CERTIFICATE OF INSURANCE

Transcription

1 CERTIFICATE OF INSURANCE Hospital Accident Recovery Plan INSURER: BMO Life Assurance Company POLICYHOLDER: Bank of Montreal Group Policy Number: BM-HARP Yonge Street Toronto, Ontario M5E 1H5 Call Toll-Free This is an important document. Please retain for your records. This Certificate provides Hospital Accident Recovery insurance. It is subject to all the terms and conditions set forth in the Master Group Policy No. BM-HARP-01 referred to as Group Policy, which can be examined upon request. The Group Policy is issued by BMO Life Assurance Company (referred to as we, our, or us ) to Bank of Montreal (referred to as Policyholder ). The Group Member Insured named in the Coverage Summary is referred to as you, your, or yours. Capitalized terms used in this Certificate are defined in the Definitions section. Both the Group Policy and the Certificate are non-participating. RIGHT TO EXAMINE CERTIFICATE If you find that this Certificate does not meet your needs, you may cancel this Certificate by calling us and receive a full refund of premiums you have paid by notifying us within thirty (30) days of receiving your Certificate. Your coverage will be deemed to have never been in effect. This Certificate supersedes any Certificate previously issued to you under the Group Policy. You and any Covered Person may qualify under one (1) Certificate only under this or any replacement group policy If any person is insured under more than one (1) Certificate, we will consider that person to be insured only under the Certificate which provides the greatest amount of coverage. This Certificate contains a provision removing or restricting the right of the Group Member Insured to designate persons to whom or for whose benefit insurance money is to be payable DEFINITIONS In this Certificate all capitalized terms specified below have the meanings attributed to them for the purposes of interpreting the Certificate: Accident means a sudden, unforeseen event happening by chance that occurs while this Certificate is in force. Covered Person means you, the Group Member Insured, who was between ages of eighteen (18) and sixty-five (65), on the Certificate Effective Date as indicated on the Coverage Summary and who has not yet attained the age of seventy-five (75). If coverage for your Spouse is added, Covered Person also includes your Spouse, who was between the ages of eighteen (18) and sixty-five (65) at the time the coverage was elected. Group Member Insured means you, the BMO Bank of Montreal customer, who holds the rights granted under this Certificate of Insurance. 1

2 Head Office means the primary place of business of BMO Life Assurance Company located at 60 Yonge Street, Toronto, Ontario, M5E 1H5, which may be changed from time to time upon notice to you. Hospital means any legally constituted establishment in North America (namely Canada, United States, Mexico and the Caribbean) which operates according to the laws of the country in which it is situated and provides a full-time service for the care of resident in-patients, excluding mental institutions; nursing, rest or convalescent homes; homes for the aged; extended care facilities; rehabilitation establishments; hospices or palliative care facilities. Injury means bodily Injury caused by an Accident, directly and independently of all other causes. It does not include any sickness, illness, disease, medical disorder or medical treatments. The Covered Person(s) must sustain the Injury and the Accident must occur while coverage is in force. Insurance Application means the enrolment form or, if applicable, the recorded verbal application and its transcripts. Paralysis means a definite diagnosis of the total loss of muscle function of two or more limbs as a result of an injury to the nerve supply of those limbs for a period of at least 90 days following the Accident. The diagnosis of Paralysis must be made by a qualified medical practitioner specializing in Neurology. Spouse means, at the time of claim, the person: (a) legally married to you or entered into a civil union with you; or (b) living in a common law relationship with you for the last twelve (12) consecutive months. COVERAGE Under this Group Policy, this Certificate is issued to the Group Member Insured and provides coverage to the Covered Person(s) for the benefits outlined in Parts I, II, III and IV. PART I - HOSPITAL CASH BENEFIT The Hospital Cash Benefit specified on the Coverage Summary is payable to the Covered Person(s) who suffered the Injury if we receive satisfactory proof that: (a) the Covered Person(s) was an in-patient in a Hospital due to an Injury; and (b) the Covered Person(s) has not attained age 75. This benefit is payable for a cumulative maximum of 365 days per hospitalization. If the Covered Person(s) is hospitalized multiple times for the same Injury within 6 months following the Injury, each subsequent hospitalization will be treated as a continuation of the previous hospitalization. PART II - HOME RECOVERY BENEFIT For each day that the Covered Person(s) is entitled to receive the Hospital Cash Benefit, we will also pay to the Covered Person(s) who suffered the Injury the Home Recovery Benefit specified on the Coverage Summary to a maximum of 30 days per hospitalization. PART III - PARALYSIS BENEFIT If an Injury results directly in Paralysis of two (2) or more limbs, we will pay to the Covered Person(s) who suffered the Injury, a lump sum Paralysis Benefit outlined in the Coverage Summary. The Paralysis Benefit will be paid if there has been no sign of improvement for a continuous period of 90 days following an Accident. PART IV - ACCIDENTAL DEATH BENEFIT If the Covered Person(s) dies as a direct result of an Injury, we will pay a lump sum Accidental Death Benefit as set out in the Coverage Summary in accordance with the Beneficiary section below. The death must occur within 365 days of the Accident that caused the Injury and both the death and the Injury must occur while this Certificate is in force. 2

