FractureCare Plus Insurance Policy BMO Life Assurance Company 60 Yonge Street Toronto, Ontario M5E 1H5 SPECIMEN. Call Toll-Free

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1 FractureCare Plus Insurance Policy BMO Life Assurance Company 60 Yonge Street Toronto, Ontario M5E 1H5 Call Toll-Free This is an important document. Please retain for your records. This Policy contains a provision removing or restricting the right of the Insured to designate persons to whom or for whose benefit insurance money is to be payable 1. INTRODUCTION BMO Life Assurance Company, also called BMO Insurance, we, our or us, is the issuer of this Policy, a legal contract with the Primary Insured of this Policy, also referred to as you, your or yours. The contract provides individual accident insurance, accidental paralysis and accidental death benefits to the Covered Person in accordance to its terms. It is a non-participating individual policy with no cash values and no dividends. Right to Examine Please read this Policy carefully. If you find that this Policy does not meet your needs, you have the right to cancel the Policy and receive a full refund of premiums provided you do so in writing within 30 days of receiving your Policy document. Your coverage will be deemed to have never been in effect. 2. DEFINITIONS All capitalized words or expressions in the Policy shall have the following meanings: Accident means a sudden, unexpected, unforeseeable, unavoidable external event that occurs while the Policy is in force. Benefit Amount means the amount of the benefit for each type of Injury and/or death referred to in the Schedule of Benefits. Covered Person means you, the Primary Insured and your Spouse, if enrolled. Dislocation means the displacement of a bone at a joint listed in the Schedule of Benefits and requiring surgery under anaesthesia. Fracture means a break in a bone or cartilage listed in the Schedule of Benefits. Injury or Injuries means bodily injury which is a Fracture, a Dislocation, Second or Third Degree burns or Paralysis caused by an Accident. It does not include any sickness, illness, disease, medical disorder or medical treatments.

2 Insured Spouse means the Spouse who has been enrolled for coverage under this Policy. Insurance Application means the acceptance form, enrolment form, or if applicable, the recorded verbal or electronic application and its transcripts. Maximum Benefit means the total Benefit Amount that a Covered Person is eligible to receive as outlined in Clause 5 of this Policy. Rule of Nine means the system used by doctors for assessing the percentage of the body surface affected by burns. In this system, the head and each arm each cover 9% of the body surface respectively; the front of the body and the back of the body and each leg each cover 18% of the body surface respectively. The groin covers the remaining 1%. Paralysis means a definite diagnosis of the total loss of muscle function of two (2) or more limbs as a result of an Injury to the nerve supply of those limbs that lasts for a period of at least 90 consecutive days following the Accident. The diagnosis of Paralysis must be made by a qualified medical practitioner specializing in Neurology licensed to practise in the jurisdiction where the medical services are performed. Premium Due Date means the date on which premiums are due and payable under the Policy and is set out in the Summary of Coverage. Primary Insured means the person who is named in the Summary of Coverage and entitled to all rights under the Policy, subject to any limits imposed by law or the Policy. Schedule of Benefits means the chart outlining the Benefit Amount for each type of Injury and/or death by Coverage Level Option. Second Degree Burns mean burns which penetrate beyond the top layer of skin, causing the formation of blisters. 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. Third Degree Burns mean burns which destroy full skin thickness. 3. ELIGIBILITY You are eligible for the FractureCare Plus coverage if you are: (a) between the ages of fifty (50) and seventy-five (75); and (b) a resident of Canada. You may also enrol your Spouse for coverage under the Policy, provided that at the time of enrolment, he or she: (a) is between the ages of fifty (50) and seventy-five (75); (b) is a resident of Canada; and (c) meets the definition of Spouse.

3 When Coverage Begins Your coverage is effective when we receive your first premium and is shown in the Summary of Coverage under the Policy Effective Date. If we do not receive the first premium, the policy will not take effect. 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 Summary of Coverage. When Coverage Ends All coverage under this Policy terminates on the earliest of: (a) thirty-one (31) days from the date a premium is due and unpaid; (b) the day before the Premium Due Date immediately following the day we receive written notice from you to cancel the Policy; (c) the payment of the Paralysis Benefit, and if there are two Covered Persons, on the date the last Covered Person is paid the Paralysis Benefit, subject to the Continuation of Coverage clause; and (d) the death of the Primary Insured, and if there are two Covered Persons, the date the last Covered Person dies, subject to the Continuation of Coverage clause. Continuation of Coverage In the event of your Paralysis or death, the Insured Spouse has the option to continue this Policy as a single policy in his or her own name and become the Primary Insured. To exercise this option, the Insured Spouse must contact us by telephone or in writing and continue to pay premium, which will be adjusted to reflect the single coverage. 4. BENEFITS This Policy is issued to the Primary Insured and subject to the Exclusions and Limitations provides coverage to the Covered Person for the benefits outlined below. Injury Benefit for Fractures, Dislocations, Second or Third Degree Burns or Paralysis Your Coverage Level Option is specified in the Summary of Coverage. We will pay the Covered Person the Benefit Amount(s) corresponding to the Coverage Level Option shown in the Schedule of Benefits when we receive satisfactory proof that: (a) the Injury or death resulted directly from an Accident; (b) the Accident, Injury or death, occurred while this Policy was in effect; (c) the death occurred within 90 days of the date of the Accident; and (d) none of the circumstances described in Exclusions and Limitations section is applicable. If the Covered Person is deceased at the time a Benefit Amount is payable, the Benefit Amount will be paid to the estate of the Covered Person.

