2. UNDERWRITING CANCER OUR WAY OR THE LONG WAY
OUR WAY OR THE LONG WAY

3. Let’s re-visit CPP’s new products
Before we talk Cancer…
Let’s re-visit CPP’s new products
Guaranteed Acceptance
$5-$25K
Perm only
Deferred
$5-$75K
Perm only
Deferred Elite
$5-$350K
Simplified Elite
$5-$500K
Preferred (subject to underwriting)
$50K-$1,000,000
Preferred Elite (subject to underwriting)
$50K-$1,000,000
“No” in Section D, complete Section E
“No” in Section D, complete Sections E & F
“Yes” in Section A
“Yes” in Section B
“Yes” in Section C
“Yes” in Section D

4. Tnm Staging and grading
Staging: Describes the SIZE of a tumour and how far it has spread
Grading: how abnormal the cells are
T = primary tumour
Tx, Tis, T1, T2, T3, T4
N = regional lymph nodes
Nx, 0, N1, N2, N3
M = distant metastasis
Mx, 0 1
Gx = cannot be assessed
G1 = low
G2 = intermediate
G3 = high
G4 = anaplastic
There are two classification systems that oncologists use to describe a tumour: staging and grading. The staging system used is called the TNM system, and it looks at how far the tumour has spread and the size of the tumour. The grading system is used to describe how abnormal the cells look under a microscope. The higher grades suggest that the cells are very abnormal, i.e poorly differentiated, and thus are growing faster and spreading earlier.
This is just an example for some cancers are classified. Colorectal cancer that is T3, N1, M1 means that the tumour has invaded into several tissues, 1-3 regional lymph nodes are involved, with metastasis, i.e spread to a distant organ
Examples:
39 yo male, colorectal cancer, T3N1M1
55 yo female, invasive papillary breast cancer, T2N1M0

5. Staging of cancer Cancer stage = major prognostic factor Decline Rated
Stage 4 (spread to other parts of the body)
Ex: breast cancer – any T, any N, M1
Stage 3 (spread into surrounding tissues or lymph nodes)
Ex: breast cancer - T3,N2,M0
Rated
The stages of cancer may be simplified as follows:
Local disease (cancer that has stayed in the area where is was diagnosed)
Metastatic disease (cancer that has spread to another part of the body)
In general, for various types of cancer:
Stage 1 cancer (small and localised)
Stage 2 cancer (larger but localised)
Stage 3 cancer (spread into surrounding tissues or lymph nodes)
Stage 4 cancer (spread to other parts of the body)
With a traditional insurer, all stages of cancer are rated. With higher stages though, higher ratings are applied accordingly.
Stage 2 (larger but localised)
Ex: breast cancer - T2,N0,M0
Standard
Stage 1 (small and localised)
Ex: breast cancer - T1,N0,M0

6. Full details of treatment
the long way
Pathology report
Full details of treatment
Occupation
APS
Family History
For a traditional insurer, when they underwriter cancer cases, they must have obtained the APS, and all pathology reports at minimum. They look at the staging and grading, they may have to refer to an MD, and require full details of treatment.
Joke: It takes a shorter amount of time to cure the cancer, than it does to underwrite it
Age
Staging and Grading

7. x x Our way Pathology Report APS
At Canada Protection, the grade and stage of the particular cancer that a client may have, has no bearing on our underwriting decisions
X’s will go through

8. Metastasis (Stage 4 and some Stage 3s)
Our way
Metastasis (Stage 4 and some Stage 3s)
Recurrence
Date of last treatment
Instead, we underwrite cancer based on:
-date of last treatment
-whether or not there has been any re-occurrences or metastasis within a specific timeframe (10 years)
-the type of cancer and how aggressive it is
Type of Cancer

9. Metastasis spreads to a distant site (m1)
Stage 4 and some Stage 3s
Within the past 10 years
HIGH MORTALITY
The second important parameter that we consider when underwriting cancer cases is whether or not there was metastasis or more than 1 occurrence within a 10-year timespan.
Why does this matter?
Higher mortality associated with metastasis
Research shows that approximately 50% of patients with colorectal cancer (CRC) will develop metastases, contributing to the high mortality rates reported for CRC (Van Cutsem 2010)
Patients with metastatic colorectal tumors frequently die of liver failure due to liver metastases.
More than 1 occurrence within a short time frame suggests:
the pathology is very aggressive or the malignant cells were partially resistant to the treatment
Treatment resistance: when cancer is treated with chemotherapy and/or radiation, the goal is to kill all of the malignant cells. If a client’s cancer recurs within a short time frame, this tells us some of those malignant cells did not stop replicating. That is, the cancer did not fully go away OR it did, and then it came back either in the same of different organ.
For our application, if within the past 10 years the client was cured but then the same or different type of cancer recurred OR if within the past 10 years, there was metastasis (meaning the cancer spread to a distant site), the client would qualify for Guaranteed Acceptance.
Sources:
Guaranteed Acceptance
Max $25K, 2-year deferral period

