UNDERWRITING GUIDELINES. Individual Insurance

Transcription

1 UNDERWRITING GUIDELINES Individual Insurance

2 TABLE OF CONTENTS About this guide... 4 Medical conditions Asthma...5 Auricular fibrillation...5 Autism...5 Bariatric surgery...5 Barrett s esophagus...5 Cancer blood (leukemia)...6 Cancer breast...6 Cancer lungs...6 Cancer prostate...6 Cancer skin...6 Malignant tumor...6 Basal cell or squamous cell carcinoma...6 Cancer thyroid...7 Cerebrovascular accident (CVA)...7 Transient ischemic attack (TIA)...7 Brain hemorrhage...7 Chronic obstructive pulmonary disease...7 Emphysema...7 Chronic bronchitis...7 Coronary artery disease...7 Myocardial infarction...7 Angioplasty...7 Bypass...7 Diabetes mellitus...8 Type 1 and Impaired glucose tolerance...8 Epilepsy...8 Herniated disc...8 Hypercholesterolemia...9 Hypertension...9

3 Multiple sclerosis...9 Paraplegia...9 Hemiplegia...9 Quadriplegia...9 Parkinson...9 Pulmonary embolism...9 Rhumatoid arthritis...10 Juvenile arthritis...10 Sleep apnea...10 Sprain (cervical, lumbar)...10 Lumbago...10 Whiplash...10 Thrombophlebitis...10 Ulcerative colitis...10 Proctitis...10 Crohn s disease...10 Irritable bowel syndrom...10

4 ABOUT THIS GUIDE The following underwriting guidelines aims to provide an overview of what the underwriting decision may be for different medical conditions. It is therefore a reference tool which will help you better prepare your clients, particularly when a rating may be applicable. It is understood that the probable decisions which are indicated in these guidelines are only preliminary estimates and do not bind SSQ Insurance in any way. If fact, all final decisions are based on a complete assessment of the file (in accordance to the underwriting s in effect). As such, the assessment of the file must necessarily start with a duly completed insurance application submitted to SSQ Insurance. GUIDE INTENDED FOR ADVISORS ONLY UNDERWRITING GUIDELINES 4

5 Asthma Auricular fibrillation Autism Bariatric surgery Barrett s esophagus Provide the date of diagnosis, date of last attack and frequency of attacks Hospitalization Activity limitation Frequency of episodes Date of surgery Complications Weight before and after surgery Treatment Lifestyle changes Questionnaire or Present or symptoms within last 2 years Non-smoker to +50 Severe or very severe symptoms: +150 to Smoker Mild to moderate symptoms: to +100 Severe or very severe symptoms: +200 to Asymptomatic > 2 years ago Non-smoker Severe or very severe symptoms: +100 to Smoker to +50 Severe or very severe symptoms: +150 to Without a complete cardiology investigation: Intermittent < 1 year since last episode: +50 > 1 year since last episode: Chronic: Depending on age: +50 to +125 < 18 years old: Decline > 18 years old: possibility of an offer depending on severity and autonomy level 0-6 months after surgery: > 6 months: rating according to height and weight Depending on severity and frequency of follow-ups Depending on levels of dysplasia found on endoscopy and time elapsed since the last symptoms: to Present or symptoms within last 2 years Non-smoker or Severe or very severe Smoker or and +50 Severe or very severe Asymtomatic > 2 years ago Severe or very severe Status asthmaticus: *Possible limitation of benefit period to 2 or 5 years Without a complete cardiology investigation: Chronic: 1 episode > 1 year since last episode: to months after surgery: > 12 months: rating according to height and weight Depending on severity and frequency of follow-ups Depending on levels of dysplasia found on endoscopy and time elapsed since the last symptoms: to Non-smoker to +50 Severe or very severe Smoker +50 to +100 Severe or very severe Without a complete cardiology investigation: With complete cardiac investigation, no known cause and no cardiac impairement Intermittent Treated with anticoagulants: +50 No treatment: minimum +75 Chronic: Treated with anticoagulants: +50 No treatment: < 18 years old: > 18 years old: Asperger s or high functioning autism, well adjusted, no accident risks: Other: 0-6 months after surgery: > 6 months: rating according to height and weight UNDERWRITING GUIDELINES 5

