AMP s Group Insurance Underwriting guide This guide provides information on AMP s underwriting as well as the procedures adopted where automatic acceptance does not apply. When underwriting terms apply In most cases, our group insurance provides cover under automatic acceptance. However, in some circumstances cover for members under a group insurance plan is subject to medical and other assessment criteria. Underwriting terms apply when: a member is eligible to be covered under a plan but does not qualify for automatic acceptance terms or transfer terms a member joins a plan outside of the defined eligibility terms a member s cover exceeds the automatic acceptance level a member applies for additional voluntary cover, and at some other time we advise. These members will need to individually apply for cover by submitting a personal statement. We will only provide cover subject to the provision of satisfactory medical and other underwriting information. Medical underwriting When a member s cover is subject to underwriting, we will require certain initial information in accordance with tables A to C. The type of information we require will depend on whether the plan is the default insurance cover as well as the type and total amount of cover requested. When determining the initial medical underwriting, the total amount of insurance for a member is taken into account. That is, if a member is applying for an increase in cover, then the amount of cover already in place will be added to the additional cover being applied for when determining the initial underwriting. Please note that additional underwriting information, other than what is stated in the following tables, may also be requested. Refer to page 2 for initial financial underwriting. Initial medical underwriting Please note that the following tables are a guide to minimum. The circumstances of each application will determine the need for any additional underwriting information. Key 1 and blood screen (HIV, MBA, Hepatitis B surface antigen and Hepatitis C antibodies) 2, blood screen and medical examination by own general practitioner (GP) 3, blood screen and medical examination by own GP and resting ECG 4, blood screen and PMAR (Personal Medical Attendant Report) 5, blood screen, Full Blood Count (FBC), Erythrocyte sedimentation rate (ESR), Microscopic urinalysis (MSU), PMAR, Specialist medical examination, Mammogram (females) over age 50, Prostate specific antigen (PSA) (males) over age 50 Table A Group Life medical underwriting Total insured cover amount Up to $600,000 $600,001 to $1,000,000 1 $1,000,001 to $1,500,000 2 $1,500,001 to $5,000,000 3 $5,000,001 plus Refer to insurer Table B Compulsory Group Salary Continuance medical underwriting Monthly insured cover amount Up to $6,000 $6,001 to $15,000 1 $15,001 to $30,000 4 $30,001 to maximum benefit limit 5 August 2012
Table C Voluntary Group Salary Continuance medical underwriting Monthly insured cover amount Up to $6,000 $6,001 to $14,000 1 $14,001 to $30,000 4 $30,001 to maximum benefit limit Further underwriting limits When an application is accepted, we will generally agree to future increases in cover, up to a set limit, without requiring further underwriting. This higher amount of cover is the further underwriting limit (). There are two types of s: compulsory/default cover (tables D and F) and salary-dependent voluntary cover (tables E and G). s are not provided for members where the amount of cover is not dependent upon his or her salary (eg units of cover). Table D Compulsory Group Life s Insured cover amount 5 Up to $600,000 $800,000 $600,001 to $1,000,000 $1,200,000 $1,000,001 to $1,500,000 $1,800,000 $1,500,001 plus Assessed cover plus $500,000 1 1 Subject to policy maximum benefit limits. Table E Voluntary 1 Group Life s Insured cover amount Up to $250,000 $300,000 $250,001 to $400,000 $450,000 $400,001 to $600,000 $700,000 $600,001 to $800,000 $900,000 $800,001 to $1,000,000 $1,150,000 $1,000,001 to $1,200,000 $1,350,000 $1,200,001 plus Assessed cover plus $250,000 2 1 Voluntary cover s do not apply to all types of voluntary cover. s for voluntary cover only apply where the benefit formula for calculating the member s amount of insured benefit is directly related to his or her salary, eg 10 per cent x salary x years to retirement, 3 x salary. 2 Subject to policy maximum benefit limits. Table F Compulsory Group Salary Continuance s Monthly insured cover amount Up to $6,000 $10,000 $6,001 to $10,000 $15,000 $10,001 to $16,000 $20,000 $16,001 to $25,000 $30,000 1 $25,001 to $35,000 $40,000 1 $35,001 plus $50,000 1 1 Subject to policy maximum benefit limits. Table G Voluntary 1 Group Salary Continuance s Monthly insured cover amount Up to $2,500 $3,500 $2,501 to $4,000 $5,000 $4,001 to $6,000 $7,000 $6,001 to $10,000 $11,500 $10,001 to $14,000 $16,000 $14,001 to $17,000 $20,000 $17,001 plus Assessed cover plus $3,000 2 1 Voluntary cover s do not apply to all types of voluntary cover. s for voluntary cover only apply where the benefit formula for calculating the member s amount of insured benefit is directly related to his or her salary, eg 75 per cent of salary. 2 Subject to policy maximum benefit limits. Initial financial underwriting Where financial evidence is necessary, the following apply depending on employment status, type and amount of cover (from all sources). Discretionary financial evidence may be requested by the underwriter at any benefit amount if clarification is required. For underwriting purposes, an employee is a person who does not have any ownership in their employer s company. A self-employed person does have ownership. For example they can be a working director or a partner.
