advisor guide sun long term care insurance · advisor guide sun long term care insurance advisor...
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HEALTH INSURANCE | Long term care
Sun LTCI overview:
Productdetails
Additionaloptions
Glossaryofterms
ADVISOR GUIDE
SUN LONG TERM CARE INSURANCE
ADVISOR USE ONLY
Life’s brighter under the sun
1SUN LONG TERM CARE INSURANCE
WithSunLifeFinancial,you’reworkingwithCanada’sleadingLTCIproductandamarketleaderwithexperiencepayingover$36.9millioninclaimsasofDecember2013.2
Asyoubuildandreviewretirementincomeplansforclients,it’simportanttohelpthemrecognizeandconsidertheirfuturehealthcareneedsandtheimpacttheirchoicesandexpectationswillhaveontheirplans.Longtermcareinsurancecanhelpwithfinancialprotectionfortheirplansandthemeanstopayforthelevelofcaretheywantandexpect.
Why include long term care insurance (LTCI) in your portfolio of product solutions?
It’s easy to take our ability to perform day-to-day activities for granted, but this can change, especially as we age.
Fortunately, most of these changes aren’t dramatically different from one day to the next – it’s more of a gradual process.
The level of health care and personal assistance we need, and the cost to meet these needs, will increase with age with the average Canadian experiencing nine to 14 of the final years of their life in diminished health.1
At birth...
theaveragelifeexpectancyofaCanadianmaleis78years.Overnineofthoseyearsareexpectedtobewithadiminishedqualityoflife.1
theaveragelifeexpectancyofaCanadianfemaleis83years.Justover14ofthoseareexpectedtobewithadiminishedqualityoflife.1
0 20 40 60 80 100
Male
Onset of health impairment
Age
Female
1 StatisticsCanada,20122 LifeInsuranceMarketingResearchAssociation(LIMRA),December2013;SunLifeFinancial,December2013.
What is the LTCI target market?
TheLTCIsolutioncanfitwithinthefinancialplanofanumberofdifferenttargetmarkets.Thesearebestsegmentedbythefollowinglifestages:
Planningforretirement Closetoretirement Retirees
TheLTCIproductoptionsavailablewillbedifferentforeachmarketandfitintotheirplanningdifferently.
This guide contains the information you need to:
understandSunLongTermCareInsurance(SunLTCI),
successfullyselltherightplan,and
helpclientsmanagetheirpolicy.
ProductinformationinthisguidereferstopoliciessoldafterDecember6,2013(2013series),unlessotherwiseindicated.
Inthisguide,the symbolisusedtoidentifyaSunLifeFinancialcompetitiveadvantage.Pleaserefertopage39forasummaryofthesecompetitiveadvantages.
2SUN LONG TERM CARE INSURANCE
Product at a glance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Product details . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Issueages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7Howwedeterminedependency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7DEFINITION:Activitiesofdailyliving. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8DEFINITION:Assistivedevices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
Plan details . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Benefittype. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Weeklybenefitamount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Waitingperiod. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Benefitperiod. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Additional options that may be applied for . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Inflationprotection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Returnofpremiumondeath(ROPD). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12DEFINITION:Returnablepremiumamount. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Plan features that are automatically included . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Waiverofpremium(whenaclaimisapproved). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Spousalwaiver. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13DEFINITION:Spouse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Firstpaymentbonus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Extendedterminsurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Planofcare. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
LifestageCare™ service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Applying for a Sun LTCI policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Residencyrequirements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Backdating. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Ownershiprules. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20Whoreceivespayment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Completingtheapplication. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Payments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Underwriting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Underwritingevidencerequirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22Riskclasses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23Typesofunderwritingdecisions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23Financialunderwriting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23
CONTENTS
3SUN LONG TERM CARE INSURANCE
Premium details . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24Premiumfrequency–monthlyorannually. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24Withdrawablepremiumfund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25Premiumpaymentoptions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25Premiumguarantee. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25Whenwewaivepremiums. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26Non-forfeitureprovision..............................................................26
Issuing a Sun LTCI policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26Policydate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26Whentheinsurancecomesintoeffect. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26
Plan changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27Changingcoverageoptions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27Terminatinganoption. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27Conversions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27Internalreplacements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27Reinstatements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28Reinstatementrulesataglance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29
Making a claim for Sun Long Term Care Insurance benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29Whentomakeaclaim. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29Howtomakeaclaim. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30Exclusionsandlimitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31Tipsforanefficientclaimsprocess. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Taxation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Product history . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34ClaricaLTCIpoliciesdatedDecember,2000-December,2003. . . . . . . . . . . . . . . . . . . . . . . . . . .34ClaricaLTCIpoliciesdatedDecember2003-September2005. . . . . . . . . . . . . . . . . . . . . . . . . . .36SunLTCIpoliciesdatedSeptember,2005–December,2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38
Competitive advantages – summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Where to go for more information? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40
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PRODUCT AT A GLANCE
PLAN DETAILS
Coverage Acomprehensiveincome-stylebenefitwhentheinsuredpersonisdependent.It’sdesignedtohelpoffsetthecostofcareservicesinanyenvironment,1including:
apersonalresidence, aretirementhome,or along-termcarefacility.
1Wewon’tpaybenefitswhentheinsuredpersonisoutsideCanadaortheUnitedStates
formorethaneightconsecutiveweeks.
How we determine dependency
Theinsuredpersonisdependentwhen:
Theyneedconstantsupervisionforprotectionfromthreatstotheirphysicalhealthandsafetyastheresultofdeteriorationinoralossof:
− short-orlong-termmemory,− orientationasitrelatestopeople,placeandtime,− reasoning,or− judgmentasitrelatestosafetyawareness.
Theyrequiresubstantialphysicalassistance,withorwithoutassistivedevices,tosafelyandcompletelyperformtwoormoreactivitiesofdailyliving(bathing,dressing,toileting,transferring,continenceandfeeding).
Theyrequirestand-byassistanceforbathingandtransferring.(Stand-byassistance2meansanotherpersonmustalwaysbewithinarm’sreachoftheinsuredpersonsotheymaysafelyandcompletelyperformtheactivitiesofbathingandtransferring).
2Iftheinsuredpersonrequiresstand-byassistanceforonlyoneofbathingortransferring,
weconsiderthemdependentwhentheyalsorequiresubstantialphysicalassistanceto
performoneoftheotheractivitiesofdailyliving.
Issue ages 21-80
Benefit amounts Minimumweeklybenefit:$150 Maximumweeklybenefit(forallLTCIcoverageononelifeinsured):$2,300
Benefit periods 100weeks(1.9years) 250weeks(4.8years) 150weeks(2.8years) Unlimited
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Palliative care (end-of-life care)
Regardlessofthewaitingperiod,aclaimmaybesubmitted30daysaftertheinsuredperson:
requiressubstantialphysicalassistanceforatleastfouractivitiesofdailyliving,
hasbeendiagnosedwithaterminaldiseaseorillnessbyaqualifiedphysicianoranotherhealthcareprofessionalacceptabletous,and
isreceivingpalliativecarethatissupportiveandprovidescomfort.
First payment bonus
Whenweapproveanewclaim,thefirstpaymentincludesabonusamount,equalto12timestheweeklyamount.
Whentheinsuredpersonisreceivingpalliativecareandqualifiesforbenefits,thebonusisequaltofourtimestheweeklyamount.
Whenthepolicyincludesinflationprotection,thebonusincludesanyaccumulatedincreasestotheweeklyamount.
Thefirstpaymentbonusdoesnotaffectthenumberofweeksremaininginthepolicy’sbenefitperiod.
Waiver of premium Whenweapproveaclaimforbenefitsontheinsuredperson,wewaivepremiumsforthepolicy.Thepremiumsmustbepaiduntilwenotifythepolicyownerthatwe’veapprovedtheclaim.
Spousal waiver of premium
Toqualify,eachpolicymusthavethespousalwaiverprovisionandmusthavebeencontinuouslyineffectwithnoapprovedclaimfromthedatestheycameintoeffectuntil:
bothpolicieshavereachedtheir10thpolicyanniversary,or
theinsuredpersonandtheirspousehavehadtheir86thbirthday.
Wewillwaivepremiumsforthepolicy:
Whenwe’repayingbenefitsforthespouse’spolicy.− Thiscontinuesevenifwe’vepaidthebenefitsfortheentirebenefit
periodofthespouse’spolicy.
Ifthespousedieswhiletheirinsuranceisineffect,regardlessofwhetherornotwewerepayingbenefits.
FEATURES (Automatically included)
Waiting periods 90days 180days
Thewaitingperiodisthelengthoftimetheinsuredpersonmustbecontinuouslydependentbeforeaclaimissubmitted.
Premium payment periods
Thelifetimeofthepolicy(untilthepolicyanniversaryfollowingthe100thbirthdayoftheinsuredperson);or
Thelatestof25yearsortothepolicyanniversaryafterage65.
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Extended term insurance
Ifthepremiumsarenotpaid,coveragemayautomaticallycontinueforaperiodoftimeassetoutintheExtendedterminsuranceschedule.Theweeklyamount,waitingperiodandbenefitperiodwillnotchange.
Premium guarantee Thepremiumwon’tchangeforthefirstfivepolicyyears.Afterthisperiod,wemayincreaseordecreasethepremiumonapolicyanniversary.Ifwechangethepremium,wewilltellthepolicyownerinadvanceandthatpremiumisguaranteedforatleastanotherfivepolicyyears.
LifestageCare™
Services (non-contractual feature)
Includesaccesstoamembers’-onlywebsiteandtoll-freetelephonesupportservice–anational,bilingualservice,available24hoursaday,sevendaysaweek.Offersclientsunbiasedinformationaboutlocal,qualifiedhealthcareandpersonalcareprovidersthatmeetstheirindividualandfamilyneeds,ateverystageoflife.LifestageCareiscurrentlyavailabletonewandexistinglongtermcareinsurancepolicyownersofSunLifeFinancial.Itisnotaguaranteedfeatureoftheproductandmaybewithdrawnatanytime.