6 Cancer blood (leukemia) Cancer breast Cancer lungs Cancer prostate Cancer skin Malignant tumor Basal cell or squamous cell carcinoma (including pathology reports) Recurrences (including pathology reports) Recurrences Frequency of follow-ups and date / result of last one (mammography) (including pathology reports) Recurrences (including pathology reports) Most recent result of prostate specific antigen (PSA) insured s complete medical file (including pathology & dermatology reports) Frequency of follow-ups and date / result of last follow-up in dermatology Chronic Lymphocyitc Leukemia 1 year post treatment: Stage 0 According to age of diagnosis: +150 to +200 Stage 1 According to age of diagnosis: +200 to +300 Stage 2 to 4: Carcinoma in situ Depending on type of situ: $5 or $7.50 per thousand x 4 years Other tumors Depending on stage: for 1 year to 5 years post treatment Afterward: $7.50 to $20 per thousand Stage 4: Stage 1: for 5 to 8 years post treatment Afterwards: $10 to $15 per thousand x 5 or 8 years Stage 2 and higher: If insured is a smoker: Diagnosis < age 50: Depending on stage: for 1 year to 3 years post treatment Afterwards: $7.50 to $10 per thousand x 5 years Basal cell or squamous cell carcinoma basocellulaire (completely excised) 1 occurrence stage 0 or 1: Stage 2 and higher, depending on pathology report and date of last treatment: between $5 to $15 per thousand up to a Other tumors Stage 0 and 1A, 6 months after last treatment: to $7.50 per thousand x 4 years Stage > 1A: 2 to 5 years post treatment All stages: Carcinoma in situ Depending on type of in situ: for 3 or 4 years Other tumors Depending on stage: for 4 to 10 years post treatment Afterward: +50 to +100 Stage 1: for 10 to 13 years post treatment If insured is a smoker: Diagnosis < age 50: Depending on stage: for 6 to 8 years post treatment Basal cell or squamous cell carcinoma basocellulaire (completely excised) 1 or 2 occurrences stage 0 or 1: > 2 occurrences stage 0 or 1: Stage 2 and higher, depending on pathology report and date of last treatment: or All stages: All stages: All stages: Stage T1a, T1b Insured > age 40 at time of diagnosis and treated with total prostatectomy 0-10 years since end of treatment: > 10 years: Insured < age 40 at time of diagnosis or not treated with total prostatectomy: Stade > T1b: Basal cell or squamous cell carcinoma basocellulaire (completely excised) 1 occurrence: > 1 occurrence: Other tumors < Age 40: > Age 40, if 1 occurrence stage 0 and no family history of skin cancer and date of diagnosis at least 2 years removed: UNDERWRITING GUIDELINES 6

7 Cancer thyroid Cerebrovascular accident (CVA) Transient ischemic attack (TIA) Brain hemorrhage Chronic obstructive pulmonary disease Emphysema Chronic bronchitis Coronary artery disease Myocardial infarction Angioplasty Bypass (including pathology reports) Recurrences Frequency of follow-ups and date / result of last one Current functionnal capacity Sequelae Frequency of follow-ups and date / result of last one Date and result of the pulmonary function test Treatment Actual symptoms Severity (number of artery involved) Frequency of follow-ups and date / result of last one Depending on the stage and age: between 3 and 15 years post treatment Thereafter: $5 to $15 per thousand CVA and brain hemorrhage: 12 months after event TIA: 6 months after event Thereafter, if no or minor sequelae, a rating can be applied depending of age and time elapsed since the event. The younger the insured is, higher the rating will be. CVA: +75 to +300 TIA: to +125 Brain hemorrhage without surgery: +75 to +150 With surgery: to +100 Multiple events: Depending on the degree of severity Non-smoker: to +150 Smoker: +75 to Severe and very severe case: Age of onset < 35: > 6 months to < 5 years post diagnosis: 35 to 40 years old: > 40 years old: +100 to +250 > 5 years post diagnosis: > 35 years old: +75 to +200 > 3 bypass: > 1 myocardial infarction: Depending on the stage and age: between 3 and 15 years post treatment Thereafter: possibility of Decline Depending on the degree of severity Non-smoker: or with a rating of +50 including duration period limited to maximum 5 years Smoker: and +50 with a duration period limited to maximum 5 years to Severe case: Stage 0 and stage 1 < 40 years at diagnosis: > 40 years at diagnosis 0-10 years post treatment: > 10 years: Stage > 1: Decline Depending on the degree of severity: Non-smoker: +25 to +100 Smoker: +50 to +125 Severe case: UNDERWRITING GUIDELINES 7

