Underwriting and New Business · 6 – ADMINISTRATIVE GUIDE FOR ADVISORS - UNDERWRITING AND NEW...

Underwriting and New BusinessAdministrative Guide for Advisors

Individual insurance

Advisor

Table of Contents

1. Introduction ....................................................................................................................................................................................1

2. Summary of changes made .........................................................................................................................................................2

3. Contact us ........................................................................................................................................................................................43.1 Partner Services and Policy Issue ....................................................................................................................................43.2 Business Development Activities ....................................................................................................................................4

4. Information requests from MGAs ..............................................................................................................................................5

5. Fillable version of the insurance application available online ..............................................................................................6

6. Electronic Express Application ....................................................................................................................................................7

7. Sending application ......................................................................................................................................................................8

8. Internal cancellation and replacement .....................................................................................................................................9

9. New business process and service standards .........................................................................................................................11

10. Secure advisor website ..............................................................................................................................................................1310.1 LifeSuite Advisor Portal ..................................................................................................................................................1310.2 Ingenium ...........................................................................................................................................................................1310.3 LifeSuite and Ingenium user guides .............................................................................................................................13

11. Follow-up tools ............................................................................................................................................................................1411.1 9450Q Policy Issue and Settling Requirements report .............................................................................................1411.2 Email notifications - Underwriting and New Business activities .............................................................................15

12. Paramedical companies / providers .........................................................................................................................................16

13. Temporary Insurance Agreement .............................................................................................................................................17

14. VIP cases ........................................................................................................................................................................................18

15. Ratings, exclusions and deferred cases ...................................................................................................................................19

16. Reinsurance ...................................................................................................................................................................................20

17. Expiry date of declarations and medical requirements ........................................................................................................21

18. Issuing a multi-life policy, related policies or an optional policy .......................................................................................22

19. Critical illness insurance offer ....................................................................................................................................................23

20. Redating a policy to the current date ......................................................................................................................................24

21. Backdating a coverage (to save age) ........................................................................................................................................26

22. Policy change retroactive to the issue date ...........................................................................................................................27

23. Settling requirements .................................................................................................................................................................29

24. New business premium ..............................................................................................................................................................30

25. Automatic day of withdrawal new business ...........................................................................................................................31

26. Third party determination (Whole life and Universal Life) ..................................................................................................32

27. Verification of the existence (identity) of corporations and other entities (Whole life and Universal Life) ...................................................................................................................................................32

28. Declaration of Tax Residence of policyowner(s) (self-certification) (Whole Life and Universal Life) ..................................................................................................................................................33

29. Identity verification – insured(s) and policyowner(s)) ..........................................................................................................33

30. Client’s right of examination (new policy) ..............................................................................................................................34

31. Disclosing information to a third party ...................................................................................................................................35

ADMINISTRATIVE GUIDE FOR ADVISORS - UNDERWRITING AND NEW BUSINESS – 1

1. Introduction

This Guide contains the key administrative rules regarding Underwriting and New business submitted with SSQ Financial Group.

The administrative personnel in the Managing General Agencies (MGAs) represent a quality resource for advisors regarding inquiries related to SSQ Underwriting and New Business.

As such, this Guide is a supportive tool that summarizes the guidelines and administrative practices relating to processing new business applications. We believe that this Guide, combined with access to our “Ingenium” and “LifeSuite” systems, follow-up reports and automatic email notifications, will allow the administrative personnel to adequately verify applications and follow-up on all pending business with SSQ.

In order to receive basic or specific training in relation to this Guide, our “Ingenium” and “LifeSuite” systems, follow-up reports or automatic email notifications, we invite you to communicate directly with your sales support team.

For ease of consultation, this Guide has been divided into several sections. We invite you to refer to the Table of Contents to find the section for which you are looking for information. This document contributes to standardizing our operations, and thereby guaranteeing quality service and compliance with recognized sound business principles.

When the Guide is updated in the future, simply refer to section 2 for a summary of changes made. All changes will also be highlighted until the subsequent update. The electronic version of the Guide and its updates will be available on our secure website.

2 – ADMINISTRATIVE GUIDE FOR ADVISORS - UNDERWRITING AND NEW BUSINESS

2. Summary of changes made

3.2 Sales offices (update)

• Sales offices remplaced by « Business development activities »• A central point of contact for all regions of Canada.• Business hours : 8:30 a.m. to 4:30 p.m. (Eastern time)

6. Electronic Express Application (update)

• Signature pages to be mailed to your agency

8. Internal cancellation and replacement (addition)

Issue of the policy: The cancellation of the replaced policy is processed at the same time as the issue of the new policy (not at the policy settlement).

Premiums: Premium payment on the policy to be replaced will not be interrupted during the underwriting process of the new policy. When cancelling the replaced policy, if there is a premium credit, an amount that represents a maximum of 3 monthly premiums will automatically be transferred to the new policy. The balance will be refunded to the policyowner(s).

Example: process of internal remplacement

9. New business process and service standards (update)

Modification of certain service standards.

12. Paramedical providers with whom SSQ does business (update)

• Dynacare, Exam One, First Financial Underwriting

19. Critical illness insurance offer (addition)

Return of premiums: available options• Return of premiums on death (available with all plans)• Return of premiums at expiry (available with T10, T20 and T75 plans)• Return of premiums on cancellation (available with T75, T100 and T100 paid-up 20 years plans)

20. Redating a policy to the current date (update)

Redating a policy without changes• particularities for “Offer to redate”

22. Policy change retroactive to the issue date - Policy already inforce (update)

The following additions will be processed retroactive to the policy issue date:

• increase or reduction of face amount • change or withdrawal of a benefit

The following changes will be processed by the Administration department, even if received within 30 days:

• addition of a life and critical illness benefit*• addition of an insured* • addition of a disability rider*

* The addition will be processed at premium due date (monthly anniversary) closest to the Underwriter’s approval date.


