Long Term Care Questions & Answers

How it works
Selection
Claims
Marketing

1. How it Works
1.1 Premium payment / laps

Q1.1 What solution can DFS offer a client who wants to pay the policy with a single premium deposit? Answer

Q1.2 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

Q1.3 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

Q1.4 If a client stops paying his/her premium, can he/she have reduced paid-up coverage? Answer

Q1.5 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

Q1.2.1 Will the company increase the benefit amount after the insured has  suffered a loss of independence? Answer

Q1.2.2 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

Q1.2.3 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

Q1.3.1 To take advantage of the spousal reduction, do both spouses have to  submit their proposal at the same time? Answer

Q1.3.2 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

Q1.4.1 Who provides the assistance services included in the Independent living  protection? Answer

Q1.4.2 Does the insured need to have suffered a loss of independence to access  those services? Answer

1.5 Exclusions

Q1.5.1 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

Q1.5.2 Exclusion number 7: mental or nervous disorder with no organic origin.  Will a nervous depression will be refused? Answer

Q1.5.3 What does the term "organic" mean? Answer

Q1.5.4 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

Q1.6.1 What would happen if there was a mistake in the age of the insured? Answer

Q1.6.2 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

Q1.7.1 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

Q2.1.1 Who does LifePlans use to conduct telephone interviews throughout Canada? Answer

Q2.1.2 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

Q2.1.3 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

Q2.1.4 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

Q2.2.1 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

Q2.3.1 When a case is declined, is it possible to ask for a second evaluation? Answer

3. Claims
3.1 File analysis

Q3.1.1 Who does the "claim adjudication"?  Answer

Q3.1.2 What steps does the client have to go through when submitting a claim? Answer

Q3.1.3 Is a face-to-face interview is needed for all claims submitted? Answer

Q3.1.4 With respect to the waiting period, what is considered the first day of loss of independence? Answer

Q3.1.5 Could the date on MD report be considered as the first day of a loss of independence? Answer

Q3.1.6 Could you give some examples of reassessment depending on specific loss of independence causes? Answer

Q3.1.7 Will the process be the same in a case of Parkinsons than in a case of Alzheimers? Answer

3.2 Claim request

Q3.2.1 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

Q3.2.2 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

Q3.3.1 For cognitive impairment, how do you measure cognitive function? Answer

3.4 Benefit payment

Q3.4.1 When is the benefit paid to the insured with a loss of Independence? Answer

Q3.4.2 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

Q3.4.3 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

Q3.4.4 How would DFS treat  the insured's death while receiving his/her first LTC benefit payment? Answer

3.5 Declines

Q3.5.1 If a case is declined, can we appeal? Answer

3.6 LifePlans

Q3.6.1 Currently LifePlans handles the claims adjudication, but will DFS handle the claims adjudication someday? Answer

4. Marketing
4.1 Marketing

Q4.1 Will Chinese marketing material be available? Answer

4.2 Competitors

Q4.2.1 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

Q5.1 How can we be sure that the role of the US-based LIFEPLANS, is limited to information gathering? Answer

Q5.2 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

Q5.3 Who does the information they gather legally belong to? Answer

Q5.4 Is there an appeal procedure for underwriting or claims decisions made by Desjardins Financial Security?  Answer

6. General information

Q6.1 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

Q6.2 Are the premiums guaranteed? Answer

Q6.3 What would initiate an increase? Answer

Q6.4 Where is LifePlans located and how long have they been in business? Answer

Complete FAQ
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