PSEU Income Protection Plan. Member s Explanatory Booklet

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1 PSEU Income Protection Plan Member s Explanatory Booklet

2 Table of Contents Introduction... 3 Protecting your Income... 3 How the Income Protection Plan works... 4 Questions and answers... 7 Contact details About Lyons Financial Services Lyons Financial Services was appointed by the Public Service Executive Union as advisors to members in relation to the PSEU Income Protection Plan, with effect from January Established in 2004, Lyons Financial Services is now one of Ireland s leading financial advice firms to employees within the Civil & Public Sector. We advise on a large range of products including; AVCs Life Assurance Income Protection Health Insurance Dental Insurance Mortgages Savings & Investments Motor & Home Insurance Through our nationwide team of Financial Advisors, Lyons Financial Service excels in providing financial services solutions to union members, consumers, employees and employers in both the Public & Private Sectors right across the country. Page 2

3 Introduction This booklet sets out in broad terms the benefits conferred on members of this Plan. It does not confer any rights on the member. In the event of a dispute, the Terms and Conditions of the Plan, as set out in the Policy Document and/or schedules, will be used to determine the outcome. Protecting your Income Perhaps the greatest threat to your livelihood is ill health. This is because if you fall ill your sick pay provides you with an income for a limited period only. Once your sick pay runs out, your income will fall dramatically. All too often you ll find that the strain and anxiety of financial difficulties accompanies the discomfort and anxiety of illness. How would you manage financially if you suffered a serious illness or long-term disability? Alarmed at the financial problems that can arise for members, who suffer long-term illness, the Public Service Executive Union, hereinafter referred to as PSEU, asked Lyons Financial Services, to negotiate an Income Protection Plan for its members. What happens to your Salary if you fall ill? Standard Sick Pay Generally sick leave is paid for 13 weeks (92 days) at full pay in one year, followed by 13 weeks (91 days) at half pay. This is subject to a maximum of 26 weeks (183 days) in a rolling 4 year period. If you exceed 183 days paid sick leave you may receive Temporary Rehabilitation Remuneration (TRR) (see below) for a further 18 months (548 days). Extended Sick Pay for Critical Illness There is a Critical Illness Protocol whereby employees may be granted extended paid sick leave of 26 weeks (183 days) at full pay in one year, followed by 26 weeks (182 days) at half pay, subject to a maximum of 52 weeks (365 days) in a rolling 4 year period. If you exceed 365 days paid sick leave, you may receive TRR (see below) for a further 12 months (365 days). TRR may be extended for a further period up to a maximum of 2 years (730 days). Temporary Rehabilitation Remuneration (TRR) TRR is based on your accrued pension benefits which would have applied had you actually retired on ill health grounds. It may be granted where there is a realistic prospect of an individual returning to work. Please note that any added years which you may have purchased are not taken into account for the purposes of the calculation of this benefit. All of the above arrangements are subject to the terms of the Public Sector sick leave arrangements and there is separate criteria used to determine entitlement to TRR. Ill Health Early Retirement Pension Alternatively, if you retire on the grounds of ill health you may be entitled to an Ill Health Early Retirement Pension. What happens when your sick pay expires? If your sick pay runs out, your only entitlement will be Social Welfare Disability Benefits. If you are paying A1 rate PRSI and you are single this equates to 9,776 per annum currently (as at 01/04/2015), which provides a subsistence income only. The reality is without additional income protection that long-term illness inevitably means a severe drop in living standards. The need for some kind of additional income is evident from the example below. Page 3