10. recurrence Guaranteed Acceptance
Cancer comes back or new cancer develops
Within the past 10 years
HIGH MORTALITY
Guaranteed Acceptance
Max $25K, 2-year deferral period

11. Date of last treatment Mortality Risk Current or <1 year
> 1 year or <3 years
>12 months or > 3 years
The first important parameter that we look at when underwriting cancer cases is the date of last treatment. This is synonymous with the date of remission or the date that the client was deemed to be cured by their doctor.
Our application is structured in such a way that if the longer the client has been cancer-free, the better the plan that they can qualify for; however, we have a plan available for any stage of cancer or remission. Even if a client currently has cancer, they can qualify for Deferred Life, then once it’s been greater than 12 months since they’ve been cured or greater that 3 years (depending on the type of cancer), they can qualify for our best non-medical plan: Simplified Elite.
Deferred
Deferred Elite
Simplified Elite
(all cancers)
(aggressive cancers)
(all cancers)

13. Our Plans: Guaranteed AccePtance Life
Coverage amount
Up to $25,000
Deferral period
2 years
Return of premiums
Not applicable for Accidental death
Eligibility
Everybody!
Speaker notes
Deferral period: Talk about natural vs accidental death

14. If…. NO METASTASIS in the past 10 years
ONLY 1 OCCURRENCE in the past 10 years
Then, move on to Section B

15. In Section B, we capture all clients that currently have cancer, or those that have been cured within the past 12 months
-regardless of the type cancer

16. Our Plans: Deferred Life
Coverage amount
Up to $75,000
Deferral period
2 years
Return of premiums
Not applicable for Accidental death
Eligibility
Yes to any question: #1 -#2

17. Type of Cancer Aggressive Lung Colon Breast, cervical or uterine
Malignant melanoma
Leukemia (all types), lymphoma or multiple myeloma
higher risk of metastasis
more likely to reoccur
more invasive treatments
The third most important parameter for us is the type of cancer.
Not all types of cancer carry the same type of mortality, and this is very important to us at CPP
We determine a client’s eligibility based on the date of last treatment, as we previously discussed, but also on the type of cancer
We exclude basal cell carcinoma from all of our cancer questions because this type of skin cancer almost never spreads. It is confined to the outermost layer of the skin.
NOTE: Basal Cell Carcinoma is EXCLUDED from all of our cancer questions

18. Section C is where we capture our aggressive cancers
If a client has an aggressive cancer, then they can get Deferred Elite is it was cured in the past 3 years

19. Our Plans: Deferred Elite
Coverage amount
Up to $350,000
Deferral period
1 year
Return of premiums on the first year
50% death benefit on the 2nd year
Not applicable for Accidental death
Eligibility
Yes to any question: #1 - #11

20. Non-Aggressive Cancers
> 1 year
Eligible
Otherwise, for all other cancers (non-aggressive), they can get our best non-medical plan once it’s been more than 1 year (next slide)

21. Our Plans: Simplified Elite
Coverage amount
Up to $500,000
Deferral period
none!
Eligibility
Yes to any question: #1 - #6

22. The long way PERMANENT EXTRA: Percentage
TEMPORARY EXTRA: Flat extra that falls off after a number of years
COMBO RATINGS: Percentage rating plus a temporary flat extra
Example: Breast Cancer, Stage IIB, T2,N1,M0
2 nodes, last treatment 7.5 years ago
Rating is 200% and $20/M X 3 years
After 3 years, temporary rating falls off, permanent rating of 200% remains
Client never becomes standard

23. Our way NO RATINGS! Aggressive vs. Non-aggressive SIMPLIFIED ELITE
Example: Breast Cancer, Stage IIB, T2,N1,M0
2 nodes, last treatment 7.5 years ago
SIMPLIFIED ELITE
Max $500K, Non-medical
immediate coverage, Issued in 1 day
Aggressive Cancers >3 years
Non-aggressive Cancers >1 year

24. CANCER CLINIC
NOW, YOU’RE THE UNDERWRITER!

25. CASE #1: 42 yo female, invasive, ductal breast cancer, 1cm diameter, no nodes involved, no metastasis, last treatment 4.5 years ago
What is the TNM?
T1, N0, M0

26. Remember…. TNM: T1, N0, M0
What is the stage?
Stage 1
Stage
TNM

27. Remember…. TNM: T1, N0, M0, Stage 1
What is the rating?
150% pm X 3 years

28. CASE #2: 65 yo male, prostate cancer, diagnosed 4 years ago
CASE #2: 65 yo male, prostate cancer, diagnosed 4 years ago. The tumour had spread to the bladder, to regional lymph nodes and TO THE BONE. The cells were moderately differentiated. He has been in remission for the past 6 months.
What is the TNM?
T4, N1, M1b

29. What is the stage and Gleason score?
Remember…. TNM: T4, N1, M1b
What is the stage and Gleason score?
Stage 4 and Gleason 7

30. Remember…. TNM: T4, N1, M1b, Stage 4 and Gleason 7
What is the rating?
Decline

31. 1-877-447-6060 WE’RE HEAR (excuse the pun) for you! When in Doubt….
AVAILABLE UNTIL 8PM E.S.T