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

9 8 country of posting on the original scheduled return flight, provided the return ticket is nonchangeable and non-refundable. Return of Vehicle Benefit Rental Expense Benefit Hotel Convalescence Benefit The Insurer will pay the reasonable and necessary transportation expenses actually incurred by the Insured Person including any related medical services and supplies. The Insurer will also pay the reasonable and necessary expenses actually incurred by a medical attendant or one (1) Immediate Family Member, who accompanied the Insured Person, for a round trip Airfare plus Accommodation and board. All covered expenses incurred by the medical attendant or Immediate Family Member are subject to a maximum amount of two thousand dollars ($ 2,000). The total maximum amount payable under this section will not exceed the amount of Evacuation Benefit stated under Item 3 of the Specific provisions as a result of any one (1) Accident, Sickness or Disease. The above benefit will be payable under one (1) of the policies issued to the Policyholder by the Insurer. Emergency Treatment Benefit Notwithstanding the definitions of Injury, Sickness or Disease under the section entitled "Definitions" and for the purposes of this section, Injury, Sickness and Disease are extended to include expenses incurred outside the Insured Employee's place of permanent posting as stated under Item 2 of the Specific provisions. When by reason of Injury, Sickness or Disease, an Insured Person incurs eligible expenses while on a Trip with the intent of returning to such place of permanent posting, the Insurer will reimburse the reasonable and necessary charges stated in the section entitled "Medical Reimbursement Expenses Benefit" and the following benefits: Accidental Dental Treatment Benefit Evacuation Benefit Repatriation Benefit Emergency Air Transportation Benefit Family Transportation and Accommodation Benefit All expenses must be incurred on a non-elective Emergency basis. Maternity Expense Benefit In the event an Insured Person incurs expenses due to her pregnancy (including complications arising from such pregnancy) or childbirth (including caesarean section which is an abdominal operation of uterine pregnancy) while this policy is in force as to such Insured Person, the Insurer will reimburse the reasonable and necessary expenses actually incurred including Hospital nursery expenses subject to all limitations, exclusions and deductible amounts and other provisions of this policy. Vision Care Benefit Expenses for the purchase and replacement but not repair of the following will be covered on the recommendation of a Physician, licensed ophthalmologist or optometrist: 1. Frames, lenses and fitting of prescription glasses, subject to a maximum of two hundred fifty dollars ($ 250) and restricted to one (1) such expense in any consecutive two (2) year period per Insured Person. 2. Contact lenses, when initially required or if required due to a change in the prescription, if visual acuity is improved to at least the 20/40 level and such visual acuity is not possible through the use of regular eyeglasses. Such expenses will be subject to a maximum of five hundred dollars ($ 500) per set and one (1) such expense in any consecutive two (2) year period. If visual acuity is not improved to at least the 20/40 level or such acuity is possible through the use of regular eyeglasses, then expenses for contact lenses will be subject to the above limitations for prescription glasses.

10 9 Covered expenses do not include: duplicate or spare eyeglasses 5. silicate, acrylic, composite and amalgam for anterior fillings and amalgam only for posterior fillings and preformed stainless steel crowns; duplicate or spare contact lenses sunglasses, safety glasses, cosmetic or other special purpose vision aids visual training or remedial therapy. 6. extractions and oral surgical procedures normally performed by a dentist, including the administration of general anaesthesia; 7. initial provision and installation of space maintainers for Insured Dependent Children under eighteen (18) years of age; Dental Benefit (THIS BENEFIT IS SELF-INSURED BY THE POLICYHOLDER. SSQ IS NOT THE INSURER BUT WILL PROVIDE ADMINISTRATIVE SERVICES ONLY (ASO) TO EMPLOYEES DEPLOYED INTO WAR RISK ZONES A1, A2, A3, B,C and D (also known as Deployed Operations) Basic Dental The necessary expenses actually incurred for the following procedures and materials will be covered: 1. treatment of pain; 2. routine examinations and diagnosis. Examinations will include: a) one (1) complete examination every twentyfour (24) months b) one (1) recall examination every six (6) months c) specific or emergency examinations limited to four (4) such examinations in any twelve (12) month period. 