IndIvIdual CrItICal Illness InsuranCe Oasis At A GlAnce

Transcription

1 Individual Critical Illness Insurance Oasis At a Glance

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3 Table of Contents Oasis...2 Built-in features...3 Basic policy...3 Benefit type...3 Coverage period...3 Premium payment period...3 Critical condition benefit...4 Critical conditions...4 Survival period...5 Supplementary benefit...6 Policy extension...7 Non-cancellable...7 Conversion...7 Optional benefit riders...8 Critical Condition and Critical Condition Plus...8 Return of Premium at Expiry...17 Return of Premium (Year 10+, Year 15+, Age 60+)...18 Return of Premium at Death...20 Second Event...21 Automatic Increasing Benefit...22 Waiver of Premium on Disability...23 Exceptions...24 General exceptions...24 Exception for certain critical conditions...24 Return of Premium at Expiry...25 Return of Premium (Year 10+, Year 15+, Age 60+)...25 Return of Premium at Death...25 Second Event...26 Automatic Increasing Benefit...26 Waiver of Premium on Disability...26 Exclusion period...27 Second Event Rider...27 Termination...28 Medical referral service...29 Counselling & support services...30 Important information...31

4 Oasis Oasis is designed to complement disability and life insurance coverage by providing a one-time, lump-sum benefit to help cover additional expenses associated with a critical condition. This brochure provides a brief description of certain important features of the Oasis plan and the optional benefit riders, which can be added to design critical illness insurance coverage to help meet your needs. For purposes of this brochure, references to "you" and "your" are to be read as references to the insured. 2

5 Built-in features Basic policy The basic policy provides the owner with a one-time lump-sum benefit if you have a critical condition which meets one of the definitions set out in the policy and the survival period has been satisfied. The critical condition must be diagnosed in writing by a physician who specializes in the field of medicine relating to the applicable critical condition in Canada, the United States or other approved jurisdictions. Benefit type The benefit types available for this plan are: level critical condition benefit where the benefit amount will remain the same throughout the coverage period, except for any automatic increases provided under the Automatic Increasing Benefit Rider (for more information, refer to the "Optional benefit riders" section of this brochure). decreasing critical condition benefit where the benefit amount will decrease evenly at the end of each year of coverage until the end of the coverage period. Coverage period The coverage periods available for this plan are: level critical condition benefit to age 65, to age 75, to age 75 (20 or 30 year pay), lifetime (paid-up at age 100) and term 10 renewable to age 75 decreasing critical condition benefit 10, 15, 20 and 25 years Premium payment period Most Oasis plans require payment of premium to the end of the coverage period. However, premium payments for a limited period are available for the following plans: to age 75 (20 year pay) level premium is payable for 20 years; to age 75 (30 year pay) level premium is payable for 30 years; and lifetime (paid-up at age 100) level premium is payable to age 100. When the last premium is paid, the policy becomes paid-up. The policy remains in force until the end of the coverage period and no further premium payments are required. 3

6 Built-in features (cont.) Critical condition benefit The critical condition benefit is the benefit amount purchased. Critical conditions The basic policy covers the following three critical conditions: Heart Attack; Life-Threatening Cancer; and Stroke. For the purposes of the policy: Heart Attack means the death of heart muscle due to obstruction of blood flow, that results in the rise and fall of biochemical cardiac markers to levels considered diagnostic of myocardial infarction, with at least 1 of the following: heart attack symptoms; new electrocardiogram (ECG) changes consistent with a heart attack; or development of new Q waves during or immediately following an intra-arterial cardiac procedure including, but not limited to, coronary angiography and coronary angioplasty. Exception: No benefit will be payable under this critical condition for elevated biochemical cardiac markers after an intra-arterial cardiac procedure including, but not limited to, coronary angiography and coronary angioplasty, in the absence of new Q waves. For greater certainty, ECG changes suggesting a prior myocardial infarction does not satisfy the above definition of Heart Attack. 4

