Income Protector Optional Rider benefits

Transcription

1 For intermediaries Sanlam Risk Cover January 2015 Income Protector Optional Rider benefits Primary Income Protector benefits Waiting period Sickness Temporary Disability Income Including fixed payment for defined list of claim events Overhead Expenses protector Extended Disability Income Fixed cease age OR Extended Disability Income Whole Life Post-retirement Impairment Income Payment on basis of permanent impairment no waiting period UP TO 24 MONTHS CHOSEN CEASE AGE OR MIN (RETIREMENT, 70) DEATH Optional rider benefits Spouse Protector Child Protector Optional rider benefits available with Sicknessand Temporary Disability Income benefits Pre-retirement Impairment Income Payment on basis of permanent impairment no waiting period Optional rider benefit available with Extended Disability Income-benefit Additional Income Protector benefits Total and Permanent Disability Income Payment on basis of permanent disability no waiting period Death Income CHOSEN CEASE AGE Sanlam is a licensed financial services provider

2 Optional rider benefits available with Sicknessand Temporary Disability Income benefits 01 Spouse protector Benefit A benefit may be claimed if the spouse of the life insured on the main benefit dies, or is diagnosed with any of the dread diseases indicated in the table below. The main benefit refers to the benefit for which this rider benefit has been chosen. If we admit a claim, we will make 6 monthly income payments. Each income payment will be equal to the cover amount of the benefit for which this protector rider benefit has been chosen, which is set out in the plan overview. We will waive the payments for the plan for as long as we make an income payment. Spouse For the purpose of this benefit a spouse is a person to whom the life insured is legally married, or with whom the life insured has concluded an agreement recognized as a marriage in accordance with any law or custom, provided that in case of a marriage by law or custom, he or she lives with that person as if legally married. Entry age Maximum entry age = 55 anb This refers to the age of the life insured of the primary benefit to which this rider benefit is linked. The age of the spouse is not recorded at application stage. Cease age Cover ceases at the same age as the age selected as the cease age on the main benefit. Underwriting No underwriting applies to the spouse s life. The spouse is also not recorded as a specific life insured. A general pre-existing clause applies to the spouse from the inception date of the rider benefit or from the date on which he or she becomes the spouse of the life insured on the main benefit, whichever is later. It also applies to cover increases and reinstatements. 2

3 Waiting period A waiting period that phases in over 2 years, applies to natural causes. The waiting period applies from the inception date of the rider benefit or the date on which the life insured meets the definition of a spouse, whichever is later. The waiting period also applies to cover increases and reinstatements. Plan year Benefit payable Year 1 0% Year 2 50% Claims Only 1 claim per plan is allowed. The benefit will be automatically removed after a claim has been admitted. Suicide clause A suicide clause applies during the first 24 months of the benefit or the first 24 months after the life insured meets the definition of a spouse (and on cover increases, and on the full cover amount after reinstatements). Claim events All the claim events will be covered at 100%. Year 3 and onwards 100% Claim event Death Aortic artery surgery Any type of cardiomyopathy on optimal treatment with functional impairment to the degree of New York Heart Association (NYHA) class IV shortness of breath Stroke resulting in permanent impairment Heart valve surgery Coronary artery bypass graft (CABG) Heart attack Renal failure Liver failure End-stage lung disease Bone marrow failure (Aplastic anaemia) Organ transplant Claim event explained in layman s terms* Death The surgical repair of a damaged section of the aorta. The aorta is the main blood vessel through which the heart pumps blood to the body. An enlarged heart with very poor function, to the extent that the patient cannot climb stairs or walk in a mall, and is short of breath even while sitting. Paralysis of one side of the body due to a blood clot or bleeding on the brain. Repairing a heart valve or hole in the heart. This is done by open-heart surgery, in other words, the chest is cut open. An operation, using veins from the patient s legs, to bypass a narrowing or blockage of one or more coronary arteries (the arteries supplying the heart muscle with blood). Heart attack Chronic kidney failure. Chronic failure of the liver with yellow jaundice. End-stage lung disease that requires the use of oxygen at home. A disease that permanently damages the bone marrow. This will require regular blood transfusions, chemotherapy or a bone marrow transplant. Applies if the spouse receives a transplanted kidney, heart, liver, lung, pancreas or bone marrow. 3

