IAP Kids Plus™ Plan

Description of Benefits

1.	Dental

When Injury to whole or sound teeth requires and first receives treatment by a dentist within 60 days from the date of an Accident, benefits will be paid for customary treatment payable by the Insured or Parent within 7 years following the date of the Accident for Children (within one year for Adults). Capped or crowned teeth are considered whole or sound.

If treatment cannot be completed within 7 years due to the development of a Child’s teeth, IAP will pay up to the specified maximum per injured tooth as shown in the Benefit Summary, for the expense incurred to cap, crown, replace, or restore each injured tooth, provided treatment is completed prior to the Child reaching the age of 26.

Benefits will be paid for dental implants (subject to a maximum of two for any one Accident) required solely as a result of an Accident provided treatment is received within 7 years following the date of the Accident for Children (one year for Adults), up to a maximum per implant per Accident as shown in the Benefit Summary.

Benefits will be paid for Injury related orthodontic treatment required solely as a result of an Accident provided treatment is received within 7 years following the date of the Accident for Children (one year for Adults), up to the specified maximum per Accident as shown in the Benefit Summary.

No Dental benefit will be paid for treatment received outside Canada, other than as provided under the Emergency Out-of-Province/Country Travel benefit.

Where one or more customarily employed and professionally adequate methods of treating an Injury to the teeth exists, IAP will pay an amount equal to the cost of the least expensive treatment.

Maximums payable under this benefit are based on the fee specified in the General Practitioner Schedule of Fees and Treatment Services of the Provincial Dental Association or its equivalent as determined by the insurance industry.

2.	Dentures and Artificial Teeth

If an Insured’s Injury requires and receives treatment by a dentist, and results in the breakage of dentures or an artificial tooth or teeth, IAP will pay the actual cost of repair or replacement up to the maximum shown in the Benefit Summary during the term of the Policy.

3.	Eyeglasses and Contact Lenses

If an Insured’s Injury is treated by a Physician, dentist or registered nurse (RN) within 30 days of an Accident AND;

1. results in broken eyeglasses or loss or breakage of a contact lens or lenses, IAP will pay the cost of repair or replacement up to the maximum shown in the Benefit Summary, or
2. necessitates the purchase of eyeglasses or contact lenses (not previously required or worn) upon the advice of a Physician, IAP will pay the amount shown in the Benefit Summary for the initial purchase.

4.	Fracture, Dislocation, or Surgery

When Injury results in any of the listed fractures, dislocations, or surgeries and requires medical or surgical treatment, IAP will pay the benefit specified in the Benefit Summary. No more than one amount (the greatest) will be payable as the result of any one Accident. For the shoulder or knee cap dislocation benefit to be payable, there must be open reduction/open primary repair. In the event of compound, comminuted, or bi-lateral fractures, the amount payable will be doubled.

5.	Hospital and Paramedical

When an Insured under the regular care and attendance of a Physician, and as a result of Injury, requires and first receives treatment within 30 days from an Accident, IAP will pay the reasonable and customary expense for items listed in the Benefit Summary up to the maximums specified on a per Injury basis. The expense must be incurred in Canada (except as otherwise provided under the Emergency Out-of-Province/Country Travel benefit) within 3 years from the date of the Accident for Children and within one year from the date of the Accident for Adults.

6.	Counselling

Upon the medical advice of the attending Physician, as a result of an Insured’s death, Injury, or Critical Illness, IAP will pay up to the maximum shown in the Benefit Summary for an Insured or his/her immediate family to undergo counselling performed by a registered psychologist or professional counsellor. Expenses must be incurred within 3 years from the date of death, Injury, or diagnosis of Critical Illness.

7.	Artificial Limbs, Eyes, Hearing Aids, and Other Prosthetic Appliances

When Injury results in these appliances being prescribed by a Physician and purchased within 3 years from the date of an Accident, IAP will pay the cost up to a maximum of $5,000 as a result of any one Accident.

If a prosthetic appliance is damaged in an Accident which causes Injury to an Insured and the appliance requires commercial repair, IAP will pay the cost of repair up to $500 for all such repairs during the term of the Policy.

8.	Emergency Out-Of-Province/Country Travel

In addition to expenses reimbursed under the Hospital and Paramedical benefit, IAP will pay the following reasonable and customary expenses incurred by the Insured as a result of being injured on a Trip outside of Canada or his/her province of residence: out-patient emergency room charges; standard hospital ward charges; the emergency treatment by a legally qualified Physician, surgeon, dentist or dental surgeon; hospital expenses, and x-rays and laboratory services as may be requested by the attending Physician. The Injury must occur while the Policy is in force and require that the Insured receive emergency treatment by a Physician or dentist.

