Group Income Protection. Technical Guide

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1 Group Income Protection Technica Guide

2 Aviva By choosing Aviva, part of the UK s argest insurance group, you benefit from our financia strength. Together with miions of customers wordwide you can fee certain of your choice whether you invest for the future, provide against the unexpected, or protect the things that are important to you. Our size and efficiency give us the strength to deiver an extensive range of vaue for money, quaity products investments, retirement, protection and heathcare designed to meet your needs, both now and in the future. This Technica Guide has been produced based on the standard format recommended by the Group Risk Deveopment group (GRiD) and The Association of British Insurers (ABI). This Technica Guide wi te you the main features and benefits about our Group Income Protection poicies. It shoud be read aongside the iustration with which it was issued. It does not form part of the poicy contract. Fu detais of the contract terms can be found in the Poicy Wording which is avaiabe at aviva-for-advisers.co.uk 2 Group Income Protection Technica Guide

3 Contents Section Poicy aims 4 Your commitment 4 Risk factors 4 Your questions answered 5 1 How does the poicy work? 5 2 What factors shoud be considered in deciding what benefits to provide? Who can be covered? Can cover be provided for members who are not in the UK? Are members covered whist on maternity or paternity eave? Can cover be provided for members that are on a sabbatica? What are the eigibiity conditions? Can different Group Income Protection poicies be inked? What are the requirements to be activey at work When wi cover stop for a member? What types of cover are avaiabe? What types of benefits wi be paid? When wi benefit payments start? For how ong wi benefits be paid? Can benefit payments be infation protected? 7 3 How is the poicy set up? What do we need to set up the poicy? Does any evidence of heath have to be provided before members are covered for their fu benefit? What if a caim happens before an underwriting decision has been made? 8 4 What premiums wi be charged for the cover? How wi premiums be cacuated? Wi there be any unexpected extra premiums? What commission is incuded? Is there a discount for good caims experience? 9 5 How does the poicy accounting work? What information is needed for accounting purposes? How are accounts adjusted for members who join, eave or have benefit increases during the poicy year? What happens to premiums if the poicy is canceed mid-year? 10 6 How are caims made? How are caims submitted? What might be needed to assess a caim? When is a caim paid? Can rehabiitation hep? For how ong wi the benefit be paid? If a member returns to work after a caim, can another caim be made for that member if the incapacity is from a different cause? Does other income the member receives affect the benefit from this poicy? 12 7 When can the poicy be canceed? Does the poicy have a surrender vaue? If the poicy is canceed during the poicy year (not at the anniversary date) wi you refund any premiums paid in advance? 12 8 What is not covered? 12 9 What are the tax considerations? Is there a continuation option? How might auto enroment affect the poicy? 13 Further information 14 Definitions 15 Page 3 Group Income Protection Technica Guide

4 Pease note Throughout this document certain words are shown in bod type. These are defined terms and have specific meanings when used in this technica guide. The meanings of these words are set out in the Definitions section in the back of this document. Poicy Aims To provide cover for a proportion of reguar income promised in a contract of empoyment, or agreed in a partnership deed, if a member is unabe to work and is suffering oss of earnings because of iness or injury. To provide a reduced repacement of income in proportion to their oss of earnings if, because of iness or injury, a member has to take a part-time or ower paid job. To offer you a choice of how soon and for how ong this income is paid. The option of a ump sum at the end of the imited payment term to hep the empoyer meet the costs invoved in the eary retirement, redundancy, and/or a repacement. Your commitment You agree to inform us straight away: about any discretionary entrants; if you want to change the cover of a category; if you want to change the eigibiity criteria for membership; or about any caims. You agree to: pay premiums when requested or as agreed; and compy with the terms and conditions of the poicy You aso agree to provide us with a of the information we need: when you appy for the poicy; at anniversary/rate guarantee dates; or when you make a caim; and te us if these detais change. Members must satisfy the activey at work requirements Benefits paid under your poicy may be reduced if the member is receiving other reguar income because of their incapacity. Receiving benefits may affect a member s entitement to some state benefits. Members may not be covered or may have their benefits restricted where reevant medica information is not provided. We recommend that a awyer considers the content of your members contracts for you in ight of this poicy, and any requirements you may have for offering the benefits to your members. Payments of caims may be deayed or rejected if you do not provide the information we ask for. We usuay guarantee the rate(s) and terms for two years after the start date of the poicy. The guarantee and terms may not appy if: the tota saary ro or tota benefit ro that we are covering changes by 25% (50% of the tota benefit ro for poicies with 19 or fewer members) or more. If this happens we reserve the right to cance the poicy; the number of members fas beow five; or there is a change to the benefit basis; eigibiity; nature of business; or companies incuded within the poicy a new empoyer joins or an existing empoyer eaves the poicy; or there is a change to the (or any new) egisation, reguation or taxation affecting the poicy We reserve the right to change the poicy terms and conditions after two years. We wi te you if we do. Risk Factors Cover may stop if you don t compy with poicy terms and conditions or if you stop paying premiums. This wi mean you have no cover in pace with us for future benefits and may resut in an uninsured iabiity. Any benefits aready in payment, and entitement to any benefits that have not aready been paid, wi continue to be paid by us on the terms aready confirmed to you. 4 Group Income Protection Technica Guide

