CERTIFICATE TERMS AND CONDITIONS

Transcription

1 CERTIFICATE TERMS AND CONDITIONS We, us, our or Industrial Alliance means Industrial Alliance Insurance and Financial Services Inc. ( Industrial Alliance ). You or your means the Insured. We agree, under the Master Policy for Group Mortgage Insurance issued to the Group Policyholder, to insure you subject to the conditions below. Words used in this Certificate that have an initial capital letter have the defined meaning or value as set out below or on the face of this Certificate. All of the terms governing coverage are set out in this Certificate. In consideration of our receipt of the Total Monthly Insurance Premium, we insure you for only the Insurance selected on the Certificate. If there is no coverage indicated or the Premium is zero, then you are not insured for that type of Insurance. Your coverage will begin on the Effective Date of Insurance. Any amounts payable under this Certificate will be paid to the Financial Institution, to reduce your loan obligation under the Mortgage. This Certificate is not assignable. SECTION 1 DEFINITIONS 1. FINANCIAL INSTITUTION means the company or organization named on the face of the Certificate under the heading Financial Institution. 2. CRITICAL ILLNESS means Diagnosis of any of the following covered conditions which occur directly as a result of illness and first occur after the Effective Date of Insurance. a. CANCER (LIFE-THREATENING): means a definite Diagnosis of a tumour characterized by the uncontrolled growth and spread of malignant cells and the invasion of tissue. The Diagnosis of Cancer must be made by a Specialist. Exclusion: No benefit will be payable under this condition for the following non-life threatening cancers: i. carcinoma in situ, or; ii. Stage 1A malignant melanoma (melanoma less than or equal to 1.0mm in thickness, not ulcerated and without Clark level IV or level V invasion), or; iii. any non-melanoma skin cancer that has not metastasized, or; iv. Stage A (T1a or T1b) prostate cancer. b. HEART ATTACK means a definite Diagnosis of the death of heart muscle due to obstruction of blood flow, that results in a rise and fall of biochemical cardiac markers to levels considered diagnostic of myocardial infarction, with at least one of the following: i. Heart attack symptoms; ii. New electrocardiogram (ECG) changes consistent with a heart attack; iii. Development of new Q waves during or immediately following an intra-arterial cardiac procedure including, but not limited to, coronary angiography and coronary angioplasty. The Diagnosis of Heart Attack must be made by a Specialist. Exclusions: No benefit will be payable under this condition for: Elevated biochemical cardiac markers as a result of an intra-arterial cardiac procedure including, but not limited to, coronary angiography and coronary angioplasty, in the absence of new Q waves, or; ECG changes suggesting a prior myocardial infarction, which do not meet the Heart Attack definition as described above. c. CORONARY ARTERY BYPASS SURGERY means the undergoing of heart surgery to correct narrowing or blockage of one or more coronary arteries with bypass graft(s), excluding any non-surgical or transcatheter techniques such as balloon angioplasty or laser relief of an obstruction. The surgery must be determined to be medically necessary by a Specialist. d. STROKE (Cerebrovascular Accident) means a definite Diagnosis of an acute cerebrovascular event caused by intra-cranial thrombosis or haemorrhage, or embolism from an extra-cranial source with: i. Acute onset of new neurological symptoms, and ii. New objective neurological deficits on clinical examination, persisting for more than 30 days following the Date of Diagnosis. These new symptoms and deficits must be corroborated by diagnostic imaging testing. The Diagnosis of Stroke must be made by a Specialist. Exclusions: No benefit will be payable under this condition for: Transient Ischaemic Attacks; or Intracerebral vascular events due to trauma; or Lancunar infarcts which do not meet the definition of stroke as described above. e. MAJOR ORGAN TRANSPLANT means a definite Diagnosis of the 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, the Insured Person must undergo a transplantation procedure as the recipient of a heart, lung,

