1100 AL-UMB version 5 Effective 4 August 2023
AIA LIVING
Understanding your policy document
We want you to feel confident with your insurance decisions. This policy document explains how your insurance cover works. It ’s important that you read it and understand what your insurance does and doesn’t cover.
If you have any questions or would like a more detailed explanation of your benefits, you can contact your adviser or get in touch with us directly using the details below.
Making a Claim
We understand that making a claim can be a stressful time in your life, and we’re committed to making th e process as fast and simple as possible. We also have one of New Zealand’s largest and most experienced claims team s and a transparent review process.
If you need to make a claim, we recommend doing so as soon as possible. Our claims team is here to guide you through the process and help you understand the information we need to assess your claim efficiently.
Reviewing your insurance cover
As your life changes, your insurance needs can change too. We recommend reaching out to your adviser regularly to review your insurance. This is especially important if you’re celebrating a milestone – for example a career move, house move, a change in your relationship status, adding to your family, or increasing or decreasing your debt.
We’re here to help
If you have any questions about your cover, would like to discuss other products and services, or need to make a claim or complaint , we’re always here to help.
• Talk to your adviser Keep in touch with your adviser, they’re there to help and will be able to support you at any stage should you need it. • Talk to us Our Customer Relationship Team is available Monday to Friday, from 8:00am to 6:00pm. You can Live Chat with us at aia.co.nz/chat or call us on 0800 500 108.
Product enhancements
We want to look after you today and in the future. That’s why from time to time we may enhance products to ensure that they remain modern and relevant.
Going forward you can find information about product enhancements and how they may be applicable to you by visiting aia.co.nz
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Contents
1
What are your policy benefits
3
2
Enhancement Pass Back Benefit
3
3
3
What are your cover options?
Benefit indexation type
Level cover
Inflation cover
Voluntary alterations to cover
Your premiums
3
4
Premium
Method of paying premiums
What happens if you do not pay the premium on time?
When can the premium change?
Premium type
How will you know what to pay?
Other circumstances that can change your premium
5
How to make a claim
5
When can your policy be cancelled?
5
6
When can you cancel your policy?
When can AIA cancel your policy?
Important Information
6
7
What forms part of this policy contract?
Law changes affecting AIA or the policy
Statutory Fund
Policy subject to laws of New Zealand
Notices
Transfer of ownership
Information about your policy
Worldwide cover
How do you make a complaint?
No surrender value
8
Key Terms
7
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1.
What are your policy benefits?
Enhancements will not be passed back to built-in benefit
sections and/or conditions that have subsequently become optional benefits within an appendix or no longer exist.
Your AIA Living policy can provide financial assistance in the event of death, disability, redundancy, or a critical condition . Details of the benefits you have chosen, and the life/lives assured are shown in the schedule . The terms of your benefits are contained in the relevant appendix . AIA will pay all benefits to the policy owner , or to the policy owner’s estate. If more than one person owns the policy then AIA will pay all benefits to the policy owners jointly or as they jointly direct, or to the survivor(s) of the policy owners . Your cover starts on the risk commencement date . Your policy contains options on the type of cover, and premium types and guarantees which are detailed below. If there is any inconsistency between these terms and your appendix , then the appendix will prevail. Some words in this document and any relevant appendix are italicised indicating they are key terms that are defined in either ‘Section 8: Key terms’ of this wording or in the key terms of the relevant appendix .
For the avoidance of doubt, where the definition of a condition or conditions is enhanced under this benefit, the enhancement will only be applied in respect of that condition or the conditions you are making a claim for. If the nature of the change to a section and/or condition means that it cannot be determined at the time of submitting a claim whether the change will be clearly favourable to you or not, you will need to elect whether or not the change will apply to the claim. After you have made the election, this election cannot be changed.
3.
What are your cover options?
Your cover starts on the risk commencement date .
Level cover (specified in the schedule as Level)
The amount of cover under the relevant benefit will remain constant.
