Technical Guide GROUP INCOME PROTECTION TECHNICAL GUIDE. People you can trust- A company you can rely on

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Technical Guide

People you can trust-

A company you can rely on

G ^ROUP I ^NCOME P ^ROTECTION T ^ECHNICAL G ^UIDE

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Omnilife Insurance Company Ltd

GPHITC14092013 Group Income Protection Technical Guide

Who are Omnilife?

Omnilife is a specialist insurer providing Group Risk benefits for employers that want to provide financial protection for their employees in the event of death or ill-health. Omnilife has more than 20 years’

experience providing innovative employee benefit solutions.

Our success is built on providing a first class service to our customers and by concentrating on a specialist product range we are able to offer highly competitive Premiums.

Omnilife is is Authorised by Prudential Regulation Authority & regulated by the Financial Conduct Authority and Prudential Regulation Authority and is fully incorporated in the UK. Omnilife has the secure backing of The Mediterranean and Gulf Insurance and Reinsurance Company (Medgulf) which is one of the leading insurance groups in the Middle East.

Technical Guide

This Technical Guide is an important document which compliments the issued quotation. You should keep your guide and quotation in a safe place in the event of a future claim or query.

Your quotation gives you an illustration of the main costs and benefits of your Policy. The Technical Guide outlines the main features and attaching conditions.

This Technical Guide does not set out, or override, the detailed terms and conditions of your policy. These are included in our Policy Conditions.

If you would like to find out more about Omnilife Insurance Company Ltd or have any queries in relation to this guide, please contact us at marketing@omnilife.co.uk and a friendly sales executive will be in touch.

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Group Income Protection Technical Guide

Contents

Page

Its Aims 1

Your Commitment 1

Risk Factors 1

How the Policy works 1

1.0 Factors to consider when deciding which benefits to provide 2

^1.1 Who can be covered 2

^1.2 Termination of cover 3

^1.3 Types of cover available 3

^1.3.1 Cover for Employees 4

^1.3.2 Cover for Partners 4

^1.4 Supplementary benefits 4

^1.5 Definition of incapacity 4

^1.6 Benefit commencement 5

^1.7 Benefit payment periods 5

^1.8 Inflation protection 5

2.0 Setting up the scheme ⁵

^2.1 Requirements for scheme set-up 5

^2.2 Evidence of health to be provided before members are covered 5

^2.3 Claims occurring during the underwriting period 5

3.0 Cost of cover ⁶

^3.1 Premium calculations 6

^3.2 Additional Premiums 6

^3.3

3.4

Commission

Discounts for good claims’ experience

6 6

4.0 Scheme accounting ⁷

^4.1 Information required for accounting purposes 7

^4.2

4.3

Adjustments for members who join, leave or have benefit increases during the year

Cancelled Schemes

7

8

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5.0 Claiming Benefits ⁸

5.1 The claim assessment process 8

^5.2 Benefit payments 8

^5.3 Employer’s lump sum 8

5.4

5.5

Linked claims

Proportionate benefit

8 9

6.0 What is not covered ⁹

7.0 Overseas Cover ⁹

8.0 Taxation Considerations ⁹

8.1 Income benefit schemes for employees 9

8.2 Income benefit schemes for partnerships 9

8.3 Employer’s lump sum 9

9.0 Glossary ¹⁰

Further information ¹⁵

Questions and complaints ¹⁵

Compensation Law

15 15

This technical guide is based on the ‘best practice’ standard format recommended by the Group Risk Insurance Development Group (GRID) and Association of British Insurers (ABI).

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Omnilife Insurance Company Ltd Page 1 of 14

GPHITG0122013 Group Income Protection Technical Guide

Its Aims

The aim of this Income Protection Policy is to provide a regular income to you in the event that a member of the scheme is unable to work and suffering loss of earnings by reason of illness or injury. Additional costs such as pension scheme and national insurance contributions may also be covered.

The Policy may also provide a proportionate replacement income to support a member’s loss of earnings if, by reason of illness or injury, a member has to take a role with reduced earnings.

Your Commitment

 To provide us with complete and accurate information that we request when you apply for your Policy; at each Anniversary Date and to advise us if this information changes.

 To make all Premiums as required in the Scheme Invoice as they fall due.

 To comply with all of the Policy Terms and Conditions.

 To notify us of potential claims as soon as possible, but in any event within six weeks of any illness or injury preventing a member from working.

 To provide us with complete and accurate information that we request when you make a claim and to advise us if this information changes.

 To notify us promptly of any changes to the companies participating in the scheme and the relationships between them.

 To notify us promptly if there are any changes to the nature of the business of the companies participating and of any changes in their location (including postcode information).

