TCS Kamloops & Area (Interior)

200 - 286 St Paul Street, Kamloops, BC V2C 6G4

T: 250-828-1508 | F: 250-372-7544
Enhancing each day for each individual Toll free: 1-844-828-1508
tcsinfo.ca

Memo
To: TCS Employees with Pacific Blue Cross Coverage

From: Miranda Groff

Date: May 2nd, 2023

OPTIONAL CRITICAL ILLNESS

Critical Illness Insurance provides you with a lump sum payment to be used ANY WAY you wish, helping
to fill the gap in other coverage and to assist you financially while you focus on recovery. If you are
unable to work as a result of your illness, your income will most likely be reduced at a time when your
expenses are increased. The FABP allows employees to purchase up to $25,000 of Critical Illness Benefit
without providing any medical evidence. This coverage is available to employee’s, spouses and
dependent children. For those who wish to obtain insurance over and above $25,000, please complete
page 2, the Critical Illness Questionnaire in addition to the Employee Application.

Attached you will find:

1. Optional Critical Illness Brochure

2. Optional Critical Illness Employee Application (page 1 only)
Must complete page 2, if applying for more than $25,000 of coverage

Please return the original completed forms to our office by May 28th, 2023
applications will be effective June 1st, 2023. Any applications returned after
June 1st, 2023 will not be accepted.

Please send completed applications to the Kamloops Payroll Office

(payroll@tcsinfo.ca) , and all originals MUST be mailed directly to Kamloops
Payroll Office.

TCS Kamloops & Area (Interior)

200 - 286 St Paul Street, Kamloops, BC V2C 6G4
T: 250-828-1508 | F: 250-372-7544
Toll free: 1-844-828-1508
tcsinfo.ca
 TCS Kamloops & Area (Interior)
200 - 286 St Paul Street, Kamloops, BC V2C 6G4
T: 250-828-1508 | F: 250-372-7544
Enhancing each day for each individual Toll free: 1-844-828-1508
tcsinfo.ca

Commonly asked questions:

Q: What happens to employee’s who are already enrolled? Do they need to apply again?

A: Employee’s who have previously enrolled will remain on the plan year after year, until they terminate
or age out (age 65). The only change you may see if when employee’s reach a new age bracket which
will increase the cost.

Q: What if an enrolled employee now wants to add their spouse/dependent child?

A: Employee’s will need to complete the application again with completing the appropriate spouse or
dependent information and coverage selection.

Q: What happens to this coverage if an employee quits?

A: This benefit is only available for active, permanent, full-time employee’s, if an employee’s terminates
from your agency so will this benefit.

Q: I’ve had cancer in the past and beat it, can I purchase this coverage and will cancer be covered?

A: Yes, you can purchase coverage. Effective June 1, 2016, a ‘cancer reoccurrence’ provision has been
added to the plan. This means that if you have been already diagnosed with cancer and, a new diagnosis
of cancer is made, a benefit will be paid, subject to all the policy terms and provisions.

Q: What is a pre-existing condition and if I have one, how would this affect my policy?

A: In the event that you claim within the first 2 years the policy comes into effect, the insurance
company has the right to look at your medical history 2 years prior to the effective date to determine if
you had any existing conditions that were treated or investigated that would link to the current
diagnosis. If there is no medical history or link then your benefit still gets paid out to you tax free!

Q: Does this benefit affect my LTD or Health Benefits?

A: No, there is no relation to having a Critical Illness plan and LTD or Health benefits. A critical illness
will pay you out a lump sum tax free benefit to help through your recovery process once you survive the
30 day survival period.

TCS Kamloops & Area (Interior)