Inflation cover (specified in the schedule as CPI Linked)
2.
Enhancement Pass Back Benefit
The amount of cover under the relevant benefit will increase at the start of each policy year by an amount we determine with reference to the annual percentage increase in the consumers price index , subject to any maximum benefit amounts allowable under the benefit. If the consumers price index falls in any year, the inflation-linked benefit amounts will not decrease. You can write to AIA if you do not want the amount of cover under the relevant benefits to be increased for a particular year.
If at any time in the future, we make a change to a section and/or condition within a section of our AIA Living policy and the change is favourable to you, the enhanced section and/or condition will automatically be applied (passed back) to this policy, subject to the following: At claim time AIA will compare the enhanced section and/or condition in the latest version of AIA Living with this policy and will apply the section and/or condition that is most favourable to you. AIA will not apply changes to sections and/or conditions set out in earlier versions of AIA Living which are not included in the latest version. The enhanced section and/or condition will only be applied to this policy if it relates to a benefit for which you have cover under this policy. The enhanced section and/or condition will be ‘applied’ to this policy with effect from the pass back date . The enhanced section and/or condition will only apply if the claim event first occurs on or after the pass back date . Eligibility criteria for individual benefits will still apply. If the claim event first occurred before the pass back date , then the claim will not be assessed or reassessed using the new wording. Any underwriting exclusions or special terms that apply to this policy will not be altered by any enhanced section and/or condition . Any associated increase in premium required will be applied when your premiums are next reviewed. Enhancements to sections and/or conditions that relate to optional benefits within an appendix will only be passed back where the optional benefit(s) are listed in the schedule .
Voluntary alterations to cover
You may apply to AIA in writing to increase or reduce the amount of cover for existing benefits, or add other benefits to the policy. AIA does not have to accept an application for any increase in existing cover. Any acceptance will depend on a number of factors, including the state of health of the life assured . You may add other benefits so long as the life assured meets AIA ’s usual requirements for those benefits. Any increase or reduction in cover will start from the next premium due date after AIA accepts your application.
4.
Your premiums
Premium
To ensure your policy remains in force you must pay the premium on a regular basis as agreed with AIA . The initial premium is shown in the schedule , the first payment is due to AIA on the first premium due date . The premium amount may change from time to time (as described below) and you will need to pay the new premium on the agreed regular basis. AIA will advise you of the new premium before the change.
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The policy illustration enclosed with this policy document gives details of the indicative changes.
(subject to any further underlying premium rates changes). At the end of the selected period, the premium type will convert to Rate for Age. Notwithstanding the above, for Life Cover, Family Protection and Accidental Death benefits, AIA guarantees the underlying premium rates (subject to relevant changes in taxation or legislation). Where a premium type of 10 years, to age 65 or to age 80 has been selected and the benefits are CPI linked, your premium has been calculated over the selected period and in addition to any underlying premium rate changes (see above) your premium will increase annually in line with any increase in your benefit. The increase in premium will be based on the increase in the sum assured and the age of the life/lives assured .
Method of paying premiums
You must pay all premiums to AIA . Premiums can be paid by direct debit, credit card or debit card. Premium payments are not effective until after they have been credited and cleared to AIA ’s bank account.
What happens if you do not pay the premium on time?
You have 30 days ’ grace in respect of any premium due. AIA will be entitled to cancel your policy by written notice to you
at your last known address if a premium remains outstanding 31 days after a premium due date .
If you want to have the policy reinstated, you must write to AIA . AIA does not have to reinstate the policy but may do so on any conditions it considers appropriate. If AIA has to pay a benefit under the policy when a premium is overdue, the overdue premium may be deducted from the claim payment.