3. dental x-rays (full mouth x-rays or panorex x-ray are limited to one (1) set in any twenty-four (24) month period and bitewing x-rays are limited to one (1) set during any six (6) month period); 4. scaling and cleaning of teeth (prophylaxis) plus topical fluoride treatments and other anticariogenic substances, which are limited to one (1) treatment in any six (6) month period; 8. consultation where required and upon referral by a dentist or Physician; 9. oral hygiene instruction for brushing, massaging and flossing limited to one (1) adult per family, lifetime; 10. periodontal services for treatment of diseases of the gums and other supporting tissues of the teeth; 11. endodontics (root canal therapy); 12. repair and recementing of crowns, inlays, bridges and dentures or relining of dentures, once in any twelve (12) month period. In the event that a charge for any dental care or service is expected to exceed five hundred dollars ($ 500), or that gold is to be used in any restoration work, written notice thereof on forms provided by the Insurer should be forwarded, together with x-rays, to the Insurer for assessment before any work or treatment commences, otherwise charges incurred for such care or services may not be considered as eligible expenses under the policy. Upon receipt of such written notice, the Insurer will determine the amount of such charges which will be considered as eligible expenses. Such work or treatment must then be completed within one hundred and eighty (180) days from the date the Insurer notifies the Insured Person of the maximum charges which will be payable by the Insurer, and such work or treatment must be performed by the dentist who first prescribed the work or treatment; otherwise, the Insured Person will be required to forward a further written notice of the proposed services to the Insurer for re-assessment.

11 10 Any payments made under this section will be reduced by any amount paid or payable under the section entitled "Accidental Dental Treatment Benefit" if expenses are incurred as a result of Injury. The maximum amount payable under this section by the Insurer to or on behalf of any Insured Person will be administered on a calendar year basis and will not exceed the amount of Dental Benefit stated under Item 3 of the Specific provisions. Major Restorative Expenses for the following services made by a licensed dentist or licensed dental mechanic are covered, subject to all limitations and any other conditions of the policy. Where there are two or more courses of treatment available to adequately correct a dental condition, reimbursement will be based on the least expensive treatment. 1) Crowns when a tooth cannot be restored with any other material. Existing crowns which are more than five (5) years old and due to injury or decay shall be replaced while insured under this benefit. 2) inlays covering at least three (3) surfaces and provided the tooth cusp is missing. 3) initial provision of a fixed bridge or a full or partial denture provided it is necessary due to the extraction of a natural tooth while insured or after one (1) year continuous coverage under this benefit. 4) replacement of a fixed bridge or a full or partial denture provided: a) the existing appliance is at least five years old and cannot be made serviceable. b) the existing appliance is a temporary and the permanent appliance is installed within twelve (12) months from the date of the initial installation. c) the new appliance is necessary as a result of the extraction of a natural tooth while insured under this benefit and the existing appliance cannot be made serviceable. 5) denture adjustments (after 3 months from insertion). 6) tissue conditioning. The amount payable under this section by the Insurer to or on behalf of any Insured Person will be administered on a calendar year basis and subject to fifty percent (50%) of the covered expenses. The total expenses will not exceed the amount of Major Restorative Benefit stated under Item 3 of the Specific provisions. Orthodontic Care Coverage for eligible orthodontic expenses is restricted to an employee s insured dependent children who are under eighteen (18) years of age at the time the orthodontic treatment commences. Eligible expenses for the correction of malocclusion caused by dental irregularities include the following: 1) examination and consultation for purposes of determining the course of orthodontic treatment, including diagnostic laboratory procedures, x- rays and study models. 2) corrective or preventative orthodontic procedures and appliances. 3) fixed appliances including diagnostic procedures, formal full-banded treatment, retention and headgear. 4) observation and adjustment. Payment of Orthodontic Claims 1) If a single charge is estimated for the entire course of treatment and this charge is paid in a lump sum, then reimbursement will be on the following basis: a) The first payment will be 50% of the initial fee. b) The balance remaining will be averaged over the number of months of treatment and paid on a quarterly basis. The official payment receipt must be submitted with the claim form. Proof shall be required in order to ensure that treatment is still in progress.

