Here to help at every step. A guide through the life of your plan

Transcription

1 Here to help at every step A guide through the life of your plan

2 Contents About this guide 3 1. Your application step-by-step 4 2. Questions you may have about your application 7 3. Making a claim Keeping you informed 14 How to contact us 15 2

3 About this guide Zurich is in business to provide financial protection for you and your family when you need it. This could be on death, the diagnosis of a critical illness, or suffering an illness or disability that prevents you from working, depending on the type of plan you have taken out. In this guide we explain step by step what happens from when you apply to when your plan starts. We give you a short summary of how the claims process works and tell you what you can expect from us while you have your plan. After reading this guide you ll have a good understanding of the kind of information we need to ask you for, and why. We want you to be confident about how Zurich uses that information and to feel properly informed about what will happen during the lifetime of your plan up to and including the point when you may need to make a claim. We recognise the importance of providing clear, understandable information about the plan(s) you have with us. This guide is part of our commitment to that aim. 3

4 1. Your application step-by-step In this section we break down the process of applying for insurance cover with us into each of its stages. The time it takes to complete the process and start your plan will largely depend on whether we need more information to assess your application fully. You can apply for a Zurich plan online yourself, or in writing with help and advice from a financial adviser. There are some differences in how the process works depending on which method you use. The information we ask for when considering your application is used the same whichever way you apply. Our aim is to make it as easy as possible for you to get the cover you need while providing a consistent approach to all our customers. Note: throughout this guide we assume you are applying for cover for yourself. If your application is for cover on another person, the information we ask for will be about that person. 4

5 You apply for your plan We ll only ask questions that are important to the type of cover you want. As you d expect these are mainly about your health, your occupation and some aspects of your general lifestyle. You ll need to answer each question fully and accurately. It makes sense to assume you ll need to make a claim at some point and bear in mind we ll assess any claim on the basis of what you tell us when you apply. We ll send you details of the information we have recorded on our system in processing your application and you need to check we ve done this correctly. Let us know if any of the information is incorrect, incomplete or has changed. It s your responsibility to tell us about any changes to the information you have provided, up to the time your plan starts. Changes that occur after your plan start date will not affect your plan. At the same time we ll confirm details of the bank account from which we ll be taking payments, how much they are, and when we ll be collecting them. You must make sure the information we re given is correct and complete otherwise we may not pay a future claim. If you or a financial adviser applies using our online system we may be able to offer you cover immediately. If we can t or you have completed a paper application we ll pass the information you have given us to our underwriting team. We consider the information you have given us Underwriters are experts, trained to assess how various factors affect whether we can offer you insurance cover and whether any specific exclusions will apply (something which presents a risk we cannot cover). You will find more information about exclusions later in this guide. An exclusion removes our obligation to pay the plan s benefits in specific defined circumstances. This could be where the claim results from you taking part in certain specified occupations or activities, or where you suffer from certain specified illnesses, disabilities or medical conditions. Our underwriter will consider all of the following when making a decision: your personal health your family medical history your occupation your residency the frequency and extent of any foreign travel any hazardous leisure activities you undertake your alcohol consumption your smoking habits your use of drugs other than prescription drugs. In most cases we are able to offer terms based on the information we get at this stage. However, in some cases we ll need more detailed information about disclosures you ve made before we can make a decision. We may ask for more information We may need to ask for more information and we may also need to write to your doctor. If we ask for more information it will be because we need to know more about your health, medical history, travel, occupation or your hobbies and pastimes. We ll only ask if we need the information. We explain the types of extra information we may request in the section In what areas might Zurich ask for more information? An underwriter will assess the additional information to see how it affects the risk you are asking us to insure. The tables in section 2 give more details of the areas in which we may ask for more information and the impact they could have on the cover we offer. We may not pay a claim if you fail to tell us about any changes to the information you have given us before your plan starts. 5

