certificate of insurance · insurance coverage at any time by contacting cibc life at the contact...

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Underwritten by: CIBC Life Insurance Company Limited (hereinafter called “CIBC Life”) Certificate of Insurance Hospital Cash Benefit Plan for CIBC Customers CIBC Life offers customers of the HOSPITAL CASH BENEFIT PLAN FOR CIBC CUSTOMERS, a special toll-free telephone service to assist in submitting a claim or to answer any questions about this plan. Before calling, we recommend that customers review the portions of the Certificate which relate to the concern. For General Information or Claims call: 1-866-774-3353 Monday to Friday (8:00 a.m. to 8:00 p.m. Eastern Time) You may also write to us at: CIBC Life Insurance Company Limited P.O. Box 4213, Stn A, Toronto, Ontario M5W 5M3 CIBC Life Insurance Company Limited The CIBC Logo is a trademark of CIBC. CIBC Life Insurance Company Limited is a licensed user of the trademark. 04/07 AF1102E SAMPLE

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Page 1: Certificate of Insurance · insurance coverage at any time by contacting CIBC Life at the contact information shown on the back of this Certificate. If the Insured Client cancels

Underwritten by:

CIBC Life Insurance Company Limited

(hereinafter called “CIBC Life”)

Certificateof Insurance

Hospital Cash Benefit Planfor CIBC Customers

CIBC Life offers customers of theHOSPITAL CASH BENEFIT PLAN FORCIBC CUSTOMERS, a special toll-free

telephone service to assist insubmitting a claim or to answer any questions about this plan.

Before calling, we recommend that customers review the portions of the Certificate

which relate to the concern.

For General Informationor Claims call:

1-866-774-3353Monday to Friday

(8:00 a.m. to 8:00 p.m. Eastern Time)

You may also write to us at:CIBC Life Insurance Company Limited

P.O. Box 4213, Stn A,Toronto, Ontario M5W 5M3

CIBC Life Insurance Company Limited

The CIBC Logo is a trademark of CIBC.

CIBC Life Insurance Company Limited is alicensed user of the trademark.

04/07 AF1102E

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Page 2: Certificate of Insurance · insurance coverage at any time by contacting CIBC Life at the contact information shown on the back of this Certificate. If the Insured Client cancels

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Important Information About Your Insurance ........................................................1

30-Day Satisfaction Guarantee ....................1

Who is Eligible to Enroll................................2

Definitions......................................................3

Effective Date of Coverage ..........................7

Currency ........................................................7

Termination of Insurance ..............................8

Benefits ..........................................................9

Exclusions and Limitations ..........................11

Premiums and Grace Period........................12

General Provisions ......................................13

Table of Contents

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Page 3: Certificate of Insurance · insurance coverage at any time by contacting CIBC Life at the contact information shown on the back of this Certificate. If the Insured Client cancels

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The statements contained in this Certificate area summary of the provisions of the Policy. Inthe event of a conflict between the provisionsof this Certificate and the provisions of thePolicy, the provisions of the Policy will govern.

Further information on the provisions of thePolicy may be obtained by contacting CIBC Lifeat the telephone number listed at the back ofthis Certificate.

Signed for CIBC Life Insurance CompanyLimited by its President:

Rick Lancaster,

President, CIBC Life Insurance Company Limited

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Insurance is provided under Group MasterPolicy Number 00017 (the “Policy”), issued byCIBC Life Insurance Company Limited toCanadian Imperial Bank of Commerce (“CIBC”).

Possession of this Certificate of Insurance(“Certificate”) and accompanying CoverageSchedule confirms that the Insured Client hascoverage as outlined on the CoverageSchedule, from the Effective Date of Coverage,subject to the Exclusions and Limitations andthe Termination of Insurance provisionscontained in this Certificate. A Certificate inthe possession of an individual who is noteligible for this insurance is of no force oreffect and shall be considered void.

Please keep this Certificate and the CoverageSchedule together, in a safe place, for futurereference.

30-Day Satisfaction GuaranteeAn Insured Client can cancel his or herinsurance coverage at any time by contactingCIBC Life at the contact information shown onthe back of this Certificate. If the InsuredClient cancels his or her insurance coveragewithin 30 days of receiving writtenconfirmation of coverage, CIBC Life willpromptly refund any premiums the InsuredClient may have paid.

Important Information About Your Insurance

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Page 4: Certificate of Insurance · insurance coverage at any time by contacting CIBC Life at the contact information shown on the back of this Certificate. If the Insured Client cancels

One Certificate OnlyAn Insured Person may obtain coverage underonly one Certificate under the Policy.

