Start a Claim

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Is the policy holder the subject of the claim? *
                               
Was this a result of an accident? *
                          
Was the patient admitted to a hospital for over 24 hours (inpatient) or less (outpatient)? *
                          
Is the patient over 15 years of age? *
                          
Select one: *
                          
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.) *
    
Are you cancelling your trip due to a medical reason or a death? *
                            
At the time of the trip cancellation, what was the cause of the cancellation itself? *
                          
Was the deceased person covered under this insurance policy? *
                          
Do you have the medical certificate of the deceased person? *
                          
Are you interrupting your trip due to a medical reason or a death? *
                          
At the time of the trip interruption, what was the cause of the interruption itself? *
                          
Was the deceased person covered under this insurance policy? *
                          
Was this due to a medical condition of an insured under this policy that was also travelling? *
                          
Files File Size  
What is the reason for your claim? *




                          
Do you have a Global Excel claim number? *
                      
XX XXXX

Policyholder Information

Claimant Information


Note

Before proceeding with the claim form, please carefully review the documents listed in the 'Required Documents' section on this page to ensure you have them readily available.

Policyholder Information

XX XXXX

Claimant Information

Other Insured Person(s)

Please list other insured person(s) required to claim
No First Name * Last Name *
DOB
*
* 		 
Add Insured

Program Coordinator Information

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

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
Send
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. 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. 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.

3. Complete Form Accurately.


1. Credit Card Statement *

2. Baggage Contents List

3. Damaged Luggage Repair Receipt

4. Property Irregularity Report

5. Proof of Settlement

6. Other Supporting Documents

1. Baggage Contents List

2. Damaged Luggage Repair Receipt

3. Property Irregularity Report

4. Proof of Settlement

5. Other Supporting Documents

1. Credit Card Statement *

2. Baggage Contents List

3. Damaged Luggage Repair Receipt

4. Custody Report

5. Other Supporting Documents

1. Baggage Contents List

2. Damaged Luggage Repair Receipt

3. Custody Report

4. Other Supporting Documents

1. Credit Card Statement *

2. Receipts

3. Baggage Claim Report

4. Proof of Delivery

5. Other Supporting Documents

1. Receipts

2. Baggage Claim Report

3. Proof of Delivery

4. Other Supporting Documents

1. Credit Card Statement *

2. Receipts

3. Flight delay report

4. Other Supporting Documents

1. Receipts

2. Flight delay report

3. Other Supporting Documents

1. Credit Card Statement *

2. Invoice

3. Account copy

4. Police Report

5. Receipts

6. Other Supporting Documents

1. Invoice

2. Account copy

3. Police Report

4. Receipts

5. Other Supporting Documents

Note that it is extremely important to submit all required documents when returning your request to us. If any documents are missing, it could cause delays.

   When using the upload function, we recommend that you take clear digital pictures of the documents you wish to upload.

XX XXXX
Do you have a Global Excel claim number? *
                      

Note

Before proceeding with the claim form, please carefully review the documents listed in the 'Required Documents' section on this page to ensure you have them readily available.

Program Coordinator Information

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

Claimant Information

Details of Loss

Loss Type: *
                      
Have you made a previous Purchase Security or Extended Warranty Claim on this account? *
                      

Incurred Expenses

No Item Description
Purchase Date
Manufacturer Model/Serial # Purchase Price  
           
Transit Number, Institution Number and Account Number

Other Insurance

Employee, Retiree or Group Plan: *
Homeowner, Tenant, Condominium Insurance: *
                      
*
                      
Card No.: *
XX XXXX
                      

REQUIRED DOCUMENTATION

We require that you send us the following documents in order to process your claim. You can attach 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 *

3. Original Itemized Store Receipt(s)

4. Repair Estimate

5. Proof of Loss

6. Personal Insurance

7. Police Report

8. Other Supporting Documents

2. Original Itemized Store Receipt(s)

3. Repair Estimate

4. Proof of Loss

5. Personal Insurance

6. Police Report

7. Other Supporting Documents

Note that it is very important to submit all required documents when returning your request to us. If any documents are missing, it could cause delays.

   When using the upload function, we recommend that you take clear digital pictures of the documents..

Authorization

  

Authorization

  • I declare that all statements made in this claim form are accurate, true and complete. I understand that making false, misleading or incomplete statements may cause not only the claim to be denied, but insurance coverage to be rescinded by the Insurer. The undersigned agrees to refund the amount of any payments that should not have been made.
  • By signing below, you agree that we may collect, use and disclose your Information as described in the Privacy Agreement including for, but not limited to, the purposes of identifying you, providing ongoing service, processing your claims, understanding your financial needs, protecting us both from fraud and error and complying with legal and regulatory requirements. For further details about this Privacy Agreement and our privacy practices, visit www.gem.com/privacy or contact us for a copy.
  • I authorize any other insurance carrier to release and exchange with GEM Life Insurance Company ("GEM Life'') and/or GEM Home & Auto Insurance Company (“GEM H&A”) and its administrator Global Excel Management Inc. (“Global Excel “) or its representatives’ benefits payment information relating to this claim.
  • The information provided with respect to this claim will be used by GEM H&A and its administrator Global Excel or their representatives to investigate any losses, assess any entitlement to benefits and to administer this claim, and as otherwise indicated in the privacy terms available at gem.com/privacy, or included with your Certificate/Policy of Insurance. We will investigate and administer this claim by consulting the insurer’s existing files and by exchanging information with the undersigned and third parties, such as law enforcement, fire and emergency services departments, parties involved with any subrogation action, and other independent sources. This may, in some cases, include the transfer of your data outside the territory of Canada.
  • I authorize Global Excel (including its representatives or affiliates) to disclose to GEM Life and/or GEM Home & Auto any information relating to this claim that it may have in its possession including information it obtains from third parties. I am aware that any authorization I provide to Global Excel to obtain information about this claim from any third party is also an authorization for GEM Life and/or GEM Home & Auto to obtain copies of the information.
  • I also authorize the Insurer, its reinsurers and its respective agents to exchange and/or transmit information concerning this claim to the organizations listed above as is necessary to evaluate this claim. This consent shall be valid during the continuation of such claim.
  • I agree to provide all necessary assistance to secure the rights and remedies to subrogation of the claim against third parties who may be responsible for the claim.
  • I understand that if I am a dependent under this insurance coverage, the named Insured Person will have access to information related to this claim in connection with the administration of this plan.
  • I agree that a photocopy or facsimile of this authorization shall be valid as the original and that this authorization shall be considered valid for the duration of this claim, but not to exceed two years from the date it is signed. I understand information about me may be reviewed in the event that this plan is audited.
  • I declare that all statements made in this claim form are accurate, true and complete. I understand that making false, misleading or incomplete statements may cause not only the claim to be denied, but insurance coverage to be rescinded by the Insurer. The undersigned agrees to refund the amount of any payments that should not have been made.
  • By signing below, you agree that we may collect, use and disclose your Information as described in the Privacy Agreement including for, but not limited to, the purposes of identifying you, providing ongoing service, processing your claims, understanding your financial needs, protecting us both from fraud and error and complying with legal and regulatory requirements. For further details about this Privacy Agreement and our privacy practices, visit www.gem.com/privacy or contact us for a copy.
  • I authorize any other insurance carrier to release and exchange with GEM Life Insurance Company ("GEM Life'') and/or GEM Home & Auto Insurance Company (“GEM H&A”) and its administrator Global Excel Management Inc. (“Global Excel “) or its representatives’ benefits payment information relating to this claim.
  • The information provided with respect to this claim will be used by GEM H&A and its administrator Global Excel or their representatives to investigate any losses, assess any entitlement to benefits and to administer this claim, and as otherwise indicated in the privacy terms available at gem.com/privacy, or included with your Certificate/Policy of Insurance. We will investigate and administer this claim by consulting the insurer’s existing files and by exchanging information with the undersigned and third parties, such as law enforcement, fire and emergency services departments, parties involved with any subrogation action, and other independent sources. This may, in some cases, include the transfer of your data outside the territory of Canada.
  • I authorize Global Excel (including its representatives or affiliates) to disclose to GEM Life and/or GEM Home & Auto any information relating to this claim that it may have in its possession including information it obtains from third parties. I am aware that any authorization I provide to Global Excel to obtain information about this claim from any third party is also an authorization for GEM Life and/or GEM Home & Auto to obtain copies of the information.
  • I also authorize the Insurer, its reinsurers and its respective agents to exchange and/or transmit information concerning this claim to the organizations listed above as is necessary to evaluate this claim. This consent shall be valid during the continuation of such claim.
  • I agree to provide all necessary assistance to secure the rights and remedies to subrogation of the claim against third parties who may be responsible for the claim.
  • I understand that if I am a dependent under this insurance coverage, the named Insured Person will have access to information related to this claim in connection with the administration of this plan.
  • I agree that a photocopy or facsimile of this authorization shall be valid as the original and that this authorization shall be considered valid for the duration of this claim, but not to exceed two years from the date it is signed. I understand information about me may be reviewed in the event that this plan is audited.
Please keep all original documentation for your records after submitting your claim. Under exceptional circumstances, we may require that you send us original documents or a signed claim form.
A claim will be created and we will email you a confirmation with the claim number and additional questions if necessary. Please keep all original receipts and documents pertaining to your claim. Once all documents are received, we will process your claim.
A. I assign to Global Excel Management Inc. any amounts obtainable from other sources for covered losses under this policy. I also direct these sources to forward payment to Global Excel Management Inc. for my claims submitted by Global Excel Management Inc. with regard to these losses and to exchange information that facilitates this process.
B. I authorize any hospital, physician, or medical facility to send my medical information to Global Excel Management Inc. authorized representatives of the insurer. I further consent to the disclosure of this information by Global Excel Management Inc. to other sources as may be required to obtain benefits from other sources.
C. I warrant that neither I, nor any insured person, have any additional coverage through any other insurer (other than that listed above).
D. I understand that my insurance shall be void if, whether before or after the loss, any person has concealed or misrepresented any fact or circumstance concerning this claim.
E. I consent to Global Excel communicating with me via electronic means regarding my claim at the email address I have provided and understand that this communication will contain personal information.
Select One: *
                      
