CRITICAL ILLNESS COVERAGE
Tier 1: Guaranteed Issue Critical Illness available in units of $5,000 up to $25,000.
Tier 2: If qualifying questions are satisfied, an additional $25,000 is available for a maximum total of up to $50,000 of Critical Illness coverage in force with EDGE.
Tier 3: If Tier 2 is achieved AND qualifying questions are satisfied, an additional $25,000 OR $50,000 is available for a maximum total of up to $100,000 of Critical Illness coverage in force with EDGE.
A tax free lump sum payment is made if you are diagnosed with an Insured Condition while insurance is in force. This benefit is meant to provide a payment if you are diagnosed with one of the Insured Conditions following the effective date of your coverage.
There is a Pre-Existing Condition limitation that applies to your coverage. It is important that you speak with a licensed advisor to understand how this could affect you at claim time.
- You must survive 30 days following the date of diagnosis
- The date of diagnosis must be after the effective date of your coverage or the most recent reinstatement date.
- Payment may be made for a second event, if you are deemed to be fully recovered from the initial diagnosis and not receiving treatment for at least 90 days. The second event must not be the same category of condition as the first.
- The Second Event Benefit is also subject to surviving 30 days after the diagnosis.
- After a second benefit is paid, coverage will terminate and you will not be eligible to re-apply for new coverage under this plan.
Automatic Increase in Benefit. Your benefits will automatically increase at no extra cost by 5% of the original amount purchased each 5 years that coverage is continuously in force, and premiums are paid in full, up to a maximum of 25% additional insurance.
List of Critical Illness Insured Conditions and their definitions
| Aorta Surgery | Coma | Loss of Independence | Occupational HIV Infection |
| Alzheimer’s Disease | Deafness | Loss of Speech | Paralysis |
| Benign Brain Tumour | Dismemberment | Major Organ Failure | Parkinson’s Disease |
| Blindness | Heart Attack | Major Organ Transplant | Severe Burns |
| Cancer | Heart Valve Replacement | Motor Neuron Disease | Stroke |
| Cancer Recurrence | Lou Gehrig’s Disease(ALS) | Multiple Sclerosis |
medically required surgery to treat disease of the aorta and that involves the excision and surgical replacement of the diseased aorta with a graft. The Aortic Surgery must be performed on the prior written advice of a Physician certified as a cardiovascular surgeon. Aorta includes the thoracic and abdominal aorta but does not include any of the branches of the aorta.
in a state of unconsciousness for a continuous period of at least 96 hours, during which external stimulation produced no more than primitive avoidance reflexes.
the definitive diagnosis by a licensed Physician of either:
1) Being totally and permanently unable to perform, by oneself, at least two (2) of the six (6) Activities of Daily Living or,
2) Cognitive impairment.
A mental or nervous disorder without a demonstrable organic cause is not covered. Loss of independence must persist for at least ninety (90) days from the date of the diagnosis.
a definite diagnosis of infection with Human Immunodeficiency Virus (HIV) resulting from accidental injury during the course of the Insured Person’s normal occupation, which exposed the person to HIV contaminated body fluids. The accidental injury leading to the infection must have occurred after the later of the effective date of the policy, the effective date of last reinstatement of the policy, or the Insured Person’s effective date of coverage.
a progressive degenerative disease of the brain. Must be supported by medical evidence that a loss of intellectual capacity, resulting in impairment of memory and judgment, which results in significant reduction in mental and social functioning, such that permanent daily personal supervision is required for the Activities of Daily Living. All other dementing organic brain disorders and psychiatric illnesses are excluded from this Insured Condition definition.
diagnosis of permanent loss of hearing in both ears, with an auditory threshold of more than 90 decibels in each ear.
total, permanent and irreversible loss of the ability to speak for a continuous period of 180 days due to physical injury or physical disease.
total and irrecoverable loss of function of two or more limbs through neurological damage due to Injury or Sickness, (for 90 consecutive days) and such loss of function is determined on evidence to be permanent.
a benign neoplasm in the brain or meninges with histologic confirmation. Cysts granulomas, malformations of intracranial arteries or veins, and tumours or lesions of the pituitary are specifically excluded.
total and permanent “loss” of any two limbs. “Loss” as used with reference to arm or leg means complete severance at or above the elbow or knee joint.
irreversible failure of the entire heart, entire liver, entire pancreas (pancreatic islet cell transplants are excluded), both lungs, both kidneys, or bone marrow, in which the affected organ is unresponsive to any treatment and for which the insured is medically required to become enrolled in a recognized Canadian transplant program to become the recipient of a heart, a liver, a pancreas, a lung, or a kidney or to receive a bone marrow transplant.
unequivocal diagnosis of primary idiopathic Parkinson’s Disease resulting in the inability to perform three of the six Activities of Daily Living without assistance. Diagnosis should show signs of progressive impairment.
total and irrecoverable loss of sight in both eyes due to Injury or Sickness. Corrected visual acuity must be 20/200 or less in both eyes and the field of vision must be less than 20 degrees in both eyes.