If any person is insured under more than oneCertificate, CIBC Life will consider that personto be insured under the Certificate whichprovides the greatest amount of coverage andterminate all other coverage upon discovery ofthe duplication. CIBC Life will refund anypremium paid for the terminated coverage.

Clerical ErrorA clerical error in the records relative to thisinsurance shall not invalidate insurance or causeinsurance to be in force or to continue in force.Upon discovery of such error, an equitableadjustment shall be made in the premium.

Governing Law

This Certificate shall be governed by andinterpreted in accordance with the laws of theProvince or Territory in which the InsuredClient is a resident.

CIBC will receive a fee from CIBC Life topromote the Policy.

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Who is Eligible to Enroll?Any Client is eligible to enroll for coverage forhimself or herself under the Hospital CashBenefit Plan for CIBC Customers, provided thatat the time of enrollment, the Client is:

1. between 18 and 70 years of age, inclusive;and

2. resident in Canada.

When a Client enrolls for coverage, or any timeafter enrollment, the Insured Client may alsoenroll for coverage for his or her spouse,provided that at the time of enrollment, thespouse:

1. meets the definition of Spouse, as defined inthis Certificate;

2. is between 18 and 70 years of age, inclusive;and

3. is resident in Canada.

The Insured Client cannot have more thanone Spouse insured under the Policy at thesame time.

When a Client enrolls for coverage, or any timeafter enrollment, the Insured Client may alsoenroll for coverage for his or her dependentchild(ren), provided that at the time ofenrollment, the dependent child(ren):

1. meets the definition of Dependent Child, asdefined in this Certificate; and

2. is resident in Canada.

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Page 5: Certificate of Insurance · insurance coverage at any time by contacting CIBC Life at the contact information shown on the back of this Certificate. If the Insured Client cancels

Once the Insured Client has coverage forInsured Dependent Children, every futuredependent child will automatically be addedto the coverage without being individuallyenrolled and at no extra premium, providedthat at the time the dependent child is addedto the coverage, such dependent child:

1. meets the definition of Dependent Child, asdefined in this Certificate; and

2. is resident in Canada.

Subject to the eligibility requirements above,the following insurance coverage options areavailable:

1. Client only;

2. Client and Spouse;

3. Client, Spouse and Dependent Child(ren);and

4. Client and Dependent Child(ren).

DefinitionsWherever used in this Certificate:

Client means a person who is a customer ofCIBC or its affiliates whose account is in goodstanding on the date of enrollment.

Insured Client means a Client who:

1. enrolled for insurance hereunder while heor she was eligible to be enrolled asoutlined above;

2. is resident in Canada;

3. is not yet age 75; and

4. has paid premiums as required.

Insured Dependent Child(ren) means theDependent Child(ren), provided that:

1. the Coverage Schedule indicates that thereis coverage for the Dependent Child(ren);

2. the Dependent Child(ren) are resident inCanada; and

3. all premiums for coverage for theDependent Child(ren) have been paid as required.

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Payment of BenefitsAll benefits provided in the Certificate will bepaid to the Insured Client, if living, otherwiseto the Insured Client’s estate.

Benefits are paid within 60 days after CIBC Lifereceives proof of loss satisfactory to CIBC Life.

Misstatement of AgeIf the date of birth of an Insured Person hasbeen misstated, the difference between anybenefits actually paid and the benefits whichshould have been paid based on the InsuredPerson’s true date of birth shall be determined.If more benefits were paid than should havebeen payable, then the difference shall be paidby the Insured Client to CIBC Life. If lessbenefits were paid than should have beenpayable, then the difference shall be paid byCIBC Life to the Insured Client. If no benefitsare payable based on the correct date of birth,then the Insured Client will reimburse anybenefits paid to CIBC Life and CIBC Life willreimburse to the Insured Client any excesspremiums the Insured Client may have paid.

AssignmentThis Certificate may not be assigned.

Legal ActionNo action at law or in equity shall be broughtto recover on the Policy prior to the expirationof 60 days after satisfactory proof of loss hasbeen filed in accordance with the Certificate,nor shall such action be brought at all unlessbrought within one year from the expirationof the time within which satisfactory proof ofloss is required by the Certificate.

If any time limitation of the Certificate withrespect to giving notice of claim or furnishingsatisfactory proof of loss, or commencing anaction at law or in equity is less than thatpermitted by law of the Canadian province or territory in which the Insured Client is aresident, the time limitation shall not be lessthan that set by the law of the applicableprovince or territory.

