EXPLAINING THE SKANDIA LIFETIME PLAN. A unit-linked critical illness plan that provides cover throughout your life

Transcription

1 EXPLAINING THE SKANDIA LIFETIME PLAN A unit-linked critical illness plan that provides cover throughout your life for information only. this product is closed to new business

2 Contents at a glance Glossary 4 quick reference Guide 5 THE SKANDIA LIFETIME PLAN 6 THE LEVELS OF COVER 6 setting and reviewing your premiums 7 Reviewing your premiums 7 YOUR FUND CHOICE 9 changing your FUND choice 9 THE CRITICAL ILLNESSES COVERED 10 SURGERY BENEFIT 10 CHILDREN S BENEFIT 11 CONTINUING COVER BENEFIT 11 OPTIONAL BENEFITS AT AN EXTRA COST 12 Total permanent disability benefit 12 Waiver of premium cover 12 increasing the cover 13 Inflation option 13 Guaranteed increase options 13 charges and allocation rates 15 Charges 15 Allocation rates 16 STOPPING PREMIUMS 16 MAKING A CLAIM 16 what might stop us paying a claim 17 Exclusions applying to critical illness cover 17 Exclusions applying to total permanent disability and waiver of premium 17 Exclusions applying to total permanent disability only 17 Exclusions applying to waiver of premium only 18 putting your policy in trust 18 cashing in your plan 19 OTHER INFORMATION 20 Contact details 20 Regulatory protection 20 Complaint procedures 20 Policyholder protection 21 APPENDIX: CRITICAL ILLNESS DEFINITIONS 22 2

3 EXPLAINING THE SKANDIA LIFETIME PLAN This brochure gives details about how the Skandia Lifetime Plan works and its benefits and options. Please note, following our name change in 2014, Skandia became Old Mutual Wealth. All references in your terms and conditions to Skandia Life refer to products provided by Old Mutual Wealth Life Assurance Limited. 3

4 GLOSSARY This section explains some of the words we use to describe the plan. cover The cash sum we will pay if you suffer one of the listed critical illnesses, you die (if you have Lifetime Cover Plus) or, if you have chosen to include total permanent disability benefit, when you become disabled. Also know as the sum assured. LIFETIME COVER If you chose Lifetime Cover you have critical illness cover only. LIFETIME COVER PLUS If you chose Lifetime Cover Plus you have critical illness and life cover. NON STANDARD TERMS When we need to increase the amount you pay for your cover, or exclude a benefit or condition from the cover, because the person covered has a medical condition or a dangerous job or pastime. Paid up plan A plan which has a remaining value, but for which regular payments are no longer made. The cover continues until the plan s value is zero. Premiums The regular payments you make each month or year to pay for your cover. Review The annual review date is the anniversary of the start of your plan. It is when we offer you the chance to increase your cover each year. After ten years, we will review your payments and you may need to increase them to keep the same level of cover. After that, we may ask you to increase your premiums at any review date to ensure that they are enough to maintain your cover. Ten-year review This is the first time after your plan starts that we check your plan to see if your payments are sufficient to keep the same level of cover for the next five years. Fund management groups These are investment management companies that use the expertise of specialist fund managers to run their portfolio of funds on behalf of both private and institutional investors. Examples are Fidelity, BlackRock and Invesco Perpetual. Units Your regular payments are invested in the funds you have chosen. Each fund is made up of investments from a large number of customers. Your share of that fund is represented by the units linked to that fund that are allocated to your plan. Each unit has a value which can change daily. 4

5 EXPLAINING THE SKANDIA LIFETIME PLAN quick reference Guide Premium guarantee Minimum increase to your premiums Your regular premiums are guaranteed to remain the same for the first ten years of the plan provided you pay all the premiums and do not change the amount of your cover. This guarantee is not affected by changes in plan charges or by the performance of the investment funds you choose. After ten years your plan will be reviewed and your premium may need to be increased a month or 15 a year. see Setting and reviewing your premiums on page 6. How many people can the plan cover? The plan owners Reduced rates for non-smokers The plan can cover: one person, or two people, to pay out when the first of them claims. The plan can have one or two owners. If you smoke, your premiums will be higher than for a non-smoker. Will you need to have a medical? What might stop us paying a claim? Can you cash in your plan? What happens if you stop paying the premiums? You will not have to answer any questions about your health or have a medical if you increase your cover. We may need some medical information if you stop paying your premiums and then ask to reinstate your plan. We may not be able to pay your claim if you did not answer all of the questions on your application form honestly. We may not be able to pay some of your claim if the person covered commits suicide within 1 year of an increase in cover. Yes, you can cash it in but it must be the entire amount. You cannot take a partial amount. If you have chosen to pay the lowest possible premiums for your level of cover, or your chosen funds have not performed well, your plan may have little or no value. After 30 days, we will make your plan paid up. If it has a value, your cover will carry on until it reaches zero value at which point your plan and your cover will end. Also see What might stop us paying a claim on page 17 see cashing in your plan on page 19 5