ADDITIONAL OPTIONSReturn of premium on death (ROPD)
Availableforissueages21-65.
Iftheinsuredpersondieswhilethepolicyisineffect,wewillpaythereturnablepremiumamounttotheROPDbeneficiarynamedinwriting,orifnonearenamed,thepolicyownerortheirestate.
Thereturnablepremiumamountisthesumofallpremiumspaidforthepolicy,minusanyunpaidpremiumsplusinterest,andanybenefitpaymentsmade.
Inflation protection Whileinflationprotectionisineffect,weincreasetheweeklyamountoneachpolicyanniversary.3
Option A:
Weeklybenefitincreasesby3%whiletheweeklybenefitispayable.
Option B:
Weeklybenefitincreasesby2%iftheweeklybenefitisnotpayableanditincreasesby3%whiletheweeklybenefitispayable.
3There’snocaponincreases;they’recompoundedannuallyandroundedtothenearestdollar.
LifestageCareisatrademarkofTakingCareInc.
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SunLTCIprovidesanincome-stylebenefitwhentheinsuredpersonisdependent.Ithelpscoverthecostofcareoveralengthyperiodoftime,givingthepeaceofmindthatcomeswithknowingthatthefinancialburdenofcarewon’trestentirelywithlovedones.
SunLifeFinancialoffersthefollowingstand-aloneplandesignsforsinglelives:
Apermanentinsurancepolicythatprovidesprotectionfortheentirelifetimeoftheinsuredpersonwhentheymeettherequirementstoqualify,aslongastherequiredpremiumsarepaidorextendedterminsuranceisavailableassetoutinthepolicy.
Coveragewillendwhentheinsuredpersondiesorwhenthepolicyiscancelled.*
Issue ages Ages21-80
How we determine dependency Theinsuredpersonisdependentwhenwe’vedeterminedthroughobjectivemeasuresthattherearefunctionallimitationsforeitherdeterioratedmentalability(cognitiveimpairment)oractivitiesofdailylivingincludingstand-byassistanceforbathingandtransferring,asdescribedbelow.
PRODUCT DETAILS
*Thepolicymayendforotherreasonsasdescribedonpage31ofthisguide.
Deteriorated mental ability (cognitive impairment)
Theinsuredpersonisdependentwhentheyneedconstantsupervisionbyanotherpersonforprotectionfromthreatstotheirphysicalhealthandsafetyastheresultofdeteriorationinoralossof:
short-termorlong-termmemory,
orientationasitrelatestopeople,placeandtime,
reasoning,or
judgmentasitrelatestosafetyawareness.
Constant supervision by another person
because of deteriorated mental ability
Substantial physical assistance with at least
two activities of daily living
Stand-by assistance to perform bathing
and transferringOR OR
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DeterioratedmentalabilitymustresultfromanorganicbraindisordersuchasAlzheimer’sdisease,irreversibledementia,orbraininjury.ThediagnosismustbemadebyaspecialistlicensedandpractisinginCanadaortheUnitedStatesbasedon:
clinicalexamination,
radiologicalstudies,and
psychologicaltesting.
Activities of daily living (ADL)
Theinsuredpersonisdependentwhentheyrequiresubstantialphysicalassistance,withorwithoutassistivedevices,tosafelyandcompletelyperformtwoormoreactivitiesofdailyliving.Activitiesofdailylivingincludebathing,dressing,toileting,transferring,continenceandfeeding.
DEFINITION: Activities of daily living
Bathingmeanswashingwithorwithouttheaidofassistivedevices:
inabathtuborshower,includinggettinginandoutofthebathtuborshower,or
byspongebath.
Bathingdoesnotincludetheabilitytoreachandwashthebackorfeet.
Dressingmeansputtingon,takingoff,fasteningandunfastening,withorwithouttheaidofassistivedevices:
clothing,and
medicallynecessarybracesorartificiallimbs.
Thereisnodependencyifreasonablealterationstoorchangesintheclothingtheinsuredpersonusuallywearswouldenablethemtodresswithoutsubstantialphysicalassistance.
Toiletingmeansgettingtoandfromandonandoffthetoilet,withorwithouttheaidofassistivedevices,andperformingassociatedpersonalhygiene.
Transferringmeansmovingintooroutofabed,chairorwheelchair,withorwithouttheaidofassistivedevices.
Continencemeanstheabilitytocontrolbothbladderandbowelfunctionsormaintainareasonablelevelofpersonalhygiene(includingcaringforcatheterorcolostomybag)whennotabletocontrolbowelorbladderfunctions.
Feedingmeanstheabilitytogetfoodintothebody,withorwithouttheaidofassistivedevices,throughthemouthorbyfeedingtube.Feedingdoesnotincludecookingorpreparingameal.
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Stand-by assistance for bathing and transferring
Theinsuredpersonisalsodependentwhentheyrequirestand-byassistanceforbathingandtransferring.Stand-byassistancemeansanotherpersonmustalwaysbewithinarm’sreachoftheinsuredpersonsotheymaysafelyandcompletelyperformtheactivitiesofbathingandtransferring.
Iftheinsuredpersonrequiresstand-byassistanceforonlyoneofbathingortransferring,weconsiderthemdependentwhentheyalsorequiresubstantialphysicalassistancetoperformoneoftheotherADLs.
DEFINITION: Assistive devices
Assistivedevicesareaidsthatwedeterminecouldbeusedtoimprovetheinsuredperson’sfunctioning.Theseincludeadjustablebeds,buttonhooks,canes,crutches,grabbars,handheldshowerheads,bathbrushes,seatlifts,transferbenches,walkersandwheelchairs.IfusinganassistivedeviceallowstheinsuredpersontoperformanADLsafelyandcompletely,theinsuredpersonisnotdependentforthatactivity.
Palliative care (end-of-life care)
Regardlessofthewaitingperiod,aclaimmaybesubmitted30daysaftertheinsuredperson:
requiressubstantialphysicalassistanceforatleastfouractivitiesofdailyliving,
hasbeendiagnosedwithaterminaldiseaseorillnessbyaqualifiedphysicianoranotherhealthcareprofessionalacceptabletous,and
isreceivingpalliativecarethatissupportiveandprovidescomfort.
–competitiveadvantage
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Scenario: not dependent
Theinsuredpersonisa55-year-oldmalewhorecentlyhadkneesurgeryandstrugglestodresshimself.
Heisnotconsidereddependentbecausehedoesnotrequireassistanceforanyactivityofdailyliving.
Scenario: dependent
Theinsuredpersonisa76-year-oldfemalewhosufferedastrokeandneedsassistanceforbathing,dressing,feeding,toileting,transferringandcontinence.
Sheisdependentbecauseshecannotindependentlyperformmanyoftheactivitiesofdailyliving.
Bathing
Dressing
Toileting
Transferring
Continence
Feeding
Constant supervision for deteriorated
mental ability
Substantial physical assistance with at least
two activities of daily living (ADL)
Stand-by assistance within arm’s reachOR OR
OR
Short- or long-term memory
Bathing and transferring
Bathing or transferring
and
Substantial physical assistance with one
or more ADL
Orientation to people, place and time
Reasoning
Judgment as it relates to safety awareness
11SUN LONG TERM CARE INSURANCE
PLAN DETAILS
Benefit type Wepayaweeklyincome-stylebenefittothepolicyownerwhentheinsuredpersonqualifiesforit.Theclaimantdoesn’tneedtosubmitreceiptsforservicestoreceivethebenefitoncetheinsuredpersonqualifiesforthebenefit.Thepolicyownercanusethemoneyhowevertheychoose.
Weekly benefit amount Thebenefitiscalculatedweeklyandpaidmonthly.
Minimum weekly benefit amount: $150
Maximum weekly benefit amount (for all LTCI coverage on one insured person):$2,300
Waiting periodThewaitingperiodisthelengthoftimetheinsuredpersonmustbecontinuouslydependentbeforeaclaimissubmitted.
ItstartsonthedatetheyfirstrequireassistancefortwoormoreADLsorthedatetheyfirstrequirecontinualsupervision.Therearetwooptionstochoosefrom:
90days 180days
Benefit period Thebenefitperiodisthelengthoftimewemaypayaclaim.
100weeks(1.9years) 250weeks(4.8years) 150weeks(2.8years) Unlimited
Ifthebenefitperiodislimitedtoamaximumnumberofweeks,eachpaymentwemakereducesthenumberofweekseligibletobepaid.Thenumberofweeksinthebenefitperioddoesnotstartoverwithanewclaim.
Ifthebenefitperiodisunlimited,it’snotaffectedbythepaymentswemake.
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12SUN LONG TERM CARE INSURANCE
Therearenocapsonincreases.
Ifanapplicantwishestoobtaincoverageformorethanthemaximumweeklybenefitamountof$2,300,thiscanbeachievedbyselectingInflationprotectionoptionB.Withthisoption,theinitialcoverageamountwilldoubleinapproximately35years.
Return of premium on death (ROPD) Iftheinsuredpersondieswhilethepolicyisineffect,wewillpaythereturnablepremiumamount,asdescribedbelow,totheROPDbeneficiarynamedinwriting,orifnonearenamed,thepolicyownerortheirestate.
DEFINITION: Returnable premium amount
Thereturnablepremiumamountisthesumofallpremiumspaidforthepolicy,minus:
anyunpaidpremiumsplusinterest,and anybenefitpaymentsmade.
Inflation protection Whileinflationprotectionisineffect,weincreasetheweeklyamountoneachpolicyanniversary,asdescribedbelow.Increasesarecompoundedannuallyandroundedtothenearestdollarandtherearenocapsonincreases.
Atthetimeofpurchase,theclientmayselectoneofthefollowingoptions.