5 Your questions answered 1 How does the poicy work? We wi need at east five peope to be covered under a poicy, and where a ump sum is to be insured the minimum number of ives is 20. You can choose whether to insure a of the empoyees or a category ony and seect the cease age You decide what eve of benefit you need, how soon it wi start and for how ong you need it to be paid, and whether the benefit is to increase each year when a caim is being paid. We provide cover no matter how many vaid caims you make, and in many circumstances continue to admit and pay caims where incapacity started before the poicy was canceed. Empoyers must pay a of the premiums, and the cost is usuay treated for tax purposes as an aowabe business expense. Premiums are not normay taxed as a benefit in kind for empoyees. You te us when iness or injury has stopped or may stop one of the members working. You provide us with the information we need to assess and monitor the vaidity of the caim. We normay pay benefits monthy in arrears from the end of the deferred period to the empoyer, for as ong as the caim is vaid. 2 What factors shoud be considered in deciding what benefits to provide? 2.1 Who can be covered? Empoyees with a current UK contract of empoyment who meet the eigibiity conditions and satisfy the activey at work criteria. If an empoyee is not activey at work on the working day prior to the start date of the poicy, they wi be deemed activey at work once they make a fu and active return to their job roe (with their GP s approva) for one whoe day For previousy uninsured singe premium poicies: If an empoyee is not activey at work on the working day prior to the start date of the poicy, they wi be deemed activey at work once they make a fu and active return to their job roe (with their GP s approva) for five consecutive days 2.2 Can cover be provided for members who are not in the UK? Yes. We are prepared to consider cover to members traveing, working or seconded overseas. However, they wi need a current UK contract of empoyment and we wi need fu detais of any members seconded overseas before we can agree to cover them. Specia terms and conditions may appy. Members are expected to foow the British Foreign & Commonweath Office s trave advice, which can be found at Are members covered whist on maternity or paternity eave? We wi maintain cover whist a member is on maternity or paternity eave, as ong as they remain empoyed with the empoyer or remain as an equity partner. If you need to make a caim for a member on maternity or paternity eave, the deferred period wi start from the date of incapacity, and benefit payments wi start from the ater of the end of the deferred period or the agreed return to work date. 2.4 Can cover be provided for members that are on a sabbatica? We wi maintain cover for a member whist they are on a sabbatica if: the duration of the sabbatica is no onger than 1 year, and a UK contract of empoyment is maintained. If you need to make a caim for a member who is on a sabbatica, the deferred period wi start from the date of incapacity, and benefit payments wi start from either the end of the deferred period or the agreed return to work date, whichever is ater. We wi cacuate the benefit based on the member s earnings at the start of the sabbatica. 2.5 What are the eigibiity conditions? The eigibiity conditions wi need to be agreed and shoud incude: the minimum and maximum entry ages, any service quaifications that appy, the categories of members to be covered, the date that new entrants can join the poicy (for exampe, monthy), and detais of when existing members can increase benefits (for exampe, annuay). If cover is dependant upon membership of a pension scheme, you must te us the pension scheme s current eigibiity terms, aong with the take up rate of eigibe members. Membership must be compusory for a eigibe members within a defined category or categories. Eigibiity conditions covering entry ages, entry dates and deferred periods must be the same for each member within a defined category. 5 Group Income Protection Technica Guide

6 2.6 Can different Group Income Protection poicies be inked? It is possibe to ink different Aviva Group Income Protection poices taken out by you or a parent/subsidiary of you. This wi be for the purpose of sharing the free cover imit and unit rate and is subject to prior agreement by us. 2.7 What are the requirements to be activey at work? Members must be activey at work in addition to the other eigibiity conditions, before they are covered under the poicy. They must be activey at work: at the start of the poicy, the working day prior to the start date, or; for joiners after the start date, the date when eigibe to be admitted to the poicy, or; for benefit increases, the date when eigibe for the increase If the member is not activey at work, we wi not provide cover unti that person has made a fu and active return to their job roe. 2.8 When wi cover stop for a member? You choose the poicy cease age, which can be state pension age (SPA) (maximum age of 68) or any fixed age up to a maximum of 70. If the cease age is currenty either SPA or a fixed age ower than 70, and you want to cover members who choose to work beyond the current cease age up to a maximum age of 70, then the cease age has to increase for the whoe poicy or appicabe category. In addition, members wi need to be activey at work when they reach the current cease age and must not have been absent from work due to iness or injury for five or more consecutive working days in the previous three months. If a member is not activey at work at the current cease age, uness agreed and confirmed in writing by us, they wi be deemed activey at work once they make a fu and active return to their job roe (with their GP s approva) for an uninterrupted period of 20 working days. Cover wi stop when the poicy is canceed, premiums are not paid within 30 days of the due date, or when a member: 2.9 What types of cover are avaiabe? Gross pay poicies You choose the benefits as a percentage of the member s gross earnings before incapacity. You seect the benefit eve depending on your budget, as a percentage of the member s earnings before incapacity. The maximum benefit you can choose is: 80% of gross taxabe earnings for empoyees; or 50% of equity partner earnings. Limited payment term You can choose for benefit payments to be imited to a period of 2,3,4 or 5 years. What can be incuded in the definition of earnings? For an empoyee: An empoyee s annua gross saary or wage from his or her empoyer before the deduction of tax. We can aso incude fuctuating emouments in the definition of earnings, but to cacuate the benefit, we wi use the average of the tota of any fuctuating emouments over the ast 3 years (or such esser period as the empoyee has been in receipt of fuctuating emouments) added to the empoyee s norma annua saary. For an equity partner: The average of the equity partner s earnings from his or her business over the previous three years (or such esser period as the partner has been a partner of the partnership), ess: any amount aowabe against income tax as expenses, where appicabe, and before the deduction of tax. Optiona benefits Empoyer s pension scheme contributions We can cover empoyer s pension scheme contributions either for fixed amounts, or based on a percentage of pensionabe saary, up to a maximum annua amount of 75,000. This means that benefits payabe under the pension poicy can be maintained, provided that the absent empoyee remains in the pension scheme. Empoyer pension contributions paid via saary sacrifice wi be treated as empoyee pension contributions. eaves your service is no onger eigibe for the poicy is no onger empoyed by the empoyer or if an equity partner eaves the partnership reaches the cease age receives a ump sum benefit (if covered) at the end of a imited payment term, or dies. We can aso cover other suppementary benefits that you continue to pay to an incapacitated member such as company car aowances and insurance premiums. However, these wi be incuded within the empoyer pension contributions overa maximum annua amount of 75, Group Income Protection Technica Guide

