With advances in modern medicine, Canadians are enjoying longer and healthier lives. Increased life expectancy does, however, increase the risk of contracting or being diagnosed with a CRITICAL ILLNESS.
Critical Illness is designed to provide a LUMP SUM payment from $10,000 to $150,000 should you be diagnosed with one of the specified conditions (restrictions apply, please see definition for eligible conditions for details).
Check out the Critical Illness Benefit Brochure for a quick snapshot of this benefit.
Covered Conditions are those recognized within the medical profession as being of a critical nature. Advances in the medical knowledge and treatment of critical illnesses will evolve, and accordingly. Manulife Financial reserves the right to change the contract definitions for Conditions covered under any given Plan. All claims under this Policy shall be adjudicated using the definition of any Condition(s) that is in effect at the time the claim is incurred.
Check out the following definitions for those Conditions that are insured under the Manulife Financial Group Critical Illness plan.
You may enrol in the benefit if your employer offers this benefit, you are a permanent active employee who is employed for at least 40% of a regular work week and you are under the age of 70.
You may enroll your *spouse for coverage if he / she is under the age of 70. You don’t have to have Critical Illness coverage yourself to apply for coverage for your spouse.
You may enroll eligible **dependents for the Dependent Critical Illness coverage. You don’t have to have Critical Illness coverage yourself to apply for coverage for your children.
*Your spouse is defined as someone to whom you are legally married or common law and with whom you have cohabited for at least 12 months. This includes spouses of the same sex.
**Your dependent children are defined as natural, adopted, or step children who are under 21 years of age or under 26 years of age attending school on a full time basis, are unemployed, and unmarried.
You are not covered for a condition resulting directly or indirectly from anyone or more of the following:
- Self-inflicted injuries or illnesses, while sane or insane,
- Abuse of addictive substances, including but not limited to legal and illegal drugs and alcohol,
- War, insurrection, the hostile actions of any armed forces or participation in a riot or civil commotion,
- The committing of or the attempt to commit an assault or criminal offence,
- Injuries sustained while operating a motor vehicle, either while under the influence of any intoxicant or if the insured’s blood contained more than 80 milligrams of alcohol per 100 milliliters of blood at the time of the injury,
- Intentionally taking a poisonous substance or inhaling toxic gases or fumes,
- Any specific exclusion relating to any given condition as more particularly set out in the Covered Critical Illness Conditions.
- During the first 24 months of coverage, no benefit is payable for a condition that is directly or indirectly related to a pre-existing condition.
- For dependent children, no critical illness benefit will be paid in relation to a child who is born within the first ten (10) months of the child coverage, and who is diagnosed with a child covered condition within those ten (10) months.
- You must survive at least 30 days following the diagnosis of a covered condition (definitions of covered conditions) in order to receive the benefit.
- Completed claims forms (written proof of loss) must be submitted ninety days after date of diagnosis. Late claims are not payable.
- No benefit will be paid for cancer or benign brain tumour within the first 90 days of your coverage effective date.
- Other than Alzheimer’s disease all other organic brain disorders and psychiatric illnesses that result in dementia are specifically excluded.
- Surgery for the diseases of the branches of the thoracic aorta or abdominal aorta are specifically excluded.
- Tumours of the bony cranium and pituitary microadenomas (less than 10mm in diameter) are excluded.
- Some types of cancer are excluded.
- Medically induced comas are specifically excluded.
- Heart attack is not included and no benefit shall be payable for an incidental finding of ECG changes suggesting a prior myocardial infarction, in the absence of a corroborating event.
- Heart valve repair is specifically excluded.
- All psychiatric related cause to loss of speech are specifically excluded.
- A major organ transplant is not covered for a transplantation that is not medically necessary is specifically excluded.
- Some exclusions apply to occupational HIV Infection.
- All psychiatric related causes for paralysis are specifically excluded.
- All types of Parkinsonism other that than the type described in the policy are excluded.
- Transient ischemic attacks (TIA) are specifically excluded.
- Critical Illness benefits are currently treated as non-taxable benefits. This status may change subject to a ruling by the Canada Revenue Agency (CRA).
A pre-existing condition is an illness or injury for which the insured person has exhibited signs or symptoms, received medical treatment, care or services (including diagnostic measures), consulted a Physician or has been prescribed medication; or where treatment would have been sought by a prudent individual during the 24 months prior to the effective date of coverage or the latest date of reinstatement for this benefit.
Unless you and/or your spouse submit a medical questionnaire and are approved for coverage by the insurer, Critical Illness benefits are not payable during the first 24 months for conditions resulting directly or indirectly from a pre-existing condition. This exclusion applies whether or not the Insured person was aware of the pre-existing condition or had received a diagnosis prior to the effective date of coverage or the latest date of reinstatement for this benefit.
If you have a child born within ten (10) months of the effective date of child coverage, and that child is diagnosed with any condition within those ten (10) months, no benefit will be paid for that condition.,
Generally, insurance is intended to provide protection from future risks. Your Critical Illness Benefit is intended to provide you with a lump sum payment in the event of a covered future illness.
