ScotiaLine Protection: Basic and Enhanced Plans

Transcription

1 CERTIFICATE OF INSURANCE BOOKLET ScotiaLine Protection: Basic and Enhanced Plans What you need to know.

2 The details of your ScotiaLine Protection are important. They are described in your Certificate of Insurance. Your Certificate of Insurance also includes your completed and signed application, if you applied in person at a Scotiabank branch or, if you applied by other means, including verbal application, your letter from Canada Life confirming your coverage. As you may need to look at details of your ScotiaLine Protection in the future, please keep all related documents inside this pocket and store this booklet in a safe place.

3 Contents Key terms Introduction Basic ScotiaLine Protection Enhanced ScotiaLine Protection Description of this product Nature of the coverage Summary of features Table of premiums Start of coverage Exclusions in coverage Restrictions in coverage Changing your coverage Cancellation If you change your mind after enrolment Cancelling your coverage End of coverage Claims How to make a claim Insurer s claim decision Appeal of insurer s decision Confidentiality Provider of this coverage How to reach us Back cover Page 1

4 Key terms ScotiaLine means any ScotiaLine account included in the ScotiaLine suite of products. This includes, but is not limited to, ScotiaLine, ScotiaLine VISA and ScotiaLine VISA card for business (unincorporated). Lender means the member of the Scotiabank group of companies from which you received a ScotiaLine, including The Bank of Nova Scotia (Scotiabank). We, our and us mean The Canada Life Assurance Company (Canada Life). You and your mean the borrower and/or co-borrower. Branch means a branch of Scotiabank. Doctor means a physician or surgeon, legally licensed and practising medicine in Canada or in another jurisdiction that we approve. Your doctor cannot be you, your relative or a business associate. Health crisis means an illness, disorder or surgery that is specifically defined in this booklet under Nature of the coverage, and which is not excluded under Exclusions in coverage or Restrictions in coverage. Terminal illness is any illness diagnosed by a doctor that will likely result in death within one year of diagnosis, but is not covered as a health crisis. Diagnosis means a written diagnosis by a doctor of your health crisis or terminal illness. The effective date of diagnosis will be the date the diagnosis is made by your doctor, as supported by your medical records. The investigation leading to this diagnosis must begin after the start date of your coverage. Surgery means you undergo surgery in Canada, or in another jurisdiction that we approve, performed by a doctor. The investigation of the medical problem leading to the surgery must begin after the start date of your coverage, and the surgery must be performed while you are insured under the Enhanced ScotiaLine Protection plan. Page 2

5 Introduction Basic and Enhanced ScotiaLine Protection Plans To remove the worry of ScotiaLine debt in the event of death or health crisis, Scotiabank and Canada Life have developed two types of ScotiaLine Protection. Basic ScotiaLine Protection provides loss of life coverage. It protects your family, should you die and have a balance remaining on your ScotiaLine. Enhanced ScotiaLine Protection provides loss of life coverage together with health crisis and terminal illness coverage. It protects you and your family, should you die or be diagnosed with a health crisis or any terminal illness and have a balance remaining on your ScotiaLine. This Certificate of Insurance describes in detail both types of ScotiaLine Protection. It will help you to understand how your coverage works and to decide whether it suits your needs. If you still have questions after reading this booklet, you are welcome to call Canada Life toll free at , 8 a.m. to 6 p.m. Eastern Time, Monday through Friday. ScotiaLine Protection has been specifically designed to cover your ScotiaLine debt. It is not intended to replace any other personal life insurance or health crisis (critical illness) insurance you may already own. Page 53

