AXA Protection Account Personal Protection Technical Guide

Transcription

1 For professional financial adviser use only and should not be distributed to, or relied upon by retail customers. AXA Protection Account Personal Protection Technical Guide

2 AXA Protection Account Personal Protection Technical Guide AXA Protection Account at a glance The AXA Protection Account enables your clients to put the protection covers they need in one place. It is available to people who, at the start of their cover, are living in England, Scotland, Wales or Northern Ireland and are aged 18 or over. This guide gives you information about the different types of cover we offer for your clients to protect them, their families and their homes. The covers available are: Life Critical Illness Life or Earlier Critical Illness Income Protection Mortgage Income Protection Payment Protection. The covers listed above offer a variety of benefits, and may be further tailored to client needs by selecting from a range of options at an additional cost. We offer maximum flexibility, cover on a single or joint basis (two people covered), allow multiple cover combinations and even provide multi-buy payment discounts in some circumstances. The covers are subject to acceptance terms and conditions and have no cash-in value at any time. The amount the customer pays each month will depend on the covers selected. Please note that general and specific exclusions may apply meaning that under certain circumstances benefits will not be paid. Exclusions could, for example, include specific activities, pre-existing medical conditions or an unreasonable failure to follow medical advice. Some covers are affected if you become resident outside of the UK after cover starts. Please see the individual covers sections for more details. For further details please read the Key Features documents and Critical Illness Guide. 2

3 AXA Protection Account Personal Protection Technical Guide ConTEnTs Contents section What s in it? Page 1. Introducing the AXA Protection Account The concept. 4 About the AXA Protection Account 2. How your clients are covered Who can be covered and how, joint cover and combining covers. s provided under the AXA Protection Account. Types of cover and payments (s include Life, Critical Illness, Life or Earlier Critical Illness, Income Protection and Mortgage Income Protection ) 4. Life and Critical Illness s 5. Income Protection and Mortgage Income Protection s 6. Extra cost options starting and managing an AXA Protection Account The different types of personal cover available and payment types. Information about Life and Critical Illness s and the associated built-in covers. Information about Income Protection s and the associated built-in covers. Payment Protection, Total and Permanent Disability and Life Buy Back Starting an AXA Protection Account 8. When clients need more than one account 9. Making payments to us 10. The flexibility of an AXA Protection Account Additional information 11. Important definitions 12. Taxation When cover starts, including Free. Situations when it could be necessary to split covers into separate accounts. Describes payments for cover under the account. The flexibility offered within the account, including Guaranteed Options, and when covers end. Important definitions linked to certain covers, such as our definition of incapacity. A quick guide to tax on the various covers You should read this guide with other literature provided by us on the AXA Protection Account. Full terms and conditions can be found in the Account pack. In the event of any inconsistency or brevity in this guide, the Account pack details apply.

4 section 1 Introducing the AXA Protection Account 1. Introducing the AXA Protection Account Designed to deliver what your clients need This section covers: the concept, the covers offered and multi-buy discounts. one AXA Protection Account many covers The AXA Protection Account can be presented as an exciting proposition designed to maximise customer value over time. Your clients can get a multi-buy discount payment depending on the covers they buy (see page 5 for details). We offer your clients maximum flexibility As you can see, the breadth and depth of our offering could help many different types of clients needs and as their lives change, you can help advise on the cover required. For example, if your clients decide to buy a house together, there will be decisions required about their protection needs. You could help by offering Life and Income Protection. There are numerous combinations. The table below shows you the covers we offer your clients. These can provide them with a secure financial foundation and real peace of mind. AXA Protection Account What your clients need to protect Your clients lives, health and the people they care about Your clients income Your clients homes Your clients can choose the covers they need Life Critical Illness Life or Earlier Critical Illness Income Protection Mortgage Income Protection 4

5 Introducing the AXA Protection Account section 1 s summary type Additional benefits automatically included at no extra cost Benefits available for an additional payment Payment basis Persons covered s Level Increasing Decreasing Terminal Illness Free Guaranteed Options Accident Hospitalisation Children s Low-grade Prostate Cancer Major Heart Surgery Total Mastectomy Hospitalisation Proportionate Rehabilitation Payment Protection Total and Permanent Disability Life Buy Back Guaranteed Reviewable 5 Year Renewable Single person covered Joint cover Life Critical Illness Life or Earlier Critical Illness Optional Optional Optional Optional Optional Optional Income Protection Automatic Mortgage Income Protection Automatic We offer your clients a multi-buy discount We offer your clients a multi-buy discount when they buy more than one cover. How the cover discount works A discount applies when your client buys more than one of the following covers: Life Life or Earlier Critical Illness Critical Illness Income Protection Mortgage Income Protection. The discount works through use of the Account Fee. If covers are purchased in independent accounts, an Account Fee is added to the payment for each cover. However, if covers are purchased in the same account, only one Account Fee is payable for all covers. Account Fee The Account Fee is a fixed amount throughout the life of the account. It does not increase, even if increasing cover is selected. For further information about Account Fees, please refer to page 22. 5

