WIXLIB

myHSA – Travel & Catastrophic, Life, AD&D &CI Multi-coverage InsurancePolicy # MYH1001-Policyholder NumberName of BrokerTHE WAWANESA LIFE INSURANCE COMPANY400-200 Main Street, Winnipeg, MB R3C 1A8Toll Free: 1-888-997-9965 wawanesalife.com

Policy #MYH1001TABLE OF CONTENTSInsuring Agreement . 1Schedule . 2General Policy Definitions . 4General Policy Provisions . 71 - Eligibility for Insurance . 71.11.2Eligibility. 7Participation in the Insurance Plan . 72 - Effective Date of Individual Insurance . 72.12.22.32.4Employee Insurance . 7Spouse and Dependent Children. 8Effective Hour on Effective Date . 8Actively at Work. 83 - Change in Coverage of an Insured Person . 84 - Termination of Individual Insurance . 94.14.24.3Employee . 9Dependents . 9Multiple Covered Critical Illness Conditions Termination . 95 - Continuation of Individual Coverage . 105.15.2Continuation of Coverage . 10Reinstatement of Individual Coverage . 106 - Waiver of Premium . 116.16.26.36.46.5Description of Disability Waiver of Premium . 11Requirements . 11Recurrence of Disability . 11Notice of Recovery or Death . 12Termination of the Waiver of Premium Benefit . 127 - Claims . ry . 12Notice and Proof of Claim . 12Insurer to Furnish Forms for Proof of Claim . 13Failure to Give Notice or Proof . 13Reserving Rights . 13Fraudulent Claims . 13Limitation of Action. 13Subrogation . 14Recovering Overpayments . 14Coordination of Coverage . 14Settlement Options . 14Extension of Coverage under Previous Insurer . 148 - Premiums . 159 - Contract . 159.19.29.39.49.59.69.79.89.9iAdministration . 15Clerical or Mechanical Errors . 15Conformity to Legislation . 15Currency . 15Entire Contract. 15Insurance Data . 16Insured Right of Access . 16Material Facts . 16Misrepresentation and Incontestability. 16

Policy tement of Age . 16Non-Participating. 16Replacement . 17Renewal of Contract . 17Responsibility of the Policyholder . 17Termination by the Group/Association . 17Termination by the Insurer . 17Termination by the Policyholder. 17Waiver . 17Coverage A: Employee Mandatory Life Insurance . 18A1 - Description of Coverage . 18A2 - Amount of Life Insurance . 18A3 - Evidence of Insurability. 18A4 - Final Expense . 18A5 - Employees Life Insurance Exclusions. 19A5.1 Pre-existing exclusion . 19Coverage B: Dependent Mandatory Life Insurance . 20B1 - Description of Coverage . 20B2 - Amount of Life Insurance . 20B3 - Evidence of Insurability. 20B4 - Final Expense . 20B5 - Dependent Mandatory Life Insurance Exclusion . 21B5.1 Pre-existing exclusion . 21Coverage C: Employee Mandatory Accidental Death or Dismemberment Insurance . 22C1 - Description of Coverage. 22C2 - Aircraft Coverage . 22C3 - Exposure and Disappearance . 22C4 - Amount of Accidental Death or Dismemberment Insurance. 23C5 - Benefits . 23C5.1 Specific Loss Accident Indemnity . 23C5.2 Cosmetic Disfigurement Benefit. 25C5.3 Day-Care Benefit . 26C5.4 Education Benefit . 27C5.5 Family Transportation Expense . 27C5.6 Home Alteration and/or Vehicle Modification Expense . 28C5.7 Hospital Indemnity . 28C5.8 Identification Expense . 29The benefit is payable under only one of the policies issued to the Policyholder by the Insurer. . 29C5.9 Occupational Training Expense . 29The benefit is payable under only one of the policies issued to the Policyholder by the Insurer. . 29C5.10 Permanent Total Disability Indemnity . 29C5.11 Rehabilitation Expense . 29The benefit is payable under only one of the policies issued to the Policyholder by the Insurer. . 29C5.12 Workplace Modification and Accommodation Expense . 30The benefit is payable under only one of the policies issued to the Policyholder by the Insurer. . 30C5.13 Repatriation Expense . 30The benefit is payable under only one of the policies issued to the Policyholder by the Insurer. . 30C5.14 Seat Belt Benefit . 30C6 - Aggregate Limit of Indemnity. 31C7 - Employee Accidental Death or Dismemberment Insurance Exclusions . 31Coverage D: Employee Mandatory Critical Illness Insurance . 32D1 - Definitions Specific to the Employee Critical Illness Insurance . 32D2 - Description of Coverage. 32ii

