Long term care insurance field underwriting guide...Autonomic Insufficiency (Shy-Drager syndrome)...

© Sun Life Assurance Company of Canada, 2009

Long Term Care Insurance Field Underwriting Guide

Weight and height guide We may be able to consider some customers who weigh slightly less than the minimums shown below. Please contact underwriting before an application is submitted.

Weight Height Minimum Maximum

4’ 8”/ 142 cm 77 lb / 35 kg 206 lbs / 93 kg

4’ 9”/ 145 cm 79 lb / 36 kg 208 lbs / 94 kg

4’10” / 147 cm 81 lb / 37 kg 210 lb /95 kg

4’11” / 150 cm 84 lb / 39 kg 214 lb / 97 kg

5’0” / 152 cm 89 lb / 41 kg 218 lb / 98 kg

5’1” / 155 cm 94 lb / 43 kg 222 lb / 100 kg

5’2” / 157 cm 96 lb / 44 kg 226 lb / 102 kg

5’3” / 160 cm 98 lb / 45 kg 230 lb / 104 kg

5’4” / 163 cm 101 lb / 46 kg 234 lb / 106 kg

5’5” / 165 cm 104 lb / 48 kg 239 lb / 108 kg

5’6” / 168 cm 107 lb / 49 kg 244 lb / 110 kg

5’7” / 170 cm 111 lb / 51 kg 249 lb / 112 kg

5’8” / 173 cm 114 lb / 52 kg 255 lb / 115 kg

5’9” / 175 cm 117 lb / 54 kg 258 lb / 117 kg

5’10” / 178 cm 119 lb / 54 kg 261 lb / 118 kg

5’11” / 180 cm 122 lb / 56 kg 264 lb / 119 kg

6’0” / 183 cm 125 lb / 57 kg 268 lb / 121 kg

6’1” / 185 cm 128 lb / 59 kg 274 lb / 124 kg

6’2” / 188 cm 132 lb / 60 kg 280 lb / 126 kg

6’3” / 191 cm 136 lb / 62 kg 287 lb / 130 kg

6’4” / 193 cm 139 lb / 64 kg 297 lb / 134 kg

6’5” / 196 cm 143 lb / 65 kg 301 lb / 136 kg

6’6” / 198 cm 146 lb / 67 kg 308 lb / 139 kg

6’7”/ 201 cm 149 lb/ 68 kg 311 lb/ 141 kg

6’8”/ 203 cm 152 lb/ 69 kg 314 lb/ 142 kg

6’9”/ 206 cm 155 lb/ 70 kg 317 lb/ 144 kg

6’10”/ 208 cm 158 lb/ 72 kg 320 lb/145 kg

6’11”/ 211 cm 161 lb/ 73 kg 321 lb/ 146 kg

7’0”/ 213 cm 164 lb/74 kg 324 lb/ 147 kg

A Condition Minimum stability

period (in months) Acoustic Neuroma • Present Decline • Post surgical or radiation treatment, now resolved 6 • Removed, facial paresis secondary to treatment 12 Acquired Immune Deficiency Syndrome (AIDS) Decline Acupuncture Stability period will depend on reason for treatment Refer to the applicable guidelines and if you are unsure, contact underwriting to pre-qualify.

ADL Deficits Anyone who requires the assistance or supervision of another person, to perform any one of the following Activities of Daily Living: • Bathing • Continence • Dressing • Eating • Toileting • Transferring

Decline

AIDS Related Complex (ARC) Decline Acromegaly Decline Alpha-Antitrypsin Deficiency Decline Alzheimer’s disease Decline Amputation • Due to trauma - single limb, independent in ADLs, IADLs Note: a face to face interview will be required

3 90 day waiting period

• Due to trauma - multiple limbs Decline • Due to disease Decline Amyotrophic Lateral Sclerosis (ALS) Decline Anemia • Cause unknown Decline • In conjunction with Peripheral Vascular Disease Decline • Sickle cell anemia Decline • Hemolytic, cause unknown, no splenectomy 12 • Iron deficiency, corrected 6

Condition Minimum stability period (in months)

• Pernicious, with B12 injections, no neurological impairment, no peripheral neuropathy

6

• Treated with splenectomy 60 Aneurysm • Any tobacco (including chewing tobacco) or marijuana use

within the past 24 months Decline

• Abdominal, thoracic, aortic – unoperated, less than 4cm in size 6 • Abdominal, thoracic, aortic – unoperated, size unknown Decline • Abdominal, thoracic, aortic - operated, complete recovery 3 • Cerebral - unoperated Decline • Cerebral - operated, complete recovery 12 Angina Also see the following related conditions if applicable: • Angioplasty • Coronary Artery Bypass Graft • Coronary Artery Disease • Heart Attack

• Asymptomatic, controlled with medication, chest pain as a result of exertion, less than once per month, coronary artery blockage < 70%

6

• With history of heart attack or congestive heart failure (CHF) 12 • Work - up in progress Decline • In conjunction with Peripheral Vascular Disease Decline Angina, Intestinal Decline Angioplasty, Cardiac (Balloon Angioplasty) Also see the following related conditions if applicable: • Angina • Coronary Artery Bypass Graft • Coronary Artery Disease • Heart Attack

• No heart attack 3 • History of heart attack prior to angioplasty or treatment for

congestive heart failure (CHF) 6

• Symptoms continue Decline

Condition Minimum stability

period (in months) Ankylosing Spondylitis • Condition stable, no progression, no functional limitations, no

ADL or IADL limitations Note: if the person requires more than 2 medications for their condition, please contact underwriting to pre-qualify before taking an application.