6 We decide the terms on which we can offer you cover We ll make a decision on your application once we have assessed all the information we need. If we decide we can offer you cover, we ll confirm in the plan schedule the amount we ll charge and any exclusions specific to your plan. These are the possible outcomes to your application: We offer you cover on standard terms This means we re able to offer you the cover you ve asked for, without any additional charges or exclusions. We offer you cover on non-standard terms This means we re able to offer you cover, but with conditions. We may need to charge you a higher than standard payment (a rating ), or exclude cover in certain circumstances. If we do this it will be because of a particular medical condition, occupational duties, travel or perhaps because you take part in sports or pastimes that may be risky. We give some details of the types of circumstances that may result in non-standard terms in the section What are the most common reasons for exclusions or an increase in the amount Zurich charges? Terms means the price we charge for providing you with cover and any specific exclusions we may apply to the cover. We postpone offering you cover We may do this if, at the time you apply, you have a medical condition that has recently been diagnosed, or is still under investigation. In these circumstances we may wait until the condition has been clearly diagnosed or the treatment has started. We may also have to postpone cover if you have suffered a very serious condition a stroke, for example. This is because we need to be sure any treatment you ve received has been successful and the illness has not recurred. Your plan starts Your plan will start when you have accepted the terms we have offered and the start date you have chosen has been reached. The start date must be the first of the month. You may also be eligible for free cover. Free cover period starts from the date of the last of the following events happens: we acknowledge a fully and correctly completed application, and we have a completed direct debit instruction or a cheque for the first payment. You receive your plan documents Once your plan has started we ll send you: full details of the terms and conditions of the type of plan you have bought the plan schedule, which gives the specific details of your individual plan including the amount, type and duration of cover, and the amount and frequency of the payments you will need to make details of how to cancel your plan if you decide you no longer need the plan. Please make sure you read and understand all the documents we send you and keep them in a safe place. We are unable to offer you cover There may be circumstances in which we cannot offer you cover on any terms. This happens rarely, but when it does it means we have to decline your application. 6

7 2. Questions you may have about your application In this section we cover some of the most commonly asked questions about the application process. How can I be sure Zurich will use my information confidentially? The Data Protection Act 1998 created obligations for companies and gave rights to individuals relating to the handling and storage of personal data held on paper files and computer databases. Zurich s internal confidentiality policy ensures that your sensitive personal data is stored under strict control and is treated with the utmost confidentiality. If during the application process we ask questions about information which you find sensitive, you can send the answers separately for the attention of our Chief Medical Officer. If you wish to provide additional information to our Chief Medical Officer, please mark the envelope Confidential. What happens if I don t tell Zurich everything about my health, hobbies and pastimes? We rely on the accuracy and completeness of the information given to us by you, your financial adviser, or anyone else who acts for you when deciding on the amount you ll have to pay us for your cover, and the terms we are able to offer you. Failure to disclose all requested information could mean you and/or your family could be disappointed should you/they claim and receive a less than full payout or none at all. Will Zurich ask my doctor for information? In some circumstances yes, but not always. You shouldn t assume we ll ask your doctor for any information about your application. It s your responsibility to make sure we have all the information we need to make a fair decision on the terms we offer. If we don t receive complete information we may not be able to pay a claim in the future. Do I need to tell Zurich of any changes after I have made my application and before my plan is issued? Yes. You need to tell us if there is any change in: your personal health your family medical history your occupation your address the frequency and extent of your foreign travel any hazardous leisure activities your alcohol and tobacco consumption your use of drugs other than prescription drugs. Your responsibility to do this continues until the date your plan starts. If you don t tell us about any changes we may not pay a future claim. If you tell us about any changes, we will tell you exactly how it affects your application. In what areas might Zurich ask for more information? We may ask for more details on any of the following to support your application: Your health and medical history. Your occupation, hobbies and pastimes. If any of these are potentially hazardous, we may ask you to give us further information and ask you to complete an additional questionnaire. Your financial circumstances. 7

