GIRAFFE & FRIENDS LIFE INSURANCE COMPANY TOTAL CARE POLICY

Transcription

1 GIRAFFE & FRIENDS LIFE INSURANCE COMPANY TOTAL CARE POLICY This is a Policy for: (a) Non-Participating Whole Life Insurance with Automatic Increase in Insurance Amount at Age 25; (b) Critical Illness Insurance with Automatic Increase in Insurance Amount at Age 25; and (c) Child Accident Insurance up to Age 25. In this Policy, Giraffe & Friends Life Insurance Company will be referred to as we, our, us and giraffe. This Policy is a legal contract between the Policyholder and Giraffe & Friends Life Insurance Company. PLEASE READ YOUR POLICY CAREFULLY. If for any reason you are not completely satisfied with your Policy, you may cancel this Policy by returning it to us within thirty (30) days of receiving the Policy. If you cancel the Policy within such thirty (30) days, the Policy shall be void from the Effective Date of Insurance, and we will refund your initial Premium payment. General Provisions The Contract: This insurance is granted in consideration of the application and payment of the Premiums. This Policy (including the Policy Schedule) and the application for this Policy are the entire contract. In the absence of fraud, all statements made in the application will be considered representations and warranties. This Policy may not be amended, nor may any of our rights be waived, except in writing signed by our President or a Vice-President. Right of Insured to Designate: This policy contains a provision that potentially removes or restricts the right of the insured to designate persons to whom or for whose benefit insurance money is to be payable. Non-participation: This Policy is a non-participating policy. It is not entitled to any share of giraffe profits or surplus. Effective Date of Insurance: This Policy takes effect on the Effective Date of Insurance noted in the Policy Schedule provided that the first premium has been paid. All Policy durations and anniversaries referred to are determined and calculated from the Effective Date of Insurance. Misstatement of Age: Except in the case of fraud for which the Policy may be terminated, if the age of the Insured has been misstated, the Life Benefit and the Critical Illness Benefit (as defined below) under this Policy will be increased or decreased to the amount that would have been provided for the same premium at the correct age as determined by giraffe. Page 1 of 16

2 Incontestability: Except for non-payment of Premiums, the Policy will be incontestable by us after it has been in force during the Insured s lifetime for two (2) years from the Effective Date of Insurance or, if applicable, two (2) years from the latest date of reinstatement. In cases involving fraud, we may contest the Policy at any time. One Policy: Only one Policy may be issued in respect of the Insured. For greater certainty, a Policyholder and/or Insured will not be entitled to benefits under more than one Policy issued by us. Exceptions This Policy will be void and our liability will be limited to the return of any Premiums paid where: (a) The Insured dies within thirty (30) days following the Effective Date of Insurance; (b) The Insured is diagnosed with Cancer within ninety (90) days following the Effective Date of Insurance; (c) Prior to the Effective Date of Insurance, there were any symptoms or medical problems which led to the commencement or initiation of investigations leading to the diagnosis of any Cancer; (d) Incomplete, inaccurate, untrue or wrong information was submitted to the Insurer by the Policyholder at any time and a claim arises under this Policy during the first two (2) years of the Policy; or (e) In cases of fraud. Termination of Policy: This Policy will terminate on the earlier of: 1. Death of the Insured; and 2. Payment of any Critical Illness Benefit under this Policy. Premium and Reinstatement Provisions Premiums: All Premiums are payable in Canadian dollars to us at our head office. Each Premium must be paid on or before its due date. A receipt signed by us will be furnished on request. Amount and Frequency: Premiums are payable in the amount and frequency shown in the Policy Schedule. You may change the frequency of the Premium payment subject to our written approval. Default: Any Premium, other than the first Premium, which is not paid on or before the due date constitutes a Default under this Policy. The Policy will then terminate, subject to the Grace Period and Reinstatement. Grace Period: A Grace Period of thirty-one (31) days will be allowed for payment of a Premium in Default. Your Policy will continue to be in force during the Grace Period. If a Life Benefit or Critical Illness Benefit is payable under this Policy, we will deduct from the Life Benefit or Critical Illness Benefit payable, as applicable, any unpaid Premium that is due. Page 2 of 16

