Online Group Life Policy for Excepted Schemes

Transcription

1 For commercial customers and their advisers only Online Group Life Policy for Excepted Schemes Technical Guide Reference BGR/5574/OCT17 This document is a guide to the features of Aviva Online Group Life Policy for Excepted Schemes which is provided by an excepted group life assurance policy issued and underwritten by Aviva Life & Pensions UK Limited, part of the Aviva group. Online Group Life Policy for Excepted Schemes is suitable for schemes with between three and 100 members. This document should be read in conjunction with the quotation which accompanies it. Full details of the insurance are contained in the policy terms and conditions which is available on request. 1

2 Contents Page Its aims 3 Employers your commitment 3 Risk factors 4 How does the policy work? 4 1 What factors should be considered in deciding which benefits to provide? 4 2 Setting up the policy 7 3 What premiums will be charged for the cover? 8 4 How does the policy accounting work? 9 5 Claiming benefit 10 6 What is not covered? 10 7 Can cover be provided for an employee who is not in the UK? 10 8 Taxation of policies 10 9 Continuation option 10 Further information 11 Questions and complaints 11 Financial Services Compensation Scheme 11 Law 11 Legislative changes 11 2

3 This technical guide has been produced based on the best practice standard format recommended by the Group Risk Insurance Development Group (GRID) and the Association of British Insurers (ABI). This technical guide is intended for use by commercial customers and their advisers. Introduction This technical guide describes the features of the group life policy for excepted schemes, which is available through the Aviva Group Protection Online Quotes facility. Aviva Online Group Life Assurance Policy for Excepted Schemes is provided by an excepted group life assurance policy provided and underwritten by Aviva Life & Pensions UK Limited, part of the Aviva group. The Aviva Group Protection Online facility has been specifically designed to provide brokers with an efficient and easy to use quotes service for small to medium sized enterprises where the quotation requirements fall within certain parameters. We can still quote for schemes falling outside these parameters (ie where individual consideration is required, for example for the inclusion of discretionary entrants) through our normal quotes process. Features which are not initially available as part of the Aviva Group Protection Online facility are shown as being subject to individual consideration and are included in this technical guide as it may be possible to include them (an appropriate premium adjustment may be required) once the scheme has commenced. Its aims Any reference to employees is also intended to refer to equity partners within a partnership or members of a limited liability partnership. Employers your commitment To pay us premiums as they become due. To provide all the information we require when you apply for cover, at each annual revision date and premium review date or in support of a claim, and to notify us if these details change. To provide postcode information giving the principal place of employment for all employees. To notify us if there is any change in the postcode information for the members. To agree at outset the eligibility conditions that govern who can be covered by the policy. To adhere to the eligibility conditions agreed. To notify us of a potential claim within one month of the death of any member or as soon as reasonably practicable. To create (prior to the scheme going on risk) or maintain a trust arrangement under which the policy will be effected. To comply with the terms and conditions of the policy. To notify us in writing of any discretionary, early or late entrants. Their inclusion will be subject to individual consideration and prior agreement by us. To notify us of any changes in the companies participating in the policy and the relationship between them. To provide insurance to cover the lump sum benefit payable on the death of a member. To offer a flexible range of choices for these benefits for schemes with between three and 100 members. As this insurance is provided for an excepted group life scheme it should be taken out under a trust arrangement. In this guide any reference to an employer is also intended to refer to: the trustees of an excepted group life scheme written on behalf of the employer; or equity partners effecting an excepted scheme for partners; or a limited liability partnership effecting an excepted scheme for members. 3

