Footprints Recruiting

This Policy takes effect at 12:01 a.m., on the date stated in the application for coverage or the date coverage is approved by the insurer and from which date all insurance months shall be calculated. It continues in force for the period for which premium has been paid. Coverage may be renewed subject to approval by the Insurer for further consecutive terms, not exceeding 12 months, on payment of premium at the rate and in the amount determined at the time of renewal by the Insurer.

For the purposes of this Policy, Insured Persons shall be considered as those persons who:

1. are employed as a faculty member, staff member on foreign assignment at an accredited educational facility located out-side of their Home Country
2. are eligible dependents residing outside of their Home Country
3. are under age sixty (60)
4. have completed and signed the application form in acceptance of the Policy terms and conditions,
5. have paid the required premium or had such premium paid on their behalf by the Policyholder.

• Accident wherever used in the Policy means any sudden and unforeseen event occurring during the Policy term, resulting in bodily injury, the cause or one of the causes of which is external to the victim’s own body and occurs beyond the victim’s control.
• Benefits wherever used in the Policy means any covered expenses / services that the Insurer will pay under the Benefit Plan wording of this Policy.
• Day Patient wherever used in the Policy means a patient who occupies a Hospital bed or is charged for a Hospital bed.
• Deductible wherever used in the Policy, means the dollar amount for which the Insured Person is liable, as stated on his / her Confirmation of Insurance, before any remaining eligible expenses are reimbursed under this Policy.
• Dependent wherever used in the Policy means:
  1. The spouse of an Insured Person (but excluding those legally separated), and under the age of 60.
  2. Unmarried children, step-children, foster children and legally adopted children, who are dependant on the Insured Person for support, provided that such children are not less than 15 days old (unless Maternity benefits are selected and the appropriate premium has been remitted to the insurer) and not more than 18 years old at the date the Policy was purchased (or 24 years old provided it can be proved that the child is continuing in full-time education).
• Diagnostic Services wherever used in the Policy means laboratory tests and x-ray services, radiographs and nuclear medicine procedures used to diagnose and treat medical conditions.
• Effective Date wherever used in the Policy means the date on which the coverage under this Policy begins, as specified on the Confirmation of Insurance.
• Emergency wherever used in the Policy means a sudden and unexpected turn of events or change of condition which requires immediate Medical Treatment and which first manifests itself while this Policy is in force as to the Insured Person.
• Expatriate wherever used in the Policy means a person who leaves his / her Home Country to reside in a foreign country for which he / she does not hold a valid passport.
• Home Country wherever used in the Policy means the country for which the Insured Person holds a passport. Where the Insured Person holds more than one passport, the Home Country will be taken to mean the country that the Insured Person has declared on the Application Form. Where a family is to be covered by the Policy, there will be deemed to be one Home Country for that family, which will be the Home Country declared on the Application Form.
• Hospital wherever used in the Policy means any medical or surgical institution which is legally licensed in the country in which it is located and whose main activities are not those of a rehabilitation centre, spa, hydro clinic, sanatorium, nursing home or home for the aged. It must be under the constant supervision of a resident Physician.
• Hospital Services wherever used in the Policy means costs for accommodation, nursing, operating theatres, drugs, dressings, diagnostic procedures or any other necessary costs made by the Hospital for Medical Treatment.
• Immediate Family Member wherever used in the Policy refers to spouse, son, daughter, father, mother, brother, sister, son-in-law, daughter-in-law, brother-in-law, sister-in-law, grandson, granddaughter, grandfather or grandmother of the Insured Person.
• Injury wherever used in the Policy means an unexpected and unforeseen harm to the body caused by an Accident occurring while the Policy is in force and resulting, directly and independently of all other causes, in the Insured Person incurring Medical Expenses.
• In-Patient wherever used in the Policy means a patient who occupies a Hospital bed for more than 24 hours for Medical Treatment and for which admission was recommended by a Physician or Surgeon.
• Insured Person / You / Your wherever used in the Policy means an eligible person as defined in the ELIGIBILITY section of this Policy.
• Insurer wherever used in the Policy means certain Underwriters at Lloyd’s of London, England who provide this insurance.
• Maternity Care wherever used in the Policy refers to the medically necessary expenses associated with pregnancy and childbirth.
• Medical Appliances wherever used in the Policy means minor appliances such as crutches, casts, splints, canes, slings, trusses, braces, orthotics and the temporary rental of a wheelchair when prescribed by a Physician or Surgeon.
• Medical Expenses wherever used in the Policy means those medical and related expenses for which coverage is provided under the Benefits Section of this Policy which are necessarily incurred as a result of Injury or Sickness while coverage is in force under this Policy as to the Insured Person.
• Medical Treatment wherever used in the Policy means surgical or medical procedures the sole purpose of which is the cure or relief of an acute Sickness or Injury. An acute Sickness or Injury is characterised by an occurrence of brief duration, after which the Insured Person returns to his / her normal or previous state and degree of activity.
• Newborn Nursery Care wherever used in the Policy means the medically necessary expenses associated with the care and treatment of a newborn child while in hospital immediately following birth and any medically necessary expenses incurred up to the guaranteed period of coverage under the Maternity Care Option.
• Out-Patient wherever used in the Policy means an Insured Person who receives treatment, including Diagnostic Services at a Hospital, or other medical institution, or at a Physician’s office; where the Insured Person is not admitted or confined to a Hospital bed as an In-Patient or Day-Patient.
• Overall Maximum Limit wherever used in the Policy means the total aggregate benefits limit that may be claimed during the lifetime of an Insured Person. Such limit is indicated in the Benefit Plan Booklet wording of this policy.
• Physician or Surgeon wherever used in the Policy means a legally licensed medical practitioner recognised by the law of the country where treatment is provided and who, in rendering such treatment, is practising within the scope of his / her licensing and training. A Physician or Surgeon must not be the Insured Person or an Immediate Family Member of an Insured Person.
• Provider wherever used in the policy means
• Reasonable and Customary Costs wherever used in the Policy means costs incurred for approved, eligible treatment or supplies that do not exceed the standard costs of other providers of similar standing in the same region, for the same treatment of a similar Sickness or Injury.
• Sickness wherever used in the Policy means any unexpected and unforeseen illness or disease manifesting itself while this Policy is in force as to the Insured Person and which causes the Insured Person to incur Medical Expenses.
• The Norfolk Mobility Benefits Inc. wherever used in the Policy means the Third Party Administrator and claims administrator appointed by the Insurer.

