Sun Critical Illness Insurance

There's good reason to consider Sun Critical Illness Insurance (Sun CII). Medical advances are helping more people survive critical illnesses like cancer, stroke and heart disease. But recovery can come with a significant financial cost that impacts Clients and their families.

Sun CII offers financial help for the costs associated with life-altering illnesses. Clients can use their coverage to help with things like:

  • Reducing debt and other financial concerns while they cope with their illness
  • Replacing any reduced or lost income for them or their spouse
  • Bringing in extra help at home from for their family or themselves
  • Pay for medical treatments, medications or other care related costs not covered by private or government health insurance plans

Why choose Sun CII?

1. Comprehensive coverage that includes:

  • 26 critical illnesses for full payout (including acquired brain injury due to external trauma and loss of independent existence)
  • 8 minor illnesses for partial payout
  • 5 additional illnesses for child plans

2. Wide ranging benefit amounts on adult and child plans:

  • Adult plans available in amounts of $25,000 to $3,000,000
  • Child plans available in amounts of $25,000 to $1,000,000

3. Simple and easy to understand return of premium options. Including graded Return of premium on cancellation or expiry on adult plans.

Overview

Sun CII provides a lump sum benefit that helps the clients respond to a critical illness in their own way.

Sun Life offers the following standalone plan designs for single lives:

  • Term 10 (T10) - Guaranteed renewable premiums every 10 years until the policy ends at the policy anniversary nearest the insured person's 75th birthday.
  • Term 75 (T75) - Guaranteed level premiums until the policy anniversary nearest the insured person's 75th birthday, at which time the policy ends.
  • Term 75 (T75) Payable for 15 years - Guaranteed level premiums for 15 policy years at which time the policy is paid up and coverage continues until the policy ends at the policy anniversary nearest the insured person's 75th birthday.
  • Lifetime (T100) - Guaranteed level premiums until the policy anniversary nearest the insured person's 100th birthday at which time the policy is paid up and coverage continues.
  • Lifetime (T100) Payable for 10 years - Guaranteed level premiums for 10 policy years at which time the policy is paid up and coverage continues.
  • Lifetime (T100) Payable for 15 years - Guaranteed level premiums for 15 policy years at which time the policy is paid up and coverage continues.

For all plans above, coverage will end when a claim is paid for a full payout illness, or when the insured person dies or when the policy is cancelled.

Base plan issue ages

Adult: 18 - 65
Child: 30 days - 17

Issue ages are based on the insured person's insurance age, or their age at their nearest birthday. For example, if your client is 48 years and 7 months, their insurance age will be 49.

Issue limits

Adult: $25,000 - $3,000,000 1
Child: $25,000 - $1,000,000 2

Premium rate bands for all plan types:

  Band 1 Band 2 Band 3 Band 4 Band 5
Child plans

$25,000 - $49,999

$50,000 - $99,999

$100,000 - $250,000

n/a

n/a

Adult plans

$25,000 - $49,999

$50,000 - $99,999

$100,000 - $249,999

$250,000 - $499,999

$500,000 and over

The annual policy fee for Sun CII is $45.00. All premiums must be paid in Canadian funds and drawn from an account at a Canadian financial institution.

Risk classes

  • Male non-smoker
  • Male smoker
  • Female non-smoker
  • Female smoker

Definition: Non-Smoker

No use of tobacco or product containing nicotine for the past 12 months.

Note: we may offer non-smoker rates for a new application where the proposed insured is an occasional large cigar smoker and had a negative cotinine test (when testing is required).

Ratings

Adult plans Child plans

The base plan and the optional Total disability waiver benefit can be rated.

The minimum rating is +25 (125%)

The maximum rating is +150 (250%)

Ratings do not apply to any premium paid for a return of premium benefit.

The Long-term care conversion option is not available on rated or modified plans and therefore can only be issued standard.

The Owner waiver benefit cannot be rated.

Children will only be accepted if they qualify as a standard risk, otherwise they will be declined.

Plans with a +25 rating will be considered a standard risk and will not be declined.

Premium frequency - monthly or annually

Depending on the premium frequency chosen by the client, payments can be made on a monthly basis through our pre-authorized chequing (PAC) process or annually by cheque.

If PAC is chosen, monthly payments are deducted automatically from the payor's account. Monthly premiums are calculated by multiplying the annual premium (including a $45 policy fee) by 0.09 (the modal factor).

The annual premium for this policy is $1,729 If the client chooses to pay monthly, the monthly premium would be $155.61 (annual premium* 0.09). Over a 1 year period, the client would pay $221 less in premiums if they decide to pay annually instead of monthly.

If the client chooses to pay annually by cheque, payments can be remitted to our head office before the policy anniversary date. An annual statement is sent to the owner approximately three weeks before the policy anniversary, reminding them that their annual premium is due.

Premium payment periods

Limited premium payment periods are available on both Sun CII T75 and T100 plans, providing the client with the opportunity to fully pay for their policy premiums in a shorter period of time instead of having to pay for the life of the policy. The options are:

  • Sun CII T75: 15 year limited premium payment option, for issue ages 30 days to 59 years
  • Sun CII T100: choose either 10 year or 15 year premium payment options

Limited premium payment periods may be suited for:

  • clients who don't want the expense of paying premiums during retirement years
  • parents/guardians who want to avoid paying premiums while financing their children's post secondary education
  • clients who want to potentially pay less total premiums for their coverage over their lifetime
  • employers who want to protect their key person while limiting premium payments 

While most features of our regular pay Sun CII plans remain the same when a limited premium payment option is selected, there are 4 exceptions you should be aware of.

  • Return of premium on cancellation or expiry - ROPC/E - age 65 and the Return of premium on cancellation or expiry - ROPC/E - age 75  are not available.
  • The Advanced return of premium on cancellation or expiry - Advanced ROPC/E for child plans is not available. Instead, child plans with a limited premium payment option may select the Return of premium on cancellation or expiry  - ROPC/E age 35 for T75 and T100 plans.
  • The Long-term care conversion option is not available.
  • The Total disability waiver for child plans is not available.

When premiums exceed the critical illness insurance benefit amount

In some CII policies, the premiums paid may exceed the critical illness insurance benefit amount of the policy. Here are some factors that may result in a client paying more in premium than the face amount of the plan:

  • Rated policies
  • An older insured at the time of issue
  • Limited pay policy
  • Smoker status
  • ROPC/E added to the policy

The below scenarios show what will be paid out for Sun CII policies sold after September 17, 2012

Scenario Claims for full benefit payout At cancellation At death

CII without any ROP benefit

CII benefit amount

$0 $0

CII with ROPD

CII benefit amount

$0

Total returnable premium amount, even if this exceeds the CII benefit amount

CII with ROPC/E (before maturity date)1

Total Returnable premium amount or the CII benefit amount, whichever is higher

$0

$0

CII with ROPC/E (after maturity date)1

Total returnable premium amount or the CII benefit amount, whichever is higher

Total returnable premium amount, even if this exceeds the CII benefit amount

$0

CII with both ROPD and ROPC/E
(before maturity date)1

Total Returnable premium amount or the CII benefit amount, whichever is higher

$0

Total returnable premium amount, even if this exceeds the CII benefit amount
CII with both ROPD and ROPC/E
(after maturity date)1

Total returnable premium amount or CII benefit amount, whichever is higher

Total returnable premium amount, even if this exceeds the CII benefit amount

Total returnable premium amount, even if this exceeds the CII benefit amount

 

1 Maturity dates will vary depending on the type of ROPC/E selected.

printable copy:  Guide to critical illness definitions

This guide to critical illness definitions will help you understand the illnesses and procedures covered by the critical illness insurance policy. This is for your reference only, and does not replace the policy. Please review the policy carefully.