8 Why do I have to tell you about my family history? We ask for details about your family history of disease on the application form as this can indicate susceptibility to disease. We only take into account a family history of first-degree blood relatives, that is, parents, brothers and sisters and we ask you to confirm factors such as the condition, relative(s) affected and their age at onset of the condition. What medical information might Zurich ask for? We may need further medical details about your current health and medical history to help us underwrite your application. Any additional reports we request or examinations we d like you to undergo will be paid for by us. You must still answer the questions on your application form fully and accurately as we won t automatically ask for additional information. The types of information we may request might be one or more of the following: Client Direct Questionnaire (CDQ) For some medical disorders (such as asthma) we may ask you to complete a CDQ. If the answers are incomplete, contradictory, or if sensitive new disclosures are made, our underwriters may request a report from your medical records held by your doctor. Own doctor s report This is a report we send to your own doctor for completion from your medical records. We need your permission to do this and will ask you to sign a consent form allowing the release of your medical information. Under the Access to Medical Reports Act 1988 you re allowed access, via your doctor, to any information provided to us on the report. The medical report your doctor fills in will include questions about your current health and previous medical history, any past or present treatment received and details of any tests or investigations. Nurse Telephone Interview If we need information about a specific condition from a medical professional and do not require you to have a physical examination we may ask a nurse, appointed by us, to call you for more information Medical Examination If we need you to attend a medical examination we will ask either your own doctor, an independent doctor or nurse, appointed by us, to undertake this. The examination will provide our underwriters with a detailed snap shot of your health at that time. This is useful because it allows us to understand your current physical condition and state of health. Cotinine Test (Smoker test) To be classed as a non-smoker you must not have used any tobacco products, including e-cigarettes and nicotine replacement products such as patches or chewing gum, in the last 12 months and have no intention to do so in the future. If you have told us on your application form you are a non-smoker, we may ask you to undertake a cotinine test. A cotinine test is a simple test to screen for tobacco use by testing a sample of saliva or urine. Blood tests We would normally only ask you to undergo a blood test if you were applying for a large amount of cover. Blood tests may be for lipids (such as cholesterol), liver function, renal function, hepatitis screening or other reasons. Exercise Electrocardiogram (Ex ECG) If you are applying for a large amount of cover we may ask you to undergo an Ex ECG. This is a simple test that looks at the rhythm and electrical activity of your heart and can indicate the possibility of heart disease. This involves walking on a treadmill as this test shows how your heart works when you re active. HIV test This is a routine requirement for applications requesting large levels of cover and involves testing a sample of your blood. If your test results are negative, the fact that you have undergone a HIV test will not, in itself, have any effect on the terms we, or any other insurance company, may offer you. Foreign travel If your travel involves a country that is considered high risk for HIV, we may ask you to have a HIV test. Why might Zurich ask for financial information? To make sure you have applied for the most appropriate level of cover we may ask you for financial information. The types of information we could ask for are: completion of our financial questionnaire copies of loan offer letters copy of company accounts letter from your accountant confirming information such as your inheritance tax (IHT) liability. 8

9 What are the most common reasons for exclusions or an increase in the amount Zurich charges? We consider every application individually so there may be disclosures which will lead to us asking for more information. This in turn may mean we offer cover at a higher cost, or exclude cover in certain circumstances or both. The following information is not exhaustive and is for guidance only, giving you an idea of the type of things that can affect the terms we offer. Medical conditions The following table lists some common medical disclosures. It shows what kind of additional evidence we re likely to ask for and the possible impact on the decisions our underwriters will make. This information is intended as a guide and you shouldn t let this influence your decision to apply to us for cover. Underwriting decisions ultimately depend on a combination of factors such as your height and weight, your family history and your lifestyle. Condition/Illness or information Evidence we are likely to need Impact on underwriting decisions Asthma and bronchitis Life: Critical illness: Income protection/payment protection benefit: CDQ or Tele-interview CDQ or Tele-interview Decisions may be affected if you are a smoker, and by the frequency of attacks and breathing difficulties. Back pain, muscular or joint problems, sore knees, shoulders, wrists etc. (and duration of problems) Life: Critical illness: Income protection/payment protection benefit: CDQ or Tele-interview CDQ or Tele-interview Decisions will depend on the cause of the problems, as well as any time off work and treatment. We will also take your occupation into account. The impact will be more significant for income protection/payment protection benefit cover than for life or critical illness. Cancer Life: Critical illness: Income protection/payment protection benefit: We usually decline or postpone life or income protection/payment protection benefit cover within 2-4 years of treatment ending depending on your individual circumstances. We will usually apply a rating for a given number of years. For critical illness, we usually apply a cancer exclusion or may decline cover altogether. Diabetes Life: Critical illness: Income protection/payment protection benefit: Decisions on life cover may vary from a small increase in payment, to declining to offer cover. The factors we consider include: the duration of the plan, your age, the date of diagnosis, whether you smoke, your height, weight and blood pressure. Terms are available for critical illness or income protection/payment protection benefit cover for non smoking, type 2 diabetics only. Family medical history Life: Critical illness: Income protection/payment protection benefit: Application Information Application Information Application Information We only take into account a family history involving natural relatives. Because of the complexity of factors we re unable to give an indication of the likely impact on underwriting decisions. Heart attack Life: Critical illness: Income protection/payment protection benefit: Cover not available Cover not available We usually postpone all cover until you have made a full recovery and returned to work or normal duties for at least six months. Decisions will also depend on the severity of the attack, age and any complications and ongoing risk factors. These include smoking habits, obesity, raised blood pressure or cholesterol. If there is a combination of heart disease and diabetes we will decline life cover. We do not usually offer terms for critical illness or income protection/payment protection benefit cover. High blood pressure or high cholesterol Life: Critical illness: Income protection/payment protection benefit: CDQ or Tele-interview CDQ or Tele-interview Generally, the younger you are, and the more significant the risk factors that are present, the bigger the increase in payment will be. Obesity Life: Critical illness: Income protection/payment protection benefit: Medical Examination Medical Examination Medical Examination Underwriters use the body mass index (BMI see below) in assessing applications. We also look at whether other risk factors are present. Generally speaking, and in the absence of other risk factors, we will consider charging a higher payment once BMI reaches 29. The fundamental cause of obesity is the consumption of excess calories, although other factors may also contribute. Significant obesity greatly increases mortality and morbidity and is associated with coronary artery disease, hypertension, stroke, diabetes, respiratory diseases and osteoarthritis. Obesity can be expressed as body mass index (BMI) which is internationally accepted as the measure for assessing body weight in relation to height as it corresponds very closely with the actual mass of body fat. Key: CDQ: Client Direct Questionnaire BMI: Adults World Health Organisation classification for BMI <18.5 underweight normal weight mild increase in mortality moderate increase in mortality substantial increase in mortality >39.9 extreme increase in mortality 9

