advisor guide sun retirement health assist€¦ · design, sun life financial is able to offer a...

HEALTH INSURANCE | Long term care

Sun RHA overview:

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ADVISOR GUIDE

SUN RETIREMENT HEALTH ASSIST

ADVISOR USE ONLY

Life’s brighter under the sun

SUN RETIREMENT HEALTH ASSIST – ADVISOR GUIDE 1

Sun Retirement Health Assist is a long term care insurance solution focused on planning for the health risks associated with later retirement and the realities of aging.

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

With Sun Life Financial, you’re working with Canada’s leading LTCI product and a market leader with experience paying over $36.9 million in claims.2

As you build and review retirement income plans for clients, it’s important to help them recognize and consider their future health care needs and the impact their choices and expectations will have on their plans. Long term care insurance can help with financial protection for their plans and the means to pay for the level of care they want and expect.

What is the LTCI target market?

TheLTCIsolutioncanfitwithinthefinancialplanofanumberofdifferenttargetmarkets.Thesearebestsegmentedbythefollowinglifestages:

Planningforretirement Closetoretirement Retirees

TheLTCIproductoptionsavailablewillbedifferentforeachmarketandfitintotheirplanningdifferently.

TheLTCIproductsavailablefromSunLifeFinancialincludeSunLongTermCareInsuranceandSunRetirementHealthAssist.Theseproductoptionsfitintoplanningforeachtargetmarketdifferently.

This guide contains the information you need to:

understandSunRetirementHealthAssist(SunRHA) successfullyselltherightplan,and helpclientsmanagetheirpolicy.

ProductinformationinthisguidereferstopoliciesavailableforsaleafterDecember6,2013.

Inthisguide,the symbolisusedtoidentifyaSunLifeFinancialcompetitiveadvantage.Pleaserefertopage25forasummaryofthesecompetitiveadvantages.

1 Statistics Canada, 2012. 2 Life Insurance Marketing Research Association (LIMRA), December 2013; Sun Life Financial, December 2013.

At birth...

theaveragelifeexpectancyofaCanadianmaleis78years.Overnineofthoseyearsareexpectedtobewithadiminishedqualityoflife.1

theaveragelifeexpectancyofaCanadianfemaleis83years.Justover14ofthoseareexpectedtobewithadiminishedqualityoflife.1

0 20 40 60 80 100

Male

Onset of health impairment

Age

Female


Product at a glance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Product details . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Issueages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Howwedeterminedependency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7DEFINITION:Activitiesofdailyliving. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8DEFINITION:Assistivedevices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Plan details . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Benefittype. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Weeklybenefitamount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Waitingperiod. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Benefitperiod. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Plan features (automatic and optional) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Inflationprotection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Waiverofpremium. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Returnofpremiumondeath(ROPD). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

LifestageCare™ services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Applying for a Sun RHA policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Residencyrequirements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13Backdating. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13Ownershiprules. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Whoreceivespayment.............................................................. 14Completingtheapplication. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Payments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Underwriting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Underwritingevidencerequirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Riskclasses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Typesofunderwritingdecisions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Premium details . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Premiumfrequency–monthlyorannually. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Withdrawablepremiumfund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Premiumpaymentoptions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Premiumguarantee. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Whenwewaivepremiums. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

CONTENTS


Issuing a Sun RHA policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Policydate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Whentheinsurancecomesintoeffect. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Plan changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Changingcoverageoptions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Terminatinganoption. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Conversions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Internalreplacements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Reinstatements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Making a claim for Sun Retirement Health Assist benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Whentomakeaclaim. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Howtomakeaclaim. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Exclusionsandlimitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23Tipsforanefficientclaimsprocess. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Taxation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Competitive advantages – summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Where to go for more information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27


PRODUCT AT A GLANCE

PLAN DETAILS

PLAN DETAILS

Coverage Anincome-stylebenefitwhentheinsuredpersonisdependent.It’sdesignedtohelpcoverthecostofcareservicesinanyenvironment,1including:

apersonalresidence, aretirementhome,or along-termcarefacility.

1Wewon’tpaybenefitswhentheinsuredpersonisoutsideCanadaortheUnitedStatesformorethaneightconsecutiveweeks.

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,weconsiderthemdependentwhentheyalsorequiresubstantialphysicalassistancetoperformoneoftheotheractivitiesofdailyliving.

Issue ages 45-71

Benefit amounts Minimumweeklybenefit:$500 Maximumweeklybenefit(forallLTCIcoverageononelifeinsured):$2,300

Benefit period Unlimited

Coverage effective date

Thecoverageeffectivedateisthedatefromwhichaclaimforbenefitsmaybesubmitted;itisshowninthepolicyandisthelaterof:

fiveconsecutivepolicyyearsfromthepolicydate,orthepolicyanniversaryimmediatelyfollowingtheinsuredperson’s65thbirthday.

Waiting periods 365days(oneyear)or 730days(twoyears)Thewaitingperiodisthelengthoftimetheinsuredpersonmustbecontinuouslydependentafterthecoverageeffectivedateandbeforeaclaimwillbepaid.

Premium payment period

Premiumsarepayableforthelifetimeofthepolicy(untilthepolicyanniversaryfollowingtheinsuredperson’s100thbirthday).


FEATURES (Automatically included)

Inflation protection Whiletheweeklybenefitispayable,weincreasetheweeklyamountby3%oneachpolicyanniversary–thedatethepolicybecameeffective.

Automatic Return of premium on death (ROPD)

Iftheinsuredpersondiesbeforethecoverageeffectivedate,we’llpaythereturnablepremiumamounttotheROPDbeneficiarynamedinwriting,orifnonearenamed,theownerofthepolicy,ortheirestate.

Thereturnablepremiumamountisthesumofallpremiumspaidforthepolicy,minusanyunpaidpremiumsplusinterest.