12 90 day waiting period Maximum lifetime benefit amount of $100,000 * * Note: if < age 60 an additional $50,000 Facility Care benefit is available

Anorexia Nervosa, Bulimia Nervosa • Successfully treated, condition resolved, weight stable for 24

months 24

Anxiety • Controlled with medication, no limitation of usual activities,

treated with only one anti-anxiety or anti-depressant medication, no previous history of treatment for anxiety or depression, no history of time off work for anxiety or depression

3

• Controlled with medication, no limitation of usual activities, treated with more than one anti-anxiety or anti-depressant medication, previous history of treatment for anxiety or depression, history of time off work for anxiety or depression, back to previous work schedule*

*Note: stability period will not start until back to previous work schedule

6

• Panic attacks, no limitation of usual activities, no cognitive impairment, no hospitalizations within 12 months

12

• Chronic or severe anxiety disorder, use of anti-psychotic medications

Decline

Arrhythmia • Mild – controlled with medication 3 • Atrial fibrillation/flutter, single episode, controlled with

medication, cardioversion or ablation, no stroke, TIA, mini-stroke, transglobal amnesia, amaurosis fugax, or syncope within 24 months

6

• Chronic atrial fibrillation/flutter, asymptomatic, controlled with medication (must be on an anti-coagulant medication), no stroke, TIA, mini-stroke, transglobal amnesia, amaurosis fugax or syncope within 24 months

12

• History of stroke, mini-stroke, TIA, transglobal amnesia, amaurosis fugax, or syncope

24


• All other Arrhythmias, no stroke, TIA, mini-stroke, transglobal amnesia, amaurosis fugax, or syncope within 24 months

3

• Defibrillator, implanted 12 Arteritis (Temporal, Giant Cell) • Any tobacco (including chewing tobacco) or marijuana use

within past 24 months Decline

• Asymptomatic, no limitation of usual activities, no active disease 24

Arthritis *Note: if the arthritis is in the back/spine, use the guidelines for Degenerative Disc Disease instead

• Mild osteoarthritis, no treatment, no limitation of usual activities, no joint deformities, no joint replacement

0

• Mild osteoarthritis, treated with non-steroidal anti-inflammatory medications (NSAIDs) only, no limitation of usual activities, no joint deformities, no joint replacement

3

• Moderate osteoarthritis/mild to moderate rheumatoid arthritis/mild to moderate psoriatic arthritis, no limitation of usual activities, no joint deformities, history of joint replacement, symptoms controlled with < 4 medications, history of cortisone injections, steroid use <10mg/day, Methotrexate use <15mg/week


• Severe Osteoarthritis/Rheumatoid arthritis/Psoriatic arthritis, requires 4 or more medications to treat, requires therapeutic medical equipment, limitations to usual activities, steroid use > 10mg/day, Methotrexate use of > 15mg/week, gold therapy, diagnostic tests (such as x-rays, CT scans) showing condition is severe, marked and/or advanced, surgery recommended

Decline

Asthma • Any tobacco (except chewing tobacco) or marijuana use with

the past 24 months Decline

• Mild, controlled with inhalers or non–steroidal oral medications, no limitation to usual activities, stable weight, no home oxygen, no hospitalization within 6 months, no evidence of congestive heart failure (CHF)*

*evidence of congestive heart failure would include symptoms such as: shortness of breath; fluid retention and/or swelling in the feet, ankles and/or legs; difficulty breathing when laying flat in bed

3


• Moderate, controlled with inhalers or non–steroidal oral medications, no limitation to usual activities, stable weight, no home oxygen, steroids (i.e. prednisone) use <10 mg per day, occasional nebulizer (mask) use, no more than 1 hospital admission in the last year

9

• Severe, steroid use >10 mg per day, home oxygen use, Nebulizer (mask) use more than 3 times a week, more than 1 hospital admission in the last year

Decline

Ataxia (Unstable Gait) Decline Atrioventricular (A-V) Heart Block • Complete block, pacemaker inserted 3 • History of stroke, TIA, mini-stroke, transglobal amnesia,

amaurosis fugax, or syncope 24

Autonomic Insufficiency (Shy-Drager syndrome) Decline Autonomic Neuropathy Decline Avascular Necrosis • No limitation to usual activities. no pending surgery, no chronic

pain 12

B Bell’s Palsy

• Asymptomatic, no limitation of usual activities, no active treatment 0

Benign Prostatic Hypertrophy (BPH) • Unoperated, asymptomatic, normal PSA* *Normal PSA is usually considered to be 0-4 if you have a customer with a slightly higher PSA who has been told by their physician this is a normal PSA for their age, please contact underwriting before an application is submitted

0

• Surgical repair (TUR/TURP, prostatectomy), no urinary catheter

3

Blastomycosis Decline Blindness • Successful adaptation to visual loss Note: a face to face interview will be required

12

• Due to Diabetes or ADL/IADL limitation Decline Bowel Incontinence Decline


period (in months) Breast Augmentation (enlargement) Surgery • Surgery planned/scheduled > 90 days 0

90 day waiting period

• Surgery planned/scheduled < 90 days Postpone Breast Reduction Surgery • Surgery planned/scheduled > 90 days

0 90 day waiting period Maximum lifetime benefit amount of $100,000 * * Note: Facility Care benefit is available with unlimited benefits (subject to total inforce maximum of $2,000/wk)

• Surgery planned/scheduled < 90 days Postpone Buerger’s Disease Decline Bursitis/Tendonitis Acute (one site and one episode) • No treatment or therapy taken, or treated with one anti-

inflammatory medication only, fully recovered, no symptoms, no limitations with range of motion

3

• Treated with surgery or one steroid injection into the joint, fully recovered, no symptoms, no limitations with range of motion

6

Chronic (multiple sites and/or multiple episodes) • No treatment or therapy taken, or treated with one anti-

inflammatory medication only, surgery or one steroid injection into the joint, fully recovered, no symptoms, no limitations with range of motion

6 90 day waiting period Benefits may be limited depending on the circumstances

• Treated with more than one anti-inflammatory medication, or more than one steroid injection into the joint in a 12 month period, fully recovered, no symptoms, no limitations with range of movement


C Condition Minimum stability

period (in months) Cancer Also see the following related conditions if applicable: • Leukemia • Lymphoma, Non-Hodgkin and Hodgkin • Multiple Myeloma • Tumours, Benign • Waldenstrom’s