Illnesses eligible for full benefit payout

If the insured is diagnosed with one of these 26 critical illnesses and meets the survival period, the client will receive a lump sum payment of their coverage amount and the policy will end. We refer to this list of illnesses as Group 1.

Childhood illnesses eligible for full benefit payout

Sun CII includes coverage for 5 additional illnesses when the insured is between ages 0 and 17 years. If the child is diagnosed with and survives one of these critical illnesses, the client will receive a lump sum payment of their coverage amount and the policy will end. Coverage for these conditions ends on the child's 24th bithday.

Illnesses eligible for partial benefit payout

If the insured person is diagnosed with and survives one of these 5 illnesses, the client will receive a partial lump sum benefit. We refer to this list of illnesses as Group 2. The partial lump sum payment will be equal to 15% of the critical illness insurance benefit amount to a maximum of $50,000 per condition. The client can make one claim per partial payout illness, to a maximum of four partial payments. The policy will not end, and the client must continue to pay premiums for coverage to continue. The critical illness benefit amount will not be reduced and the coverage will be available for any future claims.

* If an insured child is diagnosed with LOIE before the policy anniversary nearest their 18th birthday, a claim may be submitted at the policy anniversary nearest their 18th birthday and no later than the policy anniversary nearest their 19th birthday.

Eligibility qualifying periods and survival periods

The following table shows all illnesses that have an eligibility qualifying period and/or a survival period.

ILLNESS ELIGIBILITY QUALIFYING PERIOD SURVIVAL PERIOD

Acquired brain injury due to external trauma

180 days n/a

Aortic surgery

n/a

30 days following the date of surgery

Bacterial meningitis

90 days

n/a

Coma

96 hours

n/a

Congenital heart disease
(childhood illness)
n/a

30 days following the date of diagnosis. If surgery is performed, 30 days following the date of the surgery.

Coronary angioplasty
(illness eligible for partial benefit payout)
n/a

30 days following the date of the procedure

Coronary artery bypass surgery n/a

30 days following the date of surgery

Dementia, including Alzheimer’s  disease 6 months

n/a

Heart attack

n/a

30 days following the date of diagnosis

Heart valve replacement or  repair

n/a

30 days following the date of surgery

Loss of independent existence

90 days

n/a

Loss of speech

180 days

n/a

Multiple sclerosis

Refer to full definition

n/a

Occupational HIV infection

Refer to full definition

n/a

Paralysis

90 days

n/a

Parkinson’s disease and specified atypical parkinsonian disorders

1 year

n/a

Stroke 30 days

30 days following the date of diagnosis

Type 1 diabetes mellitus
(childhood illness)
3 months

n/a

Optional benefits - Availability at a glance

Issue ages (age nearest)

 

T10

T75

T100

 
ADULT Long-term care conversion option1

18 - 50

x x x
Total disability waiver

18 - 55

x x x
Owner waiver disability benefit

Owner is 18 - 55

x x x
Owner waiver death benefit

Owner is 18 - 60

x x x
Owner waiver death and disability benefit

Owner is 18 - 55

x x x
ROPD

18 - 65

x x x
ROPC/E - 15 years

18 - 60

  x x
ROPC/E - age 652

18 - 50

x x x
ROPC/E - age 752

18 - 60

x x x
CHILD Long-term care conversion option1

May apply to add at policy anniversary nearest the insured's 18th birthday

x x x

Total disability waiver2

0 - 17

x x x

Owner waiver disability benefit

Owner is 18-55

x x x

Owner waiver death benefit

Owner is 18-60

x x x

Owner waiver death and disability benefit

Owner is 18-55

x x x

ROPD

0 - 17

x x x

Advanced ROPC/E2

0 - 17

x x x

ROPC/E - age 353

0 - 17

  x x

Not available on limited pay plans. Available for standard risks only.
2 Not available on plans with a '10 years' or '15 years' payment period.
Only available on plans with a '10 years' or '15 years' payment period.

Long-term care conversion option

Adult plans: Optional benefit for issue ages 18 - 50

Child plans: The owner may apply for this option between the policy anniversary nearest the insured person's 18th birthday and the policy anniversary nearest their 19th birthday, with evidence of insurability.

This option is available only if the insured person is a standard risk. It is not available on plans with limited premium payments (10, 15 years).

If this option is included in the policy, the owner may apply once to convert a portion or the entire critical illness insurance benefit to a long-term care insurance (LTCI) policy on the insured person without evidence of insurability.

The application to convert to long term care insurance may be made during the 5 policy years that start on the policy anniversary nearest the insured person's 60th birthday.

  • We determine the type of LTCI available for conversion.
  • The weekly benefit amount will be calculated by dividing the critical illness insurance amount being converted by 200 and rounded to the nearest dollar. Minimums may apply depending on the LTCI product that is available for conversion.

 

For example: $150,000 (CII benefit amount)
200
= $750 (weekly LTCI benefit amount)

 

  • The maximum critical illness insurance amount that may be converted is $250,000 per insured person for a weekly LTCI benefit amount of $1,250.
  • Premiums for the new LTCI policy will be the attained age rates we charge for the new insurance at the time the application for the new policy is signed.
  • If a return of premium on cancellation or expiry (ROPC/E) benefit is included in the CII policy and the policy has been in effect long enough for the owner to receive the returnable premium amount if they cancelled the policy, then on conversion to LTCI, we transfer the returnable premium amount to the LTCI withdrawable premium fund.
  • If ROPD was included on the CII policy the Return of premium amount will be carried over to the Sun RHA.

NOTE: If a policy includes the Long-term care conversion option (LTCCO) and the Return of premium on cancellation or expiry - age 75 (ROPC/E - age 75), the use of these benefit will be limited. The client can choose to:

  • convert the total CII benefit to long-term care insurance between ages 60 and 65;
    • If converting between 60 and 62 the policy will end and no return of premium benefit will be payable.
    • If converting between 63 and 65 the policy will end and the return of premium benefit percent available at the given age will be payable
  • convert a portion of the CII benefit to long-term care insurance between age 60 and 65 and have the remaining ROP benefit prorated to align with the remaining CII coverage.
    • if they convert between the ages of 60 and 62 they won't receive a returnable amount. For ages 63 to 65 a portion of the returnable premium amount will be returned, based on the converted benefit amount and the chart in the ROPC/E - age 75 section below,
  • retain the full CII benefit until age 75 to gain access to the full ROP benefit but forfeit the opportunity to convert to long-term care insurance

Total disability waiver

This optional benefit maintains coverage if the insured person becomes totally disabled and is unable to earn an income. With Total disability waiver the premiums will be waived if the insured person becomes disabled.