3 Premium Refund on payment of the Life Benefit or Critical Illness Benefit: The Beneficiary will receive, in addition to the Life Benefit or Critical Illness Benefit, as applicable, any Premiums paid past the end of the Policy month in which death or a Diagnoses occurs, as applicable. Reinstatement: If the Policy has terminated because of a Default and the Grace Period has expired, the Policy may be reinstated within two (2) years of the date of Default. Reinstatement of the Policy is subject to: 1. Submission of evidence of insurability of the Insured satisfactory to us; 2. Payment of all past due Premiums with interest accrued daily at a rate determined by us, which interest rate will not exceed the lower of (i) the Bank of Canada prime rate plus 2% per year or (ii) such interest rate as is prescribed by applicable provincial insurance legislation in relation to the reinstatement of a life insurance contract, and shall be calculated on the basis of the actual number of days elapsed divided by 365 or 366, as the case may be; 3. Payment or reinstatement of any indebtedness (as defined in the Loan Provision) with interest accrued daily at a rate determined by us as at the first day of the indebtedness being outstanding, which interest rate on any day will not exceed the Bank of Canada prime rate plus 2% per year and shall be calculated on the basis of the actual number of days elapsed divided by 365 or 366, as the case may be. The loan interest will become part of the indebtedness. The Policy cannot be reinstated if the cash value of the Policy has been paid. You may be requested to pay Giraffe a charge in the event payment of Premiums are not processed by your financial institution as a result of non-sufficient funds. Policyholder, Beneficiary and Assignment Policyholder: Before the Insured reaches age twenty-five (25), unless otherwise provided in the application or any other form acceptable to us, the Policyholder will be the Beneficiary, if alive; otherwise, the Insured. After the Insured reaches age twenty-five (25), the Insured will have the right to become the Policyholder subject to making a written request to our head office in a form satisfactory to us and we have recorded the change. The change will have no effect on any payment made or other action taken by us until we have received a written request at our head office and have recorded the change. The Policyholder may exercise all rights and take any action in connection with this Policy (including changing the Policyholder as set out below). Beneficiary: The Beneficiary named in this Policy or in the last Beneficiary designation filed with us will receive the amount of insurance payable under this Policy. If two (2) or more people are named Beneficiaries, the amount of insurance will be paid to the person or persons who are alive when the benefit becomes payable. If more than one (1) Beneficiary is alive, the amount of insurance will be shared equally, unless otherwise specified in this Policy. If no Beneficiary survives the Insured, the proceeds will be payable to the Insured s estate. Change of Policyholder or Beneficiary: Subject to the prior written consent of the Insurer, the Policyholder may change the named Policyholder or Beneficiary at any time during the life of the Page 3 of 16