3 EXCLUSIONS We will not pay any benefit(s) in Parts I, II, III or IV if the death of or Injury to the Covered Person(s) results either directly or indirectly from any of the following causes: (a) suicide, attempted suicide or self-inflicted Injury, while sane or insane; (b) an Accident that occurs while the Covered Person s blood contained more than 80 milligrams of alcohol per 100 millilitres of blood or while the Covered Person(s) is under the influence of or had administered any toxic substance, narcotic or prescription drug available unless taken in strict accordance with the prescription of a physician or dentist; (c) injury received during a civil disorder or war, whether declared or not, or as a result of committing or attempting to commit an assault or criminal offence; (d) while the Covered Person(s) is serving on any active duty in any Armed Force; (e) travel, flight or descent in or from any kind of aircraft of which the Covered Person(s) was a pilot, officer or crew member, or in which the Covered Person(s) was giving or receiving any kind of training or instruction or had any duties; (f) terrorist activity involving the use or release of nuclear, chemical or biological weapons, devices, and/or agents. WHEN COVERAGE BEGINS Your coverage is effective on the Certificate Effective Date as shown in the Coverage Summary. If selected at the time of enrolment, coverage for your Spouse will become effective on the same date and time as your coverage. If spousal coverage is selected after the time of your enrolment, coverage for your Spouse will take effect on the date set out on the revised Coverage Summary. WHEN COVERAGE ENDS (a) your insurance coverage is effective until you attain the age of seventy-five (75). (b) coverage for your covered Spouse terminates on the earliest of: i. the day before the next Premium Due Date following the date your Spouse ceases to be your Spouse as defined in the definition of a Spouse; or ii. when your Spouse attains age seventy-five (75). (c) coverage for you and your Spouse will also end automatically on any of the following: i. thirty-one (31) days from the date a premium is due and unpaid; or ii. unless requested otherwise, the day before the next Premium Due Date immediately following receipt by us of the notice of termination of this Certificate. CONTINUATION OF COVERAGE In the event of your death, your Spouse, if covered, shall be deemed to be the Group Member Insured provided that he/she contacts us by telephone or in writing. In this case, the spousal coverage will cease and the premium will be adjusted accordingly. If you do not have a covered Spouse at the time of your death, the coverage will terminate. In the event of your covered Spouse s death, the spousal coverage will cease and the premium will be adjusted accordingly. If your Spouse ceases to be your Spouse, he or she will be covered until the day before the next Premium Due Date. BENEFICIARY - ACCIDENTAL DEATH BENEFIT Death of the Group Member Insured If your death results directly from an Injury, the Accidental Death Benefit will be paid to the beneficiary that you may designate. If no beneficiary is appointed, the benefit will be paid to your estate. You may alter or revoke any beneficiary designation by sending us a written and signed declaration to the extent permitted by applicable laws. The change will be effective on the date we receive a signed copy of the written request. A beneficiary designated irrevocably may not be changed without his or her consent. Death of Spouse If your Spouse is covered under this Policy, the Accidental Death Benefit payable on the death of your Spouse will be paid to you. 3

