MEDOC® Travel Plan
Out of Province/Canada Emergency Medical Insurance Plan
The MEDOC® Travel Insurance Plan offers complete coverage for your travel needs in one convenient package, with options to suit your budget. The Provincial Health Plan provides limited basic coverage for travel outside of your province of Residence. If you have a medical emergency while travelling outside Canada, costs can easily escalate and will not all be covered by the government plan.
You and/or your family must be insured under the Provincial Health Insurance Plan in your Province of Residence to be eligible to join the plan. You can also cover your spouse and your eligible dependent children under the family option.
Take a few minutes now to consider the important features of this plan.
The MEDOC® Travel Plan Consists Of Two Options: The Base Plan and the Supplemental Plan, the terms of which are outlined separately.
The Annual Base Plan
The Annual Base Plan is a continuous plan that provides emergency medical travel coverage for an unlimited number of trips, up to 35 consecutive days per trip during the policy year. Proof of travel is not required unless a claim occurs. Your trip starts from the day you depart your province of residence. The trip starts from the day you depart your province of residence.
The Supplemental Plan
You may elect coverage under the Supplemental Plan for trips of longer than 35 consecutive days on a per trip basis to a maximum of a 210 days trip limit. You are required to report the entire period of travel from the first day. From the effective date and the termination date (actual number of days). The Supplemental Plan options include the Annual Base Plan Coverage.
The policy does not cover, provide services, or pay claims, for expenses resulting if you have any pre-existing conditions unless the condition is stable prior to travel, and when medical attention is not anticipated during the travel period. To be considered medically stable you must not have, in the six months before the departure date:
- • been treated or evaluated for new symptoms or new diagnosis;
- had symptoms that increased in frequency or severity, or examination findings indicating the condition has worsened;
- been prescribed a new treatment or change in treatment for the condition;
- been admitted to or treated in a Hospital or referred to a specialist for the condition;
- been awaiting new treatment, tests, consultations or referrals regarding the medical condition (does not include routine testing provided the results are within normal limits and no change in treatment is recommended).
- This also does not include coverage for expenses incurred as a result of a condition caused by a change in medication within 90 days prior to departure (generally does not include routine changes in medication as part of an established treatment plan, for example daily/weekly adjustments of blood thinners or insulin based on blood test results or a change to a generic product, unless the dosage is modified).
The MEDOC® Travel Plan is available to active and retired members of the NSTU and their eligible dependents. You must be a resident of Canada and covered under your provincial government plan.
How to Enroll
Complete an application form, indicating the coverage required and mail it to Johnson Inc.
Your Annual Base Plan coverage begins the day Johnson Inc. receives your completed and signed application form. Your Supplemental Plan will commence on the first day of travel.
Shortly after, you will receive written confirmation of your coverage, your individual policy and a Claims Card with the toll-free telephone number of the Emergency Helpline.
In the first year, for first time MEDOC® members only, the Annual Base plan premiums are pro-rated from the date your coverage is effective until the policy renewal date, which is September 1st.
The Plan automatically renews each year on September 1st. You will receive written notification in advance. Your coverage will continue at renewal for the next policy year, unless you provide Johnson Inc. with written notice of termination within 30 days of the renewal date. Premiums are deducted monthly. Premiums under the Base Plan are non-refundable and non-cancellable.
*Supplemental Plan premiums for any of the per trip options includes coverage for any other trips of 35 consecutive days or less duration. Premiums are deducted monthly during the period remaining from the date coverage begins until the next policy renewal, which is September 1. No portion of the Supplemental Plan premiums will be prorated.
Extension of Coverage — Supplemental Plan Only
The agreement may be extended for one further period, providing benefits were not used during the preceding period. If benefits were used, extension is at the option of the Insurer. Application for extension must be received before expiry of the first period of coverage.
Definition of Dependents
“Spouse” means either:
(a) a member’s legally married spouse; or
(b) a person living with the member on a continuous basis in a conjugal relationship that is not a legal marriage, provided such relationship has existed for at least twelve (12) consecutive months at the time of application and immediately preceding the time when the status of such person is required to be determined for the purpose of coverage and the person is publicly represented by the member as the member’s spouse.
If a member has had more than one spouse, the member’s spouse shall be only the person who was the member’s most recent spouse, using the criteria in (a) and (b) above.
“Dependent Children” means either natural children (legitimate or illegitimate), adopted children, or stepchildren of an employee who are:
a) under 21 years of age, unmarried and dependent upon you for maintenance and support; or
b) under 27 years of age and unmarried and in attendance* at an institution of higher learning and dependent upon you for maintenance and support; or
c) any functionally impaired child may remain insured past the maximum age. The child upon reaching the maximum age, must still be incapable of self-sustaining employment and be completely dependent on you for support and maintenance.