7 Empoyee s pension scheme contributions Empoyee s pension contributions (incuding pension benefit paid via saary sacrifice) can aso be covered either for fixed amounts or, based on a percentage of pensionabe saary, but wi be incuded within the overa maximum of 80% of earnings up to 425,000. Where empoyee pension contributions are covered and the maximum benefit of 425,000 is exceeded, these wi be reduced to adjust the tota benefit to the maximum amount. Where age or service reated pension contributions are covered, the contribution payabe in the event of a caim wi be the contribution at the date of the member s first absence. We wi not aow increases as a resut of a birthday or a service miestone where this occurs after the first date of absence. Empoyer s nationa insurance contributions The empoyers nationa insurance contributions can aso be insured, and wi be based on the income benefit. For defined benefit pension scheme members, the eve of contributions depends on whether the empoyer is contracted-out of the state pension or not. Lump sum If you have chosen a Limited payment term, you can opt to cover a ump sum of up to 5 times the empoyee s saary or up to 9 times the annua income benefit. The ump sum wi ony be paid if the empoyee continues to meet the definition of incapacity at the end of a imited payment term. We wi not pay a ump sum of more than: 9 times the annua income benefit; or 1.6 miion, whichever is ower. A empoyees in a particuar category must be covered for the same mutipe of saary or income benefit. We wi not pay a ump sum where the period of time between an empoyee s first date of incapacity and the cease age, is ess than the imited payment term pus the deferred period. We wi not pay a ump sum which is higher than the reguar income benefit in payment at the point the ump sum is payabe, mutipied by the number of compete months to the cease age What types of benefits wi be paid? Tota benefit We wi pay tota benefit if: immediatey before the start of incapacity the member was activey at work and foowing their job roe; and after the start of incapacity the member is not foowing any other occupation and the deferred period has finished. Proportionate benefit We wi pay a proportionate benefit; if before incapacity the member was activey at work and foowing their job roe and; if incapacity has asted for at east five consecutive working days; and as a resut of iness of injury the member is either; foowing their job roe on a part-time basis; or foowing any other occupation in either case with a reduction in earnings When wi benefit payments start? Benefit wi be paid once the deferred period has finished. The deferred period starts on the first date of incapacity and can be 13, 26, 28 or 52 weeks. The deferred period wi be shown on your poicy schedue For how ong wi benefits be paid? You choose whether benefits are paid up to the poicy cease age, which can be SPA or any fixed age from 50 to 70, or whether benefit is paid to the earier of the poicy cease age or a imited period of two, three, four or five years. Reducing the benefit payment term reduces the cost of the poicy Can benefit payments be infation protected? Yes. You can choose a caims escaator which wi mean that benefit payments increase whist a caim is being paid: by a fixed percentage of 3% or 5% or; or in ine with the Retai Price Index (RPI) with increases capped at either 2.5 or 5%. The benefits wi increase by the chosen eve after they have been paid for 12 consecutive months. We wi not pay a ump sum to empoyees whose cover is extended beyond the norma poicy cease age. Empoyees on a fixed term contract of ess than four years and equity partners cannot be covered for a ump sum. 7 Group Income Protection Technica Guide

8 3 How is the poicy set up? 3.1 What do we need to set up the poicy? To ensure the premium and quote detais can be confirmed before the poicy starts, we need fu detais of members: gender; dates of birth; saaries, taxabe earnings from a partnership; benefit basis/eve occupations; work ocations; and countries of residence (if outside the UK). We wi aso need fu detais of any: ong term absentees joins within the eigibiity conditions fufis the activey at work conditions is not a discretionary entrant; and joins within 12 months of their eariest opportunity to join. If our medica underwriting requirements are not met for a member who needs underwriting, their benefit wi be restricted to the free cover imit (if any), or previousy accepted benefit (if any), whichever is higher. Medica information wi be required for a discretionary entrant s tota benefit and we wi te the poicyhoder if cover is provided and/or any additiona premiums need to be paid. The free cover imit wi not appy if at any anniversary date there are ess than 5 members covered under the poicy. In such cases we wi need medica information for: previous scheme history; and a new members; previous caims history. If any of these detais or assumptions we have made differs from those on the iustration, the iustration may be revised or withdrawn. To compete the set up of the poicy, we need: a fuy competed appication form a deposit premium or direct debit mandate a competed membership schedue, or confirmation that membership detais shown in the iustration are correct individua detais of any member whose tota benefits are above the free cover imit (shown on the iustration) for existing poicies, written confirmation from the previous insurer that any members above the free cover imit have previousy been underwritten, the amount underwritten, the underwriting decision and the date of acceptance. We agree to start cover whist this information is being provided. If you do not send us everything we need within 30 days of the start of cover, we reserve the right to cance cover and we may not pay any caims that are made whist cover was being agreed. We wi provide cover based on the information in the poicy schedue and set out in the poicy wording. 3.2 Does any evidence of heath have to be provided before members are covered for their fu benefit? Poicies with 5 or more members wi normay be offered a free cover imit. This means that medica information may ony be required for benefits above the free cover imit, provided that the member: has not had any of their benefit previousy decined, restricted (as a resut of incompete medica underwriting), or postponed, by us or any other insurer. existing members if benefits are increased. We wi reappy the free cover imit if the number of members returns to 5 or more. Once Ony medica underwriting For poicies with 20 or more ives, members wi, in most circumstances, ony be medicay underwritten once. Our once ony medica underwriting process can be offered even if specia terms have been appied to individua members. No worse terms For poicies that are currenty insured with another insurer who wish to switch to us on the same basis, we wi not normay appy worse medica underwriting terms than those appied by the previous insurer providing we are given fu information regarding a previousy underwritten members. Members with excusions, oadings or restrictions appied to their benefit by previous insurers wi not benefit from any increase in the free cover imit. 3.3 What if a caim happens before an underwriting decision has been made? We wi provide cover for fu benefits, excuding any pre-existing conditions, for a period of up to 90 days or unti our underwriting decision is made if sooner. Cover wi start from the date of joining the poicy, or the effective date of an increase in benefits. It wi not appy to any member who has previousy had any benefit: decined by us or another insurer postponed by us or another insurer restricted by us or another insurer, or; who has decined to provide fu medica information. 8 Group Income Protection Technica Guide