4 SCHEDULE OF BENEFITS The following Benefit Amounts are payable as a result of an Injury caused by an Accident. Injury Benefit Amount Coverage Level Option Paralysis Level 1 Level 2 Level 3 Loss of use of two or more limbs $62,500 $125,000 $187,500 All Fractures to: Level 1 Level 2 Level 3 1. Neck 2. Hip or Pelvis 3. Skull 4. Thigh, Heel, Upper Arm 5. Ankle, Lower Leg, Elbow, Shoulder Blade 6. Lower Jaw, Collarbone 7. Lower Arm, Wrist 8. Vertebrae (each) 9. Sternum, Kneecap, Cheekbone 10. Hand (excluding Fingers, Thumb and Wrists), Foot (excluding Toes and Heel), Coccyx 11. Nose 12. Ribs (each) 13. Toes, Thumb or Finger (each) $6,250 $5,000 $3,125 $2,500 $2,185 $1,560 $1,250 $935 $625 $250 $185 $60 $12,500 $10,000 $6,250 $5,000 $4,375 $3,750 $3,125 $2,500 $1,250 Dislocations Level 1 Level 2 Level 3 1. Hip, Knee, Wrist, Elbow, Ankle, Shoulder Blade, Collarbone or Jaw 2. Thumb 3. Toes or Fingers (each) Second or Third Degree Burns (determined by Rule of Nine) 1. 27% or more of body surface % of body surface % of body surface $1,250 $125 $60 $500 $375 $125 $2,500 $250 $125 Level 1 Level 2 Level 3 $18,750 $15, % of body surface $935 $2,810 Accidental Death Level 1 Level 2 Level 3 $3,750 $2,500 $7,500 $5,000 $3,750 $9,375 $7,500 $6,560 $5,625 $4,685 $3750 $2,810 $750 $560 $185 $3,750 $375 $185 $11,250 $7,500 $5,625 $6,250 $12,500 $18,750 Please Note: All Benefit Amounts and Maximum Benefit amounts reduce by 50% for Covered Persons aged 81 and over.

5 5. EXCLUSIONS AND LIMITATIONS Limitations Special Conditions Relating to Osteoporosis or Bone Disease If a Covered Person is diagnosed with a bone disease or osteoporosis for the first time after the Policy Effective Date, the Benefit Amount for all Fractures is subject to a lifetime Maximum Benefit of $6,250 for Coverage Level 1, $12,500 for Coverage Level 2 and $18,750 for Coverage Level 3. The Maximum Benefit includes the Benefit Amount paid for the claim submitted for the Fracture incurred at the time the bone disease or osteoporosis diagnosis is made. The insurance provided in respect of Dislocations, Second and Third Degree Burns, Paralysis and accidental death will remain unchanged. Dislocations The payment of benefits for Dislocations is limited to one payment per type of Dislocation for each 12 consecutive month period. Reduction of Benefit Amounts and Maximum Benefit at Age 81 All Benefit Amounts in the Schedule of Benefits and all Maximum Benefits will be reduced by 50% when the Covered Person turns age 81. More than One Injury from One Accident If a Covered Person suffers from more than one type of Injury in any one Accident, the Maximum Benefit for all Injuries is $6,250, $12,500 and $18,750 for Coverage Level Options 1, 2 and 3 respectively. The Maximum Benefit also applies if the Covered Person dies in the same Accident The Paralysis benefit will be paid in addition to the Maximum Benefit if Paralysis results from the same Accident in accordance with the definition. Exclusions We will not pay any benefit(s) if the death of or Injury to the Covered Person results either directly or indirectly from: (a) self-inflicted Injury, while sane or insane; (b) an Accident that occurs while the Covered Person s blood contains more than 80 milligrams of alcohol per 100 millilitres of blood or while the Covered Person is under the influence of any toxic substance, narcotic or prescription drug available unless taken in strict accordance with the prescription of a physician or dentist; (c) an 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 is serving on any active duty in any Armed Force; (e) travel, flight or descent from any kind of aircraft of which the Covered Person was a pilot, officer or crew member, or in which the Covered Person was giving or receiving any kind of training or instruction or had any duties; (f) burns caused by or as a result of sunburn and/or use of a suntanning machine; (g) an accidental death that is a result of participating in racing, scuba-diving, sky-diving, parachuting, hang-gliding, rock or mountain-climbing or bungee-jumping; or working as a high steel construction worker, an underground miner, an oil rig worker, a power line worker or a logger.