6 section 2 How your clients are covered 2. How your clients are covered This section includes: who can be covered and how, joint cover and combining covers. Who can be covered and how? The following table details the minimum and maximum entry ages for cover: Actual age at start of cover Minimum age Life 18 Life 5 Year Renewable 18 Life or Earlier Critical Illness 18 Critical Illness 18 Income Protection 18 Mortgage Income Protection 18 Maximum age Who can be covered and on what basis? One or two people may be covered. The following covers can be single or joint (joint cover is when two people are covered): Life Life or Earlier Critical Illness Critical Illness The following covers are available only on a single life basis: Income Protection Mortgage Income Protection A person covered cannot have Income Protection and Mortgage Income Protection in the same account or in separate accounts. How does joint cover work? If joint cover is required, it must be selected at the start of the cover. If your client selects single cover but wishes to change to joint cover once cover has started, the single cover will need to be cancelled and joint cover reapplied for. When two persons are covered, claims are paid on a first event basis so after a claim for the full cover amount, the cover ends. The features which define the cover, for example, the cover start date, cover end date and type of payment will be the same for both lives. should the account owner and the person covered be the same? Not always, but in most cases the account owner(s) and the person(s) covered will be the same. The owner does not have to be the same as the person covered provided there is still an insurable interest. If more than one ownership arrangement is required, then more than one account is necessary. For further information see Section 8 on page 22. How many covers can be held in one account? The minimum number of covers required to set up an account is one. There is no maximum number of covers that your client can have. For quotation purposes only, your client can select up to nine covers in a single quote. Combining covers Certain restrictions apply when combining covers. Here are some of the most important: a person can be covered for either Income Protection or Mortgage Income Protection, but not both; and a person covered can only have one Payment Protection. Combination restrictions are driven by the nature of the underlying risk. Therefore when a client is covered by more than one account, the restrictions apply across all their accounts. The reasons for holding more than one account are described in Section 10 on page 24. 6

7 Types of cover and payments section. Types of cover and payments This section covers the different types of cover available and payment types. What types of cover are available? There are different cover types: level cover increasing cover decreasing cover The table below details which types are available for each cover: Life Life 5 Year Renewable Life or Earlier Critical Illness Critical Illness Income Protection Mortgage Income Protection level increasing decreasing level increasing level increasing decreasing level increasing decreasing level increasing level What is level cover? This is where the amount that is payable in the event of a claim stays the same for the length of the cover, subject to any alterations or increases in cover requested by the owner. What is increasing cover? This means that the amount of cover increases at each AXA Protection Account anniversary to keep pace with the Retail Prices Index (RPI). For Income Protection this will happen even while a claim is being paid. The rate of increase will be equal to the increase in the RPI, subject to a maximum increase of 10% in any year. Changes in RPI will be calculated over the 12-month period ending months before the anniversary. If the RPI reduces over a year, then the cover will not reduce but will stay the same. Your client will be notified in advance of the new level of cover and new amount they will need to pay. If a new increasing cover is added to an existing account, the first increase in that cover will take place on the anniversary following the first anniversary of the new cover. What is decreasing cover? This is where the amount of cover reduces each year from the start date of your client s cover. This amount of cover is calculated to match the maximum amount outstanding on a loan in the next 12 months (based on a repayment mortgage and the interest rates shown on your client s Quotation and schedule). This is the basis regardless of the purpose of cover. We do not guarantee to pay off the full amount of your client s outstanding repayment mortgage in the event of a claim. Your client can ask us to freeze the level of cover and payment at an anniversary so that it stops increasing. If they choose to do this, the purchasing value of the amount paid at the time of a claim will be lower due to inflation. If your client subsequently decides to add back these regular increases, we will need to collect new underwriting information. 7

8 section Types of cover and payments What types of payments can be made? There are two payment types: level increasing The payment type corresponds to the cover type selected. Increasing cover will always have increasing payments, while level or decreasing cover will always have level payments, subject to any payment reviews or changes made by the owner to the cover. What are level payments? Payments will remain at the same level throughout the length of the cover unless your client chooses to increase their level of cover or they have reviewable payments. What are increasing payments? Payments increase at each anniversary to correspond with the increase in cover. The rate of increase will be equal to 1.4 times the relevant increase in the Retail Prices Index (RPI) used to calculate the increase in cover. The factor of 1.4 is used to charge correctly for the increasing risk as the person covered gets older. For example, if the increase in RPI is 2.5%, the increase in payment is.5%. Different bases of payment Guaranteed payments Guaranteed means that the basis of the payment calculation will not change during the length of the cover. Payments will only change if cover is altered or for increasing cover as described earlier. All covers are available with payment rates that are guaranteed. What a review is based on At a review, we will look at assumptions relating to the future number and timing of claims and cost of reinsurance. In reviewing assumptions the following information will be analysed: our claims experience for similar policies; industry claims experience; and the impact of future medical advances and medical practices on illnesses and medical conditions. What can happen after a review? Following a review, the account owner will be given at least 60 days notice of the outcome of the review. Where a review results in an increase to payment that the owner does not wish to accept, the amount of the cover may be reduced to maintain payments at their pre-review level. Renewable payments Life can also be taken on a five year renewable basis. This means that cover can be renewed at the end of each five year period without the need to provide any additional medical evidence. This provides cover at a significantly lower cost initially but payments should be expected to increase significantly at each renewal when they will be re-calculated using the then current age and the price/terms then available. If the final period is less than five years then Life will be offered with a length of cover of between one and four whole years, to ensure cover until the customer s 70th birthday. is available to those aged between 18 and 64 at the time the cover starts. The owner will be given at least 60 days notice at each renewal. Terms and conditions apply. Reviewable payments Some covers are also available with payment rates that are reviewable, i.e. they may change if future claims experience for the class of business is expected to differ from earlier assumptions. Payments are guaranteed for the first 5 years and are reviewable every fifth anniversary of the cover start date thereafter. If the payment resulting from the review is within 10% of the existing payment then the existing payment will not change until the next review. There is no limit to the amount by which the payment might change, but any increase or reduction will be fair and reasonable. 8