Premium guarantee Thepremiumwon’tchangeforthefirstfivepolicyyears.Afterthisperiod,wemayincreaseordecreasethepremiumonapolicyanniversary.Ifwechangethepremium,wewilltellthepolicyownerinadvance,andthatpremiumisguaranteedforatleastanotherfivepolicyyears.

Waiver of premium Whenweapproveaclaimforbenefitsontheinsuredperson,wewaivepremiumsforthepolicy.Thepremiumsmustbepaiduntilwenotifythepolicyownerthatwe’veapprovedtheclaim.

LifestageCare™ services (non-contractual feature)

Includesaccesstoamembers-onlywebsiteandtoll-freetelephonesupportservice–anational,bilingualservice,available24hoursaday,sevendaysaweek.Offersunbiasedinformationaboutlocal,qualifiedhealthcareandpersonalcareprovidersthatmeetstheirindividualandfamilyneeds,ateverystageoflife.LifestageCareiscurrentlyavailabletonewandexistinglongtermcareinsurancepolicyownersofSunLifeFinancial.It’snotaguaranteedfeatureoftheproductandmaybewithdrawnatanytime.

ADDITIONAL OPTION

Optional Return of premium on death (ROPD)

Iftheinsuredpersondieswhilethepolicyisineffect,we’llpaythereturnablepremiumamounttotheROPDbeneficiarynamedinwriting,orifnonearenamed,theownerofthepolicy,ortheirestate.Thereturnablepremiumamountiscalculatedonthedatetheinsuredpersondies.It’sthetotalof:

allpremiumspaidforthispolicy, minusanyunpaidpremiumsplusinterest, minusanybenefitpaymentswemade.

LifestageCare is a trademark of TakingCare Inc.


SunRetirementHealthAssist(SunRHA)providesanincome-stylebenefitwhentheinsuredpersonisdependent.Ithelpscoverthecostofcareoveralengthyperiodoftime,providingthepeaceofmindthatcomeswithknowingthatthefinancialburdenofcarewon’trestentirelywithlovedones.

SunLifeFinancialoffersthefollowingstand-aloneplandesignforsinglelives:

Apermanentinsurancepolicythatprovidesprotectionfortheinsuredperson,afterthecoverageeffectivedate,whentheinsuredpersonmeetstherequirementstoqualify.


ThecoverageeffectivedateisuniquetoSunRHA.Itisthedatefromwhichaclaimforbenefitsmaybesubmitted.

Itisthelaterof: fiveconsecutivepolicyyearsfromthepolicydate,or thepolicyanniversaryimmediatelyfollowingtheinsuredperson’s65thbirthday.Ifthepolicy

anniversaryisthesamedayastheinsuredperson’s65thbirthday,thenthecoverageeffectivedateistheinsuredperson’s65thbirthday.

Forallplans,coveragewillendwhentheinsuredpersondiesorwhenthepolicyiscancelled.*

ThecoverageeffectivedateisanimportantpartoftheplandesignforSunRHA.Becauseofthisdesign,SunLifeFinancialisabletoofferasimplifiedapplicationandunderwritingprocess,withthegoalofofferingthisimportanthealthinsurancesolutiontoabroadertargetmarket.

TheSunRHAapplicationisshorterthanthetraditionalapplicationforlongtermcareinsurance,andtheturnaroundtimeforissuingapolicyisfaster.Inmostcases,whilecompletingtheapplication,youwillknowwhetheryoushouldsubmitit,orwhetheryoushouldconsiderotheroptionsfortheclient.

Scenario 1

PolicydateisDecember10,2013

Insuredperson’sdateofbirthisNovember28,1968(age45)

ThecoverageeffectivedatewillbeDecember10,2033,becausethisistheanniversaryfollowingthe65thbirthday.

Scenario 2

PolicydateisDecember10,2013

Insuredperson’sdateofbirthisNovember28,1948(age65)

ThecoverageeffectivedatewillbeDecember10,2018,thefifthpolicyanniversaryfromthepolicydate.Theinsuredpersonwillbe70yearsoldatthattime.

PRODUCT DETAILS

* The policy may end for other reasons as described on page 23 of this guide.


Issue ages Ages45-71

Theissueageisbasedontheproposedinsuredperson’sageatthetimeoftheapplication.Forexample,iftheproposedinsuredpersonis55yearsandsevenmonths,theirinsuranceageis55.

How we determine dependency Theinsuredpersonisdependentwhenwe’vedeterminedthroughobjectivemeasuresthattherearefunctionallimitationsforeitherdeterioratedmentalability(cognitiveimpairment)oractivitiesofdailyliving,includingstand-byassistanceforbathingandtransferring,asdescribedbelow.

Deteriorated mental ability (cognitive impairment)

Theinsuredpersonisdependentwhentheyneedconstantsupervisionforprotectionfromthreatstotheirphysicalhealthandsafetyastheresultofdeteriorationinoralossof:

short-orlong-termmemory, orientationasitrelatestopeople,placeandtime, reasoning,or judgmentasitrelatestosafetyawareness.

DeterioratedmentalabilitymustresultfromanorganicbraindisordersuchasAlzheimer’sdisease,irreversibledementia,orbraininjury.ThediagnosismustbemadebyaspecialistlicensedandpractisinginCanadaortheUnitedStatesbasedon:

clinicalexamination, radiologicalstudies,and psychologicaltesting.

Activities of daily living (ADL)

Theinsuredpersonisdependentwhentheyrequiresubstantialphysicalassistance,withorwithoutassistivedevices,tosafelyandcompletelyperformtwoormoreactivitiesofdailyliving.Activitiesofdailylivingincludebathing,dressing,toileting,transferring,continenceandfeeding.

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


DEFINITION: Activities of daily living (ADL)

Bathingmeanswashingwithorwithouttheaidofassistivedevices:

inabathtuborshower,includinggettinginandoutofthebathtuborshoweror byspongebath.

Bathingdoesn’tincludetheabilitytoreachandwashthebackorfeet.

