Swiss Life Ltd, Zurich. General Policy Conditions for Group Life Insurance. Supplementary sheet. General Policy Conditions for Group Life Insurance

Transcription

1 Swiss Life Ltd, General-Guisan-Quai 40, P.O.Box, 8022 Zurich Swiss Life Ltd, Zurich (Swiss Life) General Policy Conditions for Group Life Insurance and Supplementary sheet for the General Policy Conditions for Group Life Insurance NVS0109_e_ V01 / 2325

2 Swiss Life Ltd, General-Guisan-Quai 40, P.O.Box, 8022 Zurich General Policy Conditions for Group Life Insurance Effective date: 1 January 2007 NVS0135_e_ V02 / 2175

3 Contents Art. 1 Art. 2 Art. 3 Art. 4 Art. 5 Art. 6 Art. 7 Art. 8 Art. 9 Art. 10 Art. 11 Art. 12 Art. 13 Art. 14 Art. 15 Legal basis Insurance year; application; commencement of liability; duty of disclosure Payment of premiums; current account; consequences of default; refund of premiums Actuarial reserve Bonus Premature termination of employment Termination of insurance contract Duty to inform; establishment of entitlement Communications; change of address Place of performance and jurisdiction Insurance benefits Collective and individual calculation of insurance tariffs Modification of the insurance tariffs Gross negligence; suicide Military service and war NVS0135_e_ V02 / 2175 page 2 / 6

4 Art. 1 Legal basis 1 - The Federal Law on Insurance Contracts of 2 April 1908 (VVG) applies to all relations between the parties which are not regulated by the terms of the group life insurance contract (insurance contract), the General Policy Conditions, the Conditions of Acceptance or the insurance lists (list of benefits and list of premiums). 2 - No specially agreed terms shall be binding unless confirmed in writing by Swiss Life's head office in Zurich. Art. 2 Insurance year; application; commencement of liability; duty of disclosure 1 - The insurance year shall start on 1 January. 2 - Persons to be insured shall be notified to Swiss Life on the application forms it supplies. Subject to the Conditions of Acceptance, Swiss Life shall assume liability for the benefits under group insurance providing the mandatory minimum benefits in accordance with the Federal Law on Occupational Retirement, Survivors' and Disability Pension Plans (BVG), upon commencement of the insurance in accordance with the BVG; under other group insurance, upon receipt of the application but not earlier than the date stipulated in the insurance contract and always provided that all contractual requirements are met. 3 - If underwriting is required in accordance with the Conditions of Acceptance, the person to be insured must supply complete and truthful answers to the questions asked by Swiss Life regarding his or her state of health. Swiss Life shall be entitled to require an examination by a doctor at its own expense. 4 - Should any questions remain unanswered or not be answered in conformity with the truth, the consequences of breach of the duty of disclosure as laid down in the VVG shall apply accordingly. 5 - Persons whose insured benefits are to be altered within the terms of the insurance contract shall be notified in writing to Swiss Life. The provisions of clauses 2-4 shall apply accordingly. Art. 3 Payment of premiums; current account; consequences of default; refund of premiums 1 - The premium is payable in advance in a single instalment at the beginning of each insurance year. The premium for benefits to be included in the insurance during the course of an insurance year shall become payable at the time of the inclusion. 2 - Swiss Life shall establish an interest-bearing current account for the purpose of premium payments. Debit and credit interest shall be determined by Swiss Life in line with market conditions. Any balance in favour of Swiss Life shall be considered as an amount outstanding within the meaning of cl. 3 below. 3 - If the amount outstanding is not paid within the stipulated period, Swiss Life will demand settlement of the unpaid premium together with any incidental charges by the party owing the premium within 14 days from the date of sending the reminder notice, which shall also inform them of the consequences of default. If this amount is not paid within the reminder period the insurance contract shall nevertheless remain in force to the previous extent until the date specified in the reminder notice, and benefits becoming due shall be paid after deducting the outstanding premium and any incidental charges. If the payment is not made or not fully made by this date, the insurance shall be converted into paid-up insurance in accordance with the provisions of Art. 7, cl. 5. The consequences of default shall not be removed until all outstanding premiums together with any incidental charges have been paid. Swiss Life reserves the right to collect outstanding premiums and incidental charges by way of legal action. 