 To agree at outset the Eligibility Conditions that governs the scheme membership.

 To notify us promptly of any Discretionary Entrants.

 To notify us promptly of any Members’ Aggregate Benefits that exceed the Free Cover Level

Risk Factors

 Cover will cease upon failure to comply with the Policy terms or if Premiums are not paid when they are due. However, Premiums are not payable in respect of any claimant who is receiving benefits under the Policy.

 We may decline claims if you do not fulfil Your Commitments

 The Premium Rates for Schemes with more than 20 employees are normally guaranteed for two years, however these rates will become reviewable should the total number of lives or total sum insured change by 25 per cent or more before the end of the normal rate guarantee period.

 If there is a change made to the Scheme Benefit Rules or the agreed Eligibility Conditions we may also review the Premium Rates.

 Payment of Scheme Benefits may be delayed or declined if we are not notified of a claim within the specified time limits.

 Benefits under the Policy may be reduced if a claimant is receiving other regular income as a result of incapacity.

 Receipt of Scheme Benefits under the Policy may disqualify a claimant from some State benefits.

 Scheme Benefits that require Underwriting may be subject to special terms or exclusions.

 Specific terms and conditions that apply to a Policy that forms part of the quotation will usually be guaranteed for three months only.

 We reserve the right to cancel or amend the Policy if the number of members falls below two.

How the Policy works

 This Policy is a contract between us, the insurer and you, the insured. In exchange for you paying the Premium and following the Policy Terms and Conditions, we will provide cover to the Members.

If a Member has a claim that meets the Policy Terms and Conditions, then we will pay the Scheme Benefit to the Policyholder.

 You decide the eligibility criteria for your Policy, the amount of benefit employees are covered for, how soon and for how long benefits will be paid.

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 You must include all eligible employees in the scheme when they first become eligible.

 If you choose benefits that are payable for a limited period you can also choose for a lump sum payment to be paid at the end of the limited period if a claimant remains incapacitated.

 We will provide cover whilst the Policy is in force irrespective of the number of claims that are made.

 You notify us as soon as possible and in any event within six weeks of an illness or incapacity preventing a member from working to avoid any delay or deferral of benefit payment.

 You and the members concerned must provide us with all relevant information we need to assess and monitor the validity of a claim.

 We pay benefits monthly in arrears from the end of the chosen deferred period and for as long as the claim remains valid.

 We pay the monthly benefit to you and the appropriate benefit should be paid to the member after deduction of tax and national insurance contributions.

 You can select to pay Premiums for the Policy on a monthly, quarterly or annual basis.

 You must pay all the Premiums due to keep the Policy in force.

1.0 Factors to consider when deciding which benefits to provide

 The benefit promises you have made

 Whether you wish to limit the member’s benefit

 Whether all members will have the same level of cover or whether you require different levels of cover for different categories of employees

 Your budget

We offer a comprehensive range of standard and flexible options which can help you to design the most appropriate level of cover to fulfil your company’s objectives and cost constraints.

1.1 Who can be covered

Employees can be covered for the Policy benefits once they become Members of the Scheme and have met the agreed Eligibility Conditions. The eligibility must be clear and agreed with us before cover can commence.

Everyone who satisfies the Eligibility Conditions and Actively at Work requirements must be included in the Policy automatically.

Eligibility

The eligibility criteria will be agreed prior to cover commencing and will include:

 minimum and maximum ages for scheme entry

 the Cease Age at which cover expires

 any service qualification applicable

 Scheme Benefit Categories if more than one category of Members is to be included. For example, Scheme Benefit Category 1: Directors;

and Scheme Benefit Category 2: All other Employees.

 When new entrants may join the scheme. For example, monthly, daily or annual entry.

In light of Age Regulations attention should be paid to any eligibility criteria linked to age or service.

Membership is compulsory for all employees who satisfy the eligibility criteria and meet the Actively at Work requirement.

The conditions for when an employee can join, entry dates and entry ages, must be the same for each employee within each Scheme Benefit Category.

Permanent full-time and part-time employees can be covered. Fixed term contract workers may be covered for a period no longer than the expiry date of their fixed term contract.

If eligibility is linked to pension scheme membership we need to know the eligibility conditions for joining the pension scheme. If a member does not join the pension scheme within six months of first becoming eligible to do so, evidence of health will be required before we will provide cover.

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‘Actively at Work’

Actively at Work means that an employee has not received medical advice to refrain from work and is not only present at their place of work on the prescribed day, but is mentally and physically capable of discharging fully the normal regular duties associated with the job for which they are employed and working their normal contracted number of hours, either at their normal place of business or at a location to which the business requires them to travel.