4 EXAMPLE A1 PRSI (STANDARD SICK PAY) Member earning 40,000 ( 1,538 per fortnight) with 8 years service on the Standard (A1) rate of PRSI, who becomes ill and had no absences from work due to ill-health in the previous 4 years. Period of absence Page 4 Employer pays Social Protection Benefits Total per fortnight First 92 days 1,162 per fortnight 376 per fortnight 1,538 (100%) Next 91 days 393 per fortnight 376 per fortnight 769 (50%) Next 547 days TRR/Ill-Health Early Retirement Pension 123 per fortnight 376 per fortnight 499 (32%) EXAMPLE B1 PRSI (STANDARD SICK PAY) Member earning 48,000 ( 1,846 per fortnight) with 20 years service on the Standard (B1) rate of PRSI, who becomes ill and had no absences from work due to ill-health in the previous 4 years. Period of absence Employer pays Social Protection Benefits Total per fortnight First 92 days 1,846 per fortnight Nil 1,846 (100%) Next 91 days 923 per fortnight Nil 923 (50%) Next 547 days TRR/Ill-Health Early Retirement Pension 615 per fortnight Nil 615 (33.3%) How the Income Protection Plan works When your salary is reduced to half pay, the Plan pays you an income of 25% of your Earnings** (initial benefit). When sick pay runs out the Plan aims to supplement your income up to 75% of your Earnings (full benefit). In arriving at the insured benefit payable to you the full benefit amount is reduced by the amount of any other income (e.g. TRR, Ill Health Early Retirement Pension, State Single Person Disability Benefit) to which you may be entitled. ** For this purpose Earnings is defined as basic annual salary at date of disability excluding commission, overtime, shift allowance, and any fluctuating emoluments. The PSEU Plan will continue to pay you until the earlier of: your return to your pre-disability occupation medical evidence confirms your ability to return to your pre-disability occupation you reach age 65 your death. You should note that only periods of illness occurring since the date you joined the PSEU Plan are taken into account when calculating how soon benefit from the PSEU Plan begins. Claims under the PSEU Plan will be paid if the Plan s Insurer is satisfied that because of injury or illness you are unable to do your normal job and are not working elsewhere. The only policy conditions excluded are war, wilfully self-inflicted injury, drug or alcohol abuse, and aviation. Please bear in mind that in some cases individual members may be accepted into the PSEU Plan subject to exclusions in respect of pre-existing specific illnesses. You should also note that the Insurer will assess and review all claims independently of any decision taken by the Employer to grant a member TRR, ill-health early retirement and extended sick pay under the Critical Illness Protocol. You must remain a member of the PSEU to continue to be covered by the Plan. If you leave the PSEU then you are no longer covered.

5 EXAMPLE - A1 PRSI (STANDARD SICK PAY) Member earning 40,000 ( 1,538 per fortnight) with 8 years service on the Standard (A1) rate of PRSI, who becomes ill and had no absences from work due to ill-health in the previous 4 years. First 183 days of absence Period of absence Employer pays Social Protection Disability Benefit PSEU Income Protection Plan Total income First 92 days 1,162 per fortnight 376 per fortnight Nil 1,538 per fortnight Next 91 days 393 per fortnight 376 per fortnight 385 per fortnight 1,154 per fortnight Absence from day 184 to day 547 Pre-disability income 1,583 per fortnight TRR/Ill Health Early Retirement Pension Social Protection Disability Benefit PSEU Income Protection Plan Total income 123 per fortnight 376 per fortnight 655 per fortnight 1,154 per fortnight As can be seen from the above example, from month three onwards (i.e. day 92), the total income is equal to 75% of pre-disability income. EXAMPLE B1 PRSI (STANDARD SICK PAY) Member earning 48,000 ( 1,846 per fortnight) with 20 years service on the Standard (B1) rate of PRSI, who becomes ill and had no absences from work due to ill-health in the previous 4 years. First 183 days of absence Period of absence Employer pays Social Welfare Disability Benefit PSEU Income Protection Plan Total income First 92 days 1,846 per fortnight Nil Nil 1,846 per fortnight Next 91 days 923 per fortnight Nil 462 per fortnight 1,385 per fortnight Absence from day 184 to day 547 Pre-disability income 1,846 per fortnight TRR/Ill Health Early Retirement Pension Social Protection Disability Benefit PSEU Income Protection Plan Total income 615 per fortnight Nil 770 per fortnight 1,385 per fortnight As can be seen from the above example, from month three onwards (i.e. day 92), the total income is equal to 75% of pre-disability income. How long am I covered for? Assuming you remain an eligible member of the PSEU, cover under the Plan ceases when you reach age 65. Page 5

