PSAC Critical Illness Insurance - Policy Information
Limitations
Cancer limitation. There is a waiting period for cancer and ductal carcinoma in situ (DCIS) claims. No benefit is paid if an insured person is diagnosed within the first 90 days after the effective date of the insurance or the effective date of the last reinstatement of the policy. Within this exclusion period, there shall be no coverage for cancer or ductal carcinoma in situ if a diagnosis of either DCIS or any other type of cancer, whether included or excluded in the contract, is made or if any symptoms or medical problems manifest themselves which, or the persistence or recurrence of which, subsequently results in an investigation leading to the diagnosis of cancer or DCIS. In the event of any such diagnosis, the policy will remain in force but cancer or ductal carcinoma in situ will no longer be considered an insured condition, except for a subsequent diagnosis of unrelated cancer.
Occupational HIV infection limitation: No critical illness benefit will be payable:
- for HIV infection resulting from or transmitted by any other means, including but not limited to sexual activity or intravenous drug use;
- if the insured elected not to take any available vaccine before becoming infected; or
- if a cure for HIV has become available prior to the accidental injury.
ACE INA Life Insurance reserves the right to have the insured tested at a facility of its choice to confirm the insured’s HIV status.
Single sum benefit will be paid upon diagnosis of a covered illness or injury and survival after 30 days (365 days for paralysis, and a 90-day waiting period for cancer applies).
Exclusions
The policy does not provide benefits for any claim caused directly or indirectly by or resulting from any one of the following:
- intentionally self-inflicted injury, suicide or any attempt there at, whether sane or insane;
- declared or undeclared war or any act thereof;
- for injury or sickness, other than one of the specified coverages, even though such injury or sickness may have been complicated by one of the specified coverages;
- a complication of Human Immunodeficiency Virus (HIV) infection or any variance thereof, including AIDS and AIDS Related Complex, except as noted under the Occupational HIV section;
- the use, existence or escape of nuclear weapons, material or ionizing radiation from or contamination by radioactivity from any nuclear fuel or waste from the combustion of nuclear fuel;
- the commission or attempted commission by the insured person of any act that, if adjudicated by a court, would be an illegal act under the laws of the jurisdiction where the act was committed; and/or
- misuse of medication or the abuse of drugs or intoxicants.
Definitions
Alzheimer’s disease: means the diagnosis that the insured has Alzheimer’s disease, which is a progressive degenerative disease of the brain. The diagnosis must be supported by medical evidence that the insured exhibits the loss of intellectual capacity resulting in impairment of their memory and judgement, which results in a significant reduction in their mental and social functioning, such that they require permanent daily personal supervision for the activities of daily living. All other dementing organic brain disorders and psychiatric illnesses are excluded from this insured condition definition. A physician who is certified as either a neurologist or a psychiatrist must confirm diagnosis in writing.
Amyotrophic lateral sclerosis: means unequivocal diagnosis of ALS resulting in the inability to perform three of the six activities of daily living without assistance. A physician who is certified as a neurologist must confirm diagnosis in writing.
Aorta surgery: means surgery to the aorta that is medically required to treat disease of the aorta and that involves the excision and surgical replacement of the diseased aorta with a graft. The aortic surgery must be performed on the prior written advice of a physician certified as a cardiovascular surgeon. Aorta includes the thoracic and abdominal aorta but does not include any of the branches of the aorta.
Benign brain tumor: means a benign neoplasm in the brain or meninges with histologic confirmation. Cysts granulomas, malformations of intracranial arteries or veins, and tumours or lesions of the pituitary are specifically excluded. The diagnosis must be confirmed neuro-radiologically by a specialist trained in the interpretation of radiological investigations.
Blindness: means the total and irrecoverable loss of sight in both eyes due to injury or sickness. Corrected visual acuity must be 20/200 or less in both eyes and the field of vision must be less than 20 degrees in both eyes. A physician certified in ophthalmology, must clinically confirm the diagnosis in writing.
Cancer: means a malignant tumor characterized by the uncontrolled growth and spread of malignant cells and invasion of tissue. This includes Leukemia, Hodgkin’s Disease and invasive melanoma but does not include:
- carcinoma in situ;
- Kaposi's Sarcoma (or other AIDS related cancers) and cancer in the presence of human immunodeficiency virus (HIV), except as noted under the Occupational HIV section;
- skin cancer or melanoma that is not invasive and has not exceeded .75 millimetres in depth;
- prostate cancer diagnosed as T1N0M0 or equivalent staging.
A physician certified as an oncologist must confirm diagnosis in writing.
Coma: means the insured has been in a state of unconsciousness for a continuous period of at least 96 hours, during which external stimulation produced no more than primitive avoidance reflexes. A physician who is certified as a neurologist must confirm diagnosis in writing.
Coronary artery by-pass surgery: means surgery performed by a physician who is certified as a cardiovascular surgeon to correct narrowing or blockage of one or more coronary arteries with bypass grafts. Non-surgical techniques such as balloon angioplasty, laser relief of an obstruction, or other intra-arterial techniques will not be considered to be a covered critical illness.