24. New business premium (addition)

New section for Universal life policies

26. Third party determination and Third Party Identification (Whole Life and Universal Life) (update)

Third party determination

In accordance with the Proceeds of Crime (Money Laundering) and Terrorist Financing Act and its regulations, the financial security advisor/representative must complete the Third party determination section of the application and make reasonable efforts to determine:

• if there is a third party regarding this insurance contract,• if the policyowner(s)/ is(are) acting on behalf of a third party (individual, corporation or other type of

entity),• if a third party is making payments for this insurance contract, or• if a third party will have the use of the value of the insurance contract or will have access to it.

Third Party Identification

Required where the premium payer is a different person or entity from the policyowner(s).

27. Verification of the existence (identity) of corporations and other entities (Whole Life and Universal Life) (update)

Documents required:

For a corporation or another type of entity, a document confirming the existence of the entity AND document(s) confirming the shareholders of the entity are required.

Consult the form to obtain information regarding the documents required according to the type of entity.

• ACTIVE Corporation or Other Type of ACTIVE Entity• PASSIVE Corporation or Other Type of PASSIVE Entity (Including Trusts and Estates)• Non-Profit Organization

28. Declaration of Tax Residence of policyowner(s) (self-certification) (Whole Life and Universal Life)(new section)

29. Identity verification - insured(s) and policyowner(s) (new section)


3. Contact us

3.1 Partner Services and Policy Issue

Advisors and offices of Associated General Agencies (AGAs) should always refer to their MGAs with regards to specific inquiries. The contact information for Partner Services in the New Business department is exclusively for the administrative staff of the General Agency (MGA).

Telephone 514-282-7320Toll free: 1-800-565-4550, Options: 3, 1

Fax 514-282-8920 Toll free: 1-866-269-8920

Business hours Monday to Friday, from 8:30 a.m. to 4:30 p.m. (Eastern time)

Email [email protected]

Website ssq.ca

New Business address(where to send paper applications / signature pages of electronic applications and settling requirements)

AddressSSQ Financial GroupIndividual Insurance, New Business200-1225 Saint-Charles St. W. Longueuil, QC J4K 0B9

3.2 Business Development Activities

Canada (all regions) Toll free: 1-888-429-2543 or 1 888-292-8483Fax: 416-928-8515 or 1 866-559-6871Business hours : 8:30 a.m. to 4:30 p.m. (Eastern time) [email protected]


4. Information requests from MGAs

Information from an underwriter • The underwriters are only assigned to risk assessment and do not handle administrative tasks (follow-ups on pending files). It should be noted that we cannot release confidential information. However, in order to help the advisor when there is an unfavorable decision, the underwriter will indicate in LifeSuite:

The document on which the decision was based (ex. Paramedical, Attending Physician’s statement, Lab tests, etc.) but not the content.

When the decision is based on the client’s declarations* regarding his medical history on different systems, the underwriter will specify which system it refers to (ex. Cardiovascular system, Respiratory system, Digestive system etc.).

*Client’s declarations: application, paramedical, tele-interview

The reconsideration of the file, if applicable. Example: “Declined due to client’s declarations during the paramedical

in regards to the Endocrine system. No reconsideration possible”.

New business files under review and policy issue

• The accredited administrative staff of MGAs having completed the training program may contact the Partner Services department assigned to New Business.

• The Partner Services department has access to a wide range of underwriting information. When necessary, partner services will ask the underwriter to contact the MGA or the advisor (with the exception made for VIP cases which allow for direct access to the underwriter).

• The Partner Services department strives to respond to email inquiries by the next business day. Advisors and offices of Associated General Agencies (AGAs) should always refer to their MGAs with regards to specific inquiries.

For preliminary underwriting opinions

• Refer to the Underwriting Guidelines.

Sales concept • Contact your Sales Support team.


5. Fillable version of the insurance application available online

Illustration Software – Method 1

The fillable paper application is available in the home page of the illustration by clicking on the “Insurance Application” tab.

Illustration Software – Method 2

The paper application is also available in the illustration software when you prepare an illustration for a given product, by clicking on the “PA” tab.

Advisor’s site – Method 3

The paper application is also available in the advisor’s site under the“Library” / “Forms” tab.


6. Electronic Express Application

General guidelines

Availability • Electronic Express Applications (EA) are available for new policy issues only. Do not use electronic express applications for policy changes, for preliminary applications or when requesting underwriting requirements from another insurance company.

Ordering underwriting requirements

• Do not order any underwriting requirements, as SSQ will handle this for you. This includes basic requirements and any additional requirements requested during the underwriting process.

The beginning of the underwriting process

• All original signed documents must be received in order to register the policy information on LifeSuite to start the underwriting process.

Sending an electronic application and illustration

A. Automatic transmission:

1. Email the electronic application and the illustration via the “Verify and send” tab (click on “Send via email”). As such, the application and the illustration will be sent to the provider Hooper Holmes and SSQ, at the same time.

2. Mail to your agency:

* the illustration * the signature pages (Part B) of the application (pages 5, 6, 7, 8, 9, 11 and,

if the client is not covered by TIA, page 10)

B. Manual transmission:

1. Save the electronic application and the illustration via the “Verify and send” tab (click on “Save”)

2. Email the electronic application and the illustration as attachments at the two following addresses, at the same time:[email protected]

[email protected]

3. Mail to your agency: * the illustration

* the signature pages (Part B) of the application (pages 5, 6, 7, 8, 9, 11 and, if the client is not covered by TIA, page 10)


7. Sending application

General guidelines

Advisor meeting the client

• The advisor must meet the client in person to complete the insurance application.

SSQ does not allow any other sales method to complete the application such as telephone, Internet or email, regardless of whether or not a paramedical is required.

• When more than one advisor is indicated in the application, the service advisor will be the one who had met the client and who has signed the application to this effect.

Verification of the application • The applications must be initially verified by the MGAs personnel

Important: To accelerate the handling of New business, all documents must be grouped together in a distinct envelope identified “New Business Department”.

Related policies

• Group together related applications for the same insured or the same policyowner. As such, the same underwriter will be assigned to the files and all policies will have the same issue date (this allows the advisor to make only one delivery).

