26 full-payout illnesses

Definition

Acquired brain injury due to external trauma means a definite diagnosis of new damage to brain tissue caused by traumatic head injury resulting in newly developed significant neurological deficit that:

• results from an external trauma severe enough to have prompted the insured to seek a medical consultation in less than a week after the occurrence of the trauma
• is present and verifiable on clinical examination
• is corroborated by abnormal magnetic resonance (MR) and/or computed tomography (CT) brain imaging studies, that confirm brain trauma, and
• persists for more than 180 consecutive days following the date of diagnosis.

The diagnosis of acquired brain injury due to external trauma must be made by a specialist.

New neurological deficits must be detectable by a physician and may include, but are not restricted to:

• measurable loss of hearing
• objective loss of sensation
• paralysis
• localized weakness
• dysarthria (difficulty with pronunciation) 
• dysphasia (difficulty with speech)
• dysphagia (difficulty in swallowing)
• measurable visual impairment
• impaired gait (difficulty walking)
• difficulty with balance
• lack of coordination
• new onset seizures undergoing treatment or
• measurable changes in neuro-cognitive function

Headache or fatigue will not be considered a neurological deficit.

Exclusion

No benefit will be payable under this condition for:

• an abnormality seen on imaging studies of the brain without corresponding clinical impairment;
• neurological deficit without corresponding imaging study lesions;
• a concussion that does not have abnormal imaging studies.

Definition

Aortic surgery means the undergoing of surgery for disease of the aorta requiring excision and surgical replacement of any part of the diseased aorta with a graft.  Aorta means the thoracic and abdominal aorta but not its branches.

The surgery must be determined to be medically necessary by a specialist.

Survival period

The insured person must survive for 30 days following the date of surgery.

Exclusion

No benefit will be payable under this condition for angioplasty, intra arterial procedures, percutaneous trans catheter procedures or non surgical procedures.

Definition

Aplastic anemia means a definite diagnosis of a chronic, persistent bone-marrow failure, confirmed by biopsy, which results in anemia, neutropenia and thrombocytopenia requiring blood product transfusion, and treatment with at least one of the following:

• Marrow stimulating agents
• Immunosuppressive agents
• Bone marrow transplantation

The diagnosis of aplastic anemia must be made by a specialist.

Definition

Bacterial meningitis means a definite diagnosis of meningitis, confirmed by cerebrospinal fluid showing the presence of pathogenic bacteria. The presence of pathogenic bacteria must be confirmed by culture or other generally medically accepted microbiological testing. The bacterial meningitis must result in new objective neurological deficits persisting for at least 90 consecutive days from the date of diagnosis.

The diagnosis of bacterial meningitis must be made by a specialist.

New neurological deficits must be detectable by a physician and may include, but are not restricted to:

• measurable loss of hearing
• objective loss of sensation
• paralysis
• localized weakness
• dysarthria (difficulty with pronunciation) 
• dysphasia (difficulty with speech)
• dysphagia (difficulty in swallowing)
• measurable visual impairment
• impaired gait (difficulty walking)
• difficulty with balance
• lack of coordination
• new onset seizures undergoing treatment or
• measurable changes in neuro-cognitive function

Headache or fatigue will not be considered a neurological deficit.

Exclusion

No benefit will be payable under this condition for viral meningitis.

Definition

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 new objective neurological deficit(s) .

These deficits must be corroborated by diagnostic imaging showing changes that are consistent in character, location and timing with the neurological deficits.

The diagnosis of benign brain tumour must be made by a specialist.

New neurological deficits must be detectable by a physician and may include, but are not restricted to:

• measurable loss of hearing
• objective loss of sensation
• paralysis
• localized weakness
• dysarthria (difficulty with pronunciation) 
• dysphasia (difficulty with speech)
• dysphagia (difficulty in swallowing)
• measurable visual impairment
• impaired gait (difficulty walking)
• difficulty with balance
• lack of coordination
• new onset seizures undergoing treatment or
• measurable changes in neuro-cognitive function

Headache or fatigue will not be considered a neurological deficit.

Exclusion

No benefit will be payable under this condition for pituitary adenomas less than 10 mm.

