Income Continuance Plan (ICP)

Transcription

1 Public Service Executive Union Income Continuance Plan (ICP) Explanatory Booklet

2 About Lyons Financial Services Lyons Financial Services was appointed by the Public Service Executive Union as advisers to members in relation to the PSEU income continuance plan, with effect from January Having been established in 2004, Lyons Financial Services is now one of Ireland s leading financial advice firms for employees in the Civil & Public sector. We advise about a range of products including; AVCs Health insurance Income continuance Life assurance Mortgages Savings & Investments Through our nationwide team of financial consultants, Lyons Financial Services excels in providing financial services solutions locally to union members, consumers, employees and employers, in both the public and private sectors right across the country.

3 contents Introduction 4 Protecting Your Income 6 How the Plan works 11 Questions & Answers Introduction This booklet sets out in broad terms the benefits conferred on members of this Plan. It does not confer any rights on the member. In the event of a dispute, the Terms and Conditions of the Plan, as set out in the Policy Document and/or Schedules, will be used to determine the outcome. Income Continuance Plan 3

4 PROTECTING YOUR INCOME Perhaps the greatest threat to your livelihood is Ill Health. This is because if you fall ill your sick pay provides you with an income for a limited period only. Once your sick pay runs out, your income will fall dramatically. All too often you ll find that the misery of financial insecurity accompanies the discomfort of illness. How would you manage financially if you suffered a serious illness or long-term disability? Alarmed at the financial problems that can arise for members, who suffer long-term illness, the Public Service Executive Union, hereinafter referred to as PSEU, asked Lyons Financial Services, hereinafter referred to as LFS to negotiate an Income Continuance Plan for its members. What happens to your Salary if you fall ill? Your Sick Pay arrangement provides for the payment of Full Salary for up to 183 days in any 12-month period and 50% of Salary thereafter subject to a maximum period of payment of Full and Half-Pay of 365 days in any consecutive 4 year period. What Happens when your Sick Pay expires? If your sick pay runs out, usually after the 365 day period of absence from work, your only entitlement is likely to be an Ill-Health Early Retirement Pension, if you have more than 2 years service and/or Social Welfare Disability Benefits. Even if you have many years service, your Ill Health Early Retirement Pension will only be a fraction of your pre-disability salary, while at 9,776 per annum currently, the Social Welfare Disability Benefit (as at 01/01/2013) provides a subsistence income only. For example, if forced to retire on grounds of ill health, a 30 year old member who has been a member of the Superannuation Scheme for 8 years and is earning 40,000 a year would see his or her income drop by 65% to less than 14,000, when payments from the Early Retirement Pension are combined with Social Welfare Benefits. That s a mere 536 per. Could you survive on 536 per? The reality is that long-term illness inevitably means a severe drop in living standards. The need for some kind of additional income is vital. 4 Income Continuance Plan

5 EXAMPLE A1 PRSI Member earning 40,000 ( 1,538 per ) with 8 years service on the Standard (A1) rate of PRSI, who becomes ill and had no absences from work due to ill-health in the previous 4 years. Period of absence Employer pays * Social Welfare Benefits Total per Fortnight * First 183 days 1,162 per 376 per Next 182 days 393 per 376 per Thereafter Ill-Health Early Retirement Pension 140 per 376 per 1,538 (100%) 769 (50%) 516 (34%) *In practice, within the first 12 months, the Employer pays an amount equal to the Social Welfare entitlement directly to the Member, who is under an obligation to claim Social welfare and refund this to the Employer. All Disability Benefits are liable for assessment for income tax purposes. EXAMPLE B1 PRSI Member earning 48,000 ( 1,846 per ) with 20 years service on the Standard (B1) rate of PRSI, who becomes ill and had no absences from work due to ill-health in the previous 4 years. Period of absence Employer pays Social Welfare Benefits Total per Fortnight * First 183 days 1,846 per Nil Next 182 days 923 per Nil 1,846 (100%) 923 (50%) Thereafter Ill-Health Early Retirement Pension 615 per Nil 615 (33.3%) Income Continuance Plan 5