definite diagnosis of the death of heart muscle due to obstruction of blood flow, that results in the rise and fall of biochemical cardiac markers to levels considered diagnostic of myocardial infarction, with at least one of the following:• heart attack symptoms; or •new electrocardiogram (ECG) changes consistent with a heart attack; or • development of new Q waves during or immediately following an intra-arterial cardiac procedure including, but not limited to, coronary angiography and coronary angioplasty. Exclusions: No benefit will be payable under this condition for: • elevated biochemical cardiac markers with a level of less than 1; or • ECG changes suggesting a prior myocardial infarction, which do not meet the Heart Attack definition as described above.
a definite diagnosis of the irreversible failure of the heart, both lungs, liver, both kidneys or bone marrow, and transplantation must be medically necessary. To qualify under Major Organ Transplant, the Insured Person must undergo a transplantation procedure as the recipient of a heart, lung, liver, kidney or bone marrow, and limited to these entities. The diagnosis of the major organ failure must be made by a specialist.
third degree burns covering at least 20%of the surface area of their body.
a malignant tumor characterized by the uncontrolled growth and spread of malignant cells and invasion of tissue. This includes Leukemia, Hodgkin’s Disease and invasive melanoma but does not include: • Carcinoma in situ • Kaposi’s Sarcoma or other AIDS related cancers and cancer in the presence of human immunodeficiency virus (HIV) • Skin cancer or melanoma that is not invasive and has not exceeded .75 millimeters in depth • Prostate cancer diagnosed as T1 N0 M0 or equivalent staging.
undergoing surgery to replace any heart valve with either a natural or mechanical valve. The surgery must be determined to be medically necessary by a specialist. Exclusion: No benefit will be payable under this condition for heart valve repair.
a definite diagnosis of one of the following: – Amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease) – Primary lateral sclerosis – Progressive spinal muscular atrophy – Progressive bulbar palsy – Pseudo bulbar palsy The diagnosis of Motor Neuron Disease must be made by a Specialist.
a cerebrovascular incident, excluding transient ischemic attack (TIA), producing infarction of brain tissue due to thrombosis, haemorrhage from an intracranial vessel or embolization caused by an extracranial source. There must be evidence of permanent neurological deficit persisting for 30 consecutive days, supported by evidence that the deficit is resulting from the Stroke.
If the insured person has already been diagnosed with Cancer and, while insured, a new diagnosis of Cancer is made, a benefit will be paid, subject to all the policy terms and provisions, if the following conditions have been met:
• More than 60 months have passed since the previous cancer diagnosis; and
• No Treatment relating directly or indirectly to cancer has been received within that 60 month period (treatment does not include preventive medications and follow up visits to the doctor).
Amyotrophic Lateral Sclerosis (ALS) – the unequivocal diagnosis of ALS by a Physician certified as a neurologist.
unequivocal written diagnosis by a neurologist confirming, at least moderate persisting neurological abnormalities, with impairment of function.
Some General Critical Illness Exclusions and Limitations
Your critical illness insurance will be void and the Insurer’s liability will be limited to the return of all premiums paid if you are diagnosed with DCIS or any type of cancer, had any signs and/or symptoms or medical problems commence, or had investigations leading to the diagnosis of DCIS or any cancer covered or excluded, initiated within 90 days of the policy effective date or the latest reinstatement date of critical illness insurance coverage.
The following are also excluded:
- Insured condition diagnosed before the effective date
- Alcohol or drug abuse
- Declared or undeclared war or any act thereof;
- Self-inflicted injury, suicide or any attempt thereat, while sane or insane
- Participating in the commission of a criminal act
- For paralysis, blindness, deafness, major burns, stroke, coma or dismemberment, no benefit will be paid if the condition is a result, directly or indirectly, from amateur or professional boxing, bungee jumping, B.A.S.E. jumping, cliff diving, mountain climbing, motor vehicle race or speed competition on land and/or water, parachuting or underwater activities, including scuba and snuba diving
- Injury or Sickness (other than Insured Conditions) even if such Injury or Sickness is complicated by one of the Insured Conditions
- A complication of Human Immunodeficiency Virus (HIV) infection or any variance thereof including AIDS and AIDS Related Complex
Pre-existing Medical Condition Limitation
“Pre-existing Medical Condition” means a sickness suffered from or injury sustained by an Insured Person for which he or she sought or received medical advice, consultation, investigation, diagnosis, or for which treatment was required or recommended by a licensed medical practitioner during the twenty-four (24) months immediately prior to such Insured Person’s effective date of insurance or prior to any increase in the amount of insurance and which directly or indirectly causes the insured condition to occur within the first twenty-four (24) months from the Insured Person’s effective date of insurance or from any increase in the amount of insurance.
This is a brief overview of the Benefits, providing some key definitions, exclusions and limitations only. A complete policy booklet will be issued once coverage is purchased, and we suggest you review for details on all policy provisions when received