9 4 What premiums wi be charged for the cover? The premium cacuated depends on severa factors which incude, but are not imited to: the eve of benefits insured the cease age eigibiity and entry conditions annua increase in benefit payments (if any) deferred period the age of members the gender spit of members the tota saary ro or tota benefit ro that we are covering changes by 25% (50% of the tota benefit ro for poicies with 19 or fewer members) or more. If this happens we reserve the right to cance the poicy; or the number of members fas beow five; or there is a change to the (or any new) egisation, reguation or taxation affecting the poicy; there is a change to the: benefit basis; eigibiity; nature of business; or companies incuded within the poicy. occupations of the members ocations of the workforce; and caim history if the poicy has been insured before. A minimum premium of 750 appies and wi be shown on the iustration. A premium payments are to be made in pounds stering. 4.1 How wi premiums be cacuated? Poices with between 5 and 19 members: singe premium basis Premiums wi be cacuated for each member using our current premium rates. These underying rates are usuay guaranteed for two years. We wi cacuate premiums each year, and the rates are dependent upon the age and gender of the members at the anniversary date. Premium rates generay increase with age. We wi aso need to know the amount of benefit needed for each member at the anniversary date. Poicies with 20 members or more: unit rated basis Premiums wi be cacuated on a unit rate: this is usuay shown per 100 of saary at the start date or anniversary date. if the number of members fas beow 20, the premium may be cacuated on a singe premium basis. 4.2 Wi there be any unexpected extra premiums? We usuay guarantee the rate(s) for two years after the start date of the poicy. A new unit rate may appy at the rate guarantee date. We aso reserve the right to change the terms and conditions at the rate guarantee date. 4.3 What commission is incuded? Commission payments to your intermediary (if appicabe) are a percentage of the premium. The iustration wi show the rate of commission we pay on your poicy. 4.4 Is there a discount for good caims experience? Caims experience is a factor in assessing a unit rate and premium for a poicy, so a good caims history wi usuay be refected in the rate and premiums charged. 5 How does the poicy accounting work? The poicy runs on one year accounting periods. The premium must be paid annuay (in advance) by direct debit, cheque or BACS, or haf-yeary, quartery or monthy by direct debit. We wi charge a 1% oading each year to cover our extra administration costs where the premiums are not paid to us on an annua basis. 5.1 What information is needed for accounting purposes? For both singe premium and unit rated poicies a ist of a members wi be required at each anniversary date showing their: name; gender; Premium oadings may be appied for members who have been medicay underwritten. Any oadings wi refect their medica condition or any hazardous pursuits they undertake. These oadings wi appy immediatey but become payabe at the next anniversary date. Terms and conditions We can change the rates, and any other term or condition of the poicy, if: date of birth; saary, earnings or benefit; occupation and work ocation (incuding postcodes); poicy category (if more than one is covered); date of joining (for any new member); ong term absentees 9 Group Income Protection Technica Guide

10 date of eaving for any member who has eft the poicy or are eaving the poicy; and any other reevant information. Six weeks prior to the anniversary date we wi request the information needed to recacuate the premium for the poicy. We wi reguary remind you for this up to 90 days after the anniversary date. If the information needed is not received after 90 days we wi process the recacuation of premium and benefits based on the atest information we hod. This coud resut in an uninsured iabiity. 5.2 How are accounts adjusted for members who join, eave or have benefit increases during the poicy year? Singe premium poicies We wi cacuate a premium adjustment to make sure that we charge the correct premium for the amount and ength of the cover that we actuay provided. Any premium adjustment for peope who join, eave or have changes in benefit wi be payabe at the end of the poicy year. The premium adjustment wi be from the reevant date to the next anniversary date. Where the period is not a compete year, the premiums wi be adjusted accordingy. Unit rate poicies We wi cacuate a premium adjustment based on the average sum insured for a members of the poicy during the previous year. What this means is that the saary and staff changes are treated as if they happened midway through the poicy year. Any premium adjustment for members who join, eave or have changes in benefit wi be payabe at the end of the poicy year. 5.3 What happens to premiums if the poicy is canceed mid-year? We wi produce a fina account based on the cover we provided up to the date you cance the poicy. We wi pay you a refund if you have made any overpayments or request payment for any premiums due. 6 How are caims made? If you need to make a caim you must give us written notice as soon as possibe, either: before the period of incapacity has asted two months; or for deferred periods of 13 weeks, before incapacity has asted one month. If you do not te us about a caim within these time imits, benefits that were due before we were tod wi not be backdated to the end of the deferred period. If you don t te us about a caim within six months from the end of the deferred period we may not accept the caim. 6.1 How are caims submitted? We wi need fuy competed empoyer and empoyee caim forms to be sent to us. These are avaiabe at or by contacting our caims team by emai at or by caing What might be needed to assess a caim? In addition to the empoyer and empoyee caim forms, we wi aso need evidence of the member s medica condition, incuding: its severity, how ong it has existed, and how it affects them. We wi aso need to know that they are continuing to receive medica advice and treatment when appropriate. We may aso ask for: evidence that the member is covered under the poicy detais of the member s insured job duties and earnings the member s passport, drivers icence with photo or birth certificate detais of any other income which the member is entited to during incapacity. If we ask for a medica report or tests, we wi pay for them (different arrangements may appy in the case of members based overseas). The member must take reasonabe steps to assist in their recovery. This incudes aowing access by disabiity counseors and/or advisers appointed by us. If you make a caim for a member who is based overseas, or if a member who was based in the UK at the start of incapacity or when benefit payment started subsequenty moves overseas, we wi ony consider paying benefit if we can obtain satisfactory medica evidence in Engish. We wi not be responsibe for any costs incurred in transation. To assess their incapacity, we may need a member who is based overseas to go for a medica examination or test(s). If we do, we wi pay an amount towards the cost of the examination or test(s) up to the amount of an equivaent cost in the UK. If we have agreed to pay any benefits directy to a member, these wi be paid to the member in the pounds stering, and into a UK bank account in the member s name. If, due to the deay in teing us, we are unabe to confirm incapacity or if our abiity to intervene has been compromised, payment of benefit may be affected. 10 Group Income Protection Technica Guide