Irrespective of the type of premium you have selected:
All changes to your premium as described above will take effect from the anniversary date . Whenever the premium is recalculated, the premium will not be affected by any change in health of a life assured which has occurred since the benefits were first added to the policy. Premiums will always be based on premium rates adopted by AIA for each benefit so that no single life assured can have his or her premium recalculated in isolation. Premiums may be re-calculated at each anniversary date to take account of changes to premium discounts. Any policy fee will normally increase annually in line with the consumers price index . However, if all benefits for all lives assured are Level and the premium type selected is 10 years, to age 65 or to age 80 then the policy fee will also remain unchanged until the end of the selected period. Premium increases will always be applied across a class of business. No increase in premium will apply to your own policy based on your own claim experience.
When can the premium change?
There are a number of circumstances that can change the premium you pay.
a.
Premium type
AIA calculates the premium for each of your benefits based on the premium type chosen and whether the benefits are Level or CPI linked. Premiums can be structured in the following ways:
Rate for Age;
10 years;
To age 65;
To age 80.
The premium type(s) you have selected are shown in the schedule . How this affects the premium you pay is explained below: Where Rate for Age has been selected, your premium will be recalculated at each anniversary date based on:
b.
Premium discounts
- the age of the life/lives assured ;
In addition to the premium type chosen, there are two premium discounts that may reduce the premium (excluding any applicable policy fee) you pay.
- the amount of cover for each benefit;
- AIA ’s underlying premium rates at that time; and
- any eligible premium discounts calculated for the life/lives assured (see premium discounts below). Where a premium type of 10 years, to age 65 or to age 80 has been selected and all benefits are Level, your premium has been calculated over the selected period and AIA will only change your premiums over the selected period to apply any eligible premium discounts calculated for the life/lives assured (see premium discounts below), or if the underlying premium rates change. If the underlying premium rates change, then at the next anniversary date AIA will recalculate the premium to apply for the remainder of the selected period
Multi-benefit discount
(if applicable) The amount of multi-benefit premium discount you are eligible to receive for each life assured will be recalculated: - on each anniversary date based on the type and number of qualifying benefits held for each life assured ; and - at any time when you add other benefits to the policy or increase or reduce the amount of benefits under the policy for each life assured. subject to the AIA Multi-Benefit Premium Discount Eligibility Rules or any subsequent version thereof.
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5.
How to make a claim
AIA Vitality discount
(if applicable) You may qualify for a premium discount on the premiums you pay for any life assured who has an AIA Vitality membership. The amount of the premium discount the life assured is eligible to receive will be calculated on each anniversary date in accordance with the AIA Vitality Premium Adjustment Rules provided at aia.co.nz/vitality as at that date. AIA reserves the right, at any time and at their sole discretion, to: Vary or restrict the qualifying benefits or products eligible for either of the abovenamed premium discounts; Vary or withdraw any of the abovenamed premium discounts based on business rules; or Cease offering any of the abovenamed premium discounts by giving at least 90 days’ notice in writing to the policy owner(s) (in which case they will cease across all AIA Living policies).
For any claims enquiries, advice about submitting a claim or before incurring any costs in respect to a claim, please phone the AIA Claims Team or your adviser for assistance.
AIA Claims Hotline: 0800 500 108
Information that may be required for each different type of benefit is detailed in the benefit appendix. AIA will tell you about any other information that may be required once notice of the claim has been received. AIA is under no obligation to consider a claim unless all of the information requested is provided. Furthermore, AIA is under no obligation to assess or pay a claim prior to receiving notification. AIA may also ask any life assured to undergo further medical examinations throughout the life of the claim. Any requests made by AIA for further medical information will be at our expense.
6.
When can your policy be cancelled?
c. Other circumstances that can change your premium
When can you cancel your policy or individual benefits?
