One of the most common questions about life insurance we get is how to qualify for it. What is "evidence of insurability", what is a pre-existing condition, and what if I have been diagnosed with a major illness like cancer, a heart attack, or diabetes, or declined for insurance in the past?
It is not impossible to qualify for insurance even if you have been diagnosed with a serious illness. Insurers call a medical condition that has been diagnosed a "pre-existing condition". The rates may not be standard, but insurers may be able to offer coverage depending on the specific condition, how long ago you were diagnosed, and your current treatment and lifestyle.
True Benefits has recently been able to secure coverage for clients with past: skin cancer, Type 1 Diabetes, Gestational Diabetes, heart attack, and cancer. Other situations that we've been able to secure coverage for clients include: past drug or alcohol abuse, and dangerous sports or avocations such as scuba diving, heli-skiing, and racing cars.
Every insurer asks for medical evidence with the application for insurance. The type of evidence will depend on several factors: the applicant's age, the amount of coverage applied for. To give you an idea of the range, a 25 year old applying for $200,000 of insurance may not be required to provide any medical evidence besides a health questionnaire, whereas a 60 year old applying for $2 million of coverage will need to see a nurse for blood and urine samples, a resting EKG, blood pressure, weight and height readings.
If you have been diagnosed with a medical condition, declined for insurance or offered non-standard rates in the past (also called a "rating" or "substandard rates"), insurers will also likely ask for an APS (Attending Physician Statement).
All of these items are paid for by the insurer, and True Benefits can arrange to have the lab results sent to your doctor so you can review them.
One of the best things to do if you suspect getting insurance may be a challenge is to ask your advisor to gather preliminary guidances for you. This is something we do for all of our clients.
A confidential description of your medical history, lifestyle, build, age and treatments is provided to the top Canadian underwriters (no names, birthdates or other identifying information should be provided to the carrier in a preliminary request). The insurer can then provide us with an estimate of potential rates, allowing the client to choose the most attractive insurer to apply with. It is best to do this before completing any applications.
A recent preliminary guidance for a client with a history of cancer showed that one carrier was able to offer standard rates, whereas the others indicated sub-standard ratings would likely be applied. The client applied to the insurer with the best offer and was able to obtain standard rates. The guidances allowed True Benefits to recommend the best underwriter, whereas if we had gone with the insurer offering the "cheapest" standard rates, the client may have ended up paying more than necessary.
Did you know that up to one third of applications for life and critical illness insurance are rated or declined? If you have any questions about applying for insurance, please feel free to call us at 604.872.2866 to discuss.
Sole-proprietors, your PHSP Year End is December 31, 2010; year end is the time to send in your 2010 claims.
The best time to make a claim is before the end of your Plan Year. This will ensure you maximize the value of your health and dental plan. Making a claim is fast and easy. If you need a claim form, feel free to call our office at
To get started, simply gather your medical receipts and start filling out your claim form!
Corporate PHSP holders, you have until your corporate year end to submit claims.
Beginning in January of 2011, self-employed Canadians will be eligible for EI benefits. The coverage available includes maternity benefits, paternity benefits, sickness coverage, and compassionate care coverage.
The criteria to sign up for these coverages: you must operate your own business or corporation, and are a Canadian citizen or permanent resident.
Keep in mind that there is a 12 month waiting period after enrolling, where you must contribute but cannot make a claim.
For more information, visit: http://www.servicecanada.gc.ca/eng/sc/ei/sew/index.shtml
Assuris is a not-for-profit organization that protects Canadian policyholders against a loss of benefits due to the financial failure of a member company. All life insurance companies in Canada are required, by the federal, provincial and territorial regulators, to become members of Assuris. This means if you buy a policy from a Canadian insurer, you are protected. What is the coverage offered by Assuris? If your life insurance company fails, your policies will be transferred to a solvent company. Assuris guarantees that you will retain at least 85% of the insurance benefits you were promised. Insurance benefits include Death, Health Expense, Monthly Income and Cash Value. Your deposit type products will also be transferred to a solvent company. For these products, Assuris guarantees that you will retain 100% of your Accumulated Value up to $100,000. Deposit type products include accumulation annuities, universal life overflow accounts and dividend deposit accounts. Products that are covered by Assuris: Life Insurance, Critical Illness Insurance, Health Expense, Disability Income, Long Term Care Insurance, Annuities, Segregated Funds and Group Insurance. True Benefits sells only Canadian insurer products. All of our clients have Assuris' protection. For more information, visit www.assuris.ca.
Assuris is a not-for-profit organization that protects Canadian policyholders against a loss of benefits due to the financial failure of a member company.
