Group Critical Illness - ntu-mychoice.co.uk€¦ · Standard Group Critical Illness Unum’s standard Group Critical Illness policy is available to employees, working directors and

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IDE Group Critical Illness

Because everyone needs a back-up plan

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Product Overview

This guide explains the main features of our Group Critical Illness (GCI) product. Please note that Unum’s Group Critical Illness policy is only available through authorised intermediaries.

GCI

• provides a tax-free lump sum direct to a member of the policy if they are diagnosed with a critical illness or undergo a surgical procedure that is covered by our policy and meets our policy definition. The lump sum can be used as the member sees fit

• members must survive at least 14 days after the critical illness event

• allows you to choose Base Cover (which insures against some of the most serious Critical Illness events) or Extra Cover (which covers a number of additional serious conditions)

• member’s children are automatically covered at no extra cost for a percentage of the members benefit - from 30 days old until 18 years old (21 if in full time education). You can also choose to insure a member’s spouse/partner at an extra cost

• can be funded entirely by you, funded by both you and your employee or entirely by the employee

• does not have a surrender value

The product information contained in this guide complies with the Association of British Insurers (ABI) Statement of Best Practice for Critical Illness Cover December 2014.

Contents Page number

A. Your commitment as the policyholder 3

B. Risk factors 3

C. How the policy works 4

1.1 Types of cover 4

1.2 Product features 5

1.3 Eligibility 6

1.4 Insured earnings 8

1.5 Temporary absence 9

1.6 Members based overseas 9

2 Preparing a quote 10

3 Starting and ending cover 11

4 Premium rates and policy accounting 12

5 Medical underwriting, pre-existing and related condition exclusions 15

6 Policy documents 19

7 Claiming benefits 19

8 Exclusions 19

9 Taxation 20

10 Equity Partners 21

11 UnumOnline 21

12 Complaints 22

13 Compensation 23

D. Glossary 23

E. Appendix 24

This document does not provide tax, legal or financial advice that can be relied upon in the specific circumstances of a particular Policyholder or in respect of any member insured under the policy.

This includes but is not limited to any potential liability to corporation tax and income tax. You should take advice from your own professional advisers to ensure that they understand the impact

of tax and legislation.

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A. Your commitment as the policyholder

By taking out a Unum policy, you are agreeing to:

• pay premiums on time

• choose the eligibility criteria for members’ entry to the policy and to abide by those conditions

• to notify us in writing if you:

- want to amend the eligibility criteria - eg. by changing the eligibility from management only to all staff

- acquire another company and wish to include their employees in the policy

- dispose of a company which results in the removal of members from the policy

- want to change the policy design – eg. benefit level or Terminal Age

- want to terminate the policy

• identify any discretionary entrants (employees who do not fulfil the standard conditions for entry)

• notify us of claims within the time limit set out in your policy documents

• supply us with any other information we may ask for

For Flexible and Voluntary Benefits, where a Third Party Administrator is involved, you must also ensure we receive:

- any information we ask for following your policy application or once the policy is live

- membership data at each policy accounting date (usually monthly) and when you make a claim

This will ensure that we are able to pay the correct benefits in the event of a claim.

B. Risk factors

1. This guide should be read with the accompanying quote. Please note that the quote takes precedence if anything in it differs from this guide.

2. The policy documents take precedence if anything differs between the policy documents, the quote and this guide.

3. Full details of your insurance cover are set out in your policy documents. The policy is issued according to the Laws of England and any dispute will fall under the exclusive jurisdiction of the English Courts.

4. Customers for this product are classed as “Commercial” as defined by the Financial Conduct Authority’s (FCA) Insurance: Conduct of Business sourcebook (ICOBS).

5. The way HMRC tax premiums and benefits may change in the future

6. The guarantee period advised in your quote applies to both the premium rate (for Unit Rated policies) - or the underlying rate table (for Single Premium policies) - and the policy conditions. When the guarantee expires at the policy review date, both the premium rate (or underlying rates), and the policy conditions are reviewable.

7. For all policies, the premium rate and policy conditions are usually guaranteed for 2 years. However, we may amend the terms at any time if we believe there is a significant change in the risk profile. The factors we take into account are:

• a change of 30% or more in the number of members or benefit insured

• the inclusion of a new participating company

• the disposal of a participating company or closure of part of your business

• the inclusion of a new member category

• a change in policy design such as an alteration of benefit level, Terminal Age or eligibility

• a significant overall change in the occupations of the members or where they work

• a change to the level or basis of the social security or income tax systems

For new policies, we may review the terms offered if there is a 30% or more change in the number of members or benefit in the data provided to produce the quote.

8. If the number of members drops below the minimum number set out in your policy documents, we reserve the right to cancel the policy at any subsequent policy accounting date. In the case of standard Group Critical Illness this is usually 5 members.

9. If premiums are unpaid cover will cease and claims will not be paid.

Flexible and Voluntary Benefits also carry the following risks:

1. If employees choose benefits which do not subsequently meet their needs, or where an employee’s circumstances change as a result of a Lifestyle Event and they do not adjust their benefit levels accordingly, they may find themselves inappropriately insured.

2. For flexible and voluntary policies, if the number of members drops below 50 we reserve the right to cancel the policy at any subsequent policy accounting date.

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C. How the policy works

1.1 Types of cover

Standard Group Critical Illness

Unum’s standard Group Critical Illness policy is available to employees, working directors and Equity Partners. Premiums are entirely funded by you for employees and working directors. Equity Partners pay their own premiums. Standard Group Critical Illness is usually only available for policies with 5 or more members. The same benefit formula applies to all members within the eligibility categories you define. This can be either a multiple of the member’s earnings or a flat benefit amount.

Flexible Group Critical Illness

Typically, employees will be covered for a core benefit and have the option to increase their cover by multiples of salary or benefit steps. The core benefit is funded by you in the same way as a Standard Group Critical Illness policy. Employees can choose to increase their benefit each year during their flexible benefits selection window or within 2 months of a Lifestyle Event. Benefits in excess of the core-benefit are typically taken in lieu of other benefits or are funded by the employee. Flexible Group Critical Illness is available for policies with 250 or more members at outset.

Voluntary Group Critical Illness

Unum’s Voluntary Group Critical Illness policy is available to your employees through you but is funded by them. Employees join the policy at their discretion and select their level of cover within the parameters you choose.

Employees can choose to join the policy or increase their benefit each year during their flexible benefits selection window. Benefits can also be increased within 2 months of a Lifestyle Event. You collect the premiums and pay them to Unum on the employees’ behalf. Voluntary Group Critical Illness is for policies with 250 or more eligible members and requires a minimum of 50 members to opt into the policy at

outset.

Flexible and Voluntary Policies

Rules will apply to when employees can increase cover and by how much. Our typical rules are:

Benefit Elections and Lifestyle Events Employees can choose to increase their benefits twice a year at the following times:

• once at the policy accounting date and

• once following an approved Lifestyle Event

Employees can:

• flex up (increase their benefits) one step at a time

• flex down (decrease their benefits) by any number of steps

Benefit Elections must be made before the effective date of cover, and for Lifestyle Event increases within 2 months of the Lifestyle Event.

A new pre-existing and related conditions exclusion will apply to benefit increases (See section 5 - Medical underwriting, pre-existing and related condition exclusions.)

The table of Lifestyle Events opposite are broad headings for information only. Unum must approve the definitions and precise wording before accepting risk. Some Lifestyle Events will incur an additional cost.

Lifestyle Events – Increasing benefit

Birth of dependant child / adoption OR getting pregnant OR starting/returning from maternity leave

Death of dependant (adult or child)

Marriage/Civil Partnership, start of a Partner relationship

Divorce or Separation1

Secondment overseas

Return from Secondment2

Increase in working hours3

Moving home

Reduction in basic salary4

Increase in salary by >5%

Promotion5

Redundancy of partner

Lifestyle Events – Reducing benefit

There are no standard restrictions on reducing benefits within the policy. Subsequent increases will be subject to the normal rules i.e. one step at a time.