Issue ages

  • Ages 0 - 55
  • For issue ages 0 - 17, premiums and coverage for this benefit begin at age 18.
Availability
  • Not available after issue.
  • Not available if the insured is between 0-17 years and the payment period is '10 years' or '15 years'.

Coverage period for this benefit

  • Until the policy anniversary nearest the insured person's 60th birthday.

Length of time premiums will be waived for

  • For the duration of disability of the insured person, even if disability extends past age 60, provided that the disability began before age 60.

Waiting period

  • Six months of continuous disability.

Maximum amount Sun Life will waive under this benefit

  • $50,000 annual premium across all Sun Life policies
Exclusions

Premiums won't be waived if the total disability:

  • continues for less than six months,
  • is the result of self-inflicted injuries, or
  • is the result of committing a criminal offence

Please refer to the policy for other exclusions.

Making a claim

For clients to make a claim:

  • notice must be given to Sun Life during total disability and before the policy anniversary nearest the insured person's 60th birthday.
  • proof of disability must be provided within six months of notice, and then periodically as required.
  • payments under this benefit won't be made for any period earlier than one year before notice of total disability is received.

Definition of total disability – An insured person must be completely unable, as a result of injury or disease, during the first two years following the date of their disability, to carry on with the essential duties of their own occupation, and thereafter to carry on any occupation. The total disability must be continuous.

  • Disabled while a student – If the insured person becomes disabled while they are a student, Sun Life considers them to be disabled if they are completely unable to attend or participate as a student in an education program or perform the duties of any occupation within their education, training or experience.
  • Disabled while unemployed – If the insured person becomes disabled while unemployed, and isn't profiting from any occupation, Sun Life considers them to be disabled if they're completely unable to perform the duties of any occupation within their education, training or experience.

Owner waiver disability benefit

This is an optional benefit that maintains coverage if the owner of the policy becomes totally disabled between the policy anniversary nearest their 18th and 60th birthdays. Premiums for the insurance amount and any optional benefits in the policy, along with the policy fee, are waived if the owner insured under this benefit becomes disabled.

Issue ages

  • Owner is 18 - 55
Availability
  • Only one owner can be covered per policy.
  • The owner must be different than the insured.
  • Not available when the policy is owned by a corporation.
  • Not available on rated policies.

Coverage period for this benefit

  • Insured ages 18 - 55: Policy anniversary nearest the owner's 60th birthday.
  • Insured ages 0 - 17: Earlier of the policy anniversary nearest the insured's 25th birthday or the policy anniversary nearest the owner's 60th birthday.

Length of time premiums will be waived for

  • For the duration of disability of the owner insured under this benefit.

Waiting period

  • Six months of continuous disability.

Maximum amount Sun Life will waive under this benefit

  • $50,000 annual premium across all Sun Life policies.

Exclusions

Premiums won't be waived if the total disability:

  • continues for less than six months,
  • is the result of self-inflicted injuries, or
  • is the result of committing a criminal offence.

Please refer to the policy for other  exclusions.

Making a claim

For clients to make a claim:

  • notice must be given to Sun Life during total disability and before the policy anniversary nearest the insured person's 60th birthday.
  • proof of disability must be provided within six months of notice, and then periodically as required, and
  • payments under this benefit won't be made for any period earlier than one year before notice of total disability is received.

If ownership of this policy is transferred, the benefits under this option aren't transferrable and therefore the new owner won't qualify for the Owner waiver on death benefit.

If there are multiple owners on one policy, the Owner waiver benefit cannot be transferred between owners.

Owner waiver death and disability benefit

This is an optional benefit that combines the coverages provided by the Owner waiver death and Owner waiver disability benefits. When both benefits are purchased, a discount is applied to the benefit premium.

The issue age for this combined benefit is 18 to 55. All other features and provisions for the separate Owner waiver death and Owner waiver disability benefits remain the same.

Return of premium on death (ROPD) - All plans

Issue ages: 30 days - 65 years

We will pay the returnable premiums (described below) to the ROPD beneficiary if the insured person dies while the policy is in effect and a critical illness benefit is not payable.

Definition:  Returnable premium amount

This definition applies to all return of premium benefits - ROPD, ROPC/E and Advanced ROPC/E.

The returnable premium amount is the sum of all premiums paid, including rated premiums, minus:

  • Any advanced return of premium amount we have paid,
  • Any premiums paid for the Long-term care conversion option, if included in the policy, and
  • Any unpaid premiums plus interest.

The returnable premium amount is not reduced by any payments made for partial payout illnesses and may be greater than the CII benefit amount.  We will pay either a return of premium benefit or a CII benefit, but not both.

Return of premium on cancellation or expiry (ROPC/E)

Summary

 

Sun CII Adult Plans

Sun CII Child Plans
  ROPC/E - age 15 years aROPC/E - age 65 ROPC/E - age 75 Advanced ROPC/E ROPC/E - age 35
T10   x x x  

T75 (lifetime pay plans)

x x x x  

T75 (10-pay or 15-pay plans)

x       x

T100 (lifetime pay plans)

x x x x  

T100 (10-pay or 15-pay plans)

x       x
Adult options:

Return of premium on cancellation or expiry (ROPC/E) – 15 years

Issue ages: 18 - 60
Plan types: T75 or T100. It is also available on plans with limited premium payment periods. It is not available on T10 plans

We will pay a percentage of the returnable premium amount to the owner if the policy is cancelled on or after the 3rd policy anniversary, if the CII benefit is not payable. The benefit has no value if the policy is cancelled before this date. The percentage amount starts at 10% of the returnable premium amount and increases by 7.5% per year to a maximum of 100%.

Policy anniversary Percentage
3

10.0%

4

17.5%

5

25.0%

6

32.5%

7

40.0%

8

47.5%

9

55.0%

10

62.5%

11

70.0%

12

77.5%

13

85.0%

14

92.5%

15

100.0%

 

If the policy expires at age 75 and no claim for a full-payout covered illness has been made, you can receive 100% of the returnable premiums. We will also pay the policy owner any amount in the withdrawable premium fund on the policy end date.

Return of premium on cancellation or expiry (ROPC/E) – age 65

Issue ages: 18 - 50
Plan types: T10, T75 or T100. It is not available on plans with limited premium payment periods.

We will pay a percentage of the returnable premium amount to the owner if the policy is cancelled on or after the policy anniversary nearest the insured person’s 53rd birthday, if the CII benefit is not payable. The benefit has no value if the policy is cancelled before this date. The percentage amount starts at 10% of the returnable premium amount and increases by 7.5% per year to a maximum of 100%.

Age nearest policy anniversary

Percentage
53 10.0%
54 17.5%
55 25.0%
56 32.5%

57

40.0%

58

47.5%
59 55.0%

60

62.5%

61

70.0%
62 77.5%
63 85.0%
64 92.5%

65+

100%

If the policy expires at age 75 and no claim for a full-payout covered illness has been made, you can receive 100% of the returnable premiums. We will also pay the policy owner any amount in the withdrawable premium fund on the policy end date.