6 The Skandia Lifetime Plan The Skandia Lifetime Plan is a critical illness contract that can provide cover for the whole of your life. It pays out a cash lump sum when a person covered by the plan, known as the lives assured, suffers a critical illness or dies. The premiums you pay are reviewable and we may need to increase them in the future for you to keep the same level of cover. The main objective of The Skandia Lifetime Plan is to provide critical illness cover and if you chose to include it, life cover. We use your premium to buy units in the investment funds chosen by you. It s possible for your plan to build up a fund value over time. This fund value helps to pay some of the charges including the cost of the critical illness cover (and life cover if you chose it), which increases with age. You can choose a level of premium that invests more, or less, in your plan. The lower your premiums are, the less we can invest to build up a value. the TYPE AND levels of cover When you started the plan you will have chosen one of the following: Lifetime cover - the cover is paid when a person covered has one of the listed critical illnesses. If a person covered dies, the payment would be limited to 101% of the fund value. see How we calculate the new premium on page 7. You can find which illnesses are covered on page 10 Lifetime cover plus - the cover is paid if a person covered dies or has one of the listed critical illnesses, whichever happens first. You will also have chosen one of the following levels of cover: Maximum cover with Minimum premiums: your premium is calculated to sustain your cover for the first ten years and less is invested to build up the value of your plan.you are likely to have to increase your payments significantly at the ten-year review and further into the future. After the first ten years we calculate the minimum premium to last for a further five years. Standard cover and premiums, premiums are higher so more is invested to build your plan s value. We work out how much you need to pay to potentially keep the same level of premiums throughout your life, making assumptions about how much your chosen investments will grow. However, you will need to pay more in the future if: your funds do not grow as much as assumed the growth assumption of your funds change you change your funds to ones which grow at a different rate the costs of your plan increase. You can also choose any level of premiums between the minimum and standards levels as described above. 6

7 EXPLAINING THE SKANDIA LIFETIME PLAN setting and reviewing your premiums Before you took out your plan, you will have been given a quotation telling you what your regular premiums will be. We calculate the premiums based on: your age the amount of cover your health any extra options you chose an estimated rate of growth for your chosen funds the level of cover and premium you chose. You may have been asked to pay a higher than normal amount depending on your health, or if you are in a risky occupation or take part in dangerous pastimes. This is known as non-standard terms. Your premium is guaranteed for the first ten years of the plan. After ten years, we will review your premiums to make sure that your plan will continue to pay for the amount of cover you have chosen. REVIEWING YOUR PREMIUMS Your premium is guaranteed for the first ten years of the plan. After ten years, we will review your premiums to make sure they will continue to pay for the amount of cover you have chosen. Following the ten-year review, we will check your plan each year to make sure that the premiums you pay are still enough for your cover. If we ever find that they are not enough, we will write to you. Increasing premiums in the early years, or before a review is needed, can help to reduce the size of any increases required in the future. HOW WE CALCULATE THE NEW PREMIUM When we review your premiums we base your premium on: your age the amount of cover any extra options an estimated rate of growth for the funds you are in at that time the value of your plan. We don t ask you anything more about your health. The new premium we offer you is calculated to stay the same for a minimum of five years before another review is required. However, because we can only estimate the growth of your funds, if they grow more than estimated we may not need to review your premium in five year s time. If they grow less than estimated we may need to review your premium sooner. When we review your plan we ll write to you and give the option to: pay the higher premium to keep the same level of cover continue to pay the same premium, but with a lower level of cover do nothing. We will tell you how long we estimate you can continue before a change has to be made. change both the premium and the cover cash in the plan (if applicable) make the plan paid up and stop paying the premiums. PLANS ESTIMATED TO LAST FIVE YEARS OR MORE If your current premium is estimated to last another five years or more we give you the option to: do nothing increase your cover and your premium increase your premium and keep the same amount of cover to make the plan last even longer reduce your cover and keep the same premium to make the plan last even longer cash in the plan (if applicable) make the premium is paid up and stop paying the premiums. If your plan estimated to stay the same for more than five years we will tell how many years and all of the options we give you will be estimated to last for this amount of time. 7

8 setting and reviewing your premiums (CONTINUED) HOW THE FUND VALUE AFFECTS YOUR CHARGES AND PREMIUM The growth of your funds and your fund value can have a big affect on your plan. Whether your plan builds a fund value is dependent on both the level of cover your chose at outset and the growth of your chosen funds. As well as some of the charges being deducted from the fund value, it also affects the amount we charge for the critical illness cover. We only charge you for the difference between the amount of cover (sum assured) and the fund value. You may see the difference referred to as the sum at risk. For example, if your cover was 100,000 and your fund value was 10,000 we would charge you for 90,000; the difference between the two. The value of your fund is therefore an important factor when we review your premium. Your level of cover This is the amount we pay when you die, irrespective of your plan s value The difference Your plan s value If you chose to pay a larger premium and the funds in your plan have performed well, their value will have built up. The difference will be smaller and you may not need to increase your premium at a review The difference Your plan s value If you chose to pay a small or minimum premium, or your funds have not performed as well as we expected, the difference will be greater and your premiums may need to increase. 8

