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New Business and Underwriting Guide Individual Health & Dental Insurance

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General Language

Applicants must be able to understand English and/or French. Eligibility

No GHIP? Use Visitors to Canada Emergency Medical Travel Insurance until GHIP is in place.

Applicants must have Government Health Insurance Plan (GHIP) coverage and must be a permanent Canadian resident to be eligible for any Extended Health and Dental Plan.

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Health and Dental Plans Flexcare® Use Flexcare® Snapshots

for specific coverage details for each province.

DentalPlus™ Basic1 DentalPlus™ Enhanced1 DrugPlus™ Basic DrugPlus™ Enhanced

Want no medical underwriting? Offer a dental plan or ComboPlus™ Starter.

ComboPlus™ Starter1 ComboPlus™ Basic ComboPlus™ Enhanced Add-on coverage available2 Stand alone coverage available2

1 These plans are Guaranteed Issue Plans not requiring any medical underwriting. 2 Extended Health Care (EHC), Hospital and Catastrophic Coverage require medical underwriting. Flexcare® Select Flexcare® Select is

guaranteed issue Extended Health Care and Vision Care coverage plus the choice of two additional coverages.

Extended Health Care (EHC) Vision Care Hospital Cash3 Fracture Benefits3 Travel Coverage3 Accidental Death and Dismemberment3

3 In addition to EHC and Vision Care coverage, choice of any two of these coverage options.

FollowMe™ Health plans DO NOT require medical underwriting.

FollowMe™ Health

Basic4 Enhanced4

Unsure which FollowMe™ Health plan is right? Offer Premiere for maximum coverage – can always choose to downgrade at renewal (but would need to be medically underwritten for upgrade).

Enhanced Plus4 Premiere4

4 These plans are Guaranteed Issue Plans not requiring any medical underwriting, if application is received within 60 days of termination from a group benefit plan. The Association Health and Dental Plan

Base Plan (Health & Dental)5 Base Dental Plan5 Bronze Plan (Health & Dental)

The Association Health and Dental Plan is a great ‘individual’ alternative to group insurance for members of both small and large associations.

Bronze Dental Plan5 Silver Plan (Health & Dental) Silver Dental Plan5 Gold Plan (Health & Dental) Gold Dental Plan5

5 These plans are Guaranteed Issue Plans not requiring any medical underwriting.

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Completing an Application Information to Have Handy

1. The Government Health Insurance Plan (GHIP) numbers of everyone applying for coverage.

2. Doctor’s name, address, last consultation date and information (for each applicant).

3. Names of all prescription drugs and the condition for which they are being taken.

Being prepared saves application completion time.

4. Credit card information or bank information for a pre-authorized payment plan.

Family coverage? Each applicant is assessed separately with a different decision possible for each applicant.

5. If the applicant recently had group insurance, the name of the insurer, the group plan and subscriber ID numbers, and the dates the benefits end(ed).

6. Driver’s license information (if applying for Catastrophic coverage). For Fast Processing

1. Make sure ALL questions are answered.

Use ‘Quote and Apply on-line’ to save courier costs & submission time.

2. Provide full details for all ‘Yes’ answers.

3. Complete the Practitioner and Medication sections (for each applicant).

4. Get the applicant and co-applicant(s) signatures.

5. Current date the application.

6. If faxing the application, make sure all information (including authorizations) is legible.

Medical condition not addressed on application? Be sure to let us know.

Completing the Medical Questions It is very important that full and complete medical information is provided during the application process, so that the underwriters will be able to make a well informed decision on the application. Application Disclosure

Underwriting cannot ignore adverse medical history or possible risks uncovered, but not indicated on the application. Details on adverse decisions can only be shared with the applicant’s doctor.

Any injury that occurred or any medical condition, the signs of which first appeared on or before the date of the application, may not be covered by the policy. Failure to disclose such information could result in the denial of a claim and/or the cancellation or modification of the policy. Manulife Financial reserves the right to recover any claims paid due to failure to disclose any injury or medical condition that existed on or before the date of this application. Beneficiary In order to expedite the application process, the beneficiary designation under the policy will automatically default to the Estate. Following approval of the application, the policy will be issued together with a change of beneficiary designation form. The policyholder must complete, sign and return this form to Manulife Financial in order to ensure that a specific individual is designated to receive any proceeds payable under the policy in the event of death. Choosing Payment Options If paying by Pre-Authorized Debit, there is a 2 % discount for premiums

Pay by Pre-Authorized Debit and save: 4% annual and 2% semi-annual payments.

paid upfront for a period of 6 months and 4 % for annual premium payments. There is no discount for monthly pre-authorized debit. Discounts are not available for the Credit Card payment option.