6 NOTE ON EARLY RETIREMENT If at the point of going on claim you do not wish to retire and so do not apply for an Early Retirement Pension (ERP) the Plan will pay out a full 75% of salary for up to 2 years. If you do retire subsequently and an Ill Health Early Retirement Pension is paid retrospectively to the end of the deferred period, the additional benefit must of course be refunded. How much does it cost? Very little! As membership is so vital, the PSEU Plan is designed to be affordable for every member. It is remarkably good value as it is negotiated on a special group basis for members of the PSEU. The contribution rate is currently set at just 1.05% (inclusive of government levy) of Earnings (i.e. basic annual salary at date of disability excluding commission, overtime, shift allowance, and any fluctuating emoluments) and can be conveniently deducted from your salary by your employer. A helping hand from the Revenue You are eligible for tax relief at your highest rate of tax, on the premium you pay for the Income Protection Plan. EXAMPLE OF TAX RELIEF Salary Gross fortnightly cost Net fortnightly cost 30, (tax 20%) 40, (tax 40%) 50, (tax 40%) Price guarantee The current rate of 1.05% of salary is in place until 30th April 2018, at which time it will be reviewed. Work sharers Eligible work sharing members may also apply to join the PSEU Plan. The level of contributions and benefits applying for them are explained on page 9. Lyons Financial Services will advise you of any special offer terms. Cover begins as soon as Generali PanEurope Limited (Generali) accepts you as a member of the PSEU Plan. If you haven t already joined the PSEU Plan, don t put it on the long finger. Apply to join NOW. Please contact Lyons Financial Services for an Application Form. Page 6

7 Questions and answers Who is eligible to join? To be eligible to apply for membership of the PSEU Plan you must be: 1. Under age 60, and 2. A member of the PSEU, and 3. Either a permanent civil servant who is working: full time, or part time and working on average not less than 20% of the normal working week as directed by the employer, or a temporary civil servant who is working full time or on contract for at least 12 months duration. Work sharers Work sharing members of PSEU who satisfy all 3 conditions above, may also apply to join the PSEU Plan. The level of contribution and benefits, which apply for them, may differ from those relevant for permanent full time members (see page 9 for details). When does my cover begin? Your cover begins from the date Generali (the Insurer) accepts your application in writing. On joining, members receive a formal acceptance letter from Lyons Financial Services confirming they have been included as members of the PSEU Plan. In some cases medical evidence may be required before cover of the PSEU Plan can be confirmed. This may involve attending for a medical examination at the Insurers expense. When does my cover end? Cover of the PSEU Plan ends: if you reach age 65, or if you no longer fulfil the eligibility criteria (see Who is eligible to join? above), or if your contributions to the PSEU Plan cease, or your employment ceases, or you take up permanent residence outside EEA. Are all applications accepted? In a small percentage of cases individual applicants to the PSEU Plan may be refused. In such cases applicants will receive a letter confirming that they have not been accepted into the PSEU Plan. In other cases, individuals may be offered cover subject to the condition that certain specified illnesses are excluded from cover. What does it mean if my application is subject to exclusions, or perhaps refused? This means that the Insurer believes they cannot, because of your health history, offer you the cover sought or they believe it is necessary to exclude certain conditions or restrict the level of cover offered. The Insurer makes such decisions only after careful consideration of the information supplied by you on your Application Form together with any details they have received from doctors you have attended. Applicants may seek additional clarification from their own doctor who can contact the Insurer to request reasons for their decision. What if I travel abroad? You are covered while on holidays travelling or living in the EEA as long as you remain an eligible member. There are certain conditions associated with business travel where travel to certain countries is advised against. Please refer to Lyons Financial Services for full details. If you are receiving benefit under the PSEU Plan and intend to live abroad you should notify Lyons Financial Services. Page 7