If, at the time of loss, the Insured Person has insurance from another source for benefits provided under this Policy, the policy with the earliest effective date will be deemed to be first payor. Any benefits payable by the following shall not be considered as a covered cost under this policy:

1. Any group or individual Hospital or Medical Plan.
2. Any government Hospital or Medical Plan.
3. Any Worker’s Compensation Act.
4. Any public or tax-supported agency.

The insurance of an Insured Person shall terminate on the earliest of the following:

1. The date this Policy is terminated;
2. The date that any premium required or due on the part of the Insured Person remains unpaid;
3. The date that the Insured Person reached age sixty (60)
4. The date the insured Dependent ceases to be an eligible Dependent as defined in this Policy.
5. When medical advice has been received that the Insured Person cannot continue foreign assignment due to a disability, then all benefits are extended for a maximum period of 90 days from the first day of disability.

Termination of the insurance of any Insured Person either because of permanent return to Home Country or termination of this Policy will not prejudice consideration of any claim that may have occurred prior to such termination.

The Insured may terminate this contract at any time by giving written notice of termination to the Plan Administrator acting on behalf of the Insurer, or by delivery thereof to an authorized agent (e.g. Norfolk Mobility Benefits Inc.) prior to the Effective Date for medical reasons, the Insured will receive a full refund of premiums paid less an administration fee of $25.

If this Policy is canceled after the Effective Date, the insurer will refund the premiums paid for unused coverage subject to the three month minimum retained premium less an administration fee of $25, provided that no claims have been incurred or paid, or are pending. A waiting period of 90-days applies to all refunds.

