CIBC TERM LIFE PROTECTION PLAN

Transcription

1 CIBC TR LIF PROTCTION AN Our promise to You: CIBC Life Insurance Company Limited will pay benefits in accordance with the provisions of this Policy. THIS IS AN IPORTANT DOCUNT. AS RAD YOUR POLICY CARFULLY AND KP IT IN A F AC. POLICY SUARY Policy Number: Plan Name: CIBC Term Life Protection Plan Owner: Insured Person: Sex: Date of Birth: Smoking Status: Insured Spouse: Sex: Date of Birth: Smoking Status: Insured Person As described in Your application or as subsequently changed Beneficiary: by the Owner Insured Spouse Beneficiary: ffective Date: Insured Person Coverage Amount: Insured Spouse Coverage Amount: Premiums: Your initial premium of $xx.xx is payable each month for the first 5-year term. Your initial premium is guaranteed to remain the same for the first 5-year term. Your premium will usually increase at each Renewal Date. Issue Date: Signed for CIBC Life Insurance Company Limited at Toronto, Ontario Rick Lancaster President, CIBC Life Insurance Company Limited The CIBC Logo is a trademark of CIBC. CIBC Life Insurance Company Limited is a licensed user of the trademark. Page 1 of 11

2 30-DAY RIGHT TO XAIN POLICY The Owner may, within thirty (30) days after receiving this Policy, return it to the address below for cancellation. In that case, the Policy will be void as of the ffective Date and any premium paid will be refunded. Such cancellation is binding on the Owner and any beneficiaries, whether revocable or irrevocable. This right of cancellation does not apply to any reissued, substituted or consolidated Policy continuing coverage under the same Policy Number, as identified on the Policy Summary. IPORTANT NOTIC A copy of Your application is included and should be carefully checked. Any inaccuracies in Your application may result in Your Policy being void. Inaccuracies should be immediately reported to Us by calling Us at the number below to ensure Your coverage is valid. Your Policy contains many valuable benefits. It is in Your own best interest to consult Us if anyone advises You to discontinue this Policy or replace it with a new contract with another insurer. Please keep Us informed of any change to Your name, address, telephone number, or any other change material to this Policy. Please include Your Policy number, name and Your current address when writing to Us. UNDRWRITTN BY: CIBC Life Insurance Company Limited P.O. Box 4213, Station A Toronto, Ontario 5W 53 For general information or to make a claim Call toll-free: Or write to Us at the address indicated above. Page 2 of 11

3 CIBC TR LIF PROTCTION AN TABL OF CONTNTS Page PRIU TABL... 4 DFINITIONS PRIUS... General... Premium payable for the first 5 years... Premium changes at Renewal Dates... Requesting a Change to Non-Smoker Premiums... Grace Period BNFITS... DATH BNFIT... LIVING BNFIT... CANCR BNFIT... TRINATION... 9 GNRAL PROVISIONS... The Policy... Non-Waiver... Applicable Jurisdiction... Incontestability... Reinstatement... isstatement of Age... isstatement of Sex... isstatement of Non-Smoker Status... Currency and Place of Payment... Assignment... Limitation of Actions... Non-Participating CIBC TR LIF PROTCTION AN SPOUS RIDR INSURD PRSON...11 AOUNT OF INSURANC DATH BNFIT LIVING BNFIT PRIU WAIVR TRINATION CONTINUATION OF COVRAG Page 3 of 11

4 PRIU TABL onthly Premiums ffective ay 1, 2006 CIBC Term Life Protection Plan - onthly Premiums $50,000 Smoker ale Female ale *66 * Female Non-Smoker Age *66 *67-69 * ale Female Age $0,000 Smoker ale Female Non-Smoker Age ale Female Smoker ale Non-Smoker $75, * * Female For renewals only Annual Premiums equal twelve times the monthly Premiums. When there are two people covered under this Policy at the same time, the total monthly Premiums payable are reduced by $4.00. Page 4 of 11

