Term Life Policy Wording

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1 Term Life Policy Wording

2 Term Life Policy Wording 1. Your Policy important 2. About the Policy 3. Policy Definitions 4. What you are insured for 5. Other Terms and Conditions 6. Policy Exclusions 7. How to make a claim

3 1. Your Policy important This booklet contains the terms and conditions that apply to your Term Life Policy. Together with your original application and the Policy Schedule, it forms the basis of the contract between you (as the Policy Owner) and the insurer, CIGNA Life Insurance New Zealand Limited (CIGNA). Please make sure that the Policy meets your requirements, and if you have any questions or want further information, do not hesitate to contact CIGNA directly. We rely on your information to issue your Policy and pay any claim. You have a duty to disclose to us every matter that you know, or could reasonably be expected to know, that is relevant to our decision whether to accept the risk of the insurance and, if so, on what terms. You have the same duty to disclose this information to us before you upgrade, vary or reinstate your insurance. If you re not absolutely truthful or if you fail to disclose all relevant Information to us, we may cancel your Policy and retain some or all of the premiums paid. If you decide that you do not wish to continue with the Policy, you must notify CIGNA within 30 days of receiving it. Any premiums that you have paid will be refunded and CIGNA will confirm in writing to you that the Policy has been cancelled.

4 2. About the Policy This Policy is designed to pay a lump sum upon the death of the Life Insured or upon diagnosis of a Terminal Illness, or if selected, upon a Life Insured suffering a covered Trauma condition or event. Providing the Policy Owner continues to pay the premiums, the Policy will continue until the Life Insured dies. The Policy is underwritten by CIGNA Life Insurance New Zealand Limited (CIGNA) who will be responsible for all claims and other matters relating to this Policy. CIGNA s contact details are on the back page of this booklet. All correspondence will be sent to the most recent address that CIGNA holds on record for you. If you change your address, it is your responsibility to notify CIGNA. Meanings of important and frequently used words and terms are set out under section 3. GE Money This Policy has been arranged by GE Money who receive a commission whilst this Policy remains in force. GE Money does not guarantee the obligations of CIGNA and will not be liable if CIGNA refuses to pay a claim.

5 3. Policy Definitions The following words and terms appear in the Policy Schedule and/or in the Policy Wording. They are defined as: Accidental Injury means bodily injury, occurring after the Cover Start Date, which occurs solely, directly and independently of any other cause by violent, unexpected, external and visible means. Anniversary Date means the date 12 months after the Cover Start Date and the same date every year after that. Cooling Off Period is a 30 day Cooling Off Period in which the Policy Owner may cancel this Policy by advising CIGNA. CIGNA will refund any premiums paid within the Cooling Off Period and will provide written confirmation that this Policy has been cancelled. Cover Start Date is shown on the Policy Schedule and means the date that the cover began. Diplegia means complete and permanent loss of function on corresponding parts of both sides of the body. Expiry Date is shown on the Policy Schedule and means the date that the Trauma Benefit will end. Hemiplegia means complete and permanent loss of motor function on one side of the body. Life Insured means the person named on the Policy Schedule. Material Information means all relevant information that CIGNA needed when it decided the terms relating to your Policy. It includes, but is not limited to, information about your health and medical history, occupation and leisure activities. Medically Acquired HIV means the Life Insured s accidental infection with the Human Immuno-deficiency Virus (HIV) resulting from one of the following medically necessary events performed in New Zealand or Australia by a recognised and registered health professional: a transfusion of blood or blood products; or organ transplant; or assisted reproductive techniques; or a medical procedure or operation performed by a medical practitioner.

