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Underwriting guide

THE QUESTIONS WE ASK AND THE INFORMATION WE NEED

“We consider the risk profile of each applicant looking at factors such as health, occupation, sports and residence. This helps us offer your clients the fairest possible terms based on their individual circumstances.”

Caroline Froude, Head of Underwriting Strategy & Development

Introduction

This guide will help you accurately complete our application for the most frequently disclosed medical conditions, sports activities, occupations and residence. It includes brief descriptions of conditions, and it covers the most relevant application questions and the things your clients need to know to be able to answer the application questions.

We can give an underwriting decision for many medical conditions your clients tell us about on their applications. For other conditions, we’ll request further medical information. For example, a customer questionnaire, GP report, nurse screening examination, medical examination, or blood test. Where we need medical evidence, this will be due to the level of cover you’ve asked us for, or the conditions disclosed by your client.

 

Key
Key

In this guide we use the following acronyms

BMI – Body mass index, i.e. weight in kilograms/height in metres x height in metres

BP – blood pressure

CI – critical illness

Ex – exclusion

FIB – Family Income Benefit

GPR – general practitioners report

IP – Income Protection

IP D4 – Income Protection with a 4-week deferred period (same principle for other deferred periods)

MER – medical examination report

NSE – nurse screening examination

PP – postpone

TPD A – total and permanent disability based on ability to perform activities

TPD O – total and permanent disability based on ability to perform own occupation

Definitions
Definitions

Decline – we can’t offer cover now or in the foreseeable future.

Exclude – we won’t pay a claim for the condition that’s excluded from the cover. An example exclusion wording is, ‘We won’t pay a total and permanent disability claim arising directly or indirectly from cancer or carcinoma in situ or its treatment’. Our underwriters can only apply exclusions to critical illness, total and permanent disability, or Income Protection.

Postpone – we can’t offer cover now but can consider it again after a defined period. For example, in a year’s time. However, your client’s health may change, so it’s not certain that cover will be possible after the postpone period.

Note total and permanent disability is part of our critical illness cover so if we decline to offer or postpone your clients’ critical illness cover, the decline and postponement applies to total and permanent disability too.

Removal – this is where we remove a critical illness definition from your client’s critical illness cover. An example removal wording is, ‘We won’t provide cover for cancer as a listed condition under critical illness’. If cancer or multiple sclerosis is removed or excluded, we’ll apply a premium discount.

Standard – standard premium rates.

Clinical Trials
Clinical Trials

Participation in a registered clinical trial, such as a vaccine trial, won’t affect our underwriting assessment of an application.

Financial Underwriting
Financial Underwriting

We financially underwrite applications for large amounts of cover to make sure the proposed cover is in keeping with the client’s financial situation.

For life cover with a cover amount of over £1.5 million, critical illness cover with a cover amount of over £500,000 (£800,000 if mortgage related and total critical illness cover in the market isn’t greater than £1 million) and/or Income Protection with a cover amount over £150,000 a year (self-employed applicants only), we’ll ask for financial evidence. This will usually be a financial questionnaire, however, for Income Protection we’ll also require proof of income. For any Income Protection cover amount, we may request a financial questionnaire for those who have been self-employed for less than a year. For very high cover amounts, we’ll ask for independent third-party evidence such as a loan offer letter, or for an accountant to sign the financial questionnaire.

Genetics
Genetics

We support and comply with the ABI Code on Genetic Testing and Insurance, which is in place to protect the interests of customers. We won’t ask anyone to have a genetic test.

Your clients don’t need to tell us the results of predictive genetic tests, except for a positive test for Huntington’s disease if they’re applying for life cover with a cover amount of more than £500,000.

Some people choose to voluntarily disclose predictive genetic test results that are in their favour (i.e. negative) – for example, to provide context for family history information. We’re happy to take this information into account.

Ratings
Ratings

Medical ratings are normally percentages known as ‘extra-mortality’ (risk of death) for life cases and ‘extra-morbidity’ (risk of disability) for disability. For Combined Life and Critical Illness Protection ratings are aggregated to generate an overall product rating. Per mille (pm) ratings are sometimes used. Per mille ratings may be for the whole policy term, or for some of the policy term.