Deafness: means the diagnosis of permanent loss of hearing in both of the insured’s ears, with an auditory threshold of more than 90 decibels in each ear. A physician, who is certified as an otolaryngologist must confirm diagnosis in writing.
Ductal Carcinoma In Situ (DCIS): means the diagnosis by a licensed Physician, of the presence of Ductal Carcinoma in Situ of the breast, as confirmed by biopsy. A Physician certified as an oncologist must confirm the diagnosis in writing.
Heart attack: means the death of a portion of heart muscle as a result of inadequate blood supply to the relevant area. Diagnosis must be confirmed in writing by a Physician who is a certified specialist in internal medicine or cardiologist and should be based on new electrocardiograph changes consistent with heart attack and at least one of the following; elevation of cardiac biochemical markers or elevation in cardiac enzyme, to levels consistent with heart attack.
Heart attack does not include elevation of cardiac biochemical markers or elevation of cardiac enzymes due to coronary angioplasty unless accompanies by diagnostic changes of a new Q wave infarction on the ECG.
Loss of independence: means the definitive diagnosis by a licensed Physician of either:
- Being totally and permanently unable to perform, by oneself, at least two of the six activities of daily living; or,
- Cognitive impairment.
A mental or nervous disorder without a demonstrable organic cause is not covered. Loss of independence must persist for at least 90 days from the date of the diagnosis.
Major organ failure: means the irreversible failure of the entire heart, entire liver, both lungs, both kidneys or bone marrow, in which the affected organ is unresponsive to any treatment and for which the insured is medically required to become enrolled in a recognized Canadian transplant program to become the recipient of a heart, a liver, a lung, or a kidney or to receive a bone marrow transplant.
Multiple sclerosis: means the unequivocal written diagnosis by a physician who is certified as a neurologist confirming at least moderate persisting neurological abnormalities, with impairment of function, but not necessarily confining the insured to a wheelchair or bed.
Occupational HIV infection: means infection with the human immunodeficiency virus (HIV) directly caused by accidental injury in the course of the insured’s normal occupation in Canada or the United States of America. A diagnosis of HIV infection must be made by a physician. To qualify for the critical illness benefit, the insured must satisfy all of the following:
- the accidental injury leading to the infection must have occurred after the later of the effective date and the date of the last reinstatement if the policy lapsed and was reinstated;
- the accidental injury must be reported to us in writing within 14 days of its occurrence;
- an HIV test must be taken within 14 days following the accidental injury and the result must be negative;
- a follow-up HIV test must be taken between 90 and 180 days following the accidental injury and the result must be positive; and
- the accidental injury has been reported, investigated and documented in accordance with prudent workplace practices and any applicable legislation, regulations or guidelines.
Non-smoker: means someone who has not used cigarettes, cigarillos, cigars, a pipe, chewing tobacco or any products that are nicotine based (patches, chewing gum, etc..) during at least 12 months prior to the date of enrolment.
Paralysis: means the total and irrecoverable loss of function of two or more limbs through neurological damage due to injury or sickness, provided such loss of function continually lasts for 365 consecutive days and such loss of function is thereafter determined on evidence satisfactory to ACE INA Life Insurance to be permanent. A physician certified as a neurologist must confirm diagnosis in writing.
Parkinson’s disease: means unequivocal diagnosis of primary idiopathic Parkinson’s disease resulting in the inability to perform three of the six activities of daily living without assistance. Diagnosis should show signs of progressive impairment and must be confirmed in writing by a physician who is certified as a neurologist.
Severe burns: means the Insured has third degree burns covering at least 20 per cent of the surface area of their body. A physician who is certified as a plastic surgeon must confirm diagnosis of this condition in writing.
Stroke: means that the insured has suffered a cerebrovascular incident, excluding transient ischemic attack (TIA), producing infarction of brain tissue due to thrombosis, hemorrhage from an intracranial vessel or embolization caused by an extracranial source. There must be evidence of permanent neurological deficit persisting for 30 consecutive days, supported by evidence that the deficit is resulting from the stroke, confirmed in writing by a physician who is certified as a neurologist.
The ACE INA Life Insurance Company underwrites PSAC critical illness insurance coverage.
ACE INA Insurance and ACE INA Life Insurance are members of the ACE Group of Companies. The ACE Group of Companies is one of the world’s leading insurance and reinsurance organizations. Their strong capital base, financial stability, diversified earnings stream and multinational operating platform are strong indicators that they are strategically well positioned for future growth and development.
The ACE Group of Companies is committed to being a leader in the international insurance and reinsurance market and is dedicated to providing:
Superior client value by committing substantial capital resources and creativity to the assumption and management of risk.
Superior shareholder value by managing capital and risks expertly, efficiently and profitably.
Superior employee value by creating a rewarding and ethical environment.
The company’s Canadian headquarters are based in Toronto.
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