6 HOW THE INCOME CONTINUANCE PLAN WORKS The PSEU Income Continuance Plan seeks to ensure that between your Ill-Health Early Retirement Pension, any Social Welfare Disability Benefits and the PSEU Income Continuance Plan, you will receive a gross income of 75% of your pre-disability salary, should you suffer a long term illness. Some benefit will commence after your Salary has dropped to 50% but the maximum amount will become payable after you have been absent from work for 52 weeks in any consecutive 4 year period since joining the Plan. The PSEU Plan will continue to pay you until the earlier of: (a) you are no longer deemed disabled by the Insurer, under the terms of the policy (b) you return to work with no loss of Income, (c) you die or (d) you are aged 65. You should note that only periods of illness occurring since the date you joined the PSEU Plan are taken into account when calculating how soon benefit from the PSEU Plan begins. Claims under the PSEU Plan will be paid if the Scheme s insurer, is satisfied that because of injury or illness you are unable to do your normal job and are not working elsewhere. The only conditions excluded are war, willfully self-inflicted injury or illness, failure to follow medical advice, pregnancy and aviation, gliding or other forms of aerial flight other than as a passenger in an aircraft and licensed to carry passengers and piloted by a pilot holding a commercial license. You should also note that the Insurer will assess and review all claims independently of any decision taken by the Employer to grant a member ill-health early retirement. You must remain a member of PSEU to continue to be covered by the scheme. If you leave PSEU then you are no longer covered. 6 Income Continuance Plan

7 How the PSEU Plan helps After 26 weeks of illness in any 12-month period the PSEU Plan pays you an income of up to 25% of your pre-disability salary supplementing your sick pay to 75% of your predisability salary. Once you have been ill for a full 52 weeks in any four year period, the PSEU Plan pays you a benefit sufficient to top up any Ill-Health Early Retirement Pension/Social Welfare Disability Benefit entitlement to 75% of your pre-disability salary. EXAMPLE 1 Member earning 40,000 ( 1,538 per ) with 8 years service on the Standard (A1) rate of PRSI, who becomes ill and had no absences from work due to ill-health in the previous 4 years. 1 st Year of Absence Period of Absence Employer Pays * Social Welfare Disability Benefit PSEU Income Continuance Plan Total Income * First 183 days 1,162 per 376 per Nil 1,538 per Next 182 days 393 per 376 per 385 per 1,154 per Absence from Year 2 Onwards Pre-Disability Income Ill-Health Early Retirement Pension Social Welfare Disability PSEU Income Continuance Plan Total Income 1,538 per 140 per 376 per 638 per 1,154 per Income Continuance Plan 7

8 As can be seen from the example, from month six onwards (i.e. day 184), the total income is equal to 75% of Pre-Disability Income. Example 2 Member earning 48,000 ( 1,846 per ) with 20 years service on the Standard (B1) rate of PRSI, who becomes ill and had no absences from work due to ill-health in the previous 4 years. 1 st Year of Absence Period of Absence Employer Pays * Social Welfare Disability Benefit PSEU Income Continuance Plan Total Income * First 183 days 1,846 per Nil Nil 1,846 per Next 182 days 923 per Nil 462 per 1,385 per Absence from Year 2 Onwards Pre-Disability Income Ill-Health Early Retirement Pension Social Welfare Disability Benefit PSEU Income Continuance Plan Total Income 1,846 per 615 per Nil 770 per 1,385 per As can be seen from the above example, from month six onwards (i.e. day 184), the total income is equal to 75% of Pre-Disability Income. *In practice, within the first 12 months, the Employer pays an amount equal to the Social Welfare entitlement directly to the Member, who is under an obligation to claim Social Welfare and refund this to the Employer. All Disability Benefits are liable for assessment for income tax purposes. 8 Income Continuance Plan

9 How Long am I Covered For? Assuming you remain an eligible member of PSEU, cover under the Plan ceases at age 65. Note on Early Retirement If at the point of going on claim you do not wish to retire and so do not apply for an Early Retirement Pension (ERP) the Plan will pay out a full 75% of salary for up to 2 years. If you do retire subsequently and an ERP is paid retrospectively to the end of the Deferred Period, the additional benefit must of course be refunded. How Much Does It Cost? Very little! As membership is so vital, the PSEU Plan is designed to be affordable for every member. It s remarkably good value because it s negotiated on a special group basis for members of PSEU. The contribution rate is currently set at just 0.59% of gross salary for income continuance (i.e. your basic salary plus any other earnings taken into account for sick pay and superannuation purposes) and can be conveniently deducted from your salary by your employer. A Helping Hand from the Revenue You are eligible for tax relief at your highest rate of tax on the premium you pay for the Income Continuance Plan. Example of Tax and PRSI Relief Salary Gross Fortnightly Cost Net Fortnightly Cost 40, , (Tax 41% ) 6.70 (Tax 41% ) Income Continuance Plan 9

