Generali Worldwide Group Total & Permanent Disability Standard Terms and Conditions

Transcription

1 Generali Worldwide Group Total & Permanent Disability Standard Terms and Conditions generali-worldwide.com

2 2 of 7 Generali Worldwide Insurance Company Limited - Group Total & Permanent Disability Terms and Conditions Contents INTRODUCTION... 3 GENERAL... 3 COMMENCEMENT OF ASSURANCE AT POLICY INCEPTION... 4 TERMINATION OF ASSURANCE... 4 TEMPORARY ABSENCE... 5 NO-WORSE TERMS... 5 EXCLUSIONS... 5 CATASTROPHE LIMIT... 6

3 3 of 7 Generali Worldwide Insurance Company Limited - Group Total & Permanent Disability Standard Terms and Conditions INTRODUCTION This document sets out the standard terms and conditions governing the Generali Worldwide Insurance Company (referred to as we or us from now on) Group Total & Permanent Disability product. The Standard Terms and Conditions, together with the corresponding quotation form part of the contract, and prospective clients are advised to read these carefully. Any special terms detailed in the quotation shall replace the corresponding standard wording contained in this document. In the event of any conflicts in any of the wordings between these documents, the wording of the Policy Document (once issued) will prevail. GENERAL Claims under this policy must arise as a result of total and permanent disability. The definition of Total and Permanent Disability for the purpose of assessing such claims is: Total permanent and irreversible disability such that the life insured will be unable to perform any gainful occupation in the future and is registered disabled. Full information, assistance and medical evidence shall be given free of expense to us as we may require to prove the Total and Permanent Disability. The Member, if and when required by us, shall submit himself to be examined by a medical referee appointed or approved by us. We will not assume risk for any Policy until all outstanding information requested in the corresponding quotation has been received, and we are satisfied that such information is acceptable. Our quotations are valid for 3 calendar months from date of issue shown, provided the following conditions are met: a) all information required on the quote front has been provided to us and accepted by us as valid. b) there has been no change in the Group s risk profile since the quote was issued c) any variation in membership or sums assured since the quote was issued does not exceed 20% For single-premium-costed quotes, please note the final premium may vary slightly subject to birthdays. No return of premium will be made in year one if the contract is cancelled. All our quotations include active employees, but exclude individuals in receipt of an income from any sickness or incapacity insurances. Cover may be approved for any such individuals once we have been provided with written confirmation of the nature of the illness or injury and the corresponding first date of absence from normal duties. A full listing of the eligible membership must be provided within 1 calendar month of the Policy incepting. Provided that satisfactory confirmation of the Policy s eligibility and take-up rate has been received by us, individuals will not be required to be medically underwritten if their full benefit entitlement does not exceed the free cover limit where applicable. Individuals not joining the Policy at the first opportunity or who do not satisfy the eligibility conditions in any other way will be excluded from any free cover limit. If the Policy is governed by a unit rate, the rate is guaranteed for two years provided that i) the number of lives, or ii) the total sum assured do not change by more than 20% to those in-force at the commencement date. In such circumstances, we reserve the right to change the premium rate at the date on which such changes first occurred. At the expiry of the guarantee period, the Policy shall be reviewed.

4 4 of 7 Generali Worldwide Insurance Company Limited - Group Total & Permanent Disability Terms and Conditions An individual s benefit entitlement will be assumed to be based on their annual basic salary. Other salary definitions to be insured must be explicitly advised to us at quotation stage. No early or late retirees will be covered by any Policy unless expressly agreed to by us. The Policy will be terminated, immediately and without notice, unless the invoiced premium has been paid within 30 days of the invoice date. We do not offer Continuation Options. COMMENCEMENT OF ASSURANCE AT POLICY INCEPTION For any individual who is eligible to be covered by the Policy, assurance for their full benefit entitlement commences on the corresponding commencement date with the following exceptions: i) Individuals who have had periods of absence from work due to illness or injury in the 12 month period immediate to inception date. For all such individuals, we will require written confirmation of the nature of the illness or injury and dates of corresponding absence before consenting to commencement of the member s insurance. Cover for such individuals would only commence once we have issued written confirmation. Please refer to the wording in the quotation which explicitly details the period of time of such absence for which we shall require to be notified. ii) Benefit in excess of the insured free cover limit will be subject to our appropriate medical underwriting procedures. a) Any individual being underwritten will be covered for their full benefit entitlement (excluding pre-existing medical conditions) for a period of 90 days to allow for the underwriting procedure to complete. If, after this period has elapsed, the underwriting decision remains outstanding, individuals will be restricted to the insured free cover limit, or for accidental death only in the absence of a free cover limit, and will continue to be so until the decision has been made. iii) b) If the underwriting decision remains outstanding after 90 days, we may agree to an extension of full cover (excluding pre-existing medical conditions) at our discretion. Any individual who is not actively at work on the commencement date as a result of illness or injury will not be covered until they have returned to work in their usual capacity for two consecutive months. Actively at work means that the individual: a) is working their contracted number of hours and undertaking their usual duties and b) is not working contrary to medical advice received. We will not agree to backdate cover for the Policy as a whole, or for any individuals subsequently joining after Policy commencement. TERMINATION OF ASSURANCE The assurance of a Member covered under the Policy will cease immediately on the earliest of the following occurrences: i) The Member ceases to be eligible in any way under the Policy; ii) Discontinuance of payment of premiums; iii) Any Member whose period of cover exceeds the provisions laid down under the Policy s temporary absence clause.