All life insurance companies in Canada are required, by the federal, provincial and territorial regulators, to become members of Assuris. This means if you buy a policy from a Canadian insurer, you are protected.
What is the coverage offered by Assuris?
If your life insurance company fails, your policies will be transferred to a solvent company. Assuris guarantees that you will retain at least 85% of the insurance benefits you were promised. Insurance benefits include Death, Health Expense, Monthly Income and Cash Value.
Your deposit type products will also be transferred to a solvent company. For these products, Assuris guarantees that you will retain 100% of your Accumulated Value up to $100,000. Deposit type products include accumulation annuities, universal life overflow accounts and dividend deposit accounts.
Products that are covered by Assuris:
Life Insurance, Critical Illness Insurance, Health Expense, Disability Income, Long Term Care Insurance, Annuities, Segregated Funds and Group Insurance.
True Benefits sells only Canadian insurer products. All of our clients have Assuris' protection. For more information, visit www.assuris.ca.
Good news: BC's Ministry of Health Services, the BC Pharmacy Association (BCPhA) and the Canadian Association of Chain Drug Stores (CACDS) have negotiated a new Pharmacy Services Agreement that is now in effect. Although the agreement is not binding on individual pharmacies, it is expected that the majority will comply.
This is good news because employee benefits plan sponsors will benefit from the savings on lower cost generics on the BC PharmaCare formulary. The expected savings between October 15, 2010 and July 3, 2011 is estimated to be 3.7% of drug costs. Savings will vary significantly by plan depending on the coverage design and employee demographics.
As of Oct. 15th, 2010, new generic drugs will be priced at 42% of brand name, and existing generics will be priced at 50% of brand name. Starting in July 2011, all generics will move to 40%, and in April 2012, they will be even further reduced to 35% of brand name!
In a move to appease pharmacies, dispensing fees will be rising slightly during the upcoming two years. Some benefits plans are designed to have a dispensing fee deductible, so the changes will not impact potential savings.
For more information, please feel free to call our office at 604.872.2866.
The Employment Insurance (EI) maximum yearly insurable earnings increased from $43,200 to $44,200 effective January 1st, 2011. As a result, the maximum weekly EI benefit amount will rise from $457 to $468.
The EI Premium Reduction Program allows employers to pay Employment Insurance premiums at a reduced rate if their employees are covered by a Short Term Disability plan that meets certain requirements set by Human Resources and Skills Development Canada (HRSDC).
To be considered for a premium reduction, a plan that provides Short Term Disability benefits to employees must:
• provide at least 15 weeks of benefits for Short Term Disability
• match or exceed the level of benefits provided under EI ($468 effective January 1, 2011)
• pay benefits to employees within 14 days of illness or injury
• be accessible to employees within three months of hiring
• cover employees on a 24‐hour‐a‐day basis
For additional information on the premium reduction program you can visit: www.servicecanada.gc.ca/prp.
ROE Web is a free service provided by Service Canada which allows Record of Employment production and management online.
With ROE Web, you can issue one or hundreds of ROEs online at the touch of a button. This service ensures accuracy by checking for errors before submission, reducing follow-up calls from Service Canada. It's also great for reducing your paper burden by eliminating the need to order or store paper ROE forms, keep paper copies on file, or send copies to Service Canada.
For additional information access the website or call 1-800-385-5470.
For the first half of 2011, the average dispensing fee in BC is $9.95. Here are the current dispensing fees for a variety of pharmacies in BC in order of most cost effective to least:
EMERGIS REIMBURSEMENTS $8.78
PHARMA PLUS / MEDICINE SHOPPE $9.49
SAVE ON FOOD & DRUG $9.58
SANTE SERVICES $9.59
MEDITRUST (mail order) $9.59
LONDON DRUGS $9.62
WAL MART $9.63
PHARMX REXALL $9.94
MEDICAL PHARMACIES (OSH) $10.35
CANADA SAFEWAY $10.54
SHOPPERS DRUG MART/PHARMAPRIX $10.72
Many clients come to me looking for insurance after an exciting event in their life, like getting married, buying a new home, but most especially when they are starting a family. It is natural to start thinking about the future of your family when you are expecting a new member to arrive soon!
These days, insurers see quite a few applications from expecting parents. The good news is that most insurance companies will welcome your life insurance or critical illness application during pregnancy or just after delivery. If your pregnancy has been normal and healthy, the underwriting will be very similar to that for non-pregnant applications. Underwriting is when the insurer reviews the medical history and potentially also medical evidence that you have provided in your application.
In most cases, insurers can issue a standard life insurance or critical illness insurance policy, with little or no change in the terms. Disability insurance applications may have to be put on hold until after your baby's delivery.