Dressingmeansputtingon,takingoff,fasteningandunfastening,withorwithouttheaidofassistivedevices:

clothingand medicallynecessarybracesorartificiallimbs.

There’snodependencyifreasonablealterationstoorchangesintheclothingtheinsuredpersonusuallywearswouldletthemdresswithoutsubstantialphysicalassistance.

Toiletingmeansgettingtoandfromandonandoffthetoilet,withorwithouttheaidofassistivedevices,andperformingassociatedpersonalhygiene.

Transferringmeansmovingintooroutofabed,chairorwheelchair,withorwithouttheaidofassistivedevices.

Continencemeanstheabilitytocontrolbothbladderandbowelfunctionsormaintainareasonablelevelofpersonalhygiene(includingcaringforcatheterorcolostomybag)whennotabletocontrolbowelorbladderfunctions.

Feedingmeanstheabilitytogetfoodintothebody,withorwithouttheaidofassistivedevices,throughthemouthorbyfeedingtube.Feedingdoesn’tincludecookingorpreparingameal.

Stand-by assistance for bathing and transferring

Theinsuredpersonisalsodependentwhentheyrequirestand-byassistanceforbathingandtransferring.Stand-byassistancemeansanotherpersonmustalwaysbewithinarm’sreachoftheinsuredpersonsotheymaysafelyandcompletelyperformtheactivitiesofbathingandtransferring.

– competitive advantage

Iftheinsuredpersonrequiresstand-byassistanceforonlyoneofbathingortransferring,weconsiderthemdependentwhentheyalsorequiresubstantialphysicalassistancetoperformoneoftheotheractivitiesofdailyliving.

DEFINITION: Assistive devices

Assistivedevicesareaidsthatwedeterminecouldbeusedtoimprovetheinsuredperson’sfunctioning.Theseincludeadjustablebeds,buttonhooks,canes,crutches,grabbars,handheldshowerheads,bathbrushes,seatlifts,transferbenches,walkersandwheelchairs.Ifusinganassistivedeviceallowstheinsuredpersontoperformanactivityofdailylivingsafelyandcompletely,theinsuredpersonisnotdependentforthatactivity.


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

Scenario: not dependent

JimpurchasedaSunRHApolicyforhimself,witha365-day(oneyear)waitingperiodwhenhewas48yearsold.

Herecentlyhadhipreplacementsurgerywhenhewas67yearsold.

Duetobendingrestrictionsafterthesurgery,herequiredassistanceforbathinganddressingfor90days.

Becauseofthe365-day(oneyear)waitingperiod,herecoveredbeforethewaitingperiodwasmet.Hewillnotqualifyforbenefits,eventhoughthecoverageeffectivedatewasmet.

Scenario: dependent

TheinsuredpersonpurchasedaSunRHApolicywitha365-day(oneyear)waitingperiodwhenshewas62.

At76shesuffersastrokeandneedsassistanceforbathing,dressing,feeding,toileting,transferringandcontinence.

Thephysicalimpactofherstrokeisexpectedtolastlongerthanthe365-day(oneyear)waitingperiodandwilllikelybepermanent.

Becauseshehasmetthecoverageeffectivedate,theclaimcanbesubmittedimmediately.Ifthedependencycontinuesbeyondtheoneyearwaitingperiod,shewillqualifytobeginreceivingbenefitsatthattime.

SUN RETIREMENT HEALTH ASSIST – ADVISOR GUIDE

Benefit type Wepayaweeklyincome-stylebenefittothepolicyownerwhentheinsuredpersonqualifiesforit.Theclaimantdoesn’tneedtosubmitreceiptsforservicestoreceivethebenefitoncetheinsuredpersonqualifiesforthebenefit.Thepolicyownercanusethemoneyhowevertheychoose.

Weekly benefit amount Thebenefitiscalculatedweeklyandpaidmonthly.

Minimum weekly benefit amount: $500Maximum weekly benefit amount (for all LTCI coverage on one insured person): $2,300

Waiting period Thewaitingperiodisthelengthoftimetheinsuredpersonmustbecontinuouslydependentafterthecoverageeffectivedateandbeforeaclaimwillbepaid.

Iftheinsuredperson’sdependencybeginsafterthecoverageeffectivedate,thewaitingperiodstartsonthedatetheyfirstrequireassistancefortwoormoreactivitiesofdailylivingorthedatetheyfirstrequirecontinualsupervision.Iftheinsuredperson’sdependencybeginsbeforethecoverageeffectivedateanditcontinues,thewaitingperiodstartsonthecoverageeffectivedate.Therearetwooptionstochoosefrom:

365days(oneyear) 730days(twoyears)

Benefit period Thebenefitperiodisthelengthoftimewemaypayaclaim.

Unlimited

Thebenefitperiodisunlimited.Thismeansaclaimcanbepaidindefinitelyaslongastheinsuredpersonisaliveandcontinuestobedependentasdefinedinthecontract.

PLAN DETAILS


10


Inflation protection Sun RHA automatically includes inflation protection.Weincreasetheweeklybenefitamountbythreepercentoneachpolicyanniversarywhenbenefitsarebeingpaid.Increaseswillbecompoundedannuallyandroundedtothenearestdollarandtherearenocapsonincreases.

Waiver of premiumWhenweapproveaclaimforbenefitsontheinsuredperson,wewaivepremiumsforthepolicy.Thepremiumsmustbepaiduntilwenotifythepolicyownerthatwe’veapprovedtheclaim.

Return of premium on death (ROPD)

Automatic ROPD Optional ROPD

What is it?

SunRHAautomaticallyincludesareturnofpremiumondeath.ThismeanstheROPDwouldbeautomaticallypayableiftheinsuredpersondiesbeforethecoverageeffectivedate.

OptionalROPDmaybeaddedtothecoverageatthetimeofapplication.

Thisadditionaloptionextendsthereturnofpremiumondeathbeyondthecoverageeffectivedate.