2 liver, kidney or bone marrow, and limited to these entities. The Diagnosis of the major organ failure must be made by a Specialist. f. PARALYSIS means a definite diagnosis of the total loss of muscle function of two 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. The diagnosis of Paralysis must be made by a Specialist. 3. DIAGNOSIS means the certified diagnosis of the Insured with a Covered Condition by a Specialist. 4. EFFECTIVE DATE OF INSURANCE means the later of the Requested Effective Date of Insurance on the Application form and the date of which each Applicant properly completes and signs the Application, provided: a. Each Applicant answers NO to the Health Questions in Part 4; and b. The Insured Amount Applied For plus the total of all mortgages currently insured through Industrial Alliance is equal to or less than $350,000 for Life or Critical Illness coverage or $2,000 for Disability coverage. If any Applicant does not meet conditions a) and/or b) above, and if coverage is approved by Industrial Alliance the Effective Date of Insurance may be no later than 120 days as specified in the Certificate by in no event later than 120 days after the date the application is signed. 5. INJURY means bodily injury caused by an accident that occurs after the Effective Date of Insurance. The Injury must result from the accident, directly and independently of any other causes and must solely cause the death or Total Disability. 6. INSURANCE means the Life Insurance, Critical Illness Insurance and/or Disability Insurance coverage you have been approved for. 7. INSURED and INSURED PERSON means the Applicant(s) named on this Certificate and who is/are debtor(s) under the Mortgage and who have been approved for Life, Critical Illness and/or Disability Insurance and is/are covered under this Certificate of Insurance. Each Insured must be a natural person, not a partnership, company or association. 8. INSURED MORTGAGE and INSURED MONTHLY MORTGAGE PAYMENT means the principal with interest that is equal to the Insured Amount Applied For amortized with regular, equal payments of principal and interest over the Mortgage Amortization Term using the interest rate of the Mortgage. If a) your Mortgage is greater than your Insured Mortgage or b) your Mortgage Amortization Term is greater than your Coverage Term, the Insurance benefit may not pay the full outstanding balance of your financial obligations. 9. MORTGAGE means the debt described on the Application payable, in whole or part by regular, equal instalments, to the Financial Institution. 10. PRE-EXISTING CONDITION means illness, disease, mental, nervous or psychiatric condition or disorder for which any of (i) medical advice (ii) treatment (iii) service (iv) prescribed medication (v) diagnosis or (vi) consultation, including consultation to investigate, follow-up and/or diagnose (where diagnosis has not yet been made) was received by you or would have been received by a prudent individual within both (a) the 6 months immediately preceding the Effective Date of Insurance, and (b) the 6 months immediately following the Effective Date of Insurance. 11. SICKNESS means illness, disease or psychiatric or other disorder that first becomes manifest after the Effective Date of Insurance. 12. SPECIALIST means a physician licensed and practicing in Canada whose practice is limited to the particular branch of medicine relating to the applicable Covered Condition and who is not the Insured, a relative or business associate of the Insured. 13. TOTALLY DISABLED or TOTAL DISABILITY means your inability, solely due to Sickness or Injury, to perform all duties of your occupation, provided you have been gainfully employed for a minimum of 20 hours per week in each of the 4 weeks immediately prior to the date that Total Disability commences. SECTION 2 COMMENCEMENT OF INSURANCE Your Insurance will commence on the Effective Date of Insurance provided that the first premium is paid. See definition of Effective Date of Insurance above for full details. SECTION 3 LIFE INSURANCE The maximum amount of insurance for ages 18 to 64 is $1 million. In the event of your death we will, upon receipt of proof of your death, pay the outstanding balance of your Insured Mortgage at the date of death, subject to the terms and conditions of this Certificate. Some limitations and exclusions apply. Please refer to the Limitations and Exclusions table in Section 6.

3 SECTION 4 CRITICAL ILLNESS INSURANCE The maximum amount of insurance for ages 18 to 64 is $1 million. Only one defined covered Critical Illness benefit is payable under each certificate issued by Industrial Alliance. Some limitations and exclusions apply. Please refer to the Limitations and Exclusions table in Section 6. SECTION 5 DISABILITY INSURANCE The maximum amount of insurance (Insured Monthly Payment) for ages is $3,500. If both Insureds are Totally Disabled at the same time, the Insured Monthly Payment will be paid for the primary insured only. If you are Totally Disabled for a consecutive number of days longer than the 60 day Waiting Period, we will pay your Insured Monthly Payment for the period of Total Disability, subject to a 12 month maximum period; subject to the Waiting Period; and subject to the terms and conditions of this Certificate. Payment will be calculated from the day following the Waiting Period. Insured Monthly Payments will stop when you are no longer Totally Disabled, or when the 12 Insured Monthly Payments per disability have been made, or upon Termination of Insurance as described below, whichever occurs first. The amount paid for periods of Total Disability which are less than one month will be calculated at a daily rate of 1/30 th of the Insured Monthly Payment. After the Waiting Period, successive periods of Total Disability, caused by the same Sickness or Injury, separated by less than one month of continuous employment are considered a continuation of a period of Total Disability and are not subject to a new Waiting Period. Some limitations and exclusions apply. Please refer to the Limitations and Exclusions table in Section 6. SECTION 6 LIFE, CRITICAL ILLNESS AND DISABILITY INSURANCE LIMITATIONS AND EXCLUSIONS Limitations and Exclusions Table Life Critical Illness Disability No Insurance will be paid under the Certificate in the event that your claim is caused or contributed to by: Suicide within the two year period following the Effective Date of Insurance Intentionally self-inflicted injury while sane or insane War or any act of war whether declared or undeclared Direct or indirect participation in a criminal act or any attempt to commit a criminal offence, including but not limited to, operating a motor vehicle while the concentration of alcohol in 100 millilitres of the Insured s blood exceeds 80 milligrams Chronic use of alcohol Drug use apart from controlled drugs used as prescribed by and on the advice of a physician A Pre-existing Condition, or as a direct or indirect result of treatment for a Preexisting Condition. This exclusion only applies if the Critical Illness or Total Disability occurs within 24 months of the Effective Date of Insurance Normal pregnancy, childbirth or termination of pregnancy, excluding medical complications Cosmetic or elective surgery, excluding unexpected medical complications In addition, no Critical Illness benefit will be paid if The insured does not survive 30 days following the Diagnosis of the Critical Illness The insured is diagnosed with Cancer, had any signs and/or symptoms or medical problems commence, or had investigations leading to the Diagnosis of any cancer covered or excluded under the group policy initiated within 90 days following the Effective Date of Insurance Any Critical Illness exists before the Effective Date of Insurance