Option A:
Whileinflationprotectionisineffect,weincreasetheweeklybenefitamountbythreepercentoneachpolicyanniversarywhenbenefitsarepayable.Increaseswillbecompoundedannuallyandroundedtothenearestdollarandtherearenocapsonincreases.
Ifbenefitsarenolongerpayableonapolicyanniversary,theweeklybenefitamountwillnotincrease.Anyaccumulatedincreaseremainsineffect.
Option B:
Whileinflationprotectionisineffect,weincreasetheweeklybenefitamountoneachpolicyanniversary.Theincreaseweapplyis:
Twopercentifwearenotpayingbenefitsonthepolicyanniversarydateor Threepercentifwearepayingbenefitsonthepolicyanniversarydate.
ADDITIONAL OPTIONS THAT MAY BE APPLIED FOR
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13SUN LONG TERM CARE INSURANCE
DEFINITION: Spouse
Spousemeansthepersonwhoismarriedtotheinsuredperson,isinacivilunionwiththeinsuredperson,orthepersonwholiveswiththeinsuredpersoninaconjugalrelationshipforatleast12consecutivemonthsbeforethedateaclaimissubmittedforthespouse.
Torequestpremiumsbewaived,thepolicynumbermustbeincludedonthespouse’sclaimform.Wemayaskforproofofthespouse’srelationshiptotheinsuredperson.
Wewillwaivepremiumsforthepolicywhenwe’repayingbenefitsforthespouse’spolicy.Wewillcontinuetowaivepremiumsforthepolicyevenafterwe’vepaidbenefitsfortheentirebenefitperiodfortheirpolicy.
Wewillalsowaivepremiumsforthepolicyifthespousedieswhiletheirinsuranceisineffect,whetherornotwewerepayingbenefitsatthetimetheydie.Wewillrequireproofofthespouse’sdeath.
Thepremiumsforthepolicymustbepaiduntilwenotifytheclientthattherequestisapproved.
Anyexcesspremiumspaidwillbedepositedtothepolicy’swithdrawablepremiumfund.
Waiver of premium (when a claim is approved)Whenweapproveaclaimforbenefitsontheinsuredperson,wewaivepremiumsforthepolicy.Thepremiumsmustbepaiduntilwenotifythepolicyownerthatwe’veapprovedtheclaim.
Spousal waiver Ifwe’veissuedalongtermcareinsurancepolicyontheinsuredperson’sspouseandapprovedaclaimforbenefitsonthatpolicy,wemaywaivepremiumsfortheinsuredperson’spolicy.
Tohavepremiumswaived,bothpoliciesmusthaveSpousalwaiver.Eachpolicymusthavebeencontinuouslyineffectwithnoapprovedclaim,fromthedatestheycameintoeffectuntil:
bothpolicieshavereachedtheir10thpolicyanniversary,or theinsuredpersonandtheirspousehavehadtheir86thbirthday.
PLAN FEATURES THAT ARE AUTOMATICALLY INCLUDED
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14SUN LONG TERM CARE INSURANCE
ElizabethownsaSunLTCIpolicywhichhasa90daywaitingperiod,a$750weeklybenefitandanunlimitedbenefitperiod.
WhenElizabethsuffersastrokeshebecomesunabletobathe,dressandfeedherself.Aftermeetingthe90daywaitingperiodshesubmitsaclaimwhichisapproved.Whenshereceivesherfirstbenefitpaymentitincludesanadditional$9000($750x12weeks)whichcanhelptooffsetsomeofthecoststhatmighthavebeenincurredwhilesatisfyingthewaitingperiod.
First payment bonus Whenweapproveanewclaim,thefirstpaymentincludesabonusamount.Itisequalto12timestheweeklyamount.
Iftheinsuredpersonisreceivingpalliativecareandqualifiesforbenefits(asdescribedearlier),thebonusisequaltofourtimestheweeklyamount.
Ifthispolicyincludesinflationprotection,thebonusincludesanyaccumulatedincreasestotheweeklyamount.
Thefirstpaymentbonusdoesnotaffectthenumberofweeksremaininginthepolicy’sbenefitperiod.
Wewillnotpayabonusif:
thereisacontinuationofapreviousclaim,or thepolicycontinuesasExtendedterminsurance,ifavailable.
MartinandJoannebothhaveSunLTCIpoliciesin-forcefor10years.NeitherofthemhasreceivedbenefitsfromtheirLTCIpolicyduringthefirst10yearsofcoverage.Inthefuture,ifoneofthembecomesdependentasdefinedinthepolicyandaclaimisapproved,orifoneofthemdies,wewillwaivepremiumsontheother’spolicy–aslongastheyarestillspousesatthetimeoftheevent.
However,ifeitherofthembecomesdependentasdefinedinthepolicyandisapprovedforbenefitsinthefirst10yearsoftheirpoliciesbeingin-force,theSpousalwaiverbecomesnullandvoid.The10yearperioddoesnotstartover.
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15SUN LONG TERM CARE INSURANCE
Extended term insurance IfpremiumsarenotpaidandthepolicyhasbeenineffectforthenumberofyearssetoutintheExtendedterminsurancescheduleinthepolicy,thepolicywillautomaticallycontinueforaperiodoftime.Attheendofthatperiod,thepolicyends.
Thepolicycontinuesineffectif:
wedonotreceivetherequiredpremiumwithin31daysafteritisdue, thereisnotenoughmoneyinthewithdrawablepremiumfundtopaytherequiredpremium,and extendedterminsuranceisavailable.
Theweeklyamount,waitingperiodandbenefitperiodwillnotchange.
Whilethepolicycontinuesasextendedterminsurance:
thepolicyownermaynotpaypremiums, thepolicyownermaynotputmoneyintothewithdrawablepremiumfund, wewillnotpayafirstpaymentbonus, Returnofpremiumondeathends,ifincludedinthepolicy,and Inflationprotectionends,ifincludedinthepolicy.(Anyaccumulatedincreasetotheweeklyamountremainsineffect).
Ifweapproveaclaimwhileextendedterminsuranceisineffect,thepolicycontinuesassetoutintheschedule.Ifwestoppayingaclaimbeforetheendofthelastavailableyearshownintheschedule,thepolicycontinuesasextendedterminsurance.
Ifwe’restillpayingbenefitsattheendofthelastavailableyearshownintheschedule,wewillcontinuetopaybenefitswhiletheinsuredpersonqualifies.Onthedatetheynolongerqualify,thepolicyends.
ThetablepresentedonthefollowingpageisanexampleofanExtendedterminsuranceschedulebasedona53yearoldfemale,whohaspurchasedthefollowingpolicy:
$650WeeklyBenefit UnlimitedBenefitperiod 90dayWaitingPeriod Withoutadditionaloption Paidforannuallyonalifetimebasis(untiltheanniversaryafterage100)
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16SUN LONG TERM CARE INSURANCE
Number of years this policy has been in effect Client age
Number of policy years Extended term insurance
is available1 54 0
2 55 0
3 56 0
4 57 0
5 58 0
6 59 0
7 60 0
8 61 0
9 62 0
10 63 0
11 64 0
12 65 0
13 66 1
14 67 2
15 68 3
16 69 4
17 70 5
18 71 5
19 72 5
20 73 5
21 74 5
22 75 5
23 76 4
24 77 4
25 78 4
26 79 3
27 80 3
28 81 3
29 82 3
30 83 2
31 84 2
32 85 2
33 86 2
34 87 2
35 88 1
36 89 1
37 90 1
38 91 1
39 92 1
40 93 0
41 94 0
42 95 0
43 96 0
44 97 0
45 98 0
46 99 0
47 100 0
17SUN LONG TERM CARE INSURANCE
Reversing Extended term insurance
Thepolicyownercanapplytoreverseextendedterminsuranceandresumepayingpremiumsforthispolicyiftheinsuredpersonisalive.
Toreverseextendedterminsurance:
applywithintwoyearsofthedatetherequiredpremiumwasnotpaid, giveusnewevidenceofinsurabilitythatweconsidersatisfactory,and makeapaymentequaltothereinstatementchargeweset.
Ifwedon’tapprovetheapplication,werefundanyamountpaidwhentherequestwassubmitted.
Plan of careTheinsuredpersonisentitledtoonefreeplanofcare.Arequestforaplanofcarecanbemadeafteraclaimhasbeenapprovedandwhiletheinsuredpersonisdependent.
Theplanofcarewilloutlinethetypeandamountofcaretheinsuredpersonrequires.Itwillalsoexplainhowcarecanbeprovidedandifgovernmentprogramsareavailable.
Fromthemomentthepolicyisissuedandaslongasitremainsinforce,thepolicyownerhasimmediateandunlimitedaccesstothevaluableresourcesprovidedthroughLifestageCareservices.
LifestageCareiscurrentlyavailabletonewandexistinglongtermcareinsurancepolicyownersofSunLifeFinancial.Itisnotaguaranteedfeatureoftheproductandmaybewithdrawnatanytime.
Accessing LifestageCare
Thepolicyownercanaccessthisuniqueserviceimmediatelyafterthepolicyisissuedandwithouthavingtomakeaclaim,aslongasthepolicyremainsinforce.LifestageCareservicesareforthepolicyowner’spersonalusebutcanalsobeusedtohelpanyfamilymember.
AccessingLifestageCareiseasy–logintotheLifestageCarewebsiteorcallthetoll-freenumber.TheLTCIpolicynumberistheclientidentifier.TheclientcanstartusingLifestageCareservicesimmediately:
www.sunlife.mylifestagecare.ca 1877-301-1515
Helping families help themselves
Theserviceprovidesunlimitedaccesstoinformationaboutlocal,qualifiedhealthcareandpersonalcareproviderscloselymatchingindividualandfamilyneeds,ateverystageoflife.
