An emergency means an acute illness or accidental injury that requires immediate, medically necessary treatment prescribed by a doctor. An emergency ends when you are medically stable to return to the province where you live. You, or someone with you, must call Global Excel Management (GEM)’s 24-hour operations centre before receiving medical care. The toll-free numbers are on the travel card.

If you cannot contact Global Excel Management (GEM) before services are provided, contact with Global Excel Management (GEM) must be made as soon as possible afterwards. If you don't contact Global Excel Management (GEM) and emergency services are provided in circumstances where you could reasonably have contacted them, then we may deny or limit payments for all expenses related to those emergency services. All invasive and investigative procedures (including any surgery, angiogram, MRI, PET scan, or CAT scan), must be pre-authorized by Global Excel Management (GEM) before being performed, except in extreme circumstances where surgery is performed on an emergency basis immediately following admission to a hospital.

Be prepared to give Global Excel Management (GEM) the following information: your name, the patient's name, location and phone number, your contract number and member ID number (shown on the Travel card), and a description of the situation.

Stay in touch with Global Excel Management (GEM) during and after the medical emergency, until Global Excel Management (GEM) confirms that you no longer need to do so. Please give Global Excel Management (GEM) your hospital, hotel, or other current telephone number. Call Global Excel Management (GEM) at 1-800-511-4610 in the USA and Canada; 1-519-514-0351 from anywhere else.

Your Travel Benefit and Medi-Passport cover you and your family members for certain eligible emergency medical expenses and emergency services, listed below. For additional information about the extent of your coverage and items that are not covered, see the section "Things you should know".

Global Excel Management (GEM)’s services 

Their services include: referring you to a medical facility, physician, or pharmacist, confirming your coverage and benefits, facilitating payments to a hospital or medical provider, whenever possible, and monitoring the medical situation if you are hospitalized. Global Excel Management (GEM) or a physician they designate will, when necessary, try to establish communications with the attending medical personnel to get an understanding of the situation and to monitor your condition.

Global Excel Management (GEM) may determine, in consultation with the attending physician, that you can be transported safely under medical supervision to a different hospital or treatment facility or be sent home. In these cases, Global Excel Management (GEM) will guarantee and, if necessary, advance payment for the transportation.

Eligible emergency medical expenses 

You and your family members are covered for reasonable and customary charges for the following expense items incurred for emergency services, less the amount payable by your provincial health plan:
 

• All services and supplies while in hospital (semi-private room), outpatient services in a hospital, physicians' services, licensed ground ambulance service to the nearest hospital equipped to provide the required treatment, or to Canada, when your physical condition prevents the use of another means of transportation, economy airfare for your return to your province of residence for medical treatment, and hotel accommodation and meals for a period of convalescence, if you have been released from hospital but Global Excel Management (GEM) and your attending doctor together determine that you are not yet able to travel (up to the dollar amount and time limit specified under your plan).
• Expenses for all other services and supplies eligible under your group plan, e.g., Drug, Hospital or Supplementary Health Care benefits, are also covered when they are incurred outside the province where you live. These expenses are subject to the appropriate deductibles, reimbursement level, maximums, limitations, exclusions and other conditions outlined in your plan.

Eligible Medi-Passport expenses 

In addition to the emergency services listed above, you and your family members are also covered for the following Medi-Passport services:
 

• Accommodation, if your return trip is delayed or interrupted due to a medical emergency involving you or another person travelling with you who is covered under this plan. Global Excel Management (GEM) can arrange and pay for hotel accommodation and meals (maximum amount depends on your plan).
• Replacement tickets, if you lose the use of your return ticket because of a medical emergency or death involving you, your spouse/partner or children covered under this plan. (Any advance will be the cost of a one-way economy fare, less any redeemable portion of the unused original ticket).
• Return home of dependent children, if you are hospitalized. Global Excel Management (GEM) can make arrangements to return safely home any unattended children covered under this plan who are under 16, or mentally or physically handicapped. If necessary, Global Excel Management (GEM) can also make arrangements for a qualified attendant to accompany the children home. (The maximum payable for the return transportation is a one-way economy fare for each dependent child, less any redeemable portion of the unused original ticket.)
• Visit by a family member, if you are travelling without a relative and are hospitalized for more than seven consecutive days. (This covers round trip economy fare, and accommodation and meals up to $150 a day for a maximum of seven days, depending on your plan.)
• Return of remains to the province of residence, if you or another person covered by this plan dies while out of province (maximum $5,000).
• Return of your personal or rented car to your home address in Canada or to the nearest appropriate rental car agency, if you are unable to drive due to a medical emergency. (Maximum amount depends on your plan.)
• Lost travel documents or luggage - If your luggage or travel documents become lost or stolen while you are travelling outside of the province where you live, Global Excel Management (GEM) will direct you in how to arrange for replacement of travel documents or who to contact about your lost or stolen luggage. This is a service only. There is no benefit amount payable in the event of lost or stolen luggage or documents.
• Translation services in any major language, to help you communicate with local medical personnel.
• Sending urgent messages to your home, business or other location. Global Excel Management (GEM) will also keep messages to be picked up in its offices for up to 15 days.

When Global Excel Management (GEM) Pays Providers 

When you contact Global Excel Management (GEM) before seeking emergency help, normally Global Excel Management (GEM) verifies your coverage and arranges for the service provider (e.g., a hospital) to bill Global Excel Management (GEM) directly. Global Excel Management (GEM) is also able to guarantee payment or advance money directly to a service provider. We then reimburse Global Excel Management (GEM) for the eligible amount. Sun Life Assurance Company of Canada and Global Excel Management (GEM) liaise with most provincial health plans and coordinate benefits with any other insurers involved. We will ask you to sign an authorization form allowing us to recover any amounts payable by your provincial health plan.

If You Pay For Items Yourself 

 

If, after obtaining confirmation from Global Excel Management (GEM) that you are covered and a medical emergency exists, we will reimburse you for services and supplies that you paid for and that are covered by this plan. In this situation, you should do the following:

• Keep the receipts.
• Always obtain a fully itemized bill for any hospital treatment.
• Within 30 days of your return home, complete an Emergency Medical Expense Claim Form, include original receipts and any itemized bills, and send directly to GEM (Global Excel Management (GEM)) at:
  
  P.O. Box 277
  Waterloo, Ontario
  N2J 4A4
  Claim Form
   
• You don't have to send claims for physicians' or hospital fees to your provincial health care plan first. Sun Life Assurance Company of Canada and Global Excel Management (GEM) co-ordinate the whole process with most provincial plans and all insurers and send you a cheque for the eligible expenses. This way, you receive your reimbursement faster. Global Excel Management (GEM) will ask you to sign a form authorizing them to act on your behalf.

Reimbursements 
 

When Global Excel Management (GEM) advances money to service providers, there are some situations when it will be necessary for you to reimburse us for any amounts that:

• are paid for services or supplies that are not covered by your plan,
• exceed the maximum amount of your coverage under your plan, and
• you are responsible for, such as deductibles and the percentage of expenses you have to pay under your plan.

Excluded emergency medical expenses 

You are not covered for any expenses related to these situations:

• services that are not immediately required or that could reasonably be delayed until you return to the province where you live, unless the medical condition reasonably prevents you from returning to your province before you receive the medical services,
• services relating to an illness or injury that caused the emergency, after the emergency ends,
• if you choose not to return to the province where you live as soon as you are medically stable to travel,
• if you choose not to follow the course of treatment recommended by the treating physician,
• services related to an illness or injury (including any complications or any emergency arising out of the illness or injury), where the trip was taken to obtain medical services for that illness or injury.