4 SECTION 7 SPECIAL LIMITATIONS In addition to the Limitations and Exclusions already stated, the following Special Limitations apply: 1. If more that one Applicant is insured under this Certificate, any Insurance payable will be paid for the applicant who dies first, or in the case of Critical Illness is diagnosed first. If both die or are diagnosed simultaneously, we will pay for only one life. 2. The Life and Critical Illness Insurance benefits payable under this Certificate and any other creditor s group personal loan or mortgage life insurance certificates issued by us to you will not exceed the Maximum Amount of Insurance stated on this Certificate. In this event, the liability under your Certificate will be adjusted on a pro-rata basis with the other creditor s group insurance certificates. 3. The combined disability insurance monthly payment payable under this Certificate and any other creditor s group disability insurance certificates issued by us to you will not exceed the Maximum Monthly Amount of Insurance stated on this Certificate. In this event, the liability for disability insurance under this Certificate will be adjusted on a pro-rata basis with the other creditor s group disability insurance certificates. 4. We will pay the accrued interest on the Insured Mortgage principal at the Mortgage interest rate in effect on the date of your death from the date of your death to the date of claim payment, but in no event for a period of more than 90 days. 5. For Life Insurance and Critical Illness Insurance, we will pay the lesser of the outstanding Mortgage principal and the outstanding principal of the Insured Mortgage on the Incurred Date. The Incurred Date is the date of death for Life Insurance and the date of first Diagnosis for Critical Illness insurance. 6. We will pay the Insured Mortgage or the Insured Monthly Mortgage Payment as defined in this the Certificate that is equal to the Insured Financed Amount amortized with regular, equal payments of principal and interest over the Mortgage Amortization Term using the interest rate of the Mortgage. If a) your Mortgage is greater than the Insured Mortgage or b) your Mortgage Amortization Term is greater than your Coverage Term, the Insurance benefit may not pay the full outstanding balance of your financial obligation. SECTION 8 CONDITIONS OF PAYMENT 1. Claim forms must be completed and submitted to us within 90 days of the date of death. Diagnosis of Critical Illness or Total Disability for which a claim is made, and thereafter as required by us. If it is not reasonably possible to complete and submit claim forms within 90 days, they must be furnished as soon as reasonably possible, and in no event later than 2 years from the incurred date. In the event disability claims forms are received after 90 days from the onset of Total Disability, benefits will only be retroactively considered for the 90 days prior to the receipt of the claim forms. 2. The expense of providing the proof of claim is the responsibility of the Insured. 3. In adjudicating any claim, we shall be entitled to receive satisfactory proof of eligibility and proof of the following: a) date of 1) birth, 2) death, 3) Critical Illness, 4) Total Disability; and b) the circumstances causing or contributing to it; and c) any treatment both before and after the Effective Date of Insurance and proof from the Finance Institution that the Insured Amount has not been paid out, re-written, or revised. 4. You must be regularly attended by a licensed physician (M.D.) while Totally Disabled. We will have the right to have you medically examined by a licensed physician of our choice as often as is reasonably required during the period for which Disability Insurance is claimed. If you fail to submit to such an examination within a reasonable period, we will be entitled to terminate payment of your Disability Insurance. 5. You are responsible to make any Mortgage payments that fall due while the claim is being adjudicated, subject to our reimbursement for the period of time for which we are responsible to make the Insured Monthly Payment. 6. We will not pay any Disability Insurance for any debt outstanding under the Mortgage on the termination date of the Insurance. 7. In the event that you were not eligible to purchase the Insurance, our only obligation is to refund any premium paid by you. 8. We will not pay any overdue payments or additional interest charges due under the Mortgage at the date of your death, Critical Illness Diagnosis or disability. 9. If the age of any Insured was understated on the Application, the Insured Amount Applied For and/or the Insured Monthly Payment will be decreased to the Amount that would be payable for the Total Monthly Insurance Premium at the correct age. If the age of any Insured was overstated on the Application, any excess premium will be refunded. In the event of a claim please call our Claims Department at

