Flexible Benefits for Group Income Protection. Policy Wording

Transcription

1 Fexibe Benefits for Group Income Protection Poicy Wording

2 Wecome to Group Risk from Aviva What the poicy wording expains This poicy wording tes you: what to do if you need to caim what is covered expanations of some of the terms used in this document. We ve tried to make this document as easy to understand as possibe, but if you have any questions or queries about the poicy pease contact us and we wi be peased to hep you. How the poicy works. If you provide us with the information we ask for, when we ask for it and pay the premiums when they are due, we wi cover the members for their insured benefts, and pay these benefts shoud a member die. Outine of the Poicy The poicy insures the benefts payabe if a member is unabe to work and is suffering oss of earnings due to iness or injury. This poicy wording, aong with the poicy schedue, sets out detais of the cover we have agreed to provide to you. It is evidence of a ega contract between you and us. Some terms of the poicy depend upon the information provided by you. If this information is incorrecty stated or any facts have changed since it was provided, we may amend, or cance the poicy. If you fai to compy with a of the poicy terms and conditions, we may not pay caims. We may aso cease to accept further premiums, meaning cover under the poicy wi cease. 2 Poicy wording

3 Contents 4 Genera poicy conditions 5 Cover 7 Benefits 9 Premiums 11 Poicy changes and canceation 12 Caims 13 If you have any cause for a compaint 14 Definitions aviva.co.uk/heath 3

4 Genera poicy conditions 1 Accurate information We rey on the information given to us. If any of the information you give us is untrue or incompete, and might have reasonaby affected our decision to provide you with this poicy or the terms we offered for the poicy, then we may: change the terms of this poicy, or restrict the benefits payabe under this poicy, or cance this poicy. Where we do any of these, we wi refund any overpayment of premium ess our reasonabe expenses. 2 Currency and jurisdiction This poicy is issued in Engand and is subject to Engish Law. A payments to or by us under this poicy wi be made in pounds stering. 3 Contacting us If you need to contact us about this poicy, pease contact us at the address shown in the poicy schedue, quoting your poicy number. 4 Third party rights No person other than Aviva Life & Pensions UK Ltd and you wi have any rights under this poicy. Any person who is not a party to this poicy 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 termination. 4 Poicy wording

5 Cover 1 Who is covered Where a member joins the poicy, they wi be covered up to the free cover imit provided that they have: satisfied the activey at work definition; and joined the poicy within 12 months of the date on which they were first eigibe to join; and not been previousy decined cover by us or another insurer where you have been informed of the decision; and not been previousy oaded, restricted or had cover postponed or excusions appied by us or another insurer. If a member is not activey at work on; the working day prior to the start date of the poicy; or for new joiners after the start date, the date when eigibe to be admitted to 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. Where an existing member requests fex benefit during a quaifying period, they must satisfy the activey at work definition on the date the increase is effective from. 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. If the member's tota benefit is above the free cover imit we wi require medica information for that member. Auto-enroment (appicabe after you reach your auto-enroment date for poicies where eigibiity for membership or benefits is inked to pension scheme membership). You must te us as soon as possibe what your auto-enroment date is if your eigibiity for membership or benefits is inked to pension scheme membership. An eigibe jobhoder who has been enroed into your autoenroment pension scheme and then eaves and re-joins the auto-enroment pension scheme on any future date other than: within the first 12 months of being eigibe to join the poicy; or at their automatic re-enroment date. wi be subject to discretionary entrant terms. Empoyees who do not meet the eigibe jobhoder criteria requiring them to be enroed, but choose to join the autoenroment pension scheme on any date other than: within the first 12 months of being eigibe to join the poicy wi be subject to discretionary entrant terms. For a poicies, medica information must be provided for: benefits above the free cover imit; and benefits for a members who are not entited to a free cover imit. TUPE If you are receiving benefit for an empoyee and they transfer to a different empoyer under TUPE, we wi: pay the benefit 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 agreements signed by a reevant parties to aow the contractua transfer of obigations of the poicy and caim. 2 Overseas cover We wi cover members who are traveing or working overseas, or those seconded to another organisation in a different country as ong as: they sti have a contract of empoyment with a UK registered company covered under this poicy the premium to cover those members is paid in pounds stering by you, and they are sti eigibe for cover on the poicy. You must te us about any members who are working overseas at the poicy start date or rate guarantee date. You must aso te us their nationaities and the countries that they wi be working in. aviva.co.uk/heath 5