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Policy Issue and Premium Draw Dates Premiums for all Guaranteed Issue plans, including Flexcare® Select, ComboPlus™ Starter, Dental Plus™ Basic, DentalPlus™ Enhanced and FollowMe™ Health, are in effect the first of the month following receipt of the application by Manulife Financial. Premiums for 2 months will be withdrawn at issue, and further premium payments will be debited on the first day of the month, either monthly or semi-annually, as chosen. ComboPlus™ Basic, ComboPlus™ Enhanced, DrugPlus™ Basic, DrugPlus™ Enhanced, Hospital Basic, Hospital Enhanced, Catastrophic Coverage and Extended Health Care are medically underwritten plans. The application will be reviewed by our underwriters and it will take approximately 4 to 6 weeks to complete the assessment. When approved, premiums for 2 months will be processed and the plan will come into effect on the first of the month following approval. Counter Offers In the event that the applicant is conditionally approved, a counter offer will be sent detailing the exclusions and restrictions. Following the receipt of the client’s acceptance of the counter offer, premiums for 2 months will be withdrawn from the payment account. Subsequent premium payments will be debited on the first day of the month, either monthly or semi-annually, as chosen.

Premiums are not reduced if exclusions or restrictions apply as full benefits are payable for all non-excluded conditions.

Health Claims Audit A Health Clains Audit involves our Claims and Underwriting areas, as well as, your client and can occur within the first two years of the policy effective date when a claim is presented, but only applies to underwritten plans. You will be notified of the audit, but the policyholder is contacted directly for a post underwriting review to determine if there was an undisclosed pre existing condition at time of application. The claim is then paid once it has been confirmed that there are no issues. If undisclosed information is uncovered, we will modify coverage or rescind the contract if necessary.

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Underwriting Requirements – Questions and Answers

We never do blood, urine or Paramedical Exams.

Questionnaires and doctor’s reports may be requested.

We underwrite up front to avoid claim issues later!

Does an applicant have to undergo a medical exam or test in order to qualify?

No. The applicant will not be asked to undergo any medical exam or test. The underwriter may, however, request a medical report from the applicant’s doctor. How will Manulife contact an applicant if more information is needed?

If the applicant has applied through an advisor, all written requests for additional information will be sent by email to the advisor’s office. Applicants who apply to us directly may be contacted by phone (by the underwriter or an external provider), email or letter. Does underwritten coverage cover pre-existing medical conditions?

Generally, no. Provided the applicant is insurable, the underwriter may offer modified coverage with an exclusion for the pre-existing condition. Only pre-existing health conditions that are pertinent or material to the risk are excluded and usually no more than 3 exclusions are offered. The underwriter may also charge a substandard premium rating, if an exclusion alone does not sufficiently cover the risk. We always obtain agreement from the applicant before issuing coverage on a modified basis.

Let your client know what to expect: There may be other

underwriting requirements

They may be declined for coverage

They may be offered different coverage than what they applied for.

If an applicant is currently undergoing medical testing and the results are not yet available, can they obtain coverage?

No. Applicants are ineligible for coverage until all pending medical testing and investigations are completed and the results are available. Can a parent buy dependent coverage without applying for coverage for themselves or their spouses?

No. At least one parent must be covered in order to insure a dependent. Can a newborn be added to active dependent coverage without underwriting?

Yes. Newborns may be added to active dependent coverage, provided a written request is submitted within 30 days of the baby’s birth. Requests submitted after 30 days or requests to add dependent coverage are subject to underwriting approval. An applicant is currently covered under a Manulife health plan but has reached the annual plan maximum. Should they cancel their current coverage and apply for a different plan with a higher maximum?

No. The different plan would be subject to underwriting approval and previously covered conditions might be excluded under the new contract. In addition, the new coverage might be declined or offered with a substandard rating. A policyholder wants to downgrade benefits. How do they do this?

Policies must be inforce 12 months before policy changes. Upgrades are subject to underwriting.

A policyholder may apply to downgrade benefits by sending a signed and dated request letter. Their coverage must be in force for at least 12 months before we will agree to downgrade coverage. A change to downgrade coverage is not subject to underwriting. Note: If the policyholder subsequently wants to upgrade their coverage, they will have to re-qualify for the upgraded benefits by completing a new application. A change to upgrade coverage is subject to underwriting approval.

