1 CFMS Individual Disability Incme Prtectin Plan Designed fr Members f the Canadian Federatin f Medical Students. This ffer is designed specifically fr CFMS Members in Partnership with Kirkham & Jack Inc., LES Financial Services, The Canadian Federatin f Medical Students and RBC Insurance. Kirkham & Jack Inc. LES Financial Services
2 Wuld yu have the right incme prtectin if yu suddenly became the patient? Lsing yur ability t earn an incme culd als mean lsing the lifestyle yu ve wrked s hard fr. Yur prvincial health plan can help with the medical bills. But t replace lst incme, yu need disability insurance. Here are sme stats t keep in mind abut disability. It s mre cmmn than yu think One in seven Canadians have a disability 1 Mst disabled peple are nt brn with their disability One in three wrking-age Canadians will becme disabled and unable t wrk befre they reach age 65 2 The mst cmmn frms f disease may surprise yu 3 31% Mental disrders (depressin, substance abuse, Alzheimer s and ther dementia) 16% Cancers (lung, cln, breast, etc.) 12% Cardivascular diseases 8% Injuries (traffic accidents, falls, etc.) 5% Musculskeletal diseases (arthritis) Csts add up ver time When a disability lasts lnger than 90 days, the length f that disability averages between 2.1 and 3.2 years 4 An average 30-year-ld Canadian has mre than three millin dllars f incme at risk due t disability 5 60% f disabled peple need help with daily activities, such as walking, cking, cleaning and persnal hygiene If yu are disabled, yu re likely t need in-hme help 6 1 Statistics Canada Cmmissiners Individual Disability Table A 3 Wrld Health Organizatin Disease and injury cuntry estimates (Nvember 2013) Cmmissiners Individual Disability Table A 5 RBC Insurance assumes average rate f Canadian = 30, average individual incme = 50k and annual increases f 3% and retirement at age 65 6 Statistics Canada Participatin and Activity Limitatin Survey 2006
3 The CFMS Individual Disability Incme Prtectin Plan is the nly plan designed specifically fr Canadian medical students that des nt require evidence f health t enrl, guarantees yur premium and cntract prvisins and has industry-leading limits f $25,000 per mnth. n Simple, ne-page enrlment frm with n medical exam r bld test required n Up t a maximum mnthly benefit f $25,000 (nn-taxable) thrughut yur career withut medical evidence n Individually wned Cntracts f Insurance n Guaranteed premiums and prvisins t age 65 n HIV and hepatitis B and C cverage n Chice f Own Occupatin Definitin f Disability n Substantial premium reductins t age 65 and five mnths f waived premiums n Exclusive ptin t add business prtectin later n with premium savings and n medical underwriting n The ptin t cntinue disability prtectin beynd age 65 r cnvert t Lng Term Care Insurance fr lifetime prtectin Specifically designed t grw with yu thrughut yur career If anyne understands the vulnerability f gd health and the need fr persnal financial prtectin, it s medical prfessinals. Yu will be expsed t surrundings and risks the average persn simply desn t have t face in their day-t-day lives. Yet, during yur training, the cst f yur educatin may accumulate t a debt that exceeds the value f yur parents first hme. They wuldn t have cnsidered leaving themselves expsed t this risk by nt insuring. Why shuld yu? As a member f CFMS, we have specifically designed a prtectin plan that fcuses n yur current needs while prviding flexibility fr yur future requirements. The CFMS ffer is an individual disability incme prtectin plicy with full return-t-wrk benefits and with premiums and wrding that are guaranteed fr the life f the cntract. These guarantees ensure that any negative market trends wn t impact yur plan, a plan that prtects yur mst valuable asset yu. Flexible slutins t meet yur needs withut ever prviding evidence f health Chice f Enhanced r Specialty Prfessinal prgram n Bth plans ffer a mnthly benefit f up t $4,000 tax-free as a medical student, with benefits payable after a 90-day eliminatin perid. Yu may chse frm either the Enhanced r Specialty Prfessinal prgram. n Enhanced Prfessinal includes features that are unique t an individually wned cntract f insurance: prtectin against ttal disability, partial and residual disability benefits, a recvery benefit and a survivr benefit at the time f death t yur designated beneficiary. The plan als includes a cst f living feature (which helps prtect yu against inflatin while disabled), the Future Incme Optin (up t $25,000 mnthly benefit with n evidence f health t keep pace with yur rising incme) and a health care rider (t prtect yu if yu becme HIV r hepatitis B/C impaired). n Specialty Prfessinal includes all f the features f Enhanced Prfessinal, and ffers yu an Own Occupatin Definitin f Disability. With this feature yu can chse t wrk in a new ccupatin while ttally disabled and may be eligible t cntinue cllecting ttal benefits even if yu are earning incme frm this new ccupatin.
