How To Pay Out Of Pocket On A Friendsprovident Policy

Transcription

1 Executive Income Protection Policy conditions Reference PN

2 Contents Page 1 Introduction 2 2 Premiums 5 3 Insured benefit 6 4 Proportionate benefit 7 5 Rehabilitation benefit 8 6 Hospitalisation benefit 9 7 Waiver of premium 9 8 Linked periods of incapacity 9 9 Increasable insurance option Increasing cover Continuation option Direct pay option Life insured not in full-time employment Claims and notifications Our right to cancel your policy If you stop your policy General 16 Important Please contact us at the start of a period of incapacity otherwise your claim may be delayed or refused. We give more information in Condition Introduction 1.1 About your Executive Income Protection policy Your policy is a legal contract between you and Friends Provident Life Assurance Limited. Insurance provides cover for events that occur by chance or accident. This policy does not provide cover for events that you or the life insured deliberately bring about. Please read your policy conditions and policy schedule carefully. You should keep them in a safe place as they will be needed if you claim under your policy. If you transfer your rights under your policy, or under any of its benefits, your policy will end immediately and no benefits will be payable other than as described in What you, your, we, us and our mean You and your: The employer. We, us and our: Friends Provident Life Assurance Limited. 1.3 General definitions we use in this document Various expressions used in this document are in bold. The meanings for these are shown below. Benefits in kind These are any benefits the life insured receives from employment that are shown on HM Revenue & Customs form P11D. 2

3 Continuing income means the weekly equivalent amounts of all the following: regular payments to the life insured or any employer of the life insured under any other insurance held by either of them against incapacity of the life insured due to illness or injury; waiver of any regular payment due from the life insured or any employer of the life insured provided by an insurance against incapacity due to illness or injury; credit repayment instalments paid or waived due to incapacity under mortgage payment protection policies and under any other form of loan, finance or credit protection policies; any continuing salary, commission, pension (unless the pension was already being paid to the life insured before this policy began) or other income, including dividends and benefits in kind, arising from all paid occupations in which the life insured has ever engaged; and any State benefits, credits and allowances arising from incapacity due to illness or injury to which the life insured is entitled (but excluding any amounts that relate to dependants and Disability Living Allowance); but does not include: premiums waived under policies of life assurance or pension schemes; or payments under insurances which fund pension scheme contributions during incapacity where the insurer makes payments directly to the administrator or provider of the pension arrangement. Deferred period This is the first part of a period of incapacity for which no benefit is payable, other than hospitalisation benefit. Your policy schedule shows how long this period is. Dividends These are any dividends that the life insured receives from a private limited company in which they and no more than three other shareholders are employed as full-time working directors. Effective date The date we show in your policy schedule from which premiums are payable. It may be before the risk date. We also use it to calculate when policy years begin. Employer The employer shown in the policy schedule or any other employer of the life insured to whom the policy has been assigned under Condition Employment This is each and every paid occupation that the life insured is engaged in immediately before a period of incapacity. Expiry date This is the latest date on which your policy can end and is shown in your policy schedule. Friends Provident group of companies This means Friends Provident plc subsidiary companies. Full-time employment This is an occupation where the life insured receives taxable earned income and in which they are actively engaged and normally work 16 or more hours a week on a regular basis. Hospital This means premises recognised as a hospital or nursing home by local or state health authorities in any of the countries listed in Condition Insured benefit The amount of this benefit is shown in the policy schedule but may be restricted by Condition 3.2. It may include any of income protection benefit, national insurance contribution protection benefit and pension contribution protection benefit. Life insured This is the person we show in the policy schedule whose life is covered by the policy. 3

