TSB Bank Term Life with Crisis Cover

Transcription

1 Expect to understand your Term Life with Crisis Cover Insurance POLICY WORDING TSB Bank Term Life with Crisis Cover Contents 1. Introducing your policy 1 2. What you re covered for 2 3. What you re not covered for 6 4. Changes you can make to your policy 7 5. How to make a claim 8 6. What you can expect from Cigna 8 7. How to register a complaint Policy definitions About Cigna 13 CIG572 13/08/1502/01 DATE 08/13 GADGET 7867

2 1. Introducing your policy This policy pays you, as the policy owner(s), a lump sum on the death of the life insured, diagnosis of a terminal illness or upon the life insured suffering from one of the medical conditions defined in this policy. In this policy wording some of the words are in bold, e.g we, you. This may mean that the bolded words have a particular meaning. To find out the meaning, please refer to Section 8. policy definitions. If you have any questions about your policy, please contact us on the TSB Bank - Cigna Insurance Helpline ( if you are calling from outside New Zealand). The policy is underwritten by Cigna Life Insurance New Zealand Limited (Cigna) who will be responsible for all claims and other matters relating to this policy. TSB Bank Limited receives a commission for arranging this insurance but does not guarantee the obligations of Cigna (described in sections 2 and 4). If Cigna refuses a claim TSB Bank will not be liable. Who is covered under this policy? You are covered if you are named as a policy owner(s), on the policy schedule. The policy owner is responsible to arrange payment of the premiums from the premium start date and as they become due. All correspondence with you will be sent to the most recent address that Cigna holds for you. If you change your address, it is your responsibility to notify Cigna. Please read all your policy documents including your policy summary, this document and your application form carefully as they contain the terms and conditions that apply to your policy and form the basis of the contract between you and Cigna. Because it s important you are entirely satisfied with your insurance, Cigna offers a 30 day free look period. If for any reason you want to cancel this policy please call our Customer Services team on Any premiums that you have paid will be refunded and Cigna will confirm in writing that the policy has been cancelled. If you cancel outside this 30 day free look period there will be no refund of premiums. All payments made in respect of this policy are in New Zealand currency. This policy does not have any surrender or cash value. Your duty to be truthful We rely on the information you provide us to issue your policy and pay any claim. If you re not absolutely truthful or don t notify us of all material information in your application, and up until the policy is issued, or when you claim, we may cancel your policy and retain all or some of your premiums. 2. What you re covered for Cigna s insurance promise Provided the terms and conditions are met and the premiums are up to date Cigna promises to pay the benefit(s) as set out in the policy summary and described here. Term Life Benefit If the life insured dies, Cigna will pay the current cover amount to you. Living Benefit If the life insured is diagnosed with a terminal illness, Cigna will pay you an early payment of the current cover amount, up to a maximum of $500,000. If Cigna pays a living benefit equal to the current cover amount, the policy will end and no further premiums will be payable. If the living benefit paid is less than the current cover amount, this will be reduced by the amount paid and the premiums will be adjusted to reflect the reduced cover. The remaining cover amount will be payable on the death of the life insured. 1 2