4 Risk factors Cover will cease if you fail to comply with the terms and conditions or if premiums are not paid within 30 days of when they are due. Cover is designed to provide death in service benefits. This policy has no surrender value. A significant change in the eligibility conditions, your business, the benefit basis and a number of other factors may bring about an adjustment in premiums and terms at any time (see 3.2 Will there be any unexpected extra premiums? ). The rates used to calculate premiums are normally guaranteed for three years and are then reviewed. However, this guarantee will cease to apply in some specified circumstances (see 3.2 Will there be any unexpected extra premiums? ) and if the total salary roll that we are covering increases or decreases by 25 percent or more (50 percent of the total benefit roll for policies with up to 19 members). In certain circumstances we will apply a restriction on the total amount of benefits payable for claims which are directly or indirectly attributable to one originating cause (see 6 What is not covered? ). If such a restriction applies details will be given in the quotation. Cover will not be in place for claims arising directly or indirectly from one originating cause unless full postcode information has been provided and terms agreed. Where there are changes to the postcode information, cover will not be in place for those members for claims arising directly or indirectly from one originating cause until we have confirmed that such cover can be provided. We have the right to change the policy terms and conditions after three years. We will tell you if we do. We reserve the right to cancel the policy if the number of members drops below three. Cover will only be provided for members shown on the data you provide. We will not pay claims in respect of any employee not shown on the data. Your questions answered How does the policy work? You decide the amount of benefit you require for your employees. The benefit basis must be the same for all members. If there are different benefit bases for different categories then multiple policies will be set up. You must include all eligible employees in the policy when they first become eligible. You pay all the premiums as they become due to keep the cover in force. We provide cover whilst the policy is in force no matter how many claims are made (subject to any restriction applied as described in 6 What is not covered? ). You notify us within one month of a member s death or as soon as reasonably practical. You must provide us with all the information needed to assess and pay a claim. The policy should be set up under a trust arrangement. We pay the lump sum benefit to the scheme trustees who will pay this in accordance with the scheme rules, normally using discretionary powers to pay the benefit to the deceased s dependants. On request, we can provide specimen trust documentation. 1 What factors should be considered in deciding which benefits to provide? An excepted group life policy must meet the following seven criteria which are contained in the Income Tax (Trading and Other Income) Act 2005 (sections 481 and 482). I. Under the terms of the policy a capital sum is payable on the death of each of the individuals insured under the policy who die before the expiry age. II. The same method is used for calculating the benefits for all members and if there is any limit on those benefits the limitation is the same for all lives insured. III. The policy does not have and is not capable of having a surrender value. IV. Benefits can only be paid on death. 4

5 V. Benefits must be paid to an individual or charity directly or via a trustee. VI. A beneficiary who is also a member of a scheme can only receive benefit if they are a dependant of the deceased. VII. The policy must not be taken out for tax avoidance purposes. The lump sum benefit selected can be a fixed amount, or more often, a multiple of salary but the same method of benefit calculation must apply to all members. Benefits paid under an excepted policy do not count towards the member s lifetime allowance. 1.1 Who can be covered? (a) Eligibility The eligibility criteria will be agreed prior to cover commencing and will include: the minimum and maximum entry ages for the employees the expiry age for the cover (selected from the options available) any service qualifications that may apply which categories of staff are eligible to be included (eg all directors or all employees) when any new entrants will be able to join the policy (eg immediately they satisfy the eligibility conditions or at the next annual revision date) whether there are any other conditions specified in order to join the scheme (eg pension scheme membership or all those who have opted out of the registered scheme for enhanced protection reasons). Please note that any eligibility criteria connected to age or service need to be considered in light of the Age Regulations. Membership is compulsory for all employees who satisfy the eligibility conditions and meet the actively at work requirements (see 1.1.(b)). Permanent full time and part time employees can be included in the policy. Fixed term contract workers can be covered for the period of their fixed term contract. If pension scheme membership is a condition of joining the excepted group life scheme we need to know the eligibility conditions for joining the pension scheme. If an employee does not join the pension scheme at the first opportunity evidence of good health will be required before we can provide cover under the policy. However, for employees joining the pension scheme within 12 months of their first opportunity cover can be provided subject to the employee meeting an actively at work requirement. (b) Actively at work This is the criterion that the member must meet, in addition to the other eligibility conditions, before they are covered under the policy. An employee is considered to be actively at work if they are present at their place of work and are mentally and physically capable of performing the normal duties for the normal hours required by the job for which they are employed. Confirmation that any actively at work requirement has been met must be provided by the employer in writing. New policies If a policy has not been previously insured employees will usually only be covered if they are actively at work on the day they first become eligible to join the policy. If they are not actively at work on the relevant date they will only be covered once they have been actively at work for the time specified in the quotation. Existing policies When cover is moved to us from another insurer the actively at work requirement is usually waived for existing members for the level of benefit covered by the previous insurer, but long term absentee requirements must still be met (see next page). New entrants and increases in benefits for existing members will usually be covered once the member is actively at work. Long term absentees The inclusion of any long term absentees will be subject to individual consideration. In all cases, regardless of whether or not the actively at work requirement has been waived we will need full details of long term absentees (ie those who have been absent from work for three months or more) at the time of quoting and at the on risk date. The details required are date of birth, gender, date first absent, reason for absence and sum assured. 5