11 6.3 When is a caim paid? We wi pay benefit when a member satisfies the definition of incapacity, and their incapacity asts beyond the end of the deferred period. The definition of incapacity wi be stated in the poicy schedue. 6.4 Can rehabiitation hep? You can hep minimise the costs of incapacity to your organisation by ensuring that rehabiitation and reintegration programmes are investigated and used wherever appropriate. Working conditions, physica features and other arrangements can often be adjusted quite reasonaby so that an i or injured person can continue to work. Our medica staff, caims visitors and caims assessors can work with you and your medica advisers to draw a this information together so that the caims process runs as smoothy as possibe. How wi rehabiitation work for ump sum benefits? If the member who is caiming is covered for a ump sum, they must participate in the treatment or rehabiitation programme proposed by a reevant medica practitioner, uness medica evidence proves that they are unabe to do so. Faiure to participate in the treatment or rehabiitation programme may mean that we wi not pay the ump sum. 6.5 For how ong wi the benefit be paid? We wi pay benefit unti: the end of incapacity, the imited payment term is competed, the member reaches the cease age, Where we do pay benefit directy to a member, any pension, suppementary and nationa insurance benefits wi stop. What happens to members that have short term contracts? Any member who is receiving benefit and has a fixed term contract of ess than four years wi ony be eigibe for benefit for the remainder of the current contract period (if any), whether this is extended or not. What happens if the member s iness or injury means that the member is working on a part-time basis, or in a ower paid job? We wi cover members for a proportionate benefit. This is a benefit that is paid in proportion to the reduction in their earnings, with an aowance for infation. What happens if a member receiving benefit is dismissed? If you remove a member from your payro who is caiming benefit, we wi consider at our reasonabe discretion paying benefit to that member where: you have requested us to do so, and you have been eigibe to receive benefit for that person under this poicy for a continuous period of more than six months before removing that empoyee from the payro. Any pension, suppementary and nationa insurance benefits wi stop. Where we pay the benefit to a member directy, and the definition of incapacity is A, this wi change to definition B (pease see the definition of incapacity). We wi not pay a ump sum at the end of the imited payment term where we have been paying the benefit directy to a member. the member eaves service, the member reaches the age at which they panned to retire, the member is remanded in custody (the benefit wi be retrospectivey paid if the member is not convicted of the offence) or receives a custodia sentence, the member is no onger eigibe for benefit or ceases to be a member; or the member reaches the end of a fixed term contract of ess than four years; or What happens to caims if the poicy is canceed? You may cance the poicy at any time, but a caims in payment at that time wi continue in ine with the terms and conditions of the poicy. Aso, new caims wi be considered, as ong as incapacity started before the date the poicy was canceed and that a premiums due were paid up to that date. If we cance the poicy due to non-payment of premiums, new caims wi ony be considered up to the date the ast premium covered. Caims in payment at that time wi continue in ine with the terms and conditions of the poicy. the member dies, whichever is sooner. If you stop trading (due to insovency or otherwise) we wi consider making continued benefit payments direct to members who are in caim, subject to: agreement between you, the member and us at that time obtaining consents and further documentation as we may reasonaby require; and What happens to a caim if the member eaves the company under TUPE? If an empoyee who is eigibe for benefit transfers to a different empoyer under TUPE we wi: pay the benefit to the new empoyer under the same terms and conditions, and treat the caim as if there had been no break in empoyment, subject to the competion of reevant documents that we require. taxation rues at the time of payment. 11 Group Income Protection Technica Guide