9 Life and Critical Illness s section 4 4. Life and Critical Illness s This section covers information about Life and Critical Illness s, which are available on a single or joint cover basis. s summary Minimum entry age 18 Life 18 Life 5 Year Renewable Life or Earlier Critical Illness Critical Illness Maximum entry age ends types On or before 85th birthday Level Increasing Decreasing On or before 70th birthday Level Increasing On or before 70th birthday Level Increasing Decreasing On or before 70th birthday Level Increasing Decreasing Payment basis Minimum payment Guaranteed pm/ 6 pa* Renewable pm/ 6 pa* Guaranteed Reviewable 5 pm/ 60 pa* Guaranteed Reviewable 5 pm/ 60 pa* Minimum cover ** ** ** ** Minimum length of cover Maximum length of cover if payments guaranteed 1 year 40 years 5 years 5 years 5 years 40 years 5 years 40 years Maximum length of cover if payments reviewable N/a N/a 40 years 40 years Length of cover to specific age (not joint covers) Yes any age from 50 to 84 No Yes any age from 50 to 69 Yes any age from 50 to 69 * The minimum excludes the Account Fee, Payment Protection and any underwriting loadings. ** Will be driven by the minimum payment. Life This is a one-off payment paid on death or earlier diagnosis of a terminal illness during the period of cover. The one-off payment will be equal to the Life and is payable only once. The cover will then end. This applies whether one or two persons are covered. A terminal illness is where a person covered has an advanced or rapidly progressing incurable illness where, in the opinion of an attending consultant at a hospital in one of the permitted countries and our Chief Medical Officer, they are expected to die within 12 months and before the expiry of the cover. Life 5 Year Renewable As Life above, but also see page 8 on Renewable payments. Critical Illness This is a one-off payment paid on the earlier of: survival of 14 days after diagnosis of a covered critical illness; or diagnosis of a terminal illness The one-off payment will be equal to the Critical Illness and is payable only once. The cover will then end. This applies whether one or two persons are covered. We will not pay a claim if it arises as a result of specific situations such as unreasonable failure to follow medical advice, or intentional self-inflicated injury. Full details can be found in the Critical Illness Guide. Total and Permanent Disability is an extra cost option that can be selected with Critical Illness. Please refer to Section 6 on page 18 for more details. For further information about the critical illnesses that we cover, please see the following table and the Critical Illness Guide. The definition of terminal illness is shown under Life. All diagnoses for claims must be made by a consultant at a hospital in one of the permitted countries who is a specialist in the field of medicine appropriate to the claim. Our Chief Medical Officer must confirm the diagnosis. during the period of cover. 9

10 section 4 Life and Critical Illness s Here are the Critical Illnesses we cover: Alzheimer s Disease resulting in permanent symptoms* Aorta Graft Surgery for disease or traumatic injury* Aplastic Anaemia of specified severity Bacterial Meningitis resulting in permanent symptoms Benign Brain Tumour resulting in permanent symptoms or requiring invasive surgery* Blindness permanent and irreversible* Cancer excluding less advanced cases* Cardiomyopathy with permanent symptoms of specified severity Coma resulting in permanent symptoms* Coronary Artery Bypass Grafts Creutzfeldt-Jakob Disease (CJD) resulting in permanent symptoms Deafness permanent and irreversible* Encephalitis - resulting in permanent symptoms Heart Attack of specified severity* Heart Valve Replacement or Repair HIV infection caught in one of the permitted countries from a blood transfusion, a physical assault or at work in an eligible occupation* Kidney Failure requiring dialysis* Liver Failure end stage Loss of Hand or Foot permanent physical severance* Loss of Independent Existence Loss of Speech permanent and irreversible* Major Organ Transplant * Motor Neurone Disease resulting in permanent symptoms* Multiple Sclerosis with persisting symptoms* Open Heart Surgery - with surgery to divide the breastbone Paralysis of Limb total and irreversible* Parkinson s Disease resulting in permanent symptoms* Pre-senile Dementia Primary Pulmonary Hypertension of specified severity Progressive Supranuclear Palsy resulting in permanent symptoms Rheumatoid Arthritis resulting in permanent symptoms Severe Lung Disease of specified severity Stroke resulting in permanent symptoms* Systemic Lupus Erythematosus (SLE) of specified severity Third Degree Burns covering 20% of the body s surface or affecting 0% of the surface area of the head and neck or 50% of the face* Traumatic Head Injury resulting in permanent symptoms* * Conditions marked with an asterisk follow the definitions of critical illness set down by the Association of British Insurers (ABI) in April Life or Earlier Critical Illness This is a one-off payment paid on the earlier of: death; diagnosis of a covered critical illness; diagnosis of a terminal illness, or undergoing a specified surgical procedure during the period of cover. The one-off payment will be equal to the Life or Earlier Critical Illness and is payable only once. The cover will then end. This applies whether one or two persons are covered. Total and Permanent Disability and Life Buy Back are our extra cost options that can be selected with Life or Earlier Critical Illness. Please refer to Section 6 on page 18 for more details. For further information about the critical illnesses that we cover, please see the table above and the Critical Illness Guide. The definition of terminal illness is shown earlier under Life. All diagnoses for claims must be made by a consultant at a hospital in one of the permitted countries who is a specialist in the field of medicine appropriate to the claim. Our Chief Medical Officer must confirm the diagnosis. Are there any exclusions for Life/Critical Illness s? Details of these can be found in the Critical Illness Guide. Additional covers automatically included Accident Hospitalisation This cover is built into Life or Earlier Critical Illness and Critical Illness and is paid in addition to those covers. It pays a one-off payment of the lower of 20% of the amount of cover and 50,000 following hospitalisation for at least 28 consecutive days due to severe physical injury following an accident. When is it payable? On hospitalisation with severe physical injuries for a minimum of 28 consecutive days immediately following an accident. Severe physical injury means an injury resulting solely and directly from unforeseen, external, violent and visible means and independent of any other cause, as confirmed by AXA s Chief Medical Officer. Before a claim can be paid, evidence must be provided by the hospital to confirm: the duration of stay; the reason for admission; and the nature of the injuries.