• Current tobacco (including chewing tobacco) or marijuana use in combination with history of lung, throat, or mouth cancer

Decline

• Skin (excluding Melanoma) 0 • Melanoma of skin, no positive/malignant lymph nodes at

diagnosis, no metastasis or recurrence unless in situ only 6

• Melanoma of skin (excluding in situ), recurrent, treatment completed and disease free


Cervical Cancer, no positive/malignant lymph nodes at diagnosis, no metastasis or recurrence

• Dysplasia and in situ only 0

• Stage 1 and 2 12

• Stage 3 36

• Brain, pituitary or spinal cord cancer, no positive/malignant lymph nodes at diagnosis, no metastasis or recurrence, no paralysis, no ADL or IADL limitations, no seizures

(Pituitary adenoma – see Tumors, Benign section)

60

• All other cancers (including breast, colon, prostate and thyroid), no positive/malignant lymph nodes at diagnosis, no metastasis or recurrence, treatment completed, disease free

12

• All other cancers, positive/malignant lymph nodes at diagnosis, treatment completed, disease free

36

• Any continuing therapy (excluding Arimidex, Femara, Lupron, Tamoxifen)

Decline

• With metastasis (spread from original site), treatment completed and disease free


• Recurrent cancer (i.e. same type or site), excluding skin, treatment completed and disease free


• Kaposi’s Sarcoma Decline


period (in months) Cardiomyopathy • Symptomatic or progressive Decline • Asymptomatic, no limitation of usual activities, no history of

congestive heart failure (CHF) 12

Carotid Artery Disease • Operated, endarterectomy 3 • Unoperated, no stroke, TIA, mini-stroke, transglobal amnesia,

amaurosis fugax, or syncope within 24 months, carotid artery blockage < 70%

12

Carpal Tunnel Syndrome • No treatment, or treated with splints only, no limitation of usual

activity 0

Carpal Tunnel Syndrome Surgery • Unilateral surgery planned/scheduled >90 days

0 90 day waiting period Maximum lifetime benefit amount of $150,000 * * Note: if < age 60 Facility Care benefit is available with unlimited benefits (subject to total in force maximum of $2,000/wk)

• Unilateral surgery planned/scheduled < 90 days Postpone • Bilateral surgery planned or scheduled Postpone • Bilateral or unilateral surgery complete, treatment free,

complete recovery, back to normal daily activities 3

Cataract • Present, surgery not planned/scheduled, no visual limitations 0 • Surgery planned/scheduled > 90 days, on one eye only, no

visual limitations in other eye 0

• Surgery planned/scheduled, on one eye only, limited vision in other eye

Postpone

• Surgery planned/scheduled > 90 days, on both eyes, no visual limitations

0 90 day waiting period Maximum lifetime benefit amount of $50,000

• Surgery planned/scheduled < 90 days Postpone • Surgery complete, treatment free, complete recovery, back to

normal daily activities 2 weeks


period (in months) Cerebral Palsy

• No limitation of usual activities, no use of canes, crutches or wheelchair

12

Chagas’ Disease, Active (Steatorrhea) Decline Charcot-Marie-Tooth Disease (CMT) Decline Chiropractic treatment • Stability period will depend on reason for treatment, refer to the

applicable guidelines and if you are unsure, contact underwriting to pre-qualify.

Chromosomal Abnormalities (Including, but not limited to, Down Syndrome, Fragile X) Also see the following related conditions if applicable: • Mentally Handicapped

Decline

Chronic Fatigue Syndrome • Stable, no limitation of usual activities Note: if the person requires more than 2 medications for their condition, please contact underwriting to pre-qualify before taking an application.


• Fatigue that limits daily function Decline Cirrhosis of the Liver Decline Colitis • Irritable Bowel Syndrome, Diverticulitis 3 • Crohn’s or ulcerative, unoperated or operated and independent

with care of associated appliances 12

• Severe, multiples surgeries or requiring treatment with immunosuppressant medication

Decline

Colostomy or Ileostomy

Look for cause * must be independent in management

Concussion

• No limitation of usual activities, no cognitive impairment 6 Confusion Decline


period (in months) Congestive Heart Failure (CHF) • Any tobacco (including chewing tobacco) or marijuana use


• Single Episode, controlled on diuretics, no limitation of usual activities

12

• Multiple episodes Decline • In conjunction with emphysema, chronic bronchitis or COPD Decline • Coronary Artery Bypass Grafts (CABG) Also see the following related conditions if applicable: • Angina • Angioplasty • Coronary Artery Disease • Heart Attack

• Asymptomatic 6 • With history of heart attack during or after surgery 12 Coronary Artery Disease/Arteriosclerotic Heart Disease (CAD, ASHD) Also see the following related conditions if applicable: • Angina • Angioplasty • Coronary Artery Disease • Heart attack

• Without heart attack*, coronary artery blockage < 70% *with heart attack see heart attack guideline

6

• Unoperated with symptoms Decline Cortisone injections

• Current treatment Postpone • Treatment completed, stability period will depend on the

reason for the treatment, refer to the applicable guideline

Cystic Fibrosis Decline

D Condition Minimum stability

period (in months) Decubitus Ulcers Decline Deep Vein Thrombosis (DVT) • Resolved, no limitation of usual activities 6

Degenerative Disc Disease Also see the following related condition if applicable: • Herniated Intervertebral Disc

• Mild, minor symptoms only that do not limit usual activities, no treatment required

3

• Mild, minor symptoms only that do not limit usual activities, treated with one non-steroidal anti-inflammatory (NSAID) medication only


• Moderate, minor symptoms only that do not limit usual activities, treated with more than one non-steroidal anti-inflammatory (NSAID) medication, history of surgery, history of cortisone injections, history of steroid medication use, history of chiropractic treatment, physiotherapy or TENS machine