4 Frequently asked questins 1. Hw des this plan differ frm an assciatin-type plan? Assciatin-type plans are nt guaranteed. Features and premiums can change at any time withut cnsent frm insured members. In additin, many assciatin-type plans include a limitatins prvisin, allwing the insurer t reduce benefits. In essence, yu may be paying fr a benefit yu may nt be receiving. Under the CFMS ffer, there is n such limitatin clause. Premiums and cntract wrding are guaranteed t age I will be receiving mandatry, prvince-specific disability cverage when I start residency. Hw des this impact my plan? Benefits under the CFMS ffer are paid regardless f yur residency cverage. It is recmmended that yu have sme privately wned disability prtectin t supplement a resident plan and fr yur pst-residency needs. 3. If I chse the Enhanced Plan nw, can I btain the Specialty Plan later? Yes, at any time during yur training r within 180 days f cmpleting residency r fellwship, yu may btain the Own Occupatin feature f the Specialty Prfessinal Plan, and n evidence f health will be required. 4. Hw des the Future Incme Optin (FIO) benefit me? This is ne f the mst imprtant features t have. Yu will be ffered an pprtunity t increase yur cverage annually. Under the CFMS ffer, we have specifically designed the FIO t allw yu t increase yur cverage up t a maximum f $25,000 tax-free, withut ever having t prvide medical evidence. Financial prf is required t supprt the increase. 5. Hw much FIO may I take? At the time f applicatin, yu can chse the size f the FIO fr bth the Enhanced and Specialty plans, frm $500 up t a maximum f $3,000 per mnth in increments f $500. In additin, at the end f medical residency and/r fellwship, yu have the ptin t increase yur FIO amunt up t the maximum $3,000 frm 180 days befre t 180 days after the cmpletin f medical residency and/r fellwship. 6. Is cverage prtable? Yes, cverage can be carried anywhere in the wrld. Membership in the CFMS is nt required in the future. 7. If I am healthy and I submit medical evidence, will my rates be less expensive? N, rates are based n yur age, gender, smking status and the CFMS premium reductin. If yu apply fr an individual disability plicy with RBC Insurance utside this ffer, yu will frg the CFMS premium reductin and yur premium rate will be based n the full underwriting f yur applicatin. 8. Is the CFMS Disability Incme Prtectin Plan different frm the current plan available t physicians n an individual basis? Yes, the CFMS plan is a special ffer with premium reductins available t CFMS members nly. It uses a simple ne-page applicatin, and medical evidence is nt required. The main cverage terms and prvisins are the same. 9. Des the premium reductin apply nly t my riginal purchase f cverage? N, yu will be ffered a premium reductin n insurance purchased tday AND any cverage purchased in the future (using the Future Incme Optin rider). As mst cverage will be added pst residency, this feature will increase in value ver time. 10. Can I chse a shrter eliminatin perid? Yes; hwever, a fully cmpleted applicatin and evidence f health is required. 11. When shuld I apply fr disability incme prtectin cverage? Nw. Yu shuld apply fr cverage while yu are a current CFMS member and can qualify fr this unique ffer. 12. Hw des the 24-mnth pre-existing clause wrk? If yu had a pre-existing cnditin within the 24 mnths prir t the cverage being in frce and the disability was related t a pre-existing cnditin and began within the 24 mnths after the cverage was in effect, then that cnditin is nt cvered. 13. What are the maximum nn-taxable mnthly issue limits at the time f applicatin? First and secnd year students receive up t $1,500, third year students receive up t $2,500 and graduating students can receive up t $4, Hw des the ptin t elect business prtectin benefit me? After this plicy has been in frce fr tw years, yu can elect t apply, withut medical underwriting, fr cverage t prtect against business verhead expenses r business lans shuld yu becme disabled. As a medical prfessinal it is imprtant that yu prtect nt nly yur incme but als yur business in the event f a disability.
