Critical Illness Definitions

Alzheimer's Disease: means the diagnosis that the Insured Person has Alzheimer's Disease, which is a progressive degenerative disease of the brain. The diagnosis must be supported by medical evidence that the Insured Person exhibits the loss of intellectual capacity resulting in impairment of their memory and judgment, which results in a significant reduction in their mental and social functioning, such that they require permanent daily personal supervision for the Activities of Daily Living. All other dementing organic brain disorders and psychiatric illnesses are excluded from this Insured Condition definition. A Physician who is certified as either a neurologist or a psychiatrist must confirm diagnosis in writing.

Amyotrophic Lateral Sclerosis (ALS): means unequivocal diagnosis of ALS resulting in the inability to perform three (3) of the five (5) Activities of Daily Living without assistance. A Physician who is certified as a neurologist must confirm diagnosis in writing.

Aorta Surgery: Means surgery to the aorta that is medically required to treat disease of the aorta and that involves the excision and surgical replacement of the diseased aorta with a graft. The Aortic Surgery must be performed on the prior written advice of a Physician certified as a cardiovascular surgeon. Aorta includes the thoracic and abdominal aorta but does not include any of the branches of the aorta.

Benign Brain Tumour: Means a benign neoplasm in the brain or meninges with histologic confirmation. Cysts granulomas, malformations of intracranial arteries or veins, and tumours or lesions of the pituitary are specifically excluded. The diagnosis must be confirmed neuro-radiologically by a specialist trained in the interpretation of radiological investigations.

Blindness: Means the total and irrecoverable loss of sight in both eyes due to Injury or sickness. Corrected visual acuity must be 20/200 or less in both eyes and the field of vision must be less than 20 degrees in both eyes. A Physician certified in ophthalmology, must clinically confirm the diagnosis in writing.

Cancer: means a malignant tumor characterized by the uncontrolled growth and spread of malignant cells and invasion of tissue. This includes Leukemia, Hodgkin's Disease and invasive melanoma but does not include:
a) Carcinoma in situ;
b) Kaposi's Sarcoma or other AIDS related cancers and cancer in the presence of human immunodeficiency virus (HIV);
c) Skin cancer or melanoma that is not invasive and has not exceeded .75 millimeters in depth;
d) Prostate cancer diagnosed as T1N0 M0 or equivalent staging.
A physician certified as an oncologist must confirm diagnosis in writing.

Coma: means the Insured Person has been in a state of unconsciousness for a continuous period of at least 96 hours, during which external stimulation produced no more than primitive avoidance reflexes. A physician who is certified as a neurologist must confirm diagnosis in writing.

Coronary Artery Bypass Surgery: means surgery performed by a Physician who is certified as a cardiovascular surgeon to correct narrowing or blockage of one or more coronary arteries with bypass grafts. Non-surgical techniques such as balloon angioplasty, laser relief of an obstruction, or other intra-arterial techniques will not be considered to be a covered critical illness.

Deafness: means the diagnosis of permanent loss of hearing in both of the Insured Person's ears, with an auditory threshold of more than 90 decibels in each ear. A Physician, who is certified as an otolaryngologist must confirm diagnosis in writing.

Dismemberment means a definite diagnosis of the complete severance of two or more limbs at or above the wrist or ankle joint as the result of an accident or medically required amputation. The diagnosis of Loss of Limbs must be made by a specialist.

Ductal Carcinoma In Situ means the diagnosis by a licensed Physician, of the presence of ductal carcinoma in situ of the breast, as confirmed by a biopsy. A Physician certified as an oncologist must confirm the diagnosis in writing.

Early Stage Prostate Cancer Treatment means Early Prostate Cancer (T1a or T1b) Treatment: The diagnosis must be made by a specialist. No benefit will be payable unless the specialist has recommended one of the following treatments:

• Prostate Surgery
• Radiation Therapy
• Chemotherapy
• Hormone Therapy

Heart Attack: means the death of a portion of heart muscle as a result of inadequate blood supply to the relevant area. Diagnosis must be confirmed in writing by a Physician who is a certified specialist in internal medicine or a cardiologist and should be based on new electrocardiograph changes consistent with heart attack and at least one of the following; elevation of cardiac biochemical markers of elevation of cardiac enzyme, to levels consistent with heart attack. Heart attack does not include elevation of cardiac biochemical markers or elevation of cardiac enzymes due to coronary angioplasty unless accompanied by diagnostic changes of a new Q wave infarction of the ECG.