5 DFINITIONS Amount of Insurance means the coverage amount on the life of an Insured Person, as shown on the Policy Summary. Policy Anniversary means the month and day every year that is the same as the month and day of the ffective Date. Premium Due Date means: ffective Date means the date on which insurance under this Policy begins as shown on the Policy Summary provided the application for insurance is approved by Us and that the first premium has been received by Us within thirty (30) days following the ffective Date. Physician means a legally qualified medical doctor who is duly licensed in the place where he or she practises and who is practising within the scope of his/her licensed authority. For the purposes of this Policy, a Physician must be a person other than an Insured Person, the Owner or an Immediate Family ember. Immediate Family ember means an Insured Person's spouse, children, parents and siblings. Insured Person means a person who: a) is identified as an Insured Person on the Policy Summary; b) at the ffective Date, was between the ages of eighteen (18) and sixty-five (65) years inclusive; c) at the time of application, was resident in Canada; d) has been approved for the insurance hereunder; and e) is an Insured Spouse, provided the CIBC Term Life Protection Plan Spouse Rider is attached to this Policy and the person is identified as an Insured Spouse on the Policy Summary. Non-Smoker means an Insured Person who has not used any form of tobacco, tobacco cessation products, or marijuana in the twelve (12) consecutive months immediately preceding the date of application for this insurance, and who meets Our health standards. Office means the office of CIBC Life Insurance Company Limited at the address identified on page 2 of this Policy. Qualifying Period means the period of ninety (90) consecutive days immediately following the ffective Date, or date of last reinstatement. CIBC-TL (V2.12/06) a) the first (1st) day of each month following the ffective Date, if premiums are paid monthly; or b) each Policy Anniversary if Premiums are paid annually. Renewal Date means each Policy Anniversary that falls at 5-year intervals, subject to the termination provisions of this Policy. We, Us and Our mean the CIBC Life Insurance Company Limited. You and Your mean the Owner. Words that are capitalized and are not contained in this Definitions section have the meanings ascribed to them as they appear in the Policy or on the Policy Summary. BNFITS While this Policy is in force and subject to the provisions of this Policy, We will pay benefits as follows. DATH BNFIT Upon the death of an Insured Person and subject to receipt of proof, satisfactory to Us, that a Death Benefit is payable under the Policy, We will pay the Amount of Insurance, less any Living Benefit paid for that Insured Person, to the Insured Person's Beneficiary. We will also deduct from the Death Benefit any Premiums due but unpaid but We will not charge interest on the unpaid Premiums. Page 5 of 11

6 xclusions and Limitations for Death Benefit If an Insured Person commits suicide, while sane or insane, within two (2) years from the ffective Date, the amount payable will be limited to sum of the Premiums paid on the life of that Insured Person and will be paid to the Insured Person's Beneficiary. Beneficiary Claims When We receive notice of a claim, We will send claim forms to the claimant. We must receive proof of the claim, satisfactory to Us, at Our Office within twelve (12) months after the date of death. Failure to submit proof within twelve (12) months after the date of death shall not invalidate any claim if it can be shown that submission of such proof was not reasonably possible and that proof was submitted as soon as was reasonably possible. In the case of reinstatement of this Policy, the two (2) year period will run from the date of the most recent reinstatement. beneficiary will pass to the surviving beneficiary, or in equal shares to the surviving beneficiaries. The Owner may designate one or more revocable or irrevocable beneficiaries to receive any Death Benefit payable under this Policy as a result of the Owner's death. LIVING BNFIT If at the date of application for the Living Benefit: a) this Policy has been in force for at least two (2) continuous years from the later of the ffective Date and the date of the last reinstatement, and The Owner may change a revocable beneficiary from time to time and a change will automatically revoke any prior appointment. A change of beneficiary appointment may be made by filing a written request with Us, in a form acceptable to Us. When it has been recorded by Us, the change will take effect as of the date the form was signed, subject to any payment made or other action taken by Us before it was recorded. An irrevocable beneficiary designation may only be changed if the irrevocable beneficiary consents to such change in writing. We have the right to investigate the circumstances of the death and to require an autopsy unless prohibited by law. Unless otherwise provided by law or the beneficiary appointment: a) if more than one beneficiary is designated by the Owner, any Death Benefit payable will be paid in equal shares; and b) if no beneficiary survives the Owner, or if none has been designated, any Death Benefit payable will be paid to the Owner if living, otherwise to the Owner's estate; c) if a beneficiary dies before the Owner, and one (1) or more beneficiaries survive, the share of the deceased xxxxxx CIBC-TL (V2.12/06) b) an Insured Person is under sixty-eight (68) years of age, is living and is suffering from an illness with a prognosis of death within twelve (12) months, subject to receipt of proof, satisfactory to Us, that a Living Benefit is payable under the Policy, We will pay to the Owner, the amount of the Living Benefit requested by the Owner up to a maximum of fifty per cent (50%) of the Amount of Insurance in force on the life of such Insured Person. When a Living Benefit is paid the Death Benefit on the life of the Insured Person for whom the Living Benefit is paid is reduced by the amount of the Living Benefit paid. We will not pay a Living Benefit more than once for an Insured Person under this Policy. Page 6 of 11