6 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 pay a benefit to you in pounds stering. Where we have agreed to pay benefit directy to a former empoyee, we wi pay the benefit to the former empoyee in pounds stering, and ony into a UK bank account that is registered in the former empoyee s name. We wi ony consider paying benefit for these members if we can obtain satisfactory medica evidence in Engish. We wi not be responsibe for any costs incurred in transation. If we need a member who is based overseas to attend a medica examination or test(s) in a foreign country, 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. Where benefit is paid directy to a member who is overseas, we wi pay the benefit in pounds stering, and ony into a UK bank account that is registered in the member s name. Members working overseas are expected to foow the British Foreign & Commonweath Office s trave advice, which can be found at There are some high risk areas for which we wi not be abe to provide cover. The tax treatment of any benefit paid out for an overseas member wi depend on whether or not they have been treated as non-resident for tax purposes at any time when covered under the poicy. 3 Time imits on payment of benefit a. We wi pay benefit for incapacity at the end of each fu month, or at the end of incapacity if earier. A proportionate amount wi be paid for any periods of incapacity which ast ess than one month. b. We wi pay benefit for incapacity unti: the end of incapacity; or the imited payment term is competed; or the member reaches the cease age; or the member vountariy eaves service; or the member is remanded in custody (the benefit wi be retrospectivey paid if the member is not convicted of the offence) or receives a custodia sentence; or the member dies, whichever is sooner. c. 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 contract period remaining as at the start of incapacity, whether this period is subsequenty extended or not. 4 Underwriting At the start date and once every month we wi ask for information about members. This information wi be the information we require to administer the poicy and wi be as agreed between you and us prior to the start date of the poicy. This wi normay incude genera information about members and their empoyment, such as name, date of birth, gender and saary so that we can assess the benefits we are providing under this poicy and a inked poicies. If any member s core benefits, or core benefits and fex benefits are above the free cover imit, we wi require medica information for that member. If benefits are beow the free cover imit at the start date, we wi sti ask for medica information if the prospective member is a discretionary entrant. You must inform us prompty of a discretionary entrants to be covered under the poicy. Temporary Cover We wi provide temporary cover for a member s tota benefit whist we are reviewing medica information for that member. We wi provide this cover for up to 90 days from the member s join date (or unti we compete our medica underwriting for that person if earier). This temporary cover wi excude: any caim made as a resut of a pre-existing condition. If we decide to: appy a medica oading; restrict benefits; and/or decine / postpone cover, 6 Poicy wording

7 these decisions wi ony appy to benefit above the free cover imit, if appicabe. Discretionary entrants are not entited to the free cover imit and medica information wi be required for their fu benefit. If norma terms or adverse terms appy foowing medica underwriting, then no further medica information is needed for benefit increases reating to an increase in saary, up to the maximum annua amount. This is known as once ony underwriting and appies to saary increases ony. 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 benefits and fex benefits are beow the free cover imit; or providing satisfactory medica information if core benefits and fex benefits are above the free cover imit. Shoud we appy adverse terms any additiona premiums appicabe in respect of these terms wi be paid in addition to the standard premium. aviva.co.uk/heath 7