4 Maximum benefit This means the weekly equivalent of income protection benefit 75% of pre-incapacity earnings up to a maximum benefit of 3,365 a week less continuing income, plus; national insurance contribution protection benefit the amount actually being paid as employer s national insurance contributions in respect of the life insured up to a limit of 425 a week, plus; pension contribution protection benefit the amount actually being paid as employer s contributions in respect of the life insured to a pension scheme up to a limit of 1,000 a week. We work out this amount by taking the contributions paid in the three years ending on the date on which the period of incapacity begins, revalued up to that date in line with the most recently available Retail Prices Index, and dividing the result by 156. Where contributions have not been payable for the full three year period, we will adjust the result to a figure which in our opinion represents the contributions the employer could have been expected to make if the life insured had been able to keep working normally until the end of that period. Paid occupation An occupation that is of financial value whether or not the life insured receives payment, profit or reward. Pension scheme This means a pension scheme registered under Part 4, Chapter 2, Finance Act Period of incapacity This is a period throughout which the life insured is: totally unable to perform the main and substantial duties of their employment due to illness or injury, other than a deliberately self-inflicted injury; and not engaged in a paid occupation. If the life insured s employment consists of two or more paid occupations, they will not be classed as incapacitated if they have the ability to perform the main and substantial duties of one or more of those occupations. Main and substantial duties are the essential duties of an occupation that take a significant part of the life insured s time and that neither they nor their employer can reasonably omit or adjust. When deciding if they are able to perform the duties of their occupation, we look at the standard duties for that occupation type rather than the particular duties for their own specific job. Availability of work is not a factor in deciding whether they are able to perform their occupation. Policy The legal contract detailed in your policy schedule and these policy conditions. Policyholder This is the owner or owners of the policy. The policyholder at the outset is shown in the policy schedule. Policy conditions The general terms and conditions set out in this document. Policy schedule The document that makes the policy conditions personal to you and the life insured and sets out the cover we provide, what it costs and how long it lasts. Policy year A year starting on the effective date or its anniversary. Pre-incapacity earnings This is the life insured s total taxable income from all paid occupations in the 52 weeks immediately before the period of incapacity. For earnings as an employee this means: taxable earnings in the United Kingdom in the 52 weeks immediately before the period of incapacity. These are pre-tax earnings for PAYE assessment purposes as shown on HM Revenue and Customs form P60; taxable earnings outside the United Kingdom in the 52 weeks immediately before the period of incapacity. These are pre-tax earnings as assessed for income tax or its equivalent, and agreed by the tax authorities in the relevant country; benefits in kind received in the 52 weeks immediately before the period of incapacity; and 4

5 dividends received in the 52 weeks immediately before the period of incapacity which represent the life insured s share in the net trading profit of the company from the company s normal regular business during those 52 weeks. For earnings from self-employment this means: taxable earnings in the United Kingdom in the 52 weeks immediately before the period of incapacity. This is income chargeable to tax under Part 2, Income Tax (Trading and Other Income) Act 2005 (in other words, the life insured s share of pre-tax profit after deduction of trading expenses) as assessed for income tax and agreed by HM Revenue and Customs; and taxable earnings outside the United Kingdom in the 52 weeks immediately before the period of incapacity. These are pre-tax earnings as assessed for income tax or its equivalent, and agreed by the tax authorities in the relevant country. The life insured s income from savings, drawings and investments, except for dividends as described above, is not included as pre-incapacity earnings. Premium The amount we show in your policy schedule that you must pay to us on each renewal date. Renewal dates The dates we show in your policy schedule on which you must pay us the premium. Retail Prices Index (RPI) This is a domestic indicator of inflation in the United Kingdom. It measures the average change from month to month in the prices of goods and services purchased in the United Kingdom. 2. Premiums 2.1 Payment of premiums Premiums are payable as shown in your policy schedule. A premium must be paid on the effective date and on each renewal date after that. All premiums are payable until the expiry date by direct debit If increasing cover is shown in your policy schedule, the amount of premium will increase by 5% compound on each anniversary of the effective date. 2.2 Non-payment of premiums If any premium stays unpaid 30 days after its due date the cover and benefits under your policy will end without payment If the cover ends for this reason, you can apply to us within the following 12 months to restart the cover. We will need satisfactory evidence of the life insured s state of health and any other factors affecting the insurance risk. We will write to you to tell you whether we can restart cover or not. If we decide to offer the cover on different terms to those we originally offered, which may include an increase in premiums and/or an exclusion, we will need to receive your signed acceptance of the revised terms before we restart the cover. To restart the cover, you must also pay all unpaid premiums. 2.3 Restriction of benefits There will be no refund of premiums if benefits are restricted under Condition 3.2. Risk date The date we show in your policy schedule when your cover and benefits actually start. Salisbury office Friends Provident Life Assurance Limited UK House Castle Street Salisbury SP1 3SH 5

