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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.
Loss of Independence Existence
If the insured is diagnosed with Loss of Independence Existence and completes the Survival Period of 90 days from the date of diagnosis, this rider will pay a lump sum benefit to the insured, unless the owner of the policy has declared otherwise.
Loss of Independence Existence is a condition that renders the insured unable to perform two (2) or more activities of daily living or cognitively impaired with no reasonable chance for recovery.
Activities of Daily Living are:
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Bathing: meaning the ability to wash oneself in a bathtub, shower or sponge bath, with or without the aid of equipment; |
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Dressing: meaning the ability to put on and remove necessary clothing including braces, artificial limbs or other surgical appliances; |
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Feeding: the ability to consume food and drink that has already been prepared and made available, with or without the use of adaptive utensils; |
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Bladder and Bowel Continence: the ability to manage bowel and bladder function, with or without protective undergarments or surgical appliances so that a reasonable level of hygiene is maintained; |
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Toileting: the ability to get on and off the toilet and maintain personal hygiene; and |
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Transferring: the ability to move in and out of a bed, chair or wheelchair, with or without the use of equipment. |
Return of Premium on Expiry
On the expiry date of the policy, provided the policy was in force (at the policy anniversary at the insured’s attained age seventy-five (75) and no Critical Illness Benefit has been paid, is pending or is payable, we will refund the return of premium to the policy owner (or in the event of the owner’s death, the owner’s estate). The return of premium benefit amount without interest, is equal to the lesser of:
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the sum of all premiums paid for the policy (including any riders, medical extras, flat extras and modal loadings) less any premiums previously waived; or |
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two million dollars ($2,000,000). |
Any return of premium amount will be payable only once and will represent full and final discharge of all claims under the policy.
Return of Premium on Death
If the insured dies during the Survival Period or from a condition or event not defined as a Critical Illness, we will return to the policy owner, or in the event of the policy owner’s death, the owner’s estate without interest the lesser of:
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the sum of all premiums paid for the policy less any premiums previously waived; or |
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two million dollars ($2,000,000). |
The policy must be in force at the time of the insured’s death. If death is a result of any exclusion listed in the policy, no Return of Premium on Death benefit is payable.
Return of Premium
An early surrender feature with two options will be available at the time of issue. We will refund premiums according to the option date they select.
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Option 1 - 10th anniversary; or |
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Option 2 - policy anniversary at the insured’s attained age 55. |
At the selected option date and upon written request from the policy owner, we will refund 50% of premiums paid (including premiums for medical extras, flat extras, modal loadings and any other riders, less any premiums previously waived. The refund increases 5% each year until the 20th policy anniversary, or age sixty-five (65), when 100% is payable each year thereafter. When the early surrender feature is exercised, coverage then terminates.
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:
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The policy has been in force for more than five years |
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Facility Care Benefits have not been paid, and |
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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:
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Is available in daily units from $10 to $300 |
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Is payable after the elimination period has been satisfied |
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Is issued to persons between the ages of 30 and 75 |
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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.
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