BCP-NBC-05/2019
Business Cover Professional - New to Business Cover SECTION A - DEFINED TERMS
DEFINED TERMS
In this Policy certain words have particular meanings. These words are in Bold and the meanings set out below. Interpretation Throughout this Policy ' We' , 'Our ', ' Us ' or ‘ AIA New Zealand ’ means AIA International Limited - New Zealand Branch, and/or any related and/or authorised companies and/or agents (including company officers acting in the scope of their authority). ' You ' or ' Your ' means the Policy Owner(s) . Benefit(s) Means the Benefit specified in the Policy Schedule (and subject to the terms and conditions of this Policy ). Civil Union Means a Civil Union as defined in the Civil Union Act 2004. Criminal Act Means participation in an action that constitutes an offence under the Crimes Act 1961, whether or not that action results in a conviction on indictment or on summary conviction. Life Assured Means the Life Assured or Lives Assured listed in Your Policy Schedule . Manifested Means that symptoms have arisen which cause an ordinarily prudent person to seek diagnosis, care or treatment, or that medical advice or treatment has been recommended by or received from a Medical Practitioner. Medical Practitioner Shall mean any person approved by Us registered with the Medical Council of New Zealand to render medical or surgical services, and who holds an Annual Practising Certificate. For diagnoses made outside New Zealand, this definition covers any appropriately qualified medical professional approved by Us . This definition excludes any person who is himself/herself the Life Assured , the Policy Owner , the spouse, de facto spouse, Civil Union partner, lineal relative, or business partner/associate of the Life Assured or Policy Owner. Policy Means this contract of insurance between You and Us . It includes the following parts: • Your application for insurance; and
• this Policy wording; and • the Policy Schedule ; and
• any addendum to the Policy Schedule ; and • any other written notice that We give You ; and • any written notice that You give Us . Policy Anniversary Date Means the anniversary of the Policy Commencement Date .
BCP-NBC-05/2019
Page 1 of 11
Policy Commencement Date Means the commencement date of the Policy as specified in Your Policy Schedule . Policy Owner Means the Policy Owner identified in the most recent Policy Schedule issued to You by Us . Policy Schedule Means the most recent Policy Schedule issued to You by Us , including any endorsements or special conditions. Policy Year Means the twelve (12) month period which starts from the Policy Commencement Date and ends on the First Anniversary Date . Each subsequent Policy Year is from Policy Anniversary Date to Policy Anniversary Date . Premium Means the Premium specified in Your Policy Schedule or in any subsequent notice issued to You by Us . Premium Rates Means the underlying Premium Rates We use to calculate Your Premium based on factors including the age, health, occupation and circumstances of the Life Assured . Sum Assured Means the Sum Assured for the Benefit(s) as set out in Your Policy Schedule. Total Premium Means the sum of the Premium and policy fee together with any applicable GST as specified in Your Policy Schedule .
BCP-NBC-05/2019
Page 2 of 11
SECTION B - NEW TO BUSINESS COVER FEATURES
JURISDICTION AND CURRENCY
1
The laws of New Zealand apply to this Policy . The New Zealand courts have exclusive jurisdiction. All monetary amounts referred to in this Policy are expressed and payable in New Zealand dollars and include GST. A When You apply for insurance with AIA New Zealand and when You make a claim on the Policy , You have a legal duty 1. All the statements that You or any Life Assured make to AIA New Zealand (both written and oral), including the answers in: a. the application; b. any claim made by You ; and c. any other communication by You or any Life Assured with AIA New Zealand ; must be complete, true and correct. 2. You and any Life Assured must disclose everything that You or any Life Assured know, or could reasonably be expected to know, that is relevant to AIA New Zealand’s decision whether: a. to accept Your application for insurance, on what terms AIA New Zealand will accept it and how much it will cost; or b. to accept Your claim on the Policy . 3. This duty of disclosure in relation to Your application for insurance continues from the time You complete the application until either: a. the Policy Commencement Date or the date AIA New Zealand accepts Your application for insurance, whichever is later; or b. AIA New Zealand declines Your application for insurance. 4. You and any Life Assured also have the same duty of disclosure to AIA New Zealand throughout the term of the Policy whenever You or any Life Assured communicate with AIA New Zealand and whenever You extend, vary or reinstate Your insurance. of disclosure to AIA New Zealand . The duty of disclosure means that: IMPORTANT If You or any Life Assured do not comply with Your duty of disclosure, AIA New Zealand may at its discretion do any or all of the following: 1. Decline any claim that You make; 2. Alter the terms of any Benefits under the Policy ; 3. Remove any Benefits under the Policy ; 4. Void Your Policy from the Policy Commencement Date ; 5. Retain all Premiums , policy fees and recover any Benefits paid; 6. Terminate this Policy . If You are not sure whether You are required to disclose a particular fact, please ask AIA New Zealand or Your insurance adviser.