Table H Group life (Death and TPD) Level of sum insured Employees at all levels of sums insured up to $1,500,000 $1,500,001 $2,500,000 $2,500,001+ Financial evidence required Table I Group Salary Continuance Level of sum insured Employees at all levels of monthly benefits monthly benefits up to $20,000 monthly benefits $20,000+ The or adviser is required to The or adviser is required to Financial Questionnaire (signed by accountant), and Adviser Report (found within the Financial Questionnaire) In addition to all the above: Detailed profit and loss accounts and balance sheets for all of the person s business entities (including any service companies and family trusts) over the last two financial years. These accounts are to include notes to the accounts, and Tax returns and assessment notices for all entities for the last two financial years, and Individual tax returns and assessment notices for the last two financial years. Financial evidence required The or adviser is required to The or adviser is required to In addition to the above: Detailed profit and loss accounts and balance sheets for all the person s business entities (including any service companies and family trusts) over the last two financial years. These accounts are to include notes to the accounts, and Tax returns and assessment notices for all entities for the last two financial years, and Individual tax returns and assessment notices for the last two financial years, and Letter from accountant with details of any income splitting arrangements (if income splitting arrangements are in place). We will also require the spouse s tax returns and assessment notices for the last two financial years. Unacceptable financial evidence For self-employed members: letter from accountant in lieu of the financial evidence. MYOB or Quicken printouts or similar Business Activity Statements Invoice books or bank statements Tax returns without assessment notices Assessment notices without tax returns. Gathering and assessing underwriting information Completing the personal statement s are supplied on request or can be downloaded from our website amp.com.au/groupinsurance. AMP provides two ways for a person to complete a personal statement. 1. A personal statement may be handwritten and sent to us by the via mail. In this case, the should ensure the person has completed all required questions and signed the declaration and the medical authority. The should also attach a cover letter to the personal statement when it is sent in. 2. A person may complete our electronic personal statement. The electronic personal statement is an Adobe Acrobat pdf document that expands and contracts depending on the answers provided. Answers can be typed in and saved. The electronic personal statement only asks relevant questions, making it simpler and quicker for the person to complete. Instead of attaching a cover letter, the should provide required information on the Intermediary and Adviser user only page of the electronic personal statement. The completed form should then be sent to us via our electronic upload facility on the secure website. This is a secure website and the will need to log on with their individual login details to access it. In every case the person completing the personal statement should be made aware of their duty of disclosure, which is printed on the form. Blood tests, medical examinations and reports A blood screen consists of testing for HIV, Hepatitis B and C and Multiple Biochemical Analysis (MBA), which measures important health indicators including blood fats, renal function and liver function. If a blood screen is required, we will refer members to our preferred paramedic service provider, Unified Healthcare Group (UHG), for the test. The member can choose to have the test in the comfort of their home or workplace if it is more convenient. Members required to undergo a medical examination will be asked to visit their general practitioner. If a client does not have a GP, a registered nurse can be arranged to visit them in the comfort of their home or workplace. We can make these arrangements through UHG.
