Accidental Death and Dismemberment Insurance

Transcription

1 Benepac Insurer Accidental Death, Dismemberment and Specific Loss Indemnity Industrial Alliance Insurance and Financial Services Inc. (IA) The loss or permanent and total loss of use must occur within 365 days of the date of the accident. These benefits are payable on a lump sum basis and in addition to any other benefits you may receive. Nature of Loss Percentage of Principal Sum Several losses paid at 200% Quadriplegia (total paralysis of all four limbs) % Paraplegia (total paralysis of both lower limbs) % Hemiplegia (total paralysis of one side of the body) % Loss of use of Both Hands or Both Arms % Loss of use of Both Legs or Both Feet % Loss of use of One Hand or One Arm + One Leg % Accidental Death % Loss of Both Hands or Both Feet % Loss of Sight of Both Eyes % Loss of One Hand + One Foot % Loss of Sight of One Eye + One Hand or One Foot % Loss of Speech + Hearing in Both Ears % Higher percentage than most plans Loss of One Hand or One Foot... 75% Loss of One Arm or One Leg... 75% Loss of Sight of One Eye... 75% Loss of use of One Hand or One Foot... 75% Loss of use of One Arm or One Leg... 75% Loss of Speech... 75% Loss of Hearing in Both Ears... 75% Benefit Highlights Loss of the Thumb and Index Finger of the Same Hand /3% Loss of Four Toes of One Foot /3% Loss of Four Fingers of the Same Hand /3% Loss of Hearing in One Ear... 25% Worldwide 24-Hour Coverage Principal Sum amount Tax Free Benefits Provides coverage 24 hours a day, anywhere in the world. The employee s Principal Sum is an amount equal to his or her Life Insurance benefit. All benefits are paid tax-free. Benefits for loss of life are paid to the employee s beneficiary named under the Life Insurance benefit. All other benefits are paid to the employee.

2 Bereavement Benefits Continuation of Coverage during approved leaves Conversion Option Coordination of Benefits If an Injury sustained by an Insured Person results in loss of life and indemnity becomes payable in accordance with the terms of this policy, IAP will pay the reasonable and necessary expenses actually incurred by the Spouse and Dependent Children of the Insured Person for up to six sessions of grief counselling, by a Professional Counsellor, subject to a maximum of $1,000. Coverage under this policy may be continued for an Insured Person during any approved leave of absence, temporary lay-off, maternity leave or disability leave, provided payment of premium is continued. In the event of the termination of the insurance of an Insured Person for any reason, the Insured Person may, within 31 days following the date of such termination, make written application to IAP for an individual Accidental Death and Dismemberment policy not to exceed the amount of insurance in force. With respect to the benefits listed below, the total maximum payable in combination with the similar benefit maximum provided under any other policy issued to BBD by IAP, for an Insured Person, will not exceed the actual expenses incurred or the maximum amount of benefit provided, whichever is less: Day Care Benefit Rehabilitation Benefit Education Benefit Repatriation Benefit Family Transportation Benefit Spousal Retraining Benefit Home Alteration & Vehicle Modification Benefit Critical Disease Benefit If an Insured Person, prior to age 65, is diagnosed by a Specialist with a Covered Disease while this policy is in force and is Totally Disabled from the Covered Disease for at least nine months following the Date of Diagnosis, IAP will pay 10% of the Principal Sum up to a maximum of $50,000. This benefit is payable only if investigations leading to the diagnosis of a Covered Disease is initiated more than 90 days following the effective date of insurance with respect to an Insured Person. Payment of the Critical Disease Benefit is limited to only the first Covered Disease to occur. Covered Disease whenever used in this policy means: Acute Poliomyelitis Alzheimer s Disease Amyotrophic Lateral Sclerosis (ALS) Huntington s Disease Multiple Sclerosis Necrotizing Fasciitis Parkinson s Disease Peripheral Vascular Disease Type 1 Diabetes (insulin dependent)