8 Diabetes mellitus Type 1 and 2 Impaired glucose tolerance Epilepsy Herniated disc Type of diabetes Complications (retinopathy, nephropathy, etc.) Date and result of last blood test Frequency of seizures Date of last seizure Type of seizures (partial or generalized) Test done and result Test done and result Time off work Activity limitation Questionnaire (Back) Type 1 According to age and duration with good control and no complication: +50 to +300 Type 2 According to age and duration with good control and no complication: to +250 Impaired glucose tolerance According to age: to +75 < 6 months of initial diagnosis: Generalized epilepsy According to time elapsed and frequency of seizures: to +200 Partial epilepsy According to time elapsed and frequency of seizures: to +100 Status epilepticus < 3 years: Pending surgery: No limitation: Severe case with chronic pain and limitation: to +50 Type 1: Type 2: < 40 years old: < 6 months of diagnosis: According to age and duration with good control and no complication: +50 to +75 with a duration period limited to 2 and 5 years Diagnosis > 5 years according to age: Impaired glucose tolerance < 30 years old: > 30 years old: +50 to +100 < 12 months of initial diagnosis: Generalized epilepsy According to time elapsed and frequency of seizures: +150 to Partial epilepsy According to time elapsed and frequency of seizures: +25 to Status epilepticus < 5 years: Without surgery 1 acute episode depending on the occupation Asymptomatic < 3 years: 2 or more acute episodes depending on the occupation Asymptomatic < 5 years: With surgery 1 acute episode depending on the occupation Asymptomatic < 1 year: Asymptomatic < 7 years: to Chronic symptoms Depending on the occupation and severity Mild symptoms: to Moderate or severe Pending surgery: *Possible limitation of benefit period to 2 or 5 years Type 1: Type 2: < 40 years old: > 40 years and < 10 years of diagnosis: +50 to +125 > 40 years and > 10 years of diagnosis: +100 to Impaired glucose tolerance > 40 years old: +50 to +125 Generalized epilepsy > 6 seizures per year: < 6 seizures per year: +25 to +75 Partial epilepsy > 6 seizures per year: < 6 seizures per year: to +50 Status epilepticus 1 event < 1 year: > 1 year: +25 to +75 > 1 event: All cases: depending on the severity UNDERWRITING GUIDELINES 8

9 Hypercholesterolemia Hypertension Multiple sclerosis Paraplegia Hemiplegia Quadriplegia Parkinson Pulmonary embolism Date and result of last followups Blood test result Control Activity limitation Walking aid Complications Recurrences Test done and result If compliant to treatment and normal cholesterol level according to age: If not: +50 to With good control: to Possible diagnosis Single attack only, no lesion magnetic resonance imaging, no family history of multiple sclerosis and no current neurological abnormalities: to +100 Definite diagnosis According to the severity and time elapsed since diagnosis Mild: to +150 Moderate: +50 to +150 Severe: > 10 years since diagnosis +250 Very severe: Paraplegia < 1 year since diagnosis: > 1 year: minimum +200 Hemiplegia < 1 year since diagnosis: > 1 year: +100 to +150 Quadriplegia: Depending on severity Stage 1 and 2 > 36 years old at diagnosis: +50 to +100 Stage 3 > 36 years old at diagnosis: +75 to +125 Stage 4: > 36 years old at diagnosis: +150 to +200 Stage 5 or uncontrolled: 1 episode, no symptoms > 6 months since episode: 2 episodes, investigation completed < 1 year since last episode: > 1 year since last episode: +50 to episodes or more: If compliant to treatment and normal cholesterol level according to age: If not: +25 to With good control: to Possible diagnosis Single attack only, no lesion magnetic resonance imaging, no family history of multiple sclerosis and no current neurological abnormalities > 5 years since attack: Definite diagnosis 1 episode, completely recovered > 6 months since episode: to +75 Multiple episodes: If compliant to treatment and normal cholesterol level according to age: With good control: to 1 episode, completely recovered > 3 months since episode: Multiple episodes: < 1 year since last episode: > 1 year since last episode: +50 to +75 UNDERWRITING GUIDELINES 9

