Group Life Insurance Excepted Policy - Policy Booklet

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1 Group Life Insurance Excepted Policy - Policy Booklet

2 Welcome to Aviva Your policy consists of this policy booklet and policy schedule. Please keep them in a safe place along with any revised policy schedules we issue showing changes to the policy. If they are lost there may be a delay in benefit payment. To help you understand some of the technical words in the policy we have highlighted them in italics. They are explained in Section 7. In the policy we, us or our are used to mean Aviva Life & Pensions UK Limited. You or your mean the trustees. 1

3 Contents Section 1 Purpose of the policy 3 Section 5 Benefits payable on death 9 Section 2 General contract terms 4 1. Start of this policy 2. Renewing this policy 3. Discontinuance 4. Policy changes 5. Rates guarantee Section 6 Charges Policy fee 2. Frequency of premium payments Section 7 Definitions Accurate information 7. Currency and jurisdiction 8. Contacting us 9. Documentation needed 10. Third Party Rights Section 3 Benefit basis of the policy 6 1. Type of benefits 2. Members covered 3. Duration of cover 4. Underwriting information Section 4 Paying for this policy 8 1. Premiums 2. Calculation of premiums 3. Method of payment 4. Unpaid premiums 2

4 Section 1 Purpose of the policy This policy confirms the contract you have with us. It applies to the scheme named in the policy schedule. You are responsible for ensuring that you use this policy in accordance with the terms of the scheme rules. The aim of the policy is to provide the death benefits shown in the policy schedule in a way that complies with the excepted group life policy conditions. The only benefits that may be paid under the policy are death benefits in the form of a lump sum or a dependant s capital sum. The policy cannot be used as security for a loan and does not have any surrender or maturity value. 3

5 Section 2 General contract terms 1. Start of this policy This policy starts on the commencement date. 2. Renewing this policy If we agree, this policy can be renewed on the renewal date. We will tell you before then the information we will need to recalculate the premium required for the following policy year. 3. Discontinuance (a) There is no cooling off period. You may discontinue this policy at any time in accordance with the scheme rules. If you do so, a final account will be provided based on the cover we provided up to the date when you discontinued this policy. Either a refund will be paid to you or you will need to pay any premiums outstanding. There will be no surrender value under this policy. The provision of the benefits under the policy will stop on the date agreed with us. Any lump sum or other capital benefit to which entitlement has already arisen at that date but where payment has not been made, will still be paid. (b) We may discontinue the provision of the benefits under this policy at any time on giving you three months prior written notice expiring at any time. If we do this, the discontinuance of the provision of the benefits under this policy will not occur, in any event, until the later of the next renewal date or the expiry of any applicable rate guarantee date as set out in the policy schedule. We will discontinue the provision of the benefits under this policy with immediate effect if premiums cease under the group life insurance policy you have taken out with us in connection with the employer s registered scheme or if you do not pay the benefits in accordance with the excepted group life policy conditions. A final account will be provided based on the cover we provided up to the date the policy discontinued. Either a refund will be paid to you or you will need to pay any premiums outstanding. There will be no surrender value under this policy. The provision of the benefits under this policy will stop on the date we advise you. Any lump sum or other capital benefit to which entitlement has already arisen at that date but where payment has not been made, will still be paid. 4. Policy changes We may change the terms of this policy for any of the following reasons: To respond, in a proportionate manner, to changes in the way we administer policies of this type; changes in technology or general practice in the Group Risk industry; changes in taxation, the law or interpretation of the law, decisions or recommendations of a regulator or similar person, or any code of practice with which we intend to comply; correct errors, if it is reasonable to do so If we consider any variation of these conditions is to your advantage or is necessary to meet regulatory requirements, we may make the change immediately and tell you at a later date. We will tell you in writing of any change we consider is to your disadvantage (other than any change necessary to meet regulatory requirements) at least 30 days before the change becomes effective, unless it is not possible for us to do this, in which case we will give you as much notice as we can. 4

