THE PROFESSIONAL INSTITUTE OF THE PUBLIC SERVICE OF CANADA

Transcription

1 Attached to and forming part of Group Policy No. issued to THE PROFESSIONAL INSTITUTE OF THE PUBLIC SERVICE OF CANADA This policy has been amended effective November 1, 2002 in respect of the PREMIUM PROVISIONS. Revision Instructions Deleted Page G 1 Replacement Page G 1 (Nov.01.02) The Group Policyholder s payment of the first premium billed for insurance starting on the effective date of this amendment will be considered acceptance of this amendment. Signed at The Great-West Life Assurance Company, Winnipeg, Manitoba, on March 5, Secretary President and Chief Executive Officer For the Actuary

2 Great-West Life Centre 60 Osborne Street North Winnipeg, Manitoba R3C 3A5 (204) December 10, 2002 The Professional Institute of the Public Service of Canada 333 Preston St Suite 200 Ottawa ON K1S 5N4 Re: Group Policy No. (the "Group Policy") The purpose of this letter is to set out the terms of an agreement between The Great- West Life Assurance Company (herein called "the Company") and THE PROFESSIONAL INSTITUTE OF THE PUBLIC SERVICE OF CANADA (herein called "the Group Policyholder") whereby, subject to the terms and conditions of the Group Policy and the terms and conditions set out below, the Company agrees to continue coverage for the spouse of a deceased member until they attain age Effective Date This agreement is effective November 1, Miscellaneous The terms, conditions and provisions of the Group Policy shall insofar as applicable and not inconsistent with the terms hereof apply to the insurance provided under this agreement.

3 Agreement Termination This agreement may be terminated at any time by the Group Policyholder or the Company provided written notice is given to the other party at least 31 days in advance. Signed at The Great-West Life Assurance Company, Winnipeg, Manitoba Secretary President and Chief Executive Officer For the Actuary The terms of this agreement are hereby accepted by the Group Policyholder on. THE PROFESSIONAL INSTITUTE OF THE PUBLIC SERVICE OF CANADA By Title

4 GROUP INSURANCE POLICY GROUP POLICYHOLDER: THE PROFESSIONAL INSTITUTE OF THE PUBLIC SERVICE OF CANADA GROUP POLICY NO.: - Billing No. for insurance over $250,000: EFFECTIVE DATE: November 1, 2002 INSURANCE PROVIDED: Optional Life Insurance

5 APPLICATION FOR GROUP POLICY THE PROFESSIONAL INSTITUTE OF THE PUBLIC SERVICE OF CANADA (the Applicant) applies to The Great-West Life Assurance Company for Group Policy No. in the attached form. The Applicant has approved this Group Policy and has accepted its terms. Dated at this day of, THE PROFESSIONAL INSTITUTE OF THE PUBLIC SERVICE OF CANADA Witness By Agent or Consultant of Record Title

6 TABLE OF CONTENTS AGREEMENT A 1 PAGE TABLE OF BENEFITS B-TB 1 INSURING PROVISIONS Insurance Clause C 1 Insurable Member C 1 Eligibility Conditions C 1 Spouse Coverage C 2 Insurable Spouse C 2 Effective Date of Insurance C 4 Changes in Insurance C 4 Underwriting Provision C 4 Termination of Insurance C 5 Member Insurance C 5 Insurance for a Member's Spouse C 5 Plan Re-Entry C 6 Conversion Privilege C 7 BENEFIT PROVISIONS Death Benefit D 1 Beneficiary D 1 Suicide Limitation D 2 Opt Life (i)

7 GENERAL PROVISIONS Proof of Claim F 1 Currency F 1 Furnishing of Information: Access to Records F 1 Misstatement of Age F 2 Disclosure Provisions F 3 Appeals F 4 Conformity to Legislation F 4 Non-Participating F 4 Assignment F 4 Gender F 4 PREMIUM PROVISIONS Payment G 1 Grace Period G 1 Calculation: Premium Rate G 1 Adjustments G 1 Rate Changes G 2 TERMINATION OF THE POLICY H 1 TRANSFER PROVISIONS Transfer of Insurance to Great-West Life I 1 Opt Life (ii)

8 AGREEMENT Great-West Life agrees to pay the benefits provided by this policy to the persons entitled to receive them. This agreement is made in consideration of the Group Policyholder's payment of the required premiums. This policy takes effect at 12:01 a.m. on the Effective Date, local time at the Group Policyholder's address. The following pages and any riders or amendments are a part of this policy. Signed at The Great-West Life Assurance Company, Winnipeg, Manitoba Secretary President and Chief Executive Officer For the Actuary Opt Life A 1