While we would prefer to arrange these examinations and tests, you can arrange the appointment on the member s behalf. If you arrange these appointments, please ensure members take an Insurance Pathology and Paramedical/ Medical Examination Request Form with them, which must be signed by the member in the presence of the health professional and returned to us. If the examination or test is arranged through UHG, then UHG will provide the member with the Insurance Pathology and Paramedical/Medical Examination Request Form at the time the blood sample is collected. In these circumstances UHG will have the member sign the form and UHG will return the form to us. The form can be downloaded from amp.com.au/groupinsurance. Multiple medical, which include Personal Medical Attendant Reports Please note that Personal Medical Attendant Reports (PMARs) should only be arranged by us. Therefore, whenever there are multiple medical, one of which is a PMAR, please allow us to arrange all medical. This will ensure that neither you nor the member are contacted multiple times or by multiple parties to arrange different, and will also ensure that you can track the entire medical requirement history for the member via UHG s website. Does AMP pay for blood tests and medical examinations? Yes, we pay the costs for all blood tests and medical examinations we request as part of the underwriting process. Online services Progress and requests for medical arranged through UHG Online requests for pathology tests, paramedical exams and medical exams by the member s own doctor can be made by accessing UHG s website www.unifier.uhg.com.au. The real-time status of all medical arranged for a member through UHG can be accessed via their website at www.unifier.uhg.com.au. You will need your AMP Adviser Number to use this service. If you do not have an AMP Adviser Number, your AMP Business Development Manager can organise one for you. UHG can be contacted by telephone on 1800 101 984 or email adviser.relations@uhg.com.au. Secure group insurance website Our leading technology will assist in the smooth handling of insurance applications. Our secure group insurance website allows plan owners/intermediaries to view the progress and current status of underwriting activities online. Plan owners/ intermediaries are also able to view outstanding underwriting, dates these items were requested, who is responsible for collection as well as a summary of items already received. You will need login details to use this secure service. If you do not have login details already, visit our group insurance website at amp.com.au/groupinsurance for registration information. Interim (provisional) accident cover Members are covered for death and group salary continuance claims resulting from accidents only during the underwriting process, provided premiums are paid (including for periods where interim cover applies). Interim cover commences from the date we receive an application for cover at our office and will cease in accordance with the policy provisions. If interim cover is provided, the amount of cover will be the amount applied for, subject to a maximum interim cover limit. See the plan document for full terms and conditions. Standard or non-standard acceptance terms Standard acceptance terms If, after assessing the member s underwriting information, we consider the member to be a standard health risk, acceptance terms will be confirmed in writing and standard premium rates will apply. Non-standard acceptance terms Where standard acceptance terms cannot be offered, due to the nature of the information gathered, we will seek to offer alternative assessment terms. Alternative assessment may include a premium loading, exclusions, restrictions or a combination of these. In some circumstances, we may not be able to accept an application for cover above the automatic acceptance limit and will decline the application by giving notice in writing. Our underwriting service and standards Some key elements of our underwriting service include: Telephone underwriting If information is missing or we have any questions about the member s state of health or medical history, we contact the applicant directly by telephone for further information. In most cases, this enables us to complete the assessment without any further avoiding unnecessary administration delays. Accessible underwriters Underwriters are available to discuss adverse decisions and unusual underwriting. Our underwriters are thoroughly trained in assessment procedures and product terms and conditions. High value member services Applications for large sums of insurance can be complex. These cases are handled by our most senior underwriters so the right questions are asked at the right times. This ensures high net worth members are given the priority they deserve. We also have clearly defined service standards for each step in the underwriting process.
Our underwriting process The following flow chart illustrates our underwriting process: Underwriting process Where a member requires underwriting, the member completes a personal statement (either electronically or on paper); fund/ sends to AMP arranges outstanding if necessary. sends required information to AMP contacts member to advise requirement advises member of decision Operations Group Insurance Administration Application received; eligibility details are verified against the policy, and then allocated to the underwriters UHG engaged if PMAR is required (UHG follow up with Doctor every 3 days) UHG contacts member if bloodscreen or medical examination is required AMP will contact members for any additional information required for underwriting GI admin advises all to plan owner/ GI admin advises fund/ of final decision AMP Underwriting Underwriter assesses application Underwriting requirement received, imaged and assessed by underwriter All information provided? NO YES Telephone underwriting if appropriate Final assessment made Indicative turnaround time depending on complexity of case 1 2 1 3 2 5 2 weeks follow up cycle by GI admin for outstanding. Application will be closed after 90 days if requested information has not been provided 1 2 Our underwriting service and standards Activity Receive and process eligibility of application Initial assessment of application Further evidence request Follow-up frequency Service level Receive, process eligibility against policy and assign application to the underwriting department within 1 to 2 Initial assessment conducted on application within 1 to 3 If required, further health evidence will be requested within 2 to 5 after the completion of the initial assessment Follow up every 2 weeks on any information we have requested from the person Advise acceptance terms Confirm in writing to the policy owner/ each person s acceptance terms 1 to 2 days after receipt of all information and completion of underwriting assessment Close assessment due to nonreceipt of requested information Application will be closed after 90 days if requested information has not been provided More information For more information visit the AMP s Group Insurance website at amp.com.au/groupinsurance. The National Mutual Life Association of Australasia Limited ABN 72 004 020 437 AFS Licence No. 234649 A member of the AMP Group Registered Office: 750 Collins Street Docklands Victoria 3008 amp.com.au/groupinsurance 01722 0812