Simplified Critical Illness (T10GR)

Transcription

1 Simplified Critical Illness (T10GR) Insurance advisor guide Many Canadians suffer from serious illnesses each year. Thanks to the advancement of modern medicine and technology, many of these people will survive. Illness can have a serious impact on our lives. Most of us know someone who has suffered from an illness such as cancer. We cannot predict the future, but we can certainly prepare for it. The RBC Insurance Critical Illness Insurance policy, offered through RBC Life Insurance Company, is designed to provide a lump-sum payment upon a diagnosis of cancer, stroke or heart attack that is followed by a 30-day survival period. This lump-sum payment can be used in many ways: > Paying off a mortgage > Helping to maintain the family s lifestyle > Paying bills, including daycare expenses > Reducing debt incurred during an illness > Funding a leave of absence > Protecting savings and assets from being spent on recovery, etc. PRODUCT DETAILS (Critical Illness T10GR) ISSUE AGE: TERMINATION AGE: 65 FACE AMOUNTS AVAILABLE: $10,000, $25,000, $50,000 or $75,000 Plan Option: Single plan COVERED CONDITIONS: Heart attack, stroke, cancer (see Definition section for more details) PREMIUMS: Premium is based on age, sex, smoking status, face amounts and any riders. It will increase every 10 years until age 65, when coverage terminates. PAYMENT MODES: Annual, monthly, semi-annual, or pre-authorized payment POLICY FEE: None

2 GUARANTEED RENEWABLE: The premium increases at each renewal date, which is every 10 years until the coverage terminates. We cannot change the plan provisions. The premiums may be subject to change; however, we cannot change the premium unless we do so for an entire group of policyholders sharing similar characteristics. The policy will be terminated at the earliest of these dates: > The date of termination by the owner > The date of the insured s death > The date the policy lapses > The date the critical illness benefit is paid in full > The expiry date; or if the insured is satisfying a survival period, the day after such survival period BENEFITS If while the policy is in force, the insured meets the specific definition of one of the insured critical illnesses defined in the policy and survives the survival period defined in the policy, we will pay a lump-sum critical illness benefit. Benefits are payable to the insured, unless the policyowner has declared otherwise. All signs or symptoms of the condition must have first been apparent after the policy was in force, or they must have been fully disclosed on the application if they were first apparent prior to the policy s issue. The survival period before the critical illness benefit is payable is 30 days from the date of diagnosis. EARLY ASSISTANCE BENEFIT: If while the policy is in force, the insured meets the specific definition of early prostate cancer, early breast cancer, early skin cancer or coronary angioplasty and completes the survival period as defined in the policy, we will pay 10% of the lump-sum critical illness benefit to a maximum of $50,000. The lump-sum critical illness benefit is not reduced by the payment of the early assistance benefit. The early assistance benefit is payable only once to the insured, regardless of the number of critical illnesses or policies the insured may have with us. CRITICAL ILLNESS OUTSIDE CANADA: If the insured is given a diagnosis for a defined critical illness outside of Canada, we will pay the critical illness benefit as long as the following conditions are met in addition to all other terms and conditions outlined in the policy. > The insured s medical records are made available to us and; The same diagnosis would have been made if the critical illness had occurred in Canada; and Immediate treatment would have been indicated under Canadian standards; and The same treatment involving the particular surgical procedure would have been advised if treatment had taken place in Canada; and > The insured must undergo an independent medical examination by a physician appointed by RBC Life Insurance Company if such a request is made. In the case of elective surgery, the insured must undergo such an examination before surgery occurs, unless RBC Insurance determines otherwise. Additional benefits More than a claim cheque: The RBC Insurance Critical Illness Insurance policy isn t just about the financial help. If a policyholder suffers a critical illness, it s understandable that their needs are not limited to financial assistance. The RBC Insurance Critical Illness Insurance policy provides more than just a claim cheque it offers a more holistic solution to non-financial needs by including Assistance Services*. These valuable services are designed to assist your client s recovery by addressing a range of common needs among critical illness survivors. Three separate services are built into our plans at no additional cost. 2 Simplified Critical Illness Licensed Insurance Advisor Guide

