Mosaik Silver Medical Protection - BMO.com

een waived, either in whole or in part, unless the
waiver is clearly stated in writing and signed by
Us.
7. The benefits, terms and conditions of this
Certificate shall be governed by the insurance
laws of the province or territory in Canada where
the Insured Person normally resides.
8. Any provision of this insurance, which is in conflict
with any federal, provincial or territorial law
of the Insured Person’s place of residence, is
hereby amended to conform to the minimum
requirements of that law.
9. Privacy:
Notice Concerning Personal Information.
We and World Access Canada Inc. (collectively
“We” in this privacy section) respect Your privacy
and are committed to protecting it. However,
by purchasing insurance from Allianz Global
Risks US Insurance Company, You have provided
us with Your consent to the collection, use
and disclosure of Your personal information,
including that previously collected, for the purposes
of: communicating with You; assessing
Your application for insurance and underwriting
Your policies; evaluating claims; detecting and
preventing fraud; analyzing business results;
and acting as required or authorized by law.
To protect the confidentiality of the information
You provide, We will establish a file for the information
You provide. We will restrict access to this
file to those employees and agents who are
responsible for the administration of this insurance
and the processing and investigation of
claims or to any other person You authorize or as
required or authorized by law. The file is secured
in the offices of World Access Canada Inc.
We will only collect and use Your personal information
in the following ways.
Collecting Information About You
When We collect information about You on Your
application for insurance, We do so for processing
Your application for insurance and to administer
this insurance and to evaluate and process
claims. When We collect information about You
which is personal information, We will only collect
and keep that necessary information We need
to process Your application for insurance or
assess claims. Most information We collect will
come directly or indirectly from You, Your family
and friends, references You provide Us, Our rep-
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resentatives, hospitals, physicians, other health
care providers, the government and its agencies
(including provincial government health insurance
plans), other insurance companies, travel
suppliers, law enforcement agencies and private
investigators.
Using Your Information
We use this information about You only to evaluate
the insurance risk, to manage Your health
care, to administer claims and negotiate the payment
on Your behalf of covered expenses. We do
not share this information with others, except
that World Access Canada Inc., Our
Administrator, is provided with Your information,
as are those who are necessary to the services
We provide and the investigation of claims,
under this insurance, including other insurance
companies, the government and its agencies
(including provincial government health insurance
plans) and other health care providers.
Access to Your Information
You have a right to request to access or correct
Your personal information We have on file. To do
so, You may contact Our Privacy Officer at:
PIPEDA@worldaccess.com
or by writing to:
Access Officer
World Access Canada Inc.
4273 King Street East
Kitchener, ON
N2P 2E9
7 CLAIM FILING PROCEDURES
Please contact Us at 1-877-704-0341 or (519) 741-0782
to obtain a claim form. This insurance will not pay for
any interest.
As a condition to the payment of benefits under this
insurance, We will need certain information from
You if You need to file a claim. This documentation
will include, at a minimum, and is not limited to, the
following:
1. General Documentation
• Originals of Your receipts and itemized bills for
all expenses.
2. Emergency Medical and Dental Claims
• Any explanation of diagnosis(es) along with
Your original itemized bills and receipts;
• The claimant’s enrollment in his/her provin-
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