9 EXPLAINING THE SKANDIA LIFETIME PLAN YOUR FUND CHOICE Your financial adviser can help you choose from over 500 unit-linked funds. They cover a wide spread of UK and overseas investments, including shares, Government stocks, fixed interest securities, such as gilts,corporate bonds and Eurobonds and/or commercial property. Old Mutual Wealth s unit-linked funds invest on behalf of clients in a wide range of underlying collective investment schemes (CIS), such as unit trusts or open-ended investment companies (OEICs). The price of units in an Old Mutual Wealth unit-linked fund will not mirror the price of the underlying CIS but the fund will perform broadly in line with then underlying CIS in which it invests. If the value of the underlying CIS rises or falls, so will the price of Old Mutual Wealth s unit-linked funds Each fund in our range is made up of units, the value of which is calculated daily. We work out the value of your plan daily, based on the total number of units you have in each unit-linked fund. As the value of the underlying fund rises or falls, so will the value of our unit-linked funds and your plan. CHANGING YOUR FUND CHOICE It is important that you regularly review your choice of funds to ensure they are performing as expected, and change them if necessary. Your financial adviser will be able to help you with this. You can switch some or all of your investment between funds and fund management groups at any time. You can also change the investment choice for just your future premiums at any time. This is often referred to as a redirection. We make no charge for switches or redirections. We reserve the right to delay any switch between funds, or cashing-in all or part of the plan, for up to two weeks to protect all the investors in the fund. If the fund holds property, either directly or indirectly, we may delay the switch or surrender by up to a year, as it may be difficult to sell the property in the short term. 9

10 THE CRITICAL ILLNESSES COVERED The following critical illnesses are covered by your plan: Angioplasty Loss of independent existence Aorta graft surgery Loss of limbs Bacterial meningitis Loss of speech Benign brain tumour Major organ transplant Blindness Motor neurone disease Cancer Multiple sclerosis Coma Paralysis/paraplegia Coronary artery by-pass surgery Parkinson s disease before age 65 Deafness Pre-senile dementia before age 65 Heart attack Stroke Heart valve replacement or repair Terminal illness HIV/AIDS Third degree burns Kidney failure Each of these illnesses has a specific definition and criteria that needs to be met in order to claim. We have added additional illnesses and made improvements to these definitions over time. We generally applied these improvements to existing policies. You may therefore have more and better definitions to the ones that originally applied to your plan. You can find the definitions that apply to your plan now in the appendix at the end of this guide. THE DEFERRED PERIOD If you have Lifetime Cover, you (or the person covered) must survive at least 14 days from the diagnosis of the illness or from the date of receiving surgery for the cover to be paid. This is known as the deferred period. Should you die before 14 days, the payment is limited to 101% of the fund value. The only exception to this is for cases of Multiple Sclerosis and Loss of Independent Existence. These have their own deferred period which can be found in the definitions at the end of this brochure. If you have Lifetime Cover Plus the 14 day deferred period does not apply. Should you (or the person covered) die, the full amount of cover would be paid. SURGERY BENEFIT If the person covered needs coronary artery by-pass surgery, we can arrange to pay some (or all) of the critical illness cover to the hospital in advance. This means you can choose to pay for private treatment rather than waiting for an operation under the NHS. To use the benefit we need to see: the fixed-price quote for the surgery from the hospital confirmation that the operation is medically necessary. We pay the hospital direct, before the operation. If the amount of your cover is less than the cost of the surgery we can only pay the amount of your cover. After the surgery, we pay any remaining cover according to the definition of coronary artery by-pass surgery. For critical illness insurance without life cover, the 14-day deferred period described above applies when claiming the remaining amount of cover. Surgery benefit also applies to any children covered by the plan and we will pay the lowest of: 50% of the cover; and 20,000; and the amount shown on the fixed price quote. We will pay the amount above to the hospital where the coronary artery by-pass surgery is to be carried out and pay any remaining cover the policyholder. 10

11 EXPLAINING THE SKANDIA LIFETIME PLAN CHILDREN S BENEFIT Children s Benefit is automatically included at no extra cost. We cover all natural children, all legally adopted children and all step-children from a legally recognised marriage or civil partnership of the person covered, from 30 days of age until their 18th birthday. It is payable in the event that a child is suffering from one or more of the listed critical illnesses. We will pay the lower of : 50% of the cover; and 20,000. If you have more than one policy the total we pay will be limited to the above and we will only pay once per child. If we pay children s benefit your plan will not end and your cover will not be reduced. THE DEFERRED PERIOD The same deferred period as described on page 10 in THE CRITICAL ILLNESSES COVERED applies to Children s Benefit apart from if the condition claimed for is Bacterial Meningitis, where no deferred period will apply. PRE EXISTING CONDITIONS We won t pay children s benefit if the condition is pre-existing. A pre-existing condition is a medical condition which existed before the later of: the child reaching 30 days old the date of legal adoption of the child in the case of step-children, the date of marriage or civil partnership of the person covered to the natural parent, and the start of the plan. CONTINUING COVER BENEFIT Continuing Cover Benefit is automatically included when a plan covers two people. If a claim for the full amount of cover is paid the plan will end. Where a plan covers two people the person who did not claim can use Continuing Cover Benefit to apply for a new Skandia Lifetime Plan as long as they are under 60. They won t have to answer any questions about their health. To use the option: they must apply between one and three months after the claim was paid the maximum amount of cover on the new policy must be the lower of the cover on the original policy at the time of the claim and 100,000. Any Waiver of Premium and Total Permanent Disability cover under the original policy will continue on the new policy as long as the occupation of the person(s) covered is still acceptable to us. The type of cover will be identical to that provided by the original policy and the new premium will be based on their age at the time of applying. The new policy will cover the illnesses and conditions covered by a series 8 policy. You can find these in the appendix on page