12 6.6 If a member returns to work after a caim, can another caim be made? Yes, as ong as we haven t paid a ump sum for that member. What happens if incapacity is from the same cause? If we have aready paid benefit for a member, and they then suffer from the same cause of incapacity within 12 months of their ast benefit payment, we wi not re-appy the deferred period. This is known as a inked caim. What happens if incapacity is from a different cause? If we have aready paid benefit for a member, and they then suffer from a different cause of incapacity (asting at east 30 consecutive days) within 12 months of their ast benefit payment, we wi not re-appy the deferred period. This is known as a inked caim. This aso appies where the poicy has been canceed, uness the former member is eigibe for, and is receiving benefit for incapacity (other than state benefit) from another source. For imited payment terms we wi ony ink the caim if the member suffers from the same cause of incapacity. 6.7 Does other income the member receives affect the benefit from this poicy? The poicy is designed to ensure that members do not receive a greater income than they received when working. The maximum income benefit we wi pay is the esser of: the income benefit stated in your poicy schedue or; 80% of gross taxabe earnings up to a maximum annua amount of 425, % of equity partner earnings for equity partners If any other benefits (apart from state benefit) are payabe during or as a resut of incapacity, we wi deduct these amounts from the maximum amount of income benefit payabe. Some of the other types of income that we wi take into account incude: continuing income from an empoyer (such as occupationa sick pay) income from a pension first paid after incapacity, excuding any ump sum payment taken from the pension continuing income from a partnership reguar income from other insurance poicies (uness the maximum benefit payment period of those poicies is 2 years or ess) incuding: income protection/permanent heath insurance mortgage payment protection oan protection. Payments from Group Income Protection may aso affect a member s entitement to means tested state benefits. 7 When can the poicy be canceed? The poicy wi be canceed if you do not pay the premium within 30 days of when it is due. Subject to our requirements, we may reinstate cover if the premium is subsequenty paid within 30 days after the 30 days foowing the due date.. This wi be subject to prospective members being activey at work on the working day prior to the reinstatement date. If a member is not activey at work on the working day prior to the reinstatement date, they wi be deemed activey at work once they make a fu and active return to their norma occupation (with their GP s approva) for one whoe day. There is no cooing off period and you may cance the poicy at any time. Cover for a benefits under the poicy wi stop on the agreed date, and a premium wi be due for the time on cover. We aso reserve the right to cance the poicy if you do not give us the information and documentation that we need to administer the poicy or if the number of members covered drops beow 5. Sanction Checking In order for us to hep manage our exposure to the risk of financia crime, we wi, from time to time, undertake a sanction check of the company, its directors and its utimate parent company as we as the country in which the company/ utimate parent company is based. If, as a resut of our investigations we reasonaby beieve that providing a group protection contract woud pace Aviva at a high risk to exposure of financia crime, we wi reserve the right to cance or amend the poicy as appropriate. 7.1 Does the poicy have a surrender vaue? There is no surrender vaue if the poicy is canceed and we wi not backdate canceations. 7.2 If the poicy is canceed during the poicy year (not at the anniversary date) wi you refund any premiums paid in advance? Yes. We wi produce a fina account based on the cover we provided up to the date when you canceed the poicy and the appropriate refund wi be paid. 8 What is not covered? There are no excusions under this poicy. However, excusions may be appied to member s benefits that are above the free cover imit or subject to discretionary entrant terms. 9 What are the tax considerations? A references to taxation are based on our understanding of current tax aw and HM Revenue and Customs (HMRC) practice. Tax aw and practices coud change in the future. You shoud get professiona advice from your own tax advisers. 12 Group Income Protection Technica Guide

13 Empoyee poicies The poicy is paid for by an empoyer with no contribution from empoyees. Benefits are payabe as saary continuance. In this situation the cost to the empoyer is normay aowed as a trading expense and benefits are normay taxed under the PAYE system. HMRC does not normay aow tax reief on premiums paid for any poicy members who have any ownership rights in the company. However, they may sometimes aow tax reief if a high number of other empoyees are entited to simiar benefits. You shoud seek carification of the tax position from your oca Inspector of Taxes. Partnerships Under current HMRC practice, benefit payabe to equity partners wi not be taxed. The cost of premiums for equity partners is not an aowabe expense. Premiums and benefits for empoyees of a partnership wi be treated in the same way as under an empoyee poicy. 10. Is there a continuation option? You can add this option to your poicy for an additiona premium, providing it aready has this option in pace with another provider, or if it s a new poicy. 11 How might Auto Enroment affect my poicy? If eigibiity for your Group Income Protection poicy is inked to Pension Scheme membership (either for a members or a category of membership), then auto-enroment can affect the membership and/or the saary ro/benefit ro insured under the poicy. The empoyer wi need to decide whether empoyees joining as a resut of Auto Enroment shoud be covered under the Group Income Protection Poicy. How do we treat empoyees joining under auto-enroment? If an eigibe jobhoder joins the quaifying pension scheme at any time other than: Your auto-enroment date or re-auto-enroment date; the standard eigibiity period for joining the poicy as set out in the poicy wording our discretionary entrant terms wi appy. If an empoyee who does not meet the eigibe jobhoder criteria chooses to join your auto-enroment pension scheme at any time other than: the standard eigibiity period for joining the poicy as set out in the poicy wording If a member eaves your service for any reason other than: our discretionary entrant terms wi appy. incapacity retirement dismissa; or redundancy they can use the continuation option to switch their cover (for basic benefits ony) to an individua poicy on our standard terms at the time, without providing medica information. The member can use this option providing: they take the option within 30 days after they eave your poicy their new occupation and residence is acceptabe under the terms and conditions of our individua income protection poicy they are not within five years of the cease age the new poicy provides the same (or ess) basic benefit than they were covered for under this poicy (excuding pension and suppementary benefits and nationa insurance contributions), subject to the individua income protection poicy benefit maximum What are our data requirements for auto-enroment? We wi require tota number of ives and the tota saary ro or benefit ro; the day before the auto-enroment date; on the auto-enroment date; and on the stabiisation date. This wi ensure that we are charging the correct premiums for the cover provided, and aso ensure that empoyers do not get unexpected premium requests. When wi any change in rate guarantee appy? If there is a change in the saary ro or benefit ro of 25% (50% of the tota benefit ro for poicies with 19 or fewer members) or more where you become subject to the auto-enroment duties, we wi: review changes in the tota saary ro or benefit ro insured on the stabiisation date and any change in rate wi be effective from the stabiisation date unti the end of your existing rate guarantee date. their benefit was accepted at ordinary rates with no restrictions or excusions the deferred period is not shorter than covered on this poicy the escaation eve is not higher than covered on this poicy the cease age is not higher than covered on this poicy. 13 Group Income Protection Technica Guide

