All eligible Members of The Insulators Local 95 Benefit Fund and their Dependents, under the age of 70 for the Accidental Death and Dismemberment and Hospital Cash Benefits, and under the age of 80 for the Emergency Out of Province Hospital/Medical Coverage, are eligible under LAMP.
The LAMP plan covers you and your eligible Dependents, 24 hours a day, each day of the year, against losses resulting from injuries which are received anywhere in the world.
"Member" means a Member eligible for benefits under Insulators Local 95 Benefit Fund.
"Insured Person" means a Member, Spouse, and/or Dependent Child insured under the Policy.
“Activities of Daily Living” means the following six activities:
“Brain Death” means the permanent, irreversible, cessation of electrical activity in both the upper brain and brain stem as certified by a qualified Physician.
“Dependent Parent” means a parent or grandparent of either the Member or the Spouse, who is dependent upon the Member or the Spouse for support, maintenance and care.
“Emergency” means medical treatment or surgery for an unforeseen sickness or injury which makes it necessary to receive immediate treatment from a Physician or Surgeon for the immediate relief of an acute symptom of which upon the advice of a Physician or Surgeon cannot be delayed until the Insured Person returns to his or her province of residence.
"Hospital" means an incorporated or licensed Hospital having accommodation for resident bed patients, a laboratory, a registered graduate nurse always on duty and an operating room where surgical operations are performed by a legally qualified Physician or surgeon, but in no event shall this include a Convalescent or nursing home or home for the aged or health spa.
“Immediate Family Member” means the Insured Person’s spouse, child including adopted children and step-children, parent, legal guardian, parent-in-law, brother or sister, including stepbrothers or stepsisters, grandparents, grandchildren, daughter-in-law son-in-law, brother-in-law and sister-in-law.
“Injury” means bodily injury which is sustained as a direct result of an unintended and unanticipated accident, provided such accident is external to the body and occurs insured under LAMP.
“Loss” when used with reference to:
“Loss” when used herein may also include “Loss of Life”.
“Medically Necessary” means the services or supplies provided by provided by a Hospital, Physician or Surgeon, licensed dentist or other licensed provider that are required to identify or treat an Insured Person’s Sickness or Injury and that are defined as follows:
“Permanent and Total Disability" means Injury which prevents the Member or Spouse from performing at least two of the six Activities of Daily Living, without assistance from another person for the rest of their life. The disability must be determined, as of twelve months after the date of Injury, to be total, permanent, and irreversible and certified to be such by a Physician acceptable to the Insurance Company. The Member’s or Spouse’s inability to actually obtain employment is not a criterion to qualify for the Permanent and Total Disability Benefit.
Your surviving Spouse and surviving Dependent Children, including any Child conceived before and born after your death, will be insured under LAMP on the date of your death. The Trust Fund will maintain premium payments under the LAMP benefit, on behalf of your surviving Dependents, to the earlier of:
Any extended benefits payable are subject to the provisions and limitations of the plan