“Over-age-Dependents” — On your dependants 21st birthday you must provide Johnson Inc. proof of full-time attendance at a post-secondary educational institution.
All dependent children between the ages of 21 and 27 attending an institution of higher learning must provide Johnson Inc. each September with proof of full-time attendance at a post-secondary educational institution.
Proof must clearly indicate your over-age dependent’s name, full-time status and the semester they are attending and can include but not limited to one of the following:
1. Timetable of courses confirming full-time status.
2. Invoice of tuition paid confirming full-time status.
3. A letter from the school confirming full-time status (any associated charges are your responsibility).
Indicate on proof of full-time status, your name plus professional number.
On-line learning reviewed on an individual basis.*
If your over-age dependent discontinues enrollment in a formal education program or graduates, you must notify Johnson Inc. immediately to terminate over-age coverage.
If attending college or university outside Canada, a dependent is covered while travelling outside of the area of residence.
Eligible Expenses for Worldwide Travel Coverage
Emergency Medical Expenses
This benefit covers the cost of Emergency Hospital, surgical and medical treatment for the following:
1. Hospital room and board including an intensive care or coronary care unit, charges for standard ward accommodation, semi-private room, or private room charges when a private room is certified as medically necessary by the attending physician;
2. Other Hospital services and supplies;
3. Medical, surgical or anesthetic treatment by a licensed physician or surgeon;
4. X-rays and other diagnostic tests;
5. Use of an operating room, anesthesia and surgical dressings;
6. The cost of licensed ambulance service;
7. Outpatient emergency room charges;
8. Drugs and medications legally requiring a licensed physician's written prescription; and
9. The rental cost of a wheelchair, or the rental or purchase of minor medical appliances such as crutches, braces and other therapeutic medical appliances when ordered by the attending physician.
Air Emergency Transportation or Evacuation
When medically required covers the following expenses:
- Air ambulance to the nearest appropriate medical facility or to a Canadian Hospital;
- Fare for transportation by stretcher to the home departure point including, when medically necessary, the return fare and approved professional charge of an accompanying registered nurse or other qualified medical attendant who is not a relative of the Participant;
- Charges in excess of booked fare or prearranged charter fare that are incurred as a result of a change in the planned schedule, including additional fare of an eligible insured person covered under this contract who was travelling with the stricken Participant; and
- Return fare for transporting a member of the immediate family (spouse, parent, child) to attend at the side of a Participant who was travelling alone, following a critical injury or illness necessitating hospitalization. Attendance and return must occur within 10 days of discharge from Hospital.
All air transportation expenses must be approved and arranged in advance by Medavie Blue Cross.
Private Nursing Expenses
Charges for services of a registered graduate nurse (R.N.) for private duty nursing care provided in a Hospital or a temporary residence, when medically necessary and ordered by the attending physician. Coverage is not included for nursing service provided by a relative of the Participant.
Charges for services of a registered physiotherapist when recommended by the attending physician.
Emergency Dental Expenses
This benefit covers the cost of repair of natural, vital teeth or fracture or dislocation of the jaw, when required as a result of injury from an external blow occurring during the term of the contract. It also covers the cost of emergency extractions, temporary fillings and replacement of
fillings. Coverage is limited to $1,000 per incident and must be provided during the term of coverage.
Board and Lodging (Meals and Accommodations)
Charges for board and lodging or similar expense up to $150 per day to a maximum of $1,500 for costs incurred by a Participant or by a travelling companion, when related to a period of hospitalization of a Participant.
Repatriation (Return of the Deceased)
If a Participant dies while on an insured trip, the cost of transportation of the deceased Participant’s remains to their province of residence, up to a maximum of $3,000 per Participant. The cost of a burial coffin is not a covered expense.
If a Participant and/or an immediate family member is unable to operate their owned or rental vehicle due to sickness, injury or death while travelling outside the Participant's province of residence, this plan will arrange for the return of the vehicle and cover the expenses up to a maximum of $1,000 provided no other person travelling with the Participant is able to operate the vehicle. Benefits will only be payable for return of the vehicle when pre-approved and/or arranged by Medavie Blue Cross.
1. To the Participant’s normal place of residence; or
2. To the nearest appropriate rental agency.
If the Participant requires hospitalization or a consultation with a physician as a result of an emergency, the travel assistance provider appointed by Medavie Blue Cross will provide the following support services:
- direct the Participant to an appropriate clinic or Hospital;
- confirm with the service provider that the Participant is covered;
- ensure a follow-up of the medical file and communicate with the Participant’s family physician;
- co-ordinate the return home of a child if the Participant is hospitalized;
- repatriation of the Participant to the province of residence if the Participant meets the eligibility requirements of this expense;
- arrange for the transportation of an immediate family member to the Participant's bedside if the Participant meets the eligibility requirements of this expense; and
- co-ordinate the return of the Participant's vehicle if the Participant meets the eligibility requirements of this expense.