6 Notification and proof of the incident will be required in the form of a statement from a District Health Board or equivalent body confirming that the infection was medically acquired. Occupationally Acquired HIV means that the Life Insured s infection with HIV was acquired as a result of: an accident arising out of your normal occupation or a malicious act of another person or persons arising out of your occupation; and sero-conversion to HIV occurring within 6 months of the accident or malicious act. Any incident giving rise to a potential claim must be: reported to the relevant authority or employer within 7 days of the incident; and reported to CIGNA with proof of the incident within 7 days of the incident; and supported by a negative HIV Antibody test taken within 7 days of the incident. Paraplegia means complete and permanent loss of function in the lower extremities and lower portions of the trunk. Policy means the terms and conditions applying to this insurance, as described in the Policy Wording and the Policy Schedule. Policy Owner means the person(s) initially named on the Policy Schedule or the Assignee(s) named on the memorandum of transfer if the Policy has been assigned. Premium Start Date is shown on the Policy Schedule and means the date that the first premium is due. Significant Life Event applies to any of the following events: a decision by the Life Insured to permanently live with someone in the nature of marriage or civil union; or the purchase by the Life Insured of an owner occupied dwelling over which a new loan is secured; or the birth or adoption of the Life Insured s first child.

7 Survival Period means that you survive at least 14 days after the later of the following: diagnosis of the covered Trauma condition or event; or undergoing a surgical procedure that is necessitated by a covered condition or event; or undergoing a covered surgical procedure. If you are on a life support system for more than 3 days during these 14 days, the period that you must survive will extend by one day for each day (beyond 3 days) that you remain on life support. Terminal Illness means an illness that CIGNA believes will result in the death of the Life Insured within 12 months of the Policy Owner applying for a Terminal Illness Benefit. The illness must commence after the Cover Start Date and be diagnosed while the Policy is in force. This illness must be supported by written diagnosis and prognosis by two unaffiliated registered medical practitioners. Terrorism means the use or threatened use of force or violence against person or property, or the commission of an act dangerous to human life or property, or the commission of an act that interferes with or disrupts an electronic or communication system, undertaken by any person or group, whether or not acting on behalf of or in any connection with any organisation, government, power, authority or military force, when the intent is to intimidate, coerce or harm a government, the civilian population or any segment thereof, or to disrupt any segment of the economy. Tetraplegia (Quadriplegia) means complete and permanent loss of motor function in all four limbs. Trauma means any of the defined conditions or events set out in section 4 of this Policy. War means any warlike activities, whether declared or not, including use of military force by any sovereign nation to achieve economic, geographic, nationalistic, political, racial or religious ends.

8 4. What you are insured for CIGNA s Insurance Promise Providing the terms and conditions are met and the premiums are up to date, CIGNA will pay the Policy Owner the benefits as detailed in this section of the Policy. Where a covered condition or event falls under both the Terminal Illness Benefit and the Trauma Benefit, any payment made will be for only one of these benefits whichever benefit provides the greater sum insured. Term Life Benefit If the Life Insured dies, CIGNA will pay the current Term Life sum insured. When a claim for Trauma and/or Terminal Illness has been paid, CIGNA will deduct any payment already made from the sum insured and the premiums will be adjusted accordingly. Bereavement Benefit If the Life Insured dies, CIGNA will pay an immediate Bereavement Benefit equal to the lesser of $10,000 or 5% of the current sum insured, on receipt of satisfactory written evidence of the Life Insured s death. Any payment made under the Bereavement Benefit will reduce the sum insured of the Term Life Benefit. This will be payable if CIGNA accepts a Term Life Benefit claim. If a Bereavement Benefit has been paid and CIGNA subsequently declines a claim for a Term Life Benefit, then CIGNA may seek recovery of the amount paid. Terminal Illness Benefit If the Life Insured is diagnosed with a Terminal Illness, CIGNA will make an early payment of the Term Life Benefit up to a maximum of $500,000. If CIGNA pays a Terminal Illness Benefit equal to the current Term Life sum insured the Policy will end and no further claims will be payable.

