Group Life Assurance Technical Guide

Transcription

1 Group Life Assurance Technical Guide Page 1 of 10

2 1. AMTRUST LIFE AIMS The information contained in this guide gives an outline of our approach to insuring Group Life business and our Standard Terms and Conditions. This document should be used as a guide only, if your enquiry or new business opportunity is outside the parameters of this document, then please give us a call or the enquiry to life@amtrust.com We generally have a flexible approach to underwriting and can consider cases that other insurers may be unwilling to insure. 2. DATA REQUIREMENTS To provide a quote for a scheme we need certain information. Wherever possible, data should be supplied electronically in Excel format. This will avoid manual entry and therefore avoid input errors and allow the quote to be produced more quickly. The data required is as follows: Scheme Data Presentation (i) (ii) (iii) (iv) (v) (vi) (vii) (viii) (ix) (x) (xi) (xii) (xiii) (xiv) A brief description of the type of business the employer is involved in, together with the geographic location(s). Scheme commencement date. Level of cover (e.g. multiple of salary, level benefit). Claims experience (ideally for the last five years). Scheme History, to include for each year insured; the number of lives, total sum assured and premium. Compulsory or Voluntary scheme (if voluntary, please provide take up rate). Temporary absence definition. Scheme eligibility condition. Expiry age. Commission required (between 0-40 percent). Any other special terms or conditions. Any PHI claimants. Any long term absentees. Employee data, to include name, gender, date of birth, salaries/sum assured, occupation and postcode where they work. Page 2 of 10

3 3. GENERAL CONDITIONS These can be found on our Standard Terms and Conditions Key Features document, which forms part of the policy certificate. We have included a brief outline of these terms and conditions below but we can consider amending these on a case by case basis upon request. a. Actively at Work and No Worse Terms i) Actively at Work Unless requested otherwise we will quote all our schemes up to and including 100 lives on an actively at work basis. This means that all members must be actively at work at the inception date of the scheme and fulfil the actively at work criteria. The full wording for the actively at work criteria is located in General Conditions 1 and 2 of our Standard Terms and Conditions. Our Actively at Work rates are discounted in comparison to our No Worse Terms rates. ii) No Worse Terms If a scheme has 100 or more lives, we can transfer all existing members of a group life scheme for their level of benefit, up to a maximum of 1,000,000 any one life. This is subject to no individual member having been loaded more than +150% above the standard rates or had any benefit under any company arrangement restricted, declined or postponed. Only members that have been assessed within the last 3 years are entitled to No Worse Terms. By assessed we mean individually underwritten or had to comply to an actively at work requirement. b. Increases in Sum Assured and Membership i) Increases in Sum Assured Increases in sum assured under the Free Cover limit will automatically be covered, providing the member conforms to the Free Cover criteria in Condition 1 of our Standard Terms and Conditions at the time of the increase. For any benefits over the Free Cover limit, the client will automatically be covered, providing they fulfil the following criteria: i) the member has previously been individually underwritten by ourselves; and ii) the increase in sum assured is no more than 20% OR the increase in sum assured is no more than 20,000, whichever is the lesser. Increases which meet these criteria need only be advised at the end of the scheme year. If any member does not conform to the above then we will need to be advised at that time. The maximum that the overall scheme sum assured can increase by during the scheme year, without AmTrust being notified, is 25%. Page 3 of 10

4 ii) Increases in Membership New members can be included within a scheme automatically, subject to all of the following: i) the member fulfils the current scheme eligibility criteria; ii) the member fulfils the actively at work criteria; iii) the member s sum assured does not exceed the Free Cover limit; and iv) the total number of lives in the scheme does not increase by more than 25% during the scheme year. AmTrust should be notified if any of the above conditions cannot be fulfilled. c. Rate Guarantee Under our standard terms, the unit rate for the scheme will be guaranteed for 2 years subject to the following: i) the eligibility criteria does not change during the scheme year; and ii) no change in the taxation system in regards to the insured benefits or the premiums paid; and iii) the total sum assured or the total number of members does not change by more than 25%; and iv) no change in the calculation basis of the scheme. A 1 year rate guarantee can be provided on request. Please advise whether this is required when submitting a quotation request. d. Temporary Absence cover Under our standard terms we will cover members whilst they are temporarily absent from work for up to 2 years, or up to the age of 65, whichever is the lesser, whilst the group policy remains in force. Upon request we can extend the period of temporary absence cover up to the age of 65 or the scheme retirement age. Please advise which basis is required when submitting a quote request. e. Catastrophe Limit The maximum liability we will payout on any one scheme, as standard, in the event of a catastrophe is 25,000,000. We can look to increase this upon request. Please refer to our Standard Terms and Conditions for a definition of a catastrophe and a single event. Page 4 of 10

