Critical Illness

Overview

The last thing you need to worry about if you’re diagnosed with a serious medical condition is money. The CPA Ontario Critical Illness Plan provides you and your spouse with valuable protection when you may need it most.

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The CPA Ontario Critical Illness offers you and your spouse coverage as follows:

You and your spouse can each apply for up to $250,000 in coverage ($25,000 increments) up to Age 65.
Coverage can continue to Age 70 if you choose.
This Plan pays the full coverage amount directly to the insured, upon first diagnosis of any of the 18 Covered Conditions:

A definitive clinical diagnosis by a specialist of Alzheimer’s Disease, which is a progressive degenerative disease of the brain. The Insured must exhibit the loss of intellectual capacity involving impairment of memory and judgement, which results in a significant reduction in mental and social functioning, as to require continuous daily supervision.

Exclusion: All other dementing organic brain disorders and psychiatric illnesses are specifically excluded.

The undergoing of surgery for disease of the aorta requiring excision and surgical replacement of the diseased aorta with a graft. Aorta refers to the thoracic and abdominal aorta but not its branches.

The total and irreversible loss of vision in both eyes as confirmed by an ophthalmologist, with the corrected visual acuity being 20/200 or less in each eye, or the field of vision being less than 20 degrees in both eyes.

A state of unconsciousness with no reaction to external stimuli or response to internal needs for a continuous period of four days. The Glasgow Coma Score must be four (4) or less, continuously over the four days.

Exclusions: A medically induced coma, and a coma which results directly from alcohol or drug use.

The undergoing of heart surgery to correct narrowing or blockage of one or more coronary arteries with bypass grafts.

Exclusion: Any non-surgical techniques such as balloon angioplasty or laser relief of an obstruction.

The total and irreversible loss of hearing in both ears, with an auditory threshold of 90 decibels or greater within the speech threshold of 500 to 3,000 cycles per second.

The death of a portion of heart muscle arising from inadequate blood supply as evidenced by:

a. new electrocardiographic (ECG) changes indicative of a myocardial infarction, and

b. the elevation of cardiac biochemical markers to levels considered diagnostic for infarction.

Heart attacks during coronary angioplasty are covered, if there are diagnostic changes of new Q wave infarction on the ECG, in addition to an elevation of cardiac markers.

Exclusion: A heart attack does not include an incidental finding of ECG changes suggesting a prior myocardial infarction, in the absence of a corroborating event.

End-stage renal disease presenting as a chronic irreversible failure of both kidneys to function, as a result of which either regular hemodialysis, peritoneal dialysis or renal transplantation is initiated.

A tumour characterized by the uncontrolled growth and spread of malignant cells and the invasion of tissue.

The following cancers are excluded from coverage:

carcinoma in situ
stage 1a malignant melanoma (melanoma of less than or equal to 1.0 mm in thickness, non-ulcerated and without level IV or V invasion)
any non-melanoma skin cancer that has not become metastatic (spread to distant organs)
stage A (T1a or T1b) prostate cancer
any tumour in the presence of Human Immunodeficiency Virus (HIV)

Limitation: No benefit will be available under this condition if, within the first 90 days following the effective date of the certificate, the Insured has any of the following:

signs or symptoms of cancer that lead to a diagnosis of cancer (covered or excluded under the policy), regardless of when the diagnosis is made
medical consultations or tests that lead to a diagnosis of cancer (covered or excluded under the policy), regardless of when the diagnosis is made
a diagnosis of cancer (covered or excluded under the policy)

This information must be reported to the Company within 6 months of the date of diagnosis. If this information is not provided, the Company has the right to deny any claim for cancer or any critical illness caused by any cancer or its treatment.

The irreversible severance of two or more limbs above the wrist or ankle joint as the result of an accident or medically required amputation.

The total and irreversible loss of the ability to speak as the result of physical injury or disease, which must be established for a continuous period of at least 180 days.

Exclusion: All psychiatric-related causes are specifically excluded.