7 Built-in features (cont.) Critical conditions (cont.) Life-Threatening Cancer means a tumour characterized by the uncontrolled growth and spread of malignant cells and the invasion of tissue. Exception: No benefit will be payable under this critical condition for the following forms of cancer: carcinoma in situ; Stage 1A malignant melanoma (melanoma less than or equal to 1.0 mm in thickness, not ulcerated and without Clark level IV or level V invasion); any non-melanoma skin cancer that has not metastasized; or Stage A (T1a or T1b) prostate cancer. Benefits for Life-Threatening Cancer are subject to the Exception for certain critical conditions provision as explained later in this brochure. Stroke means an acute cerebrovascular event caused by intra-cranial thrombosis or haemorrhage, or embolism from an extra-cranial source, with: acute onset of new neurological symptoms, and new objective neurological deficits on clinical examination, persisting for more than 30 days following the date of the critical condition. These new symptoms and deficits must be corroborated by diagnostic imaging testing. Exception: No benefit will be payable under this critical condition for: transient ischaemic attacks; or intracerebral vascular events due to trauma. For greater certainty, lacunar infarcts which do not have the neurological symptoms and deficits set out above, persisting for more than 30 days, do not satisfy the definition of Stroke. Survival period Before the critical condition benefit becomes payable, you must be alive and not have experienced irreversible cessation of all functions of the brain for a period of 30 days after the date the written diagnosis is made. The diagnosis must satisfy the definition of the critical condition. 5

8 Built-in features (cont.) Supplementary benefit This benefit provides the owner with a one-time lump-sum benefit amount for one occurrence of either, but not both, of the following events: If you receive a written diagnosis, confirmed by biopsy, that you have one of the following forms of cancer: malignant melanoma to a depth of 1.0 mm or less, excluding malignant melanoma in situ; ductal carcinoma in situ of the breast; or early prostate cancer diagnosed as T1a or T1b. If you undergo coronary angioplasty which means an interventional procedure to unblock or widen a coronary artery that supplies blood to the heart to allow an uninterrupted flow of blood. The supplementary benefit will be the lesser of: 10% of the critical condition benefit amount then in effect; and $25,000. The policy does not terminate as a result of the payment of the supplementary benefit and the critical condition benefit will not be reduced by the amount of the payment. 6

9 Built-in features (cont.) Policy extension does not apply for "lifetime (paid-up at age 100)" coverage period If the coverage period ends during the survival period, the policy will continue in force until the earlier of: the date of your death; and the date the critical condition benefit becomes payable, unless the policy has already been terminated under the provisions of the policy. Non-cancellable While the policy is in force, Great-West cannot change the policy, raise the premium (other than as provided under the term 10 renewable to age 75 policy, Second Event Rider, Automatic Increasing Benefit Rider or Graded Premium Payment Rider) or terminate the policy other than as explained under the heading Termination in this brochure. Conversion for "term 10 renewable to age 75" coverage period only The policy may be converted to a level premium critical illness insurance plan then offered by Great-West for the purpose of conversion, if any. The plans available will vary depending on your age at the time of conversion. Medical evidence will not be required. Approval of the application will be subject to: Great-West s rules then in effect, including but not limited to issue and participation limits; receipt of the written request and payment of the first premium for the converted policy not later than your 65th birthday; and if the Waiver of Premium on Disability Rider is in effect at the time of conversion you must not be disabled under the terms of that rider. 7

10 Optional benefit riders Critical Condition and Critical Condition Plus Critical Condition adds the following 21 illnesses, disorders or surgeries as critical conditions covered under the policy: Alzheimer's Disease Aortic Surgery Aplastic Anaemia Bacterial Meningitis Benign Brain Tumour Blindness Coma Coronary Artery Bypass Surgery Deafness Heart Valve Replacement Kidney Failure Loss of Limbs Loss of Speech Major Organ Failure on Waiting List Major Organ Transplant Motor Neuron Disease Multiple Sclerosis Occupational HIV Infection Paralysis Parkinson's Disease Severe Burns Critical Condition Plus adds 22 illnesses, disorders or surgeries as critical conditions covered under the policy. It includes the 21 critical conditions listed above, as well as Loss of Independent Existence. 8