The insured person dies BEFORE the coverage effective date

The insured person dies ON or AFTER the coverage effective date

Thereturnablepremiumamountispayabletothe:

ROPDbeneficiary, ownerofthepolicy,or theirestate.

ThisROPDisautomaticallyincludedinthepolicy.

IftheoptionalROPDisincludedonthepolicythereturnablepremiumamountispaybletothe:

ROPDbeneficiary, ownerofthepolicy,or theirestate.

IfthepolicydoesnotincludetheoptionalROPD,anypremiumspaidarenotreturned.

Returnable premium amount =

thesumofallpaidpremiums

minus

anyunpaidpremiums+interest

thesumofallpaidpremiums

minus

anyunpaidpremiums+interest

minus

benefitpaymentsmade

PLAN FEATURES (AUTOMATIC AND OPTIONAL)



Fromthemomentthepolicyisissuedandaslongasitremainsinforce,thepolicyownerhasimmediateandunlimitedaccesstothevaluableresourcesprovidedthroughLifestageCareservices.

LifestageCareiscurrentlyavailabletonewandexistinglongtermcareinsurancepolicyownersofSunLifeFinancial.Itisnotaguaranteedfeatureoftheproductandmaybewithdrawnatanytime.

Accessing LifestageCare

Thepolicyownercanaccessthisuniqueserviceimmediatelyafterthepolicyisissuedandwithouthavingtomakeaclaim,aslongasthepolicyremainsinforce.LifestageCareservicesareforthepolicyowner’spersonalusebutcanalsobeusedtohelpanyfamilymember.

AccessingLifestageCareiseasy–logintotheLifestageCarewebsiteorcallthetoll-freenumber.Thelongtermcareinsurancepolicynumberistheclientidentifier.

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

Expert advice. Specific information. Confidential service.

LifestageCareisamembers’-onlywebsiteandtoll-freetelephonesupportserviceavailabletolongtermcareinsurancepolicyownerswithSunLifeFinancial.

Expert–expertagentsareavailable24hoursaday,sevendaysaweektoanswerquestionsbyphoneoremail

Specific–helpsplanforandmanagefamilycareresponsibilitiesandfindresourcesbasedonspecificrequirementsandpostalcode;theinformationreceivedismatchedspecificallytotheindividual’sneeds

Confidential–acomplete,unbiasedservice;anyinformationprovidediskeptstrictlyconfidential

LIFESTAGECARE™ SERVICES


LifestageCare is a trademark of TakingCare Inc.


Care resources for the policy owner and their family

LifestageCarefocusesontheinformationandsupportneededtoprovidethebestcareforthewholefamily.Theserviceallowsthepolicyownerandtheirfamilytoquicklyandeasily:

Findacompleterangeofqualifiedlocalprofessionals,carefacilitiesandhealthcareresourcesanywhereinCanada.

Determinewhathomecare,rehabilitationtreatment,educationalandresidentialserviceswillcost.

Obtainprofessionaladviceongeriatriccareandcareforteensandchildrenincludingresourcesforspecialneeds.

Readsimpleexplanationsoftreatmentoptions.

Findtherightquestionstoaskwhenchoosingaprofessionalcaregiver.

Stayinformedaboutmultiplegovernmentfinancialassistanceprograms.

Residency requirements ForSunRHA,wecanonlyconsiderapplicantswhoareCanadiancitizensandthosewhohavepermanentresidentstatus.SunRHAisnotavailabletonon-landedimmigrantsorthosewhohaveatemporaryworkvisaorstudentvisa.

Therearenoexceptionstothisrequirement.

BackdatingWepermitbackdatingtosaveage,uptoamaximumofthreemonths.

Backdatingisonlypermittedtoreducepremiumsasaresultofthelowerissueage.Apolicycan’tbebackdatedtoapplyforcoveragethatwouldotherwisebeunavailable.

Forexample,wecan’tbackdatetoage71toapplyforaSunRHApolicy.

Ifapolicyisbackdatedtoretainage,evidencerequirementsarebasedontheproposedinsuredperson’sactualageatthetimetheapplicationissubmitted.Forexample,iftheclientturned60inthelastthreemonths,theycanbackdatetoretainage59ratesbuttheevidencerequirementswouldbebasedontheiractualageof60.

APPLYING FOR A SUN RHA POLICY


Ownership rules

When the owner(s) and insured are not the same:

Owner Insured person Example

Individualperson Individualperson(differentfromtheowner)

Husbandownsthepolicy;wifeistheinsuredperson

Adultchildownsthepolicy;fatheristheinsuredperson

Corporation Individualperson Corporationownsthepolicy;keyemployeeistheinsuredperson

Contingent ownership

Theownercanappointacontingentowneratthetimeofapplication.

ThenameofthecontingentownermustbeincludedintheSpecialInstructionsintheAdvisorStatementsectionofthepaperapplication.IfthecontingentownerisnotspecificallyindicatedinSpecialInstructions,thepolicywillbeissuedwithoutacontingentowner.

Tomakethechangeafterthepolicyhasbeenissued,submitformE28–Contingent owner change form.

Transferring ownership

Thepolicyownermaytransferownershiptoanotherperson.Transferringownershipisalsoknownasabsoluteassignmentandcouldhavetaximplications.

Theremaybetaxconsequencesifthetransferisfromacorporationtoashareholder,toanothercorporationorunincorporatedbusiness,orfromanunincorporatedbusinesstoanowneroremployee.

TherolloverrulesintheIncomeTaxAct(Canada)thatpermittax-freetransfersoflifeinsurancepoliciesincertaincircumstancesdon’tapplytoLTCIpolicies.

Totransferownership,completeformE82–Assignment of policy absolute (transfer of ownership).

Who receives payment

Claim payment

Theweeklybenefitispaidtothepolicyownerorthepolicyowner’sestate.