• If the applications were not grouped together in the same mailing, as soon as one application is approved by the underwriter, the policy will be issued immediately with no possibility to group the policies thereafter.


8. Internal cancellation and replacement

General guidelines

Issue date • The policy will be issued at the premium due date (monthly anniversary) closest to the Underwriter’s approval date.

• In order to ensure continuous protection, the issue date of the new policy and the cancellation date of the replaced coverage will have the same date.

• The cancellation of the replaced policy is processed at the same time as the issue of the new policy (not at the policy settlement).

Request for Internal cancellation and replacement - example

Issue date of the policy to be replaced June 15, 2012

Premium due date (monthly anniversary) of the replaced policy AND the new policy

15th

Application accepted in underwriting January 10, 2018

Issue of the new policy and cancellation

Issue date of the new policy January 15, 2018

Cancellation date of replaced policy January 15, 2018

Redating • Redating is not available for an internal cancellation and replacement.

Automatic backdating • When issuing the new policy, we will automatically proceed with a backdate for a maximum 30 days from the issue date and only for the sole purpose of reducing the insured’s age for premium calculation.

• NOTE: The backdated policy date cannot be prior to the premium due date (monthly anniversary) of the replaced coverage.

Signatures • The signatures of all policyowners of the replaced policy are required.

If the signautre of one policyowner is missing, we will request a letter signed by this policyowner.

• When the policyowner and/or irrevocable beneficiary of the replaced policy is (are) not the policyowner and/or irrevocable beneficiary of the new policy and one of the signatures is missing, a cancellation letter will be requested.

Notice of replacement • A Notice of replacement may be required, according to the respective provincial regulations in effect. When required, the signatures of all policyowners of the replaced policy are required.

Replacing a Term Plus benefit • When replacing a Term Plus benefit, the disability rider and critical illness rider, if inforce, must be also replaced.


8. Internal cancellation and replacement (cont’d)

Premiums • Premium payment on the policy to be replaced will not be interrupted during the underwriting process of the new policy.

• When cancelling the replaced policy, if there is a premium credit, an amount that represents a maximum of 3 monthly premiums will automatically be transferred to the new policy. The balance will be refunded to the policyowner(s).


9. New business process and service standards

Step 1 : Data entry of the application in our systems and initial assessment by the underwriting department

Cutoff time for the receipt of the application

• Noon

Data entry in our systems • 2 business days following the receipt in New Business Receipt, verification, scanning the application, data entry in Ingenium

and LifeSuite, MIB.

Initial assessment by the underwriting department

• 2 business days following the receipt in the underwriting department Underwriter’s assessment of the application.

Electronic application • The electronic application can be entered in our systems (and will be considered received) only when the signature pages are received.

Step 2: Data entry of requirements received, order of additional requirements and assessment of underwriting requirements

Cutoff time for the: - receipt of requirements - order of requirements

• Noon

Data entry of requirements received (matching to the file)

• same day of receipt

Receipt of requirements and data entry in LifeSuite.

Order of additional requirements • 1 business day Request submitted to the MGA / advisor to order the additional

requirements with their provider. SSQ will order additional requirements with its providers.

Underwriter’s assessment • 1 business day following the receipt of the requirement

Underwriter’s assessment of the requirement

When necessary, the underwriter will request additional requirements, refer the file to the medical director, the reinsurer or a co-signer. When the file is complete, the underwriter will indicate his decision.

Step 3: Final decision in underwriting further to the receipt of the last requirement

Cutoff time for the receipt of the of the last requirement

• Noon

Final decision in underwriting further to the receipt of the last requirement; file complete

• 1 business day following the receipt of the last requirement Decision indicated in LifeSuite


9. New business process and service standards (cont’d)

Step 4: Policy issue, quality control and mailing

Cutoff time for the approval by the underwriter (file complete)

• Noon

Approval of file in the system (policy issue)

• 1 business day If no settling requirements: the policy will be in force immediately

Policy assembly (for mailing) • 1 business day Printing of policy pages Production of amendments Assembling of the policy

Quality control • 1 business day Verification of the policy

Special mention • If the client no longer wants his coverage which is still under review in underwriting, a note from the advisor/MGA is mandatory; the file will then be closed.

• We cannot delay the issue of a policy which is complete and has been approved, the policy must be issued and sent to the MGA coded in the system at that time (even if there is a pending MGA transfer request).

• If the file is still incomplete after approval by the underwriter, the advisor/MGA will be notified that the policy cannot be issued. If the situation is not resolved within a certain period of time provided by Partner Services, the file will be closed without further notice.

Policies with amendments • When the application is in one language while the language of correspondence is in another language, the text of the amendment will be in the language of correspondence chosen by the client, except for written confirmations received by email/LifeSuite from the client/advisor, which will remain in the original language.

Step 5 : Processing settling requirements

Cutoff time for the receipt of settling requirements

• Noon

Putting the policy status inforce on the system

• same day of receipt If the settling requirements are received by the deadline (the date

that is indicated on the form sent with the policy): policy will come into force.

If the settling requirements are not received within the deadline (the date that is indicated on the form sent with the policy): file will be closed “rejected by client”.


10. Secure advisor website

Access to “LifeSuite” and “Ingenium” systems are available on our secured website.

10.1 LifeSuite Advisor Portal

The information available in LifeSuite allows you to follow-up on pending files until the underwriter’s approval.

• List of files in underwriting: Status “pending” or “closed”

• Client or policy search

• Messages: Access to messages in the inbox for messages received and sent. IMPORTANT: Do not delete sent messages as they will automatically be deleted when SSQ will respond.

• Information on the insured: coverage details, requirement status, underwriter’s decision, smoker status, class, etc.

10.2 Ingenium

The information in Ingenium allows you to access administrative follow-ups on the client’s policy as well as pertinent information on the advisor’s file.

• Advisor information: Advisor contact information, payment method of commissions, current and historical commission information, premiums by compensation type, FYC – persistency rates.