7 Living Benefit Premium Waiver We will waive all future Premiums due under this Policy during the lifetime of the Insured Person for whom a Living Benefit was paid, from the first Premium Due Date which falls on or immediately following the date on which the Living Benefit is paid by Us. Cancer means a tumour characterized by the uncontrolled growth and spread of malignant cells and the invasion of tissue as confirmed by histological examination of tissue samples. xclusions and Limitations for Cancer Benefit Application for a Living Benefit The following are excluded from coverage: When we receive notice of an application for a Living Benefit, we will send the appropriate forms to the Owner. We will require submission of the written medical opinion of a Physician demonstrating, to Our satisfaction, the prognosis of death of the Insured Person within twelve (12) months of the date of submission of the application for a Living Benefit. Such medical opinion must be provided at no cost to Us. We will also require the consent of any irrevocable beneficiary. a) carcinoma in situ; Notwithstanding any other provisions in this section, the final decision on payment of the Living Benefit is reserved solely by Us. Furthermore, payable: If: CANCR BNFIT a) an Insured Person is diagnosed for the first time in his/her life with a covered Cancer, and b) such Insured Person survives for at least thirty (30) days following the diagnosis of such covered Cancer, subject to receipt of proof, satisfactory to Us, that a Cancer Benefit is payable under the Policy, We will pay to the Owner a Cancer Benefit of ten per cent (%) of the Amount of Insurance in force on such Insured Person. Payment of the Cancer Benefit does not reduce the Amount of Insurance in force on the life of the Insured Person for whom the Cancer Benefit is paid. We will not pay a Cancer Benefit more than once for an Insured Person under this Policy. CIBC-TL (V2.12/06) b) Stage 1A malignant melanoma (melanoma less than or equal to 1.0 mm in thickness, not ulcerated and without level IV or V invasion); c) any non-melanoma skin cancer that has not become metastatic (spread to distant organs); d) Stage A (T1a and T1b) prostate cancer; and e) any tumour in the presence of any human immunodeficiency virus (HIV). the Cancer Benefit is not 1) if a diagnosis of any type of cancer (covered or excluded under this Policy) is made within the Qualifying Period; 2) if a diagnosis of any type of cancer (covered or excluded under this Policy) is made as the result of symptoms, signs and/or medical consultations or tests present within the Qualifying Period; or 3) if, during or after the Qualifying Period, a subsequent diagnosis of any type of cancer (covered or excluded under this Policy) is made, and such diagnosis directly results from any cancer or the treatment of cancer described under 1) or 2) above. Application for a Cancer Benefit Written notice must be given to Us within sixty (60) days after the diagnosis of a covered Cancer, or as soon thereafter as is reasonably possible. Notice given by or on behalf of an Insured Person to Us at Our Office, with information sufficient to identify the Insured Person shall be deemed to be notice to Us. Page 7 of 11