Have you contacted your travel provider to collect a refund and have you received documentation that confirms the amount of refund granted? (This could be in the form of cash or credit) *
                      
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.
XX XXXX
Do you have a Global Excel Claim number? *
                      

Note

Before proceeding with the claim form, please carefully review the documents listed in the 'Required Documents' section on this page to ensure you have them readily available.

Program Coordinator Information

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

Claimant Information

Other Insured Person(s)

Please list other insured person(s) required to claim
No First Name * Last Name *
DOB
*
* 		 
Add Insured

Details of Loss

Select the cause of the claim: *
                      
From:
To:
If you are submitting a claim for expenses outside of the province where you attend school you will need to include proof of those travel dates. Examples: airline tickets or gas receipts.

Incurred Expenses

Are you requesting a reimbursement? *
No Invoice Description
Purchase Date
Amount Paid Refund Obtained Total Amount Claimed Currency  
             
Transit Number, Institution Number and Account Number

Other Insurance

Employee, Retiree or Group Plan: *
Homeowner, Tenant, Condominium Insurance: *
                      
*
                      
Card No.: *
XX XXXX
                      

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
Send
We require that you send us the following documents in order to process your claim. You can attach 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. Medical Certificate

2. Medical Certificate

3. Death Certificate

4. Booking Invoice

6. Travel Documents

7. Proof of Cancellation

8. Proof of refund

9. Other Supporting Documents

1. Medical Certificate

1. Medical Certificate

2. Death Certificate

3. Booking Invoice

5. Travel Documents

6. Proof of Cancellation

7. Proof of refund

8. Other Supporting Documents

1. Credit Card Statement *

2. Medical Certificate

2. Medical Certificate

3. Death Certificate

4. Booking Invoice

6. Travel Documents

7. Proof of Cancellation

8. Proof of refund

9. Other Supporting Documents

1. Medical Certificate

1. Medical Certificate

2. Death Certificate

3. Booking Invoice

5. Travel Documents

6. Proof of Cancellation

7. Proof of refund

8. Other Supporting Documents

1. Credit Card Statement *

2. Medical Certificate

2. Medical Certificate

3. Booking Invoice

5. Travel Documents

6. Proof of Cancellation

7. Proof of refund

8. Other Supporting Documents

1. Medical Certificate

1. Medical Certificate

2. Booking Invoice

4. Travel Documents

5. Proof of Cancellation

6. Proof of refund

7. Other Supporting Documents

1. Credit Card Statement *

2. Proof Of Event

3. Booking Invoice

5. Travel Documents

6. Proof of Cancellation

7. Proof of refund

8. Other Supporting Documents

1. Proof Of Event

2. Booking Invoice

4. Travel Documents

5. Proof of Cancellation

6. Proof of refund

7. Other Supporting Documents

Note that it is extremely important to submit all required documents when returning your request to us. If any documents are missing, it could cause delays.

   When using the upload function, we recommend that you take clear digital pictures of the documents you wish to upload.

Authorization

  

Authorization

  • I declare that all statements made in this claim form are accurate, true and complete. I understand that making false, misleading or incomplete statements may cause not only the claim to be denied, but insurance coverage to be rescinded by the Insurer. The undersigned agrees to refund the amount of any payments that should not have been made.
  • By signing below, you agree that we may collect, use and disclose your Information as described in the Privacy Agreement including for, but not limited to, the purposes of identifying you, providing ongoing service, processing your claims, understanding your financial needs, protecting us both from fraud and error and complying with legal and regulatory requirements. For further details about this Privacy Agreement and our privacy practices, visit www.gem.com/privacy or contact us for a copy.
  • I authorize any other insurance carrier to release and exchange with GEM Life Insurance Company ("GEM Life'') and/or GEM Home & Auto Insurance Company (“GEM H&A”) and its administrator Global Excel Management Inc. (“Global Excel “) or its representatives’ benefits payment information relating to this claim.
  • The information provided with respect to this claim will be used by GEM H&A and its administrator Global Excel or their representatives to investigate any losses, assess any entitlement to benefits and to administer this claim, and as otherwise indicated in the privacy terms available at gem.com/privacy, or included with your Certificate/Policy of Insurance. We will investigate and administer this claim by consulting the insurer’s existing files and by exchanging information with the undersigned and third parties, such as law enforcement, fire and emergency services departments, parties involved with any subrogation action, and other independent sources. This may, in some cases, include the transfer of your data outside the territory of Canada.
  • I authorize Global Excel (including its representatives or affiliates) to disclose to GEM Life and/or GEM Home & Auto any information relating to this claim that it may have in its possession including information it obtains from third parties. I am aware that any authorization I provide to Global Excel to obtain information about this claim from any third party is also an authorization for GEM Life and/or GEM Home & Auto to obtain copies of the information.
  • I also authorize the Insurer, its reinsurers and its respective agents to exchange and/or transmit information concerning this claim to the organizations listed above as is necessary to evaluate this claim. This consent shall be valid during the continuation of such claim.
  • I agree to provide all necessary assistance to secure the rights and remedies to subrogation of the claim against third parties who may be responsible for the claim.
  • I understand that if I am a dependent under this insurance coverage, the named Insured Person will have access to information related to this claim in connection with the administration of this plan.
  • I agree that a photocopy or facsimile of this authorization shall be valid as the original and that this authorization shall be considered valid for the duration of this claim, but not to exceed two years from the date it is signed. I understand information about me may be reviewed in the event that this plan is audited.
  • I declare that all statements made in this claim form are accurate, true and complete. I understand that making false, misleading or incomplete statements may cause not only the claim to be denied, but insurance coverage to be rescinded by the Insurer. The undersigned agrees to refund the amount of any payments that should not have been made.
  • By signing below, you agree that we may collect, use and disclose your Information as described in the Privacy Agreement including for, but not limited to, the purposes of identifying you, providing ongoing service, processing your claims, understanding your financial needs, protecting us both from fraud and error and complying with legal and regulatory requirements. For further details about this Privacy Agreement and our privacy practices, visit www.gem.com/privacy or contact us for a copy.
  • I authorize any other insurance carrier to release and exchange with GEM Life Insurance Company ("GEM Life'') and/or GEM Home & Auto Insurance Company (“GEM H&A”) and its administrator Global Excel Management Inc. (“Global Excel “) or its representatives’ benefits payment information relating to this claim.
  • The information provided with respect to this claim will be used by GEM H&A and its administrator Global Excel or their representatives to investigate any losses, assess any entitlement to benefits and to administer this claim, and as otherwise indicated in the privacy terms available at gem.com/privacy, or included with your Certificate/Policy of Insurance. We will investigate and administer this claim by consulting the insurer’s existing files and by exchanging information with the undersigned and third parties, such as law enforcement, fire and emergency services departments, parties involved with any subrogation action, and other independent sources. This may, in some cases, include the transfer of your data outside the territory of Canada.
  • I authorize Global Excel (including its representatives or affiliates) to disclose to GEM Life and/or GEM Home & Auto any information relating to this claim that it may have in its possession including information it obtains from third parties. I am aware that any authorization I provide to Global Excel to obtain information about this claim from any third party is also an authorization for GEM Life and/or GEM Home & Auto to obtain copies of the information.
  • I also authorize the Insurer, its reinsurers and its respective agents to exchange and/or transmit information concerning this claim to the organizations listed above as is necessary to evaluate this claim. This consent shall be valid during the continuation of such claim.
  • I agree to provide all necessary assistance to secure the rights and remedies to subrogation of the claim against third parties who may be responsible for the claim.
  • I understand that if I am a dependent under this insurance coverage, the named Insured Person will have access to information related to this claim in connection with the administration of this plan.
  • I agree that a photocopy or facsimile of this authorization shall be valid as the original and that this authorization shall be considered valid for the duration of this claim, but not to exceed two years from the date it is signed. I understand information about me may be reviewed in the event that this plan is audited.
Please keep all original documentation for your records after submitting your claim. Under exceptional circumstances, we may require that you send us original documents or a signed claim form.
A claim will be created and we will email you a confirmation with the claim number and additional questions if necessary. Please keep all original receipts and documents pertaining to your claim. Once all documents are received, we will process your claim.
A. I assign to Global Excel Management Inc. any amounts obtainable from other sources for covered losses under this policy. I also direct these sources to forward payment to Global Excel Management Inc. for my claims submitted by Global Excel Management Inc. with regard to these losses and to exchange information that facilitates this process.
B. I authorize any hospital, physician, or medical facility to send my medical information to Global Excel Management Inc. authorized representatives of the insurer. I further consent to the disclosure of this information by Global Excel Management Inc. to other sources as may be required to obtain benefits from other sources.
C. I warrant that neither I, nor any insured person, have any additional coverage through any other insurer (other than that listed above).
D. I understand that my insurance shall be void if, whether before or after the loss, any person has concealed or misrepresented any fact or circumstance concerning this claim.
E. I consent to Global Excel communicating with me via electronic means regarding my claim at the email address I have provided and understand that this communication will contain personal information.
XX XXXX
Do you have a Global Excel Claim number? *
                      

