The underwriting decision

Once the underwriter has enough information about the long term care insurance applicant, they can make a decision on the application. The decision may be to:

  • accept the policy as applied for, or
  • offer the policy with a modification of benefits, or
  • decline the coverage and postpone the application with an offer to reconsider the applicant for insurance in the future, or
  • decline coverage.

Approved applications

Once we have approved an application for long term care insurance:

  1. If the policy is being mailed directly to the client, you will receive an e-mail advising:
    • that the application has been approved,
    • the effective date of the policy , and
    • the applicant's details, the policy benefits and the premiums details.
  2. The decision will be updated on the Activity centre.
  3. A welcome letter will be sent to your client (along with the policy, if it is being delivered directly to them), and
  4. The policy documents will be printed and sent (a copy of the application, policy pages, policy delivery receipt and any amendment forms, if applicable) for delivery.

Important: If at any time before the policy is issued your client decides not to proceed with the application, e-mail ServiceNow@sunlife.com to advise the Long Term Care Insurance Administration team as quickly as possible to stop the issue process.

Modified applications

Due to increased insurance risk, the underwriter may offer a modified policy with changes to any or all of the following:

  • the weekly benefit
  • the benefit period

If both the weekly benefit and the benefit period are modified, the underwriter will refer to the maximum lifetime benefit amount available.

Case study:

Your client applied for:
- benefit amount $500.00
- unlimited weeks of benefit

The modification is:
- maximum lifetime benefit $100,000

We will need you to let us know if your clients accept the modified policy offer. If they do, we need you to confirm the plan details including:
- the weekly benefit amount, and
- the benefit period they'd like to equal a maximum lifetime benefit of $ 100,000 >> For example $400 per week x 250 weeks = $100,000.

The premium will be decreased to reflect the appropriate premium for the modified terms.

Declined applications (including postponed applications)

If the application for long term care insurance has been postponed or declined:

  1. You will receive an e-mail giving our decision. We'll also give you the reason for our decision if we are able, using our usual privacy rules. For postponed applications if possible we will indicate when we might be able to review a new application.
  2. The decision will be updated on the Activity centre.
  3. A letter will be sent to the applicant with our decision.
  4. Any payments made will be returned to the applicant, without interest, along with the letter.

In some cases when an application is postponed or declined, we may not be able to disclose - to you or to your client - the reason for our decision if it's related to confidential information not disclosed in the application.

In order to disclose this information, a written request from the client or form Request for disclosure of reasons for underwriting decision - E273

can be completed allowing us to write a letter to their doctor explaining our underwriting decision.

If the client has been postponed we will then be able to advise the doctor when the client would be able to reapply and under what conditions.