Plan Summary

All Employees of municipalities and their spouses are eligible for the plan.

Key Features of Plan

• Inclusion of a Loss of Independent Existence benefit for existing enrollees
• Guaranteed $10,000 of Voluntary Critical Illness coverage for employees and their spouses
• No medical evidence required
• Medical requirements include an increased plan maximum from $150,000 to $250,000
• Includes OneWorld Medicare
• Links the insured with physicians in medical centres of excellence
• Books insured’s surgery and pre and post-operative visits;
• Makes travel arrangements and books accommodations for the insured and his/her travelling companions
• Coordinates any other details connected to the insured’s medical procedure
• Ensures the insured’s money goes considerably further than if they had arranged treatment personally

Benefit Limitations

1. Pre-existing clause:
   Any illness, disease, mental nervous or psychiatric condition or disorder for which any one of medical advice, treatment, service, prescribed medication, diagnosis or consultation including consultation to investigate and/or diagnose (where diagnosis has not yet been made) was received by the insured or would have been received by a prudent individual within the 24 months immediately preceding the effective date of an insured’s coverage.
2. Attempted suicide
3. Any covered condition diagnosed before the effective date of an insured’s coverage
4. Taking any drug other than as prescribed by a licensed physician
5. Taking poison or inhaling gas not connected with the insured’s employment
6. Flying as a student pilot or flying as a privately licensed pilot for less than 25 hours or more than 400 hours per year
7. Participation in a criminal act including operating a motor vehicle while the concentration of alcohol in 100 milliliters of the insured’s blood exceeds 80 milligrams
8. Self-inflicted injury
9. War or fulltime active service in the armed forces of any country
10. Cause of covered condition is due to a hazardous sport
11. Cancer diagnosed, any signs and/or symptoms or medical problems commenced or investigations leading to the diagnosis of any cancer covered or excluded under the group policy initiated within 90 days following the effective date of an insured’s coverage will result in a refund of all premiums paid and the coverage will be void.

Conditions of Benefit Payment

1. Survivor Benefit – the insured must survive 30 days. For paralysis, 90 days and multiple sclerosis or loss of speech, 180 days.
2. Diagnosis of a covered condition must be made by a medical specialist licensed
3. Payment of the sum insured is limited to only the first covered condition to occur.
4. Industrial Alliance Pacific reserves the right to require examination of the insured to confirm the diagnosis of the covered condition by a medical practitioner appointed by IAP.
5. The insured must also satisfy the definition of the applicable covered condition under which he/she is claiming.

Termination of the Benefit

• The termination date of the policy
• The date that the critical illness benefit is paid
• The insured (employee or spouse) reaches age 70
• The employee is no longer an eligible employee
• Unpaid premiums
• The effective date of insurance if cancer is diagnosed within 90 days of the effective date. All premiums paid will be refunded.
• The spouse is no longer an eligible spouse

Conversion

Policy can be converted into an individual critical illness policy covering the same critical conditions:

• The employee is under age 65
• The policy has been in force for at least 24 months
• Maximum of $25,000 may be converted
• 31 days to apply

Definitions:

Alzheimer’s Disease – is a progressive degenerative disease of the brain. The diagnosis must be made by a certified neurologist licensed and practicing in Canada. The insured must exhibit loss of intellectual capacity involving impairment of memory and judgement which results in significant reduction in mental and social functioning such that the insured requires supervision for daily living. All other dementing organic brain disorders and psychiatric illnesses are excluded.

Amyotrophic Lateral Sclerosis (ALS) – the unequivocal diagnosis of ALS by a neurologist licensed and practicing in Canada.
This disease is also known as “Lou Gehrig’s disease”. The symptoms are weakness and wasting of the muscles of the upper and lower limbs. Two of the tests used to diagnose ALS are electromyography (a graphic record of the contraction of a muscle as a result of electrical stimulation) and muscle biopsy. The disorder is usually diagnosed in middle age. It is progressive and usually fatal within 2-5 years. There is no known treatment for ALS.