Note

Before proceeding with the claim form, please carefully review the documents listed in the 'Required Documents' section on this page to ensure you have them readily available.

Program Coordinator Information

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

Claimant Information

Details of Loss

Cause of Loss: *
                      
                      

Other Vehicle Information

Claim Summary

Was the full cost of the rental charged to your credit card? *
                      
Did you have a rental agreement prior or following this rental? *
                      
Benefits are payable to: *
                      
Transit Number, Institution Number and Account Number

Other Insurance

                      
                      

REQUIRED DOCUMENTATION

We require that you send us the following documents in order to process your claim. You can attach 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 *

3. Rental Agency's Sales Receipt

4. Vehicle Rental Agreement

5. Accident Loss / Damage Report

6. Repair Estimate

7. Proof of Payment

8. Police Report

9. Other Supporting Documents

2. Rental Agency's Sales Receipt

3. Vehicle Rental Agreement

4. Accident Loss / Damage Report

5. Repair Estimate

6. Proof of Payment

7. Police Report

8. Other Supporting Documents

Note that it is extremely important to submit all required documents when returning your request to us. If any documents are missing, it could cause delays.

   When using the upload function, we recommend that you take clear digital pictures of the documents you wish to upload.

Authorization

  

Authorization

  • I declare that all statements made in this claim form are accurate, true and complete. I understand that making false, misleading or incomplete statements may cause not only the claim to be denied, but insurance coverage to be rescinded by the Insurer. The undersigned agrees to refund the amount of any payments that should not have been made.
  • By signing below, you agree that we may collect, use and disclose your Information as described in the Privacy Agreement including for, but not limited to, the purposes of identifying you, providing ongoing service, processing your claims, understanding your financial needs, protecting us both from fraud and error and complying with legal and regulatory requirements. For further details about this Privacy Agreement and our privacy practices, visit www.gem.com/privacy or contact us for a copy.
  • I authorize any other insurance carrier to release and exchange with GEM Life Insurance Company ("GEM Life'') and/or GEM Home & Auto Insurance Company (“GEM H&A”) and its administrator Global Excel Management Inc. (“Global Excel “) or its representatives’ benefits payment information relating to this claim.
  • The information provided with respect to this claim will be used by GEM H&A and its administrator Global Excel or their representatives to investigate any losses, assess any entitlement to benefits and to administer this claim, and as otherwise indicated in the privacy terms available at gem.com/privacy, or included with your Certificate/Policy of Insurance. We will investigate and administer this claim by consulting the insurer’s existing files and by exchanging information with the undersigned and third parties, such as law enforcement, fire and emergency services departments, parties involved with any subrogation action, and other independent sources. This may, in some cases, include the transfer of your data outside the territory of Canada.
  • I authorize Global Excel (including its representatives or affiliates) to disclose to GEM Life and/or GEM Home & Auto any information relating to this claim that it may have in its possession including information it obtains from third parties. I am aware that any authorization I provide to Global Excel to obtain information about this claim from any third party is also an authorization for GEM Life and/or GEM Home & Auto to obtain copies of the information.
  • I also authorize the Insurer, its reinsurers and its respective agents to exchange and/or transmit information concerning this claim to the organizations listed above as is necessary to evaluate this claim. This consent shall be valid during the continuation of such claim.
  • I agree to provide all necessary assistance to secure the rights and remedies to subrogation of the claim against third parties who may be responsible for the claim.
  • I understand that if I am a dependent under this insurance coverage, the named Insured Person will have access to information related to this claim in connection with the administration of this plan.
  • I agree that a photocopy or facsimile of this authorization shall be valid as the original and that this authorization shall be considered valid for the duration of this claim, but not to exceed two years from the date it is signed. I understand information about me may be reviewed in the event that this plan is audited.
  • I declare that all statements made in this claim form are accurate, true and complete. I understand that making false, misleading or incomplete statements may cause not only the claim to be denied, but insurance coverage to be rescinded by the Insurer. The undersigned agrees to refund the amount of any payments that should not have been made.
  • By signing below, you agree that we may collect, use and disclose your Information as described in the Privacy Agreement including for, but not limited to, the purposes of identifying you, providing ongoing service, processing your claims, understanding your financial needs, protecting us both from fraud and error and complying with legal and regulatory requirements. For further details about this Privacy Agreement and our privacy practices, visit www.gem.com/privacy or contact us for a copy.
  • I authorize any other insurance carrier to release and exchange with GEM Life Insurance Company ("GEM Life'') and/or GEM Home & Auto Insurance Company (“GEM H&A”) and its administrator Global Excel Management Inc. (“Global Excel “) or its representatives’ benefits payment information relating to this claim.
  • The information provided with respect to this claim will be used by GEM H&A and its administrator Global Excel or their representatives to investigate any losses, assess any entitlement to benefits and to administer this claim, and as otherwise indicated in the privacy terms available at gem.com/privacy, or included with your Certificate/Policy of Insurance. We will investigate and administer this claim by consulting the insurer’s existing files and by exchanging information with the undersigned and third parties, such as law enforcement, fire and emergency services departments, parties involved with any subrogation action, and other independent sources. This may, in some cases, include the transfer of your data outside the territory of Canada.
  • I authorize Global Excel (including its representatives or affiliates) to disclose to GEM Life and/or GEM Home & Auto any information relating to this claim that it may have in its possession including information it obtains from third parties. I am aware that any authorization I provide to Global Excel to obtain information about this claim from any third party is also an authorization for GEM Life and/or GEM Home & Auto to obtain copies of the information.
  • I also authorize the Insurer, its reinsurers and its respective agents to exchange and/or transmit information concerning this claim to the organizations listed above as is necessary to evaluate this claim. This consent shall be valid during the continuation of such claim.
  • I agree to provide all necessary assistance to secure the rights and remedies to subrogation of the claim against third parties who may be responsible for the claim.
  • I understand that if I am a dependent under this insurance coverage, the named Insured Person will have access to information related to this claim in connection with the administration of this plan.
  • I agree that a photocopy or facsimile of this authorization shall be valid as the original and that this authorization shall be considered valid for the duration of this claim, but not to exceed two years from the date it is signed. I understand information about me may be reviewed in the event that this plan is audited.
Please keep all original documentation for your records after submitting your claim. Under exceptional circumstances, we may require that you send us original documents or a signed claim form.
A claim will be created and we will email you a confirmation with the claim number and additional questions if necessary. Please keep all original receipts and documents pertaining to your claim. Once all documents are received, we will process your claim.
A. I assign to Global Excel Management Inc. any amounts obtainable from other sources for covered losses under this policy. I also direct these sources to forward payment to Global Excel Management Inc. for my claims submitted by Global Excel Management Inc. with regard to these losses and to exchange information that facilitates this process.
B. I authorize any hospital, physician, or medical facility to send my medical information to Global Excel Management Inc. authorized representatives of the insurer. I further consent to the disclosure of this information by Global Excel Management Inc. to other sources as may be required to obtain benefits from other sources.
C. I warrant that neither I, nor any insured person, have any additional coverage through any other insurer (other than that listed above).
D. I understand that my insurance shall be void if, whether before or after the loss, any person has concealed or misrepresented any fact or circumstance concerning this claim.
E. I consent to Global Excel communicating with me via electronic means regarding my claim at the email address I have provided and understand that this communication will contain personal information.
XX XXXX
Do you have a Global Excel Claim number? *
                      

Note

Before proceeding with the claim form, please carefully review the documents listed in the 'Required Documents' section on this page to ensure you have them readily available.

