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Critical Illness Insurance:
Coverage Details
Institute Members and/or their spouses can choose up to 10 units of $25,000 each, for a maximum of $250,000 coverage per person. This insurance pays the full coverage amount directly to the insured, upon satisfactory proof that this amount is payable according to the definitions, limitations and exclusions that follow.
Click on any of the 18 covered conditions listed below for details of its specific requirements, limitations and exclusions. Also take a moment to read the general limitations and exclusions that apply.
Definitions, limitations and exclusions for covered conditions:
Life-Threatening Cancer: A tumour characterized by the uncontrolled growth and spread of malignant cells and the invasion of tissue.”
The following cancers are excluded from coverage:
- carcinoma in situ
- Stage 1A malignant melanoma (melanoma less than or equal to 1.0 mm in thickness, not ulcerated and without level IV or V invasion)
- any non-melanoma skin cancer that has not become metastatic (spread to distant organs)
- stage A (T1a or T1b) prostate cancer
- any tumour in the presence of any Human Immunodeficiency Virus (HIV)
Limitation: No benefit will be available under this condition if within the first 90 days following the effective date of the certificate, the Insured has any of the following:
- signs or symptoms of cancer that lead to a diagnosis of cancer (covered or excluded under the policy), regardless of when the diagnosis is made,
- medical consultations or tests that lead to a diagnosis of cancer (covered or excluded under the policy), regardless of when the diagnosis is made,
- a diagnosis of cancer (covered or excluded under the policy).
This information must be reported to the Company within 6 months of the date of the diagnosis. If this information is not provided, the Company has the right to deny any claim for cancer or, any critical illness caused by any cancer or its treatment.
Heart Attack (Myocardial Infarction): The death of a portion of heart muscle as a result of inadequate blood supply as evidenced by
a. new electrocardiographic (ECG) changes indicative of a myocardial infarction, and,
b. the elevation of cardiac biochemical markers to levels considered diagnostic for infarction.
Heart attack during coronary angioplasty is covered provided that there are diagnostic changes of new Q wave infarction on the ECG in addition to elevation of cardiac markers.
Exclusion: Heart attack does not include an incidental finding of ECG changes suggesting a prior myocardial infarction, in the absence of a corroborating event.
Stroke: A cerebrovascular event producing neurological sequelae lasting more than 30 days and caused by intracranial thrombosis or hemorrhage, or embolism from an extra-cranial source. There must be evidence of measurable, objective neurological deficit.
Exclusion: Transient Ischemic Attacks are specifically excluded.
Coronary Artery Bypass Surgery: The undergoing of heart surgery to correct narrowing or blockage of one or more coronary arteries with bypass grafts.
Exclusion: Any non-surgical techniques such as balloon angioplasty or laser relief of an obstruction.
Kidney Failure: End stage renal disease presenting as chronic irreversible failure of both kidneys to function, as a result of which either regular hemodialysis, peritoneal dialysis or renal transplantation is initiated.
Major Organ Transplant and Major Organ Failure on Waiting List: The diagnosis of the irreversible failure of the heart, both lungs, liver, both kidneys or bone marrow. Transplantation must be medically necessary.
To qualify under Major Organ Transplant the Insured must undergo surgery as the recipient for transplantation of a heart, lung, liver, kidney or bone marrow, and limited to these entities.
To qualify under Major Organ Failure on Waiting List the Insured must become enrolled as the recipient in an approved government organ or bone marrow transplant program in Canada or the U.S, for one or more of the organs or bone marrow specified in this provision. For the purposes of the Survival Period, the date of Diagnosis is the date your enrollment in such a transplant program takes effect.
Blindness: The total and irreversible loss of vision in both eyes as confirmed by an ophthalmologist, with the corrected visual acuity being 20/200 or less in each eye or the field of vision is less than 20 degrees in both eyes.
Deafness: The total and irreversible loss of hearing in both ears, with an auditory threshold of 90 decibels or greater within the speech threshold of 500 to 3,000 cycles per second.
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.
Paralysis: The complete and permanent loss of use of two or more limbs for a continuous period of ninety days following the precipitating event, during which time there has been no sign of improvement.
Exclusion: All psychiatric related causes are specifically excluded.
Coma: A state of unconsciousness with no reaction to external stimuli or response to internal needs for a continuous period of four days. The Glasgow coma score must be four (4) or less, continuously during the four days.
Exclusions: A medically induced coma, and a coma which results directly from alcohol or drug use.
Burns: Third degree burns over at least 20% of the body surface.
Loss of Speech: The total and irreversible loss of the ability to speak as the result of physical injury or disease which must be established for a continuous period of at least 180 days.
Exclusion: All psychiatric related causes are specifically excluded.
Loss of Limbs: The irreversible severance of two or more limbs from above the wrist or ankle joint as the result of an accident or medically required amputation.
Motor Neuron Disease: A definitive 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, or pseudo bulbar palsy, and limited to these entities.
Aortic Surgery: The undergoing of surgery for disease of the aorta requiring excision and surgical replacement of the diseased aorta with a graft. Aorta refers to the thoracic and abdominal aorta but not its branches.
Alzheimer’s Disease: A definitive clinical diagnosis by a specialist of Alzheimer’s Disease, which is a progressive degenerative disease of the brain. The Insured must exhibit the loss of intellectual capacity involving impairment of memory and judgement, which results in a significant reduction in mental and social functioning, as to require continuous daily supervision.
Exclusion: All other dementing organic brain disorders and psychiatric illnesses are specifically excluded.
Parkinson’s Disease: A definitive diagnosis by a specialist of primary idiopathic Parkinson’s Disease, which is characterized by a minimum of two or more of the following clinical manifestations: muscle rigidity, tremor, or bradykinesis (abnormal slowness of movement, sluggishness of physical and mental responses). The Insured must require substantial physical assistance from another adult to perform at least 2 of the following 6 Activities of Daily Living.*
Exclusion: All other types of Parkinsonism are specifically excluded.
*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.
General Exclusions and Limitations
No benefit will be paid if the Insured while sane or insane, suffers a Covered Condition as a result of any of the following:
- Intentional self-inflicted injuries,
- Attempted suicide,
- The use of intoxicants,
- Committing or attempting to commit a criminal offence,
- Operating a motor vehicle while the concentration of alcohol in 100 milliliters of blood exceeds 80 milligrams.
No benefit will be paid unless the Insured survives 30 days following the first diagnosis of a Covered Condition or such longer period as described in the Covered Conditions Definitions.
For Cancer, the following cancers are excluded from coverage:
- carcinoma in situ
- Stage 1A malignant melanoma (melanoma less than or equal to 1.0 mm in thickness, not ulcerated and without level IV or V invasion)
- any non-melanoma skin cancer that has not become metastatic (spread to distant organs)
- stage A (T1a or T1b) prostate cancer
- any tumour in the presence of any Human Immunodeficiency Virus (HIV)
Limitation: No benefit will be available under this condition if within the first 90 days following the effective date of the certificate, the insured has any of the following:
- signs or symptoms of cancer that lead to a diagnosis of cancer (covered or excluded under the policy), regardless of when the diagnosis is made,
- medical consultations or tests that lead to a diagnosis of cancer (covered or excluded under the policy), regardless of when the diagnosis is made,
- a diagnosis of cancer (covered or excluded under the policy).
If you have questions or feedback about our coverage, click here to contact us online, telephone us toll-free at 1 866 219-4245 Monday through Friday from 8 a.m. to 8 p.m. ET, or e-mail us at am_service@manulife.com any time.
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