11 Optional benefit riders (cont.) Critical Condition and Critical Condition Plus (cont.) For the purposes of the policy: Alzheimer s Disease means a progressive degenerative disease of the brain. You must exhibit the loss of intellectual capacity involving impairment of memory and judgment, which results in a significant reduction in mental and social functioning, and requires a minimum of 8 hours of daily supervision. Exception: No benefit will be payable under this critical condition for all other dementing organic brain disorders and psychiatric illnesses. Aortic Surgery means the undergoing of surgery for disease of the aorta requiring excision and surgical replacement of the diseased aorta with a graft. Aorta refers to the thoracic and abdominal aorta but not its branches. Aplastic Anaemia means chronic persistent bone marrow failure, confirmed by biopsy, which results in anaemia, neutropenia and thrombocytopenia requiring blood product transfusion, and treatment with at least 1 of the following: marrow stimulating agents; immunosuppressive agents; or bone marrow transplantation. Bacterial Meningitis means meningitis, confirmed by cerebrospinal fluid showing growth of pathogenic bacteria in culture, resulting in neurological deficit documented for at least 90 days from the date of diagnosis. Exception: No benefit will be payable under this critical condition for viral meningitis. Benign Brain Tumour means a non-malignant tumour located in the cranial vault and limited to the brain, meninges, cranial nerves or pituitary gland. The tumour must require surgery or radiation treatment or cause irreversible objective neurological deficits. Exception: No benefit will be payable under this critical condition for pituitary adenomas less than 10 mm. Benefits for Benign Brain Tumour are subject to the Exception for certain critical conditions provision as explained later in this brochure. 9

12 Optional benefit riders (cont.) Critical Condition and Critical Condition Plus (cont.) Blindness means the total and irreversible loss of vision in both eyes, evidenced by: the corrected visual acuity being 20/200 or less in both eyes; or the field of vision being less than 20 degrees in both eyes. Coma means a state of unconsciousness with no reaction to external stimuli or response to internal needs for a continuous period of at least 96 hours, and for which period the Glasgow coma score must be 4 or less. Exception: No benefit will be payable under this critical condition for medically induced coma. Coronary Artery Bypass Surgery means the undergoing of heart surgery to correct narrowing or blockage of 1 or more coronary arteries with bypass grafts. For greater certainty, non-surgical or trans-catheter techniques such as balloon angioplasty or laser relief of an obstruction do not satisfy the definition of surgery. Deafness means the total and irreversible loss of hearing in both ears, with an auditory threshold of 90 decibels or greater within the speech threshold of 500 to 3,000 hertz. Heart Valve Replacement means the undergoing of surgery to replace any heart valve with either a natural or mechanical valve. For greater certainty, heart valve repair does not satisfy the definition of Heart Valve Replacement. Kidney Failure means chronic irreversible failure of both kidneys to function, as a result of which regular haemodialysis, peritoneal dialysis or renal transplantation is initiated. 10

13 Optional benefit riders (cont.) Critical Condition and Critical Condition Plus (cont.) Loss of Independent Existence (for Critical Condition Plus only) means: a total inability to perform, by oneself, at least 2 of the following 6 Activities of Daily Living; or Cognitive Impairment, as defined below, for a continuous period of at least 90 days with no reasonable chance of recovery. Activities of Daily Living are: bathing the ability to wash oneself in a bathtub, shower or by sponge bath, with or without the aid of equipment; dressing the ability to put on and remove necessary clothing including braces, artificial limbs or other surgical appliances; toileting the ability to get on and off the toilet and maintain personal hygiene; bladder and bowel continence the ability to manage bowel and bladder function with or without any protective undergarments or surgical appliances so that a reasonable level of hygiene is maintained; transferring the ability to move in and out of a bed, chair or wheelchair, with or without the use of equipment; and feeding the ability to consume food or drink that already have been prepared and made available, with or without the use of adaptive utensils. Cognitive Impairment means mental deterioration and loss of intellectual ability, evidenced by deterioration in memory, orientation and reasoning, which are measurable and result from demonstrable organic cause. The degree of cognitive impairment must be sufficiently severe as to require a minimum of 8 hours of daily supervision. Determination of a Cognitive Impairment will be made on the basis of clinical data and valid standardized measures of such impairments. For greater certainty, any mental or nervous disorder without a demonstrable organic cause, does not satisfy the definition of Cognitive Impairment. 11