For Insureds covered under the IAP Kids Plus™ Active Plan this benefit extends to include coverage for Injury or Sickness. The same benefit wording and limitations apply to Sickness as apply to Injury under this benefit.

The maximum aggregate amount payable, in Canadian funds, for all such Injury incurred (or in the case of the IAP Kids Plus™ Active Plan, for all such Injury or Sickness) during the term of the Policy is as shown in the Benefit Summary. Reimbursement is payable only for the excess charges over and above any amounts payable or collectable under any provincial medical care or hospital plan, or other travel policy. Coverage will be coordinated with any other policy according to the guidelines published by the Canadian Life and Health Insurance Association Inc. (CLHIA).

9.	Emergency Return Flight

If the Insured’s Sickness or Injury qualifies for the Emergency Out-of-Province/Country Travel benefits and results in the Insured having to return early or miss the scheduled return flight upon the advice and recommendation of the attending Physician, IAP will reimburse the Insured for the cost of one way Economy airfare up to the maximum shown in the Benefit Summary for the additional airfare paid to return to the original departure point. This benefit only applies to the IAP Kids Plus™ Active Plan.

10.	Family Transportation

If the Insured is hospitalized and qualifies for Emergency Out-of-Province/Country Travel benefits and the Physician requires the necessary attendance of a Parent, IAP will pay for the reasonable cost of transportation by Economy class up to the maximum shown in the Benefit Summary. This benefit only applies to the IAP Kids Plus™ Active Plan.

11.	Emergency Transportation

When Injury requires immediate medical attention but does not necessitate an ambulance, IAP will pay up to the maximum shown in the Benefit Summary for the expense to transport the Insured via private vehicle/taxi from the location of the Accident to a Physician’s office or the nearest hospital, and return to the school, workplace, or residence of the Insured, and to transport the Insured to and from school or work if the Injury requires special transportation.

12.	Special Treatment Travel

If Injury requires special medical or dental treatment by a Physician or dentist that is unavailable within a 100 mile (160 km) radius of an Insured’s residence, IAP will pay the reasonable travel expense to obtain it. If the Insured’s age necessitates an escort, the escort will be paid for reasonable travel expenses plus up to a maximum of $80 per day for commercial accommodation and meals, provided all receipts are submitted to IAP. All benefits under this section are payable for one year from the date of the Accident and subject to the maximum shown in the Benefit Summary.

13.	Accidental Death

Upon receipt of satisfactory evidence that Injury resulted in the death of an Insured within one year from the date of an Accident, IAP will pay the Accidental Death benefit as shown in the Benefit Summary. The benefit payable under this section will be the only amount payable under the Policy, unless benefits are payable for Repatriation or Counselling. Double Indemnity: The amount payable will be doubled for loss of life resulting from an Accident which occurs while riding in, boarding, or alighting from a bus, streetcar, subway coach or train, or any vehicle owned or leased by a school authority. In no event will the liability of IAP exceed twice the amount of the applicable Accidental Death benefit.

14.	Non-Accidental Death

Upon receipt of satisfactory evidence that the death of an Insured occurred while the Policy was in force, IAP will pay the Non-Accidental Death benefit as shown in the Benefit Summary if the Insured dies for any reason other than an Accident. If the Insured dies as the result of a medical condition, the Non-Accidental Death benefit will only be payable if the medical condition first manifested itself while the Policy was in force as to the Insured. The benefit payable under this section will be the only amount payable under the Policy, unless benefits are payable for Repatriation or Counselling. This benefit only applies to Children.

15.	Repatriation

If Injury results in an Insured’s loss of life outside his/her province of residence within one year of an Accident, IAP will pay the expense incurred for preparing the deceased for burial or cremation and transportation to the deceased’s city of residence, subject to a maximum of $5,000. Travelling expenses will be paid for a family member to identify the Insured’s remains, up to a maximum of $100 per day, subject to an aggregate limit of $500.

16.	Permanent Total Disability

If Injury totally and permanently disables an Insured within 120 days of the date of an Accident, IAP will pay the Permanent Total Disability benefit as shown in the Benefit Summary. Total and permanent disability must continue for 12 consecutive months, must be total, continuous, and permanent at the end of the 12 months, and must prevent the Insured from ever engaging in any occupation or employment for compensation or profit.

The benefit payable for Permanent Total Disability will be reduced by the amount(s) payable under any other section of the Policy for the same Injury. This benefit only applies to Children.

17.	Confinement Disability

If, within 30 days from the date of an Accident, an Insured is continuously confined to home or hospital while under the care and on the advice of a Physician and unable to attend classes of any type, IAP will pay the monthly Confinement Disability benefit as shown in the Benefit Summary, commencing with the 31st day up to a maximum of 36 consecutive months of confinement. This benefit only applies to Children.