New Schemes

Any employee who is to be included in the policy on the commencement date must satisfy the Actively at Work requirements on that date of joining.

For new schemes with less than 20 members if an employee is absent from work on the commencement date for reasons of ill health or incapacity, cover will commence once they have completed continuous working period of five consecutive days or provide such evidence of insurability as we may require.

For new schemes with 20 or more members anyone joining the scheme must be actively at work on the date cover commences. For anyone not meeting this requirement cover will commence when they are next actively at work.

Existing Insured Schemes

When cover is switched to us from another insurer on the same basis as previously insured a member must be Actively at Work on the day before we assume risk for the scheme. For anyone not meeting this requirement cover will commence once they have completed a continuous working period of five consecutive days or provide such evidence of insurability as we may require.

Increases in sum insured & basis enhancements

A member must be Actively at Work on the working day an increase in cover or a basis enhancement (e.g.

deferred period reduces from 26 to 13 weeks) comes into force.

If a member is not Actively at Work on the date of an increase in cover or basis enhancement on account of ill health or incapacity, cover will commence on the day they complete a continuous working period of five consecutive days or provide such evidence of insurability as we may require.

Reducing to immediately upon return to active employment if the scheme is 20 lives or over.

Should any other Actively at Work conditions be applied to a scheme these will be detailed in our quotation.

1.2 Termination of cover

i) Under Normal Circumstances

Member cover will normally cease on the earlier of:

 A member reaching the Scheme Cease Age

 A member leaving service

 A member no longer satisfying the eligibility criteria

 A member’s contract of employment ending

 On payment of the lump sum where a limited benefit option was selected

 The death of a member

 Cover will also cease when the scheme ends.

ii) Cancellation of the Scheme by Omnilife

We cannot cancel the policy unless you fail to follow to the Policy Terms and Conditions. For example;

 You fail to pay any Premiums due within a reasonable timescale required by Omnilife

 You fail to comply with any reasonable request to provide information

iii) Cancelling the scheme

You can end the scheme at any time provided that:

 Notification is given in writing

Cover will then cease and you will not be liable for Premiums for any period after that date.

Cancellation cannot be backdated.

We will continue to pay any claims that were in payment prior to the date of cancellation and will pay any valid claims where incapacity commenced prior to the date the Policy was cancelled.

1.3 Types of cover available

You decide the type and amount of basic income benefit for your employees. In addition, you should also decide if a State benefit deduction should be taken from the basic income benefit.

The maximum amount of basic income benefit we will normally insure is:

 Up to 75% of salary

 Up to an overall maximum of £250,000 per annum.

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In addition to the basic income benefit you can also insure supplementary benefits such as pension scheme contributions and/or your national insurance contributions.

1.3.1 Cover for employees

Option 1: No State benefits deduction

Here the basic income benefit is calculated on a percentage of the member’s salary as above. No deduction is made for state benefits.

Option 2: State benefits are deducted

With this option we will deduct a fixed amount from the basic income benefit in respect of State benefits available.

For the purpose of this option, State benefits can be:

 basic rate only

 basic rate plus the support component

 basic rate plus the work-related activity component

 or, a notional deduction (with prior agreement by Omnilife)

Option 3: Fully integrated option

The basic income benefit payable under this option is the percentage of normal salary you have selected minus any State benefits payable as a result of incapacity to which the employee may be entitled.

 To select this option a scheme must have at least 30 members

 The maximum benefit available under this option is 75% of salary minus the relevant State benefits

 A minimum deferred period of 26 weeks applies

 The maximum terminal age is 65 or the State Pension Age if higher (subject to a maximum State Pension Age of 68)

1.3.2 Cover for partners

A different maximum benefit applies in respect of Equity Partners or members of a limited liability partnership due to different taxation rules.

The maximum basic income benefit we will normally insure is 50% of the average net taxable earnings received in the last three years to a maximum of £250,000 per annum.

1.4 Supplementary benefits

i) Pension scheme contributions

In addition to the basic income benefit we pay, you can insure the normal contributions to a pension scheme of any employee.

The maximum amount we will pay in respect of Employer contributions is 35% of the employee’s normal salary and in respect of Employee contributions is 6% of normal salary, subject to an overall maximum of £50,000

ii) National insurance contributions

You can also insure employer national insurance contributions payable in relation to the basic income benefit.

iii) Lump sum option (Employee Schemes only)

For schemes of at least 20 members and insured on a limited term basis you can also opt for a lump sum to be paid on expiry of the limited payment period.