10 Price Guarantee The current rate of 0.59% of salary is in place until 31/12/2013, at which time it will be reviewed. Work Sharers Eligible work sharing members may also apply to join the PSEU Plan. The level of contributions and benefits applying for them are explained on page 12. LFS will advise you of any special offer terms. Cover begins as soon as Friends First accepts you as a member of the PSEU Plan. If you haven t already joined the PSEU Plan, don t put it on the long finger. Apply to join NOW. 10 Income Continuance Plan

11 QUESTIONS AND ANSWERS Who is Eligible to Join? To be eligible to apply for membership of the PSEU Plan you must be: 1. Under age 60 and 2. A member of PSEU and 3. Either a permanent member who is working: - full time or - part time and working on average not less than 20% of the normal working week as directed by the Employer Or a temporary member who is working full time or on contract for at least 12 months duration. Work Sharers Work Sharing members of PSEU who satisfy all 3 conditions above, may also apply to join the PSEU Plan. The level of contribution and benefits, which apply for them, may differ from those relevant for permanent full time members (see page 19 for details). When Does My Cover Begin? Your cover begins from the date the Insurer accepts your application in writing. On joining, members receive a formal acceptance letter confirming they have been included as members of the PSEU Plan. In some cases medical evidence may be required before cover of the PSEU Plan can be confirmed. This may involve attending for a medical examination at the Insurers expense. Income Continuance Plan 11

12 When Does my Cover End? Cover of the PSEU Plan ends: On your 65 th birthday or If you no longer fulfill the eligibility criteria (see Who is eligible to join? above) or If your contributions to the PSEU Plan cease. If you are being paid benefit under the PSEU Plan, your benefit will continue to be paid until recovery, return to work, death or your 65 th birthday, whichever occurs first. Are all Applications Accepted? In a small percentage of cases individual applicants to the PSEU Plan may be refused. In such cases applicants will receive a letter confirming that they have not been accepted into the PSEU Plan. In other cases, individuals may be offered cover subject to the condition that certain specified illnesses are excluded from cover. What Does it Mean if my Application is Subject to Exclusions, or Perhaps Refused? This means that the Insurer believe they cannot, because of your health history, offer you the cover sought or they believe it is necessary to exclude certain conditions or restrict the level of cover offered. The Insurer make such decisions only after careful consideration of the information supplied by you on your application form together with any details they have received from doctors you have attended. Applicants may seek additional clarification from their own doctor who can contact the Insurer to request reasons for their decision. What if I Travel Abroad? You are covered while travelling or living anywhere in the world as long as you remain an eligible member. However if you are receiving benefit under the PSEU Plan and intend to travel or live abroad for more than 13 weeks you should notify LFS. 12 Income Continuance Plan

13 This is because the Insurer reserves the right not to pay benefit if you travel or reside outside the European Union, Canada, USA or Australia for more than 13 weeks. Policy currently states that the Republic of Ireland & the UK are Approved Territories. What If I Have a Second Job? This may be taken into account in calculating any benefit paid should you make a claim from the PSEU Plan. It is vital therefore that you notify LFS in writing at the time of joining the PSEU Plan if you have a second job. Likewise you should notify LFS in writing if, after joining the PSEU Plan, you take on a second job. In the event that you have a second job at the time of joining the PSEU Plan or take on a second job after joining the PSEU Plan, the Insurer reserves the right to refuse cover or withdraw cover in respect of your normal job. This could happen where, for instance, the Insurer believes that your second job involves a greater degree of risk than that involved in your normal job. The cover provided by the PSEU Plan does not extend to your second job. If you would like disability cover on your second job you should contact LFS about the possibility of insuring yourself against disability through an individual policy. What if I Have Unearned Income? Investment and rental income will not be taken into account when making a claim under the PSEU Plan. What if I am not in the Superannuation Scheme? If you are not a member of the Superannuation Scheme, you are not entitled to an Early Retirement Pension should you become disabled. However if you are not a member of the Superannuation Scheme you will be paying full PRSI contributions, and therefore may be entitled to a Social Welfare Disability Benefit in the event of disability. Therefore if you are not a member of the Superannuation Scheme, the benefit will be paid after you have been ill for 13 weeks in any 12 month period. The amount paid will be 75% of you pre-disability salary less any Social Welfare Disability Benefit you may be receiving or any other payment from your employer. Income Continuance Plan 13