Underwriting QI
Underwriting QI

You can use Underwriting Qi, our pre-sale tool, through your dashboard, to get an indication of the terms we may be able to offer before you submit an application. Underwriting Qi uses all the underwriting rules as our application, so the outcomes will be consistent.

Premium Waiver
Premium Waiver

Premium Waiver isn’t underwritten so would never be declined if we’re able to offer cover. If we offer terms on Life Protection, Life Essentials, Critical Illness Protection, Combined Life and Critical Illness Protection, or Income Protection, Premium Waiver is included as standard.

The type of Premium Waiver differs depending on the type of cover your client’s choose.

Hints and tips
  • Before submitting an application please check our underwriting non-medical limits and make sure your client is aware of and comfortable with any routine medical evidence requirements.
  • Our application automatically provides underwriting decisions for most occupations based on a list of more than 6,000 occupations. However, on price comparison portals, the number of occupations you can choose from is more limited. This means an occupation you can’t select when quoting may actually be available when you come through our Protection Builder 2.0 to apply. Please consider this before entering a job title that isn’t on the list.
  • If your client is a manager but you can’t find their exact job title on our application, please enter either ‘Manager – admin only’, ‘Manager – light manual work’ or ‘Manager – heavy manual work’.
  • If your client has more than one job, please enter their main job, i.e. the one they spend most of their time doing. If your client’s applying for Income Protection our application will ask about all jobs and if there are more than 2 jobs, we’ll be unable to offer terms
  • Please take care when answering the question, ‘Are you a UK resident who has lived in the UK for the last 2 years?’ the usual answer to the other application questions is ‘no’, so it’s easy to accidentally answer ’no’ to this question.
  • Application questions ask about different timeframes. For example, ‘Have you ever…?’, ‘In the last 5 years have you…?, ‘In the last 3 years have you…’, ‘In the last month have you…?’. Please read each question carefully to identify the timeframe. This will make sure you’re making the right level of disclosure. Disregarding limited timeframes can potentially lead to over-disclosure, which can mean we ask for unnecessary evidence and can lead to incorrect terms being offered.
  • If your client has a medical condition(s) for which we can’t give an immediate underwriting decision, providing copies of their relevant hospital letters can speed up the underwriting process. Recent letters and those from the time of diagnosis are most useful. Similarly, if we ask for a medical examination, blood test, or other medical test and your client has recently had one or all of these, providing copies of their recent results can speed up the underwriting process and make things easier for them. Please note, we’ll request a GP report directly if we need one.
Medical conditions

Below we give a description of the most commonly disclosed medical conditions, relevant application questions, information your clients need to know when answering the application questions and some examples of possible underwriting outcomes.

Sports activities

Various activities can involve a higher level of risk when it comes to protection.

Relevant application question:

Do you currently, or do you intend to, participate in any of the following?

  • Mountaineering
  • Scuba or deep-sea diving
  • Sailing (other than inland)
  • Flying (other than as a fare-paying passenger)
  • Motor sports
  • Extreme sports (including, but not limited to, bungee or base jumping, canyoning, caving/potholing, white water rafting, extreme mountain biking, martial arts or combat sports)
  • Professional or semi-professional sport (including, but not limited to, rugby league, rugby union, football)

Ratings:

Sports activities ratings are normally £1 per £1,000 of cover a year. Otherwise known as per mille (pm) ratings. For example, a £2.5pm rating for a cover amount of £20,000 would be £2.5 x 20 = £50 a year.

Occupation

We have a list of more than 6,000 job titles, which automatically provides underwriting decisions for most occupations.

If you can’t find your client’s job title on the Protection Builder or Underwriting Qi occupation dropdown list, please try describing the job a different way or pick the closest match. Specific automated rules are in place for higher risk occupations.

This section also covers housepersons.

For income protection, occupations are allocated a class 1 to 4. The allocated class influences the premium.

Occupation ratings are normally £1 for each £1,000 of cover a year. Otherwise known as per mille (pm) ratings. For example, a £2.5pm rating for a cover amount of £20,000 would be £2.5 x 20 = £50 a year.