6 Description of this product Nature of the coverage Loss of Life Loss of life coverage is provided under both the Basic ScotiaLine Protection plan and the Enhanced ScotiaLine Protection plan. This coverage can pay off your ScotiaLine debt if you die, up to $150,000 for each insured ScotiaLine (maximum of two). Health Crisis Health crisis coverage is provided under the Enhanced ScotiaLine Protection plan only. This coverage can pay off your ScotiaLine debt if you are diagnosed with a health crisis, up to $150,000 for each insured ScotiaLine (maximum of two). The health crises covered are: Heart attack - meaning the death of a portion of the heart muscle due to an inadequate blood supply to the affected area. This diagnosis must be based on new (after the attack) electrocardiographic (ECG) changes consistent with a heart attack and a rise in the level of cardiac (heart) enzymes. Stroke - meaning a cerebrovascular incident caused by a haemorrhage or infarction of brain tissue due to thrombosis or embolization (a lack of circulation of blood to the brain caused by a blood clot, air bubble or other object) but not a transient ischemic attack (TIA) sometimes referred to as a mini stroke. This diagnosis must be supported by medical evidence that the stroke produced a measurable neurological deficit that has continued for at least 30 consecutive days and is considered to be permanent. Coronary artery bypass surgery - meaning surgery to correct the narrowing or blockage of one or more coronary arteries with bypass grafts. This surgery must have been done on the written advice of a doctor who is a certified Cardiologist. Non-surgical techniques such as balloon angioplasty, laser relief of an obstruction, and other intra-arterial procedures are not covered. Cancer - meaning a malignant neoplasm that is characterized by the uncontrolled growth and spread of malignant cells and the invasion of tissue. The following forms of cancer or conditions are not covered: - stage A prostate cancer, - non-invasive cancer in situ (i.e. not spreading), - pre-malignant lesions, benign tumours or polyps, - any tumour in the presence of any human immunodeficiency virus (HIV),and - any skin cancer other than invasive malignant melanoma into the dermis or deeper. We will not pay a benefit for cancer if the diagnosis or any investigation Page 4

7 leading to the diagnosis is initiated within the 90 days after the start date of your coverage. Blindness - meaning the permanent and uncorrectable loss of sight in both eyes. Corrected visual acuity must either be worse than 20/200 in both eyes (meaning at 20 feet, you can only clearly read a letter that was designed to be read at 200 feet) or field of vision is less than 20 degrees in both eyes. This diagnosis must be made by a doctor who is a certified Ophthalmologist, and the condition must be considered permanent and uncorrectable. Paralysis - meaning complete and permanent inability to use two or more limbs, as a result of physical paralysis. This diagnosis must be supported by medical evidence that the paralysis has continued for at least 180 consecutive days. Deafness - meaning the permanent loss of hearing in both ears, with an auditory threshold of more than 90 decibels in each ear. This diagnosis must be made by a doctor who is a certified Otolaryngologist. Coma - meaning a state of unconsciousness from which arousal is impossible and in which external stimulation produces no more than primitive avoidance reflexes. This diagnosis must be made by a doctor who is a certified Neurologist and be supported by medical evidence that the state has continued for a period of at least 96 consecutive hours. Terminal Illness Terminal illness coverage is provided under the Enhanced ScotiaLine Protection plan only. This coverage can pay off your ScotiaLine debt if you are diagnosed with any illness that is not a covered health crisis but will likely result in your death within one year of diagnosis, up to $150,000 for each insured ScotiaLine (maximum of two). This benefit will equal the amount that would have been paid if you had died on the date of your diagnosis. It will be paid on the date your claim is approved. All benefit payments for all types of coverage are paid to the lender. See pages 8, 9, 10 and 11 for exclusions and restrictions in coverage. Summary of features Who may apply You may apply for Basic ScotiaLine Protection (loss of life coverage only) if you have not reached your 65th birthday. You may apply for Enhanced ScotiaLine Protection (loss of life, health crisis and terminal illness coverage) if you have not reached your 56th birthday. You must be living in Canada when you apply and you may only apply for coverage on a maximum of two ScotiaLines. Your ScotiaLine must be in good standing with the lender. You may apply as an individual (single coverage) or with a co-borrower (joint or dual coverage) for any ScotiaLine. Page 5

8 Joint coverage means both of the borrowers on a joint ScotiaLine have the same ScotiaLine Protection plan. Both have Basic ScotiaLine Protection or both have Enhanced ScotiaLine Protection. Dual coverage means each borrower has different coverage. One has Basic ScotiaLine Protection and one has Enhanced ScotiaLine Protection. How to apply It s easy. Simply contact your local Scotiabank branch and complete a ScotiaLine Protection application or contact The Bank of Nova Scotia by calling Note that you do not have to buy ScotiaLine Protection to obtain or renegotiate a ScotiaLine. ScotiaLine Protection is optional. You may apply at the same time you obtain your ScotiaLine or at a later date. No health questions There are no health questions on the application for ScotiaLine Protection. Simply check pages 8, 9, 10 and 11 for exclusions and restrictions. Maximum coverage The maximum coverage is $150,000 for each insured ScotiaLine (maximum of two). Cost Your premiums (cost of insurance) are based on your age at the end of each ScotiaLine billing period and the average daily balance on your ScotiaLine during the billing period. When both of the borrowers on a joint ScotiaLine have the same ScotiaLine Protection plan (joint coverage), the premium is based on the age of the older borrower. We divide your average daily ScotiaLine balance during the billing period by 1,000 and multiply by the applicable premium rate shown in the tables below and on the following page and add any applicable provincial sales tax. Your premium is added to your ScotiaLine balance and will be included on your monthly ScotiaLine statement. The lender collects your premium and sends it to us. Table of premiums for Basic ScotiaLine Protection Rates per $1,000 of average daily ScotiaLine balance ($) Your age at the end of each Single Joint billing period coverage coverage under Sales tax will be added where applicable. Page 6