4 - Premiums paid in respect of any period subsequent to the month in which death occurs or to the commencement of disability benefits shall be refunded. Art. 4 Actuarial reserve The actuarial reserve shall always be determined in accordance with the actuarial bases on which the annual or single premiums applicable to the insurance concerned are calculated. The actuarial reserve for an insured savings plan separate from the risk insurance shall be equal to the savings capital. Art. 5 Bonus 1 - The insurance contract shall form part of Swiss Life's "Group Pension and Life Insurance Portfolio for Switzerland", for which a special profit and loss account is maintained in accordance with the legal stipulations. Group policyholders participate in the annual result for this portfolio in accordance with the principles set out below. This does not apply to group policyholders with special insurance contracts which participate in the surplus in accordance with the applicable provisions of the law. Calculation and apportionment between group policyholders and Swiss Life (statutory payout ratio) The annual result for this portfolio is always calculated for the three revenue components "revenue from the savings process", "risk" and "costs" in accordance with the legal stipulations, taking any losses carried forward from previous years into account. The apportionment between group policyholders and Swiss Life can be made on a gross or net basis, unless the supervisory authority rules otherwise within the framework of the procedure envisaged under the law. The net calculation method is used whenever revenue from the savings process amounts to 6 percent or more of the mathematical reserve (savings revenue) and the minimum interest rate set by the Federal Council for mandatory BVG coverage comes to two-thirds or a lower percentage of the savings revenue. Gross calculation method: In the first step, the group policyholders' share of the revenue per component as laid down in the law (statutory payout ratio) is subtracted from said revenue. The statutory ratio per component is applied as follows: Benefits and expenses for group policyholders are covered first. Provisioning is then subtracted from any positive balance remaining (after offsetting against a negative result for one component or another), as well as costs which have been approved by the supervisory authority. The amount left over is allocated to the reserve for policyholder bonuses. NVS0135_e_ V02 / 2175 page 3 / 6

5 Net calculation method: The share prescribed by law (statutory payout ratio) of the result as defined below, if positive, is allocated to the reserve for policyholder bonuses for the benefit of the group policyholders. First of all, however, the savings revenue determined by the solvency margin (solvency revenue) is allocated to Swiss Life. The result referred to above is produced by the aggregation of the components consisting of the revenue from the savings process (after deduction of solvency revenue), risk and costs, in each case subtracting benefits and expenses for group policyholders and the allocation for provisioning. Allocation to the group policyholder The allocation to each group policyholder is made from the reserve for policyholder bonuses. This reserve is used exclusively to cover bonuses for group policyholders comprised in the portfolio referred to above and distributions from it may not amount to more than two-thirds of the reserve in any given year, unless the supervisory authority rules otherwise within the framework of the procedure envisaged under the law. Each group policyholder is allocated an annual share of the surplus (bonus) out of the reserve for policyholder bonuses. Its level is calculated on the actuarially determined share in the portfolio and is not guaranteed in advance. If the annual result for the portfolio is negative for all three components taken together (revenue from the savings process, risk and costs), including any losses carried forward, no bonus shall be paid. The entitlement to participation in surplus arises when the insurance contract enters into force and ceases when the insurance contract is terminated. Bonuses accruing in any one year shall be payable at the beginning of the following insurance year. The bonus resulting for the last insurance year after taking account of the termination of the insurance contract shall be payable at the beginning of the next calendar year. Payment of bonuses is conditional upon the contractual obligation to pay premiums being met. 2 - Swiss Life shall make available to group policyholders the necessary information stipulated by law with regard to calculation of the bonus in a suitable form. Art. 6 Premature termination of employment 1 - In the case of premature termination of employment the group policyholder may elect to terminate the whole of the insurance of the withdrawing person, or, subject to agreement with Swiss Life, to assign or continue the insurance in whole or in part. 2 - The assignment of the insurance shall be valid if it is made in writing, with a written notice to Swiss Life, and a policy together with the General Policy Conditions is delivered to the new policyholder. The right to reassess the premiums and benefits upon assignment shall be reserved. 