4 Insured. The Insurer shall not withhold consent if the new policyholder or beneficiary has an insurable interest in the life of the Insured. The Policyholder may make these changes by making a written request to our head office in a form satisfactory to us. The change is not effective until we have consented to the change and recorded it. The change will have no effect on any payment made or other action taken by us until we have received a written request at our head office and have consented to and recorded the change. Assignment: An assignment is a transfer of some or all of the rights under this Policy. Subject to the prior written consent of the Insurer, the Policyholder has the right to assign this Policy. The Insurer shall not withhold consent if the new policyholder has an insurable interest in the life of the insured. No assignment will be binding on us or deemed to be in force until we have received a written request at our head office and have consented to and recorded the change. We assume no responsibility for the validity of any assignment. While an assignment is in force, the rights of the Policyholder and other persons referred to in the Policy are subject to the prior rights of any assignee. Cash Values and Default Cash Values: Where there is no Default, the Policyholder will be paid the Net Cash Value upon surrender of this Policy. The Policyholder may surrender this Policy for the Net Cash Value at any time during a Policy year. Cash Values are shown on the Policy Schedule. Cash Values at any time during a Policy year will be adjusted for time elapsed and for Premiums paid during the year. Net Cash Value: The net cash value is equal to the Cash Value less any Indebtedness. Default: Upon Default, while this Policy has a Net Cash Value, the Insurer may consider the Policy to have been surrendered by the Policyholder for its Net Cash Value. Loan Provision Policy Loans: While this Policy has a Loan Value, the Policyholder may obtain a policy loan from us if: 1. No Default has occurred beyond the Grace Period; and 2. The Policy is provided as security to us for the loan in a manner satisfactory to us. Loan Value: This Policy s Loan Value equals 90% of its Cash Value less any Indebtedness to the date Premiums have been paid. The amount that can be borrowed may not exceed the Loan Value. Indebtedness: Indebtedness means all unpaid loans and due and accrued loan interest. Loan Interest: Interest on a loan will accrue daily at a rate determined by us as at the first day of the indebtedness being outstanding, which interest rate on any day will not exceed the Bank of Canada prime rate plus 2% per year and shall be calculated on the basis of the actual number of days elapsed divided by 365 or 366, as the case may be. The loan interest will become part of the indebtedness. Page 4 of 16

5 Repayment of a Loan: A loan may be repaid at any time while the Insured is living and the Policy is in force. Any outstanding Indebtedness will be deducted from the policy proceeds. Termination of Policy: When the Indebtedness against this Policy equals or exceeds the Loan Value, this Policy shall be terminated and be without further value thirty-one (31) days after we have mailed notice to that effect to the Policyholder at his/her last known address. Limitation Period In Ontario, Alberta, Manitoba and British Columbia, 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. NON-PARTICIPATING WHOLE LIFE INSURANCE WITH AUTOMATIC INCREASE IN INSURANCE AMOUNT AT AGE 25 PREMIUMS PAYABLE FOR THE LIFETIME OF THE INSURED. We promise to pay the Beneficiary the amount of insurance noted below (the Life Benefit ) if: 1) this Policy is in force; and 2) we are sent proof of death of the Insured acceptable to us. Subject to the terms of this Policy, the amount of the Life Benefit is the Initial Life Amount set out in the Policy Schedule if the Insured dies before his/her twenty-fifth (25 th ) birthday. The amount of insurance is the Guaranteed Age 25 Life Amount set out in the Policy Schedule if the Insured dies on or after his/her twenty-fifth (25 th ) birthday. Automatic Increase of Insurance Amount On the Insured s twenty-fifth (25 th ) birthday, the Initial Amount will automatically be doubled to the Guaranteed Age 25 Life Amount with no increase in Premiums ( Additional Life Insurance ). Terms for Additional Life Insurance Additional Life Insurance will be on the same terms and conditions as this Policy. Additional Life Insurance will be issued subject to the following: 1. All Premiums for the Policy must be paid up to the date of the Insured s twenty-fifth (25 th ) birthday. 2. The date the Additional Life Insurance takes effect will be the day of the Insured s twenty-fifth (25 th ) birthday. Exclusions and Limitations No Life Benefit will be paid under this Policy if death results directly or indirectly from one or more of the following: 1. Suicide, while sane or insane, within two (2) years of the Effective Date of Insurance or from the latest date of reinstatement; Page 5 of 16