5 GROUP NAME DATE OF BIRTH SEX LANGUAGE Canadian Federatin f Medical Students Mnth Day Year Female Male English French NAME OF PROPOSED INSURED FIRST MIDDLE LAST ADDRESS CITY PROVINCE POSTAL CODE ADDRESS TELEPHONE NUMBER ALTERNATE CONTACT NUMBER (PARENT, SIBLING, SPOUSE) FULL NAME OF BENEFICIARY FOR SURVIVOR BENEFIT RELATIONSHIP TO INSURED UNIVERSITY NAME CURRENT YEAR OF STUDY (Circle ne) Final QUESTIONNAIRE 1. Are yu a member f the Canadian Federatin f Medical Students? 2. Are yu a Canadian Citizen r a Permanent Resident (landed immigrant)? 3. Fr the perid f time cmmencing 180 days prir t the date f this applicatin frm, are yu nw r have yu been unable t wrk cntinuusly n a full-time basis in the usual and custmary manner, perfrming all f the duties f yur ccupatin, and/r have yu been hmebund and/r hspitalized due t an accident r sickness? 4. D yu currently have the ttal lss f: yur pwer f speech, r yur hearing in bth ears, r sight in bth eyes, r the use f bth hands, r the use f bth feet, r the use f ne hand and ne ft? 5. Have yu used tbacc prducts r tbacc surrgates (marijuana, hashish, nictine gum, transdermal nictine patch, Zyban r ther smker cessatin prducts, betel nuts, betel leaves, supari, paan, gutka r shisha) within the last 12 mnths? 6. Has an individual, grup r assciatin insurance cmpany ever declined yu disability cverage? Yes N Details fr YES answers: # # PLEASE COMPLETE THE FOLLOWING TABLE IF YOU HAVE ANY INDIVIDUAL, GROUP OR ASSOCIATION DISABILITY INSURANCE IN FORCE OR PENDING OTHER THAN THE COVERAGE BEING APPLIED FOR WITH RBC LIFE. IF THIS TABLE IS LEFT BLANK, YOU ARE CONFIRMING THAT YOU HAVE NO OTHER DISABILITY INSURANCE IN FORCE OR PENDING, OTHER THAN RBC LIFE. COMPANY AMOUNT OF MONTHLY BENEFIT AND BENEFIT PERIOD TYPE (GROUP, INDIVIDUAL, ASSOCIATION) Yes TAXABLE? N ARE YOU REPLACING THIS COVERAGE WITH THE COVERAGE APPLIED FOR IN THIS APPLICATION? Yes N Yes N Yes N RBC INSURANCE APPLIED FOR BENEFIT BENEFIT AMOUNT PERIOD PLAN TYPE (Circle ne) WAITING PERIOD FIO BENEFITS INCLUDED EFFECTIVE DATE OF COVERAGE REQUESTED Enhanced Specialty 90 days T age 65 $ $ COLA HCR Mnth: Pre-Authrized Debit (PAD) frm/vid cheque and a depsit are required payable t RBC Life Insurance Cmpany. If n depsit is being prvided, I authrize RBC Life t withdraw the initial premium by PAD. It is understd and agreed as fllws: 1) I have read all the freging statements and answers. They are all true and cmplete. They are part f this applicatin and any individual plicy issued as a result. 2) N agent r brker has authrity t waive the answer t any questin, t determine insurability, t waive any rights r requirements, r t make r alter any cntract r plicy. 3) RBC Life may be entitled t render this plicy null and vid if there is misrepresentatin r nn-disclsure in any part f this applicatin that is material t the insurance risk. 4) Any plicy issued as a result f this frm shall becme effective n the Date f Issue prvided that: (a) the plicy has been tendered fr delivery t me; and (b) the answers prvided n this applicatin have nt changed frm the date f this applicatin t the Date f Issue date; and (c) the initial premium required has been paid. I will immediately advise RBC Life in writing f any changes in the answers t the questins in this applicatin between the time f this applicatin and the delivery f the plicy. 5) If applicable, any plicy issued as a result f this applicatin shall be subject t a grup/assciatin ffset amendment and/r a pre-existing cnditins amendment (which cntains a cverage exclusin based n my pre-existing health), and/r a travel exclusin (which limits cverage while travelling utside Canada r the United States). If individual disability cverage is part f a Wage Lss Replacement Plan, the plicy will include a Wage Lss Replacement Amendment. 