11 Life and Critical Illness s section 4 Only one claim can be made under Accident Hospitalisation for a person covered. How does it affect the main covers? The Life or Earlier Critical Illness /Critical Illness is not affected by any payment under Accident Hospitalisation. When does it end? Accident Hospitalisation ends when the Life or Earlier Critical Illness or Critical Illness ends. Children s This provides Critical Illness (including Major Heart Surgery ) for eligible children. It s built into Life or Earlier Critical Illness and Critical Illness and is paid in addition to those covers should an eligible child qualify for a critical illness or major surgery claim. The Critical Illness conditions and Major Heart Surgery conditions are the same as for adults but Total and Permanent Disability is not covered. Eligibility An eligible child is one that has been born to the person covered, legally adopted by the person covered, acquired by them through a legally recognised marriage or civil partnership, or for whom the person covered is an appointed legal guardian. The child must be under the age of 18 at the time of diagnosis, or under the age of 21 and in full-time education. Full-time education requires attendance at a fulltime course at a school, college or university. It does not include breaks from education such as gap years, but it does cover work placements which are a part of the full-time course. When is it payable? On diagnosis of a covered critical illness for an eligible child provided the child survives for a minimum of 14 days following diagnosis. When a child undergoes a covered major heart surgery. For each claim we will pay the lower of: 50% of the current amount of cover under your client s cover; 25,000 and the amount shown on the quotation from the hospital performing any major heart surgery (if applicable). A claim for Major Heart Surgery for an eligible child will reduce the benefit payable on a subsequent Critical Illness claim for that child. We accept a maximum of four claims per cover and one claim per eligible child. Where an eligible child is covered under more than one Account because of a different person covered, a claim for Children s can be made within each Account, up to 25,000 per Account. The overall maximum amount claimed per eligible child cannot exceed 50,000, regardless of the number of Accounts held. How does Children s affect the main cover? The Life or Earlier Critical Illness /Critical Illness (i.e. the main cover) is not affected by any payment under Children s. When does Children s end? If the Life or Earlier Critical Illness / Critical Illness ends. If four claims for Children s are made on the same AXA Protection Account. Major Heart surgery This cover is built into Life or Earlier Critical Illness and Critical Illness. This cover is also provided for eligible children. It provides a payment to a hospital to help cover the cost of specified major heart surgery allowing the person covered to have surgery undertaken privately. When is it payable? It is an advance payment of cover should a person covered require major heart surgery that would constitute a valid critical illness claim. The person covered must be on an approved NHS waiting list for one of the following: Coronary Artery Bypass Grafts Aorta Graft Surgery - for disease or traumatic injury Heart Valve Replacement or Repair Any claim payments under this cover are paid directly to the hospital performing the surgery and reduce the benefit that may subsequently become payable under a claim for a critical illness. Before the claim is accepted, information must be provided to confirm: that the operation is medically necessary; the proposed date of surgery; the costs involved; the address of the hospital where the surgery is to be performed; and who we can liaise with concerning payment. Heart surgery can be undertaken in any country within the European Union or North America. We will advance the claim payment direct to the hospital nominated to perform the surgery. Major Heart surgery amount of cover The claim payment will be the lower of: the amount of cover on the date the claim is agreed; and the amount shown on the quotation from the hospital performing the surgery (includes costs for medical procedures, hospital accommodation, medication and aftercare). 11