6 2. Taking poison or inhaling gas, whether voluntarily or involuntarily, not connected with the employment of the Insured; 3. Injury caused or contributed to by war or any act of war, whether declared or not, or terrorism; 4. Epidemic or pandemic; 5. Nuclear incident, radioactive exposure/contamination 6. Flying as a flight attendant, student pilot or pilot; 7. Direct or indirect participation in a criminal act or any attempt to commit a criminal offense, including but not limited to, operating a motor vehicle while the concentration of alcohol in one hundred (100) milliliters of Your blood exceeds eighty (80) milligrams; 8. Self-inflicted injury, while sane or insane; 9. Participation in a riot or civil commotion; 10. Active service in the armed forces of any country; 11. Chronic use of alcohol; 12. Drug use apart from controlled drugs as prescribed by and on the advice of a licensed physician; 13. Medical complications as a result of normal pregnancy, childbirth or termination of pregnancy; 14. The Insured is born more than one (1) month prematurely and death of the Insured occurs within the first six (6) months of birth; 15. Medical complications as a result of cosmetic or elective surgery; or 16. Amateur or professional boxing, bungee jumping, cliff diving, mountain climbing, motor vehicle race and/or speed competition on land and/or water, parachuting or underwater activities, including scuba diving. CRITICAL ILLNESS INSURANCE WITH AUTOMATIC INCREASE IN INSURANCE AMOUNT AT AGE 25 - PREMIUMS PAYABLE FOR THE LIFETIME OF THE INSURED. Definitions The following definitions apply to Critical Illness Insurance under this Part. Blindness means the Diagnosis of permanent loss of sight in both eyes, as confirmed by a Physician who is a licensed ophthalmologist, whereby the corrected visual acuity must be worse than twenty over two hundred (20/200) in both eyes or the field of vision must be less than twenty (20) degrees in both eyes. Page 6 of 16

7 Cancer means the Diagnosis of all malignancy, which is characterized by the uncontrolled growth and spread of malignant cells and the invasion of tissue. This includes leukemia and Hodgkin s disease, but shall exclude: - Early prostate cancer, diagnosed as T1a or T1b or equivalent staging; - Non-invasive cancer in situ; - Stage 1A malignant melanoma (melanoma less than or equal to 1.0 mm in thickness, but ulcerated and without Clark level IC or V invasion; - any non-melanoma skin cancer that has not metastasized; - Pre-malignant lesions, benign tumors or polyps; - any tumor in the presence of any human immuno-deficiency virus (HIV); and - any skin cancer other than invasive malignant melanoma into the dermis or deeper. Covered Conditions means those medical conditions which are eligible for a Critical Illness Benefit pursuant to the terms of this Policy being Blindness, Cancer, Deafness, Heart Attack, Kidney Failure, Major Organ Transplant, Severe Burns, Stroke, Type 1 Diabetes Mellitus. Date of Diagnosis means the date on which a Physician diagnoses the Insured with one of the Covered Conditions and such date must be after the Effective Date of Insurance or the latest date of reinstatement of this Policy. Deafness means the Diagnosis of the total and irreversible loss of hearing in both ears, with an auditory threshold of ninety (90) decibels or greater within the speech threshold of five hundred (500) to three thousand (3,000) hertz. Diagnosis means the diagnosis by a Specialist. Effective Date of Insurance means the date shown in the Policy Schedule. Guaranteed Age 25 Critical Illness Amount means the amount set out in the Policy Schedule. Heart Attack means the Diagnosis of the death of a portion of the heart muscle, resulting from blockage of one or more coronary arteries, which Diagnoses must be based on the presence of all of the following: 1. Chest pain; 2. An electrocardiograph of the Insured which shows changes from any prior electrocardiograph of such Insured, or an electrocardiograph of the Insured itself, either of which support the diagnosis of a heart attack; and 3. Elevation of cardiac enzymes. Initial Critical Illness Amount means the amount set out in the Policy Schedule. Insured means the Insured shown in the Policy Schedule. Kidney Failure means the Diagnosis of irreversible failure of both kidneys which necessitates treatment by regular dialysis or kidney transplantation. Page 7 of 16