TheROPDbeneficiarycanbedesignatedwhencompletingtheapplication.ThenameofthebeneficiarymustbeincludedintheSpecialInstructionssectionoftheapplication.Indicatethefullname(s)oftheROPDbeneficiary(ies)(withapercentage,ifapplicable),therelationshiptotheinsuredpersonforCommonlawpolicies(orpolicyownerforQuebec),andifnamingaspouse,indicatewhethertheappointmentisrevocableorirrevocable.


Ifthisisn’tspecifiedontheapplication,theROPDbeneficiarywillbetheownerorestateoftheowner.

FuturechangescanbesubmittedinwritingtoSunLifeFinancial’sheadoffice.Therequestmustincludethepolicyowner’sname,policynameandnumberandnewbeneficiaryappointment(asabove).Therequestmustbesignedanddatedbythepolicyowner.Ifthebeneficiarywasirrevocabletheymustalsosigngivingtheirconsenttothechange.

Completing the application

CompletetheSunRetirementHealthAssistpaperapplication,form4535-E(English)or4535-F(French),availableonwww.sunlife.ca/advisororfromyourRegionalSalesDirector.Pleaserefertotheinstructionsonthefrontcoveroftheapplication.

PleasesubmittheoriginalcopytoSunLifeFinancialthroughyourMGAorNationalAccountofficeorbackoffice.

Supportingdocumentsyoumaywishtoincludeare:

Illustration, Coveringletterormemowithdetailsofthesale.

Oncetheapplicationisreceived,itwillbeassignedtoanunderwriter.Applicationstatuscanbecheckedonwww.sunlife.ca/advisor.Ifyouneedassistance,pleasecallourAdvisorServiceCentreat1800-800-4SUN(4786).

PaymentsDependingonthepremiumfrequencychosenbytheclient,paymentscanbemadeonamonthlybasisthroughourpre-authorizedchequing(PAC)processorannuallybycheque.

IfPACischosen,monthlypaymentsaredeductedautomaticallyfromthepayor’sbankaccountandappliedtothepremiumowing.Monthlypremiumsarecalculatedbymultiplyingtheannualpremium(includingthe$50policyfee)by0.09(themodalfactor).

Forexample,aSunRHApolicywithanannualpremiumof$3,000willhaveamonthlypremiumof$270.Monthlypremium:$3,000x.09=$270

Ifthepolicyownerchoosestopayannuallybycheque,paymentscanberemittedtoSunLifeFinancial’sheadofficebeforethepolicyanniversarydate.Anannualstatementissenttotheownerapproximatelythreeweeksbeforethepolicyanniversary,remindingthemthattheirannualpremiumisdue.


UNDERWRITING

TheunderwritingprocessforLTCIevaluatestheriskofaproposedinsuredpersonbecomingdependentonanotherpersonfordailyassistance.TheunderwritingrequirementsforLTCIdifferfromthoseoflifeinsurance,whichevaluatestheriskofdeath,andcriticalillnessinsurance,whichevaluatestheriskofbeingdiagnosedwithspecificcoveredconditions.

Inparticular,SunRHAisdesignedtoprovideasimpleapplicationandunderwritingprocess.Theevidencequestionsinthepersonalhistorysectionoftheapplicationhelpidentifyexistinghealthconditionsthatrepresentthehighestriskforclaims.Theapplicationiseitherapprovedordeclined.OnceSunLifeFinancialdeclinesanapplication,thedecisionisusuallyfinal.

Theevidencequestionscoverthefollowingcategories:residency,heightandweight,andanysignificantphysicallimitations,suchastheuseofassistivedevicesortheneedforassistanceorsupervisiontoperformanactivityofdailyliving.Italsocoverscertainchronichealthconditionssuchasmultiplesclerosisanddiabetes;anditcoverssmokingstatus,whichrelatestocertainhealthconditionssuchaschronicrespiratorydisordersandlegulcers.

Onlystandardratesapply,andtherearenoratings,exclusionsormodifiedoffers.Unlikeothertypesofinsurance,smokingstatusdoesnotaffectthepremium,butitmayaffectinsurability.

Underwriting evidence requirementsEvidencerequiredtounderwriteSunRHAwilldependontheageoftheproposedinsuredperson.

Plan type Sun RHA

Ages 45 - 59 60 - 71

Requirements Application Application Memoryexercise

The health interview/The memory exercise (810-3852)willhelpyouprepareeachclientforthememoryexerciserequiredforSunRetirementHealthAssist.

Risk classes Male Female


Types of underwriting decisions

PREMIUM DETAILS

Approved Declined

BecauseSunRHAwasdesignedforasimplifiedapplicationprocess,theresultingunderwritingprocessisalsomuchmoresimplifiedthanatraditionalapplicationforLTCI.Oncetheapplicationisreceived,thereareonlytwopossibleoutcomes:theapplicationmayeitherbeapprovedordeclined.Whenwedeclineanapplication,reconsiderationofthedecisionisgenerallynotpossible.

AllpremiumsmustbepaidinCanadianfundsanddrawnfromanaccountataCanadianfinancialinstitution.

Premium frequency – monthly or annually

Monthly payments

Ifthepolicyownerchoosestopaymonthlybypre-authorizedchequing(PAC),monthlypaymentsaredeductedautomaticallyfromthepayor’sbankaccountandappliedtothepremiumowing.Monthlypremiumsarecalculatedbymultiplyingtheannualpremium(includinga$50policyfee)by0.09(themodalfactor).

Example:

ASunRetirementHealthAssistpolicyfora50-year-oldwomanwithanannualpremiumof$3,000willhaveamonthlypremiumof$270.

Monthlypremium:$3,000x.09=$270

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 Premiumsarepayableforthelifetimeofthepolicyuntilthepolicyanniversaryfollowingthe100thbirthdayoftheinsuredperson,atwhichtimethepolicyisconsideredtobepaidupandnofurtherpremiumsareowed.

