Group Risk – Key Points

GroupRisk.ie are Ireland’s leading provider of Group Risk Cover. For detailed description on our main products – Group Life Insurance, Group Income Protection and Group Critical Illness please click the link text.

1. Introduction
This page talks about important information about the following Employee Benefit products:

• Group Life Assurance
• Group Long Term Disability
• Group Critical Illness
• Group Total and Permanent Disability
• Group Accidental Death
• Group Accidental Dismemberment

2. Interpretation
Any reference in this document to words in the singular shall also include words in the plural and vice versa. Any statements that refer to “us”, “we”, “our”, “the Company”, will be taken to mean Group Risk Product Provider companies in general, operating within the Irish Marketplace. Words beginning with a capital letter are terms defined in section 3 of this document. Section 3 of this document may not necessarily apply to every single product producer and may be only referred to as an example of one or some of the providers presently offering products to customers within this marketplace. Any reference in this document to the masculine includes the female and neuter genders.
We advise you to check specifics with any underwriter so as to ensure that there are no conflicts with opinions given in our site versus the actual policy wording / Standard Terms and Conditions.

3. Definitions
Actively at Work
Means that a specific Eligible Employee
(a) is working his contracted number of hours and undertaking his usual duties and
(b) is not working contrary to medical advice received.

Any Eligible Employee who is not Actively at Work on the Commencement Date as a result of Illness or injury will not be covered until they have returned to work in his normal occupation for two consecutive months and/or have been underwritten and accepted on the company’s terms.

Benefit Entitlement
The full monetary amount that the underwriting company have committed under the terms of the Policy to pay in regard to any one Member.

Commencement Date
The date on which the Policy becomes effective, as set out in the company’s Policy Particulars.

Disability
The event affecting a Member as defined in the company’s Policy Particulars upon occurrence of which we have committed to the Employer to pay up to the Benefit Entitlement.

Eligibility
The condition under which any of your employees may qualify for the insurance coverage.

Eligible Employee
Anyone who fits the description of Eligibility agreed between the underwriting company and the trustee(s) and/or employer as outlined in the Policy Particulars of each underwriting company.

Exclusions
Provisions that state under what circumstances no payment will be made under the Policy.

Evidence of Insurability
Any documentation that the company may reasonably request from the trustee(s), employer or the Eligible Employee to assess the Eligible Employee for the inclusion in the Policy.

Free Cover Limit
The threshold of benefit above which Evidence of Insurability is required as stated in the Policy

Particulars.Illness
Sickness resulting from disease of body or mind.

Member
An employee who is included in the Policy. An Eligible Employee receiving benefit under this Policy must continue to satisfy the Eligibility rule as described in the Policy Particulars in order for benefit payment to continue (provided that the claim remains valid).

Morbidity
The rate of incidence of a disease.

Policy
The contract of insurance consisting of the signed Policy Document and Standard Terms and Conditions, Policy Particulars, Quotation, together with any special conditions or endorsements expressly stated to be incorporated in the Policy.

Policy Particulars
The schedule attaching to the Policy Document and Standard Terms and Conditions which details items specific to your Policy.

Pre-Existing Medical Condition
Any medical or related condition and/or complication of an Eligible Employee for which symptoms have appeared and which were first diagnosed, treated, advice sought or known to be in existence prior to the completion of the relevant health questionnaire.

Premium
The amount paid by you for the insurance cover.

Quotation
The quote, cover note, and Customer Information Notice issued by the underwriting company and accepted by the employer for the provision of insurance cover.

Renewal Date
The date, as shown in your Policy Particulars, when the year’s Premium is calculated.

Salary
The annual rate of basic earnings taken into account for Members, as shown in your Policy Particulars.
Bonuses, commission, remuneration for overtime etc. are not included unless specifically stated in the calculation method in the Policy Particulars.
In the event of a Member’s Salary comprising of any fluctuating emoluments, any claim made in regard to such a Member will be calculated on the basis of the average of such fluctuating payments for the last three years prior to the first day of the Member’s absence from work or since commencement of employment, if shorter.

Unit Rate
The rate used to calculate the Premium of the Policy. The Unit Rate is applied to the total Benefit Entitlement provided under the Policy. The rate is determined with reference to banded membership data and other underwriting adjustments.