8 Major Organ Transplant means the Diagnosis of an 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 must undergo a transplantation procedure as the recipient of a heart, lung, liver, kidney or bone marrow, and limited to these entities. Physician means a person who is licensed and practising within the scope of his/her licence as a doctor of medicine (M.D.) and is not (a) the Insured; or related by blood or marriage to or in a business relationship with the Insured. Severe Burns means a Diagnosis of third-degree burns over at least twenty percent (20%) of the body surface. Specialist means a Physician who holds a licence of practice and a medical training specialized in the critical illness for which the benefit is required. In the event of non-availability of a Specialist, and subject to giraffe s approval, a critical illness can be diagnosed by a Physician. Stroke means the Diagnosis of a cerebrovascular incident causing infarction brain tissue, due to hemorrhage, thrombosis or embolism, producing a measurable neurological deficit persisting for at least thirty (30) days following the occurrence of the stroke, but shall exclude Transient Ischemic Attack (TIA). Type 1 Diabetes Mellitus means the Diagnoses of total insulin deficiency and continuous dependence on exogenous insulin for survival. Dependence on insulin must persist for a continuous period of at least ninety (90) days. Eligibility No Critical Illness Benefit will be payable under this Policy unless on the date of application for this Policy, the Insured was to the best of Your knowledge and belief not suffering from any serious injury, illness or disease and each of the following conditions have been met on the date of application: 1. You and the Insured are residents of Canada; 2. The statements made by You must be true and correct as at the date of application. Critical Illness Benefit If the Insured is subject to a Diagnoses of a Covered Condition while this Policy is in force and the Insured survives for: (i) all Covered Conditions other than Cancer, thirty (30) days following the Date of Diagnosis, and (ii) Cancer, ninety (90) days following the Date of Diagnoses, the Insurer will pay to the Beneficiary the amount of insurance noted below (the Critical Illness Benefit ). Subject to the terms of this Policy, prior to the Insured s twenty-fifth (25 th ) birthday, the amount of the Critical Illness Benefit is the Initial Critical Illness Amount set out in the Policy Schedule. On or after the Insured s twenty-fifth (25 th ) birthday, the amount of the Critical Illness Benefit is the Guaranteed Age 25 Critical Illness Amount set out in the Policy Schedule. Page 8 of 16

9 If a Diagnoses is made outside of Canada, we must be satisfied, based on the medical records we receive, that the same Diagnoses would have been made if the Covered Condition developed or was diagnosed in Canada. Automatic Increase of Insurance Amount On the Insured s twenty-fifth (25 th ) birthday, the Initial Critical Illness Amount will automatically be doubled to the Guaranteed Age 25 Critical Illness Amount with no increase in Premiums ( Additional Critical Illness Insurance ). Terms for Additional Critical Illness Insurance Additional Critical Illness Insurance will be on the same terms and conditions as this Policy. Additional Critical Illness Insurance will be issued subject to the following: 1. All premiums for the Policy must be paid up to the Insured s twenty-fifth (25 th ) birthday. 2. The date the Additional Critical Illness Insurance takes effect will be the day of the Insured s twenty-fifth (25 th ) birthday. Insurer s Liability Any illness or disorder not specifically identified as a Covered Condition will not be covered by this Policy and no benefit will be payable in respect thereof. Payment of the Critical Illness Benefit is limited to only the first Covered Condition to occur. If the Insured dies as a result of a Covered Condition, only one of the Life Benefit and the Critical Illness Benefit will be payable in accordance with the terms of this Policy. For greater certainty, under no circumstances will both a Life Benefit and a Critical Illness Benefit be payable under this Policy. Exclusions and Limitations for Critical Illness Insurance No Critical Illness Benefit will be paid under this Policy if the Critical Illness results directly or indirectly from any one or more of the following: 1. Attempted suicide; 2. Any Covered Condition diagnosed prior to the Effective Date of Insurance or the latest date of reinstatement of this Policy; 3. Taking poison or inhaling gas, whether voluntarily or involuntarily, not connected with the employment of the Insured; 4. Injury caused or contributed by war or any act of war, whether declared or not, or terrorism; 5. Epidemic or pandemic; 6. Nuclear incident, radioactive exposure/contamination 7. Flying as a flight attendant, student pilot or pilot; Page 9 of 16