3 - The group policyholder may continue the insurance either unchanged or in the form of paid-up insurance. The conversion into paid-up insurance shall be subject to reassessment of benefits in accordance with Art. 7, cl When insurance is terminated, the full actuarial reserve together with any unused premiums shall, subject to Art. 7, cl. 2, be refunded as surrender value to the group policyholder. Art. 7 Termination of insurance contract 1 - Upon notice of termination by the group policyholder or by Swiss Life the group policyholder may demand the cash surrender value of the insurance as a whole (all insurance coverage falling under categories 1 and 2 as defined below) or of the insurance falling under category 1 as defined below: Category 1: Active insureds and recipients of disability benefits together with disability cases for which the onset of disability followed the termination of the insurance contract but the incapacity to work which led to the disability arose before the termination of the insurance contract. Category 2: Recipients of retirement or survivors' benefits. 2 - Surrender of the insurance for a defined category of insured persons as well as surrender of the insurance as a consequence of the restructuring of the employer's business shall, insofar as other employees continue in service, be treated as a partial termination of contract, to which the provisions of this article shall apply accordingly while Art. 6 shall not be applicable. 3 - Whichever of the contracting parties may give notice of termination, the surrender value shall be determined in accordance with the following provisions: a) The surrender value shall be computed as of the date on which termination is to become effective according to the terms of the insurance contract. b) The surrender value shall be equal to the actuarial reserve after offsetting, subject to cl. 4, any impairment of investments due to the current trend of interest levels (letter c)) as well as any unamortised acquisition costs (letter d)), provided that the total amount so offset shall in no case exceed 8% of the actuarial reserve as of the date of termination. c) The impairment of investments due to the current trend of interest levels shall be equal to six times the annual interest on the actuarial reserve, computed as of the date of termination by use of an interest rate equivalent to the difference, as of the same date, between the interest rate on new investments and the average rate, if lower, on existing investments. The rate of interest on new investments shall be the arithmetic mean of the average rate of interest on medium-term bonds (Kassenobligationen) issued by cantonal banks, the average yield on Federal bonds at the end of the current month, the average rate of interest charged by cantonal banks on first mortgages, i.e. on new mortgages for general housing construction. The figures shall be taken from the monthly reports published by the Swiss National Bank. The interest rate on new investments shall be ascertained as of the end of each month to be applied to insurance contracts terminated in the second following month. The average rate of interest on existing investments shall be the arithmetic mean over the last six years of the rates of interest on new investments specified above. This average interest rate on existing investments shall be ascertained as of the end of each quarter of the calendar year to be applied to insurance contracts terminated in the second following calendar quarter. 5 - Death and disability benefits insured at the time of termination of employment shall continue to be insured to the previous extent for a period of one month or until earlier commencement of a new employment relationship, with no premium being charged for such period. Benefits under claims arising during such period shall only be granted if any surrender value already refunded is paid back to the amount required or, if not paid back, after deduction of the appropriate amount of any surrender value previously refunded. NVS0135_e_ V02 / 2175 page 4 / 6

6 d) The amount of the unamortised acquisition costs in the first contract year shall be equal to 2% of the actuarial reserve and the annual premium applicable at the time the insurance contract is terminated. For every full year for which the insurance contract has been in force it shall be reduced by 1/10th of the initial rate, so that after a contract duration of ten years it shall be equal to nil. e) Any loans and other outstandings shall be deducted from and any amounts due from Swiss Life shall be added to the surrender value. f) The surrender value of paid-up insurance shall be computed in accordance with letters a)-e), subject to the following adaptations: The interest rates relevant for determining the impairment of investments under letter c) shall be those effective on the date of contract termination; the contract duration relevant for determining the unamortised acquisition costs under letter d) shall be the period between the effective date of the insurance contract and the date of conversion to paid-up insurance. These conditions remain subject to the provisions of the law. 4 - The group policyholder may in agreement with Swiss Life defer cashing in the surrender value for a period of up to three years to be fixed in advance. For every full month of deferment the impairment of investments according to cl. 3, letter c) shall then be reduced by 1/36th, so that with a chosen deferment period of three years no impairment of investments shall be taken into account. During deferment the surrender value shall earn interest at a rate fixed by Swiss Life. 5 - In order to reassess the benefits when insurance is converted into paid-up insurance within the meaning of Art. 3, cl. 3 or Art. 6, cl. 3, the balance of the actuarial reserve after deducting any loans and other outstandings and adding any amounts due from Swiss Life shall be applied as a single premium. The actuarial bases used in the calculation shall be those on which the annual or single premiums for the insurance have been assessed. 