Group Income Protection Flexible Benefits

Transcription

1 Group Income Protection Fexibe Benefits Technica Guide

2 Aviva By choosing Aviva, part of the UK s argest insurance group, you benefit from our financia strength. Together with miions of customers wordwide you can fee certain of your choice whether you invest for the future, provide against the unexpected, or protect the things that are important to you. Our size and efficiency give us the strength to deiver an extensive range of vaue for money, quaity products investments, retirement, protection and heathcare designed to meet your needs, both now and in the future. This Technica Guide has been produced based on the standard format recommended by the Group Risk Deveopment group (GRiD) and The Association of British Insurers (ABI). This Technica Guide wi te you the main features and benefits about our Group Income Protection poicies. It shoud be read aongside the iustration with which it was issued. It does not form part of the poicy contract. Fu detais of the contract terms can be found in the Poicy Wording which is avaiabe at 2 Group Income Protection Technica Guide

3 Contents Section Poicy aims 4 Your commitment 4 Risk factors 4 Your questions answered 5 1 How does the poicy work? 5 2 What factors shoud be considered in deciding what benefits to provide? Who can be covered? Can cover be provided for members who are not in the UK? Are members covered whist on maternity or paternity eave? Can cover be provided for members that are on a sabbatica? What are the eigibiity conditions? When can members make changes to their fex benefits? Can different Group Income Protection poicies be inked? When wi cover stop for a member? What types of cover are avaiabe? What types of benefits wi be paid? When wi benefit payments start? For how ong wi benefits be paid? Can benefit payments be infation protected? 7 3 How is the poicy set up? What do we need to set up the poicy? Does any evidence of heath have to be provided before members are covered for their fu benefit? What if a caim happens before an underwriting decision has been made? 8 4 What premiums wi be charged for the cover? How wi premiums be cacuated? Wi there be any unexpected extra premiums? What commission is incuded? Is there a discount for good caims experience? 9 5 How does the poicy accounting work? What information is needed for accounting purposes? 9 6 How are caims made? How are caims submitted? What might be needed to assess a caim? When is a caim paid? Can rehabiitation hep? For how ong wi the benefit be paid? If a member returns to work after a caim, can another caim be made for that member if the incapacity is from a different cause? Does other income the member receives affect the benefit from this poicy? 11 7 When can the poicy be canceed? Does the poicy have a surrender vaue If the poicy is canceed during the poicy year (not at the anniversary date) wi you refund any premiums paid in advance? 11 8 What is not covered? 11 9 What are the tax considerations? What are the tax considerations for payment of premiums? What are the tax considerations for payment of benefits? Is there a continuation option? How might auto enroment affect the poicy? 12 Further information 13 Definitions 14 Page 3 Group Income Protection Technica Guide

4 Pease note Throughout this document certain words are shown in bod type. These are defined terms and have specific meanings when used in this technica guide. The meanings of these words are set out in the Definitions section in the back of this document. Poicy Aims To cover a proportion of reguar income promised in a contract of empoyment, if a member is unabe to work and is suffering oss of earnings because of iness or injury To provide a reduced repacement of income in proportion to their oss of earnings if, because of iness or injury, a member has to take a part-time or ower paid job To offer you a choice of benefts as part of an empoyee s fexibe benefts package to meet yours and the empoyee s needs. Your commitment You must agree to inform us straight away: about any discretionary entrants when a TUPE or group empoyment transfer takes pace If you want to change the cover of a category; or If you want to change the eigibiity criteria for membership About any changes to the empoyer s status or structure About any caims. You agree to: Pay premiums when requested abide by the terms and conditions of the poicy. You aso agree to provide us with a of the information we need: When you appy for the poicy At each anniversary date/rate guarantee date and, if appicabe, every month; When you make a caim And te us if these detais change. Risk Factors Cover may stop if you don t compy with poicy terms and conditions or if you stop paying premiums. This wi mean you have no cover in pace with us for future benefts and may resut in an uninsured iabiity. Any benefts aready in payment, and entitement to any benefts that have not aready been paid, wi continue to be paid by us on the terms aready confrmed to you. Empoyees must satisfy the activey at work requirements before cover is provided Empoyees may not be covered or may have their beneft restricted where medica information is not provided Payment of caims may be deayed or a caim may be rejected if you do not provide the information we ask for We recommend that a awyer considers the content of the empoyees contracts for you in the ight of this poicy, and any requirements you may have for offering the benefts to the empoyees Benefts paid under your poicy may be reduced if the member is receiving other reguar income because of their incapacity. Receiving benefts may affect a member s entitement to some state benefts. We usuay guarantee the rates and terms for two years after the start of the poicy The guarantee may not appy if: The saary ro or beneft ro we are covering changes by 25%. If this happens we reserve the right to cance the poicy; or The number of members covered fas beow 50 (if this happens we reserve the right to cance the poicy); or There is a change to the (or any new) egisation, reguation or taxation affecting the poicy; or There is a change to the: Beneft basis Eigibiity Nature of business; or A new empoyer joins or an existing empoyer eaves the poicy; or Companies incuded within the poicy. We may change the terms to respond, in a proportionate manner, to changes in taxation, the aw or interpretation of the aw, decisions or recommendations of an Ombudsman, reguator or simiar person, or any code of practice with which we intend to compy. We reserve the right to change the poicy terms and conditions after two years. We wi te you if we do. 4 Group Income Protection Technica Guide