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Page 6: Certificate of Insurance · insurance coverage at any time by contacting CIBC Life at the contact information shown on the back of this Certificate. If the Insured Client cancels

General ProvisionsNotice of ClaimWritten notice of a Period of Hospitalizationon which a claim may be based must bereceived by CIBC Life within 30 days after thefirst Day of Hospitalization relating to suchclaim. Such notice given by or on behalf of theInsured Person to CIBC Life at the addressshown on the back of this Certificate, withparticulars sufficient to identify the InsuredPerson, shall be deemed to be notice to CIBCLife. Failure to give notice within the timeprovided in this Certificate shall not invalidateany claim if it shall be shown that notice wasgiven as soon as was reasonably possible. CIBCLife, upon receipt of such notice, will furnish tothe claimant, forms for filing proof of loss.

If such forms are not furnished within 15 daysafter the receipt of such notice, the claimantshall be deemed to have complied with therequirements shown in this Certificate as toproof of such loss upon submitting, within thetime fixed in this Certificate for filing proofs ofloss, written proof covering the occurrence,character and extent of the loss for which theclaim is made.

Proof of LossProof of loss must be furnished to CIBC Lifewithin 90 days after the date of such loss.

Failure to furnish such proof within such timeshall not invalidate nor reduce any claim if itshall be shown that such proof was furnishedas soon as was reasonably possible.

Physical ExaminationDoctors acting on behalf of CIBC Life shall havethe right and opportunity to examine theInsured Person whenever and as often as mayreasonably be required while a claim is pending.

The Insured Person has the sole right to selecthis or her own Doctor or Hospital, and theDoctor-patient relationship shall bemaintained, subject to the prior paragraph.

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Insured Person means the Insured Client, andshall also refer to the Insured Spouse and/orInsured Dependent Child(ren).

Insured Spouse means a Spouse, provided that:

1. the Coverage Schedule indicates that suchSpouse is insured under this Certificate;

2. such Spouse is resident in Canada; and

3. all premiums for coverage for the Spousehave been paid as required.

Spouse means either:

1. a person legally married to, or in a civilunion with, the Insured Client and under 75 years of age; or

2. a person under 75 years of age, who, has beenliving continuously with the Insured Client forat least one year in a conjugal relationship.

Dependent Child means a natural child,stepchild or legally adopted child of theInsured Client or of the Spouse who:

1. is under 19 years of age;

2. is 23 years of age or less and a full-timestudent at an accredited institute oflearning; or

3. is 23 years of age or less and is incapable ofself-sustaining employment by reason ofmental disability or physical handicap and isprimarily dependent on the Insured Clientor the Spouse for support and maintenance.

What is CoveredThe intent of this Hospital Cash Benefit Planfor CIBC Customers is to provide benefits tothe Insured Person in the event of a Period ofHospitalization as a result of Accidental BodilyInjury or Sickness.

Wherever used in this Certificate:

Accidental Bodily Injury means bodily injurysustained by an Insured Person caused byexternal, violent and purely accidental means,independent of all other causes, and causing a Period of Hospitalization developing within365 days of the accident provided that theaccident and Period of Hospitalization occur

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Page 7: Certificate of Insurance · insurance coverage at any time by contacting CIBC Life at the contact information shown on the back of this Certificate. If the Insured Client cancels

while this Certificate is in force on the InsuredPerson who is the basis of the claim.

Sickness means illness or disease causing a Period of Hospitalization provided that the illness or disease and the Period ofHospitalization occur while this Certificate is in force on the Insured Person who is thebasis of the claim.

Other DefinitionsWherever used in this Certificate:

Coverage Schedule means the most recentCoverage Schedule issued with respect to thisCertificate. In the event that the Insured Clientmakes changes with respect to insurancecoverage under this Certificate, an updatedCoverage Schedule will be sent out.

Daily Benefit means the benefit amountindicated on the Coverage Schedule, that isapplicable to each Insured Person and ispayable to the Insured Client, subject to theprovisions of this Certificate.

Day of Hospitalization means any day wherethe Insured Person is Hospitalized as an in-patient for which a full day’s room andboard is charged, provided the certificate is inforce on the Insured Person who is Hospitalized.

Doctor means a medical practitioner, who islegally licensed to practice medicine by thelicensing authority of the jurisdiction in whichhe or she practices; and whose legal andprofessional standing within his or herjurisdiction is equivalent to that of a doctor ofmedicine (M.D.) licensed in Canada and who ispractising within the scope of his or herlicensed authority. An Insured Person’s Doctormust be a person other than: himself or herself,or a member of his or her Immediate Family.

