Plan details

 
Plan details - Critical Illness Insurance

Eligibility

Effective date 

Statement of health

Amounts of insurance

Description of coverage 

Insured conditions


Eligibility

You and your spouse are eligible to apply for Critical Illness insurance if you:

  • reside in Canada, and
  • are over age 18 and are under age 60

 

Effective date

Coverage becomes effective on the first day of the month coinciding with or immediately following the date a completed application is approved by Sun Life Assurance Company of Canada, providing any evidence of insurability required is determined to be satisfactory and full premium for the insurance is received.

 

Statement of health

All applications are subject to a satisfactory statement of health. You (and your spouse, if applying) must complete a questionnaire outlining your medical history, which will be assessed by Sun Life Assurance Company of Canada to determine if coverage may be issued.

Sun Life Assurance Company of Canada reserves the right to request a medical examination or tests such as a general blood profile (including a blood test for HIV, where permitted) which will be made at no expense to you.

 

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Amounts of insurance

Critical Illness insurance is available in units of $10,000, from a minimum of $20,000 up to a maximum of $250,000.

 

Description of coverage

Following the specified survival period (usually 30 days unless otherwise specified in the description of the covered conditions) and approval of claim, Critical Illness insurance provides a one-time, lump-sum payment when the insured is diagnosed with one of the critical illnesses covered under the plan.  The benefit will be paid only on the first insured condition for which a diagnosis is made or surgery is performed, and then coverage terminates.

A qualified physician or specialist means a medical physician or specialist, duly licensed and practicing medicine in Canada, who is not you, your spouse, or any relative or business associate of either.

Before the benefit becomes payable, Sun Life Assurance Company of Canada reserves the right to require an examination of you and/or your spouse and to obtain confirmation of any diagnosis or medical operation for any insured condition under which the benefit is claimed, by a medical practitioner appointed by Sun Life Assurance Company of Canada.

No coverage is provided if any symptom or medical problem which initiated the investigation leading to a diagnosis of cancer commenced within 90 days following the first premium due date. In the event of any diagnosis based on such a symptom or medical problem, your coverage will terminate and Sun Life Assurance Company of Canada's sole liability in respect of this benefit shall be limited to a refund of the premiums paid since the effective date.

 

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 Insured conditions

1.       Alzheimer's disease
Alzheimer’s disease means a definite diagnosis of a progressive degenerative disease of the brain. The insured person must exhibit the loss of intellectual capacity involving impairment of memory and judgment, which results in a significant reduction in mental and social functioning, and requires a minimum of 8 hours of daily supervision.

The diagnosis of Alzheimer’s disease must be made by a specialist physician. The insured person must survive for 30 days following the date of diagnosis.

Exclusion:
No benefit will be payable for all other dementing organic brain disorders and psychiatric illnesses.


2.       Aortic surgery
Aortic surgery means 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.

The surgery must be determined to be medically necessary by a specialist physician. The insured person must survive for 30 days following the date of surgery.


3.       Benign brain tumour
Benign brain tumour means a definite diagnosis of a non-malignant tumour located in the cranial vault and limited to the brain, meninges, cranial nerves or pituitary gland. The tumour must require surgical or radiation treatment or cause irreversible objective neurological deficit(s).

The diagnosis of benign brain tumour must be made by a specialist physician. The insured person must survive for 30 days following the date of diagnosis.

Exclusions:
No benefit will be payable under this condition for pituitary adenomas less than 10 mm.
No benefit will be payable for a recurrence or metastasis of an original tumour which was diagnosed prior to the effective date of the policy.

Moratorium Period Exclusion:
No benefit will be payable for benign brain tumour and the insured person’s coverage for benign brain tumour will terminate, if within the first 90 days following the later of:

  • the date the application for this policy was signed;
  • the policy date; or,
  • the most recent date this policy was put back in effect (reinstatement).
the insured person has any of the following:
  • signs, symptoms or investigations that lead to a diagnosis of benign brain tumour (covered or excluded under this policy), regardless of when the diagnosis is made,
  • a diagnosis of benign brain tumour (covered or excluded under this policy).

