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ASSOCIATE CRITICAL ILLNESS (C.I.)

  
 

This benefit was developed to alleviate some of the stress and financial burden resulting from a critical illness. Disability Insurance provides income protection but does not adequately provide assistance for expenses such as convalescence, lifestyle changes, home modifications, home care, dependent care and medical expenses not covered by a group plan or by the government. If you suffer a heart attack, cancer, stroke, kidney failure, coronary artery surgery, blindness, paralysis, major organ transplant or multiple sclerosis the Critical Illness plan will pay you a lump sum equivalent to your Option choice. My Choice offers the following benefits.

  
 
  Coverage
Option 1 $5,000
Option 2 $15,000
Option 3 $30,000
Option 4 $55,000
 
 
Making Choices:

Choose the amount of C.I. coverage you want. You must choose one of the four Options.

Tax Facts: When Flex Dollars are used to pay for all or any part of C.I. Insurance these dollars may be considered a taxable benefit. (Quebec does consider this a taxable benefit). If you use payroll deduction to pay for your C.I. Insurance you are using after-tax dollars and saving your tax-free Flex Dollar Allowance to buy other non-taxable benefits.
Coverage Level: Choose the coverage level from the drop down box by selecting Option 1, 2, 3 or 4.
Payment Method: Flex Dollars, payroll deduction or combination.
 
     
 

ASSOCIATE CRITICAL ILLNESS DETAILS

The following is a further description of some of the specific elements of your Critical Illness plan. If you have further questions about the coverages offered under each option contact your Human Resources department.

Evidence of Insurability
  • Medical evidence of good health is not required for this benefit. Please refer to "Pre-Existing Condition" description below.
Definition of Coverages
  • Blindness: Means the total and irrecoverable loss of sight in both eyes due to injury or sickness. The diagnosis must be clinically confirmed in writing by a physician certified in Ophthalmology.
  • Cancer: Means a malignant tumor characterized by the uncontrolled growth and spread of malignant cells and invasion of tissue confirmed in writing by a physician certified in Oncology. This includes leukemia, Hodgkins Disease and invasive melanoma but does not include any other skin cancer that is not malignant, nor carcinoma in situ, Kaposi's Sarcoma and AIDS related cancers. Cancer does not include melanoma that is not invasive and had not exceeded .75 millimeters in depth.
  • Coronary Artery Surgery: Means open heart surgery performed by a physician who is certified as a cardiovascular surgeon to correct narrowing or blockage of two or more coronary arteries but excluding non-surgical techniques such as balloon angioplasty, laser relief of an obstruction, or other non-surgical techniques.
  • Heart Attack: Means the death of a portion of heart muscle as a result of inadequate blood supply, which must occur with chest pain and indicate at least a 15% reduction in the normal volume of blood being ejected from the left ventricle with each heart beat, new electrocardiographic changes and an elevation in cardiac enzyme levels and which must be confirmed in writing by a physician who is a certified cardiologist.
  • Kidney Failure: Means end stage renal disease due to chronic irreversible failure of both kidneys to function requiring the insured person to undergo regular hemodialysis, peritoneal dialysis, or renal transplantation and confirmed in writing by a physician who is certified in Nephrology.
  • Major Organ Transplant: Means being the recipient of a transplanted heart, heart and lung, pancreas or bone marrow performed by a physician who is certified to conduct any such transplant.
  • Multiple Sclerosis: Means the unequivocal written diagnosis by a physician who is certified as a neurologist confirming at least moderate persisting neurological abnormalities, with impairment of function, but not necessarily confining the insured person to a wheelchair or bed.
  • Paralysis: Means the total and irrecoverable loss of function of two or more limbs through neurological damage due to injury or sickness confirmed in writing by a physician certified as a neurologist provided such loss of function continually lasts for 365 consecutive days and such loss of function is thereafter determined on evidence satisfactory to ACE INA Insurance to be permanent.
  • Stroke: Means any cerebrovascular incident, excluding transient ischemic attack, producing neurological sequalae lasting more than twenty-four hours and including infarction of brain tissue, hemorrhage from an intercranial vessel and embolization caused by an extracranial source. There must be evidence of permanent neurological deficit confirmed in writing by a physician who is certified as a neurologist.
Payment Terms
  • Subject to the Pre-Existing condition described below, ACE INA will pay the insured benefit amount if:

    •  -  you suffer a Heart Attack, Stroke, Kidney Failure, Multiple Sclerosis or undergo Coronary Artery Surgery or are the recipient of a Major Organ Transplant or go blind and survive a period of 30 days, or;
     -  suffer Paralysis and survive a period of 365 days, or;
     -  after the coverage has been in effect for 90 days, are diagnosed with Cancer and survive a further period of 30 days.
Benefit Payment
  • There is no restriction on the use of the benefit, you can use it in anyway that will meet your particular needs.
  • If you suffer or undergo more than one of the specified coverages, the benefit amount will only be paid once.
Pre-Existing Condition
  • Applies only to Option 2, 3 and 4; does not apply to Option 1. A pre-existing medical condition means a sickness or injury for which you sought or received medical advice, consultation, investigation, diagnosis, or for which treatment was required or recommended by a licensed medical practitioner during the 24 months immediately prior to the effective date of your insurance or prior to any increase in the amount of insurance and which directly or indirectly causes the condition to occur within the first 24 months from the date of insurance or from any increase in the amount of insurance.
Totally Disabled
  • You are considered totally disabled, during the first 24 months in which you receive benefits, if you are unable to perform any and every duty of your occupation. After this period you are considered totally disabled if you are unable to perform any and every duty of any occupation for which you are reasonably qualified by training, education or experience.
Waiver of Premium
  • If you are totally disabled and sufficient evidence is provided annually to ACE INA Insurance, premium payments will be waived up to age 65.
Continuation of Coverage
  • If you are laid-off on a temporary basis, temporarily absent from work due to short-term disability, on leave of absence, on maternity or parental leave, coverage shall be extended for a period of 12 months following the beginning of any such event with the continuation of premium payment. If you assume other occupational duties during the leave or lay-off period, no benefits will be payable for a condition suffered or occurring during the performance of such other occupation.
Conversion Privilege
  • On the date of termination of employment or during the 31-day period
    following termination of employment, a person may convert his/her insurance
    to an individual insurance policy of the Insurance Company. The individual
    policy will be effective either as of the date that the application is
    received by the Insurance Company or on the date that coverage under the
    group policy ceases, whichever occurs later. The premium will be the same
    as a person would ordinarily pay when applying for an individual policy at
    that time. Application for an individual policy may be made at any office
    of the Insurance Company. The amount of insurance benefit converted to
    shall not exceed that amount issued during employment up to a maximum of
    $25,000.
Exclusions
  • Causes directly or indirectly by or resulting from intentionally self-inflicted injury, suicide or any attempt while sane or insane,
  • Declared or undeclared war or any act thereof,
  • injury or sickness, other than one of the specified coverages, even though such injury or sickness may have been complicated by one of the specified coverages,
  • skin cancer that is not malignant, nor carcinoma in situ, Kaposi's Sarcoma and AIDS related cancers; a complication of Human Immunodeficiency Virus (HIV) infection or any variance thereof including AIDS and AIDS Related Complex,
  • the use, existence or escape of nuclear weapons, material or ionizing radiation from or contamination by radioactivity from any nuclear fuel or waste from the combustion of nuclear fuel,
  • the commission or attempted commission by the insured person of any act which, if adjudicated by the court, would be an illegal act under the laws of the jurisdiction where the act was committed
Termination of Benefit
  • The benefit terminates at the earlier of retirement or age 65.
 
 
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