18.	Rehabilitation

If Injury requires an Insured to be trained in a special occupation, IAP will pay the necessary expense for special training during the 3 years following the Accident up to the maximum shown in the Benefit Summary. Payment will not be made for travelling or clothing expenses, room, board, or other ordinary living expenses.

19.	Private Tutor

If Injury results in a disability within 100 days of an Accident which confines the Insured to home or hospital for 30 consecutive days, IAP will pay up to $40 per hour for a qualified teacher’s private tutorial service. In addition, IAP will pay the labour charges, wiring, and rental of communication equipment to provide tutorial service from the school to home or hospital. Approval must be obtained from the proper school authority. All benefits payable under this section are subject to the maximum as shown in the Benefit Summary. This benefit only applies to Children.

20.	Wage Loss

An Insured, actively employed by a business for wages on a part-time basis who suffers an Injury, is under the regular care of a Physician, and is unable to perform all the duties of the job, will be covered for 80% of the Insured’s hourly wage during the disability. Actively employed means the Insured has been continuously employed for the 2 weeks immediately prior to the date of an Accident. Benefits will be payable from the 15th day of disability, to the maximum shown in the Benefit Summary during the term of the Policy. With respect to seasonal employment, this benefit will not be paid past the date employment would have normally ceased. This benefit only applies to the IAP Kids Plus™ Active Plan.

21.	Babysitting

If an Insured sustains an Injury that requires and receives treatment by a Physician, and confines the Insured to home following an Accident, IAP will pay for a babysitter to tend to the Insured during normal school hours or during the Parent’s workday if the Parent is unable to do so. The babysitter must be at least 18 years of age and not an immediate family member. This benefit is subject to an hourly maximum of $10 and an aggregate limit as shown in the Benefit Summary during the term of the Policy. This benefit only applies to Children.

22.	Dismemberment or Total and Permanent Loss of Use

Should Injury result in any of the scheduled losses, within one year from the date of an Accident, IAP will pay the Dismemberment or Total and Permanent Loss of Use benefit, as shown in the Benefit Summary.

“Loss” as used with reference to:

1. arm or leg means complete severance at or above the elbow or knee joint;
2. hand or foot means complete severance at or above the wrist or ankle joint;
3. eye means the irrecoverable loss of the entire sight thereof;
4. speech and hearing means the total and irrecoverable loss thereof;
5. thumb or finger means complete severance at or above the metacarpophalangeal joint;
6. toe means complete severance at or above the metatarsophalangeal joint;
7. one phalanx of any finger means complete loss of one entire phalanx.

"Loss of Use" means a loss which is permanent, total, irrecoverable and continuous for a period of 12 months from the date of the Accident.

No more than the greatest amount will be paid as the result of any one Accident sustained by any one Insured, except that when death occurs within 90 days after the date of the Accident, indemnity will only be paid for Accidental Death. Benefits paid for any of the scheduled losses under this section will be the only amount payable under the Policy unless benefits are payable for Artificial Limbs, Eyes, Hearing Aids and Other Prosthetic Appliances. In the event that the amount payable for a scheduled loss under this benefit is less than the amount payable under any other section of the Policy, the section providing the greater benefit will apply.

23.	Critical Illness

If an Insured is diagnosed by a Physician with any of the following diseases: Acquired Immune Deficiency Syndrome (AIDS), Cancer, Diphtheria, Encephalitis, Hemolytic Uremic Syndrome (renal failure resulting from E-coli bacteria), Meningitis, Multiple Sclerosis, Muscular Dystrophy, Myocarditis, Poliomyelitis, Rabies, Scarlet Fever, Tetanus, Tularemia or Typhoid; which first manifests itself while the Policy is in force, IAP will pay the reasonable expenses actually incurred within 3 years from the date the disease is first diagnosed for: hospital services – semi-private or private ward accommodation (including rental of television, radio, or telephone to a maximum of $15 per day) and the employment of a registered nurse (RN) or certified nursing aid if requested by the attending Physician, not to exceed a maximum for all such expenses as shown in the Benefit Summary.

In addition, IAP will pay a commercial accommodation and meal allowance to the Parent who must leave their residence to stay with or near the Insured, of up to $80 per day for a maximum of 30 days for any one illness, provided all receipts are submitted to IAP.

IAP will also pay reasonable travel expenses plus parking costs incurred by the Parent to visit the hospitalized Insured, up to a maximum of $500 for any one illness, provided all receipts are submitted to IAP. This benefit only applies to Children.