|
Disability Waiver of Premium
This rider is intended to waive premiums for the policy (including any riders) under certain circumstances.
After the insured has been disabled for 90 consecutive days, we will pay premiums that come due while the insured is disabled. We will also refund premiums paid during those first 90 days. Disabled means the insured is unable to perform any occupation for which they are reasonably suited by education, training or experience.
Provided policy premiums are not being waived under this rider on the insured’s 65th birthday, this rider will terminate on that date. If premiums are being waived on the insured’s 65th birthday, we will continue to waive the premiums until the earlier of the termination of the policy or when the insured no longer meets the definition of disability under this rider.
This rider is subject to the Exclusions that are set out in the policy for which it is issued with.
Functional Independence
This rider provides financial protection for some of the ongoing costs that may be associated with severely debilitating medical problems that are not caused by one of the covered critical illnesses.
After satisfying the 60 day elimination period, we will pay 1/60th of the Total Benefit Amount each month the insured is:
| 1. |
Unable to perform two or more of the 6 Activities of Daily Living (ADL) in their normal living environment without substantial daily physical assistance from another person. If home modifications and/or adaptive devices or equipment enable them to perform an ADL without assistance, they will not be considered unable to perform that ADL; or |
| 2. |
Cognitively impaired, meaning they have suffered a severe impairment of cognitive functioning or intellectual capacity that has left them dependent on another adult person’s continuous presence, stand-by assistance and verbal cueing to ensure their safety or the safety of others. |
The 6 ADL’s are:
 |
Bathing |
|
Dressing |
|
Toileting |
|
Transferring (for example from chair to bed) |
|
Continence |
|
Eating |
Benefits are paid to the insured, unless the owner has declared otherwise.
Any amounts paid under this rider will reduce the Critical Illness benefit that is payable. Once the Total Benefit Amount has been paid under this rider or the policy, the policy and all riders will terminate. Provided the insured is not satisfying the elimination period or receiving Functional Independence benefits, this rider will terminate on the insured’s 65th birthday.
Exclusions
This rider is subject to the Exclusions that are set out in the policy for which it is issued with.
Return of Premium on Expiry
This rider is intended to provide for the return of some or all of the premiums which were paid for the policy (including any riders) in certain circumstances if the policy was in force on the expiry date of the policy.
We will pay a return of premium on expiry benefit to the policyowner, if the policy is in force on the expiration date of the policy (the insured’s 65th or 75th birthday, depending on the plan type selected) and there is no critical illness benefit or functional independence rider benefit payable or pending.
The return of premium benefit is equal to the lesser of:
|
the face amount of the policy; and |
|
the premiums paid under this policy (including riders and ratings) while this rider was in force. |
It will be reduced by any premiums waived or refunded (if the Disability Waiver of Premium rider is purchased) and any benefits paid under the Functional Independence rider (if purchased).
Termination of this Rider
This rider will terminate at the earliest of:
| 1. |
when the policy terminates; or, |
| 2. |
the insured’s 65th or 75th birthday (depending on plan type selected) |
Cost of Living Adjustment Benefit
The Cost Of Living Adjustment (COLA) Benefit is an optional benefit that keeps inflation from eroding the Long Term Care Benefit the insured receives for either facility or home care. After the insured has been receiving Long Term Care Benefits for 12 consecutive months, the daily benefit will be increased by the cost of living adjustment at the beginning of each successive 12-month period that benefits are paid.
The cost of living adjustment will be based on the increase in the Consumer Price Index to a maximum of 4% per year. Each year’s increase is based on the original daily benefit. The combined COLA increases cannot exceed 100% of the original daily benefit.
If the insured is no longer receiving benefits under the policy, the policyowner has the option to increase the daily benefit amount to the last daily benefit amount including the cost of living adjustment. The premium for the increased coverage will be at the insured’s attained age rates at the time this purchase is exercised. Any subsequent Facility or Home Care Benefits paid will reflect this new amount.
See sample contract for complete provisions and coverage exclusions.