Program Coordinator Information

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

Claimant Information

Details of Loss

Loss Type: *
                      

Item Information

Was the item(s) given as a gift(s)? *
                      
Have you made a previous Purchase Security or Extended Warranty claim on this account? *
                      
Transit Number, Institution Number and Account Number

Required documentation

We require that you send us the following documents in order to process your claim. You can attach 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 *

3. Receipts

4. Manufacturer's Warranty

5. Repair Estimate

6. Other Supporting Documents

2. Receipts

3. Manufacturer's Warranty

4. Repair Estimate

5. Other Supporting Documents

Note that it is extremely important to submit all required documents when returning your request to us. If any documents are missing, it could cause delays.

   When using the upload function, we recommend that you take clear digital pictures of the documents you wish to upload.

Authorization

  

Authorization

  • I declare that all statements made in this claim form are accurate, true and complete. I understand that making false, misleading or incomplete statements may cause not only the claim to be denied, but insurance coverage to be rescinded by the Insurer. The undersigned agrees to refund the amount of any payments that should not have been made.
  • By signing below, you agree that we may collect, use and disclose your Information as described in the Privacy Agreement including for, but not limited to, the purposes of identifying you, providing ongoing service, processing your claims, understanding your financial needs, protecting us both from fraud and error and complying with legal and regulatory requirements. For further details about this Privacy Agreement and our privacy practices, visit www.gem.com/privacy or contact us for a copy.
  • I authorize any other insurance carrier to release and exchange with GEM Life Insurance Company ("GEM Life'') and/or GEM Home & Auto Insurance Company (“GEM H&A”) and its administrator Global Excel Management Inc. (“Global Excel “) or its representatives’ benefits payment information relating to this claim.
  • The information provided with respect to this claim will be used by GEM H&A and its administrator Global Excel or their representatives to investigate any losses, assess any entitlement to benefits and to administer this claim, and as otherwise indicated in the privacy terms available at gem.com/privacy, or included with your Certificate/Policy of Insurance. We will investigate and administer this claim by consulting the insurer’s existing files and by exchanging information with the undersigned and third parties, such as law enforcement, fire and emergency services departments, parties involved with any subrogation action, and other independent sources. This may, in some cases, include the transfer of your data outside the territory of Canada.
  • I authorize Global Excel (including its representatives or affiliates) to disclose to GEM Life and/or GEM Home & Auto any information relating to this claim that it may have in its possession including information it obtains from third parties. I am aware that any authorization I provide to Global Excel to obtain information about this claim from any third party is also an authorization for GEM Life and/or GEM Home & Auto to obtain copies of the information.
  • I also authorize the Insurer, its reinsurers and its respective agents to exchange and/or transmit information concerning this claim to the organizations listed above as is necessary to evaluate this claim. This consent shall be valid during the continuation of such claim.
  • I agree to provide all necessary assistance to secure the rights and remedies to subrogation of the claim against third parties who may be responsible for the claim.
  • I understand that if I am a dependent under this insurance coverage, the named Insured Person will have access to information related to this claim in connection with the administration of this plan.
  • I agree that a photocopy or facsimile of this authorization shall be valid as the original and that this authorization shall be considered valid for the duration of this claim, but not to exceed two years from the date it is signed. I understand information about me may be reviewed in the event that this plan is audited.
  • I declare that all statements made in this claim form are accurate, true and complete. I understand that making false, misleading or incomplete statements may cause not only the claim to be denied, but insurance coverage to be rescinded by the Insurer. The undersigned agrees to refund the amount of any payments that should not have been made.
  • By signing below, you agree that we may collect, use and disclose your Information as described in the Privacy Agreement including for, but not limited to, the purposes of identifying you, providing ongoing service, processing your claims, understanding your financial needs, protecting us both from fraud and error and complying with legal and regulatory requirements. For further details about this Privacy Agreement and our privacy practices, visit www.gem.com/privacy or contact us for a copy.
  • I authorize any other insurance carrier to release and exchange with GEM Life Insurance Company ("GEM Life'') and/or GEM Home & Auto Insurance Company (“GEM H&A”) and its administrator Global Excel Management Inc. (“Global Excel “) or its representatives’ benefits payment information relating to this claim.
  • The information provided with respect to this claim will be used by GEM H&A and its administrator Global Excel or their representatives to investigate any losses, assess any entitlement to benefits and to administer this claim, and as otherwise indicated in the privacy terms available at gem.com/privacy, or included with your Certificate/Policy of Insurance. We will investigate and administer this claim by consulting the insurer’s existing files and by exchanging information with the undersigned and third parties, such as law enforcement, fire and emergency services departments, parties involved with any subrogation action, and other independent sources. This may, in some cases, include the transfer of your data outside the territory of Canada.
  • I authorize Global Excel (including its representatives or affiliates) to disclose to GEM Life and/or GEM Home & Auto any information relating to this claim that it may have in its possession including information it obtains from third parties. I am aware that any authorization I provide to Global Excel to obtain information about this claim from any third party is also an authorization for GEM Life and/or GEM Home & Auto to obtain copies of the information.
  • I also authorize the Insurer, its reinsurers and its respective agents to exchange and/or transmit information concerning this claim to the organizations listed above as is necessary to evaluate this claim. This consent shall be valid during the continuation of such claim.
  • I agree to provide all necessary assistance to secure the rights and remedies to subrogation of the claim against third parties who may be responsible for the claim.
  • I understand that if I am a dependent under this insurance coverage, the named Insured Person will have access to information related to this claim in connection with the administration of this plan.
  • I agree that a photocopy or facsimile of this authorization shall be valid as the original and that this authorization shall be considered valid for the duration of this claim, but not to exceed two years from the date it is signed. I understand information about me may be reviewed in the event that this plan is audited.
Please keep all original documentation for your records after submitting your claim. Under exceptional circumstances, we may require that you send us original documents or a signed claim form.
A claim will be created and we will email you a confirmation with the claim number and additional questions if necessary. Please keep all original receipts and documents pertaining to your claim. Once all documents are received, we will process your claim.
A. I assign to Global Excel Management Inc. any amounts obtainable from other sources for covered losses under this policy. I also direct these sources to forward payment to Global Excel Management Inc. for my claims submitted by Global Excel Management Inc. with regard to these losses and to exchange information that facilitates this process.
B. I authorize any hospital, physician, or medical facility to send my medical information to Global Excel Management Inc. authorized representatives of the insurer. I further consent to the disclosure of this information by Global Excel Management Inc. to other sources as may be required to obtain benefits from other sources.
C. I warrant that neither I, nor any insured person, have any additional coverage through any other insurer (other than that listed above).
D. I understand that my insurance shall be void if, whether before or after the loss, any person has concealed or misrepresented any fact or circumstance concerning this claim.
E. I consent to Global Excel communicating with me via electronic means regarding my claim at the email address I have provided and understand that this communication will contain personal information.
XX XXXX
Do you have a Global Excel Claim number? *
                      

Note

Before proceeding with the claim form, please carefully review the documents listed in the 'Required Documents' section on this page to ensure you have them readily available.