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Can a policyholder cancel coverage and re-apply later?

Yes. However, there is a 24 month waiting period before a new application can be submitted and approval will be subject to underwriting. What options are available if an applicant is declined?

Our goal is to offer ‘standard issue’.

We may place exclusions when required.

We will make a ‘counter offer’ of a guaranteed issue plan automatically for declined cases if possible.

If an applicant is declined or does not wish to accept modified coverage, they will be offered a choice of one of our guaranteed issue products. In addition, applicants who apply for underwritten coverage within 60 days of losing their group coverage are eligible to purchase non-underwritten ‘FollowMe™ Health’ coverage.

Depending on the medical condition, we may be able to reconsider a declined applicant at a later date, provided their health condition has improved or stabilized. A fully completed application is always required for reconsideration and approval is subject to underwriting. Note: not all declined applicants can be reconsidered. Refer to the attached list of ‘Ineligible Conditions.’ If an individual’s group health coverage is terminating, can they

FollowMe™ Health is a guaranteed issue plan if applied for within 60 days of leaving a group plan.

obtain Manulife health coverage without underwriting?

Yes, provided they apply within 60 days of losing their group insurance benefits. Our ‘FollowMe™ Health’ product is available and is not subject to medical underwriting. Under the FollowMe™ Health plan, is coverage from a group plan ‘uninterrupted’ when the FollowMe™ Health plan takes effect?

The benefits under the previous group coverage and the FollowMe™ Health plan may not be entirely the same. In particular, a customer who has ongoing major dental work on his group plan may expect uninterrupted services on the FollowMe™ Health plan. However, only the FollowMe™ Health Premiere plan covers major dental work after a waiting period of 24 months.

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Ineligible Conditions Important Notes: i. These ineligible conditions apply only to underwritten Health and Dental applications

ii. The list is not complete, but covers some of the more commonly seen conditions or concerns. Other conditions or risk factors not listed here may also be ineligible

iii. Individual consideration (IC) will be given only if the stated criteria are met. The applicant must be fully recovered and no longer receiving preventative or clinical treatment

iv. For individual consideration, the applicant must provide Manulife with copies of any medical records or tests required to complete the underwriting assessment and must also assume the cost

Medical Condition or Concern Decision Individual Consideration (IC)

Period and/or Requirements Acromegaly Decline – if unoperated, or if below IC

requirements 3-year stability period post surgery (tumour removal)

Addison’s Disease Decline – if below IC requirements 3-year stability period Adrenal Hyperplasia Decline – if current, or if below IC

requirements 6-month post surgery period

AIDS/HIV Decline with no reconsideration Alcohol Abuse Decline – if current, or if below IC

requirements 5-year full recovery period + total abstinence

Alzheimer’s Disease Decline with no reconsideration Amnesia Decline with no reconsideration - if

cause is not traumatic Decline – if current, or if below IC requirements

If cause is traumatic + return of normal cognitive functions

Amyotrophic Lateral Sclerosis (ALS) /Lou Gehrig’s Disease

Decline with no reconsideration

Aneurysm, Aortic or Carotid Decline with no reconsideration Aneurysm, Cerebral Decline – if current, or if below IC

requirements 1-year full recovery period from surgery

Angina/Angina Pectoris Decline with no reconsideration Angioplasty Decline with no reconsideration Ankylosing Spondylitis Decline with no reconsideration, if

severe If other than severe

Anorexia Nervosa Decline – if current, or if below IC requirements

5-year full recovery period + post-adolescence

Aortic Stenosis Decline with no reconsideration - if moderate to severe

If mild

Aplastic Anemia Decline with no reconsideration Arteriosclerosis (ASVD) Decline with no reconsideration Ascites Decline with no reconsideration Bipolar Affective Disorder/Manic Depression


Brain Disorder Decline with no reconsideration Brain Injury Decline – if current, or if below IC

requirements 1-year recovery from injury + depending on residuals

Bulimia Decline – if current, or if below IC requirements

5-year full recovery period + post-adolescence

Cancer Decline – if current, or if below IC requirements (See IC for some skin cancers)

10-year full recovery period N.B. Underwrite – Skin cancers except Melanomas

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Medical Condition or Concern Decision Individual Consideration (IC) Period and/or Requirements

Cardiomyopathy Decline with no reconsideration 1-year full recovery period + only if cause is viral

