Claims Information
Medical & Hospital Insurance For Visitors / New Immigrants To Canada

21st Century Insurance Plan

Information required to submit a claim:

• Completed Attending Physician’s Statement and Visitors to Canada Claim Form;
• Copy of Policy Confirmation (including all extensions);
• Copy of airline ticket or passport, showing entry date into Canada;
• Original receipts for all medical expenses (hospital, doctor, prescriptions, X-Ray, lab. test etc.)
• Original itemized medical bills and invoices;
• For motor vehicle accident, please provide police report.

Claims must be submitted within 365 days of initial treatment.
There is a $50.00 deductible per claim for those under age 86.
There is a $50 deductible per claim for those under 86, unless you have purchased the insurance with “$O” deductible, with additional 5% per person premium surcharge.
There is a $500.00 deductible per claim for those age 86 and over.
Any fee for completion of forms is not covered under this insurance.
Incomplete forms will delay your claim.

You may submit the above documents directly to:

21st Century Visitor’s Claims Dept.
c/o Manulife Financial
P.O. Box 4262, Stn. A,
Toronto, ON. Canada M5W 5T4
Toll-Free No. 1-866-228-6386

OR,

You may send your claim papers through us. We are pleased to forward them to Manulife Financial on your behalf.

Fok’s Insurance Agency
(Division of 1216251 Ontario Inc.)
Unit 25-145 Royal Crest Court
Markham, ON. Canada L3R 9Z4
(NE corner of Warden Ave. and 14^th Ave.)
Tel. No. 905-480-9993
Toronto Line: 416-229-9076
Canada-wide Toll-Free No. 1-800-811-9988
Fax: 905-480-9939

Claims Information (TIC Plans)

Claims Procedure

1. Claims must be reported within 30 days of occurrence.
2. Written proof of claim must be submitted within 60 days of occurrence.
3. Fully complete sections A to section D of the Claim Form, and section E if applicable. You must sign sections D and F, have section D witnessed; and section E if applicable.
4. Claims can be submitted by going to www.travelinsurance.ca/claims/claimsHowTo.php, or mail to TIC Claims Department.

Important Notes

1. In the event of a medical emergency like hospitalization, TIC Emergency Assistance must be notified prior to, any surgery being performed or within 24 hours of, admission to Hospital. Failure to do so, without reasonable cause, will result in the reduction of eligible benefit amounts payable by 20%.
2. Any fee for the completion of forms is not covered under this insurance.
3. Incomplete forms will delay your claim.

Claims Documents

a). Fully completed and signed *Claim Form.
b). Original itemized bills &/or receipts show dates and costs of all treatment received for all
expenses incurred. Photocopies will not be accepted.
c). *“Medical Certificate” completed and signed by the treating physician at your destination.
d). Any medical reports you may have been given at the time of treatment (such as a copy of ER
report or written letter from the treating physician).
e). For chiropractic/physiotherapy visits, obtain a letter from the referring physician.
f). In the event of an injury, provide details of other insurance which may respond to this loss
(auto plans, homeowners/tenants or commercial insurance).
g). For Ontario residents – a copy of your OHIP card.
For other plans, please refer to the policy booklet for details.

*Forms
All forms can be downloaded from Fok’s Insurance Agency’s website: www.fok.ca or,
TIC website: www.travelinsurance.ca/claims/claimsForms.php

T.I.C. Claims Department

1200 – 438 University Avenue
Toronto, ON. Canada M5G 2K8
Collect Worldwide: 416-340-8809
Toll free Canada / USA: 1-800-869-6747

TIC EMERGENCY ASSISTANCE
1-800-995-1662 (Toll free: USA / Canada)
800-842-08420 or 00-800-842-08420 (Toll free: Worldwide)
416-340-0049 (Collect Call)
www.travelinsurance.ca