Benign Brain Tumour – a benign tumour within the substance of the brain. Excluded are cysts, granulomas, meningiomas, malformations of the intracranial arteries or veins, or tumours of the cranial nerves, pituitary or spinal cord.

Blindness – permanent loss of sight in both eyes, as confirmed by an ophthalmologist registered and licensed to practice in Canada. The corrected visual acuity must be 20/200 or less in both eyes or the field of vision must be less than 20 degrees in both eyes.
Blindness, whether it is caused by accident, illness or disease is covered. The loss of vision to a corrected visual acuity or 20/200 or less in both eyes prevents most persons from performing their normal work. The blindness must be permanent and be confirmed by an ophthalmologist practicing in Canada.

Cancer – a malignancy characterized by the uncontrolled growth and spread of malignant cells and the invasion of tissue. The following conditions are NOT covered:

• Early prostate cancer, diagnosed as T1 N0 M0 or equivalent staging.
• Pre-malignant lesions, benigh tumours or polyps
• Non-invasive cancer in situ
• Any skin cancer other than invasive malignant melanoma into the dermis or deeper, and
• Any tumour in the presence of the human immunodeficiency virus (HIV).

Life threatening cancers are covered by the policy. There are some early stage cancers that are little more than a minor inconvenience and are easily curable. These are not covered. If one of these early stage cancers is not cured and later worsens, benefits may become payable if the policy is still in force. Cancer diagnosed, any signs and/or symptoms or medical problems commenced, or investigations leading to the diagnosis of any cancer covered or excluded under the Group Policy initiated within 90 days of the effective date of coverage will void the coverage.

Coma - a state of unconsciousness with no reaction to external stimuli, for a continuous period of at least 96 hours. The diagnosis must be made by a neurologist licensed and practicing in Canada.

Coronary Artery Bypass Surgery - heart surgery performed to correct narrowing or blockage of one or more coronary arteries with bypass grafts and which has been recommended by a consultant cardiologist registered and licensed to practice in Canada. Non-surgical techniques such as balloon angioplasty, laser embolectomy or other non-bypass techniques are excluded.

Only coronary artery bypass surgery is covered. The use of other techniques to clear the obstruction from inside the coronary artery, such as balloon angioplasty, is not covered. Emergency bypass operations performed outside Canada without the recommendation of a Canadian registered cardiologist are not generally covered, but may be considered.

Deafness - permanent and profound loss of hearing in both ears, with an auditory threshold of more than 90 decibels, as confirmed by an otolaryngologist registered and licensed to practice in Canada.

Dismemberment - the total and permanent "loss" of any 2 limbs. "Loss" as used with reference to arm or leg means complete severance at or above the elbow or knee joint.
Dismemberment, whether it is caused by accident, illness or disease, is covered.

Heart Attack (Myocardial Infarction) - the death of a portion of the heart muscle as a result of inadequate blood supply to the relevant area. The diagnostic must be confirmed by both:

1. new electrocardiographic changes indicative of a myocardial infarction or by a new clinical presentation, only in cases where the ECG can not be interpreted (complete bundle branch block, WPW, pace-maker), and
2. characteristic changes of cardiac biochemical markers (troponine or CPK or CPK-MB) to levels consistent with acute myocardial infarction.

Exclusions:

1. Heart Attack occurring in the 48 hours following an elective revascularization procedure, unless it is accompanied by new pathological Q waves.
2. Heart Attack diagnosed by any other method, unless the diagnosis is confirmed as described above.

Damage to the heart muscle will cause changes in the ECG and elevation of the cardiac (heart) enzymes. There must be a definite event with medical evidence to support the diagnosis. The chance finding of ECG changes suggestive of a previous heart attack is not covered.

Kidney Failure - permanent irreversible failure of both kidneys which necessitates treatment by regular peritoneal dialysis or haemodialysis or kidney transplantation.

Loss of Independent Existence -means an unequivocal Diagnosis by a Specialist of either:

1. being totally and permanently unable to perform, by oneself, for a continuous period of 90 days, at least two of the following six Activities of Daily Living, with no reasonable chance of recovery, or
2. Cognitive Impairment for a continuous period of 90 days, as defined below.