3 Crisis Cover Benefit If the life insured is diagnosed with one of the conditions listed below, Cigna will pay you the crisis cover benefit shown on the most recent policy summary. The crisis cover benefit will end on the anniversary date immediately prior to the life insured s 65th birthday. If a crisis cover benefit is paid, the current cover amount will be reduced by the amount paid and the premiums will be adjusted to reflect the reduced cover. The remaining cover amount will be payable on the death of the life insured. Only one crisis cover benefit is payable under this policy, if a crisis cover benefit is paid, the policy will still provide cover for the term life and living benefits. If a terminal illness is covered under both living benefit and crisis cover, Cigna will pay the higher of the two benefits. The crisis cover conditions covered are: Cancer means the presence of one or more malignant tumours. The malignant tumour is to be characterised by the uncontrolled growth and spread of malignant cells and the invasion and destruction of normal tissue for which major interventionist treatment or surgery (excluding endoscopic procedures alone) is considered medically necessary. The following conditions are specifically excluded under this section of the policy: all cancers which are histologically described as premalignant, non-invasive, carcinoma in situ except as otherwise specifically detailed in this section of the policy; malignant melanomas of less than 1.5mm maximum thickness as determined by histological examination using the Breslow method; all other skin cancers unless there is evidence of metastases; papillary micro-carcinoma of the thyroid or bladder; chronic lymphocytic leukaemia less than Rai Stage 3; prostate cancer which is histologically described as TNM classification T1 (including T1(a) or T1(b)) or another equivalent or lesser classification; cancers associated with Acquired Immune Defiency Syndrome (AIDS) or the Human Immunodeficiency Virus (HIV), unless they are the result of Medically or Occupationally Acquired HIV. Carcinoma in situ of the breast is covered under this section of the policy where it leads to the removal of the breast by a mastectomy. The procedure must be: performed as a direct result of the carcinoma in situ; specifically to arrest the spread of malignancy; and medically considered the necessary and appropriate treatment Coronary Artery Bypass Surgery means the open heart surgical grafting of a bypass to a coronary artery to overcome narrowing or obstruction. Heart Attack means diagnosis of the death of a portion of heart muscle arising from inadequate blood supply to the relevant area. The diagnosis must be supported by the following criteria being present, and consistent with a heart attack: confirmatory new electrocardiogram (ECG) changes; and diagnostic elevation of cardiac enzyme CK-MB or an elevation of Troponin of 5 times the upper limit of normal. Other causes of severe non-cardiac chest pain, heart failure and angina are specifically excluded. Stroke means diagnosis of a cerebrovascular accident or event producing a permanent neurological deficit lasting more than 24 hours. A consultant neurologist must produce clear evidence: of infarction of brain tissue by thrombosis, haemorrhage or embolisation from an extracranial source; and on a CT, MRI or similar scan that a stroke has occurred; and 3 4

4 of the onset of objective neurological deficit. The following are specifically excluded: transient ischaemic attacks (TIAs); cerebral events due to reversible neurological deficits; vascular accidents affecting solely the eyes; and neurological deficits due to migraines, hypoxia or trauma, physical head injury, or any blood vessel outside the cranium except embolism resulting in stroke. Total and Permanent Disablement means bodily injury caused by violent, accidental, external and visible means or sickness or disease. The life insured must be entirely prevented from working in any occupation for a period of six consecutive months and on the basis of medical evidence satisfactory to Cigna, and in Cigna s opinion, incapacitated to such an extent as to be unlikely to ever engage in or work in any occupation for which they are reasonably qualified by education, training or experience. Cover under the above definition only applies where the life insured is in paid employment for 25 hours or more per week at the date of the event. Where the life insured is not in paid employment for 25 hours or more per week at the date of the event, the insured must be confined to their home under regular medical supervision or to a recognised medical institution under regular medical care and where disablement in Cigna s opinion, results in the life insured being unlikely to ever be able to do three or more of the following daily activities without assistance: dressing and undressing; washing and bathing; toileting; eating and drinking; Cigna must be satisfied that the life insured is unlikely to ever engage in or work in any occupation or employment for monetary reward. Cigna will not pay a crisis cover benefit if the condition, event or symptoms of a condition existed, or first occurred, within 90 days of the cover start date. This also applies to increases to the crisis cover benefit. This exclusion does not apply to total and permanent disablement claims for bodily injury caused by violent, accidental, external and visible means. 3. What you re not covered for Cigna will not pay any benefit under this policy if: you or the life insured did not completely and truthfully answer the questions asked when the policy was issued, increased or reinstated. Cigna may cancel the policy from the cover start date and keep any premiums paid; or you or the life insured failed to provide Cigna with any material information before the policy was issued, increased or reinstated. Cigna may cancel the policy from the cover start date and keep any premiums paid; or the life insured death is caused or contributed to, directly or indirectly, by suicide, attempted suicide or intentional self injury, whether sane or insane, within 13 months of the cover start date: or the claim is due, directly or indirectly, to war or any act of war, invasion, terrorism or any acts of terrorism, act of foreign enemy, hostilities, strike, riot and/or civil commotion, civil war, rebellion, revolution, insurrection, military or usurped power. If the cover amount has been increased within the 13 months prior to the life insured death from suicide, attempted suicide or intentional self injury, whether sane or insane, Cigna will only pay the cover amount that applied prior to the increase. mobility (from place to place with or without a wheelchair or a prosthetic device), 5 6