14 On What Salary is My Cover Based? If you are paying by salary deduction, your cover is based on the salary provided by the employer. The level of cover you enjoy and the amount of contribution you pay will be increased periodically (See page 20 does my cover increase in line with my rising salary for details). Your salary will be calculated as basic salary plus any other payments which are taken into account for sick pay and Superannuation purposes on the last day worked before the expiry of the Deferred Period. If you are not a member of the Superannuation Scheme, your salary will be calculated as basic salary plus any other earnings which would be taken into account for sick pay and superannuation purposes if you were a member of the Superannuation Scheme. What if I Take a Career Break? Generally, members of the PSEU Plan who take a career break fall into one of the following categories: - 1. Members who wish to continue their full cover under the PSEU Plan for up to 12 months duration of their career break because they are taking up alternative employment. If you are in this category you may apply within 2 months of taking a career break to transfer benefits similar to those you enjoyed under the PSEU Plan to any new job. This is however at the Insurer s discretion and subject to your new job being acceptable to the Insurer from an Underwriting point of view, e.g. that your new job does not involve a greater degree of risk than that in your normal job. Naturally, your pre Career Break salary will determine the rate and amount of your contribution and benefit level, as you will no longer be an active member of the PSEU Plan. You should remember to notify LFS on taking up your normal job at the end of your 12 month career break if you wish to re-activate your cover of the PSEU Plan. The level of cover applying when you take up your employment again may be higher than that you enjoyed while on your career break. 14 Income Continuance Plan

15 2. Members who do not wish to continue the Disability Benefit element of their cover may re-activate their membership of the PSEU Plan on completing their career break without having to undergo any medical underwriting, if they re-join the Plan within 2 months of the end of their career break. This option applies only to career breaks up to a maximum of 5 years. Remember you must advise Lyons Financial Services of your decision on taking a career break, as to which option you would like to take. 3. Members on a Career Break who simply decide to discontinue cover of the PSEU Plan. If you are in this category, or do not notify LFS of your intention to take a career break, your cover under the PSEU Plan will cease as soon as your salary ceases and therefore your Income Protection contribution stops. Thereafter you must complete a full medical application form and undergo medical underwriting should you wish to rejoin the PSEU Plan upon returning to work. What if I Leave PSEU? In such circumstances you are no longer eligible for the PSEU Plan. You should therefore write to LFS to cancel your cover. LFS may, depending on your circumstances, be able to offer you an individual policy providing similar cover. If you move to another division within the Public / Civil Service, you may be able to transfer to the Plan in operation for the division to which you are transferring. In such circumstances you should contact LFS or the Insurer for details. Does It Affect My Entitlement to Benefit if I Pay A1 PRSI Contributions? No! Many members are paying PRSI contributions on the modified B1 PRSI rate and so pay less PRSI contributions than those members on the A1 PRSI rate. If a member paying PRSI at the lower B1 rate retires on Ill Health Early Retirement Pension (ERP) under the Superannuation Scheme he or she is not entitled to any Social Welfare Disability Benefit. On the other hand members paying the higher A1 PRSI rate may be entitled to a Social Welfare Disability Benefit if they suffer prolonged illness. Members in this situation may also be entitled to an integrated Ill Health Early Retirement Pension. Income Continuance Plan 15

16 The benefit payable under the PSEU Plan is the amount needed to top up any Ill Health Early Retirement Pension and any Social Welfare Disability Benefit to 75% of pre-disability salary. In effect this means that whether you are a B1 or an A1 PRSI contributor, taking both Ill Health Early Retirement Pension and the Social Welfare Disability Benefit into account, the combined amount you receive inclusive of the benefits under the scheme in the event of disability is the same. What Happens if I Change My Terms of Employment If your terms of employment change, this may affect your cover under the PSEU Plan. For instance if you reduce the overall number of hours you are working each week, your benefits under the PSEU Scheme may be affected. It is vital therefore that you should notify LFS in writing should you change your terms of employment. Are There Any Special Considerations for Part Time Members? Yes. Amongst the issues you should consider are: 1. Part time members are eligible to join only if they are working on average not less than 20% of the normal working week as directed by the employer and, in the case of temporary part time members, are on a contract of employment of at least 12 months duration. 2. Eligible part time members should also bear in mind that in some cases cover in the PSEU Plan may not be suitable for them. This could be the case if, for instance: you are on a relatively low salary and are paying PRSI at the A1 rate. This means that if you become disabled you would receive Social Welfare Disability Benefit (currently 9,776 per annum). If this is more than 75% of your pre-disability salary you would not receive any benefit from the PSEU Plan because you would already be receiving more than the maximum 75% of pre-disability salary you are entitled to under the PSEU Plan. 3. Eligible part time members should also remember that benefits paid under the Plan may be reduced if, for instance, you spent some years as a full time member and were a member of the Superannuation Scheme. Assuming you were contributing to the Superannuation Scheme for more than 2 years, this means that if you become disabled you would be entitled to receive an Ill Health Early Retirement Pension (ERP). If the greater portion of your superannuation contributions were made while you were on a full time salary, it may be the case that your ERP (much of which would be based on your full time salary) is in fact very large in relation to your current part time salary. 16 Income Continuance Plan