Program Coordinator Information

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

Claimant Information

Other Insured Person(s)

Please list other insured person(s) required to claim
No First Name * Last Name *
DOB
*
* 		 
Add Insured

Claim Information

Claiming for: *
                      
Did you file a report with the police or other authority? *

Incurred Expenses

Are you requesting a reimbursement? *
No Invoice Description
Purchase Date
Amount Paid Refund Obtained Total Amount Claimed Currency  
             
Transit Number, Institution Number and Account Number

Other Insurance

Employee, Retiree or Group Plan: *
Homeowner, Tenant, Condominium Insurance: *
                      
*
                      
Card No.: *
XX XXXX
                      

REQUIRED DOCUMENTATION

We require that you send us the following documents in order to process your claim. You can attach 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. Account Statement

3. Tickets

4. Baggage Claim Ticket

5. Original Itemized Store Receipt(s)

6. Common Carrier Report

7. Proof of Settlement

8. Baggage Contents List

9. Proof of Loss

10. Police Report

11. Other Supporting Documents

1. Account Statement

2. Tickets

3. Baggage Claim Ticket

2. Original Itemized Store Receipt(s)

5. Common Carrier Report

6. Proof of Settlement

7. Baggage Contents List

4. Proof of Loss

6. Police Report

6. Other Supporting Documents

1. Credit Card Statement *

2. Tickets

3. Common Carrier Report

4. Itemized Receipts

5. Proof of Settlement

6. Proof of delivery

7. Other Supporting Documents

1. Tickets

2. Common Carrier Report

3. Itemized Receipts

4. Proof of Settlement

5. Proof of delivery

6. Other Supporting Documents

1. Credit Card Statement *

2. Tickets

3. Baggage Content List

4. Itemized Receipts

5. Common Carrier Irregularity/Loss Report

6. Proof of Settlement

7. Other Supporting Documents

1. Tickets

2. Baggage Content List

3. Itemized Receipts

4. Common Carrier Irregularity/Loss Report

5. Proof of Settlement

6. Other Supporting Documents

1. Credit Card Statement *

2. Tickets

3. Baggage Content List

4. Itemized Receipts

5. Common Carrier Irregularity/Loss Report

6. Police Report

7. Proof of Settlement

8. Other Supporting Documents

1. Tickets

2. Baggage Content List

3. Itemized Receipts

4. Common Carrier Irregularity/Loss Report

5. Police Report

6. Proof of Settlement

7. Other Supporting Documents

Note that it is very important to submit all required documents when returning your request to us. If any documents are missing, it could cause delays.

   When using the upload function, we recommend that you take clear digital pictures of the documents.

Authorization

  

Authorization

  • I declare that all statements made in this claim form are accurate, true and complete. I understand that making false, misleading or incomplete statements may cause not only the claim to be denied, but insurance coverage to be rescinded by the Insurer. The undersigned agrees to refund the amount of any payments that should not have been made.
  • By signing below, you agree that we may collect, use and disclose your Information as described in the Privacy Agreement including for, but not limited to, the purposes of identifying you, providing ongoing service, processing your claims, understanding your financial needs, protecting us both from fraud and error and complying with legal and regulatory requirements. For further details about this Privacy Agreement and our privacy practices, visit www.gem.com/privacy or contact us for a copy.
  • I authorize any other insurance carrier to release and exchange with GEM Life Insurance Company ("GEM Life'') and/or GEM Home & Auto Insurance Company (“GEM H&A”) and its administrator Global Excel Management Inc. (“Global Excel “) or its representatives’ benefits payment information relating to this claim.
  • The information provided with respect to this claim will be used by GEM H&A and its administrator Global Excel or their representatives to investigate any losses, assess any entitlement to benefits and to administer this claim, and as otherwise indicated in the privacy terms available at gem.com/privacy, or included with your Certificate/Policy of Insurance. We will investigate and administer this claim by consulting the insurer’s existing files and by exchanging information with the undersigned and third parties, such as law enforcement, fire and emergency services departments, parties involved with any subrogation action, and other independent sources. This may, in some cases, include the transfer of your data outside the territory of Canada.
  • I authorize Global Excel (including its representatives or affiliates) to disclose to GEM Life and/or GEM Home & Auto any information relating to this claim that it may have in its possession including information it obtains from third parties. I am aware that any authorization I provide to Global Excel to obtain information about this claim from any third party is also an authorization for GEM Life and/or GEM Home & Auto to obtain copies of the information.
  • I also authorize the Insurer, its reinsurers and its respective agents to exchange and/or transmit information concerning this claim to the organizations listed above as is necessary to evaluate this claim. This consent shall be valid during the continuation of such claim.
  • I agree to provide all necessary assistance to secure the rights and remedies to subrogation of the claim against third parties who may be responsible for the claim.
  • I understand that if I am a dependent under this insurance coverage, the named Insured Person will have access to information related to this claim in connection with the administration of this plan.
  • I agree that a photocopy or facsimile of this authorization shall be valid as the original and that this authorization shall be considered valid for the duration of this claim, but not to exceed two years from the date it is signed. I understand information about me may be reviewed in the event that this plan is audited.
  • I declare that all statements made in this claim form are accurate, true and complete. I understand that making false, misleading or incomplete statements may cause not only the claim to be denied, but insurance coverage to be rescinded by the Insurer. The undersigned agrees to refund the amount of any payments that should not have been made.
  • By signing below, you agree that we may collect, use and disclose your Information as described in the Privacy Agreement including for, but not limited to, the purposes of identifying you, providing ongoing service, processing your claims, understanding your financial needs, protecting us both from fraud and error and complying with legal and regulatory requirements. For further details about this Privacy Agreement and our privacy practices, visit www.gem.com/privacy or contact us for a copy.
  • I authorize any other insurance carrier to release and exchange with GEM Life Insurance Company ("GEM Life'') and/or GEM Home & Auto Insurance Company (“GEM H&A”) and its administrator Global Excel Management Inc. (“Global Excel “) or its representatives’ benefits payment information relating to this claim.
  • The information provided with respect to this claim will be used by GEM H&A and its administrator Global Excel or their representatives to investigate any losses, assess any entitlement to benefits and to administer this claim, and as otherwise indicated in the privacy terms available at gem.com/privacy, or included with your Certificate/Policy of Insurance. We will investigate and administer this claim by consulting the insurer’s existing files and by exchanging information with the undersigned and third parties, such as law enforcement, fire and emergency services departments, parties involved with any subrogation action, and other independent sources. This may, in some cases, include the transfer of your data outside the territory of Canada.
  • I authorize Global Excel (including its representatives or affiliates) to disclose to GEM Life and/or GEM Home & Auto any information relating to this claim that it may have in its possession including information it obtains from third parties. I am aware that any authorization I provide to Global Excel to obtain information about this claim from any third party is also an authorization for GEM Life and/or GEM Home & Auto to obtain copies of the information.
  • I also authorize the Insurer, its reinsurers and its respective agents to exchange and/or transmit information concerning this claim to the organizations listed above as is necessary to evaluate this claim. This consent shall be valid during the continuation of such claim.
  • I agree to provide all necessary assistance to secure the rights and remedies to subrogation of the claim against third parties who may be responsible for the claim.
  • I understand that if I am a dependent under this insurance coverage, the named Insured Person will have access to information related to this claim in connection with the administration of this plan.
  • I agree that a photocopy or facsimile of this authorization shall be valid as the original and that this authorization shall be considered valid for the duration of this claim, but not to exceed two years from the date it is signed. I understand information about me may be reviewed in the event that this plan is audited.
Please keep all original documentation for your records after submitting your claim. Under exceptional circumstances, we may require that you send us original documents or a signed claim form.
A claim will be created and we will email you a confirmation with the claim number and additional questions if necessary. Please keep all original receipts and documents pertaining to your claim. Once all documents are received, we will process your claim.
A. I assign to Global Excel Management Inc. any amounts obtainable from other sources for covered losses under this policy. I also direct these sources to forward payment to Global Excel Management Inc. for my claims submitted by Global Excel Management Inc. with regard to these losses and to exchange information that facilitates this process.
B. I authorize any hospital, physician, or medical facility to send my medical information to Global Excel Management Inc. authorized representatives of the insurer. I further consent to the disclosure of this information by Global Excel Management Inc. to other sources as may be required to obtain benefits from other sources.
C. I warrant that neither I, nor any insured person, have any additional coverage through any other insurer (other than that listed above).
D. I understand that my insurance shall be void if, whether before or after the loss, any person has concealed or misrepresented any fact or circumstance concerning this claim.
E. I consent to Global Excel communicating with me via electronic means regarding my claim at the email address I have provided and understand that this communication will contain personal information.
If you are currently travelling, seeking treatment, or planning to seek treatment please contact us at +1 819-780-1999, for toll-free number+1-855-237-6911
Please print, complete, and sign the provincial form. Once completed, upload a photocopy along with your other required documents.
XX XXXX

Note

Before proceeding with the claim form, please carefully review the documents listed in the 'Required Documents' section on this page to ensure you have them readily available.

Policyholder Information

Claimant Information


Note

Before proceeding with the claim form, please carefully review the documents listed in the 'Required Documents' section on this page to ensure you have them readily available.

Program Coordinator Information

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

Claimant Information

Do you authorize us to communicate with you regarding your claim using this e-mail address with the understanding that these communications may contain personal information?

Other Insurance?