Seniors–foraging,retirementresidences,nursinghomes,homecare,andcommunitycare
Self-care–forpersonaladviceandwell-being,addictiontreatment,budgetandcreditcounseling,andphysicalrehabilitation
Children and teens –forparenting,childcare,andspecialneedsservices
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LIFESTAGECARE™ SERVICE
18SUN LONG TERM CARE INSURANCE
APPLYING FOR A SUN LTCI POLICY
Residency requirements
Non-residents
WeconsiderresidentsofCanadatobeindividualswhoresideinCanadaforsixmonthsormoreeachyear.SunLifeFinancialproductsarepricedforindividualslivinginCanada.WedonotacceptapplicationsforindividualswhodonotliveinCanada.
Permanent residents of Canada
Iftheindividualhaspermanentresidentstatus,theycanbeconsidered.However,iftheyliveinCanadalessthan12monthsperyear,wewillrequireaparamedicalandbloodprofile.
Expert advice. Specific information. Confidential service.
LifestageCareisamembers’-onlywebsite,andtoll-freetelephonesupportserviceisavailabletolongtermcareinsurancepolicyownerswithSunLifeFinancial.
Expert–expertagentsareavailable24hoursaday,7daysaweektoanswerquestionsbyphoneoremail
Specific–helpsplanandmanagefamilycareresponsibilitiesandfindresourcesbasedonspecificrequirementsandpostalcode.Theinformationreceivedismatchedspecificallytotheindividual’sneeds
Confidential–acomplete,unbiasedservice;anyinformationprovidediskeptstrictlyconfidential
Care resources for the policy owner and their family
LifestageCarefocusesontheinformationandsupportneededtoprovidethebestcareforthewholefamily.Theserviceallowsthepolicyownerandtheirfamilytoquicklyandeasily:
Findacompleterangeofqualifiedlocalprofessionals,carefacilitiesandhealthcareresourcesanywhereinCanada.
Determinewhathomecare,rehabilitationtreatment,educationalandresidentialserviceswillcost.
Obtainprofessionaladviceongeriatriccareandcareforteensandchildrenincludingresourcesforspecialneeds.
Readsimpleexplanationsoftreatmentoptions.
Findtherightquestionstoaskwhenchoosingaprofessionalcaregiver.
Stayinformedaboutmultiplegovernmentfinancialassistanceprograms.
LifestageCareisatrademarkofTakingCareInc.
19SUN LONG TERM CARE INSURANCE
Non-landed immigrants
Generallyspeaking,non-landedimmigrantsarenoteligibletoapplyforlongtermcareinsurance.However,exceptionsmaybemadefordoctors,professionals,investors,entrepreneursandotherindividualsapprovedunderaprovincialnomineeprogram(withtheexceptionofrefugees).Inthesecaseswewillrequireacopyoftheiremploymentcontractandworkvisaorprovincialnomineeacceptanceletter.
Ifthereismedicalhistoryrequiringtreatmentorfollow-up,weexpecttheproposedinsuredpersontohaveamedicaldoctorinCanadabeforewecanconsiderthem.
MaximumLTCIcoverageof$1,000perweekmaybeconsidered.
IftheyhaveresidedinCanadalessthan12months,wewillrequireaparamedicalandbloodprofile.
Temporary work visa
LTCIisgenerallynotavailable.
Exception:TheproposedinsuredpersonmustbearesidentofCanadaforaminimumofoneyearbeforeapplication.Theymustprovideacopyoftheiremploymentcontractandworkvisaandconfirmtheyintendtoapplyfortheirpermanentresidentstatuswheneligible.
Ifthereismedicalhistoryrequiringtreatmentorfollow-up,weexpecttheclienttohaveamedicaldoctorinCanadabeforewecouldcanthem.
MaximumLTCIcoverageof$750perweekmaybeconsidered.
Other temporary residents (includingthoseonastudentvisa)
LTCIisnotavailable.
BackdatingWepermitbackdatingtosaveageuptoamaximumofthreemonths.
Backdatingisonlypermittedtoreducepremiumsasaresultofthelowerissueage.Apolicycannotbebackdatedinordertoapplyforcoveragethatwouldotherwisebeunavailable.
Forexample,wecannotbackdatetoage80toapplyforaSunLTCIpolicy.
Ifapolicyisbackdatedtoretainage,evidencerequirementsarebasedontheproposedinsuredperson’sactualageatthetimetheapplicationissubmitted.Forexample,iftheclientturned70inthelastthreemonths,theycanbackdatetoretainage69ratesbuttheevidencerequirementswouldbebasedontheiractualageof70.
20SUN LONG TERM CARE INSURANCE
Ownership rules
When the owner(s) and insured person are not the same:
Owner Insured person Example
Individualperson Individualperson(differentfromtheowner)
Husbandownsthepolicy;wifeistheinsuredperson
Adultchildownsthepolicy;fatheristheinsuredperson
Corporation Individualperson Corporationownsthepolicy;employeeistheinsuredperson
Contingent ownership:
Theownercanappointacontingentowneratthetimeofapplication.
ThenameofthecontingentownermustbeincludedintheSpecialInstructionsintheAdvisorStatementsectionofthepaperapplication.IfthecontingentownerisnotspecificallyindicatedinSpecialInstructions,thepolicywillbeissuedwithoutacontingentowner
Tomakethechangeafterthepolicyhasbeenissued,submitformE28–Contingentownerchangeform.
Transferring ownership:
Thepolicyownermaytransferownershiptoanotherperson.Transferringownershipisalsoknownasabsoluteassignmentandcouldhavetaximplications.
Theremaybetaxconsequencesifthetransferisfromacorporationtoashareholder,toanothercorporationorunincorporatedbusiness,orfromanunincorporatedbusinesstoanowneroremployee.
TherolloverrulesintheIncomeTaxAct(Canada)thatpermittax-freetransfersoflifeinsurancepoliciesincertaincircumstancesdonotapplytoLTCIpolicies.
Totransferownership,completeformE82–Assignmentofpolicyabsolute(transferofownership).
21SUN LONG TERM CARE INSURANCE
Who receives payment
Claim payment
Theweeklybenefitispaidtothepolicyownerorthepolicyowner’sestate.
Return of premium on death (ROPD)
TheROPDbeneficiarypayeecanbedesignatedwhencompletingtheapplication.ThenameofthebeneficiarymustbeincludedintheSpecialInstructionssectionofthepaperapplication.Indicatethefullname(s)oftheROPDbeneficiary(ies)(withapercentage,ifapplicable),therelationshiptotheinsuredpersonforCommonlawpolicies(orpolicyownerforQuebec),andifnamingaspouse,indicatewhethertheappointmentisrevocableorirrevocable.Ifthisisnotspecifiedontheapplication,theROPDbeneficiarywillbetheownerorestateoftheowner.
FuturechangescanbesubmittedinwritingtoSunLifeFinancial’sheadoffice.Therequestmustincludethepolicyowner’sname,policynameandnumberandnewbeneficiaryappointment(asabove).Therequestmustbesignedanddatedbythepolicyowner.Ifthebeneficiarywasirrevocable,theymustalsosigngivingtheirconsenttochange.
Completing the applicationCompletetheSunLifeFinancialpaperapplication,form810-3523(English)or820-3523(French),availableonwww.sunlife.ca/advisororfromyourRegionalSalesDirector.Pleaserefertotheinstructionsonthefrontcoveroftheapplication.
PleasesubmittheoriginalcopytoSunLifeFinancialthroughyourMGAorNationalAccountofficeorbackoffice.
Supportingdocumentsyoumaywishtoincludeare:
illustration, coveringletterormemowithdetailsofthesale,and completedunderwritingquestionnaire,ifapplicable
Oncetheapplicationisreceived,itwillbeassignedtoanunderwriter.Applicationstatuscanbecheckedonwww.sunlife.ca/advisor.Ifyouneedassistance,pleasecallourAdvisorServiceCentreat1800-800-4SUN(4786).
PaymentsDependingonthepremiumfrequencychosenbytheclient,paymentscanbemadeonamonthlybasisthroughourpre-authorizedchequing(PAC)processorannuallybycheque.
IfPACischosen,monthlypaymentsaredeductedautomaticallyfromthepayor’sbankaccountandappliedtothepremiumowing.Monthlypremiumsarecalculatedbymultiplyingtheannualpremium(includingthe$150policyfee)by0.09(themodalfactor).
Forexample,aSunLTCIpolicywithanannualpremiumof$3,000willhaveamonthlypremiumof$270.
Monthlypremium:$3,000x.09=$270
Ifthepolicyownerchoosestopayannuallybycheque,paymentscanberemittedtoourheadofficebeforethepolicyanniversarydate.Anannualstatementissenttotheownerapproximatelythreeweeksbeforethepolicyanniversary,remindingthemthattheirannualpremiumisdue.
22SUN LONG TERM CARE INSURANCE
TheunderwritingprocessforLTCIevaluatestheriskofaproposedinsuredpersonbecomingdependentonanotherpersonfordailyassistance.TheunderwritingrequirementsforLTCIdifferfromthoseoflifeinsurance,whichevaluatestheriskofdeath,andcriticalillnessinsurance,whichevaluatestheriskofbeingdiagnosedwithspecificcoveredconditions.
Underwriting evidence requirementsEvidencerequiredtounderwriteSunLTCIwilldependontheplantypeselectedandtheageoftheproposedinsuredperson.
Plan type Sun LTCI
Ages 21 – 49 50 – 69 70 – 80
Requirements Application Application Phoneinterview
Application Face-to-faceinterview Medicalrecords
PleaserefertothefollowingSunLTCIunderwritingresourcesformoreinformation:
UNDERWRITING
How to field underwrite Sun Long Term Care Insurance (810-3821)—providesyouwithinformationonthemostcommonreasonstopostponesubmittinganapplication,themostcommonreasonswedeclineanapplicationandwhotocontactifyouneedmoreinformation.