14 Optional benefit riders (cont.) Critical Condition and Critical Condition Plus (cont.) Loss of Limbs means the complete severance of 2 or more limbs at or above the wrist or ankle joint as the result of an accident or medically required amputation. Loss of Speech means the total and irreversible loss of the ability to speak as the result of physical injury or disease for a period of at least 180 days. Exception: No benefit will be payable under this critical condition for all psychiatric related causes. Major Organ Failure on Waiting List means irreversible failure of the heart, both lungs, liver, both kidneys or bone marrow, and transplantation must be medically necessary. To qualify under Major Organ Failure on Waiting List, you must become enrolled as the recipient in a recognized transplant centre in Canada or the United States that performs the required form of transplant. For the purposes of the survival period, the date of the critical condition is the date of your enrollment in the transplant centre. 12

15 Optional benefit riders (cont.) Critical Condition and Critical Condition Plus (cont.) Major Organ Transplant means irreversible failure of the heart, both lungs, liver, both kidneys or bone marrow, and transplantation must be medically necessary. To qualify under Major Organ Transplant, you must undergo a transplantation procedure as the recipient of a heart, lung, liver, kidney or bone marrow, and limited to these entities. Motor Neuron Disease means 1 of the following: amyotrophic lateral sclerosis (ALS or Lou Gehrig s disease), primary lateral sclerosis, progressive spinal muscular atrophy, progressive bulbar palsy, or pseudo bulbar palsy, and limited to these conditions. Multiple Sclerosis means at least 1 of the following: 2 or more separate clinical attacks, confirmed by magnetic resonance imaging (MRI) of the nervous system, showing multiple lesions of demyelination; well-defined neurological abnormalities lasting more than 6 months, confirmed by MRI imaging of the nervous system, showing multiple lesions of demyelination; or a single attack, confirmed by repeated MRI imaging of the nervous system, which shows multiple lesions of demyelination which have developed at intervals at least 1 month apart. 13

16 Optional benefit riders (cont.) Critical Condition and Critical Condition Plus (cont.) Occupational HIV Infection means infection with Human Immunodeficiency Virus (HIV) resulting from accidental injury during the course of your normal occupation, which exposed you to HIV contaminated body fluids. The accidental injury leading to the infection must have occurred following the later of the benefit effective date of the rider, or the last date of reinstatement of the rider. Payment under this condition requires satisfaction of all of the following: the accidental injury must be reported to Great-West within 14 days of the accidental injury; a serum HIV test must be taken within 14 days of the accidental injury and the result must be negative; a serum HIV test must be taken between 90 days and 180 days after the accidental injury and the result must be positive; all HIV tests must be performed by a duly licensed laboratory in Canada or the United States; and the accidental injury must have been reported, investigated and documented in accordance with current Canadian or United States workplace guidelines. Exceptions: No benefit will be payable under this critical condition if: you have elected not to take any available licensed vaccine offering protection against HIV; or a licensed cure for HIV infection has become available prior to the accidental injury. For greater certainty, non-accidental injury including, but not limited to, sexual transmission or intravenous (IV) drug use does not satisfy the definition of Occupational HIV Infection. 14

17 Optional benefit riders (cont.) Critical Condition and Critical Condition Plus (cont.) Paralysis means total loss of muscle function of 2 or more limbs as a result of injury or disease to the nerve supply of those limbs, for a period of at least 90 days following the precipitating event. Parkinson s Disease means primary idiopathic Parkinson s Disease, which is characterized by a minimum of 2 or more of the following clinical manifestations: muscle rigidity; tremor; or bradykinesis (abnormal slowness of movement, sluggishness of physical and mental responses). You must require substantial physical assistance from another adult to perform at least 2 of the following 6 Activities of Daily Living. Activities of Daily Living are: bathing the ability to wash oneself in a bathtub, shower or by sponge bath, with or without the aid of equipment; dressing the ability to put on and remove necessary clothing including braces, artificial limbs or other surgical appliances; toileting the ability to get on and off the toilet and maintain personal hygiene; bladder and bowel continence the ability to manage bowel and bladder function with or without protective undergarments or surgical appliances so that a reasonable level of hygiene is maintained; transferring the ability to move in and out of a bed, chair or wheelchair, with or without the use of equipment; and feeding the ability to consume food or drink that already have been prepared and made available, with or without the use of adaptive utensils. Exception: No benefit will be payable under this critical condition for all other types of Parkinsonism. Severe Burns means third degree burns over at least 20% of the body surface. 15

