What to expect when you apply for insurance coverage

Transcription

1 What to expect when you apply for insurance coverage As you know, an informed customer is a smart customer. When you purchase insurance, the application and underwriting processes can be confusing. The Alberta Medical Association (AMA), through its wholly owned insurance subsidiary, ADIUM Insurance Services Inc. (ADIUM), has partnered with Sun Life Assurance Company of Canada (Sun Life) to offer you a comprehensive and affordable insurance program. This brochure is designed to help you understand what you need to do and what to expect when you apply for coverage.

2 The application process Once you have made a decision to buy insurance, the first step in applying for coverage involves completing an application form. The initial application contains questions that identify your coverage requirements and your personal information. Depending on the product(s) you apply for,the application may include occupational and financial questions. You are a key player in this process. It is important that you fill out the form completely and accurately, for two reasons: 1. An incomplete application will be returned to you for further information and will delay the process. 2. Your completed application is considered a legal, binding document that forms part of your contract for insurance coverage. Once you have completed your application please send it to ADIUM who will forward it to Sun Life. ADIUM Insurance Services INC. CMA Alberta House Ave. NW Edmonton, AB T5N 9Z9 Personal information All personal information you provide will be kept confidential. Both Sun Life and the AMA adhere to applicable federal and provincial privacy legislation. To find out more about Sun Life s privacy policy and code, please contact Sun Life for a copy of their Respecting your privacy booklet, or review the privacy policy for Canada online at You can also obtain privacy information from the AMA s website at What happens next? Initial screening An administrator from ADIUM will conduct an initial review of the non-medical portion of your application to ensure it contains all the required information. After the initial screening your contact details will then be forwarded to Dynacare Insurance Solutions (DIS) to complete the medical underwriting portion of your application.

3 Underwriting Underwriting is the process of assessing and classifying the degree of risk that each applicant represents. Through this risk-selection process your eligibility and insurability for coverage will be determined. It also ensures that you are charged an appropriate premium rate; for instance, if you are a non-smoker, you should not pay the same premium rate as a smoker. You will be contacted by DIS, who will conduct a confidential interview with you which will be recorded. Following that, an appointment will be made to complete any required medical tests such as vitals, blood chemistry profile (which includes serology for AIDS, HIV, hepatitis, other viral infections and a drug screen). The DIS representative will advise which tests are required. These tests will be obtained at no cost to you and an appointment will be made for you during your DIS interview. A copy of your blood chemistry profile results and interview will be sent automatically to you from Sun Life. If needed, Sun Life may contact you for additional medical and/or financial information. In addition, a medical report from your family physician may be requested. Monitoring Sun Life actively tracks your application during the underwriting process and follows up on outstanding requirements. Sun Life will liaise with service providers regularly to ensure that information is received promptly. Dedicated support staff will keep you up-to-date and send follow-up letters to you on a regular basis. Service representatives from both AMA and Sun Life are also available to answer any questions you may have about your application. The underwriting decision It takes approximately 30 to 35 business days for Sun Life to receive all the necessary medical and/or financial information from the various sources. More time may be needed to obtain medical requirements, in particular, the time it takes to receive the medical report from your family physician. Once all the information is received, the underwriter will render a decision within an average of five business days and you will be notified of the decision.

4 Your application will be either: Approved standard, which means it is approved as applied for. This is the most common result. Approved substandard, which can mean that it is approved with an exclusion or limitation. For example, a pre-existing activity such as skydiving will not be covered. This outcome occurs occasionally. Declined, which means that coverage cannot be provided. Whenever possible, the underwriter will invite you to re-apply in the future. Appeals If you do not agree with the underwriting decision, you have the right to appeal. Simply notify Sun Life in writing and provide additional information that you believe will help re-assess your application. In reviewing your appeal, the underwriter will consult other members of the underwriting team who have specialized expertise. Note that the majority of appeals are resolved after more information is provided, which can either reverse the original underwriting decision or support it. Underwriting team The underwriting team includes qualified underwriters, medical doctors, accountants, and professional support staff who have decades of underwriting experience. Rest assured, they exercise sound, objective, fair, and consistent judgement in making underwriting decisions. The underwriting team has an enviable track record and are highly respected in the industry for their impeccable underwriting standards and practices.

5 Need more information? If you have any questions regarding the underwriting process, contact either: Sun Life s customer service centre toll-free at or by at Can_AssocAndAffinity@sunlife.com, or ADIUM Insurance Services at or or by at adium@albertadoctors.org Insurance coverage is available as a member benefit of the AMA and is underwritten by Sun Life Assurance Company of Canada, a member of the Sun Life Financial group of companies. A market leader in group benefits, Sun Life Financial serves more than five million people in over 10,000 corporate, association, affinity and creditor groups across Canada. The core values integrity, service excellence, customer focus and building value are at the heart of who they are and how they do business. Extensive products, services and technology enable them to tailor group benefit programs to meet virtually any customer s needs competitively and cost-effectively. Sun Life Financial and its partners have operations in key markets worldwide including Canada, the United States, the United Kingdom, Hong Kong, the Philippines, Japan, Indonesia, India, China and Bermuda. This brochure is intended for general guidance and is not a contract. The complete terms, conditions, limitations and exclusions governing the insurance coverage are found in the relevant group insurance policies issued to the AMA by Sun Life Assurance Company of Canada. AA _AMA_Applying for Insurance Brochure