Product Specific Questions
All Academic Staff Members, Management & Professional Staff, Affiliate Members or Support Staff Employees (collectively "Eligible Participants") hired on a continuous basis, either full-time or part-time and their spouses are eligible to apply. Applicants must be under age 70. Your spouse can apply, even if you choose not to.Spouses must meet the policy definition for spouse.
Here are some of the more important limitations and exclusions you should be aware of:
Any covered condition or AdvanceCare Benefit Condition diagnosed prior to the effective date of coverage is excluded.
If the insured person is diagnosed with a benign brain tumour, cancer or early stage cancer within the first 90 days of coverage, or with multiple sclerosis or Parkinson's within the first year of coverage, a benefit will not be payable and the diagnosed condition will no longer be considered a covered condition for the insured.
A diagnosis of Benign Brain Tumour, Multiple Sclerosis or Parkinson’s within the applicable limitation period will also result in any condition under MEC Group 3 no longer being payable (specialmarkets.ia.ca/mec).
No benefit will be paid if the covered condition or AdvanceCare Benefit 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. There is also an exclusion for certain pilots.
For paralysis, blindness, deafness, severe burns, stroke, coma, or loss of limbs no benefit will be paid if the condition is a result of participating in amateur or professional boxing, bungee jumping, B.A.S.E. jumping, cliff diving, mountain climbing, motor vehicle racing or speed competition on land and/or water, parachuting or underwater activities, including scuba diving and snuba diving.
Some illnesses have exclusions, refer to the full illness definition list for details.
Coverage terminates on the earliest of the following dates:
- the date on which the eligible participant is no longer eligible;
- the end of the month in which the eligible participant reaches age 75;
- the date of any unpaid premiums;
- with regard to your spouse's Critical Illness Insurance, the earliest of the above or the end of the month following the date they reach age 75, or the end of the month in which they no longer qualify as a "spouse"
The Covered Condition Benefit is a tax-free, lump-sum benefit which will be paid if you are diagnosed with one of the 25 covered critical illnesses. This benefit will be paid to you if you survive for 30* days after first being diagnosed with one of the covered illnesses. *90 days for Paralysis, Loss of Independent Existence or Bacterial Meningitis. 180 days for Multiple Sclerosis or Loss of Speech.
We want your claims process to be as hassle-free as possible. If you need to file a claim, please call our toll-free Client Customer Service line on 1-800-266-5667. A claims specialist will walk you through the necessary steps.
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.
Yes, provided your total coverage does not exceed the maximum available. To increase coverage, you will need to complete a new application.
Decreases in coverage require your written authorization. These can be submitted to us by mail. Include how much coverage you would like to have in total, your full name, your policy number and your member ID. Please ensure you have signed and dated your request.
Please note that non-smoker rates apply to individuals who, at the time of application, have not used tobacco, nicotine, or cannabis mixed with tobacco in any form whatsoever within the last 12 months. If you met this criteria please complete the Request for Non-Smoker Rates Form and submit it to our office.
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.