3 Day Care Benefit Education Benefit Exposure and Disappearance If injury results in the loss of life, IAP will pay 5% of the principal sum for each year the dependent child is enrolled in a legally licensed day care (not to exceed four years) for each dependent child who is under 13 years of age and enrolled in a legally licensed day care centre on the date of the accident, or within the 12 months following. Maximum benefit is $5,000 per year. If injury results in loss of life within 12 months of the date of accident, IAP will pay 5% of the principal sum to any dependent child who, on the date of the accident, was enrolled as a full-time student in any institution of higher learning beyond the secondary school level (not to exceed four years). Maximum benefit is $5,000 for each year the dependent child continues education on a full-time basis. If, at the time of loss, there are no dependent children eligible for the Education Benefit, IAP shall pay an additional amount of $2,500 to the designated beneficiary. If, as the result of an accident, an Insured Person is unavoidably exposed to the elements and if, as a result of such exposure and within 12 months after the date of the accident, the Insured Person suffers a loss for which indemnity would otherwise have been payable hereunder, such loss will be deemed to be the result of Injury. Where, due to the accidental wrecking, sinking or disappearance of a conveyance in which an Insured Person was riding, the Insured Person disappears, and if the body of the Insured Person is not found within 12 months after the date of such wrecking, sinking or disappearance, it will be presumed, subject to there being no evidence to the contrary and subject to all other terms and conditions of the policy, that the Insured Person suffered loss of life as a result of Injury. Eyeglasses, Contact Lenses and Hearing Aids Benefit Family Transportation Benefit Funeral Expense Benefit When, as the result of injury, which requires and receives treatment by a physician, which results in the purchase of eyeglasses, contact lenses or hearing aids within 365 days of the date of the accident, when none of which were previously required or worn, IAP will pay the reasonable and necessary expenses incurred, not to exceed $1,000. If injury results in confinement as an inpatient in a hospital, and such injury results in a loss being payable under the Accidental Death, Dismemberment and Specific Loss Indemnity, and the hospital is located at least 150 km from the insured s residence, IAP will pay the expenses actually incurred by all members of the immediate family, living in Canada, for hotel accommodation and transportation by the most direct route to the confined insured. Payment will not be made for board or other ordinary living, travelling or clothing expenses. If transportation occurs in a Vehicle or device other than one operated under a license for the conveyance of passengers for hire, then reimbursement of transportation expenses will be limited to a maximum of $0.35 per kilometer travelled. The maximum amount payable under this benefit is $15,000 for all such expenses. If injury results in loss of life, an additional amount is payable for funeral expenses actually incurred, subject to a maximum of $5,000.

4 Home Alteration and Vehicle Modification Benefit Rehabilitation Benefit Repatriation Benefit Seat Belt Benefit If injury requires the use of a wheelchair to be ambulatory, IAP will pay the cost of alterations to the insured s principal residence and/or the cost of modification to one motor vehicle utilized by the insured, provided such injury results in a loss payable under the Accidental Death, Dismemberment and Specific Loss Indemnity. Maximum benefit is $15,000 as the result of any one accident. If injury requires that the insured undergo special training in order to be qualified to engage in a special occupation in which the insured would not have engaged except for such injury, IAP will pay the reasonable and necessary expense incurred for such training, within 3 years of the date of accident, provided such injury results in a loss payable under the Accidental Death, Dismemberment and Specific Loss Indemnity. Maximum benefit is $15,000 as the result of any one accident. If injury results in the loss of life of an Insured Person within 365 days of the date of the accident, IAP will pay the expense incurred for the preparation and shipment of the body to the city of residence of the deceased, subject to a maximum of $15,000. If injury results in a loss payable under the Accidental Death, Dismemberment and Specific Loss Indemnity, the principal sum will be increased by 10% if, at the time of the accident, the insured was driving or riding in a vehicle and wearing a properly fastened seat belt. The driver of the Vehicle must hold a current and valid driver's license of a rating authorizing him to operate such Vehicle and neither be intoxicated nor under the influence of drugs, unless such drugs are taken as prescribed by a Physician, at the time of the accident. "Intoxicated" and "under the influence of drugs" are as defined by the local jurisdiction where the accident occurs. Spousal Retraining Benefit In the event an Employee suffers a Covered Loss payable at 100% or more, IAP will pay the reasonable and necessary expenses actually incurred for tuition and books for the Spouse of the Employee to participate in a formal occupational training program to become qualified for active employment in an occupation for which the Spouse would not otherwise have sufficient qualification. Expenses must be incurred within 3 years from the date of the Employee s Covered Loss and are subject to a maximum lifetime payment of $15,000. Payment will not include incidental expenses including without limitation charges for room and board, ordinary living, travelling or clothing expenses. Waiver of Premium In the event of total disability and waiver of premium has been approved and accepted by the group life carrier, then premium under this plan will be waived until the earlier of: death, recovery, attainment of age 65 or the date the policy is cancelled.

5 Limited Air Travel Coverage Coverage includes injury sustained in consequence of riding as a passenger and not as a pilot or member of the crew; in boarding or alighting from or being struck by; or making a forced landing with or from: (a) any aircraft having a current and valid airworthiness certificate and which is operated by a person holding a current and valid pilot's license of a rating authorizing him to pilot such aircraft, or (b) any transport-type aircraft operated by the Canadian Armed Forces or by the similar air transport service of any duly constituted governmental authority of the recognized government of any nation anywhere in the world, provided the aircraft is not being used for test or experimental purposes. Notwithstanding (a) and (b) above, coverage excludes injury sustained while and in consequence of riding as a passenger, pilot, operator or member of the crew, in or on, boarding or alighting from or being struck by or making a forced landing with or from any aircraft owned, operated or leased by the policyholder. Exclusions & Limitations This policy does not cover loss, fatal or non-fatal, caused by or resulting from: a) declared or undeclared war or any act thereof; b) active full-time service in the armed forces of any country; c) committing, attempting or provoking an assault or criminal offence including without limitation driving a vehicle with alcohol in the blood in excess of 80 milligrams of alcohol per 100 millilitres of blood. A vehicle means a vehicle that is drawn, propelled or driven by any means or other than muscular power; d) suicide or any attempt thereat or intentionally self-inflicted Injury, while sane or insane; e) injury sustained in consequence of riding as a passenger or otherwise in any vehicle or device for aerial navigation, except as provided in the part titled Limited Air Travel Coverage.