9 If the Terminal Illness Benefit paid is less than the current Term Life sum insured this will be reduced by the amount paid. The remaining Term Life sum insured will be payable following the death of the Life Insured and premiums for the remaining Term Life Benefit will adjust to reflect the reduced sum insured. Trauma Benefit If this benefit has been selected and the Life Insured suffers from one of the following conditions prior to the Anniversary Date following the Life Insured s 65th birthday, CIGNA will pay a benefit as outlined below. Angioplasty If the Life Insured undergoes Coronary Artery Angioplasty, 90 or more days after the Cover Start Date and the Survival Period is reached, CIGNA will pay 20% of the current Trauma Benefit sum insured, or $20,000, whichever is the lesser. This benefit will only be payable if Angioplasty is the first covered Trauma condition or event that is being claimed for. Any payment made for Angioplasty will reduce the Trauma Benefit sum insured and the Term Life Benefit sum insured. Premium for the remaining cover will be adjusted to reflect the reduced sum insured. Angioplasty means the first undergoing of a medically necessary coronary angioplasty to overcome arterial narrowing or obstruction regardless of whether or not a stent is inserted. Cancer If the Life Insured is diagnosed with Cancer as defined here, 90 or more days after the Cover Start Date and the Survival Period is reached, CIGNA will pay the full current Trauma Benefit sum insured and cover under the Trauma Benefit will stop. The Term Life Benefit sum insured will reduce by the amount paid under this benefit and the premium for the remaining cover will be adjusted to reflect the reduced sum insured. Cancer means the presence of one or more malignant tumours. The malignant tumour is to be characterised by the uncontrolled growth and spread of malignant

10 cells and the invasion and destruction of normal tissue for which major interventionist treatment or surgery (excluding endoscopic procedures alone) is considered medically necessary. The following conditions are specifically excluded under this section of the Policy: all cancers which are histologically described as pre-malignant, non-invasive, carcinoma in situ except as otherwise specifically detailed in this section of the Policy; malignant melanomas of less than 1.5mm maximum thickness as determined by histological examination using the Breslow method; all other skin cancers unless there is evidence of metastases; papillary micro-carcinoma of the bladder; chronic lymphocytic leukaemia less than Rai Stage 3; cancers associated with Acquired Immune Deficiency Syndrome (AIDS) or the Human Immunodeficiency Virus (HIV), unless they are the result of Medically or Occupationally Acquired HIV. Carcinoma in situ of the breast is covered under this section of the Policy where it leads to the removal of the breast by a mastectomy. The procedure must be: performed as a direct result of the carcinoma in situ; and specifically to arrest the spread of malignancy; and medically considered the necessary and appropriate treatment. Chronic Kidney Failure If you suffer Chronic Kidney Failure, 90 or more days after the Cover Start Date and the Survival Period is reached, CIGNA will pay the full current Trauma Benefit sum insured and cover under the Trauma Benefit will stop. The Term Life Benefit sum insured will reduce by the amount paid under this benefit and the premium for the remaining cover will be adjusted to reflect the reduced sum insured. Chronic Kidney Failure means end stage renal disease with permanent and irreversible loss of function of both kidneys, which requires permanent dialysis or kidney transplantation.

11 Coronary Artery Bypass Surgery If you undergo Coronary Artery Bypass Surgery, 90 or more days after the Cover Start Date and the Survival Period is reached, CIGNA will pay the full current Trauma Benefit sum insured and cover under the Trauma Benefit will stop. The Term Life Benefit sum insured will reduce by the amount paid under this benefit and the premium for the remaining cover will be adjusted to reflect the reduced sum insured. Coronary Artery Bypass Surgery means the first undergoing of open heart surgical grafting of a bypass to a coronary artery to overcome narrowing or obstruction. Heart Attack If you suffer a Heart Attack, 90 or more days after the Cover Start Date and the Survival Period is reached, CIGNA will pay the full current Trauma Benefit sum insured and cover under the Trauma Benefit will stop. The Term Life Benefit sum insured will reduce by the amount paid under this benefit and the premium for the remaining cover will be adjusted to reflect the reduced sum insured. Heart Attack means diagnosis of the death of a portion of heart muscle arising from inadequate blood supply to the relevant area. The diagnosis must be supported by the following criteria being present, and consistent with a Heart Attack: confirmatory new electrocardiogram (ECG) changes; and diagnostic elevation of cardiac enzyme CK-MB or an elevation of Troponin of 5 times the upper limit of normal. Other causes of severe non-cardiac chest pain, heart failure and angina are specifically excluded. Loss of Limbs If you suffer a Loss of Limbs as a result of an Accidental Injury and the Survival Period is reached, CIGNA will pay the full current Trauma Benefit sum insured and cover under the Trauma Benefit will stop.