8 Benefits 1 Payee of benefit Tota benefit We wi pay tota benefit if immediatey before the start of incapacity the member was activey at work and foowing their norma occupation and, after the start of incapacity they are not foowing any other occupation, and the deferred period has finished. The benefit payabe wi be shown in the poicy schedue. Proportionate benefit We wi pay proportionate benefit if, before incapacity, the member was activey at work and 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, in either case with a reduction in earnings. The percentage reduction in the member s earnings wi be used to cacuate the amount of proportionate benefit we wi pay. For exampe: If a member s earnings are reduced by 70%, we wi pay 70% of the tota benefit. Incapacity must ast at east five consecutive working days. After this period, their iness or injury must restrict the scope of the member s duties for the rest of the deferred period. When paying proportionate benefit, we wi not reduce your benefit due to increases in earnings, as ong as those increases are not higher than the increase in the retai price index. If the income benefit amount stated in the poicy schedue incudes a deduction of empoyment and support aowance, we wi ignore that deduction as ong as the amount payabe as proportionate benefit is not more than woud be paid under tota benefit. To cacuate proportionate benefit when it is first paid, we wi use the member s earnings at the start of incapacity, adjusted in ine with the movement in the retai price index. Recipient of benefit We wi normay pay a benefit under this poicy to the poicyhoder. Entitement to benefit The poicyhoder wi become eigibe to caim benefit for a member s incapacity when the deferred period has finished. 8 Poicy wording 2 Maximum benefit payabe a. The maximum income benefit we wi pay is the esser of: the income benefit stated in your poicy schedue or; 80% of gross taxabe earnings up to a maximum annua amount of 350,000. If any other benefits (apart from state benefit) are payabe during or as a resut of incapacity, we wi deduct these amounts from the maximum amount of income benefit payabe. We can aso cover fuctuating emouments in the definition of earnings but to cacuate the 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. If any other benefits (apart from state benefit) are payabe during or as a resut of incapacity, we wi deduct these amounts from the maximum amount of income benefit payabe. Other benefits incude: continuing income from an empoyer (such as occupationa sick pay) income from a pension first paid after incapacity reguar income from other insurance poicies (uness the maximum benefit payment period of those poicies is 2 years or ess) incuding: income protection / permanent heath insurance mortgage payment protection oan protection Benefit received by a member from this poicy may affect their entitement to certain means tested state benefits. b. Empoyer pension contributions, for core benefit. This can be for a fixed amount, or based on a percentage of pensionabe saary, up to a maximum annua amount of 75,000. c. 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 Empoyer pension contributions paid via saary sacrifice wi be treated as empoyee pension contributions. d. Poicyhoder 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.

9 If pension contributions and nationa insurance contributions are covered it wi be stated in the poicy schedue. We wi not refund any premiums if we have to reduce benefits that are above the maximums as stated in 2a and 2b. 3 Increases in benefit You must te us as soon as reasonaby possibe when a member s benefit is to be increased. A member must be activey at work to be eigibe for an increase in benefit and medica information wi be required for members; if the increased benefits are above the free cover imit; or benefit increases for members who are not entited to a free cover imit; uness you have been advised in writing that once ony medica underwriting has aready been appied for that member. If a member is not activey at work 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. This wi not appy to increases in benefit through a fex benefit seection. 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. 4 Escaation (if appicabe see poicy schedue) Benefit wi increase at the eve stated in the poicy schedue once benefit has been paid for a tota of one whoe year, and at the end of each subsequent whoe year of payment. We wi not restrict benefit where escaation is the ony reason that it has increased above the maximum benefit. At the end of any caim period, benefit wi go back to the eve at which it woud have been had escaation not been appied. 5 Waiver of premium We wi not charge you a premium from the next anniversary date (or rate guarantee date if sooner) whist you are receiving benefit for that member. 6 Linked caims We wi not re-appy the deferred period where: you have received benefit for a member; and that member suffers from the same cause of incapacity within 12 months of the ast monthy benefit payment. This aso appies for members 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. 7 Linked periods of absence Separate periods of incapacity (from the same cause) may be inked to count as part of the deferred period, provided that: each period of incapacity asts at east 5 consecutive working days; and the deferred period is competed within a period of time twice its ength (deferred period x 2). Periods of incapacity which ast for ess than 5 consecutive working days wi not be counted as part of the deferred period. 8 If the poicyhoder stops trading or a member is removed from payro a. If the poicyhoder stops trading (due to insovency or otherwise) we wi consider making continued benefit payments direct to members who are in caim, subject to: agreement between the poicyhoder, 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. b. Where the poicyhoder removes a member from its payro, we wi consider paying benefit to that member (former empoyee) where: the poicyhoder has requested us to do so, and the poicyhoder has been eigibe to receive benefit for that person under this poicy for a continuous period of more than six months before that empoyee was 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 incapacity in the definitions section). aviva.co.uk/heath 9