4 Claim event Cancer, except the cancers excluded under Exclusions in the contract Benign brain tumour that is inoperable or recurrent or results in permanent neurological impairment Motor neuron disease Multiple sclerosis Coma Parkinson s disease Alzheimer s disease Loss of vision in both eyes Hearing loss Permanent loss of more than 90% of the use of each of any two limbs Muscular dystrophy Paraplegia Quadriplegia Burns Accidental HIV infection Sero-positive rheumatoid arthritis Claim event explained in layman s terms* Cancer, excluding most skin cancers and very early stages of some cancers that recover completely with minimal treatment. A brain tumour that is not cancerous, but impossible to operate or keeps coming back after surgery or results in permanent brain damage. A disease that affects the muscles in the body, including the ability to speak, walk and swallow. A disease that damages the nerves in the brain and spinal cord. Also known as MS. Being in a coma in the intensive care unit (ICU). A degenerative brain condition that leads to various symptoms, like tremor of the hands and head, a slow gait with shuffling feet, inability to show emotions, and a forward-falling posture. It often runs in families. A degenerative brain condition that leads to loss of memory and concentration, and confusion. Total and permanent blindness in both eyes. Total and permanent deafness in both ears. Losing the use of any two limbs permanently. A disease that causes muscles to waste away, leaving patients weak and eventually unable to help themselves. Also known as MD. Permanently lame in both legs, requiring the use of a wheelchair. Permanently lame in both legs and both arms. Serious burn wounds requiring skin grafts over at least 20% of the body. HIV infection / AIDS that is acquired accidentally through a needlestick injury, blood transfusion, organ transplant, violent crime, rape or medical emergency procedure. Rheumatoid arthritis with a positive blood test for rheumatoid factor. *The explanations provided in this column are intended only to give a better understanding of the claim events in the first column. They are not to be used in the legal interpretation of the claim events. The definitions of the claim events as described under Explanations in the contract are the only contractual definitions applicable. 4

5 02 Child protector Benefit A benefit may be claimed if a child of the life insured on the main benefit dies, or suffers any of the illnesses or injuries indicated in the table below. The main benefit refers to the benefit for which this rider benefit has been chosen. If we admit a claim, we will make 6 monthly income payments. Each income payment will be equal to the cover amount of the benefit for which this protector rider benefit has been chosen, subject to legislation. If a child dies, legislation limits the total amount we are allowed to pay to R for a claim event before the child s 6th birthday, and R for a claim event on or after the child s 6th birthday, but before that child s 14th birthday. We will waive the payments for the plan for as long as we make an income payment. Waiting period A waiting period that phases in over 2 years, applies to natural causes. The waiting period applies from the inception date of the rider benefit or the date on which the life insured on the main benefit becomes the parent of the child, whichever is later. The waiting period also applies to cover increases and reinstatements. Children Biological, legally adopted and stepchildren. Entry age Children are covered from their 1st birthday. No maximum entry age. Cease age Cover ceases at the same age as the age selected as the cease age on the main benefit, but the following two illness and injury claim events will fall away on the child s 19th birthday: juvenile rheumatoid arthritis cystic fibrosis Underwriting No underwriting applies to the children s lives. Children are also not recorded as specific lives insured. A general pre-existing clause applies to a child from the inception date of the rider benefit or from the date on which the life insured on the main benefit becomes the parent of the child, whichever is later. It also applies to cover increases and reinstatements. Plan year Benefit payable Year 1 0% Year 2 50% Year 3 and onwards 100% Claims A maximum of 1 claim per child and 3 claims per benefit apply. The benefit will be automatically removed after 3 claims have been admitted. Suicide clause A suicide clause applies during the first 24 months of the benefit or the first 24 months after the life insured of the main benefit becomes the parent of an adopted or stepchild (and on cover increases, and on the full cover amount after reinstatements). Claim events All the claim events will be covered at 100%. 5

