Eligibility

• In order for a member to be eligible for Basic Critical Illness coverage they must be currently participating in the NLTA Group Insurance Program.
• Subject to eligibility guidelines, NLTA members and employees residing in Canada are eligible to participate in this option.
• A 24 month pre-existing conditions clause applies.
• No benefit payable for cancer or benign brain tumor if symptoms or problems that give rise to the diagnosis of these conditions appear within the first 90 days of coverage or reinstatement of coverage.
• Member must survive at least 14 days after the date the diagnosis was made by a licensed physician.
• Coverage ceases upon retirement or attainment of age 65.
• Spousal/Dependent coverage is not available under this Option but is available under option CS/CC – Voluntary Critical Illness.
• Any NLTA member/employee may choose to remove him/herself from this option by contacting the Plan Administrator, Johnson Inc., to complete an Opting Out form. Subsequent to opting out or allowing coverage to lapse or terminate, should a teacher wish to rejoin this plan, an application will be required providing medical evidence of insurability to the insurance carrier.

Pre-existing Conditions Limitations Clause

It is important to note that this Critical Illness benefit has a 24-month Pre- existing Conditions Limitations clause. This limitation states that no benefit is payable for an illness or pre-existing condition for which the participant has received care, treatment or services, consulted a physician, or taken medication, in the 24 months prior to the effective date of coverage, unless the illness in question was diagnosed at least 24 months after the effective date of the insurance of the participant, subject to other applicable provisions of this policy.

Schedule of Benefits

The Basic Critical Illness coverage provides a benefit of $10,000 to NLTA Members and staff who are under age 65, actively at work, and currently participating in the NLTA Group Insurance Program.

Complete Policy Provision Exclusions and Limitations

Illnesses or conditions covered under this benefit

Aortic surgery
Aplastic anemia
Bacterial meningitis
Benign brain tumour
Blindness (loss of sight of both eyes)
Coma
Coronary artery bypass surgery
Deafness (loss of hearing in both ears)
Dementia including Alzheimer’s disease
Dilated cardiomyopathy
Fulminant viral hepatitis
Heart attack (myocardial infarction)
Heart valve replacement or repair
HIV infection (occupationally-acquired infection)
Kidney failure
Life-threatening cancer
Liver failure of advanced stage
Loss of independent existence
Loss of limbs
Loss of speech
Major burns (severe)
Major organ failure (on waiting list)
Major organ transplant
Motor neuron disease
Multiple sclerosis
Muscular dystrophy
Paralysis
Parkinson’s disease
Primary pulmonary hypertension
Progressive Systemic Sclerosis
Stroke (cerebrovascular accident)

These “new” conditions are effective May 1, 2022 and are considered at a reduced coverage level:
Coronary angioplasty
Crohn’s disease requiring surgery
Ductal carcinoma in situ of the breast
Hip or knee replacement surgery
Severe rheumatoid arthritis
Stage 1A malignant melanoma
Stage A (T1a or T1b) prostate cancer
Systemic lupus erythematosus