12 OPTIONAL BENEFITS AT AN EXTRA COST You may have chosen to add one or both of the additional benefits below, for an extra cost, when you first started the plan. If we have insured any of the people covered by your plan on non-standard terms, you will not have been able to add either of these options to your plan. These options cannot be added after the plan has started. total PERMANENT disability BENEFIT If you chose this option, we will pay the full amount of your cover if you become totally, permanently and irreversibly disabled. You can make a claim any time before your 60th birthday. You can make a claim when an accident or illness means that you will never again be able to do your main occupation. You must tell us if you change your job. If you chose this option and your plan covers two people, both will be covered for total permanent disability. If you are not in full time employment (more than 16 hours a week) you can make a claim if you are unable to perform at least four of the following working age activities: Transference and mobility walking 100 metres and getting into and out of a car. Dressing putting on and taking off all items of clothing which are normally worn. Eating using everyday cutlery to eat food once prepared. Finance recognising money and its value and making purchases/checking change etc. Healthcare independently arranging to see a doctor and taking routine prescribed medication. Communication answering the telephone and taking a message for someone. Your plan will end once we have paid a claim for total permanent disability. waiver of premium cover If you chose to add this cover to your plan, we will pay the premiums for you if you cannot work due to an accident or illness. You can make a claim any time before your 60th birthday. You will need to pay your premiums for the first six months following the event or diagnosis of the illness which has stopped you working. After that, you will not need to pay premiums until the first of the following happens: your 60th birthday you recover and return to work you surrender your plan we pay a claim for total permanent disability or a critical illness or your death. If you have used the inflation option to increase your cover each year, we will continue to increase your cover each year while you remain unable to work. Your cover will not end when you make a waiver of premium claim. If you miss paying a premium for your plan, the waiver of premium cover will end after 30 days, even if your plan is paid up and your critical illness cover continues. The definition of total permanent disability in your terms and conditions: Total permanent disability shall mean total permanent and irreversible disability by reason of accident or illness to the extent that the life assured is unable to and will never again be able to perform his or her own occupation as disclosed in the application form (or any subsequent written notification to Skandia Life). Totally and permanently disabled shall have the corresponding meaning. The definition of disability, for waiver of premium, in your terms and conditions: Disability in the context of waiver of premium shall mean total incapacity by reason of accident or illness which, in the opinion of Skandia Life, prevents the disabled individual from following their own occupation (as disclosed in the original Policy application or in any subsequent written notification to Skandia Life) and the disabled individual is not following any gainful occupation. Disabled shall have a corresponding meaning. see Increasing the cover of the Skandia Lifetime Plan on the next page. 12

13 EXPLAINING THE SKANDIA LIFETIME PLAN increasing the cover of The Skandia Lifetime Plan Your needs may change as you get older and you may want more cover. In the circumstances shown below, you can increase the cover without telling us anything more about your health, even if it has worsened since your plan started. inflation option If your level of cover remained the same for many years, inflation would gradually reduce its relative worth. We offer you the chance to increase your cover each year. This option allows you to increase your cover by the increase in RPI (UK Retail Prices Index) over the last 12 months. If you want to increase your cover by a higher amount, please contact us. We will calculate the extra premium for your increased cover in the same way as we did for the rest of your cover. So if we accepted your insurance on non-standard terms and you pay higher premiums, for example due to your health, we will work out how much extra premium you need to pay on the same basis. Your premiums may increase by a higher percentage than your cover, particularly as you get older. If you chose for the increases to happen automatically we will continue to increase your cover and premium each year without you having to do anything. If you ask us not to increase the cover we will stop making automatic increases, however we will continue to offer you the opportunity to increase each year. If you do not increase your cover for 10 years in a row the inflation option will end and you will not be able to increase the cover other than using the guaranteed increase options below. guaranteed increase options The Skandia Lifetime Plan also includes a number of special increase options, so you can get more cover when any of the specific events listed below happen. You can use these options provided we did not ask you to pay on non-standard terms. You can use each option as many times as you need to, provided the total increases are not more than the maximum allowed for each event. Each time, we shall need to see the appropriate documents which show that the event has happened. The table on the next page shows the events covered, and by how much you can increase your cover when any of them happens to you. continued 13