Pre-screening checklist (810-3579)—savesyoutimeandhelpsincreaseyourplacementratebyidentifyingcommonrisksthatleadtoadecline;anditprovidesyouwithcontactinformationifyouhavequestions.
The health interview / The memory exercise (810-3852)—helpsyouprepareeachclientforthehealthinterviewandincludescontactinformationiftheclienthasquestionsorconcernsabouttheprocess.
The Long term care insurance field underwriting guide (downloadable PDF) —providesguidancetohelpyoudetermineifaparticularconditionwouldbeconsideredforLTCI,aswellasinformationaboutstabilityperiodrestrictions.
23SUN LONG TERM CARE INSURANCE
Risk classes Male Female
Types of underwriting decisions
Whilelife,criticalillness(CII)anddisabilityinsurance(DI)productscanberated,SunLTCIcannot.
LikeDIproducts,SunLTCIcanbemodifiedtoalongerwaitingperiod(i.e.from90daysto180days),ashorterbenefitperiod(i.e.fromunlimitedto250weeks)oranoverallmaximum(i.e.$250,000)tobepaidout.
Inthosesituationsyou’llbeaskedtoworkwiththeclienttodetermineiftheyareinterestedinasmalleramountoveralongerbenefitperiodoralargeramountoverashorterbenefitperiod(seetheexamplebelow).
Ifamodifiedofferismade,thepremiumsareadjustedtothenewwaitingperiodandbenefitperiod,andthereisnoextrapremiumcharge.
Approved MODIFIED Postponed Declined
Example:Theunderwritermightindicatethatthemaximumamountwecanofferis$250,000.
Youwoulddeterminethevariousoptionswhichwouldinclude$1,000weeklyfor250weeksor$1,650weeklyfor150weeks.Youwouldthendiscusstheoptionswiththeclienttodeterminewhichwouldbestmeettheirneeds.
WhenwepostponeaSunLTCIapplication,theunderwriterwillindicatewhenwecouldreconsiderourdecision.However,whenwedeclineanapplication,reconsiderationofthedecisionisgenerallynotpossible.
Financial underwritingThetotalamountofLTCImustbereasonablecomparedtotheclient’scurrentstandardofliving.
Todetermineiftheamountisreasonable,we’lllooktoensurethepremiumisnotafinancialhardshipandthattheclientisn’tbetterofffinanciallythantheywerebeforebecomingphysicallydependent.Weexpectthatthemajorityofthetimetheamountappliedforfitswiththeclient’sfinancialcircumstances.
Ourpricingassumestheinsuredpersonismotivatedtorecoverfromphysicaldependencyiftheirconditionpermitsrecovery.Ifapersonisbetterofffinanciallywhilereceivingbenefits,theremaybelessmotivationtorecover.
24SUN LONG TERM CARE INSURANCE
Whencompletinganapplication,youwillbeaskedforthetotalannualincomeandnetworthfortheproposedinsuredpersonandtheirspouse/partner,ifapplicable.Makingsuretheamountappliedforisalignedwiththeclient’sfinancialsituationwillhelpyousubmitqualitybusinessandmaintainyourreferralrelationships.
Bankruptcy (personal/business bankruptcy, current not yet discharged)
Inthissituation,thefollowingfactorsaretakenintoaccountwhenconsideringeligibility:
Stableemployment
Aminimumgrossannualsalaryof$30,000
Ifself-employedusegrossincomelessbusinessexpenses
Ifapplicationsarereceivedonbothspouses,onewithbankruptcynotyetdischargedandtheothernotworking,aminimumgrossannualsalaryof$60,000
Maximumweeklybenefitamountof$500forallapplicants
Unlimitedbenefits,ifallisfavourable;otherwise,wemayconsiderareducedbenefitamount
AllpremiumsmustbepaidinCanadianfundsanddrawnfromanaccountataCanadianfinancialinstitution.
Premium frequency – monthly or annually
Monthly payments
Ifthepolicyownerchoosestopaymonthlybypre-authorizedchequing(PAC),monthlypaymentsaredeductedautomaticallyfromthepayor’sbankaccountandappliedtothepremiumowing.Monthlypremiumsarecalculatedbymultiplyingtheannualpremium(includinga$150policyfee)by0.09(themodalfactor).
PREMIUM DETAILS
Example:ASunLongTermCareInsurancepolicywithanannualpremiumof$3,000.00willhaveamonthlypremiumof$270.00.
25SUN LONG TERM CARE INSURANCE
Annual payment
Ifthepolicyownerchoosestopayannuallybycheque,paymentscanberemittedtoSunLifeFinancial’sheadofficebeforethepolicyanniversarydate.Anannualstatementissenttothepolicyownerapproximatelythreeweeksbeforethepolicyanniversarytoremindthemthattheirannualpremiumisdue.
Withdrawable premium fundIfwereceivemoremoneythanisowedinpremiums,wewillholdtheexcessamountinthewithdrawablepremiumfund.Wemaysetamaximumamountthatcanbeinthefund.Thisfundcanbeusedtopaypremiumsatanytime.
Theamountinthewithdrawablepremiumfundwillearninterestdaily.Wesettheinterestrateeachdaybasedonshort-terminterestrates.Interestearnedonthepremiumfundistaxable.
Themoneyfromthisfundcanbewithdrawnatanytime.Theremaybelimitsonwithdrawalamountsandwemaychargeafeeforthesewithdrawals.You’llbeinformedofanyrulesandlimitationswhenyousubmitawithdrawalrequest.
PleasecalltheAdvisorServiceCentreat1800-800-4SUN(4786)fordetails.
Premium payment options Theapplicantmustselectoneofthefollowing:
Premiumsarepayableforthelifetimeofthepolicy(untilthepolicyanniversaryfollowingthe100thbirthdayoftheinsuredperson,or
Premiumsarepayabletothelatestof25yearsortothepolicyanniversaryafterage65.
Premium guarantee ThepremiumshownonthePolicysummarywon’tchangeforthefirstfivepolicyyears.Afterthisperiod,wemayincreasethepremiumonapolicyanniversary.Ifwechangethepremium,wewilltellthepolicyownerinadvanceandthatpremiumisguaranteedforatleastanotherfivepolicyyears.
Anypremiumchangeisbasedontheinsuredperson’sageonthepolicydate.Wedonotconsidertheinsuredperson’shealthwhenwemakeapremiumchange.
Inthisscenario,thepurchasedateofthepolicywasJanuary20,2013.
2010 2015 2020 2025 2030
Premium
Year
After the 2018 (five year) policy anniversary: option to increase premium, but no
increase is applied at this point in time2022: premium increase occurs;
rates locked in for the next five years
Cycle can repeat2013: policy purchased
26SUN LONG TERM CARE INSURANCE
When we waive premiumsWhenweapproveaclaimforbenefits,wewaivepremiumsforthepolicy.Thepremiumsmustbepaiduntilwenotifythepolicyownerthatwe’veapprovedtheclaim.
Non-forfeiture provision (Extended term insurance)IfpremiumsarenotpaidandthepolicyhasbeenineffectforthenumberofyearssetoutintheExtendedterminsurancescheduleinthepolicy,thepolicywillautomaticallycontinueforaperiodoftime.Attheendofthatperiod,thepolicyends.
FormoredetailsaboutthisprovisionpleaseseeExtendedTermInsuranceonpage15.
Policy dateThepolicydateindicatedinthepolicyisthestartdateofthatpolicy.
Thepolicydateisthedatethepolicyisissued,ortheretainedagedateifrequested.
Pleaserefertotheadvisorsiteformoredetailsonpolicydeliveryrequirements.
When the insurance comes into effectThesepoliciescomeintoeffectwhenallsettlerequirementsarereceivedandapproved.
ISSUING A SUN LTCI POLICY
27SUN LONG TERM CARE INSURANCE
Changing coverage options Thereareavarietyofchangespossibleincluding:
decreasingtheweeklybenefitamount, decreasingthebenefitperiod, lengtheningthewaitingperiod, changingtheinflationprotectionoptionfromtwopercent/threepercenttozeropercent/threepercent,
decreasingthebenefitamountattributedtoinflationprotectionincreases,and changingthepremiumpaymentfrequency.
TorequestanyofthesechangesuseformE220–Changeform–Longtermcareinsurance.
Wedeterminetheminimumbenefitamountthatmustremainineffect.
Terminating an optionItispossibletoterminateanoption,suchas:
Inflationprotection,or OptionalReturnofpremiumondeath.
TorequestthisuseformE220–Changeform–Longtermcareinsurance.
ConversionsSunLongTermCareInsurancedoesn’thaveanyconversionoptions.
Internal replacementsAninternalreplacementallowsforaplanchangeoutsideofthecontractualright.Undermostcircumstances,evidenceofinsurabilitymustbesubmittedforinternalreplacements.Anewapplicationisalwaysrequired.Quebecspecific-InQuebec,advisorsmustfollowthereplacementprocedure.
Examplesofinternalreplacementsinclude:
increasingthebenefitamount, increasingthebenefitperiod, shorteningthewaitingperiod, addingoptionalReturnofpremiumondeath(ROPD), addingInflationprotection, changingInflationprotectionbenefitfromzeropercent/threepercentwhilereceivingbenefitstotwopercent/threepercentwhilereceivingbenefits,and
lengtheningpremiumpaymentperiod.
PLAN CHANGES
28SUN LONG TERM CARE INSURANCE
Note:Becausethisisnotacontractualright,therulesforinternalreplacementsmaychange.
Exception–AninternalreplacementwithoutevidenceispossibleforSunLTCIinthefollowingscenarios:
Ifthenewapplicationisexactlythesameastheoldoneexcepttheclientwishesto:
a)Shortenthepremiumpaymentperiod.
b)Shortenthepremiumpaymentperiodincombinationwithanyofthefollowing:
− Iftheoriginalpolicy(eitherClaricaorSunLife)hasROPD,nounderwritingisrequiredtohaveROPDonthenewpolicy.
