SUN SENIOR CARE

Your Best Care for Your Best Years

ADVISOR’S MANUAL

THIS MATERIAL IS A COPYRIGHTED WORK. IT IS FOR INTERNAL USE ONLY AND NOT FOR
DISTRIBUTION BOTH ONLINE AND PRINT. YOU MAY NOT REVISE, TRANSFORM, OR
BUILD UPON THIS MATERIAL WITHOUT PRIOR WRITTEN CONSENT TO SUN LIFE OF
CANADA (PHILIPPINES), INC.

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 Table of Contents

I. Introduction

II. Key Product Features

III. List of Covered Critical Illnesses

IV. Product Specifications

V. Underwriting
A. Guidelines
B. NMA Limits for Critical Illness
C. Special Tests Limits for Critical Illness

VI. Claims
A. Claims Investigation Process
B. Claims Requirements

VII. Frequently Asked Questions

VIII. Guide to Critical Illness Definitions

IX. Premium Rates

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I. INTRODUCTION
The purpose of this manual is to present the features of SUN Senior Care, and to make you aware of
the guidelines that apply to this product.

Implementation date for SUN Senior Care was last October 8, 2018.

This manual discusses the market overview, product features, underwriting and claim guidelines, and
guide to critical illness definitions - all of which you should pay particular attention to when discussing
the product with a prospect. Understanding the covered illnesses / surgeries, procedures, exclusions,
waiting period and limitations that apply to the product can facilitate easier handling at the time of a
claim. By carefully studying this guide, you will be able to explain the nature of the cover and answer
most of the questions that may arise.

Please take time to study this manual as this will help ensure that your client's business is dealt with
speedily and professionally at both the underwriting and more importantly, the claim stage.

II. KEY PRODUCT FEATURES

SUN Senior Care is a participating, limited-pay whole life critical illness (CI) plan that offers a
combined benefit of savings and comprehensive health protection even at a late stage in life, providing
coverage during one’s golden years up until age 100.

It is specifically designed to address the evolving life and health protection needs of those who are
already in the pre-retirement or retirement stage, protecting their hard-earned savings even if an illness
strikes.

HEALTH PROTECTION

 Prevention1
Offers special access and privileges to a wealth of information, nutrition and health experts,
fitness activities and events, and other available preventive care programs to help one live a
healthier life.

 Diagnosis, Treatment and Rehabilitation2

Provides lump sum financial benefit equal to 150% of the plan’s Face Amount in case the
insured is diagnosed with any of the covered 17 common advanced-age critical illness
conditions. This benefit will help replace the funds spent for diagnostic investigations as well as
other expenses related to treatment and recovery.

 Special Benefit
Gives additional one-time cash benefit equal to 5% of the plan’s Face Amount to help ease the
financial burden caused by any one of the four (4) specific covered surgeries/conditions.

LIFE INSURANCE PROTECTION3

Assuming no critical illness benefit has been paid, SUN Senior Care guarantees the insured a life
insurance protection equal to 150% of the plan’s Face Amount.

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 LIMITED PAYMENT PERIOD

Available in easy payment terms, SUN Senior care may be paid in three (3), five (5), or ten
(10) annual installments with a fixed amount throughout the chosen period. Semi-annual,
quarterly, or monthly4 modes of payment are also available.

LIVING BENEFITS

Allows one to earn dividends5 from the plan which may be used to pay for future premiums, left
with Sun Life to accumulate, or received in cash. In case of emergency, money also comes in handy
as the plan’s cash value is available for a loan.

Note: Benefits indicated in this material are subject to the specific guidelines set by Sun Life and the actual provisions
of the insurance policy contract.

1Sun Life reserves the right to determine the wellness programs.

2Diagnosis of any of the covered critical illness conditions and/or specific surgeries performed must be aligned with the
definitions indicated in the insurance policy contract.
3Benefit is payable assuming no critical illness benefit has been paid previously.
4Monthly payment through Auto-Debit or Auto-Charge may also be arranged after payment of the initial quarterly premium.
5Dividend earnings are not guaranteed.

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III. LIST OF COVERED COMMON ADVANCED-AGE CRITICAL ILLNESSES (CI) AND COVERED
CONDITIONS FOR SPECIAL BENEFIT

Common Advanced-Age Critical Illness

1. Acute Heart Attack 10. Major Organ Transplant
2. Alzheimer's Disease* 11. Motor Neuron Disease
3. Bilateral Amputation due to 12. Multiple Sclerosis
Diabetic Complication
4. Deafness 13. Paralysis
5. End-stage Lung Disease 14. Parkinson's Disease*
6. End-stage Renal Disease 15. Severe Rheumatoid Arthritis
7. Invasive Cancer 16. Stroke
8. Loss of Speech 17.Total Blindness
9. Major Head Trauma

Special Benefit
1. Cochlear Implant Surgery
2. Glaucoma Surgery
3. Knee Replacement Surgery for one or both knee(s)
4. Severe Osteoporosis*
*Coverage for this condition is until policy anniversary on or following the life insured’s 85 th birthday.

Note: Please refer to the Critical Illness (CI) Definitions found in the succeeding pages for the description
on each critical illness / condition covered under this product. Please note the definitions are for reference
only and does not replace the policy contract. It is still important the definition and condition described in
the policy be met in order for a claim to be valid. It is recommended that a Financial Advisor review the
policy with the client to ensure that he/she fully understands the definition.

IV. PRODUCT SPECIFICATIONS:

Product Type A participating whole life critical illness insurance product which
accumulates cash values and earns dividends while providing CI coverage
up to age 100.
Currency Philippine Peso

Payment Period 3 /5 / 10 years

Payment Mode

Note: The monthly mode is available only via Salary Deduction, ADA, and Auto charge.
Monthly ADA and ACA may be availed after first payment of one quarterly premium.
Payment mode may be requested to be changed after policy issue, provided the new mode is
allowed for the specific payment variant and age.

