Friends Life Group Critical Illness Cover For Flexible Benefit Schemes Guide to Cover

Transcription

1 Friends Life Group Critical Illness Cover For Flexible Benefit Schemes Guide to Cover Reference CGTC/104(s,c)/SEP15 Comprehensive This guide contains key information about the Friends Life flexible benefit Group Critical Illness Policy. You should read this guide carefully along with the Group Critical Illness Protection conditions covered booklet and keep it in a safe place afterwards. This guide gives details of what is and is not covered. It does not give the full terms and conditions, which are contained in the policy document issued to your employer. Nothing in the policy confers any contractual rights on you. In deciding you wish to join your employer s group scheme, you are responsible for deciding if cover meets your needs. If you have any existing critical Illness provision, we recommend you seek independent financial advice before deciding whether or not to cancel your existing arrangements. What is Friends Life Group Critical Illness Cover? The Friends Life Group Critical Illness cover is provided under a group critical illness policy by Friends Life Limited, part of the Aviva group. Your employer has taken out the group policy which will be used to provide the cover. Only one policy is issued to your employer for the whole group scheme, it is not possible to divide the policy into separate policies. The policy has no cash value and if you leave the scheme any premiums you have paid will not be returned. The policy aims to provide: A lump sum benefit which is payable if you, your spouse/partner or your child: are diagnosed with one of the specified medical conditions or undergo one of the listed operations; and survive for at least 14 days; and the medical condition or operation meets the definition in the policy conditions. The amount of cover you select through your. The full list of medical conditions and operations covered is given overleaf and the full definitions are available in the Group Critical Illness Protection conditions covered booklet.

2 Who can be covered? If you are eligible for cover under your employer s flexible benefit scheme, you can select this benefit. You will not have to complete an application form but all cover (including any increases in cover) will be subject to the pre-existing conditions exclusion which is described in When will the cover not pay out? later in this document, from the date that cover starts or you increase your cover. Children s cover Your children (including stepchildren and legally adopted children) aged between 30 days and 18 years (21 if in full time education) are automatically covered. There is no limit to the number of children who can be covered. The amount of benefit provided for each child will be 25% of your benefit up to a maximum of 20,000. Spouse/Partner cover You can also select a benefit for your spouse/partner. They will not have to complete an application form but all cover (including any increases in cover) will be subject to the pre-existing conditions exclusion which is described in When will the cover not pay out? later in this document, from the date that cover starts or you increase the cover. You can only select cover for your spouse/partner if you also select the cover for yourself and their benefit cannot be higher than your benefit. Which critical illnesses are covered? The Group Critical Illness Protection conditions covered booklet contains the full definitions for all the medical conditions and operations covered under your employer s policy. You, your spouse/partner or any children will only be covered for the medical conditions and operations listed below. No other conditions or operations are covered. The conditions covered may be changed for new members joining in the future and for everyone once the policy has been in force for five years. If this happens you will be informed of the changes. The complete list of conditions and operations that are covered by the policy are: Alzheimer s disease resulting in permanent symptoms aorta graft surgery aplastic anaemia with permanent bone marrow failure bacterial meningitis resulting in permanent symptoms benign brain tumour resulting in permanent symptoms or removed via craniotomy benign spinal cord tumour blindness permanent and irreversible cancer excluding less advanced cases cancer second and subsequent cardiac arrest cardiomyopathy of specified severity coma resulting in permanent symptoms coronary angioplasty to two or more coronary arteries coronary artery by-pass grafts Creutzfeldt-Jakob disease resulting in permanent symptoms deafness permanent and irreversible dementia resulting in permanent symptoms encephalitis heart attack of specified severity heart valve replacement or repair HIV infection caught from a blood transfusion, a physical assault or at work in an eligible occupation* kidney failure requiring dialysis liver failure of advanced stage loss of hand or foot permanent physical severance loss of independent existence permanent and irreversible loss of speech permanent and irreversible major organ transplant motor neurone disease resulting in permanent symptoms multiple sclerosis with persisting symptoms open heart surgery with surgery to divide the breastbone paralysis of limbs total and irreversible Parkinson s disease resulting in permanent symptoms primary pulmonary arterial hypertension 2