90 day exclusion period for benign brain tumour

No benefit will be payable for benign brain tumour if, within the first 90 days following the later of:

• the date the application for this policy was signed
• the underwriting decision date, but only if shown under the heading, Amendments to this policy
• the policy date, shown on the Policy summary, or
• the most recent date this policy was put back into 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 the policy), regardless of when the diagnosis is made, or
• a diagnosis of benign brain tumour (covered or excluded under the policy).

Your responsibility to notify us about benign brain tumour

You have a responsibility to notify us about benign brain tumour, regardless of when a diagnosis is made:

• If we are notified within 6 months of the date of the diagnosis and the coverage for benign brain tumour is excluded based on the 90 day exclusion, coverage for all other covered critical illnesses will continue.
• If information is not provided within 6 months of the date of diagnosis, we have the right to deny a claim for benign brain tumour or any critical illness caused by any benign brain tumour or its treatment.

To notify us, contact us at the toll free phone number shown at the beginning of this policy.  We will then send you the appropriate form to be completed.

Definition

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.

Definition

Cancer means a definite diagnosis of a malignant tumour. This tumour must be characterized by the uncontrolled growth and spread of malignant cells and the invasion of tissue.  Types of cancer include carcinoma, melanoma, leukemia, lymphoma, and sarcoma.

The diagnosis of cancer must be made by a specialist and must be confirmed by a histopathology report or appropriate pathological testing in the case of non solid tumours.

Exclusion

No benefit will be payable for the following:

• lesions described as benign, pre‑malignant, uncertain, borderline, non‑invasive, carcinoma in‑situ (Tis), or tumours classified as Ta
• malignant melanoma skin cancer that is less than or equal to 1.0 mm in thickness, unless it is ulcerated or is accompanied by lymph node or distant metastasis
• any non‑melanoma skin cancer, without lymph node or distant metastasis
• prostate cancer classified as T1a or T1b, without lymph node or distant metastasis
• papillary thyroid cancer or follicular thyroid cancer, or both, that is less than or equal to 2.0 cm in greatest diameter and classified as T1, without lymph node or distant metastasis
• chronic lymphocytic leukemia classified less than Rai stage 1, or
• gastro-intestinal stromal tumours classified as AJCC Stage 1
• grade 1 neuroendocrine tumours (carcinoid) confined to the affected organ, treated with surgery alone and requiring no additional treatment, other than medication to counteract the effects from hormonal oversecretion by the tumour.

For purposes of the policy, the terms Tis, Ta, T1a, T1b, T1 and AJCC Stage 2 are to be applied as defined in the American Joint Committee on Cancer (AJCC) Cancer Staging Manual, 7th Edition, 2010.  For purposes of the policy, the term Rai staging is to be applied as set out in KR Rai, A Sawitsky, EP Cronkite, AD Chanana, RN Levy and BS Pasternack:  Clinical staging of chronic lymphocytic leukemia.  Blood 46:219, 1975.

90 day exclusion period for cancer

No benefit will be payable for cancer if, within the first 90 days following the later of:

• the date the application for this policy was signed
• the underwriting decision date, but only if shown under the heading, Amendments to this policy
• the policy date, shown on the Policy summary, or
• the most recent date this policy was put back into effect (reinstatement),

the insured person has any of the following:

• signs, symptoms or investigations, that lead to a diagnosis of cancer (covered or excluded under the policy), regardless of when the diagnosis is made, or
• a diagnosis of cancer (covered or excluded under the policy).

Your responsibility to notify us about cancer

You have a responsibility to notify us about cancer, regardless of when a diagnosis is made:

• If we are notified within 6 months of the date of the diagnosis and the coverage for cancer is excluded based on the 90 day exclusion, coverage for all other covered critical illnesses will continue.
• If information is not provided within 6 months of the date of diagnosis, we have the right to deny a claim for cancer or any critical illness caused by any cancer or its treatment.

To notify us, contact us at the toll free phone number shown at the beginning of this policy.  We will then send you the appropriate form to be completed.

Definition

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.

Exclusions

No benefit will be payable under this condition for:

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

Definition

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).

