Contents:
1. Eligibility and Effective
Date of Coverage
2. Coverage
3. Exclusions
4. Exposure
and Disappearance
5. Termination
of Coverage
6. Claims Procedure
1. Eligibility and Effective
Date of Coverage
1.1
Employee Eligibility
Generally speaking, employees hired on a full-time
or part-time basis (i.e., more than 1/3 of the
normally scheduled hours of work for his/her
occupational group), who are under age 75 and
residing in Canada, are covered automatically
when they travel for business purposes.
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1.2
Dependants Eligibility
Under the Business Travel Accidental Death
and Dismemberment Plan:
A spouse is defined as a person, under age
75 and who is either legally married to the
employee or a person who cohabits with the employee
and has been publicly represented as his/her
domestic partner for a period of one year or
longer in the community in which they both reside
and continue to be represented; and a dependant
child means any unmarried, natural child, step
child or legally adopted child of the employee
or a child of the employee’s spouse who
is in the care, custody and control of the employee
and living with the employee in a parent-child
relationship, and who, in either case is:
- under the age of 21 and is a dependant,
or
- under the age of 25 and is a dependant in
full-time attendance as a student at an accredited
institute of higher learning or on a vacation
therefrom; or a dependant by reason of mental
or physical infirmity.
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2. Coverage
2.1
General
Business Travel AD&D is payable, in addition
to any other insurance benefits, for paralysis,
loss of life, limb, sight, speech or hearing
which is the result of accidental bodily injuries
and which occur within 365 days from the date
of the accident.
The coverage applies during your travel and
sojourn while on NAV CANADA business, provided
you are traveling to a point or points located
away from NAV CANADA premises and the period
of assignment is not more than 60 days. Coverage
begins at the actual start of an anticipated
trip whether it be from your place of employment,
home or other location. This coverage terminates
upon return to your home or your place of employment.
Commutation travel is not covered under the
Business Travel Accidental Death and Dismemberment
Plan.
You will also be covered as follows:
- While as a passenger, pilot or member of
the crew, riding in, boarding or alighting
from the aircraft described below, provided
such aircraft is operated by a properly certified
pilot, including non-scheduled flights for
the purposes of equipment checks and calibration;
- In consequence of making a parachute jump
from such aircraft for the purpose of self-preservation;
or
in consequence of being struck by such aircraft.
- Your spouse and dependent children will
be covered for any accident which occurs during
travel for relocation and the purpose of house-hunting.
Under certain circumstances, a guest (i.e.,
any person receiving an expressed or implied
invitation from NAV CANADA or from any other
person having authority to extend such an invitation
and whose expenses and travel arrangements are
paid for by NAV CANADA) can also be covered.
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2.2
Benefit Amounts
Benefit amounts are equal to:
Class |
Coverage |
I - Union Employees
|
Up to 3X annual earnings
(to a maximum of $350,000) |
II
- Management Group Employees
|
Up
to 4X annual earnings (to a maximum
of $500,000) |
III - Spouses and
Dependent Children of Class I and
II Employees (during travel for
relocation and house-hunting only)
|
Up to $100,000 for
your spouse
Up to $10,000 for each child |
IV - Guests of NAV
CANADA
|
Up to $50,000 |
|
Coverage terminates upon the
earlier of termination/retirement or attainment
of age 75.
In the event of your death, the Benefit Amount
is payable to the beneficiary you have named
under the Basic Life Insurance Plan or, in the
absence of such designation, to your Estate.
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2.3
Schedule of Losses
If loss of life, limb, speech,
hearing, sight, indemnity, loss of use and paralysis
results in any one of the following specific
losses within one year from the date of accident,
CIGNA Life will pay the benefit specified below,
based on the Principal Sum which is equal to
the benefit amount in 2.2 above, provided however,
that not more than one (the largest) of such
benefits shall be paid with respect to injuries
resulting from one accident, directly and independently
of all other causes from bodily injuries.
