Group Life Assurance Flexible Benefits Scheme for Spouse/Partner Terms and Conditions. Reference HFL/SPLATC/SEP15

Transcription

1 Group Life Assurance Flexible Benefits Scheme for Spouse/Partner Terms and Conditions Reference HFL/SPLATC/SEP15

2 Contents Page Definitions 3 1 The scheme benefit 5 2 Commencement of cover 3 Claims 4 Benefit level 5 Premiums 6 6 Amendment of cover terms 7 7 Termination 8 8 Other matters 9 9 Notices 10 Complaints 10 2

3 Definitions The Friends Life Spouse Partner Life Assurance is provided under a group life insurance policy by Friends Life Limited, which is part of the Aviva group. All references to Friends Life should be read as reference to Friends Life Limited. The terms set out below are defined terms. Where they are used in bold in these terms and conditions they shall have the meaning set out below unless the context indicates otherwise. Where appropriate, the singular includes the plural, references to males include females and expressions defined in the definitions or elsewhere in the policy shall have the meanings respectively ascribed to them. Reference to any statutory provision shall be deemed to include any consolidation, modification, re-enactment or replacement or regulations thereunder made and in force from time to time. A reference to a person shall include an individual, a corporate body, a firm, association, partnership or trust. Agreed minimum The minimum number of members, as specified in the policy schedule; Benefit limit The maximum amount of member benefit payable by Friends Life as specified in the policy schedule; Commencement date The date on which cover under the policy commences, as set out in the policy schedule; Employer The principal employer or (to the extent applicable) any participating employer; Expiry age The age specified in the policy schedule at which a partner will cease to be covered under the policy; Friends Life Friends Life means Friends Life Limited, part of the Aviva group, which is an incorporated company limited by shares and registered in England and Wales number Registered office: Pixham End, Dorking, Surrey RH4 1QA; Member An employee of the principal employer or any participating employer who: (a) fulfils the eligibility criteria for the scheme as set out in the policy schedule; and (b) is ordinarily working in the United Kingdom; and (c) is specified as a member by the policyholder; and (d) has requested cover for a partner who meets the specified definition of a partner for the terms of the scheme; and (e) whose partner has been accepted for cover under the scheme by Friends Life; Member benefit The agreed lump sum payable to a member by Friends Life on the death of the partner of the member covered by the scheme and set out in the policy schedule subject to the benefit limit; Minimum premium level The minimum premium levels specified in the policy schedule; Participating employer Any employer (other than the principal employer) which is directly or indirectly controlled by or associated with the principal employer where; (a) that employer has made an arrangement with the policyholder to be included in the scheme as a participating employer; and (b) Friends Life has agreed that employer may be covered under the policy as a participating employer (with written confirmation from Friends Life); Partner The Legal Spouse, Civil Partner, or the person who is financially dependent on the employee or has a financial interdependency with the employee or such other basis as set out in the policy schedule; Policy This policy, which shall include the policy schedule, the terms and conditions together with any endorsements; 3