10 Premiums 1 Paying for this poicy Premiums are paid by you. Fex benefit premiums are normay paid by you via a saary sacrifice arrangement. The premium is normay paid annuay in advance by either cheque or direct debit. Where premiums are not paid on an annua basis, a 2.5% oading wi appy each year to cover our extra administration costs. 2 Cacuation of premium The basis of how we cacuate your premium depends on the type of benefit seected. The unit rate basis is normay used to cacuate the core benefit. The singe premium basis is normay used to cacuate the fex benefit. Unit rate basis We cacuate these premiums by mutipying; the monthy member s saary received, if unit rate of saary is seected; or the monthy 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. Premiums for pension benefits are cacuated separatey using the unit rate for that benefit. For members who join, eave or have changes in the eve of benefit during the poicy year, we wi make a premium adjustment, either on a monthy basis or at the anniversary date. The premium adjustment wi be cacuated based on the sum assured and ength of cover for a members over the poicy year. Singe premium fex benefit basis We cacuate these premiums by mutipying the member s benefits received monthy in the membership isting, by a tabe of rates as shown in the poicy schedue. The rates wi take into account the member s age. For members who join, eave or have changes in the eve of benefit during the poicy year, we wi make a premium adjustment at the anniversary date. For those poicies where a unit rate basis is used, the same unit rate wi appy to a inked poicies if appicabe. Where an additiona premium for specia terms appies, this wi be cacuated on a singe premium basis irrespective of the number of ives covered by this poicy and any inked poicies. Auto-enroment (appicabe after the empoyer reaches their auto-enroment date for poicies where eigibiity for membership or benefits is inked to pension scheme membership). We wi cacuate a premium to refect time on risk and we wi appy an average saary or benefit ro for a members of the poicy between; The start date and the empoyers auto-enroment date, and The empoyers auto-enroment date and the stabiisation date, and The stabiisation date and your anniversary date. Minimum premium The minimum premium we wi charge is 750 per poicy. 3 Review of premiums Your poicy has reviewabe premiums. This means that the tabe of rates on which your premium has been cacuated may be changed to refect updated views on the expected cost of providing cover. For unit rated poicies, we guarantee to maintain the unit rate upon which the first premium has been cacuated unti at east the second anniversary date, after which we may review the rate at each rate guarantee date. For singe premium fex benefit top ups, we guarantee that we wi use the underying tabe of rates upon which the first premium has been cacuated unti at east the second anniversary date, after which we may change the underying tabe of rates at each rate guarantee date. Your premium, or rate, may go up, down, or may remain unchanged as a resut of the review. When reviewing the premiums we wi take a fair and reasonabe view on the ikey cost of providing cover by considering: our caims and operating costs, incuding the poicy fee; our experience to date on our Group Income Protection product, and a other Aviva income protection poicies of a simiar nature; 10 Poicy wording

11 information avaiabe to us on the actua and expected experience of insurers of simiar income protection pans; and widey avaiabe economic information such as interest rates and tax rates. For each rate guarantee date, we need you to compete and send us the documents that we reasonaby request so that we can review the terms and / or cacuate the rates for this poicy. You must te us as soon as reasonaby possibe if any member s occupation changes to an occupation not aready covered under this poicy. We reserve the right (in ine with reasonabe underwriting practice) to change the poicy terms and premium or cance cover for a member at any time if their profession or occupation changes to one not aready insured under this poicy. 5 Unpaid premiums Payment of premiums must be made within 30 days of the origina request date. We wi cance the poicy upon non payment of premiums. This wi mean you wi have no cover in pace with us. We wi reinstate cover if the premium is subsequenty paid within 30 days of the end of the 30 day period foowing the origina request date. This wi be subject to prospective members being activey at work on the working day prior to the reinstatement date. We reserve the right (in ine with reasonabe underwriting practice) to review the premium and terms offered or cance the poicy at any time in respect of a members if: there is a materia change in your manufacturing or other physica process; there is a change in the nature of your business; the number of members changes by 25% or five ives, whichever is higher; or you are or become subject to the auto-enroment duties and where eigibiity is inked to pension scheme membership, there is a change in saary ro of 25% or more. We wi review changes in saary ro on the stabiisation date and any change in rate wi be effective from the date of the review unti the end of your existing rate guarantee date if: there is a change to the benefit basis of the poicy and /or eigibiity of the poicy a new empoyer joins (or an existing empoyer eaves) the poicy the number of members fas beow 50 4 Anniversary procedure This poicy wi be renewed on the anniversary date. Each month we require a membership isting (in eectronic format) detaiing the required information agreed between you and us prior to the start date of the poicy. If the information is not received within 30 days of this date, we wi cacuate the benefit and premiums paid on the atest information we hod. This coud resut in an uninsured iabiity. aviva.co.uk/heath 11