12 The Term Life Benefit sum insured will reduce by the amount paid under this benefit and the premium for the remaining cover will be adjusted to reflect the reduced sum insured. Loss of Limbs means the loss by physical separation or the total and permanent loss of all use of: both hands; or both feet; or one hand and one foot. Major Organ Transplant If you are the recipient of a Major Organ Transplant, 90 or more days after the Cover Start Date and the Survival Period is reached, CIGNA will pay the full current Trauma Benefit sum insured and cover under the Trauma Benefit will stop. The Term Life Benefit sum insured will reduce by the amount paid under this benefit and the premium for the remaining cover will be adjusted to reflect the reduced sum insured. Major Organ Transplant means the actual undergoing, as a recipient, of a medically necessary transplant of the heart, one or both lungs, liver, one or both kidneys, pancreas or bone marrow. The transplant of all other organs or any other tissue transplant, or transplantation of isolated pancreatic islets, is excluded. Paralysis If you are diagnosed with Paralysis and the Survival Period is reached, CIGNA will pay the full current Trauma Benefit sum insured and cover under the Trauma Benefit will stop. The Term Life Benefit sum insured will reduce by the amount paid under this benefit and the premium for the remaining cover will be adjusted to reflect the reduced sum insured. Paralysis means Diplegia; or Hemiplegia; or Paraplegia; or Tetraplegia (Quadriplegia).

13 Stroke If you suffer a Stroke, 90 or more days after the Cover Start Date and the Survival Period is reached, CIGNA will pay the full current Trauma Benefit sum insured and cover under the Trauma Benefit will stop. The Term Life Benefit sum insured will reduce by the amount paid under this benefit and the premium for the remaining cover will be adjusted to reflect the reduced sum insured. Stroke means diagnosis of a cerebrovascular accident or event producing a permanent neurological deficit lasting more than 24 hours. A consultant neurologist must produce clear evidence: of infarction of brain tissue, by thrombosis, haemorrhage or embolisation from an extracranial source; and on a CT, MRI or similar scan that a stroke has occurred; and of the onset of objective neurological deficit. The following are specifically excluded: transient ischaemic attacks (TIAs); cerebral events due to reversible neurological deficits; vascular accidents affecting solely the eyes; neurological deficits due to migraines, hypoxia or trauma, physical head injury, or any blood vessel outside the cranium except embolism resulting in Stroke.

14 5. Other Terms and Conditions Policy Increases Term Life Benefit If the Term Life Benefit sum insured has been increased within the 13 months prior to the Life Insured s death from suicide, attempted suicide or intentional self injury, whether sane or insane, CIGNA will only pay the Term Life Benefit sum insured that applied prior to the increase. Trauma Benefit If the Trauma Benefit sum insured under this Policy is increased and then, within 90 days of the date of the increase, you suffer from or develop symptoms of a covered condition or event for the first time, CIGNA will only pay the Sum Insured that applied prior to the increase. Significant Life Event Insurability Option If the Policy Owner is eligible to exercise the Significant Life Event Insurability Option then, upon a Significant Life Event occurring after the Cover Start Date, the Policy Owner may apply to CIGNA to increase the Term Life Benefit sum insured under this Policy without the need for further medical evidence. CIGNA will only accept an application to increase the Term Life Benefit sum insured if: the Life Insured is under the age of 55 at the date the Policy Owner applies for an increase; and the Policy is not subject to any existing underwriting special terms due to the Life Insured s health or lifestyle (such as an increased premium or policy exclusion). Any application to increase the Term Life Benefit sum insured must be in writing prior to the later of: 60 days after the occurrence of the Significant Life Event; and 30 days after the Anniversary Date immediately following the occurrence of the Significant Life Event.