5 4. Changes you can make to your policy Increase your cover You can apply to increase your cover amount at any time by completing a new application, which will go through the same process as your original application. The terms and conditions for your additional cover may differ from those for your existing cover. Your existing cover amount will continue with your original terms and conditions, unless material information was not provided or misrepresented on the earlier application(s). Decrease your cover You can apply to decrease your cover amount at any time by writing to Cigna. Cancellation of cover You can cancel your policy at any time. Your cover will stop as soon as you advise us. If you cancel your policy within the free look period you will receive a full refund of all premium payments you have made. If you cancel your policy outside the free look period there will be no refund of premiums. Change your payment method and frequency You can apply to change the method and frequency of premium payments at any time by contacting Cigna. Change the Policy Owner(s) You can transfer the policy ownership at any time. To do this you need to complete a Memorandum Of Transfer form and return it to Cigna. Cigna will need to register the transfer for it to be legally recognised. Reinstate your cover You can apply to Cigna for your policy to be reinstated if it has been cancelled through unpaid premiums. You may need to provide Cigna with information about the life insured s health and lifestyle and reinstatement will be at Cigna s discretion. The terms applying to the reinstatedcover may be different to those applying before it was stopped. You will be issued with a new policy summary. 5. How to make a claim If you need to make a claim against this policy, contact Cigna as soon as possible to request a claim form. Cigna will send the claim form within 24 hours of your request. Complete the claim form and return it to Cigna together with any supporting documents requested. Any medical information required to support a claim for a term life benefit, living benefit or crisis cover benefit must be: provided by appropriately qualified medical practitioners registered in New Zealand or Australia (or any other country approved by Cigna); and paid for by you. If Cigna requires the life insured to undergo any further examinations or tests to confirm that the life insured is suffering a terminal illness, or a crisis cover condition, these costs will be met by Cigna. 6. What you can expect from Cigna Renewal of cover For variable premium policies Cigna guarantees renewal of the policy. Each year on the anniversary date cover will continue if you do not cancel the policy and premiums continue to be paid. For fixed premium policies your policy will end on the expiry date shown on the policy summary. If you wish to apply to renew your policy you will need to complete a new application and complete the same process as the original application. Premium adjustments Your initial premium payable is shown on your policy summary and is based on the current cover amount. 7 8

6 For variable premium policies, your premiums will be adjusted on each anniversary date as you get older. Cigna will advise you in writing before your anniversary date of any changes to your premium payable for the coming year. For fixed premium policies, as the name suggests, your premiums will remain fixed for the life of the policy. Cigna may review and change its premium rates for variable premium policies. Cigna will give you 30 days prior written notice of any such change. Inflation adjustments To help keep your cover up to date, Cigna may offer you a yearly increase on the current cover amount, up to 10%, on each anniversary date. The percentage increase offered will be based on the most recent 12 month increase in the Consumer Price Index (CPI). If you accept the offer, your premium will increase in line with the premium rates applicable at the date of the increase. This applies to both Fixed and Variable policies. You do not have to accept an increase but no further increases will be offered once: 7. How to register a complaint If you have a complaint we are happy to discuss it. Please contact us on the TSB Bank - Cigna Insurance Helpline on (or if you are calling from outside New Zealand), or us on [email protected]. Our Customer Service team will do their best to resolve your issue straight away. However, if they can t sort out the issue, our dedicated Customer Resolution Consultant will personally take on your case. Also, Cigna is a member of the Insurance and Savings Ombudsman (ISO) scheme, a free, independent service which can help settle any dispute you are unable to resolve with us. Any dispute or action relating to your policy will be determined in accordance with New Zealand law. ISO contact details Post PO Box , Wellington 6143 Phone [email protected] Website 9 you have declined 3 offers; an offer to increase will lead to the total cover amount under the policy exceeding $2,000,000; Cigna has been notified of a possible claim under this policy; or the anniversary date after the life insured s 65th birthday has been reached. Stop your policy Cigna will stop the policy when any of the following happens: if the premiums are unpaid for 3 months, cover will end on the date the last premium was paid up to; Cigna pays a living benefit equal to the cover amount; Cigna pays out your full cover amount; you request Cigna to cancel your policy. the policy expiry date is reached. 10