• Severe Decline Dejerine-Sottas Disease Decline Dementia Decline Demyelinating Disease Decline Dental Surgery • Surgery pending, general anesthesia required, planned or

scheduled < 90 days Postpone

• Surgery pending, general anesthesia required, planned or scheduled > 90 days

0

• Surgery completed, fully recovered 2 weeks Depression Also see the following related conditions if applicable: • Anxiety • Anorexia Nervosa, Bulimia Nervosa • Manic Depression • Nervous Breakdown • Phobias, Psychoneurosis • Schizophrenia


• Situational, no limitation of usual activities, treated with only one anti-depressant or anti-anxiety medication, no previous history of treatment for depression or anxiety. no history of time off work for depression or anxiety

3

• Situational, no limitation of usual activities, treated with more than one anti-depressant or anti-anxiety medication, previous history of treatment for depression or anxiety, history of time off work for depression or anxiety, back to previous work schedule*

*Note: stability period will not start until back to previous work schedule.

6

• Chronic History, stable on non anti-psychotic medication, no limitation of usual activities, no hospitalization in 2 years

12

• Requiring anti-psychotic medication Decline • Suicide Attempt, One attempt only, stable on non anti-

psychotic medication, no limitation of usual activities, no hospitalization in 3 years

36

• Multiple Suicide Attempts Decline Diabetes Mellitus • Any tobacco (including chewing tobacco) or marijuana use


• Any history of stroke, TIA, mini-stroke, transglobal amnesia or amaurosis fugax

Decline

• Non-insulin dependent, diagnosed less than 5 years ago, no circulatory disease, including peripheral vascular disease, or leg ulcers, no neurological disease (neuropathy), no kidney disease, (nephropathy), no proteinuria, fasting blood sugar < 10.0 mmol/L and HbA

1C< 8 % for the past 6 months,

no steroidal medication

6

• Non-insulin dependent, and all others who don’t meet the criteria above

Decline

• Gestational diabetes, currently pregnant and gestational diabetes in current or previous pregnancy

Postpone

• Gestational diabetes, pregnancy completed, no ongoing diabetes or blood sugar problems

6

• Insulin dependent Decline • In conjunction with retinopathy successfully treated with

surgery, no further hemorrhage or vision loss 12

• In conjunction with retinopathy, not treated with surgery Decline


• With ulcers/open wounds, circulatory, neurological or renal complications

Decline

Dialysis – Hemodialysis or Peritoneal Decline Dizziness/Vertigo • Acute viral labrynthitis, benign positional vertigo 3 • Vasovagal syncope spell 6 • Meniere’s disease, controlled with medication 6 • Cause unknown, no neurological impairment 12 • Ongoing problem Decline Driving Offences 1 alcohol related driving offence, no evidence of alcohol abuse • Within 3 years 0

90 day waiting period Maximum lifetime benefit of $100,000 * * Note: if < age 60 an additional $100,000 Facility Care benefit is available

• After 3 years 0 2 or more alcohol related driving offences, no evidence of alcohol abuse

• Most recent offence within 5 years Decline • Most recent offence between 5 – 7 years

0 90 day waiting period Maximum lifetime benefit of $100,000 * * Note: if < age 60 an additional $100,000 Facility Care benefit is available

• Most recent offence more than 7 years ago 0 • Other driving offences 0 Drug/Chemical Dependency (including Drugs, Alcohol and other Chemical Dependency)

• Marijuana only, no more than 3 joints monthly 0 • Marijuana, more than 3 joints monthly Decline • All other drugs and alcohol, treated and current abstinence,

normal liver function tests 36

• Current Use Decline

E Condition Minimum stability

period (in months) Edema (Swelling) Look for cause Ehlers-Danlos Syndrome Decline Emphysema • Any tobacco (except chewing tobacco) or marijuana use within

the past 24 months regardless of severity Decline

• Mild, controlled with non - steroidal medication, no limitation of usual activities, stable weight, no home oxygen, no hospitalization within 6 months, no evidence of congestive heart failure (CHF)*

*evidence of congestive heart failure would include symptoms such as: shortness of breath; fluid retention and/or swelling in the feet, ankles and/or legs; difficulty breathing when laying flat in bed

6

• Moderate, same as above, steroids at or <10 mg per day 9

• Severe, abnormal pulmonary function tests, with congestive heart failure (CHF), steroids >10 mg per day

Decline

Encephalitis • no cognitive impairment, no limitation of usual activities 12 Endocarditis, Infectious • Single episode, resolved, stable, antibiotic prophylaxis 6

• More than one episode Decline Epilepsy/Seizure Disorder • Controlled with medication, no seizure activity, no limitation of

usual activities, no cognitive impairment 12

• Uncontrolled, unknown reason Decline Esophageal Stricture • No symptoms/limitations, 2 or less dilatations 0 • 3 or more dilatations 3 • Ongoing difficulty swallowing Decline Esophageal Varices Decline

F Condition Minimum stability

period (in months) Factor V Leiden

• Any tobacco (including chewing tobacco) or marijuana use in past 24 months

Decline

• Any current hormone replacement therapy (HRT) Decline • Heterozygous type, with history of blood clot(s), not currently

on anticoagulant medication Decline

• Heterozygous type, with history of blood clot(s), currently on anticoagulant medication (including ASA)

24

• Heterozygous type, with no history of blood clot(s), not on anticoagulant medication

0

• Homozygous type, not currently on anticoagulant medication (for homozygous ASA is NOT considered to be an anticoagulant)

Decline

• Homozygous, currently taking a true anticoagulant medication (ASA is NOT considered to be a true anticoagulant)

24 90 day waiting period Maximum lifetime benefit of $150,000

Falls Look for cause

Family History • family includes natural parents, brothers and sisters, whether

living or dead

• Huntington’s Chorea, genetic testing completed and negative 0 • Huntington’s Chorea, genetic testing completed and positive, or

not done Decline

• All other family histories 0 Fatty Liver • Cause known, liver function tests all within normal limits 12 • Liver function tests abnormal Decline Fibromyalgia • Stable, no limitation of usual activities Note: if the person requires more than 2 medications for their condition, please contact underwriting to pre-qualify before taking an application.