6 Aviva are not on risk for any long term absentees until full details have been provided and we have specifically confirmed that cover is in place for each long term absentee. 1.2 When will cover cease? Under normal circumstances Cover ceases on the earlier of: a member reaching the scheme expiry age a member leaving service a member no longer satisfying the eligibility criteria. Cover will also end when the policy ends. The policy will end when: you fail to pay any premiums due the number of members is reduced below the minimum number we agree you fail to comply with any reasonable request for information there is a material change in your business you or any employee covered fail in your duty of utmost good faith towards us you end the policy. We will pay any valid claims after the policy ends if they arose during the period of cover Cancelling the cover You can end the scheme at any time by providing written notification that you wish to terminate the scheme. Termination cannot be backdated. 1.3 What types of cover are available? The lump sum benefit selected can either be a fixed amount, or more often, a multiple of salary but the same method of benefit calculation must apply to all members. If there are different benefit bases for different categories then multiple policies will be set up. The seven requirements for a policy to be considered an excepted policy only allow a capital sum to be paid and therefore, dependants pensions cannot be provided. 1.4 Are there any special coverages possible under the policy? Where a member is off work due to sickness or injury, the cover can continue until the policy expiry age providing the premiums are paid. For absence due to any other reason the cover can be maintained for up to three years. Cover will normally be at the level in force on the day before absence begins. Subject to individual consideration, if a member retires early through ill health, cover for lump sum benefits can usually continue until the relevant expiry age. This option must be selected at policy level and will result in an additional charge. For an additional premium, and subject to individual consideration, it may be possible to continue cover for lump sum benefits for members who are made redundant. Cover is normally provided until the end of the notice period but can continue for up to two years. Cover will cease on the earlier of: the date the member is re-employed the date the member becomes self-employed the member reaching the policy expiry age the end of the specified period. In all of the above, you must continue to pay premiums during the period of cover. 6

7 2 Setting up the policy 2.1 Requirements to set up the policy In order for us to assume risk the policy must start within three months of the quotation. Cover will only be effective once we have confirmed in writing (via ) that we will assume risk (cover cannot be backdated). You will be asked to confirm the on risk date online. This will include confirming that: you have read and accepted the terms and conditions of the quote all the information supplied at the quote stage (including member details, policy history (including details of any underwriting decisions for members underwritten under the previous policy) and claims history for the last five years or such shorter time as the policy has been in force if previously insured) was correct and has not changed since that date. In accordance with the requirements above we will assume risk on the basis of the information that was entered into the online quotes facility at the time of the quote. You will receive an confirming that cover is in place and the following attachments: a copy of the quote that is being put on risk a partially pre-populated application for completion and signing a list of members (as entered at the quote stage) highlighting those who are over the free cover level and therefore subject to medical underwriting. We will then require: within 30 days of the start of the policy, a deposit premium or completed direct debit, and 2.2 Evidence of health to be provided before members are covered Since a group scheme is designed to cover all the employees who satisfy the eligibility conditions, we normally only require medical or pastime information for those employees whose benefit exceeds the free cover level. The free cover level will be shown in our quotation. The free cover level is usually based on the number of members and benefits provided under the policy. There must be at least three members in the policy for a free cover level to be available. The free cover level only applies to those employees who join the scheme when they first become eligible and satisfy the actively at work requirement applicable to the scheme. If an employee s cover exceeds the free cover level they will be asked to complete an employee s health declaration. We may then need further information which could involve us asking additional questions, their own doctor for a medical report, or requesting a medical examination or other medical tests. The underwriting process may result in additional premiums or exclusions being applied to cover in excess of the free cover level for some members. In some cases we may be unable to provide cover in excess of the free cover level or previously insured benefit, if higher. For members who have been underwritten and accepted for cover we may be able to accept future increases in benefit without further medical underwriting. If the free cover level is increased, we will not automatically increase the free cover level for member s who have submitted evidence of insurability or have had their cover restricted to the free cover level. within 60 days of the start of the policy: return of the signed and fully completed application confirmation that the list of employees with benefits in excess of the free cover level is correct details of employees not actively at work at the commencement date. Cover will cease immediately if the above requirements are not met. A premium will be charged for the time on risk. 7