9 TABLE OF BENEFITS This table must be read in conjunction with the rest of this policy. ELIGIBLE CLASSES: AMOUNT OF INSURANCE: All members, staff, affiliate members and retired members under age 70 Any multiple of $25,000 up to $500,000 per person. At age 65, amounts of insurance in excess of $150,000 will reduce to $150,000. Opt Life B-TB 1 (Nov.01.02)

10 INSURING PROVISIONS INSURANCE CLAUSE To become insured under this policy a person must: 1. be employer by the Group Policyholder; 2. either be a member of the Group Policyholder or be a retired member; 3. be an insurable member; 4. be in an eligible class; 5. satisfy the eligibility conditions; and 6. satisfy the effective date of insurance provisions. INSURABLE MEMBER A staff of the Group Policyholder is insurable if he is employed: 1. on a permanent, non-seasonal, and fulltime basis; and 2. for at least 30 hours each week. A member is insurable if he is in good standing with the Group Policyholder. - retired members - affiliate members A retired member is insurable if he was a member of the Group Policyholder the day before he retired. An affiliate member is a former member who is continuing to contribute to the plan. ELIGIBILITY CONDITIONS - eligibility limitation A member is eligible immediately if he is insurable on the effective date of this policy. Otherwise he is eligible on the date he becomes an insurable member. A member is only eligible for the benefits provided for his class in the Table of Benefits. Insuring Provisions C 1 (Nov.01.02)

11 INSURING PROVISIONS SPOUSE COVERAGE A member is eligible to insure his or her spouse on the later of: 1. the date the member becomes eligible; and 2. the date the spouse becomes an insurable spouse. The effective date of insurance section determines when the insurance for the spouse actually starts. INSURABLE SPOUSE A spouse is insurable if that person is: 1. the member's legal spouse, common-law spouse, or former spouse; and 2. under age 70; and 3. not insured as a member. A member can only insure one spouse at a time. The member must insure the same person for all spouse benefits provided under the participating Group's benefit program. Where the member has more than one insurable spouse, Great-West Life will consider his or her insured spouse to be the one for whom the member first submits a claim for any benefit provided under the participating Group's benefit program. - legal spouse - common-law spouse - former spouse A legal spouse means the person lawfully married to the member according to applicable provincial legislation. A common-law spouse means a person who is living with the member in a conjugal relationship. A former spouse means a divorced or excommon-law spouse of the member for whom insurance protection for some of the benefits available under the participating Group's benefit program is mandated by court order. Insuring Provisions C 2

12 INSURING PROVISIONS - change in spouse The member can change from one insured spouse to another by submitting a claim for a different spouse for any benefit provided under the Group Policyholder's benefit program. The change will take effect on the later of: 1. the date of the loss claimed for the new spouse; and 2. the day after the date of the last loss claimed for the previous spouse. A change from a common-law spouse to a legal spouse is valid only when the legal spouse is living with the member. A change from a former spouse to a legal or common-law spouse is not allowed unless the provision in the court order by which the former spouse qualified for coverage is no longer in effect. Insuring Provisions C 3

13 INSURING PROVISIONS EFFECTIVE DATE OF INSURANCE A member must complete an application for insurance and supply the information Great-West Life requests. Great-West Life will then assess the information according to its underwriting rules. The application will be approved if it meets underwriting standards. Insurance takes effect on the date of written approval. Changes in Insurance Any member other than an affiliate member may apply for an increase or decrease in his insurance at any time. An affiliated member may apply for a decrease in his insurance at any time. Increases are subject to the same underwriting process as the initial application for insurance. They take effect on the date of written approval. Decreases take effect on the date the application for a decrease is made. Underwriting Provision Members who wish to obtain insurance that is subject to this provision must apply for it and supply the information Great-West Life requests. Great-West Life will then assess the information according to its underwriting rules. Applications will be approved if they meet underwriting standards. Insuring Provisions C 4

14 INSURING PROVISIONS TERMINATION OF INSURANCE The following provisions describe when insurance terminates. Member Insurance Insurance for a member terminates on the earliest of the following dates: 1. the date this policy terminates; 2. the due date of the first premium to which the member has not made a required contribution for member coverage; 3. the date the member ceases to be in an eligible class; 4. the date he ceases to be an insurable member. Insurance for a Member's Spouse Insurance for a member's spouse terminates on the earliest of the following dates: 1. the date optional spouse coverage ceases to be available under this policy; 2. the due date of the first premium to which the member has not made a required contribution for spouse coverage; 3. the date the member ceases to be in a class eligible for spouse coverage; 4. the date the spouse ceases to qualify as an insurable spouse; or 5. the day before the effective date of a change to a new insured spouse. Insuring Provisions C 5 (Nov.01.02)