Premium guarantee ThepremiumshownonthePolicysummarywon’tchangeforthefirstfivepolicyyears.Afterthisperiod,wemayincreasethepremiumonapolicyanniversary.Ifwechangethepremium,we’lltellthepolicyownerinadvanceandthatpremiumisguaranteedforatleastanotherfivepolicyyears.

Anypremiumchangeisbasedontheinsuredperson’sageonthepolicydate.Wedon’tconsidertheinsuredperson’shealthwhenwemakeapremiumchange.

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

When we waive premiumsWhenweapproveaclaimforbenefits,wewaivepremiumsforthepolicy.Thepremiumsmustbepaiduntilwenotifythepolicyownerthatwe’veapprovedtheclaim.



Policy dateThepolicydateindicatedinthepolicyisthestartdateofthatpolicy.

Thepolicydateisthedatethepolicyisissued,ortheretainedagedateifrequested. Thepolicydateisusedtodeterminethecoverageeffectivedate definedbelow.

Pleaserefertotheadvisorsiteformoredetailsonpolicydeliveryrequirements.

When insurance comes into effect – the coverage effective dateASunRHApolicyprovidesbenefitsafterthecoverageeffectivedate.

Thecoverageeffectivedateindicatedinthepolicyisthelaterof:

fiveconsecutivepolicyyearsfromthepolicydate,or thepolicyanniversaryimmediatelyfollowingtheinsuredperson’s65thbirthday.

Changing coverage options Thereareavarietyofchangespossibleincluding:

decreasingtheweeklybenefitamount, lengtheningthewaitingperiod,and changingthepremiumpaymentfrequency.

TorequestanyofthesechangesuseformE220–Change form – Long term care insurance.

Wedeterminetheminimumbenefitamountthatmustremainineffect.

Terminating an option It’spossibletoterminateanoption,suchasOptionalReturnofpremiumondeath.

TorequestthisuseformE220 – Change form – Long term care insurance.

Conversions SunRHAdoesn’thaveanyconversionoptions.

Internal replacements Aninternalreplacementallowsforaplanchangeoutsideofthecontractualright.Undermostcircumstances,evidenceofinsurabilitymustbesubmittedforinternalreplacements.Anewapplicationisalwaysrequired.Quebecspecific-InQuebec,advisorsmustfollowthereplacementprocedure.

ISSUING A SUN RHA POLICY

PLAN CHANGES


Examplesofinternalreplacementsinclude:

increasingthebenefitamount, shorteningthewaitingperiod,and addingoptionalReturnofpremiumondeath(ROPD).

Reinstatements Therequiredpremiumsforthepolicymustbepaidbytheduedate.Ifpremiumsarenotpaidwhendue,wewillwithdrawtheunpaidpremiumfromthewithdrawablepremiumfundifithassufficientfunds.

Thepolicywillendif:

premiumsarenotreceivedbeforetheendofthe31stdayaftertheyaredue,and thereareinsufficientfundsinthewithdrawablepremiumfund.

Ifthepolicyendsthisway,it’scalledalapse.Ifthepolicyendedbecauseitlapsed,thepolicyownercanapplytohaveitputbackintoeffect(reinstated)iftheinsuredpersonisalive.

Toreinstatethepolicy,thepolicyownermust:

applywithintwoyearsofthedatethepolicyended, providenewevidenceofinsurabilitythatweconsidersatisfactory,and makeapaymentequaltothereinstatementchargeweset.

Ifwedon’tapprovetheapplication,werefundtheamountpaidtoputthepolicybackintoeffect.

Reinstatement rules at a glance:

Number of days from the premium due date

Amount and type of insurance

Evidence requirements

Less than 62 Any None

62 to 180 Any Application for reinstatement, Sun Retirement Health Assist, form 4549

Greater than 180 Any Sun Retirement Health Assist, form 4549.and Usualunderwritingevidence,basedonattainedageatreinstatement

Becausethisisnotacontractualright,therulesforinternalreplacementsmaychange.


When to make a claimThepolicymustbeineffectonthedateaclaimissubmitted.Theinsuredpersonmustbecontinuouslydependentforlongerthanthewaitingperiodandtheconditionsdescribedundertheheading,How we determine dependencyaresatisfied.

We’llconsideralateclaimexceptionif:

wereceivetheclaimnolaterthanoneyearfromthedatetheinsuredpersonbecamedependent,and

theclaimantprovidesawrittenexplanationdescribingwhytheclaimislateandweagreetheexplanationisreasonable.

MAKING A CLAIM FOR SUN RETIREMENT HEALTH ASSIST BENEFITS

Dependency beginning before the coverage effective date

Iftheinsuredperson’sdependencycontinuesbeyondthe coverageeffectivedate,wemustreceiveaclaimassoonaspossibleandnolaterthan120daysafterthecoverageeffectivedate.Ifweagreetheinsuredpersonisdependent,wewillconfirmthedatethewaitingperiodstarts.Anyclaimreceivedafter120daysislateandwemaydeclineitwithoutassessingdependency.

Dependency beginning on or after the coverage effective date

Wemustreceiveaclaimwithin120daysofthestartoftheinsuredperson’sdependency.Ifweagreetheinsuredpersonisdependent,wewillconfirmthedatethewaitingperiodstarts.Anyclaimreceivedafter120daysislate,andwemaydeclineitwithoutassessingdependency.


How to make a claim

Step 1: Notify us

Contact us–Tomakeaclaim,theclaimantshouldcontactSunLifeFinancialusingthetollfreenumberlistedintheirpolicy.Thisnumberis1877-SUN-LIFE(786-5433).Wewillthensendtheappropriateclaimformtobecompleted.YoucancallIndividualClaimsServicestollfreeat1877-272-2020oremailltcclaims@sunlife.com.

Form–Thepersonmakingtheclaimmustcompletetheform(s)andgiveustheinformationweneedtoassesstheclaim.

TheinsuredpersonmustbeinCanadaortheUnitedStatesatthetimeaclaimismade.Iftheyaren’t,theymustreturntobeassessedbyaphysicianlicensedandpractisinginCanadaortheUnitedStates.