12 90 day waiting period Maximum lifetime benefit amount of $50,000* * Note: if < age 60 an additional $50,000 Facility Care benefit is available

• Fatigue that limits daily function Decline


period (in months) Foot Surgery (minor surgeries such as bunion, hallux valgus, hammer toe, Morton’s neuroma)

• Surgery planned/scheduled > 90 days 0 90 day waiting period

• Surgery planned/scheduled < 90 days Postpone • Surgery completed, treatment free, complete recovery

including return to normal footwear, back to normal activities 2 weeks

Fractures • Arms, fully recovered, no limitation of usual activities 3 • Legs, fully recovered, no limitation of usual activities 3

• Skull, fully recovered, no limitation of usual activities, no cognitive impairment

Also see Head (i.e. Brain) Injury section if applicable

12

• Vertebral, due to accident, fully recovered, no limitation of usual activities

6

• Vertebral, due to Osteoporosis or Paget’s disease, refer to the applicable guideline

• Orthopedic hardware removal surgery planned/scheduled Postpone • Orthopedic hardware removal surgery completed, fully

recovered, no limitations in usual activities 6

Friedreich’s Ataxia Decline

G Gall Bladder removal (Cholecystectomy) • Laparoscopic cholecystectomy, surgery complete, treatment

free, complete recovery, back to normal daily activities 2 weeks

• Laparoscopic surgery planned/scheduled > 90 days

0 90 day waiting period Maximum lifetime benefit amount of $100,000 * * Note: if < age 60 Facility Care benefit is available with unlimited benefits (subject to total inforce maximum of $2,000/wk)

• Laparoscopic surgery planned/scheduled < 90 days Postpone


• Open cholescystectomy (not laparoscopic), surgery planned/scheduled

Postpone

• Open cholescystectomy (not laparoscopic), surgery complete, treatment free, complete recovery, back to normal daily activities

3

Gastric Balloon Decline Gastric Bypass Surgery • Surgery planned/scheduled Postpone • Surgery completed, fully recovered, weight stable within

acceptable limits 12

Gastro-Esophageal Reflux Disease (GERD) • No stability period required for new medication 0 Gaucher’s Disease Decline Gilbert’s Disease 0 Glaucoma • Stable vision, no progressive visual loss, successful adaptation

to previous visual loss 6

Gout • No limitation of usual activities, no joint deformities 3 Guillian Barre • No residual neurological impairment 6

H Head (i.e. Brain) Injury • Full recovery, no limitation of usual activities 24

• With residual impairment Decline Headaches/Migraines • No limitation of usual activities 0 Hearing Loss

• Successful adaptation to hearing loss Note: a face to face interview will be required for individuals who would normally require a phone interview but are unable to complete one because of their hearing loss

0


period (in months) Heart Attack (Myocardial Infarction) Also see the following related conditions if applicable: • Angina • Angioplasty • Coronary Artery Bypass Graft • Coronary Artery Disease

• No ongoing chest pain or intermittent chest pain, controlled with medication, chest pain less than once per month as a result of exertion, coronary artery blockage < 70%, no limitation of usual activities

12

• With chest pain at rest Decline Heart Valve Disease • Aortic stenosis/aortic insufficiency, unoperated, no congestive

heart failure (CHF) or angina, no limitation of usual activities 6

• Mitral stenosis/insufficiency, unoperated, no congestive heart failure (CHF) or angina, no limitation of usual activities

6

• Heart Valve Replacement, single or double valve replacement, no congestive heart failure (CHF) or angina

12

Hemochromatosis • Internal organ involvement or Bronze Diabetes Decline • Asymptomatic, phlebotomy (once every 6 weeks or less often),

normal laboratory values 12

• Phlebotomy more often than every 6 weeks Decline • Abnormal laboratory values Decline Hemophilia • Von Willebrands, no anti-coagulant or non-steroidal anti-

inflammatory drugs (NSAIDs) 12 90 day waiting period

• All other types Decline Hemorrhoids • Surgery planned/scheduled > 90 days 0 • Surgery planned/scheduled < 90 days Postpone • Surgery completed, treatment free, complete recovery, back to

normal activities 2 weeks


period (in months) Hepatitis • Acute, Type A, B, resolved, normal liver function laboratory

values, no alcohol or drug abuse 6

• Type B carrier, normal liver function laboratory values 6

• Chronic, active, Type A, B Decline • Type A, B, abnormal liver function laboratory values Decline • Type C, Non-A, Non-B or Autoimmune Decline Hernia Repair • Laparoscopic surgery planned/scheduled > 90 days 0

90 day waiting period Maximum lifetime benefit amount of $100,000 * * Note: if < age 60 Facility Care benefit is available with unlimited benefits (subject to total inforce maximum of $2,000/wk)

• Laparoscopic surgery planned/scheduled < 90 days Postpone • Laparoscopic hernia repair, surgery complete, treatment free,

complete recovery, back to normal daily activities 2 weeks

• Open hernia repair (not laparoscopic), surgery planned/scheduled

Postpone

• Open hernia repair (not laparoscopic), surgery complete, treatment free, complete recovery, back to normal daily activities

3

Herniated Intervertebral Disc Also see the following related condition if applicable: • Degenerative Disc Disease

• Operated, fully recovered, no ongoing symptoms or limitation of usual activities

3

• Unoperated, minor symptoms only that do not limit usual activities, no epidural (spinal) injections, steroid medication, narcotic or central acting analgesia within 12 months


• Unoperated, all others Decline


period (in months) Herpes Zoster (Shingles) • Post acute episode 3 • Rehabilitation complete, no pain or neuralgia 12 • Requiring neurological work – up Decline Hiatal Hernia 0 High Blood Pressure/Hypertension • Controlled with one anti-hypertensive medication only, under

age 70, average BP readings under current treatment regime <174/90 no other cardiac or circulatory conditions, has had follow-up with doctor since any change in medication or dosage, only one change in medication or dosage in the last 12 months.