5 Your questions answered 1 How does the poicy work? For new poicies, we need a minimum of 250 empoyees to be covered. You can choose whether to insure a of the empoyees or a category ony and seect the cease age You decide the eve of core benefts you wi fund and the fex beneft options avaiabe to empoyees You wi be required to pay the premium for the defaut beneft and fex beneft. Fex beneft premiums are normay paid by you via a saary sacrifce arrangement The cost is usuay treated for tax purposes as an aowabe business expense Premiums are not normay taxed as a beneft in kind for empoyees We provide cover no matter how many vaid caims you make, and in most circumstances continue to admit and pay caims where incapacity started before the poicy was canceed You provide us with the information we require to assess any caims We pay benefts monthy in arrears from the end of the deferred period for as ong as the caim is vaid We normay pay a benefts to the empoyer. 2 What factors shoud be considered in deciding what benefits to provide? 2.1 Who can be covered? Empoyees with a current UK contract of empoyment who meet the eigibiity conditions and satisfy the activey at work criteria. If an empoyee is not activey at work on the working day prior to the start date of the poicy, they wi be deemed activey at work once they make a fu and active return to their norma occupation (with their GP s approva) for one whoe day. Detais of the eigibiity and activey at work conditions are in section 2.5 and the definitions section at the back of this guide. 2.2 Can cover be provided for members who are not in the UK? Yes. We are prepared to offer cover to members traveing, working or seconded overseas. However, they wi need a current UK contract of empoyment and we wi need fu detais of any members seconded overseas before we can agree to cover them. Specia terms and conditions may appy. Members are expected to foow the British Foreign & Commonweath Office s trave advice, which can be found at Are members covered whist on maternity or paternity eave? We wi maintain cover whist a member is on maternity or paternity eave, as ong as they remain empoyed with the empoyer. If you need to make a caim for a member on maternity or paternity eave, the deferred period wi start from the date of incapacity, and benefit payments wi start from the ater of the end of the deferred period or the agreed return to work date. We wi cacuate the benefit based on the member s saary at the start of the maternity or paternity eave. 2.4 Can cover be provided for members that are on a sabbatica? We wi maintain cover for a member whist they are on a sabbatica if: the duration of the sabbatica is no onger than 1 year, and a UK contract of empoyment is maintained. If you need to make a caim for a member who is on a sabbatica, the deferred period wi start from the date of incapacity, and benefit payments wi start from either the end of the deferred period or the agreed return to work date, whichever is ater. We wi cacuate the benefit based on the member s saary at the start of the sabbatica. 2.5 What are the eigibiity conditions? The eigibiity conditions wi need to be agreed and shoud incude: minimum and maximum entry ages, any service quaifcation periods, the categories of empoyees to be covered, the date that new entrants can join the poicy (for exampe, monthy), and Membership must be open to a eigibe empoyees within a defined category or categories. Eigibiity conditions covering entry ages, entry dates and waiting periods must be the same for each empoyee within a defined category. You wi aso need to choose (subject to our agreement) The eves of beneft. For exampe, you can provide 40% of earnings on a 5 year imited term and aow the empoyee to seect fex benefts above this eve subject to the chosen maximum beneft 5 Group Income Protection Technica Guide