3 progressive supranuclear palsy resulting in permanent symptoms pulmonary artery graft surgery respiratory failure of advanced stage rheumatoid arthritis chronic and severe stroke resulting in permanent symptoms systemic lupus erythematosus with severe complications terminal illness where death is expected within 12 months third degree burns covering 20 percent of the body s surface area or 30 percent loss of surface area to the face traumatic brain injury resulting in permanent symptoms * The eligible occupations for HIV infection caught at work are: the emergency services police, fire and ambulance the medical profession including administrators, cleaners, dentists, doctors, nurses and porters the armed forces The following cover is not available for any children covered under the scheme: loss of independent existence permanent and irreversible. The following cover is not available to your spouse/partner: Children s benefit. How much does the cover cost? The cost of the cover will be shown on your employer s flexible benefit system and will be based on your and your spouse/partner s age and the amount of cover you select. The premium is based on your and your spouse/partner s age and each year will go up when you, your spouse/partner enter a new age band. This means the same level of critical illness cover will increase in cost as you both get older. When does cover start? You will normally have the opportunity to join the scheme during a fixed enrolment period each year or shortly after your employment starts. Your employer will be able to confirm the date that your cover can start but this will always be after the selection date. No cover will be in place before the start date. You will not have to fill out an application form in order for cover to begin. However, all cover will be subject to a pre-existing conditions exclusion (please refer to the When will cover not pay out? section later in this document). When does cover stop? Your cover will stop if: you reach the policy expiry age shown on your you leave the service of your current employer (in which case, cover will cease on the last working day of the month in which you leave) you de-select this benefit as an option under your your contract of employment is ended you die a benefit is paid in respect of a claim the policy is stopped by your employer. Your spouse/partner cover will stop if: they reach the policy expiry age shown on your - you leave the service of your current employer (in which case, cover will cease on the last working day of the month in which you leave) - you de-select this benefit as an option under your - your contract of employment is ended - you or your spouse/partner dies - a benefit is paid in respect of a claim - the policy is stopped by your employer. If, following a claim, you return to work you may re-enter the scheme one day after your cover has ended. You will be treated as a new member and the pre-existing conditions exclusion will be re-applied from the date that you re-enter the scheme. 3

4 You will not be able to re-enter the scheme if you have claimed for Alzheimer s disease, coma, Creutzfeldt-jakob disease, dementia, HIV infection, liver failure, loss of independent existence, motor neurone disease, progressive supranuclear palsy, systemic lupus erythematosus or traumatic brain injury. Cover for an individual child will stop if a claim is paid for the child, they reach 18 or 21 if in full time education, or the cover ceases. Child cover can only be paid once for each child. There is no option for your spouse/partner or any children covered under the scheme to re-enter the scheme following payment of a claim for them. When will the cover not pay out? A claim for a critical illness will not be paid: if you, your spouse/partner or your child suffers a critical illness not covered by the policy or if the condition or operation is listed but your diagnosis or treatment fails to meet the relevant definition in the Group Critical Illness Protection conditions covered booklet if you, your spouse/partner or your child die within 14 days (or such longer time as is specified in the definition) of meeting the definition of a critical illness if the cause of claim results from intentional self-inflicted injury. A pre-existing conditions exclusion also applies to all benefits under this policy (i.e. benefits for you, your spouse/partner and your children). This means that if you are suffering from, or have suffered from, or have any symptoms of, any critical illness or undergone any operation covered by the policy at any time prior to entering the scheme then you will not be able to claim for that or any further incidence of that critical illness or operation (except cover for cancer - second and subsequent ), or for any other critical illness or operation which is directly or indirectly linked to the prior critical illness or operation. For your spouse/partner and your children, the pre-existing condition exclusion means that they are not covered for any critical illness or operation linked directly or indirectly to any condition or illness suffered prior to cover commencing (except cover for cancer - second and subsequent ). Full details are contained in the Group Critical Illness Protection conditions covered booklet available from your employer. In addition No benefit will be paid in respect of any critical illness or operation where you, your spouse/partner or your child has suffered from an associated condition (including but not limited to the examples listed in the Group Critical Illness Protection conditions covered booklet) prior to the commencement of your/their cover. This will apply whether or not any treatment has been administered and/or diagnosis made of the associated condition. For all critical illnesses or operations with the exception of loss of independent existence, paralysis of limbs and terminal illness, the associated conditions will be disregarded if you or your spouse/partner or your child do not suffer a critical illness or operation covered by the policy within two years from the date of your/their entry to the scheme. Associated conditions for loss of independent existence, paralysis of limbs and terminal illness remain applicable indefinitely. Important When deciding if a condition is pre-existing, the onset or occurrence of aorta graft surgery, cardiac arrest, cardiomyopathy, coronary angioplasty, coronary artery by-pass graft, heart attack, heart transplant, heart valve replacement or repair, primary pulmonary arterial hypertension, pulmonary artery graft surgery, stroke or valvuloplasty will all be considered to be directly linked. No benefit will be paid in respect of blindness, coma, deafness, loss of independent existence, loss of speech, paralysis of limbs or terminal illness linked directly or indirectly to a prior critical illness or operation. The pre-existing conditions exclusion applies from the date of commencement of cover and will also apply to any increases you elect to make to your cover. If you re-enter the scheme (including following a claim) you will be treated as a new member and the pre-existing conditions exclusion will be re-applied from the date of re-entry to the scheme. The following cover is not available for any children covered under the scheme: loss of independent existence permanent and irreversible. 4