Please also refer to accompanying notes below.

1. Except Partner’s/Spouse’s cover.

2. Not eligible if through ill health. The time period of overseas secondment must have been fully completed.

3. Only allowed if changing contract of employment from part-time to full-time.

4. This will relate to basic salary only (so cannot include any other remuneration). It will not be allowed if the reduction in salary is going from full-time to part-time. It will also not be allowed if the salary reduction is due to ill health.

5. There could be an overlap with salary increase with this Lifestyle Event. In the event of both being Lifestyle Events, only one increase

in total will be allowed.

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1.2 Product Features

We offer two types of cover, Base Cover and Extra Cover. The full list of conditions is set out below.

These headings are only a guide - the full definitions of the illnesses covered (usually in medical terms) and the circumstances when you can claim are given in the appendix and your policy documents.

Group Base cover Extra cover

Cancer Cancer - excluding less advanced cases

Heart and circulatory diseases

Coronary artery bypass grafts*

Heart attack*

Heart transplant - from another donor

Stroke*

Aorta graft surgery*

Cardiac arrest - with insertion of a defibrilator

Cardiomyopathy - of specified severity

Coronary angioplasty - to 2 or more coronary arteries

Heart valve replacement or repair*

Primary pulmonary arterial hypertension - of specified severity

Pulmonary artery surgery - for disease

Structural heart surgery - with surgery to divide the breastbone

Organ failure Kidney failure - requiring permanent dialysis

Major organ transplant* - from another donor

Aplastic anaemia - of specified severity

Liver failure - of specified severity

Diseases of the brain and central nervous system

Creutzfeldt-Jakob disease - resulting in permanent symptoms

Dementia includng Alzheimer’s disease - resulting in permanent symptoms

Motor neurone disease - resulting in permanent symptoms

Multiple sclerosis* - with persisting symptoms

Parkinson’s disease and Parkinson plus syndromes* - resulting in permanent symptoms

Bacterial meningitis - resulting in permanent symptoms

Benign brain tumour* - with permanent symptoms or specified treatments

Benign spinal cord tumour - with permanent symptoms or specified treatments

Coma - with associated permanent symptoms

Encephalitis - resulting in permanent symptoms

Respiratory diseases Lung transplant - from another donor Respiratory failure - of specified severity

Accidents HIV infection - caught within specified geographic limits from a blood transfusion, physical assault or at work

Third degree burns* - covering 20% of the body or face

Traumatic brain injury - resulting in permanent symptoms

Terminal illness Terminal illness - where death is expected within 12 months

Disability Blindness* - permanent and irreversible

Deafness - permanent and irreversible

Loss of hand or foot* - permanent physical severance

Loss of speech - total, permanent and irreversible

Paralysis of limb* - total and irreversible

Rheumatoid arthritis - of specified severity

Total permanent disability - of specified severity

*The Association of British Insurers produces a statement of best practice for Critical Illness. Group Critical Illness Cover provides wider cover than that definition.

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Section 1.3 – Eligibility

You can insure the following people under a Unum Group Critical Illness policy:

• employees, working directors and Equity Partners who fulfil the eligibility set out in your policy documents

• children aged between 30 days and 18 years (21 if in full time education) are covered automatically for as long as the member is insured

• you have the option to cover member’s spouses on all variations of Group Critical Illness at extra cost

Eligibility Benefit Notes

Employee, Working Director or Equity Partner

16-70 years of age Multiple of earnings – eg.1x, 2x, 3x, 4x or 5x subject to a maximum of £500,000.

Or

Flat benefit - eg. £50,000, £100,000 or £150,000 subject to a maximum of £150,000.

The employee can be a part-time worker.

Fixed term contractors can be insured for the duration of their current contract.

Spouse 16-70 years of age

The spouse must be:

• the legal spouse or civil partner of the employee, and

• living with the employee

Flat benefit up to £150,000 or the member’s benefit if lower.

The spouse will only be insured while the member is insured.

Pre-existing and related conditions exclusions apply to the spouse’s entire benefit and any increases in benefit.

The spouse will be insured on the same basis as the member (Base or Extra cover).

Where Extra cover applies the Total Permanent Disability definition will be Activities of Daily Living.

Children 30 days – 18 years (21 years if in full time education or vocational training)

The child must be:

• the biological offspring of the member or

• the member’s stepchild, or

• legally adopted by the member or

• financially dependent on the member

25% of the employee’s benefit up to a maximum of £25,000.

A child will only be insured while the member is insured.

Pre-existing and related conditions exclusions apply to the child’s entire benefit and any increases in benefit.

The child will be insured on the same basis as the member (Base or Extra cover).

Where Extra cover applies, the Total Permanent Disability definition will be Any Occupation.

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Eligibility

You should clearly state a defined eligibility for each membership category. This must be the same for each member within that category.

This should include:

• the minimum and maximum entry ages allowed for new members

• the categories of member you want covered and the benefits required eg. Directors 4x earnings, Staff 2x earnings.

• if a minimum service requirement is in place and the duration eg. Members must be employed for 3 months before they are covered by the policy.

• the date when new members will be covered and when existing members will be eligible for increases in insured benefits. This can be annually, monthly or daily

Daily entry and increases in benefit will apply unless otherwise agreed.

If cover is dependent on membership of the employer’s pension scheme, you will also need to provide the pension scheme’s current eligibility requirements.

Discretionary, Late and Early Entrants

A Discretionary Entrant is a member you wish to cover who does not fit the eligibility criteria for the policy – eg. a non-pension scheme member who you wish to be covered under a category that only covers pension scheme members.

You must contact Unum to discuss whether or not we are prepared to offer cover and the terms that will apply. This may include medical underwriting on the member’s full benefit. The only exception to this is where a member is to be covered as an Early or Late Entrant.

An Early Entrant or Late Entrant is someone you wish to join the policy before or after their first opportunity to do so. Unum will treat these members as standard new entrants to the policy with the exception that you must inform us in advance in writing of their inclusion date for cover to be agreed.

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Section 1.4 – Insured earnings

If you select a multiple of earnings for your benefit design, you must choose an insured earnings definition for calculating the members’ benefits. Common definitions of insured earnings include, but are not limited to:

Basic annual salary Basic annual salary plus fluctuating payments during the last 12 months

Basic annual salary plus fluctuating payments averaged over the last 3 years

Gross Earnings P60 earnings

The member’s basic salary excluding other payments such as bonus, commission or dividends.

The member’s basic salary including other defined payments such as bonus, commission, overtime or dividends.

The fluctuating payments are limited to 20% of basic annual salary.

The member’s basic salary including other defined payments such as bonus, commission, overtime or dividends.

The fluctuating payments are averaged over the last 3 years without the 20% limitation.

The earnings received during the previous 12 months. Including variable forms of pay such as overtime, bonuses and commissions.

Any fluctuating payments will be limited to 20% of basic annual salary.

Alternatively, the average of the last 3 years’ total earnings can be used to smooth benefit changes so they are not based on a particularly high or low year.

The earnings received during the previous tax year (up to 5th April) - This would only change the benefit level when passing 6th April each year.

Any fluctuating payments will be limited to 20% of basic annual salary.

Alternatively, the average of the last 3 years’ P60 earnings can be used to smooth benefit changes so they are not based on a particularly high or low year.

Employees

It is important that your definitions are clear and unambiguous – eg. are all fluctuating payments to be included? Or only bonuses or other specific payments?

Different categories of member may have different definitions outlining how they are paid – eg. members involved in sales may have a large portion of performance-related pay, while administration staff only have a basic salary.

Changes to earnings are usually either daily or annual.

Where an employer operates salary sacrifice – eg. in favour of childcare vouchers or pension contributions, we can consider insured earnings reflecting the ‘pre-sacrifice’ figure.