4 Policyholder The holder of the policy for the time being; Policy schedule The details of cover in respect of the policy set out in the schedule to the policy as amended from time to time; Policy year In the case of the first such period, the period from (and including) the commencement date to (and including) the day before the first scheme anniversary date and thereafter each annual period from (and including) the scheme anniversary date to (and including) the day immediately preceding the next scheme anniversary date or the date of termination of the policy, if sooner; Pre-existing condition Any disease, illness or injury for which a partner has: (a) received advice and/or consulted a doctor and/or received medication and/or received treatment; or (b) experienced symptoms; whether the condition was diagnosed or not before the member s qualification date or any condition which relates to any such disease illness or injury; Premium The premium payable in respect of the policy calculated in accordance with the terms of the policy as charged from time to time; Premium guarantee period In the case of the first such period, the period from (and including) the commencement date and ending immediately before the first premium review date and thereafter a period from each premium review date to the day immediately before the succeeding premium review date; Premium review date The second scheme anniversary date and every second anniversary thereafter or such other dates agreed in writing by Friends Life and set out in the policy schedule; Principal employer The principal employer named in the policy schedule or any other company, firm, organisation, person or body of persons which succeeds the principal employer under the scheme, and Friends Life acknowledges as having done so; Qualification date The date on which a person becomes a member; Scheme anniversary date The annual review date set out in the policy schedule; Scheme benefit The maximum amount of member benefit capable of being paid under the policy for all members at the relevant time assuming a valid claim had been made under the policy for the full amount of member benefits; Single premium amount The premium notified by Friends Life to the principal employer for each member for a policy year. Unless the previous policy year ends on a premium review date Friends Life may only change the single premium rate used to calculate the premium for each member to reflect the change in that partner s age, Friends Life shall only amend the single premium rate applicable for each age at a premium review date; Single premium rate The rate of premium used by Friends Life to calculate the single premium amount; Terms and conditions These terms and conditions reference HFL/SPLATC/SEP15; Working day A day other than a Saturday or Sunday or a public holiday in England and Wales or in Scotland or Northern Ireland. 4

5 1 The scheme benefit 1.1 Friends Life will provide cover on the partner of each member (accepted by Friends Life as having cover) equal to the member benefit calculated in accordance with the policy. The member benefit shall not exceed the benefit limit. 1.2 Friends Life shall pay to the member on the death of the partner of that member covered, the member benefit applicable. Payment is subject to: (i) the terms and conditions; and (ii) the member having claimed such member benefit and the policyholder and member having complied with all their respective obligations under these terms and conditions (including, without limitation, all requests from Friends Life for information pursuant to clauses 3 and 6). 2 Commencement of cover 2.1 Subject to these terms and conditions and the policy schedule, cover under the policy will begin on the commencement date and continue until determined in accordance with the policy. 2.2 Subject to these terms and conditions and the policy schedule, cover on the partner of any member will begin on their qualification date and continue until determined in accordance with the policy. 2.3 The partner shall provide Friends Life with such information as Friends Life requires to determine whether or not to provide cover on the partner. 3 Claims Member benefit payment 3.1 The member shall inform Friends Life of the death of their partner as soon as practicable and in any event within one month of the event occurring. When making a claim the member shall provide such information as Friends Life may reasonably request, including, but not limited to: (a) a death certificate; and (b) such medical reports and other information about the partner s medical condition and history as Friends Life may reasonably require; and (c) evidence of the member s age; and (d) such other information as Friends Life may require pursuant to this clause If the member, partner or policyholder fails to comply with any of the provisions of this clause 3 in relation to any member or partner then Friends Life shall be entitled to withhold payment until the relevant requirement has been fulfilled. 3.3 Friends Life shall not be liable for any act, error or omission arising directly or indirectly from any error in or omission from any data, information or evidence provided to it by the policyholder, member or partner provided that Friends Life will use reasonable endeavours to avoid making any error or omission. 3.4 Friends Life shall be entitled to recover from the policyholder any overpayment of benefit which was the direct or indirect result of any incorrect data, information or evidence provided to it. 4 Benefit level 4.1 Subject to clause 4.2 no member benefit shall be provided for a particular member in relation to a partner unless Friends Life has agreed in writing with the policyholder that it will provide cover and the amount of cover it will provide. 4.2 Where an application for cover, or an increase in cover, has been submitted to Friends Life by a member, the member benefit shall be the amount applied for, save as set out in clause 4.3 below, in respect of any claim in relation to that partner between the date on which the application was notified to Friends Life and the earlier of: (a) the day being 90 days after the application was notified or such other date as Friends Life may agree in writing for that member; and (b) the date from which Friends Life has agreed or declined to provide terms for member benefit, subject to the other terms and conditions of the policy. 4.3 Where clause 4.2 applies, the member benefit shall be limited to zero where no member benefit level has been previously agreed for the partner or the amount of any previously agreed member benefit level immediately prior to the application for the cover for the partner for whom an application for cover has been made in respect of: (a) any claim in relation to that partner arising directly or indirectly as a result of a pre-existing condition; or (b) any partner who has been accepted for cover under the policy on non-standard terms. 5