5 The following cover is not available to your spouse/partner: Children s benefit. Can I change the cover? You may change your cover during the annual enrolment period or after a lifestyle event. The lifestyle events have been agreed between Friends Life and your employer. Typically events as marriage and birth of a child are included. Your employer will be able to tell you the full list of any lifestyle events applicable to their scheme. Further information How to make a claim Claims should be submitted through your employer within 3 months of first diagnosis or undergoing surgery or as soon as reasonably practicable. Claim forms can be obtained by writing to Friends Life Group Protection Claims Management Team, 2nd Floor, Anchorage 1, Anchorage Quay, Salford Quays M50 3YL Call us on Calls may be recorded and may be monitored. How to complain If you have a query or complaint about anything other than a claim you should speak to your employer (the policyholder) who will contact us. If you are complaining about the decision we have made on a claim we will consider any new medical evidence submitted by you or your employer. The medical evidence should support the contention that you, your spouse/ partner or your child has been diagnosed with one of the specified medical conditions or undergone one of the listed operations. Information should be sent to the Friends Life Group Protection Claims Management Team at the address given in the How to make a claim section. Any appeal by you or your employer must be made in writing within three months of receipt of notification from us of a claim being rejected or as soon as reasonably practicable. If you disagree with the claim decision following such written appeal you may refer the question of whether you, your spouse/partner or your child has a valid claim under the policy to: The Financial Ombudsman Service Exchange Tower, Harbour Exchange Square, London E14 9SR Telephone or complaint.info@financial-ombudsman.org.uk Law and language The cover is governed by the law of England and Wales. All communications will be in English. Compensation We are covered by the Financial Services Compensation Scheme (FSCS). If we cannot meet our obligations you may be entitled to compensation under the scheme. This will depend on the type of business and the circumstances of your claim. Further information see Alternatively, you can contact the FSCS on or Please note that FSCS s first responsibility is to seek continuity of cover rather than to pay compensation. Taxation of premiums and benefit Any premiums paid by your employer will be treated by HM Revenue and Customs as a benefit in kind, so will be added to your taxable income. Under current HM Revenue & Customs practice benefit under a Friends Life Group Critical Illness policy is payable free of tax. HM Revenue & Customs rules regarding the taxation of benefits and premiums may change in the future and are based on individual circumstances. 5

6 This document is available in other formats. If you would like a braille, large print or audio version of this document, please contact us. Friends Life Limited An incorporated company limited by shares and registered in England and Wales, number Registered office: Pixham End, Dorking, Surrey RH4 1QA. Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Calls may be recorded. Friends Life is a registered trade mark of the Friends Life group. CGTC/104(s,c)/SEP15