Do you have any other insurance? *
Have you filed a claim with them? *
List of accepted file types are doc, pdf, txt, pcx, docx, jpg, jpeg, jpe, jfif, gif, tiff, tif, bmp, png.
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.
Files File Size
Transit Number, Institution Number and Account Number

Travel Information:






Reason for Consult:

Are you claiming for an illness or injury? *
Was there an official diagnosis? *
Have you ever experienced this illness before? *
Have you ever received a consult or treatment for this illness? *
Admissions dates: *
Is there another party who may be responsible for your injury? *
Do you plan to pursue legal action and have you obtained a legal representative? *
Do you have a family physician? *

Provincial Health Card Number

List of accepted file types are doc, pdf, txt, pcx, docx, jpg, jpeg, jpe, jfif, gif, tiff, tif, bmp, png.
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.
Files File Size

Required Documentation

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. Itemized receipts for all bills and invoices

3. Proof of Payment

4. Medical Records including complete diagnosis by attending physician.

5. Proof of Travel

6. Police accident report - MVA including report number (If applicable)

7. Pharmacy Receipt

8. Pharmacy Transaction Receipt

9. Other Supporting Documents

1. Itemized receipts for all bills and invoices

2. Proof of Payment

3. Medical Records including complete diagnosis by attending physician.

4. Proof of Travel

5. Police accident report - MVA including report number (If applicable)

6. Pharmacy Receipt

7. Pharmacy Transaction Receipt

8. Other Supporting Documents

Note that it is extremely important to submit all required documents when returning your request to us. If any documents are missing, it could cause delays.
When using the upload function, we recommend that you take clear digital pictures of the documents you wish to upload.

Authorization

  

Authorization

  • I declare that all statements made in this claim form are accurate, true and complete. I understand that making false, misleading or incomplete statements may cause not only the claim to be denied, but insurance coverage to be rescinded by the Insurer. The undersigned agrees to refund the amount of any payments that should not have been made.
  • By signing below, you agree that we may collect, use and disclose your Information as described in the Privacy Agreement including for, but not limited to, the purposes of identifying you, providing ongoing service, processing your claims, understanding your financial needs, protecting us both from fraud and error and complying with legal and regulatory requirements. For further details about this Privacy Agreement and our privacy practices, visit www.gem.com/privacy or contact us for a copy.
  • I authorize any other insurance carrier to release and exchange with GEM Life Insurance Company ("GEM Life'') and/or GEM Home & Auto Insurance Company (“GEM H&A”) and its administrator Global Excel Management Inc. (“Global Excel “) or its representatives’ benefits payment information relating to this claim.
  • The information provided with respect to this claim will be used by GEM H&A and its administrator Global Excel or their representatives to investigate any losses, assess any entitlement to benefits and to administer this claim, and as otherwise indicated in the privacy terms available at gem.com/privacy, or included with your Certificate/Policy of Insurance. We will investigate and administer this claim by consulting the insurer’s existing files and by exchanging information with the undersigned and third parties, such as law enforcement, fire and emergency services departments, parties involved with any subrogation action, and other independent sources. This may, in some cases, include the transfer of your data outside the territory of Canada.
  • I authorize Global Excel (including its representatives or affiliates) to disclose to GEM Life and/or GEM Home & Auto any information relating to this claim that it may have in its possession including information it obtains from third parties. I am aware that any authorization I provide to Global Excel to obtain information about this claim from any third party is also an authorization for GEM Life and/or GEM Home & Auto to obtain copies of the information.
  • I also authorize the Insurer, its reinsurers and its respective agents to exchange and/or transmit information concerning this claim to the organizations listed above as is necessary to evaluate this claim. This consent shall be valid during the continuation of such claim.
  • I agree to provide all necessary assistance to secure the rights and remedies to subrogation of the claim against third parties who may be responsible for the claim.
  • I understand that if I am a dependent under this insurance coverage, the named Insured Person will have access to information related to this claim in connection with the administration of this plan.
  • I agree that a photocopy or facsimile of this authorization shall be valid as the original and that this authorization shall be considered valid for the duration of this claim, but not to exceed two years from the date it is signed. I understand information about me may be reviewed in the event that this plan is audited.
  • I declare that all statements made in this claim form are accurate, true and complete. I understand that making false, misleading or incomplete statements may cause not only the claim to be denied, but insurance coverage to be rescinded by the Insurer. The undersigned agrees to refund the amount of any payments that should not have been made.
  • By signing below, you agree that we may collect, use and disclose your Information as described in the Privacy Agreement including for, but not limited to, the purposes of identifying you, providing ongoing service, processing your claims, understanding your financial needs, protecting us both from fraud and error and complying with legal and regulatory requirements. For further details about this Privacy Agreement and our privacy practices, visit www.gem.com/privacy or contact us for a copy.
  • I authorize any other insurance carrier to release and exchange with GEM Life Insurance Company ("GEM Life'') and/or GEM Home & Auto Insurance Company (“GEM H&A”) and its administrator Global Excel Management Inc. (“Global Excel “) or its representatives’ benefits payment information relating to this claim.
  • The information provided with respect to this claim will be used by GEM H&A and its administrator Global Excel or their representatives to investigate any losses, assess any entitlement to benefits and to administer this claim, and as otherwise indicated in the privacy terms available at gem.com/privacy, or included with your Certificate/Policy of Insurance. We will investigate and administer this claim by consulting the insurer’s existing files and by exchanging information with the undersigned and third parties, such as law enforcement, fire and emergency services departments, parties involved with any subrogation action, and other independent sources. This may, in some cases, include the transfer of your data outside the territory of Canada.
  • I authorize Global Excel (including its representatives or affiliates) to disclose to GEM Life and/or GEM Home & Auto any information relating to this claim that it may have in its possession including information it obtains from third parties. I am aware that any authorization I provide to Global Excel to obtain information about this claim from any third party is also an authorization for GEM Life and/or GEM Home & Auto to obtain copies of the information.
  • I also authorize the Insurer, its reinsurers and its respective agents to exchange and/or transmit information concerning this claim to the organizations listed above as is necessary to evaluate this claim. This consent shall be valid during the continuation of such claim.
  • I agree to provide all necessary assistance to secure the rights and remedies to subrogation of the claim against third parties who may be responsible for the claim.
  • I understand that if I am a dependent under this insurance coverage, the named Insured Person will have access to information related to this claim in connection with the administration of this plan.
  • I agree that a photocopy or facsimile of this authorization shall be valid as the original and that this authorization shall be considered valid for the duration of this claim, but not to exceed two years from the date it is signed. I understand information about me may be reviewed in the event that this plan is audited.
Please keep all original documentation for your records after submitting your claim. Under exceptional circumstances, we may require that you send us original documents or a signed claim form.
A claim will be created and we will email you a confirmation with the claim number and additional questions if necessary. Please keep all original receipts and documents pertaining to your claim. Once all documents are received, we will process your claim.
A. I assign to Global Excel Management Inc. any amounts obtainable from other sources for covered losses under this policy. I also direct these sources to forward payment to Global Excel Management Inc. for my claims submitted by Global Excel Management Inc. with regard to these losses and to exchange information that facilitates this process.
B. I authorize any hospital, physician, or medical facility to send my medical information to Global Excel Management Inc. authorized representatives of the insurer. I further consent to the disclosure of this information by Global Excel Management Inc. to other sources as may be required to obtain benefits from other sources.
C. I warrant that neither I, nor any insured person, have any additional coverage through any other insurer (other than that listed above).
D. I understand that my insurance shall be void if, whether before or after the loss, any person has concealed or misrepresented any fact or circumstance concerning this claim.
E. I consent to Global Excel communicating with me via electronic means regarding my claim at the email address I have provided and understand that this communication will contain personal information.

Note

Before proceeding with the claim form, please carefully review the documents listed in the 'Required Documents' section on this page to ensure you have them readily available.

Policyholder Information

Claimant Information


Note

Before proceeding with the claim form, please carefully review the documents listed in the 'Required Documents' section on this page to ensure you have them readily available.

Program Coordinator Information

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

Claimant Information

Do you authorize us to communicate with you regarding your claim using this e-mail address with the understanding that these communications may contain personal information?

Other Insurance?

Do you have any other insurance? *
Have you filed a claim with them? *
List of accepted file types are doc, pdf, txt, pcx, docx, jpg, jpeg, jpe, jfif, gif, tiff, tif, bmp, png.
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.
Files File Size
Transit Number, Institution Number and Account Number

Travel Information:

Reason for Consult:

Are you claiming for an illness or injury? *
Was this an annual or wellness exam? *
Was there an official diagnosis? *
Have you ever experienced this illness before? *
Have you ever received a consult or treatment for this illness? *
Admissions dates: *
Is there another party who may be responsible for your injury? *
Do you plan to pursue legal action and have you obtained a legal representative? *
Do you have a family physician? *
Do you have any chronic illness or disease? *
No Name of illness *
Date Last Consulted
* 		Still Seeking Treatment?