10 8. Direct or indirect participation in a criminal act or any attempt to commit a criminal offense, including but not limited to, operating a motor vehicle while the concentration of alcohol in one hundred (100) millimeters of the insured's blood exceeds eighty (80) milligrams; 9. Self-inflicted injury while sane or insane; 10. Participation in a riot or civil commotion; 11. Active service in the armed forces of any country; 12. Chronic use of alcohol; 13. Drug use apart from controlled drugs as prescribed by and on the advice of a licensed physician; 14. Medical complications as a result of normal pregnancy, childbirth or termination of pregnancy; 15. The Insured is born more than one (1) month prematurely and Critical Illness occurs within the first six (6) months of birth; 16. Medical complications as a result of cosmetic or elective surgery; or 17. Amateur or professional boxing, bungee jumping, cliff diving, mountain climbing, motor vehicle race and/or speed competition on land and/or water, parachuting or underwater activities, including scuba diving. CHILD ACCIDENT INSURANCE Definitions The following definitions apply to this Policy. Accident means an unforeseen and unexpected event beyond the Policyholder s and the Insured s control occurring while this Policy is in force which causes Injury to the Insured. Broken Bone means a break in one of the following bones: femur, tibia, fibula, humerus, radius, ulna, sternum, pelvis, spine, bones of hand or foot (except fingers and toes), clavicle, patella, scapula. Broken Tooth means a break to any tooth. Effective Date of Insurance means the date shown in the Policy Schedule. Fracture means a fracture to one of the following bones: femur, tibia, fibula, humerus, radius, ulna, sternum, pelvis, spine, bones of hand or foot (except fingers and toes), clavicle, patella, scapula. Page 10 of 16

11 Injury means a Fracture, Broken Bone or Broken Tooth that is diagnosed by a Physician and that is caused directly and independent from all other causes by an Accident sustained by the Insured while this Policy is in force. Insured means the Insured shown in the Policy Schedule. Physician means a person who is licensed and practising within the scope of his/her licence as a doctor of medicine (M.D.) and is not the Insured; or related by blood or marriage to or in a business relationship with the Insured. Eligibility None of the Child Accident Benefit or the Emergency Out-of-Province / Country Accident Benefit will be payable under this Policy unless: (i) on the date of application for this Policy, to the best of Your knowledge and belief, the Insured is not suffering from any serious injury, illness or disease; (ii) on the date of application for this Insurance, the Insured is a resident of Canada; and (ii) on the date of an Accident, the Insured is over six (6) months of age and under twenty-five (25) years of age. Child Accident Benefit When the Insured, under the regular care and attendance of a Physician, and as a result of Injury requires and first receives treatment in the jurisdiction where the Insured resides within thirty (30) days from an Accident, the Insurer will pay a Child Accident Benefit under this Policy so as to reimburse the Policyholder for the reasonable out-of-pocket expenses associated with the Injury and incurred by the Policyholder within one year from the Accident. Such reasonable out-ofpocket expenses shall be limited to the following: a) Hospital services (including rental of television, wifi, electronic device to a maximum of $25.00 per day); b) Parking at the hospital up to a maximum of $20.00 per day; c) Meals up to a maximum of $30.00 per day; d) Ground or air ambulance service; e) The employment of a registered nurse or certified nursing aid if requested by the attending Physician; f) Reasonable and customary treatment by a chiropractor, osteopath, physiotherapist or registered massage therapist, when requested by the attending Physician, to an aggregate limit of $500.00; g) Rental of crutches and appliances, wheelchair, or hospital-type bed; h) Prescription drugs; i) Splints, trusses and braces requested by the attending Physician for curative or therapeutic purposes only (limited to one purchase only with respect to any one Injury); Page 11 of 16