18 Optional benefit riders (cont.) Critical Condition and Critical Condition Plus (cont.) Critical condition benefit The critical condition benefit is the benefit amount purchased. Survival period Before the critical condition benefit becomes payable, you must be alive and not have experienced irreversible cessation of all functions of the brain for a period of: 90 days for Bacterial Meningitis, Loss of Independent Existence and Paralysis; 180 days for Loss of Speech; and 30 days for all other critical conditions. The diagnosis must satisfy the definition of the critical condition. Advance payment for Coronary Artery Bypass Surgery Great-West will pay the owner an advance on the critical condition benefit if you have Coronary Artery Bypass Surgery. The advance payment amount will be the lesser of: 10% of the critical condition benefit amount then in effect; and $10,000. The advance payment will become payable on the date the surgery is performed. The critical condition benefit will be reduced by the amount of this advance payment. The balance of the critical condition benefit will be paid if you satisfy the survival period. The advance will not have to be repaid if you do not survive the survival period

19 Optional benefit riders (cont.) Return of Premium at Expiry Provides for the return of the eligible premium paid for the policy if the policy is in force on your 75th birthday. The return of premium benefit will be the lesser of: the eligible premium paid for the policy from the date the Return of Premium at Expiry Rider was added to the policy to your 75th birthday; and $2,000,000. To be eligible for the return of premium benefit, you must be living on your 75th birthday and must not have experienced irreversible cessation of all functions of the brain. For purposes of determining the return of premium benefit, premium is the sum of the policy fee, premium for the benefit amount and any optional benefit rider(s), and any premium ratings. It will not include any interest, any additional fees or any premium waived by Great-West. If the benefit amount is reduced or an optional benefit rider is removed, the return of premium benefit will be reduced accordingly. Reinstatement the Return of Premium at Expiry optional benefit will not be available for reinstatement if the rider or the policy is terminated for any reason (such as the policy lapsed due to non-payment of premium). 17

20 Optional benefit riders (cont.) Return of Premium (Year 10+, Year 15+, Age 60+) Provides for the return of all or a portion of the eligible premium paid for the policy if the owner elects a partial or maximum return of premium benefit on one of the optional return of premium dates. There are 3 versions of the Return of Premium optional benefit to choose from: Return of Premium (Year 10+) Return of Premium (Year 15+) Return of Premium (Age 60+) Maximum return of premium will be the percentage of the eligible premium paid for the policy on the applicable policy anniversary following the effective date of the rider shown in the table below. Return of Premium (Year 10+) Policy anniversary Return of Premium (Year 15+) Policy anniversary Return of Premium (Age 60+) Policy anniversary nearest your age Return of premium benefit (% of eligible premium) % % % % % % The return of premium benefit will not exceed $2,000,000. Payment of a maximum return of premium benefit will cause the policy to terminate. For purposes of determining the return of premium benefit, premium is the sum of the policy fee, premium for the benefit amount and any optional benefit rider(s), and any premium ratings. It will not include any interest, any additional fees or any premium waived by Great-West. If the benefit amount is reduced or an optional benefit rider is removed, the return of premium benefit will be reduced accordingly. 18