10 How could my hobbies and pastimes affect the cover Zurich offers? We accept most hobbies and pursuits without additional ratings, but some represent extra risks for life cover, critical illness cover and/or income protection/payment protection benefit. These are examples of pursuits we may rate for life or critical illness cover. We usually exclude them from income protection/payment protection benefit cover. If you take part in any of these we will ask you to complete a questionnaire about it. We will consider whether you are taking part for competition or pleasure, your level of experience and exposure, any accident risks, and whether it is amateur or professional: What can I do to help Zurich issue my plan quickly? To help avoid any unnecessary delays and to make sure your plan starts as soon as possible, you can help to speed up this process by: making sure your contact details on the application form are correct giving us all the information we ask for when applying for your plan arranging an appointment for a medical test, nurse interview or examination (if required) as soon as you can aviation: gliding, hang-gliding, micro-lighting, ballooning, private flying, parachuting boxing caving and potholing diving horse riding/racing ice hockey martial arts motor sport, including power boat racing mountaineering and rock climbing professional golf professional rugby skiing water-skiing weightlifting yachting making sure you tell us or your financial adviser the date when you want your plan to start if you or your financial adviser has applied online, confirming that the details we have recorded on our application system are full and accurate. 10

11 3. Making a claim In this section we give you an overview of what will happen when you, or your representative or a person dealing with your affairs, make a claim on your plan. We ll give you more specific details of the information we ll need when assessing the claim, how we ll manage it and how long it might take at the time the claim is made. At Zurich we understand the trauma associated with bereavement, a critical illness, or the difficulties experienced when you are ill, can be distressing. Our overriding objective is to make sure we pay genuine claims as promptly and efficiently as possible. If you want to make a claim, it s important you let us know as soon as possible and ensure all necessary payments are paid to date at the time of the claim. When we receive a claim, we will first check to make sure it is properly covered by the terms and conditions of the plan. Once we have confirmed it is, we ll allocate it to a claims assessor who ll be the main point of contact throughout the process. After reviewing initial information about the claim, our claims assessor will decide what the next steps should be. 11

12 What information might Zurich need when assessing a claim? We ll always need some form of evidence to support a claim on one of our plans. Where a payment is necessary to obtain this evidence, this will be at our expense. We try to get information as soon as possible but occasionally we may experience some delays when getting medical evidence. There are differences in the process depending on the type of claim being made. Death claims For claims after the death of an insured person, we need to see the original death certificate. We may also need to see medical information or other evidence such as coroners notes. All original documentation will be copied and returned securely and promptly. Critical illness claims When you make a claim on a critical illness plan, the claim form you complete includes your consent to allow us to obtain the medical information we need. We ll usually get this from your GP or specialist who has been treating you. If the claim arises in the early years of the plan, it is likely we ll look in more detail at medical records to make sure they are fully consistent with what we were told at the time you applied for your plan. Income Protection/Payment Protection Benefit/Waiver of Payment (WOP) claims For Income Protection/Payment Protection Benefit claims, our claims assessor will conduct a full telephone interview as part of the assessment of the claim. We ll ask for full details of your incapacity, occupation and evidence of earnings. These financial details are necessary because the plan aims to provide a replacement of income when incapacitated. Medical information is usually obtained from your GP and the treating hospital specialist. Occasionally we may ask for an independent examination or a home visit to progress the claim. We review Income Protection/Payment Protection Benefit/Waiver of Payment claims periodically to make sure they re still valid. How long does it take for Zurich to pay a claim? Our aim is to pay valid claims promptly and without fuss. The time it takes will largely depend on the type of evidence we require to assess the claim and how quickly we get the information we need. This can be affected by the complexity or size of the claim. We ll automatically, and regularly, remind you what outstanding information we need. Once we have everything we need we ll make a decision within five days. For death claims we ll issue cheques for accepted claims within 24 hours of making a decision. For accepted critical illness and Income Protection/Payment Protection Benefit claims, cheques will be issued within five days. The quicker we can get the information and evidence we need to assess a claim, the quicker we can make a decision about it and send out any cheques. What could prevent a claim being paid? The three main reasons why we can t pay a claim are: the claim does not meet the plan definition for a specified critical illness or level of disability on Income Protection/Payment Protection Benefit or waiver of payment claims we weren t told all of the medical details or other information when the plan was applied for this is known as non-disclosure the cause of claim is excluded under the plan. Understanding the definitions To make a successful claim for critical illness you must meet the specific definition for the condition being claimed for. Similarly, on Income Protection/Payment Protection Benefit plans the claim must satisfy the definition of incapacity stipulated. You can see these definitions in your plan terms and conditions. Like all insurance companies we price our products carefully using these definitions. For a claim to be successful, these definitions have to be met exactly to ensure consistency and fairness to other planholders. This also allows us to continue to offer our products at a competitive price. Please take the time to read the relevant sections of your terms and conditions to make sure you understand the definitions. If you have any questions, or need anything clarified, speak to the financial adviser who recommended the product, or contact us direct. 12