Return of premium on cancellation or expiry (ROPC/E) – age 75

Issue ages: 18 - 60
Plan types: T10, T75 or T100. It is not available on plans with limited premium payment periods.

We will pay a percentage of the returnable premium amount to the owner if the policy is cancelled on or after the policy anniversary nearest the insured person’s 63rd birthday, if the CII benefit is not payable. The benefit has no value if the policy is cancelled before this date. The percentage amount starts at 10% of the returnable premium amount and increases by 7.5% per year to a maximum of 100%.

Age nearest policy anniversary

Percentage
63

10.0%

64

17.5%

65

25.0%

66

32.5%

67

40.0%

68

47.5%

69

55.0%

70

62.5%

71

70.0%

72

77.5%

73

85.0%

74

92.5%

75

100.0%

 

If the policy expires at age 75 and no claim for a full-payout covered illness has been made, you can receive 100% of the returnable premiums. We will also pay the policy owner any amount in the withdrawable premium fund on the policy end date.

Child options:

Advanced return of premium on cancellation or expiry - Advanced ROPC/E
Issue ages:
 30 days - 17 years
Plan types: T10, T75 or T100. It is not available on plans with limited premium payment periods.

If a CII benefit is not payable, we will automatically pay the owner 75% of the returnable premiums (described below) on the 15th policy anniversary or the policy anniversary nearest the insured person's 25th birthday, whichever is later, and coverage continues.

If a CII benefit is not payable, we will pay the owner the remainder of the returnable premiums if they cancel the policy on or after the 30th policy anniversary or the policy anniversary nearest the insured person's 40th birthday, whichever is later. This benefit has no value prior to these maturity dates.

For T10 and T75 plans, we will pay the returnable premiums (described below) to the owner if the policy has not been cancelled and therefore expires (ends) and a CII benefit is not payable. These policies expire on the policy anniversary nearest the insured person's 75th  birthday.

Return of premium on cancellation or expiry - ROPC/E - age 35
Issue ages: 30 days - 17 years
Plan types: T75 or T100 plans with limited premium payment payment periods.

If a CII benefit is not payable, we will pay the owner the returnable premiums (described below) if they cancel the policy on or after the policy anniversary nearest the insured person's 35th birthday.

For T75 plans with a 15-year limited payment period, we will pay the returnable premiums (described below) to the owner if the policy has not been cancelled and therefore expires (ends) and a CII benefit is not payable. These policies expire on the policy anniversary nearest the insured person's 75th birthday.

This benefit has no value prior to its maturity at age 35.
Note: ROPD and ROPC/E cannot be added after issue except in certain cases of internal replacement.

Definition:  Returnable premium amount

This definition applies to all return of premium benefits - ROPD, ROPC/E and Advanced ROPC/E.

The returnable premium amount is the sum of all premiums paid, including rated premiums, minus:

  • Any advanced return of premium amount we have paid,
  • Any premiums paid for the Long-term care conversion option, if included in the policy,
  • Any unpaid premiums plus interest.

The returnable premium amount is not reduced by any payments made for partial payout illnesses and may be greater than the CII benefit amount. We will pay either a return of premium benefit or a CII benefit, but not both.

Secure a child's future

The benefit from critical illness insurance when a child is seriously ill can help a family cope financially at a very stressful time. But more than that, choosing to put critical illness insurance in place when a child is young can mean affordable, guaranteed coverage for life. Sun CII has unique benefits designed just for kids that can contribute financially to their futures even if they don't suffer an illness in childhood. A Sun CII policy can be a great gift for parents or grandparents to give a child or young adult.

Key features

A smart plan that grows with the child that can be converted to LTCI coverage later.

The optional Advanced return of premium on cancellation or expiry benefit gives the client the opportunity to get 75% of premiums back and keep their coverage.

The optional Owner waiver benefits provide an additional coverage for parents, ensuring that premiums are waived if the owner dies or becomes disabled.

The child gets their own policy and does not need to re-apply as an adult.

There are no specific tax laws governing critical illness insurance (CII) policies.

Based on these general tax laws and guidance, we expect that:

  • Premiums paid for a CII policy owned by an individual or individuals will not be tax deductible, nor can they be used towards a claim for the medical expense tax credit.
  • Any cash benefits paid from a CII policy will be tax free when the policy owner and benefit payee are the same.

If the policy is owned by a corporation, different tax laws may apply to some circumstances:

  • Premiums paid for a CII policy owned by a corporation will not be tax deductible, except in strictly limited circumstances that are beyond the scope of this guide.
  • Any cash benefits paid from a CII policy will be tax free when the policy owner and benefit payee are the same.
  • Since CII is not life insurance, no part of the CII benefit that a corporation receives can be credited to the corporation's capital dividend account.
  • If the corporation transfers ownership of a CII policy to one of its shareholders or employees, there may be tax consequences for the recipient. If the corporation pays or directs the insurance company to pay any benefit under a CII policy to which it is entitled to another person, directly or indirectly, that person may have to treat the receipt of the benefit as taxable income.

This is only a general summary. A tax professional should be consulted for more information.

Education and training

The following policy wording is provided solely for your convenience and reference. It is incomplete and reflects only some of the general provisions that may be found in some of our insurance policies. We periodically make changes to policy wording and therefore this incomplete sample may not duplicate the wording of any actual issued policy. It is not to be construed or interpreted in any manner as a contract or an offer to contract. The actual policy issued to any given client will govern that relationship.

Policy ownership

Critical illness insurance can be owned by an individual or a corporation. In most cases, the owner, the insured, and the payee will be the same person.

But there are some special circumstances where the owner, insured, or payee differ.

  1. Different owner than insured
    • If the owner of the policy dies and the policy is still in force, the ownership of the policy goes to the estate (depending on the directions in the deceased's will, the estate has authority to transfer ownership).
    • You should urge the client to include specific instructions in their will about transferring ownership of their policy when they die.
  2. Juvenile policies (where owner is different than the insured)
    • If the owner of the policy dies and the policy is still in force, the ownership of the policy goes to the estate (depending on the directions in the deceased's will, the estate has authority to transfer ownership).
    • You should urge the client to include specific instructions in their will about transferring ownership of their policy when they die.
  3. Corporate ownership with corporate benefit payee
    • The critical illness benefit should be received tax free if the corporation is the payee.
    • Since critical illness insurance is accident and sickness insurance, the benefit cannot flow through the capital dividend account to the company's shareholders.
    • For detailed tax information, clients should consult their tax advisor.
  4. Corporate ownership, not part of a “grouped plan”, with the insured or another individual as the payee
    • The income tax implications of this type of arrangement are complex and depend on the type of CI policy, the presence or absence of ROP benefits, and the applicable provincial law (which varies considerably). We recommend that you contact a tax expert for more information.
  5. Shared ownership works when 2 or more parties agree to share a single asset. This way each party only pays for benefits they want.
    • Shared ownership using critical illness insurance allows a business to cover the risk of losing a key employees or to fund a buyout under a buy-sell agreement. The strategy also allows an employee to potentially collect the return of total premiums.