In emergency situations, the travel assistance provider appointed by Medavie Blue Cross will also provide the Participant with the following services:
- transmittal of urgent messages;
- co-ordination of claims;
- services of an interpreter for emergency calls;
- referral to legal counsel in the event of a serious accident;
- settlement of formalities in the event of death;
- assistance with the loss or theft of identity papers; and
- information regarding embassies and consulates.
In addition, pre-travel advice regarding visas and vaccines is available (although vaccines may not be covered under your medical plan).
Medavie Blue Cross and its travel assistance provider are not responsible for the quality of medical and Hospital care provided to the participant or for the availability of such care.
This benefit covers emergency expenses occurring when you and your dependents are travelling outside of your province of residence.
WORLDWIDE TRAVEL COVERAGE
Travel Assistance Lines (Out of Province Emergencies)
In the event of a medical emergency while travelling outside your province of residence, you or your representative must call Medavie Blue Cross’ appointed travel assistance provider as soon as possible at one of the following numbers:
From Canada or the United States: 1-800-563-4444
From anywhere else: 1-506-854-2222 (collect)
If calling collect is not possible, Medavie Blue Cross will reimburse the cost of the call.
On your first call, you will be asked for the following:
• ID card numbers
• Your name and the group you are insured under
• Your birthdate
• Your home address and travel address
• Your dates of travel
• A contact number
• Your provincial health care number
• Details of your current medical situation
• Info on whether you are covered under other policies
If someone is calling for you, they will be asked to provide the above on your behalf. Depending on the situation, other questions may be asked. A file number will be given, and it needs to be noted and quoted each time you call.
Eligible Expenses for Worldwide Travel Coverage
The plan reimburses all usual and reasonable expenses incurred following an emergency situation resulting from an accident or an illness, up to a maximum amount payable of $2,000,000 per incident, per covered Participant and a maximum amount payable of $5,000,000 for one occurrence.
Occurrence refers to each related claim arising as a result of one accident or cause, regardless of the number of policies or covered persons involved.
All customary and reasonable expenses and services described in the Worldwide Travel Benefit are eligible if they are incurred following an emergency resulting from an accident or sudden illness which occurs outside the Participant’s province of residence, provided the Participant is covered under the Hospital and health government programs of his province of residence when the emergency occurs.
Eligible treatments and benefits are supplemental to those provided for by government plans or from any other medical reimbursement plan under which you may have coverage.
When a medical emergency occurs, you must seek treatment from a physician and/or Hospital within the managed care network as referred by Medavie Blue Cross’ appointed travel assistance provider. The travel assistance provider will refer you to the physician and/or Hospital within the network that is best suited to your needs.
If you do not call the travel assistance provider, your eligible expenses will be reimbursed at 80%, except in extreme circumstances where you are unable to call. In a critical emergency, have someone call the travel assistance provider on your behalf as soon as possible and they will coordinate your benefits as usual.
If you choose not to receive treatment from the managed care network that is recommended by the travel assistance provider, your eligible expenses will be reimbursed at 80%.
Filing a Claim (Upon Return to Canada)
Please contact Medavie Blue Cross (See contact information below) and every effort will be made to assist you in making payment to the providers of service and coordinate with your provincial government plan.
Claims for services outside of Canada are paid by Medavie Blue Cross in Canadian currency based on the rate of exchange in effect at the conclusion of the services. Interest will not pay be paid should you delay sending the forms to Medavie Blue Cross.
Claim forms can be obtained from Medavie Blue Cross by calling or emailing (See contact information below). The duly completed claim form must be filed with Medavie Blue Cross no later than six months after the date expenses are incurred. When you receive these forms, please review them very carefully and ensure all sections are completed so there is no delay in reimbursement of your claim.
Medavie Blue Cross Contact Information (Within Canada)
Toll-free Customer Information Line: 1-800-667-4511 (ask for Travel Claims)
Coverage will be automatically extended beyond your day of return if you, a travelling companion, or your immediate family member travelling with you, is confined to a Hospital on your day of return due to a medical emergency. Your coverage will remain in force for as long as you, your travelling companion or your immediate family member is hospitalized plus an additional period of 5 days following discharge from Hospital.
The period of insurance coverage is automatically extended for 72 hours when:
1. the delay of a plane, bus, ship or train in which you are a passenger causes you to miss your scheduled return to your province of residence;
2. the personal means of transportation in which you are travelling is involved in an accident or mechanical breakdown that prevents you from returning to your province of residence on or before your day of return; or
3. you must delay your scheduled return to your province of residence by the personal means of transportation in which you are travelling, due to extreme weather conditions.
