Voluntary

Current Underwriter (2020) - Desjardins Financial Security
Policy Number: 70671

Eligibility

Subject to the eligibility guidelines, NLTA members and employees residing in Canada are eligible to participate in this option providing they are a member of the NLTA Group Insurance Program. Note: In order for active teachers to be eligible to apply for Voluntary Critical Illness insurance benefits they must be enrolled in the $10,000 Basic Critical Illness Insurance Benefit.

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 that was prescribed to him/her, 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.”

Termination of Benefits

  • Voluntary Critical Illness insurance has no waiver of premium clause. Member must continue paying the applicable premium to maintain coverage when on an approved leave of absence.
  • After a lump-sum benefit has been paid, the Voluntary coverage (Basic or Voluntary) terminates and no additional premiums are payable.
  • Plan member’s coverage will terminate for the Voluntary Critical Illness benefit on the earlier of:
    • the plan member’s 65th birthday
    • Termination of Policy or eligibility of coverage
    • the date on which the insurance company pays a benefit for a covered critical illness under your group contract
  • Spousal coverage will end on the earlier of:
    • the insured spouse’s 65th birthday
    • Termination of Policy or eligibility of coverage
    • the date on which the insurance company pays a benefit for a covered critical illness under your group contract
  • The dependent child coverage will end on the earlier of:
    • The plan member’s 65th birthday
    • Termination of Policy or eligibility of coverage
    • The date on which the insurance company pays a benefit for a covered critical illness under your group contract

Conversion Option for Option CV/CS

Your group contract includes a conversion privilege clause that allows you and your spouse to convert your group Critical Illness insurance to an individual contract when your group coverage ends (age 65) or if you decide to terminate your group benefits. This individual Critical Illness insurance will terminate when you turn 70. To avail of the Conversion Privilege, you must contact the insurance company within 31 days of the termination of your Critical Illness benefit.

Restrictions, Exclusions and Limitations

  1. No benefit is payable for any Critical Illness resulting directly or indirectly from any of the following:
    1. intentionally self-inflicted injury, voluntary exposure to an Illness, or attempted suicide while sane or insane;
    2. war, whether declared or not, active service in the armed forces of any country or participation in a riot, insurrection or civil commotion;
    3. committing or attempting to commit a criminal offence;
    4. alcohol abuse;
    5. the use of any medication, narcotic, intoxicant or any other harmful substance, except when prescribed or recommended by a Physician.
  2. No benefit is payable for the following:
    1. an Illness or pre-existing condition for which the Participant has received care, treatment or services, consulted a Physician, or taken medication that was prescribed to him, 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;
    2. paralysis, paraplegia, hemiplegia, or quadriplegia resulting directly or indirectly from the practice of one or more of the following activities: amateur or professional boxing, bungee jumping, cliff diving, mountain climbing, car racing or speed races on land or water, parachuting, or underwater activities;
    3. transient cerebral ischemia;
    4. all types of parkinsonism other than idiopathic and degenerative Parkinson’s disease;
    5. non-surgical techniques such as balloon angioplasty or the correction of an occlusion using laser treatment or any other non-bypass technique;
    6. organic brain syndromes and psychiatric disorders other than Alzheimer’s disease;
    7. lesser acute coronary syndromes including unstable angina and acute coronary insufficiency;
    8. spina-bifida occulta.
  3. Restrictions, exclusions, and limitations related to cancer diagnosis. This Benefit does not apply when cancer is diagnosed within 90 days of the effective date of coverage or last reinstatement of coverage or when the medical symptoms or problems giving rise to the diagnosis of cancer appeared during this initial 90-day period. In addition, no benefit is payable for the following forms of cancer:
    1. early prostate cancer, diagnosed as T1A N0 M0 and T1B N0M0 or equivalent staging;
    2. non-invasive cancer in situ;
    3. precancerous lesions, benign tumours, or polyps;
    4. any tumour that develops in a person who is HIV seropositive;
    5. any skin cancer other than invasive malignant melanoma greater than 0.75 mm.
  4. Restrictions, exclusions, and limitations related to diagnosis of HIV infection. Benefits are payable provided that the following conditions are met:
    1. the Insured Person (or the Policyholder) must inform the Insurer of any Accident or injury that could result in HIV infection within 14 days of the event;
    2. within 14 days of the Accident or injury, the Insured Person must undergo blood tests confirming that he is HIV seronegative;
    3. an HIV test must be taken between 90 days and 180 days after the accidental injury and the result must be positive;
    4. the accidental injury must have been reported, investigated, and documented in accordance with workplace legislation and regulations;
    5. the Insurer may require that all blood samples taken be provided so they can be analyzed by an independent lab and may request any other blood test that it deems appropriate;
    6. if an HIV vaccine becomes available, no benefits will be paid to an Insured Person who has an Accident or is injured on the job and who previously refused to be vaccinated. In addition, no benefits will be payable if a cure for HIV became available prior to the Accident or injury giving rise to the claim. HIV infections resulting from any cause not related to the Insured Person’s work, such as sexual activity or drug use, are not covered under this Benefit.