9 Table of premiums for Enhanced ScotiaLine Protection Rates per $1,000 of average daily ScotiaLine balance ($) Your age at the end of each Single Joint billing period coverage coverage under Sales tax will be added where applicable. In the case of dual coverage (when one borrower on a joint ScotiaLine chooses Basic ScotiaLine Protection and the other borrower chooses Enhanced ScotiaLine Protection), the cost is the sum of the single premium for each borrower, multiplied by.95. Examples of premium calculation Single coverage: You have applied for Basic ScotiaLine Protection. If you are 25 years old at the end of a billing period and your average daily ScotiaLine balance for the billing period was $5,000, then your premium would be $1 ($0.20 x 5) for that billing period. Sales tax will be added where applicable. Joint coverage: You and a co-borrower on a joint ScotiaLine both have Enhanced ScotiaLine Protection. If you are 25 years old and the other borrower is 40 years old at the end of a billing period, and your average daily ScotiaLine balance for the billing period was $10,000, then your premium (which is based on the age of the older borrower) would be $12.90 ($1.29 x 10) for that billing period. Sales tax will be added where applicable. Dual coverage: You hold a joint ScotiaLine. You are 31 years old and the other borrower is 40 years old at the end of a billing period. You have Basic ScotiaLine Protection and the other borrower has Enhanced ScotiaLine Protection. If your average daily ScotiaLine balance for the billing period was $5,000, then your premium would be $4.32 (.95 x ($ $0.66) x 5) for that billing period. Sales tax will be added where applicable. You will be sent advance written notice of any changes in the tables of premiums and/or premium calculation method. Start of coverage Your coverage starts the day the lender receives your application. Page 7

10 Exclusions in coverage Loss of Life Caution We will not pay a claim if you commit suicide within 24 months of the start date of your coverage, whether you are sane or not. Caution We will not pay a claim if you die within 24 months of the start date of your coverage and the main or secondary cause of your death is a pre-existing condition. We consider you to have a preexisting condition if you consulted a doctor, had tests, or received treatment, including taking any medication or injection, for any of the following illnesses at any time during the 12 months before the start date of your coverage. cancer leukemia AIDS (Acquired Immune Deficiency Syndrome) ARC (AIDS related complex) lung disease liver disease, or heart disease Health Crisis or Terminal Illness Caution We will not pay a claim if the investigation leading to the diagnosis of a health crisis or terminal illness began before the start date of your coverage. We will not pay a claim if your health crisis or terminal illness is caused, directly or indirectly, by: you attempting to commit suicide or harm yourself, whether you are sane or not your use of any drug, poisonous substance, intoxicant or narcotic not taken according to the instructions of a doctor your committing or attempting to commit a criminal offence or provoke an assault your operation or control of any motorized vehicle or water craft, while your blood alcohol concentration is higher than 80 milligrams per 100 millilitres, or war, insurrection, or hostilities of any kind, whether you take part or not. Health Crisis Caution We will not pay a claim if you die within 30 days after the date you are diagnosed with a health crisis or have surgery. We will not pay a claim for coronary artery bypass surgery if the investigation of the medical problem leading to surgery began before the start date of your coverage. Page 8

11 There are also several illnessspecific exclusions. They are: Stroke: We will not cover a transient ischemic attack (TIA), sometimes referred to as a mini stroke. Coronary artery bypass surgery: We will not cover non-surgical techniques such as balloon angioplasty, laser relief of an obstruction, and other intraarterial procedures. Cancer: We will not cover the following conditions or forms of cancer: - stage A prostate cancer, - non-invasive cancer in situ, - pre-malignant lesion, benign tumours or polyps, - any tumour in the presence of any human immunodeficiency virus (HIV), and - any skin cancer other than invasive malignant melanoma into the dermis or deeper. We will not pay a claim for cancer if the diagnosis or any investigation leading to the diagnosis is initiated within the 90 days after the start date of your coverage. Page 9