• Access to clients’ files: Client information, policy information, policyowners, beneficiaires, benefit, billing, settling requirements, policy issue.

10.3 LifeSuite and Ingenium user guides

For details, please refer to the LifeSuite and Ingenium user guides available in the advisor’s site under “Reference Manual”:


11. Follow-up tools

In order to stay informed on pending files in New business, certain tools are available to facilitate follow-ups, from the receipt of the application to the policy settlement. Consequently, you will always be well informed of the policy status and any action required can be taken promptly.

Two follow-up tools are available, the “9450Q Policy Issue and Settling Requirements” report and “automatic email notifications”.

11.1 9450Q Policy Issue and Settling Requirements report

This report is updated daily and includes policy issue and settling requirements of each advisor.

This report is available on our secured Website, under “Reports “.

When you select an advisor code, choose the report 9450Q from the list of reports available.

You will find below an example of the type of policy requirements “EXEM“ and settling requirements “EXMEV“ with details under “Description”.


11.2 Email notifications - Underwriting and New Business activities

If such a request has been made in this regard, the New Business contact of each general agent will automatically receive a daily email notification with an attachment of all new activities generated on the previous business day for Underwriting and New Business.

This report will be generated for each new activity in the new business process but does not include standard requirements based on age and amount. A description of the activity with pertinent information relating to a specific insured or the policy, in general is also included.

Given that the attached report is an EXCEL file, this allows you to easily filter the information you wish to display, either by: Advisor code, Advisor name, Application number, Policy number, Policyowner(s), Notification type, or Department.

The column Notification type allows a filter by type, such as:

• Information: refers to a new activity for information purposes only (no action required)

• Action required: refers to a new activity for which an action is required by the advisor

• Communication: refers to a message that was sent in LifeSuite

• Settlement requirement: refers to an outstanding requirement to be received to settle the policy

The column Department allows a filter by department, such as:

• Underwriting

• Policy issue

• Underwriting/issue

• Policy settlement

The email contains a link which directs you to the login page of our Website. You will then access LifeSuite and Ingenium to obtain additional information.

You will find below an example of the message sent by email:


12. Paramedical companies / providers

General guidelines

MGA’s responsibility(sometimes delegated to the advisor)

• Order the basic requirements, as per the Underwriting guidelines (based on age and amount), with a provider of choice (pre-authorized by SSQ). SSQ is not responsible for the fees incurred for requirements that are not required (ex: a paramedical ordered when in fact, it is not required).

• Notify the client of actions that will be taken by the paramedical providers, so that the client is prepared. Advise the client of the importance being present at the appointment to avoid additionnal fees.

• Order additional requirements requested by the underwriter with their provider.

• Follow-up with the paramedical providers for placed orders.

• IMPORTANT: If a questionnaire is required during the assessment of the application, the underwriter will notify the MGA via LifeSuite that an order for a tele-interview has been placed with our provider in order to consequently prepare the client.

SSQ’s responsibility • Pay the fees for the necessary requirements

• Order and ensure follow-ups for the following requirements:

– Inspection Report

– Motor Vehicle Report*

– Underwriting Questionnaires ordered by Underwriting to Paradex™ services at Hooper Holmes

* In Alberta, the client must order this report himself (regulations are different in this province).

Paramedical providers with whom SSQ does business

• Dynacare• Exam One• First Financial Underwriting


13. Temporary Insurance Agreement

General guidelines

Premium The premium must be sent with the application and be payable by:

• Cheque (must be cashable on the date the application was signed)

• Pre-authorized debit (only available if the payment frequency chosen is monthly, the pre-authorized debit agreement has been completed, a specimen cheque and the payer’s identity have also been received)

• Credit card (must be cashable on the date the application was signed. The detachable section must be filled in the application)

If the payment cannot be cashed when the application is received, the temporary insurance agreement will not be in force and no exception will be granted.

When the Temporary Insurance Agreement is not applicable due to the eligibility criteria not satisfied

• The premium payment is cashed and will be used to put the policy in force, as soon as the policy is accepted and the settling requirements are received.

• The premium is not returned to the client.

• A letter is not sent to the client.

When the Temporary Insurance Agreement is refused during the underwriting process

• The received payment is retained and will be used to put the policy in force, as soon as the policy is accepted and the settling requirements are received.


When the Temporary Insurance Agreement terminates automatically 90 days from the signature date of the application

• The received payment is retained and will be used to put the policy in force, as soon as the policy is accepted and the settling requirements are received.


When the Temporary Insurance Agreement terminates at the date a counter offer has been presented to the advisor, therefore, the insured has been approved but the policy cannot be settled immediately due to outstanding settling requirements

• The received payment is retained and will be used to put the policy in force when the settling requirements are received.



14. VIP cases

General guidelines

Definition • Total amount of LIFE INSURANCE $5 million +: Criteria per insured on one or several policies (related policies);

OR

• Total amount of CRITICAL INSURANCE of $500,000 +: Criteria per insured on one or several policies (related policies);

OR

• Total annual premium of $15,000 +: Criteria for one or several policies with the same insured or the same

policyowner (related policies), all products combined. For Universal Life products, only the minimum premium will be considered.

Note: The eligibility of a “VIP” case is determined when the application is received in the New Business Department and not when there is a change thereafter during processing (ex. Rating).

Advantages • A highly specialized underwriter will be assigned to major cases.

• Direct access to the underwriter. The underwriter will notify the MGA/the advisor via LifeSuite that the application has been received along with the current status on the case. In addition, the underwriter will provide a phone number where they can be reached for any inquiries that the MGA or advisor may have during the underwriting process.

• Priority processing at all levels of Underwriting and New Business.

• Policy mailed in a leather folder.

• Policy sent by priority mail (next business day delivery) where the address allows.

For any questions relating to administrative procedures, the administrative staff of MGAs may contact the Partner services (refer to p.4). As for the advisor, the MGA is always the contact.


15. Ratings, exclusions and deferred cases

Ratings and exclusions

Rating • The policy is automatically issued.

• The rating appears under the coverage information in LifeSuite under “Disposition Reason” and “Table Rating”.

