Start a Claim

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* Indicates a required field

Select your insurance type: *

Select your category type: *

Select your card type: *

Select type of Claim: *

Is the policy holder the subject of the claim? *

Yes No

Was this a result of an accident? *

Yes No

Was the patient admitted to a hospital for over 24 hours (inpatient) or less (outpatient)? *

Inpatient Outpatient

Is the patient over 15 years of age? *

Yes No

Select one: *

Trip Cancellation Trip Interruption

Have you contacted your travel provider to collect a refund and have documentation that confirms the amount of refund granted? (This could be in the form of cash or credit.) *

Yes No

Please be sure to attach this documentation to your claim. As per the terms and conditions of your policy, you may be entitled to a reimbursement of the non-refundable portion of your prepaid travel arrangements. If you have been, or will be, refunded in the form of a credit from your travel provider, we will be unable to provide reimbursement under this policy.

As per the terms and conditions of your policy, you may be entitled to a reimbursement of the non- refundable portion of your prepaid travel arrangements. If credits exist from your travel provider, we will be unable to provide reimbursement under this policy.

Are you cancelling your trip due to a medical reason or a death? *

Yes No

At the time of the trip cancellation, what was the cause of the cancellation itself? *

Due to a death Medical Reason

Was the deceased person covered under this insurance policy? *

Yes No

Do you have the medical certificate of the deceased person? *

Yes No

Are you interrupting your trip due to a medical reason or a death? *

Yes No

At the time of the trip interruption, what was the cause of the interruption itself? *

Due to a death Medical Reason

Was the deceased person covered under this insurance policy? *

Yes No

Was this due to a medical condition of an insured under this policy that was also travelling? *

Yes No

Attach Bills/Documents: *

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What is the reason for your claim? *

Lost or Stolen Baggage (With Airline)
Lost or Stolen Baggage (Other)
Baggage Delay
Flight Delay

Do you have a Global Excel claim number? *

Yes No

Global Excel claim number: *

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Select your insurance type: *

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What is the name of your insurance product? *

{{litcertificateno}} *

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First 6 Digits

XX XXXX

Last 4 Digits

Policyholder Information

First Name: *

Last Name: *

Date of Birth: *

Policy Number:

Member ID:

Network Identifier:

Phone Number: *

Email Address: *

Is the claimant the policyholder? *

Claimant Information

First Name: *

Last Name: *

Date of Birth: *

Relationship: *

Policyholder Information

Policyholder Information

First Name: *

Last Name: *

Date of Birth: *

Title:

Email Address: *

Address in Canada: *

Province: *

City: *

Postal Code:

Phone Number: *

{{litcertificatenumber}}*

First 6 Digits

Last 4 Digits

XX XXXX

Claimant Information

First Name: *

Last Name: *

Date of Birth: *

Email Address:

Relationship: *

Address in Canada: *

Province: *

City: *

Postal Code:

Phone Number: *

Provincial Health Card Number:

Other Insured Person(s)

Please list other insured person(s) required to claim

No	First Name *	Last Name *	DOB *	Relationship to the Policyholder *
{{objItem.valNumber}}				Specify:
Add Insured

Provincial Health Card Number:

Program Coordinator Information

If you are a Program Coordinator completing this claim on behalf of the organization or cardholder, please complete the following fields:

Program Coordinator Name:

Date of Birth:

Email Address:

Business Address:

Province:

City:

Postal Code:

Phone Number:

PREFERRED METHOD OF REIMBURSEMENT

Direct Bank Deposit Check

Mailing address: *

Bank Country: *

ABA(branch) / Transit Number: *

Account Number: *

Type: *

Email to transfer funds: *

Transit Number: *

Institution number: *

Account number: *

REQUIRED DOCUMENTATION

We require a completed medical certificate. Please print and have it completed. You can also email it to yourself for later printing.

Print Email

Enter your email address :*

Send

{{litUpdatedTripCanRDHeader}} List of accepted file types are pdf, tiff, png, jpeg, jpg, gif, bmp, doc, docx, rtf, txt, odt.
Please ensure that any documents uploaded are not password protected. If they are, please remove the password before uploading. This will help reduce delays in processing your claim.

We require that you send us the following requirements in order to process your claim. You can upload these documents to your request using the upload function below. List of accepted file types are pdf, tiff, png, jpeg, jpg, gif, bmp, doc, docx, rtf, txt, odt.
Please ensure that any documents uploaded are not password protected. If they are, please remove the password before uploading. This will help reduce delays in processing your claim.