6 The defnition of saary to use. You may need to take into account bonuses, commissions and overtime if they form part of the empoyees reguar saaries. It is recommended that empoyers consut their own advisers to ensure that their proposed poicy arrangement and poicy set up does not breach equaity and discrimination aws. 2.6 When can members make changes to their fex benefits? Members can change their eve of benefit through fex benefits at a quaifying period. Increases wi be subject to our activey at work conditions being met. If a member is not activey at work on the effective date of a benefit increase through fex benefits, then the increase in benefit wi not be covered unti; the next quaifying period; subject to the member being activey at work. 2.7 Can different Group Income Protection poicies be inked? It is possibe to ink different Aviva Group Income Protection poices taken out by you or a parent/subsidiary of you. This wi be for the purpose of sharing the free cover imit and unit rate and is subject to prior agreement by us. 2.8 When wi cover stop for a member? You choose the poicy cease age, which can be SPA or any fixed age up to a maximum of 70. If the cease age is inked to SPA, the cease age wi be the atter of either 65 or the member s SPA. If the cease age is currenty either state pension age or a fixed age ower than 70, and you want to incude members beyond the current cease age up to a maximum age of 70, then the cease age has to increase for the whoe poicy or appicabe category, and we wi appy our activey at work definition to a members when they reach the current cease age. The member must not have been absent from work due to iness or injury for five or more consecutive working days in the previous three months. If a member is not activey at work, uness agreed and confirmed in writing by us, they wi be deemed activey at work once they make a fu and active return to their norma occupation (with their GP s approva) for an uninterrupted period of 20 working days. Cover wi stop when the poicy is canceed, premiums are not paid within 30 days of the due date, or when a member: is no onger empoyed by the empoyer is no onger eigibe for the scheme reaches the cease age; or dies. 2.9 What types of cover are avaiabe? Income benefit The maximum amount of income benefit we wi pay is: 80% of gross taxabe earnings for empoyees, up to a maximum annua amount of 350,000. You decide on the core benefit, defaut benefit and maximum benefit you wi fund and the fex benefit increments that an empoyee can seect. This can vary from one category to another subject to not exceeding our maximum benefit imits. What can be incuded in the definition of earnings? An empoyee s annua gross saary or wage from his or her empoyer before the deduction of tax. We can aso incude fuctuating emouments such as: proft reated pay, overtime, commission, shift or region aowances, taxabe bonuses, or the P11D vaue of benefts in kind in the definition of earnings, but to cacuate the income benefit we wi use the average of the tota of any fuctuating emouments over the ast 3 years (or such esser period as the member has been in receipt of fuctuating emouments) added to the member s norma annua saary. Any data provided to us for costing or accounting purposes must refect the agreed definition of earnings. Optiona benefits Empoyer s pension scheme contributions We can cover empoyer s pension scheme contributions for core benefit ony. This can be for a fixed amount, or based on a percentage of pensionabe saary, up to a maximum annua amount of 75,000. This means that benefits payabe under the pension poicy can be maintained, provided that the absent empoyee remains in the pension scheme. Empoyer pension scheme contributions paid via saary sacrifice wi be treated as empoyee pension contributions. Empoyee s pension scheme contributions We can cover empoyee pension contributions for core benefit. This can be for a fixed amount, or based on a percentage of pensionabe saary and is incuded within the overa maximum of 80% of gross taxabe earnings up to 350,000. Where empoyee pension contributions are covered and the persona maximum income benefit of 350,000 is exceeded, these wi be reduced to adjust the tota persona income benefit to the maximum amount. 6 Group Income Protection Technica Guide

7 Where age or service reated pension contributions are covered for either empoyer or empoyee pension scheme contributions, the contribution payabe in the event of a caim wi be the contribution at the date of the member s first absence. We wi not aow increases as a resut of a birthday or a service miestone where this occurs after the first date of absence. Empoyer s nationa insurance contributions Empoyer nationa insurance contributions can be covered and wi be based on the member s income benefit. They cannot be used for fex benefit but wi be cacuated on the member s income benefit regardess of whether the member s income benefit is equa to or above the core benefit What types of benefits wi be paid? Tota benefit We wi pay tota benefit if immediatey before the start of incapacity the member was foowing their norma occupation and, after the start of incapacity they are not foowing any other occupation, and the deferred period has finished. Proportionate benefit We wi pay a proportionate benefit if, before incapacity, the member was foowing their norma occupation and as a resut of the iness or injury they: are foowing their norma occupation on a part-time basis; or are foowing any other occupation, and as a resut are experiencing a reduction in earnings When wi benefit payments start? Benefit wi be paid once the deferred period has finished. The deferred period starts on the first date of incapacity and can be 13, 26, 28, 41, 52 or 104 weeks. The deferred period wi be shown on your poicy schedue For how ong wi benefits be paid? You choose whether benefits are paid up to the poicy cease age, which can be SPA or any fixed age from 50 to 70, or whether benefit is paid to the earier of the poicy cease age or a imited period of two, three, four or five years. 3 How is the poicy set up? 3.1 What do we need to set up the poicy? If a poicy starts within 3 months of the iustration, and any additiona requirements of the iustration have been met, we wi start cover once you have asked us to, in writing, and we wi require: a fuy competed appication form together with any additiona information required within 30 days of the start of the poicy, and the deposit premium or competed direct debit mandate returned within 30 days of the start of the poicy; and detais of each members : gender; dates of birth; saaries; beneft basis/eve; occupations; work ocations; and countries of residence(if outside the UK). We wi aso need fu detais of any: ong term absentees previous underwriting decisions previous scheme history; and previous caims history. If any of these detais or assumptions we have made differ from those on the iustration or cannot be supported, the iustration may be revised or withdrawn. We agree to start cover whist this information is being provided. If you do not send us everything we need within the time periods given, we reserve the right to cance cover and we may not pay any caims that are made whist cover was being agreed. We reserve the right to review the terms of this poicy or to cance cover from the start date if: the tota saary ro or tota beneft ro that we are covering changes by 25% or more to the iustration; or Reducing the benefit payment term reduces the cost of the poicy. you give us further information which affects the terms offered by us; or 2.13 Can benefit payments be infation protected? Yes. You can choose a caims escaator which wi mean that benefit payments increase whist a caim is being paid. You can choose for benefits to increase by a fixed percentage of 3 or 5% or in ine with the Retai Price Index (RPI) with increases capped at either 2.5 or 5%. The benefits wi increase by the chosen eve after they have been paid for 12 consecutive months. The number of members covered fas beow 50; or the premium, appication form or iustration requirements are not met. We wi provide cover based on the information in the poicy schedue and set out in the poicy wording. Where there are any differences, the poicy schedue takes precedence over both the iustration and the poicy wording. 7 Group Income Protection Technica Guide

