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List of covered illnesses

Here is a list of the 25 illnesses covered by the promotional offer for critical illness insurance and their definitions.

Stroke

A cerebrovascular accident that produces neurological sequelae that last over thirty (30) days and are caused by thrombosis, hemorrhage or extracranial embolism. There must be evidence of objective, measurable neurological deficit. Transient ischemic attacks (TIAs) are specifically excluded.

Cancer

A tumour characterized by the uncontrolled proliferation and spread of malignant cells and the invasion of tissue.

The following forms of cancer are excluded:

  • carcinoma in situ;
  • stage 1A malignant melanoma as defined by the TNM classification (no more than one [1.0] millimetre thick, without ulceration and without invasion at Clark’s Level IV or V);
  • any non-melanoma skin cancer that has not become metastatic (spread to adjacent organs);
  • stage A (T1a or T1b) prostate cancer.

Moratorium period: No benefit is payable for any Cancer when the earliest of the following dates occurs within ninety (90) days of this coverage’s effective date or reinstatement:

  • the date of diagnosis for any Cancer, whether covered or excluded; or
  • the date at which any early signs or symptoms for any Cancer, whether covered or excluded, appear; or
  • the date at which the Insured has any medical consultation or test leading to the diagnosis of any Cancer, whether covered or excluded.

However, these exclusions do not result in termination of the coverage. The Insured remains insured against the other covered Illnesses.

Disclosure Obligation: Any diagnosis of Cancer (whether covered or excluded under this coverage) or any sign or symptom or medical consultation or test leading to a diagnosis of Cancer (whether covered or excluded under this coverage) that manifests during the moratorium period must be reported in writing to the Insurer within six (6) months of the diagnosis. Failure to do so entitles the Insurer to refuse any Critical Illness claim under this coverage.

Heart Attack (myocardial infarction)

Necrosis of a portion of the cardiac muscle resulting from inadequate blood supply, as evidenced by:

  • recent electrocardiographic (ECG) changes indicative of a myocardial infarction; and
  • elevation of cardiac biochemical markers to levels considered diagnostic for infarction.

Heart Attack during an angioplasty is covered provided new Q-wave changes on the electrocardiogram are diagnosed in addition to the elevation of cardiac markers.

Heart Attack does not include incidental discovery of ECG changes suggestive of a past symptomless myocardial infarction or a past myocardial infarction without a corroborating medical event.

Coronary Surgery (coronary artery bypass surgery)

Heart surgery that uses a coronary artery bypass to correct the narrowing or obstruction of at least one coronary artery. Non-surgical procedures such as angioplasty and laser relief of obstruction are not covered.

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 present signs of significant loss of intellectual capacity impairing memory and judgment and resulting in significantly reduced mental and social functioning, such that the Insured requires continuous daily supervision. All other dementing organic brain disorders or psychiatric Illnesses are excluded.

Aortic Surgery

Surgery to correct a condition of the aorta requiring surgical replacement of the affected artery with a graft. “Aorta” or “aortic” refers to the thoracic and abdominal aorta, excluding its branches.

Autism

An organic abnormality in brain development, characterized by the inability to develop a language of communication or other forms of social communication. The diagnosis must be confirmed by a Specialist before the Insured’s third (3rd) birthday.

Benign Brain Tumour

A non-malignant tumour of the brain or meninges. The histological nature of the tumour must be confirmed by an examination of tissues through biopsy or surgical excision. Tumours of the bony cranium and pituitary microadenomas of less than ten (10) millimetres in diameter are excluded.

Moratorium period: No benefit is payable for any Cancer or Benign Brain Tumour when the earliest of the following dates occurs within ninety (90) days of this coverage’s effective date or reinstatement:

  • the date of diagnosis for any Cancer, whether covered or excluded, or for Benign Brain Tumour; or
  • the date at which any early signs or symptoms for any Cancer, whether covered or excluded, or for Benign Brain Tumour appear; or
  • the date at which the Insured has any medical consultation or test leading to the diagnosis of any Cancer, whether covered or excluded, or of Benign Brain Tumour.

However, these exclusions do not result in termination of the coverage. The Insured remains insured against the other covered Illnesses.

Disclosure Obligation: Any diagnosis of Cancer (whether covered or excluded under this coverage) or of Benign Brain Tumour or any sign or symptom or medical consultation or test leading to a diagnosis of Cancer (whether covered or excluded under this coverage) or of Benign Brain Tumour that manifests during the moratorium period must be reported in writing to the Insurer within six (6) months of the diagnosis. Failure to do so entitles the Insurer to refuse any Critical Illness claim under this coverage.

Blindness

Total and irrecoverable loss of sight in both (2) eyes, confirmed by an ophthalmologist, with a corrected visual acuity of twenty over two hundred (20/200) or less in each eye, or a field of vision of less than twenty (20) degrees in both (2) eyes.

Burns

Third-degree burns over at least twenty percent (20%) of the body surface.

Coma

A state of unconsciousness without reaction to external stimuli or response to internal needs for a continuous period of four (4) days. The Glasgow Coma Scale must continuously indicate four (4) or less during the four (4) days.

Exclusions:

  • a medically induced coma;
  • a coma resulting directly from alcohol or drug use.

