1. How it Works
1.1 Premium payment / laps
Q. What solution can DFS offer a client who wants to pay the policy with a single premium deposit? Answer
Q. If the client's financial situation changes or if a premium rate increase occurs, can the client make any changes to the policy to decrease the premium? Answer
Q. Similar to life insurance, can a client who stopped paying the premium on his/her Independent living policy put the policy back in force within the following two years? Answer
Q. If a client stops paying his/her premium, can he/she have reduced paid-up coverage? Answer
Q. If a client with the independant living 20 policy goes on claim for a few years during the premium payment period, how does the waiver apply? For example, the client pays premiums for 5 years, then goes on benefit for exactly 2 years and then recovers. After coming off benefit, does he have to pay for a further 15 years (20 years total premium payment), or just 13 years (until 20 years after the effective date)? Answer
1.2 Increasing the insurance amount
Q. Will the company increase the benefit amount after the insured has suffered a loss of independence? Answer
Q. In the section "Increase the amount of long term care benefit" of the contract, it is mentioned that this benefit will terminate after two consecutive option periods have ended without fully exercising the options. What does that mean? Answer
Q. What happen if a client takes the option to increase the insurance amount at some occasion and realizes after a while that he does not have the money to pay the premium? Can he decide to come back and cancel the optional increase? Answer
1.3 Spousal reduction
Q. To take advantage of the spousal reduction, do both spouses have to submit their proposal at the same time? Answer
Q. If both spouses purchase Independent Living at the same time and one is refused, can the other one take advantage of the 10% rebate? Answer
1.4 Assistance services
Q. Who provides the assistance services included in the Independent living protection? Answer
Q. Does the insured need to have suffered a loss of independence to access those services? Answer
1.5 Exclusions
Q. Exclusion number 6: The insured person's participation in any criminal act or related act. What happens if a person is accused, but is not guilty? Answer
Q. Exclusion number 7: mental or nervous disorder with no organic origin. Will a nervous depression will be refused? Answer
Q. What does the term "organic" mean? Answer
Q. As for organic causes, what happens if the doctor prescribes drugs that can cause loss of independence to the insured? Would the insured be covered? Answer
1.6 Age of the insured
Q. What would happen if there was a mistake in the age of the insured? Answer
Q. Is it possible to do an illustration by changing the in-force date of the contract to an older date so the age of the client at the nearest anniversary is inferior? Answer
1.7 Policyholder
Q. Can children, age 18 or older, of the insured be policyholders and beneficiaries on their parent's policy? Answer
2. Selection
2.1 Selection interview
Q. Who does LifePlans use to conduct telephone interviews throughout Canada? Answer
Q. When the nurse calls a client for an interview or when he/she visits for a face-to-face interview, does the nurse have a copy of the application with him/her? Answer
Q. With Independent Living, we want to target the Chinese market. Is it possible to have Chinese-speaking nurses available for telephone and face-to-face interviews? Answer
Q. When LifePlans schedules a phone interview, how many times do they attempt to reach the client before cancelling the case? If a nurse leaves a voice mail message, do they still attempt to reach the client afterwards? How much time do they wait for a response? Lastly, does LifePlans send a letter if no response is received? Answer
2.2 Questions in the application
Q. If the client did not answer all the medical questions in the application, who will complete that information? Is it the face-to-face Interviewer? Answer
2.3 Medical underwriting decision
Q. When a case is declined, is it possible to ask for a second evaluation? Answer
3. Claims
3.1 File analysis
Q. Who does the "claim adjudication"? Answer
Q. What steps does the client have to go through when submitting a claim? Answer
Q. Is a face-to-face interview is needed for all claims submitted? Answer
Q. With respect to the waiting period, what is considered the first day of loss of independence? Answer
Q. Could the date on MD report be considered as the first day of a loss of independence? Answer
Q. Could you give some examples of reassessment depending on specific loss of independence causes? Answer
Q. Will the process be the same in a case of Parkinsons than in a case of Alzheimers? Answer
3.2 Claim request
Q. Once the contract has been issued, can the insured file a claim even if he is out of Canada? Will the benefits be paid while the insured is outside of Canada? Answer
Q. We know that an insured outside Canada or US cannot be covered for Independent Living. But, if an insured started his loss of independence outside Canada or US and comes back in Canada to file a claim, will he/she be covered? Answer
3.3 Cognitive impairment
Q. For cognitive impairment, how do you measure cognitive function? Answer
3.4 Benefit payment
Q. When is the benefit paid to the insured with a loss of Independence? Answer
Q. It is indicated in the policy contract that the determination of cognitive impairment will be made on the basis of clinical data and valid standardized measures of such impairment. Is the treating physician involved in that evaluation process? Answer
Q. Is the waiting period cumulative? As an example, what happens to an insured who has two consecutive losses of independence resulting from the same cause, but for short periods that do not satisfy the waiting period? Answer
Q. How would DFS treat the insured's death while receiving his/her first LTC benefit payment? Answer
Q. How does the benefit period apply when a loss of independence is recurrent, is it restored after each loss of independence? For example, a client purchases a 2 year benefit period and receives a benefit for 6 months because of a hip surgery. The next time he wants to claim for the same cause or another cause, is he limited to claim for only 18 months? Answer
3.5 Declines
Q. If a case is declined, can we appeal? Answer
3.6 LifePlans
Q. Currently LifePlans handles the claims adjudication, but will DFS handle the claims adjudication someday? Answer
4. Marketing
4.1 Marketing
Q. Is there Chinese marketing material available? Answer
4.2 Competitors
Q. What are the strengths of Independent Living against our competitors products? Answer Part 1 / Part 2 / Part 3
5. Managing of the confidential information and complaint
Q. How can we be sure that the role of the US-based LIFEPLANS, is limited to information gathering? Answer
Q. What guarantees do we have that the information (medical records, etc) gathered by LIFEPLANS will be kept confidential -- i.e., not released to US, Canadian or other government agencies or any entities other than Desjardins? Answer
Q. Who does the information they gather legally belong to? Answer
Q. Is there an appeal procedure for underwriting or claims decisions made by Desjardins Financial Security? Answer
6. General information
Q. DFS researched the claims experience of France, the USA, and to a lesser extent the Canadian marketplace in setting our premiums. What are the main factors learned from this research? What claims experience did we assume in setting our premium rates? Answer
Q. Are the premiums guaranteed? Answer
Q. What would initiate an increase? Answer
Q. Where is LifePlans located and how long have they been in business? Answer
Complete FAQ
Complete FAQ
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