6 4.4 Any application in respect of any partner shall be considered by Friends Life at its sole discretion and may result in loadings, postponements and declinatures or additional terms and the member and/or partner shall provide to Friends Life in respect of each partner such evidence of his health and other matters relevant to the assessment of risk as Friends Life may reasonably require. 5 Premiums Premiums payable 5.1 The policyholder shall pay the premium to Friends Life for each policy year and the minimum premium payable for a policy year shall be the minimum premium level. 5.2 The premium the policyholder shall pay shall be calculated as a separate premium for each individual who is or becomes a member during the policy year and the premium payable for each member for the policy year shall be the single premium amount. 5.3 The policyholder shall pay in respect of the premium to be paid an amount for each individual who is a member at the start of each month during the policy year. The amount shall be the sum equivalent to one twelfth of the premium that would be payable for the policy year if the individual remained a member for the whole of the policy year and the member benefit in respect of the partner remained the same as at the commencement of that month. Premium adjustment 5.4 Friends Life shall at the end of the policy year, calculate the total amount due under clause 5.1 in respect of premiums for the whole of the policy year, taking into account, as appropriate, individuals who have become or ceased to be members and any changes to the scheme benefits during the policy year. If the total amount due is more than the total amount received on account the policyholder shall pay to Friends Life the amount of the difference and vice versa. Premium due dates 5.5 The payments on account in respect of each policy year shall, unless stated otherwise in the policy schedule, be payable in advance on the later of: (a) the working day which falls 30 days after the relevant premium (or estimate thereof) is notified by Friends Life to the policyholder; and (b) the commencement of the policy year. 5.6 If it is not possible for Friends Life to calculate the premium or payments on account (under clause 5.3) in respect of any month in the policy year prior to the commencement of that month in the policy year or within 30 days of the end of that month in the policy year in the case of the premium, then Friends Life shall estimate the premium or payment on account on the basis of such information as it has in its possession and notify the policyholder accordingly. The policyholder shall pay such estimated amount as if it were the premium or payment on account as the case may be. When it is possible to calculate the premium or payment on account, Friends Life shall inform the policyholder of the actual premium or payment on account accordingly. Subject to clause 5.7 Friends Life shall refund any overpayment and any underpayment by the policyholder shall become due for payment within 30 days of notification by Friends Life to the policyholder of the relevant amount. 5.7 Friends Life may agree with the policyholder that any underpayment or overpayment pursuant to clause 5.6 shall be repaid or recouped by adjustment of the premium or estimated premium for the succeeding month in the policy year. Non-payment 5.8 If the policyholder fails to make any payment when due under the policy then, cover under the policy shall terminate with immediate effect, and all outstanding payments under the policy shall become due and payable. If the policyholder makes the outstanding payment which has given rise to a termination of cover under this clause within 30 days of the due date Friends Life may at its entire discretion reinstate cover. 5.9 If at any time the monthly or quarterly premium payable by the policyholder is reduced to less than the monthly or quarterly minimum premium level, Friends Life shall be entitled to require full payment for the policy year in advance. 6