8 3.2 Does any evidence of heath have to be provided before members are covered for their fu benefit? Poicies wi normay be offered a free cover imit. This means that medica information may may ony be required for benefits above the free cover imit, provided that the empoyee; increase in benefits. It wi not appy to any member who has previousy: been decined by us or another insurer; been postponed by us or another insurer been restricted by us or another insurer; or has not had any of their beneft previousy decined, restricted (as a resut of incompete medica underwriting), or postponed, by us or any other insurer. joins within the eigibiity conditions fufs the activey at work conditions; and is not a discretionary entrant decined to provide medica information. 4 What premiums wi be charged for the cover? The premium cacuated depends on severa factors which incude, but are not imited to: If our medica underwriting requirements are not met for a member who needs underwriting, their benefit wi be restricted to the free cover imit (if any), or previousy accepted benefit (if any), whichever is higher. Medica information wi be required for a discretionary entrant s tota benefit and we wi te you if cover is provided and if any additiona premiums need to be paid. If norma terms or rated terms appy foowing medica underwriting, then no further information is needed, provided that any increases resuting from saary increases do not take benefits above the amount confirmed and agreed by us. This is known as once ony underwriting. eve of benefts insured; eigibiity and entry conditions as shown in the poicy schedue; the cease age; age of members annua increase in beneft payments (if any) deferred period gender spit of the members; occupations of the members; ocations of the members; and Once ony underwriting wi not appy where the member has seected to increase their cover through fex benefit. Any fex increase in benefit wi be subject to the member either; satisfying activey at work if core benefts and fex benefts are beow the free cover imit, or; providing satisfactory medica information if core benefts and fex benefts are above the free cover imit. Shoud we appy specia terms, any additiona premiums wi be paid in addition to the norma terms premium paid in a poicy year. No worse terms For poicies that are currenty insured with another insurer who wish to switch to us on the same basis, we wi not normay appy worse medica underwriting terms than those appied by the previous insurer providing we are given fu information regarding a previousy underwritten members. Members with excusions, oadings or restrictions appied to their benefit by previous insurers wi not benefit from any increase in the free cover imit. 3.3 What if a caim happens before an underwriting decision has been made? We wi provide cover for fu benefits, excuding any pre-existing conditions, for a period of up to 90 days or unti our underwriting decision is made if sooner. Cover wi start from the date of joining the poicy, or the effective date of an caim history if the poicy has been insured before. You are responsibe for cacuating and coecting any premiums from the empoyee. The minimum premium we wi charge for the poicy is 750. A premium payments are to be made in pounds stering. 4.1 How wi premiums be cacuated? Core Benefit Premiums are cacuated by mutipying the monthy member s saary received, if unit rate of saary is seected, or member s benefit, if unit rate of benefit is seected, as detaied in the membership isting, by the unit rate that appies at that date. Fex Benefit Uness otherwise agreed by us, benefits in excess of the core benefit wi be cacuated using the appicabe fex benefit premium rates. Fex benefit rates are cacuated based on the members age at the beginning of each poicy year. Premium rates generay increase with age. 4.2 Wi there be any unexpected extra premiums? We usuay guarantee the rate(s) for two years after the start date of the poicy. A new rate(s) may appy at the rate guarantee date. 8 Group Income Protection Technica Guide

9 Premium oadings may be appied for members who have been medicay underwritten. Any oading wi refect their medica condition or any hazardous pursuits they may undertake. These oadings appy immediatey but become payabe at the next anniversary date. Terms and conditions We can change the rates, and any other term or condition of the poicy, if: the tota saary ro or tota beneft ro that we are covering changes by 25% or more. If this happens we reserve the right to cance the poicy; or the number of empoyees who are covered fas beow 50. If this happens we reserve the right to cance the poicy; or there is a change to the (or any new) egisation, reguation or taxation affecting the poicy; or there is a change to the: beneft basis; eigibiity; nature of business; or companies incuded within the poicy. We aso reserve the right to change the terms and conditions at the rate guarantee date. 4.3 What commission is incuded? Commission payments to your intermediary (if appicabe) are usuay a percentage of the premium. The iustration wi show the rate of commission we pay on your poicy. 4.4 Is there a discount for good caims experience? Caims experience is a factor in assessing a unit rate and premium for a poicy, so a good caims history wi usuay be refected in the rates and premiums charged. 5 How does the poicy accounting work? The poicy runs on one year accounting periods. The premium must be paid monthy, quartery, haf yeary or annuay by direct debit, or any other method agreed with us. Where premiums are paid annuay, we wi charge a deposit premium based on the membership at the start date or anniversary date. We wi then record the accurate premiums based on the monthy data suppied, and produce a fina account at the end of the poicy year. We wi then issue an invoice for any premiums due, or issue a refund for any over payment that has been made. Where premiums are paid monthy, quartery or haf yeary, we wi coect a eve premium based on the membership at the start date or anniversary date. We wi then record the accurate premiums based on the monthy data suppied, and produce a fina account at the end of the poicy year. We wi then advise you of any additiona premiums due before they are coected, or issue a refund for any over payment that has been made. We wi charge a 2.5% oading each year to cover our extra administration costs where the premiums are not paid to us on an annua basis. 5.1 What information is needed for accounting purposes? Uness otherwise agreed with us, we wi require fu and accurate membership data to be sent to us in an eectronic spreadsheet format every month and at each anniversary date. This shoud incude: names; genders; dates of birth; saaries; core benefts; fex benefts; detais of any member increasing or decreasing their eve of beneft; dates of joining for any new members; date of eaving for any members who have eft the empoyer or are eaving the empoyer; and poicy category (if more than one category is covered). Cover for members that are eigibe and join part way through the month wi start immediatey with premiums becoming payabe at the beginning of the foowing month. Premiums for members that eave part way through the month wi not be refunded. 6 How are caims made? If you need to make a caim you must give us notice as soon as possibe, either: before the period of incapacity has asted two months; or for deferred periods of 13 weeks, before incapacity has asted one month. If you do not te us about a caim within these time imits, benefits that were due before we were tod wi not be backdated to the end of the deferred period. If, due to the deay in teing us, we are unabe to confirm incapacity or if our abiity to intervene has been compromised, payment of benefit may be affected If you don t te us about a caim within six months from the end of the deferred period we may not accept the caim 9 Group Income Protection Technica Guide