RESPONSIBILITY FOR TRUTHFULNESS
2
BCP-NBC-05/2019
Page 3 of 11
B
If the age of the Life Assured was misstated in the application, the amount payable under this Policy will be adjusted to the amount that the Premiums would have purchased if the correct age had been disclosed. No increase in Premium Rates will apply to this Policy as a result of a change in the health, occupation or circumstances of the Life Assured . However, We have the right to review at any time and from time to time the Premium Rates and handling fees applicable to all New to Business Cover policies and to apply the reviewed rates and fees to this Policy on thirty (30) days notice. With Our agreement the annual Total Premium may be paid by equal fortnightly, monthly, quarterly or half-yearly instalments but with such handling fees as We shall determine from time to time. We may cancel this arrangement at any time in respect of future Total Premiums . The Policy Owner may apply to Us to change the Premium or Benefits attributable to this Policy . Subsequent to this, We may change the Premium and/or alter any Benefits under this Policy in accordance with this instruction.
PREMIUM RATES
3
PREMIUM PAYMENTS
4
POLICY FEE
5
We will charge You a policy fee, which forms part of Your Total Premium . The policy fee is used to pay the ongoing administration costs of this Policy . The policy fee is specified in Your Policy Schedule . We may change this policy fee from time to time. If this occurs any such change will be notified to You in writing. The term of this Policy and the period of assurance covered by each annual Total Premium , or instalment of annual Total Premium , terminate on the due date of the next annual Total Premium or instalment. A thirty (30) day grace period is allowed after the due date for payment of each Premium . This Policy will automatically terminate if the Total Premium is not paid before the expiration of the grace period. In such an instance this Policy can be reinstated subject to: • Our consent; and • such evidence of continued good health of the Life Assured as We may require; and • the payment of all Total Premiums in arrears together with such interest thereon as We may decide. We may vary your Benefits , charge additional Premiums or not allow You to reinstate the Policy if the health, occupation, financial position or pastimes of the Life Assured have changed. A Written proof of Total Disability (as defined in Clause 1 “Total Disability” under Section D below) acceptable to Us must be given to Us within thirty (30) days after the Life Assured becomes Totally Disabled .
PERIOD OF ASSURANCE
6
CLAIM PROCEDURE 7
BCP-NBC-05/2019
Page 4 of 11
B If You do not provide written proof satisfactory to Us within that time, the Waiting Period (as defined in Clause 6 “Waiting Period” under Section D below) may be deemed by Us to have commenced no earlier than thirty (30) days before We received written proof. C Any expense incurred in providing due proof of the existence of a claim or of income shall be borne by You . D We shall have the right and opportunity to call for an examination of the Life Assured by any Medical Practitioner or appropriately qualified health professional of Our choice at Our expense as often as We may reasonably require both during the initial assessment of a claim and during any ongoing claim. E If the Life Assured suffers personal injury or sickness which is as a result of or in any way caused by any other person or party, then We shall be entitled at Our expense and in the name of the Life Assured to take any proceedings necessary to obtain recovery from any other party. The Life Assured must provide all reasonable assistance and co-operation in the prosecution of the claim. F Responsibilities during claims assessment and while in receipt of New to Business Cover Benefits : 1. Undergo assessment of present and likely capabilities for the purposes of rehabilitation, at the expense of AIA New Zealand . 2. Follow the advice of the treating Medical Practitioner , including recommended courses of treatment and rehabilitation. 3. Co-operate with AIA New Zealand in the development and implementation of a rehabilitation plan in order to endeavour to terminate or reduce the extent of any disability, impairment or incapacity. 4. The Life Assured must notify AIA New Zealand before he or she returns to any work, paid or unpaid, in any capacity. 5. The Life Assured must advise AIA New Zealand immediately if they increase work hours. a. If any of these responsibilities are not met when reasonably required by AIA New Zealand , We have the right to either suspend claim payments or decline Your claim.
AIA New Zealand must give the Life Assured written notice of any proposed suspension not less than thirty (30) days before the proposed suspension date. AIA New Zealand may decline to provide any Benefit f o r as long as the Life Assured
b.
unreasonably fails to comply with any requirement of the terms and conditions relating to Your claim or fails to meet their responsibilities outlined above. We also have the right to recover overpayments from You , if these responsibilities are not met.
BCP-NBC-05/2019
Page 5 of 11
FORFEITURE OF PREMIUMS
8
If this Policy becomes void or is terminated under any of these conditions all Total Premiums paid shall be absolutely forfeited to Us . Unless previously terminated, this Policy and any ongoing claims shall terminate on the earliest of: A The anniversary of the Policy Commencement Date following the Life Assured attaining the age of sixty-five (65) regardless of whether a claim is being paid. B Written notification of cancellation from You to Us at any time. C The death of the Life Assured . D Non-payment of Total Premium as set out in Clause 6 “Period of Assurance” above. E The Life Assured is declared bankrupt or their business is liquidated, placed into receivership, ceases to operate or cannot pay its debts when they fall due or is deemed not to be able to pay them in accordance with Section 287 of the Companies Act 1993 unless such action has occurred as a direct result of the death or disability of the Life Assured as determined by Us at Our sole discretion.