Cerebral Atrophy Decline with no reconsideration Cerebral Palsy Decline with no reconsideration - if

moderate to severe Decline – if at younger ages

If mild or if at older ages

Cerebral Vascular Accident (CVA)/Stroke


Charcot-Marie Tooth Syndrome Decline with no reconsideration Chronic Obstructive Pulmonary Disease (COPD)/Chronic Obstructive Lung Disease (COLD)


Heavy Cigarette Smoking, (Over 50 per day cigarette usage or equivalent of any other tobacco products)


Cirrhosis Decline with no reconsideration Claudication Decline with no reconsideration Congestive Heart Failure Decline with no reconsideration Connective Tissue Disease Decline with no reconsideration Coronary Artery Bypass (CABG) Decline with no reconsideration Coronary Artery Disease (CAD) Decline with no reconsideration Crohn’s Disease Decline with no reconsideration CREST Syndrome Decline with no reconsideration Cushing’s Syndrome Decline – if current, or if below IC

requirements 1-year post surgery period + if stable

Cystic Fibrosis Decline with no reconsideration Dementia Decline with no reconsideration Diabetes, Insulin Dependent (IDDM)/ Type 1 Diabetes


Down’s Syndrome Decline with no reconsideration – if moderate to severe Decline – if below IC requirements

If Mild + post adolescence

Drug Abuse Decline – if current, or if below IC requirements

5-year full recovery period

Dwarfism Decline – up to adolescence Post adolescence + no associated impairments

Emphysema Decline with no reconsideration Encephalitis Decline with no reconsideration – if

cause is other than viral Decline – if current, or if below IC requirements

1-year full recovery period + if cause is viral

Fibromyalgia/Fibrositis Decline with no reconsideration Gaucher’s Disease Decline with no reconsideration Gender Identity Crisis Decline with no reconsideration Giantism Decline – if current, or if below IC period 3-year stability period post

surgery (tumour removal) Glomerulonephritis Decline – if current, or if below IC

requirements 1-year full recovery period

Guillan Barre Syndrome Decline – if current, or if below IC requirements


Heart Attack/Myocardial Infarction


Hemiplegia Decline with no reconsideration Hemochromatosis/Bronzed Diabetes


Hemophilia Decline with no reconsideration Hepatitis B Decline – if current, or if below IC


Hepatitis C Decline with no reconsideration Hepatitis Carrier Decline with no reconsideration

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HIV/AIDS Decline with no reconsideration Hodgkin’s Disease Decline – if current, or if below IC


Huntington’s Chorea Decline with no reconsideration Hydrocephalus Decline – if untreated & depending on

residuals

1-year recovery from surgery + depending on residuals

Investigations or Tests Ongoing, Awaiting Test Results/Diagnosis

Decline – Consider after final diagnosis has been made

Apply after final diagnosis or tests completed (with results)

Kidney, 1 previously removed Decline with no reconsideration Kidney Disease, Kidney Failure Decline with no reconsideration Leukemia Decline – if current, or if below IC


Lou Gehrig’s Disease (ALS) Decline with no reconsideration Lung, 1 previously removed Decline with no reconsideration - if

smoker or other co-morbid factors, or if cause is other than traumatic

If cause is traumatic + no co-morbid factors

Lupus, SLE Decline with no reconsideration Lyme Disease Decline – if current, or if below IC


Lymphomas Decline – if current, or if below IC requirements


Manic Depression/Bipolar Affective Disorder


Major Depression Decline – if below IC requirements 2-year stability period + post-adolescence + no suicidal attempt or ideation

Marfan’s Syndrome Decline with no reconsideration Memory Loss/Memory Deficit Disorder

Decline with no reconsideration - if cause is other than traumatic

If cause is traumatic

Multiple Sclerosis (MS) Decline with no reconsideration Muscular Dystrophy Decline with no reconsideration Myalgic Encephalomyelitis Decline with no reconsideration Myasthenia Gravis Decline with no reconsideration Myocardial Infarction/Heart Attack


Nephrotic Syndrome Decline with no reconsideration Neurofibromatosis, Multiple – Dependant on Type


Obesity Decline with no reconsideration – if morbid obesity, or severely overweight with co-morbid risk factors

Underwrite – all others

Pacemaker (Artificial) Decline with no reconsideration Palindromic Arthritis Decline with no reconsideration Pancreatitis Decline – if current, or if below IC