15 INSURING PROVISIONS Plan Re-Entry Once a member's insurance has terminated, a member re-entering the plan will be treated as a new member unless the insurance terminated because the member stopped making required premium contributions. If it did, re-entry is subject to the underwriting provision. Insuring Provisions C 6

16 INSURING PROVISIONS CONVERSION PRIVILEGE - conditions - exceptions If the insurance for a member or spouse terminates under this policy, that person is entitled to obtain an individual life insurance policy without evidence of insurability under the following conditions. A person must apply for the individual policy in writing and pay the first premium within 31 days after the insurance terminates. In the case of insurance for the spouse, either the member or the spouse may apply. The conversion privilege is not available if insurance terminates because the member stops making required premium contributions. The conversion privilege is not available to a spouse for whom insurance terminates because: 1. he ceases to be an insurable spouse; or 2. the member chooses to insure a different spouse. - policy form The individual policy may be in any one of Great- West Life's standard conversion forms. Term insurance is only available in the following forms: 1. a non-renewable term insurance policy to age 65; or 2. a 1 year non-renewable term insurance policy with premium frequency not less than quarterly. This type of policy can be converted to any other form of conversion policy being offered, without evidence of insurability, if the change is made before the end of the 1-year term. No disability or accidental death benefit will be offered. Insuring Provisions C 7

17 INSURING PROVISIONS Dividend options on whole life participating policies will be limited to: 1. cash; 2. premium reduction; or 3. dividends left on deposit. - premium - amount The premium for the individual policy will be based on the person's age, sex, and class of risk, and on the type and amount of policy being issued. The amount of the individual policy will not exceed the lesser of: 1. the amount of terminated insurance less the amount of any group term life insurance for which the person becomes eligible within the 31 days allowed for conversion; and 2. $200, This is the combined maximum that can be converted under all group life plans issued to the Group Policyholder by Great-West Life. A person can convert less than the maximum individual policy amount but cannot convert an amount less than the minimum issued by Great- West Life for the type of policy chosen. - conversion policy effective date - extension The individual policy takes effect at the end of the 31 days allowed for conversion. If a person dies within the 31 days allowed for conversion, the total amount of terminated insurance is payable under this policy's death benefit provision as if the death occurred while the insurance was still in force. Insuring Provisions C 8

18 BENEFIT PROVISIONS DEATH BENEFIT If a member dies while insured, Great-West Life will pay the member's amount of insurance to his or her beneficiary. If a spouse dies while the spouse's life is insured, Great-West Life will pay the amount of insurance to the member. Beneficiary A member has the right to name a beneficiary when he applies for insurance. He can change his beneficiary at any time, where permitted by law. If the beneficiary dies before the member or if the member has not named a beneficiary, payment will be made to the member's estate. Benefit Provisions - Opt Life D 1

19 BENEFIT PROVISIONS SUICIDE LIMITATION If a person commits suicide within 2 years after the insurance on his life takes effect or increases, Great-West Life's liability for the portion of the insurance that has been in force for less than 2 years will be limited to the premiums paid for that insurance. All periods of coverage under this and previous optional life plans sponsored by the Group Policyholder are considered together in satisfying the 2-year condition as long as there is no interruption from one to the other. Benefit Provisions - Opt Life D 2

20 GENERAL PROVISIONS PROOF OF CLAIM Death benefits under this policy will be paid only after Great-West Life has received satisfactory proof that payment is due. CURRENCY All money payable under this policy will be in Canadian funds. FURNISHING OF INFORMATION: ACCESS TO RECORDS Upon request, the Group Policyholder must forward to Great-West Life: 1. required information on the eligibility of members; 2. member applications; 3. details relating to changes in insurance; and 4. information required for assessment of claims. Great-West Life has the right to inspect the Group Policyholder's records relating to members' insurance. Inspections can take place while this policy is in force and during the first year after it terminates. All requests, notices, applications, and claims must be made to Great-West Life in writing. Great-West Life will not be liable for the Group Policyholder's failure to supply required information or records. General Provisions - Opt Life F 1