While the insured person’s insurance for benign brain tumour terminates, insurance for all other covered conditions remains in force.

This information described above must be reported to us within 6 months of the date of diagnosis. If this information is not provided, we have the right to deny any claim for benign brain tumour or any critical illness caused by any benign brain tumour or its treatment.


4.       Blindness
Blindness means a definite diagnosis of the total and irreversible loss of vision in both eyes, evidenced by:

  • the corrected visual acuity being 20/200 or less in both eyes; or,
  • the field of vision being less than 20 degrees in both eyes.

The diagnosis of blindness must be made by a specialist physician. The insured person must survive for 30 days following the date of diagnosis.


5.       Cancer
Cancer means a definite diagnosis of a tumour characterized by the uncontrolled growth and spread of malignant cells and the invasion of tissue.

The diagnosis of cancer must be made by a specialist physician. The insured person must survive for 30 days following the date of diagnosis.

Exclusions:
No benefit will be payable for a recurrence or metastasis of an original cancer which was diagnosed prior to the effective date of coverage.

No benefit will be payable under this condition for the following non-life threatening cancers:

  • carcinoma in situ; or,
  • Stage 1A malignant melanoma (melanoma less than or equal to 1.0 mm in thickness, not ulcerated and without Clark level IV or level V invasion); or,
  • any non-melanoma skin cancer that has not become metastasized; or,
  • Stage A (T1a or T1b) prostate cancer.
Moratorium Period Exclusion: No benefit will be payable for cancer and the insured person’s coverage for cancer will terminate if, within 90 days following the later of:
  • the date the application for this policy was signed;
  • the policy effective date; or,
  • the most recent date this policy was put back in effect (reinstatement).
the insured person has any of the following:
  • signs, symptoms or investigations, that lead to diagnosis of cancer (covered or excluded under this policy), regardless of when the diagnosis is made,
  • a diagnosis of cancer (covered or excluded under this policy).

While the insured person’s insurance for cancer terminates, insurance for all other covered conditions remains in force.

This information described above must be reported to us within 6 months of the date of the diagnosis. If this information is not provided, we have the right to deny any claim for cancer or, any critical illness caused by any cancer or its treatment.


6.       Coma
Coma means a definite diagnosis of a state of unconsciousness with no reaction to external stimuli or response to internal needs for a continuous period of at least 96 hours, and for which period the Glasgow coma score must be 4 or less.

The diagnosis of coma must be made by a specialist physician. The insured person must survive for 30 days following the date of diagnosis.

Exclusion:
No benefit will be payable under this condition for:

  • a medically induced coma; or,
  • a coma which results directly from alcohol or drug use; or,
  • a diagnosis of brain death.

7.       Coronary artery bypass Surgery 
Coronary artery bypass surgery means the undergoing of heart surgery to correct narrowing or blockage of one or more coronary arteries with bypass graft(s), excluding any non-surgical or trans-catheter techniques such as balloon angioplasty or laser relief of an obstruction.

The surgery must be determined to be medically necessary by a specialist physician. The insured person must survive for 30 days following the date of surgery.


8.       Deafness
Deafness means a definite diagnosis of 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 hertz.

The diagnosis of deafness must be made by a specialist physician. The insured person must survive for 30 days following the date of diagnosis.


9.       Heart attack
Heart attack means a definite diagnosis of the death of heart muscle due to obstruction of blood flow, that results in a 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.
The diagnosis of heart attack must be made by a specialist physician. The insured person must survive for 30 days following the date of diagnosis.

Exclusion:
Heart attack does not include:
  • elevated biochemical cardiac markers as a result of an intra-arterial cardiac procedure including, but not limited to, coronary angiography and coronary angioplasty, in the absence of new Q waves; or,
  • ECG changes suggesting a prior myocardial infarction, which do not meet the heart attack definition as described above.

10.       Kidney failure
Kidney failure means a definite diagnosis of chronic irreversible failure of both kidneys to function, as a result of which regular haemodialysis, peritoneal dialysis or renal transplantation is initiated.

