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Critical Illness Insurance - Underwriting guidelines
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Underwriting requirements

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Advisor guide

Sun Critical Illness Insurance

The Sun CII advisor guide is available online. View it

Evidence requirements

For evidence requirements, please refer to the Pre-underwriting guide for Sun Critical Illness Insurance - E3493 Adobe PDF document .

Based upon information gathered during the application process, the underwriter retains the option to order additional requirements.

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Attending Physician Statement (APS) guidelines

The underwriter orders APS reports. Keyfacts, a third party company, collects the information for these reports.

An APS will be a routine requirement for any age and amount in the following situations:

  • When a doctor has been seen recently for any reason.
  • When a physical exam has been completed within the past 6 months.

New Guidelines for APS requests on Critical Illness Insurance

Critical Illness Insurance - Routine Age and Amount

Age Amount
0-12 months $250,001 and up
13 months-40 Not required
41-50 $500,001 and up
51-60 $250,001 and up
61-70 $100,001 and up

Critical Illness Insurance - Recent visits or check-ups
An APS will be required on applicants who have had recent visits or check-ups (other than cold/flu, normal pre-natal, or employment physicals).

Age Amount
13 months-40 $500,001 and up, within 3 months of application
41-60 $250,001 and up, within 3 months of application

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Approved paramedical companies

  • ExamOne
  • Medifast
  • Medysis
  • Hooper-Holmes (Portamedic)
  • Quality Underwriting Services

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For Quebec only

An APS is often required for critical illness insurance underwriting. Please note that form Authorization to disclose medical information (E276) Adobe PDF document is required by all clinics and hospitals in Quebec. An original signature (not copied or faxed) is required. To avoid asking the client for another signature, it is advisable to complete and sign the form at the time of application.

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Rules for purchasing child critical illness insurance

The following persons may buy a critical illness insurance policy that insures a child:

  • a parent
  • legal guardian, or
  • grandparent.

When a grandparent (who is not the legal guardian) purchases a policy on their grandchild:

  • They can own the policy, but we require that all critical illness benefits must be directed to be paid to the child's parent or legal guardian.
  • All siblings from a family must be insured for a similar amount. “Similar” can mean the:
    • same amount of premium
    • same face amount, or
    • maximum CII for their age on each child.
  • We'll consider amounts up to $150,000 regardless of the amount of coverage on the parents. For amounts over $150,000, both parents should have some individual or group CII, DI or LTCI coverage in force or applied for (unless uninsurable).

If a person other than a parent, legal guardian or grandparent of the child applies to purchase the policy:

  • the person purchasing the policy must provide details about their insurable interest in the child, and
  • all critical illness benefits must be directed to be paid to the parent or legal guardian of the child.

The grandparents will be required to complete a family history questionnaire if:

  • the child's issue age is 30 days - 15 years, and
  • either parent is under 40 years old.

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Financial underwriting guidelines for child policies

Parents can apply for up to $150,000 of coverage on their children, regardless of the amount of critical illness coverage they themselves have in force. Higher amounts are available if both parents have some insurance coverage in force. For more details, refer to the Critical Illness Insurance - Financial Underwriting Guidelines.

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Financial Underwriting Guidelines for adults and students

Please refer to the Critical Illness Insurance - Financial Underwriting Guidelines.

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Non-smoker definition

No use of tobacco or product containing nicotine or marijuana for the past 12 months.

Note: We may offer non-smoker rates for new applications where the proposed insured is an occasional large cigar smoker (up to 12 large cigars per year) and has a negative cotinine test (when testing is required).

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Ratings

The minimum rating is +25 (125%).
The maximum rating is +150 (250%).

Children will only be accepted if they qualify as a standard risk.

Ratings do not apply to any premium paid for a return of premium benefit.

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Travel and foreign residence

We will issue critical illness insurance policies to an owner or insured person who has “permanent Canadian residence status”.

Frequent foreign travel may be rated or declined. We will decline an application where the proposed insured travels to destinations we consider unsafe.

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Temporary critical illness insurance

Subject to exclusions and restrictions, some of which are described below, from the moment the application is signed, temporary insurance coverage is available on any insured person age 65 or less, equal to the amount of the critical illness insurance benefit applied for, up to a maximum of $500,000 per insured person and applies to any and all pending critical illness insurance applications with the company. A full description of the temporary insurance is included in the Application for life and/or critical illness - 810-2799 Adobe PDF document .

Temporary insurance coverage is available if:

  • the temporary insurance questions in the application have been truthfully answered
  • all other required questions in the application have been truthfully and completely answered, and
  • a payment of at least 1/12th of the annual premium for the base policy and any additional benefits has been made with the application.

The temporary insurance coverage provides immediate coverage and terminates on the earliest of:

  • the instant the insurance applied for comes into effect
  • the day we decline your application for insurance, upon which we will mail a notice of the decline
  • to the address given in the application
  • the 90th day following the date the application for insurance was signed
  • the date the applicant asks us to cancel the application, or
  • the date the applicant declines our offer of insurance.

In the unlikely event we are not able to complete the underwriting assessment in 90 days, the temporary insurance coverage will terminate and any premiums paid will be refunded.

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When coverage for cancer or benign brain tumour ends

The coverage for cancer or benign brain tumour will end and we will not make any payment if within the first 90 days following the later of:

  • the date the application for this policy was signed
  • the policy date
  • the underwriting decision date if included in the policy, or
  • the most recent date this policy was put back into effect (reinstatement),

the insured person has:

  • signs, symptoms or investigations that lead to a diagnosis of cancer or benign brain tumour (covered or excluded under the policy), regardless of when the diagnosis is made
  • a diagnosis of cancer or benign brain tumour (covered or excluded under the policy)

Coverage for all other covered critical illnesses will continue provided the insured person's critical illness does not result directly or indirectly from any cancer or benign brain tumour or cancer treatment or treatment for benign brain tumour.

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Backdating

We permit backdating to save age up to a maximum of 90 days from the application signed date. The insurance coverage including the benefits is determined according to the client’s actual age at the time they sign the application. We will not accept backdating if the client’s actual age makes them ineligible to apply for a policy or a benefit.

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Published: 01/09/2005
Last updated: 20/01/2014

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