12 11 2) If arrangements are made to pay the estimated single charge in monthly or quarterly installments over the course of treatment, then reimbursement will be made each time a bill or receipt is submitted. 3) If charges are made as each treatment is performed, then reimbursement will be made as the charge is incurred. The amounts payable under this section by the Insurer is subject to 50% of the covered expenses up to a maximum of one thousand dollars($ 1,000) per calendar year and limited to a lifetime maximum amount of the Orthodontic Care Benefit stated under Item 3 of the Specific provisions per person. Repatriation Benefit In the event a loss of life resulting from Injury, Sickness or Disease is sustained by an Insured Person while outside of Canada, the Insurer will pay the reasonable and necessary expenses actually incurred for the transportation of the body of the deceased Insured Person to the first resting place in Canada (including but not limited to a funeral home or the place of interment) in the vicinity of the normal place of residence in Canada, including charges for the preparation of the body for such transportation, subject to the maximum amount of Repatriation Benefit stated under Item 3 of the Specific provisions. The benefit payable under this section will be payable to the person who actually incurred the expenses. Emergency Air Transportation Benefit A. If, while outside the Insured Employee's place of permanent posting as stated under Item 2 of the Specific provisions and as the result of Injury, Sickness or Disease: 1) the attending Physician certifies in writing that the Insured Person's medical condition warrants immediate return to his Residence or to Canada for treatment, which is not available at the local Hospital in the vicinity where such Injury, Sickness or Disease occurred; or 2) an Insured Person is confined as an inpatient in a Hospital and under the Regular Care and Attendance of a Physician, thus preventing him from returning to his Residence or to Canada (whichever is recommended by the attending Physician) on the original scheduled return flight, provided the return ticket is non-changeable and non-refundable; the Insurer will pay the reasonable and necessary expenses actually incurred for the transportation of the Insured Person by the most direct route to the air terminal nearest his Residence or to Canada (whichever is recommended by the attending Physician), subject to the cost of one (1) way Airfare, to a maximum amount of two thousand five hundred dollars ($ 2,500). B. If, for medical reasons, the Insured Person requires stretcher accommodation on the return flight stated in paragraph "A" above, regardless if he has missed his original scheduled return flight, and such requirement is on written recommendation of the attending Physician, the Insurer will pay the Airfare expense for one (1) additional seat, subject to a maximum amount of two thousand five hundred dollars ($ 2,500). C. In the event the attending Physician further recommends in writing or the air carrier's rules and regulations require the presence of a medical attendant during the transportation of the Insured Person, regardless if he has missed his original scheduled return flight, the Insurer will pay the reasonable and necessary expenses actually incurred for the round trip Airfare for such medical attendant. Expenses will also include one (1) day Accommodation and board for that day. The medical attendant must be qualified to work as such in the place where the Insured Person received Emergency medical attention, does not ordinarily reside in the Insured Person's Residence and is not an Immediate Family Member. All covered expenses incurred by such attendant are subject to a maximum amount of five thousand dollars ($ 5,000). The total maximum amount payable under this section by the Insurer to or on behalf of any Insured Person will not exceed the amount of Emergency Air Transportation Benefit stated under Item 3 of the Specific provisions as a result of any one (1) Accident, Sickness or Disease.