The surgery must be determined to be medically necessary by a specialist.

Survival period

The insured person must survive for 30 days following the date of surgery.

Exclusion

No benefit will be payable under this condition for angioplasty, intra arterial procedures, percutaneous trans catheter procedures or non surgical procedures.

Definition

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.

Definition

Dementia, including Alzheimer’s disease means a definite diagnosis of dementia, which must be characterized by a progressive deterioration of memory and at least one of the following areas of cognitive function:

• aphasia (a disorder of speech)
• apraxia (difficulty performing familiar tasks)
• agnosia (difficulty recognizing objects), or disturbance in executive functioning (e.g. inability to think abstractly and to plan, initiate, sequence, monitor and stop complex behaviour), which is affecting daily life.

The insured person must exhibit:

• dementia of at least moderate severity, which must be evidenced by a mini mental State Exam of 20/30 or less, or equivalent score on another generally medically accepted test or tests of cognitive function, and
• evidence of progressive worsening in cognitive and daily functioning either by serial cognitive tests or by history over at least a 6 month period.

The diagnosis of dementia must be made by a specialist.

Exclusion

No benefit will be payable under this condition for affective or schizophrenic disorders, or delirium.

Definition

Heart attack (acute myocardial infarction) 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 acute myocardial infarction, with at least one of the following:

• heart attack symptoms
• new electrocardiogram (ECG) changes consistent with a heart attack
• development of new pathological Q waves on ECG following coronary angiography and/or angioplasty.
  

Survival period

The diagnosis of heart attack (acute myocardial infarction) must be made by a specialist.  The insured person must survive for 30 days following the date of diagnosis.

Exclusion

No benefit will be payable under this condition for:

• 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.

Definition

Heart valve replacement or repair means the undergoing of surgery to replace any heart valve with either a natural or mechanical valve or to repair heart valve defects or abnormalities.

The surgery must be determined to be medically necessary by a specialist.

Survival period

The insured person must survive for 30 days following the date of surgery.

Exclusion

No benefit will be payable under this condition for angioplasty, intra arterial procedures, percutaneous trans catheter procedures or non surgical procedures.

Definition

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.

Definition

Loss of independent existence means a definite diagnosis of the total inability to perform, by oneself, at least 2 of the following 6 activities of daily living for a continuous period of at least 90 days with no reasonable chance of recovery.

The diagnosis of loss of independent existence must be made by a specialist.

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 assistive devices
• Dressing: the ability to put on and remove necessary clothing, braces, artificial limbs or other surgical appliances with or without the aid of assistive devices
• Toileting: the ability to get on and off the toilet and maintain personal hygiene with or without the aid of assistive devices
• 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 aid of assistive devices, and
• Feeding: the ability to consume food or drink that already has been prepared and made available, with or without the use of assistive devices.

If the insured person has a loss of independent existence before the policy anniversary nearest their 18th birthday, you must wait to send us a claim for this illness. The earliest you may submit a claim is the policy anniversary nearest the insured person’s 18th birthday. The latest you may submit a claim is the policy anniversary nearest the insured person’s 19th birthday.

Definition

Loss of limbs means a definite diagnosis of the complete severance of 2 or more limbs at or above the wrist or ankle joint as the result of an accident or medically required amputation.

The diagnosis of loss of limbs must be made by a specialist.

Definition

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.

Exclusion

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

Definition

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 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.

Definition

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 enrollment in the transplant centre. The diagnosis of the major organ failure must be made by a specialist.

Definition

Motor neuron disease means a definite diagnosis of one of the following conditions and is limited to these conditions:

• amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease)
• primary lateral sclerosis
• progressive spinal muscular atrophy
• progressive bulbar palsy, or
• pseudo bulbar palsy.

The diagnosis of motor neuron disease must be made by a specialist.

Definition

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
• 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.

