Critical Illness - Coverage Choices
Members and their spouses can both choose up to 40 units of $25,000 each, for a maximum of $1,000,000 coverage per person, of either Essential (6-condition) Coverage or Enhanced (18-condition) Coverage. 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.
This table shows the covered conditions for both types of Coverage. Click on a covered condition for details of its specific 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 as confirmed by histological examination of tissue samples. The following cancers are excluded from coverage:
Subject to the above definition, no Critical Illness benefit for cancer will be payable if a diagnosis of any type of cancer is made within ninety (90) days of the date of approval of coverage or of a reinstatement, or if such diagnosis is made as the result of symptoms present within that period. Furthermore, no benefits will be payable for a subsequent diagnosis of any cancer or other Covered Conditions directly resulting from any cancer or its treatment. Any diagnosis of any type of cancer or symptoms leading to such diagnosis occurring within this period must be reported to the Company in writing within six (6) months of diagnosis. If you fail to disclose this information, we have the right to deny any claim under this coverage.
- Carcinoma in situ;
- Stage 1A malignant melanoma (melanoma less than or equal to 0.75 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 and T1b) prostate cancer; and
- Any tumour in the presence of any human immunodeficiency virus (HIV).
Heart Attack (Myocardial Infarction): The death of a portion of the heart muscle due to atherosclerotic heart disease. The diagnosis must be based on all of the following criteria occurring at the same time:
- New episode of typical chest pain or equivalent symptoms; and
- Resulting from the blockage of one or more coronary arteries; and
- New electrocardiographic changes indicative of myocardial infarction; and
- Biochemical evidence of myocardial necrosis including elevated cardiac enzymes and/or troponin; and
- Excluding minor heart attacks that do not meet all of these criteria.
Stroke: A cerebrovascular incident causing infarction of your brain tissue, due to intracranial hemorrhage, thrombosis or embolism, producing a new measurable permanent clinical neurological deficit persisting for at least thirty (30) days following the occurrence of the stroke. Transient Ischemic Attacks (TIA) and neurological deficits caused by external trauma are specifically excluded.
Coronary Artery Bypass Surgery: You have undergone heart surgery to correct narrowing or blockage of one or more coronary arteries with bypass grafts. This excludes non-surgical techniques such as balloon angioplasty or laser relief of an obstruction.
Kidney Failure: End stage renal disease, due to whatever cause or causes, as a result of which you are undergoing peritoneal dialysis or haemodialysis on a regular basis or have received a transplanted human kidney.
Major Organ Transplant: You have undergone transplantation of a human heart, liver, lung or kidney due to irreversible failure of such organ or you have received transplanted human bone marrow.
Blindness: Total and permanent loss of sight in both eyes, as confirmed by a qualified ophthalmologist. The corrected visual acuity must be worse than 20/200 in both eyes, or the field of vision must be less than 20 degrees in both eyes.
Deafness: Total, permanent and profound 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, as confirmed by a doctor who is a certified otolaryngologist, and such loss of hearing cannot be corrected by any hearing aid, implant or device.
Multiple Sclerosis: The unequivocal diagnosis of definite Multiple Sclerosis by a doctor who is a certified neurologist. The diagnosis must be based on well-defined neurological abnormalities on physical examination persisting for a continuous period of at least one hundred and eighty (180) days and confirmed by imaging techniques.
Paralysis: 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. All psychiatric-related causes are specifically excluded.
Coma: A state of unconsciousness, with no reaction to external stimuli or response to internal needs, continuing for at least four (4) days.
Burns: Third degree burns covering at least 20% of the surface area of the body. The diagnosis must be confirmed by a certified plastic surgeon.
Loss of Speech: Total and irreversible loss of the ability to speak as the result of physical injury or disease which loss continues for a continuous period of at least one hundred and eighty (180) days. All cases associated with psychiatric disorders are specifically excluded.
Loss of Limbs: The irreversible severance of two or more limbs at or above a point that is proximal to the wrist or ankle joint as the result of an accident or medically required amputation.
Motor Neuron Disease: You receive an unequivocal diagnosis, by a doctor who is a certified neurologist, that you have one of the following: amyotrophic lateral sclerosis (A.L.S. or Lou Gehrig’s disease), primary lateral sclerosis, progressive spinal muscular atrophy, progressive bulbar palsy, or pseudo bulbar palsy, and limited to these entities. The diagnosis must be accompanied by typical progressive neurological findings on physical examination for at least one hundred and eighty (180) days.
Aortic Surgery: The undergoing of surgery for disease of the thoracic or abdominal aorta, requiring excision of the diseased segment of the aorta and replacement of it with a graft. Surgery for diseases of the branches of the thoracic or abdominal aorta, and aortic valve surgery are specifically excluded.
Alzheimer’s Disease: The definite diagnosis of Alzheimer’s Disease, by a doctor who is a certified neurologist, with progressive degeneration of the brain, memory and the ability to reason and perceive. You must exhibit the loss of intellectual capacity involving impairment of memory and judgment, which results in such a significant reduction of mental and social functioning, as to require continuous daily supervision. All other dementing organic brain disorders and psychiatric illnesses are specifically excluded.
Parkinson’s Disease: The diagnosis, by a doctor who is a certified neurologist, with primary idiopathic Parkinson’s disease, characterized by two or more of the following clinical manifestations:
All other types of Parkinsonism are specifically excluded.
- Muscle rigidity;
- Bradykinesis (abnormal slowness of movement, sluggishness of physical and mental responses).
General Exclusions and Limitations
Note that no benefit will be paid if the Insured while sane or insane, suffers a Covered Condition as a result of intentional self-inflicted injuries, the abuse of alcohol or drugs, committing or attempting to commit a criminal offence, or 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 thirty (30) days following the first diagnosis of a covered condition or such longer period as described in the above definition of that condition.