12 j) Private tutoring; or k) Accommodations if the Policyholder s residence is located more than one hundred and sixty (160) kilometers away from the hospital where the Insured is being treated, up to a maximum of $300; The aggregate amount payable under the Child Accident Benefit is $1000 in each calendar year. The amount payable under the Child Accident Benefit will be less the amount allowed by any provincial health plan. If the Insured is entitled to similar benefits through any other insurer, the benefits payable under this insurance shall be co-ordinated so that the total benefits from all insurers shall not exceed the actual loss incurred. Emergency Out-of-Province / Country Accident Benefit When Injury occurs outside of the Insured s province of residence and requires emergency treatment of the Insured by a Physician, the Insurer will pay to the beneficiary under this Policy a benefit (the Emergency Out-of-Province/Country Accident Benefit ) in the amount of the expense actually incurred for: a) Hospital expenses; b) Diagnostic imaging as may be requested by the attending Physician; c) Laboratory services as may be requested by the attending Physician; d) Parking at the hospital up to a maximum of $20.00 per day; e) Meals up to a maximum of $30.00 per day; f) Ground or air ambulance service up to a maximum of $1,000; or g) Prescription drugs up to a maximum of $1,000. The maximum aggregate amount payable under the Emergency Out-of-Province/Country Accident Benefit is $20,000 per calendar year and $100,000 over the term of this Policy, less the amount allowed by any provincial health plan. If an Injury occurs outside of Canada, we must be satisfied, based on the medical records we receive, that the same diagnoses would have been made if the Injury occurred in Canada. If the Insured is entitled to similar benefits through any other insurer, the benefits payable under this insurance shall be co-ordinated so that the total benefits from all insurers shall not exceed the actual loss incurred. Exclusions and Limitations for Child Accident Insurance and Emergency Out-of-Province / Country Accident Benefit None of the Child Accident Benefit or the Emergency Out-of-Province / Country Accident Benefit will be paid under this Policy if death, Accident or Injury results directly or indirectly from one or more of the following: 1. Attempted suicide; Page 12 of 16

13 2. Taking poison or inhaling gas, whether voluntarily or involuntarily, not connected with the employment of the Insured; 3. Injury caused or contributed by war or any act of war, whether declared or not, or terrorism; 4. Epidemic or pandemic; 5. Nuclear incident, radioactive exposure/contamination 6. Flying as a flight attendant, student pilot or pilot; 7. Direct or indirect participation in a criminal act or any attempt to commit a criminal offense, including but not limited to, operating a motor vehicle while the concentration of alcohol in one hundred (100) millimeters of the insured's blood exceeds eighty (80) milligrams; 8. Self-inflicted injury while sane or insane; 9. Participation in a riot or civil commotion; 10. Active service in the armed forces of any country; 11. Chronic use of alcohol; 12. Drug use apart from controlled drugs as prescribed by and on the advice of a licensed physician; 13. Normal pregnancy, childbirth or termination of pregnancy; 14. The Insured is born more than one (1) month prematurely and Injury occurs within the first six (6) months of birth; 15. Cosmetic or elective surgery; or 16. Amateur or professional boxing, bungee jumping, cliff diving, mountain climbing, motor vehicle race and/or speed competition on land and/or water, parachuting or underwater activities, including scuba diving. No benefits or expenses are payable under this Policy for treatment or services which are insured services or basic health services (e.g. Physician's fees) under the provincial medical care or hospital plan applicable to the Insured, whether or not that person is covered thereunder. STATUTORY CONDITIONS The Statutory Conditions listed below are deemed to be part of the terms and conditions of this Policy as it relates to the Critical Illness Benefit, the Child Accident Benefit, and the Emergency Out-of-Province / Country Accident Benefit. The Contract: The application, this Policy, any document attached to this Policy when issued, and any amendment to the contract agreed upon in writing after the Policy is issued, constitute Page 13 of 16