Exclusion • The policy is automatically issued.

• Under the coverage information in LifeSuite under “Disposition Reason”, the mention “With an exclusion” will be indicated.

Deferred case

Definition • A deferred case is a declined case.

• Under the coverage information in LifeSuite under “Disposition Reason”, the mention “Postpone” will be indicated.

There are 3 situations for which a file can be deferred by the underwriter

1. A condition that may satisfy the underwriting criteria in the next 12 months (maximum).

2. A medical investigation that was requested to the insured by his physician in the last 12 months (maximum).

3. A medical investigation suggested by the underwriter.

For the 3 deferred situations, when the results are known and if the application and the requirements are still valid

• The advisor may relay the information to the underwriting department by specifying the policy number. The file will then be reviewed in its entirety.

• In the event that the file is approved by the underwriter, the policy will have to be settled before the expiration date of the application and requirements.

For the 3 deferred situations, when the results are known and the application or the requirements are no longer valid, or the coverage cannot be placed before the expiration date

• A new application and new requirements will be required.


16. Reinsurance

General guidelines

Definition • The transfer of a portion of SSQ risk to a specialized company (reinsurer).

Automatic reinsurance • SSQ assesses the risk based on standards accepted by the reinsurer and cedes the portion of risk (determined by a treaty) without the reinsurer having to approve each case; the reinsurer assumes that underwriting standards and administrative rules have been followed by SSQ.

• When the risk is greater than the established parameters of the automatic treaty, the file must then be submitted to the reinsurer for approval. Regular verifications are made by the reinsurer.

Optional reinsurance • For a more favorable decision:

• SSQ uses optional reinsurance when the underwriter wants a more favorable decision that the one dictated by established standards.

• The underwriter submits the optional reinsurance case only if it is believed that a more favorable decision may be obtained for the client. The file is then submitted to different reinsurers who are asked to make an offer. The risk is ceded to the reinsurer who makes the best offer.

Withdrawal of an offer • In a situation where a rated case has not been submitted to a reinsurer (in order to obtain a more favorable decision), and the advisor makes such a request, the initial offer of the underwriter is withdrawn.

• The reinsurer’s decision who submitted the best offer will be the final one, and this, even if it is not as favorable for the client as the initial offer made.


17. Expiry date of declarations and medical requirements

Declarations and medical requirements

Expiry date

Insurance application declarations

• Valid 12 months (after 3 months, a Declaration of Insurability signed by the insured and the policyowner is required).

• Take note that any new request for insurance must be made using a new application (we cannot use the insurance application that was used for a previous policy).

Paramedical • Valid 12 months (after 3 months, a Declaration of Insurability signed by the insured and the policyowner is required).

Tele-interview • Valid 12 months (after 3 months, a Declaration of Insurability signed by the insured and the policyowner is required).

Medical exam • Valid 12 months (after 3 months, a Declaration of Insurability signed by the insured and the policyowner is required).

Urine • Valid 12 months

Blood profile • Valid 12 months

Electrocardiogram • Valid 12 months

Reinstatement form • Valid 6 months (after 3 months, a Declaration of Insurability signed by the insured and the policyowner is required).

Note: The expiry dates mentioned above are valid for a maximum period of 12 months until the age of 69, and for a maximum period of 6 months as of age 70 (after 3 months, Declaration of Insurability signed by the insured and the policyowner is required).

The 12 month delay is calculated from the date of signature of the declaration or from the date of completion of the requirement. The requirement must be valid at the settlement of the coverage or at the approval date of the revision.

In order to determine if the requirement should be ordered when a change request is submitted, anticipate an additionnal delay for the underwriting assessment and the receipt of the delivery requirements, where required.

Important: At any time, the underwriter may request a new medical declaration or medical requirement, notwithstanding the information mentioned above.


18. Issuing a multi-life policy, related policies or an optional policy

General guidelines

Issuing a multi-life policy • The policy will be issued once the underwriter has made a decision for all insureds (all insureds that are part of the same policy).

• If the advisor requests to issue a policy for only one insured (while the file for the other insured still has pending requirements), underwriting will determine if the conditions allow for this change. If the request is accepted, we will proceed with the issue of the policy for the approved insured. The underwriting for the 2nd insured will continue and will be considered as an additional coverage on the original policy issued, once approved.

Issuing related policies • The policies will be issued only when the underwriter has made a decision for all insureds (all the policies will have the same issue date for a single delivery by the advisor).

• Take note that if the applications were not grouped together in the same mailing, as soon as one application is approved by the underwriter, the policy will be issued immediately with no possibility to group the policies thereafter.

Issuing optional policy • Only one optional policy is allowed.

• Ideally, the request must be submitted at the same time as the application. However, a request for an optional policy may be considered if we receive this request before the settlement of the initial policy.


19. Critical illness insurance offer

General guidelines

Criteria for eligibility • When your client is eligible for a class 1, non-smoker rate for Term products (T10, T20, T70, Term Plus), an offer for a Critical Illness insurance may be made to the policyowner and at the underwriter’s discretion.

• This offer does not apply to policies issued with both a life coverage and a critical illness coverage.

The offer is made up of three documents

1) Letter explaining the offer

2) Form with different options offered to the client

3) Declaration of Insurability form

Amount offered • The amount of insurance offered is between $25,000 and $100,000 without evidence of insurability.

Issue age • You must respect the issue according to the plan:

T10, T75, T100: 18 to 65 years old

T20: 18 to 55 years old

T100 paid-up 20 years: 18 to 50 years old

Return of premiums:available options

Return of premiums on death (available with all plans)

Return of premiums at expiry (available with T10, T20 and T75 plans)

Return of premiums on cancellation (available with T75, T100 and T100 paid-up 20 years plans)

How to respond to a Critical Illness insurance offer

• If the client accepts this offer, SSQ must receive the following within 30 days from the date of the offer (letter to the client):

Duly completed form, based on the choice of the client

Declaration of Insurability signed by the client

Premium difference

Illustration (not mandatory, but recommended)

Effective date new coverage or new policy

• Additional coverage on a existing policy: At the original issue date

• Issue a new policy: At the signature date of the request.