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 Issue Age ISSUE AGE
Payment Period
Non-Smoker Smoker
3 Years 50 – 70 years old 50 – 65 years old

5 Years 50 – 65 years old 50 – 60 years old

10 Years 50 – 60 years old 50 – 55 years old

Face Amount Minimum Face Amount: Php 300,000

Maximum Face Amount: Php 10Mn, assuming no existing CI plan from

Sun Life.

Overall per life cap on all CIs is 15M coverage (combined limit for CI Benefit
Rider, Sun LifeAssure, Sun Maiden/Sun Maiden Plus, Sun Milady/Sun Milady Plus, SUN
Healthier Life, SUN Fit and Well, SUN Senior Care, and Female Critical Illness Rider)

Note: Senior Care is equivalent to 150% of the FA = 10M x 150% = 15M

Benefit Period Coverage will continue up to age 100 except for the following illnesses
which will automatically terminate on the policy anniversary on or
following the life insured’s 85th birthday:
Alzheimer’s Disease
• Alzheimer’s Disease
• Parkinson’s Disease
• Severe Osteoporosis

Riders • No riders will be attached to this product.

• Living Benefit Rider is also not available for this product.

Policy Fee None.

Death Benefit 150% of Face Amount plus accumulated dividends (if any), less any
advances with interest. This is assuming no CI Benefit has been paid.

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 Critical Illness • Lump Sum CI Benefit equal to 150% of the Face Amount (FA) +
Benefit accumulated dividends, if any
• Covers 17 Major Critical Illness conditions inclusive of those that commonly
affects people in advanced-ages:
1. Acute Heart Attack
2. Alzheimer’s Disease*
3. Bilateral Amputation due to Diabetic Complication
4. Deafness
5. End-stage Lung Disease
6. End-stage Renal Disease
7. Invasive Cancer
8. Loss of Speech
9. Major Head Trauma
10. Major Organ Transplant
11. Multiple Sclerosis
12. Motor Neuron Disease
13. Paralysis
14. Parkinson’s Disease*
15. Severe Rheumatoid Arthritis
16. Stroke
17. Total Blindness

* Coverage for this condition is until policy anniversary on or following the life
insured's 85th birthday.

Special Benefit One time special benefit equal to 5% of the Face Amount for any one of
these surgeries/ conditions:

1. Cochlear Implant Surgery

2. Glaucoma Surgery
3. Knee Replacement Surgery for one or both knee(s)
4. Severe Osteoporosis*

* Coverage for this condition is until policy anniversary on or following the life insured's
85th birthday.
Surrender Benefit Guaranteed cash value + accumulated dividends, if any, less any advances
with interest

Maturity Benefit At age 100: 150% of the Face Amount + accumulated dividends, if any, less
any advances with interest

Guaranteed Available
Cash Value
Dividends Not-guaranteed

Dividend Options • Cash

• Dividend Accumulation (default option)
• Premium Reduction

Waiting Period • 90 days from issue date or date of last reinstatement

• 180 days for Cancer
• 1 year for Alzheimer’s / Parkinson’s Disease

Contestability 2 years from issue date or date of last reinstatement.

Period
Note: For any benefit other than death benefit, a claim is considered contestable if the date
of the diagnosis, confinement or occurrence of any covered event falls within two years from
date of issue or last reinstatement.

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 Termination of The policy automatically terminates and its premium ceases to be payable on
Cover the earliest of the following:
• the day the policy lapses;
• the day the policy matures;
• the day Sun Life Philippines receives written notice from the owner to cancel
the policy;
• upon death of the life insured;
• upon claim of a total of 150% of the Face Amount resulting from the
diagnosis of the major critical illness.

Backdating Not Allowed

Grace Period 31 days from the due date

Policy Loan Allowed up to 75% of Cash Surrender Value

Non-Forfeiture • Reduced Paid-Up (RPU) – Default Option

Option • Automatic Premium Loan

Note: Reinstatement from RPU is not allowed if One-time Special Benefit has
already been availed.
Change in Face Not Allowed
Amount and
Change of Plan
Conversion of Term Not Allowed
Plan to SUN Senior
Care
Reinstatement Reinstatement is allowed at any time not exceeding three (3) years after lapse
date.

V. UNDERWRITING

A. Guidelines

1) Regular underwriting guidelines will apply to this product.

2) Ownership of the policy:

• Proposed insured; or
• Child/Grandchild of the proposed insured who must be at least 25 years old and has his/her
own income.

3) Net Amount at risk (NAAR) for underwriting.

• Use 150% of the CI amount and follow aggregation rules to determine routine age/amount
requirements.

4) Underwriting decisions:
• Standard, offer with extra loading (expressed in terms of extra premiums), exclusion clauses,
postpone or decline.
• Maximum mortality rating should not exceed 250% mortality rating.

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 5) Financial Underwriting:

Critical Illness (CI)

• Maximum CI for working individuals

Ages 40 to 50 = 10 x annual income
51 to 60 = 8 x annual income
61 to 65 = 5 x annual income
66 to 70 = 2 x annual income

Information needed to underwrite: Annual income of proposed insured

• Maximum CI for non-working individual :

- 15% of Net Worth
- Reason for insuring the non-working individual must be clearly explained.
Information needed to underwrite:
- Net Worth via completion of Agent’s Confidential Report or Agent’s Report regarding
previous occupation, income and employer.

• Maximum for non-working individual with child or grandchild as applicant:

- Maximum CI is equal to income of the son/daughter or grandchild multiplied by the
income factor of the proposed insured based on age.

Information needed to underwrite:

- Annual income of the son/daughter/grandchild and income factor of the proposed insured
based on age.

6) Reinstatement.
Follow existing reinstatement guidelines.

Checking of MID for SRO cases will be added. If there is a finding, SRO will be declined and
regular reinstatement procedures will apply.

B. NMA Limits for Critical Illness

Critical Illness Amount (Philippine Peso)

Aggregate all previously issued CI policies and riders and Female Benefit policies and
Age of Proposed Insured
riders issued within the past 24 months and add to pending application. Do not include
the basic life coverage in the aggregation.
50 2,000,000
51 to 60 1,000,000
61 to 70 Medical regardless of amount

C. Special Tests Limits for Critical Illness:

Maximum CI limit per life: Php 15,000,000. Maximum FMB limit per life: Php 2,000,000.

Age of Proposed
Urinalysis Cotinine Blood Tests* ECG Treadmill X-ray
Insured
50 3,000,000 3,000,000 3,000,000 3,000,000 5,000,000 -
51 to 60 2,000,000 2,000,000 2,000,000 2,000,000 5,000,000 8,000,000
61 to 70 All amounts 1,000,000 All amounts 1,000,000 3,000,000 5,000,000

Notes:
• Cotinine is required if applying for nonsmoker rate.
• Mature Age Questionnaire will be required for age 70.
• Validity of Mature Age Questionnaire will follow the validity period of routine medical exam:
a) Valid for six (6) months if taken from a previously issued standard policy.
b) Valid for three (3) months if taken from a previously rated, declined, postponed, or NPW’ed case.
*Blood tests: Php 2 Million and up – will include PSA for males age 55 and above.

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VI. CLAIMS

A. Claims Investigation Process

Claims investigation will follow Sun Life’s existing claim investigation guidelines for Common-
Advanced-Age Critical Illness
 Claim investigation has to be done for all Sum Assured in accordance with the contestability
provision of this product.
 There is no waiver of any medical evidence at the time of claims (i.e. all claims should enclose the
medical report along with all necessary evidence).
 Additional medical history is requested or secured from doctors or hospitals.
 An investigation agency is retained by Sun Life to conduct the claim investigation for Sun Life.
 The investigation agency conducts interviews with the claimant, relatives, neighbors, schools
attended, employees, barangay, etc. and obtains documents from doctors, diagnostic centers,
hospitals, employers, schools attended, etc. based on the initial claims requirements submitted by
the claimant and information obtained from interviews.
 The Claims Analyst assigned to the case will handle review of the submitted claim requirements,
claims investigation reports and the documents obtained.
 If there are findings not disclosed at the time of the application for insurance, Sun Life will obtain
Underwriting opinion to find out if the medical information not disclosed is material or not to the
issuance of the policy and the riders (if any rider becomes available).
 Upon receipt of the Underwriting opinion, the assigned Claims Analyst will make a
recommendation to the Senior Manager and the Head for a claim decision.

B. Claims Requirements

Basic Claim Requirements

 Claimant’s Statement – to be completed by the claimant
 Attending Physician’s Statement (“APS”) – one APS for each CI claim
 Authorization – to conduct background investigation on the insured
 Admitting History or its equivalent from the hospital
 Discharge Summary or its equivalent from the hospital
 Police Report and Medico-Legal Report, if critical illness is caused by an accident or violence

Additional Claim Requirements

Common Advanced-Age Critical Conditions
1. Acute Heart (must be diagnosed by Cardiologist or Cardiovascular Surgeon)
 New electrocardiographic (ECG) changes
 Blood Test with evidence of elevation of enzyme e.g. Troponin I / CKMB
 Medical Records indicating the history of typical chest pain

2. Alzheimer’s Disease (must be diagnosed by Neurologist, Psychiatrist or Neuro-Psychiatrist)

 Accepted Standardized Questionnaires or Tests
 Medical Records
 ADL Report

3. Bilateral Amputation due to Diabetic Complication (must be confirmed by

Endocrinologist)
 Record of Operation
 All objective laboratory and diagnostic reports

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 4. Deafness (must be confirmed by an Otorhinolaryngologist or ENT Specialist)
 Medical Records from Hearing Diagnostic Center
 Audiometry
5. End Stage Renal Disease (must be certified by Nephrologist or Urologist)
 Creatinine Clearance
 Laboratory Tests/Procedures (Blood Tests, Ultrasound, etc.)

6. End Stage Lung Disease

 FEV1 Test Result
 Medical Records
 Any objective laboratory and diagnostic procedures

7. Invasive Cancer
 Surgical Pathology Report/Histopathology Report/Biopsy Results
 PET MRI Scan Report or CT Scan Report

8. Loss of Speech (must be confirmed by Neurologist or ENT Specialist)

 Medical Records/Laboratory Results indicating total and irrecoverable loss of the
ability to speak for a continuous period of 12 months due to physical damage to
the vocal chords

9. Major Head Trauma (must be confirmed by Neurologist)

 Medical Records for at least 3 months
 CT Scan or X-ray

10. Major Organ Transplant

 Record of Operation
 All objective laboratory and diagnostic reports

11. Multiple Sclerosis (must be confirmed by Neurologist)

 Nerve Biopsy, Neural Biopsy or Electrophysiology
 MRI, CT Scan or other reliable imaging techniques
 Medical records indicating the following:
 2 episodes of well-defined neurological abnormalities
 Evidence of demyelinating lesions at more than 1 site within the central
nervous system

12. Motor Neuron Disease (MND) (must be confirmed by Neurologist)

 Electromyography

13. Paralysis (must be confirmed by Neurologist)

 Medical Records indicating complete and permanent loss of use of arms and legs
 All objective laboratory and diagnostic reports

14. Parkinson’s Disease (must be confirmed by Neurologist)

 Laboratory Tests/Procedures (Blood Test, Ultrasound, PET/MRI/CT Brain Scan,
etc.)

Note: RGA agreed that assessment of an occupational therapist may not be required in the
Philippine setting after the specialist confirms the condition.

15. Severe Rheumatoid Arthritis (must be confirmed by Rheumatologist)

 Medical records showing that the diagnostic criteria of the American College of
Rheumatology re met

16. Stroke (must be confirmed by Neurologist)

 CT Scan or MRI
 Medical Records indicating major and permanent neurological deficit lasting at
least 4 weeks that will require physical rehabilitation

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 17. Total Blindness (must be confirmed by Ophthalmologist)
 Medical records indicating total, permanent and irrecoverable loss of all vision in
both eyes

Special Benefit
1. Cochlear Implant surgery (must be confirmed by an ENT Specialist)
 Medical Records rom Hearing Diagnostic Centre
 Audiometry
 Record of Operation

2. Glaucoma surgery (must be confirmed by an Ophthalmologist)

 Complete eye exam
 Record of Operation

3. Knee Replacement surgery for one or both knee(s)

 Medical records showing that the diagnostic criteria of the American College of
Rheumatology are met
 Record of Operation

4. Severe Osteoporosis
 Bone Density Test Results

Note: Additional Claim Requirements may still be required while claim is still being evaluated.

VII. FREQUENTLY ASKED QUESTIONS

Product Features and Design

1. What is SUN Senior Care?

Ans: SUN Senior Care is a participating whole life critical illness (CI) insurance product that accumulates cash values
and earns dividends while providing protection from any of the covered common advanced-age critical illness
conditions. It also gives additional one-time special benefit in case a client experienced any one of the covered
surgeries/conditions that commonly happens to the senior market segment.

Designed to address the evolving life and health protection needs of clients in the pre-retirement and retirement
stages, SUN Senior Care ensures coverage fit for them, while they go through the key stages of their health journey
(Prevention, Diagnosis, Treatment and Rehabilitation).

2. How many common advanced-age critical illness conditions does SUN Senior Care cover?
Ans: SUN Senior Care covers seventeen (17) advanced-age critical illness conditions.

3. How much is the critical illness or death benefit amount of this product?
Ans: SUN Senior provides a lump sum financial benefit equal to 150% of the plan’s Face Amount, plus any accumulated
dividends (if any), less any advances with interest (if any).

4. How much is the additional one-time Special Benefit offered by SUN Senior Care?
Ans: Special Benefit is equal to 5% of the plan’s Face Amount. This is provided in case the insured has undergone or
experienced any one of these: Knee Replacement Surgery, Glaucoma Surgery, Cochlear Implant, or Severe
Osteoporosis.

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 5. What makes SUN Senior Care unique from CI products that Sun Life or other companies currently offer?
Ans: SUN Senior Care is the only critical illness insurance product in the market today that aims to provide coverage to
the underserved market. This product is specifically designed to address the evolving life and health protection
needs of those who are in the pre-retirement and retirement stages.

6. Which life stage does SUN Senior Care address?

Ans: SUN Senior Care addresses the needs of clients belonging to the Preparing Ahead and Leaving a Legacy life stages.

7. If SUN Senior Care covers clients in the Preparing Ahead and Leaving a Legacy life stages, what specific
ages are acceptable for coverage?
Ans: SUN Senior Care provides coverage to individuals age 50 to 70 years old.

8. Once accepted for coverage, how long will SUN Senior Care provide protection?
Ans: SUN Senior Care provides protection until age 100.

9. What will happen to a SUN Senior Care policy if no critical illness has been paid to the client and he/she
survives age 100?
Ans: Upon reaching age 100 of the insured or the maturity of the policy, the SUN Senior Care maturity beneficiary will
receive a maturity benefit equal to 150% of the plan’s Face Amount, plus any accumulated dividends (if any), less
any advances with interest (if any).

10. What are the payment terms of SUN Senior Care?

Ans: SUN Senior Care plan can be fully paid in 3, 5, or 10 annual installments. Semi-annual, quarterly, and monthly
modes of payment are also available for client’s convenience.

11. Why do payment modes differ on certain issue ages for SUN Senior Care?
Ans: Since modal factor will add up to the premiums that a client will be paying, Sun Life made sure that , for certain
issue ages (without substandard rating), total premiums paid by the client will not exceed the benefits he/she will
receive.

12. Assuming client has no existing CI plan with Sun Life, what is the maximum Face Amount that a client
can apply for under SUN Senior Care?
Ans: The maximum Face Amount that a client can apply for under SUN Senior Care is Php 10 Million, which offers
clients a maximum CI coverage of up to the usual overall life cap of Php 15 Million (i.e. 150% of the maximum
Face).

13. If in case a working and employed child or a grandchild wants to purchase SUN Senior Care for his/her
parents / grandparents, what is the minimum age allowed as a payor for SUN Senior Care?
Ans: Payor child or grandchild, working and employed, should be at least 25 years old under SUN Senior Care.

14. What are the Non-Forfeiture Options available for SUN Senior Care?
Ans: The available non-forfeiture options for SUN Senior Care are Reduced Paid-up and Automatic Premium Loan.

15. Why is Extended Term Insurance (ETI) not included in the Non-Forfeiture Options of SUN Senior Care?
Ans: The absence of ETI in the Non-Forfeiture Option of SUN Senior Care prevents the policy to be converted to a pure
term life insurance policy. Such conversion defeats the purpose of SUN Senior Care to provide critical illness
insurance protection.

16. What are the dividend options available for SUN Senior Care?
Ans: The dividend options available are cash, dividend accumulation, and premium reduction.

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 17. Does SUN Senior Care cover both minor and major critical illness conditions?
Ans: No. Since SUN Senior Care clients are those in the advanced ages already, the likelihood of having a late stage
serious illnesses is high. Hence, Major Critical Illness Conditions will only be covered.

18. Why is the coverage for Alzheimer’s disease, Parkinson’s disease and Severe Osteoporosis until age 85
only?
Ans: To manage the risk in terms of claims and the cost of the product, coverage for such illnesses/conditions is limited
only until age 85. This is because clients who are above 85 years old have a very high chance of acquiring such
illnesses/conditions.

19. Under the SUN Senior Care’s Prevention Benefit, when will the GoWell Gold Membership and Preventive
Care Cards be given to clients?
Ans: The GoWell Gold Membership and Preventive Care Cards will be given to SUN Senior Care clients once they sign-
up to the GoWell website and activate their Gold Membership. These cards will be delivered to clients within 4 to
6 weeks after the clients’ Gold Membership activation.

Claims

20. What is the waiting period for SUN Senior Care?

Ans: All illnesses/conditions covered under SUN Senior Care requires 90 days waiting period except for Cancer which
requires 180 days, and Alzheimer’s / Parkinson’s Disease which requires 1 year waiting period (i.e. from issue
date or date of last reinstatement of the policy).

21. Why is the waiting period for Cancer and Alzheimer’s / Parkinson’s disease different compared to the
waiting period of other illnesses covered under SUN Senior Care?
Ans: Since clients covered under SUN Senior Care are in the advanced age group already and have a high probability
of acquiring Cancer or Alzheimer’s/Parkinson’s disease, Sun Life set a longer waiting period. This is to avoid
anti-selection from those who want to buy SUN Senior Care because they are sure that they can claim from the
policy.

22. Is a claim payable if a client insured under SUN Senior Care is diagnosed with a major critical illness
within the waiting period?
Ans: No. If a client is diagnosed to have an illness covered under SUN Senior Care but the diagnosis falls within the
waiting period, claim will not be payable.

23. If a claim is filed, is it considered payable if the Critical Illness is diagnosed after the waiting period but
still within the 2 year contestable period?
Ans: Decision will depend on the claim investigation. If there is material misrepresentation and/or concealment,
claimwill be denied, policy will be rescinded (i.e. declared as null and void), premiums will be refunded to the
client, and advisor's commissions will be reversed. However, if no material misrepresentation and/or concealment
was identified during claim investigation, claim may then be payable provided that the diagnosis meets the
definition and provisions found in the contract.

24. Is it true that a critical illness claim is forever contestable?

Ans: No. When a diagnosis/claim happens within the contestability period of the policy, SUN Life can contest all the
declarations made in the application (i.e. New Business or reinstatement) and declare the policy or riders null and
void. After the 2-year contestability period, SUN Life can only deny critical illness claims on the basis of not meeting
the contract definitions/policy provisions or if the claim is part of the exclusions.

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 25. Critical Illness benefit is payable to the policyholder while death benefit is payable to the beneficiary. If
critical illness claim has been filed and eventually the life insured dies while the critical illness claim is
still being processed, to whom will the benefits be payable once claim is approved?
Ans: If the life insured dies during processing of claim, then the benefits will be payable to the beneficiary.

26. If the life insured’s cause of death is due to a critical illness condition and said condition was only
identified as such at the time of death, does Sun Life pay both death and critical illness benefit?
Ans: No. If the diagnosis of the critical illness happens after the death of the insured, Sun Life will only pay the death
benefit to the beneficiaries.

27. What if a critical illness or death benefit claim happens during premium-paying period of a SUN Senior
Care plan, will the insured or insured’s beneficiary be required to pay the remaining premiums?
Ans. No. Since payment of the Death Benefit, Maturity Benefit or Critical Illness Benefit will automatically terminate
the policy, premium payments are no longer required.

28. What if a client has two SUN Senior Care policies, can he/she avail a critical illness claim in only one of
his policies?
Ans: No. Once the client files a critical illness claim, it is SOP for Claims Services Section to check all policies of the
insured with critical illness benefits and appraise claims on all. Claims, not only on all SUN Senior Care policies
but on all policies of the insured with critical illness benefits (including critical illness riders), will be evaluated.

29. What kind of cancer do we cover?

Ans: For SUN Senior Care, invasive cancer is covered, except those that have been specifically excluded in the definition.

Policy Administration

30. A life insured has an existing Critical Illness Term Insurance policy with Sun Life. Can he/she upgrade it
to SUN Senior Care?
Ans: No. Although both products are designed to address health protection needs, they are different in product design.
SUN Senior Care is a participating whole life critical illness insurance plan while other Sun Life critical illness term
insurance products are non-participating 5-year renewable term plans.

31. A life insured has an existing Term Life Insurance policy from Sun Life. Can he/she request to convert it
to SUN Senior Care?
Ans: No. Both products are different in product design and addresses different types of protection needs. SUN Senior
Care is a limited pay standalone critical illness insurance product that addresses life, wellness and health protection
needs of a client while Term Life Insurance products of Sun Life are non-participating renewable term insurance
that addresses pure life protection needs in case of untimely demise.

An existing Term Life Insurance policy from Sun Life can only be converted to any eligible Life or Endowment
(including VUL) insurance of Sun Life. This is allowed to continue the life protection needs of the insured if in
case he/she wants to have coverage for a longer period.

Moreover, SUN Senior Care applicants should be freshly underwritten.

Underwriting

32. Is SUN Senior Care a simplified issue offer product like SUN Healthier Life?
Ans: No. SUN Senior Care was priced to be fully underwritten. This provides fairness to all the applicants
because each one will have a premium corresponding to the degree of risk presented at the time of
underwriting. Healthy applicants will not subsidize the cost of insurance of impaired applicants.

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 33. If a policyholder has an existing Sun Life Critical Illness Insurance Policy with a Face amount
of Ps. 1.5 Million, can he/she still avail of SUN Senior Care?
Ans: Yes. The policyholder can still avail of SUN Senior Care but for up to another Ps. 9 Million Face Amount
only, since coverage for SUN Senior Care is equal to 150% of the Face Amount and maximum CI
coverage limit is up to Ps. 15 Million per life, inclusive of all existing and pending Critical Illness rider
and plans.

Sample Computation:
Maximum Allowable Face Amount for SUN Senior Care
= (Maximum CI Limit – Existing Sun Life CI Coverage) ÷ 150%
= (15 Million - 1.5 Million) ÷ 150%
= 9 Million Face Amount (Coverage is equal to 150% of 9 Million or 13.5 Million)

34. Why is there a limitation on the amount of critical illness benefit per any one life?
Ans: A cap is set to prevent over insurance of a single person against critical illnesses. This is also to avoid
anti-selection.

35. If a client has already maximized the 15 Million CI coverage limit, is it still possible for the client to
apply for a SUN Senior Care plan with the condition that if his/her application gets approved, he/she
will cancel out his/her existing CI rider coverage?
Ans: No. If the client has already maximized his/her CI coverage, he/she will no longer be eligible to apply for an
additional Critical illness product.

36. What are the requirements needed upon submission of SUN Senior Care application?
Ans: Completed Regular application form, routine medical requirements based on Published Underwriting
Guidelines, and Mature Age Questionnaire (only for 70 Years old and above) are needed for SUN Senior Care
Application.

37. What is a Mature Age Questionnaire and why is it being required from SUN Senior Care applicants age
70 and above?
Ans: Mature Age Questionnaire forms part of the Medical Examiner’s Report section of the Full Medical Examination
Form on adult. This is completed by the Medical Examiner specifically for a SUN Senior Care proposed insured
age 70 years old and above.

38. Allowable issue age for SUN Senior Care is only up to age 70, why is Sun Life requiring completion of
Mature Age Questionnaire for SUN Senior Care applicants above 70 years old?
Ans: Mature Age Questionnaire is not only required for new SUN Senior Care applicants but also for those existing
SUN Senior Care clients who are above 70 years old with policies due for reinstatement.

39. Where can I get a Mature Age Questionnaire for my client?

Ans: Mature Age Questionnaire is available with the Medical Examiner. If a Sun Senior Care client is age 70 years
old and above, the Sun Life Advisor needs to inform or remind the Medical Examiner to accomplish the form
while medical examination is in process.

40. If the Maturity Age Questionnaire is a requirement for SUN Senior Care applicants, will this be required
also to applicants of other Sun Life products with issue ages of 70 years old and above?
Ans: For now, the completion and submission of Maturity Age Questionnaire is only required for SUN Senior Care
applicants.

41. Who will shoulder the medical expenses required upon application?
Ans: If the tests done are routine requirements and requested by the Underwriter, the cost is shouldered by Sun Life.

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 42. Can client’s business/entity be the owner of the policy?
Ans: No. For SUN Senior Care plan, only the proposed insured or his/her child or grandchild (at least 25 years old)
is allowed to be the owner of the policy.

43. Can the source of fund for a SUN Senior Care plan be from a third party?
Ans: Decision will depend on the assessment of the Underwriter on the third party. It is recommended that the source
of fund be declared in the application form for the Underwriter to identify if source of fund is acceptable.

44. Can the third party be a company?

Ans: This may be acceptable but will have to undergo the detailed checking of complete information by New Business
and Underwriting. This is to ensure that there is no Money Laundering involved. Also, the owner of the application
should still be the insured or the insured’s child/grandchild (at least 25 years old), and declared beneficiary
should still be his/her immediate relatives and not the company or employer who was declared initially in the
application as the third party that will pay for the premiums.

45. Is it possible for Sun Life underwriters to lessen piecemeal requirements since clients for this product
are those in the advanced ages already and may have a hard time going back and forth to submit
additional requirements?
Ans: Yes. This is possible as long as no piecemeal declaration of medical history or piecemeal submission of requirements
is done. If the medical history of the proposed insured is properly disclosed on the application form and medical
exam, the application form is free from any omissions, proposal and AML requirements are complete, and all other
routine requirements are submitted at once, it will be easier for the underwriter to review and underwrite the case.

VIII. GUIDE TO CRITICAL ILLNESS DEFINITIONS

This guide to critical illness definitions will help you understand the illnesses and procedures covered
under SUN Senior Care product. Each of the covered illnesses is defined for your reference. Exclusions
and conditions not covered by the definitions are also indicated in this material.

This guide is for your reference only and does not replace the policy. Hence, the policy must still
be reviewed carefully.

Illnesses not specifically mentioned or not meeting the stated criteria based on the definition are not
covered.

Activities of Daily Living (ADL)

• Washing – the ability to wash in the bath or shower (including getting into and out of the bath or shower) or wash
satisfactorily by other means;
• Dressing – the ability to put on, take off, secure and unfasten all garments and, as appropriate, any braces, artificial
limbs or other surgical appliances;
• Transferring – the ability to move from a bed to an upright chair or wheelchair and vice versa;
• Mobility – the ability to move indoors from room to room on level surfaces;
• Toileting – the ability to use the lavatory or otherwise manage bowel and bladder functions so as to maintain a
satisfactory level of personal hygiene;
• Feeding – the ability to feed oneself once food has been prepared and made available.

Common Advanced-Age Critical Conditions

1. Acute Heart Attack
Acute Heart Attack means a confirmed diagnosis of the death of heart muscle due to acute obstruction of a
coronary artery that results in a documented rise and fall of biochemical cardiac markers to levels considered
diagnostic of myocardial infarction and includes at least one of the following:
• acute heart attack symptoms for which the insured is admitted to hospital;
• new electrocardiogram (ECG) changes characteristic of a Heart Attack

Exclusions:
Heart Attack does not include:

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 • myocardial infarction that occurs as a consequence of any interventional procedure (such as coronary
angiography, percutaneous coronary artery intervention or coronary artery bypass grafting) unless the infarct
results in the development of new Q waves or new regional wall motion abnormalities that are deemed to be
permanent. This exclusion pertains to all infarcts that occur during interventional procedures and to all
infarcts that occur within the 30-day period following the procedure;
• silent myocardial infarction, including ECG or imaging changes suggesting a prior myocardial infarction,
without a documented rise in biochemical markers;
• elevated biochemical cardiac markers due to myocarditis, traumatic myocardial injury or in the presence of
angiographically normal coronary arteries;
• cardiac arrhythmia or cardiac arrest unless there is proof of acute coronary artery occlusion by angiography, or
new Q waves on the ECG.

2. Alzheimer's Disease
Progressive and permanent deterioration or loss of intellectual capacity as evidenced by clinical state and accepted
standardized questionnaires or tests or abnormal behavior arising from Alzheimer's disease or irreversible organic
degenerative brain disorders resulting in significant reduction in mental and social functioning and requiring the
continuous supervision of the life insured and subject to the acceptance of Sun Life Philippines’ medical officer.
There must also be an inability of the life insured to perform (with or without assistance) at least three (3) of the
Activities of Daily Living (ADL) for a continuous period of at least six (6) months. The ADL’s are required to be
assessed by a certified occupational therapist and the diagnosis confirmed by a specialist.

Exclusions:
• other causes of dementia and psychiatric disease
• Neurosis and psychotic illnesses

Coverage for this condition is until policy anniversary on or following the life insured's 85th birthday.

3. Bilateral Amputation due to Diabetic Complication

Diabetic neuropathy and vasculitis resulting in the bilateral amputation of lower limb at or above the ankle
certified to be absolutely necessary by a specialist. The diagnosis of diabetes must be made during the policy term
and confirmed with appropriate diagnostic tests by the specialist in diabetology.

4. Deafness
Acquired total and irreversible loss of hearing (involving the loss of at least 90 decibels in all frequencies of
hearing) in both ears as a result of illness or injury. The diagnosis must be clinically confirmed by an
Otorhinolaryngologist or ENT specialist.

Exclusions:
• partial or temporary loss of hearing
• loss of hearing in one ear
• surgically correctible loss of hearing

5. End Stage Lung Disease

End stage lung disease including interstitial lung disease, as evidenced by all of the following:

1. requiring continuous oxygen therapy;

2. FEV1 test result of consistently less than 1L despite bronchodilators;
3. Baseline arterial blood gas analysis (in room air) showing arterial partial oxygen pressure at a level of fifty-five
(55) mmHg or less; and
4. Dyspnea at rest

6. End Stage Renal Disease

End stage renal failure presenting as chronic irreversible failure of both kidneys to function, as a result of which
either chronic renal dialysis or renal transplant is initiated.

Acute reversible kidney failure is specifically excluded.

7. Invasive Cancer
The presence of one or more malignant tumors characterized by the uncontrolled growth and spread of malignant
cells, and invasion of tissue, including Leukemia (other than chronic lymphocytic leukemia less than RAI Stage 2)
and Hodgkin’s disease.

The cancer must require treatment by surgery, radiotherapy, or chemotherapy. The diagnosis must be confirmed
with a valid pathology report from tissue of the cancer of origin and a report from an approved specialist.

The following are excluded:

• Liquid Biopsy results
• All carcinoma-in-situ or Non-invasive cancer;
• Non-invasive, pre-malignant or benign tumors or growths;
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 • Prostatic Intraepithelial Neoplasia (PIN);
• Cervical Intraepithelial Neoplasia (PIN);
• Any skin cancer other than malignant melanoma;
• Thyroid cancer that is histologically described utilizing the TNM classification as T1N0M0 as well as Papillary
microcarcinoma of thyroid that is less than 2 cm in diameter;
• Malignant melanoma of less than 1.5mm Breslow thickness unless there is spread to lymph nodes or distant
metastases;
• Prostate cancer classified as stage T1N0M0 unless the Gleason stage is 7 or higher and the pre-treatment PSA is
>10;
• Ovarian cancer classified as T1a according to TNM Classification;
• Cancer of urinary bladder classified as stage T1N0M0 according to TNM Classification;
• Borderline malignancy or Low malignant potential;
• Tumor in presence of HIV infection.

8. Loss of Speech
Acquired total and irrecoverable loss of the ability to speak for a continuous period of twelve (12) months due to
physical damage to the vocal chords as a result of physical injury or disease. Diagnosis must be clinically confirmed
by a certified neurologist or ENT specialist.

Exclusion:
Loss of speech caused by or related either directly or indirectly to a psychiatric illness.

9. Major Head Trauma

Major trauma to the head with clinically permanent disturbance of brain function and must include brain
abnormalities seen on diagnostic imaging such as CT scan or MRI.

The diagnosis must be confirmed by a neurologist, and result in a permanent bedridden condition or the inability
to perform with or without assistance three (3) or more Activities of Daily Living (ADL).

The ADLs are required to be assessed by a certified occupational therapist. The condition must be medically
documented for at least 6 months.

10. Major Organ Transplant

The actual undergoing of transplant of a heart, liver, lung, kidney, pancreas or bone marrow as recipient. The major
organ transplant must have been done because of the specific organ failure. Stem cell and Pancreatic Islet cell
transplant are excluded.

11. Motor Neuron Disease

A group of disorders characterized by a steady progressive degeneration of motor neurons in the brain, brainstem
and spinal cord. The specific disease covered under this benefit includes spinal muscular atrophy, progressive
bulbar palsy, amyotrophic lateral sclerosis and primary lateral sclerosis. A certified neurologist must make the
unequivocal diagnosis of a motor neuron disease that is verified by typical changes on electrodiagnostic studies.
There must also be evidence that the disease is progressive and resulting in permanent functional neurological
deficit.

For the above definition, the following are not covered:

a) Multifocal motor neuropathy (MMN) and inclusion body myositis;
b) Post-polio syndrome; and
c) Polymyositis and Dermatomyositis.

12. Multiple Sclerosis

Confirmation by a certified neurologist of multiple sclerosis with a definite diagnosis of having at least two
clinically documented episodes of well-defined neurological abnormalities with objective evidence of
demyelinating lesions at more than one site within the central nervous system. Investigations such as Magnetic
Resonance Imaging, Computerized Tomography, or other reliable central nervous system imaging techniques must
confirm the diagnosis. One of these episodes must persist for a continuous period of at least four (4) months and
resulted in score 6.0 or higher in Expanded Disability Status Scale.

13. Paralysis
Complete and permanent loss of use of both arms or both legs, or of one arm and one leg through paralysis which
has been present for at least six (6) consecutive months.