Injury
|
Benefit
Amount |
| Loss of life |
the Principal Sum |
| Loss of both hands
or both feet |
the Principal Sum |
| Loss of entire sight
of both eyes |
the Principal Sum |
| Loss of one hand and
one foot |
the Principal Sum |
| Loss of one hand and
entire sight of one eye |
the Principal Sum |
| Loss of one foot and
entire sight of one eye |
the Principal Sum |
| Loss of speech and
hearing |
the Principal Sum |
| Loss of use of both
arms or both hands |
the Principal Sum |
| quadriplegia |
two times the Principal
Sum |
| paraplegia |
two times the Principal
Sum |
| hemiplegia |
two times the Principal
Sum |
| Loss of one arm or
one leg |
three-quarters of
the Principal Sum |
| Loss of use of one
arm or one leg |
three-quarters of
the Principal Sum |
| Loss of one hand or
one foot |
two-thirds of the
Principal Sum |
| Loss of entire sight
of one eye |
two-thirds of the
Principal Sum |
| Loss of use of one
hand |
two-thirds of the
Principal Sum |
| Loss of speech or
hearing |
two-thirds of the
Principal Sum |
| Loss of thumb and
index finger of the same hand |
one-third of the Principal
Sum |
| Loss of four fingers
of the same hand |
one-third of the Principal
Sum |
| Loss of hearing in
one ear |
one-quarter of the
Principal Sum |
| Loss of all toes of
the same foot |
one-eighth of the
Principal Sum |
|
"Loss" means:
-
With respect to hand or
foot, actual severance through or above
the wrist or ankle joint;
-
With respect to arm or leg,
actual severance through or above the elbow
or knee joint;
-
With respect to eye, the
total and irrecoverable loss of sight;
-
With respect to speech,
the total and irrecoverable loss of speech
which does not allow audible communication
in any degree;
-
With respect to hearing,
the total and irrecoverable loss of hearing
which cannot be corrected by any hearing
aid or device;
-
With respect to thumb and
index finger, actual severance through or
above the first phalange;
-
With respect to fingers,
the actual severance through or above the
first phalange of all four fingers of the
same hand; or
-
With regard to toes, the
actual severance of both phalanges of all
toes of the same foot.
"Loss" as used with reference
to quadriplegia (paralysis of both upper
and lower limbs), paraplegia (paralysis
of both lower limbs) and hemiplegia (paralysis
of upper and lower limbs of one side of
the body), means the complete and irrecoverable
paralysis of such limbs.
"Loss of Use"
shall mean the total and irrecoverable loss
of function of an arm, hand or leg, provided
such loss of function is continuous for twelve
consecutive months and such loss of function
is thereafter determined on evidence satisfactory
to CIGNA Life to be permanent.
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2.4
Emergency Medical Reimbursement Expense (Applicable
to Employees Only)
If on account of such injuries or sickness,
you (the employee) require Emergency Medical
treatment by a legally qualified physician
or surgeon, confinement in a legally constituted
hospital, employment of a trained nurse, x-ray
examination or the use of an ambulance, CIGNA
Life, subject to the lifetime maximum amount
of $500,000 per person, will pay the actual
cost of the following covered expenses incurred
while outside of Canada for trips of 60 days
or less to the extent that such expenses are
of an emergency nature and do not duplicate
the cost of any such services covered under
the terms of any health insurance services
plan.
"Emergency Medical" means any unforeseen
illness or accidental bodily injury occurring
while this insurance is in force, which requires
immediate emergency medical treatment by a
physician.
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2.4.1
Eligible Expenses
Covered emergency expenses include the following:
-
Drugs and medicines that
require a doctor’s prescription and
are listed in the current Compendium of
Pharmaceutical and Specialties;
-
Private duty nursing, prescribed
by a physician as being medically necessary,
where the service is provided by a registered
nurse who is not a member of your family
or ordinarily a resident in your home, up
to a maximum of $1,000 per person;
-
Transportation by a local
licensed ambulance service for emergency
medical reasons;
diagnostic laboratory and X-ray examination;
-
Administration of anesthesia,
oxygen, blood and blood transfusions;
-
Charges made by a hospital
for reasonable and customary expenses for
semi-private room and board and other necessary
services and supplies, including drugs administered
while confined to hospital for emergency
medical care and treatment for up to a maximum
of 30 days; and
-
Charges made by a physician
for professional services for emergency
medical treatment or surgical procedures.