12 Poicy changes and canceation 1 Review of terms We may, at each rate guarantee date, or at any time if required, make reasonabe changes to the terms and conditions provided for in this poicy and any inked poicy which, are needed to: respond in an appropriate manner to changes in the way we administer poicies of this type; respond in an appropriate manner to changes in technoogy or genera practice in the insurance industry; respond in an appropriate manner to changes in taxation, the aw or interpretation of the aw, decisions or recommendations of a Court, Ombudsman, Reguator or simiar person, or any code of practice with which we intend to compy; or correct errors that need correcting and it is reasonabe to do so. If we consider any change is to your advantage or is needed to meet reguatory or ega requirements, we may make the change immediatey and te you at a ater date. We wi te you in writing of any change we consider is to your disadvantage (other than any change needed to meet any ega or reguatory requirements) at east 30 days before the change becomes effective, uness it is not possibe for us to do this, in which case we wi give you as much notice as we can. 2 Canceation We may at any time (and retrospectivey where appropriate) cance the poicy or cover in respect of a member, or appy different terms in ine with reasonabe underwriting and insurance practice if you have at any time: knowingy withhed reevant information from us; defrauded/attempted to defraud us; agreed to any attempt by someone ese to defraud us; or faied to observe the terms and conditions of this poicy. We may aso at any time (and retrospectivey where appropriate) cance cover in respect of a member, or appy different terms in ine with reasonabe underwriting and insurance practice if that member has at any time: knowingy withhed reevant information from us; defrauded/attempted to defraud us; agreed to any attempt by someone ese to defraud us; or faied to observe the terms and conditions of this poicy. 12 Poicy wording

13 Caims 1 Caims procedure You can ony caim if premiums are up to date. You must te us about any caim 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 within these time imits and, due to the deay in notification we are unabe to confirm incapacity, payment of benefit may be affected and benefits that were due before we were tod wi not be backdated. 2 Our requirements Caim forms and any other documentation issued by us in reation to the caim must be competed and returned to us as soon as reasonaby possibe. Apart from medica information requested by us, you or the member (or their persona ega representative) wi pay for a certificates, information and evidence that we reasonaby require (incuding proof of age). We wi not be abe to process any caim uness the member signs the consent forms provided by us, to aow us access to their reevant medica records hed by a medica practitioner. We may need additiona evidence of income and we wi et you know if we do. In these circumstances these are our minimum requirements and we reserve the right to request more evidence: a copy of the four paysips prior to incapacity (incuding the paysip for the month in which incapacity starts) and the ast P60 certificate together with a PAYE Coding Notice (or repacement) in respect of benefits in kind; and The member must take reasonabe steps to assist their recovery and to hep us assist their recovery, incuding meeting and working with disabiity counseors and / or advisers appointed for our purpose; and signing any consent forms requested by us. You must make whatever reasonabe adjustments are necessary to the member s working conditions in order to compy with your obigations under discrimination and equaity aws. If you don t, and if your faiure to compy with your obigations prevents the reevant member from working then we may not pay some or a of the benefit. 3 Medica supervision The member must be under the reguar supervision and treatment of a medica practitioner to be eigibe for benefit. 4 Payment of caims A payments wi be made in pounds stering. 5 Unfounded caims If any caim under this poicy is in any respect unfounded, then without affecting any other ega rights we may have, any benefit paid for that caim wi be recaimed, and no further benefit wi be paid. In these circumstances we wi have the right to cance the poicy or remove the member from cover without refunding any premiums. evidence reating to a ifestye event, where appicabe. The member needs to provide a of the information that we request, and: undergo medica examinations or tests (on our behaf and at our expense) by a medica examiner appointed by us in respect of the incapacity that has ed to the caim; and sign any consent forms we require to aow us access to the resuts of any reevant medica examinations and / or tests. aviva.co.uk/heath 13