This Policy does not cover expenses caused or contributed to directly or indirectly by:

1. air travel, other than as a passenger in a certified commercial aircraft that provides passenger service and complies with government regulations concerning pilot licensing and current certificates of airworthiness;
2. active participation in war or any act of war, or while participating in any armed forces training exercises or manoeuvre; radioactive contamination or committing or attempting to commit any criminal act;
3. intentionally self-inflicted injury, suicide or self-destruction or any attempt (while sane or insane);
4. mountaineering, scuba diving, rock or precipice climbing, hang gliding, paragliding, sport parachuting, sky diving, athletic or sports activities for remuneration or prize money, or while riding or driving in or on any motorised vehicle or device in any race of speed contents;
5. injuries received, if operating a vehicle when the Insured Person’s blood contains more than 80 milligrams of alcohol per 100 millilitres of blood;
6. mental, nervous or emotional disorders, misuse of medication, use of intoxicants or illegal drugs, or treatment therefore, or accidents related thereto;
7. examinations by, or the services of, a physician if required solely for the use of a third party;
8. any claim arising from a trip or assignment undertaken outside the home country for the purpose of securing treatment (or therapy unless pre-approved by the Insurer.
9. persons age sixty (60) or over (special application must be made for coverage);
10. any costs incurred during any period for which the appropriate premium has not been paid or while the Policy is not in force as to the Insured Person;
11. pregnancy, miscarriage, childbirth or termination of pregnancy or expenses relating thereto, except as provided under the optional Maternity benefit of this Policy if elected at the time of application;
12. fertility Treatment and/or drugs related to;

LIMITED WAR EXCLUSION CLAUSE

(Personal Accident or Illness Insurances)

Notwithstanding anything to the contrary contained herein, this Insurance does not cover loss consequent on:

1. war, whether declared or not, between any of the following countries, namely, China, France, the United Kingdom, the Russian Federation and the United States of America, or war in Europe, whether declared or not, other than:
   1. civil war,
   2. any enforcement action by or on behalf of the United Nations, in which any of the countries stated in (a) above or any armed forces thereof are engaged.

NMA 2582B
14/05/2002

NUCLEAR, CHEMICAL, BIOLOGICAL TERRORISM EXCLUSION

Notwithstanding any provision to the contrary within this insurance or any endorsement thereto it is agreed that this insurance excludes any losses, directly or indirectly arising out of, contributed to or caused by, or resulting from or in connection with any act of nuclear, chemical, biological terrorism (as defined below) regardless of any other cause or event contributing concurrently or in any other sequence to the loss. For the purpose of this endorsement: “Nuclear, chemical, biological terrorism” shall mean the use of any nuclear weapon or device or the emission, discharge, dispersal, release or escape of any solid, liquid or gaseous Chemical agent and/or Biological agent during the period of this insurance by any person or group(s) of persons, whether acting along or on behalf of or in connection with any organization(s) or government(s), committed for political, religious or ideological purposes or reasons including the intention to influence any government and/or to put the public, or any section of the public, in fear.

“Chemical” agent shall mean any compound, which, when suitably disseminated, produces incapacitating, damaging or lethal effects on people, animals, plants, or material property.

“Biological” agent shall mean any pathogenic (disease producing) micro-organism(s) and/or biologically produced toxin(s) (including genetically modified organisms and chemically synthesized toxins) which cause illness and/or death in humans, animals or plants.

If the Underwriters allege that by reason of this exclusion any loss is not covered by this insurance the burden of proving the contrary shall be upon the Insured.

Arbitration:  Any differences with respect to medical opinion will be settled between two medical experts appointed by the two parties.  This dispute resolution will be in writing.  Any differences of opinion between the two medical experts shall be referred to an umpire who shall have been appointed in writing at the outset by the two medical experts.

Legal Proceedings:  No legal proceedings shall be commenced until 60 days after a claim had been correctly submitted and no such action shall be brought unless commenced within 3 years from the first date of treatment.

The Laws of Canada and the province of Alberta govern this Policy and any dispute arising out of this Policy shall be settled in the courts of Alberta.

