Product Specific Questions

The Family Accident Reimbursement Plan is designed to include an Insured Adult, their Spouse and any number of Dependent Children qualifying under the eligibility definitions stated below.

Adult is defined as the parent or legal guardian of a Dependent Child who is attending a school within an eligible school board. At the time of application, the Insured Adult must be a permanent resident of Canada, under 65 and have Provincial Health Coverage.

Spouse is defined as the legal or common-law spouse of an Insured Adult. At the time of the application, the Spouse must be a permanent resident of Canada, under 65 and have Provincial Health Coverage. Only one individual will qualify as a Spouse under the policy.

Dependent Child/Children means any natural child, step-child or legally adopted child of an Insured Adult. Dependent Children are eligible to apply provided they are permanent residents of Canada, under age 21 (up to age 24 if they are enrolled full-time at a post-secondary school), and the Insured Adult also applies for coverage.

Quick Overview

  • Any Insured Adult, Spouse or Dependent Child is not eligible for insurance under more than one Family Accident Reimbursement Plan.
  • No benefits will be paid if the accident causing injury occurs, or the expenses for the injury are incurred, outside of Canada.
  • No benefits will be paid for services which are insured services or basic health services under a provincial medical care or hospital plan.
  • Dental benefits are for the excess of expenses paid, payable, or insured under a government sponsored dental care plan, or any other health plan providing accidental dental benefits.
  • Coverage under this Policy will be secondary to any other benefits from a primary insurer or plan and will be coordinated with any other insurer or plan so that the total benefits from all insurers or plans will not exceed the actual loss incurred, in accordance to the Canadian Life and Health Insurance Association Inc. (CLHIA) Guidelines.
  • Complete Exclusions and Limitations can be found in the link below. You will also receive a complete listing of the Exclusions and Limitations in your Insurance Benefit Summary.

Critical Illness-specific Exclusions and Limitations

  • Coverage is subject to a Pre-Existing Condition Exclusion. In general terms, this means that no benefit will be paid during the first 24 months after you purchase this insurance for any medical condition which was present in the 24 months previous to your purchase.
  • The insured person must survive for 30 days after first being diagnosed for a benefit payment to be made.
  • If the insured person is diagnosed with cancer within the first 90 days of coverage, a benefit will not be payable and cancer will no longer be considered a covered condition.
  • Any covered condition diagnosed prior to the effective date of coverage is excluded.
  • No benefit will be paid if the covered condition results from: attempted suicide, alcohol or drug abuse, war or armed forces service, self-inflicted injury, taking poison or inhaling gas, or participation in a criminal act. For blindness, coma, deafness, loss of limbs, severe burns, paralysis or stroke, no benefit will be paid if the condition is a result of participating in hazardous sports or activities.

There is also an exclusion for certain pilots.

Please refer to the detailed summary of the Exclusions and Limitations for further information.

A complete listing of the Exclusions and Limitations will be provided in your Insurance Benefits Summary.

 

  • Coverage can be cancelled at any time at the request of the Insured Adult.
  • Coverage will terminate on the earliest of the following dates:
    1. August 31st following the policy year in which the Insured Adult or Insured Spouse reaches age 65
    2. The date of any unpaid premiums
  • For Dependent Children, coverage terminates at age 21 (or at age 24 if receiving full parental support while attending university, college, CEGEP or trade school on a full-time basis).

General Questions

Please contact our Claims Department toll-free at 1-800-266-5667 for the appropriate form and details on claims procedures.

  • If you or your child is injured while insured under the Family Accident Reimbursement Plan, a claim form is required to be completed and submitted to Industrial Alliance Insurance & Financial Services Inc.
  • When completing the form, please follow the instructions found on the Claims Information Sheet and at the bottom of the Standard Claim Form.
  • Claims must be received within 90 days of the date of the Accident, and no later than one year, whether or not expenses are incurred.
  • In providing this claim form for the convenience of the claimant, the Company does not admit any liability or waive any of the terms and conditions of the policy. Provision of this claim form does not indicate coverage. Only eligible claims will be paid.

Benefit Payment

  • All benefits payable under the Policy on behalf of Children are payable to or at the direction of the Parent/Legal Guardian.
  • All benefits payable under the Policy on behalf of an Adult are payable to the Adult Insured or in the case of Accidental Death to the Estate of the Adult Insured or designated beneficiary. Critical Illness is payable to the Insured, except for the Dependent Child in which case the benefit is payable to the Insured Adult.
  • Full details on Claims procedures will be found on the Insurance Benefits Summary provided to Insureds.

Please complete the Name and/or Address Change Form and submit it to our office.

If you are changing your name, we will issue you a new Insurance Certificate.

Spouse means the legal spouse of a member, providing there is no separation in effect, or an individual who has been residing in a marriage-like relationship with the member for a period of at least 12 consecutive months.

Dependent child means any natural child, step-child or legally adopted child to whom you are providing full parental support and who is unmarried and less than 21 years of age (up to 24 if they are full-time post-secondary student) as of the date of application.

Critical Illness Definitions

25 life-changing illnesses

These are the 2013 Critical Illness Benchmark Definitions published by the Canadian Life and Health Insurance Association (CLHIA). If you are insured under a Special Markets Solutions group critical illness insurance plan, please refer to your Insurance Benefits Summary or booklet wording for the definitions currently in force under your group insurance plan.