12 section 4 Life and Critical Illness s Any shortfall between the amount claimed and the total cost of surgery will be the responsibility of the person covered. We will not pay any additional cost incurred because of complications/secondary conditions arising as a result of the surgery. Claim payments If the amount paid out under Major Heart Surgery is equal to the full Life or Earlier Critical Illness /Critical Illness (i.e. the main cover), then the main cover will end. If the amount paid out under Major Heart Surgery is less than the main cover, then the balance will be paid as a critical illness claim after surgery is completed (under Critical Illness your client needs to survive for at least 14 days). The main cover will then end. Until the balance of the claim is paid, payments must continue to be paid. Any subsequent claim under Critical Illness or Total and Permanent Disability, before the balance of the Major Heart Surgery is paid, will be reduced by the amount paid under Major Heart Surgery. When does it end? When the Life or Earlier Critical Illness / Critical Illness ends; or when a claim for Major Heart Surgery is paid (except if it is paid for an eligible child see above) whichever comes first. Are there any exclusions for additional covers? Details of these can be found in the relevant Key Features document. Total Mastectomy This cover is built into Life or Earlier Critical Illness and Critical Illness and is paid in addition to these covers. When is it payable? We will pay a claim for carcinoma in-situ of the breast which is treated by total mastectomy, that is the total removal of all of the tissue of one breast. Before a claim can be paid evidence must be provided to us confirming: a diagnosis of carcinoma in-situ of the breast that treatment by total mastectomy has taken place We will not pay a claim for: Treatment by any procedures other than total mastectomy For preventative mastectomy unless this results in evidence of carcinoma in-situ. The claim payment will be the lower of 15,000; and 20% of the amount of cover. Only one claim can be made per cover under this benefit, irrespective of the number of people covered. How does it affect main covers? The Life or Earlier Critical Illness /Critical Illness is not affected by any payment under this benefit. When does it end? When a claim for total mastectomy for carcinoma in-situ is paid When the Life or Earlier Critical Illness / Critical Illness ends Low-grade Prostate Cancer This cover is included with your Life or Earlier Critical Illness and Critical Illness and is paid in addition to these covers. When is it payable? We will pay a claim for low grade prostate cancer if you have been diagnosed with prostate cancer. Before a claim can be paid evidence must be provided to AXA confirming; the tumour has been histologically classified as having a Gleason score from 2 to 6 inclusive or the tumour has progressed to a TNM classification of at least T1N0M0 and that treatment of the tumour by complete removal, external beam or interstitial implant radiotherapy has taken place. We will not pay a claim if: the above definitions are not met. the treatment is by any procedure other than complete removal of the prostate, external beam or interstitial implant radiotherapy. a claim for Low-grade Prostate Cancer has already been paid under this cover. The claim payment will be the lower of: 15,000; and 20% of the amount of cover Only one claim can be made per cover under this benefit, irrespective of the number of people covered. How does it affect main covers? The Life or Earlier Critical Illness / Critical Illness is not affected by any payment under this benefit. When does it end? When a claim for Low-grade Prostate Cancer is paid When the Life or Earlier Critical Illness / Critical Illness ends. 12

13 Income Protection and Mortgage Income Protection s section 5 5. Income Protection and Mortgage Income Protection s This section covers information about our Income Protection s. Please note that your client cannot have both Income Protection and Mortgage Income Protection. summary Minimum entry age Maximum entry age ends types Payment basis Minimum payment Minimum cover Maximum cover Minimum cover length Maximum cover length Length of cover Renewable Deferred period (weeks) Income Protection On or before 65th birthday Level Increasing Guaranteed Reviewable 5 pm/ 60 pa* 100 pm 11,000 pm 5 years Must not extend beyond 65th birthday To age specific any age from 50 to 65 No 4, 8, 1, 26, 52 or 104 Mortgage Income Protection On or before 65th birthday Level Guaranteed Reviewable pm/ 6 pa* 100 pm 1,500 pm 5 years Must not extend beyond 65th birthday Whole years 5 to 40 years No 4, 8, 1, 26, 52 or 104 * The minimum excludes the Account Fee, Payment Protection and any underwriting loadings. Income Protection This is a regular monthly benefit payment that is made if, because of injury or illness: the person covered is unable to work, based on a specified definition of incapacity; and there is a loss of income. The benefit payment will begin once the selected deferred period has expired and will continue to be paid as long as the claim is valid. will be provided until the end of the cover period, no matter how many claims are made. Eligibility (employment status) Employed Self-employed House person (non-earning partner, husband or wife or someone working less than 16 hours each week) We do not need to be told if the person covered changes their occupation during the period of cover. How much can be covered? The maximum cover is based on a percentage of gross annual earnings subject to an overall monthly payment limit: 65% of yearly earnings up to 0,000 and 40% of yearly earnings over 0,000 divided by 12; or 11,000, whichever is the lower. The maximum cover for a house person is 1,250 a month ( 15,000 per year). The cover may be less than the customer needs if they do not review it regularly in relation to their earnings. The amount of cover should be based on the level of the customer s net earnings before they became unable to work. This is because the benefits are tax free (tax benefits can vary). It is important that the customer does not buy too much cover. If they do and a claim is made, we will not pay the full amount. 1