14 If you have any cause for a 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: Financia services compensation scheme (FSCS) The Financia Services Compensation Scheme (FSCS) may cover your poicy. It 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 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. 14 Poicy wording

15 Definitions Throughout this document certain words are shown in bod type. These are defined terms and have specific meanings when used in this poicy wording. The meanings of these words are set out beow. Activey at work Means the member 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 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 this poicy, or, if 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 this 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 can t exceed midnight on the day before a member s 70th birthday. Core benefit The minimum amount of benefit for every member covered under the poicy as stated in the poicy schedue. Defaut benefit The eve of benefit that a member wi receive on joining the poicy if no fex benefit is seected. Deferred period The number of consecutive weeks of incapacity which must pass before you become entited to receive benefit. Discretionary entrant A discretionary entrant is an empoyee who needs cover, but has joined the scheme: before the date they are first eigibe to join; or 12 months or more than 12 months after they were first eigibe to join; or is not in a category of member covered by the poicy. Duties The materia and substantia duties of the member s 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. Eigibe jobhoders Empoyees who must be enroed into an automatic enroment pension scheme. Empoyee A person empoyed by you. Fex benefit The benefit seected as a resut of a member increasing or decreasing their income benefit eves or benefit term at a quaifying period. If a member has a 5 year imited payment term they may increase their benefit term to the poicy cease age. This option ony appies where a member has a 5 year imited payment term, it is not avaiabe if their existing imited payment term is for ess than 5 years. A member may increase their fex benefit eve or benefit term one step at a time but reduce it any number of steps, subject to their income benefit not reducing to beow the core benefit. Where a member increases the benefit term from a 5 year imited payment term to the poicy cease age this wi be treated as one step. The benefit steps wi be detaied in the poicy schedue. Increases are imited to two per poicy year; one at the anniversary date; and one within two months foowing a quaifying ifestye event. aviva.co.uk/heath 15

16 Fuctuating emouments Empoyee earnings not paid on a fixed basis but additiona to their basic saary. If fuctuating emouments are covered they wi be detaied in the poicy schedue. Free cover imit The eve of benefit (as stated in the poicy schedue) under which medica information is not needed. Incapacity Means either A, B or C beow as specified in the poicy schedue (if none specified, A wi appy). 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. 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. 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 other occupations for which they are suited by reason of education, training or experience, resuting from their iness or injury. Income benefit The benefit payabe under this poicy, not incuding pension and nationa insurance contributions as stated in the poicy schedue. Lifestye event A quaifying event aowing a member to increase their income benefit eve or benefit term. The ifestye events are detaied in the poicy schedue. 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. Linked poicies Any Aviva group income protection poicies taken out by the empoyer or parent and subsidiary undertakings of the empoyer covering different categories of empoyees and/or benefits. Long term absentee A member 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. Overseas Any country that is not part of the United Kingdom, Channe Isands or 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). 16 Poicy wording

17 Poicy year The period between: the start date and the first anniversary date or two anniversary dates. Poicyhoder / you / your The company named as poicyhoder in the poicy schedue. 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 on the poicy schedue. Retai price index The rate of retai prices index decared by the 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 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. TUPE Transfer of undertakings (Protection of empoyment) Reguations We / our / us Aviva Life & Pensions UK Limited. aviva.co.uk/heath 17

18 Aviva Heath UK Limited. Registered in Engand Number Registered Office 8 Surrey Street Norwich NR1 3NG. Authorised and reguated by the Financia Conduct Authority. Firm Reference Number This insurance is underwritten by Aviva Insurance Limited. Aviva Life & Pensions UK Limited. Registered in Engand No Rougier Street, York, YO90 1UU. Authorised by the Prudentia Reguation Authority and reguated by the Financia Conduct Authority and the Prudentia Reguation Authority. Firm Reference Number Poicy wording GEN /2014 Aviva pc