This page describes the structure and contents of the policy wording.
The life insurance policy wording is comprised of three documents:
TotalCareMax Life Cover is Sovereign’s flagship life insurance policy. The Umbrella Wording is common to all TotalCareMax policies. The Benefit Appendix provides details of the life cover benefit. The Policy Schedule is customised to the life (or lives) insured as it contains personal details such as who is insured and the amount of cover. Each of these documents is explained below.
The Umbrella Wording comprises eight sections, and these cover (in this order) the four major areas of benefits, premiums, claims and policy information. The purpose of each of the eight sections is summarised as follows, with the numbering following that in the Umbrella Wording:
A statement of what your policy is and what benefits it can provide. This section links the Umbrella Document to the Benefit Appendix and the Policy Schedule, and makes those part of the overall policy.
This provides a guarantee that if any applicable section or condition of your policy is enhanced in the future, then that enhancement will automatically be applied to your policy, subject to the conditions specified.
This describes the two inflation adjustment (indexation) options for your policy, namely no indexation at all and indexation which is based on changes in the Consumers Price Index. It also describes how you can increase or reduce the amount of cover under your policy.
This section is a statement of the need to pay the agreed premiums on a regular basis, how premiums can be paid, what happens if you don’t pay a premium on time and when the premium can change. The premium type for your policy is rate for age.
This section describes how to make a claim, and it provides an 0800 claims hotline number for that purpose. It also refers to the Benefit Appendix for information that may be required in order to make a claim.
This section details when and how you can cancel your policy, both during and after the initial 15-day free look period, and what happens if you give notice of cancellation. It also details the circumstances under which Sovereign would be entitled to cancel your policy.
This specifies important information regarding your policy, including what forms part of the policy contract, changes in law, New Zealand jurisdiction, notices to Sovereign and to you, transfer of the ownership of your policy, worldwide cover and how to make a complaint.
This section defines the meanings of special words which are used throughout the document, including ‘Claim Event’, ‘Fraudulently’, ‘Material’, ‘Pass Back Date’, ‘Policy Illustration’, ‘Substantially Incorrect’ and ‘Term Life Insurance Policy’.
The Benefit Appendix is a shorter and simpler document than the Umbrella Wording, and while it comprises 13 sections, five of those detail the special benefits which the policy provides, namely the terminal illness benefit, the specified terminal conditions benefit, the bereavement support benefit, the children’s funeral benefit, the special events increase facility, the special events TPD/trauma facility, the financial advice benefit and the repatriation benefit.
Section 1 of the Benefit Appendix is a straightforward statement on when Sovereign will pay a life cover benefit under your policy, while section 12 details when Sovereign will not pay a benefit under the policy. Importantly, section 12 states that Sovereign will not pay any benefit detailed in the Benefit Appendix where the person insured under the policy dies or becomes terminally ill due to an intentional self-inflicted act (whether sane or insane) within 13 months of the commencement date. That exclusion period applies to the initial cover, any reinstated cover and any subsequent increase in cover.
The Policy Schedule comprises the customised part of the policy wording, and is relatively brief. It specifies the following principal information:
The individual details on the Policy Schedule can be varied by notice or application to Sovereign as applicable, where permitted in accordance with the terms of the Umbrella Wording.
Please note that if you have already taken out a life insurance policy through KiwiCover, your policy wording may be different from the policy wording referred to above.