Working directors

We can include dividends from the employer in an insured earnings definition, but this only applies to working directors.

As dividend income is irregular (depending upon the profitability of the business and the director’s shareholding), we treat it the same as other fluctuating payments:

• basic annual salary plus average of the last 3 years’ dividends

• total earnings averaged over the last 3 years including dividend payments

Working directors must receive a basic annual salary.

Equity Partners

Equity Partners in partnerships and LLP members of Limited Liability Partnerships, share in the profits of the partnership, which can vary from year to year, and are taxed by HMRC under Schedule D. The normal definition of insured earnings is average of the last 3 years’ earnings.

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Section 1.5 – Temporary absence

Where an absent member is still considered by you as remaining in service, benefit may be maintained:

• in cases of illness or injury – you have the option to continue cover for either a maximum period of 36 months (not exceeding the Terminal Age) or until the Terminal Age

• during statutory absences such as maternity, adoptive, paternity, unpaid parental leave - for a maximum period of 36 months not exceeding the Terminal Age

• for any other reason such as sabbaticals, unpaid leave or compassionate leave for a maximum period of 36 months not exceeding the Terminal Age

Salary increases that result in an increase in benefit during absence for illness, injury or statutory absence will be accepted under Unum’s cover provided that the increase is in line with your general pay increases and will be subject to a maximum of 5% per annum.

We will not cover increases for a flat benefit.

Increases to benefit during non-statutory absence will not normally apply.

Section 1.6 – Members based overseas

Members employed outside of the UK Secondment outside the UK

Members who work overseas for their UK resident employer are covered, as long as:

• the member meets the policy eligibility conditions

Members seconded from their UK resident employer to another company (registered in the UK or overseas) are covered as long as:

• the member meets the policy eligibility conditions

• the member has a contract of employment with the UK employer

• the UK employer retains controls over where and for who the member works

• both the UK employer and member expect the latter to resume employment with the UK employer at the end of the secondment (or will retire to the UK if the period of secondment extends to the date the member chooses to retire)

You must declare each member’s nationality and the countries they work in at the start of the policy and at each policy review date. This affects the premium rate quoted and our ability to provide cover

B enefits are paid in Sterling and to a UK account. Foreign earnings will be converted to Sterlingusing the same exchange rate used to convert the non-UK earnings to Sterling to establish thepremium payable.References to the UK include the Channel Islands and the Isle of Man.

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Section 2 – Preparing a quote


We will prepare a quote based upon:

• the risk specification

• membership data

• claims history over the last 5 years (if previously insured)

• industry type

• the occupation and location of the members to be covered under the policy

• details of any employees who have had benefits declined or have had adverse underwriting decisions

The membership data must be as current as possible and taken from a date within 12 months of the quotation request.

Your intermediary can prepare quotes quickly and simply over the internet via our UnumOnline facility for policies with up to 100 members. Alternatively, they can submit a written request via our Regional Sales Offices which cater for a wider range and more complex benefit bases.

Once we have the data, specification and claims experience, we will supply a quote detailing the applicable rate, premium and Automatic Entry Limit. The premium we charge will depend on a number of factors. These include the nature and level of the benefits to be provided and details of the employees you want to insure, such as, but not limited to:

• the multiple of insured earnings or flat benefit

• definition of incapacity selected (for Total Permanent Disability under an Extra Cover policy)

• whether temporary absence for illness or injury is provided for 3 years or until Terminal Age

• Terminal Age for cover

• eligibility and entry conditions

• age and gender of employees

• occupation, industry and locations of employees

• claims history, if previously insured

• our then current minimum annual premium

We will normally guarantee the quote for 3 months.

Flexible and Voluntary Group Critical Illness

In addition to the information required under Standard Group Critical Illnesss, when preparing a quote for Flexible and Voluntary Group Critical Illness policies, we also require:

• the core and default levels of benefit (Flexible policies only)

• the maximum level of benefit

• size of steps

• Lifestyle Events

Once we have all the information required, we will provide the following:

Flexible Group Critical Illness – a quote illustrating the Unit Rate for the core benefit plus a rate table illustrating the top up premiums applicable for increasing benefits

Voluntary Group Critical Illness – a rate table illustrating the premiums applicable for each unit or benefit step

Please note that the top-up and voluntary rate tables can be provided in the following formats:

• Gender Specific rates – the table provided will illustrate rates that are specific to the gender of the member

or

• Unisex rates – illustrates the same rates for male and female members

and

• Individual age rates (current or age next birthday) – illustrates will illustrate rates for each age

or

• 5-year age banded rates – illustrates rates in 5-year age bands

It may only be possible to offer unisex and 5-year age-banded rates for existing policies or new policies where the potential membership is high.

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Section 3 – Starting and ending cover

Setting up the policy


Your intermediary needs to contact us in writing in advance to advise us when you want cover to commence. So cover for a 1st January start date will begin at 00.01 a.m. on 1st January - subject to satisfactory answers to any specific caveats shown in our quote. We will not backdate cover.

Once you have accepted our quote, you will need to provide the following information within the 30-day conditional cover period:

• a fully completed Quotation Acceptance and Application Form

• membership data at the start date

• deposit premium or Direct Debit mandate

• a customer verification statement signed by your intermediary

You need to inform us of any material changes which may impact on the risk profile of the policy between the accepted quotation and the on risk date - eg. changes in the locations where members work, their occupations, the industries they work in or your claims history. We will then advise you if we will continue cover, of any additional requirements and if needed, the revised premium.

If the information we asked for is not provided within 30 days, cover will stop. We will then charge a premium based on the time we have provided cover.


Once you have accepted the quote for a Flexible or Voluntary policy, you will have up to 3 months from your chosen start date to communicate the benefits, terms and premiums to your employees. The 30-day conditional cover period provided under a standard policy will not apply.

Cancelling cover

The policyholder

You can cancel the policy at any time, provided you do so in writing. Cover will then end and you will not be liable for payments for periods after this date. Cancellation cannot be backdated.

If the policy is cancelled, we will still consider claims for events which occurred before the cancellation date provided there are no outstanding premiums.

Unum

We cannot cancel the policy unless:

• the number of members insured under the policy drops below the number stipulated for the policy (usually 5 for Standard policies and 50 for Flexible and Voluntary policies)

• premiums are overdue

• you fail to provide all the information we ask for when applying for the policy, administering the policy or when claiming for benefit relating to a member

• the company stops trading

• trade sanction controls are put in place against an employer or members with a significant shareholding

• the policy no longer complies with current legislation

• you assign the policy without our agreement

• you amend or terminate an associated policy

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Section 4 – Premium rates and policy accounting


Unit Rated or Simplified Administration policies (20 or more members) Single Premium policies (between 5 and 19 members)

Quote The 1st-year premium advised at the start date of your policy is provisional.

The premium is based on the total benefit roll at the start date and the unit rate (expressed as a cost per £1,000 of benefit).

Our quote states an estimated 1st-year cost assuming an annual premium is paid and that all members can be accepted for their full benefit entitlement on standard terms.

Premiums will be calculated for each member according to our current premium rates.

Premiums are recalculated each year and depend on the age of the member and their benefit at each policy accounting date.

Our quote states an estimated 1st-year cost assuming an annual premium is paid and that all members can be accepted for their full benefit entitlement on standard terms.

Rate Guarantee Unit rates are usually guaranteed for 2 or 3 years and are then reviewable. New rates and terms may apply at the end of this period or at any event which triggers a policy review.

The underlying premium rate table is usually guaranteed for 2 or 3 years and is then reviewable. New rate tables and terms may apply at the end of this period or at any event which triggers a policy review.

Costing basis If the number of members insured under an existing policy falls below 20 at a policy accounting date, we may calculate the premium on the Single Premium basis.

If the number of members insured under an existing policy increases to 20 or more at a policy accounting date, we may calculate the cost on the Unit Rated basis.

