INMO Income Protection Scheme - Prismic
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Contents This book is split into the following sections: 1. Introduction 4 2. Benefits 9 3. Cost 24 4. Claims 26 5. Frequently Asked Questions 36 6. Specified Illnesses Appendices 40 Disclaimers This book is intended as a guide only. The Scheme is governed by the master Policy Document No. 9236 issued by Irish Life. Members of the Scheme may request a copy of the policy document from the head office of the INMO or the Dublin office of Cornmarket Group Financial Services Ltd. This book is issued subject to the provisions of the policy and does not create or confer any legal rights. The information contained herein is based on our current understanding of Revenue law and practice as of January 2019. If there is any conflict between this document and the policy document, the policy document will prevail. No part of this book should be read in isolation. Please save a copy of this book for future reference. Information in this book is correct as of January 2019 but may change. For the latest information, please see cornmarket.ie Where we say ‘Insurer’ in this book, we mean Irish Life. Where we say ‘we’ or ‘us’ we mean Cornmarket. Visit cornmarket.ie 3
1. Introduction Overview of Key Benefits 1 A replacement income of up to 75% of Disability Benefit your annual salary if you can’t work due to illness or injury* 2 A benefit of 25% of your annual salary if Specified Illness you suffer one of the 36 Specified Illnesses Benefit covered** A Death Benefit of twice your annual salary. Also: 3 • Accidental Death Benefit – €15,000 Life Cover • Children’s Death Benefit - €4,000 • Terminal Illness Benefit – 25% of Death Benefit *Less any other income that you may be entitled to e.g. half pay, Ill Health Early Retirement Pension, Temporary Rehabilitation Remuneration, State Illness or Invalidly Benefit. **Please see the Appendices from page 40 to 65 for full details, in particular the policy definition of each Specified Illness and its pre-existing and related conditions. 4 INMO Income Protection Scheme
The Scheme in Action* The true value of the Scheme can be seen in the vital benefits that it pays out to members and their families. 10,110 €33.8 million Members currently Paid in Disability Benefit in the Scheme† to date €9.6 million €3.6 million Paid in Disability Benefit Currently paid in Disability since the 2016 review Benefit annually €2.9 million €6.6 million Paid in Death Benefit Paid in Death Benefit since the 2016 review to date *Source: Claims: Irish Life, August 2018. †Membership: Cornmarket, July 2018. Visit cornmarket.ie 5
Eligibility You may apply to join this Scheme if you are: 1) A member of the INMO union. *Actively at work today This means you: You must remain a member of the - Are working your normal contracted hours INMO union to remain an eligible - Have not received medical advice to refrain member of the Scheme and from work - Are not restricted from fully performing the 2) Under age 60 and normal duties associated with your occupation You are considered to be ‘actively at work’ if you are 3) Working as an agency Nurse/Midwife on paid or unpaid maternity leave. for 2 or more years and You are not considered to be ‘actively at work’ if you are on Career Break or any other type of unpaid 4) Working 8 hours or more per week leave and cannot apply to join the Scheme. and Those who are job/work sharers (i.e. work 50% or less than the normal working week) and who satisfy the 5) Employed under at least one of the above criteria may apply to join. following conditions: • On a permanent basis or • On a fixed-term contract of at least 12 months duration or • Working continuously for the past 12 months and 6) Actively at work today.* Apply to join now, simply call us on (01) 470 8054 6 INMO Income Protection Scheme
Roles Cornmarket’s role The Insurer’s role includes: includes: 1. Negotiating with the 1. Deciding the policy Insurers to obtain the terms and conditions best possible benefits and creating a policy and cost. document to reflect these. 2. Assisting members who wish to make a claim 2. Medically assessing from the Scheme. Please applications and claims. see page 26 for more Please see page 26 for information. more information. 3. Promoting the Scheme. 3. Deciding the various aspects of an individual member’s cover e.g. if membership of the Scheme can be reactivated, if refunds can be made and if arrears and/or a declaration of health are required. Visit cornmarket.ie 7
8 INMO Income Protection Scheme
2. Benefits Disability Benefit In the event that your salary* is affected because you are unable to work due to illness or injury, this benefit aims to pay you an income of up to 75% of salary after a certain period of time. The Disability Benefit paid is less any Ill Health Early Retirement Pension other income, reward, award, pension, applies regardless of whether you are a or benefit that you are entitled to ‘D’ or ‘A’ PRSI contributor and whether (regardless of whether you are receiving you contribute to the Superannuation this amount or not). For example: Scheme or not. - Temporary Rehabilitation There is no limit on the number of Remuneration (TRR) - May be paid by Disability Benefit claims you can make an employer to an employee subject while a member of the Scheme. to certain criteria. *See page 12 for definition of Salary. - State Illness Benefit/State Invalidity Pension - Those paying PRSI at the ‘A’ rate may be entitled to this benefit from the State. - Ill Health Early Retirement Pension (IHERP) - Those who retire on the grounds of ill health may be entitled to this from their employer. Visit cornmarket.ie 9