21 Optional benefit riders (cont.) Return of Premium (Year 10+, Year 15+, Age 60+) (cont.) Partial return of premium will be available on any optional return of premium date provided the minimum critical condition benefit is maintained. A partial return of premium involves a reduction in the benefit amount under the policy and a partial payment of the return of premium benefit. If the owner elects a partial return of premium, the return of premium benefit will be reduced accordingly. Payment of a partial return of premium benefit does not cause the policy to terminate. Paid-up option (for lifetime (paid-up at age 100) only) the first paid-up option will be available on the applicable policy anniversary following the effective date of the rider: 15th policy anniversary for Return of Premium (Year 10+); 20th policy anniversary for Return of Premium (Year 15+); and policy anniversary nearest your age 65 for Return of Premium (Age 60+). The paid-up option will then be available every 5 years thereafter if this option has not already been exercised. The owner will have the option to receive 100% of the return of premium benefit or have the policy become fully paid-up at a benefit amount that may be reduced. If the paid-up option is selected, all riders (except the Critical Condition Rider or Critical Condition Plus Rider, if included in the policy) will terminate. Additional optional benefit riders cannot be added to the paid-up policy. The paid-up option is not available in conjunction with a partial withdrawal. Return of premium at expiry (for to age 75 and term 10 renewable to. age 75 only) the return of premium benefit will be payable to the owner on your 75th birthday if the rider is then in force. Note to be eligible for a return of premium benefit, you must be living on the applicable return of premium date and must not have experienced irreversible cessation of all functions of the brain. Reinstatement the Return of Premium (Year 10+, Year 15+ and Age 60+) optional benefit will not be available for reinstatement if the rider or the policy is terminated for any reason (such as the policy lapsed due to non-payment of premium). 19

22 Optional benefit riders (cont.) Return of Premium at Death Provides for the return of the eligible premium paid for the policy if you die from any cause. The return of premium benefit will be lesser of: the eligible premium paid for the policy from the date the Return of Premium at Death Rider was added to the policy to the date of your death; and $2,000,000. For purposes of determining the return of premium benefit, premium is the sum of the policy fee, premium for the benefit amount and any optional benefit rider(s), and any premium ratings. It will not include any interest, any additional fees or any premium waived by Great-West. If the benefit amount is reduced or an optional benefit rider is removed, the return of premium benefit will be reduced accordingly. Reinstatement the Return of Premium at Death optional benefit will not be available for reinstatement if the rider or the policy is terminated for any reason (such as the policy lapsed due to non-payment of premium). 20

23 Optional benefit riders (cont.) Second Event Provides the owner with a limited amount of protection for a specified condition if you have received the critical condition benefit before age 65 for Heart Attack, Life-Threatening Cancer or Stroke. Should the critical condition benefit become payable for one of these critical conditions: your policy will become paid-up and no further premium will be required; the supplementary benefit provision will not apply; and all optional benefit riders, except this rider, will terminate. If your critical condition was: Heart Attack or Stroke limited coverage will be provided for Life-Threatening Cancer. Life-Threatening Cancer limited coverage will be provided for Heart Attack. The second event critical condition benefit will be the lesser of: 50% of the critical condition benefit; and $50,000. This benefit will be paid as a one-time lump-sum benefit. No benefit will be payable if you have been diagnosed with a second event critical condition during the 1 year exclusion period, or had any signs or symptoms during the exclusion period leading to a diagnosis of a second event critical condition. Coverage for the second event is provided until the earlier of: 10 years from the date the exclusion period was satisfied; and your 75th birthday. Before the second event critical condition benefit becomes payable, you must satisfy a 30 day survival period. The premium for the Second Event Rider is not guaranteed and is subject to change. Any change in the Second Event Rider premium will not be made more than once in any 12 month period and may occur on other than a policy anniversary. It will be made to all policies within a particular risk class. 21

24 Optional benefit riders (cont.) Automatic Increasing Benefit Provides for automatic increases in the critical condition benefit. There are 2 versions of the Automatic Increasing Benefit optional benefit to choose from: Automatic Increasing Benefit (100%) An automatic increase of 25% of the original benefit amount will occur on the 4th, 6th, 8th and 10th policy anniversary following the effective date of the rider. Automatic Increasing Benefit (45%) An automatic increase of 15% of the original benefit amount will occur on the 3rd, 6th and 9th policy anniversary following the effective date of the rider. The total increase in benefit amount will not exceed $500,000. The premium for the original benefit amount is guaranteed for the life of the policy. The premium associated with an increase in benefit amount is not guaranteed. It will be based on Great-West s rules and rates in effect on the applicable premium increase date. If the owner does not want future increases to take effect, the owner may by written request terminate the rider. The rider will also terminate if the critical condition benefit is reduced at the request of the owner. 22