The diagnosis of the irreversible failure of the heart, both lungs, liver, both kidneys or bone marrow. Transplantation must be medically necessary.

To qualify under Major Organ Transplant, the Insured must undergo surgery as the recipient for transplantation of a heart, lung, liver, kidney or bone marrow, and limited to these entities.

To qualify under Major Organ Failure on Waiting List, the Insured must become enrolled as the recipient in an approved government organ or bone marrow transplant program in Canada or the U.S., for one or more of the organs or bone marrow specified in this provision. For the purposes of the Survival Period, the date of Diagnosis is the date your enrollment in such a transplant program takes effect.

A definitive diagnosis of one of the following: amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease), primary lateral sclerosis, progressive spinal muscular atrophy, progressive bulbar palsy, or pseudo bulbar palsy, and limited to these entities.

A diagnosis by a neurologist of definite Multiple Sclerosis, characterized by well-defined neurological abnormalities persisting for a continuous period of at least six months, or with evidence of two separate clinically-documented episodes. Multiple areas of demyelination must be confirmed by MRI scanning or imaging techniques generally used to diagnose multiple sclerosis.

The complete and permanent loss of use of two or more limbs for a continuous period of 90 days following the precipitating event, during which time there has been no sign of improvement.

Exclusion: All psychiatric-related causes are specifically excluded.

A definitive diagnosis by a specialist of primary idiopathic Parkinson’s Disease, which is characterized by a minimum of two or more of the following clinical manifestations: muscle rigidity, tremor, or bradykinesia (abnormal slowness of movement, sluggishness of physical and mental responses). The Insured must require substantial physical assistance from another adult to perform at least 2 of the following 6 Activities of Daily Living.*

*Activities of Daily Living are:

Bathing – the ability to wash oneself in a bathtub, shower or by sponge bath, with or without the aid of equipment.
Dressing – the ability to put on and remove necessary clothing including braces, artificial limbs or other surgical appliances.
Toileting – the ability to get to and from the toilet and maintain personal hygiene.
Bladder and Bowel Continence – the ability to manage bowel and bladder function with or without protective undergarments or surgical appliances so that a reasonable level of hygiene is maintained.
Transferring – the ability to move in and out of a bed, chair or wheelchair, with or without the use of equipment.
Feeding – the ability to consume food or drink that already has been prepared and made available, with or without the use of adaptive utensils.

Exclusion: All other types of Parkinsonism are specifically excluded.

Third degree burns over at least 20% of the body surface.

A cerebrovascular event producing neurological sequelae lasting more than 30 days and caused by intracranial thrombosis or hemorrhage, or embolism from an extra-cranial source. There must be evidence of a measurable, objective neurological deficit.

Exclusion: Transient ischemic attacks are specifically excluded.

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This coverage includes the following features at no additional cost:

Waiver of Premium During Total Disability
All premiums will be waived if you suffer a Total Disability help before Age 65. If approved, you will not be required to pay any premiums for Member and Spouse Critical Illness Insurance. This begins after three continuous months of Total Disability, and for as long as the disability continues.
Low Rates for Non-Smokers
Apply for non-smoker rates if you have not used any form of tobacco or tobacco cessation products within the past 12 months.
Volume Savings
Purchase coverage of $125,000 or more to get a 10% rate reduction on the premiums for all your Critical Illness coverage.
Health Service Navigator® (HSN)
HSN is an integrated health information and online resource centre that enables you and your family members to quickly and easily get answers to your medical questions and access to support services. Access isn’t dependent upon making a claim – it’s available immediately.

HSN support services are included with your Critical Illness coverage. You can receive information, medical coordination services, resources on how to navigate the Canadian health care system, and world-class medical second opinions.
HSN is available online or by calling a dedicated representative. Insured members can go online to www.manulifehealth.ca to log in.

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See the rates that apply to CPA Ontario Member and Spouse Critical Illness Insurance.