14 the entire contract, and no agent has authority to change the contract or waive any of its provisions. Waiver: The insurer shall be deemed not to have waived any condition of this contract, either in whole or in part, unless the waiver is clearly expressed in writing signed by the insurer. Copy of Application: The insurer shall, upon request, furnish to the insured or to a claimant under the contract a copy of the application. Material Facts: No statement made by the insured or person insured at the time of application for this contract shall be used in defence of a claim under or to avoid this contract unless it is contained in the application or any other written statements or answers furnished as evidence of insurability. Notice of Proof of Claim: The insured or a person insured, or a beneficiary entitled to make a claim, or the agent of any of them, shall, (a) give written notice of claim to the insurer, (i) by delivery thereof, or by sending it by registered mail to the head office or chief agency of the insurer in the Province, or (ii) by delivery thereof to an authorized agent of the insurer in the Province, not later than thirty days from the date a claim arises under the contract on account of an accident, sickness or disability; (b) within ninety days from the date a claim arises under the contract on account of an accident, sickness or disability, furnish to the insurer such proof as is reasonably possible in the circumstances of the happening of the accident or the commencement of the sickness or disability, and the loss occasioned thereby, the right of the claimant to receive payment, his or her age, and the age of the beneficiary if relevant; and (c) if so required by the insurer, furnish a satisfactory certificate as to the cause or nature of the accident, sickness or disability for which claim may be made under the contract and as to the duration of such disability. Failure to Give Notice or Proof: Failure to give notice of claim or furnish proof of claim within the time prescribed by this statutory condition does not invalidate the claim if the notice or proof is given or furnished as soon as reasonably possible, and in no event later than one year from the date of the accident or the date a claim arises under the contract on account of sickness or disability if it is shown that it was not reasonably possible to give notice or furnish proof within the time so prescribed. Insurer to Furnish Forms for Proof of Claim: The insurer shall furnish forms for proof of claim within fifteen days after receiving notice of claim, but where the claimant has not received the forms within that time the claimant may submit his or her proof of claim in the form of a written statement of the cause or nature of the accident, sickness or disability giving rise to the claim and of the extent of the loss. Page 14 of 16

15 Rights of Examination: As a condition precedent to recovery of insurance money under this contract, (a) the claimant shall afford to the insurer an opportunity to examine the person of the person insured when and so often as it reasonably requires while the claim hereunder is pending; and (b) in the case of death of the person insured, the insurer may require an autopsy subject to any law of the applicable jurisdiction relating to autopsies. When Money Payable Other Than for Loss of Time: All money payable under this contract, other than benefits for loss of time, shall be paid by the insurer within sixty days after it has received proof of claim. FINANCIAL CONSUMER AGENCY OF CANADA If you have a concern and wish to make a complaint, please visit the giraffe & friends website at or call us toll free at for information on our Complaint Resolution process. Please note that consumers may contact the following federal agency in Canada at any time for information and assistance on complaints: Financial Consumer Agency of Canada 427 Laurier Ave. West, 6th Floor Ottawa, Ontario K1R 1B9 Website: Page 15 of 16

16 POLICY SCHEDULE Policyholder: Insured: Beneficiary: Age of Insured: Initial Life Amount: Guaranteed Age 25 Life Amount: Initial Critical Illness Amount Guaranteed Age 25 Critical Illness Amount Effective Date of Insurance: Policy Number: Premiums Values Monthly Quarterly Semi-Annual Annual Premium Period For Life Values shown in this table are for completed policy years. These values assume that premiums are paid for the number of years stated and that there is no indebtedness. The cash and loan values are for the Initial Life Amount. Values between policy anniversaries will be adjusted for any premiums paid and time elapsed during the year. Values for any policy years not shown in the table will be furnished on request. End of Policy Year Cash Value Loan Value Page 16 of 16