The amount of the lump sum may be a multiple of salary or a multiple of the benefit payable, and will be subject to the lower of:

 £250,000

 Five times annual salary

 The member’s monthly amount of basic income (excluding any supplementary benefits) multiplied by the complete months from the end of the limited period to the earliest of the following dates:

 when the member’s contract of employment expires

 the date the member reaches their normal State Pension Age or Scheme Cease Age if earlier

1.5 Definition of incapacity

In most cases Omnilife will apply a standard definition of incapacity. The definition of incapacity applicable to your scheme will be shown on the quotation and confirmed in the Policy document.

‘Standard’ definition

A member is incapacitated if at the end of the deferred period he or she is totally unable by reason of illness or injury to perform the material and substantial duties of his or her normal occupation and is not following any other gainful occupation, whether as an employee or otherwise.

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‘Standard or suited’ definition

A member is incapacitated if at the end of the deferred period he or she is totally unable by reason of illness or injury to perform the material and substantial duties of his or her normal occupation, or any other occupations for which he or she is reasonably suited by reasons of training, education or experience, and is not following any other gainful occupation whether as an employee or otherwise.

‘Standard definition switching to suited after 2 years’

For the first 24 months a claim will be paid if the member meets the ‘standard’ definition. At the end of 24 months benefits will only continue if the member meets the

‘standard or suited’ definition of incapacity.

1.6 Benefit commencement

Benefit payments will start at the end of the deferred period and are payable monthly in arrears at the end of each calendar month during periods of continuous incapacity.

The deferred period is the period of time following the claimant first being unable to work due to illness or injury and is defined as, ‘the period of incapacity before any benefit is paid’.

If we are notified of a claim after the end of the deferred period we reserve the right to commence the deferred period from the date we are notified of the incapacity.

The standard deferred periods available are 13, 26, 28, 39, 41 and 52 weeks. The minimum deferred period under the Fully Integrated option is 26 weeks.

The deferred period is normally a period of continuous absence however there may be times when the deferred period is punctuated. In these circumstances and provided that the cause of illness or injury is from the same underlying cause as that when the member first became incapacitated, periods of absence may be treated as a ‘Linked Claim’.

1.7 Benefit Payment Periods

Income benefits will be paid to a member suffering incapacity provided they satisfy the definition of incapacity until they reach the Scheme Cease Age as specified by you, or, in the case of a limited payment term option, until the end of the limited payment period.

In the case of the limited payment option which can be two, three, four or five years, periods of incapacity arising from the same underlying cause are added together and benefits will cease when payments have been made for the maximum term chosen. Where the lump sum option has been selected this will be paid at the end of the limited payment period provided the claimant satisfies the relevant definition of incapacity.

Benefits will also cease on the earlier of

 death of the member

 Where the member leaves the service of the employer or reaches the end of their contract of employment

 Ceases to be a member of the scheme

1.8 Inflation protection

You can choose whether benefits in payment remain level or for them to increase annually at rates of 2.5%, 3% or 5% or alternatively, limited to the Retail Prices Index subject to a maximum of 5%.

2.0 Setting Up The Scheme

We prepare your quotation based upon a specification provided by your intermediary. The specification will detail the Scheme eligibility, benefit options and membership data, together with claims history for the last five years or such shorter period the Scheme may have been insured along with any Underwriting decisions.

The quotation terms will usually be guaranteed for three months.

If the inception data differs by more than 10% over the quotation data, we may need to issue a new quotation, which may result in a change of cost and our requirements.

2.1 Requirements for scheme set-up

You must contact us before the date you want cover to commence and before the quotation expiry date, which is normally three months. To provide cover we will require:

 A fully completed application form

 A deposit Premium or completed standing order form

 Completed Actively at Work and/or continuation of cover declarations

 Complete and accurate Membership data at the start date

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 Details of any member with benefits in excess of the Free Cover Level

 Evidence of a contractual employment extension for any member working beyond the scheme’s cease Age

 Any other requirements we have asked for in our covering letter confirming risk

Premiums will normally be paid annually in advance by cheque payable to Omnilife Insurance Company Limited or by electronic funds transfer. Quarterly payments will be administered in the same way. However, monthly payments will require a standing order.

Cover for your Scheme will cease if the above is not provided within 30 days of the start date.

2.2 Evidence of health to be provided before members are covered

Our quotation will provide a Free Cover Level. This is the total amount of cover we will provide on standard terms for a member before underwriting is required.

If a member has cover equal to or below the Free Cover Level and provided an employee satisfies the rules for joining the scheme and satisfies our Actively at Work requirement then no further evidence of health is required.

If the member has cover above the Free Cover Level then additional evidence of health will be required. Initially the member will be asked to complete an employee health declaration. On receipt of this we may require further medical evidence which could involve applying to the member’s own doctor for a report, medical examination or other medical tests.