If for any reason you are not happy with your policy or individual benefits you may return it to us within 15 days from the date your policy document is received. You will be deemed to have received your policy document five days after postage from AIA . AIA will promptly refund any premiums paid under your policy provided that no benefit has been paid or any claim has been made. Alternatively changes to your policy or individual benefits may be made and a replacement policy document issued. You can cancel your policy or individual benefits at any time by giving AIA notice in writing. If you have elected to pay premiums less frequently than monthly, we will refund any part of a premium already paid for this policy or the cancelled benefits to cover any period of more than one month beyond the date of cancellation (being the date we receive the cancellation notice). Otherwise, we do not have to refund any premiums or part of premiums already paid. You will remain liable to pay any premium due on the policy before AIA received the cancellation notice. From (and including) the date AIA receives notice of cancellation of your policy, you will not be entitled to any benefits under the policy, unless otherwise agreed in writing by AIA . From (and including) the date AIA receives notice of cancellation of any individual benefits, you will not be entitled to any of the cancelled benefits under the policy, unless otherwise agreed in writing by AIA .
The other circumstances in which your premium will change are as follows: When you add other benefits to the policy or increase or reduce the amount of benefits under the policy. When you add or delete a life assured or lives assured to or from this policy. When you request, and we agree to, a change in premium type. When a claim is paid and the benefit ceases as a result of the payment being made. When a benefit ceases due to the life assured covered for that benefit attaining the benefit expiry age as specified in the schedule . Any changes to the tax treatment of any premium payable or claims receivable in respect of the policy (such as changes to GST).
How will you know what to pay?
Each year prior to the anniversary date, AIA will write to you and tell you how much the premium will need to be to maintain your existing cover. If AIA tells you that your benefit premiums need to increase to maintain your existing benefit amounts, you can choose to: increase the premium to maintain the existing benefit amounts; or reduce the benefits to the amount which your existing premium will cover.
When can AIA cancel your policy?
AIA can cancel this policy if the premium has not been paid within 31 days of the premium due date . If AIA issues you this policy with the understanding that it is to replace a policy, you already have then you must cancel your existing policy. If you fail to cancel your existing policy, AIA can cancel this policy or decline liability for any claims made under this policy. A Replacement Policy Advice form (or equivalent), application form, illustration or quote which
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7.
Important information
indicates this policy is intended to replace an existing policy will be sufficient evidence that your policy was issued on the basis that you would cancel the existing policy. AIA can cancel this policy and decline liability for any claims made under this policy if you or any life assured , or anyone acting on your or any life assured’ s behalf, makes a claim under this policy that is false or fraudulent in any respect. In the event that a false or fraudulent claim is established after payment of a claim, all amounts paid in relation to the false or fraudulent claim must be repaid by you to AIA .
What forms part of this policy contract?
All the terms of this policy are contained in and based on:
This policy document including the schedule and any alterations made as permitted under the policy.
The relevant benefit appendix .
Any application forms and declarations made by you and any life assured , at any time, concerning this policy. All statements which anybody who is insured under this policy has made to AIA . Any provisions which any legislation states must be included in this contract, unless those provisions can be contracted out of, in which case they are not included.
Cancellation due to Sanctions
We shall not provide cover for any risk and/or activity and shall not be liable to pay any claim or pay any benefit hereunder to the extent that the provision of such cover, payment of such claim or provision of such benefit would be in respect of a person who is the subject of any sanction, prohibition or restriction under United Nations resolutions or trade or economic sanctions, laws or regulations of New Zealand, the European Union, United Kingdom or United States of America, or any of its states and/or any other applicable economic or trade sanction laws or regulations. This provision applies without limitation not only to the policy owner or holder, but to the life assured and any assignee, other third party, related party or beneficiary of the policy. Should we determine that the above is applicable, we may at our sole discretion terminate the policy with immediate effect.
Nothing else forms part of this contract.
Law changes affecting AIA or the policy
If changes in the law occur after the risk commencement date and AIA believes on reasonable grounds that those changes will affect:
AIA ’s liability to pay any tax; or
The tax treatment of any premiums payable or claims receivable in respect of the policy (such as GST); or The way in which the policy works or the amount which can be paid under benefits; then AIA can change the provisions of the policy or the benefits, but only to take into account the effect of the law change.
Non-disclosure or the provision of false or misleading information
Any information you or any life assured gives us, and any information given to us on your behalf, must be complete, true and correct.