Additional premiums Premiums may vary if there are:

• members whose benefits exceed the Automatic Entry Limit and they have been declined for the excess benefits or loaded on their benefit

• members who have been restricted to the Automatic Entry Limit due to non-provision of medical evidence

• members who are joining outside the normal eligibility conditions, (Discretionary Entrants)

Additional premiums, restrictions or exclusions may be due to particular medical conditions or if the member takes part in an unusually hazardous pursuit.

If applicable, additional premiums are payable from the date we make the decision.

Account We calculate a premium adjustment at the end of each policy accounting period, based on the average total benefit for all members covered by the policy during that time.

This means changes in salary and membership are treated as if they occurred halfway through the accounting period.

We will apply any premium adjustment for members who leave, join or whose benefit increases at the policy accounting date.

We calculate a premium adjustment at the end of each policy accounting period, taking into account joiners, leavers and changes in benefit throughout that time.

This means that premiums are calculated on the specific duration and level of cover for each member.

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Unit Rated or Simplified Administration policies (20 or more members) Single Premium policies (between 5 and 19 members)

Data requirements At the start date and at each policy accounting date, we require a list of all members showing:

• name

• date of birth

• gender

• earnings (where multiples of earnings are insured)

• benefit entitlement

• membership category

• date of joining or date of leaving (if applicable)

You must identify members whose benefits exceed the Automatic Entry Limit or who are joining outside the policy’s normal eligibility conditions.

Where spouses are insured, we require their:

• date of birth

• gender

• benefit entitlement

Where children are insured, details are only required when making a claim.

Non-annual premium payment

Premiums are normally paid annually or monthly by Direct Debit. There is a standard load of 3% for all non-annual payments.

Commission Any commission paid to your intermediary is a percentage of the gross premium paid. The premium shown in our quote includes the level of commission payable.

New joiners Other than at the policy accounting dates, we only need details of new joiners if their benefit exceeds the Automatic Entry Limit or if they are joining outside the normal eligibility conditions of the policy.

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Flexible Group Critical Illness Rates Core (Unit Rated) rates

The annual rate of premium that applies to all members is calculated at the start of the guarantee period and is referred to as the Core Rate.

The 1st-year premium notified at the Commencement Date of your Unum policy is provisional. It is based on the total benefit at the Commencement Date multiplied by the Unit Rate.

Unit Rates are usually guaranteed for 2 years and are subject to review after. A new rate may apply at the end of this period.

Top-up (single premium) rates

Premiums will be calculated for each member according to our current age - and gender-related premium rates. Premiums are recalculated at each policy accounting date and are dependent on the age of the member at that time. Premium rates increase with age.

The underlying rate table is usually guaranteed for 2 years and is subject to review after. A new rate table may apply at the end of this period.

Voluntary Group Critical Illness Rates Premiums will be calculated for each member according to our current age - and gender-related premium rates. Premiums are recalculated at each policy accounting date and are dependent on the age of the member at that time. Premium rates increase with age.

The underlying rate table is usually guaranteed for 1 policy accounting period for previously uninsured policies and 2 policy accounting periods for established polices and is subject to review after. A new rate table may apply once the guarantee has expired.

Flexible and Voluntary Data Each month, we will require the following defined individual membership data in electronic format:

• member’s name, date of birth, gender, flex or voluntary benefit and their corresponding premium calculations

• joiners and leavers

• benefit movements (up and down) identifying Lifestyle Event changes

• any lives to be medically underwritten

• If applicable, spouses gender, date of birth and benefit entitlement

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Section 5 – Medical underwriting, pre-existing and related condition exclusions

Pre-existing and related conditions exclusion

Where a member has previously experienced a critical illness, they will not subsequently be able to claim for that event.

If a member has already suffered or received a previous diagnosis of one of the critical illnesses in the heart and circulatory diseases group, they may not claim for any subsequent incidences of any critical illnesses in that group.

If a member has previously suffered any critical illness no benefit is payable under terminal illness or any critical illness in disability group 1 or 2.

A member who qualifies under the terminal illness event will not be able to claim again under any other critical illness event.

Under the related conditions exclusion, a member will not be able to claim for a critical illness event which is linked to a related condition which the member was aware of, or received treatment or advice for, on or before the date they joined the policy. The related conditions either apply indefinitely or are limited to the 2 years after joining.

The pre-existing and related conditions exclusions apply from when the member joins the policy, after a successful Critical Illness claim and to all increases in benefit other than those related to standard pay increases.

Group Critical Illness Events Related conditions

Cancer Base cover

Cancer - excluding less advanced cases

Applies for 2 years

Polyposis coli

Papilloma of the bladder

Any carcinoma-in-situ


Base cover

Coronary artery bypass grafts

Heart attack

Heart transplant - from another donor

Stroke

Extra cover

Aorta graft surgery

Cardiac arrest - with insertion of a defibrillator

Cardiomyopathy - of specified severity

Coronary angioplasty - to 2 or more coronary arteries

Heart valve replacement or repair

Primary pulmonary arterial hypertension - of specified severity

Pulmonary artery surgery - for disease

Structural heart surgery - with surgery to divide the breastbone

Applies for 2 years

Any disease or disorder of the heart

Any obstructive or occlusive arterial disease

Blood pressure treated at any time by prescribed medication

Applies indefinitely

Diabetes mellitus

Details of the specific exclusions which apply to each critical illness event.

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Organ failure Base cover

Kidney failure - requiring permanent dialysis

Major organ transplant - from another donor (other than heart or lung transplant)

Extra cover

Aplastic anaemia - of specified severity

Liver failure - of specified severity

Applies for 2 years

Any chronic renal disease or disorder

Any chronic liver disease

Chronic pancreatitis

Chronic leukemia


Diabetes mellitus


Base cover

Creutzfeldt-jakob disease - resulting in permanent symptoms

Dementia including Alzheimer’s disease – resulting in permanent symptoms

Motor neurone disease - resulting in permanent symptoms

Multiple sclerosis - with persisting symptoms

Parkinson’s disease and Parkinson plus syndromes - resulting in permanent symptoms

Extra cover

Bacterial meningitis - resulting in permanent symptoms

Benign brain tumour - with permanent symptoms or specified treatments

Benign spinal cord tumour - with permanent symptoms or specified treatments

Coma – with associated permanent symptoms

Encephalitis - resulting in permanent symptoms

Applies for 2 years

Any disease or disorder of the brain or central nervous system

Respiratory diseases

Base cover

Lung transplant - from another donor

Extra cover

Respiratory failure - of specified severity

Applies for 2 years

Any chronic lung disease

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Accidents Extra cover

HIV infection - caught within specified geographic limits from a blood transfusion, physical assault or at work

Third degree burns - covering 20% of the body or face

Traumatic brain injury - resulting in permanent symptoms

There are no related conditions

Terminal illness Extra cover

Terminal illness - where death is expected within 12 months


All other critical illness events

Disability group 1

Extra cover

Blindness - permanent and irrevirsible

Deafness - permanent and irreversible

Loss of hand and foot - permanent physical severance

Loss of speech - total, permanent and irreversible

Rheumatoid arthritis - of a specified severity

Applies for 2 years


Peripheral vascular disease

Inflammatory polyarthropathy



Diabetes mellitus

Disability group 2

Extra cover

Paralysis of limb - total and irreversible

Total permanent disability - of specified severity




Chronic or recurring mental illness

Chronic symptoms of fatigue, back, joint or muscle pain

Diabetes mellitus

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Medical Underwriting

For most policies, medical underwriting will not be carried out because the pre-existing or related conditions exclusion is applied. Where medical underwriting does apply, a Scheme Member’s Application Form must be completed. This may lead to requests for further information that may include, but is not limited to, a GP report, medical examination or blood tests.

Switch Terms for a policy with existing members whose benefits have been medically underwritten.