7 8. Policy definitions The following words and terms appear in the policy summary and/or in this document. They are defined as: Anniversary date means the date 12 months after the premium start date and the same date every year after that. Cover amount means the amount this policy pays out. Cover start date means the date that the cover began. Expiry date means the date that the policy expires as set out in the policy summary. Fixed premium means your premium will remain unchanged for the life of the policy. Free look period means a 30 day period starting on the day that Cigna posts or s this policy. Life insured means the person(s) who are insured under this policy. Material information means all the relevant information that Cigna needed in order to decide the terms relating to your policy. It includes, but is not limited to; information about a life insured s health, medical history, occupation and leisure activities. Policy means the terms and conditions applying to this insurance as described in the policy document, policy summary and your application form. Terminal illness means an illness that Cigna believes will result in the death of the life insured within 12 months of the policy owner(s) applying for a living benefit. The illness must commence after the cover start date or the reinstatement date if Cigna reinstates this policy, and be diagnosed while this policy is in force. This illness must be supported by written diagnosis and prognosis by two unaffiliated registered medical practitioners. Terrorism means the use or threatened use of force or violence against human life or property, or commission of an act dangerous to human life or property, or commission of an act that interferes with or disrupts an electronic or communication system, undertaken by any person or group, whether or not acting on behalf of or in any connection with any organisation, government, power, authority or military force, when the intent is to intimidate, coerce or harm a government, civilian population or any segment thereof, or to disrupt any segment of the economy. Variable premium means your premium will be recalculated each year based on your age and other relevant factors. War means any war, whether declared or not, or any warlike activities including use of military force by any sovereign nation to achieve economic, geographic, nationalistic, political, racial or religious ends. Policy owner(s) means the person(s) initially named as the policy owner(s), or the assignee(s) named on the most recent Memorandum of Transfer if the policy has been assigned. The Policy owner(s) is also referred to as you or your in this document. Policy summary means the summary sent to you with this document on which details specific to your policy are listed, or any replacement summary. Premium start date means the date that the first premium is due

8 9. About Cigna Cigna New Zealand is a leading specialist provider of insurance products and services including life insurance, identity theft protection, funeral insurance, income protection insurance, accidental death insurance, trauma insurance and travel insurance. We ve been operating in New Zealand for more than 85 years, and now protect over 275,000 New Zealanders with our insurance policies. Cigna New Zealand is part of Cigna Corporation, a Fortune 500 company and one of the world s largest publicly-owned companies. A copy of Cigna s latest financial statements is available on request. Cigna has an A- (Excellent) financial strength rating which was given by A.M. Best Company Inc. The rating scale is: Secure Vulnerable A++, A+ (Superior) B, B- (Fair) A, A- (Excellent) C++, C+ (Marginal) B++, B+ (Good) C, C- (Weak) D (Poor) E (Under Regulatory Supervision) F (In Liquidation) S (Suspended) For more rating information visit Privacy Any details you provide will be held securely by Cigna for the purpose of providing you with quotations and information about TSB Bank products and services. Your details will never be disclosed to third parties, except for purposes of setting up and administering any policy you wish to take out. From time to time, TSB Bank may contact you with information about products and services, which TSB Bank feels may be of interest to you. Under the Privacy Act 1993 you have the right of access to and correction of personal information provided by you. If you would prefer not to be contacted about these products please call the TSB Bank Cigna Insurance Helpline on Contact Cigna Phone Fax [email protected] For general information about your policy, including premiums, address changes etc [email protected] To request a claim form or ask any questions related to a claim Postal address Cigna Life Insurance P O Box Wellington