7 6 Amendment of cover terms 6.1 The policyholder will immediately inform Friends Life, providing full details of: (a) any change in the identity of the principal employer; or (b) any addition to, or subtraction from, the participating employers; or (c) any material change in the nature of the business or undertaking of the principal employer or any participating employer; and the policyholder shall give Friends Life prior written notice of any amendment to the scheme provisions or rules no later than 30 days before such amendment comes into effect and clause 6.2 shall apply accordingly. Changes to terms by Friends Life 6.2 Friends Life shall have the right to vary, modify or amend forthwith any term of the policy at any time during any premium guarantee period (including, without limitation the premium rate) by notice to the policyholder if: (a) the number of members is reduced below the agreed minimum; or (b) the number of members at any time increases or decreases during a premium guarantee period by more than 25 per cent; or (c) the aggregate amount of the scheme benefit under the policy increases or decreases during a premium guarantee period by more than 25 per cent; or (d) the policyholder has failed to comply to Friends Life s reasonable satisfaction with any request for additional information under the policy within 60 days of such request; or (e) there is any material change in the nature of the business or constitution of the principal employer or of any participating employer; or (f) there is any material change in law or practice of any governmental or statutory body (including without limitation rates of taxation and social security benefits or practice or any levy or charge under the Financial Services Compensation Scheme) which materially affects the cost to Friends Life of providing cover; or (g) there is any addition to or subtraction from the participating employers; or (h) there is any change in the identity of the principal employer. 6.3 The policyholder shall promptly notify Friends Life of any circumstance coming to their attention within sub-clauses 6.2(a) to (e) (inclusive) and provide Friends Life with full details of the same. Changes on premium review 6.4 Prior to any premium review date the policyholder must provide such information as is reasonably requested by Friends Life to allow Friends Life to determine the terms on which cover may be provided. 6.5 In addition to the provisions set out in clause 6.2 and 6.10 Friends Life shall be entitled to vary, amend or modify any term of the policy (including, without limitation the premium rate and premium payment provisions) with effect from every premium review date. 6.6 Variations, amendments or modifications under clause 6.5 other than changes to the premiums payable or premium rates under the policy shall only affect cover under the policy in respect of persons who become members and increases in the level of member benefits after the changes take effect. 6.7 Friends Life will give notice to the policyholder of any variation, amendment or modification pursuant to clause 6.5 but, subject to clause 6.8, shall not be obliged to provide such notice prior to the relevant premium review date. Policyholder s right to terminate 6.8 Following notification by Friends Life of any variation, amendment or modification of a term of the policy the policyholder shall be entitled to terminate cover with immediate effect by notice given to Friends Life within 30 days of service of such notice from Friends Life subject to the terms and conditions of the policy which existed immediately prior to the giving of the notice by Friends Life or, in the case of a notice under clause 6.7 the premium review date on which the change would otherwise have taken effect. In the absence of service of a notice by the employer within 30 days, the policyholder will be deemed to have accepted the changes notified by Friends Life. 7

8 Changes by Friends Life after the second anniversary 6.9 In addition to the provisions set out in clauses 6.3 and 6.6 Friends Life may at any time after the second anniversary of the commencement date vary, amend or modify any term of the policy (with the exception of the premium rate which shall only be modified in accordance with clause 6.5) Variations, amendments or modifications under clause 6.9 shall apply to all members under the policy with the exception of those members in respect of whom a claim for member benefit has been made at the date the change applies Friends Life will give notice to the policyholder of any variation, amendment or modification pursuant to clause 6.9 at least 14 days before the date on which the changes are due to take effect. 7 Termination 7.1 Cover will terminate under the provisions of clause 5.8. Termination by Friends Life 7.2 Cover under the policy may be terminated by Friends Life: (a) in any of the circumstances referred to in clauses 6.2(a), 6.2(d) or 6.2(e); (b) with immediate effect in respect of any or all members, by notice from Friends Life, if the policyholder (or in respect of any member if that member or partner) has supplied misleading, incorrect or incomplete information to Friends Life. Termination by policyholder 7.3 Cover under the policy may be terminated by the policyholder: (a) at any time provided that prior written notice of such termination has been served by the policyholder on Friends Life. Termination of the policy cannot be backdated to before the date of the written notice by the policyholder. Continuation of claims 7.4 All valid claims, accepted by Friends Life as such, notified to Friends Life in respect of the death of a partner who died prior to the date on which notice of termination is duly served in accordance with this clause 7 shall continue to be eligible for payment. Termination of membership 7.5 A member will cease to be covered under the policy on the earliest to occur of the following events: (a) on reaching the expiry age; (b) on the death of the member; (c) a valid claim being paid under the policy in respect of a member s partner who they have covered under the scheme; (d) on the member to whom the cover relates electing not to continue cover under the terms offered to them by the policyholder; (e) on termination of the policy; (f) on their cover ending in accordance with clause 7.6; (g) on ceasing to satisfy the definition of partner in the policy schedule. 7.6 Cover will cease under the policy for any member on the earliest to occur of the following events: (a) on the member retiring from the service of the principal employer or any participating employer prior to the expiry age; (b) on the member leaving the service of the principal employer or any participating employer; (c) on the expiry of the member s contract of employment; (d) on the member ceasing for any reason to be covered by the policy. 8