200 - 286 St Paul Street, Kamloops, BC V2C 6G4
T: 250-828-1508 | F: 250-372-7544
Toll free: 1-844-828-1508
tcsinfo.ca
Optional Critical Illness Insurance
What is the Risk?
Despite the staggering increase of
incidents of the most common critical
conditions; cancer, heart attack and
stroke, we continue to see a decrease in
mortality rates. This is GREAT NEWS,
but it can come with a hefty price tag.
Provincial plans do not take care of all that
is needed when an individual is diagnosed
with a critical condition.
At a time when incomes are potentially
reduced, and expenses increase (due to
medical needs), a critical illness plan is the
best way to fund a possibly lengthy
recovery period.
Did You Know?
• An estimated 196,900 new cases of
cancer occurred in Canada in 20151.
• There are an estimated 70,000 heart
attacks each year in Canada. That’s one
heart attack every 7 minutes2.
• Up to 40,000 cardiac arrests occur each
year in Canada. That’s one cardiac
arrest every 12 minutes2.
• There are estimated 50,000 strokes in
Canada each year. That’s one stroke
every 10 minutes2.
How to Protect Yourself
When an individual receives the news they
have been diagnosed with a critical
condition and are bracing themselves for a
long recovery battle the emotional impact
is immeasurable.
Chubb’s Critical Illness program provides
the kind of financial assistance that allows
an individual to focus on the important
things during a recovery time: like getting
better.
This program offers a lump sum
pay-out following the diagnosis of a
covered condition3, that can be used any
way the insured wishes.
Chubb’s Critical Illness program provides
coverage for 23 covered conditions, as well
as the following additional benefits4:
• Ductal Carcinoma in Situ
(early stage breast cancer)
• Early Prostate Cancer Treatment
• 2nd Event Coverage
 Premium Rate Charts
Covered Conditions
LEVEL 1 – Guaranteed Issue
• Alzheimer’s Disease Rates per $5,000 Per Insured per Month
• Aorta Surgery Male Female
• Benign Brain Tumour Age
Non-Smoker Smoker Non-Smoker Smoker
• Blindness Under 25 $0.68 $0.92 $0.68 $0.92
• Cancer 25 to 29 $0.68 $0.92 $0.68 $0.92
• Cancer Recurrence
30 to 34 $0.97 $1.41 $1.21 $1.65
• Coma
35 to 39 $1.31 $2.03 $1.57 $2.35
• Coronary Artery Bypass Surgery
40 to 44 $1.97 $3.35 $2.21 $3.88
• Deafness
45 to 49 $3.30 $6.44 $3.42 $6.33
• Dismemberment
50 to 54 $6.18 $11.75 $4.84 $10.43
• Heart Attack
55 to 59 $9.12 $19.84 $6.30 $15.79
• Heart Valve Replacement
60 to 64 $13.89 $32.42 $8.20 $18.05
• Loss of Independence
• Loss of Speech LEVEL 2 – Medical Evidence
• Major Organ Transplant Rates per $5,000 Per Insured per Month
• Major Organ Failure Male Female
• Motor Neuron Disease Age
Non-Smoker Smoker Non-Smoker Smoker
• Multiple Sclerosis Under 25 $0.61 $0.83 $0.61 $0.83
• Occupational HIV 25 to 29 $0.61 $0.83 $0.61 $0.83
• Paralysis 30 to 34 $0.87 $1.26 $1.09 $1.48
• Parkinson’s Disease 35 to 39 $1.18 $1.82 $1.42 $2.11
• Severe Burns 40 to 44 $1.78 $3.01 $1.99 $3.49
• Stroke 45 to 49 $2.98 $5.80 $3.08 $5.70
50 to 54 $5.56 $10.57 $4.36 $9.38
Optional Critical Illness
Coverage Choices 55 to 59 $8.21 $17.85 $5.67 $14.21
60 to 64 $12.50 $29.18 $7.38 $16.24
Level 1 – Guaranteed Issue
How to Calculate Rates? What is a Pre-Existing
You and your spouse are eligible for Condition Limitation?
$10,000 to $25,000 of coverage with NO For Level 1 coverage, use the rate in the
MEDICAL EVIDENCE*. chart provided that corresponds with your This means that we won’t pay for a critical
gender and smoking status. condition diagnosed in the first 2 years of
*A pre-existing medical condition coverage, if that diagnosis was directly or
limitation provision is applied. For Level 2 coverage, use the rate in the indirectly caused by an injury or sickness
chart provided that corresponds with your you’ve received treatment, advice or a
Level 2 – Medical Evidence gender and smoking status then multiply diagnosis on, in the 2 years just prior to
that rate by the number of units you wish your effective date of coverage.
You and your spouse are also eligible for purchase.
additional benefits from $30,000 to For application forms please see your
$150,000 with the completion of a short- For example: $50,000 for a non-smoking Plan Administrator.
form medical questionnaire. male at age 40 (10 x 1.78 = 17.80 per
month).
Child Benefit
Add Level 2 monthly premiums to
You may also purchase coverage for your Level 1 for the total amount of coverage
children (in conjunction with enrollment being purchased.
of an employee and/or spouse). This
covers all eligible dependent children you The combined Mandatory and Optional
have. benefit amount cannot exceed $150,000
per Insured Person.
Benefit Amounts Available:
• $5,000 or $10,000

Monthly Premium:
• $0.75/$5,000/month or
• $1.50/$10,000/month

1. Canadian Cancer Society. 2. Heart and Stroke Foundation. 3. A single sum benefit is paid upon diagnosis of one of the listed covered illness, or injury, and survival after 30 days (180 days
survival for Paralysis, and a 90 day waiting period for Cancer applies). 4. Additional benefits paid at a percentage of the lump sum benefit.