3 * Assistance services complements the RBC Insurance Critical Illness Insurance policy. The program is currently provided by Best Doctors Inc., Ceridian Inc. and the Healing Journey/PMH Foundation. RBC Insurance does not guarantee the availability of this service before, after or at the time of claim. RBC Insurance may change or cancel access to this service at any time without notice. Best Doctors, Inc. To assist your clients in making choices about their medical treatment, the RBC Insurance Critical Illness Insurance policy includes a service provided by Best Doctors, Inc. a world-leading provider specializing in medical information and services. This service can help policyholders find and access treatments and medical experts that they might not otherwise be aware of. While there is no obligation, RBC Insurance Critical Illness Insurance policyholders are entitled to personally use this service once at no additional cost even if they do not submit a critical illness claim to RBC Life Insurance Company. There are also significant discounts on any subsequent usage and on all usage by the policholder s dependants under the age of 21. Any treatment resulting from this service will be the responsibility of the policyholder. As well, all dealings with Best Doctors, Inc. are the responsibility of the policyholder. Who is Best Doctors, Inc.? Best Doctors, Inc. is the world leader in connecting people with expert medical care. Using its renowned database of over 50,000 doctors, recognized as the best by top specialists, Best Doctors, Inc. provides immediate access to leading medical knowledge to millions of people around the world when faced with a serious condition. Its service is available worldwide and serves more than 10 million individuals in 30 countries. Best Doctors, Inc. was founded in 1989 by a 16-year survivor of a critical illness and two renowned professors of medicine at Harvard Medical School. The unique patient insight into their co-founders ability to survive a life altering illness, along with the medical expertise they possess, has created a company committed to providing services that help patients cope with catastrophic illnesses. Best Doctors, Inc. integrates a unique set of critical care services, including a proprietary global database of over 50,000 world-renowned physicians, for the review and treatment of complex cases. Best Doctors, Inc. services provide the guidance and support required to successfully navigate the hurdles to identifying the best medical care without restrictions. Services offered There are three seamless components to the Best Doctors*, service. The InterConsultation*, service will always be offered as the first step. The policyholder may then decide whether they wish to continue with the FindBestDoc* global database of physicians and/or the FindBestCare* network of preferred providers. InterConsultation is a service that provides customers and their physician(s) with access to advanced, case-specific recommendations from world-renowned medical experts. Best Doctors, Inc. defines the essence of the medical problem. Then, through consultation with a world authority on that problem, they provide the patient s treating physician with an in-depth medical report that clarifies the diagnosis and/or sheds light on new treatment alternatives that may not have been made available to the medical community at large. Often complex cases can be resolved locally without the disruption and expense of patient travel. findbestdoc is a customized search for the best doctors including specialized Canadian physicians based on a peer review. Once the treatment is identified, the FindBestDoc global database of physicians provides a list of names of specialized local (or worldwide) physicians who are identified as the best for treating the specific condition. The renowned physicians in the database were chosen by their peers in a thorough survey of more than 40 specialists and 400 sub-specialties of medicine. FindBestCare is a service that helps your clients to identify the optimal physician or hospital for treatment of their medical problem. After submitting a care request form, the customer will receive care proposals from qualified, experienced, U.S. medical providers (hospitals, specialists, etc.) for their specific treatment. These proposals will allow your client to make an informed decision based on criteria such as qualifications of the provider, location and cost of treatment. They will also benefit from the attractive discounts on the cost of care and hospitalization. Throughout the process, Best Doctors, Inc. will act as an advocate for your client, offering assistance with travel and lodging arrangements, pre-admission arrangements, medical appointments and co-ordination of patient inquiries. Simplified Critical Illness Licensed Insurance Advisor Guide 3

4 Best Doctors * Over the past 20 years Best Doctors has completed over 20,000 case reviews through the InterConsultation Program. It s healthcare navigation system, Best Doctors 360 0, has been part of the process every step of the way. Designed to enhance the healthcare system, Best Doctors delivers information that is individually tailored to meet the needs of each Best Doctors member. The Best Doctors Member Advocate - registered nurse - provides the resources needed to offer one-on-one support, customized advice and guidance, personally delivered to the members. By offering members additional services to take control of their own healthcare needs, Best Doctors helps bridge the knowledge gap. Available with one simple phone call, Best Doctors provides knowledge, answers and hope to Best Doctors members whenever they have questions about their own medical case. Daily Living Assistance Once a critical illness claim is approved, claimants are eligible for the Daily Living Assistance service at no additional cost. They will have access to a care coach (a specially trained consultant), who will work with them to develop a plan of action for meeting their needs related to handling everyday concerns. Care coaches can conduct customized research and access local resources that can help the claimant manage a range of daily activities. They can provide listings to service providers and arrange for appointments with service providers. Based on their experience, they can even make suggestions for services that the claimant may never have thought of. Daily Living Assistance provides support for a wide range of everyday concerns: > Locating child care or elder care > Arranging transportation > Setting up appointments with physicians, physical and occupational therapists, personal trainers, nutritionists or other professionals > Arranging purchases and services (e.g. grocery shopping, preparing food, mowing the lawn, paying bills) > Identifying social and recreational opportunities (e.g. companionship programs, leisure or volunteer activities) > Maintaining independence (e.g. home or vehicle modifications) > Accessing support organizations (e.g. local charities or other support groups) > Accessing tip sheets and other information (including a website created specifically for critical illness claimants) > And more Daily Living Assistance is provided by Ceridian LifeWorks Services the leading provider of employee assistance programs and work-life services in North America. Healing the Whole Person RBC Insurance will make a gift of membership in this powerful program of mental coping support to all claimants under the Critical Illness Recovery Plan policy. This program can help claimants successfully manage the stress associated with their illness. Known as The Healing Journey this program has provided help to thousands of cancer survivors for over 20 years and was developed by Dr. A.J. Cunningham a cancer survivor while working at a large cancer research and treatment centre in Canada. Membership in The Healing Journey includes the following: > The Healing Journey book by Dr. A.J. Cunningham > Video tapes focusing on different aspects of the journey including interviews with program participants who share their experiences and reactions > Audio tapes for practicing the exercises > A workbook with a detailed written explanation of all aspects of the program > A website for facilitating interactions with other critical illness survivors and providing access to qualified professionals such as Dr. A.J. Cunningham 4 Simplified Critical Illness Licensed Insurance Advisor Guide