We need details of the previous insurer’s Free Cover Limit or Automatic Entry Limit, and - for each member whose cover has been medically underwritten or restricted:

• name

• date of birth

• gender

• full underwriting decision

• special term or restriction applied (including percentage loadings and amount of benefit above which the loading/restriction applied)

• benefit on risk at previous policy cancellation date

Claims arising before full cover has been agreed

A member whose benefit entitlement does not exceed the Automatic Entry Limit is fully covered as soon as they join the policy (subject to the pre-existing and related conditions exclusions).

If a member whose benefit entitlement exceeds the Automatic Entry Limit claims before we have agreed full cover, the following terms will apply:

Temporary Cover Where a member’s benefit needs underwriting because it exceeds the Automatic Entry Limit, we provide a maximum period of 3 months’ temporary cover in respect of the amount being underwritten.

Temporary cover pending underwriting is subject to ALL of the conditions opposite

During this period, any benefit that exceeds either the Automatic Entry Limit or the member’s insured benefit level immediately before the start of the policy will be subject to a pre-existing and related conditions exclusion. This means we will not pay benefit for any medical condition where the member received treatment, care or services (including diagnostic measures), or took prescribed drugs or medicines during the 12 months before the date they first became eligible, or the date of any increase in cover

Temporary cover starts • either the date the member joins the policy with benefits above the Automatic Entry Limit , or

• the effective date of an increase in benefit above the Automatic Entry Limit

Temporary cover ends on the first date either of the following events occur

• we issue terms following completion of medical underwriting, or

• the 3-month period of temporary cover expires

For underwriting purposes, a new member of a policy that has no Automatic Entry Limit is treated as a Discretionary entrant. Once we have agreed full cover, we treat a Discretionary entrant in the same way as an ordinary member, granting temporary cover the next time we underwrite an increase in cover.

What happens if a critical illness event arises before we have agreed full cover?

If a member claims after the temporary cover period ends, but before we have agreed full cover, benefit is restricted to:

In the case of new business - either our quoted Automatic Entry Limit, or, if previously insured, any amount the member was covered for and which we have agreed to accept without additional medical underwriting.

In the case of existing business - the amount insured with us immediately before the effective date of the increase being underwritten.

Exclusions from temporary cover The pre-existing and related conditions exclusion will apply to the full amount of benefit being underwritten in the event of a claim during the temporary cover period.

Benefits will not be paid under temporary cover arrangements for conditions resulting from hazardous sports and pastimes, attempted suicide or self-inflicted injury.

If you selected Total Permanent Disability Any Occupation or Total Permanent Disability Own Occupation, neither will apply in the event of a claim during the temporary cover period. If a member becomes disabled because of an illness commencing or an injury sustained during the temporary cover period, a claim for Total Permanent Disability will be payable if the member satisfies the Activities of Daily Living conditions.

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Section 6 – Policy documents

Once cover under the policy commences goes live, we will issue a copy of your Policy Documents.

The policy is issued on the basis of the information provided:

• in the quotation request or specification

• the Quotation Acceptance and Application Form completed by you

• any questionnaire completed by a member

• any proposal or supplementary proposal made by you or on your behalf

The policy comprises the policy conditions, the schedule (including any endorsements) and any special provisions or notices specified in writing by us.

Your policy conditions could change following any event which triggers a policy review.

Section 7 – Claiming benefits

This section deals with common questions that arise when a member suffers from one of the insured Critical Illness events.

For a claim to be valid, the following criteria must be met:

• the claimant must be an eligible member of the policy

• the claim event which occurs or is diagnosed must meet one of the Critical Illness definitions listed in your policy conditions

• the member must not have suffered a pre-existing or related condition (where applicable)

• the claimant must survive for 14 days after satisfying the definition for a qualifying Critical Illness event.

Notification of Claim

Please notify us of a claim under this policy as soon as possible after the event or diagnosis - ideally within 21 days - by telephoning our Customer Care department on 01306 873243.

We will issue you with the appropriate claim forms.

We may not consider a claim where the claim forms are received more than 90 days after the event of diagnosis.

Section 7.1 – Making a claim

We require the following:

• evidence that the claimant is eligible to claim under the policy

• evidence of the claimant’s earnings where a multiple of earnings is insured

• a claim form completed by the policyholder

• a claim form completed by the claimant, together with the claimant’s consent under the Access to Medical Reports Act and Data Protection Act, granting us the authority to ask for further information from the claimant’s doctors

• the claimant’s original birth certificate

• confirmation that the claimant fulfilled the survival period for the Critical Illness event

• if the claim is for a spouse - their original birth and marriage certificates

• if the claim is for a child - their original birth certificate

When we have received all the necessary documents, we will review the medical evidence to ensure the diagnosis satisfies the Critical Illness event as defined in your policy conditions. If the claimant satisfies the

criteria, for the Critical Illness event, we will pay the claim by Direct Credit to them - tax free.

Section 7.2 Recurrence of a claim event

Once a claim is admitted for a specific Critical Illness event, no further claims can be made in for that and some some other events. Cover will automatically continue, but a new pre-existing and related conditions exclusion will apply as if the member has just joined the policy.

Section 7.3 How to appeal a claim decision

If you are not satisfied with a claim decision, you can ask us to review it.

Any request for a decision review should be addressed to our Quality Assurance Manager, Claims Department, Unum, Milton Court, Dorking, Surrey, RH4 3LZ and detail the reasons why you disagree with our decision, plus any additional evidence (medical or otherwise) that you would like us to consider. Any request for a review should be made within 90 days of the date of the decision.

If you remain dissatisfied, you can make a formal complaint at any time. See our Compliants section for details.

Section 8 – Exclusions

Other than the pre-existing and related condition exclusions illustrated under each group of Critical Illness events, there are no standard exclusions under this policy. If any specific exclusions are applied this will be illustrated in your policy documents.

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Section 9 – Taxation

PolicyholderEmployee

Premium Benefit

Employee, Working Director, Spouse or Child – Employer-paid Group Critical Illness

Premiums paid by you to insure employees, working directors, spouses or children against Group Critical Illness events are a trading expense and can be offset against Corporation Tax. You may be liable for Class 1A National Insurance Contributions on the premiums.

The employee or working director is taxed on the amount of the premium paid on their behalf by their employer as a benefit in kind. This will include any premium payable for spouses or children’s cover.

A tax-free lump sum is paid direct to the employee or working director in the event of a claim. Where a claim is for a spouse or child of the member, a tax-free lump sum will be paid direct to the member.

Employee, Working Director, Spouse or Child – Employee-paid Group Critical Illness

Although you are the policyholder, you are collecting the premiums on behalf of the employee, working director, spouse or child and passing them on to us. The premiums will already have been subject to taxation including any 1A National Insurance liability. You cannot offset the premiums as a trading expense against Corporation Tax.

The premium is collected from the employee or working director’s net earnings. There is no tax relief on the premium paid.

A tax-free lump sum is paid direct to the employee or working director in the event of a claim. Where a claim is in respect of a spouse or child of the member, a tax-free lump sum will be paid direct to the member.

Equity Partner Premiums are collected by the partnership on behalf of the Equity Partners.

Each Equity Partner (not taxed under PAYE) pays for their cover. There is no tax relief on the premium paid.

A tax-free lump sum is paid direct to the Equity Partner. Where a claim is in respect of a spouse or child of the member, a tax-free lump sum will be paid direct to the member.

This information is based on our understanding of current tax legislation. Employers should refer to their professional advisers for advice on the tax implications for themselves and their employees. Equity Partners should refer to their local HMRC office for clarification on the tax position or speak to their professional advisors for advice on the tax implications.

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Section 10 – Equity Partners

The Terms and Conditions of our standard Group Critical Illness policy for employers will generally apply to our policy for Equity Partners. Some aspects of the policy may differ for Equity Partners. Please refer to the conditions as noted below.

The policy for Equity Partners is available to those partners with an equity share in the firm and whose earnings from the firm are taxed under Schedule D.

