HOW CAN I
KNOWING WHEN WE WON’T BE ABLE TO PAY A CLAIM ON A SIMPLE LIFE CAN HELP YOU DECIDE IF IT’S RIGHT FOR YOU.
We want you to have all the information you need when choosing your insurance with Sovereign. There are some things that Simple Life won’t cover.
This web page explains some of the most important exclusions – including pre-existing conditions and hazardous activities – so there are no surprises at claim time. You’ll find more details in your policy document.
If after reading this you’re not sure whether Simple Life is right for you, please get in touch with us on 0800 500 108 and we can talk about other insurance options. We have plenty to choose from.
Simple Life will not cover you for pre-exisiting conditions.
SO WHAT EXACTLY IS A PRE-EXISTING CONDITION?
Generally, a pre-existing condition is any illness, injury or medical condition (or sign or symptom of one) that the life assured, you, or any previous policy owner was aware of, or that the life assured sought medical treatment or advice for, in the last five years before the policy started. This includes any medical condition(s), which had not necessarily been diagnosed, but of which the life assured had signs or symptoms. If your claim under your insurance with Simple Life is directly or indirectly related to this medical condition, then it’s likely to be declined. This diagram explains how it works.
Simple Life won’t cover you if your claim results from a hazardous activity.
WHAT DO WE MEAN BY HAZARDOUS ACTIVITIES?
You may not realise it, but the life assured’s work or hobbies, regardless of how often the life assured undertakes them, could have an effect on your insurance. We need to put exclusions on activities that are considered dangerous because they greatly increase your chance of making a claim.
Here’s what we consider to be hazardous activities:
- Any form of aviation (other than as a fare-paying passenger on a commercial airline** on a regular route),
- Any activity at a height of 20 metres or more above ground outside a building or in a building under construction, or at a depth of 30 metres or more below ground or underwater,
- Any activity involving the use of firearms or explosives,
- Participating in, or training or preparation for, competitive motorsport activity, or
- Any form of mountaineering, rock climbing, abseiling or off-piste skiing.
**A Commercial Airline is an airline that has an Air Operator Certificate issued by the Civil Aviation Authority of New Zealand or equivalent International Civil Aviation Organisation (ICAO) authority.
A FEW EXAMPLES OF PRE-EXISTING CONDITIONS
Here are some examples of how the pre-existing condition exclusions to your Simple Life policy might work in practice. These are examples only based on hypothetical scenarios.
Obviously everyone is different, and if you make a claim we will assess it on an individual basis, looking at the facts available and considering any supporting medical or other evidence.
A FEW EXAMPLES OF HAZARDOUS ACTIVITIES
Here are some examples of how the hazardous activity exclusions to your Simple Life policy might work in practice.
SOME FINAL EXCLUSIONS
Simple Life also has a number of other exclusions which you need to be aware of.
1. We won’t pay the Life Benefit if the life assured’s death or terminal illness is directly or indirectly caused or contributed to by suicide or attempted suicide within thirteen months of the policy start date.
2. We won’t pay the Loan and Rent Assistance Benefit if the life assured’s Total Disability* is directly or indirectly caused or contributed to by:
- a. Pregnancy or childbirth unless the Total Disability* lasts for more than 90 days, in which case we will pay for Total Disability from the 91st day; or
- b. an illness or injury deliberately inflicted by the life assured; or
- c. non-compliance with medical treatment; or
- d. The life assured participating in a Criminal Act*.
3. We won’t pay the Redundancy Benefit if the life assured has been on leave without pay for more than 12 months at the time the life assured is made redundant.
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