6 5. Rates guarantee The rates used to calculate premiums are normally guaranteed for two years from the commencement date and are then reviewed. The policy schedule will show the rate guarantee date. The guarantee will not apply if at any time there is a change of 25% (50% where the employer s registered scheme has less than 20 members) or more in the number of members in the employer s registered scheme or there is a change to law or interpretation of the law, decisions or recommendations of a regulator or similar body. In addition, a significant change to the benefit basis, eligibility, nature of business or companies included within the employer s registered scheme or the scheme may also mean that an adjustment in the rates used to calculate premiums is necessary. 6. Accurate information We rely on the information given to us. If any of this information you give is untrue or incomplete and this might reasonably have affected our decision to provide you with this policy, or the terms of this policy, then we may: (i) change the terms of this policy, or (ii) restrict the benefits payable under this policy, or (iii) cancel this policy and refund the contributions paid less our reasonable expenses. 7. Currency and jurisdiction This policy is issued in England and is subject to English Law. All payments to or by us under this policy will be made in the currency of the United Kingdom. 8. Contacting us If you need to contact us about this policy, please write to us at the address shown in the policy schedule. Please quote the policy number on all of your letters. We may refuse to take action until you have met all of our requirements. We may ask you to send us any relevant forms or other documents, completed by the appropriate person(s). 9. Documentation needed When we deal with this policy we will tell you what we need at the time. This may include one or more of the following: (i) (ii) a completed form of request or discharge; the policy schedule; (iii) proof that the claim is valid; (iv) proof of the member s date of birth and, where applicable, marriage; (v) (vi) death certificate; underwriting information; (vii) any other information, such as that needed to show that we have authority from the appropriate person(s) to deal with this policy; (viii) any other documents or additional information needed to deal with this policy. 10. Third Party Rights This policy does not confer any rights on any person other than you and us. A person who is not a party to this policy shall have no rights pursuant to the Contracts (Rights of Third Parties) Act 1999 to enforce any terms under this policy. The parties may amend or rescind this policy without reference to, or the consent of, any person who is not a party to this policy. 5

7 Section 3 Benefit basis of the policy 1. Type of benefits The benefits to be provided are shown in the policy schedule. The types of benefit that may be provided are a lump sum benefit and/or a dependant s capital sum. In a way that complies with the excepted group life policy conditions: (1) a sum or other benefit of a capital nature is payable or arises on the death of each of the members covered under this policy who dies before attaining an age which is specified in the policy schedule and is not greater than 70 years; (2) the same method is to be used for calculating the sums or other benefits of a capital nature payable or arising on each death and, if there is any limitation on those sums or other benefits of a capital nature, the limitation is the same in the case of any death; and (3) no sums or other benefits may be paid or conferred under this policy, except as mentioned in (1) above or in section 2.3. We will confirm the total amount of benefits provided by this policy at the commencement date and at each renewal date. 2. Members covered In order to be a member covered for benefits under this policy, each member must also be a member of the employer s registered scheme. 3. Duration of cover Members will be covered for benefits under this policy once we have confirmed their inclusion, and the amount of the benefits we are providing and we have received the premium due. Actively at work conditions We will not include any members who are absent from work due to illness or injury on the day on which their cover (including any free cover) would otherwise start. Their cover (including any free cover) will only start after they have returned to work and completed a further one month of continuous employment or less if medical evidence of health acceptable to our underwriters is provided. We will waive our actively at work conditions for Schemes of 50 or more lives for any members where immediately before the commencement of this policy, the benefits for those members were provided by another insurer. This is provided there has been no break in cover or increase in benefit levels. For such schemes we will also waive our actively at work conditions for any new employees. However, our actively at work conditions may apply where groups of employees join the scheme as a result of a TUPE (Transfer of Undertakings Protection of Employment Regulations) or other group employment transfer. Before any decision can be made to waive our actively at work conditions we require full disclosure of details of any long term absentees and lives rated, declined, restricted or postponed. Members will stop being covered for the benefits under this policy on the earliest of the following dates: When they leave the scheme When they retire When they leave service (including redundancy) When they reach normal retirement age 30 days after the due date of any unpaid premium (see section 4.4) The date advised by you from which cover is to end The date advised by us from which cover is to end. 6