Exclusions and Limitations for Worldwide Travel Coverage
The policy does not cover, provide services, or pay claims, for expenses resulting from:
- a sickness or injury occurring while the policy is not in force as per your trip;
- eye glasses, contact lenses, hearing aids or prescriptions for same;
- air travel other than as a passenger in a commercial aircraft licensed to carry passengers for hire;
- preventative, experimental or patented medicines or vaccines;
- for elective (non-emergency) treatment or surgery which is defined as treatment or surgery (a) not required for the immediate relief of acute pain and suffering, or (b) which reasonably could be delayed until the Participant has returned to Canada or (c) which the Participant elects to have rendered or performed outside of Canada following emergency treatment for, or diagnosis of, a medical condition which (on medical evidence) would not prevent the Participant from returning to Canada prior to such treatment or surgery; also check-ups or treatment for cosmetic purposes;
- pregnancy, childbirth or miscarriage or any complications arising from pregnancy;
- mental or emotional disorders that do not require hospitalization; abuse of medication, drugs or alcohol; intentional self-injury, suicide or attempted suicide (whether sane or insane);
- excludes loss, damage, cost or expense of whatsoever nature directly or indirectly caused by, resulting from or in connection with any of the following regardless of any other cause or event contributing concurrently or in any other sequence to the loss:
- expenses incurred while travelling in a country (or a specific region of a country) for which there is a Government of Canada travel warning, when such travel warning was issued before the departure date and the loss or expense is related to the reason for which the travel warning was issued; and
- insurrection, war (declared or not), the hostile action of the armed forces of any country or participation in any riot or civil commotion.
- willful exposure to peril except in an attempt to save human life;
- expenses covered by any Provincial or Federal Act or Acts;
- the continued treatment, recurrence or complication of a medical condition following emergency treatment of that medical condition during your trip if the medical advisors of Medavie Blue Cross and its travel assistance provider determine that you are able to return to Canada and you chose not to return;
- any emergency transplants including but not limited to organ transplants and bone marrow transplants;
- cardiac procedures, including cardiac catheterization, or surgery unless approved by Medavie Blue Cross prior to being performed, except in extreme circumstances where surgery is performed on an emergency basis immediately following admission to Hospital; or
- expenses incurred for residents travelling outside their province of residence primarily or incidentally to seek medical advice or treatment, even if such a trip is on the recommendation of a physician;
- Any pre-existing conditions unless the condition is stable prior to travel, and when medical attention is not anticipated during the travel period.
- Medavie Blue Cross will not cover expenses in excess of $2 million Canadian per covered participant, per incidence outside the province of residence. A maximum amount of $5 million will be paid by Medavie Blue Cross for all claims incurred due to any one occurrence.
Coordination of Benefits
Benefits payable under this policy shall be coordinated with any other coverage(s) and are payable in excess of all other benefits in effect on the Insured Person’s behalf, so that payment under this policy and any other plan, including but not limited to the Insured Person’s Provincial Health Insurance Plan, individual or group policy, credit card coverage or other insurance, shall not exceed 100% of the eligible charges incurred.
There are no refunds available under the base plan.
If the Supplemental Plan is terminated prior to your day of departure, the difference in premium between the Base Plan and the Supplemental Plan will be refunded. If your Supplemental Plan is reduced to a Supplemental Plan with a shorter trip option prior to your day of departure (provided no claims have been made or pending), the difference in premium will be refunded or your monthly premium will be reduced accordingly for the remainder of the policy year.
If you return from your Supplemental Trip early and you provide proof of early return (provided no claims have been made or are pending), the difference in premium between plan options will be refunded or your monthly premiums will be reduced if applicable. Proof of early return can include: a stamped passport, airline ticket, credit card receipt, restaurant receipt or border crossing slip.
The policy automatically renews each year on September 1st; you will receive written notification of the renewal in advance. Your coverage will continue at renewal for the next policy year, unless you provide Johnson Inc. with written notice of termination within 30 days of the renewal date. Your premium is paid monthly. In the first year of coverage, your Base Plan premium is pro-rated from the effective date to the renewal date. If premium payments are not made, the amount owing will be added to the balance of premium owing. Future deductions will be adjusted accordingly. No portion of the Supplemental Plan premiums will be pro-rated.
When you receive your renewal documentation from Johnson Inc., and were previously covered under the Supplemental Plan, notify Johnson Inc. as soon as possible if you have a change in travel dates.
Also, if you are not travelling under a Supplemental Plan in the new policy year, please notify Johnson Inc. and your coverage will be adjusted back to a Base Plan.
For further information:
Visit the Johnson Inc. website: www.johnson.ca