6 3. Insured benefit You can claim this benefit from the end of a deferred period. It pays out a regular income when a period of incapacity continues after the end of the deferred period, subject to the policy terms and conditions. 3.1 When it is payable The benefit shown in your policy schedule (limited where appropriate by Condition 3.2) is payable from the end of the deferred period for any period of incapacity that starts: after the risk date; and before the expiry date We will continue to pay the insured benefit until whichever happens first: the end of the period of incapacity; the death of the life insured; the expiry date; the life insured ceasing to be in the service of the employer; as long as: the requirements of Condition 14 are met; any exclusions shown in your policy schedule do not apply; we are not entitled to cancel your policy under Condition 15; we are not entitled to cancel your policy under Condition ; and your policy has not ended for any other reason We will not pay insured benefit for any period during which the life insured engages in a paid occupation but they may qualify for proportionate benefit or rehabilitation benefit You will not be entitled to insured benefit at the same time as any other benefit under your policy. 3.2 How much is payable The insured benefit that we pay will be the lower of: We will recalculate the amount of benefit payable as described in Condition 3.2.1: whenever there is a change in continuing income; if increasing cover, as detailed in Condition 10, is included in your policy, whenever there is an increase in cover; or in any event at least every three years; using revised figures as appropriate. When we recalculate the amount we can pay, we will adjust pre-incapacity earnings to reflect changes in the Retail Prices Index since the start of the period of incapacity If as a result of the incapacity of the life insured you are entitled to claim benefit under any other policy with us or any company in the Friends Provident group of companies that includes: income protection; permanent health insurance; or any similar benefit. We will calculate the amount we will pay under this policy and those other policies in a strict date order, based on the dates on which cover started for each policy. We will first assess how much we can pay under the policy with the earliest risk date, then under the policy with the next earliest risk date and so on, taking into account benefit from any previous policies as continuing income If as a result of their incapacity the life insured is entitled to claim benefit under any other policy with us or any other company in the Friends Provident group of companies that includes: income protection; permanent health insurance; or any similar benefit. We will apply Condition 3.2 of this policy to decide whether to limit the benefits under it before we apply any similar provision under any other policy to the benefits under that policy. We will do this no matter when the cover started under the other policy. insured benefit specified in your policy schedule; and the maximum benefit. 6

7 4. Proportionate benefit This benefit pays out a regular income if the life insured is still medically unfit to perform the main and substantial duties of their employment after the end of the deferred period but takes up a different less well-paid occupation, subject to the policy terms and conditions. 4.1 When it is payable We will pay this benefit after the end of the deferred period provided: the life insured would qualify in every respect for insured benefit other than being engaged in a paid occupation which is different to their employment; and their earnings in that paid occupation are less than their pre-incapacity earnings Your entitlement to this benefit continues until whichever happens first: the life insured ceases to meet the requirements of Condition 4.1.1; the life insured leaves the service of the employer; death of the life insured; the expiry date You will not be entitled to proportionate benefit at the same time as any other benefit under this policy. 4.2 How much is payable We calculate the amount of proportionate benefit payable using the following formula. Example of how we calculate the amount of proportionate benefit payable: weekly amount of income protection = 300 benefit entitled to receive weekly pre-incapacity earnings = 520 weekly earnings from new occupation = x 300 = The weekly amount of proportionate benefit payable is therefore We will recalculate the amount of benefit payable as described in Condition 4.2.1: whenever there is a change in the life insured s continuing income; if increasing cover, as detailed in Condition 10, is included in your policy, whenever there is an increase in cover; or in any event at least every three years; using revised figures as appropriate. When we recalculate the amount we can pay, we will adjust the pre-incapacity earnings figure to reflect changes in the Retail Prices Index since the date the life insured s incapacity started If the calculation in Condition means we pay no benefit of any type for 52 weeks in a row, your claim will end. There will be no further entitlement to benefit without the life insured suffering a new period of incapacity. pre-incapacity earnings less income new earnings x protection = proportionate benefit pre-incapacity benefit* earnings * We use the amount of income protection benefit which would be payable under Condition 3.2 if there were no new earnings. We will also reduce the amount of continuing income, used in our calculations, to take account of any State benefits, credits or allowances the life insured loses by taking up their new occupation. 7