6 - Risk insurance has neither surrender value nor conversion value. 4 - If disability benefits are claimed, the documents to be furnished to Swiss Life shall include reports of the physicians who are attending or have attended the insured person on the cause, the beginning and the course of disability, a statement regarding the occupation followed by the insured person prior to the commencement of disability, and any rulings available from the IV, accident insurers or Military Insurance. Recovery from disability or any change in its degree shall be immediately reported. 5 - If an insured person dies, Swiss Life must be notified of the death immediately. If death benefits are claimed, the policyholder must indicate the cause of death and submit an official death certificate. If widows', widowers' or registered partner's pensions are claimed, the age of the widow, widower or partner and the length of the marriage or partnership must be evidenced by official documents; in the case of a divorced woman, this must be accompanied by the legal divorce decree and documentation concerning benefits from other insurances, especially from the AHV and IV. If, in accordance with the insurance contract, higher benefits are to be paid for full orphans than for half-orphans, an official death certificate must be presented as proof of the spouse's death. 6 - If orphans' benefits, disabled persons' children's benefits or retired persons' children's benefits are claimed on the grounds that the child is continuing education, then, in addition to an official birth certificate (Family Certificate, etc.), periodic confirmation by the educational establishment shall be supplied and the completion of education shall be reported. In order to claim benefits for foster children, an official certificate shall be submitted showing that the qualifying conditions are met. When claiming orphans' benefits, disabled persons' children's benefits or retired person's childrens' benefits or pensions for children of disabled or retired persons on the ground that the child is disabled, the relevant IV ruling or a medical report on the disability of the child shall be produced. 7 - Swiss Life must be notified immediately of the death of persons drawing pensions; the same applies to the remarriage of persons to whom a widow's, widower's or unmarried partner's pension is being paid. Art. 8 Duty to inform; establishment of entitlement 1 - The group policyholder shall report to Swiss Life any occurrences material to a claim of entitlement to benefits arising or lapsing and supply such information and evidence as Swiss Life may require to determine its liability for benefits. The group policyholder shall further be bound to forward to Swiss Life any application made by claimants wishing to exercise a lump sum option provided for by the insurance contract. 2 - Swiss Life may request the group policyholder or those persons for whom benefits are claimed to supply the information and documentary evidence it deems necessary for the verification of its liability. This shall apply in particular to any relevant rulings available from the AHV, IV, accident insurers and Military Insurance. Swiss Life shall have the right to obtain such information and evidence directly from third parties. 3 - Swiss Life is entitled to demand proof at any time that the persons for whom benefits are to be provided survived the due date of these benefits if retirement, disability, widow's, widower's, unmarried partner's, orphan's and children's benefits are claimed. It may require that an official certificate of survival be produced before the benefits are provided. Art. 9 Communications; change of address 1 - No notice given to Swiss Life shall have legal effect unless it is communicated to Swiss Life in writing at its head office in Zurich. 2 - The group policyholder shall notify Swiss Life in writing of any change of address. Any notice communicated to the group policyholder at the last address in Switzerland known to Swiss Life shall be legally valid. Art. 10 Place of performance and jurisdiction All contractual obligations shall be performed in Switzerland. As place of jurisdiction, the group policyholder shall have the option of either Zurich or their domicile in Switzerland. As far as Swiss Life is concerned, the place of jurisdiction shall be the domicile in Switzerland of the defendant. Art. 11 Insurance benefits The benefits insured shall be stated in the insurance contract and in the insurance lists (list of benefits and list of premiums). NVS0135_e_ V02 / 2175 page 5 / 6