3

• All others controlled with medication, Average BP readings under current treatment regime <174/90

6

• Uncontrolled readings >175/91 Decline HIV Positive Decline Hospitalization • currently in hospital or anticipated admission Decline Hunter’s Syndrome Decline Huntington’s Chorea (also see Family History if applicable) Decline Hurler’s Syndrome Decline Hydrocephalus Decline Hypercholesterolemia No stability period required for new medication

0

Hyperthyroidism 6 Hypertrophic Interstitial Neuropathy Decline Hypothyroidism • No stability period required for new medication

0

I


IADL Deficits Anyone who requires the assistance or supervision of another person, to perform two or more of the following Instrumental Activities of Daily Living: • Using the Telephone • Managing Finances • Taking Transportation • Shopping • Laundry • Housework • Taking all Medications • Preparing Meals/Cooking

Decline

Ileitis, Regional, end stage Decline Ischemic Bowel Disease Decline

J Joint Replacement (Hip, Knee, Shoulder)

• One joint only, due to trauma or injury, no other musculoskeletal disease such as arthritis, osteopenia or osteoporosis, physical therapy completed and returned to usual activities

6

• All others, physical therapy completed and returned to usual activities


K Knee Disorder Acute (one site and one episode) • Post arthroscopy, no further surgery recommended, no

limitations of ADLs/IADLs, fully recovered, no symptoms and no limitations with range of motion, no medical equipment or braces. treated with one anti-inflammatory medication only

3


• Treated with one steroid injection into the joint, fully recovered, no symptoms, no limitations with range of motion

6

Chronic (both knees and/or multiple episodes) • Post arthroscopy, no further surgery recommended, no

limitations of ADLs/IADLs, fully recovered, no symptoms, and no limitations with range of motion, no medical equipment or braces, treated with one anti-inflammatory medication only


• Treated with more than on anti-inflammatory or more than one steroid injection into the joint in a 12 month period, fully recovered, no symptoms, no limitations with range of motion


Korsakoff’s Psychosis Decline

L Laser eye correction (LASIK or PRK) • Surgery planned/scheduled > 90 days 0 • Surgery planned/scheduled < 90 days Postpone • Surgery complete, treatment free, complete recovery, back to


Lesch - Nyhan Syndrome Decline Leukemia • Acute (any type), stable and treatment free 60 • Chronic, non-lymphocytic, stable and treatment free 60 • Chronic lymphocytic, stable and treatment free 36 Lues (Stage IV Syphilis/Tabes Dorsalis) Decline Lupus • Discoid, inactive 12 • Systemic lupus Decline Lyme Disease • Resolved 6 • Residuals or complications that are not neurological 12 • Neurological residuals or complications Decline Lymphoid Interstitial Pneumonia Decline Lymphoma, Non - Hodgkin • Asymptomatic, disease and treatment free, normal laboratory

values 60


Lymphoma, Hodgkin Asymptomatic, disease and treatment free, normal laboratory values

• Stage 1 and 2 12

• Stage 3 and 4 60 90 day waiting period

M Macular Degeneration • No limitation to usual activities, no progression in vision loss,

successful adaptation to existing vision loss 12

Manic Depression Also see the following related conditions if applicable: • Anxiety • Anorexia Nervosa, Bulimia Nervosa • Depression • Nervous Breakdown • Phobias • Psychoneurosis Schizophrenia

• No psychiatric hospitalization in 5 years, no Anti-psychotic use 24

Marfan’s Syndrome Decline Massage Stability period will depend on reason for treatment, refer to the applicable guidelines and if you are unsure, contact underwriting to pre-qualify.

Memory Loss Decline Menopause • Treated with hormone replacement medication 0 • Treated with anti-anxiety or anti-depressant medication 3 Mentally Handicapped Also see the following related conditions if applicable: • Chromosomal Abnormalities

• Living independently, employed, able to perform all ADLs and IADLs independently

Note: a face to face interview will be required

0

• All others Decline


period (in months) Mitral Valve Prolapse 0 Mixed Connective Tissue Disease Decline • Mobility limitations (With limitation to usual activities) Decline Monoclonal Gammopathy of Unknown Significance (MGUS) Decline Motor Neuron Disease Decline Multiple Myeloma Decline Multiple Sclerosis Decline Muscular Dystrophy Decline Myasthenia Gravis • Without symptoms or complications, receiving no ongoing

treatment or medication 60

• Post surgery with full recovery and rehabilitation complete 36 • Disease process unresponsive to treatment Decline • Any ongoing medication (i.e. Mestinon) use for control Decline Myelofibrosis • Asymptomatic with normal laboratory values (including RBC,

WBC, platelets, bilirubin), and spleen not enlarged 24

• Abnormal bone marrow exam 24 • Splenectomy 60 • With abnormal laboratory values or enlarged spleen Decline

N Narcolepsy • Asymptomatic 12 • Recent onset or hospitalization 24 Nephrectomy, Unilateral (Loss of one Kidney) • Normal renal functions 12 • Due to Disease Look for cause Nephritis, Glomerulonephritis • Normal renal function 12 Nephrolithiasis/Urolithiasis/Renal Calculus • Post lithotripsy 3 • Hospitalization or surgery 3


period (in months) Nervous Breakdown Also see the following related conditions if applicable: • Anxiety • Anorexia Nervosa, Bulimia Nervosa • Depression • Manic Depression • Phobias, Psychoneurosis • Schizophrenia

• No psychiatric hospitalizations in 2 years, no anti-psychotic use 24

Neurogenic Arthropathy • Post joint replacement 6 • History of compression fracture 24