Premiums • each Equity Partner (taxed under Schedule D) pays for their own cover, but all premiums are paid by the partnership together in one payment.

Participation • you must include all Equity Partners for cover under the policy when they first become eligible.

Policy Accounting • we normally calculate benefits using the Single Premium Costing method, regardless of the number of people insured. This is so premiums can be illustrated for all members who are expected to pay their own premiums.

Claiming benefits • claims must be made by the Partnership.

Section 11 – UnumOnline

UnumOnline is our online quote and on risk facility that intermediaries can use to create new business quotations. The table below outlines the terms which are available.

Product Variants • Standard Group Critical Illness only – Base or Extra cover

Number of Lives • policies with 3 –100 members

Categories • you can include up to 4 membership categories

Earnings Definitions • basic annual salary plus all fluctuating payments averaged over the last 3 years

• non-PAYE taxed – eg. Equity Partners - average annual net taxable earnings received in the previous 3 years

• gross earnings in the previous 12 months (fluctuating payments are limited to 20% of basic annual salary)

• P60 earnings in the previous tax year (fluctuating payments are limited to 20% of basic annual salary)

• basic annual salary plus all fluctuating payments received in the last 12 months (fluctuating payments are limited to 20% of basic annual salary)

Temporary Absence for illness or injury • 3 years

• Terminal Age

TPD (Extra Cover only) • Own Occupation

• Any Occupation

• Activities of Daily Living

Eligibility • the client must be a UK-registered company or a UK-based Equity Partnership

• the policy must be open to new entrants and not have a closed eligibility

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Locations • quotes cannot be provided via UnumOnline where members travel to, or work outside of the following locations:

European Union, Australia, USA, Canada, Hong Kong, Switzerland, Iceland, Japan, Singapore, New Zealand - Norway

Occupations • quotes cannot be provided via UnumOnline for the following occupations:

professional sports people, entertainers, air crew, air traffic controllers, ships crew, offshore, underground or underwater working, fire fighters, ambulance crew, police or armed forces, forestry, mining or quarrying, dealing with asbestos, nuclear, explosive materials or firearms, regular dealing or trading in Money Market instruments

Premium • if quoted via UnumOnline, premiums must be paid via Direct Debit

• where a quotation is produced by your intermediary via UnumOnline, the estimated 1st-year cost will also include any loadings (medical or non-medical) supplied at the time the quote was produced

Section 12 – Complaints

We want you to be entirely satisfied with your Group Critical Illness policy. If you do have a query or complaint, please contact the intermediary who arranged the policy for you. If there was no intermediary, please contact us directly.

If you are still not satisfied, please write to:

Technical Complaints Team Leader

UnumMilton CourtDorking Surrey RH4 3LZ Tel: 01306 644761

If you are still dissatisfied, you have the option to contact the Financial Ombudsman Service at the address below up to 6 months after our final decision. Your legal rights are not affected.

The Financial Ombudsman Service,Exchange Tower, London E14 9SR Tel: 0800 023 4567Email: [email protected]

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Section 13 – Compensation

If we cannot meet our liabilities, you may be entitled to compensation under the UK Financial Services Compensation Scheme (FSCS). You can find out more about the FSCS including eligibility to claim, by visiting www.fscs.org.uk or calling 0800 6781100.

Section D - Glossary

Automatic Entry Limit (AEL) means the maximum benefit that Unum will provide for any member without the need for medical underwriting, subject to the pre-existing conditions exclusion.

Commencement date means the date Unum first assumed risk for the policy.

Core Benefit is the minimum level of benefit for each member.

A Critical Illness event means the diagnosis of a medical condition or undergoing a surgical procedure listed as a critical illness by a medical practitioner, which is subsequently confirmed according to the terms of the definition of the relevant critical illness covered under the policy..

A Discretionary Entrant is an individual who does not satisfy the eligibility conditions but is included as a member (but excludes an Early Entrant and a Late Entrant).

An Early Entrant is an individual who is to be included in the policy before the date of their first opportunity.

Implementation Date (or Commencement Date) is the date on which the Flexible Benefits scheme is to commence and on which Unum is to assume risk.

A Late Entrant is an individual who is to be included in the policy after the date of their first opportunity.

Lifestyle Events are agreed qualifying events when Benefit Elections may be made outside the normal annual election period.

Partner describes a relationship to the member that you define for your policy and that is acceptable to us. A typical definition is “a person who is over age 18 and not a relative of the employee, other than their legal spouse, and who is financially dependent upon them and sharing the same main residence with them and has been doing so for a specified period (minimum 6 months)”.

The policy accounting date is the date from which the premium due for the next policy accounting period is calculated.

The policy accounting period is defined as the period from the commencement date of the policy up to the first policy accounting date, and from one policy accounting date to the next policy accounting date.

The policy review date is the date when the premium rate and terms of the policy are reviewed and guaranteed for a further period (typically 2 or 3 years).

Spouse means the legal husband or wife or the civil partner of the member and who is living with the member.

The policy Terminal Age is the age at which cover under the policy ceases and can be a set age or linked to the member’s State Pension Age (SPA). If SPA is selected, subsequent changes to the SPA will apply to all members. The SPAs are set out in the table on our website in ‘State Pensionable Ages=Policy Terminal Age’

(UP2105) which can be found here: http://online.positiveimagesuk.com/unum/images/UP2105.pdf

Cover can cease at any pre-agreed point within the month during which the member reaches Terminal Age, such as the last day of the month. Unless otherwise stated, cover will cease at 23:59 on the day prior to the member reaching Terminal Age.

Total Permanent Disability (TPD) also referred to as Permanent Total Disability (PTD) is defined as a permanent disability caused by any illness (not just a Critical Illness event) or any injury.

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Section E - Appendix

The following are the defined conditions under which benefits are payable and which must be established to the satisfaction of Unum’s Chief Medical Officer.A pre-existing conditions exclusion applies. This means a

Group Cover Critical Illness event Definition

Cancer Base Cancer - excluding less advanced cases Any malignant tumour positively diagnosed with histological confirmation and characterised by the uncontrolled growth of malignant cells and invasion of tissue.

• The term malignant tumour includes leukemia, sarcoma and lymphoma except cutaneous lymphoma (lymphoma confined to the skin).

For the above definition, the following are not covered:

• all cancers which are histologically classfield as any of the following:

- pre-malignant;

- non-invasive;

- cancer in situ;

- having borderline malignancy; or

- having low malignant potential.

All tumours of the prostate unless histologically classified as having a Gleason score of 7 or above or having progressed to at least clinical TNM classification T2bN0M0.

Chronic lymphocytic leukaemia unless histologically classified as having progressed to at least Binet Stage A.

Any skin cancer (including cutaneous lymphoma) other than:

- malignant melanoma that has been histologically classified as having caused invasion beyond the epidermis (outer layer of skin), or

- basal cell carcinoma or squamous cell carcinoma that has spread to lymph nodes or metastasized to distant organs.


Base Coronary artery bypass grafts The undergoing of surgery on the advice of a Consultant Cardiologist to correct narrowing or blockage of one or more coronary arteries with by-pass grafts.


Base Heart attack Death of heart muscle, due to inadequate blood supply, that has resulted in all of the following evidence of acute myocardial infarction:

• new characteristic electrocardiographic changes or other positive findings on diagnostic imaging tests.

• the characteristic rise of cardiac enzymes or Troponins

The evidence must show a definite acute myocardial infarction.


• other acute coronary syndromes or

• angina without myocardial infarction

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Base Heart transplant - from another donor Included in ‘Major organ transplant’


Base Stroke Death of brain tissue due to inadequate blood supply or haemorrhage within the skull that has resulted in all of the following evidence of stroke:

- Neurological deficit with persisting clinical symptoms lasting at least 24 hours; and

- Definite evidence of death of tissue or haemorrhage on a brain scan


- Transient ischaemic attack.

- Traumatic injury to brain tissue or blood vessels.