Heart Valve Replacement means undergoing surgery to replace any heart valve with either a natural or mechanical valve. The surgery must be determined to be medically necessary by a Specialist.
Exclusion: No benefit will be payable under this condition for heart valve repair.

Loss of Independence: Means the definitive diagnosis by a licensed Physician of either:
(1) Being totally and permanently unable to perform, by oneself, at least two of the six Activities of Daily Living
or,
(2) Cognitive impairment
A mental or nervous disorder without a demonstrable organic cause is not covered. Loss of independence must persist for at least ninety (90) days from the date of the diagnosis.

Loss of Speech means the definite diagnosis of the total and irreversible loss of the ability to speak as the result of physical injury or disease, for a period of at least 180 days. The diagnosis of Loss of Speech must be made by a specialist.

Major Organ Failure means the irreversible failure of the entire heart, entire liver, both lungs, both kidneys or bone marrow, in which the affected organ is unresponsive to any treatment and for which the insured is medically required to become enrolled in a recognized Canadian transplant program to become the recipient of a heart, a liver, a lung, or a kidney or to receive a bone marrow transplant.

Major Organ Transplant means a definite diagnosis of the irreversible failure of the heart, both lungs, liver, both kidneys or bone marrow, and transplantation must be medically necessary. To qualify under Major Organ Transplant, the Insured Person must undergo a transplantation procedure as the recipient of a heart, lung, liver, kidney or bone marrow, and limited to these entities. The diagnosis of the major organ failure must be made by a specialist.

Multiple Sclerosis: Means the unequivocal written diagnosis by a Physician who is certified as a neurologist confirming at least moderate persisting neurological abnormalities, with impairment of function, but not necessarily confining the insured to a wheelchair or bed.

Occupational HIV Infection means a definite diagnosis of infection with Human Immunodeficiency Virus (HIV) resulting from accidental injury during the course of the Insured Person's normal occupation, which exposed the person to HIV contaminated body fluids. The accidental injury leading to the infection must have occurred after the later of the effective date of the policy, the effective date of last reinstatement of the policy, or the Insured Person's effective date of coverage. Payment under this condition requires satisfaction of all of the following:

1. The accidental injury must be reported to the insurer within 14 days of the accidental injury;
2. A serum HIV test must be taken within 14 days of the accidental injury and the result must be negative;
3. A serum HIV test must be taken between 90 days and 180 days after the accidental injury and the result must be positive;
4. All HIV tests must be performed by a duly licensed laboratory in Canada or the United State of America;
5. The accidental injury must be reported, investigated and documented in accordance with current Canadian or United States of America workplace guidelines.

The diagnosis of Occupational HIV Infection must be made by a Specialist.
Exclusion: No benefit will be payable under this condition if:

• The Insured Person has elected not to take any available licensed vaccine offering protection against HIV; or,
• A licensed cure for HIV infection is available prior to the accidental injury; or,
• HIV infection has occurred as a result of non-accidental injury including, but not limited to, sexual transmission and intravenous (IV) drug use.

Paralysis: Means the total and irrecoverable loss of function of two (2) or more limbs through neurological damage due to Injury or sickness, provided such loss of function continually lasts for 365 consecutive days and such loss of function is thereafter determined on evidence satisfactory to ACE INA Life Insurance to be permanent. A Physician certified as a neurologist must confirm diagnosis in writing.

Parkinson's Disease: Means unequivocal diagnosis of primary idiopathic Parkinson's Disease resulting in the inability to perform three of the five Activities of daily Living without assistance. Diagnosis should show signs of progressive impairment and must be confirmed in writing by a Physician who is certified as a neurologist.

Severe Burns: Means the Insured has third degree burns covering at least 20% of the surface area of their body. A physician who is certified as a plastic surgeon must confirm diagnosis of this condition in writing.

Stroke: Means that the Insured Person has suffered a cerebrovascular incident, excluding transient ischemic attack (TIA), producing infarction of brain tissue due to thrombosis, hemorrhage from an intracranial vessel or embolization caused by an extracranial source. There must be evidence of permanent neurological deficit persisting for 30 consecutive days, supported by evidence that the deficit is resulting from the Stroke, confirmed in writing by a Physician who is certified as a neurologist.

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