Statutory Fund
Your insurance policy is part of the Statutory Fund Number 1.
If you or any life assured :
Policy subject to laws of New Zealand
fails to disclose material information to AIA prior to inception of this policy or any variation or reinstatement of this policy; or has made a substantially incorrect statement on the faith of which the policy was issued, renewed, varied or reinstated.
The laws of New Zealand govern this policy, which has been issued in New Zealand.
Notices
When you write to AIA about this policy, you must send the letter to AIA ’s head office in New Zealand or a substitute address AIA gives you.
AIA may, at its complete discretion either:
subject to the Insurance Law Reform Act 1977, avoid your entire policy from its inception (this means the policy is deemed to have never existed); or avoid from its inception any individual benefits provided by your policy (this means the individual benefit(s) are deemed to have never existed); or alter the terms upon which cover is provided under your policy (such alteration of terms will be effective from the risk commencement date or such date of our choosing, at our discretion); or remove from cover any life assured from inception but leave the policy in force for the remaining lives assured . If this policy is avoided or any terms altered or a life assured is removed from cover, we may retain all premiums paid in relation to the policy or that life assured .
The postal address of AIA ’s head office is: Freepost AIA
Private Bag 92499 Victoria Street West Auckland 1142 New Zealand
The street address of AIA ’s head office is:
AIA New Zealand Limited AIA House 74 Taharoto Road Takapuna Auckland 0622 New Zealand
If more than one person owns this policy, all the policy owners must sign any letter or notice to AIA . However, AIA
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8.
Key terms
will not be liable to any policy owner if we act on a letter or notice signed by one or more, but not all, of the policy owners . AIA is not bound by anything contained in a letter or notice you send unless we actually receive the letter or notice at the relevant address. When AIA writes to you about this policy, we will send the letter or notice to the address for the policy owner shown in the schedule , or to the email address(es) provided for the policy owner in the application for this policy, or any substitute postal and/or email address(es) you give us. You must immediately notify AIA of any changes to your postal, residential or email address. Every notice required to be given to you by AIA shall be deemed to be delivered five days after having been posted, or, where the notice is sent by email, 24 hours after the email has been sent.
In this policy document and optional benefit appendices some words have special meanings:
ACC
The Accident Compensation Corporation of New Zealand (or any organization or agency executing or administering the Accident Compensation Act 2001 ).
accident
Injury caused by violent, accidental, external and visible means.
accredited Adviser
Either an Adviser with a current financial adviser agreement with AIA Services Limited or a member of a financial services industry body approved by AIA .
Transfer of ownership
You may transfer the ownership of your policy at any time.
AIA
Means AIA New Zealand Limited, also referred to in this policy as ‘we’, ‘our’ or ‘us’.
To be valid the transfer must be on a transfer of ownership form and registered with us. If ownership of your policy has been transferred, references in this policy document to you, your and the policy owner(s) are references to the most recent transferee(s). A trust cannot be the owner of this policy. No charge is payable for a transfer of ownership of the policy.
AIA policy/policies
Any policy or policies where AIA is the insurer, this includes any related policy/policies issued by either: Sovereign Assurance
Company Limited or AIA International Limited, New Zealand Branch.
Information about your policy
Shortly before each anniversary date , AIA will send you a letter containing information about your policy. You may at any time write to AIA or your AIA accredited Adviser for further information about your policy.
AIA Vitality
Means AIA Vitality, a health and wellbeing programme offered by AIA.
anniversary date
The anniversary in each year of the first premium due date.
Worldwide cover
This policy and benefits cover the lives assured anywhere in the world. All payments AIA makes under this policy will be in New Zealand dollars.
annual salary
Regular remuneration that is subject to PAYE, excluding allowances in lieu of non- monetary remuneration and extra income such as, but not limited to, bonuses and overtime payments.
How do you make a complaint?