- Death of tissue of the optic nerve or retina / eye stroke


Extra Aorta graft surgery The undergoing of surgery to the aorta with excision and surgical replacement of a portion of the aorta with a graft. The term aorta includes the thoracic and abdominal aorta but not its branches.


• Any other surgical procedure, for example, the insertion of stents or endovascular repair


Extra Cardiac arrest - with insertion of a defibrillator

Sudden loss of heart function with interruption of blood circulation around the body resulting in unconsciousness and resulting in either of the following devices being surgically implanted:

• Implantable Cardioverter-Defibrillator (ICD); or

• Cardiac Resynchronization Therapy with Defibrillator (CRT-D).

For the above definition the following are not covered:

• Insertion of a pacemaker


Extra Cardiomyopathy - of specified severity A definite diagnosis of cardiomyopathy by a Consultant Cardiologist. There must be clinical impairment of heart function resulting in the permanent loss of ability to perform physical activities to at least Class 3 of the New York Heart Association classification of functional capacity (marked limitation of physical activities where less than ordinary activity causes fatigue, palpitation, breathlessness or chest pain). The diagnosis must be supported by echocardiogram.


• All other forms of heart disease, heart enlargement and myocarditis

• Cardiomyopathy secondary to alcohol or drug abuse

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Extra Coronary angioplasty - to 2 or more coronary arteries

The undergoing of balloon angioplasty, including atherectomy, laser treatment or stent insertion on the advice of a Consultant Cardiologist to two or more main coronary arteries as a single procedure to correct:

• narrowing or blockages of at least 70%, or

• narrowing or blockages where there is a fractional flow reserve ratio of <0.8.

The main coronary arteries for this purpose are defined as Right Coronary Artery, Left Main Stem, Left Anterior Descending and (Left) Circumflex.

Angiographic evidence will be required.


Extra Heart valve replacement or repair The undergoing of surgery (including balloon valvuloplasty) on the advice of a Consultant Cardiologist to replace or repair one or more heart valves.


Extra Primary pulmonary arterial hypertension - of specified severity

A definite diagnosis of pulmonary arterial hypertension of unknown cause. There must be clinical impairment of heart function resulting in the permanent loss of ability to perform physical activities to at least Class 3 of the New York Heart Association classification of functional capacity (marked limitation of physical activities where less than ordinary activity causes fatigue, palpitation, breathlessness or chest pain).

For the above definition, the following is not covered:

- pulmonary hypertension secondary to any other known cause i.e. not primary


Extra Pulmonary artery surgery - for disease The actual undergoing of surgery on the advice of a Consultant Cardiothoracic Surgeon for a disease of the pulmonary artery to excise and replace the diseased pulmonary artery with a graft.


Extra Structural heart surgery - with surgery to divide the breastbone

The undergoing of surgery requiring median sternotomy (surgery to divide the breastbone) on the advice of a Consultant Cardiologist to correct any structural abnormality of the heart.

Organ failure Base Kidney failure - requiring permanent dialysis

Chronic and end stage failure of both kidneys to function, as a result of which regular dialysis is permanently required

Organ failure Base Major organ transplant - from another donor

The undergoing as a recipient from another donor, or inclusion on an official UK waiting list for a transplant of any of the following:

• bone marrow, or

• a complete heart, kidney, liver, lung or pancreas, or

• a lobe of liver, or

• a lobe of lung.


• transplant of any other organs, parts of organs, tissues or cells.

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Organ failure Extra Aplastic anaemia - of specified severity Complete bone marrow failure which results in anaemia, neutropenia and thrombocytopenia and requires as a minimum one of the following treatments;

- Blood transfusion,

- Bone-marrow transplantation,

- Immunosuppressive agents,

- Marrow stimulating agent.

Organ failure Extra Liver failure - of specified severity End-stage liver failure resulting in all of the following:

- Permanent jaundice

- Ascites (fluid retention in the abdominal cavity)

- Encephalopathy (mental confusion due to nitrogenous substances not being removed by the liver).


- Liver disease secondary to alcohol or drug misuse.


Base Creutzfeldt-Jakob disease - resulting in permanent symptoms

A definite diagnosis of Creutzfeldt-Jakob disease by a Consultant Neurologist resulting in permanent neurological deficit with persisting clinical symptoms.


Base Dementia including Alzheimer’s disease – resulting in permanent symptoms

A definite diagnosis of dementia including Alzheimer’s disease by a Consultant Neurologist, Psychiatrist or Geriatrician. There must be permanent clinical loss of the ability to do all of the following:

• remember;

• reason; and

• perceive, understand, express and give effect to ideas.


Base Motor neurone disease - resulting in permanent symptoms

A definite diagnosis of one of the following motor neurone diseases by a Consultant Neurologist:

- Amyotrophic lateral sclerosis (ALS)

- Primary lateral sclerosis (PLS)

- Progressive bulbar palsy (PBP)

- Progressive muscular atrophy (PMA)

There must be permanent clinical impairment of motor function.

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Base Multiple sclerosis - with persisting symptoms

A definite diagnosis of multiple sclerosis by a Consultant Neurologist that has resulted in either of the following:

• clinical impairment of motor or sensory function, which must have persisted from the time of diagnosis; or

• two or more attacks of impaired motor or sensory function together with findings of clinical objective evidence on Magnetic Resonance Imaging (MRI scan)

All of the evidence must be consistent with multiple sclerosis.


Base Parkinson’s disease and Parkinson plus syndromes - resulting in permanent symptoms

A definite diagnosis of Parkinson’s disease or one of the following Parkinson plus syndromes by a Consultant Neurologist or Geriatrician.

- Multiple system atrophy

- Progressive supranuclear palsy

- Parkinsonian-dementia-amyotrophic lateral sclerosis complex

- Corticobasal ganglionic degeneration

- Diffuse Lewy body disease

There must be permanent clinical impairment of motor function with associated tremor and muscle rigidity.


• any other Parkinsonian syndromes/Parkinsonism.


Extra Bacterial meningitis - resulting in permanent symptoms

A definite diagnosis of bacterial meningitis by a Consultant Neurologist resulting in permanent neurological deficit with persisting clinical symptoms.


- all forms of non-bacterial meningitis


Extra Benign brain tumour - with permanent symptoms or specified treatments

A non-malignant tumour or cyst originating from the brain, cranial nerves or meninges within the skull, resulting in any of the following:

• permanent neurological deficit with persisting clinical symptoms; or

• undergoing invasive surgery to remove part or all of the tumour; or

• undergoing either stereotactic radiosurgery or chemotherapy treatment to destroy tumour cells.


• tumours in the pituitary gland

• tumours originating from bone tissue

• angioma and cholesteatoma.

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Extra Benign spinal cord tumour - with permanent symptoms or specified treatments

A non-malignant tumour originating from the spinal cord, spinal nerves or meninges, resulting in any of the following:

- permanent neurological deficit with persisting clinical symptoms; or

- undergoing invasive surgery to remove the tumour; or

- undergoing stereotactic radiotherapy to the tumour.


- granulomas, haematomas, abscesses, disc protrusions or osteophytes.


Extra Coma – with associated permanent symptoms

A state of unconsciousness with no reaction to external stimuli or internal needs which:

• requires the use of life support systems for a continuous period of at least 96 hours; and

• with associated permanent neurological deficit with persisting clinical symptoms.


• medically induced coma

• coma secondary to alcohol or drug abuse


Extra Encephalitis - resulting in permanent symptoms

A definite diagnosis of encephalitis by a Consultant Neurologist resulting in permanent neurological deficit with persisting clinical symptoms.


Base Lung transplant - from another donor Included in ‘Major organ transplant’.


Extra Respiratory failure - of specified severity Confirmation by a Consultant Physician of severe lung disease which is evidenced by the need for continuous daily oxygen therapy on a permanent basis and that has either of the following:

• Carbon monoxide diffusion capacity (DLCO) of less than 40% of normal; or

• Lung function tests persistently showing Forced Expiratory Volume in 1 second (FEV1) less than 50% and Forced Vital Capacity (FVC) less than 50% of normal.