17 As a result you would be eligible for little or no benefit under the PSEU Plan as you would already be receiving close to or more than 75% of your pre-disability salary in the form of an Ill Health Early Retirement Pension. For this reason when calculating the amount of benefit to be paid under the PSEU Plan in such cases, the Insurer may reduce the deduction in respect of any ERP in order to be fair and equitable to the member. A similar approach is applied for those who are job sharers or work sharers (see below). What Benefits Does This Plan Provide for Job Sharers and Work Sharers? The benefits and contribution rate for job-sharing and work sharing members are based on job-sharing/work sharing salary. In the event of a claim the Insurer may deduct a lesser amount than the actual Ill Health Early Retirement Pension (ERP) entitlement from the benefit paid by the PSEU Plan. This is because, were the Insurer to deduct the actual ERP (which might include many years of Superannuation contributions based on full time income), the member s ERP entitlement could come close to, or actually exceed, the benefit paid under he PSEU Plan. This would mean little or no benefit would be paid under the PSEU Plan. For this reason when calculating the amount of benefit to be paid under the PSEU Plan, the Insurer may reduce the deduction in respect of any ERP in order to be fair and equitable to the member. A similar approach is applied for those who take up a part time position following a period spent in full time employment. Example 1 Job-Sharer on Class B1 PRSI The benefit for job sharers is reduced pro rata in line with their job sharing salary. For example, a job sharer working 50% of the full time equivalent is paid a benefit of 50% of the full time benefit. In practice, a member who works 50% of the full time equivalent Job sharing salary 30,000 Equivalent full time salary 60,000 ERP Entitlement 15,000 Benefit based on full time salary = 60,000 x 50% - 15,000 = 15,000 Benefit for job sharer is 50% of full time benefit, i.e. 50% of 15,000 = 7,500 Income Continuance Plan 17

18 Please also note that a pro rata benefit will apply to members who opt for 60% and 80% Job Sharing, along similar lines to the above example. What if I Take Parental, Maternity or Adoptive Leave? If you avail of your entitlement to take unpaid Parental, Maternity or Adoptive Leave, and are making your contributions to the Plan through salary, no contributions will be collected in respect of periods for which you are on leave as you will not be paid a salary while on leave. Nonetheless your cover will continue unaffected while you are on leave and no repayment of the skipped contributions will be sought. However this is subject to the period of leave being no longer that 18 weeks in total in any 12 month period. Cover for members who make their contributions by direct debit is likewise unaffected where such leave is for a period of less than 18 weeks in total in any 12 month period. Where the period of leave is more than 18 weeks in total in any 12 month period, members should contact LFS for details of their options. These will be similar to those available to members who take a career break. What if I Take Unpaid Leave to Take Care of a Dependant Relative? If you avail of your entitlement to take unpaid Carer s Leave, and are making your contributions to the Plan through salary, no contributions will be collected in respect of periods for which you are on leave as you will not be paid a salary while on leave. Nonetheless your cover will continue unaffected while you are on leave and no repayment of the skipped contributions will be sought. However this is subject to the period of leave being no longer than 18 weeks in total. Cover for members who make their contributions by direct debit is likewise unaffected where such leave is for a period of less than 18 weeks in total. Where the period of leave is more than 18 weeks, members should contact LFS for details of their options. These will be similar to those available to members who take a career break. What if I am a Term Timer? Typically term timers work 9 months of the year and take unpaid leave for the months of June, July and August. They have two options regarding their pay: 18 Income Continuance Plan

