Underwriting guidelines

Personal Health Insurance (PHI) has different underwriting guidelines than life insurance or critical illness insurance. An underwriter can often make a decision based on the information provided in the application. We will be able to process a client's application faster if the application is completed in full, including all information relevant to the client's overall health. PHI underwriters take into consideration the proposed insured's medical history including and pre-existing conditions.

The client won't be eligible for coverage for pre-existing conditions or treatments. In these situations, a modified offer may be made with exclusions. A pre-existing condition or treatment is identified where a client has symptoms, received medical treatment, care, advice or diagnosis was recommended or received for any injury, illness, disease or sickness before the date the application was signed.

Underwriting decisions

  • Standard issue
  • Modified - offer made with exclusions in the policy because of pre-existing condition or treatment and/or a rating because of a person's build.
  • Declined - Coverage is not available if the client:
    • is currently awaiting doctor recommended tests or investigations,
    • has a pending surgery, or
    • has had any of the following illnesses or conditions, listed in the chart below:

Pre-existing illnesses or conditions that will be declined

This is a partial list of common conditions that result in uninsurability and there may be others that may also be uninsurable. Please do not submit an application for coverage if the client has one of the following conditions:

  • AIDS or tested positive for HIV
  • Alzheimer's disease or dementia
  • aneurism (abdominal or aortic)
  • angina
  • anorexia nervosa/bulimia within the last five years
  • anxiety, depression or mood disorder resulting in recent hospitalization or time off work
  • cancer within the last ten years
  • cerebral palsy
  • congestive heart failure
  • coronary artery disease including bypass grafting
  • cystic fibrosis
  • Down's syndrome
  • drug/alcohol abuse within the last five years
  • heart attack
  • heart valve replacement
  • hepatitis B, C, D
  • Huntington's chorea
  • Hydrocephalus
  • kidney disease
  • liver disease (chronic), including cirrhosis
  • major organ transplant
  • morbid obesity
  • multiple sclerosis
  • muscular dystrophy
  • pacemaker
  • paralysis treatment by angioplasty or coronary artery
  • Parkinson's disease
  • peripheral vascular disease
  • schizophrenia
  • spina bifida
  • stroke (cerebral vascular accident) or TIA
  • systemic lupus erythematosus

Send medical evidence to:

Sun Life Assurance Company of Canada
227 King St S
PO Box 1601  STN Waterloo
Waterloo ON N2J 4C5
Fax 1-866-487-4745

Send your underwriting questions by email to PERHLTH.