Beforeweapprovetheclaim,theinsuredperson’sdateofbirthmustbeverified.Ifit’sincorrect,we’lladjusttheamountwepaytoreflecttheinsuredperson’scorrectage.

Pay premiums–Policypremiumsmustcontinuetobepaiduntilweadvisethatwe’veapprovedtheclaim.

Send form–Theform(s)andinformationmustbesentto:

IndividualClaimsServices SunLifeAssuranceCompanyofCanada 227KingStS,POBox1601,StnWaterloo WaterlooONCanadaN2J4C5

Fees–Physiciansmaychargeafeetocompletecertainforms.Thepersonmakingtheclaimisresponsibleforanyfeesforthisinformation.

Step 2: Collection of medical information

Information we need–Theclaimantmustgiveustheinformationweneedtoassesstheclaim.Thisincludesourformwhichmustbecompletedbyaphysicianoranotherhealthcareprofessionalwedeemacceptable.Thephysicianmustdescribetheinsuredperson’smedicalcondition,limitationsandfunctionalabilitiesandprovideobjectivemedicalinformationabouttheirdependence.

Additional information–We’lladviseifweneedanyotherinformationtoassesstheclaim,whichcouldinclude:medicalrecords,clinicaltests,physiotherapyreports,psychologicaltestsandanyotherobjectivemedicalinformationthatsupportstheclaim.

Fees–Anyfeeschargedbyphysicianstocompleteformsorprovideinformationaretheclaimant’sresponsibility.


Doctors–Physicians,specialistsorhealthcarepractitionerswhoprovideinformationtousmustbelicensedandpractisinginCanadaortheUnitedStates.Theymaynotbethepolicyowner,insuredperson,anyoneentitledtomakeaclaimunderthispolicy,oranyrelativeorbusinessassociateofthesepeople.

Documentation by us–Wemayrequirethattheinsuredpersonisexaminedbyanappointedhealthcarepractitioner.Thesemaybelicensedphysicians,physiotherapists,occupationaltherapists,psychiatrists,psychologistsorothers.Wepayfortheseexaminations.Wemayalsorequiretheinsuredpersontoauthorizeustogatheranduseinformationfromotherinsurersorgovernmentagencies.

Step 3: Making the claims decision

Oncewereceiveallinformationneeded,we’llassesstheinformationandmakeadecision.Wecommunicatethisdecisionandpaythebenefittothepolicyownerortheestate,ifapplicable.

Ifwedenyaclaim,we’llsendaletterexplainingthedecisiontothepolicyowner.Ifthepolicyownerandtheinsuredpersonarenotthesameperson,we’llsendtwodeclineletters:

onelettertotheclaimant,fullyexplainingourdecision,and

asecondlettertothepolicyowner,confirmingourdenialoftheclaim.Forprivacyreasons,nomedicalinformationisgiventothepolicyowner.

TocontacttheIndividualClaimsServicesdepartment,RequestCentre–LTCIClaimInquiry:

Email: [email protected]: 1877-272-2020Fax:1866-487-4745

Exclusions and limitationsThepolicyendsandbenefitsarenotpayableiftheinsuredperson’sdependencystartedbeforethelaterof:

themostrecentdateanapplicationforthepolicywassigned, thepolicydateshownundertheheadingPolicysummary,or themostrecentdatethepolicywasputbackintoeffect,ifthepolicyhasbeenreinstated.

Wewon’tpaybenefitswhentheinsuredpersonisoutsideCanadaortheUnitedStatesformorethaneightconsecutiveweeks.Ifwe’vepaidbeyondtheeightconsecutiveweeklimitation,wehavetherighttodeducttheoverpaymentfromanyfuturebenefits.

Wewillnotpaybenefitsiftheinsuredperson’sdependencyisdirectlyorindirectlycausedbyorassociatedwiththeinsuredpersonoperatingavehiclewhiletheirbloodalcohollevelismorethan80milligramsofalcoholper100millilitresofblood.Avehicleincludesanyformofground,airormarinetransportationthatcanbeputintomotionbyanymeans,includingmuscularpower.Wedon’ttakeintoaccountwhetherornotthevehicleisinmotion.



Wewon’tpaybenefitsiftheinsuredperson’sdependencyisdirectlyorindirectlycausedbyorassociatedwiththeinsuredperson:

committingorattemptingtocommitacriminaloffence, attemptingtotaketheirownlife,regardlessofwhethertheinsuredpersonhasamental

illnessorunderstandsorintendstheconsequencesoftheiraction(s), causingthemselfbodilyinjury,regardlessofwhethertheinsuredpersonhasamentalillness

orunderstandsorintendstheconsequencesoftheiraction(s), intentionallytakinganydrugotherthanasprescribedbyalicensedmedicalpractitionerand

inaccordancewiththeinstructionsgiven,and/or intentionallytakinganyintoxicant,narcoticorpoisonoussubstance.Thisdoesn’tinclude

smokingcigarettes,cigarillos,cigars,chewingtobaccooroccasionaluseofalcohol.

Wewon’tpaybenefitsiftheinsuredperson’sdependencyisdirectlyorindirectlycausedbyorassociatedwithcivildisorderorwar,whetherdeclaredornot.

Tips for an efficient claims process Ensureyouunderstandtheclaimtriggersandthattheinsuredpersonmeetsthedefinition

ofdependenceasdefinedbythecontract.Thiswillhelpreduceineligibleclaims,setbetterexpectationsfortheinsuredpersonandreducepotentialexpenses.

Verifythecoverageeffectivedate andwaitingperiodsetoutinthepolicy.

Ensuretheformiscomplete,signedanddatedbeforeyousubmitit.You’llneedtoinclude: - thefulladdress(includingpostalcode)ofalldoctorstheinsuredpersonhasconsulted,and - thephonenumberofalldoctorstheinsuredpersonhasconsulted.