6 Pre-Existing Conditions We will not pay any benefit(s) for any one of the following pre-existing conditions: (a) Fractures or Dislocations if prior to the Policy Effective Date the Covered Person was diagnosed with a bone disease or condition; (b) any Injury for which the Covered Person received medical treatment in the 12 months prior to the Policy Effective Date. Coverage will be available after 12 consecutive months immediately following the Policy Effective Date. 6. PREMIUMS 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 Summary of Coverage. 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 is not paid at the time it is due, you have a grace period of 30 days following the Premium Due Date to pay the premium. If the premium is still unpaid at the end of the grace period, this policy will automatically terminate without notice, unless required by law. This Policy does not allow for reinstatement. 7. STATUTORY CONDITIONS The Contract The Insurance Application, this Policy, any document attached to this Policy when issued, and any amendment to the contract agreed upon in writing after the Policy is issued, constitute the entire contract and no agent has authority to change the contract or waive any of its provisions. Copy of Application BMO Insurance shall, upon request, furnish to you or to a claimant under the contract a copy of the Insurance Application. Material Facts No statement made by you at the time of application for this contract shall be used in defence of a claim under or to avoid this contract unless it is contained in the Insurance Application or any other written statements or answers furnished as evidence of insurability. Notice and Proof of Claim You, or someone on your behalf, shall (a) give written notice of claim to BMO Insurance not later than 30 days from the date a claim arises; (b) within 90 days from the date a claim arises, furnish to BMO Insurance such proof as is reasonably possible in the circumstances of your claim, your right to receive payment; and (c) if so required by BMO Insurance, furnish a satisfactory certificate as to the cause or nature of the circumstances for which a claim may be made under the contract and the duration of such circumstances Failure to Give Notice or Proof Failure to give notice of claim or furnish proof of claim within the time prescribed by this statutory condition does not invalidate your claim if the notice or proof is given

7 or furnished as reasonably as possible, and in no event later than 1 year of the day a claim arises if it is shown that it was not reasonably possible to give notice or furnish proof within the time so prescribed. Insurer to Furnish Forms for Proof of Claim BMO Insurance shall furnish forms for proof of your claim within 15 days after receiving notice of your claim, but where you have not received the forms within that time you may submit proof of claim in the form of a written statement of the cause or nature of the illness giving rise to the claim and of the extent of the loss. Rights of Examination As a condition precedent to recovery of insurance monies under this Contract: (a) the claimant shall allow us an opportunity to examine the Covered Person when and so often as it reasonably requires while the claim is pending; (b) in the case of death of the Covered Person, we may require an autopsy to be performed, unless forbidden by law. Limitation Period - An action or proceeding against the insurer for the recovery of a claim under this contract shall not be commenced more than two years after the date the insurance money became payable or would have become payable if it had been a valid claim. Termination by You You may terminate this contract at any time by giving written notice of termination to BMO Insurance. We will refund the unused portion of the premium, if any. Waiver BMO Insurance 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 BMO Insurance. When Money is Payable All money payable under this contract shall be paid by BMO Insurance within 60 days after it has received proof of claim. 8. GENERAL PROVISIONS You are eligible for only one (1) FractureCare Plus Policy. If any person is insured under more than one (1) FractureCare Plus Policy, we will consider that person to be insured only under the FractureCare Plus Policy which provides the greatest amount of coverage. Age of the Insured We have prepared this Policy in reliance on the statement of the age of the Primary Insured contained in the Insurance Application. The age we have used appears on the Summary of Coverage. If the age is misstated, you must notify us immediately as benefits may not be available under the Policy, unless prohibited by law. In this case, any premiums paid will be refunded. Amendments to the Contract We may from time to time make changes to the Contract upon 30 days notice in writing to you. Assignment No assignment of any benefit is permitted under this Policy. Authority to Make Changes Only our executive officers have 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. Clerical Error Neither clerical error in record keeping, nor delays in making entries shall invalidate insurance otherwise validly in force under this Policy.

8 Currency All amounts in the Summary are in Canadian currency. Governing Law This Policy is governed by the laws of the province in which the Primary Insured is resident at the time of enrolment. Language The parties expressly consent that this Policy as well as other documents, agreements, notices relating to them be drafted in English. Les parties reconnaissent expréssement que le présent contrat ainsi que tous les documents, conventions ou avis s y rattachant directement ou indirectement soient rédigés en langue anglaise. 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). Travel, Residence and Occupation Once this Policy has taken effect and so long as it remains in effect, any benefits provided shall not be prejudiced or affected by any travel, change of residence or change of occupation of the Primary Insured unless otherwise stated in this Policy. Signed for and on behalf of BMO Life Assurance Company Peter McCarthy President and Chief Executive Officer Vandra M. Goedvolk Corporate Secretary Registered trade-mark of Bank of Montreal, used under licence.