Deadline • SSQ must receive all requirements, including the premium for the new coverage within a maximum of 30 days from the date the offer is made to the client. If not received, it is impossible to proceed and no exception can be granted.


20. Redating a policy to the current date

Redating a policy with or without changes

Redating a policy without changes

Criteria for an “Offer to redate” to be included with the policy

• Not an internal replacement

• No backdating to save

• The policy is not in force

An “Offer to redate” can be communicated two ways

1. Offer to redate with a checkbox included the document Amendment to the application or Declaration of insurability.

2. Offer to redate on a distinct page, when there is no document Amendment to the application or declaration of insurability.

How to accept an “Offer to redate”

• In order to accept the offer to redate on the document Amendment to the application or Declaration of insurability, the box provided for this purpose must be checked and the document must be duly dated and signed by the policyowner(s) and insured(s).

• In order to accept the offer to redate on a distinct page, the document must be duly dated and signed by the policyowner(s).

• The request must be received within the specified deadline (verify the date on the Settling requirements form sent with the policy).

• All settling requirements must be received within the specified deadline (verify the date on the form sent with the policy).

The signature date of the document shall be considered as proof of the client’s authorization to change the policy date. Given that no changes were made to the policy, there is no need to return the issued policy. We will not reprint a new policy.

Redating the policy

• The policy will be issued at the signature date of the document.

• When the document is signed on the 29th, 30th or 31st, the “Policy date” will be the 28th day of the month. When this date affects the age that was used for purpose of premium calculation, the “Policy date” will then be the day preceding the age change, in order to maintain the current premium.

• When the day of withdrawal is the issue date, this day will be modified to coincide with the new policy issue date.

An “Offer to redate” is not included with the policy

• When the criteria is not satisfied, an offer to redate is not included with the policy. However, if a redate is requested, the policy must be returned and a new policy will then be issued at the current date, the signature date of Amendment to the application or the Declaration of insurability, as the case may be.


20. Redating a policy to the current date (cont’d)

Redating a policy with or without changes (continued)

Redating a policy with changes

Requirements to proceed with redating• No temporary insurance agreement was in force when approved in

underwriting.• The policy is not yet in force.• The request must be received within the specified deadline (verify the

date on the form sent with the policy).• All settling requirements must be received within the specified deadline

(verify the date on the form sent with the policy).

To avoid an amendment, we suggest that the request be signed and dated by the insured(s) and policyowner(s). When a payment is submitted with the request, the policy will be placed without delay.Important: Certain changes require the intervention of the Underwriting department and / or reinsurer (change in coverage amount, change of product, etc.). In such instances, the calculation of the service standard will only begin when it is returned to the policy issue department.

Particularities • Only one request is permitted (one single re-issue).

• If changes are still required after re-issue, in order to re-issue a third policy, a new application will be required to confirm client’s choices.

• The product must still be available at the new policy date.

• When the Amendment to the Application or Declaration of Insurability is required, the date of the new policy will be the same as the signature on the document(s). When the document is signed on the 29th, 30th or 31st, the “Policy date” will be the 28th day of the month.

• A postdated cheque is not accepted.

• We do not issue policies with a future date.

• No re-dating is possible when adding a Critical Illness insurance further to an acceptance of our offer (see section “Critical Illness offer”).

Communication to the MGA(via LifeSuite)

• Once we receive the policy in the New Business Department (we will specify that the file has been referred to the Underwriting department, when applicable).

Service standards • The policy will be sent by mail within 3 business days after the issue date (excluding the assessment in underwriting, if applicable).


21. Backdating a coverage (to save age)

Concept

Backdating a policy is allowed for the sole purpose of reducing the insured’s age for premium calculation.

Maximum issue age allowed further to backdating, by product

Product New issue date further to backdating Special mention

Permanent Life Insurance (section C1 of the application)

• Maximum 6 months before the issue date originally established.

• Further to backdating, and only when a critical illness rider is requested at the same time, an amendment will be included in the policy.

Term Life Insurance (section C2 of the application)



Term Plus Life Insurance (section C3 of the application)


• Further to backdating, and only when a disability rider and / or a critical illness rider is requested at the same time, an amendment will be included in the policy.

Critical Illness Insurance (section C4 of the application)

• Maximum 30 days before the issue date originally established.

• Further to backdating, an amendment will be included in the policy.

Universal Life Insurance (section C5 of the application



General guidelines

Criteria for eligibility • The product must have been available on the new date requested.

• It is not an internal replacement.

• The client must have been eligible for the product at the time the application is signed.

• All premiums must be paid as of the new issue date.

Automatic backdating • At the issue, we will automatically backdate all policies up to a maximum of 30 days from the issue date, only when this allows to save age.


22. Policy change retroactive to the issue date

Policy status Prerequisites Special mention

Policy not in force at the policy issue

• The request must be received within the specified deadline indicated on the Settling requirements form sent with the policy.

• To avoid an amendment, we suggest that the request be signed and dated by the insured(s) and policyowner(s).

• Once a payment or request for withdrawal is sent with the request, the policy will be settled without delay.

• Only one request is permitted (one single re-issue).

• If changes are still required after re-issue, in order to re-issue a third policy, a new application will be required to confirm the client’s choices.

Policy already in force at the policy issue

• Return of the policy within 30 calendar days following the settlement date of the policy.

The following changes will be processed retroactive to the policy issue date: • increase or reduction of face

amount • change or withdrawal of a benefit

The following additions will be processed by the Administration department, even if received within 30 days:• addition of a life and critical illness

benefit*• addition of an insured* • addition of a disability rider*

* The addition will be processed at premium due date (monthly anniversary) closest to the Underwriter’s approval date. However, the effective date of the addition cannot be prior to the signature date of the request (form).

• After 30 days following the settlement date of the policy, all policy changes must be submitted to the Administration department (In force business).