8 What if I have unearned income? Investment and rental income will not be taken into account when making a claim under the PSEU Plan. What if I am not in one of the Civil Service Superannuation Schemes? If you are not a member of one of the Civil Service Superannuation Schemes, you are not entitled to an Ill Health Early Retirement Pension should you become disabled. However if you are not a member of one of the Civil Service Superannuation Schemes you will be paying full PRSI contributions, and therefore may be entitled to a Social Welfare Disability Benefit in the event of disability. Therefore if you are not a member of one of the Civil Service Superannuation Schemes, the benefit will be paid after you have been ill for 13 weeks in any 12 month period. The amount paid will be 75% of you predisability salary less any Social Welfare Disability Benefit you may be receiving or any other payment from your employer. What if I take a career break? Generally, members of the PSEU Plan who take a career break fall into one of the following categories: 1. Members who wish to continue their full cover under the PSEU Plan for up to 36 months duration of their career break. Premiums must continue to be paid in full. If you take up alternative employment while on a career break you are no longer eligible to claim a benefit under the policy. 2. Members who do not wish to continue the disability benefit element of their cover may re-activate their membership of the PSEU Plan on completing their career break without having to undergo any medical underwriting, as long as they re-join the Plan within 30 days of the end of their career break. This option applies only to career breaks up to a maximum of 5 years. Remember upon your decision to take a career break, you must advise Lyons Financial Services as to which option you would like to take. 3. Members on a career break who simply decide to discontinue cover of the PSEU Plan. If you are in this category, or do not notify Lyons Financial Services of your intention to take a career break, your cover under the PSEU Plan will cease as soon as your salary ceases and therefore your Income Protection contribution stops. Thereafter you must complete a full medical Application Form and undergo medical underwriting should you wish to re-join the PSEU Plan upon returning to work. What if I leave the PSEU? In such circumstances you are no longer eligible for the PSEU Plan. You should therefore write to Lyons Financial Services to cancel your cover. Lyons Financial Services may, depending on your circumstances, be able to offer you an individual policy providing similar cover. If you move to another division within the Public/Civil Service, you may be able to transfer to the plan in operation for the division to which you are transferring. In such circumstances you should contact Lyons Financial Services for details. Does it affect my entitlement to benefit if I pay A1 PRSI contributions? No! Many members are paying PRSI contributions on the modified B1 PRSI rate and so pay less PRSI contributions than those members on the A1 PRSI rate. If a member paying PRSI at the lower B1 rate retires on Ill Health Early Retirement Pension (ERP) under the Superannuation scheme he or she is not entitled to any Social Welfare Disability Benefit. On the other hand members paying the higher A1 PRSI rate may be entitled to a Social Welfare Disability Benefit if they suffer prolonged illness. Members in this situation may also be entitled to an integrated Ill Health Early Retirement Pension. The benefit payable under the PSEU Plan is the amount needed to top up any Ill Health Early Retirement Pension and any Social Welfare Disability Benefit to 75% of pre-disability salary. In effect this means that whether you are a B1 or an A1 PRSI contributor, taking both Ill Health Early Retirement Pension and the Social Welfare Disability Benefit into account the combined amount you receive inclusive of the benefits under the PSEU Plan in the event of disability should be the same. Page 8

