Critical Illness Insurance For Your Employees
AN E X T R A M E A S U R E O F COMFORT – WHEN I T ’ S N E E D E D MOS T
“With each passing year, there is an increasing awareness of critical illness. Medical advances are improving the probability of survival, but that survival is often followed by a lengthy, and costly recovery. To help ease the financial burden linked to a decrease in income when a critical illness strikes, we have partnered with Sun Life Assurance Company of Canada to add a new element to the First Nations Insurance Services (FNIS) benefits package – Group Critical Illness Insurance that you can elect to offer your employees.
Group Critical Illness Insurance is designed to complement other types of insurance such as Disability and Life Insurance. Payment is made even if the insured makes a full recovery; continues earning an income; or receives any other insurance benefits. The benefit is payable in full on the first covered illness only; coverage terminates with this payment. There are no restrictions on how the benefit is used – for medical treatment, home renovations or private duty nursing.
Following the specified survival period, on approval of a claim, Group Critical Illness Insurance pays a one-time lump-sum benefit to the insured who is diagnosed with one of these 10 critical illnesses:
- Heart attack
- Kidney failure
- Paralysis
- Cancer
- Major organ transplant
- Deafness
- Stroke & Multiple sclerosis
- Blindness
- Coronary artery bypass surgery
Under this plan, a mandatory coverage of $25,000 is available for all eligible employees, and medical evidence is not required.
Exclusions - no benefit is payable for claims resulting directly or indirectly from any of the following:
- declared or undeclared war, insurrection, or rebellion
- voluntary participation in a riot or act of civil disobedience
- attempted suicide, or intentionally self-inflicted injuries while sane or self-inflicted injury while insane
- the act of committing or attempting to commit a criminal offence
- use of illegal or illicit drugs or substances, misuse of drugs or alcohol
- death of insured during the required survival period
There is a pre-existing condition limitation where no benefit will be paid for any insured
condition that occurs within 24 months of the insured’s effective date of insurance coverage, and that resulted from any injury, sickness or medical condition (whether or not it was diagnosed) for which the insured had symptoms, consulted a physician or other health care practitioner or was provided any health-related care, advice or treatment, or that a reasonably prudent person with such injury, sickness or medical condition or symptom(s) would have consulted a physician or any other health care practitioner, during the 24 months prior to the effective date of the insured’s coverage.
The coverage will terminate the earlier of the first of the month following the insured’s 65th birthday; the date the Group Critical Illness Insurance benefit is paid; the date employment ends; the date the participating affiliate or policy holder terminates; the date the master policy terminates; the date the insured is no longer actively working or a resident of Canada; the date the insured retires or dies.
Claims payments are based on the definitions of the covered illnesses provided by Sun Life Assurance Company of Canada as follows:
Heart attack
The death of a portion of the heart muscle, resulting from a blockage of one or more coronary arteries due to atherosclerotic heart disease. The diagnosis, which must be made by a cardiologist licensed and practising in Canada, must based on all of the following criteria occurring at the same time:
- New episode of typical chest pain or equivalent symptoms
- New electrocardiographic (ECG) changes indicative of an acute myocardial
infarction, and
- BIochemical evidence of myocardial necrosis (heart muscle death) including
elevated cardiac enzymes and/or troponin Lesser acute coronary syndromes including unstable angina and acute coronary insufficiency are specifically excluded.
Stroke
Unequivocal diagnosis by a neurologist licensed and practising in Canada, of the death of brain tissue caused by thrombosis, hemorrhage or embolism. The diagnosis must be based on all of the following:
n Sudden onset of new neurological symptoms
- New objective neurological deficits on clinical examination persisting continuously for at least sixty (60) days following the diagnosis of the stroke
- New findings on CT scan or MRI, if done, consistent with the clinical diagnosis Transient ischemic attacks (TIA) are specifically excluded.
Cancer
Diagnosis of a malignancy, which is characterized by the uncontrolled growth of cancer cells with invasion of tissue. The diagnosis must be made by an appropriate specialist, licensed and practising in Canada, and supported by relevant investigation and appropriate diagnostic tests. The following conditions are excluded from coverage under this covered critical illness definition:
- Early prostate cancer, diagnosed as T1A NO MO and T1B NO MO or equivalent staging
- Pre-malignant lesions, benign tumours or polyps
- Non-invasive cancer in situ
- Any skin cancer, other than invasive malignant melanoma greater than 0.75mm
- Any tumour in the presence of any Human Immunodeficiency Virus (HIV)
There is no coverage for cancer if the insured is diagnosed with cancer and such diagnosis was made, or any symptom or medical problem is determined, which initiated the investigation leading to a diagnosis of cancer, within 90 days following the effective date of the insured’s Group Critical Illness Insurance coverage. However, insurance for all other insured conditions of Group Critical Illness Insurance continues in-force.
Coronary Artery Bypass Surgery
The undergoing of heart surgery to correct narrowing or blockage of one or more coronary
arteries with bypass grafts. The surgery must have been recommended by a cardiologist licensed and practising in Canada. Exclusions: non-surgical techniques such as balloon angioplasty, laser embolectomy or other non-bypass techniques.
Kidney Failure
Diagnosis of irreversible failure of both kidneys, which necessitates treatment by regular dialysis or kidney transplantation. This diagnosis must be made by a nephrologist, licensed and practicing in Canada.
Major Organ Transplant
Undergoing of surgery, or treatment by an appropriate specialist, licensed and practising in
Canada, as a recipient by transplant of any of the following organs or tissues: heart, liver, lung, kidney or bone marrow.
Multiple Sclerosis
Unequivocal diagnosis by neurologist licensed and practising in Canada of at least two episodes of well defined neurological abnormalities lasting for a continuous period of at least six months and confirmed by modern imaging techniques.
Paralysis
Complete and permanent loss of use of two or more limbs through paralysis, for a continuous period of 180 days, diagnosed by a physician licensed and practising in Canada.
Blindness
Diagnosis of permanent loss of sight in both eyes, as confirmed by an ophthalmologist
licensed and practising in Canada. 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
Diagnosis of the permanent loss of hearing in both ears with an auditory threshold of
more than 90 decibels, as confirmed by an otolaryngologist licensed and practising in Canada”
VOLUNTARY CRITICAL ILLNESS INSURANCE
If employer has elected to participate in mandatory Group Critical Illness Insurance your employee and their spouse become eligible to apply for coverage under the voluntary plan.
Additional Voluntary CI coverage can be purchased in units of $10,000. A minimum of $20,000 must be purchased up to a combined maximum of $105,000 (mandatory and voluntary combined) for the employee and a maximum of $100,000 for the employee’s spouse.
Contact First Nations Insurance Services for more information about the Voluntary Critical Illness Insurance benefit.