Definition

Occupational HIV infection means 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 most recent date the application for this policy was signed
• The policy date, or
• The most recent date this policy was put back into effect (reinstatement)

Payment under this condition requires satisfaction of all of the following:

• The accidental injury must be reported to us within 14 days of the accidental injury
• A serum HIV test must be taken within 14 days of the accidental injury and the result must be negative
• A serum HIV test must be taken between 90 days and 180 days after the accidental injury and the result must be positive
• All HIV tests must be performed by a duly licensed laboratory in Canada or the United States
• The accidental injury must have been reported, investigated and documented in accordance with current workplace guidelines for Canada or the United States.

The diagnosis of occupational HIV infection must be made by a specialist.

Exclusion

No benefit will be payable under this condition if:

• The insured person has elected not to take any available licensed vaccine offering protection against HIV
• A licensed cure for HIV infection has become available prior to the accidental injury, or
• HIV infection has occurred as a result of non-accidental injury including, but not limited to, sexual transmission and intravenous (IV) drug use

Definition

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.

Definition

Parkinson’s disease means a definite diagnosis of primary Parkinson’s disease, a permanent neurologic condition which must be characterized by bradykinesia (slowness of movement) and at least one of:

• muscular rigidity, or
• rest tremor.

The insured person must exhibit objective signs of progressive deterioration in function for at least 1 year, for which the treating neurologist has recommended dopaminergic medication or other generally medically accepted equivalent treatment for Parkinson’s disease.

Specified atypical parkinsonian disorders means a definite diagnosis of progressive supranuclear palsy, corticobasal degeneration, or multiple system atrophy.

The diagnosis of Parkinson’s disease or a specified atypical parkinsonian disorder must be made by a neurologist.

Exclusion

No benefit is payable under this condition for all other types of parkinsonism.

1 year exclusion period for Parkinson's disease and specified atypical parkinsonian disorders

No benefit will be payable for Parkinson’s disease or specified atypical parkinsonian disorders if, within 1 year following the later of:

• the date the application for the policy was signed
• the policy date
• the underwriting decision date if included in the policy, or
• the most recent date the policy was put back into effect (reinstatement)

the insured person has any of the following:

• signs, symptoms or investigations that lead to a diagnosis of Parkinson’s disease, a specified atypical parkinsonian disorder or any other type of Parkinsonism, regardless of when the diagnosis is made, or
• a diagnosis of Parkinson’s disease, a specified atypical parkinsonian disorder or any other type of Parkinsonism.

Your responsibility to notify us about Parkinson’s disease and specified atypical parkinsonian disorders

You have a responsibility to notify us about Parkinson’s disease or specified atypical parkinsonian disorders, regardless of when a diagnosis is made:

• If we are notified within 6 months of the date of the diagnosis and the coverage for Parkinson’s disease or specified atypical parkinsonian disorders is excluded based on the 1 year exclusion, coverage for all other covered critical illnesses will continue.
• If information is not provided within 6 months of the date of diagnosis, we have the right to deny a claim for Parkinson’s disease or specified atypical parkinsonian disorders or any critical illness caused by Parkinson’s disease or specified atypical parkinsonian disorders or its treatment.

Definition

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.

Definition

Stroke (cerebrovascular accident) resulting in persistent neurological deficits means a definite diagnosis of an acute cerebrovascular event caused by intracranial thrombosis or haemorrhage, or embolism from an extracranial source, with:

• acute onset of new neurological symptoms, and
• new objective neurological deficits on clinical examination,

persisting for more than 30 consecutive days following the date of diagnosis. 

These new symptoms and deficits must be corroborated by diagnostic imaging testing showing changes that are consistent in character, location and timing with the new persistent neurological deficits.

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

New neurological deficits must be detectable by a physician and may include, but are not restricted to:

• measurable loss of hearing
• objective loss of sensation
• paralysis
• localized weakness
• dysarthria (difficulty with pronunciation) 
• dysphasia (difficulty with speech)
• dysphagia (difficulty in swallowing)
• measurable visual impairment
• impaired gait (difficulty walking)
• difficulty with balance
• lack of coordination
• new onset seizures undergoing treatment or
• measurable changes in neuro-cognitive function

Headache or fatigue will not be considered a neurological deficit.

Exclusion

No benefit is payable under this condition for:

• transient ischaemic attacks
• intracerebral vascular events due to trauma, or
• lacunar infarcts which do not meet the definition of stroke as described above.