Activities of Daily Living are:

• Bathing – the ability to wash oneself in a bathtub, shower or by sponge bath, with or without the aid of equipment.
• Dressing – the ability to put on and remove necessary clothing including braces, artificial limbs or other surgical appliances.
• Toileting – the ability to get to and from the toilet and maintain personal hygiene.
• Bladder and Bowel Continence – the ability to manage bowel and bladder function with or without protective undergarments or surgical appliances so that a reasonable level of hygiene is maintained.
• Transferring – the ability to move in and out of a bed, chair or wheelchair, with or without the use of equipment.
• Feeding – the ability to consume food or drink that already have been prepared and made available, with or without the use of adaptive utensils.

Cognitive Impairment -means mental deterioration and loss of intellectual ability, evidenced by deterioration in memory, orientation and reasoning, which is measurable and results from demonstrable organic cause as diagnosed by a Specialist. The degree of cognitive impairment must be sufficiently severe as to require continuous daily supervision.

Determination of a Cognitive Impairment will be made on the basis of clinical data and valid standardized measures of such impairments.

Exclusions: A mental or nervous disorder without a demonstrable organic cause is not covered.

Loss of Speech - total, permanent and irreversible loss of the ability to speak for a continuous period of 180 days due to physical injury or physical disease. The diagnosis must be made by an appropriate specialist physician licensed and practicing in Canada.

Major Burns - third degree burns covering at least 20% of the surface area of the body of the insured. The diagnosis must be made by a plastic surgeon licensed and practicing in Canada

Major Organ Failure Requiring Transplant - the irreversible failure of the heart, liver, bone marrow, both lungs or both kidneys requiring a transplant of that organ, resulting in the insured being accepted into a recognized transplant program in Canada. The insured must survive at least 30 days following the date of enrollment into the transplant program

Multiple Sclerosis - a diagnosis by a neurologist of definite Multiple Sclerosis, characterized by well defined neurological abnormalities persisting for a continuous period of at least six months or with evidence of two separate clinically documented episodes. Multiple areas of demyelination must be confirmed by MRI scanning or imaging techniques generally used to diagnose multiple sclerosis.
Multiple Sclerosis is a slowly progressive brain and spinal cord disease resulting in multiple and varied neurological symptoms and signs. It usually runs an intermittent course of relapses and remissions. It may be difficult to diagnose or distinguish from other diseases in its early stages. Modern image scanning techniques are generally used in making the diagnosis.

Parapleqia/Quadripleqia/Hemipleqia - paralysis resulting in complete and permanent loss of use of two or more limbs without interruption for a period of 90 days. At the end of such period, the specialist must certify that the paralysis is complete and permanent.
Any permanent type of paralysis of 2 limbs or more, whether it is caused by accident, illness or disease is covered. Accident is the most frequent cause. It may take some time after the accident or illness to determine the full extent of recovery and this may be hampered by other injuries sustained in an accident. A waiting period of 90 days is reasonable in order to determine that the paralysis is permanent and not temporary.

Parkinson's Disease - the diagnosis of primary idiopathic Parkinson's Disease by a Neurologist licensed and practicing in Canada and characterized by the clinical manifestation of two or more of the following:

• Rigidity
• Tremor
• Bradykinesis
• All other types of Parkinsonism are excluded

Stroke - an acute cerebral vascular accident (CVA) producing neurological impairment and resulting in paralysis or other measurable objective neurological deficit persisting for at least thirty days following the occurrence of the stroke. Transient Ischemic Attacks (TIAs) are not covered.

The stroke or CVA may be caused by any type of vascular accident - haemorrhage (bleeding into the brain), thrombosis (blood clotting in a brain artery blocking it) or embolus (usually a clot from elsewhere in the body, carried in the blood stream and blocking a brain artery). Strokes usually cause damage which may improve considerably over time.

Note: Any illness or disorder not specifically defined as a covered condition will not be payable. Payment of the benefit is limited to the first covered condition to occur as defined in the Master Group Policy.

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