This insurance coverage is underwritten by Chubb Life Insurance Company of Canada (“Chubb Life”). Product highlights are summaries only. For full benefit details including
exclusions and limitations, please refer to the master policy issued to the group policyholder. Chubb Life is part of the Chubb group of companies. With operations in 54 countries,
Chubb provides commercial and personal property and casualty insurance, personal accident and supplemental health insurance, reinsurance and life insurance to a diverse group
of clients. Chubb Limited, the parent company of Chubb Life, is listed on the New York Stock Exchange (NYSE: CB) and is a component of the S&P 500 index.

Rev.01 (07-2018)
 GROUP INSURANCE PLAN
OPTIONAL CRITICAL ILLNESS ENROLLMENT FORM

GROUP POLICY INFORMATION

Policyholder Name: FABP Policy #: CO 50058301

EMPLOYEE INFORMATION
Last Name: First Name: Telephone #: ( )

Date of Birth: Gender:

Address - Street: City: Province: Postal Code:

SPOUSAL INFORMATION (Only to be completed if applying for Coverage)

Last Name: First Name: Date of Birth: Gender:

DEPENDENT INFORMATION (Only to be completed if applying for Coverage)

Dependent Full-Time Disabled
Birthdate Gender
Last Name First Name Children Student Dependent
(D/M/Y) (M/F)
(< age 21) (< age 25) (> age 21)

COVERAGE SELECTION – Please refer to the Critical Illness Product summary page for Benefit Levels available and Rate Chart
Employee Spouse Dependent Children*
Smoker Status Smoker or Non-Smoker Smoker or Non-Smoker n/a
Benefit Amounts Selected $ $ $5,000 or $10,000
Monthly Premium (see Rate Chart) $ $ $
*Only available in conjunction with the enrollment of the employee and/or spouse

BENEFICIARY DESIGNATION
All benefit payments, including benefits payable for any insured dependent child covered under this plan, if applicable are paid directly to you. If you are deceased at
the time that a benefit becomes payable, we will pay benefits to the beneficiary you named below. If you do not designate a beneficiary we will use the beneficiary
designation made under the Policyholder’s Group Life Insurance Policy. Failing such designation, all benefits will be paid to your Estate.
I appoint the following revocable beneficiary (Irrevocable in the province of Quebec) for Insurance benefits payable as a result of this plan. If the beneficiary is under
the age of majority, I appoint the trustee named below to receive any amount payable to a minor beneficiary.

Please Note: In the province of Quebec, if you have designated your married or civil union spouse as beneficiary, the designation will be considered irrevocable unless
you check here: Revocable.

Relationship to Insured
Full Legal Name
(or minor for Trustee)

Primary Beneficiary

Contingent Beneficiary

Trustee (for minor beneficiary)

PRIVACY STATEMENT
At Chubb Life, we are committed to protecting our customers’ privacy. Chubb Life’s policy is to limit access to customer information to those who need it to serve customers'
insurance needs and to maintain and improve customer service. The information provided by customers is required by us, our reinsurers and authorized administrators to assess
customers’ entitlement to benefits, including but not limited to determining if coverage is in effect, investigating the applicability of exclusions and co-ordinating coverage with
other insurers. For these purposes, we, our reinsurers and authorized administrators consult existing insurance files about customers, collect additional information about and
from customers, and where required, collect information from and exchange information with, third parties. We do not disclose customer information to third parties other than
our agents and brokers, except as necessary to conduct business, e.g., processing claims or as required by law. We advise customers that, in some instances, employees, service
providers, agents, reinsurers, and any of their providers, of Chubb and/or Chubb Life may be located in jurisdictions outside Canada and that customers’ personal information may
thus be subject to the laws of those foreign jurisdictions.
To find out more about the Chubb Privacy Policy or our privacy practices please visit chubb.com/ca or send a written request to: Privacy Officer, Chubb, 199 Bay Street - Suite
2500, P.O. Box 139, Commerce Court Postal Station, Toronto, Ontario M5L 1E2.

AUTHORIZATION
I hereby apply for coverage under the Group Insurance Plan, underwritten by Chubb Life Insurance Company of Canada, for which I am eligible and authorize any required payroll
deductions for administration of my benefits. I certify that the information provided herein is true, accurate and complete.