The following forms must be completed:

  • E82 - Transfer of ownership and clear notes on the form about who will own what portion of the policy (CII benefit, return of premium on death benefit, return of premium on cancellation or expiry benefit)
  • E53 - Payee designation change for critical illness insurance policies to name: 
    • a benefit payee
    • a return of premium on death benefit payee, if applicable, and
    • a return of premium on cancellation or expiry payee, if applicable
  • Premium payment arrangements by PAC
    • Usually with a shared ownership arrangement, there is a shared PAC arrangement. We require a new signed Pre-authorized chequing (PAC) authorization (E75) form for each PAC payor with their banking information and direction as to what premiums for the applicable coverage will be paid

 

Plan changes, conversions, internal replacements and reinstatements

What is a Plan change?

A plan change is a non-contractual administrative process. It allows the policyowner to modify a policy with coverage options that were available at issue. We don’t require medical evidence for these changes and the original policy remains otherwise intact.

Plan changes allowed for CII policies

A) Changing from a smoker to a non-smoker

 If the insured person was a juvenile at the time of issue:

  • We’ll charge smoker rates beginning the policy anniversary nearest the insured person’s 18th birthday. The owner may apply for non-smoker rates on or after the policy anniversary nearest the insured person’s 17th birthday.
  • If the Client requests non-smoker rates, we require form E3331 – Juvenile declaration of smoking status. We send Clients this form with their statement between the policy anniversary nearest the insured person’s 17th and 19th birthdays.  

If the insured person was not a juvenile at the time of issue:

If we approve the request, we’ll classify the insured person as a non-smoker. We’ll base the premiums on the non-smoker rates in effect for the insured person’s sex and age on the policy date.

B) Decreasing the benefit amount - use Application for change to an existing critical illness policy - E328

Policyowners can decrease the policy’s benefit amount down to the minimum issue limit for their specific CII product. This can be different from the minimum issue limit of $25K offered now for Sun CII.

If the policy includes Additional Group 1 covered critical illnesses, those benefits will also decrease. Additional Group 1 illnesses offered on Sun CII plans include:

  • Acquired Brain Injury (Sun CII 2009 to 2012 series), and
  • Loss of independent existence (Sun CII 2009 to 2017 series).

If the policy includes a long-term care insurance (LTCI) conversion option, we’ll also decrease the LTCI conversion option. We’ll calculate the new weekly LTCI benefit amount by:

  • dividing the new CII benefit amount by 200, and
  • rounding to the nearest dollar.

Minimums may apply depending on the LTCI product that is available for conversion. For example: $150,000 (CII benefit amount) / 200 = $750 (weekly LTCI benefit amount)

If the policy includes Return of premium (ROP) options:

If the policy includes the Return of Premium on Cancellation/Expiry (ROPC/E) benefit, a partial return of premium may be available. Reducing the CII benefit amount won’t reduce any accumulated ROP balance. The return of premium amount will continue to accumulate based on the new premium.

  • If the policyowner decreases the insurance benefit after the returnable premium amount is available:
    •  they’ll receive a partial return of the ROP value.
    • We treat a decrease of the benefit amount as a partial cancellation of the coverage.
    • We base the partial payment on the percentage of the ROP amount available when the policyowner decreases the benefit amount.
    • This percentage is available in the policy.
  • If the policyowner decreases the insurance benefit before the returnable premium amount is available:
    • we won’t pay a partial return of premium.  
  • If the policy includes an ROPD and ROPC/E benefit, and we pay the Client a returnable premium amount:
    • we’ll decrease the ROP value by the amount of the payment.
    • The ROP balance will continue to accumulate based on the new premium.
  • If the policy only includes an ROPD benefit:
    • there’s no change to the accumulated returnable premium amount when the policyowner reduces the CII benefit amount.
    • ROPD will continue to accumulate based on the new premium.

C) Decreasing the automatic increase benefit (AIB) from 50% to 25% (Sun CII series prior to 2009) - use Application for change to an existing critical illness policy - E328

D) Terminating an optional benefit - use Application for change to an existing critical illness policy - E328
If the Client terminates the Additional Group 1 covered critical illnesses benefit, we’ll also terminate any long-term care insurance conversion option on the policy. 

E) Adding the long-term care insurance conversion option on child plans only - use Policy change, reinstatement and/or reconsideration of rating application requiring evidence - E245

  • Clients can add the long-term care insurance conversion option to a child plan between the policy anniversary nearest the insured person’s 18th birthday and the policy anniversary following their 19th birthday.
  • We require evidence of insurability.
  • If we approve the request, we’ll add the long-term care insurance conversion option to the policy.
  • We calculate premiums based on the attained age of the insured person.

CII Conversions

What is a conversion?

Certain CII Term policies allow the policyowner to change the renewable term coverage to a level premium plan.  They won’t have to give proof of insurability if they apply within the timeframe set out in the contract. We determine which types of plans are available for conversion and the terms and conditions of the new policy. We can limit the amount of coverage and which optional benefits are available for the conversion.

We won’t require evidence if converting to a plan with the same number of illnesses. Conversions are subject to minimums except where the full benefit amount is converted.

We’ll issue the new policy on the same basis as the original policy (i.e., smoker or special class basis).

If policyowners add benefits or features on the new policy that weren’t on the original, we usually require evidence. 

We’ll date the new policy from the date the Client applied for conversion unless they backdate to retain age.  We can backdate a CII policy up to a maximum of 6 months. Rates will be current and at the Client's current age or backdated age.

Partial conversions of CII are not contractually guaranteed. We may allow partial conversions when the original and new policy’s benefit amounts meet the minimum amount requirements. Clients can partially convert their policy and keep the existing amount in force if:

  • the new CII policy has the minimum benefit amount required, and
  • the existing decreased CII policy still meets the minimum benefit amount required.

Which existing CII plans can Clients convert?

Clients can convert:

  • Sun CII Term 10
  • SunSpectrum/Clarica CII Term 10/Term plans
  • CII Term Insurance benefit on Universal Life plans

There is no conversion from Sun Life Assist, Basic CII, Sponsored CII, Prudential, and Met Life plans.

If the original plan is Sun T10, Clients can convert:

  • Sun CII T10 to Sun CII T75 policy, or T100 for policies issued after January 26, 2009
  • up to the policy anniversary following or nearest the insured person's 65th birthday.

See Sun T10 conversion rules at a Glance (810-5139)

If the original plan is Clarica CII or SunSpectrum CII Term, Clients can convert:

  • after the insured person's 20th birthday and
  • up to the policy anniversary following the insured person's 65th birthday.

See Clarica or SSP conversion rules at a Glance (810-5138)

If the original plan is CII Term Insurance Benefit on Universal Life, Clients can convert:

  • up to the policy anniversary following the insured's 65th birthday.

See CII Term Insurance Benefit on Clarica Universal Life or CII Term Insurance Benefit on SunSpectrum Universal Life conversion at a Glance (810-5137)

Things to know about applying for a conversion

If the Client is in Quebec, we require disclosure statements for conversions or partial conversions Notice of Replacement of Insurance of Persons contract  .

We don’t require evidence of insurability for conversions and partial conversions if:

  • the amount at risk is not increasing,
  • there is no change in the number of covered illnesses, and
  • there is no change in risk class (smoker/non-smoker).