Exclusion wording:

“We won’t pay a critical illness claim arising directly or indirectly from any accident, injury or condition that occurs as a result of performing your occupation. Any accident or injury that occurs outside of your work or occupation that causes a valid claim is covered.”

Things we’ll ask:

What is your job? Are you a member of the armed forces, Territorial Army or a reservist?

Job types that have specific automated underwriting rules are shown below. However, some jobs within these areas will be underwritten based on the job title only. Where that happens, no further job-related questions will be asked:

  • Armed forces
  • Aviation
  • Explosives
  • Fishing
  • General labouring
  • Heights
  • Merchant marine
  • Mining
  • Oil & natural gas
  • Publican
  • Underwater

Actual outcomes depend on your client’s answers to application questions. Below are example outcomes for armed forces, aviation, diving, fishing, housepersons, merchant marine, mining, oil/natural gas, police and quarrying.

Residence

Living in other countries can involve a higher level of risk because of things like political instability or poor healthcare facilities.

Residence ratings are normally £1 for each £1,000 of cover a year. Otherwise known as per mille (pm) ratings. For example, a £2.5pm rating for a cover amount of £20,000 would be £2.5 x 20 = £50 a year.

Applicants need to be a UK resident which is defined as someone who fulfils the following requirements:

  • They have been permanently resident in the UK for past 2 years with the right to remain in the UK.
  • Their permanent home must be in the UK.
  • They have a UK bank account which must be used to make payment.
  • They have a UK address (not a ‘care of’ address).
  • They’ve been registered with a UK doctor for the past 2 years.

US

Because of US taxation we only cover US nationals if they fulfil the following requirements:

  • they’re permanently resident in the UK
  • they work for a UK company
  • they only pay tax in the UK.

If your client lives in or is planning to live in the US, we won’t be able to offer them cover. If they have dual US and UK nationality, we’ll be able to offer them cover subject to normal underwriting. For the avoidance of doubt, Canadian nationals or residents are underwritten in the usual way.

Relevant application questions:

Have you lived in Africa, Thailand, Russia, Ukraine or the Caribbean for more than 3 months during the last 2 years?

If your client answers ‘yes’ to the above question, we’ll request an HIV test for Life Protection and HIV/hepatitis B&C tests for Combined Life and Critical Illness Protection, Critical Illness Protection and Income Protection.

In the next 2 years, are you planning to travel, live or work outside of the European Union (EU), Isle of Man, Channel Islands, Australia or New Zealand? (They don’t need to tell us about any holiday they’re taking which is less than 30 days in a year.)

We also ask if your client has lived in the UK for the last 2 years, and if they’ve been registered with a UK doctor for the last 2 years. We wouldn’t be able to offer cover to anyone who hasn’t lived in the UK and been registered with a UK GP for the last 2 years. We also ask whether they’ve visited, are currently visiting, or intending to visit any doctor outside the UK for medical treatment, investigations or advice.

Things we’ll ask about:

  • Your client’s intended country or countries of residence
  • How long they expect to live in the intended country or countries of residence
  • Whether they plan to leave the UK permanently
  • The number and duration of trips they take each year
  • Their reason for travelling there

Example underwriting outcomes:

Future residence Life cover Critical illness cover Income protection
Low-risk country e.g. Norway
Residence of less than 12 months
Currently resident in the UK
Standard Standard Standard
Moderate-risk country e.g. Nepal
No travel to hazardous parts of the country
Residence of less than 12 months
Currently resident in the UK
Individual consideration
Likely
£1.25pm to £6.25pm rating
Individual consideration
Likely
£1.25pm to £6.25pm rating
TPD O unable to offer terms
TPD A unable to offer terms
Unable to offer terms
High-risk country e.g. Yemen Unable to offer terms Unable to offer terms Unable to offer terms

WE MAKE EVERY EFFORT TO UNDERWRITE EVERYONE AND OFFER THEM THE BEST POSSIBLE TERMS.

Caroline Froude
Head of Underwriting
Strategy and Development

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