Complaints by policy owners to AIA must be made in writing. If the policy owner is not satisfied with the outcome of the complaint, they may have the right to refer the complaint to the Insurance and Financial Services Ombudsman . The Ombudsman can only deal with a complaint after AIA ’s internal complaints procedure has been exhausted and a letter acknowledging this has been sent to the complainant. You can obtain more information about the Ombudsman from the website: www.ifso.nz
appendix
The appendix contains the terms of any benefit you have chosen.
child/children
Any biological child/children, adopted child/children or child/children under the legal guardianship of:
The Ombudsman’s address is:
a life assured ; or
Insurance and Financial Services Ombudsman PO Box 10-845 Wellington 6143 Phone: (04) 499 7612 or 0800 888 202
the spouse, civil or de facto partner of a life assured .
claim event
The death, illness, injury, condition , or redundancy that you are claiming for under your AIA Living policy.
No surrender value This policy does not participate in the profits of AIA . The policy has no surrender value or cash value if it is cancelled.
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registered medical practitioner(s)
A person, acceptable to AIA , who holds a current practising certificate in compliance with the Health Practitioners Competence Assurance Act 2003 (or its successor) and who is registered and practising as a medical practitioner in New Zealand or Australia, other than: The policy owner(s) ; The life assured ; A family member of the life assured or policy owner(s) ; or The business partner or associate of a life assured or policy owner . AIA reserves the right to accept the advice of a medical practitioner practising outside New Zealand or Australia with qualifications equivalent to New Zealand or Australian standards. Any in force policy/policies for the life assured that were issued on or before the 4 th August 2019, where:
condition(s)
As defined in the Optional Benefit Appendix for Critical Conditions Benefit and Progressive Care Benefit. The Consumers Price Index (all groups) issued by the Government Statistician as at 30 September each year, or any index which may replace that index. A relative who is the life assured's spouse, civil or de facto partner, mother, father, stepmother, stepfather, brother, sister, stepbrother, stepsister, child , grandfather or grandmother.
consumers price index
close relative
life/lives assured
The person or people insured for the benefit(s) as named in the schedule.
material
A statement is material only if that statement would have influenced the judgment of a prudent insurer in fixing the premium or in determining whether he/she would have taken or continued the risk upon the same terms.
related policy/policies
Sovereign Assurance Company Limited ( ‘ Sovereign ’ ) was the insurer; and/or
pass back date
The date that the relevant change to AIA’s Living policy
AIA International Limited, New Zealand Branch ( ‘ AIA International ’ ) was the insurer.
comes into effect, as determined by AIA .
AIA in its sole discretion may pay more than one benefit, or more than the stated maximum sum assured for the same claim event should the life assured have cover under one or more related policy/policies through both Sovereign and AIA International.
policy fee
The administration fee charged by AIA as detailed in the policy illustration or in any communication to you containing information about your policy. The person or people named as ‘policy owner’ in the schedule, also referred to in this policy as ‘you’ or ‘your’. The period from the risk commencement date to (but excluding) the first anniversary date , or from an anniversary date to (but excluding) the next anniversary date . The amount payable by you to AIA under this policy, comprising the cost of the benefits chosen by you, plus any applicable policy fee , less any eligible premium discounts if any.
policy owner(s)
risk commencement date
The commencement date of the benefit, as shown in the schedule .
policy year
specialist
A registered medical practitioner who is a member of an appropriately recognised specialist college and has authority granted under the Health Practitioners Competence Assurance Act 2003 (or its successor) to perform that health service and has Medical Council of New Zealand (or its successors) vocational registration for that health service. A statement is substantially incorrect only if the difference between what was stated and
premium
premium due date
The date on which the premium is payable under the policy, as agreed with AIA .
substantially incorrect
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what is actually correct would have been considered material by a prudent insurer.
the schedule
The most recent schedule for your policy and: any notice of a change to premiums ; and any policy alteration or
endorsement documents recording a change to your policy.
transfer of ownership form
AIA’s standard form for an assignment of a policy by way of ordinary transfer.
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