8 5. Rehabilitation benefit This benefit pays out a regular income if the life insured returns to employment in a reduced capacity and for lower earnings because of continuing partial incapacity, following a period when we have paid you either insured benefit or proportionate benefit, subject to the policy terms and conditions. 5.1 When it is payable You are entitled to rehabilitation benefit if immediately after a period of incapacity, during which we have paid insured benefit or proportionate benefit, the life insured returns to employment and as a direct result of continuing partial incapacity resulting from illness or injury, other than a deliberately self-inflicted injury: remains restricted in the scope of their occupational activities; continues to earn less than their pre-incapacity earnings; and continues to require regular supervision and treatment by a registered medical practitioner Your entitlement to this benefit continues until whichever happens first: the life insured ceases to meet the requirements of Condition 5.1.1; the life insured leaves the service of the employer; death of the life insured; the expiry date You will not be entitled to rehabilitation benefit at the same time as any other benefit under this policy. 5.2 How much is payable We calculate the amount of rehabilitation benefit payable using the following formula. pre-incapacity earnings less income new earnings x protection = pre-incapacity benefit* earnings rehabilitation benefit * We use the amount of income protection benefit which would be payable under Condition 3.2 if there were no new earnings. We will also reduce the amount of continuing income, used in our calculations, to take account of any State benefits, credits or allowances the life insured loses by taking up their new occupation. Example of how we calculate the amount of rehabilitation benefit payable: weekly amount of income protection = 300 benefit entitled to receive weekly pre-incapacity earnings = 520 weekly earnings from new occupation = x 300 = The weekly amount of rehabilitation benefit payable is therefore We will recalculate the amount of benefit payable as described in Condition 5.2.1: whenever there is a change in the life insured s continuing income; if increasing cover, as detailed in Condition 10, is included in your policy, whenever there is an increase in cover; or in any event at least every three years; using revised figures as appropriate. When we recalculate the amount we can pay, we will adjust the pre-incapacity earnings figure to reflect changes in the Retail Prices Index since the date the life insured s incapacity started If the calculation in Condition means we pay no benefit of any type for 52 weeks in a row, your claim will end. There will be no further entitlement to benefit without the life insured suffering a new period of incapacity. 8

9 6. Hospitalisation benefit This benefit pays out a cash sum if the life insured is admitted to hospital as an in-patient for a continuous period of more than seven consecutive days during the deferred period, subject to the policy terms and conditions. 6.1 When it is payable You are entitled to hospitalisation benefit if during a period of incapacity the life insured is admitted to hospital and remains an in-patient for a continuous period of more than seven days during the deferred period Hospitalisation benefit is payable for their eighth complete day in hospital and for each successive day that they are required to stay in hospital until, and including, the earliest of: the last complete day of their stay in hospital; the 91st complete day of their stay in hospital; the date on which the deferred period ends; the date of their death; and the expiry date You will not be entitled to hospitalisation benefit if the life insured s claim is directly or indirectly due to mental or functional nervous disorders or any non-specific chronic viral infection or chronic fatigue syndrome. 6.2 Premiums You must continue to pay the premiums during a claim for hospitalisation benefit. 6.3 How much is payable The daily amount of hospitalisation benefit payable will be the lower of: one seventh of the insured benefit; and 150; for each complete day the life insured stays in hospital The overall maximum that we will pay to you under this benefit is 150 a day and this will take account of this policy and any policies issued to you or to the life insured by us or any other company in the Friends Provident group of companies and providing similar benefits on the incapacity of the life insured Where hospitalisation benefit is payable under any earlier policies within Condition 6.3.2, then: if the total benefit payable under those policies exceeds 150 a day, there will be no hospitalisation benefit payable under this policy; or if the total benefit payable under those policies is less than 150 a day, the hospitalisation benefit payable under this policy will be limited to the amount needed to bring the total benefit up to 150 a day. 7. Waiver of premium 7.1 We will waive any premiums that become due during a period where we are making payments of any benefit other than hospitalisation benefit. 8. Linked periods of incapacity 8.1 We will link together any period of incapacity if it starts: within 52 weeks of the end of a previous period during which income protection benefit or proportionate benefit was payable; or during a period of entitlement to rehabilitation benefit and all such periods arise from the same cause. 8.2 Where the requirements of Condition 8.1 are met the claim arising from the linked period of incapacity will be assessed in accordance with the appropriate conditions for the benefit being claimed with the exception that; we will make up the shortfall of 52 weeks earnings by taking the proportion of the pre-incapacity earnings figure used in the previous claim; and the deferred period will not apply. 9