The policy must be in force for the Client to convert it. This means the policy cannot be in a lapsed position with premiums outstanding for no more than 40 days.

Important things to remember:

  • The owners of the original and new policy must be the same. If not, submit form E82 - Transfer of ownership. We’ll change the ownership on the original policy to match the new policy.
  • The original policy cannot have an irrevocable or preferred beneficiary. Submit form E36 - Release of beneficiary's interest. We’ll release the interest of the beneficiary on the original policy.
  • The original policy cannot have a bankruptcy notice on it. We can’t convert the policy until the bankruptcy is released.
  • All conversions must meet current product minimums. Conversions are subject to the terms and conditions of the new policy and our administrative rules.

CII Conversions at age nearest 66

Submit a Special Issue application if the Client has a contractual right to convert a CII plan and:

  • the plan is not past the final conversion date, and
  • the Client is age nearest 66

Obtain a special quote and provide it to the Client before you submit the application. Special Instructions in the application should state the following:

  • Conversion to Sun CII (T75 or Lifetime) - age nearest 66
  • Quote number: ########

Sun CII Conversion FAQ

1. What happens if the Client converts a child policy when the child is 18 or older?

When converting a child policy after age 18, the new policy will be an adult policy.

  • The new policy won't cover the additional childhood illnesses.
  • The Advanced Return of Premium on Cancellation/Expiry (ROPC/E) benefit isn't transferrable to the new policy. The policyowner won't receive 75% of the returnable premium amount. This would normally occur at the policy anniversary nearest the insured's 25th birthday or 15th policy anniversary, whichever is later.
  • If the policy included an ROPC/E benefit and the Client adds it to the new policy, we’ll transfer the accumulated returnable premium amount to the new policy.

2. Can a Client partially convert the original policy? How does that affect any Return of Premium on Death (ROPD) or Return of Premium on Cancellation/Expiry (ROPC/E) benefit?

We allow partial conversions, subject to the minimum face amounts for the original policy and the new policy.

If the policy included an ROPC/E or ROPD benefit and the Client adds either of these to the new policy, we’ll transfer the prorated accumulated returnable premium amount to the new policy.

3. How do we know which optional benefits the Client can add to the new policy?

Clients can add or carry over optional benefits from the original policy if they qualify for the benefits based on their attained age when they convert.

For example, if the Client had an ROPC/E at age 65 on the original policy and converts:

  • the new policy can include the same benefit if the Client converts before age 50.
  • the new policy can include the ROPC/E – 15 years option if the Client converts before age 60.
  • the Client will forfeit the accumulated returnable premium amount if they convert after age 60.

4. Do we ever request evidence of insurability on conversion?

Conversions and partial conversions need evidence of insurability if:

  • the Client increases the amount at risk,
  • there is a change in the number of covered illnesses, and
  • there is a change in risk class (smoker/non-smoker).

5. What happens if the original policy has ROPC/E that has met the maturity date?

When the original policy includes ROPC/E, the conversion never triggers a return of premium.

If ROPC/E is not available on the new policy due to issue age limitations, the Client forfeits the accumulated returnable premium amount.

6. What happens when a Client converts an older Sun CII plan with ROPC/E to a new Sun CII plan with graded ROPC/E?

There are no changes to our conversion rules because of the new graded ROPC/E.

  • The accumulated returnable premium amount carries over to the new policy issued from the conversion.
  • The accumulated years do not carry over, except for policies issued with ROPC/E 15 from January 2005 to March 2006.

The new graded ROPC/E will apply for newly issued plans. This means access to a portion of the returnable amount may be available according to the following tables:

ROPC/E 15
Policy Anniversary Percentage
3 10.0%
4 17.5%
5 25.0%
6 32.5%
7 40.0%
8 47.5%
9 55.0%
10 62.5%
11 70.0%
12 77.5%
13 85.0%
14 92.5%
15+ 100.0%
ROPC/E 65
Policy Anniversary Age Nearest Percentage
53 10.0%
54 17.5%
55 25.0%
56 32.5%
57 40.0%
58 47.5%
59 55.0%
60 62.5%
61 70.0%
62 77.5%
63 85.0%
64 92.5%
65+ 100.0%
ROPC/E 75
Policy Anniversary Age Nearest Percentage
63 10.0%
64 17.5%
65 25.0%
66 32.5%
67 40.0%
68 47.5%
69 55.0%
70 62.5%
71 70.0%
72 77.5%
73 85.0%
74 92.5%
75+ 100.0%

CII Internal Replacements

What is an internal replacement?

An internal replacement allows for a plan change outside of the contractual right. Clients must always submit evidence for internal replacements. A benefit of the internal replacement is that we may pay out the accumulated ROPC/E benefit cancellation values.

  • An internal replacement can be used to switch from a T75 plan to a T100 plan or vice versa
  • to add optional benefits that were not included at the time of application
  • to change the payment period

Note: Clients can only surrender Clarica Basic CII (sold up until April 24, 2008). They can’t replace these policies. Complete a surrender form and proceed as new business.

The new policy will use the date the Client applied for the internal replacement unless they backdate the policy.  We can backdate a policy up to 6 months to retain age. Rates will be current and at the Client’s current age or backdated age.

The same backdating rules apply to new business, internal replacements, and conversions.

How is a replacement different from a surrender or cancellation?

An internal replacement doesn't require a surrender form, and we don’t immediately cancel the original policy. Instead, we terminate the original policy once we issue the new replacing policy. If we decline the replacement application, we won’t terminate the original policy.

Why is evidence required?

Clients must submit evidence for internal replacements because the new policy is a new risk.  We need evidence to assess this risk.

What happens to the ROPC/E value on an internal replacement?

If the original policy has an accumulated ROPC/E value, we’ll pay the return of premium amount to the owner. If the original plan is a SunSpectrum CII permanent policy, we’ll pay any accumulated cancellation value when we cancel the original policy.

General rules to keep in mind for CII internal replacements

A) When the original policy is a Clarica or SunSpectrum CII

  • If the existing plan has a cancellation value, we’ll pay the applicable accumulated value when we cancel the policy.
  • Clients will forfeit any ROPD value from the existing policy.
  • If the Client is replacing their policy with Sun CII, they can add ROPC/E and ROPD benefits, subject to attained age. We’ll require underwriting.

B) When the original policy is a Sun CII plan

  • If the policy includes an ROPC/E benefit and the policy has a returnable premium amount, we’ll pay applicable return of premium amount when we cancel the policy. Otherwise, it is forfeited.
  • The Client will forfeit any return of premium on death (ROPD) value from the existing policy.
  • If the existing policy doesn’t have an ROPC/E or ROPD benefit, the owner can apply to add them to the new policy. The ROP benefits must be available when the Client replaced their policy. The benefits will be based on attained age and underwriting is required.

