Accidental Death & Dismemberment

You have the option to choose a principal sum amount for yourself, which is set out in your application for enrollment. If you elect family coverage, your spouse’s principal sum will equal 50% of your principal sum, and each of your eligible dependent children will be covered for 15% of your principal sum. If you do not have any eligible dependent children, your spouse will be covered for 60% of your principal sum. If you do not have a spouse, your eligible dependent children will be covered for 25% of your principal sum.

Beneficiary Designation

You have the option to designate a beneficiary. Should you choose not to, in the event of accidental loss of life, the benefit will be paid to the beneficiary you have designated in writing under your employer’s current Group Life policy. If there is no written designation, then the benefit will be paid to your estate.

All other benefits will be payable to you.

Benefits and Coverages

Accidental Death, Dismemberment, Paralysis and Loss of Use

If a covered loss occurs within 365 days after the date of the covered accident causing the loss, the benefits provider will pay in one installment the indicated percentage of the principal sum as set out in the following table of losses. If more than one loss is sustained, only one benefit shall be payable: the largest.

List of Losses

• Loss of Life – 100%
• Loss of both hands or both feet – 200%
• Loss of both arms or both legs – 200%
• Loss of entire sight of both eyes – 100%
• Loss of one hand and one foot – 100%
• Loss of one hand and the entire sight of one eye – 100%
• Loss of one foot and the entire sight of one eye – 100%
• Loss of one arm or one leg – 75%
• Loss of one hand or one foot – 75%
• Loss of the entire sight of one eye – 75%
• Loss of thumb and index finger of the same hand – 33.33%
• Loss of speech and hearing – 100%
• Loss of speech or hearing – 75%
• Loss of hearing in one ear – 33.33%
• Loss of four fingers of one hand – 33.33%
• Loss of all toes of one foot – 25%
• Brain Death – 100%

Loss of Use

• Loss of use of both arms or both legs or both hands – 200%
• Loss of use of one hand or one foot – 75%
• Loss of use of one arm or one leg – 75%
• Loss of use of thumb and index finger – 33.33%

Paralysis

• Quadriplegia (total paralysis of both upper and lower limbs) – 200%
• Paraplegia (total paralysis of both lower limbs) – 200%
• Hemiplegia (total paralysis of upper and lower limbs of one side of the body) – 200%

Indemnity provided under this policy for all losses sustained by any one insured person as the result of any one accident will not exceed the principal sum, except those losses listed in the table of losses where the Indemnity is shown as two times the principal sum.

Definitions

Loss when used with reference to:

Quadriplegia, Paraplegia, and Hemiplegia mean the complete and irreversible paralysis of such limbs;

Hand or Foot means the complete severance through or above the wrist or ankle joint but below the elbow or knee joint;

Arm or Leg means the complete severance through or above the elbow or knee joint;

Thumb and Index Finger means the complete severance through or above the first phalange;

Fingers means the complete severance through or above the first phalange of all four fingers of one hand;

Toes means the complete severance of both phalanges of all the toes of one foot;

The Entire Sight of One Eye means the total and irrecoverable loss of sight such that corrected visual acuity must be 20/200 or less in such eye;

The Entire Sight of Both Eyes means the total and irrecoverable loss of sight in both eyes such that corrected visual acuity must be 20/200 or less and the field of vision must be less than 20 degrees in both eyes. A physician certified in ophthalmology must clinically confirm the diagnosis in writing.

Hearing in One Ear means the diagnosis of permanent loss of hearing in one ear, with an auditory threshold of more than 90 decibels. A physician certified in otolaryngology must confirm the diagnosis in writing.

Hearing means the diagnosis of permanent loss of hearing in both ears, with an auditory threshold of more than 90 decibels in each ear. A physician certified in otolaryngology must confirm the diagnosis in writing.

Speech means complete and irrecoverable loss of the ability to utter intelligible sounds.

Loss of Use means the total and irrecoverable loss of use provided the Loss is continuous for 12 consecutive months, and such loss of use is determined to be permanent.