4 AGE OF INSURED This Certificate is issued in reliance on the statement of the age of the Group Member Insured contained in the Insurance Application. The date of birth which we have used appears on the Coverage Summary. If the date of birth of the Group Member Insured is misstated, you must notify us immediately as benefits may not be available under the Group Policy, unless prohibited by law. In this case, the premiums paid will be refunded. ELIGIBILITY To be eligible to enrol, you must be a customer of the Policyholder. You and your Spouse must be between the ages of eighteen (18) and sixty-five (65) at the time of enrolment and resident in Canada at the Certificate Effective Date. TRAVEL, RESIDENCE AND OCCUPATION Once this Policy has taken effect and so long as it remains in effect, the benefits provided shall not be prejudiced or affected by any travel, change of residence or change of occupation of the Covered Person(s) unless otherwise stated in this Policy. PAYMENT OF PREMIUMS To keep this Policy in effect, the correct premium must be paid at our Head Office on or before each Premium Due Date shown in the Coverage Summary. The premium is not guaranteed and may be changed on a class of insured basis and not on an individual basis upon at least 30 days prior notice to you. Such notice will specify the new premium and the effective date of the new premium. FAILURE TO PAY PREMIUMS If a premium (other than the first premium) is not paid at the time it is due, the premium may be paid within a grace period of 30 days from and excluding the Premium Due Date as specified in the Coverage Summary. This Certificate will lapse, without notice, at the end of the grace period if the overdue premium has not been paid during that period and our liability under this Certificate shall automatically cease. This Certificate does not allow for reinstatement. GENERAL CONDITIONS Access to documents You have the right to examine and obtain a copy of the Group Policy, Insurance Application and other written statements or records you have submitted to us. The Contract The Insurance Application, this Certificate, the Coverage Summary and any document attached to this Certificate when issued, and any amendment to the Contract agreed upon in writing after the Certificate is issued, constitute the entire contract between you and us. Waiver We shall be deemed not to have waived any condition of this Contract, either in whole or in part, unless the waiver is clearly expressed in writing and signed by us. Termination by You You may terminate this Contract at any time by giving notice of termination to us. No partial refunds will be payable on monthly premiums. Notice and Proof of Claim The person entitled to receive benefits shall: (a) give written notice of claim to BMO Life Assurance Company s Head Office at 60 Yonge Street, Toronto, Ontario, M5E 1H5 within thirty (30) days of the date of the Injury/death, (b) within ninety (90) days from the date of the Injury/death, furnish to us satisfactory proof of the Injury/death of the Covered Person(s), the name and age of each designated beneficiary, the right of each beneficiary to receive payment and the age of the Covered Person(s) to whom the claim relates, and (c) furnish satisfactory proof as to the cause or nature of the death or of the hospitalization for which a claim may be made under the Contract. Failure to Give Notice or Proof - Failure to give notice of claim or furnish proof of claim within the time set out above does not invalidate the claim if the notice or proof is given or furnished as soon as reasonably possible, and in no event later than one year from the date of the Accident if it is shown that it was not reasonably possible to give notice or furnish proof within the time so prescribed. 4

5 Rights of Examination As a condition precedent to payment of the benefit, we have the right and opportunity to examine the body of the Covered Person(s) and to require that an autopsy be made, unless forbidden by law. When Money is Payable - All money payable under this Contract shall be paid by us within sixty (60) days after we have received satisfactory proof of the death or Injury and the related information set out in this Certificate. Any payment the Insurer makes in good faith fully discharges the Insurer's liability to the extent of the payment made. Limitation of Actions - Every action or proceeding against an insurer for the recovery of insurance money payable under the Contract is absolutely barred unless commenced within the time set out in the Insurance Act (or the applicable legislation). Amendments to the Contract We may from time to time make changes to the Contract upon 30 days notice in writing to you. Authority to Make Changes Only one of our executive officers has the authority to bind BMO Life Assurance Company or to make any change to the Contract, and then only in writing. We will not be bound by any promise, waiver or representation made by any other person. Assignment No assignment of any benefit is permitted under this Group Policy. Clerical Error - Neither clerical error in record keeping, nor delays in making entries shall invalidate insurance otherwise validly in force under this Certificate. Currency - All amounts in the Coverage Summary are in Canadian Currency. Language - The parties expressly consent that this Certificate as well as other documents, agreements, notices relating to them be drafted in English. Les parties reconnaissent leur volonté expresse que le présent contrat ainsi que tous les documents, convention ou avis s y rattachant directement ou indirectement soient rédigés en langue anglaise. This Certificate is governed by the laws of the province in which the Group Member Insured is resident at the time of enrolment. Signed for and on behalf of BMO Life Assurance Company. Peter McCarthy President and Chief Executive Officer Vandra M. Goedvolk Corporate Secretary Registered trademark of Bank of Montreal, used under licence. BMO-HARP-POL-E-04/10 5