Cystic Fibrosis

A final diagnosis of cystic fibrosis made before the Insured reaches the age of eighteen (18), as evidenced by chronic lung disease and pancreatic failure.

Deafness

Total and irrecoverable loss of hearing in both (2) ears, with a hearing threshold of ninety (90) decibels or greater, within a speech threshold of five hundred (500) to three thousand (3,000) cycles per second.

Heart Valve Replacement

Replacement of any heart valve with a natural valve, a valve made of animal tissue, or a mechanical valve. Heart valve repair is specifically excluded.

Kidney Failure

End stage of the chronic, irreversible failure of both (2) kidneys, requiring treatment through regular dialysis, peritoneal dialysis or kidney transplant.

Loss of Autonomy

A definitive diagnosis, by a specialist, for a continuous period of ninety (90) days, confirming the Insured’s complete and permanent inability to perform, on his or her own, at least two (2) of the six (6) Activities of Daily Living listed in that definition, without reasonable likelihood of recovery, or confirming a Cognitive Impairment as defined below.

Cognitive Impairment is defined as:

Mental deterioration and loss of mental capacity resulting in a deterioration of memory, orientation and the faculty of reason, which are measurable and due to an objective organic cause, diagnosed by a specialist. The degree of cognitive impairment must be serious enough to warrant continuous daily supervision.

The finding of cognitive impairment must be based on clinical data and standardized assessments, validating the impairment. Any mental or nervous disorder without a demonstrable organic cause is not covered.

Loss of Limbs

Irreversible severance of two (2) or more limbs above the wrist or ankle joint, resulting from an Accident or a medically necessary amputation. A loss resulting directly from drug or alcohol use is excluded.

Loss of Speech

The total and irrecoverable loss of the faculty of speech, resulting from an Injury or a physical and persistent Illness for a continuous period of at least one hundred and eighty (180) days. Any psychiatric cause is specifically excluded.

Major Organ Failure on Waiting List

The diagnosis of irreversible failure of the heart, both (2) lungs, liver, both (2) kidneys, or bone marrow. Transplantation must be medically necessary.

To qualify under Major Organ Failure on Waiting List, the Insured must be an eligible recipient, as part of an approved government program for organ or bone marrow transplant in Canada or in the United States, for one (1) or more organs or of bone marrow, as specified in this clause.

With respect to the Survival Period, the date of diagnosis is the date at which the Insured’s registration with the transplant program takes effect.

Major Organ Transplant

The diagnosis of irreversible failure of the heart, both (2) lungs, liver, both (2) kidneys, or bone marrow. Transplantation must be medically necessary. To qualify under Major Organ Transplant, the Insured must undergo surgery to receive transplantation of the heart, both (2) lungs, liver, both (2) kidneys, or bone marrow. For the purposes of this coverage, “Major Organ Transplant” is limited to the organs specified in this paragraph.

Motor Neuron Disease

A definitive diagnosis of one of the following diseases: amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease), primary lateral sclerosis, spinal muscular atrophy, progressive bulbar palsy or pseudobulbar palsy. For the purposes of this coverage, “Motor Neuron Disease” is limited to the diseases specified above.

Multiple Sclerosis

A definitive diagnosis, by a neurologist, of multiple sclerosis, characterized by well-defined neurological abnormalities that persist for a continuous period of at least six (6) months or with two (2) separate episodes, documented with clinical facts. The disseminated demyelinating lesions must be confirmed by magnetic resonance imaging (MRI) or by a medical imaging technique customarily used to diagnose multiple sclerosis.

Occupational HIV

A diagnosis of infection by the human immunodeficiency virus (HIV), resulting from Accidental Injury in the course of the Insured performing the regular duties of his or her Occupation, which exposes him or her to body fluids contaminated with HIV.

The benefit will be payable provided all of the following criteria are met:

  • the Accidental Injury must be reported to the Insurer within fourteen (14) days of the Accidental event;
  • a test for HIV must be performed within fourteen (14) days of the Accidental Injury and the result must be negative;
  • a test for HIV must be performed between ninety (90) and one hundred and eighty (180) days after the Accidental Injury and the result must be positive;
  • all HIV tests must be conducted by a laboratory approved by the Insurer;
  • the Accidental Injury must be reported, investigated and documented in accordance with Canadian labour standards.

No benefit will be payable if:

  • the Insured refuses a vaccine that is approved and available and that offers protection from HIV;
  • an approved preventive or curative treatment for HIV infection becomes available before the Accidental Injury;
  • the HIV infection was contracted otherwise than as the result of Accidental Injury (including, but not limited to, sexual transmission or the use of intravenous drugs).

Paralysis

Complete and permanent loss of use of two (2) or more limbs during a continuous period of ninety (90) days following the event giving rise to the loss, without any sign of improvement during that period. Any psychiatric cause is specifically excluded.

Parkinson’s Disease

A definitive clinical diagnosis, by a specialist, of primary idiopathic Parkinson’s disease, which is characterized by at least two (2) of the following clinical features: muscle rigidity, tremor or bradykinesia (abnormal slowing of movement, slowing of physical and mental reactions). The Insured must require substantial physical help from another adult to perform two (2) or more of the following six (6) Activities of Daily Living: bathing, dressing, toileting, continence, transferring or eating, as specified in the definitions. Any other type of parkinsonism is specifically excluded.