Example of how the Scheme works This example is based on a Public Sector It is assumed that standard Public employee, who is a member of the Sector sick leave arrangements apply, Superannuation Scheme with 20 years’ extended paid sick leave under the service earning €50,000 per annum, Critical Illness Protocol does not apply who is now unable to work due to illness and Ill Health Early Retirement Pension is or disability. granted after 2 years. WITHOUT Income Protection D Rate PRSI Example A Rate PRSI Example 100% 100% €962 €962 p.w. p.w. 75% 75% 50% 50% €481 €481 33% 37% p.w. p.w. of salary €198 €204 of salary €321 €321 p.w. p.w. p.w. p.w. €158 €158 p.w. p.w. 0% 0% First 13 After 13 After 26 After 2 First 13 After 13 After 26 After 2 weeks weeks weeks years weeks weeks weeks years of illness of illness of illness sick leave of illness of illness of illness sick leave Sick Pay Temporary Ill Health Early State Illness State Invalidity Rehabilitation Retirement Benefit Pension Remuneration Pension 10 INMO Income Protection Scheme
WITH Income Protection D Rate PRSI Example A Rate PRSI Example 100% 100% €962 €962 p.w. p.w. 75% 75% of salary €240 of salary €240 €400 €400 p.w. €365 €359 p.w. 50% p.w. p.w. 50% p.w. p.w. €481 €481 €198 €204 25% 25% p.w. p.w. p.w. p.w. €321 €321 p.w. p.w. €158 €158 p.w. p.w. 0% 0% First 13 After 13 After 26 After 2 First 13 After 13 After 26 After 2 weeks weeks weeks years weeks weeks weeks years of illness of illness of illness sick leave of illness of illness of illness sick leave Scheme Sick Pay Temporary Ill Health Early State Illness State Invalidity Benefit Rehabilitation Retirement Benefit Pension Remuneration Pension Staff recruited to the Public Service on or after 6th April 1995 pay class A PRSI. Their Superannuation Scheme pension is integrated to take account of the value of the Contributory State Pension in calculating the pension payable. In the event of illness, they may typically claim State Illness Benefit. Visit cornmarket.ie 11
Deferred Period Definition of Salary After you are accepted as a member of For those who pay their premiums the Scheme, if you need to make a claim through their salary, salary is defined as: the Deferred Period is the waiting period (i) For members of a Superannuation before the Disability Benefit becomes Scheme: Basic annual salary at the payable. end of the relevant Deferred Period, For the purpose of this Scheme the plus the average of any allowances Deferred Period is: received in the preceding 3 years, which are taken into account for sick pay and/or for the purposes of that - 13 weeks (92 days) disability in Superannuation Scheme* or a rolling 12 month period or 26 weeks (183 days) in a rolling 4 (ii) For those who are not members year period, where standard sick of a Superannuation Scheme: leave has been granted. Basic annual salary at the relevant Deferred Period, plus the average - 26 weeks (183 days) disability in of any allowances received in the a 12 month period or 52 weeks preceding 3 years; which would be (365 days) in a rolling 4 year taken into account for sick pay and period, where extended paid for the purposes of a Superannuation sick leave has been granted Scheme*. - referred to as Critical Illness Protocol. For those who pay their premiums by direct debit, salary is defined as: The lower of either the salary covered by If you have taken sick leave before your premiums or the actual salary you joining the Scheme, the Insurer will take are earning at the end of the relevant this into account when calculating your Deferred Period, as confirmed by your Deferred Period. employer. You must advise Cornmarket of any salary changes so that we can If you have been accepted with an adjust your premium accordingly. This is excluded condition, any sick leave to ensure that your cover is provided in relating to that condition will not be line with your current gross salary and taken into account for the calculation of that you are paying the correct premium the Deferred Period. amounts. For Agency nurses/midwives joining the Scheme, your salary is based on self declared earnings. Declared salary should be the average of the previous 2 years’ earnings. 12 INMO Income Protection Scheme
Periodically, you may review your *Depending on the type of claim being made, the salary will be established at different points in time e.g. declared earnings subject to proof of • Disability Benefit - the end of the relevant Deferred actual earnings e.g. payslip or P60. Period • Death Benefit - on the date of death You must advise Cornmarket of any • Specified Illness - on the date of diagnosis. salary changes so that we can adjust your premium accordingly. This is to ensure that your cover is provided in line with your current gross salary and that you are paying the correct premium amounts. Disability Benefit Exclusions There are no general exclusions on If this happens, a form will be sent to Disability Benefit. you as part of the application process with the details of the exclusion(s) and However, when you apply to join the you will have the opportunity to decide Scheme, the Insurer may offer you if you wish to accept the cover with cover with some exclusions that apply the exclusion(s) or not. If an exclusion(s) specifically to you. For example, if you applies to you, then sick leave used for inform the Insurer that you have a back the excluded condition(s) cannot be problem on your application form, taken into account for the calculation of they may offer you membership of the the Deferred Period. Scheme with a back exclusion. This means that you would never be able to claim for an illness or injury relating to your back. Visit cornmarket.ie 13