19 1. Be paid as normal for the 9 months they are working. 2. Spread their salary over the full twelve months of the year i.e. instead of taking 100% of their salary for 9 months and nothing for the remaining three months, take 75% of salary each month for the 12 months of the year. Your actual salary will typically be 75% of the salary you would have received were you still working a full 12 months. OR In general, term timers benefits under the Plan are assessed in the same way as other members who take unpaid leave of less than 18 weeks (see What if I take parental, maternity or adoptive leave? And What if I take unpaid leave to take care of a dependant relative? above). However, for those who work in a term timer capacity on a regular basis (i.e. over each year for periods of two years of more) cover under the Plan remains in force with benefit based on actual salary (i.e. 75% of your full salary) you were receiving over the previous 12 months. Does it Affect my Benefit Under the Plan if my Disability is Due to an Injury at Work? Yes. If you are injured at work, depending on the circumstances, social welfare benefits, etc., you may be entitled to payments in excess of 75% of salary. In such cases, as you would already be receiving a payment greater than 75% of your pre-disability salary, you would not be entitled to any benefit under the Plan. What if I Take out a Critical Illness Policy? Such policies pay out a lump sum on the diagnosis of certain specified serious illnesses. Although many of these policies provide valuable additional financial security, the cover they provide invariably will not match or replace the cover provided by the PSEU Plan. On the other hand, some serious illnesses will not result in an inability to work and therefore will not give rise to a claim under the PSEU Plan, even though such illnesses might be covered by a critical illness policy. Benefits paid under the critical illness policies are often taken into account when assessing the level of benefit to be paid under salary protection schemes. However Income Continuance Plan 19

20 the Insurer has agreed special preferential arrangements for members of the PSEU Plan. This means that currently payments of up to four times salary under a critical illness policy will not be taken into account when calculating the benefit to be paid to you under the PSEU Plan. Does My Cover Increase in Line With My Rising Salary? One of the great advantages of the PSEU Plan is that it allows for your cover to be increased in line with salary rises, promotions, etc, this means that the cover you enjoy under the PSEU Plan remains realistic over the years ahead. The automatic updating of the members contribution and cover avoids the necessity to complete new application forms, attend for medicals etc. If I am Claiming from the PSEU Plan, Does the Amount I Receive Increase Each Year? Yes. The benefit paid to you by the PSEU Plan increases by 5% each year or the rate of increase in the Consumer Price Index, if lower. This helps ensure the benefit you receive remains realistic despite the effects of inflation. You should bear in mind that any Ill-Health Early Retirement Pension you receive will generally increase each year in line with salary rises awarded to working members. What if I Already Have Some Form of Salary Protection? If you already have a salary protection or permanent health insurance policy you should bear in mind that the cover provided by such a policy may overlap with that provided by the PSEU Plan, i.e. it will be taken into account when calculating how much benefit should be paid under the PSEU Plan to ensure you receive 75% of pre-disability salary. You should therefore contact your local LFS consultant for advice before joining the PSEU Plan. Will I Receive Money Back if I Never Claim Under the PSEU Plan? No. As with health insurance or car insurance, your contributions go to meet the cost of cover for you and your colleagues. This keeps the cost of cover to the minimum and means that there is no cash value paid out to those who never make a claim under the PSEU Plan. 20 Income Continuance Plan

21 Do I Have to Pay Tax on Benefits From The Plan? Disability Benefit paid by the PSEU Plan will be treated as normal income and as such is liable to income tax and PRSI/USC. The Insurer will deduct any tax due from the payment made to the member in the same way as an employer deducts PAYE and PRSI/USC. How Do I Claim My Tax Relief on Contributions Under the 1979 Finance Act, tax relief was granted on Income Continuance Plan contributions. The method of granting tax relief on member contributions to approved disability plans changed with effect from April 6 th Where an employer deducts the contributions from the member s pay, a Net Pay arrangement applies, just as it applies to your superannuation contributions. This means that your gross pay is effectively reduced for the purpose of calculating income tax. It means that income tax relief is given automatically at source. Consequently there is no need for you to refer direct to your local Inspector of Taxes for income tax relief. Are There any Exclusions Under The PSEU Plan? The exclusions under the PSEU Plan that apply to all members are those disabilities arising due to: - wilfully self-inflicted injury or illness including alcohol or drug abuse. - failure to follow medical advice. - disabilities arising due to war - aviation, gliding or other forms of aerial flight other than as a passenger in an aircraft licensed to carry passengers and piloted by a pilot holding a commercial license Please bear in mind that in some cases individual members may be accepted into the PSEU Plan subject to exclusions in respect of specific illnesses (see page 15 for details) Income Continuance Plan 21