15 The application must be accompanied by documentation satisfactory to CIGNA to support the occurrence of a Significant Life Event. The Policy Owner may apply to increase the Term Life Benefit sum insured each time a Significant Life Event occurs subject to the following restrictions: each increase is limited to a maximum of 25% of the original Term Life Benefit sum insured; the total of all increases during the term of this Policy may not exceed $75,000; only one increase may be exercised in respect of any 12 month period; and exercise of this option may not increase the total sum insured beyond 150% of the original sum insured. Indexation To help keep the cover up to date with inflation, CIGNA may offer the Policy Owner a yearly increase of up to a maximum of 7.5% on each Anniversary Date. The Policy Owner does not have to accept an increase but no further increases will be offered if: 3 offers have been declined; or an offer to increase will lead to the sum insured exceeding $1,000,000; or CIGNA has been notified of a possible claim under this Policy; or once the Anniversary Date after the Life Insured s 60th birthday has been reached. Premiums The initial premium payable is shown on the Policy Schedule. From the first Anniversary Date, the premium amount will adjust each year until the Policy stops. The premium payable is based in part on the sum insured. Therefore: if the cover has increased as a result of indexation the premium will increase accordingly; and is the cover has decreased because CIGNA has paid a Terminal Illness or Trauma claim the premium will decrease accordingly.

16 If the Policy is adjusted for indexation CIGNA will advise the Policy Owner of the new premium for the coming year. If the Policy Owner cancels the Policy after the Cooling Off Period there will be no refund of premiums unless you have paid an annual, biannual or quarterly premium, in which case your refund will be calculated on a pro rata basis for the cover paid in advance. The Policy Owner can apply at any time to change the method and frequency of the premium payments. Policy Changes CIGNA may review and change any of the terms and conditions, including the premium rate for all Policies issued. CIGNA will notify the Policy Owner in writing at least 90 days before any change takes effect. Renewal after Age 76 From the Anniversary Date after the Life Insured s 76th birthday, CIGNA will renew the cover every year and cover will continue providing premiums continue to be paid. Cover will continue until the Policy ends as detailed below. When the Policy stops The Policy will stop when any one of the following happens: if the premiums remain unpaid for 3 months, in which case cover will end on the date the last premium was paid up to; or the Policy Owner requests that CIGNA cancels this Policy; or the Life Insured dies; or CIGNA pays a Terminal Illness Benefit equal to the sum insured. Cover under the Trauma Benefit will stop when the earlier of the following occurs: CIGNA has paid the full Trauma Benefit sum insured; or the Anniversary Date immediately following the Life Insured s 65th birthday is reached.

17 Policy Reinstatement If this Policy is stopped due to unpaid premiums, the Policy Owner can apply to CIGNA for it to be reinstated. The Policy Owner will need to provide CIGNA with any information it requires about the Life Insured s health and lifestyle and reinstatement is at CIGNA s discretion. The terms and conditions applying to the reinstated cover may be different from those applying to the Policy before it was stopped, and the Policy Owner will be issued with a new Policy Schedule. Disputes If you have a complaint, in the first instance you should contact CIGNA to discuss it. Refer to the Contacts section for the details. This will initiate CIGNA s internal complaints resolution process. CIGNA is a member of the Insurance and Savings Ombudsman scheme which is a free, independent service that can help settle any unresolved disputes you may have. Any dispute or action relating to this Policy will be determined in accordance with New Zealand law. Policy Value This Policy does not have any surrender or cash value. Policy Ownership The Policy Owner is either the person initially named on the Policy Schedule or the assignee(s) if the Policy Owner later assigns this Policy. In order to assign this Policy, the current Policy Owner must complete a Memorandum of Transfer. To be legally recognised, CIGNA must have registered the transfer.