14 increasing the cover of The Skandia Lifetime Plan (CONTINUED) Event Available to age Maximum cover increase If you get married or enter into a civil partnership (as defined by the Civil Partnership Act 2004)* If you give birth to or adopt a child* If you increase your mortgage* If the value of your assets (your estate ) increases and gives you a higher potential liability to inheritance tax after you die** Increase in inheritance tax liability if the Government changes rates or rate bands** If you are using your plan for partner or shareholder protection and the value of your share in the business rises No age limit No age limit 59 30,000 20,000 for each child 60,000 total The lower of the increase in the mortgage and 50,000 The lower since the last plan anniversary of: the increase in potential liability, the greater of 10% and the increase in inflation and 50,000 The increased liability due to the change in legislation The lower of: the increase in the value of the share of the business, the greater of 10% and the increase in inflation and 50,000 ** If you use any of these options between plan anniversary dates, we will increase your cover, but we will not increase your premiums or charges until the next anniversary date. After the next anniversary date you will need to pay the increased premium to keep the increased cover. We will tell you what the increase in premium will be at the time. ** these options are only available if you chose to include life cover (Lifetime Cover Plus). If you have cover in other Skandia or Old Mutual Wealth policies, the maximum overall increase to your cover from any of these options may not be more than the highest available in any one plan. You can find further details of these increase options in the Policy Terms, which are available on request 14

15 EXPLAINING THE SKANDIA LIFETIME PLAN charges and allocation rates for The Skandia Lifetime Plan charges The charges you pay are to cover the cost of your critical illness and, if applicable, life cover, any additional benefits you chose and for administering your plan. Details of which charges apply to your plan and how much we are charging can be found in the annual statement that we send to you. Charge for CRITCIAL ILLNESS AND life cover The cost of critical illness and, if you chose to include it, life cover is based on the risk of the person covered becoming ill or dying. As that persons ages the risk increases and so does the cost. The amount you pay each month for the cover will therefore depend on your age and also, the amount of cover and the value of your plan. We only charge you for the difference between the amount of cover (sum assured) and the fund value. The higher the fund value, the lower this charge will be for that month. If your plan s value is more than your cover, we will not make this charge. Total PERMANENT disability cover The charge for your cover is increased if you include this option in your plan and will depend on your age, the amount of cover and the value of your plan. Waiver of premium cover If you add this option, we will reduce the amount we regularly invest for you by 2% for each person covered. For example, without this cover, if you pay 50 a month, we will invest 100% of your premiums. If you add waiver of premium cover, we will only invest 98%, and if your plan covers two people with this benefit, the rate will drop to 96%. Setting-up charge We make this charge when we set up your plan, and if you chose to do so, each time you increased your premium or cover. It was based on your age, your level of cover, and if your premium was monthly or yearly. We no longer make this charge. Annual management charge This charge is 0.75% of the value of your plan and it is built into the fund pricing. Fund management charges These are the charges made by the fund managers of each individual fund, to pay for managing the assets such as stocks and shares which make up the fund. The charges may change in the future, for example due to a change in the mix of assets in the fund, the fund manager, or the rate of VAT. BID OFFER SPREAD This is the difference between the offer price, which is the price we use when we buy units for your plan, and the lower bid or selling price, which is the one we use to calculate your fund value. The difference is 5%. You therefore only pay the higher price when units are bought. There is no charge if you decide to switch or cash in all or part of your plan. MAINTENANCE CHARGE This monthly charge covered the cost of administering your plan. The amount we charged depended on the changing cost of administering your plan and whether you increased your premium at your review dates. From 1 January 2018 we stopped applying this charge. see also setting and reviewing your payments on page 7 see Optional benefits at an extra cost on page 10 see Allocation rates on page 16 15

16 charges and allocation rates for The Skandia Lifetime Plan (CONTINUED) allocation rates The amount of your premium that gets used to buy units in your plan (the allocation rate) varies depending on the size of your premium. It ranges from 92% to 103% of your premium. You can find your allocation rate in the summary section of your annual statement. You can find the full table of allocation rates in your original terms brochure, or you can contact us for details. STOPPING PREMIUMS If you miss a premium you will have 30 days to make a payment. If you haven t paid after 30 days one of the following will happen: If your plan has a fund value the cover can continue, but any waiver of premium will end. We will continue to deduct the charges from the fund value. This is referred to as being paid up. If your plan plan has no fund value it will lapse and all cover will end. You may be able to reinstate your cover and start paying premiums again. We ll tell you what information we ll need to do this when you contact us. You can choose to stop paying the premiums at any time. MAKING A CLAIM Please contact us as soon as possible after any event that could give rise to a claim. We will provide a claim form and details of the information we will need. Heritage Claims Old Mutual House Portland Terrace Southampton SO14 7AY Phone: claims@omwealth.com 16