14 Further information Pease contact your usua financia adviser or ca us on Third Party Rights Ony we and the empoyer taking out this poicy wi have any rights under this Poicy. Any person or persons who are not a party to these poicies sha have no rights under the Contracts (Rights of Third Parties) Act 1999 to enforce any terms under this poicy. Reference to, or the consent of, any person who is not a party to the poicy is not required for any changes to it or its rescission. Compensation The Financia Services Compensation Scheme (FSCS) may cover your poicy. It wi cover you if Aviva becomes insovent and we are unabe to meet our obigations under the poicy. For this type of poicy, the FSCS wi cover you for 100% of the tota amount of an existing caim. The FSCS wi aso provide a refund of 100% of the premiums that have not been used to pay for cover whether you are making a caim under the poicy or not. For further information, see or teephone Currency and jurisdiction These poicies are issued in Engand and subject to Engish Law. A payments made to or by us under this poicy wi be made in pounds stering. Insurer The Group Income Protection poicies are underwritten by Aviva Life and Pensions UK Limited. Aviva Life and Pensions UK Limited is a company in the United Kingdom. The Head Office of Aviva Life and Pensions UK Limited is 2 Rougier Street, York, YO90 1UU, United Kingdom. Aviva Life and Pensions UK Limited is a whoy owned subsidiary of Aviva pc. If you have any cause for compaint Our aim is to provide a first cass standard of service to our customers, and to do everything we can to ensure you are satisfied. However, if you ever fee we have faen short of this standard and you have cause to make a compaint, pease et us know. Our contact detais are: Group Protection Compaints Aviva Life & Pensions UK Ltd PO Box 540 Easteigh SO50 0ET Teephone: E-mai: We have every reason to beieve that you wi be totay satisfied with your Aviva poicy, and with our service. It is very rare that matters cannot be resoved amicaby. However, if you are sti unhappy with the outcome after we have investigated it for you and you fee that there is additiona information that shoud be considered, you shoud et us have that information as soon as possibe so that we can review it. If you disagree with our response or if we have not repied within eight weeks, you may be abe to take your case to the Financia Ombudsman Service to investigate. Their contact detais are: The Financia Ombudsman Service Exchange Tower London E14 9SR Teephone: Emai: Website: Pease note that the Financia Ombudsman Service wi ony consider your compaint if you have given us the opportunity to resove the matter first. Making a compaint to the Ombudsman wi not affect your ega rights. 14 Group Income Protection Technica Guide

15 Definitions Activey at Work Means that the member must have been activey foowing their norma fu duties at their pace of work and have been mentay and physicay capabe of a the norma duties of their job roe. Anniversary/anniversary date The anniversary of the start date, uness you have agreed another date with us. This date is stated in the poicy schedue. Auto-enroment date(s) Your staging date and, if different, the staging date for members covered under the poicy or, if you have chosen to use postponement, the date you have chosen as your deferra date, and if different, the deferra date for members covered under this poicy. Benefit The benefit described in this guide and shown on your poicy schedue. Cease age Midnight on the day before the age at which cover for a member ceases, as set out in the reevant poicy schedue appicabe to that member s category. The maximum age cannot exceed midnight on the day before a member s 70th birthday. Deferred period The number of consecutive weeks of incapacity which must pass before you become entited to receive benefit, as shown in the poicy schedue. Discretionary entrant An empoyee or equity partner who needs cover, but has joined the poicy: before the date they are first eigibe to join, or 12 months or more than 12 months after they were first eigibe to join, not in a category of member covered by the poicy Duties The materia and substantia duties that: are normay required to perform the job roe for the poicyhoder and; perform a significant and integra part of the performance of the job roe for the poicyhoder and; cannot be reasonaby omitted or modified by the member or the poicyhoder. Duties do not incude the journey as part of a reguar commute to and from a norma pace of work. Earnings As defined by you and accepted by us and detaied in the poicy schedue under definition of saary. The definition of saary wi indicate if fuctuating emouments are incuded. Eigibe/eigibiity The factor(s) we consider when assessing whether or not a person can be automaticay covered by the poicy. This wi be detaied in the poicy schedue. Eigibe jobhoders Empoyees the empoyer must enro into their automatic enroment pension scheme. Empoyee A person empoyed by you, who is covered under the poicy and is not an equity partner. Empoyer A company, partnership, imited iabiity partnership or other organisation that is participating in the poicy. Empoyment and Support Aowance/ESA The eve of state benefit as specified in the poicy schedue. This is usuay shown as the gross eve of base empoyment and support aowance pus the work reated activity component whether payabe or not. In the event of empoyment and support aowance being modified or repaced, we may use the new modified or repacement state benefit for the purposes of this definition. Equity partner An equity partner (or fixed share partner) in your partnership business who (as evidenced by a partnership deed or contract): is a part owner of the assets of the business, participates jointy and severay in the risks and rewards of the business; and is treated by HM Revenue & Customs as a sef-empoyed partner for tax purposes. Equity partner earnings The average annua earnings: received in the previous three consecutive years, or such esser period as the partner has been a partner of the partnership, which are iabe to tax. 15 Group Income Protection Technica Guide