For extended health benefits, such as individual health and dental plans, in many cases a standard policy can be issued.
With life and critical illness insurance applications, insurers will adjust their underwriting standards to take into account changes that are normally seen in pregnancy but don't affect your ability to get coverage, such as weight gain (approximately 15 to 40 pounds), blood profile (such as increased cholesterol, or lower iron), and innocent heart murmurs (due to increased blood volume).
Unfortunately, there are some situations where the insurer may ask you to postpone your application until after the baby is born: if you have been diagnosed with gestational diabetes or have a history of gestational diabetes, toxemia / pre-eclampsia, full eclampsia, and HELLP syndrome. High risk pregnancies due to an existing medical condition also fall into this category.
If you are pregnant and looking into insurance, please feel free to call me at 604.872.2866 to talk about the specifics of your situation. I've helped many preganant clients get coverage and I'd be happy to answer any questions you may have!
Rachel von Sturmer
Many of our clients are champions of the environment, and we are proud to work on their behalf to provide benefits to employees in the most sustainable manner possible.
The insurance industry is still a very paper intensive business; but we are doing what we can to improve the situation. Here are the top 5 strategies that True Benefits suggests to create an effective and conscientious benefits plan.
#1: Suppress Printed Materials: True Benefits can arrange with your insurance carrier to reduce the printed material produced. Employee benefit booklets, contracting, and administrative guides can all be offered in digital format. Employees can log into a secure website that will contain all of their benefits details.
#2: Implement Online Management: Plan Administrators can save time and reduce paperwork by managing the plan online, using features such as archived billing and instant reporting; employees can set up direct deposit and email claims notifications, and access coverage information. True Benefits works one-on-one to train your Administrator, and review the online system with employees as a group.
#3: Offer Pay Direct Claims: A pay-direct card enables employees to submit claims directly from the point of sale to the insurer. This saves the employee from filling out a paper form, while offering the benefit of instant reimbursement.
#4: Choose the Right Insurer: Several carriers now offer employees the ability to submit their claims directly over the internet using a secure online portal. Claims can be adjudicated with no paperwork and paid directly into the employee’s bank account. An email confirmation is sent instead of the traditional mailed statement.
#5: Encourage and Support Employee Wellness: Offering an Employee Wellness Program provides employees with a confidential resource to make healthy choices such as quitting smoking, improving nutrition or fitness, and managing stress. Employees feel more engaged when their place of business pursues making a positive difference in their lives. Best of all, many insurers are now offering Wellness Programs as a complimentary component of their extended health care coverage.
At True Benefits our focus is employee benefits; we specialize in helping small and mid-sized BC businesses create fantastic plans. The clients we work with care deeply about their employees and are recognized for providing some of the most creative and sought after benefits available.
Benefits Specialist Rachel von Sturmer has years of experience managing plans for a wide variety of clients, ranging from sole proprietors to large companies and associations. She holds the Certified Financial Planner (CFP) and Group Benefits Associate (GBA) designations. She can be reached at firstname.lastname@example.org or 604.872.2866.
"Rachel is professional, courteous and very knowledgeable while providing outstanding customer service. She is well prepared, delivers personal service, and understands our desire to provide the best possible benefit plan to our employees in the most cost effective manner."
"I appreciate having a person who is both local and accessible, and was impressed with the initial presentation outlining the options available to us. It is extremely helpful to have Rachel advocating on our behalf."
"True Benefits has totally met our needs. Rachel gives personalized attention, and is very thorough. She has suggested many good ideas that we have used to benefit our employees."
"I have referred many clients to Rachel in the past, and without exception, they have all commented to me on her professionalism, vast industry knowledge, great service, and fast response time."
Thank you for everything that you have done for our family. We are grateful for all your hard work. We look forward to working with you again in the future.
"True Benefits has an understanding and awareness of the importance of an effective benefits program. They're proactive in looking for cost effective improvements to plan design and cost containment strategies. My expectations were exceeded - Rachel delivered as promised in a timely manner."
"Thank you Rachel. Great service as always. You anticipated our needs."
I used True Benefits to sort through a tricky health insurance issue related to immigration status and an expired work permit. Rachel recommended a cost effective solution and quickly verified the policy was the best choice for my situation. My new health coverage was effective within 2 hours of my initial call to Rachel! I highly recommend working with Rachel at True Benefits for cost effective solutions and friendly and efficient service.
Your attention to detail and willingness to never to never take "no" for an answer on my behalf left me in awe of your business ethics.
I will continue to use your services, based on your work ethic and my ability to trust that the policy you are suggesting is perfect for me.