• Certain changes require the intervention of the Underwriting department and / or reinsurer (change in coverage amount, change of product, etc.). In such instances, the calculation of the service standard will only begin when it is returned to the New Business department.


22. Policy change retroactive to the issue date (cont’d)

General guidelines

Communication to the agency (via LifeSuite)

• Once we receive the policy in the New Business Department (we will specify that the file has been referred to the Underwriting department, when applicable).

Service standards • The policy will be sent within 3 business days after the issue date (excluding underwriting assessment, if applicable).


23. Settling requirements

General guidelines

Deadline • 45 days from the mailing date in order to receive all the settling requirements. The delay may be shorter depending on the expiration dates of declarations/requirements received.

• The deadline is indicated on the Settling Requirements form that is sent with the policy and in Ingenium, in the screen “Policy issue and settling requirements”.

Receipt of requirements • If the requirements are received within the established deadline, the coverage will come into force the next business day following receipt of all requirements.

Policy coming into force • When an Amendment to the Application or a Declaration of insurability is part of the settling requirement, the date that the policy will come into force cannot be prior to the signature date of the document.

• When an Amendment to the Application or a Declaration of insurability is not part of the settling requirement, the date that the policy will come into force will be the receipt date of the settling requirements at SSQ.

Premiums required • The premium is required from the issue date of the policy. Therefore, it is possible that more than one premium will be collected upon receipt of the settling requirements or within a short timeframe

• When the last settling requirement is the payment of the 1st premium, we will immediately withdraw the 1st premium from the client’s bank account, if we have received the duly completed “Pre-authorized debit form” and the void cheque.

Modification or new information received

• Any new information received or any modification will be subject to new insurability review before the policy settlement.

File closure • If all requirements are not received within the deadline, the underwriter’s offer is no longer valid, and the file will be closed without further notice.

Settling requirements received after the file has been closed

• We cannot proceed with the settlement without reviewing the file.

If we maintain our offer: a Declaration of Insurability will be a minimum requirement.

If we do not maintain our offer: the underwriter will require a new application with current declarations

and in certain instances, request that new medical requirements be completed. The underwriter will then proceed with a new assessment of the file and the final decision may be different.

To avoid all unnecessary delays, it is important to respect the deadline indicated on the form Settling Requirements which is sent with the policy.


24. New business premium

Payment of the first premium submitted with the application

Particularities • 3 options are offered but only one choice is allowed.

1st option • Cashed on reception of the application. Cashed on reception of the application. Must be cashable on the date the application was signed.

2nd option • Credit card (complete section P)

Cashed on reception of the application.– If the payment frequency is annual, the amount payable by credit card

is limited to 1/12th of the annual premium (or 1/12th of the MINIMUM annual premium for universal life insurance), subject to a maximum of $5,000.

– If the payment frequency is monthly, the amount payable by credit card is limited to the first monthly premium (or first MINIMUM monthly premium for universal life insurance), subject to a maximum of $5,000.

3rd option • Pre-authorized debit Withdrawal on reception of the application.

Only available if the payment frequency chosen is monthly, the pre-authorized debit agreement has been completed, a specimen cheque and the payer’s identity have also been received.

Payable on delivery of the policy

• If the option “Payable on delivery of policy” is selected, the first premium payment will be cashed on reception of settling requirements except if the “credit card” option is selected given that it has necessarily been cashed on reception of the application (we cannot keep credit card information on file for future use).

Minimum annual premium to issue a policy

• A minimum annual premium of $100 must be reached on at least one adult coverage (excluding policy fees and additional benefits).


24. New business premium (cont’d)

Universal Life Billing premium

• When the billing premium amount is not specified in the application, we consider that it corresponds to that of the illustration.

Payment received with the application

• It will be cashed on reception of the application

• The deposit will be credited to the policy at the settlement date.

If the policy issue date is prior to settlement date:- The minimum premium will be applied retroactive to the policy issue

date to cover the cost of insurance. - The remaining balance of the deposit will be applied at the settlement

date, according to the client’s investement choices (beginning of the return on investment).

Payment received with the settling requirements

• The deposit will be credited to the policy at the settlement date.

If the policy issue date is prior to settlement date:- The minimum premium will be applied retroactive to the policy issue

date to cover the cost of insurance. - The remaining balance of the deposit will be applied at the settlement

date, according to the client’s investement choices (beginning of the return on investment).

25. Automatic day of withdrawal new business

Automatic day of withdrawal for pre-authorized debits: Traditional and Universal life

Traditional • Unless stated to the contrary, the withdrawal date will be the same date the policy is issued.

• By specifying a withdrawal date on the application, the result may be that two (2) premiums could be withdrawn from the client’s bank account within a very short time interval.

Example: The policy date is September 28th, but the client has chosen the 1st as the day of withdrawal. If the premium is received with the settling requirements of the policy in mid-October, we will deposit the premium immediately to cover the September premium, and we will proceed with a pre-authorized debit immediately to cover the October premium, as the October 1st withdrawal date has already passed. We therefore suggest not specifying a day of withdrawal on the application.

Universal life • Method of payment by monthly pre-authorized debits must be made on or before the policy anniversary date. In fact, funds must be deposited towards the policy before the cost of insurance deducted.

Example: A policy issued on February 4th, cannot have an pre-authorized debit on February 15th. The pre-authorized debit must be made on either February 1st, 2nd, 3rd, or 4th. If the day of withdrawal specified is after the policy issue date, the day of withdrawal will be automatically changed to coincide with the policy issue date.


26. Third party determination (Whole life and Universal Life)

Third party determination and Third Party Identification, if applicable

Third party determination • In accordance with the Proceeds of Crime (Money Laundering) and Terrorist Financing Act and its regulations, the financial security advisor/representative must complete the Third party determination section of the application and make reasonable efforts to determine: - if there is a third party regarding this insurance contract,- if the policyowner(s)/ is(are) acting on behalf of a third party (individual,

corporation or other type of entity),- if a third party is making payments for this insurance contract, or- if a third party will have the use of the value of the insurance contract or will

have access to it.