10 9. Increasable insurance option This option applies only if your policy schedule says your policy includes it. This option allows you to increase your cover on certain future dates, without having to give us any further details of the life insured s health, occupation or pastimes, subject to the policy terms and conditions. 9.1 The option When the option is available you may start a new policy, of the same type as this policy, on the life of the life insured without having to provide us with any further evidence of insurability. The new policy will be issued on the terms set out in Condition The option is available at the 3rd, 6th, 9th, 12th, 15th and 18th anniversaries of the effective date. The option is not available within 10 years of the expiry date of this policy To take up this option you must request an application form which you and the life insured must complete. We must receive the completed application, and you must start the new policy, within 30 days after the date on which the option was available. 9.2 Terms of new policies The total amount of insured benefit and pension contribution protection benefit under a new policy cannot be more than 30% of that under this policy, current at the time you take up the option. A new policy will not be available if the premium would be less than the minimum amount referred to in Condition Except where we say otherwise in Condition 9.2, the new policy will be subject to our standard terms and conditions that apply at the time it starts and that are appropriate to the then age of the life insured. The standard terms and conditions, which may include a minimum amount of insured benefit, premium and period for which cover will last, will be available on request The deferred period under a new policy cannot be shorter than that under this policy The expiry date under a new policy cannot be later than that under this policy Any new policy will not include: the increasable insurance option; or any other options which allow you to increase benefits or take out further policies If you take out a new policy: during a period of incapacity; within six months after such a period ends; or when we are paying you rehabilitation benefit; you will not be entitled to any benefit under the new policy until the life insured has recovered and has been actively engaged in full-time employment for six months The new policy will include any special terms or conditions that apply to this policy Premiums and benefits under the new policy will be payable in the same way as under this policy. 10

11 10. Increasing cover This cover applies only if your policy schedule says your policy includes it. This cover increases the amount of cover and premium on your insured benefit every year, subject to the policy terms and conditions The insured benefit and premium will increase automatically by 5% on each anniversary of the effective date This table shows how a weekly insured benefit which starts at 10 would increase. Policy year Income Policy year Income protection protection benefit ( ) benefit ( ) If you instruct us not to proceed with an increase: no further increases in the insured benefit or premium will be allowed; and the insured benefit and premium will then remain unaltered The amount of benefit that we will pay following an increase under this option will always be subject to Condition 3.2. The amount of your cover will increase but this may not increase the amount of benefit we can pay in the event of a claim. 11. Continuation option 11.1 The option This option allows the life insured to replace this policy with a new policy, without having to give us any further evidence of insurability. It is available, if before this policy is terminated: they leave the service of the employer; or their service is terminated by the employer; or the employer ceases trading and this does not happen during a period of incapacity The new policy may be one with income protection benefit as described in Condition 11.2 (but only if the life insured is in full-time employment when the new policy begins) or one with houseperson s benefit alone as described in Condition In either case the new policy will be written on underwriting terms no less favourable than those which apply to this policy To exercise the option, the life insured must complete the relevant application form. We must receive this not later than 30 days after the date on which the relevant event in Condition takes place This policy will be cancelled immediately the new policy begins. Where the weekly amount of insured benefit or pension contribution protection benefit is more than 10, the above figures should be increased proportionately. 11