Hospital means an institution which is

1. licensed as a hospital;

2. is open at all times for the Treatment of sickand injured persons; and

3. provides 24-hour nursing services.

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6. Mental or Nervous Disorder – neurosis,psychoneurosis, psychopathy, psychosis,mental or emotional disorder or disease of any kind;

7. Uncomplicated pregnancy or childbirth;

8. Cosmetic Surgery – cosmetic Treatment orcosmetic surgery, except when necessarydue to Accidental Bodily Injury;

9. Criminal Offence – from or whilecommitting or attempting to commit a criminal offence, or committing orprovoking an assault;

10. Attempted suicide or intentional self-inflicted injury while sane or insane;

11. War or Insurrection – declared or undeclaredwar, or any act of war, riot, terrorism orinsurrection, or service in the armed forcesof any country or international organization.

Premiums and Grace PeriodThe monthly premium shown on your CoverageSchedule is due on the first day of each monthand is payable using a payment methodacceptable to CIBC Life. Except for the firstpremium, a grace period of a minimum of 30 days will be granted for any premiumpayment. During such grace period, coverageshall continue in force. The grace period willcommence from the date on which thepremium is due. Coverage shall automaticallyterminate at the expiration of the grace periodif the premium due has not been paid.

CIBC Life reserves the right to change thepremium rates. However, rates can only bechanged on a class-wide basis. CIBC Life willgive the Insured Client 30 days’ notice of sucha change. Any change in premiums will takeeffect on the premium due date coincidentwith or immediately following the effectivedate of change.

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SAMPLE

Page 8: Certificate of Insurance · insurance coverage at any time by contacting CIBC Life at the contact information shown on the back of this Certificate. If the Insured Client cancels

Exclusions and LimitationsThis insurance does not cover any Period ofHospitalization that is in any way related, ordirectly or indirectly caused or contributed toby one or more of the following:

1. Pre-existing Condition and Sickness – anypre-existing condition, illness, disease, injury,or symptom, diagnosed or undiagnosed, forwhich the Insured Person has receivedTreatment within the 12 months prior to theInsured Person’s Effective Date of Coverage.Any Period of Hospitalization that is in anyway related to a pre-existing condition willbe covered after the Insured Person hasbeen free of symptoms or Treatment forthat condition for 12 consecutive months;

2. Intoxication – any event or illness directly or indirectly related to the operation of any motorized vehicle while theconcentration of alcohol in the InsuredPerson’s blood exceeds 80 milligrams ofalcohol in 100 millilitres of blood;

3. Drugs or Poison – the use of any illicit or prescribed drug, poisonous substance,intoxicant or narcotic other than asprescribed and administered by or inaccordance with the instruction of a licensed medical practitioner;

4. Treatment, care or services provided fordrug addiction, drug abuse, alcoholism,rehabilitation, custodial or education care,whether in a Hospital or otherwise, oradmission to a rest home, nursing home, or convalescent hospital or facility;

5. High Risk Activities – including, but notlimited to, participating as a paidprofessional in sports, a contest of speed,scuba-diving, unless the Insured Personholds a basic scuba-diving designation froma certified school, skydiving, parachuting,hang-gliding, rock or mountain climbing,bungee jumping, or a flight accident exceptwhen travelling as a passenger on acommercially licensed airline;

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Hospitalized means confined to a Hospital asan in-patient under the care of a Doctor.

Immediate Family means the Insured Person’sspouse, children, parents and siblings.

Intensive Care Unit means a Hospital unitwhere patients are grouped in an area which:

1. has facilities and staff both of which are tailored to the special needs of theseriously ill;

2. always has life-saving drugs and equipmentat hand; and

3. provides 24-hour-per-day continuous careand observation by registered graduatenurses and close observation by trained andqualified medical staff whose duties areconfined to such part of the Hospital.

Such unit must render care more intensivethan that rendered in the general surgical ormedical nursing units treating the majority ofpeople in the Hospital.

Period of Hospitalization means a singleuninterrupted period of time that an Insured Person is Hospitalized as determinedby accumulating each consecutive Day of Hospitalization.

Qualifying Period means the minimum numberof Days of Hospitalization in any one Period ofHospitalization before benefits will becomepayable under this Certificate.

Treatment means medical advice, consultation,care, treatment and/or service provided by a Doctor in respect of an injury or sickness,subject to the Exclusions and Limitationsprovisions contained in this Certificate.

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Page 9: Certificate of Insurance · insurance coverage at any time by contacting CIBC Life at the contact information shown on the back of this Certificate. If the Insured Client cancels

Effective Date of CoverageThe Effective Date of Coverage for the InsuredClient is indicated on the Coverage Schedule.