9 What happens if I change my terms of employment If your terms of employment change, this may affect your cover under the PSEU Plan. For instance if you reduce the overall number of hours you are working each week, your benefits under the PSEU Plan may be affected. It is vital therefore that you should notify Lyons Financial Services in writing should you change your terms of employment. Are there any special considerations for part-time members? Yes. Amongst the issues you should consider are: 1. Part time members are eligible to join only if they are working on average not less than 20% of the normal working week as directed by the employer and, in the case of temporary part time members, are on a contract of employment of at least 12 months duration. 2. Eligible part time members should also bear in mind that in some cases cover in the PSEU Plan may not be suitable for them. This could be the case if, for instance, you are on a relatively low salary and are paying PRSI at the A1 rate. This means that if you become disabled you would receive Social Welfare Disability Benefit (currently 9,662 per annum). If this is more than 75% of your pre-disability salary you would not receive any benefit from the PSEU Plan because you would already be receiving more than the maximum 75% of pre-disability salary you are entitled to under the PSEU Plan. 3. Eligible part time members should also remember that benefits paid under the Plan may be reduced if, for instance, you spent some years as a full time member and were a member of any of the Civil Service Superannuation Schemes. Assuming you were contributing to any of the Civil Service Superannuation Schemes for more than 2 years, this means that if you become disabled you would be entitled to receive an Ill Health Early Retirement Pension (ERP). If the greater portion of your superannuation contributions were made while you were on a full time salary, it may be the case that your ERP (much of which would be based on your full time salary) is in fact very large in relation to your current part time salary. As a result you would be eligible for little or no benefit under the PSEU Plan as you would already be receiving close to or more than 75% of your pre-disability salary in the form of an Ill Health Early Retirement Pension. What benefits does this plan provide for job sharers and work sharers? The benefits and contribution rate for job sharing and work sharing members are based on job sharing/work sharing salary. In the event of a claim the Insurer may deduct a lesser amount than the actual Ill Health Early Retirement Pension (ERP) entitlement from the benefit paid by the PSEU Plan. This is because, were the Insurer to deduct the actual ERP (which might include many years of Superannuation contributions based on full time income), the member s ERP entitlement could come close to, or actually exceed, the benefit paid under the PSEU Plan. This would mean little or no benefit would be paid under the PSEU Plan. EXAMPLE 1 JOB SHARER ON CLASS B1 PRSI The benefit for job sharers is reduced pro-rata in line with their job sharing salary. For example, a job sharer working 50% of the full time equivalent is paid a benefit of 50% of the full time benefit. In practice, a member who works 50% of the full time equivalent: Job sharing salary 30,000 Equivalent full time salary 60,000 ERP Entitlement 15,000 Benefit based on full time salary = 60,000 x 50% - 15,000 = 15,000 Benefit for job sharer is 50% of full time benefit i.e. 50% of 15,000 = 7,500 Please also note that a pro-rata benefit will apply to members who opt for 60% and 80% job sharing, along similar lines to the above example. Page 9

10 What if I take parental, maternity or adoptive leave? If you avail of your entitlement to take unpaid parental, maternity or adoptive leave, and are making your contributions to the Plan through salary, no contributions will be collected in respect of periods for which you are on leave as you will not be paid a salary while on leave. Nonetheless your cover will continue unaffected while you are on leave and no repayment of the skipped contributions will be sought. However this is subject to the period of leave being no longer than 18 weeks in total in any 12 month period. Cover for members who make their contributions by direct debit is likewise unaffected where such leave is for a period of less than 18 weeks in total in any 12 month period. Where the period of leave is more than 18 weeks in total in any 12 month period, members should contact Lyons Financial Services for details of their options. These will be similar to those available to members who take a career break. What if I take unpaid leave to take care of a dependant relative? If you avail of your entitlement to take unpaid carer s leave, and are making your contributions to the Plan through salary, no contributions will be collected in respect of periods for which you are on leave as you will not be paid a salary while on leave. Nonetheless your cover will continue unaffected while you are on leave and no repayment of the skipped contributions will be sought. However this is subject to the period of leave being no longer than 18 weeks in total. Cover for members who make their contributions by direct debit is likewise unaffected where such leave is for a period of less than 18 weeks in total. Where the period of leave is more than 18 weeks, members should contact Lyons Financial Services for details of their options. These will be similar to those available to members who take a career break. What if I am a term timer? Typically term timers work 9 months of the year and take unpaid leave for the months of June, July and August. They have two options regarding their pay: 1. Be paid as normal for the 9 months they are working. OR 2. Spread their salary over the full twelve months of the year i.e. instead of taking 100% of their salary for 9 months and nothing for the remaining three months, take 75% of salary each month for the 12 months of the year. Your actual salary will typically be 75% of the salary you would have received were you still working a full 12 months. In general, term timers benefits under the Plan are assessed in the same way as other members who take unpaid leave of less than 18 weeks (see What if I take parental, maternity or adoptive leave?, and What if I take unpaid leave to take care of a dependant relative? above). However, for those who work in a term timer capacity on a regular basis (i.e. over each year for periods of two years of more) cover under the Plan remains in force with benefit based on actual salary (i.e. 75% of your full salary) you were receiving over the previous 12 months). Are there any other benefits under the Plan? Yes, the following extra benefits have been negotiated with the Insurer at no extra cost to the member. 1. Accidental Death Benefit In the event of an accidental death of a member, 20,000 will be payable. Accidental death is defined as: An unexpected or unplanned external event causing the death of the member within 180 days of that event and resulting solely from external means subject to the exclusions of this policy. Death as a result of an infection or surgical operation made necessary solely by such an event and performed within 90 days of the event is included. Page 10