5 SECTION 9 TERMINATION OF INSURANCE Insurance under this Certificate will terminate with respect to all Insureds when any of the following events occur: a) Upon the date the Mortgage Loan is fully discharged or repaid; or b) The terms of payment, the creditor or financial lender, or the amount payable, under the Mortgage Loan have been increased or extended (subject to paragraph 1 of this section below); or c) The Finance Institution has demanded payment of the full amount due under the Mortgage for any reason; or d) Upon our receipt of written notice signed by all Insureds that you wish to cancel the Insurance coverage; or e) Upon our payment of the Life or Critical Illness Insurance benefit; or f) You reach your 75 th birthday for Life Insurance or 70 th birthday for Disability Insurance and Critical Illness Insurance; or g) For Disability only, the date of retirement from regular or Seasonal employment; or h) You fail to pay any Total Monthly Insurance Premium within 31 days after its due date; or i) 40 years after the Effective Date of Insurance. 1. Upon your written request, we may continue to offer coverage, at our option, under your Certificate upon refinancing of the Mortgage Loan. In the event we offer such coverage, the Effective Date of Insurance, Expiry Date of Insurance, Insurance amounts and all other terms and conditions will remain the same. 2. If the insured(s) neglects to advise the Company that termination events a), b), c) or g) has occurred but does so at a later date, the Company will reimburse the premiums paid since that date up to a maximum of three (3) months. 3. If you sell, convey, transfer or otherwise dispose of your right, title or interest in the mortgaged property, your insurance will remain in-force until you advise Industrial Alliance of any of the termination events described above. In the event a benefit is payable, Industrial Alliance s liability will only be limited to an amount equal to that which would have been payable under the terms of the original mortgage insurance certificate, said amount being payable to your current creditor. 4. Please be advised that any misrepresentation may result in the voiding of your coverage from the Effective Date of Insurance and Industrial Alliance will return any premiums you have paid. It is the Insured(s) responsibility to advise Industrial Alliance of any of the above termination events. SECTION 10 PREMIUMS The Total Monthly Insurance Premium is due and payable in advance, on a monthly basis, through the pre-authorized payment plan on the monthly anniversary of the Effective Date of Insurance, or on the next business day. If the Effective Date of Insurance is the 29 th, 30 th or 31 st of any month, your premium will be due and payable on the 1 st of each month or on the next business day. Industrial Alliance reserves the right to change the monthly premium rates. You will be given advance notice of any change. If your certificate is cancelled due to non-payment of premiums, Industrial Alliance will not reinstate the certificate. SECTION 11 PRIVACY NOTICE We will collect and retain all personal information concerning your insurance and claims. The information will be used for purposes of underwriting, marketing, administration and cancellation of your Certificate and investigation of claims. We will only access your file on a need to know basis and it will be kept at Special Markets Solutions, a division of Industrial Alliance, at 2165 West Broadway, Vancouver, BC, V6B 5H6. Your file can be reviewed and/or rectified by written request. MONEY BACK GUARANTEE You have 30 days from the issue date of this Certificate to decide if you still want the coverage. If you do not, return this insurance package together with a signed cancellation request to Special Markets Solutions of Industrial Alliance within 30 days of the issue date. Once received, we will cancel your coverage from the Effective Date of Insurance and refund any premium paid.

6 LIMITATION OF ACTION Every action or proceeding against an insurer for the recovery of insurance money payable under the contract is absolutely barred unless commenced within the time set out in the Insurance Act, or other applicable legislation. Special Markets Solutions Industrial Alliance Insurance and Financial Services Inc West Broadway, P.O. Box 5900 Vancouver, B.C., V6B 5H6 Tel: Fax : solutions-creditor@inalco.com