17 EXPLAINING THE SKANDIA LIFETIME PLAN what might stop us paying a claim We aim to pay as many claims as possible, as quickly as possible. There are however times where we may not be able to pay a claim. This is explained below. If your plan includes life cover the amount paid will be limited to a refund of premiums if the person covered commits suicide within one year of the cover being reinstated after a lapse or being made paid up. If the person covered commits suicide within a year of an increase in the cover the amount paid will be limited to: the amount of cover before the increase, and a refund of premiums paid after the increase. If the plan has been assigned to a lender (such as a mortgage provider) the amount payable will be will be the smaller of: the amount of cover at the time of death the amount owed to the lender. If you did not answer all the questions in the application form completely and accurately, it may mean that your claim is not valid and we will not be able to pay it. We may not be able to pay a claim if the illness, disability or procedure you are claiming for does not match those covered by your policy. You can find full details of these in the appendix at the end of this guide. EXCLUSIONS APPLYING TO CRITICAL ILLNESS COVER A critical illness claim may not be paid if it was caused, either directly or indirectly, or accelerated by any of these: self-inflicted injury using alcohol, solvent abuse or drugs other than as prescribed by your doctor participation in any criminal act unreasonable failure to seek or follow medical advice the person covered becoming infected with HIV or conditions due to AIDS, apart from the circumstances covered by the HIV/AIDS definitions of the policy. exclusions APPLYING TO BOTH TOTAL PERMANENT DISABILITY AND WAIVER OF PREMIUM If your plan includes total permanent disability benefit or waiver of premium we will be unable to pay a claim if it was caused, either directly or indirectly, or accelerated by any of these: self-inflicted injury using alcohol or drugs other than as prescribed by your doctor participation in any criminal act war, riot or commotion injury while taking part in (or practising for) horse racing, motor sport, mountaineering, potholing or under-water diving flying other than as a fare-paying passenger unreasonable failure to follow medical advice disability as a result of HIV or AIDS. EXCLUSIONS APPLYING TO TOTAL PERMANENT DISABILITY ONLY We will not pay a claim for total permanent disability if: you change your occupation to one we consider more dangerous. You must let us know within 30 days if you change your occupation you regularly take part in hazardous activities including, but not limited to, horse racing, underwater diving, power boat racing, mountaineering, climbing, pot-holing and any race, trial or timed motor sport. This does not apply to normal holiday activities such as on-piste skiing, jet skiing, parascending, hill walking etc. 17

18 what might stop us paying a claim (CONTINUED) EXCLUSIONS APPLYING TO WAIVER OF PREMIUM ONLY We may not accept a claim if you visit or live in any country, other than those listed below, for more than 3 months in any 12 month period: Australia Austria Belgium Canada Channel Islands Denmark Finland France Germany Gibraltar Isle of Man Italy Luxembourg Netherlands New Zealand Norway putting your policy in trust Portugal Republic of Ireland Spain Sweden Switzerland United Kingdom United States of America We will cancel your cover if you move outside the United Kingdom, Channel Islands, Isle of Man and the Republic of Ireland for more than six months. You can find further details of these two options and full details of when we might not pay a claim in the Policy Terms, which are available on request If you do not put your policy in a suitable trust, if we pay a cash lump sum when you die it will become part of your estate. That is the total value of all your assets, for example your house, car, and personal possessions. If your estate is large enough when you die, inheritance tax will be due on it. The value of your life assurance payment may mean that tax is payable when it would not have been without the cash sum, and that tax of 40% will be due on the payment. Putting your policy in a suitable trust means that you give it to people you choose to look after it (the trustees) and, after you die, they will give the money to the people you want it to go to (the beneficiaries). The money does not become part of your estate, so no inheritance tax will be due on it. Putting the policy in trust can also mean that your family receives it sooner, as they do not have to wait until all the legal formalities are completed on your estate. Your financial adviser can give you more information about putting your policy in trust, whether it is the right thing for you to do, and the best type of trust for you to use. 18

19 EXPLAINING THE SKANDIA LIFETIME PLAN cashing in your plan You can cash in your plan whenever you wish, and we will not make a charge on the value of your plan if you do so. Cashing in is also known as surrendering. You can find your surrender value, the total amount you can cash in, in your annual statement. Alternatively you can contact us to find out the latest value. However, because your plan is primarily designed to provide critical illness cover it may have little or no fund value. You can gets the forms on our website or by contacting us. 19

20 OTHER INFORMATION CONTACT DETAILS If you need any further information about the Skandia Lifetime Plan, please contact your financial adviser. If you wish to contact us directly, you can do so by: Phone: (free) Mail address: Old Mutual Wealth Old Mutual House Portland Terrace Southampton SO14 7EJ REGULATORY PROTECTION Under Financial Conduct Authority (FCA) rules, we classify all our customers as retail clients which means you benefit from the highest level of regulatory protection. COMPLAINT PROCEDURES Customer satisfaction is very important to us at Old Mutual Wealth, but if you do have any cause to complain about the services provided, either by your financial adviser or by us, clear procedures are laid down by the FCA to ensure that your complaint is dealt with fairly. If your complaint relates to the advice you have been given, you should write in the first instance to your financial adviser. If it concerns the service you have received from us, please write to us at the address on the previous page, and we will do everything we can to resolve the problem. If you are not satisfied with the response you receive, you can complain to: Financial Ombudsman Service Exchange Tower London E14 9SR Complaining to the Ombudsman will not affect your legal rights. 20

21 EXPLAINING THE SKANDIA LIFETIME PLAN POLICYHOLDER PROTECTION The Financial Services Compensation Scheme (FSCS) acts as a safety net for customers of financial services providers. If Old Mutual Wealth Life Assurance Limited cannot meet its liabilities, the FSCS may arrange to transfer your policy to another insurer, provide a new policy or, if these actions are not possible, provide compensation. For long-term insurance (such as pension plans and life assurance), the level of compensation you can receive from the scheme is as follows: The Scheme covers payment to 100% of the value of a policy in liquidation. Further information about compensation arrangements is available from the Financial Services Compensation Scheme website 21