Monthly rates shown below are for $25,000 of Critical Illness coverage
You and your spouse can apply for coverage amounts from $50,000, up to $250,000 per person
Premiums increase as you move from one age range to the next (see chart below) and are subject to change, rates over Age 64 apply to renewals of existing coverage only
Savings for volume purchases begin on coverage of $125,000 or more - see Rate Savings section below

CPA ONTARIO MEMBER & SPOUSE CRITICAL ILLNESS INSURANCE
Monthly Premium per $25,000 of Critical Illness Insurance

Non-Smoker *
Age**	Male	Female
18 to 24	$3.69	$3.32
25 to 29	$4.01	$3.68
30 to 34	$4.86	$4.77
35 to 39	$5.93	$6.30
40 to 44	$8.14	$8.88
45 to 49	$12.70	$12.49
50 to 54	$19.54	$17.83
55 to 59	$31.60	$24.58
60 to 64	$52.49	$34.05
65 to 69***	$71.14	$47.05

**Smoker**
Age**	Male	Female
18 to 24	$4.72	$4.22
25 to 29	$5.21	$4.72
30 to 34	$6.88	$6.22
35 to 39	$9.32	$8.48
40 to 44	$13.89	$13.14
45 to 49	$24.73	$21.36
50 to 54	$42.82	$31.76
55 to 59	$70.06	$46.90
60 to 64	$103.48	$63.63
65 to 69***	$148.44	$83.25

*"Non-smoker" premiums apply to members and spouses who have not used tobacco or tobacco cessation products in the past 12 months.

**"Age" means age attained as of the Policy Anniversary date (June 1).

*** Rates over Age 64 apply to renewals of existing coverage only.

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Additional savings are available for those applying for CPA Ontario Member or Spouse Critical Illness coverage:

Volume Savings

You will get 10% off your premiums when you purchase $125,000 or more (per person) in coverage under the Critical Illness Plan.

Lower Rates for Non-Smokers

Provided you have not used tobacco or tobacco cessation products in the last 12 months, you can apply for the lower non smoker rates shown in the Plan Rates section above.

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To qualify for the Member and/or Spouse Critical Illness coverage, you must be:

a member (or spouse/common-law partner of a member) of one the participating bodies:

Chartered Professional Accountants of New Brunswick
Chartered Professional Accountants of Newfoundland and Labrador
Chartered Professional Accountants of Nova Scotia
Chartered Professional Accountants of Ontario
Chartered Professional Accountants of Prince Edward Island
Charted Professional Accountants of Bermuda;

a resident of Canada or Bermuda;
under Age 65; and
free of all the specific pre-existing medical conditions or procedure listed below:

Active hepatitis, AIDS or AIDS-related disease
Alcohol abuse in the past five years
Alzheimer's disease
Any heart condition or heart trouble (excluding controlled hypertension)
Cancer - all cancers except basal cell skin cancer
Coronary bypass surgery
Diabetes
Heart attack
Huntington's chorea
Kidney disease - other than kidney stones or a history of kidney infection
Lou Gehrig's disease - amyotrophic lateral sclerosis (ALS)
Major organ transplant recipient
Multiple sclerosis
Permanent paralysis (paraplegia, quadriplegia) - other than Bell's Palsy
Pulmonary fibrosis
Stroke - cerebrovascular accident
Transient ischemic attack

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Payment of any benefit under the Critical Illness Plan is subject to specific and general limitations and exclusions. Please review your Certificate carefully for all exclusions pertaining to your coverage, as this is not a complete list of all exclusions that may apply.

No benefit will be paid if the Insured Member or Insured Spouse suffers a Covered Condition as a result of:

intentional self-inflicted injuries,
the use of intoxicants,
committing or attempting to commit a criminal offence, or

operating a motor vehicle while the concentration of alcohol in 100 milliliters of blood exceeds 80 milligrams.

No benefit will be paid unless the Insured survives 30 days (excluding any time on life support) following the first diagnosis of a Covered Condition (or a longer period, as described in the Covered Conditions and provided to the Insured upon acceptance).

Note: For a complete list of Covered Conditions and their definitions, please refer to the Plan Basics section above.

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