4. Quotation
Any document relates to the Quotation with which it is issued and you should keep them together for future reference.
The Quotation gives the employer an illustration of the costs of the Policy and is usually valid for 3 calendar months from the date of issue shown.
Some Quotations will include active employees, but may exclude employees in receipt of an income from any sickness or incapacity insurances. Cover may be approved for any such employees once the underwriting company have been provided with written confirmation of the nature of the Illness or injury and the corresponding first date of absence from normal duties.

5. Policyholder’s and Member’s commitment
Full information, assistance and medical evidence shall be given by Members and/or policyholders free of charge by proposers to all underwriting companies.
The Member, if and when required, shall submit himself to be examined by a medical referee appointed or approved by the underwriting company. The Underwriter will not assume risk for any Member until all outstanding information requested in the corresponding Quotation has been received and they are satisfied that such information is acceptable.
You must provide the underwriting company with a full listing of the Eligible Employees within one calendar month of the Commencement Date. Provided they have received all the relevant documents, Members will not be required to be medically underwritten if the Member’s Full Benefit Entitlement does not exceed the Free Cover Limit where applicable.

6. Insured benefit
The amount of the Benefit Entitlement will be negotiated with the policyholder and will be set out in the Quotation and, as soon as the Policy commences, in the Policy Particulars too. A Member’s Benefit Entitlement will be assumed to be based on his annual basic Salary and will be outlined in the Policy Particulars. Other Salary definitions to be insured must be explicitly advised to the underwriting company at Quotation stage. No early or late retirees will be covered by any Policy unless expressly agreed to by the underwriting company.

7. Commencement of insurance cover
For any individual who is eligible to be covered by the Policy, the following will apply from certain underwriting companies: insurance cover for their Full Benefit Entitlement commences on the corresponding Commencement Date with the following exceptions:
Any employee who has had 10 consecutive days or more off work due to illness or injury in the 3 month period immediately prior to the date at which the employee first became eligible for insurance cover under the Policy.
Certain underwriting companies may consent to providing insurance cover subject to receipt of written details stating the reason for the absence concerned with the corresponding dates that the employee was absent from work. Insurance cover for such employees would only commence once we have issued written confirmation.
Benefit in excess of the insured Free Cover Limit will be subject to the underwriting company’s appropriate medical underwriting procedures. Risks related to any employee being underwritten will be covered for their Full Benefit Entitlement (excluding pre-existing Medical Conditions) for a period of 90 days (subject to differences between underwriting company’s) following the Commencement Date, to allow for the underwriting procedure to be completed. If after this period the underwriting decision remains outstanding, Members will be restricted to the insured Free Cover Limit and will continue to be so until the decision has been made. If the underwriting decision remainsoutstanding after 90 days, the underwriting company may agree to an extension of Full Benefit Entitlement (excluding pre-existing Medical Conditions) at their discretion.
Any employee who is not Actively at Work on the Commencement Date as a result of illness or injury may not be covered until they have returned to work in their usual capacity for two consecutive months (subject to differences between underwriting company’s).
Employees not joining the Policy at the first opportunity or who do not satisfy the Eligibility Conditions in any other way will be excluded from any Free Cover Limit and will be subject to underwriting in respect of their full benefit entitlement.

8. Termination of insurance cover
The Insurance Cover of a Member will cease immediately on any of the earliest of the following occurrences:

• the Member ceases to be an Eligible Employee;
• discontinuance of payment of Premiums; and
• any Member whose period of cover exceeds the provisions laid down under the underwriter’s temporary absence clause.

The Policy will be terminated, immediately and without notice, unless the invoiced Premium has been paid within 30 days of the invoice date.

9. Temporary absence
The period of permitted absence from work covered by the Policy is normally 12 months for any cause (subject to differences between underwriters). Any Member who is absent from work up to 12 months will remain covered accordingly. Should payment of Premium be discontinued in respect of any Member covered in temporary absence, such insurance cover will cease for that Member. Insurance cover may be subsequently resumed without the need to provide evidence of health on completion of two consecutive months in their ordinary occupation following a return to work and a resumption of Premium payment (subject to differences between underwriters).

