Basic

Current Underwriter (2020) - SSQ Insurance Company Inc.
Policy Number: 1FX45

ELIGIBILITY

Subject to eligibility guidelines, NLTA members and employees residing in Canada are eligible to participate in this plan.

Any NLTA member/employee may choose to remove him/herself from this plan 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.

COVERAGE

The amount of insurance with respect to each eligible member/employee is:

  1. Member/Employee: Two times annual salary/pension rounded to the next higher multiple of $1,000 if not already a multiple of $1,000, to a maximum of $400,000.
  2. Replacement and Term Contract Teacher: The amount of insurance for term contract/replacement teachers for the term of their contract period is two times annual salary rounded to the next higher multiple of $1,000, if not already a multiple of $1,000, to a maximum of $400,000. After the end of the contract period, these teachers are eligible for $15,000 coverage as a substitute teacher until November 30 of the following year.
  3. Substitute Teachers’ Plan: $15,000 members only.
  4. NLTA Members Teaching in Private Schools: $15,000 members only.

EXCLUSIONS

No benefit will be paid for any loss, fatal or non-fatal, caused or contributed to by:

  1. self-inflicted injuries, suicide or attempted suicide, whether the Insured Person was sane or insane;
  2. war whether declared or undeclared, and whether or not the Insured Person was actually participating therein;
  3. civil commotion, riot, insurrection, armed conflict if the Insured Person was participating therein;
  4. the Insured Person’s service, whether as a combatant or noncombatant, in the armed forces of any country;
  5. the Insured Person riding as a passenger or otherwise in any vehicle or device for aerial navigation, other than as provided in the section entitled “Aircraft Coverage”;
  6. medical treatment or surgery on the Insured Person, except if the medical treatment or surgery was needed because of an Accident.

CLAIMS PROCEDURE

To make a claim, the insured or insured’s beneficiary should notify the
Plan Administrator, Johnson Inc., immediately after an accident. The Plan Administrator, Johnson Inc., must provide written notice of claim to the underwriter within thirty (30) days from the date of the accident and written proof of loss must be submitted to the underwriter within ninety (90) days after the date of such loss. Failure to submit such proof within the time required shall not invalidate nor reduce any claim if it was not reasonably possible to give proof within such time, provided such proof is furnished as soon as reasonably possible; but in no event later than one (1) year after the date of accident.

In the event of accidental death, the Accidental Death benefit shall be payable to the beneficiary or beneficiaries designated by the insured on the most recent enrollment form under this policy. If there is no such beneficiary designation, the benefit shall be payable to the beneficiary or beneficiaries designated under the Basic Group Life Insurance. In the event that there is no beneficiary designation under this policy and the NLTA Group Insurance Program Basic Group Life policy, the Accidental Death benefit shall be payable to the estate. All other benefits payable other than “Education Benefit” and “Day-Care Benefit” are payable to the insured.

Conversion to an Individual Insurance Contract

In the event your coverage is terminated because:

  1. you cease to be an active person of the Policyholder on account of resignation, dismissal, retirement, or failure to return to work for the Policyholder following a period of total disability; or
  2. you cease to be an eligible person under the Policy.

The benefits provided will be set out in a Specific Loss Accident Indemnity schedule available from the Insurer at the time of conversion, and the amount of insurance that may be converted will not exceed the lesser of:

  1. the amount of insurance then in effect on the date of termination; or
  2. a total aggregate amount of five hundred thousand dollars ($500,000) for all such conversions by any insured person. Premiums for such an individual accident policy being issued in compliance with the aforementioned condition will be calculated at the Insurer’s rates then in force for your attained age at the date of conversion.

Premiums will be payable annually in advance and the accident policy will be issued on an annually renewable basis.

Termination

Insurance for the Insured Person will cease on the earliest of the following events:

  1. On date insured turns age 65.
  2. For those teachers who resign during school year and cease to be NLTA members, coverage will cease on the effective date of resignation.
  3. For those teachers on replacement/term contract coverage will cease at the end of the contract period.
  4. Termination of employment, other than retirement under the provisions of the eligibility guidelines.
  5. On the date of death.
  6. On the day the Insured Person enters the armed forces of any country on a full-time basis.
  7. Termination of the Policy or eligibility of coverage.
  8. On the date the Insured Person no longer pays the required premium towards the cost of insurance, where applicable.
  9. On the date the Insured Person reaches age 75.
  10. For substitute teachers, on November 30th of the following school year if, during the preceding three months, the substitute teacher has not taught at least one day, and has not taught at least 10 days in the previous school year.
  11. For private school teachers, coverage terminates upon termination of the teaching contract.

SCHEDULE OF BENEFITS

The insurance includes benefits for Accidental Death, Dismemberment, Loss of Speech and/or Hearing, Paralysis and Loss of Use, any of which are caused by accident.

Specific Loss Accident Indemnity
If within one year from the date of the accident, injury results in any of the following specific losses, the underwriter pays the percentage set opposite such loss for injury resulting from an accident. Each sum is calculated based on the amount of insurance.

Additional Benefits...

Schedule of Benefits

Maximum Amount

Assault
10% of amount insured (max. $25,000)
Bereavement
6 grief sessions to a max. $2,500
Brain Damage
Amount of Insurance (less other AD&D benefits paid)
Carjacking
10% of amount insured (max. $10,000)
Comatose
Amount of Insurance (less other AD&D benefits paid)
Cosmetic Disfigurement
Amount of Insurance
Critical Illness Benefit
Maximum $2,000 (Basic AD&D only)
Day Care
5% of amount insured (max. $5,000)
Education
5% of amount insured (max. 5,000)
Exposure and Disappearance
Specific Loss Accident Indemnity or Principle Sum
Family Transportation
Maximum $15,000
Funeral Expenses
Maximum $5,000
Home Alteration and/or Vehicle Modification
Maximum $20,000
Identification
Maximum $25,000
Hospital Indemnity
Maximum $2,500 per month
Occupational Training
Amount of Insurance (less other AD&D benefits paid)
Psychological Therapy
12 sessions to a max. $5,000
Public Transportation
Maximum 100% of Amount of Insurance
Rehabilitation
Maximum $20,000
Repatriation
Maximum $25,000
Seat Belt
25% of the Specific Loss Accident Indemnity
Workplace Modification and Accommodation
Maximum $10,000

Maximum Amount:

Assault
0% of amount insured (max. $25,000)
Bereavement*
6 grief sessions (max. $2,500)
Brain Damage
Amount of Insurance
(less other AD&D benefits paid)
Carjacking
10% of amount insured (max. $10,000)