10 6.1 How are caims submitted? We wi need fuy competed empoyer and empoyee caim forms to be sent to us. These are avaiabe at or by contacting our caims team by emai at or by caing What might be needed to assess a caim? In addition to the empoyer and empoyee caim forms, we wi aso need evidence of the member s medica condition, incuding: its severity, 6.4 Can rehabiitation hep? You can hep minimise the costs of incapacity to your organisation by ensuring that rehabiitation and reintegration programmes are investigated and used wherever appropriate. Working conditions, physica features and other arrangements can often be adjusted quite reasonaby so that an i or injured person can continue to work. Our medica staff, caims visitors and caims assessors can work with you and your medica advisers to draw a this information together so that the caims process runs as smoothy as possibe. how ong it has existed, and how it affects them. 6.5 For how ong wi the benefit be paid? We wi pay benefit unti: We wi aso need to know that they are continuing to receive medica advice and treatment when appropriate. We may aso ask for: the end of incapacity, the imited payment term is competed, the member reaches the cease age, evidence that the member is covered under the poicy the member vountariy eaves service, detais of the member s insured job duties and earnings the member s passport, drivers icence with photo or birth certifcate detais of any other income which the member is entited to during incapacity evidence that a ifestye event has taken pace if the member has seected fex benefts. If we ask for a medica report or tests, we wi pay for them (different arrangements may appy in the case of members based overseas). The member must take reasonabe steps to assist in their recovery. This incudes aowing access by disabiity counseors and/or advisers appointed by us. If you make a caim for a member who is based overseas, or if a member who was based in the UK at the start of incapacity or when benefit payment started subsequenty moves overseas, we wi ony consider paying benefit if we can obtain satisfactory medica evidence in Engish. We wi not be responsibe for any costs incurred in transation. To assess their incapacity, we may need a member who is based overseas to go for a medica examination or test(s). If we do, we wi pay an amount towards the cost of the examination or test(s) up to the amount of an equivaent cost in the UK. If we have agreed to pay any benefits directy to a former empoyee, these wi be paid to the former empoyee in pounds stering, and into a UK bank account in the former empoyee s name. 6.3 When is a caim paid? We wi pay benefit when a member satisfies the definition of incapacity, and their incapacity asts beyond the end of the deferred period. The definition of incapacity wi be stated in the poicy schedue. the member is remanded in custody (the beneft wi be retrospectivey paid if the member is not convicted of the offence) or receives a custodia sentence, the member dies, whichever is sooner. If you stop trading (due to insovency or otherwise) we wi consider making continued benefit payments direct to members who are in caim, subject to: agreement between you, the member and us at that time obtaining consents and further documentation as we may reasonaby require; and taxation rues at the time of payment. Where we do pay benefit directy to a member, any pension and nationa insurance benefits wi stop and if the definition of incapacity is A, this wi change to definition B (pease see incapacity in the definitions section). What happens to members that have short term contracts? Any member who is receiving benefit and has a fixed term contract of ess than four years wi ony be eigibe for benefit for the remainder of the current contract period (if any), whether this is extended or not. What happens if the member s iness or injury means that the member is working on a part-time basis, or in a ower paid job? We wi cover members for a proportionate benefit. This is a benefit that is paid in proportion to the reduction in their earnings, with an aowance for infation. What happens if a member receiving benefit is dismissed? If you remove a member from your payro who is caiming benefit, we wi consider paying benefit to that member where: 10 Group Income Protection Technica Guide