11 The following exclusions will apply: If death is caused by intentional self-inflicted injury If death is caused by the person taking part in aviation other than as a fare paying passenger If death is caused by weapons of mass destruction If death is caused by participation in hazardous pursuits If death is caused by the taking of drugs and/or alcohol See full Terms and Conditions for full information on exclusions. This benefit is provided free of charge. 2. Survivor Benefit of 3 months income for Income Protection claimants If a claimant who is receiving benefit from the Plan dies and they have a spouse or other dependents, an extra three months benefit will paid to the member s estate. This can be paid in addition to the Accidental Death Benefit should it be in the event of an accidental death of a claimant and the above criteria are met. This benefit is provided free of charge. Does it affect my benefit under the plan if my disability is due to an injury at work? Yes. If you are injured at work, depending on the circumstances, social welfare benefits, etc., you may be entitled to payments in excess of 75% of salary. In such cases, as you would already be receiving a payment greater than 75% of your pre-disability salary, you would not be entitled to any benefit under the Plan. What if I take out a Critical Illness policy? Such policies pay out a lump sum on the diagnosis of certain specified serious illnesses. Although many of these policies provide valuable additional financial security, the cover they provide invariably will not match or replace the cover provided by the PSEU Plan. On the other hand, some serious illnesses will not result in an inability to work and therefore will not give rise to a claim under the PSEU Plan, even though such illnesses might be covered by a Critical Illness policy. Benefits paid under Critical Illness policies are often taken into account when assessing the level of benefit to be paid under salary protection schemes. However the Insurer has agreed special preferential arrangements for members of the PSEU Plan. This means that currently payments from a Critical Illness policy will not be taken into account when calculating the benefit to be paid to you under the PSEU Plan. Does my cover increase in line with my salary? One of the great advantages of the PSEU Plan is that it allows for your cover to be increased in line with salary rises, promotions etc. This means that the cover you enjoy under the PSEU Plan remains realistic over the years ahead. The automatic updating of the members contribution and cover avoids the necessity to complete new Application Forms, attend for medicals etc. What if I already have some form of salary protection? If you already have a salary protection or permanent health insurance policy you should bear in mind that the cover provided by such a policy may overlap with that provided by the PSEU Plan i.e. it will be taken into account when calculating how much benefit should be paid under the PSEU Plan to ensure you receive no more than 75% of pre-disability salary. You should therefore contact Lyons Financial Services for advice before joining the PSEU Plan. Will I receive money back if I never claim under the PSEU Plan? No. As with health insurance or car insurance, your contributions go to meet the cost of cover for you and your colleagues. This keeps the cost of cover to the minimum and means that there is no cash value paid out to those who never make a claim under the PSEU Plan. Page 11

