Progressive Care Policy

This page describes the structure and contents of the policy wording.

The Progressive Care policy wording is comprised of three documents:

1. The TotalCareMax Umbrella Wording PDF

2. The Progressive Care Benefit Appendix PDF

3. The Policy Schedule

The Umbrella Wording is common to all of Sovereign’s TotalCareMax policies. The Benefit Appendix provides details about the Progressive Care benefit. The Policy Schedule is a customised document as it contains personal details such as who is insured and the amount of cover. Each of these parts is summarised as follows:

TotalCareMax Umbrella Wording

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:

• 1. Policy Benefits

  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.

• 2. Guaranteed Enhancement

  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.

• 3. Cover Options

  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.

• 4. Your Premiums

  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.

• 5. Making a Claim

  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.

• 6. Cancellation

  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.

• 7. Important Information

  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.

• 8. Key Terms

  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’.

Progressive Care Benefit Appendix

The Benefit Appendix contains the terms and conditions specific to the Progressive Care benefit that are not contained in the Umbrella Wording.

• Section 1 of the Benefit Appendix states the criteria under which Sovereign will pay a Progressive Care benefit.
• Section 2 specifies the categories of conditions under which a benefit payment may be made. The covered medical conditions are detailed in sections 13 to 17 and section 12 provides examples of related conditions for the purposes of benefit payments.
• Section 3 contains a table which details the benefits which are subject to a three-month stand down period from the risk commencement date.
• Section 4 explains the distinction between a standalone and an accelerated benefit. Unless you have requested otherwise, your Progressive Care benefit will be standalone.
• Section 5 contains a table of severity levels and the corresponding percentages used to calculate benefit payments.
• Section 6 specifies the maximum amounts payable for your first and any subsequent claims.
• Section 7 details the exclusions under which Sovereign will not pay a benefit.
• Section 8 provides information on how to make a claim.
• Section 9 describes a special policy benefit known as a benefit increase facility. This allows you to increase your cover at every third anniversary date of your policy without the need to answer any medical questions or provide any medical evidence. Terms and limits apply.
• Section 10 allows you to reduce your cover and explains the impact this would have with regard to future claim limits.
• Section 11 defines key terms used in the Benefit Appendix.

Policy Schedule

The Policy Schedule comprises the customised part of the policy wording, and it is relatively brief. It specifies the following principal information:

• The policy number;
• The name of the person insured (the ‘Life Assured’);
• The date of birth, gender and occupation of the person insured;
• The amount of Progressive Care cover for the person insured;
• The name and physical address of the policy owner;
• The monthly premium payable;
• The risk commencement date (the date on which cover starts);
• The signatures of two authorised officers of Sovereign in issuance of the policy.

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.