11 you have requested us to do so, and you have been eigibe to receive beneft for that person under this poicy for a continuous period of more than six months before that empoyee being removed from the payro. Any pension and nationa insurance benefits wi stop. Where we pay the benefit to a member directy, and the definition of incapacity is A, this wi change to definition B (pease see the definition of incapacity). What happens to caims if the poicy is canceed? You may cance the poicy at any time, but a caims in payment at that time wi continue in ine with the terms and conditions of the poicy. Aso, new caims wi be considered, as ong as incapacity started before the date the poicy was canceed and that a premiums due were paid up to that date. If we cance the poicy due to non-payment of premiums, new caims wi ony be considered up to the date of the ast premium paid in fu. Caims in payment at that time wi continue in ine with the terms and conditions of the poicy. What happens to a caim if the member eaves the company under TUPE? If a member who is eigibe for benefit transfers to a different empoyer under TUPE we wi: pay the beneft to the new empoyer under the same terms and conditions, and treat the caim as if there had been no break in empoyment, subject to the competion of reevant documents that we require. 6.6 If a member returns to work after a caim, can another caim be made for that member if the incapacity is from a different cause? Yes. What happens if incapacity is from the same cause? If we have aready paid benefit for a member, and they then suffer from the same cause of incapacity within 12 months of their ast benefit payment, we wi not re-appy the deferred period. This is known as a inked caim. This aso appies where the poicy has been canceed, uness the former member is eigibe for, and is receiving benefit for incapacity (other than state benefit) from another source. 6.7 Does other income the member receives affect the benefit from this poicy? Any other income which is paid during or as a consequence of incapacity is ikey to affect the amount of benefit payabe from this poicy. The poicy is designed to ensure that members do not receive a greater income than they received when working. The norma maximum is 80% of their gross taxabe earnings before incapacity. Some of the other types of income that we wi take into account incude: continuing income from an empoyer (such as occupationa sick pay) income from a pension frst paid after incapacity reguar income from other insurance poicies (uness the maximum beneft payment period of those poicies is 2 years or ess) incuding: income protection / permanent heath insurance mortgage payment protection oan protection. Payments from Group Income Protection may aso affect a member s entitement to means tested state benefits. 7 When wi the poicy be canceed? There is no cooing off period and you may cance the poicy at any time. Cover for a benefits under the poicy wi stop on the agreed date, and a premium wi be due for the time on cover. The poicy wi be canceed if you do not pay the premium within 30 days of when it is due. We wi aso reserve the right to cance the poicy if you do not give us the information and documentation that we need to administer the poicy or if the number of ives covered under the poicy drops beow 50. Subject to our requirements, we may reinstate cover if the premium is subsequenty paid within a reasonabe period. This wi be subject to prospective members being activey at work on the working day prior to the reinstatement date. If an empoyee is not activey at work on the working day prior to the reinstatement date, they wi be deemed activey at work once they make a fu and active return to their norma occupation (with their GP s approva) for one whoe day. We wi not backdate canceations. 7.1 Does the poicy have a surrender vaue? No, there is no surrender vaue if the poicy is canceed and we wi not backdate canceations. 7.2 If the poicy is canceed during the poicy year (not at the anniversary date) wi you refund any premiums paid in advance? Yes. We wi produce a fina account based on the cover we provided up to the date when you canceed the poicy and the appropriate refund wi be paid. 8 What is not covered? There are no excusions under this poicy. However, excusions may be appied to member s benefits that are above the free cover imit or subject to discretionary entrant terms. 11 Group Income Protection Technica Guide

12 9 What are the tax considerations? A references to taxation are based on our understanding of current tax aw and practices. Tax aw and practices coud change in the future. You shoud get professiona advice from your own tax advisers. 9.1 What are the tax considerations for payment of premiums? The whoe premium is normay paid through the empoyer. HMRC wi generay agree to this being aowed as a business expense. Empoyers premiums are not normay treated as a benefit in kind for empoyees. 9.2 What are the tax considerations for payment of benefits? Benefits are payabe as saary continuance. In this situation the cost to the empoyer is normay aowed as a trading expense and benefits are normay taxed under the PAYE system. 10. Is there a continuation option? This option is not avaiabe under this product. 11 How might Auto Enroment affect my poicy? If eigibiity for your Group Income Protection poicy is inked to Pension Scheme membership (either for a members or a category of membership), then auto-enroment can affect the membership and/or the saary ro/benefit ro insured under the poicy. The empoyer wi need to decide whether empoyees joining as a resut of Auto Enroment shoud be covered under the Group Income Protection Poicy. What are our data requirements for auto-enroment? If you aready suppy your data to us on a monthy basis then that wi be a that we require. However, if data is normay suppied to us on an annua basis then we wi require tota number of ives and the tota saary ro or benefit ro; the day before the auto-enroment date (or automatic re-enroment date); on the auto-enroment date (or automatic re-enroment date); and on the stabiisation date. This wi ensure that we are charging the correct premiums for the cover provided, and aso ensure that empoyers do not get unexpected premium requests. When wi any change in rate guarantee appy? If there is a change in the saary ro or benefit ro of 25% or more where you become subject to the auto-enroment duties, we wi: review changes in the tota saary ro or beneft ro insured on the stabiisation date and any change in rate wi be effective from the stabiisation date unti the end of your existing rate guarantee date. How do we treat empoyees joining under auto-enroment? If an eigibe jobhoder joins the quaifying pension scheme at any time other than: Your auto-enroment date automatic re-enroment date; or the standard eigibiity period for joining the poicy our discretionary entrant terms wi appy. If an empoyee who does not meet the eigibe jobhoder criteria chooses to join your auto-enroment pension scheme on any date other than: the standard eigibiity period for joining the poicy our discretionary entrant terms wi appy. 12 Group Income Protection Technica Guide