22 How do I Claim From The PSEU Plan? LFS guides members through the claims procedures and ensure that all legitimate claims are paid promptly by the Insurer of the PSEU Income Continuance Plan. You should contact LFS for a claim form, approximately 10 weeks in advance of the expiry of your sick leave entitlements. LFS will explain the additional documentation you will need to submit. Prior to completing your claim form please consult with LFS. Upon receipt of your claim form, LFS will process your claim with the Insurer. All evidence reasonably required by the Insurer must be provided by the member. The member may be required to undergo medical examinations (at the insurer s expense) and may also be visited by a Disability Counsellor. Once benefit is being paid members may be required from time to time to provide evidence of ongoing disability. Who Decides Whether or Not I am Entitled to Payment under the Plan? The Insurer, advised by its Chief Medical Officer, will decide whether or not you are entitled to benefit under the PSEU Plan, based on an assessment of all medical information. To qualify for benefit under the PSEU Plan, the Insurer must be satisfied that you are unable to carry out your duties under your normal occupation because of illness or injury and that you are not following any other occupation. In certain cases benefits may be paid where the member returns to work to take up another occupation, but at a reduced level of earnings due to partial disability (see page 26 for details) While you are being paid benefit under the PSEU Plan, the Insurer may seek regular medical certificates from your doctor. This is because you must continue to be disabled and unable to work in order to be entitled to continue to claim under the PSEU Plan. The Insurer may also require an independent medical examination or specific information from your doctors. These medical examinations will be at the insurer s expense. You may also be visited by an Insurer s Disability Counselor from time to time. 22 Income Continuance Plan

23 Are Claims Ever Turned Down by The Insurer? The great majority of claims, typically over 90%, are paid. However experience has shown that when difficulties do arise, they usually arise because When joining, the member did not disclose his or her full medical history. In such cases the Insurer reserves the right not to pay a claim. It is very important that when applying to join the PSEU Plan you ensure that you make a full disclosure in relation to any questions asked on the application form and during any medical examination you may undergo. If you don t, any claims you make may be turned down and cover under the PSEU Plan may be cancelled. Medical opinion is that the member is not disabled from carrying out his or her normal occupation. Dependent upon the medical condition at issue, specialist opinion may be required. If ultimately in the Insurer s view, the medical opinion is that you are not disabled as defined under the PSEU Plan, benefit will not be paid regardless of whether you have been retired on grounds of ill health by your employer. In the event of a dispute you may appeal to the insurer by providing additional specialist evidence. Should your appeal be unsuccessful you have the right to seek the assistance of the Insurance Ombudsman who may take up your case without cost to you. Finally, if all other avenues fail, you can take your case to the courts, using the arbitration procedures provided for under the Plan. When Will Benefit Payment Under The PSEU Plan End? The PSEU Plan will continue to pay benefit as long as your illness or injury prevents you from doing your normal job and you are not following any other occupation. Benefit payments will stop at the earliest of: - your recovery i.e. when the Insurer decides, based on medical evidence, that you are no longer prevented from doing your normal job because of illness or injury - your return to work Income Continuance Plan 23

24 - death - your 65 th birthday - failure to satisfy Eligibility Criteria In certain cases benefits may be paid where the member returns to work but at a reduced level of earnings due to partial disability (see below for details). What Happens if I Return to Work Only to Find That I Become Ill Again a Few Months Later? If you return to work after a period claiming benefit through the Plan only to find that you fall ill again within 26 weeks of your return to work your benefit will begin again immediately, i.e. you will not have to wait the usual period before your benefit is paid. This is subject to the Insurer being satisfied that you are unable to carry out your duties under your normal occupation because of illness or injury and that you are not following any other occupation. What Happens if I Return to Work But At a Reduced Salary Or Take Up a Different Less Well Paid Job? If you are able to return to work in your normal job on a reduced basis only due to ill health, the Insurer will continue to pay you a proportionately reduced income, i.e. your benefit under the PSEU Plan will be reduced to take account of additional income you are now earning. Should you be unable to follow your normal job and take up a different job at a lower rate of pay, again the Insurer will continue to pay you a proportionately reduced income. Who Administers and Insures The PSEU Plan? The PSEU Plan is administered by LFS and is insured by Friends First Life Assurance Company Ltd. Deductions Responsibility for ensuring that the deductions to the PSEU Plan are made and remitted to Friends First rests with the individual member. If deductions to the plan cease then the member ceases to be a member of the Plan and no longer qualifies for any benefit. 24 Income Continuance Plan