90 day waiting period Maximum lifetime benefit amount of $50,000

• Hospitalizations for arthropathy or related neurological disorders 12 Neurofibromatosis Decline Neurogenic Bladder Decline Neuropathy • Any tobacco (including chewing tobacco) or marijuana use with

past 24 months Decline

• With history of diabetes or anemia Decline • Mild, no weakness, non progressive, treatment free 12 • Moderate, no limitation of usual activities Look for cause

O Obesity • Weight outside acceptable guidelines Decline • Current use of weight reduction agents such as Xenical, Meridia Decline Obsessive Compulsive Disorder • No hospitalization in 5 years, no limitation of usual activities 24

Occupational Therapy, (current treatment) Decline

Organic Brain Syndrome Decline


period (in months) Osler - Weber - Rendu Disease (Telanglectasis) Decline Osteomyelitis (Bone Infection) • Resolved 12 • Chronic, active Decline Osteoporosis/Osteopenia • Bone density test T-score worse than -2.5 Decline • Any history of 3 or more fractures not caused by trauma Decline • History of multiple falls (2 or more within the past 24 months) Decline • No history of fractures, Bone density test T-score –2.5 (or less

bone loss) 0

• 1 or 2 fractures not caused by trauma, no limitation of usual activities


Oxygen Use Decline

P Paget’s Disease (Oseitis Deformans) • Asymptomatic 6 • Moderate disease, no limitation of usual activities, history of

joint replacement 24 90 day waiting period Maximum lifetime benefit amount of $50,000

• Severe disease Decline Pancreatitis • Acute, no alcohol abuse in the past 36 months 12 • Chronic Decline Paralysis/Paresis • No limitation of usual activities Look for cause • Hemiplegia, paraplegia, quadriplegia Decline Parkinson ’s disease Decline Peptic Ulcer Disease (PUD) • Asymptomatic 0 • History of Gastrointestinal Bleed 6


period (in months) Pericarditis • Resolved 6 Peripheral Vascular Disease/Claudication • Any tobacco (including chewing tobacco) or marijuana use

within the past 24 months Decline

• No leg pain, no limitation of usual activities, no skin breakdown within 24 months, no vascular surgery within 6 months

6

• Occasional leg pain, no limitation of usual activities, no vascular surgery within 6 months ,leg pain less than once per week

12

• Moderate Leg Pain, more than one time per week Decline • History of Stroke, TIA, mini-stroke, transglobal amnesia, or

amaurosis fugax Decline

• Any history of Diabetes or glucose intolerance Decline • In conjunction with anemia or diagnosis of ischemia Decline Phobias, Psychoneurosis Also see the following related conditions if applicable: • Anxiety • Anorexia Nervosa, Bulimia Nervosa • Depression • Manic Depression • Nervous Breakdown • Schizophrenia

• Treated with antipsychotic medication Decline Physiotherapy • Stability period will depend on reason for treatment, refer to the

applicable guidelines and if you are unsure, contact underwriting to pre-qualify.

Pick’s Disease Decline Pneumocystic Pneumonia Decline Polyarteritis Nodosa Decline Polycystic Kidney Disease • Asymptomatic 6 • Hospitalizations for acute renal failure or surgery 24 • Transplant 60 • Dialysis or surgery anticipated Decline


period (in months) Polymyalgia Rheumatica • Resolved, steroids at <10 mg per day 6

90 day waiting period Maximum lifetime benefit amount of $50,000 * * Note: if < age 60 an additional $50,000 Facility Care benefit is available

• Unresolved Decline • Steroids at > 10 mg per day Decline Polyps • Benign 0 Portal Hypertension Look for cause Post Paralytic Syndrome • No history of paralysis 0 • History of paralysis, no limitation of usual activities, no 4-prong

cane, crutches, walker or wheelchair usage, no fatigue or change in muscle strength

24

• Any equipment usage or limitation of activities Decline • Symptomatic Decline Post Polio Syndrome Decline Postero – Lateral Sclerosis Decline Pregnancy • Currently pregnant, no complications with current pregnancy no

history of complications, including toxemia, with prior pregnancies

0

• Postpartum, no limitation of usual activities 0 Progressive Muscular Atrophy Decline Progressive Systemic Sclerosis Decline Pulmonary Embolism • Single episode, cause known and treated, no breathing

difficulty, no limitation of usual activities 6

• Single episode, cause unknown, no breathing difficulty, no limitation of usual activities

12

• Multiple episodes Decline


period (in months) Pulmonary Fibrosis • Any tobacco (except chewing tobacco) or marijuana use in the

past 24 months Decline

• Asymptomatic, no treatment, incidentally found by chest X-ray, no COPD, emphysema, asthma or other lung disease, no steroid medications

24

• Symptomatic or treatment within 24 months

Decline

R Renal Disease • Mild renal insufficiency, Azotemia 6 • End stage disease, dialysis within past 2 years, prednisone,

leukeran, or cytoxan within last 2 years Decline

Restless Leg Syndrome • No treatment 0 • Valium or Ativan use, neurological work-up completed

confirming no diagnosis of Parkinson’s Disease

3

• Sinemet or Clonazepam use, no visible head, neck or hand tremors, neurological work-up completed confirming no diagnosis of Parkinson’s Disease

12

Retinal Artery Occlusion

• Any tobacco (including chewing tobacco) or marijuana use within past 24 months

Decline

• Full recovery, no residuals, no limitation of usual activities 24

Retinal Detachment and/or Hemorrhage • Asymptomatic, successfully treated with surgery 6 • Successfully treated with surgery in conjunction with Diabetes,

no further hemorrhage or vision loss 12

Retinitis Pigmentosa • No limitation to usual activities, no progression in vision loss,

successful adaptation to existing vision loss

12


period (in months) Retinopathy • Asymptomatic, recovered post surgery 6 • Successfully treated with surgery in conjunction with Diabetes,

no further hemorrhage or vision loss 12

S Sarcoidosis • Asymptomatic in lung only, no other internal organ involvement,

no steroids 36

Schizophrenia Decline Sclerosing Cholangitis Decline Scleroderma • Skin only (i.e. morphea) 6 • All others, in remission 12 • All others, active Decline Scoliosis • Mild, no limitation of usual activities, normal range of motion, no

treatment or therapy taken 0

• All others, see degenerative disc disease guidelines

Senility Decline Sleep Apnea • Asymptomatic 3 • CPAP machine without bottled oxygen 6 • Hospitalization 12 • CPAP machine with bottled oxygen Decline • Any tobacco (except chewing tobacco) or marijuana use within

the past 24 months Decline

• With narcolepsy Decline Soft Tissue Disorders (such as whiplash, lumbago, muscle strains and pulls, sciatica, ligament, tendon, and menisci problems, etc.)