13 Further information Pease contact your usua financia adviser or ca us on Third Party Rights Ony we and the empoyer taking out this poicy wi have any rights under this Poicy. Any person or persons who are not a party to these poicies sha have no rights under the Contracts (Rights of Third Parties) Act 1999 to enforce any terms under this poicy. Reference to, or the consent of, any person who is not a party to the poicy is not required for any changes to it or its rescission. Compensation The Financia Services Compensation Scheme (FSCS) may cover your poicy. It wi cover you if Aviva becomes insovent and we are unabe to meet our obigations under the poicy. For this type of poicy, the FSCS wi cover you for 90% of the tota amount of an existing caim. The FSCS wi aso provide a refund of 90% of the premiums that have not been used to pay for cover whether you are making a caim under the poicy or not. For further information, see or teephone Currency and jurisdiction These poicies are issued in Engand and subject to Engish Law. A payments made to or by us under this poicy wi be made in the currency of the United Kingdom. Insurer The Group Income Protection poicies are underwritten by Aviva Life and Pensions UK Limited. Aviva Life and Pensions UK Limited is a company in the United Kingdom. The Head Office of Aviva Life and Pensions UK Limited is 2 Rougier Street, York, YO90 1UU, United Kingdom. Aviva Life and Pensions UK Limited is a whoy owned subsidiary of Aviva pc. If you have any cause for compaint Our aim is to provide a first cass standard of service to our customers, and to do everything we can to ensure you are satisfied. However, if you ever fee we have faen short of this standard and you have cause to make a compaint, pease et us know. Our contact detais are: Group Risk Compaints Aviva Heath UK Ltd PO Box 540 Easteigh SO50 0ET Teephone: E-mai: grcomp@aviva.co.uk We have every reason to beieve that you wi be totay satisfied with your Aviva poicy, and with our service. It is very rare that matters cannot be resoved amicaby. However, if you are sti unhappy with the outcome after we have investigated it for you and you fee that there is additiona information that shoud be considered, you shoud et us have that information as soon as possibe so that we can review it. If you disagree with our response or if we have not repied within eight weeks, you may be abe to take your case to the Financia Ombudsman Service to investigate. Their contact detais are: The Financia Ombudsman Service Exchange Tower London E14 9SR Teephone: Emai: compaint.info@financiaombudsman.org.uk Website: Pease note that the Financia Ombudsman Service wi ony consider your compaint if you have given us the opportunity to resove the matter first. Making a compaint to the Ombudsman wi not affect your ega rights. 13 Group Income Protection Technica Guide

14 Some of the terms and expressions that we use in this Technica Guide have a specific meaning for this type of poicy. Here are some of the terms expained. Activey at Work Means that the empoyee must have been activey foowing their norma fu duties at their pace of work and have been mentay and physicay capabe of a the norma duties of their occupation. Anniversary/anniversary date An anniversary of the start date, uness you have agreed another date with us. This date is stated in the poicy schedue. Auto-enroment date(s) Your staging date and, if different, the staging date for members covered under the poicy or, if the you have chosen to use postponement, the date you have chosen as your deferra date, and if different, the deferra date for members covered under the poicy. Cease age Midnight on the day before the age at which cover for a member ceases, as set out in the reevant poicy schedue appicabe to that member s category. The maximum age cannot exceed midnight on the day before a member s 70th birthday. Core benefit The minimum amount of benefit provided to the member and paid by you. Defaut benefit The eve of benefit that a member wi receive on joining the poicy if no fex benefit is seected. The premiums for defaut benefit are paid by you. Deferred period The number of consecutive weeks of incapacity which must pass before you become entited to receive benefit. Discretionary entrant An empoyee who needs cover, but has joined the poicy: before the date they are frst eigibe to join, or 12 months or more than 12 months after they were frst eigibe to join, not in a category of member covered by the poicy Duties The materia and substantia duties of the member s norma occupation which cannot reasonaby be omitted or modified. Earnings As defined by you and detaied in the poicy schedue under definition of saary. Eigibe/eigibiity The factor(s) we consider when assessing whether or not a person can be automaticay covered by the poicy. This wi be detaied in the poicy schedue. Eigibe jobhoders Empoyees the empoyer must enro into their automatic enroment pension scheme. Empoyee A person empoyed by you. Empoyer/You/Your The company or other organisation that is covered under the poicy as stated in the poicy schedue. Fex benefits The benefits seected as a resut of a member increasing or decreasing their benefit eves or term at a quaifying period. A member may increase their benefit eve one step at a time but reduce it any number of steps, subject to their benefit not reducing beow the core benefit. A member who has a 5 year imited payment term may increase their benefit term to the poicy cease age. A member cannot make this increase in their benefit term if they have a imited payment term of ess than 5 years. The benefit steps wi be detaied in the iustration and poicy schedue. Benefit eve or term increases are imited to two per poicy year; one at the anniversary date one within two months foowing a quaifying ifestye event. Fuctuating emouments Empoyee earnings not paid on a fixed basis but additiona to their basic saary. Free cover imit The eve of benefit (as stated in your iustration and poicy schedue) under which medica information is not needed. 14 Group Income Protection Technica Guide

