Manulife CoverMe
CoverMe™ Critical Illness Exclusions and Limitations

General Conditions and Limitations

At the time of application for the CoverMe Critical Illness plan, you must be a resident of Canada. When applying for:

  • $25,000 of coverage, you must be 18 - 65 years of age;
  • $50,000 of coverage, you must be 18 - 60 years of age;
  • $75,000 of coverage, you must be 18 - 55 years of age;
  • any CoverMe Critical Illness benefit amount with the Return of Premium Option, you must be 18 - 55 years of age.

The coverage is renewable until the policy anniversary date following the insured's 75th birthday, at which time the policy will terminate.

Specific Conditions, Exclusions and Limitations

Cancer

The following cancers are not covered under the plan:

  • carcinoma in situ; or
  • stage 1A malignant melanoma (melanoma less than or equal to 1.0 mm in thickness, not ulcerated and without Clark level IV or level V invasion); or
  • any non-melanoma skin cancer that has not metastasized; or
  • stage A (T1a and T1b) prostate cancer.

What this means...

These exclusions are for cancers that are not generally considered life threatening and are readily treatable.

If within the first 90 days of the effective date of coverage, the insured is diagnosed with any cancer (covered or excluded under the CoverMe Critical Illness insurance plan), or if the insured or his/her physician becomes aware of any sign, symptom, condition or medical problem that leads to the diagnosis of cancer at any time in the future, then no benefit with respect to cancer will be paid, nor will any benefit be paid for any other condition or procedure directly caused by any cancer of the treatment or cancer.

What this means...

The CoverMe Critical Illness insurance plan does not cover cancers diagnosed during the first 90 days of the coverage or cancers whose symptoms first appear during the first 90 days. Consequently, any other covered condition diagnosed during the first 90 days which results from cancer or the treatment of cancer, is not eligible for payment under this plan.

The diagnosis of any cancer must be reported to Manulife within six months of the date of diagnosis. Any failure to do so may lead to the denial of any claim with respect to CoverMe Critical Illness coverage.

The diagnosis of cancer must be made by a specialist.

Benefits will be paid only when the insured survives for 30 days following the date the condition is diagnosed.

Heart Attack (Myocardial Infarction)

Benefits will be payable only when there is a diagnosis of the death of heart muscle due to obstruction of blood flow that results in a rise and fall of biochemical cardiac markers to levels considered diagnostic of a heart attack.

What this means...

If you suffer a heart attack, you will have damage to the heart muscle which causes changes in your electrocardiogram (ECG) that indicate a myocardial infarction and the elevation of cardiac (heart) biochemical markers.

The CoverMe Critical Illness plan covers a heart attack when diagnosis also confirms at least one of the following:

  • symptoms of a heart attack;
  • new electrocardiogram (ECG) changes consistent with a heart attack;
  • development of new Q waves during or immediately following a cardiac procedure (such as coronary angiography and coronary angioplasty).

If you suffer a heart attack during a cardiac procedure, there must be diagnostic changes of new Q waves on the ECG. ECG changes that do not meet our definition of heart attack as described above will not be covered.

The diagnosis of heart attack must be made by a specialist.

Benefits will be paid only when the insured survives for 30 days following the date the condition is diagnosed.

Stroke (Cerebrovascular Accident)

Benefits will only be payable when there is diagnosis of an acute cerebrovascular event producing neurological symptoms lasting longer than 30 days which is caused by intracranial thrombosis, hemorrhage, and embolism from an extra-cranial source. The new symptom(s) and deficit(s) must be corroborated by diagnostic imaging testing.

What this means...

The CoverMe Critical Illness plan only covers strokes that result from:

  • thrombosis, caused by a blockage by a thrombus (clot) that has built up on the wall of a brain artery;
  • embolization, caused by an embolus (usually a clot) that is swept into a brain artery causing blockage; and
  • hemmorhage that is caused by the rupture of a blood vessel in or near the brain's surface.