• Acute (one site and one episode), fully recovered with no ongoing pain, no limitations to range of motion, no limitations to ADLs/IADLs, no discontinuance of usual activities, treated with one anti-inflammatory medication only, no ongoing therapy (i.e. chiropractic, massage, physiotherapy) or recommendation for them

3


period (in months)

• Chronic (multiple sites and/or episodes), fully recovered with no ongoing pain, no limitations to range of motion, no limitations to ADLs/IADLs, no discontinuance of usual activities, no ongoing therapy (i.e. chiropractic, massage, physiotherapy) or recommendation for them


Speech Therapy • Current treatment Postpone Spinal Muscle Atrophy Decline Stroke including Cerebrovascular Accident - CVA), Transient Ischemic Attack (TIA), Mini-stroke, Transglobal Amnesia, Amaurosis Fugax

• Any tobacco (including chewing tobacco) or marijuana use within the past 24 months

Decline

• Any history of Diabetes or glucose intolerance Decline • Single episode, full recovery, no residuals, no limitation of usual

activities, no syncope within the past 24 months 24

• More than one stroke, TIA, mini-stroke, transglobal amnesia, or amaurosis fugax

Decline

• In combination with peripheral vascular disease Decline Surgery • Breast Augmentation (enlargement) • Breast Reduction • Carpal Tunnel Syndrome • Cataract • Dental • Foot • Gall Bladder removal (cholecystectomy) • Gastric Bypass • Hemorrhoid • Hernia Repair • Laser Eye Correction • Orthopedic hardware removal, see Fractures • Tubal ligation • Vasectomy

See specific condition


period (in months) All other surgeries • Surgery complete, treatment free, complete recovery, back to

normal daily activities 3

• Planned surgery < 90 days Postpone • Planned surgery > 90 days • Contact underwriting to pre-qualify. You may be able to submit

an application depending on the reason for the surgery. Examples of surgeries we can’t consider are hip and knee replacements.

90 day waiting period Benefits may be limited depending on type of surgery

T Thrombocythemia (elevated platelets) • Asymptomatic, normal laboratory values 12

• With history of stroke, mini-stroke, TIA, transglobal amnesia, amaurosis fugax, or other clotting disorders

Decline

• Treated with anti-neoplastic, immunosuppressant or steroid medications

Decline

Thrombocytopenia (low platelets) • Unoperated, asymptomatic, normal laboratory values 12

• Operated, asymptomatic, normal laboratory values 24 • With abnormal laboratory values Decline • With history of stroke, mini-stroke, TIA, transglobal amnesia,

amaurosis fugax, or other clotting disorders Decline

Thrombophlebitis, superficial 0 Transplant, Organ • Corneal 3 • Kidney, due to primary kidney disease and not a secondary

cause like diabetes, all lab tests normal 36

• Bone marrow, all lab tests normal



period (in months) • Stem cell, all lab tests normal


• Change in anti-rejection medication following an organ transplant (assuming original stability period has been met)

6

• All other organ transplants

Decline

Transverse Myelitis • Acute episode, fully recovered, no limitation of usual activities 24

• Residual or progressive symptoms Decline • Multiple episodes Decline Tremors • Benign, essential or familial, no limitation of usual activities 6

• Work-up in progress Decline • Due to Parkinson’s Disease Decline Tubal ligation • Surgery planned/scheduled > 90 days 0 • Surgery planned/scheduled < 90 days Postpone • Surgery complete, treatment free, complete recovery, back to


Tuberculosis • Resolved 12 • Active Decline • Positive skin test only, no evidence of disease 0


period (in months) Tumours, Benign (surgically removed, or unoperated and followed regularly with no evidence of progression) Also see the following related condition if applicable: • Acoustic Neuroma

• Brain, spinal cord, no neurological impairment, no limitation of usual activities, no seizures

24

• Pituitary adenoma 12 • Benign skin, breast, uterine and ovarian cysts 0 • Other sites, such as kidney, bladder, liver, etc. 6

U Ulcers Skin • Resolved 24 • Active or chronic Decline Resulting in amputation Decline Duodenal • Asymptomatic 0 • History of gastrointestinal bleed 6 Urinary Incontinence • Occasional stress or urge incontinence, independent in care 0 • Complete incontinence, including continuous dribbling Decline • Use of catheter, intermittent or indwelling Decline

V Varicose Veins (Legs)

• No ADL or IADL limitations, not associated with peripheral vascular disease, no surgery or treatment planned

0

• Minor treatment/surgery planned, Saline injections, EndoVenous Laser Treatment, Closure

0

• Other surgery planned Postpone • Surgery completed, fully recovered 2 weeks


period (in months) Vasectomy • Surgery planned/scheduled > 90 days 0 • Surgery planned/scheduled for < 90 days Postpone • Surgery complete, treatment free, complete recovery, back to


Von - Hippel – Lindau Decline VP Shunt Decline

W Waldenstrom’s Decline Walker Use Decline Wegener’s Granulomatosis Decline Wernicke-Korsakoff Syndrome Decline Whipple’s Disease Decline Wilson’s Disease Decline Wiskott - Aldrich Syndrome Decline

X Xeroderma Pigmentosa Decline

Long term care insurance field underwriting guide...Autonomic Insufficiency (Shy-Drager syndrome)...

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