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2.4.2
Exclusions
No benefit is payable for:
-
Expenses paid for or furnished
under the terms of any other health plan
arranged through the employer;
services provided by an agency or department
of any government which are normally provided
free of charge
-
Non-emergency medical treatment,
routine health check-ups, eye and ear examinations,
eye glasses and hearing aids; or treatment
which can be reasonably delayed until return
to Canada;
dental care
-
Hospital charges for non-medical
services, such as radio or telephone;
services not listed as covered expenses
-
Services rendered before
coverage became effective or after termination
of employment or termination of insurance
-
Cosmetic surgery or treatment,
except as required for correction of damage
caused by accidental injury sustained while
this coverage is in force
-
Dental services or supplies
and appliances, except as previously mentioned
-
Services or supplies that
are available through any plan established
pursuant to the laws or regulations of any
government, including any motor vehicle
no fault coverage required by statute
-
Any service to the extent
that any government prohibits payment of
benefits services, drugs or supplies which
are deemed experimental in nature delivery
and transportation charges
-
Services and supplies which
are required for recreation or sport but
which are not medically necessary for regular
activities
-
Services received for confinement
which is primarily for chronic or custodial
care
-
Services received in a government
hospital unless you are required to pay
for such services
-
Services to which you are
entitled without charge, or for which there
would be no charge if there were no insurance
-
Services received from a
dental or medical department maintained
by the employer, a mutual benefit association,
labour union, trustee or similar type of
group
-
Expenses in respect of services
provided by a member of your family or by
a person customarily living with you
-
Chronic alcoholism or drug
addiction
-
Mental or nervous disorders
or psychiatric treatment, unless necessitating
hospital or institutional confinement, in
which case coverage shall not extend beyond
3 months
-
AIDS or AIDS-related disease
or disorders
-
Any condition for which
you received medical advice for treatment
during the 90 days immediately prior to
becoming insured, until after the expiration
of 12 months from the date you are eligible
for insurance.
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2.5
Emergency Evacuation Benefit
If an injury or sickness commencing during
the course of a trip results in your necessary
emergency evacuation, CIGNA Life will pay
benefits for covered expenses incurred by
up to 10% of the Emergency Medical Reimbursement
Expense Benefit maximum. An emergency evacuation
must be ordered by a legally licensed physician
who certifies that the severity of your injury
or sickness warrants your emergency evacuation.
Emergency evacuation means that:
a) Your medical condition
warrants immediate transportation from the
place where you are injured or sick to the
nearest hospital where appropriate medical
treatment can be obtained.
b) After being treated
at a local hospital, your medical condition
warrants transportation to the place where
you reside (provided such residence is located
in the United States or Canada) to obtain
further medical treatment or to recover.
c) Both a) and b) above.
Covered expenses are expenses, up to the
maximum, for transportation, medical services
and medical supplies necessarily incurred
in connection with your emergency evacuation.
All transportation arrangements made for
evacuating you must be by the most direct
and economical route. Expenses for special
transportation must be:
Expenses for medical services and supplies
must be recommended by the attending physician.
Transportation means any land, water or air
conveyance required to transport you during
an emergency evacuation.
Special Transportation includes, but is not
limited to, air ambulance, land ambulances,
and private motor vehicles.
Sickness means sickness or disease which
causes loss covered herein for which symptoms
are manifested while the policy is in force.
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2.6
Repatriation Benefit
When injuries covered by this policy result
in a loss of life of an insured person outside
150 km from your city of permanent residence
or outside Canada and occurs within 365 days
from the date of the accident, CIGNA Life
will pay the actual expense incurred for preparing
the deceased for burial and shipment of the
body to the city of residence of the deceased,
to a maximum of $10,000.
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2.7
Family Transportation Benefit
When injuries covered by this policy, result
in an insured person being confined as an
Inpatient in a hospital outside 150 km from
the city of permanent residence or outside
Canada and requires personal attendance of
a member of the insured person’s immediate
family as recommended by the attending physician,
in writing, CIGNA Life will pay for the expense
incurred by the member of the family, for
the transportation by the most direct route
by a licensed common carrier to confined insured
person, to a maximum of $10,000.
"Member of the immediate family"
means insured person’s spouse, legal
or common-law, parents, grandparents, children
over age 18, brother or sister.