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Accidents Extra HIV infection - caught within specified geographic limits from a blood transfusion, physical assault or at work

Infection by Human Immunodeficiency Virus (HIV) resulting from:

• a blood transfusion given as part of medical treatment

• a physical assault, or

• an incident occurring during the course of performing normal duties of employment, after the date of becoming a member and satisfying all of the following:

• The incident must have been reported to appropriate authorities and have been investigated in accordance with the established procedures

• Where HIV infection is caught through a physical assault or as a result of an incident occurring during the course of performing normal duties of employment, the incident must be supported by a negative HIV antibody test taken within 5 days of the incident

• There must be a further HIV test within 12 months confirming the presence of HIV or antibodies to the virus

• The incident causing infection must have occurred in the E.C., North America or Australasia

For the above definition the following is not covered:

• HIV infection resulting from any other means, including sexual activity or drug abuse

Accidents Extra Third degree burns - covering 20% of the body or face

Burns that involve damage or destruction of the skin to its full depth through to the underlying tissue and covering at least 20% of the body’s surface area or 20% of the face. For the purposes of this definition the face includes the forehead and ears.

Accidents Extra Traumatic brain injury - resulting in permanent symptoms

Death of brain tissue due to traumatic injury resulting in permanent neurological deficit with persisting clinical symptoms.

Terminal illness Base Terminal illness - where death is expected within 12 months

A definite diagnosis by the attending Consultant of an illness that satisfies both of the following:

• The illness either has no known cure or has progressed to the point where it cannot be cured, and

• In the opinion of the attending Consultant, the illness is expected to lead to death within 12 months

Disability Extra Blindness - permanent and irreversible Permanent and irreversible loss of sight to the extent that when tested with the use of visual aids, vision is measured at 6/60 or worse in the better eye using a Snellen chart, or visual field is reduced to an arc of 20 degrees or less, as certified by an ophthalmologist

Disability Extra Deafness – permanent and irreversible Permanent and irreversible loss of hearing to the extent that the loss is greater than 95 decibels across all frequencies in the better ear using a pure tone audiogram.

Disability Extra Loss of hand or foot - permanent physical severance

Permanent physical severance of a hand or foot at or above the wrist or ankle joint.

Disability Extra Loss of speech - total, permanent and irreversible

Total permanent and irreversible loss of the ability to speak as a result of physical injury or disease.

Disability Extra Paralysis of limb - total and irreversible Total irreversible loss of muscle function to the whole of any limb.

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Disability Extra Rheumatoid arthritis - of specified severity A definite diagnosis by a Consultant Rheumatologist of chronic rheumatoid arthritis as evidenced by widespread joint destruction with major clinical deformity.

In addition the member must permanently satisfy three of the four following criteria:

Bending - The inability to bend or kneel to pick up something from the floor and stand up again and the inability to get into and out of a standard saloon car.

Dexterity - The inability to use hands and fingers to pick up and manipulate small objects such as cutlery, including being unable to write using a pen or pencil.

Lifting - The inability to lift, carry or otherwise move everyday objects by hand. Everyday objects include a kettle of water, a bag of shopping and an overnight bag or briefcase.

Mobility - The inability to walk a distance of 200 metres on flat ground, with or without the aid of a walking stick and without having to rest or experiencing severe discomfort.

Disability Extra Total permanent disability - of specified severity

The bases of total permanent disability which may apply are:

(a) Any occupation (unable to do any occupation at all ever again)

(b) Activities of daily living (unable to look after yourself ever again)

(c) Own occupation (unable before age 60 to do your own occupation ever again)

In respect of a total permanent disability claim for a member’s child, benefit will be payable if the member’s child satisfies the conditions under the total permanent disability (any occupation) basis when considered as if they were an adult.

In respect of a total permanent disability claim for a member’s spouse, benefit will be payable if the member’s spouse satisfies the conditions under the total permanent disability (activities of daily living) basis.

In respect of all total permanent disability claims, no benefit shall be payable in respect of a member (or the member’s child or member’s spouse, as appropriate) for any incapacity which directly or indirectly results from, or is related to, the member (or the member’s child or member’s spouse, as appropriate) being infected with HIV or having developed AIDS. HIV means any Human Immunodeficiency Virus with which the member (or the member’s child or member’s spouse, as appropriate) is at any time found to be infected. AIDS means Acquired Immunodeficiency Syndrome which the member (or the member’s child or member’s spouse, as appropriate) is at any time found by medical history, examination or testing to have developed.

Extra a) Total permanent disability - unable to do any occupation at all ever again

Loss of the physical or mental ability through an illness or injury to the extent that the insured person is unable to do the material and substantial duties of any occupation at all ever again. The material and substantial duties are those that are normally required for, and/or form a significant and integral part of, the performance of the occupation that cannot reasonably be omitted or modified.

Any occupation means any type of work at all, irrespective of location and availability.

The relevant specialists must reasonably expect that the disability will last throughout life with no prospect of improvement, irrespective of when the cover ends or the insured person expects to retire.

For the above definition, disabilities for which the relevant specialists cannot give a clear prognosis are not covered.

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Extra b) Total permanent disability - unable to look after yourself ever again

Loss of the physical ability through an illness or injury to do at least 3 of the 6 tasks listed below ever again.


The insured person must need the help or supervision of another person and be unable to perform the task on their own, even with the use of special equipment routinely available to help and having taken any appropriate prescribed medication.

The tasks are:

• Washing – the ability to wash in the bath or shower (including getting into and out of the bath or shower) or wash satisfactorily by other means.

• Getting dressed and undressed – the ability to put on, take off, secure and unfasten all garments and, if needed, any braces, artificial limbs or other surgical appliances.

• Feeding yourself – the ability to feed yourself when food has been prepared and made available.

• Maintaining personal hygiene – the ability to maintain a satisfactory level of personal hygiene by using the toilet or otherwise managing bowel and bladder function.

• Getting between rooms – the ability to get from room to room on a level floor.

• Getting in and out of bed – the ability to get out of bed into an upright chair or wheelchair and back again.


Extra c) Total permanent disability - unable before age 60 to do your own occupation ever again

Loss of the physical or mental ability through an illness or injury before age 60 to the extent that the insured person is unable to do the material and substantial duties of their own occupation ever again. The material and substantial duties are those that are normally required for, and/or form a significant and integral part of, the performance of the person’s own occupation that cannot reasonably be omitted or modified.

Own occupation means your trade, profession or type of work you do for profit or pay. It is not a specific job with any particular employer and is irrespective of location and availability.



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We monitor telephone conversations and e-mail communications from time to time for the purposes of training and in the interests of continually improving the quality of service we provide.

Registered office: Milton Court Dorking Surrey RH4 3LZ

Critical IllnessIncome Protection Life Cover

Tel: 01306 887766 Fax: 01306 881394

About Unum

Unum is one of the UK’s leading providers of financial protection with more than 40 years’ experience.

Unum helps employers protect their workers by providing access to financial protection, safeguarding employees from the consequences of serious illness, injury or death.

At the end of 2013, Unum protected almost 1.6 million people in the UK and paid claims of £320 million - representing in excess of £6 million a week in benefits to our customers - providing security and peace of mind to individuals and their families.

In the UK, Unum has a financial strength rating of A- (Strong) from Standard & Poor’s with a stable outlook.

Its US parent company, Unum Group, traces its history back to 1848 and is one of the leading providers of employee benefits products and services, and the largest provider of group and individual disability insurance in the United States. Premium income for Unum Group and its subsidiaries totaled $7.6 billion in the year ended 31 December 2013, with reported revenues for the group totaling $10.4 billion. Total assets were $59.4 billion at 31 December 2013.

For more information please visit www.unum.co.uk.

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