8 When we receive notice of an application for a Cancer Benefit, we will send the appropriate forms to the Owner. We will require submission of the written medical opinion of a Physician demonstrating, to Our satisfaction, the existence of Cancer of the Insured Person. Such medical opinion must be provided at no cost to Us. The Premium payable for the first five (5) years from the ffective Date is shown in the Policy Summary, on page 1 of this Policy. Subject to coverage changes or any approved change to Non-Smoker status, Your Premium is guaranteed not to change for the first five (5) years from the ffective Date. Renewal Premiums at the end of each 5-year term are not guaranteed. Premium changes at Renewal Dates Your Premium will usually Renewal Date. Premiums year renewal period will be the premium table then in based on: increase at each for each five (5) determined using effect and will be Written proof of Cancer must be furnished to Us at Our Office within one-hundred twenty (120) days after the diagnosis of a covered Cancer. Failure to furnish such proof within the time required shall not invalidate nor reduce any claim if it was not reasonably possible to give proof within such time, provided such proof is furnished as soon as reasonably possible and in no event, except in the absence of legal capacity, later than one (1) year from the time proof is otherwise required. Premium payable for the first 5 years We reserve the right, at Our own expense, to have the Insured Person medically examined when and as often as may be reasonably required prior to the settlement of any claim hereunder, except when it is forbidden by law. Notwithstanding any other provisions in this section, the final decision on payment of the Cancer Benefit is reserved solely by Us. PRIUS General Premiums for this Policy at the ffective Date are determined using the premium table attached to this Policy and are based on an Insured Person's age, sex, and smoking status as stated on the application. Premiums are payable in advance on the ffective Date and on each Premium Due Date. Premiums may be paid in accordance with the method of payment selected in the application for insurance, or by any other method satisfactory to Us. You may change Your method of payment to another method of payment, satisfactory to Us, by contacting Us at least thirty (30) days prior to Your Premium Due Date. Changes to Your payment frequency can only be made effective on a Policy Anniversary. CIBC-TL (V2.12/06) a) the Insured Person's age on each Renewal Date; b) the Insured Person's sex and c) the Insured Person's smoking status on the later of the application date, the date of last Reinstatement (as described in the Reinstatement section of this Policy) or the date of any approved coverage change or change to Non-Smoker status. The Premiums set out in the premium table attached to this Policy are not guaranteed and may change after the Policy is issued. We will send You written notice of premium changes to the address We have on file for You. Requesting a Change to Non-Smoker Premiums If Your Premiums were calculated using smoker premiums at the ffective Date of the Policy, or any subsequent date of Reinstatement (as described in the Reinstatement section of this Policy), You may apply for a change to Non-Smoker Premiums. At the time of such application, the Insured Person must not have used any form of tobacco, tobacco cessation products, or marijuana forxthe twelve (12) consecutive months immediately preceding such application. Page 8 of 11

9 If We approve the change, Your future Premiums will be payable on a Non-Smoker basis. The change will take effect on the Premium Due Date following the date We approve the change to Non-Smoker status. (including Riders if any), the application for insurance, a copy of which is attached (including a copy of the telephone interview report, if any), and any amendment(s) agreed to in writing by Us and the Owner. Grace Period A change in the Policy may be made with the written consent of Us and the Owner. Only Our President has the authority to waive or agree to change any of the conditions or provisions of this Policy on Our behalf. If any Premium or any part thereof is not paid by the end of the grace period, this Policy, including any Rider attached hereto, will, without any notice or act on Our part, cease to be in force and will not be in force thereafter unless the Policy is Reinstated pursuant to the Reinstatement provisions of this Policy. If the Insured Person dies during the grace period, any Premium due but unpaid will be deducted from the Death Benefit. TRINATION Non-Waiver xcept for the first Premium, a grace period of thirty (30) days is allowed for payment in full of any Premium due, during which time this Policy will stay in force subject to the termination provisions of this Policy. This Policy will terminate on the earliest of the following dates: a) the end of the grace period, after any Premium due or any part thereof has not been paid, unless premiums are being waived in accordance with the Living Benefit provision; b) the Premium Due Date coinciding with or immediately following the date on which We receive a written request from the Owner to terminate this Policy; c) the Policy Anniversary on which the Owner, as identified on the Policy Summary, is seventy (70) years of age; or d) the date the Owner, as identified on the Policy Summary, dies. GNRAL PROVISIONS If We waive or fail to insist on performance of any of the provisions of this Policy, that will not be construed as a waiver of any subsequent breach of the same provision or any other provision. If We consent to or approve any act by the Owner or an Insured Person, that will not be construed as a consent to or approval of any subsequent similar act by the Owner or an Insured Person. Applicable Jurisdiction The Policy shall be subject to the laws of the Canadian province or territory in which the Owner resided at the time of application for this insurance. Incontestability In the absence of fraud, We will not contest the validity of this Policy after it has been in force during the lifetime of the Insured Person for two (2) years from the later of the ffective Date or from the date of the last Reinstatement. In issuing this Policy, We have relied on statements made in connection with the application. These are representations and not warranties. No statement will be used by Us to void this Policy or to deny a claim unless the statement is a material misrepresentation and is made in connection with this insurance. The Policy The Policy consists of this Policy, any documents attached to this Policy by Us xxxx CIBC-TL (V2.12/06) Page 9 of 11