8 Please note that the free cover level will not apply to: Discretionary entrants (employees who do not satisfy the normal eligibility conditions) Late entrants (employees joining the scheme after the date they were first eligible), and Early entrants (employees joining the scheme before they meet the normal eligibility conditions). All cover for discretionary, late or early entrants will be subject to individual consideration and prior agreement by us. No cover will be in place until we have provided confirmation in writing. Evidence of good health will be needed before we can consider providing cover. 2.3 What happens if a claim arises before a decision has been made? Employees who are entitled to benefits above the free cover level have up to 90 days to complete the underwriting process after the date they are first covered. During this time we will provide temporary cover for each employee for their full benefit up to a maximum of 1million of benefit insured above the greater of the free cover limit or previously underwritten benefit (as long as the cover has not previously been declined by us or another insurer), but any benefit in excess of the free cover level or previously insured benefit will be subject to a preexisting conditions exclusion. Claims will be subject to any other underwriting restriction we may specify. Temporary cover does not apply to discretionary, late or early entrants. 3 What premiums will be charged for the cover? The premium calculated depends on factors which include the nature and amount of the benefits to be provided and details of the employees to be insured. The information used to calculate the premiums includes: level of benefits eligibility and entry conditions ages and genders of the employees occupation of the employees location of the workforce. The minimum premium applicable to the policy will be shown on the quotation. Premiums payable more frequently than annually must be paid by direct debit. All premium payments are to be paid in sterling, or other such currency as may be agreed in writing by us. 3.1 How will premiums be calculated? (a) Policies covering up to 19 people: Single premium costed policies Premiums will be calculated for each employee based on the premium rates current at the beginning of the premium guarantee period. The premium guarantee period is the three year period either from the commencement of a policy or from the last review of premium rates. For this type of policy the premium for each employee is recalculated each policy year based on the applicable premium rate and the employee s age at the start of that year. Premium rates increase with age. If the number of employees increases to 20 or more we may administer the scheme and calculate the premiums by the unit rate method, as set out below, from the annual revision date following the increase. (b) Policies covering 20 or more people: Unit rate policies For these policies a premium rate is calculated and expressed as a rate per 1000 of lump sum benefit. The rate is calculated using the individual data provided. If the number of employees decreases below 20 we may administer the scheme and calculate the premiums by the single premium method, as set out above, from the annual revision date following the decrease. 3.2 Will there be any unexpected extra premiums? The unit rate and the rates used in calculating the single premium costed policies are usually set for three years. New rates may be applied at the end of the three year period. The rates and conditions may be varied at any time in the following circumstances: if the number of employees covered is reduced below the agreed minimum 8

9 if the total salary roll that we are covering increases or decreases by 25 percent or more (50 percent of the total benefit roll for policies with up to 19 members) from the start of the premium guarantee period. if you fail to provide any information reasonably required within 60 days if there is a material change in your business if there is any change in legislation or taxation which affects the cost of cover. Additional premiums may be applied to employees whose benefits exceed the free cover level, discretionary entrants, late entrants or early entrants. The additional premium will reflect that they are suffering from certain medical conditions or partake in hazardous pastimes. You will be notified of any increase in the premiums and the date from when they will be payable. 3.3 What commission is included within the premium? The rate of commission will be shown on the quotation. 4 How does the policy accounting work? The policy normally operates on a one year accounting period. Premiums are payable on account on an annual, quarterly or monthly basis, as selected. At each annual revision date and premium review date we must be provided promptly with all the information necessary to prepare the account. Until we have the most accurate data we will charge approximate premiums. 4.1 What information is required for accounting purposes? We will advise you before each annual revision date what information we require. (a) Single premium costed policies: A list of all employees in the scheme will be required at the annual revision date. The list must show the name, occupation, location of work, gender, date of birth, salary and, if applicable, the date of joining and the date of leaving for each employee. It is also necessary to advise us immediately of: employees whose cover exceeds the free cover level during the scheme year, discretionary entrants, late entrants and early entrants. (b) Unit rate policies: A list of all employees in the scheme will be required at the annual revision date. The list must show the name, occupation, location of work, gender, date of birth, salary and if applicable, the date of joining and the date of leaving for each employee. It is also necessary to advise us immediately of: employees whose cover exceeds the free cover level during the scheme year, discretionary entrants, late entrants and early entrants. Additional information will be required when the rates used to calculate the premiums are reviewed. 4.2 How are accounts adjusted for members who join, leave or have benefit increases during the year? (a) Single premium costed policies: A premium adjustment will be calculated reflecting the amount and duration of the cover actually provided. Any premium adjustment for employees who join, leave or have benefit increases becomes payable at the end of the policy year. (b) Unit rate policies: A premium adjustment will be calculated based on the average total benefit for all employees covered during the previous policy year. Effectively this means salary and staff changes are treated as if they occurred at mid-year. 4.3 If the policy is discontinued mid-year will premiums paid in advance be lost? No. A final account will be produced based on the cover provided up to the date when you cancelled the policy. Either a refund will be paid or any outstanding premiums will be requested. 9