22 APPENDIX: CRITICAL ILLNESS DEFINITIONS Following our name change in 2014, Skandia became Old Mutual Wealth and all references in these definitions to Skandia Life refer to products provided by Old Mutual Wealth Life Assurance Limited. We added illnesses to the cover and made improvements to these definitions over time. We generally applied these improvements to existing policies. If a definition was made more restrictive we did not apply it to existing plans. Not all policies, therefore, will have the same definitions and you may have more and better definitions to the ones that originally applied when your cover started. You can identify which definitions now apply to your policy by the series number on your original Terms and Conditions leaflet or by the start date of your plan. SERIES 1 : 13 MAY 1991 TO 31 DECEMBER 1991 Angioplasty The undergoing on two or more arteries to correct blockage of at least 50% in each of the affected arteries on the undisputed advice of a consultant cardiologist holding such a position at a major hospital in the UK. Balloon angioplasty, excimer laser, rotablation, stents and directional atherectomy are specifically included. Aorta graft surgery Undergoing surgery for disease of the aorta needing excision and surgical replacement of a portion of the diseased aorta with a graft. For this definition, aorta means the thoracic and abdominal aorta but not its branches. Bacterial meningitis The Life Assured suffering a permanent neurological or physical deficit following and resulting from the contraction of bacterial meningitis. Bacterial meningitis must have been unequivocally diagnosed by a consultant holding an appropriate position at a major hospital in the UK. All other forms of meningitis, including viral, are not covered. Benign brain tumour A non-malignant tumour in the brain, excluding cysts, granulomas, malformation in or of the arteries or veins of the brain, haematomas or tumours in the pituitary gland or spine. Blindness Total permanent and irreversible loss of all sight in both eyes. Cancer A malignant tumour characterised by the uncontrolled growth and spread of malignant cells and the invasion of tissue. The term cancer includes leukaemia and Hodgkin s disease but the following are excluded: All tumours which are histologically described as pre-malignant, as non-invasive or as cancer in situ Kaposi s sarcoma in the presence of any Human Immunodeficiency Virus Any skin cancer other than malignant melanoma. Coma Unconsciousness, with no reaction to stimuli, continuing for at least 96 hours. Life support systems must be required throughout the period of unconsciousness. Coronary artery by-pass surgery The undergoing of an operation on the advice of a consultant to correct narrowing or blockage of one or more coronary arteries with by-pass grafts. Deafness Total permanent and irreversible loss of all hearing in both ears. Heart attack The death of a portion of heart muscle as a result of inadequate blood supply as evidenced by an episode of typical chest pain, new electrocardiographic changes and by elevation of cardiac enzymes. 22

23 EXPLAINING THE SKANDIA LIFETIME PLAN Heart valve surgery The replacement of one or more heart valves on the advice of a consultant cardiologist holding such an appointment at a major hospital in the UK. HIV/AIDS The Life Assured being infected by Human Immunodeficiency Virus, or suffering from Acquired Immune Deficiency Syndrome (AIDS) or other similar or related condition or syndrome provided that: (i) the Life Assured is either a medical practitioner, a person employed in a medical facility, a member of the emergency services (fire, police, ambulance), a prison officer or a pharmacist; the infection must have arisen in the course of the Life Assured s normal duties and must have been acquired as a result of contact with a HIV infected person, involving passing of blood or body fluid from an HIV infected person or with an HIV infected medical instrument; the incident that results in such contact must have occurred after the Making of Assurance Date and must have been reported, investigated and documented in accordance with established procedures for the occupation in which it occurred; the life assured must have been tested immediately after the incident and shown not to have antibodies of the Human Immunodeficiency Virus. OR (ii) the infection is due to a blood transfusion received in the UK after the Making of Assurance Date of the Plan. Kidney failure End stage renal failure presenting as chronic irreversible failure of both kidneys to function as a result of which either regular renal dialysis or renal transplant is initiated. Loss of independent existence The Life Assured being permanently and irreversibly unable to perform three or more Activities of Daily Living (ADLs) described below without the assistance of another person, even with the use of special devices or equipment. This must be supported by medical evidence from a relevant specialist as Skandia Life considers appropriate and have continued without interruption for three consecutive months. The ADLs: Mobility the ability to move from one room to another on level surfaces Dressing the ability to put on, take off, secure and unfasten all necessary items of clothing and any braces, artificial limbs or other surgical devices Feeding the ability to eat food which has been prepared and cooked (if appropriate) Continence the ability to manage bowel and bladder functions (including the use of protective undergarments and surgical appliances if appropriate) so as to maintain personal hygiene Transferring the ability to get on and off the toilet, in and out of bed and move from bed to an upright chair or wheelchair and back again Loss of limbs The permanent physical severance of two or more limbs from above the wrist or ankle joint. Loss of speech Total and irrecoverable loss of the ability to speak because of physical injury, disease or mental trauma as confirmed by an appropriate consultant physician holding an appointment at a major UK hospital in the UK. Major organ transplant Major organ transplant means the receipt of a transplant of a heart, liver, lung, kidney, pancreas or bone marrow or the confirmation by a suitably qualified consultant physician at a major hospital in the UK that such a transplant is essential. Motor neurone disease Confirmation by a consultant neurologist of a definite diagnosis of motor neurone disease. 23