The diagnosis of kidney failure must be made by a specialist physician. The insured person must survive for 30 days following the date of diagnosis.


11.       Loss of independent existence
Loss of independent existence means a definite diagnosis of either:

  • a total inability to perform, by oneself, at least 2 of the following 6 activities of daily living; or,
  • cognitive impairment, as defined below,
  • for a continuous period of at least 90 days with no reasonable chance of recovery.
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 on and off 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 are measurable and result from demonstrable organic cause as diagnosed by a specialist physician. The degree of cognitive impairment must be sufficiently severe to require a minimum of 8 hours of daily supervision.

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

The diagnosis of loss of independent existence must be made by a specialist physician. No additional survival period is required once the conditions described above are satisfied.

Exclusion:
No benefit will be payable under this condition for any mental or nervous disorder without a demonstrable organic cause.


12.       Loss of speech
Loss of speech means a definite diagnosis of the total and irreversible loss of the ability to speak as the result of physical injury or disease, for a period of at least 180 days.

The diagnosis of loss of speech must be made by a specialist physician. The insured person must survive for 180 days following the date of diagnosis.

Exclusion:
No benefit will be payable under this condition for all psychiatric related causes.


13.       Major organ failure on waiting list
Major organ failure on waiting list means 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 failure on waiting list, the insured person must become enrolled as the recipient in a recognized transplant centre in Canada or the United States that performs the required form of transplant surgery.

The date of diagnosis is the date of the insured person’s enrolment in the transplant centre.

The diagnosis of the major organ failure must be made by a specialist physician. The insured person must survive for 30 days following the date of diagnosis.


14.       Major organ transplant
Major organ transplant means 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 for transplantation 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 physician. The insured person must survive for 30 days following the date of their transplant.


15.       Multiple sclerosis
Multiple sclerosis means a definite diagnosis of at least one of the following:

  • two or more separate clinical attacks, confirmed by magnetic resonance imaging (MRI) of the nervous system, showing multiple lesions of demyelination; or,
  • well-defined neurological abnormalities lasting more than 6 months, confirmed by MRI imaging of the nervous system, showing multiple lesions of demyelination; or,
  • a single attack, confirmed by repeated MRI imaging of the nervous system, which shows multiple lesions of demyelination which have developed at intervals at least one month apart.

The diagnosis of multiple sclerosis must be made by a specialist physician. The insured person must survive for 30 days following the date of diagnosis.


16.       Paralysis
Paralysis means a definite diagnosis of the total loss of muscle function of two or more limbs as a result of injury or disease to the nerve supply of those limbs, for a period of at least 90 days following the precipitating event.

The diagnosis of paralysis must be made by a specialist physician. The insured person must survive for 90 days following the precipitating event.


17.       Parkinson’s disease
Parkinson’s disease means a definite diagnosis 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 diagnosis of Parkinson’s disease must be made by a specialist physician. The insured person must satisfy the above conditions and survive for 30 days following the date all these conditions are met.

Exclusion:
No benefit will be payable under this condition for all other types of Parkinsonism.


18.       Severe burns
Severe burns means a definite diagnosis of third-degree burns over at least 20% of the body surface.

The diagnosis of severe burns must be made by a specialist physician. The insured person must survive for 30 days following the date the severe burn occurred.


19.       Stroke
Stroke (cerebrovascular accident) means a definite diagnosis of an acute cerebrovascular event caused by intra-cranial thrombosis or haemorrhage, or embolism from an extra-cranial source, with:

  • acute onset of new neurological symptoms; and,
  • new objective neurological deficits on clinical examination; and,
  • persisting for more than 30 days following the date of diagnosis.
These new symptoms and deficits must be corroborated by diagnostic imaging testing.

The diagnosis of stroke must be made by a specialist physician. The insured person must survive for 30 days following the date of the diagnosis.

Exclusion:
No benefit will be payable under this condition for:
  • transient ischaemic attacks; or,
  • intracerebral vascular events due to trauma; or,
  • lacunar infarcts which do not meet the definition of stroke as described above.


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