Individual Health and Dental Insurance New Business and ... · 2 Hospital and Catastrophic Coverage require medical underwriting. 3 These plans are Guaranteed Issue Plans not requiring

Individual Health and Dental Insurance

New Business and Underwriting GuideTHE MANUFACTURERS LIFE INSURANCE COMPANY

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GeneralLanguageApplicants must be able to understand English and/or French (verbal and written).

EligibilityApplicants must have Government Health Insurance Plan (GHIP) coverage and must be a resident of Canada at the time of application to be eligible for any Extended Health and Dental Plan.

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

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Health and Dental PlansFlexcare®

• DentalPlus™ Basic1

• DentalPlus™ Enhanced1

• DrugPlus™ Basic• DrugPlus™ Enhanced• ComboPlus™ Starter1

• ComboPlus™ Basic• ComboPlus™ Enhanced• Add-on coverage available2

• Stand alone coverage available2

Use Flexcare® Snapshots for specific coverage details for each province.

Don’t want medical underwriting? Offer a dental plan or ComboPlus™ Starter.

FollowMe™ Health

• Basic3

• Enhanced3

• Enhanced Plus3

• Premiere3

FollowMe™ Health plans DO NOT require medical underwriting when applying if the application is received within 90 days after group benefits have ended.

The Association Health and Dental Plan

• Base Plan (Health & Dental)4

• Base Dental Plan4

• Bronze Plan (Health & Dental)• Bronze Dental Plan4

• Silver Plan (Health & Dental)• Silver Dental Plan4

• Gold Plan (Health & Dental)• Gold Dental Plan4

Unsure which FollowMe™ Health plan is right? Notify your client that plans can be downgraded on the policy’s anniversary date (but would need to be medically underwritten for upgrade).

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

Application Disclosure

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 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.

1 These plans are Guaranteed Issue Plans not requiring any medical underwriting at the time of application.2 Hospital and Catastrophic Coverage require medical underwriting.3 These plans are Guaranteed Issue Plans not requiring any medical underwriting, if application is received within

90 days of termination from a group benefit plan.4 These plans are Guaranteed Issue Plans not requiring any medical underwriting at the time of application.

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Completing an ApplicationInformation to Have on Hand1. 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(s) for which

they are being taken.4. Credit card information or bank information for a pre-authorized

payment plan.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 licence information (if applying for Catastrophic coverage).

Being prepared saves application completion time.

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

For Fast Processing1. Make sure ALL questions are answered.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.

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

Completing the Medical QuestionsIt 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.

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

Underwriting cannot ignore adverse medical history or possible risks uncovered, but not indicated on the application.

Details on adverse decisions will only be shared with the applicant’s doctor, upon written consent.

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BeneficiaryIn 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 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 OptionsIf paying by pre-authorized debit, there is a 2% discount for premiums paid upfront for a period of 6 months (semi-annually) 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.

Pay by pre-authorized debit and save: 4% on annual and 2% on semi-annual payments.

Policy Issue and Premium Draw DatesPremiums for all Guaranteed issue plans—Combo Plus™ Starter, Dental Plus™ Basic, DentalPlus™ Enhanced and FollowMe™ Health—are in effect the first of the month following receipt of the application by Manulife. 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 and Catastrophic Coverage 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 OffersIn 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 AuditA health claims 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 to determine if there was an undisclosed pre-existing condition at the 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 RequirementsQuestions and Answers

Does an applicant have to undergo a medical exam or test in order to qualify for coverage?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?All written requests for additional information will be sent to the advisor’s office. Applicants may also be contacted directly by an external provider or underwriter.

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.

If an applicant is currently undergoing medical tests and the results are not yet available, can they obtain coverage?No. Applicants are ineligible for coverage until all pending medical tests and investigations are completed and the results are available.

Can a parent buy dependant coverage without applying for coverage for themselves or their spouses?No. At least one parent must be covered in order to insure a dependant.

Can a newborn be added to active coverage without underwriting?

Yes. Newborns may be added to an active policy, provided a written request is submitted within 30 days of the baby’s birth. Requests submitted after the child is 30 days old will require a full medical questionnaire. If the parent’s application is still being underwritten when a baby is born, a full medical questionnaire is required to assess the eligibility of the newborn.

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.

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A policyholder wants to downgrade benefits. How do they do this?

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.

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. The 24-month waiting period does not apply if someone leaves an individual plan for a group plan. This must be stated in the original cancellation letter.

What options are available if an applicant is declined?

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 90 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 obtain Manulife health coverage without underwriting?

Yes, our FollowMe™ Health product is available and does not require medical underwriting at the time of application if an individual applies within 90 days of losing their group insurance benefits.

