> Enhancements will not be passed back to built-in benefit
1. What are your policy benefits?
sections and/or conditions that have subsequently become optional benefits within an appendix or no longer exist.
Your Sovereign TotalCare Max policy can provide financial assistance in the event of death, disability, redundancy, a critical condition or if a life assured incurs specialist or diagnostic testing expenses. Details of the benefits you have chosen and the names of the people insured for the benefits (called the life or lives assured) are shown in the schedule . The terms of your benefits are contained in the relevant appendix . Sovereign will pay all benefits to the policy owner, to the Registered Medical Practitioner ( health benefits only), or to the policy owner’s estate. If more than one person owns the policy then Sovereign will pay all benefits to the policy owners jointly or as they jointly direct, to the Registered Medical Practitioner or facility ( health benefits only) or to the survivor(s) of the policy owners. Your cover starts on the risk commencement date .
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 .
Benefit indexation type (Applicable to non-health benefits only)
Your policy contains options on the type of cover, and premium types and guarantees which are detailed below.
Level cover (specified in the schedule as Level)
If there is any inconsistency between these terms and your appendix , then the appendix will prevail.
The amount of cover under the relevant benefit will remain constant. Inflation cover (specified in the schedule as CPI Linked) The amount of cover under the relevant benefit will increase on each anniversary date , by the same percentage as the percentage increase in the consumer price index for the preceding year ending 30 September. If the consumer price index falls in any year, the inflation-linked benefit amounts will not decrease. You can write to Sovereign if you do not want the amount of cover under the relevant benefits to be increased for a particular year. Voluntary alterations to cover You may apply to Sovereign in writing to increase or reduce the amount of cover for existing benefits, or add other benefits to the policy. Sovereign 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 Sovereign’s usual requirements for those benefits. Any increase or reduction in cover will start from the next premium due date after Sovereign accepts your application.
2. Guaranteed Enhancement Benefit
If at any time in the future, we make a change to a section and/or condition within a section of our Sovereign TotalCare Max policy and the change is favourable to you , the enhanced section and/or condition will automatically be applied to this policy, subject to the following: > At claim time Sovereign will compare the enhanced section and/or condition in the latest version of Sovereign TotalCare Max with this policy and will apply the section and/or condition that is most favourable to you . Sovereign will not apply changes to sections and/or conditions set out in earlier versions of Sovereign TotalCare Max 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 not be passed back.
4. Your premiums
Premium
> To ensure your policy remains in force you must pay the premium on a regular basis as agreed with Sovereign.
800 TC-UMB Version 9 Effective 06 March 2017
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