Verifytheinsuredperson’sdateofbirthandcheckitagainstthatshowninthepolicy.

It’simportantthatweobtainallmedicalreportsfromthephysiciantosupporttheclaim.Ifthereportsaren’tsenttous,wecan’tdoafullevaluation,whichwillcausedelays.


Therearenospecifictaxlawsgoverninglongtermcareinsurancepolicies.

BasedoncurrenttaxlawsandguidancefromtheCanadaRevenueAgency,weexpect:

Premiumspaidforalongtermcareinsurancepolicyownedbyanindividualorindividualswillnotbetaxdeductible.

Anycashbenefitspaidfromalongtermcareinsurancepolicywillbetax-freewhenthepolicyownerandbenefitpayeearethesame.

Ifthepolicyisownedbyacorporation,differenttaxlawsmayapplytosomecircumstances:

Premiumspaidforalongtermcareinsurancepolicyownedbyacorporationwillnotbetaxdeductible,exceptinstrictlylimitedcircumstancesthatarebeyondthescopeofthisguide.

Anycashbenefitspaidfromalongtermcareinsurancepolicywillbetax-freewhenthepolicyownerandbenefitpayeearethesame.

Paymentofanypartofthecashbenefitfromthecorporationoranunincorporatedbusinesstoanemployeeorshareholdercouldproducetaxconsequencesfortherecipient.

Sincelongtermcareinsuranceisnotlifeinsurance,nopartofthelongtermcareinsurancebenefitthatacorporationreceivescanbepaidtoitsshareholdersasatax-freecapitaldividend.

Ifthecorporationtransfersownershipofalongtermcareinsurancepolicytooneofitsshareholdersoremployees,theremaybetaxconsequencesfortherecipient.

Theforegoingisonlyageneralsummary.Consultataxprofessionalformoreinformation.FormoreinformationconsulttheCanadianHealthInsuranceTaxGuide:www.sunlife.ca/advisor/HealthTaxGuide

TAXATION

SUN RETIREMENT HEALTH ASSIST – ADVISOR GUIDE


Thisuniqueapproachmeanswecanofferasimplifiedapplicationandunderwritingprocess.Thedatefromwhichaclaimforbenefitsmaybesubmittedisthelaterof:

fiveconsecutivepolicyyearsfromthepolicydate,or thepolicyanniversaryimmediatelyfollowingtheinsuredperson’s65thbirthday.

Stand-by assistance for bathing and transferring

WhenitcomestoLTCI,definitionsmakeallthedifference.Stand-byassistanceisanimportantpartofourdefinitionofdependence.Itmeansthattheinsuredpersonmaybeeligibletomakeaclaimsoonerorlongerthanwithapolicythatdoesn’tincludethisaspartoftheirdependencedefinition.

Income-style benefit

ManyLTCIplansofferanincome-stylebenefitwhichisdesignedtooffsetthecostofcareservicesprovidedbyprofessionalorfamilycaregiverswhetherinapersonalresidence,retirementhomeorlong-termcarefacilitybecauseofalossofindependence.Thistypeofplanoffers:

flexibility–thebenefitcanbeusedforanypurpose,and

simplicity–there’snoneedtosubmitproofofservice.

Waiting period

SunRHAwasdesignedwithlongerwaitingperiodsthantraditionallongtermcareinsurance.Thisshiftsthefocusonplanningforthehealthrisksspecificallyassociatedwithlateretirementandtherealitiesofaging.It’saninsurancesolutiontotransferthemostsevereriskinanaffordableway.TheselongerwaitingperiodsalsocontributetoalowercostofinsurancecomparedtotraditionalLTCIproducts.

Unlimited benefit period

Withtheunlimitedbenefitperiod,clientshaveaccesstoanunlimitedstreamofbenefits.Thisplandesignmeansthatwhentheyneedthecare,clientsdon’thavetoworryaboutthebenefitsending.

Inflation protection

Theimpactofinflationonthefuturecostofcareisoftenoverlooked.Tooffsettheinflationrisk,we’veincludedinflationprotectioninthebaseplandesign.Therearenoextrapremiumstopayforthisaddedprotection.Whenbenefitsarebeingpaid,thebenefitamountwillincreasebythreepercentoneachpolicyanniversary.


Automatic ROPD–SunRHAoffersabuilt-inROPD.Thismeansthatiftheinsuredpersondiesbeforethecoverageeffectivedate(beforebeingeligibletoclaim),wewillreturnallpremiumstotheROPDbeneficiarythatwasnamedinwriting.Ifnonewasnamed,wepaytotheownerofthepolicy,ortheirestate.Therearenoextrapremiumstopayforthisaddedprotection.

26

COMPETITIVE ADVANTAGES – SUMMARY


Optional ROPD–Whenthisoptionisaddedtothecoverage,itmeansthatiftheinsuredpersondiesatanytimewhilethepolicyisinforce,wewillpaythereturnablepremiumamounttotheROPDbeneficiarythatwasnamedinwriting.Ifnonewasnamed,wepaytotheownerofthepolicy,ortheirestate.

Returnable premium amount –Thesumofallpremiumspaidforthepolicy,minusanyunpaidpremiums(plusinterest)andanybenefitpaymentsmade.

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.SunRHAprovidescoverageforeightconsecutiveweekswhentheinsuredpersontravelsoutsideeithercountry.

WHERE TO GO FOR MORE INFORMATION

ContactyourRegionalSalesDirectorortheSalesSupportteamformoreinformationonlongtermcareinsuranceproducts.

Telephone: 1800-800-4SUN(4786)Email: [email protected]

It’simportanttomeetwithclientsregularlytoreviewtheircoverageandhelpthemwithanycontractualconversionsorrenewalstoensuretheyhavetheprotectionthatmeetstheirneeds.

SunLifeAssuranceCompanyofCanadaisamemberoftheSunLifeFinancialgroupofcompanies.

©SunLifeAssuranceCompanyofCanada,2017.

810-4079-Digital-07-17

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