13 12 Family Transportation and Accommodation Benefit In the event a loss of life resulting from Injury, Sickness or Disease is sustained by an Insured Person or if the Insured Person is confined as an inpatient in a Hospital for at least four (4) consecutive days and under the Regular Care and Attendance of a Physician, the Insurer will pay the reasonable and necessary expenses actually incurred by an Immediate Family Member or family representative for board, Accommodation and transportation by the most direct route from the normal place of residence of the Immediate Family Member or family representative to the bedside of such Insured Person and return to the normal place of residence of such Immediate Family Member or family representative, if such Insured Person had been travelling unaccompanied by a family member at the time he became hospitalized. Reimbursement of transportation expenses under this section is limited to seventy-five percent (75%) of the cost of one (1) return Fare. If transportation occurs in a Motorized Vehicle other than one operated under a license for the conveyance of passengers for hire, then reimbursement of transportation expenses will be limited to a maximum of thirty-five cents ($ 0.35) per kilometre travelled. The total maximum amount payable under this section by the Insurer to or on behalf of any Insured Person will not exceed the amount of Family Transportation and Accommodation Benefit stated under Item 3 of the Specific provisions as a result of any one (1) Accident, Sickness or Disease. Return transportation of Travelling Companion If the Insured Person is repatriated to his or her country of residence in accordance with the repatriation benefit or is returned to Canada or his country of residence in accordance with the transportation benefit, reimbursement of the extra cost of a one (1) way economy air fare on a commercial flight or charter via the most cost effective itinerary to transport the insured person s travel companion to his or her country of residence, up to a maximum of two thousand dollars ($2,000). Return and escort of dependent children under age If the Insured Person is repatriated or transported to Canada or their country of residence, reiumbusement of the cost of a one (1) way economy air fare on a commercial flight or charter via the most cost effective itinery to transport the Insured person s dependent children travelling with the Insured person, plus reasonable overnight hotel accommodation and meal expenses and for the services of an attendant to escort dependent children under age of 16, if required. The maximum amount payable under this section by the Insurer is limited to five thousand dollars ($ 5,000). Return of Vehicle Benefit If, while outside the Insured Employee's place of permanent posting as stated under Item 2 of the Specific provisions and as the result of Injury, Sickness or Disease, the attending Physician certifies in writing that the Insured Person has become disabled and is unable to continue the Trip by means of driving the owned or rented Motorized Vehicle used as a conveyance during such Trip, the Insurer will pay the reasonable and necessary expenses actually incurred for the return of such vehicle by a commercial agency to the Insured Person's normal place of Residence or the rental agency, as the case may be. The maximum amount payable under this section by the Insurer to or on behalf of any Insured Person will not exceed the amount of Return of Vehicle Benefit stated under Item 3 of the Specific provisions as a result of any one (1) Accident, Sickness or Disease. Rental Expense Benefit If, as a result of Injury, Sickness or Disease, an Insured Person is confined as an inpatient in a Hospital and under the Regular Care and Attendance of a Physician, the Insurer will pay the reasonable expenses actually incurred by the Insured Person for the rental of a telephone and/or television set. The maximum amount payable under this section by the Insurer to or on behalf of any Insured Person will not exceed the amount of Rental Expense Benefit

14 13 stated under Item 3 of the Specific provisions as a result of any one (1) Accident, Sickness or Disease. Hotel Convalescence Benefit If, while outside of the Insured Employee's place of permanent posting as stated under Item 2 of the Specific provisions and as the result of Injury, Sickness or Disease, the attending Physician certifies in writing that the Insured Person, due to his medical condition, is prohibited from resuming any travel following discharge from the Hospital, the Insurer will pay the reasonable and necessary expenses actually incurred for board and Accommodation. The maximum amount payable under this section by the Insurer to or on behalf of any Insured Person will not exceed the amount of Hotel Convalescence Benefit stated under Item 3 of the Specific provisions as a result of any one (1) Accident, Sickness or Disease. Maximum Limit of Indemnity With the exception of those benefits listed below, the total amount payable under this policy for reimbursement of all expenses, which an Insured Person has incurred as the result of all Injuries caused by any one (1) Accident or as the result of any one (1) Sickness or Disease, will not exceed the Maximum Limit of Indemnity stated under Item 4 of the Specific provisions. The following benefits are excluded from the Maximum Limit of Indemnity: Evacuation Benefit Dental Benefit Repatriation Benefit Emergency Air Transportation Benefit Family Transportation and Accommodation Benefit Return of Vehicle Benefit Rental Expense Benefit Hotel Convalescence Benefit Deductible The deductible amount indicated under Item 3 of the Specific provisions applies to all benefits payable under the sections listed below as a result of any one (1) Accident, Sickness or Disease. Medical Reimbursement Expense Benefit Emergency Treatment Benefit Maternity Benefit Reimbursement of insured expenses commences following satisfaction of the deductible amount, if any. Coinsurance The coinsurance percentage indicated under Item 3 of the Specific provisions applies to all benefits payable under the sections listed below as a result of any one (1) Accident, Sickness or Disease. Medical Reimbursement Expense Benefit Emergency Treatment Benefit Maternity Benefit Dental Benefit Reimbursement of insured expenses will be made at the percentage indicated, following satisfaction of the deductible, if any. Recurrent Injury, Sickness or Disease If an Injury, Sickness or Disease causes the Insured Person to incur eligible expenses following which a continuous period of six (6) or more months elapses during which the same Injury, Sickness or Disease does not cause the Insured Person to incur any eligible expenses and does not require any treatment of the Insured Person by a Physician, the Insured Person will be deemed to have recovered from the Injury, Sickness or Disease at the end of the period of six (6) or more months. Thereafter, a subsequent recurrence of the Injury, Sickness or Disease, which causes the Insured Person to incur eligible expenses will be deemed to be a different Injury, Sickness or Disease to which the full Maximum Limit of Indemnity will be applicable without any reduction or variation by reason of eligible expenses incurred as a result of the Injury, Sickness or Disease from which the Insured Person was deemed to have recovered.