− IftheoriginalpolicyisaSunLifeFinancialplanwithInflationprotection,nounderwritingisrequiredtohaveInflationprotectiononthenewpolicy.
− Iftheoriginalpolicy(eitherClaricaorSunLife)hasaccumulatedInflationprotectionamountsandtheclientselectsaplanamounttotallingtheexistingbasebenefitplusanyaccumulatedamountsforthenewpolicy,nounderwritingisrequired.(Example:Theexistingpolicyhasa$500basebenefitwith$75.00add-inInflationprotectionaccumulation,thenewplancanhave$575.00withnounderwritingrequired).
ReinstatementsTherequiredpremiumsforthepolicymustbepaidbytheduedate.Ifpremiumsarenotpaidwhendue,wewillwithdrawtheunpaidpremiumfromthewithdrawablepremiumfundifithassufficientfunds.
Thepolicywillendif:
premiumsarenotreceivedbeforetheendofthe31stdayaftertheyaredue, thereareinsufficientfundsinthewithdrawablepremiumfund,and extendedterminsuranceisnotavailable.
Ifthepolicyendsthisway,itiscalledalapse.Ifthepolicyendedbecauseitlapsed,thepolicyownercanapplytohaveitputbackintoeffect(reinstated)iftheinsuredpersonisalive.
Toreinstatethepolicy,thepolicyownermust:
applywithintwoyearsofthedatethepolicyended, providenewevidenceofinsurabilitythatweconsidersatisfactory,and makeapaymentequaltothereinstatementchargeweset.
Ifwedon’tapprovetheapplication,werefundtheamountpaidtoputthepolicybackintoeffect.
29SUN LONG TERM CARE INSURANCE
Number of days from the premium due date
Amount and type of insurance
Evidence requirements
Lessthan62 Any None
62to180 Any Applicationforreinstatement–ClaricaorSunLongTermCareInsurance,formE226
Greaterthan180 Any Applicationforreinstatement–ClaricaorSunLongTermCareInsurance,formE226
MedicalinformationandfunctionalabilityquestionnaireforLTCIformE223,and
Usualunderwritingevidence,basedonattainedageatreinstatement
REINSTATEMENT RULES AT A GLANCE
MAKING A CLAIM FOR SUN LONG TERM CARE INSURANCE BENEFITS
When to make a claimThepolicymustbeineffectonthedateaclaimissubmitted.Theinsuredpersonmustbecontinuouslydependentforlongerthanthewaitingperiod,andtheconditionsdescribedundertheheading,Howwedeterminedependencymustbesatisfied.
Aclaimmaybesubmittedwhena30-daywaitingperiodissatisfiediftheinsuredpersonisreceivingpalliativecare.Thisisdescribedundertheheading,Palliativecare(end-of-lifecare).
Wemustreceivetheclaimimmediatelyfollowingtheendofthewaitingperiodandnolaterthan120daysfromthatdate.Anyclaimreceivedafterthattimeislateandwemaydeclineitwithoutassessingdependency.
We’llconsideralateclaimexceptionif:
wereceivetheclaimnolaterthanoneyearfromthedatetheinsuredpersonbecamedependent,and
theclaimantprovidesawrittenexplanationdescribingwhytheclaimislateandweagreetheexplanationisreasonable.
30SUN LONG TERM CARE INSURANCE
How to make a claim
Step 1: Notify us
Contact us–Tomakeaclaim,theclaimantshouldcontactSunLifeFinancialusingthetollfreenumberlistedintheirpolicy.Thisnumberis1877-SUN-LIFE(786-5433).Wewillthensendtheappropriateclaimformtobecompleted.YoucancallIndividualClaimsServicestollfreeat1800-800-4SUN(4786)[email protected].
Form–Thepersonmakingtheclaimmustcompletetheform(s)andgiveustheinformationweneedtoassesstheclaim.
TheinsuredpersonmustbeinCanadaortheUnitedStatesatthetimeaclaimismade.Iftheyarenot,theymustreturntobeassessedbyaphysicianlicensedandpractisinginCanadaortheUnitedStates.
Beforeweapprovetheclaim,theinsuredperson’sdateofbirthmustbeverified.Ifthedateofbirthgivenontheapplicationisincorrect,we’lladjusttheamountwepaytoreflecttheinsuredperson’scorrectage.
Pay premiums–Policypremiumsmustcontinuetobepaiduntilweadvisethatwe’veapprovedtheclaim.
Send forms–Theform(s)andinformationmustbesentto:
IndividualClaimsServicesSunLifeAssuranceCompanyofCanada227KingStS,POBox1601,StnWaterlooWaterlooONCanadaN2J4C5
Fees–Physiciansmaychargeafeetocompletecertainforms.Thepersonmakingtheclaimisresponsibleforanyfeesforthisinformation.
Step 2: Collection of medical information
Information we need–Theclaimantmustgiveustheinformationweneedtoassesstheclaim.Thisincludesourformwhichmustbecompletedbyaphysicianoranotherhealthcareprofessionalacceptabletous.Thephysicianmustdescribetheinsuredperson’smedicalcondition,limitationsandfunctionalabilitiesandprovideobjectivemedicalinformationabouttheirdependence.
Additional information–We’lladviseifweneedanyotherinformationtoassesstheclaim.Thiscouldincludemedicalrecords,clinicaltests,physiotherapyreports,psychologicaltestsandanyotherobjectivemedicalinformationthatsupportstheclaim.
Fees–Anyfeeschargedbyphysicianstocompleteformsorprovideinformationaretheclaimant’sresponsibility.
31SUN LONG TERM CARE INSURANCE
Doctors–Physicians,specialistsorhealthcarepractitionerswhoprovideinformationtousmustbelicensedandpractisinginCanadaortheUnitedStates.Theymaynotbethepolicyowner,insuredperson,anyoneentitledtomakeaclaimunderthispolicy,oranyrelativeorbusinessassociateofthesepeople.
Documentation by us–Wemayrequiretheinsuredpersontobeexaminedbyanyhealthcarepractitionersthatweappoint.Thesemaybelicensedphysicians,physiotherapists,occupationaltherapists,psychiatrists,psychologistsorothers.Wepayfortheseexaminations.
Wemayalsorequiretheinsuredpersontoauthorizeustogatheranduseinformationfromotherinsurersorgovernmentagencies.
Step 3: Making the claims decision
Oncewereceiveallinformationwerequire,wewillassesstheinformationandmakeadecision.Wecommunicatethisdecisionandpaythebenefittothepolicyownerortheestate,ifapplicable.
Ifwedenyaclaim,wesendaletterexplainingthedecisiontothepolicyowner.Ifthepolicyownerandtheinsuredpersonarenotthesameperson,wewillsendtwodeclineletters:
onelettertotheclaimant,fullyexplainingourpolicydecision,and asecondlettertothepolicyowner,confirmingourdenialoftheclaim.Nomedicalinformationisgiventothepolicyownerforprivacyreasons.
TocontacttheIndividualClaimsServicesdepartment,use:
Email:[email protected]:1800-800-4SUN(4786)Fax:1866-487-4745
Exclusions and limitationsThepolicyendsandbenefitsarenotpayableiftheinsuredperson’sdependencystartedbeforethelaterof:
themostrecentdateanapplicationforthispolicywassigned, thepolicydateshownundertheheadingPolicysummary,or themostrecentdatethispolicywasputbackintoeffect,ifthepolicyhasbeenreinstated.
Wewon’tpaybenefitswhentheinsuredpersonisoutsideCanadaortheUnitedStatesformorethaneightconsecutiveweeks.Ifwe’vepaidbeyondtheeightconsecutiveweeklimitation,wehavetherighttodeducttheoverpaymentfromanyfuturebenefits.
Wewon’tpaybenefitsiftheinsuredperson’sdependencyisdirectlyorindirectlycausedbyorassociatedwiththeinsuredpersonoperatingavehiclewhiletheirbloodalcohollevelismorethan80milligramsofalcoholper100millilitresofblood.Avehicleincludesanyformofground,airormarinetransportationthatcanbeputintomotionbyanymeans,includingmuscularpower.Wedonottakeintoaccountwhetherornotthevehicleisinmotion.
–competitiveadvantage
32SUN LONG TERM CARE INSURANCE
Wewon’tpaybenefitsiftheinsuredperson’sdependencyisdirectlyorindirectlycausedbyorassociatedwiththeinsuredperson:
committingorattemptingtocommitacriminaloffence,
attemptingtotaketheirownlife,regardlessofwhethertheinsuredpersonhasamentalillnessorunderstandsorintendstheconsequencesoftheiraction(s),
causingthemselfbodilyinjury,regardlessofwhethertheinsuredpersonhasamentalillnessorunderstandsorintendstheconsequencesoftheiraction(s),
intentionallytakinganydrugotherthanasprescribedbyalicensedmedicalpractitionerandinaccordancewiththeinstructionsgiven,and/or
intentionallytakinganyintoxicant,narcoticorpoisonoussubstance.Thisdoesnotincludesmokingcigarettes,cigarillos,cigars,chewingtobaccooroccasionaluseofalcohol.
Wewon’tpaybenefitsiftheinsuredperson’sdependencyisdirectlyorindirectlycausedbyorassociatedwithcivildisorderorwar,whetherdeclaredornot.
Tips for an efficient claims process Makesureyouunderstandtheclaimtriggersandthattheinsuredpersonmeetsthedefinitionofdependenceasdefinedbythecontract.Thiswillhelpreduceineligibleclaims,setbetterexpectationsfortheinsuredpersonandreducepotentialexpenses.
Verifythewaitingperiodsetoutinthepolicy.Afterthewaitingperiodhasbeenmet,completeandsubmittheclaimform.