12 Restrictions in coverage Loss of Life, Health Crisis and Terminal Illness The maximum benefit payable for any one ScotiaLine is $150,000. You may have ScotiaLine Protection on a maximum of two ScotiaLines only. The following restrictions will only apply if your claim is more than $10,000 and the difference between your claim amount and the average ScotiaLine balance during the 12 months before diagnosis is more than $5,000. Your average monthly ScotiaLine balance is calculated by adding the balance on each of your monthly ScotiaLine statements for the 12- month period, then dividing the total by 12. Loss of Life We will limit your benefit if, after becoming insured, you are diagnosed with any of the following conditions, that condition is the primary or secondary cause of death, and you die within 24 months of diagnosis: cancer leukemia AIDS (Acquired Immune Deficiency Syndrome) ARC (AIDS related complex) lung disease liver disease, or heart disease In such an event, the benefit will be limited to not more than your average monthly ScotiaLine balance during the 12 months before you were diagnosed with the condition causing death. Your average monthly ScotiaLine balance is calculated by adding the balance on each of your monthly ScotiaLine statements for the 12- month period, then dividing the total by 12. If upon diagnosis, you had ScotiaLine Protection for less than 12 months, we calculate your average monthly ScotiaLine balance during the period from the start date of your coverage to the date you were diagnosed. We will not pay more than the outstanding balance of your ScotiaLine on the date of death, regardless of your average monthly ScotiaLine balance. Health Crisis or Terminal Illness If you are diagnosed with a health crisis or terminal illness and your outstanding ScotiaLine balance increased by more than 20% during the 3 month period before the date of diagnosis, the benefit will be limited to your ScotiaLine balance at the date of diagnosis or your average monthly ScotiaLine balance during the 12 months before the month in which you were diagnosed, whichever is less. Page 12

13 Your average monthly ScotiaLine balance is calculated by adding the balance on each of your monthly ScotiaLine statements for the 12- month period, then dividing the total by 12. If upon the day you are diagnosed with a health crisis or terminal illness, you had ScotiaLine Protection for less than 12 months, we calculate your average monthly ScotiaLine balance during the period from the start date of your coverage to the date you were diagnosed. We will not pay more than the outstanding balance of your ScotiaLine on the date of diagnosis, regardless of your average monthly ScotiaLine balance. Page 13

14 Changing your coverage You may upgrade from Basic ScotiaLine Protection to Enhanced ScotiaLine Protection or downgrade from Enhanced ScotiaLine Protection to Basic ScotiaLine Protection (subject to the Who may apply provision on page 5 of this booklet) at any time by contacting Scotiabank. However, if you are upgrading your coverage, Exclusions in coverage and Restrictions in coverage for the loss of life coverage under the Enhanced ScotiaLine Protection plan will be based on the original start date of your Basic ScotiaLine Protection plan. Cancellation If you change your mind after enrolment You re protected by our 10-day free look guarantee. If you provide your branch a signed request to cancel the insurance within 10 days of applying, we will credit to your ScotiaLine any premiums you have paid. Cancelling your coverage You may cancel your coverage at any time. All you have to do is give a signed, dated request to your branch. In the case of a joint ScotiaLine account both borrowers must sign the request to cancel even if the request is to cancel coverage for only one of the borrowers. Coverage will be cancelled on the date the lender receives your request. If ScotiaLine Protection is cancelled on a ScotiaLine (whether the cancellation is for one borrower or both borrowers) the lender will mail a letter (to the most recent address they have on file) addressed to both parties confirming the cancellation requested. End of coverage Your coverage ends on whichever of the following dates comes first: the date the lender receives your signed, dated request to cancel coverage the date you die or in the case of joint or dual coverage, the date you or your co-borrower die the date we pay a ScotiaLine Protection claim (in the case of a joint ScotiaLine, coverage will end for both borrowers) your 70th birthday the date your ScotiaLine becomes 120 days past due or is terminated by the lender the date you become insolvent or bankrupt, or the date the group policy ends. Enhanced ScotiaLine Protection automatically terminates and is converted to Basic ScotiaLine Protection when you reach your 56th birthday. Page 14