15 Incapacity Means either A, B or C beow as specified in the poicy schedue. A. The member s inabiity to perform, on a fu or part time basis, the duties of his or her norma occupation, as a resut of their iness or injury. divorce/dissoution of marriage/civi partnership; separation from spouse, civi partner or unmarried partner; change in contracted hours of empoyment from part-time to fu-time or vice versa; change in basic saary exceeding 20%; B. The member s inabiity to perform, on a fu or part time basis, the duties of his or her norma occupation, and other occupations for which they are suited by reason of education, training or experience, as a resut of their iness or injury. moving home; addition of spouse, civi partner or unmarried partner to tite deeds; C. For the first 24 months after the deferred period has been competed the member s inabiity to perform, on a fu or part time basis, the duties of his or her norma occupation resuting from their iness or injury. After 24 months the member s inabiity to perform, on a fu or part time basis, the duties of his or her norma occupation, and any other occupation for which he or she is suited by reason of education, training or experience, resuting from their iness or injury. Where the member s occupation requires a icence (other than an ordinary UK driving icence for Group 1 vehices) or medica certificate, for exampe an HGV driver, definition B wi be appied to that member in a cases. Income Benefit The benefit payabe under this poicy, not incuding empoyer pension and nationa insurance contributions. Lifestye event An event as agreed with us upon which members can change their eve of cover. The ifestye events covered by this poicy are; birth/adoption of a chid; pregnancy of member, spouse, civi partner or unmarried partner; start of maternity eave of empoyee, spouse, civi partner or unmarried partner; end of maternity eave of empoyee, spouse, civi partner or unmarried partner; Pease note, ony one from the above events can be treated as a ifestye event in reation to a particuar pregnancy. redundancy of spouse, civi partner or unmarried partner Limited payment term The number of years (if any) specified in the poicy schedue as the imited payment term. Benefit for incapacity resuting whoy or party from one iness or injury, or any iness, injury or other condition reated to it wi be imited to this period. The imited payment term starts when the deferred period has finished. Long term absentee An empoyee who is not activey at work and, has been absent from work for more than three continuous months immediatey before the start date or anniversary date. Medica information Competion of a member decaration and/or any other medica evidence incuding but not imited to medica history and ifestye factors, required to fuy assess the member and enabe us to appy an underwriting decision. Medica practitioner A medica practitioner registered with the Genera Medica Counci in the UK or, in the case of benefit paid for overseas residence, the equivaent body in the reevant country. Member An empoyee who was activey at work and who is covered under the poicy. Norma occupation A member s norma occupation at the time incapacity starts. Other occupation Any occupation performed for profit or reward, other than the member s norma occupation. death of a chid, spouse, civi partner or unmarried partner; 15 Group Income Protection Technica Guide

16 Overseas Any country that is not part of the United Kingdom, Channe Isands or the Ise of Man. Pensionabe saary As defined by you and detaied in the poicy schedue. Poicy The Aviva group income protection insurance poicy which covers the poicy benefits and forms the contract between you and us. The appication, poicy wording, a future decarations made and the poicy schedue form part of the contract. Poicy schedue The current schedue (as issued by us from time to time) stating detais of the empoyer, cover provided by this poicy, and any specia terms (if appicabe). Poicy year The period between: accepted by us). This period aows for your auto-enroment pension scheme membership to stabiise foowing the autoenroment process. Start date The date the poicy starts as stated on the poicy schedue. State pension age (SPA) The eariest age at which the empoyee can start to receive the UK State pension, as defined in paragraph 1, schedue 4 of the Pensions Act The maximum state pension age we wi cover is 68. TUPE Transfer of undertakings (Protection of empoyment) Reguations We / our / us Aviva Heath UK Limited on behaf of the insurer Aviva Life & Pensions UK Limited. the start date and the frst anniversary date; or two anniversary dates. Pre-existing condition A condition that is directy or indirecty inked to any medica and/or reated condition or compication that the member was: aware of, or suffered symptoms of, or had been treated for, in the previous five years before any cover is provided for under the poicy. Quaifying period the start date or scheme eigibiity date or; the poicy anniversary date or; within two months foowing a quaifying ifestye event. Rate guarantee date The date unti which rates are guaranteed to appy, as shown in the poicy schedue. Retai Prices Index (RPI) The rate of retai prices index decared by the UK Government for the period from 1 October to 30 September ending in the year before the caendar year of the pension increase date, or any other index which repaces it. Stabiisation date The date three months after your auto-enroment date(s) (uness you notify us in writing of a esser period and this is 16 Group Income Protection Technica Guide