6) I acknwledge that if I answered yes t questin fur (4), I will nt be cvered under the Presumptive Ttal Disability Benefit prvisin that is cntained in the plicy issued t me fr the specific cnditin(s) that required questin fur (4) t be answered yes. 7) I understand that when RBC Life determines the amunt f insurance cverage that it will issue, they will rely n the infrmatin I have prvided abut any existing r pending disability cverage. I acknwledge that if I either d nt discntinue cverage that I have indicated will be replaced r I have nt disclsed all existing cverage (ther than RBC Life), the benefits under this plicy may be reduced r nt prvided at all. 8) The actual amunt RBC Life will issue will be based n the maximum amunt I qualify fr, any ther disability cverage in frce r pending that is nt being replaced r cancelled and RBC Life Issue and Participatin Limits. RBC Life is nt required t specifically ntify me if the amunt applied fr and the amunt issued are different. 9) RBC Life shall nt be liable fr any claim n accunt f any benefits applied fr, cmmencing prir t the effective date f cverage. Ntwithstanding any interim premium payments, n temprary r cnditinal insurance is being prvided t either the prpsed insured r the prpsed wner. 10) Acceptance f any plicy issued as a result f this applicatin frm will ratify my acceptance f any differences in the terms f cverage between the plicy wrding and as stated in this frm. 11) I have read the sectin entitled Cllectin and Use f Persnal Infrmatin appearing in this applicatin and understand and agree t its terms. SIGNATURE Prpsed Insured: Date: TURN OVER
6 Print and scan the applicatin and it t Please keep the riginal cpy. Or alternatively yu can mail it t: RBC Life Insurance Cmpany, P.O. Bx 1218, Statin B, Mississauga, Ontari, L4Y 3W5 ADVISOR S REMARKS Pre-Authrized Debit (PAD) Agreement The Payr(s) named belw agrees that: 1. A RBC Life Insurance Cmpany (RBC Life) is authrized t make scheduled mnthly withdrawals t pay the premium in accrdance with the premium schedule set ut in this plicy/plicies, including the initial premium, against the accunt at the financial institutin belw, r any ther financial institutin that the Payr(s) may later designate. B RBC Life is nt required t prvide ntificatin befre the initial premium is debited, r if the amunt f withdrawal shuld vary. C Unless therwise indicated in the Special Requests sectin belw, such withdrawals shall be dated n the day f the mnth n which the premium is due under the plicy r, if mre than ne plicy is included in this Agreement, the withdrawals shall be dated t cincide with the existing plicy/plicies. D The financial institutin indicated belw is authrized nw r at any subsequent time t hnur any requests made by RBC Life t withdraw premiums r fees frm the accunt indicated belw, which may include a redraw within 30 days shuld any withdrawal nt clear the accunt. E Ntificatin f any change t the infrmatin prvided belw shall be given t RBC Life by the Payr(s) at a minimum f five days prir t the next scheduled withdrawal. The Payr(s) agrees that frm time t time they may authrize RBC Life t deduct such payments frm anther accunt upn the Payr s ral r written instructins. F This Agreement will terminate in respect f all plicies included in it upn 10 days written ntice by RBC Life r by the Payr(s). The Payr(s) may btain further infrmatin n their right t cancel a PAD agreement by visiting the Canadian Payments Assciatin website at G In the event that a PAD is disputed, the Payr(s) agrees t cntact RBC Life. Fr recurse purpses, this PAD is cnsidered a Persnal PAD. The Payr(s) has certain recurse rights if any debits d nt cmply with this agreement. Fr example, the Payr(s) has the right t receive reimbursement fr any PAD that is nt authrized r is nt cnsistent with this PAD Agreement. T btain mre infrmatin n recurse rights, the Payr(s) may cntact their financial institutin r visit H The names and signatures f all persns required t authrize withdrawals frm the accunt indicated are included belw. 2. Add t existing PAC with plicy number(s) 3. Special Requests (withdrawals are limited between the 1st and 28th f the mnth) Bank infrmatin Please attach a sample cheque marked vid (a line f credit accunt cannt be used). NAME OF BANK OR FINANCIAL INSTITUTION TRANSIT NUMBER BANK NUMBER ACCOUNT NUMBER ADDRESS CITY PROVINCE POSTAL CODE DATED AT THIS DAY OF City Prvince Day Mnth Year PRINT NAME OF PAYOR (ACCOUNT HOLDER) PRINT NAME OF SECOND PAYOR (ACCOUNT HOLDER) (IF ANY) SIGNATURE OF PAYOR X SIGNATURE OF SECOND PAYOR (IF ANY) X