1. Credit Card Statement *

2. Proof of Event

2. Medical Certificate

2. Death Certificate

3. Booking Invoice

4. Proof of Payment

5. Airline Ticket

6. Proof of Cancellation

7. Refund Statement

8. Other Supporting Documents

1. Proof of Event

1. Medical Certificate

1. Death Certificate

2. Booking Invoice

3. Proof of Payment

4. Airline Ticket

5. Proof of Cancellation

6. Refund Statement

7. Other Supporting Documents

1. Credit Card Statement *

2. Medical Certificate

3. Death Certificate

4. Booking Invoice

5. Proof of Payment

6. Airline Ticket

7. Proof of Cancellation

8. Refund Statement

9. Other Supporting Documents

1. Medical Certificate

2. Death Certificate

3. Booking Invoice

4. Proof of Payment

5. Airline Ticket

6. Proof of Cancellation

7. Refund Statement

8. Other Supporting Documents

1. Credit Card Statement *

2. Proof of Event

2. Medical Certificate

2. Death Certificate

3. Airline Ticket

4. Booking Invoice

5. Proof of Payment - Original

6. New Boarding Passes

7. Proof of Payment - Interruption

8. Other Supporting Documents

2. Medical Certificate

3. Death Certificate

4. Airline Ticket

5. Booking Invoice

6. Proof of Payment - Original

7. New Boarding Passes

8. Proof of Payment - Interruption

9. Other Supporting Documents

1. Proof of Event

1. Medical Certificate

1. Death Certificate

2. Airline Ticket

3. Booking Invoice

4. Proof of Payment - Original

5. New Boarding Passes

6. Proof of Payment - Interruption

7. Other Supporting Documents

1. Medical Certificate

2. Death Certificate

3. Airline Ticket

4. Booking Invoice

5. Proof of Payment - Original

6. New Boarding Passes

7. Proof of Payment - Interruption

8. Other Supporting Documents

1. Invoices

Take and upload clear pictures of the invoices for medical, dental or pharmacy services purchased.

2. Receipts

Take and upload clear pictures of the receipts for payment of associated invoices. Credit card or bank statements will not be accepted.

** IMPORTANT NOTICE **

Policyholder Information

Claimant Information

Policyholder Information Policyholder Information

Claimant Information

Other Insured Person(s)

Program Coordinator Information

REQUIRED DOCUMENTATION

1. Credit Card Statement *

1. Credit Card Statement *

2. Proof of Event

2. Proof of Event

2. Medical Certificate

2. Medical Certificate

2. Death Certificate

2. Death Certificate

3. Booking Invoice

3. Booking Invoice

4. Proof of Payment

4. Proof of Payment

5. Airline Ticket

5. Airline Ticket

6. Proof of Cancellation

6. Proof of Cancellation

7. Refund Statement

7. Refund Statement

8. Other Supporting Documents

8. Other Supporting Documents

1. Proof of Event

1. Proof of Event

1. Medical Certificate

1. Medical Certificate

1. Death Certificate

1. Death Certificate

2. Booking Invoice

2. Booking Invoice

3. Proof of Payment

3. Proof of Payment

4. Airline Ticket

4. Airline Ticket

5. Proof of Cancellation

5. Proof of Cancellation

6. Refund Statement

6. Refund Statement

7. Other Supporting Documents

7. Other Supporting Documents

1. Credit Card Statement *

1. Credit Card Statement *

2. Medical Certificate

2. Medical Certificate

3. Death Certificate

3. Death Certificate

4. Booking Invoice

4. Booking Invoice

5. Proof of Payment

5. Proof of Payment

6. Airline Ticket

6. Airline Ticket

7. Proof of Cancellation

7. Proof of Cancellation

8. Refund Statement

8. Refund Statement

9. Other Supporting Documents

9. Other Supporting Documents

1. Medical Certificate

1. Medical Certificate

2. Death Certificate

2. Death Certificate

3. Booking Invoice

3. Booking Invoice

4. Proof of Payment

4. Proof of Payment

5. Airline Ticket

5. Airline Ticket

6. Proof of Cancellation

6. Proof of Cancellation

7. Refund Statement

7. Refund Statement

8. Other Supporting Documents

8. Other Supporting Documents

IMPORTANT NOTICE

Policyholder Information

Policyholder Information