TERMINATION
9
WORLDWIDE COVER
10
Cover under this Policy applies twenty-four (24) hours a day, anywhere in the world. If You are overseas during the period of a claim, Benefits will be paid in New Zealand currency. This Policy is the entire contract of insurance between You and AIA New Zealand . It comprises the following parts: • Your application for insurance; and • this Policy wording; and • the Policy Schedule ; and • any other written notice that AIA New Zealand gives You ; and • any written notice that You give Us . In the event of any changes in taxation after the Policy Commencement Date which affects the Benefits or Our liability, We may make such amendments or modifications to the Premium and Benefits and this Policy as We consider appropriate. This Policy does not participate in bonus distributions or acquire a cash surrender, loan or maturity value.
ENTIRE CONTRACT
11
TAX CHANGES
12
GENERAL
13 A
B Where this Policy refers to an Act of Parliament, this includes any Regulations made under it. It also includes any Act or Regulations enacted in substitution. C Your life insurance Policy is part of the AIA New Zealand Statutory Fund, effective 1 st September 2013. This is a requirement under the Insurance (Prudential Supervision) Act 2010, for policyholder protection.
BCP-NBC-05/2019
Page 6 of 11
FREE LOOK PERIOD 14
To enable You to consider the Policy in detail You will have a free look period of fourteen (14) days after You receive Your Policy document. During this period, if You decide that the Policy does not suit Your needs then You may return it to Us and receive a full refund of all Total Premiums paid and the Policy will be cancelled. Should You write to Us about this Policy , You must send the letter to Our head office in New Zealand as notified by Us to You from time to time. The postal address of AIA New Zealand’s head office is: AIA New Zealand Private Bag 300981 Albany AUCKLAND CITY 0752 The street address of AIA New Zealand’s head office is: AIA New Zealand Level 15 5-7 Byron Avenue Takapuna AUCKLAND CITY 0740
NOTICES
15
BCP-NBC-05/2019
Page 7 of 11
SECTION C - NEW TO BUSINESS COVER BENEFITS
TOTAL DISABILITY BENEFIT
1
If the Life Assured is Totally Disabled , We will pay, following the Waiting Period , the monthly Benefit for such period as the Life Assured remains Totally Disabled up to the Benefit Period (as defined in Clause 5 “Benefit Period” under Section D below) or until the Life Assured is no longer Totally Disabled , whichever is the sooner. This is a monthly Benefit payable in advance subject to receipt of a progress report completed by the Life Assured and a Medical Practitioner . Successive periods of Total Disability resulting from the same or related cause within twelve (12) months of resuming work shall be considered a continuation of the same Total Disability and no Waiting Period shall apply. Such periods of recurrent Total Disability shall be added to the original Total Disability period for the purposes of applying the Benefit Period . This option is only available to You if it is shown in the Policy Schedule . We will pay a Partial Disability Benefit if the Life Assured is Partially Disabled (as defined in Clause 2 under Section D below) and the Waiting Period has elapsed. The amount payable under this Optional Partial Disability Benefit will be a percentage of the monthly Sum Assured as shown in the Policy Schedule . The percentage is the number of hours per week that the Life Assured is able to work while Partially Disabled as a percentage of the average number of hours that the Life Assured worked in the 3 months immediately prior to becoming Totally Disabled . Calculation: % = 1 - (hours worked while Partially Disabled / hours worked on average in the three months prior to Total Disability ). For example, if the Life Assured is able to work 20 hours per week while Partially Disabled and was working 40 hours per week on average in the three (3) months immediately prior to becoming Totally Disabled then the percentage payment will be 50% of the monthly Sum Assured as shown in the Policy Schedule . To allow Us to accurately assess the ongoing validity of a Partial Disability claim, the Partial Disability benefit will be paid monthly in arrears until the Life Assured is no longer Partially Disabled .
