MLC Insurance & Super Adviser Guide 300813

209 Pages·2013·1.54 MB·English

Adviser use only
Financial
Adviser Guide
MLC Insurance
MLC Insurance (Super)
Issue date: MLC Limited and MLC Nominees Pty Limited Trustee for The Universal Super
30 August 2013 ABN 90 000 000 402 ABN 93 002 814 959 Scheme ABN 44 928 361 101
AFSL 230694 AFSL 230702 RSE L0002998 R1056778 SFN 281440944
Issuer of MLC Insurance Issuer of MLC Insurance (Super)
Contents
At a glance, what is covered in this guide
1 Contact Summary 3 Underwriting
requirements tables
Contact MLC 11
Medical requirements 21
2 U nderwriting philosophy
What is the combined
and service
sum insured? 21
Underwriting philosophy Life Cover, Accidental Death,
statement 13 TPD and Critical Illness 21
Table A: Life Cover, Accidental Death,
Underwriting service 14
TPD and Critical Illness combined
Your underwriting team 14 sum insured 22
How do we help you? 14
Table B: Additional requirements for
How you can help your client 14 Critical Illness over $500,00 22
MLC Riskfirst applications 15
Income Protection 23
Legislation, FSC standards
Table C: Income Protection 23
and guidelines 16
Business Expenses 23
Privacy 17
Business Expenses with Income
Alternative terms and policy Protection 23
amendments 18
Key to type of medical evidence
Exclusions 18 required in addition to the personal
Why do we offer exclusions? 18 statement 24
Can exclusions be reviewed? 19 Glossary of requirements 25
If your client is in an accident, will
Financial requirements 26
their claim be considered? 19
Personal insurance: Life Cover,
Accidental Death, TPD and
Critical Illness 26
Multiple of earnings 27
Page 2 Financial Adviser Guide
Contents
(continued)
Business insurance: Life Cover, 5 Occupation
Accidental Death, TPD and
underwriting guide
Critical Illness 28
Occupation underwriting 95
Income Protection 30
Hard-to-classify
What is the maximum occupations 96
monthly benefit? 30
Change of occupation 96
When is financial evidence
More than one occupation 96
required? 30
Special occupation eligibility
Which type of evidence
categories 97
is required? 31
Apprentices 97
Business Expenses 32
Armed services 97
4 O ccupation groups guide Bankruptcy, insolvency or
liquidation 97
How occupations are
Financial advisers 97
grouped 34
Homemakers – Total and
MLC can help you 34 Permanent Disability 97
Key to occupation groups 35 Leave from employment 98
Product codes 35 Newly self-employed 98
Life Cover and Critical Illness 35 Part-time workers 98
Income Protection, Business Total and Permanent Disability 98
Expenses and Total and Permanent Income Protection 98
Disability 36 Seasonal workers 99
Eligibility for ‘Own Occupation’ Professionals package 99
definition TPD 37 Eligibility 99
Occupation group Levels of cover 99
tables A–M 38 Professional sportspeople 101
Occupation group Working at heights 101
tables N–Z 74 Working at home 101
Working more than 60 hours
per week 101
Page 3 Financial Adviser Guide
Contents
(continued)
6 P astimes table Joint and several liability 123
Business Safeguard 123
and guide
Income Protection 125
How pastimes are classified 103
Calculating the monthly benefit 125
Key to pastime classifications 104
Conditions for monthly benefits over
Pastime classification $30,000 125
tables A–Z 105 Income Protection Agreed Value
vs Indemnity benefit 126
7 Financial underwriting
Agreed Value cover 126
Financial requirements: why Agreed Value cover endorsed 126
financially underwrite? 118 Indemnity cover 126
Personal Insurance: Life Cover, Earnings 126
Accidental Death, TPD and Self-employed 126
Critical Illness 119 Employee 127
Other earnings 127
Employed/Self-employed
- Bonuses 127
applicants 119
- Commissions 127
Homemakers 120
- Depreciation 128
Unemployed, student and
- Donations 128
retired applicants 120
- I ncome distribution to spouse/
Business Insurance: Life, defacto/life partner 128
Accidental Death, TPD, - N on-cash personal benefits
Critical Illness and Business as earnings 129
Safeguard Option 121 Unearned income and assets 130
Purpose of Business 121 Business Expenses 131
Who can apply? 131
Ownership Protection (Buy/Sell)
insurance 121 Partnerships 131
Small businesses 131
Revenue Protection (Key person)
Sole traders 131
insurance 122
Expenses covered 132
Asset (Debt) Protection or loan
Expenses not covered 132
guarantee insurance 122
What is a Locum? 132
Page 4 Financial Adviser Guide
Contents
(continued)
8 Medical underwriting Underwriting medical
conditions 147
Medical requirements 134
Asthma 147
New business 134
Underwriting approach 147
Increases 135
Business Safeguard Option 135 Back/Neck pain or disorders 147
Arranging medical Underwriting approach 147
requirements 136 Blindness 148
MLC can arrange medical Causes of blindness 148
requirements 136 Underwriting approach 148
What is a PMAR? 136 Cardiovascular disease 149
You can arrange medical The heart 149
requirements 136 Common cardiac disorders 149
What is a RapidCheck? 136 - H yperlipidaemia or raised
Does your client need to fast cholesterol 149
for a blood test? 136 - Coronary heart disease 150
- Hypertension 150
Underwriting questionnaires 138
Underwriting approach 151
Health pre-assessment 140
Diabetes 152
Health affects applications 140
Type 1 diabetes 152
Critical Illness Extra Benefits
Type 2 diabetes 152
Option – Partial Benefits 140
Gestational diabetes 152
Critical Illness – alternative terms
Underwriting approach 152
for special cardiovascular and