12 Do I have to pay tax on benefits from the Plan? Disability Benefit paid by the PSEU Plan will be treated as normal income and as such is liable to income tax and PRSI. How do I claim my tax relief on contributions? Under the 1979 Finance Act, tax relief was granted on Income Protection Plan contributions. The method of granting tax relief on member contributions to approved disability plans changed with effect from 6th April Where an employer deducts the contributions from the member s pay, a Net Pay arrangement applies, just as it applies to your superannuation contributions. This means that your gross pay is effectively reduced for the purpose of calculating income tax. It means that income tax relief is given automatically at source. Consequently there is no need for you to refer direct to your local Inspector of Taxes for income tax relief. How do I claim from the PSEU Plan? Lyons Financial Services guides members through the claims procedures and ensure that all legitimate claims are paid promptly by the Insurer of the PSEU Income Protection Plan. As soon as you become aware that, due to illness or injury that your salary is likely to reduce to half pay, or cease altogether, you should contact Lyons Financial Services, Office 1 Dunboyne Business Park, Dunboyne, Co Meath. Telephone +353 (0) for a claim form. Lyons Financial Services will explain the additional documentation you will need to submit. Prior to completing your claim form, please consult with Lyons Financial Services. Upon receipt of your claim form, Lyons Financial Services will process your claim with the Insurer. All evidence reasonably required by the Insurer must be provided by the member. The member may be required to undergo medical examinations (at the Insurer s expense) and may also be visited by a disability counsellor. Once benefit is being paid members may be required from time to time to provide evidence of on-going disability. Who decides whether or not I am entitled to payment under the Plan? The Insurer will decide whether or not you are entitled to benefit under the PSEU Plan, based on an assessment of all medical information. To qualify for benefit under the PSEU Plan, the Insurer must be satisfied that you are unable to carry out your duties under your normal occupation because of illness or injury and that you are not following any other occupation. In certain cases benefits may be paid where the member returns to work to take up another occupation, but at a reduced level of Earnings due to partial disability (see page 13 for details). While you are being paid benefit under the PSEU Plan, the Insurer may seek regular medical certificates from your doctor. This is because you must continue to be disabled and unable to work in order to be entitled to continue to claim under the PSEU Plan. The Insurer may also require an independent medical examination or specific information from your doctors. These medical examinations will be at the Insurer s expense. You may also be visited by the Insurer s disability counsellor from time to time. Are claims ever turned down by the Insurer? The great majority of claims are paid. However experience has shown that when difficulties do arise, they usually arise because: When joining, the member did not disclose his or her full medical history. In such cases the Insurer reserves the right not to pay a claim. It is very important that when applying to join the PSEU Plan you ensure that you make a full disclosure in relation to any questions asked on the Application Form and during any medical examination you may undergo. If you don t, any claims you make may be turned down and cover under the PSEU Plan may be cancelled. Page 12