Policy #MYH1001D3 - Amount of Critical Illness Insurance . 33D4 - Covered Critical Illness Conditions . 33D5 - Critical Illness Conditions – Defined . .22D5.23D5.24D5.25Alzheimer’s Disease . 33Aortic Surgery . 34Aplastic Anemia. 34Bacterial Meningitis . 34Benign Brain Tumour. 34Blindness . 35Cancer (Life-Threatening) . 35Coma . 35Coronary Artery Bypass Surgery . 36Deafness . 36Heart Attack . 36Heart Valve Replacement . 36Kidney Failure . 36Loss of Independent Existence . 37Loss of Limbs. 37Loss of Speech . 37Major Organ Failure on Waiting List . 38Major Organ Transplant . 38Motor Neuron Disease . 38Multiple Sclerosis . 38Occupational HIV Infection . 39Paralysis . 39Parkinson’s Disease . 39Severe Burns . 39Stroke. 40D6 - Employee Mandatory Critical Illness Exclusions . 40D6.1 Pre-existing Conditions exclusion . 41Coverage E: Travel Emergency Medical . 42E1 - Description of Coverage . 42E2 - Amount of Travel Emergency Medical . 42E3 – Benefits and Eligible Expenses . .12E3.13E3.14E3.15E3.16Ambulance . 42Anesthetist . 42Appliances and Durable Equipment . 42Drug Therapy . 42Emergency Dental Treatment Expense . 43Family Transportation . 43Hospital . 43Hotel Convalescence Expense . 43Meals and Accommodation . 43Medical/Surgical Services . 44Nursing Care . 44Other Medical Supplies and Services . 44Paramedical . 44Physiotherapy . 44Return of Remains . 44Vehicle Return . 44E4 - Travel Emergency Medical Limitations . 45E5 - Travel Emergency Medical Exclusions . 45Coverage F: Excess Medical . 47F1 - Description of Coverage . 47iii

Policy #MYH1001F2 - Amount of Excess Medical . 47F3 - Benefits and Eligible Expenses . 47F3.1F3.2F3.3F3.4F3.5F3.6F3.7Ambulance . 47Dental Injury . 47Drug Therapy . 48Durable Equipment . 48Nursing Care . 48Paramedical . 48Semi-Private Room Costs . 48F4 - Deductible . 48F5 - Recurrent Injury, Sickness or Disease . 49F6 - Exclusions, Limitations, and Special Provisions . 50ALLIANZ ASSIST SERVICES . 52iv

Policy #MYH1001Insuring AgreementThe Wawanesa Life Insurance Company hereby contracts with:Name and Address of Policyholder:Participating Member Clients of the Administrator120 6815 8 Street NECalgary, AB T2E 7H7“Member Client” means clients who are participating in the benefitprograms administered by the Policy Administrator.Policy Effective Date:November 1, 2012 at 12:01 A.M. standard time at the head officeaddress of the Policyholder as stated above.It continues in force for the period for which premium has been paid.Renewal DateAugust 1, 2017 and each August 1 thereafter, subject to the terms ofthis policy.Premiums DuePayment is due on the first day of each month and a period of 60 daysis allowed for the payment of every premium starting on the premiumdue date.The Wawanesa Life Insurance Company (“Insurer”) agrees with the Policyholder named above(“Policyholder”) to insure eligible persons specified herein (“Insured Employee”) and their eligiblespouses and dependent children, if any, (“Insured Spouse” and “Insured Dependent Child”,respectively) and promises to pay for the benefits specified in this policy; to the extent herein limitedand provided.This agreement is made in consideration of the Policyholder’s payment of the required premium.Signed by The Wawanesa Life Insurance Company at its Executive Office in Winnipeg, Manitoba,Canada on the Master Policy Effective Date.Pat HorncastlePresidentMulti-Coverage Policy Plus Underwritten by The Wawanesa Life Insurance CompanyPage 1Wawanesa Life and the tree logo are registered trade-marks of The Wawanesa Mutual Insurance Company and used under license by The Wawanesa Life Insurance Company.

Policy #MYH1001Schedule1. Eligible Employee Class:Class I:All permanent Employees under the Age of 65 working a minimum of 15 hours perweek (averaged over the latest three-month period of being Actively at Work) who havesatisfied their Employer’s Waiting Period.2. Waiting Period: as shown on the Member Clients Enrolment Form and on file with theAdministrator.3. Deductible:Excess Medical Deductible: 2,500 per person per calendar year4. Aggregate Limit of Indemnity: 2,000,0005. Grace Period for premium payment: 60 days6. Non-Evidence Benefit Maximums:Employee Life Insurance . 15,000Spouse Life Insurance . 10,000Dependent Child Life Insurance (Each Child) . 5,000Employee Accidental Death or Dismemberment Benefit. 60,000Employee Critical Illness Insurance . 15,000Travel Emergency Medical . 2,000,000Excess Medical . Multi-Coverage Policy Plus 250,000Underwritten by The Wawanesa Life Insurance CompanyPage 2Wawanesa Life and the tree logo are registered trade-marks of The Wawanesa Mutual Insurance Company and used under license by The Wawanesa Life Insurance Company.

Policy #MYH10017. Benefit AmountsCoverage A: Employee Mandatory Life insurance . 15,000Coverage B: Dependent Mandatory Life Insurance:Spouse Life Insurance .

Policy #MYH1001 Multi-Coverage Policy Plus Underwritten by The Wawanesa Life Insurance Company Page 1 Wawanesa Life and the tree logo are registered trade-marks of The Wawanesa Mutual Insurance Company and used under license by The Wawanesa Life Insurance Company. Insuring Agreement The Wawanesa Life Insurance Company hereby contracts with: Name and Address of Policyholder: