1. Underwriting
Heart Disease & Stroke
Our way or the long way

2. High RISK Low Guaranteed Acceptance Life Perm Only NO MEDICAL
‘YES’ in Section A
Guaranteed Acceptance Life Perm Only NO MEDICAL
$5,000 – $25,000
‘YES’ in Section B
Deferred Life Perm Only NO MEDICAL
$5,000 – $75,000
‘YES’ in Section C
Deferred Elite Perm/Term NO MEDICAL
$5,000 – $350,000
‘YES’ in Section D
Simplified Elite Perm/Term NO MEDICAL
$5,000 – $500,000
‘NO’ in Section D, Complete Section E
Preferred Perm/Term May be Subject to Underwriting
$50,000 - $1,000,000
‘NO’ in Section D, Complete Sections E & F
Preferred Elite Perm/Term Subject to Underwriting
$500,000 - $1,000,000

3. Heart Disease
Heart disease refers to a group of conditions that affect the structure and functions of the heart.
Structure : the heart is made up of 4 chambers: The left and right Atrium and the left and right ventricle. Each chamber is separated by valves that keep the blood going in the right direction.
Main functions: Transport of nutrients, oxygen and hormones to cells throughout the body and removal of wastes.
Heart diseases can hinder or prevent the oxygen, nutrients and hormones from getting to parts of the body.

4. A well functioning heart should…
Pump blood throughout the body
Supplies oxygen and nutrients
Remove carbon dioxide and other wastes
The heart does this by pumping deoxygenated blood to the lungs to be oxygenated, then pumps the oxygenated blood throughout the body.

5. Heart Disease - Did You Know?
Every 7 minutes in Canada someone dies from heart disease.
About 2.4 million Canadians aged 20 years and older live with ischemic heart disease.
Heart disease is the 2nd leading cause of death in Canada.
Opportunity.

6. Heart Diseases on our Application
Coronary Artery Disease (CAD)
Angina
Heart Attack
Angioplasty
Bypass Surgery
Coronary artery disease: Blockage of one or more arteries that supply blood to the heart, usually due to atherosclerosis (hardening and narrowing of the arteries). This can lead to chest pain (angina) or a heart attack.
ANGINA: heart is not getting enough blood causing chest pain.
HEART ATTACK: blood flow to the heart is completely blocked, resulting in the death of part of the heart muscle.
ANGIOPLASTY: Surgical procedure to open up/widen blocked blood vessels that supply blood to the heart (coronary arteries).
BYPASS: Surgical procedure to replace damaged arteries in the heart.
STENT: a tiny wire mesh tube, which props open an artery and is left there permanently. Stents help keep coronary arteries open and reduce the chance of a heart attack.
Cardiomyopathy: Chronic weakening of the heart muscle; the pumping of the heart gets weak. This can often lead to heart failure.
Congestive Heart Failure: A chronic, irreversible condition in which the heart can no longer pump enough blood to all parts of the body.
Stent Insertion
Cardiomyopathy
Congestive Heart Failure

7. Don’t Ask, Don’t Tell NOT on our Application Atrial Fibrillation
Arrhythmia
Congenital Heart Disease
Heart Murmur
Valvular Heart Disease
Atrial Fibrillation : Abnormal heart rhythm that starts in the atrial chambers of the heart
Arrhythmia – irregular heart beat – rhythm / rate.
Congenital Heart Disease or Defect : is a problem in the structure of the heart that is present at birth.
Heart Murmur - Heart murmurs are heart sounds produced when blood flows across one of the heart valves that are loud enough to be heard with a stethoscope.
Heart murmurs are caused by faster blood flow through the heart vessels
Valvular Heart Disease - Valvular heart disease is any disease process involving one or more of the four valves of the heart (the aortic and bicuspid valves on the left side of heart and the pulmonary and tricuspid valves on the right side of heart.

8. The interruption of the blood supply to any part of the brain.
Stroke
The interruption of the blood supply to any part of the brain.

9. Similar to a stroke, except the blockage lasts for less than 24 hours
STROKE vs. TIA
Stroke
TIA
Stroke is caused by blockage of blood flow or rupture of an artery to or in the brain
Similar to a stroke, except the blockage lasts for less than 24 hours
A stroke can happen in two main ways: Something blocks the flow of blood, or something causes bleeding in the brain. 
Ischemic (Clots) stroke is when an there’s an obstructions within a blood vessel supplying blood to the brain
Hemorrhagic (Bleeds) when a weakened blood vessel ruptures
TIA (Transient Ischemic Attack) is caused by temporary clot – with TIA’s there is usually complete recovery and no evidence of brain damage found on scans. However, it raises your odds of having a full-scale stroke.
Heart and Stroke Foundation Canada

10. Stroke - Did You Know?
Every year, nearly 14,000 Canadians die from stroke.
Every year in Canada, there are over 50,000 new strokes—that's one stroke every 10 minutes
Stroke is the 3rd leading cause of death.
Opportunity to SELL!
Stroke is the 3rd leading cause of death.
Nearly 14,000 Canadians die from a stroke annually.
There are over 50,000 new strokes every year in Canada – that is 1 stroke every 10 minutes.

11. Traditional uw – Heart & stroke
The Long Way
Stress Test
Cardiac Report
APS
Traditional Underwriting
Attending Physician Statement(APS)
Thallium scan: radioactive tracer to see if the blood is reaching the different areas of the heart.
Electrocardiogram(ECG) at rest: measures the electrical activity of the heart at rest – usually 6 electrodes are attached to the chest and hooked up to the ECG machine. It shows  heart rate and rhythm, whether there is enlargement of the heart due to high blood pressure or evidence of a previous heart attack
Stress test (exercise ECG) : Measures the heart’s ability to respond to external stress in a controlled clinical environment. This test can be used to diagnose coronary artery disease  and assess patient prognosis after a  heart attack
Echocardiogram: uses ultrasounds to create an image of the heart. Prodominatly used in the diagnosis, management, and follow-up of patients with any suspected or known heart diseases
ECG
Blood/Urine

12. Our Way X
This is all you need:
APS

13. Canada Protection Plan
A Few Examples
Case
Traditional
Canada Protection Plan
12 months post stroke
Postponed
Deferred Elite up to $350,000
More than 1 stroke
Declined
Potentially Simplified Elite up to $500,000
Stroke combined with Diabetes
Declined
Deferred Elite up to $350,000
Congestive Heart Failure
Declined
Guaranteed Acceptance up to $25,000
Angina (chest pain) 53 M, more than 3 years ago
Possible ECG, stress test
Rated or Declined
Simplified Elite up to $500,000

14. How We Underwrite – What Matters Most to us
1. Date and Age at which event (CAD/MI or stroke) took place
2. Treatment versus Maintenance Medications
The younger a person is when they experience Coronary Artery Disease, the higher the risk for mortality.
Treatments such as angioplasty, stent, bypass surgery and nitrogen (anticoagulants), while we consider
medications such as antihypertensives or cholesterol lowering pills maintenance & preventative
Diabetes increases the chance of having certain risk factors such as hypertension and elevated cholesterol which increase the chances how having heart disease or stroke.
3. CAD Coupled with Diabetes

15. 1. Date and Age Heart Attack (Myocardial Infarction)
Angina (Cardiac Chest Pain)
Stent Insertion
Angioplasty
Bypass Surgery
Stroke & TIA

16. 1. Date and Age
Section A, Q#9. Have you ever had, been treated for, or been diagnosed prior to age 40, with: coronary artery disease, heart bypass surgery, angioplasty, stent insertion, angina or heart attack…?
Guaranteed Acceptance
Up to $25,000
No Medical
2-year deferral period
Canada Protection Plan
Premature CAD has a poor long term prognosis….higher mortality.
Mortality
Age at onset 40 80

17. On the Application
If event occurs prior to the age of 40, than client would answer YES to Q#9 in Section A.

18. 1. Date and Age If coronary event occurred > age 40...
Canada Protection Plan
Deferred Life
Up to $50,000
No Medical
2-year deferral period
Section B, Q#1. Within the past 12 months have you had, been told you have, or been treated for: a) Cardiac chest pain (angina), heart attack (myocardial infarction), coronary artery disease, stroke (CVA), heart bypass surgery, angioplasty, stent insertion…..?
Date of the event (MI, Angina) or surgery took place.