The Effective Date of Coverage for the InsuredSpouse is indicated on the Coverage Schedule.

The Effective Date of Coverage for an InsuredDependent Child is the later of:

1. the Effective Date of Coverage for InsuredDependent Children as is indicated on theCoverage Schedule; and

2. the date the Insured Dependent Childbecame a Dependent Child.

All periods of coverage shall begin and end at12:01 a.m. local time, at the address of theInsured Client.

CurrencyAll monies payable hereunder are payable inlawful money of Canada.

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Qualifying Period has been satisfied. However,in no event, will the Daily Benefit be paid formore than 365 days in total per AccidentalBodily Injury or Sickness.

If an Accidental Bodily Injury or Sickness causesmore than one Period of Hospitalization dueto the same or related causes, then themaximum benefit period (365 days) will bereinstated provided a period of 183 days haselapsed between Periods of Hospitalization.

The amount payable will be the applicableDaily Benefit as shown in the CoverageSchedule for the Insured Person, except in the following cases:

1. The Daily Benefit payable for each Day ofHospitalization for an Insured Person willbe increased by 100%:

• for each day the Insured Person isHospitalized in an Intensive Care Unit;

• if the Insured Client and the InsuredSpouse are Hospitalized at the sametime; or

• if the Insured Person is Hospitalizedoutside his or her province of residence.

This increase will be payable to a maximum of thirty days per Accidental Bodily Injury orSickness and there will only be one increaseeven if more than one of the abovecircumstances apply.

2. If the Insured Person is age 65 or overthe Daily Benefit will be reduced by 50%.

The Qualifying Period for Sickness is 3 days.There is no Qualifying Period for AccidentalBodily Injury.

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SAMPLE

Page 10: Certificate of Insurance · insurance coverage at any time by contacting CIBC Life at the contact information shown on the back of this Certificate. If the Insured Client cancels

terminate on the anniversary of theEffective Date of Coverage coinciding withor, if not, next following the date theInsured Spouse turns 75 years of age;

3. on the date of the death of the InsuredSpouse; and

4. on the date coverage for the Insured Clientterminates.

Coverage under this Certificate with respect to an Insured Dependent Child shall terminateautomatically on the earliest of the followingdates:

1. on the premium due date coinciding withor, if not, next following the date CIBC Lifereceives a request by the Insured Client toterminate coverage for his or her InsuredDependent Child(ren);

2. on the premium due date coinciding withor, if not, next following the date theInsured Dependent Child ceases to qualify asan Insured Dependent Child as definedunder this Certificate;

3. on the date of the death of the InsuredDependent Child; and

4. on the date coverage for the Insured Clientterminates.

Benefits

Hospital BenefitA Daily Benefit is payable to the Insured Clientwhen an Insured Person is Hospitalized, butonly if the Period of Hospitalization:

1. is necessary for the Treatment of AccidentalBodily Injury or Sickness;

2. does not result from any of the risks listedbelow under Exclusions and Limitations; and

3. begins while coverage under this Certificateis in force on that Insured Person.

The Daily Benefit will be paid for each Day ofHospitalization from the first day, provided the

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Termination of InsuranceAll coverage under this Certificate shallterminate automatically on the earliest of thefollowing dates:

1. on the date the Policy is terminated;

2. on the premium due date coinciding withor, if not, next following the date CIBC Lifereceives a request by the Insured Client toterminate his or her own coverage;

3. on the premium due date coinciding withor, if not, next following the date theInsured Client ceases to qualify as an InsuredClient as defined under this Certificate.However, if the Insured Client ceases toqualify as an Insured Client due to his or her turning 75 years of age, coverage forthe Insured Client will terminate on theanniversary of the Effective Date ofCoverage coinciding with or, if not, nextfollowing the date the Insured Client turns75 years of age;

4. on the premium due date coinciding withor, if not, next following the date of thedeath of the Insured Client; and

5. on the expiration of the grace period, asdescribed in this Certificate, if the premiumdue has not been paid.

Coverage under this Certificate with respect toan Insured Spouse shall terminate automaticallyon the earliest of the following dates:

1. on the premium due date coinciding with or, if not, next following the date CIBC Life receives a request by the InsuredClient to terminate coverage for his or her Insured Spouse;

2. on the premium due date coinciding withor, if not, next following the date theInsured Spouse ceases to qualify as anInsured Spouse as defined under thisCertificate. However, if the Insured Spouseceases to qualify as an Insured Spouse dueto his or her turning 75 years of age,coverage for the Insured Spouse will

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