Coverage

If, as a result of an accident, the plan member or dependent dies, falls into a Coma or suffers a loss defined in this benefit, Medavie Blue Cross will pay a specified percentage of the amount of the optional Accidental Death and Dismemberment benefit in effect at the time of the accident

To be covered, a loss must:

• result from an accident that occurs while the plan member or dependent is covered under this benefit and
• occur within 365 days after the date of the accident.

A plan member or dependent will be considered to have suffered loss of life as a result of an accident if the plan member’s or dependent’s death is due to accidental drowning

Maximum Amount Payable

The total amount payable for one or more losses or a coma that results from the same accident will not exceed 100% of the amount of coverage, except for Quadriplegia, Paraplegia and Hemiplegia that are paid at 200%.

Medavie Blue Cross will only pay one amount, the largest applicable, for injuries to the same limb that result from the same accident.

When a plan member is also covered by the group Accidental Death and Dismemberment benefit, the total maximum amount payable under this benefit and the group Accidental Death and Dismemberment benefit is limited to the following amounts:

• Repatriation - total of $10,000
• Rehabilitation - total of $10,000
• Occupation Training for the Spouse - total of $10,000
• Education for Children - total of $5,000 per year to a maximum of 5 years
• Family Travel - total of $3,000
• Common Disaster
• Extended Family Benefit

Additional Benefits

Medavie Blue Cross will also pay the following additional benefits, if applicable, and subject to the terms and conditions of the policy:

• Coma – 1% per month
• Exposure and Disappearance
• Repatriation – maximum of $10,000
• Rehabilitation - maximum of $10,000
• Occupation Training for the Spouse - maximum of $10,000
• Education for Children - $5,000 per child to a maximum of 5 years
• Family Travel – maximum of $3,000
• Common Disaster
• Extended Family Benefit

Exclusions and Limitations

Medavie Blue Cross will not pay any benefits for a loss or a coma that results directly or indirectly from the following causes:

• any medical or surgical treatment or illness or disease of any kind, other than septic infection caused through a wound sustained as a result of an accident
• suicide, attempted suicide or voluntary injury or Illness
• voluntary ingestion of poison or drugs
• inhalation of fumes, unless an occupational health and safety board has deemed such inhalation to be an accident
• any accident or injury occurring while participating in a criminal act or attempting to commit a criminal act, regardless of whether charges are laid or a conviction is obtained
• insurrection, war (declared or not), the hostile action of the armed forces of any country or participation in any riot or civil commotion
• injuries sustained while flying or attempting to fly an airplane or other type of aircraft if the member or dependent is part of the crew or is performing any other flight duties or
• any accident or injury that occurs while operating a vehicle under the influence of any intoxicant or with a blood alcohol level in excess of the legal limit in the jurisdiction in which the accident occurred