24 Multiple sclerosis Unequivocal diagnosis of multiple sclerosis made by a consultant neurologist holding such an appointment at a major hospital in the UK. The claimant must exhibit neurological abnormalities that have existed for a continuous period of at least 6 months or have had at least one relapse of such abnormalities. This must be evidenced by the typical symptoms of demyelination and impairment of motor and sensory function. Paralysis/paraplegia Total loss of muscle function or sensation to the whole of any two or more limbs as a result of injury or disease. Disability must be established for a continuous period of 12 calendar months and be supported by appropriate neurological evidence. Parkinson s disease Parkinson s Disease as diagnosed, before the 65th birthday of the Life Assured, by a consultant neurologist holding such an appointment at a major hospital in the UK. Only ideopathic Parkinsonism is covered. All other forms of Parkinsonism are not covered. Pre-senile dementia Pre-senile dementia as diagnosed, before the 65th birthday of the Life Assured, by a consultant neurologist holding such an appointment at a major hospital in the UK. The diagnosis must be supported by evidence of progressive deterioration of memory and of the ability to reason and to perceive, understand, express and give effect to ideas. Stroke A cerebrovascular incident resulting in permanent neurological damage. Transient Ischaemic Attacks are specifically excluded. Terminal illness This means any disease process which, in the opinion of a specialist consultant holding such an appointment at a senior hospital in the UK, is likely to lead to death within 12 calendar months of Skandia Life being notified of a claim under this policy. Third degree burns Third degree burns covering at least 20% of the surface area of the body. SERIES 2 : 1 JANUARY 1992 TO 10 OCTOBER 1993 Angioplasty The undergoing on two or more arteries to correct blockage of at least 50% in each of the affected arteries on the undisputed advice of a consultant cardiologist holding such a position at a major hospital in the UK. Balloon angioplasty, excimer laser, rotablation, stents and directional atherectomy are specifically included. Aorta graft surgery Undergoing surgery for disease of the aorta needing excision and surgical replacement of a portion of the diseased aorta with a graft. For this definition, aorta means the thoracic and abdominal aorta but not its branches. Bacterial meningitis The Life Assured suffering a permanent neurological or physical deficit following and resulting from the contraction of bacterial meningitis. Bacterial meningitis must have been unequivocally diagnosed by a consultant holding an appropriate position at a major hospital in the UK. All other forms of meningitis, including viral, are not covered. Benign brain tumour A non-malignant tumour in the brain, excluding cysts, granulomas, malformation in or of the arteries or veins of the brain, haematomas or tumours in the pituitary gland or spine. Blindness Total permanent and irreversible loss of all sight in both eyes. 24

25 EXPLAINING THE SKANDIA LIFETIME PLAN Cancer A malignant tumour characterised by the uncontrolled growth and spread of malignant cells and the invasion of tissue. The term cancer includes leukaemia and Hodgkin s disease but the following are excluded: All tumours which are histologically described as pre-malignant, as non-invasive or as cancer in situ Kaposi s sarcoma in the presence of any Human Immunodeficiency Virus Any skin cancer other than malignant melanoma. Coma Unconsciousness, with no reaction to stimuli, continuing for at least 96 hours. Life support systems must be required throughout the period of unconsciousness. Coronary artery by-pass surgery The undergoing of an operation on the advice of a consultant to correct narrowing or blockage of one or more coronary arteries with by-pass grafts. Deafness Total permanent and irreversible loss of all hearing in both ears. Heart attack The death of a portion of heart muscle as a result of inadequate blood supply as evidenced by an episode of typical chest pain, new electrocardiographic changes and by elevation of cardiac enzymes. Heart valve surgery The replacement of one or more heart valves on the advice of a consultant cardiologist holding such an appointment at a major hospital in the UK. HIV/AIDS The Life Assured being infected by Human Immunodeficiency Virus, or suffering from Acquired Immune Deficiency Syndrome (AIDS) or other similar or related condition or syndrome provided that: (i) the Life Assured is either a medical practitioner, a person employed in a medical facility, a member of the emergency services (fire, police, ambulance), a prison officer or a pharmacist; the infection must have arisen in the course of the Life Assured s normal duties and must have been acquired as a result of contact with a HIV infected person, involving passing of blood or body fluid from an HIV infected person or with an HIV infected medical instrument; the incident that results in such contact must have occurred after the Making of Assurance Date and must have been reported, investigated and documented in accordance with established procedures for the occupation in which it occurred; the life assured must have been tested immediately after the incident and shown not to have antibodies of the Human Immunodeficiency Virus. OR (ii) the infection is due to a blood transfusion received in the UK after the Making of Assurance Date of the Plan. Kidney failure End stage renal failure presenting as chronic irreversible failure of both kidneys to function as a result of which either regular renal dialysis or renal transplant is initiated. Loss of independent existence The Life Assured being permanently and irreversibly unable to perform three or more Activities of Daily Living (ADLs) described below without the assistance of another person, even with the use of special devices or equipment. This must be supported by medical evidence from a relevant specialist as Skandia Life considers appropriate and have continued without interruption for three consecutive months. 25