14 section 5 Income Protection and Mortgage Income Protection s Pre-incapacity earnings take into account: Employed Self-employed In the case of an employed person, earnings are defined as the pre-tax earnings for PAYE assessment purposes, as shown in the HM Revenue & Customs Form P60 for the immediately preceding tax year, plus any benefits in kind, as shown in the HM Revenue & Customs Form P11D, averaged over the previous three years. If the named HM Revenue & Customs forms cease to exist, we will use a suitable alternative. In the case of a self-employed person, earnings are defined as the average taxable income after the deduction of business expenditure as permitted by HM Revenue & Customs over the previous three complete financial years (i.e. net profit ). If the business has been established for a period less than three complete financial years, we will work out the average over the period for which the business has been established. What can trigger a claim? An injury or illness which means that the person covered fulfils the definition of incapacity determined by their occupation when the cover started and as set out in the schedule. We will assess claims based on their occupation at the time of claim unless they are not in employment in which case we will use the Activities of Daily Work test. There are 2 definitions of incapacity for these two covers: Own Occupation; and Activities of Daily Work What is our own occupation definition? We will agree that the person covered is incapacitated if, because of any injury or illness, they are unable to perform the essential duties of their own occupation and are not following any other occupation. The essential duties of an occupation are those that cannot reasonably be omitted without affecting the ability to carry out that occupation. Certain professional occupations will not be eligible for an Own Occupation definition, because of the specialised or expert nature of their profession. What is our Activities of Daily Work definition? We accept that the person covered is incapacitated if, because of any injury or illness, they are unable to perform any three Activities of Daily Work without the direct assistance of another person, but with the use, where appropriate, of certain aids; or they suffer from mental incapacity. Activities of Daily Work are: walking; climbing; bending; communicating; eyesight; healthcare; and financial independence. see section 11 on page 29 for further details. Regrettably, high-risk occupations will not qualify for either definition of incapacity. Can a person have multiple covers? A person covered can hold more than one Income Protection with different deferred periods see below. This may be appropriate for an employee with sick pay from an employer that reduces over time. Maximum cover limits will be calculated on the total amount of cover. A person covered cannot have Income Protection and Mortgage Income Protection in the same account, or in separate accounts. Can money from other sources affect the Income Protection payments? Yes. At the time of claim, the maximum amount payable will be reduced by: any State Benefits the person covered is entitled to receive (not applicable to Mortgage Income Protection ). State Benefit means the long-term income that a single person with no dependants is entitled to receive for incapacity, if eligible, through the social security benefit system in the United Kingdom; any earnings or payments the person covered continues to receive from their employer or business; any income from any pension arrangement that was not being received before the onset of incapacity; and any income, payment or waived premium from any other insurance policy which pays out while the person covered is unable to work. Can the cover be continued even if the client isn t working? Yes. Income Protection will continue during periods of maternity leave, unemployment or career break for any other reason. We will not pay if the conditions giving rise to the claim are a result of the normal pregnancy of the person covered, except where the person is experiencing pregnancy complications. If incapacity occurs after the first six 14

15 Income Protection and Mortgage Income Protection s section 5 months of maternity leave, unemployment or career break: the Activities of Daily Work definition will be used to define incapacity; and the maximum cover will be 1,250 a month ( 15,000 per year). What is the deferred period and how does it work? The deferred period is the continuous period of incapacity (due to injury or illness) before any claim is paid. It must be selected at outset, however it can be changed at a later point in time, subject to underwriting. Certain occupations may not be eligible for shorter deferred periods. The deferred periods in weeks are: 4, 8, 1, 26, 52 and 104. The table below shows the claim notification period that applies for each deferred period. Your client should tell us about any claims that they would like to make within the notification period shown: Deferred period Four weeks Eight weeks 1 or more weeks notification period Two weeks Four weeks Eight weeks If your client does not tell us about a claim within this period we may refuse to pay your client s claim or we will extend the deferred period by the duration of the delay. When can a claim start? The claim needs to meet the appropriate definition of incapacity, be accepted by us and we need to have received a valid completed claim form. Then, following the completion of the deferred period, the claim will start. Claims are paid monthly in arrears and there is no reimbursement of payments made to us during the deferred period. What is needed to support a claim? To support a claim, while it is being paid or before it starts, the person covered must: complete a claim form; supply a certificate of incapacity from a doctor; attend an examination(s) by a doctor we choose (if requested) at our expense; and provide any other evidence we consider reasonable. We may arrange for a home visitor or other appropriate person to visit the person covered. When does a claim end? Payments will stop as soon as the first of the following happens: the person covered no longer meets the definition of incapacity; the person covered dies; the cover ends; or the person becomes resident outside of the permitted countries (see page 0) for a period longer than 12 months. What if the person becomes incapacitated again? (Linked Claims) If the person covered returns to work after a valid claim and subsequently becomes incapacitated again within 12 months of the end of the claim period and from the same or a related cause, these periods of incapacity will be treated as continuous. We must be notified within weeks of your client stopping work again and need to be assured that your client did not go back to work against the advice of their doctor. If the person covered returns to work against the advice of their doctor then they will have to wait before any additional benefit will be paid, just as if it was a new claim. How do you define incapacity? This can be found in Section 11 on page 29. Are there any exclusions? Details of these can be found in the Key Features of Income Protection document. Mortgage Income Protection Mortgage Income Protection is broadly similar to Income Protection, so the details previously shown apply to it. There are some key differences though. Mortgage Income Protection is only available with a mortgage. It provides a regular monthly payment to pay regular mortgage payments and related commitments, if because of injury or illness: the person covered is unable to work, based on a specified definition of incapacity; and there is a loss of income. The benefit payment will begin once the selected deferred period has expired and will continue to be paid as long as the claim is valid. will be provided until the end of the cover period, no matter how many claims are made. The maximum cover that can be applied for is therefore based on the mortgage amount and a percentage of gross yearly pre-incapacity earnings, subject to an overall limit. The maximum that we will pay each month will be the lower of: 150% of the regular monthly mortgage repayment; 0% of pre-incapacity monthly earnings; and 1,500 per month ( 18,000 per year). The maximum cover for a house person is 100% of the regular monthly mortgage up to 1,250 a month ( 15,000 per year). 15