Loss, when used herein, may also include loss of life.

Common Disaster Benefit

If you and your Insured spouse both are injured in the same accident and both die within 90 days of the accident as a direct result of such injuries, your spouse’s principal sum amount will be increased to equal yours.

Rehabilitation Benefit

Pays the expenses incurred for occupational training to a maximum of $15,000 if such expenses are incurred within three years of and as a result of an injury for which you receive a benefit under the plan.

Home Alteration and Vehicle Modification Benefit

Pays a one-time benefit of up to $50,000 for modification to your home or vehicle if you suffer an injury for which you receive a benefit under the plan and require a wheelchair to be ambulatory.

In-Hospital Benefit

Pays a benefit of

• 1% of the principal sum to a maximum of $2,500 per month for hospital confinements of more than 30 nights, or
• 1/30th of the amount determined under (i) for hospital confinements of more than five but less than 30 nights if you suffer an injury for which you receive a benefit under the plan and are confined to hospital as a result of such injury, for a maximum of 12 months.

Family Transportation

Pays a benefit of up to $15,000 for the expenses incurred for the transportation of an immediate family member to your hospital if you suffer an injury for which you receive a benefit under the Plan and as a result are confined to a hospital more than 100 kilometres from home.

Repatriation Benefit

Pays a benefit of up to $15,000 to cover the expenses to return your body to your city of residence if you suffer a covered accidental death while at least 50 kilometres from home.

Identification Benefit

Pays a benefit of up to $15,000 for the transportation and commercial lodging of an immediate family member to identify your body if you suffer a covered accidental death at least 150 kilometres from home, and a law enforcement agency requests such identification.

Seat Belt Benefit

Pays an additional benefit of 10% of the principal sum to a maximum of $50,000 if you suffer a covered accidental death while operating or riding as a passenger in a private passenger automobile in which your seat belt was fastened correctly.

Day Care Benefit

Pays an annual benefit of up to 5% of the principal sum to a maximum of $5,000 per year for the daycare costs of each dependent child under age 13 who is enrolled, or who enrolls within 90 days in a daycare facility if you suffer a covered accidental death. The benefit is payable for up to four consecutive years.

Dependent Child Educational Benefit

Pays an annual benefit of up to 5% of the principal sum to a maximum of $5,000 per school year for the tuition costs of each dependent child who is enrolled in post-secondary education if you suffer a covered accidental death. The benefit is payable for up to four consecutive years.

Spousal Educational Benefit

Pays a benefit of up to $15,000 for your spouse’s expenses in enrolling in a professional or trades training program for the purpose of obtaining an independent source of income if you suffer a covered accidental death and such expenses are incurred within 30 months of your death.

Extended Family Coverage

If you die, the coverage of your insured spouse and/or insured dependent children will continue for up to six months, subject to payment of premium.

Child Enhancement Benefit

With the exception of loss of life, all indemnities provided under the table of losses of this policy are doubled with respect to insured dependent child. The maximum amount payable shall not exceed $100,000.00 combined. This benefit is not applicable if loss of life occurs within ninety (90) days after the date of the accident.

Funeral Expense

Pays a benefit of up to $5,000 to reimburse funeral expenses if you suffer a covered accidental death.

Bereavement Benefit

Pays a benefit of up to $1,000 if you suffer loss of life in a covered accident and your eligible dependents require counselling within one year of the accident.

Cosmetic Disfigurement

Pays a percentage of the principal sum up to a maximum of $25,000 if you suffer a 3rd degree burn by means of exposure to fire, heat, caustics, electricity or radiation.

Exposure and Disappearance

If by reason of an accident covered by the policy, an insured person is unavoidably exposed to the elements and, as a result of such exposure, suffers a loss for which indemnity is otherwise payable hereunder, such loss will be covered under the terms of the policy.