Under the FollowMe™ Health plan, will an individual’s coverage be the same as their group plan 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 ConditionsImportant Notes

i. These ineligible conditions apply only to underwritten Health and Dental applications.ii. This 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 not operated, 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 + no current anxiety or depression

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

5-year full recovery period from surgery + no residuals

Angina/Angina Pectoris Decline with no reconsideration

Angioplasty Decline with no reconsideration

Ankylosing Spondylitis Decline with no reconsideration, if severe

Adults only; no symptoms and no treatments

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

5-year full recovery period + post-adolescence + no current anxiety or depression

Antipsychotic Medications Decline – if current Off medication for at least 12 months

Aortic Stenosis Decline with no reconsideration – if moderate to severe

Older applicants; incidental finding; no symptoms

Aplastic Anemia Decline with no reconsideration

Arteriosclerosis (ASVD) Decline with no reconsideration

Ascites Decline with no reconsideration

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Bipolar Affective Disorder/Manic Depression

Decline with no reconsideration

Brain Disorder Decline with no reconsideration

Brain Injury Decline – if current, or if below IC requirements

1-year recovery from injury + depending on residuals

Bronchiectasis Decline with no reconsideration if treated with pneumonectomy; otherwise, decline if below IC requirements

5-year full recovery period

Bulimia Decline – if current, or if below IC requirements

5-year full recovery period + post adolescence + no current anxiety or depression

Cancer Decline – if current, or if below IC requirements

(See IC for some skin cancers)

10-year full recovery periodN.B. Underwrite – skin cancers except Melanomas

Cardiomyopathy Decline with no reconsideration

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 Decline with no reconsideration

Charcot-Marie Tooth Syndrome Decline with no reconsideration

Chronic Obstructive Pulmonary Disease (COPD)/Chronic Obstructive Lung Disease (COLD)


Cigarette Smoking, Heavy (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 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 + no current anxiety or depression

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

Dystonia Decline with no reconsideration

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 Disorders Decline – if current, or if below IC requirements

5 years post-procedures + no complications + no emotional issues

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


Guillain-Barré Syndrome Decline – if current, or if below IC requirements


Heart Attack/Myocardial Infarction Decline with no reconsideration

Hemiplegia Decline with no reconsideration

Hemochromatosis/Bronzed Diabetes Decline with no reconsideration

Hemophilia Decline with no reconsideration

Hepatitis B Decline – if current, or if below IC requirements

2-year full recovery period; subject to availability of current screening

Hepatitis C Decline with no reconsideration

Hepatitis Carrier Decline with no reconsideration

HIV/AIDS Decline with no reconsideration

Hodgkin’s Disease Decline – if current, or if below IC requirements


Huntington’s Chorea Decline with no reconsideration

Hydrocephalus Decline – if untreated & depending on residuals

1-year recovery from surgery + depending on residuals

Hypermobility Syndrome Decline with no reconsideration

Hyperthyroidism Decline – if below IC requirements Over 12 months since diagnosis + stable + on treatment + no symptoms

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 requirements


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

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Lyme Disease Decline – if current, or if below IC requirements


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 Decline with no reconsideration

Narcotic/Opioid Medications Decline – if current Off medication for at least 12 months

Nephrotic Syndrome Decline with no reconsideration

Neurofibromatosis, Multiple – Dependent on Type


Non-Hodgkin’s Disease Decline with no reconsideration

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 requirements

2-year full recovery period + total alcohol abstinence

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


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

Polymyositis Decline with no reconsideration

Premature Birth with Complications Decline – if below IC requirements 5-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

Rheumatoid Arthritis Decline with no reconsideration

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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

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 Decline with no reconsideration

Stroke Due to Vascular Disease Decline with no reconsideration – if due to vascular disease


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 Decline with no reconsideration

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

Decline with no reconsideration – if recipient

If donor + no other risk factors

Torticollis Decline with no reconsideration if spasmodic/dystonia

Tuberculosis Decline – if current, or if below IC requirements

12-month full recovery period after treatment is complete

Wilson’s Disease Decline with no reconsideration

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Individual Health & Dental Underwriting Build TableImportant 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 centimetres between bands, round up to next higher band

Height Maximum Standard Weight

Maximum Substandard

WeightHeight Maximum

Standard Weight

Maximum Substandard

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' 0" 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.

INTENDED FOR ADVISOR USE ONLY – NOT TO BE REPRODUCED OR DISTRIBUTED WITHOUT AUTHORIZATION

Plans underwritten by The Manufacturers Life Insurance Company.Manulife, Manulife & Stylized M Design, the Stylized M Design and Flexcare are trademarks of The Manufacturers Life Insurance Company and are used by it, and by its affiliates under license. Flexcare® is offered through The Manufacturers Life Insurance Company (Manulife). TM/® Trademarks held by The Manufacturers Life Insurance Company. © 2019 The Manufacturers Life Insurance Company. All rights reserved. Manulife, PO Box 670, Stn Waterloo, Waterloo, ON N2J 4B8.

Accessible formats and communication supports are available upon request. Visit Manulife.ca/accessibility for more information.

HD.Guide.NBU.IHD.A.EN (01/2020) 200009

Documents

Individual Health and Dental Insurance New Business and ... · 2 Hospital and Catastrophic Coverage require medical underwriting. 3 These plans are Guaranteed Issue Plans not requiring