14. Parkinson's Disease

Slowly progressive disease of the central nervous system with an unequivocal diagnosis by a certified specialist and
agreed to by Sun Life Philippines’ medical officer and where the condition:
a) cannot be resolved by medication; and
b) shows signs of progressive impairment; and
c) the inability to perform with or without assistance three (3) or more Activities of Daily Living (ADL). The
ADL’s are required to be assessed by a certified occupational therapist
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 Only idiopathic Parkinson’s Disease is covered. All others including drug-induced or toxin causes are excluded.
Coverage for this condition is until policy anniversary on or following the life insured's 85th birthday.
15. Severe Rheumatoid Arthritis
Severe Rheumatoid Arthritis where the following criteria are met

a) the diagnostic criteria of the American College of Rheumatology are met;

b) the inability to perform with or without assistance of two (2) or more Activities of Daily Living (ADL). The
ADL must be assessed by a certified Occupational Therapist;
c) widespread joint destruction and major clinical deformity of three or more of the following joint areas: hands,
wrists, elbows, knees, hips, ankles, cervical spine or feet; and
d) the condition has been present for at least six (6) months.

The diagnosis has to be confirmed by a certified rheumatologist.

16. Stroke
Any cerebrovascular incident producing infarction of brain tissue or hemorrhage resulting in any major, clinically
permanent neurological deficit lasting at least four (4) weeks that will require physical rehabilitation. The diagnosis
of Stroke must be based on changes seen with diagnostic imaging such as CT scan or MRI and must be confirmed
by a neurologist.

Specifically excluded are:

1 transient ischemic attacks

2. attacks of vertebrobasilar ischemia,
3. brain damage due to an accident or injury, infection, vasculitis, inflammatory disease or migraine.
4. Vascular disease affecting the eye or optic nerve or vestibular functions.

17. Total Blindness

Acquired total permanent and irrecoverable loss of all vision in both eyes.

The corrected visual acuity must be less than 6/60 or 20/200 using standard eye chart e.g. Snellen chart, or visual
field restriction to 20° or less in both eyes.

The diagnosis must be clinically confirmed by an appropriate consultant. The blindness must not be correctable by
aides or surgical procedures.

Special Benefit
1. Cochlear Implant Surgery
The actual undergoing of a surgical cochlear implant as a result of permanent damage to the cochlea or auditory
nerve. The surgical procedure as well as the insertion of the implant must be certified to be absolutely necessary by
an Ear, Nose, Throat (ENT) specialist.

2. Glaucoma surgery
The actual undergoing of open surgical procedure of the eye for treatment of glaucoma. A Specialist must confirm
the diagnosis of glaucoma and the procedure must be medically necessary for the treatment of glaucoma.

Any other procedure not involving open surgery on the globe that are not directly related to the treatment of
glaucoma or any laser therapies are excluded.

3. Knee Replacement Surgery for one or both knee(s)

Severe Rheumatoid Arthritis resulting in the actual undergoing of unilateral/bilateral total knee replacement
surgery.

4. Severe Osteoporosis
Osteoporosis is a degenerative bone disease that results in loss of bone. The diagnosis must be supported by a
bone density reading which satisfies the World Health Organization (WHO) definition of osteoporosis with a
bone density reading T-score of less than –3.0. There must also be a history of three (3) or more osteoporotic
fractures involving either femur, wrist or vertebrae. These fractures must directly cause the Insured's permanent
inability to perform (with or without assistance) at least one (1) Activity of Daily Living (ADL).

Coverage for this condition is until policy anniversary on or following the life insured's 85th birthday.

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IX. PREMIUM RATES

3-PAY
Male Female Male Female
Issue Issue
Age Non- Non- Age Non- Non-
Smoker Smoker Smoker Smoker
Smoker Smoker Smoker Smoker
50 350.72 366.09 343.66 349.91 61 419.70 447.63 399.15 407.69
51 355.41 371.81 347.91 354.41 62 427.91 457.44 407.73 416.56
52 360.10 377.54 352.16 358.91 63 436.13 467.26 416.30 425.42
53 364.79 383.26 356.42 363.42 64 444.34 477.07 424.88 434.29
54 369.48 388.99 360.67 367.92 65 452.56 486.89 433.45 443.15
55 374.17 394.71 364.92 372.42 66 460.45 440.91
56 381.63 403.33 370.05 377.70 67 468.34 448.37
57 389.09 411.95 375.18 382.98 68 476.22 455.83
58 396.56 420.57 380.32 388.27 69 484.11 463.29
59 404.02 429.19 385.45 393.55 70 492.00 470.75
60 411.48 437.81 390.58 398.83

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 5-PAY

Male Female Male Female

Issue Issue
Age Non- Non- Age Non- Non-
Smoker Smoker Smoker Smoker
Smoker Smoker Smoker Smoker
50 211.15 223.77 210.58 213.72 58 244.32 262.73 236.36 243.57
51 215.44 228.11 213.79 217.70 59 248.22 268.49 239.61 246.88
52 219.73 232.45 217.00 221.68 60 252.13 274.25 242.85 250.19
53 224.02 236.78 220.21 225.67 61 257.80 247.02
54 228.31 241.12 223.42 229.65 62 263.48 251.19
55 232.60 245.46 226.63 233.63 63 269.15 255.35
56 236.51 251.22 229.87 236.94 64 274.83 259.52
57 240.41 256.98 233.12 240.25 65 280.50 263.69

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 10-PAY
Male Female Male Female
Issue Issue
Age Non- Non- Age Non- Non-
Smoker Smoker Smoker Smoker
Smoker Smoker Smoker Smoker
50 106.33 116.91 106.11 107.86 56 120.44 117.54
51 108.57 120.03 107.80 110.15 57 123.35 120.53
52 110.81 123.15 109.49 112.43 58 126.25 123.53
53 113.05 126.27 111.17 114.72 59 129.16 126.52
54 115.29 129.39 112.86 117.00 60 132.07 129.51
55 117.53 132.51 114.55 119.29

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