10 Reinstatement isstatement of Sex This Policy may be Reinstated by the Owner within two (2) years from the due date of the first unpaid Premium. The requirements to Reinstate are: If the Insured Person's sex has been misstated in the application for this Policy, the Amount of Insurance and/or the Premium required will be adjusted on the basis of the correct sex and reflect the Premiums paid (subject to the maximum Amount of Insurance available under the CIBC Term Life Protection Plan). If the Premiums paid exceeded the amount required for the maximum Amount of Insurance available under the CIBC Term Life Protection Plan, then such excessive Premiums will be refunded. a) written application to CIBC Life Insurance Company Limited; b) evidence of insurability satisfactory to Us; and c) payment of overdue Premiums interest at a rate determined by Us. with isstatement of Age Provided the above requirements are met, and We approve the application for Reinstatement, We will Reinstate Your Policy on the day these requirements are met. If this Policy is Reinstated, the contestability period, the suicide exclusion period and the Qualifying Period begin anew. If the Insured Person's date of birth has been misstated in the application for this Policy, the Amount of Insurance will be adjusted on the basis of the correct date of birth and reflect the Premiums paid (subject to the maximum Amount of Insurance available under the CIBC Term Life Protection Plan). If the Premiums paid exceeded the amount required for the maximum Amount of Insurance available under the CIBC Term Life Protection Plan, then such excessive Premiums will be refunded. If at the Insured Person's correct age this Policy or any Rider attached hereto: a) would not have been issued; or b) would have terminated at an earlier date, the only amount payable by Us for the period that coverage would not have been in effect will be the Premiums paid for that period. isstatement of Non-Smoker Status We reserve the right to void insurance if Non-Smoker status has been misstated. Currency and Place of Payment All payments to be made hereunder to or by Us shall be in the lawful currency of Canada. Payments to Us shall be made at Our Office or elsewhere as may be determined by Us. Payments by Us shall be made in the Applicable Jurisdiction or elsewhere if We consent. Assignment The Owner may not assign this Policy. Limitation of Actions An action or proceeding against Us for the recovery of a claim under this Policy must begin within two (2) years (three (3) years in the Province of Quebec) of the date the insurance money became payable or would have become payable if the claim had been valid. Non-Participating This Policy is not eligible to share in the divisible surplus of the Insurer. This Policy does not have any cash value and is not eligible for dividends. CIBC-TL (V2.12/06) Page of 11

11 CIBC TR LIF PROTCTION AN SPOUS RIDR INSURD PRSON TRINATION An Insured Spouse shall be the person shown as the Insured Spouse on the Policy Summary. For the purposes of this Rider, the term Insured Person throughout the Policy shall also refer to an Insured Spouse and the provisions of the Policy not inconsistent with the provisions below shall apply to an Insured Spouse. This Rider and coverage under the Policy on the Insured Spouse will terminate on the earliest of the following dates: AOUNT OF INSURANC c) the Policy Anniversary on which the Insured Spouse is seventy (70) years of age; or The beneficiary of the Death Benefit payable on the death of the Insured Spouse is the Owner. LIVING BNFIT PRIU WAIVR If no premiums are payable under the Policy because a Living Benefit has been paid on the life of the Insured Spouse and the Insured Spouse dies, premiums for the Owner will resume as of the Premium Due Date immediately following the date of death of the Insured Spouse subject to the premiums then in effect, provided no Living Benefit has been paid on the life of the Owner. CIBC-ST (V2.12/06) b) the date the Policy is terminated; Amount of Insurance means the coverage amount on the life of an Insured Spouse as shown on the Policy Summary. DATH BNFIT a) the Premium Due Date coinciding with or immediately following the date on which We receive a written request from the Owner to terminate this Rider; d) the date the Insured Spouse dies. CONTINUATION OF COVRAG In the event the Policy terminates due to: a) the death of the Owner, as identified on the Policy Summary, or b) the Owner, as identified on the Policy Summary, attaining age seventy (70), the Insured Spouse insured under this Rider will be eligible to have the Insured Spouse Coverage Amount on his/her life continued in force under a new policy without providing evidence of insurability. Upon receipt of information required by Us and payment of the required premium within thirty (30) days of the termination of this Rider, the Insured Spouse will be issued a new CIBC Term Life Protection Plan Policy containing its then current terms and conditions. The premiums will be calculated based on the Insured Spouse's age on the ffective Date of the new Policy and his/her smoking status and sex of record, subject to the premiums then in effect for the CIBC Term Life Protection Plan. Page 11 of 11