5 5 of 7 Generali Worldwide Insurance Company Limited - Group Total & Permanent Disability Standard Terms and Conditions TEMPORARY ABSENCE The period of permitted absence from work covered by the Policy is 12 months for any cause. Any Member covered by this Policy who is absent from work will remain covered accordingly. Should payment of premium be discontinued in respect of any Member covered in temporary absence, such cover will cease for that Member. The cover may be subsequently resumed without the need to provide evidence of health on completion of two consecutive months in their ordinary occupation following a return to work and a resumption of premium payment. NO-WORSE TERMS For insured policies that switch to us, all medical underwriting terms applied by the previous insurer will be matched by us on a no-worse terms basis at the date of switch of cover subject to: i) Such terms will only apply to the Member s sum assured that had been previously underwritten. Any subsequent increase in sum assured that a Member is entitled to would be underwritten on our terms; ii) If our free cover limit is higher than the previous insurer s, our free cover limit will not apply to any Members whose previous cover had been subject to adverse underwriting decisions, or who had previously had any benefit entitlement restricted due to non completion of medical underwriting; further increases in benefit entitlement for these Members will be fully underwritten on our terms. iii) The previous underwriting decision was made less than 36 months before the date of the Policy switching to us. For Members whose underwriting decisions were made prior to this 36-month period, we reserve the right not to offer no-worse terms; iv) Such terms will only apply to previous medical ratings of up to +300% extra morbidity. v) No Member had been restricted to a previous free cover limit as a result of poor health. For individuals restricted in this manner, we would underwrite the Member for their full benefit entitlement before terms would be considered; vi) Similarly, any Member previously declined cover by the previous insurer would be underwritten for their full benefit entitlement before acceptance terms would be considered. In instances of v) or vi), any free cover limit that the Policy may have will not apply to such Members. Clients shall agree to provide any information requested by us to support previous underwriting terms. Failure to provide such details will result in the offer of no-worse terms being withdrawn by us. EXCLUSIONS Policy Exclusions No benefit shall be paid in respect of claims that are directly or indirectly attributable to, or consequential upon: i) Nuclear transmutation, or radiation, resulting from the artificial acceleration of atomic particles. ii) Chemical or biological substances which are not used for peaceful means. Member-specific Exclusions In certain instances, Members may have specific conditions applied to them resulting in exclusions of cover. Claims arising either directly or indirectly from causes excluded in this manner will not be accepted under any circumstances. These will be explicitly detailed if they apply to any Members.

6 6 of 7 Generali Worldwide Insurance Company Limited - Group Total & Permanent Disability Terms and Conditions CATASTROPHE LIMIT The Company will not pay more than the catastrophe limit (as detailed in our quotation) in the aggregate for the total of benefits which may be due under this Policy as a consequence of any single incident or series of incidents arising out of one event or occurrence and resulting in claims in which 2 (two) or more Members die within a period of 12 (twelve) months of the event. Where the event in question is a natural disaster such as earthquake, storm or flood, all claims resulting there from within a period of 72 (seventy-two) hours of the occurrence of the event shall be considered as arising from a single event. Where a pension is payable, the capital value of that payment will be used for this calculation.

7 Registered Head Office address: Generali Worldwide Insurance Company Limited, Generali House, Hirzel Street, St Peter Port, Guernsey, Channel Islands GY1 4PA. Incorporated in Guernsey under Company Registration No T +44 (0) F +44 (0) EBLifeCustomerService@generali-worldwide.com generali-worldwide.com Regulated in Guernsey as a licensed insurer by the Guernsey Financial Services Commission under the Insurance Business (Bailiwick of Guernsey) Law, 2002 (as amended). Generali Worldwide Insurance Company Limited is part of the Generali Group, listed in the Italian Insurance Group Register under number 026. Websites may make reference to products that are not authorised or regulated and/or are not available for offering to planholders in certain jurisdictions.