5 The program harnesses the power of the mind to help critical illness survivors deal proactively with their illness and enhance their mental and perhaps even their physical recovery. Its benefits range from overcoming fear, anxiety and depression to managing thoughts and feelings, controlling symptoms and experiencing improved quality of life through a positive outlook. RIDERS AVAILABLE Return of Premium on Death Rider Issue age: If the insured dies during the survival period or from a condition or event not defined in the policy as a critical illness, we will pay a return of premium on death benefit to the policyholder or to the policyholder s estate as long as the coverage is in force and there is no critical illness benefit payable or pending. The benefit is equal to the sum of all premiums paid for the policy including riders, ratings and modal loadings. If death is a result of any of the exclusions listed in the policy, no return of premium on death benefit is payable. The rider is not available after the policy s issue. UNDERWRITING GUIDELINES The RBC Insurance Critical Illness Insurance policy is not class specific. Our rates are based on the age, sex, smoker/nonsmoker status 1 and general health of the customer. Critical Illness Medical Requirements Age Amount Underwriting Requirement $10,000, $25,000, $50,000 or $75,000 Tele-application Qualifying Checklist The qualifying checklist is a list of medical illnesses and conditions that indicate when a customer is not eligible for critical illness coverage. Do not submit an application for critical illness insurance if the applicant currently has or has had any of the following illnesses or conditions: > AIDS (AIDS related disease or HIV positive) > Alcohol abuse (within past two years) > Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig s disease > Angina > Angioplasty > Cancer 2 > Chronic hepatitis (other than type A) > Colon polyps 3 > Coronary artery bypass surgery > Cystic fibrosis > Diabetes (insulin dependent) > Heart attack > Huntington s chorea > Kidney disease > Kidney failure > Major organ failure on waiting list > Major organ transplant > Multiple sclerosis > Peripheral vascular disease > Permanent paralysis > Sickle cell disease > Stroke > Systemic lupus erythematosis > Transient ischemic attack (TIA) > Valvular heart surgery 1 To qualify for non-smoker rates, an applicant must not have used tobacco or tobacco surrogates for at least one year, except an average of one large cigar per month or less. Smoker rates will apply to users of any tobacco surrogates including marijuana, hashish, nicotine gum, transdermal nicotine patch, Zyban, other smoking cessation products, betel nuts, betel leaves, supari, paan or gutka. 2 Applicants with certain skin cancers, other than melanoma, or certain early stage cancers may be eligible for coverage. Consult with your underwriting case assistant before submitting an application. Some forms of testicular cancer may be considered for coverage five years after the successful completion of treatment. Any request for coverage where the client has a history of testicular cancer should be reviewed with your underwriting case assistant prior to submitting an application. 3 If colon polyps are present, coverage is not available. Once colon polyps have been removed and a biopsy performed, coverage may be available depending on the medical details. Consult your underwriting case assistant before submitting an application. Simplified Critical Illness Licensed Insurance Advisor Guide 5