21 GENERAL PROVISIONS MISSTATEMENT OF AGE Great-West Life may request proof of a member's age at any time. If his age has been misstated, entitlement to insurance and benefits will be determined according to his true age. If premiums have been underpaid for a member's true age, a retroactive adjustment must be paid by the Group Policyholder before any benefits will be paid or continued. If premiums have been overpaid for a member's true age, Great-West Life will pay or credit a retroactive adjustment to the Group Policyholder. General Provisions - Opt Life F 2

22 GENERAL PROVISIONS DISCLOSURE PROVISIONS 1. This policy will be available through the Group Policyholder for review by members. Great-West Life, at its discretion, may release a copy of this policy in order to settle claims. 2. If asked to do so within 2 years after notification of a decision concerning insurance or benefits, Great-West Life will disclose to the member the name of each person or organization that provided information concerning his application. 3. If a member submits written authorization from a person or organization that provided medical information, Great-West Life will disclose the information to the member or, at Great-West Life's discretion, to the member's doctor. 4. Great-West Life may, without specific authorization, disclose information about a member's claim to another insurer or benefits administrator if: (a) (b) the information could be relevant to assessment of the member's entitlement to other benefits for the same period of time; and the information is given in confidence with the stipulation that it may not be released to another party. General Provisions - Opt Life F 3

23 GENERAL PROVISIONS APPEALS A member has the right to appeal a denial of all or part of the insurance or benefits described in this policy as long as he or she does so within 2 years after the denial. An appeal must be in writing and must include the member's reasons for believing the denial to be incorrect. CONFORMITY TO LEGISLATION If this policy does not conform to legislation that governs it, it is considered automatically amended to comply with the minimum requirements of that legislation. NON-PARTICIPATING This is a non-participating policy. ASSIGNMENT Members may not assign their insurance under this policy. GENDER The words he, him and his refer to both genders. General Provisions - Opt Life F 4

24 PREMIUM PROVISIONS PAYMENT - billing number The first premium is due on the effective date of this policy. After that, premiums are due on the first day of each month. Premiums must be paid by the Group Policyholder at Great-West Life's Head Office. Premiums not paid on time will be in default. Separate billing number applies to the premium for optional insurance in excess of $250,000. All other insurance is billed under the group policy number. GRACE PERIOD After the first premium has been paid, 60 days of grace are allowed to pay a premium in default. During this time the policy will stay in force. If the premium is not paid by the end of the days of grace this policy will terminate. The Group Policyholder is liable for a pro rata premium for the time this policy is in force during the grace period and for all other unpaid premiums. CALCULATION: PREMIUM RATE - non-smoker rates - premium payment not a guarantee of coverage The amount of each premium is the sum of the premiums for each insured member calculated at the rate last set by Great-West Life. Premium rates are based on the person's age, sex, and smoker/non-smoker status. To qualify for non-smoker rates, a person must not have smoked cigarettes for the last 12 months. Payment of premium will not cause insurance to take effect or continue if it would not do so according to this policy's insuring provisions. ADJUSTMENTS The premium will be adjusted retroactively to reflect changes in insurance amounts. Credits will be given only for the 4 months preceding receipt of notice. Premium Provisions - Opt Life G 1 (Nov.01.02)

25 PREMIUM PROVISIONS RATE CHANGES Great-West Life can change the premium rates at any time. Written notice will be sent to the Group Policyholder before a change is made. Once a change is made, Great-West Life cannot make another change for 12 months or such other period as may be agreed to by the Group Policyholder, unless: 1. the policy provisions are changed at the request of the Group Policyholder. 2. the introduction, revision, or repeal of a government statute or regulation results in a change in: (a) (b) the benefits payable under this policy; or taxes payable to a government authority. Premium Provisions - Opt Life G 2

26 TERMINATION OF THE POLICY The Group Policyholder may terminate this policy by giving written notice to Great-West Life. Termination by the Group Policyholder will take effect on the later of: 1. the date of termination stated in the written notice; and 2. the date Great-West Life receives the written notice. Great-West Life may terminate this policy at any renewal date by giving written notice of termination to the Group Policyholder at least 31 days in advance. This policy will automatically terminate if a premium in default is not paid by the end of the grace period for that premium. Policy Termination - Opt Life H 1

27 TRANSFER PROVISIONS Transfer of Insurance to Great- West Life Any person who was covered in a terminating class under the previous insurer's policy when insurance for that class ended will be insured on the effective date of insurance for that class under this policy, as long as he is then an insurable member. This provision applies when insurance takes effect under this policy during the 31 days after the optional life insurance coverage ends for that class under another group life insurance policy. Transfer Provisions - Opt Life I 1