10. Switching cover from a previous insurer
For existing insured policies that are transferred, all underwriting terms applied by the previous insurer will be matched by us on a no-worse terms basis at the date of switch of cover (subject to differences between underwriters) on the basis that:
(i) such terms will only apply to the Member’s Benefit Entitlement that had been previously underwritten. Any subsequent increase in sum assured that a Member is entitled to would be underwritten on the underwriting company’s terms;
(ii) if the underwriting company’s Free Cover Limit is higher than the previous insurer’s, their Free Cover Limit will not apply to any Members whose cover under the previous insurer’s policy had been subject to adverse underwriting decisions. Further increases in Benefit Entitlement for these Members will be fully underwritten on their terms;
(iii) the previous underwriting decision was made less than 12 months before the date of the insurance risks being transferred. For risks related to Members whereby underwriting decisions were made prior to this 12-month period, the underwriting company can reserve the right to not offer no-worse terms;
(iv) such terms will only apply to previous medical ratings of up to the Morbidity percentage specified in the Policy Document/ Standard Terms and Conditions;
(v) no Member had been restricted to a previous insurer’s Free Cover Limit as a result of poor health. For individuals restricted in this manner, the underwriting company would underwrite risks related to the Member for his Full Benefit Entitlement before terms will be accepted; and
(vi) similarly, risks related to any Member whereby cover was declined by the previous insurer will be underwritten for his Full Benefit Entitlement before acceptance terms will be considered.

11. Exclusions
Each Underwriter will have differing exclusions and these will be subject to change from time to time. Please refer to the underwriter’s policy booklet for exact wording.

12. How premiums are calculated
On the Commencement Date and each subsequent Renewal Date, the underwriting company will calculate the annual Premium in respect of the Policy for each future 12 month period by taking the Rate shown in your Policy Particulars and applying it to the total Benefit Entitlement for all Members included in the Policy as at that date (other than for those in respect of whom benefits are being paid).
If the period of time from the Commencement Date and any subsequent Renewal Date to the following Renewal Date is longer than a year, an additional Premium will be required to cover that part of the period exceeding one year. This Premium will be calculated on a pro rata basis, according to the period of time in question, and will be payable on the Commencement Date or subsequent Renewal Date.
The Premium will be adjusted at each Renewal Date to take account of any changes in membership and Salary during the previous year (or part if applicable). If this results in an additional Premium or any refund, it will be shown on your statement.
Where a Member has been accepted on non standard terms any additional Premium due will be calculated specifically in respect of that Member and added to the employer’s Premium statement. Any additional Premium or refund of Premium due under the Policy as above will be calculated by reference to the number of days in the period concerned, expressed as a proportion of a complete year, and will be that proportion of a full year’s Premium.
Should you choose to cancel your policy during the renewal year, a refund of the unused risk premium will be refunded. Each underwriting company reserve the right to deduct expenses from this refund due.
If the Policy is governed by a Single Premium Rate, each underwriting company will calculate a separate Premium in respect of each Member who has not then reached the Normal Retirement Age.
If a Unit Rate is applicable to the Policy, the rate is guaranteed as specified on the quotation from the Commencement Date provided that:

• the number of Members, or
• the total sum assured

does not change by more than 20% (subject to differences between underwriting company’s) to that in force at the Commencement Date. In the case of a change of more than 20%, each underwriting company reserve the right to change the Unit Rate at the date on which such changes first occurred. At the end of the guarantee period, the Unit Rate will be reviewed.

13. Details regarding the premium payment
Generally premiums are payable by you to the Underwriting company in advance, the first Premium being due on the Commencement Date and subsequent premiums being payable annually in advance or in advance at such other frequencies as specified in the Policy Particulars on each Renewal Date after the Commencement Date.
The Premium may be paid via cheque, EFT or direct debit in Euro, US Dollar or Sterling agreed between the employer and the Underwriting company as outlined in the Policy Particulars.

14. Tax regulations in Ireland
Under current Irish legislation, provided the recipient is an Irish tax resident, all benefits payable under the Policy are paid without deduction of Irish tax. This may be subject to change from time to time.

15. Cancellation rights
If you are not satisfied with the Policy, you can choose to cancel the Policy within 30 days from the Commencement Date (subject to differences between underwriting company’s). A written cancellation communication to the underwriting company the timeframe detailed in the policy wording is usually sufficient in order to exercise your cancellation right. Usually the underwriting company will refund all Premiums paid within the cancellation period less an adjustment for administration fees.

16. How to contact us
Grouprisk.ie
4 Fitzwilliam Square East
Dublin 2
Ireland

Contact details
Tel: + 353 (1) 6601 016
Fax: + 353 (1) 6642 988
E-mail: info@grouprisk.ie
Website: www.grouprisk.ie

GroupRisk.ie specialise in areas such as Group Life Assurance, Group Income Protection and Group Risk Cover.

Visit our FAQ Page for further information or call us directly on +353 (01) 6601 016.