12 CIBC Life Insurance Company Limited P.O. Box 4213, Stn A Toronto, ON 5W Re: Your Privacy atters At CIBC Life Insurance Company (CIBC Life), a member of the CIBC Group of Companies, we understand and respect our clients' need for privacy. This note explains how we protect your right to privacy. And it tells you how you are in control of the way your personal information will be used. What information do we keep, and how do we use it? When you requested coverage from CIBC Life, you gave us information about yourself, which we added to a client file. We may also need to collect information about you from other sources such as hospitals, doctors and other health care providers, the edical Information Bureau, the government (including government health insurance plans) and other governmental agencies, other insurance companies, financial institutions, motor vehicle reports and your current and former employers. We maintain records for each customer, which allow us to conduct all the necessary business of insurance (including setting premiums, offering insurance products to you, paying claims and administering your insurance coverage). CIBC Life may use your information to produce internal reports. In what other ways is information used? At times we use third party suppliers outside CIBC Life to help us provide the services you have requested (for example, third party administrators, other financial institutions, the edical Information Bureau and other insurance companies), which may involve sharing some of your personal information. We expect our third party suppliers to maintain the confidentiality of your information by not using or disclosing your information for unauthorized purposes or without your consent. CIBC Life also looks forward to offering you a variety of new innovative insurance products in the future. The information you provided us - including your name, address, marital status, or date of birth - lets us bring you news about those products that are most relevant to your needs. You may also appreciate getting information about other financial services from the larger CIBC Group of Companies. We will share non-sensitive information about you (i.e. not medical history or financial status) within - but not outside - the CIBC Group of Companies. You can see your personal information You, too, can see your personal information. Just call us at our convenient toll-free number (see above), and we will be happy to share - or correct - any information you have with us. If you are requesting to see your information, we may ask you to put your request in writing, and there may be a charge for such a request. If so, we will advise you of this in advance. We will respond to any request you make regarding your personal information within 30 days. If we need to extend that time, or we have to refuse your request, we will tell you why, subject to any legal restrictions. If you have a sensory disability, we will give you access to your information in any alternative format you request, if we have it in that format, or if its conversion into that format is reasonable and necessary. The CIBC Logo is a trademark of CIBC. CIBC Life Insurance Company Limited is a licensed user of the trademark.

13 Are there limits to how information will be shared? Your non-sensitive information will never be given to a person or firm outside of the CIBC Group of Companies and third party suppliers (except if we are required by law). Sensitive information, like your medical history or financial status will never be shared outside CIBC Life or its third party suppliers without your previous written consent (unless we are required or permitted by law). If you wish, you can further limit how your information is used by calling our toll-free number. You can ask not to be included in any future communications about other products or services. Our Service Commitment to You We treat your personal information with respect and care, and we use it only to serve you better. Part of our commitment to your right to privacy is to make it easier than ever before for you to understand - and control - how your information will be used. Your privacy matters to us, because it matters to you. If you would like additional information on the CIBC Group of Companies privacy policy and practices, you can request a copy of the brochure Your Privacy Is Protected by calling , or you can obtain a copy from Re - Your Right to be Treated Fairly and to Have Your Concerns Heard We have created a process for dealing with customer concerns and complaints. If you have a complaint or concern, we encourage you to follow the complaint procedure outlined here. Contact CIBC Life at or fax If further discussion is required, contact CIBC Life's Ombudsman at , or via insurance.ombudsman@cibc.com Should you not be able to accept the conclusion of CIBC Life's Ombudsman, you can ask how your complaint can be further escalated If the above steps fail to resolve your privacy concern you may also contact the Office of the Privacy Commissioner of Canada: Place de Ville 112 Kent Street, 3rd Floor Ottawa, ON K1A 1H3 Call toll free at