Disability Benefit Limitations and Restrictions Definition of Disability In order for a claim to be paid, the Insurer must be satisfied that you are totally disabled. This means that you are totally unable to carry out the duties of your normal occupation because of illness or injury and that you are not engaged in any other occupation (whether or not for profit, reward, remuneration or benefit- in-kind). Late Notification of Claims: It is not Disability Benefit will not be paid often possible to retrospectively if you cannot work due to strike or assess the validity of a claim in cases unemployment. where a significant period of time The maximum benefit is €150,000 (approx. 3 months) has elapsed since per year. your salary reduced or ceased. For this reason, it is vital that you register Any sick leave used before you are your claim promptly in line with the accepted as a Scheme member will guidelines given (8-9 weeks before not be used in the calculation of the your salary reduces to half pay or Deferred Period. ceases altogether). In the case of late If you have been accepted with an notification of a claim, cases will be excluded condition, any sick leave assessed on individual merit and the relating to that condition, will not be Insurer reserves the right to decline taken into account for the calculation of to assess the claim. the Deferred Period. If your claim is admitted... - 75% of salary will be paid for a maximum of two years only. After this a pension amount will be deducted from the benefit regardless of whether or not you are in receipt of same. This is referred to as Notional Early Retirement Pension (NERP). 14 INMO Income Protection Scheme
- the benefit you receive from the Insurer will be treated as income and **INMO members who as such is liable to income tax, PRSI, Universal Social Charge, etc. The entered/re-entered the Insurer will deduct any tax due from Public Sector before the 1st the Benefit made to the member, April 2004 are covered until in the same way as an employer age 60. INMO members deducts tax from an employee. who entered/re-entered Public Sector on/after 1st If your claim is admitted, this Disability Benefit will continue until: April 2004 are covered until - You recover age 62. If you re-entered - You resign service on/after 1st April - You go back to work (benefit may 2004 with a break of more continue to be paid if the return is than 26 weeks that was at a reduced level due to partial not due to a career break disability) or unpaid leave, you are - the Insurer decides that you are fit deemed to be a new to return to work based on medical evidence* entrant. - You reside outside of Ireland for more than 6 calendar months (unless agreed otherwise with the Insurer in advance) - You retire (unless you are claiming from the Scheme and retire on an Ill Health Early Retirement Pension) - You reach age 60/62 depending on date of entry/re-entry to the Public Sector** - You die whichever is earliest. *If you have been in continuous receipt of Disability Benefit for more than 12 months, 3 months notice will be given before your Disability Benefit is ended. Visit cornmarket.ie 15
Death Benefit In the event of your death, a once-off lump sum will be paid to your estate. For most members the amount paid will be twice their gross annual salary*. However, for some members who availed of the option to increase their Terminal Illness Death Benefit, this will be 3 or 4 times Benefit their gross annual salary*. In the event that you are certified by a medical consultant** with a terminal If a Death Benefit claim is admitted, the illness, with death expected within 12 benefit will be paid by the Insurer tax months, and the Insurer accepts this; free. However, thereafter, beneficiaries the Scheme will pay 25% of the Death of the estate will be subject to Benefit to you tax-free. whatever taxes apply at the time of the inheritance and it will be their ** The consultant must be of a major hospital in Ireland or the United Kingdom. responsibility to ensure they are meeting their full tax liability. Terminal Illness Benefit - Exclusions Exclusions Exclusions apply where death is caused Exclusions apply where the death is from directly or indirectly by: taking part in war. 1. Taking part in any criminal act Limitations and Restrictions 2. Taking drugs (other than under the This Benefit ceases at age 65. direction of his/her own or any other registered medical practitioner) or As this is a Group Scheme you cannot alcohol assign the Death Benefit against a 3. Taking part in aviation (other than as mortgage. a fare-paying passenger) or in motor car or motor cycle racing or 4. The member’s own deliberate act. Terminal Illness Benefit - *Please see page 12 for definition of Salary. Limitations and Restrictions This benefit ceases at age 62. 16 INMO Income Protection Scheme