5 4. WHAT THE CLIENTS ARE NOT COVERED FOR The following exclusions form part of our Standard Terms and Conditions but, again, if there is anything that the clients would like to have included or any exclusion(s) removed, then please contact us and we will endeavour to accommodate this request. a. Exclusions i) Toxic Substances Any members working in an industry that has exposure to chemicals, toxic or explosive substances are automatically excluded. If you are unsure as to what constitutes a hazardous substance, then please contact us for advice. ii) Non-Commercial Flights Any members or groups who fly on non scheduled airlines for business purposes will be automatically excluded, unless pre-agreed in writing by ourselves. iii) Members Travelling Together Cover is automatically excluded in respect of eleven or more members travelling together (this may be expanded upon request). b. When Does Cover Automatically Terminate Cover for any member will automatically cease in the following circumstances: i) the member s contract of employment expires or is terminated; ii) payment of premium by the Grantee is discontinued; iii) a member attains the scheme retirement age or the age of 65 (higher upon request), whichever is the lesser; iv) death of a Member; v) the member no longer conforms to the eligibility criteria of the scheme. 5. PREMIUMS a. Minimum Premiums The minimum Single Premium is (net of commission). The minimum Monthly Premium is (net of commission). b. Premium Payments Premiums may be paid annually by cheque or by direct BACS transfer, or monthly by direct debit. Page 5 of 10

6 c. Charges Where premiums are paid monthly or quarterly a loading of 2% will be added to the annual premium. Where the total of these premiums are 10,000 or more, the monthly premium charge is waived. We do not apply any policy fees as part of our Standard Terms and Conditions d. Ratings If we apply an additional rating to an individual on a scheme for medical, occupational or vocational reasons we will advise when the additional premium is to be paid. e. Adjustment Premiums Any adjustment premiums are calculated and paid at the expiry date of the scheme. Generally the calculation is the difference between the total sum assured at inception and the total sum assured at expiry, multiplied by the scheme unit rate, divided by DEATH BY NATURAL CAUSES As a Lloyd s Syndicate, we are experienced in providing cover for natural causes only. For situations where there is an increased Catastrophe risk, such as oil rig workers, flight crews and ships crews we can generally offer Natural Causes Only cover through the life syndicate but by working with our Personal Accident team we can look to offer all causes cover by splitting the risk so that we offer natural causes and they write the accidental death element. 7. TEMPORARY COVER We can provide temporary cover either for death by all causes or for accidental death (depending on individual underwriter consideration) for scheme members at outset in the following circumstances: (a) (b) During any period of service which is required when a member cannot meet the actively at work requirement when he/she first becomes eligible for cover. During any period in which medical evidence and any other underwriting information is obtained when an individual s cover exceeds the free cover level. This would only apply when underwriting is not completed prior to eligibility for cover, or an increase in cover, and would also be limited to the amount of the excess over the free cover and any existing cover. Page 6 of 10

7 (c) During any period in which medical evidence and any other underwriting information is obtained for individuals covered where there is no free cover available. This would only apply when underwriting is not completed prior to eligibility for cover or an increase in cover and would also be limited to the amount of the excess over any existing cover with ourselves. A maximum period of thirty days is permitted for temporary cover, but can be extended subject to a case by case review. 8. SCHEME UNDERWRITING Scheme underwriting will be based on the information provided for the quotation. Factors that will be taken into account are the geographical location of the members, the occupations, claims experience and the proposed benefit structure. 8.1 Free Cover Level For schemes with 3 or more lives a Free Cover Level will be granted. The standard maximum Free Cover Level available is 1,000,000 (for large or unusual cases we can consider providing a free cover in excess of 1m). 8.2 Maximum Benefit The maximum cover we can provide for any one life is 2,000,000. There is no limit to the total maximum sum assured we can insure on any one scheme however, any claim would be subject to the catastrophe event limit shown below. 8.3 Maximum Event Limit The maximum sum insured payable as a result of a single event is 25,000,000 (we can look to extend this on a case by case basis). Page 7 of 10