Paraplegia Decline with no reconsideration Parkinson’s Disease Decline with no reconsideration Pemphigus Decline with no reconsideration Peripheral Vascular Disease Decline with no reconsideration Pick’s Disease Decline with no reconsideration Polycystic Kidney Disease Decline with no reconsideration Polycystic Ovarian Syndrome Decline with no reconsideration Polycythemia Decline with no reconsideration Polymyalgia Rheumatica Decline with no reconsideration - if

moderate to severe Decline - if below IC requirements

If mild + 5-year stability period with use of appropriate medication

Polymyositis Decline with no reconsideration Pre-Mature Birth with Complications

Decline – if below IC requirements 2-year full recovery period

Pulmonary Fibrosis Decline with no reconsideration Psoriatic Arthritis Decline with no reconsideration Quadriplegia Decline with no reconsideration Renal Artery Stenosis Decline with no reconsideration

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Rheumatoid Arthritis Decline with no reconsideration Sarcoidosis Decline with no reconsideration Schizophrenia Decline with no reconsideration Scleroderma (Systemic) Decline with no reconsideration Sclerosing Cholangitis Decline with no reconsideration Senile Dementia Decline with no reconsideration Sex Change Decline – if below IC requirements 2-year post surgery period + no

residual issues Sickle Cell Disease Decline with no reconsideration Spina Bifida Decline - depending on severity &

residuals [N.B. GENERALLY DECLINED]

Depending on severity & residuals

Spinal Cord Disorder/Spinal Cord Injury


Stroke Due to Vascular Disease Decline with no reconsideration - if due to vascular disease Decline – if below IC requirements

If other than cardiovascular cause +2-year full recovery period

Suicide Attempt Decline – if below IC requirements 5-year full recovery period + Depending on cause & health status + post adolescence

Surgery – Pending or Scheduled Decline – Consider after surgery & recovery

Depending on type of surgery

Tetralogy of Fallot Decline with no reconsideration Thalassemia Major Decline with no reconsideration Transient Ischemic Attack (TIA)/Mini Stroke


Transplant (Major Organs, e.g. lung or kidney)

Decline with no reconsideration - if recipient

If donor + no other risk factors

Tuberculosis Decline – if current, or if below IC requirements

6-month full recovery period after treatment is completed

Wilson’s Disease Decline with no reconsideration

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Individual Health & Dental Underwriting Build Table Important Notes:

i. This table applies only to underwritten Health & Dental insurance applications. ii. Underweight applicants are assessed on an individual basis. If insurable, a substandard

premium rating may be applied. iii. Applicants whose weight exceeds the MAXIMUM STANDARD WEIGHT may be offered coverage

with a substandard premium. iv. Applicants whose weight exceeds the MAXIMUM SUBSTANDARD WEIGHT will be declined. v. Other medical risk factors may warrant an exclusion, rating or decline. vi. Height and weight for children are assessed on an individual basis.

For ½ inches, round up to the nearest inch - Example: 5’ 6 ½” = 5’ 7” For ½ pounds, round up to the nearest pound - Example 177 ½ lbs = 178 For centimeters between bands, round up to next higher band

HEIGHT MAXIMUM STANDARD

WEIGHT

MAXIMUM SUBSTANDARD

WEIGHT HEIGHT

MAXIMUM STANDARD WEIGHT

MAXIMUM SUBSTANDAR

D WEIGHT

Feet & Inches

Pounds Pounds Centimetres Kilograms Kilograms

4'9" 160 190 145 72 86

4'10" 166 197 147 75 89

4'11" 172 204 150 77 92

5’0” 178 211 152 80 95

5’1” 184 218 155 83 98

5’2” 190 225 157 86 101

5’3” 196 233 160 88 105

5’4” 202 240 163 91 108

5’5” 209 248 165 94 112

5’6’ 215 256 168 97 115

5’7’ 222 263 170 100 118

5’8’ 229 271 173 103 122

5’9” 236 279 175 106 126

5’10” 242 288 178 109 130

5’11” 249 296 180 112 133

6’ 257 304 183 116 137

6'1” 264 313 185 119 141

6’2” 271 322 188 122 145

6’3” 278 330 191 125 149

6’4” 286 339 193 129 153

6’5” 294 348 196 132 157

6'6" 301 357 198 135 161

6'7" 309 367

201 139 165

Manulife reserves the right to change the above table

new business and underwriting guide individual health ... · new business and underwriting guide ....

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