Misrepresentation and Fraud:  All benefits under this Policy shall be voidable if the Insurer determines, whether before or after the loss, the Insured Person has concealed or misrepresented any material fact or circumstance concerning this Policy or his / her interest therein, or in the case of fraud or false swearing by you or if you refuse to disclose information or permit the use of such information, pertaining to any of the insured persons under this Policy.  The completed and signed Application Form is the basis of and forms part of this Policy and any erroneous responses therefore constitute material misrepresentation.  Any claim to which any concealed or misrepresented material fact or circumstance pertain shall not be payable under this Policy and You shall be solely responsible for all expenses relating to Your claim, including Part F – Emergency Medical Evacuation costs.

Payment of Benefits:  The claims administrator will, on behalf of the Insurer, make payment to the Insured Person or legal representative or directly to the provider of treatment or services.  Payment will be made in CDN currency.

Pre-Authorization:  All In-Patient and Day-Patient hospitalizations and special Out-Patient Services must be pre-authorized and arranged in advance by The Norfolk Mobility Benefits Inc. or the medical assistance provider.

Return to Home Country:  Benefits shall be limited to emergency medical care for a period of 90 consecutive days per trip in Home Country, provided premium has been paid for Geographical Area including their Home Country.

Subrogation:  If an Insured Person suffers a loss covered under this Policy, the Insurer is granted the right from the Insured Person to take action to enforce all the rights, powers, privileges and remedies of the Insured Person, to the extent of Benefits paid under this Policy, against any person or organisation which caused such loss.  Additionally, if No Fault benefits or other collateral sources of payment of expenses are available to the Insured Person, regardless of fault, the Insurer is granted the right to make a demand for, and recover those benefits.  If the Insurer institutes an action, the Insurer may do so at its’ own expense, in the Insured Person’s name, and the Insured Person will attend at the place of loss to assist in the action.  If the Insured Person institutes a demand or action for a covered loss he or she shall immediately notify the Insurer so that it may safeguard its’ rights.  The Insured Person shall take no action after a loss that will impair the rights of the Insurer.

The Application, the Policy, any document attached to the Policy when issued, and any amendment to the contract agreed upon in writing after the Policy is issued, constitute the entire contract.  Any provision of the Policy, which, on its effective date, is in conflict with the statutes of the jurisdiction in which the Policy was issued, is hereby amended to conform to the minimum requirements of such statutes.

This insurance has been effected in accordance with the authorization granted to the undersigned by certain Underwriters at Lloyd’s, whose definitive members and proportions underwritten by them can be ascertained be references to this policy which bears the seal of Lloyd’s Policy Signing Officer and has been certified by the Underwriter’s Attorney In Fact in Canada and may be seen at the office of the undersigned.  The Underwriters identified in the said contract shall be liable hereunder each for his own part and not one for another in proportion to the several sums by each of them subscribed to the said contract.

Norfolk Mobility Benefits Inc., recognize and respect every individual’s right to privacy. When you apply for coverage or submit a claim, we establish a confidential file of personal information.

We use the information to administer the individual benefit plan under which you are covered. This includes many tasks, such as:

• Determining your eligibility for coverage under the plan
• Enrolling you for coverage
• Assessing your claims and providing you with payment
• Managing your claims
• Verifying and auditing eligibility and claims
• Underwriting activities, such as determining the cost of the plan, and analyzing the design options of the plan
• Preparing regulatory reports, such as tax slips

Notwithstanding the limits stated in the separate sections of this Policy, the Overall Maximum Limit for Medical Expenses shall not exceed one million dollars ($1,000,000) per Lifetime of the Insured

80% Reimbursement of eligible expenses with a $500.00 deductible per policy year.

When, by reason of Injury or Sickness, an Insured Person is confined to a Hospital the Insurer will pay the Reasonable and Customary costs for room and board charges (up to semi-private room accommodation), including the costs relating to Physicians, Surgeons, nursing, operating room, prescription drugs, dressings, diagnostic services, medical appliances, and any other necessary cost made by the Hospital for In-Patient Hospital Services, Day-Patient Hospital Services, as well as costs incurred in an Intensive Care Unit. Insured Persons must obtain Pre-Authorization from The Norfolk Group or the medical assistance provider.