16 Fuctuating emouments Empoyee earnings not paid on a fixed basis but additiona to their basic saary. This can incude items such as: profit reated pay, overtime, commission, shift or region aowances, taxabe bonuses, or the P11D vaue of benefits in kind. We wi use the average of the tota of any fuctuating emouments over the ast 3 years (or such esser period as the member has been in receipt of fuctuating emouments). Free cover imit The eve of benefit (as stated in your iustration and poicy schedue) under which medica information is not needed. Gross Taxabe Earnings Gross taxabe earnings incuding any fuctuating emouments reating to the empoyee s job roe with the poicyhoder. Incapacity Means either A, B or C beow as specified in the poicy schedue. A. The member s inabiity to perform, on a fu or part time basis, the duties of his or her job roe, as a resut of their iness or injury. B. The member s inabiity to perform, on a fu or part time basis, the duties of his or her job roe, and other occupations for which they are suited by reason of education, training or experience, as a resut of their iness or injury. C. For the first 24 months after the deferred period has been competed - the member s inabiity to perform, on a fu or part time basis, the duties of his or her job roe resuting from their iness or injury. After 24 months - the member s inabiity to perform, on a fu or part time basis, the duties of his or her job roe, and any other occupation for which he or she is suited by reason of education, training or experience, resuting from their iness or injury. Where a ump sum is insured with a 2 year imited payment term, definition B wi be appied. Where the member s occupation requires a icence (other than an ordinary UK driving icence for Group 1 vehices) or medica certificate, for exampe a HGV driver, definition B wi be appied to that member in a cases. Income Benefit The benefit payabe under this poicy, not incuding pension, suppementary benefits and nationa insurance contributions. Job roe A member s job roe with the poicyhoder at the time incapacity starts Limited payment term The number of years (if any) specified in the poicy schedue as the imited payment term. Benefit for incapacity resuting whoy or party from one iness or injury, or any iness, injury or other condition reated to it wi be imited to this period. The imited payment term starts when the deferred period has finished. Lump sum The tota ump sum benefit that woud be paid for a member in the event of a caim, as shown in your iustration and poicy schedue. Medica information Information incuding but not imited to medica history and ifestye factors, required to fuy assess the member and enabe us to appy an underwriting decision. Medica practitioner A medica practitioner registered with the Genera Medica Counci in the UK or, in the case of benefit paid for overseas residence, the equivaent body in the reevant country. Member An empoyee or equity partner covered under the poicy. Other occupation Any occupation performed for profit or reward, other than the member s job roe. Overseas Any country that is not part of the United Kingdom, Channe Isands or the Ise of Man. Pensionabe saary As defined by you and agreed by us and detaied in the poicy schedue. Poicy The Aviva group income protection insurance poicy (incuding the poicy schedue together with any endorsements) which covers the poicy benefits and forms the contract between you and us. Poicyhoder/you/your The company, partnership or other business entity named as poicyhoder in the poicy schedue. Poicy schedue The current schedue (as issued by us from time to time) stating detais of the poicyhoder, cover provided by this poicy, and any specia terms (if appicabe). 16 Group Income Protection Technica Guide

17 Poicy year The period between: the start date and the first anniversary date two anniversary dates; or an anniversary date and the date of termination of the poicy (if termination occurs before the next anniversary date) Pre-existing condition A condition that is directy or indirecty inked to any medica and/or reated condition or compication that the member was: aware of, or experienced symptoms of, or received medication, advice or treatment for, in the previous five years before any cover is provided for under the poicy. Proportionate benefit A proportion of tota benefit. The proportion wi be the percentage reduction in the member s earnings. For exampe: If a member s earnings are reduced by 70%, we wi pay 70% of the tota benefit. When paying proportionate benefit, we wi not reduce your benefit due to increases in earnings, as ong as those increases are not higher than the increase in the retai price index. To cacuate proportionate benefit when it is first paid, we wi use the member s earnings at the start of incapacity, adjusted in ine with the movement in the retai price index. If the income benefit amount stated in the poicy schedue incudes a deduction of empoyment and support aowance, we wi ignore that deduction as ong as the amount payabe as proportionate benefit is not more than woud be paid under tota benefit. Singe premium The premium notified by us to you for each member. Stabiisation date The date three months after your auto-enroment date(s) (uness you notify us in writing of a esser period and this is accepted by us). This period aows for your auto-enroment pension scheme membership to stabiise foowing the auto-enroment process. Start date The date the poicy starts as stated on the poicy schedue. State pension age (SPA) The eariest age at which the empoyee can start to receive the UK State pension. The maximum state pension age we wi cover is 68. Tota benefit The benefit cacuated as described in the poicy schedue. This is normay shown as income benefit and where appicabe empoyer and empoyee pension contributions, other suppementary benefits and empoyer nationa insurance contributions. TUPE Transfer of undertakings (Protection of empoyment) Reguations Unit Rate The rate of premium specified in the poicy schedue as the unit rate as changed from time to time being the amount payabe for every 100 of saary or benefit (dependant on poicy basis) covered under the poicy. We/our/us Aviva Life & Pensions UK Limited. To cacuate proportionate benefit when it is first paid, we wi use the member s earnings at the start of incapacity, adjustedin ine with the movement in the retai price index. Rate guarantee date The date unti which rates and are guaranteed to appy, as shown in the poicy schedue. Retai Prices Index (RPI) The rate of retai prices index decared by the UK Government for the period from 1 October to 30 September ending in the year before the caendar year of the pension increase date, or any other index which repaces it. 17 Group Income Protection Technica Guide

18 Aviva Life & Pensions UK Limited. Registered in Engand Number Registered Office 2 Rougier Street, York, YO90 1UU. Authorised by the Prudentia Reguation Authority and reguated by the Financia Conduct Authority and the Prudentia Reguation Authority. Firm Reference Number GR /2015 Aviva pc

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