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2.8
Home Alteration and Vehicle Modification
In the event an insured person sustains an
injury which results in a payment being made
under the Schedule of Losses, excluding the
Loss of Life Benefit, and such injury subsequently
requires the use of a wheelchair to be ambulatory,
CIGNA Life will pay the reasonable and necessary
expenses actually incurred within 365 days
from the date of accident for:
Benefit payments herein will not be paid unless:
-
Home alterations are made
by a person or persons experienced in such
alterations and recommended by a recognized
organization, providing support and assistance
to wheelchair user
-
Vehicle modifications are
carried out by a person or persons with
experience in such matters and modifications
are approved by the provincial vehicle licensing
authorities.
The combined maximum payable
will not exceed $10,000.
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2.9
Seat Belt Benefit
In the event an insured person sustains an
injury which results in a payment being made
under the Schedule of Losses, the Principal
Sum amount will be increased by ten percent
if, at the time of the accident, the insured
person was driving or riding in a vehicle
and wearing a properly fastened seat belt.
Due proof of seat belt use must be provided
as part of the written proof of loss.
"Vehicle" means a private passenger
car, station wagon, van, or jeep-type automobile.
"Seat belt" means those belts that
form a restraint system.
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2.10
Special Education Benefit
If you (the employee) suffer loss of life
in a covered accident while the policy is
in force, CIGNA Life will pay, in addition
to all other benefits payable, a "special
education benefit" up to a maximum of
$5,000 per year, on behalf of any dependant
child who, on the date of the accident, is
enrolled as a full-time student in any institution
of higher learning beyond the 12th or 13th
grade level, or was at the 12th or 13th grade
level and subsequently enrolls as a full-time
student in an institution of higher learning
within 365 days following the date of the
accident.
The "special education benefit"
is payable annually for a maximum of four
consecutive annual payments but only if the
dependant child continues his/her education
as a full-time student in an institution of
higher learning. If, at the time of the accident,
none of the dependant children qualify, CIGNA
Life pays an additional benefit of $2,500
to the designated beneficiary.
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3.
Exclusions
The plan does not cover any loss which is
the result of:
-
Intentionally self-inflicted
injuries, suicide or any attempt thereat,
while sane or insane;
full-time, active duty in the armed forces
-
Injury sustained while
the insured person is performing any common,
manual, or mechanical labour which may be
construed as part of the insured person’s
regular duties for NAV CANADA
-
Any accident which occurs
during the period you (the employee) are
required to live in another community, away
from the work premises in the city of permanent
assignment, for reasons of training or work
assignments lasting longer than 60 days
-
Acrobatic flying as defined
by the Department of Transport
-
Operations requiring a special
permit or waiver from the Department of
Transport even though granted, other than
a permit waiver issued because of the territory
to be flown over or landed upon
-
Crop dusting or spraying,
seeding, fire fighting, sky writing, pipeline
inspection, power-line inspection, aerial
photography, exploration, racing, endurance
test or exhibition stunt flying.
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4.
Exposure and Disappearance
Loss resulting from unavoidable exposure
to the elements and arising out of hazards
described above shall be covered to the extent
of the benefits afforded you.
If your body has not been found within one
year of the disappearance, stranding, sinking
or wrecking of the conveyance in which you
were riding at the time of the accident it
shall be presumed, subject to all other conditions
of the policy, that you suffered a loss of
life resulting from bodily injuries sustained
in the accident and covered.
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5.
Termination of Coverage
Coverage terminates upon the earlier of termination/retirement
or attainment of age 75.
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6.
Claims Procedure
In the event of a claim, notice of claim
must be given to ACE INA Life Insurance Company
of Canada within 30 days from the date of
accident and subsequent proof of claim must
be submitted to ACE INA Life Insurance Company
of Canada within 90 days from the date of
the accident.
A claim form can be obtained from the Benefits
and Disability Management Section.
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The above text has been prepared
in respect of a group plan underwritten by
ACE INA Life Insurance Company of Canada.
For ease of reference it contains a brief
description only and does not mention every
provision of the contract issued. Please remember
that rights and obligations are determined
in accordance with the contract between NAV
CANADA and ACE INA Life Insurance Company
of Canada and not this text. For exact provisions
applicable please consult the Benefits and
Disability Management Programmes Section.
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