Reference guide

Determining if plan is eligible for a conversion or an internal replacement

From Existing Policy:
Plan Name
To New:
Sun CII Term 10
To New:
Sun CII Term 75
To New:
Sun CII Lifetime
Sun Critical Illness Term 10 (pre-2009) Internal replacement Conversion Internal replacement
Sun Critical Illness Term 10 (series 2009) Internal replacement Conversion Conversion
Sun Critical Illness Term 75 Internal replacement Internal replacement Internal replacement
Sun Critical Illness Lifetime Internal replacement Internal replacement Internal replacement
Sun Life Assist Internal replacement Internal replacement Internal replacement
Clarica/SunSpectrum CII Term Internal replacement Conversion Conversion
Clarica/SunSpectrum CII Perm Internal replacement Internal replacement Internal replacement
Clarica Ulife 2000 CII Term Rider Internal replacement Conversion Conversion
SunSpectrum Basic CII (available as of April 25, 2008) Internal replacement Internal replacement Internal replacement
Met Assist Internal replacement Internal replacement Internal replacement
Clarica Universal Life CII Term Rider  Internal replacement Conversion Conversion
SunSpectrum Universal Life CII Term Rider (clone of Sun CII Term 10) Internal replacement Conversion Internal replacement

Notes:

  • *Clients can only surrender Clarica Basic CII (sold up until April 24, 2008). It can’t be replaced. Request a surrender and proceed as New Business.
  • Clients must convert on or before the policy anniversary following the insured’s 65th birthday. For Sun CII series 2012 and after, it’s the policy anniversary nearest the insured’s 65th birthday.
  • Review the policy wording. It sets out the policyowner's contractual rights. We’ll always use the policy to make a final decision on any type of transaction.

What is the long-term care conversion (LTCCO) on Sun CII?

The LTCCO allows the owner to apply once to convert their Sun CII benefit to a long-term care insurance (LTCI) policy. Coverage is for the insured person. Clients can convert some or all of their CII benefit without evidence of insurability.

When Clients become eligible to exercise this option, we send them a letter.  We send a letter every year they're eligible to convert. As always, you will receive a copy of this letter in your activity center.

There are various factors to consider about converting from CII to LTCI.

When should the Client consider converting?

For all Sun CII policies with a Long-term care conversion option

  • The Client can convert during the 5-year period after the policy anniversary following their 60th birthday. For series 2012 and later / policies sold after September 17, 2012, it’s the policy anniversary nearest their 65th birthday.
  • We’ll base the LTCI premiums on the insured person’s age at conversion. The later a Client converts, the higher their premium will be.
  • If we're assessing a CII claim, the Client must wait until after we’ve made our decision before applying to convert.
    • If we approve a claim for a Group 1 Covered critical illness, the policy ends. This option to convert also ends.
    • If we deny a claim for a Group 1 or a Group 2 Covered critical illness, and the last date to convert passed while we assessed the claim, we'll extend the LTCCO application window by 30 days after the claim decision date.

For series 2009 only: If we're waiving premiums under the disability waiver benefit, the Client must wait until the final conversion date to convert.

For CII policies with a Return of premium on cancellation or expiry (ROPC/E) benefit

If the Client's CII policy includes ROPC/E - age 65, the Client may want to receive the return of premium before converting. This means they’ll need to wait until age 65 before conversion.

Three scenarios for the Client to consider with ROPC/E - age 65.

  • Convert the total CII benefit before age 65:  the policy will end and no return of premium (ROP) benefit will be payable.
  • Convert part of the CII benefit between age 60 and 65: we’ll prorate the remaining ROP benefit to align with the remaining CII coverage. The adjusted ROP benefit will be payable at age 65.
  • Convert all or a portion of the CII benefit at age 65:  the Client will be able to access the ROP benefit and convert to LTCI.

Important: This also applies if a policy includes the ROPC/E - 15 years benefit and the ROP amount becomes payable between ages 60-65.

How much can the Client convert?

  • A Client can convert all or part of their CII coverage to LTCI. Having both CII and LTCI provides well-rounded coverage.
  • The new weekly LTCI benefit will equal the amount of CII coverage converted, divided by 200.
    • For example, if the Client converts $100,000 of the CII benefit, the new LTCI benefit would be $500.00 per week.
  • The maximum amount of CII the Client can convert is $250,000. This translates to a weekly LTCI benefit amount of $1,250.
  • If considering a partial conversion, minimums on both products must be met.
    • The minimum weekly benefit amount on Sun RHA is $125, so the minimum conversion amount is $25,000 of CII.
    • The minimum CII benefit amount on series 2009 Sun CII is $50,000
    • The minimum CII benefit amount on 2012, 2017 and 2021 Sun CII is $25,000.

Assessing Client needs

Use the cost of care reports to help Clients understand how much long-term care costs in their province today.

Remember the effect of inflation while determining an appropriate benefit amount.

What happens to optional benefits on conversion?

Sun CII policy LTCI policy
ROPD included

Converting to Sun Retirement Health Assist (Sun RHA): 

The returnable premium amount is transferred to Sun RHA

ROPD is not included

Optional ROPD can be added to Sun RHA

ROPC/E is included

ROPC/E is not available on Sun RHA

If the Sun CII policy is converted before the returnable premium amount is payable, the Client forfeits ROPC/E benefit.

Additional things to note about partial conversions

  1. Minimums must be maintained on both the CII and LTCI policy.
  2. The CII benefit amount is reduced by the amount converted to LTCI.
  3. Once a partial conversion is completed, the long-term care insurance conversion option on the Sun CII policy ends.

If ROPD is included on the CII policy

  • The returnable premium amount on the CII policy is reduced to align with the lower CII benefit amount.
  • The balance of the returnable premium amount is transferred to the LTCI policy.

If the CII policy includes ROPD and ROPC/E, and the Client converts before the ROPC/E benefit is available:

  • We reduce the ROPC/E amount payable to align with the lower CII benefit amount.
  • We don't reduce the ROPD amount payable. If the Client selects ROPD on the LTCI policy, we transfer a portion of the returnable premium amount to the LTCI policy.

If the CII policy includes ROPD and ROPC/E, and the Client converts after the ROPC/E benefit is available:

  • We reduce the ROPC/E amount payable to align with the lower CII benefit amount.
  • We reduce the ROPD amount payable to align with the lower CII benefit amount.
  • We transfer premiums paid for the difference between the original CII benefit amount and the lower face amount to the withdrawable premium fund of the LTCI policy.

If the CII policy includes ROPC/E and the Client converts before the ROPC/E benefit is payable:

  • We reduce the returnable premium amount to align with the lower CII benefit amount. The Client will forfeit premiums paid for the difference between the original CII benefit amount and the lower face amount. 

If the CII policy includes ROPC/E and the Client converts after the ROPC/E benefit is payable:

  • We reduce the returnable premium amount to align with the lower CII benefit amount. We transfer premiums paid for the difference between the original CII benefit amount and the lower face amount to the withdrawable premium fund of the LTCI policy.

How to apply for the LTCI conversion?

To apply, please complete and submit Application for Sun Retirement Health Assist (4535).

You will not need to complete Sections 8 as evidence information is not required.

In Section 10: Special instructions please indicate “This is a conversion application for policy LI-XXXX,XXX-X”.

The required premiums for the CII policy must be paid by the due date. If premiums aren’t paid when due, we’ll withdraw the unpaid premium from the withdrawable premium fund if it has enough funds.

If premiums aren’t received within 30 days after they’re due and there are insufficient funds in the withdrawable premium fund, the policy will end. If the policy ends this way, it’s called a lapse.