Signed at this day of 20

Employee’s Signature Spouse’s Signature (if applicable)

If APPLYING FOR COVERAGE AMOUNTS HIGHER THAN THE GUARANTEED ISSUE LEVEL PLEASE COMPLETE PAGE 2

Underwritten by Chubb Life Insurance Company of Canada CI-OPT-05-2019

 **HEALTH QUESTIONNAIRE FOR COVERAGE AMOUNTS HIGHER THAN GUARANTEED ISSUE AMOUNT**
IMPORTANT Note: Review all questions before completing; if you would answer “YES” to any of the following questions you are only
eligible for the Guaranteed Issue amounts, and should only complete Page 1 of the enrolment form.
Employee Spouse
Yes No Yes No
1. Have you ever sought advice or received treatment for, or had any known indication of:
a) Stroke (including transient ischemic attack), heart attack, coronary artery disease, severe valvular
heart disease e.g. aortic stenosis, or any type of cardiac surgery?
b) Cancer, tumour or malignancy?
c) Advanced ophthalmic disease?
d) Multiple sclerosis or paralysis?
e) Any chronic or progressive disease or disorder of the kidney, lung, liver, pancreas or bone marrow that
may lead to the failure of the organ or that may require transplantation?
f) AIDS, HIV, chronic or unexplained infections?

2. Within the last 5 years have you had; or been diagnosed with, or had any known indication of, a medical problem with respect to the following:

a) Untreated or uncontrolled high blood pressure, angina, heart murmur associated with known cardiac
disease, or an abnormal ECG associated with the potential for or evidence of, a cardiac event?
b) Diabetes, digestive or intestinal disorder, excluding functional disorders e.g. Irritable Bowel
Syndrome?
c) Hospitalized due to a medical problem with respect to severe respiratory disorder?

d) Used habit forming drugs, or received treatment or medical advice due to the use of drugs or alcohol?

3. Have you ever been declined for life insurance or offered coverage only at higher than standard rates?
4. Have you ever sought advice or received treatment for, or had any known indication of:
a) Advanced loss of hearing?
b) Alzheimer’s disease, Parkinson’s disease, motor neuron disease or other neuro-degenerative
disorders?
c) any psychiatric disorder, mental deterioration or loss of intellectual ability?
d) Gout, Arthritis, Scleroderma, Muscular Dystrophy, Ataxia, Systemic Lupus Erythematosus, transverse
myelitis, myasthenia gravis, post-polio syndrome, sarcoidosis or cystic fibrosis?
e) Amputation due to disease?
5. Do you currently:
a) Use or require the use of any mechanical or medical devices such as: a wheelchair, walker, multi-prong
cane, crutches, hospital bed, dialysis, oxygen, motorized cart or stair lift?
b) Need help, assistance or supervision in doing any of the following: bathing, eating, dressing, toileting,
walking, transferring, or maintaining continence?
c) Need help, assistance or supervision in performing two or more of the following everyday activities:
taking medication, doing housework, laundry, shopping or meal preparation?
6. Does your height and weight fall outside the chart noted below?

Males Females

Min. Max Min Max Min Max Min Max

Height Height Height Height
Weight Weight Weight Weight Weight Weight Weight Weight
4' 8'' 95 145 5' 8'' 132 207 4' 8'' 86 145 5' 8'' 119 207
4' 9'' 98 150 5' 9'' 137 213 4' 9'' 88 150 5' 9'' 123 213
4' 10'' 100 155 5' 10'' 141 219 4' 10'' 90 155 5' 10'' 127 219
4' 11'' 103 160 5' 11'' 145 225 4' 11'' 93 160 5' 11'' 131 225
5' 0'' 105 165 6' 0'' 150 233 5' 0'' 95 165 6' 0'' 135 233
5' 1'' 108 170 6' 1'' 155 241 5' 1'' 97 170 6' 1'' 140 241
5' 2'' 111 175 6' 2'' 160 249 5' 2'' 100 175 6' 2'' 144 249
5' 3'' 114 180 6' 3'' 165 257 5' 3'' 103 180 6' 3'' 149 257
5' 4'' 118 185 6' 4'' 170 265 5' 4'' 106 185 6' 4'' 153 265
5' 5'' 121 190 6' 5'' 175 272 5' 5'' 109 190 6' 5'' 158 272
5' 6'' 124 195 6' 6'' 180 279 5' 6'' 112 195 6' 6'' 162 279
5' 7'' 128 201 6' 7'' 185 285 5' 7'' 115 201 6' 7'' 167 285

By signing Page 1 of this form you certify that the medical information provided herein is true, accurate and complete.

Underwritten by Chubb Life Insurance Company of Canada CI-OPT-05.2019