RECURRENT DISABILITY BENEFIT
2
OPTIONAL PARTIAL DISABILITY BENEFIT
3
BCP-NBC-05/2019
Page 8 of 11
DEATH BENEFIT
4
The Death Benefit is payable if the Life Assured dies whilst receiving a New to Business Cover claim payment from Us and the Policy is inforce. The amount payable will be a lump sum amount of six (6) times the monthly Sum Assured detailed in the Policy Schedule . During a period of Total , Partial or Recurrent Disability for which a Benefit is being paid, all Total Premiums due will be waived by Us . If the Life Assured takes a period of leave without pay from his/her regularly remunerated occupation, You may elect to: A Suspend cover and the payment of Total Premiums for a maximum of twelve (12) months provided You have given Us prior notice and obtained Our approval. We will resume cover without requiring evidence of health for any insured person when the requested suspension period expires. Once cover is reinstated, Total Premiums must recommence. B We will not pay any Benefits under this Policy in respect of any event incurred while cover is suspended. C You can elect to keep Your cover in force. The annual Total Premium or instalment of the Total Premium is payable for the entire duration of the Benefit . Please note that the Premium Rates are not guaranteed and are subject to review from time to time. The Premium will be determined by the Premium Rates in effect at that time. The New to Business Cover Benefit may be renewed up to the anniversary of the Policy Commencement Date following the Life Assured attaining age sixty-five (65) as per the Policy Schedule , regardless of changes in the health or occupation of the Life Assured . You may convert Your Policy on the second and subsequent Policy Anniversary Date(s) prior to the Life Assured reaching age sixty-five (65) to an Indemnity Income Protection Policy of the same Benefit Period and Waiting Period . We will not require You or the Life Assured to produce further medical evidence at the time of conversion. The terms and conditions of the new Policy will be those which are then offered by Us to the general public.
WAIVER OF PREMIUM
5
LEAVE WITHOUT PAY
6
PREMIUM
7
RENEWAL
8
CONVERSION OPTION
9
BCP-NBC-05/2019
Page 9 of 11
EXCLUSIONS
10
No Benefits shall be paid if the Life Assured is working less than thirty (30) hours per week at the time of making a claim. No Benefits shall be paid under this Policy if the injury or sickness resulting in Total Disability directly or indirectly was caused by or resulted from: A Intentionally self-inflicted injury whether the Life Assured is sane or insane. B Participation in any Criminal Act . C Pregnancy, childbirth, abortion or miscarriage unless the Total Disability lasts for more than ninety (90) days after the end of the pregnancy, at which time the Waiting Period will commence. D Any injury, sickness, or related condition in respect of which twenty-four (24) months of the Benefit has already been paid unless the Life Assured returns to work for more than twelve (12) consecutive months. Where the Life Assured has returned to work for more than twelve (12) consecutive months all of the following conditions must be met for Us to consider a claim for the same or related condition: • The Life Assured must have ceased to be either Totally Disabled or Partially Disabled during the consecutive twelve (12) months of returning to work; and • The Life Assured must have been able to perform all of their pre-disability duties during the consecutive twelve (12) months of returning to work; and • The Life Assured must have worked the same number of hours during the consecutive twelve (12) months of returning to work that they undertook prior to the Total Disability .
BCP-NBC-05/2019
Page 10 of 11
SECTION D - NEW TO BUSINESS COVER DEFINITIONS
TOTAL DISABILITY
1
Means a period of injury or sickness commencing when the Life Assured first received advice from a Medical Practitioner for that injury or sickness provided that: A The Life Assured is under the regular and personal care of a Medical Practitioner ; and B The Life Assured’s injury or sickness is supported by clinical evidence and approved by Us ; and C The Life Assured is unable to perform at least one important income producing duty of the Life Assured's occupation and is not working in their occupation; and D Inability to perform the Life Assured's occupation is as follows: Occupation Classes 1, 2, 3 & 4 : Inability to follow one's own occupation for more than ten (10) hours per week. We will arrange assessments with an appropriately qualified health professional if this situation occurs. E The Life Assured is not working or engaged in any other occupation or business. F Totally Disabled has a corresponding meaning.
PARTIAL DISABILITY 2
Means a disability resulting from a serious injury or sickness which results in the Life Assured having returned to work in a reduced capacity. The reduction in work capacity must be as a result of the continuation of the disability. The Partial Disability must be supported by an appropriate Diagnosis from a Medical Practitioner and evidence acceptable to Us . Subject to the following conditions: The hours worked by the Life Assured per week are less than 75% of the hours worked per week in the three (3) months immediately prior to being Total Disabled ; and The Life Assured is under the regular and personal care of a Medical Practitioner , and The Life Assured is not Totally Disabled . Means the monthly Benefit , paid monthly in advance, specified in the Policy Schedule . This Benefit will not be reduced by any other income replacement Benefits being received by You in respect of the Life Assured .
A
B
BENEFIT
3
OFFSETS
4
BENEFIT PERIOD
5
Means the Benefit Period specified in the Policy Schedule .
WAITING PERIOD
6
Means the Waiting Period specified in the Policy Schedule of continuous Total Disability which must elapse from the date upon which the Life Assured first received medical advice from a Medical Practitioner in respect of that disability before the monthly Benefit becomes payable.
(INSIGHT 35.0.0 May 2019)
BCP-NBC-05/2019
Page 11 of 11
Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11Powered by FlippingBook