Once we have completed the medical underwriting process this may result in additional Premiums being charged or exclusions being applied to that part of the member’s benefit in excess of the Free Cover Level. In some cases we may be unable to provide cover for that part of the benefit in excess of the Free Cover Level.

If the Free Cover Level increases we will not automatically enhance the Free Cover Level applicable to a member who has provided evidence of insurability or who has had their benefit restricted to a previous Free Cover Level.

Discretionary entrants (ie an employee who does not satisfy the normal rules for joining the scheme) will be subject to evidence of good health and cover will be at our discretion. Initially the employee will be required to complete an employee health declaration but further medical evidence may be required.

2.3 Claims occurring during the underwriting period

From the date they are first covered, a member whose total benefit exceeds the Free Cover Level has up to 60 days to complete the medical underwriting process.

During this time we will insure the member for their full benefit, provided they have not previously been declined by us or another insurer. However, that part of the benefit in excess of the Free Cover Level will be subject to a pre-existing conditions exclusion. Claims will be subject to any other underwriting restrictions we may specify

3.0 Cost of cover

The calculated Premium depends on the scheme design and the level of benefits provided. The information used to determine Premiums include:

 Level of cover; the insured level of income benefits to be provided

 Benefit payment period selected

 Eligibility and entry conditions

 Benefit increase option selected

 Age and gender profile of employees covered

 Occupation of employees covered

 Location of the workforce

 Claims history (for previously insured schemes)

 Payment frequency

The minimum annual Premium applicable to a scheme is currently £500.

Premiums are usually paid annually in advance but other payment frequencies are possible subject to an additional charge.

All Premium payments must be paid in sterling or other such currency as agreed in writing by Omnilife.

3.1 Premium calculations

(a) Schemes covering 2 to 19 employees Single Premium costed schemes

Premiums are calculated for each member based on the Premium rates current at the commencement of the scheme.

With single Premium costed schemes the Premium for each member is calculated each scheme year based on the member’s age and applicable Premium rate at the start of that year.

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If the number of members increases to 20 or more, the scheme may be administered and costed on a Unit Rate basis as detailed below.

(b) Schemes with 20 or more employees Unit rate schemes

Member’s Premiums are prepared as those for single Premium costed schemes however these are then aggregated in order to provide a unit rate normally expressed as a percentage of the scheme total salary roll.

If the number of members decreases to less than 20 we may administer the scheme on a Single Premium basis as set out above.

3.2 Additional premiums

If the information provided by you to Omnilife used to calculate the Premiums is incomplete or incorrect this could mean you are not paying the correct Premium.

Additional Premiums may be charged for:

 members medically underwritten and for whom special terms apply to that part of benefit in excess of the Free Cover Level.

 discretionary entrants

You will be notified of any increase in the Premiums and the date from when they will be payable.

3.3 Commission

The rate of commission payable to your financial adviser is shown on the front of our quotation. The Premium shown includes the level of commission payable.

3.4 Discounts for good claims’

experience

The claims experience is one of the factors we use to calculate the final Premium and good experience will usually be reflected in the final Premium charged.

4.0 Scheme accounting

The Policy usually operates on one year accounting periods.

At each Anniversary Date and Premium review date we need new complete and accurate data in order to charge the correct Premium. Until we receive this data we will charge approximate Premiums. Once accounts have been finalised we will advise you of what arrears are due, or if you have overpaid, we will make a refund to you.

4.1 Information required for accounting purposes

A full list of all employees in the scheme is required at the start and end of each Policy year. The list must show:

 name;

 gender;

 date of birth;

 salary;

 post code of member’s work location;

 scheme category (if more than one category of membership)

 date of joining scheme (if a new member)

 date of leaving scheme (if applicable)

 It is also necessary to advise us if a member’s benefit exceeds the Free Cover Level during the scheme year and of any member who is temporarily absent from work.

4.2 Adjustments for members who join, leave or have benefit increases during the year

(a) Single Premium cost schemes

At each annual revision date we will calculate a Premium adjustment for the amount and duration of the cover actually provided since the last annual revision date (or commencement date if later).

(b) Unit rate schemes

At each annual revision date we will calculate a Premium adjustment to allow for any increases or decreases in salaries or membership since the last annual revision date (or commencement date if later). What this means is that we assume all changes occurred halfway through the Policy year.

If there is any change to the

 Scheme Benefit Rules

 Eligibility Conditions

 Scheme Benefit Categories

 Legislative or Tax regime

 Unit rate applicable

During that period, we will calculate adjustments for the periods before and after the change took effect.

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4.3 Cancelled schemes

A final account will be produced based on the cover provided up to the date you cancelled the Policy and either a refund will be paid or any outstanding Premiums requested.