Transient ischemic attacks or intracerebral vascular events due to trauma or lacunar infarcts are generally not covered.

What this means...

An incident with stroke-like symptoms that lasts less than 24 hours is referred to as a Transient Ischemic Attack and does not qualify for coverage.

The diagnosis of stroke must be made by a specialist.

Benefits will be paid only when the insured survives for 30 days following the date the condition is diagnosed.

Coronary Artery Bypass Surgery

Benefits will only be payable when surgery is performed to correct narrowing or blockage of one or more coronary arteries with a bypass graft.

No benefit will be payable if the treatment for coronary artery disease is limited to non-surgical techniques such as coronary balloon angioplasty or laser relief of an obstruction.

What this means...

Only artery bypass surgery is covered by the CoverMe Critical Illness plan because artery bypass surgery requires open-heart surgery. Coronary balloon angioplasty and laser relief are generally less critical procedures with quick recovery times.

Artery bypass surgery must be determined medically necessary by a specialist and performed by a physician.

Benefits will be paid only when the insured survives for 30 days following the date of the surgery.

Aortic Surgery

Benefits will only be payable when surgery for disease of the aorta requires excision and surgical replacement of the diseased aorta with a graft. The CoverMe Critical Illness plan covers the surgery of the thoracic and abdominal aorta, but not its branches.

What this means...

The aorta is the largest artery in the body. CoverMe Critical Illness insurance covers replacement of diseased portions with a graft. However, the use of balloon angioplasty to widen narrowed passages is not covered, nor is surgery to the branches of the aorta.

Aortic surgery must be determined medically necessary by a specialist and performed by a physician.

Benefits will be paid only when the insured survives for 30 days following the date of the surgery.

Return of Premium Option on Expiry of Policy (if this Option is purchased)

The Return of Premium benefit will not be payable where the insured has survived the waiting period for a covered condition at the time of expiry of the policy and the benefit is payable. The Return of Premium Option may only be purchased when the insured is 18 - 55 years of age and must be purchased at the same time as the original coverage. Once purchased, the Return Premium Option cannot be cancelled separately.

General Conditions, Exclusions and Limitations Applicable to all Covered Conditions

No benefit will be payable if the insured, while sane or insane, suffers a covered condition which results directly or indirectly from, or is in any way associated with:

  • intentional self-inflicted injuries,
  • intentional use or intake by the insured of:
    • any prescription drug or narcotic other than as instructed by a physician;
    • any drug or narcotic legally available for sale in Canada without a prescription, other than as recommended by the manufacturer;
    • any drug or narcotic not legally available in Canada; or
    • any poisonous substance or intoxicant, including alcohol;

  • committing or attempting to commit a criminal offence,
  • operation of a motor vehicle while the concentration of alcohol in 100 milliliters of blood exceeds 80 milligrams.

No benefit will be payable if the insured suffers a covered condition at any time during the 24-month period following the effective date of the policy or the date of the last reinstatement which results directly or indirectly from, or is in any way associated with, a Pre-Existing condition. A Pre-Existing condition is an illness or condition for which, during the 24-month period prior to the effective date of the policy, the insured was diagnosed or was treated, hospitalized or attended to by a physician or was advised to seek treatment or consult a physician; was prescribed or took medication; showed indications, signs or symptoms or underwent tests or investigations.

No benefit will be payable where a covered condition is diagnosed in a jurisdiction other than Canada or the United States, unless the insured makes all requested medical records available to the insurer and the insurer is satisfied that:

  • the same diagnosis would have been made if the covered condition had occurred in Canada or the United States;
  • the physician making the diagnosis was licensed to practise in the jurisdiction in which the diagnosis was made and had medical credentials equal to those required in Canada or the United States;
  • the diagnosis is fully supported by all appropriate diagnostic tests and other investigation which would normally be undertaken in Canada or the United States (including those required by the policy); and
  • the same type of surgery or procedure as required under the policy in order for the benefit to be payable would have been advised if the diagnosis had been made in Canada or the United States.