10 5 Claiming benefit This section deals with common questions which arise following a member s death. 5.1 How are claims made? The evidence required to assess a claim will include, but not be limited to: an original of the member s death certificate evidence of the employee being covered and their earnings a signed claim form. Claim forms can be obtained by writing to Aviva Group Protection Claims Management Team, PO Box 3620, Norwich, NR7 7XS. Call us on Calls may be recorded and may be monitored. 6 What is not covered? There are no general exclusions under the policy. Exclusions for claims arising from certain specified medical conditions or for specified circumstances may be imposed on benefits that are subject to underwriting. We will apply a restriction on the total amount of benefits payable for claims which are directly or indirectly attributable to one originating cause 1, irrespective of the period of time or area over which the deaths occur. This is commonly known as an event limit. This restriction will apply to the total of the lump sum death benefits payable under this policy and any lump sum death benefits and additional lump sums (including capitalised values) insured to provide for dependant s death in service pension benefits payable under any associated policies. The event limit will be shown on the quotation and will never be more than 100 million. In some postal locations 2 we will be unable to provide any cover for claims arising directly or indirectly from one originating cause (in such cases the event limit for those postal locations will be zero). 1 An originating cause will include, but not be limited to, a series or sequence of causes which on the balance of probability result from persons acting in concert or in accordance with a plan or design. 2 A postal location comprises any area wherein the postcodes, up to but not including the last two characters are identical. 7 Can cover be provided for an employee who is not in the UK? Individual consideration will be given to covering employees who either work overseas or spend much of their time travelling overseas. In order to be considered employees must satisfy the eligibility conditions of the scheme. In order to grant cover we will need to know the frequency of foreign travel, where the employee will work and the duration of the contract. 8 Taxation of policies Premiums If premiums paid by the employer are wholly and exclusively used for the purposes of the business they may qualify for tax relief but guidance should be sought from the local inspector of taxes. Premiums paid by the employer are not treated as a benefit in kind for members. Benefits Lump sum benefits paid under an excepted group life policy do not count towards the deceased member s lifetime allowance. Inheritance tax rules mean that exit and periodic charges may apply but individual guidance should be sought. The tax and pension information contained in this document is given for guidance only and is based on Aviva s understanding of current legislation. It is not intended to give definitive advice and employers should seek clarification of the tax position and pensions issues for their specific circumstances. 9 Continuation option A continuation option allowing cover to continue for employees leaving service is not available. 10

11 Further information Aviva Online Group Life Assurance Policy for Excepted Schemes is provided by a group life assurance policy for excepted schemes policy issued and underwritten by Aviva Life & Pensions UK Limited, part of the Aviva group. Questions and complaints We want you to be entirely satisfied with your group life policy. If you have a query or complaint, then in the first instance please contact the financial adviser who arranged the policy. If there was no adviser, please contact us directly. If this does not resolve the matter then please contact: Head of Group Protection Aviva Group Protection PO Box 3620, Norwich, NR7 7XS. Call us on Calls may be recorded and may be monitored. If you are complaining about the decision we have made on a claim or disagree with our response, or if we have not replied within eight weeks, you may be able to take your case to the Financial Ombudsman Service for them to investigate. Their contact details are: Financial Services Compensation Scheme In the unlikely event that we cannot meet our financial obligations, you may be entitled to compensation from the Financial Services Compensation Scheme (FSCS). This will depend on the type of business and the circumstances of your claim. The FSCS may arrange to transfer the policy to another insurer, provide a new policy or where appropriate, provide compensation. Further information about compensation scheme arrangements is available from FSCS on or at its website Law The policy is issued subject to the law of England. Our standard policy provides that employees do not have any rights under the Contracts (Right of Third Parties) Act This means that there is no requirement to involve employees in day to day decisions on the administration and insurance of the policy. Legislative changes HM Revenue and Customs rules regarding taxation of benefits and premiums may change in the future. The Financial Ombudsman Service (FOS) Exchange Tower London E14 9SR Telephone: or complaint.info@financial ombudsman.org.uk Website: ombudsman.org.uk Please note that the Financial Ombudsman Service will only consider your complaint if you have given us the opportunity to resolve the matter first. Making a complaint to the Ombudsman will not affect your legal rights. 11

12 Aviva Life & Pensions UK Limited. Registered in England No Registered office: Aviva, Wellington Row, York, YO90 1WR. Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Firm Reference Number Calls to Aviva may be recorded BGR/5574/OCT17 10/2017 Aviva plc