The Client will have until day 61 to reinstate without providing evidence of insurability.

If the policy ended because it lapsed, the owner can apply to have it put back into effect (or reinstated) if:

  • the insured hasn’t been diagnosed with a covered critical illness,
  • the insured hasn’t had any signs or symptoms of a covered critical illness, or
  • the insured hasn’t had a change in health, family history or occupation.

To reinstate the CII policy, the owner must:

  • apply within two years of the date the policy ended,
  • make a payment equal to the reinstatement charge, and
  • provide new evidence of insurability.

Critical illness insurance reinstatement rules:

Number of days from the premium due date Amount of insurance Evidence requirements Payment requirements
Less than 62 Any None The total of all back payments to the current date, without interest.
62 - 180 Any Application for reinstatement of life or critical illness insurance (form E67).
Greater than 180 Any

Option 1: Regular evidence for age and amount

Option 2: Policy change, reinstatement and/or reconsideration of rating application requiring evidence (form E245)

Claims

Step 1: Completion of the claim forms

When an insured person has an eligible illness as defined in the critical illness policy, a claim should be submitted immediately1. A claim must be sent to us while the policy is in effect and within 1 year of the date the insured person has a covered critical illness.

Please contact the Individual Claims Services department directly for the appropriate critical illness claim forms. You can call Individual Claims Services toll free by dialing 1 800-800-4SUN (1 800 800-4786).

The person making the claim must complete the form and give us the information we need to assess the claim.

The form and information must be sent to this address:

  • Individual Claims Services
    Sun Life Assurance Company of Canada
    227 King St S, PO BOX 1601 Stn Waterloo
    Waterloo ON N2J 4C5

Physicians may charge a fee to complete certain forms. The person making the claim is responsible for any fees for this information.

1Child plans: The first date a claim for Loss of independent existence may be made is the policy anniversary nearest the insured person's 18th birthday. If the insured person would have qualified for a Loss of independent existence before this date, you may still make a claim. However, you must submit the claim to us no later than the policy anniversary nearest the insured person's 19th birthday.

Note: No benefit is payable if the illness is cancer or benign brain tumour where signs or symptoms began in the first 90 days following the later of:

  • the date the application for the policy was signed,
  • the policy date,
  • the underwriting decision date if included in the policy, or
  • the most recent date this policy was put back into effect (reinstatement),

If this is the case, the client still has a responsibility to report the cancer or benign brain tumor. Form Responsibility to report cancer or benign brain tumour - E277

will need to be completed. You can print the form here or call the underwriting department toll free by dialing 1 800-800-4SUN (1 800 800-4786) for a copy of this form.

If this information is not provided within 6 months of the date of diagnosis, we have the right to deny any claim for cancer or benign brain tumor or any critical illness caused by any cancer or benign brain tumor or their treatment.

This form E277 will need to be forwarded to:

  • Sun Life Assurance Company of Canada
    Document Centre, Underwriting and Issue
    227 King St S
    PO Box 1601 Station Waterloo
    Waterloo ON N2J 4C5

Note: No benefit will be payable for Parkinson's disease or specified atypical parkinsonian disorders if, within 1 year following the later of:

  • the date the application for this policy was signed
  • the underwriting decision date, but only if shown under the heading, Amendments to this policy
  • the policy date, shown on the Policy summary, or
  • the most recent date this policy was put back into effect (reinstatement) and/or

the insured person has any of the following:

  • signs, symptoms or investigations that lead to a diagnosis of Parkinson's disease, a specified atypical parkinsonian disorder or any other type of parkinsonism, regardless of when the diagnosis is made, or
  • a diagnosis of Parkinson's disease, a specified atypical parkinsonian disorder or any other type of parkinsonism.

If this is the case, the client still has a responsibility to notify us about Parkinson's disease or specified atypical parkinsonian disorders. Form Responsibility to report Parkinson's Disease and Specified Atypical Parkinsonian Disorders will need to be completed. You can print the form here or call the underwriting department toll free by dialing 1 800-800-4SUN (1 800 800-4786) for a copy of this form.

This form 4860-E will need to be forwarded to:

  • Sun Life Assurance Company of Canada
    Document Centre, Underwriting and Issue
    227 King St S
    PO Box 1601 Station Waterloo
    Waterloo ON N2J 4C5
    Sun Code 300B25

Step 2: Collection of medical information

Once we receive the forms, we will assess the insured person's eligibility for benefits. Written requests for additional medical information may be sent directly to the physician by Individual Claims Services as we may require additional medical information to assess the claim. If the policy was issued within the last five years, be sure to advise the client that these additional reports will be requested by Individual Claims Services to complete the assessment of the claim.

Step 3: Making the claims decision

Once we receive all information we require, Individual Claims Services assesses the information and makes its decision. We communicate the decision to the advisor. We send payment cheques to the advisor for delivery. If we deny a claim, we send a letter explaining the decision to the owner. If the owner and insured person are not the same person, we send two decline letters. We send one letter to the insured person fully explaining our decision. We send a separate letter to the owner confirming our denial of the claim but no medical information is given to the owner for privacy reasons.

To contact the Individual Claims Services department, you have the following options:

Critical illness occurring or diagnosed while in Canada

The person making a claim for a covered critical illness that occurs or is diagnosed in Canada must give us all information we need to assess the claim, including:

  • proof that they have the right to receive a critical illness insurance benefit
  • proof that the insured person suffered a critical illness while this policy was in effect
  • a written diagnosis which describes the conditions and the cause of the illness, and
  • the complete medical records of the insured person.

The written diagnosis must:

  • include appropriate information to assess the illness, and
  • be prepared and signed by a specialist licensed and practicing in Canada or by another physician acceptable to us.

A specialist is a licensed medical practitioner who has been trained in the specific area of medicine relevant to the critical illness for which a benefit is being claimed, and who has been certified by a specialty examining board. In the absence or unavailability of a specialist, a condition may be diagnosed by another qualified medical practitioner as approved by us.

Please refer to the sample policy pages for more details.

Critical illness occurring or diagnosed while outside of Canada

A claim can be made for a critical illness insurance benefit if a covered critical illness develops or is diagnosed while outside of Canada. The person making the claim will be required to provide us with all of the information described above. If the medical records of the insured person are not in French or English, the original records must be provided along with a translation2 of the records in either French or English. The person making the claim is responsible for any cost associated with providing the translation.

2The translator may not be the owner, any person insured under this policy, anyone entitled to make a claim under this policy, or any relative or business associate of these people.
Based on the medical records we require, we must be satisfied that the same diagnosis would have been made if the illness developed in Canada.

Tips for speeding up the claims process

Ensure the person making the claim completes all the information and fields on the claims forms and signs and dates the form.

The most common missing information is:

  • Signatures: if the insured person is incapable of signing the claim form (incapacitated) ensure the CI claim form is signed by the Power of Attorney and submit the Power of Attorney papers with the signed claim form.
  • Physician contact information: the full address, including postal code and phone number, of all doctors the insured person has consulted. Include all names of regular attending physicians and specialists.

If the claim is approved, the CII benefit is issued once the eligibility period has been satisfied subject to the definition outlined in the policy.