13 If you have a financial adviser, they should always be your first port of call if you think you may have a claim under your plan. In many instances, they will be able to help you determine whether your claim appears to meet the plan definition or not. We find a number of claims are made in error either because the plan definitions have not been checked or it is assumed the condition is covered. This can lead to disappointment so it s worth checking your plan terms and conditions before telling us of a claim. Disclosing information fully, accurately and honestly Another reason for claims being unsuccessful is that the questions in the application form have not been answered correctly or, in some instances, not truthfully. Exclusions There can be circumstances in which we haven t been able to offer you full cover because of the information you have given us. Your plan documents will show you what is not covered. In addition, life assurance and critical illness contracts contain a small number of standard exclusions events under which a claim cannot be made by anyone, whatever the circumstances. The terms and conditions of your plan will confirm any general exclusions which apply. We won t be able to pay claims if the condition is not covered by your plan, or the information you gave us when you applied was incomplete, inaccurate or untrue. As we have already explained, we rely on our customers completing application forms accurately and honestly. If this is not the case our underwriters can t accurately assess the risk and set appropriate terms. These omissions or discrepancies may only come to light when a claim is made. This can occasionally result in a claim not being paid at a time when the funds are needed most. 13

14 4. Keeping you informed By taking out a protection plan with Zurich, you are giving yourself valuable peace of mind. The plans we provide are designed to give that reassurance over the long term. Of course, as your circumstances are likely to change during that time, your needs for protection may change as well. Many of our plans include the ability to increase the level of cover without giving us any more details about your health or activities. Where this option is available you might find it useful at key moments in your life, including: the birth of a child marriage or civil partnership an increase in your mortgage Each year around the anniversary of your plan s start date we ll send you a statement showing you how much cover and of what type your plan provides. We believe this yearly communication is an effective way of not only reminding you of the cover you already have in place, but also prompting you to check it s still right for your needs. Remember to let us know if you change your address so we send our communications to the right place and avoid any unnecessary delays at claim stage. Many of our plans are designed to adapt to your changing needs. We strongly recommend you review your cover regularly with your financial adviser. If you don t have an adviser you may prefer to take the time to go through a full review of your needs with a financial adviser (who may charge for this service). a job change or promotion which increases your salary by 10% or more. 14

15 How to contact us If you have any questions, in most cases your first point of contact should be your financial adviser, if you have one. If you don t have an adviser you can write to us or phone us. The security of our customers data is important to us. To check a caller s identity we ll ask a range of security questions before releasing any information. If you answer the questions incorrectly, we ll ask you to put your request in writing. So, to help us with your call, please have your plan number and plan details to hand. For underwriting queries: Write to: The Chief Medical Officer Zurich Assurance Ltd Swindon SN38 5AD Phone: Monday to Friday 8.30am 6pm For claims: Write to: Claims Department Zurich Assurance Limited Tricentre One New Bridge Square Swindon SN1 1HN Phone: Monday to Friday 9am 5pm We are not open on public holidays. We may record or monitor calls to improve our service. An answerphone is in operation outside office hours. 15

16 Zurich Assurance Ltd, authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Registered in England and Wales under company number Registered Office: The Grange, Bishops Cleeve, Cheltenham, GL52 8XX. Telephone: We may record or monitor calls to improve our service. NP127634A55 (12/15) RRD