7 Art. 12 Collective and individual calculation of insurance tariffs 1 - The following principles apply if the insurance contract provides for death coverage (lump-sum death benefits, widows' pensions, widowers' pensions, unmarried partners' pensions, survivors' temporary benefits and joint life and survivorship annuities) in accordance with the collective or individual method: Under the collective method all insured men and/or all insured women shall be covered for such benefits irrespective of marital status. Premiums shall be assessed without reference to the individual case, on the basis of statistical average values. Under the individual method the insurance of these benefits shall be dependent on marital status. Changes in the marital status of persons for whom such benefits have been or are to be included must be immediately reported to Swiss Life. Widows', widowers' and unmarried partners' pensions are insured, taking account of the age of the spouse or partner. Entitlement to a widow's, widower's or unmarried partner's pension shall lapse in the event of dissolution of the marriage as a result of divorce, the legal dissolution of the registered partnership, a decree of nullity or the death of the spouse or partner. The actuarial reserve concerned and the unused premium shall be refunded to the policyholder in the event of divorce, the legal dissolution of the partnership or the issuing of a decree of nullity. 2 - Orphan's benefits, disabled persons' children's benefits and retired persons' children's benefits shall be provided for all insured men and, if so agreed upon in the insurance contract, for all insured women on a collective basis, irrespective of marital status. All children shall be covered without any notification being required. Where women are not included in this collective coverage under the insurance contract, their children must be notified to Swiss Life individually, with dates of birth recorded, in order to qualify for orphan's and children's benefits. Art. 13 Modification of the insurance tariffs 1 - If Swiss Life modifies all or part of the insurance tariffs which are recalculated yearly, the new rates shall apply to all insurance subject to such tariffs. 2 - If Swiss Life modifies the insurance tariffs for multiyear level premiums on which the insurance contract is based, the new tariffs shall apply to new benefits and benefit increments subsequently to be included in the insurance. Art. 14 Gross negligence; suicide 1 - Swiss Life waives the right conferred upon it by law to reduce payments on account of the insured event being brought about through gross negligence. Art. 15 Military service and war (standard for all life insurance companies operating in Switzerland) 1 - Active service to protect Swiss neutrality or for the maintenance of internal peace and order, both without warlike actions, is regarded as military service in time of peace and is therefore covered by the insurance contract in accordance with the General Policy Conditions. 2 - If Switzerland is involved in a war or warlike actions, a one-time war contribution, due from the date marking the start of war, becomes due one year after the date marking the cessation of war. Whether the insured person takes part in the war or whether they are in Switzerland or abroad is irrelevant. 3 - The war contribution serves to cover losses caused directly or indirectly by the war, if these affect the insurance contracts to which these Conditions apply. Determination of such losses and of the funds available for coverage, together with calculation of the war contribution and the options for its payment - if necessary by reduction of the insured benefits - shall be undertaken by Swiss Life in agreement with the Swiss supervisory authority. 4 - If benefits from the insurance contract become due prior to determination of the war contribution, Swiss Life is entitled to withhold an appropriate portion of such benefits up to one year after cessation of the war. The withheld portion of benefits and the interest rate on it shall be determined by Swiss Life in agreement with the Swiss supervisory authority. 5 - The dates which are regarded as marking the start and the end of the war for the purposes of the preceding provisions shall be determined by the Swiss supervisory authority. 6 - If the insured person takes active part in a war or warlike actions without Switzerland itself being involved in the war or warlike actions, and dies during the war or within six months after the conclusion of peace or the end of hostilities, Swiss Life shall be liable for an amount corresponding to the mathematical reserve as calculated at the date of death of the insured person, but not exceeding the death benefit insured. Where survivors' pensions are insured, the liability shall be for pensions corresponding to the mathematical reserve as calculated at the date of death and in no case exceeding the pensions insured. 7 - Swiss Life reserves the right to modify the provisions relating to coverage in the event of war, in agreement with the Swiss supervisory authority. Any such alterations would apply to this contract. This contract is also subject to any official or legislative measures decreed in connection with a war, in particular to those relating to surrender of the insurance contract. 2 - In the case of suicide, the benefits insured in the case of death shall be paid in full. * * * NVS0135_e_ V02 / 2175 page 6 / 6