25 Are there any other benefits under the Scheme? Yes, the following extra benefits have been negotiated with the insurer at no extra cost to the member. 1. Accidental Death Benefit In the event of an accidental death of a member, 20,000 will be payable. Accidental death is defined as: Death caused solely and directly by external trauma, as a result of an accident caused by unforeseen violent, visible, and external means, and independently of any other cause. The following exclusions will apply: If death is caused directly or indirectly by the person taking part in a criminal act. If death is caused by suicide or intentional self-inflicted injury. If death is caused by the person taking part in aviation other than as a fare paying passenger. If death is caused by activities related to membership of the Armed forces. If death is caused by participation in hazardous pursuits If death is caused by the taking of drugs and/or alcohol This benefit is provided Free of Charge. 2. Survivor Benefit of 3 months income for Income Protection Claimants If a claimant who is receiving benefit from the Plan dies, an extra three months benefit will paid to the member s estate. This can be paid in addition to the Accidental Death Benefit should it be in the event of an accidental death of a claimant and the above criteria are met. This benefit is provided free of charge. Income Continuance Plan 25

26 What Happens if I Cease to be a member of the PSEU Plan? Membership of the PSEU Plan may be cancelled at any time by notifying LFS or the Insurer in writing or stopping your deduction at source. As your contributions are designed to cover the cost of paying benefit to those members of the PSEU Plan who become disabled, there is no cash value paid to you should you stop contributions to the PSEU Plan. It is important that you think carefully before cancelling your membership of the PSEU Plan as once you have left the PSEU Plan you will be required to provide information about your state of health should you apply for cover again. Should any medical problems have arisen in the interim, it is unlikely that you will be re-admitted to the PSEU Plan and if you are, you may have certain illnesses excluded. Under What Circumstances can The Plan be Amended? Benefit levels and the rate of contributions under the PSEU Plan are reviewed on a regular basis. The next review of the PSEU Plan is on the 31/03/2015. These reviews are designed to provide LFS with an opportunity to canvass the market to ensure that the best deal is being provided for members. Likewise the reviews provide the insurer with an opportunity to adjust the benefit levels and/or the rate of contribution in the light of relevant factors such as membership level, age profile, the male/female ratio of the membership and the claims experience of the PSEU Plan. At such reviews, the PSEU Plan s insurer and PSEU reserve the right to increase or reduce the rate of contribution and vary the benefit levels under the PSEU Plan for all members or terminate the PSEU Plan as a whole. The PSEU Income Continuance Plan is governed by a Master Policy Document. This booklet provides a brief summary of the main policy conditions only and confers no legal rights. Friends First Life Assurance Company Ltd is regulated by the Central Bank of Ireland. PSEU represents the interests of members in the PSEU Plan and any decisions taken in these areas by PSEU will be considered binding on all members of the PSEU Plan. This is a condition of membership and entry to the PSEU Plan is allowed to members only on this understanding. In the event of termination or amendment of the PSEU Plan, those members who are already receiving benefit payments under the PSEU Plan will continue to receive those benefit payments and any subsequent increases in those benefits due under the terms of the Plan. 26 Income Continuance Plan

27 Please note: This explanatory booklet provides a brief outline only of the main benefits of the Income Continuance Plan for members of PSEU as of January 2013 and is issued subject to the provisions of the policy and does not create or confer any legal rights. The information contained herein is based upon our current understanding of Revenue law and practice as at January If you have any queries about your membership of the PSEU Scheme or require a copy of the full policy document please contact LFS at the address below. If you have a complaint and wish to discuss this please contact or write to: Lyons Financial Services Office 1 Dunboyne Business Park Dunboyne Co Meath Tel: (01) Fax: (01) icp@lfs.ie Website: Roisin Lyons t/a Lyons Financial Services is regulated by the Central Bank of Ireland. If you are still dissatisfied you should contact either: Insurance Ombudsman, Irish Insurance Federation 32 Upper Merrion Street 39 Molesworth Street Dublin 2 Dublin 2 Tel: Tel: enquiries@ombudsman-insurance.ie fed@iif.ie Website:

28 Lyons Financial Services Office 1 Dunboyne Business Park Dunboyne Co Meath Tel: (01) Fax: (01) icp@lfs.ie Website: Roisin Lyons t/a Lyons Financial Services is regulated by the Central Bank of Ireland. Friends First Life Assurance Company Ltd is regulated by the Central Bank of Ireland.