A guide to underwriting. Here to help at every step

Transcription

1 A guide to underwriting Here to help at every step

2 Contents About this guide 3 Higher paid members of staff 4 People joining the policy 4 When is evidence of health required? 4 How is evidence of health collected? 4 Telephone data collection customer journey 5 Medical examinations 6 Temporary cover 6 Underwriting decisions 6 Forward underwriting 6 How to contact us 7 2

3 About this guide At Zurich Corporate Risk we believe it s important to make every aspect of dealing with us as easy and straightforward as possible. The purpose of this guide is to provide employers with a clear step-by-step understanding of our medical underwriting process for individual employees to help make sure they get the cover or benefits they need as quickly as possible. To reduce the need to medically underwrite employees before they are covered under the policy, we set a limit called the automatic acceptance limit below which we do not normally need evidence of health. The automatic acceptance limit is shown in the employer s policy schedule and may be revised from time to time. 3

4 About this guide Higher paid members of staff Usually only the higher paid members of staff have to be medically underwritten, for the element of their cover which is above the automatic acceptance limit. People joining the policy We don t usually need to underwrite a person who joins the policy, unless the cover they need is above the automatic acceptance limit, they don t meet the conditions for normal inclusion or they don t join at their first opportunity. We refer to a person joining the policy outside the normal conditions for inclusion as a discretionary entrant. How is evidence of health collected? We offer two different ways for an employee to provide their health and activities detail. They can choose either; Telephone Data collection. This is where a qualified nurse contacts the employee by telephone, at an agreed time, to obtain the health and activities information. A major benefit of telephone data collection is that we are less likely to need to ask for additional information or a report from a doctor. or Completion of a Health and Activities form. When is evidence of health required? If we need to medically underwrite an employee, our aim is to provide unrestricted cover and to be flexible in our approach. We aim to be consistent in the quality, speed and accuracy of the service we provide. For cover above the automatic acceptance limit, or for those employees not eligible for the limit, we will ask for evidence of health. It is therefore important that the employer lets us know straightaway if they need cover for: a new employee whose cover exceeds the automatic acceptance limit a new employee who is joining as a discretionary entrant* an existing employee whose cover increases above the automatic acceptance limit. Employees whose cover would exceed the automatic acceptance limit can opt for their cover to be capped at the current automatic acceptance limit if they would prefer not to be medically underwritten for the additional cover. * If evidence is provided to show that a discretionary entrant is a new recruit and that cover will replace cover with their immediate former employer, we may agree to waive the need for health and activity details. 4

5 Telephone data collection customer journey We are committed to providing a flexible, dependable and, above all, highly responsive service for our customers. Step-by-step, this telephone data collection customer journey explains the process for underwriting an employee s benefit where information concerning health and other selected details is required Step Employee s benefits require medical underwriting Arrange the telephone data collection call Telephone data collection call Summary of the telephone data collection call Telephone data collection call outcome Objective To gather personal health and activities information. To book a telephone appointment with the employee. To gather information so appropriate underwriting can progress. Confirm factual information provided during the telephone data collection call. Make an underwriting decision. Process The employee completes the short form to request Telephone Data Collection, this provides their personal contact details and declaration to access their medical reports. The employee returns the form. Contact the employee within two working days of receipt of their Health and Activities form. The nurse validates that they are speaking to the correct individual. If it is convenient for the employee. The nurse offers to collect the data immediately. Explain what is involved in telephone data collection, including the information we are likely to need and how long the call will take. If we have not collected the information over the telephone within 21 days, we ll send a Health and Activities form to the employee to complete in full. Calls are recorded. The nurse validates that they are speaking to the correct individual. The employee can suspend the call at any time if necessary. The nurse will update the employee about the next steps. Employee s personal information is kept secure and confidential. The employee is sent a copy of the questions they have been asked and the answers they have given so they can review information to make sure it s accurate and correct any mistakes. We can start to collect any additional medical evidence we need. We communicate medical underwriting decision to you. or Proceed with additional medical evidence and then we ll communicate medical underwriting decision. Benefit Employee does not have to complete a detailed form and by talking to a qualified nurse can be helped to provide that extra level of detail needed to reduce subsequent delays and the need for a doctor s report. The telephone appointment is arranged at the employee s convenience. The form is completed over the phone with the assistance of a qualified nurse. A single, secure event for collecting all relevant information which avoids having to clarify details at a later date. Gives the employee the opportunity to review the information they have provided, thereby avoiding accidental non-disclosure. The detailed information received from this process means the majority of underwriting decisions can be made without the need for further information and delays. 5

6 Medical examinations We want to make it as convenient as possible for an employee when a medical examination is needed. We can consider using a company or private health care medical examination if it was carried out during the previous twelve months. If a new examination is needed, we can offer the employee the choice of one of the following; A surgery based examination by their own GP. A surgery based examination, near to their place of work or home, carried out by an independent examiner appointed by us. A home or workplace examination carried out by an independent examiner. Temporary cover We ll provide temporary cover while underwriting an employee s benefits which exceed the automatic acceptance limit. This temporary cover will end when we offer underwriting terms or after 90 days from the date the employer notifies us of the employee s benefit amount whichever happens first. We ll backdate temporary cover to the date the employee became entitled to the benefit if employer tells us within 30 days of the employee first becoming entitled to that benefit level. Temporary cover doesn t apply to: discretionary entrants employees for whom we, or a previous insurer, either refused cover or offered cover on non-standard terms Underwriting decisions If our medical underwriting identifies that an employee has a medical condition or involvement in hazardous pursuits, we may impose special terms. This may result in an additional premium or cover restriction. Forward underwriting Once we have agreed the terms of cover for an employee, we ll apply these to future increases, subject to the limits described in the policy. We won t normally need further evidence of health for increases providing the employee is actively at work. There may be circumstances when we will limit, or not apply, the terms we have agreed for future increases for individual employees. Actively at work means that an employee has not received medical advice to refrain from work, is not absent from work or restricted from working due to illness or injury and is actively following their normal occupation. This means working at their normal capacity for the normal number of hours required by their contract, either at their normal place of business or at a location at which the business requires them to work. Where the requirement to be actively at work refers to a particular day, which is not a working day, employees will be considered to be actively at work unless their medical record shows that they were suffering from a medical condition which would reasonably have been expected to prevent them from working normally. employees who have previously failed to provide us or a previous insurer with medical evidence or any other requirements asked for any part of the employee s benefit that brings their total Group Life benefit to more than 3,000,000 or total Group Income Protection income benefit to more than 300,000 a year, or employees whose death (group life) or incapacity (group income protection) arises from a medical condition which happened, or for which they had treatment, routine monitoring or underwent investigation during the 24 months immediately before their entry date (or date of an increase in benefits). 6

7 How to contact us If you have any questions please call us on or fax us on Opening hours We re open Monday to Friday 9.00am to 5.00pm. We may record or monitor calls to improve our service. Address Zurich Corporate Risk PO Box 3512 Swindon SN3 9AH For general enquiries please us at 7

8 NP128443A53 (01/15) RRD Zurich Assurance Ltd. Registered in England and Wales under company number Registered Office: The Grange, Bishops Cleeve, Cheltenham, GL52 8XX. We may record or monitor calls to improve our service.