16 section 5 Income Protection and Mortgage Income Protection s cannot start before the exchange of contracts date for the house purchase, or in Scotland, missives have been concluded. If the mortgage has been repaid at the date any claim payment is due and there is no contractual mortgage payment due at this time, no payment is payable under this cover. Are there any exclusions? Details of these can be found in the Key Features of Mortgage Income Protection document. Additional covers automatically included Hospitalisation This is built into Income Protection and Mortgage Income Protection. A regular income is paid if the person covered is hospitalised during the deferred period. It allows a claim to be made immediately, regardless of the length of the deferred period. When is it payable? It is paid on hospitalisation for six or more consecutive nights during the deferred period as a direct result of an injury or illness. The amount paid for each night is 1/0th of the monthly Income Protection or Mortgage Income Protection amount, subject to a maximum of 200 for each night. The claim amount is paid monthly in arrears. When does it start? The claim starts from the 6th night. Payments will be calculated on a daily basis and paid monthly in arrears. When does a Hospitalisation claim end? The claim will end as soon as any one of the following events takes place: the person covered has spent 1 consecutive weeks in hospital; the person leaves hospital; the Income Protection /Mortgage Income Protection ends; a deferred period for any Income Protection /Mortgage Income Protection comes to an end; or the person dies. Rehabilitation and Proportionate These covers are built into Income Protection and Mortgage Income Protection. Rehabilitation and Proportionate pay a monthly income to someone returning to work with reduced earnings, immediately following a period when they have been claiming income protection or mortgage income protection. Rehabilitation applies if they return to their current occupation, Proportionate if they start a new occupation. When is it payable? Claimants must: have been receiving income protection/ mortgage income protection benefit; be medically unable to work to their normal capacity; and demonstrate a financial loss. For your client to be eligible, their earnings must be at a lower level because of one or more of the following: In the case of Rehabilitation (returning to their current occupation): a reduction in duties; or a return to work with reduced hours In the case of Proportionate (starting a different occupation): a permanent change of job, role or function in a full-time or part-time capacity. There is a maximum of 12 monthly payments for Rehabilitation. The claimant must provide evidence to support the ongoing reduction in earnings due to incapacity. When does a claim start? Immediately after making a claim for income protection or mortgage income protection benefit payments, when the person goes back to work. They will need to provide supporting evidence that earnings will be lower as a direct consequence of their incapacity. When does a claim end? Payments will stop as soon as any one of the following events takes place: the person s new earnings are more than their pre-incapacity earnings; the Income Protection /Mortgage Income Protection ends; the person dies; the person leaves their employment for any reason; or the person makes a full income protection/ mortgage income protection claim. 16

17 Extra cost options section 6 6. Extra cost options This section covers information about our extra cost options: Payment Protection (which you may know as Waiver of Premium), Total and Permanent Disability and Life Buy Back. Payment Protection Payment Protection makes sure the account continues if a person covered is unable to work because of injury or illness (based on a definition of incapacity). In the event of a claim, their payments are waived. It is an extra cost option with our life and critical illness covers. It is automatically included at extra cost with Income Protection and Mortgage Income Protection. What are the minimum and maximum ages? The minimum age is 18, the maximum age is 59 at entry. At age 70, Payment Protection will end. Any Life expiring after age 70 will continue without this for the remaining period of your client s cover. How does it work? If included, Payment Protection applies to all the life protection covers in an AXA Protection Account. For an account with joint covers and/or with single covers for two persons covered, Payment Protection may be added for either person or for both persons covered. When a Payment Protection claim is paid, payments for all covers in the relevant account are waived, including the Account Fee. What is the deferred period? This is the period of continuous incapacity before any claim becomes payable. Choices are 4, 8, 1, 26, 52 or 104 weeks. Certain occupations may not be eligible for the shorter deferred periods. The deferred period for Payment Protection may match or be shorter than that for Income Protection /Mortgage Income Protection, but it cannot be longer. Can you give me an example? An account includes two Income Protection s for two people where Person A has a deferred period of 4 weeks and Person B has a deferred period of 52 weeks. Both people will automatically be quoted Payment Protection as they both have Income Protection s. Person A will be quoted a deferred period of 4 weeks, and Person B can choose any deferred period shorter than or equal to 52 weeks. How do you define incapacity? You can find this in Section 11 on page 29. When is it payable? When the person covered gets an injury or illness which means that the person covered fulfils the definition of incapacity determined by their occupation when the cover started and as set out in the schedule. For own occupation definitions of incapacity, we will assess claims based on their occupation at the time of claim unless they are not in employment in which case we will use the Activities of Daily Work test. Claims made by your clients aged 65 or over revert to Activities of Daily Living definition of incapacity. When does a claim end? Payments will stop being waived as soon as: the person covered recovers and no longer meets the criteria for claiming; the person covered reaches their 70th birthday; the person dies; the covers end, or if there is a claim that ends all of the covers; or the person becomes resident, either temporarily or permanently, outside of the range of permitted countries for a period longer than 12 months. See page 0 for details of permitted countries. What will be paid? We will meet the current payments during a valid claim period. The payments will include the Account Fee. The claim period starts at the end of the deferred period and payments made to us during the deferred period will not be reimbursed. During a claim period the daily entitlement will be calculated and the direct debit will be adjusted accordingly. After a claim, the direct debit payments will return to the full amount. Please also see the taxation information on page 1. 17

