Travel Emergency Medical Coverage

The TMU group benefits plan provides you with out-of-of province/out-of-country medical coverage for expenses normally covered under the TMU group benefit plan and for emergencies. Understanding the out-of-country coverage that the TMU group benefits plan provides can give you peace of mind when travelling, and help you determine whether you need to purchase additional coverage before you go.

Below is an overview of your out-of-country emergency coverage below, but for complete details, review the Emergency Travel Assistance Benefit policy.

Travelling outside of Ontario

Continuation of non-emergency expenses covered under the TMU group benefit plan

When you leave the province, eligible expenses normally covered under the TMU group benefits plan continues. However, reimbursement is limited to the amount you would have received had the expenses been incurred in Ontario. This means that you are responsible for purchasing additional coverage or paying the difference.

Coverage for emergencies

Eligible employees, their covered spouses and dependents have emergency out-of-country/out-of-province coverage for up to 180 days per trip, to a lifetime maximum of $1 million per covered person.

Specifics of coverage

Emergency services

all in-patient hospital services and supplies
outpatient and physicians’ services
ground ambulance service to the nearest hospital
transportation to the province where you live for medical treatment, as appropriate
hotel accommodation and meals if you have been released from hospital but AZGA Service Canada Inc. determines you are not yet able to travel

Other services

24-Hour Access to Allianz Global Assistance emergency centre
medical evacuation necessary for transportation under medical supervision to a different hospital or treatment facility, in consultation with the local attending physician based on medical factors
hotel accommodation and meals, if your return trip is delayed by a medical emergency involving a covered family member travelling with you
replacement transportation tickets, if you lose the use of your return ticket due to a medical emergency
return home of unattended dependent children who are under age 16 or who have a cognitive or physical disability, if you are hospitalized
- a qualified attendant, approved by an immediate family member, to accompany the child will be provided
visit by a family member, if you are traveling alone or only with a child and are hospitalized for more than seven consecutive days
return of remains to your home province, in the event of death as a result of a medical emergency
return of your personal or rented car
help with arrangements for replacing lost or stolen travel documents and luggage as a result of a medical emergency
translation service, to help you communicate with local medical personnel
sending of urgent messages to your home or business

Maximums and limitations

coverage is for a maximum of 180 days from the date you leave your province of residence
coverage is contingent on members having provincial health insurance coverage (e.g. OHIP)
maximum benefit for eligible expenses incurred is $1 million per person per lifetime
emergency coverage ends when you or your family member is medically stable to return to the province where you live. If you choose not to do so, any further expenses would not be covered
any invasive and investigative procedures (e.g., surgery, angiogram, MRI) must be pre-authorized by Allianz Global Assistance, except in extreme circumstances.
maximum of $150 per day for up to seven days for meals and accommodations for the covered person when the trip is delayed or interrupted due a medical emergency or death of another member of the travelling party who is also a covered person
maximum of $150 per day for up to seven days for meals and accommodations at a commercial establishment for visiting family member
maximum of $150 per day for a maximum of five days for a covered person for a period of convalescence following a medical emergency when the attending physician and Allianz Global Assistance determine that hospitalization is no longer required and the covered person is not ready to travel home
maximum of $5,000 for return of remains
maximum of $500 for the return of a covered person’s vehicle
maximum of 15 days for the transmission and retention of urgent messages
Allianz Global Assistance’s services are not available in all countries
- the list of countries is subject to change so please contact Sun Life Insurance for details
for expenses incurred out-of-country, if you did not contact Allianz Global Assistance at the time of emergency, you must submit claims within 30 days of returning home
no services are provided in the covered person’s place of residence
no services are provided during any trip undertaken for the purposes of seeking medical treatment or advice
criteria for determining what qualifies as an emergency is determined by Sun Life Insurance

What qualifies as an emergency?

For a situation to qualify as an emergency, it must be an acute illness or accidental injury and require immediate medically necessary treatment prescribed by a doctor.

Emergency services means any reasonable medical services or supplies, including advice, treatment, medical procedures or surgery, required as a result of an emergency.

Examples

Having a heart attack while on vacation in Florida would be covered; needing a regular dialysis treatment would not.
If you are past a certain point in your pregnancy, or your pregnancy is considered high-risk and you go into labour or need medical assistance on a trip outside Canada, any resulting medical costs would not be covered. Although the situation requires immediate assistance, the condition is not unexpected, and therefore does not qualify as an “emergency.”

Any follow-up appointments, even as a result of a qualifying emergency, are not typically covered.

Coverage for routine medical services normally covered by OHIP

If you travel outside Canada and wish to be covered for routine medical services such as doctors’ visits and hospital accommodation normally covered by OHIP (and not TMU coverage), you must purchase specialty OHIP replacement coverage.

TMU HR strongly recommends you purchase additional coverage if you plan to travel for a long period of time.

If you require medical assistance while you are away

If you require medical assistance while you are away, you or someone you know must contact Sun Life's emergency travel assistance partner, Allianz Global Assistance.

Allianz Global Assistance will:

arrange for direct payment to the service provider (e.g. hospital or physician);
prevent out-of-pocket expenses for you; and
approve any invasive or investigative procedures to confirm you do not receive treatment that is not typically covered by the plan.

Toll-free numbers for Allianz Global Assistance can be found on your travel card.

Any invasive or investigative procedures (e.g. surgery, MRI etc.) must be pre-authorized by Allianz Global Assistance, except in extreme medically necessary circumstances.

If Allianz Global Assistance is not contacted prior to treatment, you must submit your expenses within 30 days of returning home and your claim could be reduced or declined.

How to obtain a travel card

Sign into Sun Life Plan Member by visiting www.mysunlife.ca and clicking on the "Take me to…" drop down box and select "Print Travel Card." Carry this card with you whenever you travel outside of Ontario.

You can also use your smartphone as your travel card by downloading Sun Life's free BlackBerry or iPhone application, my Sun Life Mobile (external link) , from the Apple App Store or BlackBerry App World. To sign in, use your Sun Life access ID and password.

Resources for more information

To find out more about OHIP coverage, visit the Apply for OHIP and get a health card (external link, opens in new window) page on the Government of Ontario website.

You can also contact Sun Life at 1-800-361-6212 or visit the Member Service website (external link, opens in new window) .

Questions

If you have any questions about the plan or its coverage, please submit a request to HR.