12 11.2 Terms of new policy with income protection benefit The new policy will be subject to the same terms and conditions, including minimum amounts of benefit and premium, which apply at that time to policies that we issue to individuals and provide income protection benefit. We will provide a copy of those terms and conditions if you ask. The new policy will also be subject to the restrictions in Conditions to The deferred period under the new policy must not be shorter than the deferred period under this policy The expiry date under the new policy must not be later than the expiry date under this policy The amount of income protection benefit under the new policy must not exceed the amount of that benefit under this policy at the date the life insured leaves the service of the employer. We may further reduce the income protection benefit under the replacement policy to the maximum amount we allow under a new policy of that type at the time the life insured takes up the option, based on their level of earnings after leaving the service of the employer We will calculate the premium for the new policy at the time the continuation option is taken up. The premium will be based on our rates in general use for policies of that type at the time The new policy will not include any option to increase benefits or take out further policies The new policy can only include increasing cover if this policy includes it, and on the same basis The new policy will include any special terms and conditions applied by our underwriters to this policy Terms of new policy with houseperson s benefit only The new policy will be subject to the same terms and conditions, including minimum amounts of benefit and premium, which apply at that time to policies that we issue to individuals and provide houseperson s benefit only. We will provide a copy of those terms and conditions if you ask. The new policy will also be subject to the restrictions in Conditions and The weekly amount of houseperson s benefit under the new policy must not exceed: the weekly amount of insured benefit under this policy at the date the life insured leaves the service of the employer; or the maximum weekly amount of houseperson s benefit we allow on new policies generally at the time the life insured take up the continuation option; whichever is less The new policy will not include increasing cover or any option to increase benefits or take out further policies. 12. Direct pay option This option allows us us to pay benefit direct to the life insured in certain circumstances This option is available to the life insured if before this policy is terminated: they leave the service of the employer; or their service is terminated by the employer; or the employer ceases trading; and this happens during a period of incapacity, and after we have told the employer that we have admitted a claim for benefit The option allows the life insured to take out a temporary continuation policy which will provide only for payment of income protection benefit under the claim we have already admitted. The amount of income protection benefit under the new policy will not exceed the amount agreed under the admitted claim This policy will be cancelled immediately the new policy begins The deferred period under the new policy must not be shorter than the deferred period under this policy. 12

13 The new policy will end on the earliest of the following: the expiry date under this policy; the end of the period of incapacity; the earliest date on which we would have been entitled to cancel this policy under Condition 15 if it had remained in force The new policy will not include any option to increase benefits or take out further policies but will include increasing cover if this policy includes it, and on the same basis. 13. Life insured not in full time employment 13.1 We will not pay benefit under this policy for any period of incapacity unless the life insured is in full-time employment when the period of incapacity begins We will treat maternity or paternity leave as full-time employment as long as the life insured was in full-time employment when it began We will not return any premiums if we refuse a claim because the life insured was not in full-time employment. 14. Claims and notifications 14.1 Notifying a claim If the deferred period is thirteen weeks or more, you must tell us in writing within four weeks of the start of a period of incapacity unless the claim is for hospitalisation benefit If the deferred period is four weeks, you must tell us in writing within two weeks of the start of a period of incapacity unless the claim is for hospitalisation benefit If you do not tell us as specified under Conditions or , we will treat the incapacity as having started on the date that we receive your notification and the deferred period will start on that date. We may use an earlier date if we are satisfied the nature of the incapacity prevented you and the life insured from telling us Other claims conditions We will send you a claim form to you and the life insured. You must complete and return this to us within three weeks of its date of issue. There will be no entitlement to benefit for any period more than one month before we receive the completed claim form You must continue to pay your premiums until: we tell you that we admit liability for the claim; and the deferred period has ended There will only be entitlement to benefit, other than hospitalisation benefit, after the deferred period has ended For benefits other than hospitalisation benefit we pay one-seventh of the weekly benefit for each day of entitlement. We pay these benefits monthly in arrears Any money we pay will be in pounds sterling from the Paying Office we state in your policy schedule. 13