8 Swiss Life Ltd, General-Guisan-Quai 40, P.O.Box, 8022 Zurich Supplementary sheet for the General Policy Conditions for Group Life Insurance Swiss Life Ltd, Zurich (Swiss Life) Effective date: 1 January 2006 Objective / content This sheet explains and supplements the General Policy conditions for Group Life Insurance (GPC). It forms an integral part of the GPC. In so far as no other regulation provides differently, the stipulations of the GPC shall apply. Actuarial reserve / actuarial bases The actuarial reserve in accordance with Art. 4 GPC is based on the following actuarial bases: GKM/F 2004, GRM/F 2004, GIM/F 2004 with technical interest rate of 2.50% GKM/F 1995, GRM/F 1995, GIM/F 1995 with technical interest rate of 3.50% GKM/F 1980, GRM/F 1980 with technical interest rate of 3.00% GKM/F 1970, GRM/F 1970 with technical interest rate of 3.25% Surrender value Upon termination of an insurance contract with a group policyholder that is an employee benefits institution governed by the FZG, the following additional provisions shall apply: For the actuarial reserve (Art. 4 and Art. 7, cl. 3b GPC) The actuarial reserve for current disability benefits shall be calculated at a technical interest rate of 3.50%, based on the 1995 GIM/F actuarial bases, if the incapacity to work which led to the disability arose before 1 January If the onset of the incapacity to work which led to the disability arose on or after 1 January 2005, then the GIM/F 2004 actuarial bases with a technical interest rate of 2.50% shall be applied. The actuarial reserve for the current retirement benefits (including prospective future survivors' benefits), that has been calculated on the basis of a conversion rate, corresponds to the actuarial reserve for the insured benefits determined by the 1995 GRM/F actuarial bases, with a technical interest rate of 3.50%. For the calculation of the surrender value in the case of surrender in accordance with Art. 7, cl. 3 GPC Unamortised acquisition costs are not deducted from the surrender value. A maximum of 8% of the actuarial reserve, computed as of the date of termination of the contract is retained for any potential impairment of investments due to the current trend of interest levels. It is calculated based on Art. 7, cl. 3c GPC in accordance with legal stipulations (at the present time Art. 53e, cl. 3 BVG, in force since 1 April 2004, which stipulates that no costs of surrender value may be deducted if the contractual relationship has been in existence for at least five years). Insofar as the retirement savings in accordance with Art. 15 BVG are insured in the contract to be terminated, the amount of the surrender value to be paid will be equal to the retirement savings in every case. Experience rating In the case of insurance contracts based on insurance tariffs which are recalculated yearly (Art. 13, cl. 1 GPC), the calculation of the annual premium to be paid for disability and death benefits can be based on the experience rating. With the experience rating, the risk premiums for the risks of death and disability are calculated by multiplying the basic premium by the risk factors. The factors for the risk of death and the risk of disability are recalculated every year. They provide a weighted average for determining both individual customer claims experience and group claims experience over the past five years. The weighting of individual customer claims experience and group claims experience depends on the size of the insurance contract. Swiss Life's claims experience in the Group Pension and Life Insurance Portfolio for Switzerland forms the basis for the group claims experience. It can be supplemented by the claims experience of the sector to which the insurance contract is assigned in the case of the disability risk. The risk factors are recalculated annually and can change from one year to the next. They improve if the individual customer or group claims experience improves and vice versa. Accordingly, the premium for disability and death benefits can fall or rise on an annual basis. Guarantee of insurance tariffs, premium adjustment and adjustment of GPC Insurance tariffs, which are recalculated yearly, are guaranteed during the insurance year (Art. 13, cl. 1 GPC). If Swiss Life adjusts these insurance tariffs, subject to the approval of the competent supervisory authority, the adjustments will take effect in the subsequent insurance year. This can mean a change in the premium and in the GPC. Changes to the GPC by Swiss Life, which are also subject to the approval of the competent supervisory authority, are always possible when rate adjustments involve changes in the text of the GPC. In the case of insurance tariffs for multiyear level premiums (Art. 13, cl. 2 GPC) the above principles shall apply to new benefits and benefit increments subsequently to be included in the insurance. NVS0136_e_ V02 / 2176