Return of Premium on Death
Return of Premium (ROP) is an optional benefit that will reimburse all annual premiums paid for Facility Care (including the Policy Fee and the Return of Premium Benefit, with the exception of the Home Care Benefit, and any other benefits added to the policy) upon the death of the insured. The Return of Premium Benefit will be paid to the beneficiary.
The Return of Premium Benefit will only be paid if:
|
The policy has been in force for more than five years |
|
Facility Care Benefits have not been paid, and |
|
The policy is still in force at the time of death. |
Note: The insured can receive Home Care Benefits and still be eligible for the Return of Premium Benefit. See the specimen contract for further details.
See sample contract for complete provisions and coverage exclusions.
Home Care Benefit
The Home Care Benefit is an optional benefit that reimburses the insured’s cost of medically necessary home care services that are recommended by a physician and provided by a licensed nurse, authorized employee of a Health Care Agency or private care giver. This could be as a result of an inability to perform two or more activities of daily living or cognitive impairment. Benefits are paid directly to the insured. See the specimen contract for further details.
The Home Care Benefit:
|
Is available in daily units from $10 to $300 |
|
Is payable after the elimination period has been satisfied |
|
Is issued to persons between the ages of 30 and 75 |
|
May be equal to or less than the Facility Care Daily Benefit, but cannot exceed it. |
Note: Home Care Benefit may not be purchased as a stand-alone plan, it can only be added to a plan that already provides Facility Care Coverage, and will be paid in addition to any government benefits that the insured may be receiving. Receipts for home care services must be submitted to be eligible for reimbursement.
See sample contract for complete provisions and coverage exclusions.
Total Disability Waiver of Premium Benefit Rider
This overview is prepared to help you understand the Total Disability Waiver of Premium Benefit, an optional benefit that may be added as a rider to your Term 20 Guarantee Standard Issue® plan. It is not a contract or an offer to provide insurance. If your policy is issued, complete insurance coverage details will be made available in your policy, and the terms and conditions of your policy will take precedence over any information included in this document.
Your Waiver of Premium Benefit
When your have been totally disabled for 6 consecutive months, we will waive the payment of policy premiums while you continue to be totally disabled. Total disability must commence while this benefit is in force and prior to the policy anniversary nearest the insured person’s 60th birthday.
Total disability or totally disabled means that, due directly to injury or sickness, you are unable to perform the essential duties of your regular occupation, are not engaged in any other gainful occupation, and are receiving appropriate physician’s care.
After the payment of premiums has been waived for a period of 24 months during any one period of total disability, then total disability means that, due directly to injury or sickness, you are unable to engage in any gainful occupation for which you are reasonably fitted by education, training or experience, and continue to be under appropriate physician’s care.
Coverage under this rider ends on the policy anniversary nearest your 60th birthday, unless you are totally disabled and we are waiving premiums at that time. In that event we will continue to waive the premium while you remain totally disabled and the policy remains in force.
Exclusions and Limitations
We will not waive premiums if you had a pre-existing condition within the 24 months prior to the date coverage became effective, and the disability is related to a pre-existing condition, and the disability begins within twenty-four 24 months after coverage is in effect.
Pre-existing condition means any injury or illness, or any medical condition or symptom(s) whether or not diagnosed), in respect of which you incurred any health-related expenses on the advice of a physician or any other health care practitioner, took any prescribed medication, consulted a physician or any other health care practitioner, received any health-related care, advice or treatment from a physician or any other health care practitioner. It will also be considered a pre-existing condition if a reasonably prudent person with such medical condition or symptom(s) would have consulted a physician or any other health care practitioner. A disability is related to a pre-existing condition if it results, directly or indirectly, from the pre-existing condition.
We will not waive your premiums if your total disability resulted directly or indirectly from intentional self-inflicted injury, or the commission or attempted commission of a criminal offence or provocation of an assault, or poisoning or inhalation or gas or fumes, or any event, illness or treatment related to the excessive use or chronic use of alcohol, or related to the voluntary ingestion of illegal drugs, or related to the misuse of prescribed or non-prescribed medication.
| 