9 8 Other matters 8.1 All payments to be made by Friends Life under this agreement shall be payable in sterling at the address of Friends Life stated in clause The receipt of any benefits payable under this policy by the policyholder or any person authorised by them for payment shall be a good discharge to Friends Life which shall not be concerned to see further to the discharge of such benefits. 8.3 The policy shall have no surrender value at any time. 8.4 The policy and/or any benefit payable under it shall be incapable of assignment by the policyholder without the prior consent of Friends Life. 8.5 No benefit shall be payable under this policy by virtue of any statutory provision, governmental or regulatory restriction or rule of law which applies to it. 8.6 No variation or amendment of the terms of this policy shall be effective unless it is agreed in writing by or on behalf of the policyholder and Friends Life. 8.7 No failure or delay by Friends Life in exercising any right, power or privilege under this policy shall act as a waiver thereof or shall preclude the exercise by Friends Life of any other right or power available to it. 8.8 We and you have a free choice of law that can apply to a contract. Friends Life propose to choose the law of England and Wales and by entering in to this contract the policyholder agrees that the law of England and Wales applies. 9 Notices 9.1 Any notice or other communication to be given or served under or in connection with this policy shall be in writing and shall be sufficiently served or given if delivered or sent: In the case of Friends Life to: Head of Group Protection, Friends Life Group Protection, 2nd Floor, Anchorage 1, Anchorage Quay, Salford Quays M50 3YL Telephone Calls may be recorded and may be monitored. In the case of the policyholder, to their last address correctly notified to Friends Life in accordance with this clause. 9.2 Any such notice or other communication shall be delivered by hand or sent by courier, fax or pre-paid first class post. If sent by courier or fax such notice or communication shall, in the case of service in the United Kingdom, conclusively be deemed to have been given or served 24 hours after the time of despatch (in the case of fax the time of despatch being the time on which the fax has been sent in readable form in its entirety), or 48 hours after despatch in the case of international service. If sent by pre-paid post such notice or communication shall, in the case of inland mail in the United Kingdom, conclusively be deemed to have been received 48 hours from the time of posting, or three days after despatch in the case of international mail. 8.9 This contract is only capable of enforcement by the parties to it. No rights of enforcement or any other rights are given to any third parties, including those described in these conditions. 9

10 10 Complaints We want you to be entirely satisfied with your group protection 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. Head of Group Protection, Friends Life Group Protection, 2nd Floor, Anchorage 1, Anchorage Quay, Salford Quays M50 3YL Call us on Calls may be recorded and may be monitored. If a disagreement continues with regard to a claim and you meet the eligibility criteria set by the Financial Ombudsman Service, you may refer the matter to them, as detailed below. The Financial Ombudsman Service Exchange Tower, Harbour Exchange Square, London E14 9SR Telephone or complaint.info@financial-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. 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 10

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12 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. HFL/SPLATC/SEP15