Required Documentation

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. Itemized receipts for all bills and invoices

3. Proof of Payment

4. Medical Records including complete diagnosis by attending physician.

5. Proof of Travel

6. Police accident report - MVA including report number (If applicable)

7. Pharmacy Receipt

8. Pharmacy Transaction Receipt

9. Proof of Arrival to Canada

10. Other Supporting Documents

1. Itemized receipts for all bills and invoices

2. Proof of Payment

3. Medical Records including complete diagnosis by attending physician.

4. Proof of Travel

5. Police accident report - MVA including report number (If applicable)

6. Pharmacy Receipt

7. Pharmacy Transaction Receipt

8. Proof of Arrival to Canada

9. Other Supporting Documents

Note that it is extremely important to submit all required documents when returning your request to us. If any documents are missing, it could cause delays.
When using the upload function, we recommend that you take clear digital pictures of the documents you wish to upload.

Authorization

  

Authorization

  • I declare that all statements made in this claim form are accurate, true and complete. I understand that making false, misleading or incomplete statements may cause not only the claim to be denied, but insurance coverage to be rescinded by the Insurer. The undersigned agrees to refund the amount of any payments that should not have been made.
  • By signing below, you agree that we may collect, use and disclose your Information as described in the Privacy Agreement including for, but not limited to, the purposes of identifying you, providing ongoing service, processing your claims, understanding your financial needs, protecting us both from fraud and error and complying with legal and regulatory requirements. For further details about this Privacy Agreement and our privacy practices, visit www.gem.com/privacy or contact us for a copy.
  • I authorize any other insurance carrier to release and exchange with GEM Life Insurance Company ("GEM Life'') and/or GEM Home & Auto Insurance Company (“GEM H&A”) and its administrator Global Excel Management Inc. (“Global Excel “) or its representatives’ benefits payment information relating to this claim.
  • The information provided with respect to this claim will be used by GEM H&A and its administrator Global Excel or their representatives to investigate any losses, assess any entitlement to benefits and to administer this claim, and as otherwise indicated in the privacy terms available at gem.com/privacy, or included with your Certificate/Policy of Insurance. We will investigate and administer this claim by consulting the insurer’s existing files and by exchanging information with the undersigned and third parties, such as law enforcement, fire and emergency services departments, parties involved with any subrogation action, and other independent sources. This may, in some cases, include the transfer of your data outside the territory of Canada.
  • I authorize Global Excel (including its representatives or affiliates) to disclose to GEM Life and/or GEM Home & Auto any information relating to this claim that it may have in its possession including information it obtains from third parties. I am aware that any authorization I provide to Global Excel to obtain information about this claim from any third party is also an authorization for GEM Life and/or GEM Home & Auto to obtain copies of the information.
  • I also authorize the Insurer, its reinsurers and its respective agents to exchange and/or transmit information concerning this claim to the organizations listed above as is necessary to evaluate this claim. This consent shall be valid during the continuation of such claim.
  • I agree to provide all necessary assistance to secure the rights and remedies to subrogation of the claim against third parties who may be responsible for the claim.
  • I understand that if I am a dependent under this insurance coverage, the named Insured Person will have access to information related to this claim in connection with the administration of this plan.
  • I agree that a photocopy or facsimile of this authorization shall be valid as the original and that this authorization shall be considered valid for the duration of this claim, but not to exceed two years from the date it is signed. I understand information about me may be reviewed in the event that this plan is audited.
  • I declare that all statements made in this claim form are accurate, true and complete. I understand that making false, misleading or incomplete statements may cause not only the claim to be denied, but insurance coverage to be rescinded by the Insurer. The undersigned agrees to refund the amount of any payments that should not have been made.
  • By signing below, you agree that we may collect, use and disclose your Information as described in the Privacy Agreement including for, but not limited to, the purposes of identifying you, providing ongoing service, processing your claims, understanding your financial needs, protecting us both from fraud and error and complying with legal and regulatory requirements. For further details about this Privacy Agreement and our privacy practices, visit www.gem.com/privacy or contact us for a copy.
  • I authorize any other insurance carrier to release and exchange with GEM Life Insurance Company ("GEM Life'') and/or GEM Home & Auto Insurance Company (“GEM H&A”) and its administrator Global Excel Management Inc. (“Global Excel “) or its representatives’ benefits payment information relating to this claim.
  • The information provided with respect to this claim will be used by GEM H&A and its administrator Global Excel or their representatives to investigate any losses, assess any entitlement to benefits and to administer this claim, and as otherwise indicated in the privacy terms available at gem.com/privacy, or included with your Certificate/Policy of Insurance. We will investigate and administer this claim by consulting the insurer’s existing files and by exchanging information with the undersigned and third parties, such as law enforcement, fire and emergency services departments, parties involved with any subrogation action, and other independent sources. This may, in some cases, include the transfer of your data outside the territory of Canada.
  • I authorize Global Excel (including its representatives or affiliates) to disclose to GEM Life and/or GEM Home & Auto any information relating to this claim that it may have in its possession including information it obtains from third parties. I am aware that any authorization I provide to Global Excel to obtain information about this claim from any third party is also an authorization for GEM Life and/or GEM Home & Auto to obtain copies of the information.
  • I also authorize the Insurer, its reinsurers and its respective agents to exchange and/or transmit information concerning this claim to the organizations listed above as is necessary to evaluate this claim. This consent shall be valid during the continuation of such claim.
  • I agree to provide all necessary assistance to secure the rights and remedies to subrogation of the claim against third parties who may be responsible for the claim.
  • I understand that if I am a dependent under this insurance coverage, the named Insured Person will have access to information related to this claim in connection with the administration of this plan.
  • I agree that a photocopy or facsimile of this authorization shall be valid as the original and that this authorization shall be considered valid for the duration of this claim, but not to exceed two years from the date it is signed. I understand information about me may be reviewed in the event that this plan is audited.
Please keep all original documentation for your records after submitting your claim. Under exceptional circumstances, we may require that you send us original documents or a signed claim form.
A claim will be created and we will email you a confirmation with the claim number and additional questions if necessary. Please keep all original receipts and documents pertaining to your claim. Once all documents are received, we will process your claim.
A. I assign to Global Excel Management Inc. any amounts obtainable from other sources for covered losses under this policy. I also direct these sources to forward payment to Global Excel Management Inc. for my claims submitted by Global Excel Management Inc. with regard to these losses and to exchange information that facilitates this process.
B. I authorize any hospital, physician, or medical facility to send my medical information to Global Excel Management Inc. authorized representatives of the insurer. I further consent to the disclosure of this information by Global Excel Management Inc. to other sources as may be required to obtain benefits from other sources.
C. I warrant that neither I, nor any insured person, have any additional coverage through any other insurer (other than that listed above).
D. I understand that my insurance shall be void if, whether before or after the loss, any person has concealed or misrepresented any fact or circumstance concerning this claim.
E. I consent to Global Excel communicating with me via electronic means regarding my claim at the email address I have provided and understand that this communication will contain personal information.
By selecting the "I Accept" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement.
Sign above

Items Claimed

Are you requesting a reimbursement? *
   
No Invoice Description
Purchase Date
Amount Paid Refund Obtained Total Amount Claimed Currency  
             

CLAIM DETAILS

No Description Invoice Date Amount Currency  
         

Additional Information

Do you have a Global Excel claim number? *
                      



From:
To:
If you are submitting a claim for expenses outside of the province where you attend school you will need to include proof of those travel dates. Examples: airline tickets or gas receipts.
Arrival in Canada:
Planned Departure:
If you are submitting a claim for expenses outside of the province where you attend school you will need to include proof of those travel dates. Examples: airline tickets or gas receipts.

INFORMATION ON OTHER ACTIVE INSURANCE

Do you have other health coverage? *
                          
No Name of Insurance Company Policy number  
     
1. I assign to Global Excel Management Inc. any amounts obtainable from other sources for covered losses under this policy. I also direct these sources to forward payment to Global Excel Management Inc. for my claims submitted by Global Excel Management Inc. with regard to these losses and to exchange information that facilitates this process.
                          
2. I warrant that neither I, nor any insured person, have any additional coverage through any other insurer (other than that listed above).
                          
3. I understand that my insurance shall be void if, whether before or after the loss, any person has concealed or misrepresented any fact or circumstance concerning this claim.
                          