Makesuretheformiscomplete,signedanddatedbeforeyousubmitit.Youneedtoinclude:
− thefulladdress(includingpostalcode)ofalldoctorstheinsuredpersonhasconsulted,and− thephonenumberofalldoctorstheinsuredpersonhasconsulted.
Verifytheinsuredperson’sdateofbirthandcheckitagainstthatshowninthepolicy.
Itisimportantthatweobtainallmedicalreportsfromthephysiciantosupporttheclaim.Ifthereportsarenotsenttous,wecannotdoafullevaluationandthiswillcausedelays.
33SUN LONG TERM CARE INSURANCE
TAXATION
TherearenospecifictaxlawsgoverningLTCIpolicies.
BasedoncurrenttaxlawsandguidancefromtheCanadaRevenueAgency,weexpectthat:
Premiumspaidforalongtermcareinsurancepolicyownedbyanindividualorindividualswillnotbetaxdeductible.
Anycashbenefitspaidfromalongtermcareinsurancepolicywillbetax-freewhenthepolicyownerandbenefitpayeearethesame.
Ifthepolicyisownedbyacorporation,differenttaxlawsmayapplytosomecircumstances:
Premiumspaidforalongtermcareinsurancepolicyownedbyacorporationwillnotbetaxdeductible,exceptinstrictlylimitedcircumstancesthatarebeyondthescopeofthisguide.
Anycashbenefitspaidfromalongtermcareinsurancepolicywillbetax-freewhenthepolicyownerandbenefitpayeearethesame.
Paymentofanypartofthecashbenefitfromthecorporationoranunincorporatedbusinesstoanemployeeorshareholdercouldproducetaxconsequencesfortherecipient.
Sincelongtermcareinsuranceisnotlifeinsurance,nopartofthelongtermcareinsurancebenefitthatacorporationreceivescanbepaidtoitsshareholdersasatax-freecapitaldividend.
Ifthecorporationtransfersownershipofalongtermcareinsurancepolicytooneofitsshareholdersoremployees,theremaybetaxconsequencesfortherecipient.
Theforegoingisonlyageneralsummary.Ataxprofessionalshouldbeconsultedformoreinformation.FormoreinformationconsulttheCanadianHealthInsuranceTaxGuide:www.sunlife.ca/advisor/HealthTaxGuide
34SUN LONG TERM CARE INSURANCE
Clarica Long Term Care Insurance (Dec. 4, 2000 to Dec. 11, 2003)
Issue ages 31–80
Coverage type Comprehensive
Whentheinsuredpersonqualifiesforthisincome-stylebenefit,wepayitnomatterwheretheyliveorreceivecarewithinCanadaortheUnitedStates.
Withincome-stylebenefits,clientsdonotneedtosubmitreceiptstoreceivetheirweeklybenefit;theycanusethemoneyhowevertheychoose.
Claim triggers Aclaimispaidwhentheinsuredperson:
alwaysneedssubstantialphysicalassistancefromanotherpersontocompletetwoormoreoftheactivitiesofdailyliving(bathing,dressing,toileting,movingtoorfromabedorchair,continence,andfeeding),or
hasdeterioratedmentalability.
Weekly benefit amounts
Minimum$150 Maximum$2,000
Waiting periods 30days 90days 180days
Benefit periods 100weeks 150weeks
250weeks 500weeks Unlimited
Payment period options
15years 20years Lifetime
Return of premium on death (ROPD)
Thereturnableamountisbasedonhowlongthepolicyhasbeeninforce.
Claimsaresubtractedfromthereturnableamount.
Thereisnoreturnofpremiumifthepolicyisonextendedtermcoverage.
PLAN DETAILS
PRODUCT HISTORY
Inforceproductnolongersold
35SUN LONG TERM CARE INSURANCE
Inflation protection Everythreeyearsanincreaseincoverageisoffered,withoutnewevidenceofinsurability,basedontheincreaseinlongtermcarecosts.
Theofferwillbepricedaccordingtoattainedage.
Offersarenotmadeif:
twooffershavebeendeclined, therehasbeenaclaimagainstthepolicy, premiumsarebeingwaivedunderthespousalwaiverbenefit, thepolicyispaidup,or theinsuredpersonhasreachedage85.
Waiver of premium when claim is approved
Premiumsarenotrequiredwhilebenefitsarebeingpaid,butpremiumsarepayableduringthewaitingperiod.
Premiumsarealsonotpayableifwe’vepaidthetotalnumberofweeksofthebenefitpaymentperiod.
Spousal waiver of premium
Toqualifyforthisbenefit,allrequiredpremiumsmusthavebeenpaidonbothspouses’policiesandbothpolicieshavebeencontinuouslyineffectandwithoutclaimfor10years(oruntilbothspouseshavereachedage86ifearlier).
Premiums are waived if:
benefitsarebeingpaidonthespouse’spolicy,or
thespousedies(whetherornottheywereonclaimatthetime).
Extended term insurance
Ifpremiumsarenotpaid,coveragewillcontinueforanadditionalperiodoftimedeterminedbyhowlongcoveragehasbeeninplace,age,genderandpremiumpaymentperiod.Benefitswillnotchange.
Premium guarantee Premiumsareguaranteedonafiveyearrollingbasis.
Plan of care Yes
Withdrawable premium fund
Yes
Support services LifestageCare™services
In2012,LifestageCare™serviceswereretroactivelymadeavailabletoallLTCIpolicyowners.
Itincludesaccesstoamembers-onlywebsiteandtoll-freetelephonesupportservice-anational,bilingualservice,available24hoursaday,7daysaweek.
Itoffersclientsunbiasedinformationaboutlocal,qualifiedhealthcareandpersonalcareprovidersthatmeettheirindividualandfamilyneeds,ateverystageoflife.
LifestageCare™isathird-partyserviceandisnotaguaranteedpartoftheLTCIpolicy.Itmaybewithdrawnoralteredatanytime.
Policy fees $150.00
Inforceproductnolongersold
36SUN LONG TERM CARE INSURANCE
Clarica Long Term Care Insurance (Dec. 12, 2003 to Sep. 18, 2005)
Issue ages 31–80
Coverage type Comprehensive
Whentheinsuredpersonqualifiesforthisincome-stylebenefit,wepayitnomatterwheretheyliveorreceivecarewithinCanadaortheUnitedStates.
Withincome-stylebenefits,clientsdonotneedtosubmitreceiptstoreceivetheirweeklybenefit;theycanusethemoneyhowevertheychoose.
Claim triggers Aclaimispaidwhentheinsuredperson:
alwaysneedssubstantialphysicalassistanceorstandbyassistancefromanotherpersontosafelyandcompletelyperformtwoormoreoftheactivitiesofdailyliving(bathing,dressing,toileting,movingtoorfromabedorchair,continence,andfeeding),or
hasdeterioratedmentalability.
Weekly benefit amounts
Minimum$150 Maximum$2,000
Waiting periods 30days 90days 180days
Benefit periods 100weeks 150weeks
250weeks 500weeks Unlimited
Payment period options
15years 20years Lifetime
Return of premium on death (ROPD)
Returnableamountisbasedonhowlongthepolicyhasbeeninforce.
Claimsaresubtractedfromthereturnableamount.
Thereisnoreturnofpremiumifthepolicyisonextendedtermcoverage.
Inforceproductnolongersold
PLAN DETAILS
37SUN LONG TERM CARE INSURANCE
Inflation protection Everythreeyearsanincreaseincoverageisoffered,withoutnewevidenceofinsurability,basedontheincreaseinlongtermcarecosts.
Theofferwillbepricedaccordingtoattainedage.
Offersarenotmadeif:
twooffershavebeendeclined, therehasbeenaclaimagainstthepolicy, premiumsarebeingwaivedunderthespousalwaiverbenefit, thepolicyispaidup,or theinsuredpersonhasreachedage85.
Waiver of premium when claim is approved
Premiumsarenotrequiredwhilebenefitsarebeingpaid,butpremiumsarepayableduringthewaitingperiod.
Premiumsarealsonotpayableifwe’vepaidthetotalnumberofweeksofthebenefitpaymentperiod.
Spousal waiver of premium
Toqualifyforthisbenefit,allrequiredpremiumsmusthavebeenpaidonbothspouses’policiesandbothpolicieshavebeencontinuouslyineffectandwithoutclaimfor10years(oruntilbothspouseshavereachedage86ifearlier).
Premiums are waived if:
Benefitsarebeingpaidonthespouse’spolicy.
Thespousedies(whetherornottheywereonclaimatthetime).
Wepaidthemaximumlongtermcareinsurancebenefitundertheotherpolicyifapplicable.
Extended term insurance
Ifpremiumsarenotpaid,coveragewillcontinueforanadditionalperiodoftimedeterminedbyhowlongcoveragehasbeeninplace,age,genderandpremiumpaymentperiod.Benefitswillnotchange.
Premium guarantee Premiumsareguaranteedonafiveyearrollingbasis.
Plan of care Yes
Withdrawable premium fund
Yes
Support services LifestageCare™services
Itincludesaccesstoamembers-onlywebsiteandtoll-freetelephonesupportservice-anational,bilingualservice,available24hoursaday,7daysaweek.
Itoffersclientsunbiasedinformationaboutlocal,qualifiedhealthcareandpersonalcareprovidersthatmeettheirindividualandfamilyneeds,ateverystageoflife.
LifestageCare™isathird-partyserviceandisnotaguaranteedpartoftheLTCIpolicy.Itmaybewithdrawnoralteredatanytime.
Policy Fees $150.00
Inforceproductnolongersold
38SUN LONG TERM CARE INSURANCE
Sun Long Term Care Insurance (Sep. 19, 2005 to Dec. 6, 2013)
Issue ages 21-80
Coverage type ComprehensiveWhentheinsuredpersonqualifiesforthisincome-stylebenefit,wepayitnomatterwheretheyliveorreceivecarewithinCanadaortheUnitedStates.