8 9. UNDERWRITING OF INDIVIDUALS Members of a scheme will need to be underwritten under the following circumstances: a) if a member has been declined, loaded more than 150% or restricted by a previous insurer; or b) if a member has an increase in sum assured, which takes their benefit over the Free Cover limit; or c) if a member who is already insured by AmTrust has an increase in sum assured over the free cover limit which is larger than 20% or 20,000, whichever is the lesser; or d) if a new member of a scheme is not fit and actively at work on the commencement day of their employment, or has had more than 10 days off work in the last twelve months. Note: The actively at work requirement also applies to any increases in cover. Initially we will require any member that is being underwritten to complete a member s declaration. This will be assessed by our Underwriters and if any additional evidence is required we will organise the evidence and advise any action the member needs to take. 10. MAKING A CLAIM The Grantee of a scheme should contact their Financial Adviser, who should, as soon as is practical, contact ourselves by telephone on or by writing to AmTrust Life at Lloyds, 1 Great Tower Street, London, EC3R 5AA. Within 2 working days of notification we will issue confirmation of our requirements in order to settle the claim. 11. SCHEME PRICING 11.1 Pricing Approach For most schemes we will calculate the premium and this will be expressed as a unit rate per thousand (per mille) of the sum assured rounded to two decimal places. In some cases a unit rate will not be appropriate, for example where age banded or individually rated schemes may be more appropriate. Lives over 65 may be single premium costed. Page 8 of 10

9 11.2 Rate Guarantee Period 12. RENEWALS Under our standard terms, the unit rate for the scheme will be guaranteed for 2 years. Any rate guarantee period is subject to: - no change in the eligibility conditions; and - no change in the taxation of the scheme benefits and/or premium; and - the number of members or value of benefits provided at inception not increasing by more than 25%; and - no change in the basis for calculating the scheme benefits Advice of Renewal Advice of renewal will be sent to the intermediary at least 21 days before cover is due to expire. We will request an up-to-date list of scheme members which should include their names, dates of birth, salaries/sums assured, occupations and postcode of the work location Maintaining Cover If we do not receive advice as to whether the scheme renewal terms are required then we will automatically hold cover for 30 days from the renewal date. If the scheme subsequently lapses Time on Risk premium will apply. Ideally the renewal data should be provided before cover expires. Where this is not possible we are prepared to hold cover for 30 days from the renewal date to allow the client time to forward the renewal data to us. Upon receipt of the renewal data we will produce renewal terms. Once the renewal terms have been issued we can hold cover for a further 14 days whilst these terms are considered and to allow the premium and any other underwriting requirements to be provided to us. Upon receipt of these items we will issue the certificate for the scheme. If the scheme does not renew, we will charge a time on risk premium where we have been holding cover. 13. TIME ON RISK PREMIUMS AND CANCELATION PREMIUMS For any period we hold cover and for any mid term cancelations the premium charged will be on a pro-rata basis. Note that the minimum Time On Risk (TOR) Premium is 150. Page 9 of 10

10 14. COMMISSION 14.1 Commission is payable on a non indemnity basis. Commission will be paid within 60 days of receipt of the premium to the intermediary s nominated bank account. If the intermediary prefers to be paid by cheque, then the payment will be made within 60 days of the total amount of commission due exceeding In the event of cancellation of the cover, leading to a refund in whole or in part, the intermediary will be liable to repay such proportion of the commission paid equal to the proportion of the premium refunded. 15. CANCELLATIONS Cancellation of cover will be accepted upon receipt of written instructions from the intermediary. Any refund of the annual premium paid will be calculated from the date cancellation instructions are received. Only in exceptional circumstances will backdating of cancellation be allowed. Notices of Cancellation should be forwarded in writing to AmTrust Life at Lloyds, 1 Great Tower Street, London, EC3R 5AA or via to life@amtrust.com 16. DOCUMENTATION We will issue policy documentation once we have the premium. Any members whom have yet to be underwritten will usually be restricted or excluded depending on their circumstances. Underwriters may agree to hold full cover in some circumstances. 17. CONTRACTS (Rights of Third Parties) ACT 1999 AmTrust Life policy provides that members do not have any rights under the Contracts (Rights of Third Parties) Act This means that there is no requirement to involve members in day to day decisions on the administration of these schemes. No other party shall be entitled to any rights under the contracts (Rights of Third Parties) Act 1999 as a result of any statement in this technical guide. 18. ON RISK REQUIREMENTS: The following will be required before a Group Life Scheme can be set up with us: 1. Quotation Request 2. On risk Instruction from the Intermediary (we can hold cover for up to 30 days, without receipt of any forms). 3. Group Life Proposal Form 4. Underwriting Requirements, if any, 5. The Premium. Page 10 of 10