The Critical Condition Benefit is underwritten by Blue Cross Life Insurance Company of Canada.

Qualifying Critical Conditions

The Benefits

Pre-Existing Conditions Restriction

Waiting Period

Overview of Critical Conditions

Activities of Daily Living

Qualifying Critical Conditions

A benefit will be paid if, as a result of sickness or disease (or accident if it is a severe burn) a Plan Member suffers from one of the following critical conditions that are severe and meet the degrees of severity in the contract:

• Severe heart attack Life threatening cancer Kidney failure Liver failure Heart transplant Severe burns
• Deafness Loss of speech Blindness Coma Paralysis Alzheimer’s disease
• Multiple Sclerosis Parkinson’s disease Senile dementia Severe stroke Motor neurone disease Lung failure or transplant

For example, only the most severe level of heart attack is covered (a Class 4 heart attack as classified by the Canadian Cardiovascular Society) i.e. unable to do physical activity such as walking down steps without discomfort.

The Benefits

The benefit amount for a critical condition is a lump sum non-taxable benefit payment of $50,000.

Benefit restrictions include:

1. Coverage is provided prior to the Member’s 65th birthday.
2. A 30 day waiting period. The Member must survive the critical condition for 30 days and still meet the definition of critical condition.
3. One payment of $50,000 can be paid for each type of critical condition.
4. Up to two payments, or $100,000 can be paid during a Member’s lifetime.

Pre-Existing Conditions Restriction

If a Member is disabled when this benefit was introduced on April 1, 1997, the critical condition benefit coverage does not begin until the disability stops and the Member is available to return to work.

Any medical conditions for which the Member has received medical treatment, consultation, care or services (including diagnostic measures) and/or for which he or she has been prescribed medication during the 24 months immediately before coverage begins is not covered unless the critical condition begins after 24 consecutive months or more of coverage.

Waiting Period

The critical condition benefit is a living benefit, which means the Member must survive the onset of the critical condition for a period of 30 days before the benefit will be paid. At the end of this 30 day period, the Member must still meet the definition of critical condition

Overview of Critical Conditions

• All conditions, with the exception of burns, must be the result of illness or disease.
• Conditions resulting from an accident (except in the case of burns) will not be covered.

Blindness: Permanent and uncorrectable loss of sight from both eyes as determined through vision acuity testing and according to set degrees of severity.

Burns: Third degree burns covering at least 20 percent of the body.

Coma: State of unconsciousness with no reaction to external stimuli and the requirement of life support systems.

Deafness: Permanent and uncorrectable functional deafness as determined by a specialist.

Heart transplant: Medically necessary heart transplant from a donor to the insured person.

Kidney failure or transplant: End-stage renal disease requiring permanent, regular dialysis or kidney transplantation.

Life threatening cancer: A malignant tumour characterized by uncontrollable growth and spread of malignant cells (including leukaemia) which is likely to result in death within 24 months.

Liver failure or transplant: End-stage liver failure with permanent jaundice, encephalopathy and ascites or liver transplantation.

Loss of speech: Complete, permanent and uncorrectable loss of speech.

Lung failure or transplant: End-stage lung disease requiring permanent oxygen therapy. The condition must meet set degrees of severity according to a respiratory specialist, or require lung transplantation.

Motor neurone disease: Unequivocal diagnosis by a specialist. The condition must be to the degree of severity that the insured person is unable to perform three of the five Activities of Daily Living without assistance.

Multiple Sclerosis: Unequivocal diagnosis by a specialist. The condition must be to the degree of severity that the insured person is unable to perform three of the five Activities of Daily Living without assistance.

Paralysis: Total and permanent loss of use of two or more limbs.

Parkinson’s disease: Unequivocal diagnosis by a specialist. The condition must be to the degree of severity that the Insured person is unable to perform three of the five Activities of Daily Living without assistance

Senile dementia: Unequivocal diagnosis by a specialist. The degree of severity must require daily supervision for the Insured person.

Severe heart attack: The death of heart muscle to a degree of severity of at least Class 4 of the Canadian Cardiovascular Society’s classification of cardiac impairment.

Severe stroke: Significant, permanent neurological impairment as determined by a specialist. The condition must be to a degree of severity that the insured person is unable to perform three of the five Activities of Daily Living without assistance.

Activities of Daily Living:

The five activities of daily living that a member would normally perform without assistance are:

1. Eating: manipulating prepared foods or liquid into the mouth.
2. Dressing: putting on or removing necessary articles of clothing that are normally worn, including leg braces.
3. Bathing: the ability to cleanse the entire body using soap and water including turning on faucets and shower mechanisms, getting into and out of the bath itself, and drying oneself off.
4. Ambulation: The ability to move independently from place to place with or without the use of equipment.
5. Toileting: The ability to use a toilet, bedside commode or urinal.