18 section 6 Extra cost options What if the person becomes incapacitated again? If the person covered returns to work after a valid claim and subsequently becomes incapacitated again within 12 months of the end of the claim period and from the same or a related cause, these periods of incapacity will be treated as continuous. We must be notified within weeks of your client stopping work again and need to be assured that your client did not go back to work against the advice of their doctor. If the person covered returns to work against the advice of their doctor then they will have to wait before any additional benefit will be paid, just as if it was a new claim. When will the cover end? It ends as soon as any one of the following events takes place: if payments remain unpaid after the grace period please see page 0 for definitions; when the last remaining cover ends for any reason; or if the person becomes resident, either temporarily or permanently, outside of the permitted countries for a period longer than 12 months. See page 0 for details of permitted countries. Can it be added or removed Payment Protection can be selected when an account is set up or can be added (subject to underwriting) or removed from an existing AXA Protection account. Payment Protection cannot be removed if you have Income Protection or Mortgage Income Protection. Total and Permanent Disability This cover is an extra cost option and is available if either of the following covers are selected: Life or Earlier Critical Illness Critical Illness A one-off payment is paid if the person covered is expected never to be able to work again. How we assess the claim will be based on a definition of incapacity of either own occupation, Activities of Daily Work or, if over the age of 65, Activities of Daily Living. What is payable? The amount payable is the amount of cover under the Critical Illness /Life or Earlier Critical Illness at the date that AXA s Chief Medical Officer confirms the diagnosis. Once a claim is paid, the Critical Illness /Life or Earlier Critical Illness will end. What about joint cover? If cover against Total and Permanent Disability is required then both applicants must apply for it. An applicant may be excluded from having Total and Permanent Disability because of pre-existing conditions, participation in hazardous pursuits or a hazardous occupation. If this occurs, joint cover will not be available, and two separate covers for Life or Life or Earlier Critical Illness (as appropriate) will be issued under one AXA Protection Account (as long as the account owner is the same for both) reflecting the fact that one person covered has Total and Permanent Disability and the other does not. How do you define incapacity? You can find this in Section 11 on page 29. When is the cover payable? When the person covered fulfils the definition of incapacity as set out in their schedule and based on their occupation at the time of claim, or if they are over 65, Activities of Daily Living. When does it end? It ends as soon as any one of the following events takes place: if payments remain unpaid after the grace period please see page 0 for details; or when the Life or Earlier Critical Illness or Critical Illness ends. Life Buy Back This gives your client the ability to reinstate Life 12 months after a critical illness or total and permanent disability claim without having to provide further evidence of health (see below for cancer claims). This is an extra cost option only available with Life or Earlier Critical Illness and can only be exercised once. Who can get this? This option is only available on cover accepted at standard rates. If your clients are on joint cover, and this option is required, both people must apply for it. But if one of them is excluded from cover by underwriting, the other can still have the benefit. If this occurs, joint cover will not be available, and two separate covers for Life or Earlier Critical Illness will be issued under one account (as long as the account owner is the same for both) reflecting the fact that one person covered has Life Buy Back and the other does not. Life Buy Back can only be selected when an account is set up. 18

19 Extra cost options section 6 When can it start? Bought back Life cannot start earlier than 12 months following the date that we paid the claim or, where the claim paid was in relation to cancer, 12 months after the person covered is confirmed by a consultant as being free of all detectable cancer. Once this date is reached, your client will then have three months within which to buy back Life. In the case of cancer, the buy back must occur within five years of the date of the claim. Are there any other special rules or conditions? The new cover amount cannot exceed the claim amount. The new cover will be for a single person only (joint cover not available). Current terms, conditions and payments for standard Life will apply at the date the new cover starts. The length of cover cannot exceed that remaining on the original cover on the date the new cover starts. will be on the same basis as that of the original cover, for example increasing or decreasing cover. None of the following covers are provided on bought-back cover: Payment Protection Guaranteed Options Terminal Illness The maximum amount that can be reinstated under the Life Buy Back for one person covered is 500,000. To exercise the option, the person covered must be age 68 or less at the date of the claim. Life cannot be bought back following a claim for Terminal Illness. No payments are due in the period before the new cover begins (unless other covers are included). 19

20 section 7 starting an AXA Protection Account 7. starting an AXA Protection Account This section covers how to start an AXA Protection Account and when Free is available before cover starts. Main stages of our process We provide access to the AXA Protection Account in a variety of ways to meet the needs of you and your clients. These enable you to go through the main stages of the process to start an account as quickly and easily as possible: 1 Quotation 2 Application Underwriting 4 Acceptance 5 Agreement to terms and start date will not start until we have gone through all these stages and received the first payment or have a valid direct debit instruction. However you may authorise us in advance to pass straight to starting cover on a specified date or as soon as we have accepted the application. No cover will start until we have accepted the application and we have confirmed cover in writing and/or verbally. Any change to standard terms is subject to agreement by the applicant. We will not start some mortgage and house related covers until the house is purchased and the related mortgage starts. We will provide some Free on Life and Critical Illness applied for during the process of starting an account. See below for details. Information about standard and non-standard terms can be found in the Underwriting Guide. Reason for cover The reason for the cover determines which covers are available, drives underwriting procedures and tailors the Guaranteed Options. Each cover will be either: Personal Mortgage Business Protection Free Free is provided while any life or critical illness application is being processed. Eligibility This applies to applications for: Life or Earlier Critical Illness ; Critical Illness ; Life ; and Life 5 Year Renewable. The rules Free applies to applicants who are: aged 59 or under at the time of application (if joint cover, both people must be aged 59 or under); UK residents, living in the UK; and not making multiple applications to other life insurance companies for similar cover. The amount of Free provided is the same as your client s application up to a maximum of 500,000 Life and 50,000 Critical Illness. Free does not form part of the terms and conditions of the AXA Protection Account it s an ex gratia benefit and payment. Details of the cover are provided below. When the cover starts As soon as we have received: the completed application form confirming that the applicants are under age 60; and the completed direct debit instruction. In mortgage-related cases contracts need to have been exchanged, or in Scotland, missives need to have been concluded. 20