8 The date premiums cease under the group life insurance policy you have taken out with us in connection with the employer s registered scheme. Cover under this policy may be extended beyond these dates if: the scheme rules allow it, and our written agreement has been obtained, and it applies to all members who currently and in the future are in the circumstances covered by the extension, and any further requirements we may have, are met. Where an existing member is off work due to illness or injury, cover can continue up to normal retirement age providing premiums continue and a contract of employment is maintained. 4. Underwriting information At the commencement date and each renewal date, we will ask for general information about members and their employment to enable us to fully assess the benefits we are providing under this policy. We will ask for more detailed underwriting information if the following applies: members of this scheme are entitled to benefits that are higher than the free cover limit less the member s benefits provided by the employer s registered scheme; or the member s benefits in the employer s registered scheme are greater than the free cover limit. While underwriting information is being processed, we will provide cover for full benefits for any member (but excluding any pre-existing medical conditions) for up to 90 days from the date of joining the scheme, or the effective date of an increase in benefits. Cover will be subject to a maximum of 1 million sum insured (or such other amount as we shall decide) in excess of the free cover limit or previously underwritten benefit. The 1 million sum insured (or such other amount as we shall decide) will apply to the total of the capitalised benefits in the employer s registered scheme and the benefits in this scheme. This cover will not be available to any member who has previously been declined, postponed, rated or has previously declined to provide full medical evidence. Excluding any pre-existing medical conditions means that a claim will not be accepted if the death is directly or indirectly linked to any medical and/or related condition or complication the person was aware of, or suffered symptoms of, or had been treated for in the 5 years immediately before the 90 day period. Production of underwriting information may however be required at other times. This includes occasions when new members are included for cover at a date later than the earliest date they could have been included, and also where cover under the policy is extended (see section 3.3). 7

9 Section 4 Paying for this policy 1. Premiums Premiums are paid by the employer for each member. 2. Calculation of premiums The method of calculating the premiums payable is determined by the number of members in the employer s registered scheme. Single premium rate schemes: Premiums will be calculated for each member on our current premium rates. This means premiums are recalculated each year and are dependent upon the age of the members at the beginning of each policy year. The amount of cover required is also needed at the renewal date. This will be the amount of cover that applies to the member during the policy year. For members who join, leave or have benefit rises during the policy year, a premium adjustment will be calculated reflecting the amount and duration of the cover we actually provided. Any premium adjustment for members who join, leave or have benefit increases, is charged on a pro rata basis (to the higher whole month) and becomes payable at the end of the policy year. For members who join, leave or have benefit rises during the policy year, a premium adjustment will be calculated based on the average sum assured for all members in the employer s registered scheme during the previous policy year. Effectively this means that salary and staff changes are treated as if they occur midway through the policy year. Any premium adjustment for members who join, leave or have benefit rises becomes payable at the end of the policy year. 3. Method of payment Premiums are payable in advance, yearly by cheque and direct debit. However, premiums can also be paid monthly by direct debit (see section 6 for additional charges). 4. Unpaid premiums A premium will be deemed to be unpaid if it has not been received within 30 days after its due date for payment. If it has not been paid by this time the policy will stop and have no value. We will then cease to provide any further benefits under this policy. Any entitlement to any benefits which has already arisen will continue to be paid by us on the terms already confirmed to you. Unit rate schemes: A unit rate, usually expressed as a rate per 1000 of cover, is calculated based upon the total cover for members at the commencement date or renewal date. The premium charged for the insured benefits is based on the unit rate. If the number of members in the employer s registered scheme falls below 20, the costing basis will revert to single premium costing. 8