Notice and Proof of Claim

Before settling any claim under this Benefit, the Insurer will require satisfactory written proof of the existence of the relevant Illness and of the Insured Person’s eligibility for benefits at the time the diagnosis was made.

A written initial notice of claim must be submitted to the Insurer within 30 days of the event.

The Insurer reserves the right to verify the diagnosis with the attending Physician(s) and to require any Insured Person who has submitted a claim to be examined at the Insurer’s expense.

Proof of claim related to an accident or injury that may result in HIV infection.

A written notice of claim must be submitted to the Insurer within 14 days of the Accident or injury.

The Insured Person (or the Policyholder) must notify the Insurer of the Accident or injury, which will then be investigated and a report produced in accordance with the established procedures for the occupation in question.

Schedule of Benefits:

The Voluntary Critical Illness for NLTA members and staff provides the following benefits:

  • Plan members – Units of $10,000 to a maximum of $300,000
  • Spouse – Units of $10,000 to a maximum of $300,000
  • Dependent child(ren) – $5,000 maximum
  • A $50,000 non-evidence maximum. However, the Pre-existing Conditions Limitations Clause applies

Illnesses or conditions covered under option CV/CS

Conditions covered under the extended coverage

% payable

Alzheimer’s disease
100%
Aortic surgery
100%
Aplastic anemia
100%
Bacterial meningitis
100%
Benign brain tumour
100%
Blindness (loss of sight of both eyes)
100%
Coma
100%
Coronary bypass
100%
Deafness (loss of hearing in both ears)
100%
Dilated cardiomyopathy
100%
Fulminant viral hepatitis
100%
Heart attack (myocardial infarction)
100%
Heart valve replacement
100%
HIV infection (occupationally-acquired infection)
100%
Kidney failure
100%
Life-threatening cancer
100%
Liver failure
100%
Loss of independent existence
100%
Loss of limbs
100%
Loss of speech
100%
Major burns (severe)
100%
Major organ failure (on waiting list)
100%
Major organ transplant
100%
Motor neuron disease
100%
Multiple sclerosis
100%
Muscular dystrophy
100%
Paralysis
100%
Parkinson’s disease
100%
Primary pulmonary hypertension
100%
Progressive Systemic Sclerosis
100%
Stroke (cerebrovascular accident)
100%

Illnesses and conditions covered under Option CC – Dependent Child

To provide additional security for parents, dependent children are covered for 22 illnesses or conditions, some of which are often diagnosed early in life. The Dependent Child benefit is a flat $5,000 and covers all eligible dependent children.

Conditions covered under the extended coverage

% payable

Aortic surgery
100%
Benign brain tumour
100%
Blindness (loss of sight of both eyes)
100%
Cancer
100%
Cerebral palsy
100%
Coma
100%
Congenital heart disease requiring surgery
100%
Cystic fibrosis
100%
Deafness (loss of hearing in both ears)
100%
Down’s syndrome
100%
Heart valve surgery
100%
Kidney failure
100%
Liver failure
100%
Loss of limbs
100%
Loss of speech
100%
Major organ failure (on waiting list)
100%
Major organ transplant
100%
Progressive Systemic Sclerosis
100%
Serious cerebral lesion
100%
Serious mental deficiency
100%
Spina bifida cystica
100%