4. I authorize any hospital, physician, or medical facility to send my medical information to Global Excel Management Inc., authorized representatives of the Insurer. I further consent to the disclosure of this information by Global Excel Management Inc. to other sources as may be required to obtain benefits from other sources.
                          
Please keep all original documentation for your records after submitting your claim. Under exceptional circumstances, we may require that you send us original documents or a signed claim form.
Transit Number, Institution Number and Account Number

Do you have any other travel insurance?

Credit card insurance: *
                          
Enter your credit card number: *
XX XXXX
Other Insurance: *
                          
1. I assign to Global Excel Management Inc. any amounts obtainable from other sources for covered losses under this policy. I also direct these sources to forward payment to Global Excel Management Inc. for my claims submitted by Global Excel Management Inc. with regard to these losses and to exchange information that facilitates this process.
                          
2. I warrant that neither I, nor any insured person, have any additional coverage through any other insurer (other than that listed above).
                          
3. I understand that my insurance shall be void if, whether before or after the loss, any person has concealed or misrepresented any fact or circumstance concerning this claim.
                          
4. I consent to Global Excel communicating with me via electronic means regarding my claim at the email address I have provided and understand that this communication will contain personal information.
                          
5. I authorize any hospital, physician, or medical facility to send my medical information to Global Excel Management Inc., authorized representatives of the Insurer. I further consent to the disclosure of this information by Global Excel Management Inc. to other sources as may be required to obtain benefits from other sources.
                          

Authorization

  

Authorization

  • I declare that all statements made in this claim form are accurate, true and complete. I understand that making false, misleading or incomplete statements may cause not only the claim to be denied, but insurance coverage to be rescinded by the Insurer. The undersigned agrees to refund the amount of any payments that should not have been made.
  • By signing below, you agree that we may collect, use and disclose your Information as described in the Privacy Agreement including for, but not limited to, the purposes of identifying you, providing ongoing service, processing your claims, understanding your financial needs, protecting us both from fraud and error and complying with legal and regulatory requirements. For further details about this Privacy Agreement and our privacy practices, visit www.gem.com/privacy or contact us for a copy.
  • I authorize any other insurance carrier to release and exchange with GEM Life Insurance Company ("GEM Life'') and/or GEM Home & Auto Insurance Company (“GEM H&A”) and its administrator Global Excel Management Inc. (“Global Excel “) or its representatives’ benefits payment information relating to this claim.
  • The information provided with respect to this claim will be used by GEM H&A and its administrator Global Excel or their representatives to investigate any losses, assess any entitlement to benefits and to administer this claim, and as otherwise indicated in the privacy terms available at gem.com/privacy, or included with your Certificate/Policy of Insurance. We will investigate and administer this claim by consulting the insurer’s existing files and by exchanging information with the undersigned and third parties, such as law enforcement, fire and emergency services departments, parties involved with any subrogation action, and other independent sources. This may, in some cases, include the transfer of your data outside the territory of Canada.
  • I authorize Global Excel (including its representatives or affiliates) to disclose to GEM Life and/or GEM Home & Auto any information relating to this claim that it may have in its possession including information it obtains from third parties. I am aware that any authorization I provide to Global Excel to obtain information about this claim from any third party is also an authorization for GEM Life and/or GEM Home & Auto to obtain copies of the information.
  • I also authorize the Insurer, its reinsurers and its respective agents to exchange and/or transmit information concerning this claim to the organizations listed above as is necessary to evaluate this claim. This consent shall be valid during the continuation of such claim.
  • I agree to provide all necessary assistance to secure the rights and remedies to subrogation of the claim against third parties who may be responsible for the claim.
  • I understand that if I am a dependent under this insurance coverage, the named Insured Person will have access to information related to this claim in connection with the administration of this plan.
  • I agree that a photocopy or facsimile of this authorization shall be valid as the original and that this authorization shall be considered valid for the duration of this claim, but not to exceed two years from the date it is signed. I understand information about me may be reviewed in the event that this plan is audited.
  • I declare that all statements made in this claim form are accurate, true and complete. I understand that making false, misleading or incomplete statements may cause not only the claim to be denied, but insurance coverage to be rescinded by the Insurer. The undersigned agrees to refund the amount of any payments that should not have been made.
  • By signing below, you agree that we may collect, use and disclose your Information as described in the Privacy Agreement including for, but not limited to, the purposes of identifying you, providing ongoing service, processing your claims, understanding your financial needs, protecting us both from fraud and error and complying with legal and regulatory requirements. For further details about this Privacy Agreement and our privacy practices, visit www.gem.com/privacy or contact us for a copy.
  • I authorize any other insurance carrier to release and exchange with GEM Life Insurance Company ("GEM Life'') and/or GEM Home & Auto Insurance Company (“GEM H&A”) and its administrator Global Excel Management Inc. (“Global Excel “) or its representatives’ benefits payment information relating to this claim.
  • The information provided with respect to this claim will be used by GEM H&A and its administrator Global Excel or their representatives to investigate any losses, assess any entitlement to benefits and to administer this claim, and as otherwise indicated in the privacy terms available at gem.com/privacy, or included with your Certificate/Policy of Insurance. We will investigate and administer this claim by consulting the insurer’s existing files and by exchanging information with the undersigned and third parties, such as law enforcement, fire and emergency services departments, parties involved with any subrogation action, and other independent sources. This may, in some cases, include the transfer of your data outside the territory of Canada.
  • I authorize Global Excel (including its representatives or affiliates) to disclose to GEM Life and/or GEM Home & Auto any information relating to this claim that it may have in its possession including information it obtains from third parties. I am aware that any authorization I provide to Global Excel to obtain information about this claim from any third party is also an authorization for GEM Life and/or GEM Home & Auto to obtain copies of the information.
  • I also authorize the Insurer, its reinsurers and its respective agents to exchange and/or transmit information concerning this claim to the organizations listed above as is necessary to evaluate this claim. This consent shall be valid during the continuation of such claim.
  • I agree to provide all necessary assistance to secure the rights and remedies to subrogation of the claim against third parties who may be responsible for the claim.
  • I understand that if I am a dependent under this insurance coverage, the named Insured Person will have access to information related to this claim in connection with the administration of this plan.
  • I agree that a photocopy or facsimile of this authorization shall be valid as the original and that this authorization shall be considered valid for the duration of this claim, but not to exceed two years from the date it is signed. I understand information about me may be reviewed in the event that this plan is audited.
Please keep all original documentation for your records after submitting your claim. Under exceptional circumstances, we may require that you send us original documents or a signed claim form.
A claim will be created and we will email you a confirmation with the claim number and additional questions if necessary. Please keep all original receipts and documents pertaining to your claim. Once all documents are received, we will process your claim.
A. I assign to Global Excel Management Inc. any amounts obtainable from other sources for covered losses under this policy. I also direct these sources to forward payment to Global Excel Management Inc. for my claims submitted by Global Excel Management Inc. with regard to these losses and to exchange information that facilitates this process.
B. I authorize any hospital, physician, or medical facility to send my medical information to Global Excel Management Inc. authorized representatives of the insurer. I further consent to the disclosure of this information by Global Excel Management Inc. to other sources as may be required to obtain benefits from other sources.
C. I warrant that neither I, nor any insured person, have any additional coverage through any other insurer (other than that listed above).
D. I understand that my insurance shall be void if, whether before or after the loss, any person has concealed or misrepresented any fact or circumstance concerning this claim.
E. I consent to Global Excel communicating with me via electronic means regarding my claim at the email address I have provided and understand that this communication will contain personal information.
Please keep all original documentation for your records after submitting your claim. Under exceptional circumstances, we may require that you send us original documents or a signed claim form.

Claim Information

Admitted in Hospital? *
                          
Maximum of 1000 characters allowed.

This section can be used to submit any bills or document(s) that are required by Global Excel Management to properly process your claim. You may consult your policy wording for further details.
Please note the following:
1. If you are submitting a claim for expenses outside of the province where you attend school you will need to include proof of those travel dates. Examples: airline tickets or gas receipts.
2. Along with the submission of any self-paid bills you will need to provide proof that the expenses has been paid to the provider. Examples of proof of payments: cash register receipt, credit card statement or cheque.

Files File Size  
List of accepted file types are doc, pdf, txt, pcx, docx, jpg, jpeg, jpe, jfif, gif, tiff, tif, bmp, png.
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.
Any non-standard tests must be pre-approved by Global Excel Management Inc.; what is meant by non-standard testing is anything other than blood work, x-rays, urine analysis and electrocardiograms.



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Global Excel Management Inc. - All rights reserved        
Global Excel Management Inc. - All rights reserved   
    
Global Excel