cancer risks 143 Family history 153
Critical conditions not covered 144 What family history is relevant? 153
Child Critical Illness 145 What is the risk? 153
Body mass index: height FSC Family History 153
and weight 145 Genetics 154
BMI ranges – what do they mean? 146 FAQs 157
Underwriting requirements 146
Page 5 Financial Adviser Guide
Contents
(continued)
Joint/Musculoskeletal 9 New business and policy
disorders 155 alterations
Underwriting approach
for disability cover 155 Application process 162
- Fracture 155 PDS and Application Form 163
- Arthritis 155 MLC Riskfirst 164
- M uscular or tendon injuries MLC Riskfirst – first class
and repetitive strain injuries 156 service for you 170
- Gout 156 Top 10 reasons why advisers
Mental health 156 choose Riskfirst 164
Some types of disorders 156 Travel and residency 166
- Anxiety 156 Must your client be a permanent
- Depression 156 resident of Australia? 166
- Bipolar disorder 156 Does your client plan to travel
- Postnatal depression 156 overseas? 166
Underwriting approach 157 Is your client an Australian citizen
FSC Mental Health Guidelines living and working overseas? 167
(Guidance Note No. 15) 157 General information
Memorandum of Understanding 157 for applications 168
Skin Lesions 158 Does your client read and
Basal cell carcinoma (BCC) 158 understand English? 168
Melanoma 158 Is your client having a break
Moles (benign naevus) 158 in employment? 168
Sebaceous cysts 158 Does your client have a disability
Squamous cell carcinoma (SCC) 158 claim pending? 168
Sunspots (solar keratosis) 158 Backdating applications 169
Underwriting approach 158 What if your client has a birthday
Sleep apnoea 159 before the policy completes? 169
Underwriting approach 159
Smoking 160
Underwriting approach 160
Page 6 Financial Adviser Guide
Contents
(continued)
Replacement business 170 Remuneration on Buy
Eligibility 170 Back benefits 183
Remuneration on
Evidence requirements 170
rewritten business 187
New business follow-up
Substitute business rules 187
procedures 171
Reinstating 172 Remuneration on substitute
Reinstating cancelled business 188
applications 172 Changing the level of cover, adding
Reinstating lapsed policies 172 extra cost options or altering
options which affect premiums 190
Continuation options for Group
Remuneration for special cases 190
Insurance, MasterKey Business
Super and MasterKey Wrap 173 Responsibility period 190
Premium discount on
What are the terms
commission 190
of eligibility? 173
Group Insurance and MasterKey 10 Premium Information
Business Super (MKBS) 173
Premium rates 192
MasterKey Wrap 173
Minimum premium 192
What cover options
are available? 173 How clients can pay
Requirements 174 premiums 193
Alterations to existing What payment options are
policies 175 available? 193
Financial advisers’ Which payment form
commission 186 is required? 193
Change of servicing adviser Direct debit system 194
or licensee 186 Credit card deductions 194
Remuneration rate 186 Cheque 194
Change of authorised Bpay® facility 194
representative before completion 186 Eligible MLC Account
Clawback after change of deductions 196
authorised representative 186
Page 7 Financial Adviser Guide
Contents
(continued)
11 C laims procedures Structuring insurance
information between policies using
Connected Benefits 204
Claims process and contacts 197
Example 1: Structuring insurance
Claims procedures 199 inside and outside super 205
Claims philosophy 199 Example 2: Structuring insurance
Notification 199 inside and outside super (with an
Time limits on claims 200 external trustee) 205
Example 3: Structuring insurance
Submission of completed claim
for business and personal
forms/Proof of Loss 200
purposes 206
12 Product Information Fees and payment methods under
Connected Benefits 206
Policy structures 202
Setting up Connected Benefits 206
MLC Insurance (Super)
– insurance inside super 202 Sums insured, claims, cancellation
and options with Connected
Number of lives Insured 202
Benefits 207
Policy ownership 202
Rules unaffected by
MLC Insurance – insurance
Connected Benefits 207
outside super 202
Policy ownership 203 Nominating a beneficiary 208
Income Protection and Business Non-binding death benefit 208
Expenses third-party ownership 203 Non-lapsing binding
Ownership by a trust or death benefit 208
self-managed super fund 203 No nomination 208
Page 8 Financial Adviser Guide
Your financial
adviser guide
This is your guide to MLC insurance and
underwriting. It is designed to assist you
in writing MLC insurance by explaining our
underwriting philosophy, requirements and
practices, as well as our claims procedures and
product information.
The guide is comprehensive, but you may
need to discuss particular issues or
aspects of applications with one of MLC’s
Business Development Managers (BDMs)
or experienced underwriters.
The MLC Service teams are also there to help
you and we encourage you to call us about
any underwriting, new business, maintenance or
product enquiry you may have.
This guide is for adviser use only and is
not intended for general distribution.
It has been prepared by MLC Limited and
is intended as a reference and training
guide for advisers. The product information
contained in this guide should be read in
conjunction with the Product Disclosure
Statement (PDS) and the applicable
Policy Documents.
Page 9 Financial Adviser Guide
Contacts
summary
1
Page 10 Financial Adviser Guide