10 Section 5 Benefits payable on death A single lump sum benefit and/or a single dependant s capital sum will be paid to you on the death of a member in accordance with the policy schedule if: (i) we are providing cover for them under this policy (see section 3), and (ii) all our requirements have been met. You will be given full details of the amount payable following the member s death. You should deal with this payment in accordance with the scheme rules and the excepted group life policy conditions. In a way that complies with the excepted group life policy conditions: Any sums payable or other benefits arising under this policy must (whether directly or indirectly) be paid to or for, or conferred on, or applied at the direction of: (a) an individual or charity beneficially entitled to them, or No person: (a) who is an individual whose life is insured under this policy, or (b) who is connected with an individual whose life is so insured, may, by virtue of a group membership right relating to that individual, receive (directly or indirectly) any death benefit in respect of another group member. For the purposes of this provision charity, group membership right, death benefit in respect of another group member and connected are defined in the excepted group life policy conditions. Note: We will not meet any claims, or any requests for additional amounts of benefit submitted more than 2 years after the member s death. (b) a trustee or other person acting in a fiduciary capacity who will secure that the sums are paid to or for, or conferred on, or applied in favour of, an individual or charity beneficially. 9

11 Section 6 Charges 1. Policy fee There is no additional annual fee for administering the policy 2. Frequency of premium payments Where the premium is paid to us other than on a yearly basis we will charge 2.5% each year (or such other amount as we shall decide) to cover the extra administration costs. This charge will be added to the total premium which we require from you. 10

12 Section 7 Definitions We have had to use some technical words in this policy. These are explained below. actively at work Means a member who is actively at work and not working contrary to medical advice to refrain from work. The employee must be following their normal occupation, working the normal number of contracted hours either at their normal place of business or at a location to which business requires them to travel. commencement date The date on which the policy takes effect and on which the first premiums are due in respect of initial members. It is shown in the policy schedule. employer An employer who is participating in the scheme. employer s registered scheme A pension scheme of the employer that is registered or treated as registered under Chapter 2 of Part 4 of the Finance Act The name of that scheme is shown in the policy schedule. excepted group life policy conditions The conditions for being an excepted group life policy set out in section 539A of the Income and Corporation Taxes Act free cover limit This is a monetary level set by us for the employer s registered scheme. long term absentee A member who is not actively at work and has been absent from work (includes not working their normal number of contracted hours) for more than three continuous months immediately prior to the scheme commencement date or renewal date. member A member of the scheme for whom cover for a lump sum benefit and/or dependant s capital sum is to be provided under this policy. normal retirement age The age at which members are due to retire. It is shown in the policy schedule. policy schedule The schedule included with this policy booklet and any changes made to it. Any changes will be recorded on revised policy schedules which will be issued to you. policy year A period of 12 months from the commencement date or a subsequent renewal date, or any other period agreed with us. renewal date An anniversary of the start date of the employer s registered scheme unless you have agreed another date with us. It is shown in the policy schedule. scheme The scheme named in the policy schedule (other than the employer s registered scheme). scheme rules The rules of the scheme. service Employment with an employer. single premium rate schemes Policies with between 5 and 19 members. trustees The current trustees of the scheme as shown in the policy schedule. underwriting information Information we need to assess the risk of insuring the benefits. We can then decide if and at what cost the benefits can be provided. This will include member s age, sex, state of health, medical history, occupation, place of residence, lifestyle and recreational activities. unit rate schemes Policies with 20 members or more. 11

13 Aviva Health UK Limited. Registered in England Number Registered Office 8 Surrey Street, Norwich, NR1 3NG. This insurance is underwritten by Aviva Life & Pensions UK Limited. Registered in England Number Registered Office: 2 Rougier Street, York, YO90 1UU. Authorised and regulated by the Financial Services Authority. Aviva Health UK Limited, Head Office: Chilworth House, Hampshire Corporate Park, Templars Way, Eastleigh, Hampshire, SO53 3RY. SP /2009 Aviva plc

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