15 14 Indemnity Payments Unless otherwise indicated, all benefits including those benefits payable for Insured Spouse and/or Insured Dependent Children, will be paid to or at the direction of the Insured Person. Accrued benefits, if any, unpaid at the time of the Insured Person s death will be paid to his estate. Individual Terminations Insurance provided under this policy will immediately terminate on the earliest of the following dates: A. With respect to an Insured Employee 1. on the date this policy is terminated; 2. on the premium due date if the Policyholder fails to pay the required premium for the Insured Employee,; 3. on the date the Insured Employee reaches seventy (70) years of age; 4. on the date the Insured Employee ceases to be associated with the Policyholder in a capacity making such person eligible for insurance hereunder except when the Insured Employee has completed his foreign work assignment and is waiting to become eligible under either a Canadian federal and/or provincial health and hospitalization insurance plan or the Policyholder's other group hospital and medical insurance plan and premiums are paid; 5. on the date the Insured Employee becomes eligible under either a Canadian federal and/or provincial health and hospitalization insurance plan or the Policyholder's other group hospital and medical insurance plan; 6. on the date the Insured Employee departs from the place of permanent posting stated under Item 2 of the Specific provisions except as provided under the sections entitled "Emergency Treatment Benefit" and "Continuation of Coverage". B. With respect to the Insured Spouse and/or Insured Dependent Child 1. on the date such person ceases to be eligible; 2. on the date the Insured Employee's insurance is terminated; 3. on the date the Insured Spouse or Insured Dependent Child departs from the Insured Employee's place of permanent posting stated under Item 2 of the Specific provisions except as provided under the sections entitled "Emergency Treatment Benefit" and "Continuation of Coverage". Termination of the insurance of any Insured Person will not prejudice consideration of any claim submitted within ninety (90) days of such termination as a result of Injury, Sickness or Disease which occurred prior to such termination. In the event the Insured Person is hospitalized as a result of Injury, Sickness or Disease prior to the termination of insurance, benefits will be paid provided treatment is continuous for such Injury, Sickness or Disease, subject to the terms and provisions of this policy in effect as of the date of the termination of insurance. However, benefits will not be payable for any expenses incurred after the Insured Person is no longer confined as an inpatient in a Hospital or twelve (12) months from the first day of hospitalization, whichever occurs first. Continuation of Coverage A. In the event an Insured Person returns to Canada during the Insured Employee s course of foreign work assignment for any reason approved by the Policyholder and provided premiums are paid for such Insured Employee, this policy will be extended while the Insured Person is in Canada subject to a maximum duration of thirty (30) days for each return. B. If an Insured Employee has completed his foreign work which caused him to become covered under the terms of this policy and if he is expected to be reassigned by the Policyholder to another assignment which will qualify him for coverage under the terms of this policy, then at the discretion of the Policyholder coverage for such Insured

16 15 Employee and his dependents, if any, will be continued until such re-assignment or until ninety (90) days from the date of completion of the original assignment, whichever is sooner, subject to payment of premium which will be calculated at the Insurer s manual rates then in force for the location the Insured Employee will be staying. C. Coverage under this policy may be continued for an Insured Person without payment of premium in the event the Insured Person is delayed beyond his termination date as follows: 1. If the Insured Person is returning to his province of Residence or place of permanent posting and the delay is caused by a mechanical breakdown of the conveyance in which he is travelling or scheduled to travel, a traffic accident or inclement weather, coverage will continue up to seventy-two (72) hours from the date his insurance would have terminated. 2. If, as a result of Injury, Sickness or Disease, the Insured Person is confined as an inpatient in a Hospital, coverage will continue up to seventy-two (72) hours from the date of discharge from such Hospital. 