14 14.3 Evidence We will only pay benefit if, and when, we are satisfied that the claim is valid. As often as we decide, we will ask for evidence to support your claim. Payment of your claim is dependent on this evidence being produced. Evidence of a claim that we need may include but is not limited to: evidence through examination by a medical examiner we name that the life insured continues to be incapacitated; any other medical tests or investigations of the life insured our Chief Medical Officer considers appropriate; evidence that the life insured is attending an appropriate medical practitioner and receiving medical treatment in accordance with NHS Best Practice; the life insured s medical records; evidence of employment and the duties of the life insured s employment; the employer s occupational health and/or human resources records relating to the life insured; evidence of the life insured s pre-incapacity earnings and continuing income; evidence of the employer s contributions to a pension scheme in respect of the life insured over the three years ending when the period of incapacity begins; evidence that the employer is continuing to apportion and apply the insured benefit as set out in Condition evidence of the life insured s age Application of insured benefit We will make all payments of insured benefit to the employer Payment of income protection benefit is subject to the employer paying the same amount as salary to the life insured, except that the employer may reduce this by any Statutory Sick Pay which it pays to the life insured after the end of the deferred period Payment of national insurance protection benefit is subject to the employer making a payment of at least the same amount as Employer s National Insurance Contributions in respect of the life insured Payment of pension contribution protection benefit is subject to the employer making a payment of at least the same amount as employer s contributions to a pension scheme in respect of the life insured Termination of benefit The employer and the life insured must tell us in writing immediately if the medical adviser of the life insured decides that a period of incapacity has ended. Payment of insured benefit will then cease If: the employer provides continuing income; the amount of this when added to the income protection benefit under this policy and any other policies held by the employer on the life of the life insured exceeds the maximum benefit for income protection benefit; and the employer knows this to be the case; we will not pay income protection benefit under this policy or will stop payment of that benefit if it has already started Pregnancy Pregnancy is not an illness. We will therefore not consider any claim that arises solely from the normal effects of pregnancy When we admit and review a claim for insured benefit, we will confirm to the employer the maximum amount which can be applied as each of income protection benefit, national insurance contribution protection benefit and pension contribution protection benefit. Subject to these limits the employer will decide how to apply the insured benefit. The employer must tell us what it has decided. 14

15 14.7 Information during claim You and the life insured must tell us in writing immediately if: the life insured s doctor stops issuing medical certificates stating that the life insured is unable to work; State benefits, credits or allowances being paid to the life insured because of incapacity are stopped or reduced for any reason; the life insured returns to paid or unpaid work or engages in rehabilitation or attends a work training programme; or the life insured is travelling or residing abroad, outside their normal place of residence, during your claim. 15 Our right to cancel your policy 15.1 Information provided to us We have the right to cancel your policy if we find out at any time that information given by you or the life insured, or on behalf of either of you, is not true, not accurate or not complete The information referred to in Condition means all information given to us at our request, or at the request of a doctor or nurse acting on our behalf, up to the risk date, that affects our decision to provide cover or the terms of that cover We have the right to cancel your policy under Condition even if the information is not connected to the cause of a claim Changes before the risk date We also have the right to cancel your policy if we find out at any time that you or the life insured has failed to tell us of any changes in the life insured s health or circumstances that: happened before the risk date; would have led to any of the information referred to in Condition being different if given on the risk date; and would have affected our decision to provide cover or the terms of that cover The changes referred to in Condition include the life insured: having or expecting to have doctor, hospital or clinic consultations, treatment as an in-patient or out-patient or a blood test for any reason; having a symptom of any type that we asked about in the application; taking up any hazardous sport or pastime, or intending to do so; working or travelling abroad, or intending to do so; or changing country of residence, or intending to do so; and changes in: the life insured s family history; or the life insured s occupation or the duties of that occupation We have the right to cancel your policy under Condition 15.2 even if the information or change is not connected to the cause of a claim Information given when applying to restart your policy We also have the right to cancel your policy if we restart your policy under Condition and later find out that: any statement you or the life insured made to us for that purpose, or that was made on behalf of either of you, was not true, not accurate or not complete; the answer to a question in any letter or questionnaire we sent to you or the life insured, or any person acting for either of you, was not true, not accurate or not complete; or the answer to a question asked by any doctor or nurse acting on our behalf was not true, not accurate or not complete; where the statement or answer would have affected our decision to restart cover or the terms of that cover We have the right to cancel your policy under Condition 15.3 even if the information is not connected to the cause of a claim. 15