5.0 Claiming benefits

We aim to make the claim process as simple as possible and would normally request that the Policyholder contact the policy Intermediary.

Claims should be notified to Omnilife not less than six weeks before the end of the Policy Deferred Period.

5.1 The Claim assessment process

The Policyholder must provide us with full documents and information required to process the claim. This will usually include

 An original fully completed Policyholder claim form

 An original fully completed Member claim form Additional evidence may also be required at outset to validate the claim and at any periodic future claim reviews required by Omnilife.

Omnilife will not pay any claims where completed claim documentation is not received within six months after the end of the scheme deferred period.

Once all the required documentation and reports have been received, Omnilife will aim to process this claim within five working days.

It may be necessary to request further information to assess the claim. This may include

 A specialist to conduct an independent medical examination

 Additional investigations to be undertaken

 Any medical reports or additional information provided by you or the member

If we cannot consider the claim, we will initially call and explain the rationale for the decision. We will then follow this up in writing.

5.2 Benefit payments

The benefits payable under the policy will be paid by Omnilife to the Policyholder in UK currency.

The benefit is payable monthly in arrears after the deferred period. Any part-month outstanding at the end of the claim payment period will be paid on a daily basis based on 1/30^th of the monthly benefit.

Benefits will continue until the end of the benefit payment period.

5.3 Employer’s lump sum

If the Policy includes an employer’s lump sum, this becomes payable at the end of the limited income period provided that the member:

 has qualified for benefits continuously throughout the limited income period; and

 satisfies the incapacity definition at the end of the limited income period; and

 has not refused treatment or refused to participate in any rehabilitation programme.

A final medical review will be undertaken prior to the end of the limited income period to determine if the member satisfies the incapacity definition at that point.

Once the Employer’s lump sum has been paid, the member’s benefits will cease and no further benefits will be payable.

5.4 Linked Claims

A claim will be treated as a ‘linked claim’ if the member suffers a repeat of incapacity provided that

 the incapacity was from the same underlying cause; and

 the incapacity occurred within one year after the member’ benefits have stopped; and

 the incapacity period has lasted for a minimum of 30 consecutive days.

Under Linked Claims, no further deferred period is applicable.

If a member wishes a claim to be treated as linked, Omnilife need to be informed immediately once any new period of incapacity has lasted for two consecutive weeks.

For claims that are treated as not linked, a member will have to complete a new deferred period before any further benefit becomes payable.

5.5 Proportionate benefit

Where a member returns to work in a reduced capacity which results in lower earnings, a proportionate benefit may be payable.

The proportionate benefit is based on the reduction in gross earnings as applied to the income benefit. For example, if the gross earnings are reduced by 50%, then the gross benefit payable is reduced by 50%.

The proportionate benefit is only payable where the standard definition of incapacity applies and is subject to regular review including allowance for cost of living increases.

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6.0 What is not covered

There are no specific exclusions in the policy however, as a general point of law, no benefit can be payable that arises directly or indirectly from a Member’s own illegal or criminal act.

If we agree to provide cover in special circumstances where Underwriting has been required. This will be detailed in the quotation on a case by case basis.

7.0 Overseas Cover

Employees who are seconded or working abroad or whose position requires them to travel outside the United Kingdom may be covered under the Policy provided Omnilife has agreed to do so in writing and all information we may have requested has been provided to us.

Cover for such employees will be subject to:

 Meeting the eligibility conditions of the scheme

 The employee has a contract of employment with a UK registered company covered under the policy

 The employee is declared in the membership data and premiums being paid in respect of their cover

 All premiums must be paid in UK Sterling by the UK employer.

The nationality of the employee and countries worked in must be declared at the commencement of cover and each rate review. We will require full details of the type of work the employee undertakes and the period of time employment is outside the UK.

Prior to the commencement date of the policy we will advise in writing for how long claim payments will be paid whilst the member resides outside the UK.

In all cases we require satisfactory medical evidence (in English) to support a claim and any member seconded overseas may be required to return to the UK in order for us to obtain this.

In the event of a claim, benefit payments for those who are seconded or working abroad will be made in UK sterling to a UK bank account of the UK employer.

8.0 Taxation Considerations

Omnilife would recommend seeking financial advice as rules can be complex; require understanding relating to specific circumstances of the Policyholder; require discussion with your local Tax inspector and rules are subject to change.

The following does not constitute tax or financial planning advice but represents Omnilife’s current understanding of the treatment of Premiums and benefits.

8.1 Income benefit schemes for employees

Premiums paid by the Policyholder are usually treated as a business expense.

However, this relief is not usually available in respect of any members who have a proprietorial interest in the company.

Premiums are not treated as a P11D benefit for employees.