7 Cllectin and use f persnal infrmatin Cllecting yur persnal infrmatin We (RBC Life Insurance Cmpany) may frm time t time cllect infrmatin abut yu such as: n infrmatin establishing yur identity (fr example, name, address, phne number, date f birth, etc.) and yur persnal backgrund; n infrmatin related t r arising frm yur relatinship with and thrugh us; n infrmatin yu prvide thrugh the applicatin and claim prcess fr any f ur insurance prducts and services; and n infrmatin fr the prvisin f prducts and services. We may cllect infrmatin frm yu, either directly r thrugh representatives. We may cllect and cnfirm this infrmatin during the curse f ur relatinship. We may als btain this infrmatin frm a variety f surces including hspitals, dctrs and ther health care prviders, the MIB, Inc., the gvernment (including gvernment health insurance plans) and ther gvernmental agencies, ther insurance cmpanies, financial institutins, mtr vehicle reprts and yur emplyer. Using yur persnal infrmatin This infrmatin may be used frm time t time fr the fllwing purpses: n t verify yur identity and investigate yur persnal backgrund; n t issue and maintain insurance prducts and services yu may request; n t evaluate insurance risk and manage claims; n t better understand yur insurance situatin; n t determine yur eligibility fr insurance prducts and services we ffer; n t help us better understand the current and future needs f ur clients; n t cmmunicate t yu any benefit, feature and ther infrmatin abut prducts and services yu have with us; n t help us better manage ur business and yur relatinship with us; and n as required r permitted by law. Fr these purpses, we may make this infrmatin available t ur emplyees, ur agents and ur service prviders, and t third parties, wh are required t maintain the cnfidentiality f this infrmatin. In the event ur service prvider is lcated utside Canada, the service prvider is bund by, and the infrmatin may be disclsed in accrdance with, the laws f the jurisdictin in which the service prvider is lcated. Third parties may include ther insurance cmpanies, the MIB, Inc. and financial institutins. We may als use this infrmatin and share it with RBC cmpanies: (i) t manage ur risks and peratins and thse f RBC cmpanies; (ii) t cmply with valid requests fr infrmatin abut yu frm regulatrs, gvernment agencies, public bdies and ther entities wh have a right t issue such requests; and (iii) t let RBC cmpanies knw yur chices under Other uses f yur persnal infrmatin fr the sle purpse f hnuring yur chices. If we have yur scial insurance number, we may use it fr tax-related purpses and share it with the apprpriate gvernment agencies. Yur right t access yur persnal infrmatin Yu may btain access t the infrmatin we hld abut yu at any time and review its cntent and accuracy, and have it amended as apprpriate; hwever, access may be restricted as permitted r required by law. T request access t such infrmatin, t ask questins abut ur privacy plicies r t request that the infrmatin nt be used fr any r all f the purpses utlined in Other uses f yur persnal infrmatin, yu may d s nw r at any time in the future by cntacting us at: RBC Life Insurance Cmpany P.O. Bx 515, Statin A Mississauga, Ontari L5A 4M3 Telephne: Facsimile: Our privacy plicies Yu may btain mre infrmatin abut ur privacy plicies by asking fr a cpy f ur Financial fraud preventin and privacy prtectin brchure, by calling us at the tll-free number abve r by visiting ur website at
8 Kirkham & Jack Inc. LES Financial Services This ffer is designed specifically fr CFMS Members in Partnership with Kirkham & Jack Inc., LES Financial Services, The Canadian Federatin f Medical Students and RBC Insurance. Fr mre infrmatin abut the CFMS Individual Disability Incme Prtectin Plan, please visit Underwritten by RBC Life Insurance Cmpany / Trademark(s) f Ryal Bank f Canada. Used under licence. VPS (09/2014)