If you are diagnosed within the first 24 months of coverage with a covered condition that is not related to a pre-existing condition and all other contractual provisions are met, benefits would be payable. The claim would still be investigated for a pre-existing condition. However, the exclusion would not apply if medical evidence supports the finding that the current diagnosis and any pre-existing conditions are unrelated.
The Critical Illness benefit is payable if one of the following conditions is diagnosed (restrictions apply; please see Adult Covered Critical Illness Condition Definitions for details on any limitations to benefit payment):
- Alzheimer's Disease
- Aortic Surgery
- Benign Brain Tumour
- Coronary Artery Bypass Surgery
- Heart Attack
- Heart Valve Replacement
- Kidney Failure (End Stage Renal Disease)
- Loss of Limbs
- Loss of Speech
- Major Organ, Bone Marrow Failure on Waiting List
- Major Organ or Bone Marrow Transplant
- Motor Neuron Disease
- Multiple Sclerosis
- Occupational HIV infection
- Parkinson's Disease
- Severe Burns
- Stroke (Cerebrovascular Accident - CVA)
In addition to the adult illnesses, the following childhood conditions are covered (restrictions apply; please see Child Covered Critical Illness Condition Definitions for details on any limitations to benefit payment):
- Cerebral Palsy
- Congenital Heart Disease (certain conditions apply)
- Cystic Fibrosis
- Down’s Syndrome
- Muscular Dystrophy
- Type 1 Diabetes Mellitus (Juvenile Diabetes)
Coverage is available for you and/or your spouse in units of $5,000, with a minimum of $10,000 and a maximum of $150,000. Proof of good health is not required for the first $25,000(pre-existing may apply), but you must provide proof of good health and be approved by the insurer for all amounts greater than $25,000.
If you enroll for Dependent Critical Illness, coverage is available for your children in the amount of $10,000 per child (pre-existing may apply).
You don’t have to have Critical Illness coverage yourself to apply for coverage for your spouse and/or children.
Monthly Rates per $5,000 of Principal Sum:
Any misrepresentation of smoker status on your application for you or your spouse will be deemed fraudulent and coverage will become void.
Age, gender and smoker status determine the unit rates that apply to you and/or your spouse. Multiply the unit rates by the number of $5,000 units of insurance selected for both you and/or your spouse.
Example: If both you and your spouse should participate and each of you select $25,000 of principal sum the following would be your premium:
Your premiums are paid through Payroll Deduction.
Contact your Benefits Administrator to complete a Group Benefits Enrollment Form or a Benefits Change Form.
Coverage for the first $25,000 or less does not require proof of good health and coverage starts the date your employer receives your application.
If you apply for an amount greater than the medical evidence free amount, coverage for this particular amount starts the date the insurer approves the medical evidence free amount.
You must be considered actively at work for coverage to begin. If you are not actively at work the coverage will take effect on the next day on which you are considered actively at work.
The Principal Sum payable in the event of a Critical Illness will be payable to you, the Employee, or the Employee’s Estate.
You and/or your spouse's insurance coverage will stop on the earliest of the following dates:
- The date you, the employee, no longer satisfies the definition of employee,
- The date your employer terminates your coverage,
- The date you enter the armed forces of any country on a full-time basis,
- The date this Group Policy terminates or insurance on the classification to which you the employee belongs terminates,
- The date you retiree,
- The date you reach age 70,
- The date the critical illness benefit is paid out.
To submit a Critical Insurance claim, you must complete the Critical Illness Notice of Claim Form which is available from your Benefits Administrator or from the Health Association website at www.healthassociation.ns.ca/benefits/forms
Documents necessary to submit with the form are listed on the form.
Written notice of the claim must be submitted within ninety (90) days of the first diagnosis of the condition.
Manulife Financial will apply the following criteria in determining your entitlement to Critical Illness Benefits:
- Medical evidence documenting your diagnosis of a covered Critical Illness condition;
- The diagnosis of any Critical Illness made by a Physician, practicing medicine in Canada in a specialty relating to the applicable Critical Illness.
At any time, Manulife Financial may require you to submit to a medical examination or evaluation by an examiner selected by Manulife Financial.
In addition to the critical illness coverage, Manulife provides you and your eligible dependents with access to Health Service Navigator (HSN), a comprehensive, integrated health information and online resource centre.
Health Service Navigator:
- Provides a resource to help you navigate the Canadian health care system,
- Is aaccessible to you and your eligible family members,
- Is available even when you are not making a critical illness claim, and
- Provides access to a world-class medical second opinion service.
- Visit www.healthservicenavigator.com/insurance
- Click on the Register button and follow the online instructions.
- You will be asked to enter the Critical Illness Insurance Policy number, which is 87916,
- You will be asked to enter your Member Certificate Number. If you are a member of our Health and/or Dental Plan with Manulife, you will find your certificate number on your benefits card. If not, please call Health Association Nova Scotia, Group Benefits Solutions toll-free at 1-866-886-7246 and we will provide you with your certificate number.