10 Rhumatoid arthritis Juvenile arthritis Sleep apnea Sprain (cervical, lumbar) Lumbago Whiplash Thrombophlebitis Ulcerative colitis Proctitis Crohn s disease Irritable bowel syndrom Activity limitation Time off work Treatment and prescribed medication Date and frequency of flare ups Provide date of diagnosis, severity, treatment prescribed and compliance (if cpap prescribed confirm number of hours used per night) Date / result of last sleep study Current state since start of treatment Date and frequency of flare ups Test done Time off work Activity limitation Treatment and prescribed medication Number of episodes Frequency of flare-ups Severity (mild, moderate or severe) Treatment and prescribed medication Frequency of follow-ups (colonoscopy) Hospitalization Questionnaire (Back) Depending on severity: to Treated, good response to treatment and depending on severity: to +150 Without treatment and depending on severity: +50 to More the sleep apnea is severe more the rating will be high. Untreated and severe case will be. If no limitation: Severe case with chronic pain and limitation: to episode No complication: to +50 With complication: +50 to +100 Multiple episodes: +100 to +150 Irritable bowel syndrom: Others Depending on severity, time elapsed since of last flare-ups and without surgery: to +200 With surgery > 6 months post surgery: to +75 Depending on severity: to rating of +25 to +50 benefit period will be limited to 2 to 5 years maximum Severe case: Juvenile arthritis < 25 years old: Treated, good response to treatment and depending on severity: to +50 Without treatment and depending on severity: +50 to Untreated and severe case will be d. *Possible limitation of benefit period to 2 or 5 years 1 acute episode (depending of occupation) Asymptomatic < 3 years: 2 and more acute episodes (depending of occupation) Asymptomatic < 5 years: Chronic symptoms Depending of occupation and severity Mild symptoms: Moderate to severe *Possible limitation of benefit period to 2 or 5 years 1 episode, non-smoker, no treatment and completely recovered > 6 months since episode: to +50 With complication: Multiple episodes: Irritable bowel syndrom, depending on severity: to +50 with Others Depending on severity and without surgery: between 2 and 5 years Thereafter:, +50 and benefit period limited to 2 and 5 years maximum With surgery < 2 years post surgery: Thereafter:, +50 and benefit period limited to 2 and 5 years maximum Depending on severity: +25 to +150 including Treated, good response to treatment and depending on severity: to +100 Without treatment: moderate and severe case will be d All cases: 1 episode > 3 months since episode: Multiple episodes > 3 months since last episode: to +50 Irritable bowel syndrom: Others < 1 year since last diagnosis: 1-2 years since diagnosis: Mild condition: years since diagnosis: +50 to +100 depending on severity > 10 years since diagnosis: +75 to depending on severity Total colectomy: UNDERWRITING GUIDELINES 10

11 About SSQ Financial Group With a business volume of $3 billion and nearly $11 billion in assets under management, SSQ Financial Group is a prominent mutualist diversified financial institution in Canada. The Group serves over 1 million clients and employs 2,000 employees. SSQ, Life Insurance Company Inc., the Group s principal company, is recognized for its leadership in the group insurance industry and excellence and expertise in the investment and retirement sector. SSQ Financial Group has also made its mark through sustained growth in the home and auto insurance (SSQ General Insurance Company Inc.) and individual insurance (SSQ Insurance Company Inc.) markets. For more information, please visit ssq.ca. MIND0077A ( )