If the body of an insured person has not been found within one year of disappearance, forced landing, stranding, sinking or wrecking of a conveyance in which such person was an occupant, then it shall be deemed subject to all other terms and provisions of the policy, that such insured person shall have suffered loss of life within the meaning of the policy.

Waiver of Premium

In the event an insured person becomes disabled, and their waiver of premium claim is accepted and approved under the Basic Life coverage, then the premiums payable for this benefit are waived as of the same date the claim is accepted and approved under the Basic Life coverage until one of the following occurs, whichever is earlier:

• The date the insured person attains age 65 or 35 years of pensionable service under the Municipal Pension Plan (MPP) or any other registered pension plan arising out of employment with an Employer and a minimum age of 55.
• The date the insured person ceases to be disabled
• The date of the death of the insured person.
• The date the contract for this benefit is terminated.

Conversion Privilege Benefit

If you leave your job for any reason, you have 60 days to convert your coverage under the plan to an individual insurance policy providing comparable coverage and with a coverage amount not greater than the principal sum at individual rates in force at that time.

Aircraft Coverage

Such insurance includes such injury sustained while the member is riding as a passenger (but not as a pilot, operator or member of the crew) in or on, boarding or alighting from, any aircraft having a current and valid airworthiness certificate or from any transport type aircraft operated by the transport command of the Canadian Armed Forces Air Transport Command or by the similar Transport Service of any country but excluding while flying in any aircraft owned or operated by the policyholder.

Policy Exclusions

The plan will not cover any losses caused in whole or in part by, or resulting in whole or in part from, the following:

• suicide or any attempt thereat by the member while sane
• self-inflicted Injury or any attempt thereat by the member
• travel or flight in or on (including getting in or out of, or on or off of) any Aircraft if the insured member is:
  (i) riding as a passenger in any Aircraft not intended or licenced for the transportation of passengers; or
  (ii) performing, learning to perform or instructing others to perform as a pilot or crew member of any Aircraft; or
  (iii) riding as a passenger in an Owned or Leased Aircraft.

• declared or undeclared war or any act thereof
• Injury or Loss sustained while the insured member is on full-time active duty in the armed forces or organized reserve corps of any country or international authority. (Unearned premium for any period for which the insured member is on full-time active duty shall, upon application to the Company by the policyholder, be refunded);
• infections of any kind regardless of how contracted, except bacterial infections that are directly caused by botulism, ptomaine poisoning or an accidental cut or wound independent and in the absence of any underlying sickness, disease or condition including but not limited to diabetes
• Injury or Loss sustained while the Insured member is under the influence of alcohol and operating any vehicle or means of transportation or conveyance while his or her blood alcohol is over 80 milligrams in 100 millilitres of blood;
• Injury or loss sustained while the insured member is under the influence of a drug or substance which is controlled as specified under the Controlled Drugs and Substances Act (Canada) unless taken pursuant to the advice of and in strict accordance with the instructions of a duly licenced physician;
• the commission or attempted commission by an insured member or Injury incurred while an insured member is in the course of committing or attempting to commit any act which if adjudicated by a court would be an indictable offence under the laws of the jurisdiction where the act was committed;
• an act, attempted act or omission taken or made by the insured member, or an act, attempted act or omission taken or made with the insured member’s consent, for the purposes of interrupting the blood flow to the insured member’s brain or to cause asphyxiation to the insured member whether with intent to cause harm or not; and
• natural causes

Effective Date

Your coverage begins on the date you satisfy the definition of member.

Coverage for an insured member, spouse, or dependent child begins on the latest of:

• the policy effective date;
• the first day of the month following receipt of your completed application by your benefits plan administrator or
• the date such person satisfies the definition of “member,” “spouse,” or “dependent child.”

Termination Date

Coverage for an insured member, spouse, or dependent child ends on the earliest of:

• the date the policy is terminated;
• the premium due date if premiums are not paid when due;
• the date such person no longer satisfies the definition of member, spouse, or dependent child; or
• the first day of the month following the date the Insured member no longer belongs to an eligible class of members as set out in the policy.