Facility Care Wepaythisincome-stylebenefitifcareisprovidedinalong-termcarefacilityinCanada.AsimilarfacilityintheUnitedStatesmaybeconsidered,subjecttoourapproval.
Withincome-stylebenefits,clientsdonotneedtosubmitreceiptstoreceivetheirweeklybenefit;theycanusethemoneyhowevertheychoose.
Claim triggers Aclaimispaidwhentheinsuredperson:
alwaysneedssubstantialphysicalassistanceorstand-byassistancefromanotherpersontosafelyandcompletelyperformtwoormoreoftheactivitiesofdailyliving(bathing,dressing,toileting,transferring,continence,andfeeding),or
requirescontinualsupervisiontoprotecttheirhealth.
Weekly benefit amounts Minimum(foreachcoverageselected):$150
Maximum(forallselectedcoverage):$2,000
Ifbothbenefittypesareselected,thecomprehensiveweeklybenefitamountmustbeatleast50%ofthefacilitycareweeklybenefitamount.
Forexample,ifthefacilitycarebenefitis$1,000,thecomprehensivebenefitmustbeatleast$500.
Waiting periods Comprehensive
30days 90days
Facility Care
0days(onlyavailableifbothcoveragetypesareselected)
30days 90days
Benefit periods 100weeks 150weeks
250weeks Unlimited
Thepolicyownermaychooseadifferentbenefitdurationforeachbenefittype.
Payment period options Lifetime Thelongerof20yearsortoage55
Inforceproductnolongersold
PLAN DETAILS
39SUN LONG TERM CARE INSURANCE
Return of premium on death (ROPD)
Thisoptionalbenefitreturnsaportionofpremiumstotheownerofthepolicy(ortheowner’sestate)iftheinsuredpersondies.
Returnableamountisbasedonhowlongthepolicyhasbeeninforce.
Calculatedseparatelyforeachbenefittype.
Claimsaresubtractedfromthereturnableamount.
Doesnotincludepremiumsforinflationprotectionbenefit.
Ifbothbenefittypesareselected,thisoptionappliestoboth.
Inflation protection Option A
− Weeklybenefitincreasesby3%eachpolicyanniversary-thedatethepolicybecameeffective-whiletheweeklybenefitispayable.
Option B
− Weeklybenefitincreasesby2%eachpolicyanniversaryiftheweeklybenefitisnotpayable.
− Weeklybenefitincreasesby3%eachpolicyanniversarywhiletheweeklybenefitispayable.
Thesameoptionmustbechosenforbothbenefittypesbutitworksindependentlyforeach.
Increasesarecompoundedannually.
Nocaponincreases.
Benefitmaximummayexceed$2,000perweekduetoinflationprotectionincreases.
Waiver of premium when claim is approved
Premiumsarenotrequiredwhilebenefitsarebeingpaid,butpremiumsarepayableduringthewaitingperiod.
Premiumsarealsonotpayableifwe’vepaidthetotalnumberofweeksineitherthecomprehensiveorfacilitycarebenefitperiod.
Spousal waiver of premium
Toqualifyforthisbenefit,allrequiredpremiumsmusthavebeenpaidonbothspouses’policiesandbothpolicieshavebeencontinuouslyineffectandwithoutclaimfor10years(oruntilbothspouseshavereachedage86ifearlier).
Premiums are waived if:
Benefitsarebeingpaidonthespouse’spolicy.
We’vepaidthetotalnumberofweeksinthecomprehensiveorfacilitycarebenefitperiodforthespouse’spolicy.
Thespousedies(whetherornottheywereonclaimatthetime).
Inforceproductnolongersold
40SUN LONG TERM CARE INSURANCE
Extended term insurance Ifpremiumsarenotpaid,coveragemaycontinueforalimitedtimebasedon:
Basebenefittype(comprehensiveorfacilitycare) Ageatpurchase Gender Premiumpaymentperiod Thenumberofyearsthepolicyhasbeeninforce
Whileextendedterminsuranceisineffect:
Noreturnofpremiumondeathbenefitispaid Noinflationprotectionincreasesaremade
Premium guarantee Premiumsareguaranteedonafiveyearrollingbasis.
Plan of care Yes
Withdrawable premium fund
Yes
Support services LifestageCare™services
Itincludesaccesstoamembers-onlywebsiteandtoll-freetelephonesupportservice-anational,bilingualservice,available24hoursaday,7daysaweek.
Itoffersclientsunbiasedinformationaboutlocal,qualifiedhealthcareandpersonalcareprovidersthatmeettheirindividualandfamilyneeds,ateverystageoflife.
LifestageCare™isathird-partyserviceandisnotaguaranteedpartoftheLTCIpolicy.Itmaybewithdrawnoralteredatanytime.
Policy fees $150.00
Inforceproductnolongersold
41SUN LONG TERM CARE INSURANCE
Stand-by assistance for bathing and transferring
WhenitcomestoLTCI,definitionsmakeallthedifference.Stand-byassistanceisanimportantpartofourdefinitionofdependence.Itmeansthattheinsuredpersonmaybeeligibletomakeaclaimsoonerorlongerthanwithapolicythatdoesn’tincludethisaspartoftheirdependencedefinition.
Palliative care (end-of-life care)
Regardlessofthewaitingperiod,thepolicyownercansubmitaclaim30daysaftertheinsuredperson:
hasbeendiagnosedwithaterminaldiseaseorillness, requiressubstantialphysicalassistanceforatleastfouractivitiesofdailyliving,and isreceivingpalliativecarethatissupportiveandprovidescomfort.
Income-style benefit
ManyLTCIplansofferanincome-stylebenefitwhichisdesignedtooffsetthecostofcareservicesprovidedbyprofessionalorfamilycaregiverswhetherinapersonalresidence,retirementhomeorlong-termcarefacilitybecauseofalossofindependence.Thistypeofplanoffers:
flexibility–thebenefitcanbeusedforanypurpose,and simplicity–there’snoneedtosubmitproofofservice.
Unlimited benefit period option
Anunlimitedbenefitperiodisanexcellentoptionforclientswhoarelookingforthepeaceofmindthatcomesfromhavingaccesstoanunlimitedstreamofbenefitsincaseofaprolongedcareneed.Thismeansthatwhentheyneedthecare,clientsdon’thavetoworryaboutthebenefitsending.
Inflation protection option
Theimpactofinflationonthefuturecostofcareisoftenoverlooked.Talktoclientsaboutaddinginflationprotectiontotheircoverageorpurchasingalargeramountofcoveragetooffsetinflationrisk.
Return of premium on death (ROPD)
WithSunLTCI,clientscanenhancetheircoveragewithasimple,easy-to-understandReturnofpremiumoption.Iftheinsuredpersondieswhilethepolicyisineffect,wewillpaythereturnablepremiumamounttotheROPDbeneficiarynamedinwriting.Ifnoneisnamed,wepaytothepolicyownerortheirestate.Thereturnablepremiumamountisthesumofallpremiumspaidforthepolicy,minusanyunpaidpremiums(plusinterest)andanybenefitpaymentsmade.
Spousal waiver
ThespousalwaiverbenefitisuniquetoSunLife.Ifbothspousesarecoveredunderpoliciesthatincludespousalwaiver,premiumswillbewaivedifonespousediesorifwe’repayingbenefitsoneitherpolicy.Evenafterwe’vepaidbenefitsfortheentirebenefitperiodonthespouse’spolicy,premiumswillbewaived.
COMPETITIVE ADVANTAGES – SUMMARY
42SUN LONG TERM CARE INSURANCE
Toqualifyforthebenefit,eachspousemusthaveapolicythathasbeencontinuouslyineffectwithnoapprovedclaimfromthedatestheycameintoeffectuntil:
bothpolicieshavereachedtheir10thpolicyanniversaries,or bothspouseshavehadtheir86thbirthdays.
First Payment bonus
Whenweapproveanewclaim,thefirstpaymentincludesabonusamountequalto12timestheweeklyamount.Iftheinsuredpersonisreceivingpalliativecareandqualifiesforbenefits,thebonusisequaltofourtimestheweeklyamount.Thisbonuscanhelpoffsetsomeofthecoststhatmighthavebeenincurredwhilesatisfyingthewaitingperiod.
Extended term insurance
WithSunLTCI,iftheclientcan’tpaythepremiums,extendedterminsurancemayhelp.Ifthisprovisionapplies,thepolicymaystayinforceforaspecifiedtime,andthebenefitamount,benefitperiodandwaitingperioddon’tchange.
LifestageCare™ services
ThepolicyownerhasimmediateandunlimitedaccesstoLifestageCare–anational,bilingualinformationserviceavailable24hoursaday,sevendaysaweek–oncethepolicyisissuedandaslongasit’sinforce.
Clientsgetaccesstounbiasedinformationaboutlocal,qualifiedhealthandpersonalcareprovidersthatmeetstheirindividualandfamilyneedsateverystageoflife.ThepolicyownercanuseLifestageCareservicestohelpanyfamilymember.
Premium guarantee
Allinsurersguaranteetheirratesforthefirstfivepolicyyears.However,manymaychangetheirratesanytimeafterward.AtSunLifeFinancial,ifwechangeourrates,wewon’tchangethemagainforatleastanotherfiveyears.
Coverage extended outside of Canada and the United States
Mostinsurersdon’tprovidecoverageforanyamountoftimespentoutsideofCanadaortheUnitedStates.SunLTCIprovidescoverageforeightconsecutiveweekswhentheinsuredpersontravelsoutsideeithercountry.
WHERE TO GO FOR MORE INFORMATION?ContactyourRegionalSalesDirectorortheSalesSupportteamformoreinformationonlongtermcareinsuranceproducts.
Telephone:1800-800-4SUN(4786)Email:[email protected]
It’simportanttomeetwithclientsregularlytoreviewtheircoverageandhelpthemwithanycontractualconversionsorrenewalstoensuretheyhavetheprotectionthatmeetstheirneeds.