Policy benefits are treated as business income though when passed onto the member as salary should be treated as a business expenses and therefore the overall tax position should be neutral.

Benefits paid to the member are subject to income tax.

8.2 Income benefit schemes for partnerships

Premiums in respect of partnership partners are not treated as a business expense.

Partnership benefits will usually be payable to the partnership on trust for payment to the partner. As such, the benefits paid to partnership partners are not subject to income tax.

8.3 Employer’s lump sum

The tax treatment of the premiums and benefits will depend on a number of factors including whether employees have a contractual right or expectation to the benefit.

Generally, the premiums are treated as a business expense and are usually treated as a P11D benefit for employees.

The lump sum is treated as a business income though when passed onto the member as salary should be treated as a business expenses and therefore the overall tax position should be neutral.

Benefits paid tothe member are subject to income tax if it is not as a result of terminating the contract.

If the payment is due to termination of the contract the employee may not be subject to income tax on account of incapacity or redundancy (limits apply).

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9.0 Glossary

In this guide, when we refer to ‘we’, ‘us’ or ‘our’ we mean Omnilife Insurance Company Limited.

When we refer to ‘you’ or ‘your’, we mean the trustees of the Scheme as detailed in the Policy.

Some terms have specific meanings and are referenced by capital letters in your Policy literature. These terms are listed below in alphabetical order together with their meanings. The singular is deemed to include the plural where relevant.

Aggregate Benefit

The total benefits payable from all policies insured by us including any Lump Sum Benefit.

Anniversary Date

The annual anniversary of the Commencement Date of the Policy.

Benefit

See ‘Scheme Benefit’.

Benefit Payment Period

The maximum period of time during incapacity for which the Scheme Benefit is paid and starts the day after the end of the deferred period. The period may be limited to two, three, four or five years or continue to the Scheme Cease Age.

Cease Age

The age agreed between us as being the age at which cover for a member expires as set out in your quotation. The maximum age must not exceed a member’s 70th birthday.

Commencement Date

The Policy start date as shown in the Schedule.

Deferred Period

An initial period of continuous incapacity when the Member is first unable to work before any benefit is paid.

The standard deferred periods available are 13, 26, 28, 39, 41 and 52 weeks. The minimum deferred period under the Fully Integrated option is 26 weeks.

The period starts on the first day that the member is unable to work due to that incapacity.

We do not pay any income benefit during the deferred period.

Discretionary Benefit

A benefit you want us to provide for a member that is larger or smaller than the normal scheme benefit, for which the member would be eligible.

Discretionary Entrant

An individual who does not meet the scheme eligibility criteria but who you wish to include in the Policy.

Eligible Employee

Anyone that meets the eligibility rules of the scheme and thereby inclusion in the Policy.

Eligibility Conditions

These refer to the Eligibility Conditions shown in the Policy Schedule.

Employee Entry Date

The first date on which an employee becomes eligible for membership of the Scheme.

Employer

The Principal Employer and any Associated Employers shown in the Policy Schedule.

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Employer’s Lump Sum

A lump sum benefit payable in respect of a Member’s continued incapacity after the end of a limited period of time (either two, three, four or five years) assuming the member satisfies the definition of incapacity you have agreed with us.

The employer’s lump sum option is not available for partnership partners or members of limited liability partnerships.

Endorsement

A legal amendment to the terms and conditions of the Policy usually due to Underwriting or due to a request of the Policyholder usually for a change in Scheme Benefits and/or Members.

Escalation Rate

The rate at which Scheme Benefit increases each year. The increases will be effective on the annual anniversary of the start of the payment of the Scheme Benefit.

Evidence of Insurability

Additional documentary or medical evidence that we may reasonably require to include someone in the Policy.

Free Cover Level

This is the total amount of cover we will provide on standard terms and without the need for evidence of insurability before underwriting is required.

Head Office

24 Chiswell Street, London EC1Y 4TY, England.

Insured Benefit

The total benefit or benefits for which the member has been included in the Policy.

Late Entrant

A member who joins the Scheme after the Employee Entry Date.

Linked Claims

A repeat claim where a subsequent deferred period is not applicable.

A claim can be treated as linked if:

 A member suffers a repeat of incapacity; and

 the incapacity was from the same underlying cause; and

 the incapacity occurred within one year after the member’ benefits have stopped; and

 the incapacity period has lasted for a minimum of 30 consecutive days.

The Linked Claim period commences on the first day of a return to work and will be effective for twelve months.

If a member wishes a claim to be treated as linked, Omnilife need to be informed immediately once any new period of incapacity has lasted for two consecutive weeks.

For claims that are treated as not linked, a member will have to complete a new deferred period before any further benefit becomes payable.