15 In the case of joint or dual coverage: any request to cancel must be signed by both borrowers even if the request is to cancel coverage for only one of the borrowers. when the older person reaches age 70 we will automatically change the younger person to single coverage, and change the premium accordingly. if a ScotiaLine Protection loss of life, health crisis or terminal illness claim is paid for one borrower the other borrower must re-apply (subject to the Who may apply provision on page 5 of this booklet) if they wish to have new ScotiaLine Protection coverage. Claims How to make a claim For loss of life, your estate representative can call us at For a health crisis or terminal illness, you or your representative can call us at the same toll-free number. We will send a claim form, including an Attending Physician Statement, to be completed. Any cost involved in the completion of the forms will be at your or your representative s expense. A completed loss of life claim form must be sent to us within one year of the date of your death. The Attending Physician Statement is required for proof of death. A completed health crisis or terminal illness claim form must be sent to us within 90 days of the date of diagnosis or surgery. It must be completed by the doctor who made the diagnosis or performed the surgery. At our expense, we may also ask you to have a medical examination by a doctor of our choice. Benefits will not be paid if examination is refused. If we do not receive notice of claim within the specified time, we will only process the claim if you can show reasonable cause for delay. Insurer s claim decision We will notify you or your estate representative in writing of our decision to approve or deny your claim within 30 days after receiving all of the information we need to make a decision. If we deny the claim or reduce the benefit because of an exclusion or restriction described in this booklet, we will explain this in our decision letter. Appeal of insurer s decision If we deny your claim, you or your estate representative may appeal the decision. The appeal must be sent to us in writing within six months of the date of our decision letter, and it must include the reason or reasons for appealing plus any additional relevant information or documentation that was not initially submitted with your claim. Page 13

16 Legal action No one may take legal action against us less than 60 days after we receive initial proof of a claim or more than one year after the deadline for providing notice of claim. Confidentiality To ensure the confidentiality of your personal information, we will establish a claim file when we are notified of a claim. Your claim file will be kept at our offices. Only our employees or representatives responsible for the administration and investigation of the claim, as well as anyone you personally authorize, will have access to your file. If you wish to access your file, and have it corrected if necessary, send a written request to: The Canada Life Assurance Company Attention: Ombudsman and Director of Customer Relations 330 University Avenue Toronto, Ontario M5G 1R8 If we receive a request for access or correction, we will reply to you within 30 days. We may require a reasonable charge for reproduction and transmission of any information provided. Page 14

17 Provider of this coverage Basic ScotiaLine Protection is provided by The Canada Life Assurance Company under group insurance policy G30680, issued to The Bank of Nova Scotia. Enhanced ScotiaLine Protection is provided by The Canada Life Assurance Company under group insurance policies G30680 and H30680, issued to The Bank of Nova Scotia. This booklet and the completed application are part of a set of documents legally describing ScotiaLine Protection. Any subsequent letters from us or the lender regarding your ScotiaLine Protection are also part of this set. The lender is not an agent of Canada Life, and no employee can waive or change any of the terms of this booklet. Should The Bank of Nova Scotia and Canada Life revise the coverage described in this booklet, you will be notified in writing before the changes are made. You will be deemed to have received such notice on the fifth business day after it is mailed to your last address shown in the lender s records. Page 15

18 Scotiabank Founded in 1832, Scotiabank is one of North America s premier financial institutions. It is also Canada s most international bank. Through a network of more than 2,000 branches and offices, Scotiabank and its affiliates serve individuals, small businesses, commercial, corporate, institutional and government clients in some 50 countries around the world. In Canada, the Bank s Retail and Small Business, Commercial Banking and Wealth Management operations provide a full range of financial services to more than seven million customers. Scotiabank is also committed to helping the communities in which it does business. Its strategy is to focus on education, health, social services, the arts and culture and community programs through donations, sponsorships and active employee involvement. Canada Life Founded in 1847, Canada Life was the first Canadian insurance company. Today, it is among the country s top life insurers and top 30 in North America. Throughout Canada, the United States, the United Kingdom and Ireland, Canada Life serves more than 8.0 million people through individual and group contracts. It has over 40 years experience in creditor insurance and currently insures over $94 billion in loans and mortgages in Canada. The company consistently earns high ratings from independent agencies, including Standard and Poor s, Moody s and A.M. Best.

19 How to reach us For questions concerning your insurance application, insurance claims or this Certificate of Insurance booklet, you can contact us directly at: The Canada Life Assurance Company Group Creditor Benefits Department 330 University Avenue Toronto, Ontario M5G 1R8 Toll-free: a.m. to 6 p.m. Eastern Time, Monday through Friday Fax: creditor_info@canadalife.com trademarks of The Bank of Nova Scotia. Trademarks used under the authorization and control of The Bank of Nova Scotia. Canada Life * Registered Trademark of The Canada Life Assurance Company (3/02) For use outside Quebec only