16 15.4 Information given when making a claim If in connection with a claim for any benefit you or the life insured: make an untrue statement about a material fact; deliberately omit to disclose a material fact; or provide false or falsified evidence of a material fact; then we will reject any pending claim and cancel your policy A material fact is anything that is likely to influence our assessment of a claim including: the cause, nature, scope and degree of any illness, accident or incapacity; the treatment received or recommended for any illness, accident or incapacity; occupation details including the duties of the life insured s occupation; pre-incapacity earnings; continuing income; details of other insurance claims on the life of the life insured, personal injury claims or compensation claims arising from incapacity; any work performed by the life insured during a claim, whether paid or unpaid; and place of residence of the life insured Transfer of your policy rights If you transfer your rights under your policy or under any of its benefits, except in the circumstances in Condition , we will immediately cancel your policy Termination of policy If we have the right to cancel your policy under Condition 15 then no benefit will be payable in respect of the period from when the right arose. 16. If you stop your policy 16.1 You can tell us to stop your policy at any time. If you do, no further premiums will be payable and all cover will stop. You may find: you are unable to get new cover to replace any cover that has stopped; or any new cover costs more or is subject to exclusions Your policy will not have any cash value. 17. General 17.1 Changed circumstances We may change the terms of your policy to reflect any changes in taxation, insurance or other law affecting our obligations under it Events or circumstances beyond our control We will not be liable to pay you, or any other person, any compensation for loss caused by events or circumstances beyond our control. This includes loss caused by any delay in carrying out our obligations caused by restrictions imposed on us by law or regulation Proof of age Before paying any claim we must receive proof that the life insured s date of birth given in the application is correct If we find the life insured was born earlier than the date of birth given, we will adjust the benefits under your policy to those we would have offered had we known the correct age from the start. If we would not have offered terms, we will cancel your policy and refund any premiums paid without interest If we find the life insured was born later than the date of birth given, we will calculate what your premium would have been had we known the correct age at the start of your policy. We will then refund any overpayment with interest. The amount of interest will depend on the interest rates we are using at the time. We will not pay interest if it is below our minimum. Details of our current interest rate and minimum payment will be available on request. If we pay interest, we will take off income tax as law requires. 16

17 17.4 Residence and travel The life insured may travel or live anywhere in the world without affecting the cover under your policy but your right to benefit is: restricted to a maximum of 26 weeks in any 52 week period; and subject to an overall maximum of 52 weeks; when they are travelling or living outside the countries listed in Condition The countries referred to in Condition are: Andorra Australia Austria Belgium Canada Channel Islands Cyprus Denmark Finland France Germany Gibraltar Greece Iceland Isle of Man Italy Liechtenstein Luxembourg Malta Monaco Netherlands New Zealand Norway Portugal Republic of Ireland San Marino Spain Sweden Switzerland the United Kingdom the United States of America the Vatican State Rights of other parties We and you are the parties to this contract and we do not intend anyone else to have direct or indirect contractual rights under it Sending instructions to us You should send any instructions, notifications or requests to our Salisbury office. They should be in writing, in English and include any documents, information or agreements we may need Assignment You can not transfer this policy or any rights under it to any person in any way, except in the circumstances in Condition If the life insured leaves your service and joins the service of another employer, you may transfer the ownership of this policy to the new employer Notice of the transfer of ownership must be sent to us at our Salisbury office within one calendar month after you make the transfer The law that applies to your policy We show the law that applies to your policy in your policy schedule. 17

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20 Friends Provident Life Assurance Limited Salisbury Office: United Kingdom House, Castle Street, Salisbury, Wiltshire SP1 3SH Registered and Head Office: Pixham End, Dorking, Surrey RH4 1QA Incorporated company limited by shares and registered in England number Telephone FRIENDS and the power of FRIENDS are registered trade marks of Friends Provident in the UK and other countries PN (PDF)