3. If, as a result of Injury, Sickness or Disease, the Insured Person is not confined in a hospital but the attending Physician certifies that his medical condition prevents him from returning to his province of Residence or place of permanent posting, coverage will continue up to a maximum of ten (10) days from the date his insurance would have terminated. The coverage which is continued under this section will be subject to the terms and provisions of this policy in effect as of the date the Insured s Person s insurance would have terminated including any provisions providing for reductions in amounts of insurance. Exclusions and Limitations A. This policy does not cover loss (fatal or non-fatal) or expenses caused by or resulting from: 1. suicide or intentionally self-inflicted Injury; 2. war, whether declared or not within Canada or the United States of America; 3. perpetration of acts of terrorism or participation in a riot, insurrection, civil commotion or disturbance; 4. active full-time, part-time or temporary service in the armed forces of any country; 5. pregnancy or childbirth, except as provided under the section entitled "Maternity Expense Benefit"; 6. a trip outside the Insured Employee's place of permanent posting stated in Item 2 of the Specific provisions undertaken by the Insured Person for the purpose of obtaining medical treatment, assessment or consultation, except as provided under the section entitled "Evacuation Benefit" or the eligible expenses are incurred in Canada; 7. participation in any professional athletics; or 8. participation in acrobatic or stunt flying, mountaineering, hang gliding, scuba diving, any racing or speed contests. B. This policy does not cover any of the following supplies or services or costs thereof: 1. expenses paid or payable under any government/group hospital, medical, dental or health care plan, or expenses for which insurance is prohibited by law; 2. medical examinations for the use of third (3rd) party and cosmetic surgery other than those required as a result of an Accident;

17 16 3. charges for experimental drugs not approved by Drugs Directorate, Health Protection Branch of Health and Welfare Canada, contraceptives of any type or form and patent medicines; 4. charges for any experimental medical treatments; 5. Charges for over the counter products, vitamins, first aid supplies, anti-obesity drugs, treatments, proteins, minerals, food supplements and smoking cessation products. 6. services for which no charge would ordinarily be made if there was no insurance coverage; 7. expenses incurred for hearing aids; 8. drugs for infertility or erectile dysfunction, or 9. expenses incurred outside the Insured Employee's place of permanent posting stated in Item 2 of the Specific provisions except as provided under the sections entitled "Emergency Treatment Benefit" and "Continuation of Coverage". 10. Dental expenses not listed under Insured Expenses. 11. Dental surgery or treatment for cosmetic purposes, except as a result of accidental injury while insured, provided such surgery or treatment is given within one (1) year of the injury, and coverage is in force at the time of treatment. 12. Expenses for broken appointments, transportation costs, completion of claim forms, third party examinations or any advice given by telephone. 13. Benefits covered by any other insurance plan, in accordance with the Non- Duplication section of the policy. 14. Appliances, restorations or treatment procedures related to temporomandibular joint dysfunction or solely to increase or restore vertical dimension. 15. Services or supplies for equilibration of dentures. 16. Splinting (other than provisional splinting). 17. Mouthguards. 18. Dental treatment which is not approved by the Canadian Dental association and which is clearly experimental in nature. 19. General anesthesia and/or nitrous oxide administered for non-surgical treatment. 20. Replacement of dentures or crowns, except as provided under the section entitled Dental Benefit 21. Implantology (Surgical Implants). 22. The use of facings on crowns and pontics posterior to the second bicuspid. C. In consultation with the attending Physician, the Insurer reserves the right to transfer an Insured Person to another Hospital or return an Insured Person to Canada for necessary treatment. In the event the Insured Person refuses to comply, the Insurer will no longer be liable for further expenses incurred, which are related to the condition causing the treatment, after the proposed transfer date. Non-Duplication Any benefits normally payable under any other insurance policy or plan that duplicate benefits payable under this policy will be co-ordinated with this policy to the extent that the aggregate reimbursement does not exceed the total expenses incurred. The Insurer may, at its discretion, require from the Insured Person an assignment of all right of recovery against any other party for loss to the extent that payment is made hereunder.