When by reason of Injury or Sickness, an Insured Person incurs expenses for any of the following while under the regular care and attendance of a Physician or Surgeon, the Insurer will pay the reasonable and customary costs incurred for the following:

1. Diagnostic, X-Ray, and Laboratory Services.
   • X-Ray or Laboratory examinations under the attendance or supervision of a Physician or Surgeon for Diagnostic Services. Laboratory and x-ray services must be provided by or ordered by a Physician. This Policy does not cover magnetic resonance imaging (MRI), cardiac catheterisation, computerised axial tomography (CAT) scans for reasons considered non-emergency unless such services are Pre Authorised and arranged in advance by the Insurer.
2. Paramedical Services.
   • The services of a registered massage therapist, chiropractor, physiotherapist, psychologist, osteopath, naturopath, speech therapist, podiatrist or acupuncturist up to a maximum of $500 per profession, per policy year per insured.
3. Nursing at Home.
   • The reasonable and customary cost for the medical services of a licensed nurse in the Insured Person’s home when prescribed by a Physician and related directly to a medical condition for which the Insured Person has received or is receiving treatment covered under this Policy. This benefit is available for up to 12 weeks per lifetime. The nurse cannot be an Immediate Family Member or currently residing with the Insured Person.
4. Ambulance Charges.
   • Charges for licensed ground ambulance transportation to the nearest Hospital, or from one Hospital to another or from a Hospital to the Insured Person’s residence.
5. Routine Annual Check-ups.
   • Insured to a maximum of $300.00 per insured per 12-month period after 6 months of continuous coverage.

1. Physician or Surgeon’s service fees 
2. Personal Aids
   • rental (or purchase, at the option of the Insurer) of crutches, casts, splints, canes, slings, trusses, braces, orthotics to a maximum of $200 per policy year and the temporary rental of a wheelchair when prescribed by a Physician or Surgeon, hospital-type bed, iron lung, or other approved durable equipment for temporary therapeutic use.
3. Blood or blood plasma (includes the administration of blood).

All indemnity payable under this Part D is subject to a maximum amount of $2,500 per Insured Person, per occurrence.

Further, if an Insured Person who is a single parent is confined to a Hospital as an In-Patient, the Insurer will pay the reasonable and customary costs for a Dependent child under 15 to stay with such Insured Person.

1. Prostheses, corrective devices and medical appliances unless required as a result of a surgical procedure including glasses, contact lenses, hearing aids, dentures or dental appliances;
2. elective and / or cosmetic surgery, whether or not for psychological reasons unless required as the result of Injury incurred while this Policy is in force;
3. Acquired Immune Deficiency Syndrome (AIDS), AIDS related Complex Syndrome (ARCS) and all diseases caused by/and/or related to the HIV virus or any other sexual transmitted disease;
4. Out-patient Prescription Medication and injections
5. any Medical Expense incurred while covered under the plan but submitted 365 days following the date the expense was incurred or 90 days after coverage terminated.

Please refer to each benefit description for additional exclusions.

The Insurer will pay Benefits provided that:

1. the Insured Person has contacted and received Pre-Authorization of any costs to be incurred as either a Day-Patient or an In-Patient.  In an emergency when the claims administrator cannot be contacted in advance, then the admission to Hospital must be reported as soon as reasonably possible;
2. written details of all claims have been sent to the claims administrator as soon as possible and in any event not later than 365 days from the beginning of the Medical Treatment; 
3. all documentation relating to the claim including the claim form and accounts are originals and not copies; and
4. the required premiums have been paid relative to the Insured Person making the claim.

It is understood that:

1. the insurer can ask for medical information from any Physician or Surgeon as often as required and if necessary examine the Insured Person; and
2. the insurer shall be notified of any circumstances that may lead to a claim against a third party or any other insurance; and 
3. in the case of a claim in the Insured Person’s Home Country, proof of the Insured Person’s entry date into their Home Country is provided.

All pertinent information shall be sent to:

The Norfolk Mobility Benefits Inc.

Suite 1100, 940 – 6 Ave. SW
Calgary, AB
T2P 3T1