13 Medical opinion is that the member is able to carry out his or her normal occupation. Dependent upon the medical condition at issue, specialist opinion may be required. If ultimately in the Insurer s view, the medical opinion is that you are not disabled as defined under the PSEU Plan benefit will not be payable. Benefit payment is not dependent on whether you have been retired on grounds of ill health by your employer. In the event of a dispute you may appeal to the Insurer by providing additional specialist evidence. Should your appeal be unsuccessful you have the right to seek the assistance of the Insurance Ombudsman who may take up your case without cost to you. Finally, if all other avenues fail, you can take your case to the courts, using the arbitration procedures provided for under the Plan. What happens if I return to work only to find that I become ill again a few months later? If you return to work after a period claiming benefit through the Plan only to find that you fall ill again due to the same condition within 26 weeks of your return to work your benefit will begin again immediately i.e. you will not have to wait the usual period before your benefit is paid. This is subject to the Insurer being satisfied that you are unable to carry out your duties under your normal occupation because of illness or injury and that you are not following any other occupation. What happens if I return to work but at a reduced salary or take up a different less well paid job? If due to ill health you are able to return to work in your normal job on a reduced basis only, the Insurer will continue to pay you a proportionately reduced income i.e. your benefit under the PSEU Plan will be reduced to take account of additional income you are now earning. Should you be unable to follow your normal job and take up a different job at a lower rate of pay, again the Insurer will continue to pay you a proportionately reduced income. Who administers and insures the PSEU Plan? The PSEU Plan is administered by Lyons Financial Services and is insured by Generali. Deductions Responsibility for ensuring that the deductions to the PSEU Plan are made and remitted to Generali rests with the individual member. If deductions to the Plan cease then the member ceases to be a member of the Plan and no longer qualifies for any benefit. What happens if I cease to be a member of the PSEU Plan? Membership of the PSEU Plan may be cancelled at any time by notifying Lyons Financial Services or the Insurer in writing or stopping your deduction at source. As your contributions are designed to cover the cost of paying benefit to those members of the PSEU Plan who become disabled, there is no cash value paid to you should you stop contributions to the PSEU Plan. It is important that you think carefully before cancelling your membership of the PSEU Plan as once you have left the PSEU Plan you will be required to provide information about your state of health should you apply for cover again. Should any medical problems have arisen in the interim, it is unlikely that you will be re-admitted to the PSEU Plan. If you are re-admitted, you may have certain illnesses excluded. Under what circumstances can the Plan be amended? Benefit levels and the rate of contributions under the PSEU Plan are reviewed on a regular basis. The next review of the PSEU Plan is on the 1st May These reviews are designed to provide Lyons Financial Services with an opportunity to research the market to ensure that the best deal is being provided for members. Likewise the reviews provide the Insurer with an opportunity to adjust the benefit levels and/or the rate of contribution in the light of relevant factors such as membership level, age profile of the membership and the claims experience of the PSEU Plan. At such reviews, the PSEU Plan s insurer and PSEU reserve the right to increase or reduce the rate of contribution and vary the benefit levels under the PSEU Plan for all members or terminate the PSEU Plan as a whole. Page 13

14 The PSEU Income Protection Plan is governed by a Master Policy Document that is available from Lyons Financial Services. The Policy is issued by Generali. Members of the PSEU Plan may examine the policy at any reasonable time at the office of Lyons Financial Services. This booklet provides a brief summary of the main policy conditions only and confers no legal rights. The PSEU represents the interests of members in the PSEU Plan and any decisions taken in these areas by the PSEU will be considered binding on all members of the PSEU Plan. This is a condition of membership and entry to the PSEU Plan is allowed to members only on this understanding. In the event of termination or amendment of the PSEU Plan, those members who are already receiving benefit payments under the PSEU Plan will continue to receive those benefit payments. Contact details Please note: This explanatory booklet provides a brief outline only of the main benefits of the Income Protection Plan for members of the PSEU as of May 2015 and is issued subject to the provisions of the policy and does not create or confer any legal rights. The information contained herein is based upon our current understanding of Revenue law and practice as at May If you have any queries about your membership of the PSEU Plan or require a copy of the full policy document please contact Lyons Financial Services at the address below. If you have a complaint and wish to discuss this please contact or write to, Lyons Financial Services at the address below. Lyons Financial Services Office 1 Dunboyne Business Park Dunboyne Co. Meath Tel: +353 (0) Fax: +353(0) Website: If you are still dissatisfied you should contact one of the following organisations: Insurance Ombudsman 32 Upper Merrion Street Dublin 2 Tel: +353 (0) Website: Irish Insurance Federation 39 Molesworth Street Dublin 2 Tel: +353 (0) Page 14

15 Page 15

16 Arranged and administered by Underwritten by Lyons Financial Services Office 1 Dunboyne Business Park Dunboyne Co. Meath Ireland Tel: +353 (0) Fax: +353 (0) Generali PanEurope Limited Generali House Navan Business Park Athlumney, Navan Co. Meath Ireland Tel: +353 (0) Fax: +353 (0) Roisin Lyons t/a Lyons Financial Services is regulated by the Central Bank of Ireland. Generali PanEurope Limited is regulated by the Central Bank of Ireland. Generali PanEurope Limited is a limited Company registered in Ireland (Number ) with a registered office at North Wall Quay, Dublin 1, Ireland. Generali PanEurope Limited is part of the Generali Group. The Generali Group has a listed number in the Italian Insurance Group Register of 026. GPE EB PSEU MB 04/15

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