19. On the Application
Within the past 12 months

20. 1. Date and Age If coronary event occurred > age 40...
Canada Protection Plan
Deferred Elite
Up to $350,000
No Medical
2 year deferral period. After 1 year, 50% of the face amount if death occurs
Section C, Q#4
a) Are you age 54 or under and within the past three years, have you had treatment or surgery for or been diagnosed as having cardiac chest pain (angina), heart attack (myocardial infarction), coronary artery disease, heart bypass surgery, angioplasty, stent insertion,…?
Why do we ask within:
12 months? 2 years? 3 years?
More recent  Higher Mortality
Less recent  Lower the Mortality
b) Are you age 55 or over and within the past two years…

21. On the Application

22. NO MEDICAL Deferred Elite Up to $350,000 Issue Ages: 18 - 80
Section C
Deferred Elite
Up to $350,000
Our NEW Deferred Elite…..on our old app this was our Deferred for up to $250,000 with a 2 year deferral period.
NO MEDICAL
Issue Ages:
New deferral conditions…

23. 50% of the coverage amount is payable.
…If the death occurs during the second year
and is due to non-accidental means,
50% of the coverage amount is payable.
On our new app…Deferred Elite goes up to $350,000 with no medicals and…here comes another WOW…we pay 50% of the death benefit in the 2nd year!!!! What!!!!
The full coverage is payable after two years. If cause of death is accidental, the full coverage is payable any time.

24. …Then, move on to Section D
If…
The client is </= 54 years old and the cardiovascular event/stroke took place OVER 3 years ago OR
The client is >/= 55 years old and the cardiovascular event/stroke took place OVER 2 years ago
…Then, move on to Section D

25. NO MEDICAL Simplified Elite Immediate Coverage Up to $500,000
Section D
Immediate Coverage
Simplified Elite
Up to $500,000
Our old Simplified Plus of $300,000 is now $500,000 No Medical and re-named as Simplified Elite.
That is unheard of in the industry…but again we listened to you and we delivered what you wanted!
Why do we ask within:
12 months? 2 years? 3 years?
More recent  Higher Mortality
Less recent  Lower the Mortality
NO MEDICAL
Issue Ages:

26. Any history of heart disease or stroke
NOT ELIGIBLE FOR PREFERRED

27. 2. Treatment versus Maintenance Meds
“…been treated for…”
Treatment =
Surgery
Stent insertion
Angioplasty
Heart bypass surgery
Maintenance =
Medications
Long-term use, to prevent reoccurrence
Most often: blood thinners, cholesterol-lowering medications, anti-hypertensive medications
When we use the term treatment in relation of the Cardiac questions, we are referring to cardiac surgery.
Afterward, the medications prescribed for long term use are considered maintenance medications for our application purposes.

28. 3. CAD/Stroke Coupled with Diabetes
Cardiovascular disease is the leading cause of death among people with type 1 and type 2 diabetes.
Did you know….
Adults with diabetes are two to four times more likely to die from heart disease than adults without diabetes.

29. On the Application
Section D #3 - If you have diabetes, that is controlled with no complicating risk factors, you may be eligible for our Simplified Elite plan.

30. 3. CAD/MI Coupled with Diabetes
CPP
A history of CAD + diabetes =
APPROVED!
Deferred Elite, max $350K, non-medical
Traditional Insurer
A history of CAD/stroke + diabetes =
DECLINED

31. 1. Spotlight: Heart Disease & Stroke
33-year-old Male, Non-Smoker
Had a sudden heart attack while at work. A stent was inserted, and he was prescribed aspirin, 81 mg per day, for prevention/maintenance.
DARE TO COMPARE
Canada Protection Plan
Approved Guaranteed Acceptance
Up to $25,000
No Medical
2 year deferral period
$56.57/month
Guaranteed Acceptance Life for $25,000
APS
Full cardiology reports
New labs
Decision:
Likely Declined
Traditional Provider

32. 2. Spotlight: Heart Disease & Stroke
48-year-old Female, Non-Smoker
Diabetes type II, uses only non-insulin medication for 7 years. She had a stroke 4 years ago.
DARE TO COMPARE
Canada Protection Plan
Approved Deferred Elite
Up to $350,000
No Medical
2 year deferral period. After 1 year, 50% of the face amount if death occurs
$43.65/month
Deferred Elite T10 for $100,000
APS
Full cardiology reports
New labs
Decision:
Likely Declined
Traditional Provider

33. 3. Spotlight: Heart Disease & Stroke
55-year-old Female, Smoker
Experienced severe chest pains 6 years ago. She was taken to the ER and had a stent inserted. She also had a stroke 2 years prior to this incident. She currently takes a blood thinner and cholesterol-lowering medication.
DARE TO COMPARE
Canada Protection Plan
Approved Simplified Elite
Up to $500,000
No Medical
No deferral period
$93.89/month
Simplified Elite T20 for $75,000
APS
Full cardiology reports
New labs
Decision:
Likely Declined
Traditional Provider

34. We Speak Agent! Monday – Friday until 8pm EST 
Speak to an Underwriter!!
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