6 Claim event Claim event explained in layman s terms* Death Death Surgery to major blood vessel: aorta, carotid, pulmonary, coronary or femoral artery Fixing a damaged section of a major blood vessel. Cardiomyopathy An enlarged heart with very poor function. Stroke resulting in permanent impairment Paralysis of one side of the body due to a blood clot or bleeding on the brain. Open-heart surgery Repairing a heart valve or hole in the heart, usually after rheumatic fever or discovering a birth defect. This is done by open-heart surgery, in other words, the chest is cut open. Heart attack Heart attack. Primary pulmonary hypertension (PPH) Abnormal blood flow and abnormal pressure in the lungs. Renal failure Chronic kidney failure. Liver failure Chronic failure of the liver with yellow jaundice. End-stage lung disease End-stage lung disease that requires the use of oxygen at home. Bone marrow failure (aplastic anaemia) A disease that permanently damages the bone marrow. This will require regular blood transfusions, chemotherapy or a bone marrow transplant. Organ transplant Applies if the child receives a transplanted kidney, heart, liver, lung, pancreas or bone marrow. Cancer, except the cancers excluded under Exclusions in the contract Cancer, excluding most skin cancers and very early stages of some cancers that recover completely with minimal treatment. Benign brain tumour that is inoperable or recurrent or results in permanent neurological impairment A brain tumour that is not cancerous, but impossible to operate or keeps coming back after surgery or results in permanent brain damage. Motor neuron disease A disease that affects the muscles in the body, including the ability to speak, walk and swallow. Multiple sclerosis A disease that damages the nerves in the brain and spinal cord. Also known as MS. Loss of vision in both eyes Total and permanent blindness in both eyes. Hearing loss Total and permanent deafness in both ears. 6

7 Claim event Claim event explained in layman s terms* Loss of speech Permanently losing the ability to speak; muteness. Not due to psychiatric reasons. Permanent colostomy or ileostomy The need to permanently wear a bag for stools. Head injury Serious head injury, requiring surgery. Paraplegia Permanently lame in both legs, requiring the use of a wheelchair. Quadriplegia Permanently lame in both legs and both arms. Accidental HIV infection HIV infection / AIDS that is acquired accidentally through a needlestick injury, blood transfusion, organ transplant, violent crime, rape or medical emergency procedure. Bacterial meningitis or encephalitis with permanent impairment A severe and contagious form of meningitis that results in permanent damage to the brain or nerves. Cerebral malaria Malaria affecting the brain, and resulting in permanent damage to the brain or nerves. Rabies A deadly infection after being bitten by a dog or other animal with mad dog disease. Juvenile rheumatoid arthritis An autoimmune disease that affects the joints in children younger than 16 causing pain and deformity in large joints, not only the hands. Cystic fibrosis A genetic disorder affecting multiple organs including the lungs. Also known as Mucoviscidosis. *The explanations provided in this column are intended only to give a better understanding of the claim events in the first column. They are not to be used in the legal interpretation of the claim events. The definitions of the claim events as described under Explanations are the only contractual definitions applicable. i /2015 7

8 Optional rider benefit available with the Extended Disability Income benefit (term and whole-life version) Pre-retirement Impairment Income With this rider benefit income claims can be admitted on the basis of permanent functional impairment, regardless of the ability to work. The rider benefit will pay a percentage (up to 100%) of the cover amount, based on the severity of the impairment. Automatic waiver of payment is included. Waiting period No waiting period applies to this rider benefit. This means that even though the rider benefit is added to the Extended Disability Income benefit with a 24- month waiting period, the income payment will start as soon as permanent functional impairment has been established. Claims If a claim qualifies under both the main benefit and this rider benefit, only the claim event resulting in the largest pay-out will be admitted. For impairments in multiple body systems, payout percentages can be added together, up to a maximum of 100%. Once a claim has been admitted, it will be paid until the cease age of the benefit to which this rider benefit is linked or until 70 anb if it is linked to the whole-life version of the benefit. If we admit a claim, we will make an income payment of up to 100% of the cover amount linked to a particular claim event*. The following body systems are covered: Valvular heart disease, cardiomyopathy Ischaemic heart disease Arrhythmia Hypertension Pheripheral arterial disease Pheripheral venous disease Haematopoietic system Respiratory system Central nervous system Gastro-intestinal system: upper and lower digestive track Gastro-intestinal system: liver Gastro-intestinal system: biliary tract Endocrine system Urinary tract Diabetes mellitus: type I or II with target organ complications Locomotor system: upper extremity Locomotor system: lower extremity Spine Visual system Hearing Speech Psychiatric conditions *The full details of all the claim events, percentage pay-outs linked to the claim events and the full definitions of these claim events are available in the Risk Technical Guide. i /2015 8