The survival period is 30 days, unless a longer waiting period is specified in the definition of a Critical Condition.
The following definitions may be changed at any time by the carrier chosen and are illustrated here as a guideline only.
- Heart Attack (Myocardial Infarction)
The death of a portion of the heart muscle, resulting from a blockage of one or more coronary arteries due to atherosclerotic heart disease. The diagnosis must be based on all of the following criteria occurring at the same time:
- new episode of typical chest pain or equivalent symptoms;
- new electrocardiographic (ECG) changes indicative of an acute myocardial infarction; and
- biochemical evidence of myocardial necrosis (heart muscle death) including elevated cardiac enzymes and/or troponin.
Lesser acute coronary syndromes including unstable angina and acute coronary insufficiency are specifically excluded.
- Stroke
Unequivocal diagnosis of the death of brain tissue caused by thrombosis, haemorrhage or embolism. The diagnosis must be based on all of the following:
- sudden onset of new neurological symptoms;
- new objective neurological deficits on clinical examination persisting continuously for at least sixty (60) days following the diagnosis of the stroke; and
- new findings on CT scan or MRI, if done, consistent with the clinical diagnosis.
Transient ischemic attacks (TIA) are specifically excluded.
- Cancer
Diagnosis of a malignancy, which is characterized by the uncontrolled growth of cancer cells with invasion of tissue. The diagnosis must be supported by relevant investigation and appropriate diagnostic tests.
The following conditions are excluded from coverage under this covered critical illness definition:
- early prostate cancer, diagnosed as T1A N0 M0 and T1B N0 M0 or equivalent staging;
- pre-malignant lesions, benign tumours or polyps;
- non-invasive cancer in situ;
- any skin cancer, other than invasive malignant melanoma greater than 0.75mm; and
- any tumour in the presence of any Human Immunodeficiency Virus (HIV).
There is no coverage for cancer if the insured is diagnosed with cancer and such diagnosis was made, or any symptom or medical problem is determined, which initiated the investigation leading to a diagnosis of cancer, within 90 days following the effective date of the insured’s Critical Illness insurance coverage. However, insurance coverage for all other insured conditions of Critical Illness insurance continues in-force.
- Coronary Artery Bypass Surgery
The undergoing of heart surgery to correct narrowing or blockage of one or more coronary arteries with bypass grafts.
Exclusions:
- non-surgical techniques such as balloon angioplasty, laser embolectomy or other non-bypass techniques.
- Kidney Failure
The diagnosis of irreversible failure of both kidneys, which necessitates treatment by regular dialysis or kidney transplant.
- Major Organ Transplantation
Undergoing of surgery or treatment as a recipient by transplant of any of the following organs or tissues: heart, liver, lung, kidney or bone marrow.
- Multiple Sclerosis
Unequivocal diagnosis of at least two episodes of well-defined neurological abnormalities lasting for a continuous period of at least six months and confirmed by modern imaging techniques.
- Paralysis
The complete and permanent loss of the use of two or more limbs through paralysis, for a continuous period of 180 days.
- Blindness
Diagnosis of permanent loss of sight in both eyes. The corrected visual acuity must be worse than 20/200 in both eyes and the field of vision must be less than 20 degrees in both eyes.
- Deafness
Diagnosis of the permanent loss of hearing in both ears with an auditory threshold of more than 90 decibels.
- Loss of Independent Existence
Loss of independent existence means:
i. being permanently unable to perform, by oneself, at least two of the Activities of Daily Living without Substantial Assistance from another person; or,
ii. Having a Cognitive Impairment.
Activities of Daily Living are:
Bathing: washing oneself by sponge bath, or in either a tub or shower, including the task of getting into or out of the tub or shower.
Dressing: dressing oneself, even with appropriate therapy, medication and devices. This includes the putting on and taking off any necessary braces, fasteners or artificial limbs or other surgical appliances.
Feeding: consuming food that has already been prepared and made available, with or without appropriate therapy, medication and devices.
Continence: managing bowel or bladder functions, even with appropriate therapy, medication and devices, including performing associated personal hygiene including caring for a catheter or colostomy bag.
Toileting: getting to and from the toilet, getting on and off the toilet and maintaining an adequate level of personal hygiene.
Transferring: moving in and out of a chair, wheelchair or bed.
Substantial Assistance is either hands-on or standby assistance. Hands-on assistance means the physical assistance of another person without which the insured is unable to perform the Activities of Daily Living. Standby assistance means the presence of another person, within arm’s reach, who is necessary to prevent by physical intervention, injury to the insured while the insured is performing the Activities of Daily Living.