18 6. Policy Exclusions CIGNA will not pay any Trauma, Terminal Illness or Term Life Benefit under this Policy if: the Policy Owner or Life Insured did not completely and truthfully answer the questions asked when the Policy was issued, upgraded or reinstated. In this event CIGNA may cancel the Policy from the Cover Start Date and keep any premiums paid; or the Policy Owner or Life Insured failed to provide CIGNA with any Material Information before the Policy was issued, upgraded or reinstated. In this event CIGNA may cancel the Policy from the Cover Start Date and keep any premiums paid; or where the covered condition or event is caused or contributed to by War or any act of War, invasion, Terrorism or any acts of Terrorism, act of foreign enemy, hostilities, strike, riot and/or civil commotion, civil War, rebellion, revolution, insurrection, military or usurped power. Trauma Benefit CIGNA will not pay a Trauma Benefit if the condition or event is caused directly or indirectly result of: any Trauma condition or event that the Life Insured or Policy Owner did not disclose in the application for insurance and which, prior to Cover Start Date, medical advice or treatment was recommended or given to the Life Insured by a registered medical practitioner, or symptoms existed which would cause a reasonable person to seek diagnosis, care or treatment from a registered medical practitioner; or attempted suicide or intentional self-injury, whether sane or insane; or infection with AIDS, AIDS Related Complex (ARC) or HIV, other than Medically or Occupationally Acquired HIV. Additionally, CIGNA will not pay a Trauma Benefit if the condition or event or symptoms of the condition existed, or first occurred, within 90 days of the Cover Start Date, or the date of any subsequent increase in cover. However, this exclusion does not apply to cover for Loss of Limbs or Paralysis.

19 Term Life Benefit CIGNA will not pay any benefit if the Life Insured s death is caused or contributed to, directly or indirectly, by suicide, attempted suicide or intentional self-injury, whether sane or insane, within the first 13 months of the Cover Start Date.

20 7. How to make a claim If the Policy Owner needs to make a claim against this Policy, please contact CIGNA as soon as possible to request a claim form. The claim form will be sent out within 24 hours of the request. The Policy Owner must complete the claim form and return it to CIGNA together with any supporting documents that CIGNA may reasonably require. CIGNA s medical advisers must agree that the condition or event for which you are claiming meets the definition outlined in the Policy Wording. Any medical information required to support a Term Life, Trauma or Terminal Illness Benefit claim must be: provided by appropriately qualified medical practitioners registered in New Zealand or Australia (or any other country approved by CIGNA); and paid for by the Policy Owner. If CIGNA requires the Life Insured to undergo any further examinations or tests to confirm that the Life Insured is suffering a Terminal Illness or a covered Trauma condition or event, these costs will be met by CIGNA.

21 About CIGNA CIGNA Corporation, based in Philadelphia USA, is one of the world s largest life and health insurance companies. It is a Fortune 500 company and manages total assets exceeding US$17.8 billion. The company originally started over 200 years ago and now operates in 25 countries around the world, with a strong presence in the Asia Pacific region. CIGNA NZ currently protects over 275,000 Kiwis and has been operating in New Zealand since 1968.

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24 Contact CIGNA By phone By for general information about your Policy, including premiums, address changes etc. to register a complaint to request a claim form or ask any questions related to a claim By letter CIGNA Life Insurance PO Box Wellington 6142 By fax A copy of CIGNA s latest financial statements is available on request. CIG351 10/03/1802/01

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