6 DEFINITIONS The definitions below are a summary only, for complete definitions refer to specimen policy wording available in the RBC Insurance Business Intelligence Centre. Cancer means a tumour characterized by the uncontrolled growth and spread of malignant cells and the invasion of tissue. A diagnosis of Cancer must be made by a specialist. The following forms of cancer are excluded: > Carcinoma in situ; > Stage 1A malignant melanoma (melanoma less then or equal to 1 millimetre in thickness); > Any non-melanoma skin cancer that has not metastasized; or > Stage A (T1A or T1B) prostate cancer. Note: Benefits for this condition are subject to the Moratorium Period for Cancer Provision (Refer to Exclusions on page 7) Early Breast Cancer means ductal carcinoma in situ of the breast as confirmed by biopsy and diagnosed by a specialist. Early Prostate Cancer means prostate cancer that is either T1A or T1B (or equivalent staging) and diagnosed by a specialist. Early Skin Cancer means malignant melanoma of the skin less than 1 millimetre as confirmed by biopsy and diagnosed by a specialist. Coronary Angioplasty means the undergoing of an interventional procedure to unblock or widen a coronary artery that supplies blood to the heart. The procedure must be determined to be medically necessary by a specialist. Heart Attack means the death of heart muscle due to obstruction of blood flow that results in a rise and fall of biochemical cardiac markers with at least 1 of the following: > Heart attack symptoms > New electrocardiographic (ECG) changes consistent with a heart attack; or > Development of new Q waves during or immediately following an intra-arterial procedure such as coronary angiography and coronary angioplasty. The diagnosis of a Heart Attack must be made by a specialist. No critical illness benefit will be payable under Heart attack for: > Elevated biochemical cardiac markers as a result of an intra-arterial cardiac procedure such as coronary angiography and coronary angioplasty in the absence of new Q waves; or > ECG changes suggesting a prior myocardial infarction (heart attack). Stroke means an acute cerebrovascular event caused by intra-cranial thrombosis or haemorrhage, or embolism from an extra-cranial source with: > The acute onset of new neurological symptoms; and > New objective neurological deficits on clinical examination. persisting for more than 30 days following diagnosis. The new symptoms and deficits must be corroborated by diagnostic imaging testing. The diagnosis of Stroke must be made by a specialist. Stroke does not include Transient Ischemic Attack (TIA), intracerebral vascular events due to trauma; or Lacunar infarcts which do not meet the definition of Stroke as defined above. 6 Simplified Critical Illness Licensed Insurance Advisor Guide

7 EXCLUSIONS No benefit (including any riders) will be paid under the policy, nor will premiums be refunded for any critical illness, death or other loss that results directly or indirectly from any of the following: > The insured s suicide, attempted suicide or intentional self-inflicted injury, whether or not the insured was in possession of their mental faculties at the time; or > The insured s intentional use of or intake of any drug, intoxicant, narcotic or poisonous substance, except as prescribed by a physician or as directed by the manufacturer in the case of non-prescribed medication; or > The insured s attempt to commit or commission of a crime, whether charged or not; or > The insured s participation in war, (whether such war is declared or undeclared), or hostile action of the armed forces of any country, insurrection or civil commotion; or > The insured s operation of any land, water or air conveyance that is moved or operated by any means other than muscular power while the insured s concentration of alcohol in 100 millilitres of blood exceeds 80 milligrams, or while the insured is under the influence of any drug, intoxicant, narcotic or poisonous substance except as prescribed by a physician or as directed by the manufacturer in the case of non-prescribed medication. No benefit will be paid under the policy (including any riders), nor will any premiums be refunded for any critical illness, death or other loss that results, directly or indirectly, from any condition(s) that we have excluded by name or specific description in an endorsement or amendment to the policy. No critical illness benefit will be paid unless the insured survives the survival period of 30 days. Moratorium Period Exclusion for Cancer No critical illness benefit or early assistance benefit will be payable if within the first ninety (90) days following the later of the effective date of this policy and the date of the last reinstatement of this policy: > The insured has any signs, symptoms or investigations that lead to a diagnosis of cancer (covered or excluded under this policy), regardless of when the diagnosis is made; or > a diagnosis of cancer (covered or excluded under this policy). Thereafter, Cancer, Early Breast Cancer, Early Prostate Cancer, and Early Skin Cancer will be deemed not to be a critical illness under the policy. No benefit will be payable under the policy, nor will we refund any premiums paid for the policy, if the insured suffers a critical illness or death as a direct or indirect result of any type of cancer including Cancer, Early Breast Cancer, Early Prostate Cancer, or Early Skin Cancer (whether covered or excluded in this policy). This medical information as 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 cancer or its treatment. Simplified Critical Illness Licensed Insurance Advisor Guide 7

8 Underwritten by RBC Life Insurance Company This Insurance Advisor Guide is a summary only. For complete details, including terms and conditions, please refer to the policy contract. Registered trademarks of Royal Bank of Canada. TM Trademark of Royal Bank of Canada. Used under licence. * BEST DOCTORS and other trademarks shown are trademarks of Best Doctors, Inc. Used under licence. VPS49362 (01/2009)