Lump Sum Benefit

This is a Scheme Benefit that is paid as single one-off payment.

Member

An employee who has been admitted to membership of the scheme and so included in the Policy.

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Membership Declaration

The form which is used to provide us with details of the cover required for specific members and which an Employer completes when a scheme is set up.

Normal Entrant

An eligible person who you include in the scheme on the first day they meet the normal entry conditions and for the normal scheme benefit under the rules of the scheme.

Policy

The legal contract between us, the insurer and you, the insured. The Policy is effective from the Commencement Date until the Termination Date inclusive.

It comprises the Policy Terms and Conditions, which set out the standard terms of the contract and also includes the Policy Schedule and Scheme Invoice.

Policyholder

The insured party named as the Policyholder in the Policy Schedule.

Policy Year

Any 12-month period running from the Commencement Date of the Policy up to the day preceding the Anniversary Date inclusive.

Policy Schedule

The Policy Schedule provides a summary of the key financial terms and cover provided by the Policy. It forms part of the legal contract.

Premium

The amount payable to provide insurance cover under the Policy. The cost of the Policy will be determined by the Premium Rate and the level of Scheme Benefits. The Premium will be shown on the Scheme Invoice and will be payable in the currency of the UK.

Premium Rate

The rate shown in the Policy Schedule used to determine the cost of cover.

Quotation

The quotation provides the rate and key terms and conditions applicable for your Scheme and is based on, amongst other things, scheme eligibility, benefit options, membership profile and claims history along with any underwriting decisions.

The Quotation will usually be guaranteed for three months unless stated otherwise.

Rate Guarantee Period

This refers to the period at which the Premium Rate is guaranteed not to change. For schemes with 20 or more members and priced on a unit rate basis, the Premium Rate is usually guaranteed for the first two Policy Years.

Renewal Date

The date which the Policy will need to be renewed for cover to remain in place. This usually occurs on each Anniversary Date but may differ if the Scheme has a partial first year.

Rules of the Scheme

The Scheme rules governing Benefits, Eligibility, Beneficiaries and Dates as shown in the Policy Schedule, the Policy Conditions and any Endorsements to the Policy.

Scheme

The Scheme set up to pay the benefits promised under the scheme to employees.

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Scheme Benefit

The benefit or benefits set out in your quotation which represents the amount payable to an individual Member in the event of a valid claim. The amount of cover will be determined in accordance with the Scheme’s Benefit Rules.

Scheme Benefit Categories

Members with the same Scheme Benefit Rules will fall under one Scheme Benefit Category. Where Scheme Benefit Rules differ across members for example due to grade, additional Scheme Benefit Categories will be required.

Scheme Benefit Rules

The rules for determining the Scheme Benefits for each member. These are usually in line with the Rules of the Scheme and will depend upon, amongst other things, how base salary and pension benefits are defined.

Scheme Invoice

The Scheme Invoice specifies the cost of the Policy and method of payment. It forms part of the legal contract.

State Pensionable Age (SPA)

The earliest age at which the member can start to receive the UK State pension, as defined in paragraph 1, schedule 4 of the Pensions Act 1995.

Statutory Leave

Any statutory leave taken from active employment because of maternity, adoption or paternity.

Termination Date

The date on which cover under the Policy ceases.

Underwriting

The process whereby evidence of insurability is obtained and assessed.

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Further Information

Group Life Assurance policies are issued by Omnilife Insurance Company Ltd whose office is incorporated in the United Kingdom. Registered number 2294080. The office address is:

Omnilife Insurance Company Ltd 24 Chiswell Street

LONDON EC4Y 4YT

Phone: 0207 374 0123

Email: marketing@omnilife.co.uk

Questions and Complaints

If you have any questions or wish to make a complaint about your Policy, you should first speak to the financial adviser who arranged it for you.

If you then still need to speak to us, you should send the details of your question or complaint to the address above.

Omnilife Insurance Company Ltd 24 Chiswell Street

LONDON EC4Y 4YT

Phone: 0207 374 0123

Email: marketing@omnilife.co.uk

If we cannot settle a complaint you may be able to refer it to:

Financial Ombudsman Service South Quay Plaza

183 Marsh Wall London E14 9SR

Phone: 0845 080 1800

Email: complaint.info@financial-ombudsman.org.uk Website: www.financial-ombudsman.org.uk

Making a complaint will not affect your right to take legal action.

Compensation

If we cannot meet our liabilities, you may be entitled to compensation under the Financial Services Compensation Scheme.

Further information is available from the Financial Services Compensation Scheme.

Law

The construction, validity and performance of the Policy will be governed by the Law of England and Wales.

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