Cognitive Impairment means confusion or disorientation due to a permanent deterioration or loss in intellectual capacity that is measured by clinical evidence and standardized tests which reliably measure impairment in:
- short-term or long-term memory,
- orientation to people, places or time, and
- deductive or abstract reasoning.
The insured suffering a Cognitive Impairment is unable to perform the mental functions necessary for everyday life, even with Substantial Assistance, appropriate therapy, medication, special devices or other aids. Mental functions for everyday life include, but are not limited to: adaptive functioning, memory, problem-solving, goal-setting, and judgment.
Loss of independent existence must be:
- the result of sickness or accidental injury;
- persisting for a continuous period of 90 days; and
- permanent.
For the purpose of this benefit, permanent means beyond an expectation of recovery taking into account current medical knowledge and technology.
- Loss of Speech
Diagnosis of the total, permanent, and irreversible loss of the ability to speak for a continuous period of six months due to physical injury or physical disease.
- Coma
Diagnosis of the state of unconsciousness with no reaction to external stimuli, for a continuous period of at least 96 hours.
- Benign Brain Tumour
Diagnosis of a benign tumour within the substance of the brain. Excluded are cysts, granulomas, meningiomas, malformations of the intracranial arteries or veins, or tumours of the cranial nerves, pituitary or spinal cord.
- Major Burns
Diagnosis of third degree burns covering at least 20% of the surface area of the insured’s body.
- Major Organ Failure Requiring Transplant
The irreversible failure of the heart, liver, bone marrow, both lungs or both kidneys requiring receipt of a transplant of that organ, resulting in the insured being accepted into a recognized transplant program. The insured must survive at least 30 days following the date of enrolment into the transplant program.
- Aorta Surgery
The undergoing of surgery for disease of the aorta, requiring excision and replacement of such diseased aorta with a graft. Aorta refers to the thoracic and abdominal aorta but not its branches.
- Alzheimer’s Disease
Diagnosis of the loss of intellectual capacity involving impairment of memory and judgement, which results in significant reduction in mental and social functioning requiring supervision for daily living. Excluded are dementing organic brain disorders and psychiatric illnesses
- Parkinson’s Disease
Diagnosis of primary idiopathic Parkinson’s Disease characterized by the clinical manifestations of two or more of the following:
- rigidity;
- tremor;
- bradykinesis.
Excluded are all other types of Parkinsonism.
- ALS and other Motor Neuron Diseases
ALS means a definite diagnosis of Amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease).
Other motor neuron diseases means the insured has received a definite diagnosis of one of the following diseases:
- primary lateral sclerosis;
- progressive spinal muscular atrophy;
- progressive bulbar palsy; or
- pseudo bulbar palsy.
- Aplastic Anemia
Definite diagnosis of a chronic persistent bone marrow failure, which results in anemia, neutropenia and thrombocytopenia requiring treatment with at least one of the following:
- blood product transfusion;
- marrow stimulating agents;
- immunosuppressive agents; or
- bone marrow transplant.
The diagnosis must be confirmed by a bone marrow biopsy.
- Bacterial Meningitis
Diagnosis must be confirmed by laboratory analysis of cerebrospinal fluid that shows growth of pathogenic bacteria in culture. There must be a permanent neurological deficit that persists for a continuous period of at least 90 days from the date of diagnosis. A permanent neurological deficit is a measurable objective impairment supported by medical investigation and testing.
- Heart Valve Replacement
Replacement of any heart valve with either a natural or mechanical valve.
- Loss of Limbs
Complete and permanent severance of two or more limbs through or above the wrist or ankle. A physician must confirm that the severance cannot be corrected by surgery or other means.
- Occupational HIV Infection
Infection with Human Immunodeficiency Virus (HIV) resulting from an accidental injury which occurred in Canada after the issue date of the coverage, and which exposed the insured to HIV contaminated blood or body fluids, during the course of the insured’s normal occupation.
Payment under this condition requires satisfaction of all of the following:
a. The accidental injury must be reported to the insurer within 14 days of the accidental injury.
b. An HIV test must be taken within 14 days of the accidental injury and the result must be negative.
c. An HIV test must be taken between 90 days and 180 days after the accidental injury and the result must be positive.
d. The accidental injury must have been reported, investigated and documented in accordance with workplace legislation and regulations.
No payment will be made if:
- the insured has elected not to take any available, licensed vaccine offering protection against the HIV; or
- a licensed cure for HIV infection has become available prior to the accidental injury; or
- HIV infection occurs as the result of sexual transmission or IV drug use