Third Party Identification(if applicable)

• When the financial security advisor / representative who determines or who suspects the existence of a third party that may have an interest in the issue of the policy or where the premium payer is a different person or entity from the policyowner(s), he must provide the information regarding the third party in the Third Party Identification section of application.

27. Verification of the existence (identity) of corporations and other entities (Whole life and Universal Life)

Verification of the existence of entities: forms and additional documents required

Form required • When the policyowner is a corporation or another type of entity and the benefit requested is whole life and universal life insurance, the Verification of the existence (identity) of corporations and other entities form is required.

Form available • Please refer to “Library” section of the Illustration Software, under “ Forms and Questionnaires / Anti-Money Laundering”.

Document(s) required • The Verification of the existence (identity) of corporations and other entities form, duly completed and signed.

For a corporation or another type of entity, a document confirming the existence of the entity AND document(s) confirming the shareholders of the entity are required.

Consult the form to obtain information regarding the documents required according to the type of entity. - ACTIVE Corporation or Other Type of ACTIVE Entity- PASSIVE Corporation or Other Type of PASSIVE Entity (Including Trusts

and Estates)- Non-Profit Organization


28. Declaration of Tax Residence of policyowner(s) (self-certification) (Whole Life and Universal Life)

Declaration of Tax Residence of policyowner(s) (self-certification)

(whole life and universal life)

Policyowner individual • Each policyowner (individual) must confirm if he/she is a tax resident of Canada and/or a tax resident in a jurisdiction other than Canada or the United States.

• When the policyowner is a tax resident resident in a jurisdiction other than Canada or the United States, the form Declaration of Tax Residence (Self-Certification) – Individual is mandatory.

Policyowner Entity • The authorized signatory of the entity must confirm :- if the entity is a tax resident of Canada and/or a tax resident of a

jurisdiction other than Canada AND- if each controlling person of the entity is a tax resident of Canada and/

or a tax resident of a jurisdiction other than Canada

This information must be confirmed on the Verification of the Existence (Identity) of Corporations or Other Entities form or the Declaration of Tax Residence (Self-Certification) – Entity form.

29. Identity verification – insured(s) and policyowner(s))

Identity verification – insured(s) and policyowner(s)

Insured(s)

All types

of benefits

• The financial security advisor/representative must verify the identity of each insured, at all times and for all types of benefits.

Policyowner(s)

Whole life and

Universal life

• According to the Proceeds of Crime (Money Laundering) and Terrorist Financing Act, the financial security advisor/representative must verify the identity of each policyowner for whole life and universal life benefits.

If the policyowner is also insured, the identification of the policyowner is not required.

Information required regarding the verification document

• The financial security advisor/representative must indicate for each person, the applicable document (government issued photo identification document) was examined, its number, its expiration date and jurisdiction. The identifying document must be an unexpired original.


30. Client’s right of examination (new policy)

General guidelines

Our practice based on the text in the policy

• We provide the policyowner a period of 10 calendar days from the delivery date to allow the client to examine the policy.

• During this period, the policyowner may cancel the policy by returning the policy along with a written request. If this is received within the time frame provided, we will proceed with a refund of any premiums paid.

Determining the delivery date • If the policy was settled without delivery requirements

30 calendar days as of the mailing date of the policy (information indicated in Ingenium).

• If the policy was put into force further to the receipt of the settling requirements

10 calendar days from the signature date of the Policy amendment or Declaration of insurability form (signature date confirms the delivery date). If there was no policy amendment or declaration of insurability form, the date indicated on another document (for ex: cheque date) will be considered as being the delivery date of the policy.

After these delays, the examination period expires. The cancellation request, redating or policy change will be handled in accordance with the procedures then in effect.

Note: If the issued policy is not yet in force, and a policy change is desired, refer to the section “Policy change retroactive to issue date“.


31. Disclosing information to a third party

General guidelines

Disclosing test results to the client’s physician

If the insurance application is refused due to test results ordered

• We will automatically send the test results to the client’s physician (unless the content is highly confidential).

• Allow 5 business days for processing following the underwriter’s decision.

• The test results will be sent by fax, when the coordinates are available.

If the risk is rated

• An email request made by the advisor / MGAs is sufficient, as we already have the authorization in the application.

• An email request made by the advisor / MGAs is sufficient, as we already have the authorization in the application.

• The test results will be sent by fax, when the coordinates are available.

Disclosing the reason for the decision to the client’s physician (rating or refusal)

• The client’s (insured / owner) signed and dated written authorization is required.

• Allow 5 business days for processing following the receipt date of the request.

• A confirmation will be sent in LifeSuite, for example, a “Letter from the underwriter was sent to the doctor”.

• Due to a risk associated with an incorrect interpretation, the information is always disclosed to the client’s physician and not the client.

Transmitting documents to another insurer

• The other insurer must provide us with the client’s authorization.

• We will transmit all the requirements that we have on file, at the receipt date of the request.

IMPORTANT: Please note that if certain requirements requested are still outstanding, we will advise the other insurer to submit the new request at a later date.

• Allow 5 business days for processing following the receipt date of the request.

Requesting documents from another insurer

• Generally, we cannot use the paramedical (or medical exam) which was used in the context of another insurance request with another insurer, as the content is different. Please note that we do not have any control regarding the receipt of requirements requested.


About SSQ Financial Group

With $11 billion in assets under management, SSQ Financial Group is a prominent mutualist diversified financial institution in Canada. The Group serves over 3 million customers and employs 2,000 individuals. SSQ Financial Group is recognized for its leadership in the group insurance industry and excellence and expertise in the investment sector. SSQ Financial Group has also made its mark through sustained growth in the general insurance and individual insurance markets.

For more information, please visit ssq.ca.

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Underwriting and New Business · 6 – ADMINISTRATIVE GUIDE FOR ADVISORS - UNDERWRITING AND NEW...

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Transcript of Underwriting and New Business · 6 – ADMINISTRATIVE GUIDE FOR ADVISORS - UNDERWRITING AND NEW...