Accidental Death Children’s Death Benefit Benefit In the event of accidental death, a In the event that a member’s child benefit of €15,000 is payable tax-free between the ages of 0-21 dies, a Death in addition to the normal Death Benefit. Benefit of €4,000 will be paid to the ‘Accidental Death’ is defined as ‘death member tax-free. Children’s Death as a direct result of a bodily injury arising Benefit applies to all natural or adopted from an external and accidental cause children. which leaves a visible bruise or wound’ and is in no way linked to disease or Children’s Death Benefit - physical disorder. Exclusions This benefit can only be claimed by the Accidental Death Benefit - Scheme member. This means that the Exclusions Scheme member’s Estate cannot claim Exclusions apply where death is caused it in the event that the Scheme member directly or indirectly by: has died. 1. Taking part in any criminal act In the event that both parents are 2. Taking drugs (other than under the members of this Scheme, this benefit will direction of his/her own or any other only be paid once. registered medical practitioner) or alcohol Children’s Death Benefit - 3. Taking part in aviation (other than as Restrictions and Limitations a fare-paying passenger) or in motor This benefit ceases at age 21. car or motor cycle racing or 4. The member’s own deliberate act. Accidental Death Benefit - Restrictions and Limitations This benefit ceases at age 65. Visit cornmarket.ie 17
Specified Illness Benefit Full Benefit If you are diagnosed with one of the illnesses listed below, and meet the definition/criteria of that illness (see Appendices from page 40 - 65), this benefit will pay a once-off, tax-free lump sum of 25% of your annual salary* at the date of diagnosis. Please note: The Specified Illnesses marked ❖ below, were introduced at the 1st June 2012 review. The other Specified Illnesses were introduced from 1st April 2007. Only members with diagnoses that occur after these dates are eligible to claim Specified Illness Benefit for these illnesses. If, prior to joining the Scheme, you have suffered from one of the Specified Illnesses, you will never be covered for that illness. • Alzheimer’s Disease • HIV infection • Aorta graft surgery • Kidney failure • Aplastic Anaemia ❖ • Liver failure ❖ • Bacterial Meningitis ❖ • Loss of limbs • Benign brain tumour ❖ • Loss of speech • Benign spinal cord tumour • Major organ transplant • Blindness • Motor Neurone Disease • Cancer (malignant) • Multiple Sclerosis • Cardiomyopathy ❖ • Paralysis of Limbs • Coma • Parkinson’s Disease (idiopathic) • Coronary artery bypass graft • Primary Pulmonary Hypertension ❖ • Creutzfeldt-Jakob Disease ❖ • Progressive Supranuclear Palsy ❖ • Deafness • Pulmonary Artery Surgery ❖ • Dementia ❖ • Respiratory failure of specified • Encephalitis ❖ • severity ❖ • Heart attack (diagnosed) • Severe burns or 3rd-degree burns • Heart surgery requiring median • Stroke • sternotomy • Systemic Lupus Erythematosus ❖ • Heart valve replacement or repair • Traumatic head injury ❖ *See page 12 for definition of Salary. 18 INMO Income Protection Scheme
Partial Benefit If you are diagnosed with one of the illnesses listed below, and meet the definition/criteria of that illness (see Appendices from page 40-65), this benefit will pay a once-off, tax-free lump sum of the lesser of €10,000 or 25% of your salary* at the date of diagnosis. Please note: The qualifying Specified Illnesses below were introduced at the 1st June 2012 review. Only members with diagnoses that occur after this date are eligible to claim Specified Illness Benefit under the Partial Payment section for these illnesses. If, prior to joining the Scheme, you have suffered from one of the Specified Illnesses listed below you will never be covered for that illness. • Brain abscess drained via • Ductal carcinoma in situ of the craniotomy breast • Carcinoma in situ • Low level prostate cancer with • Carotid artery stenosis Gleason score between 2 and 6 • Cerebral arteriovenous • Less severe 3rd-degree burns malformation • Loss of one limb • Coronary Angioplasty • Surgical removal of one eye *See page 12 for definition of Salary. Visit cornmarket.ie 19
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Specified Illness Benefit Exclusions Specified Illness Benefit and Partial Specified Illness Benefit Claims will not be paid, if, in the opinion of the Insurer, the diagnosis arises directly or indirectly as a result of: a) taking alcohol or drugs (other than under the direction of a registered medical practitioner) or b) failure to follow reasonable medical advice in relation to a cause or latent cause of sickness. Visit cornmarket.ie 21
Specified Illness Benefit Limitations and Restrictions Specified Illness Benefit became a - You will not be able to make a benefit of the Scheme on 1st April 2007. Specified Illness Claim for an illness The Specified Illnesses marked ❖ on that: page 18, were introduced on 1st June • You suffered from prior to joining 2012. You can only claim for diagnoses the Scheme that occur after these dates. • Relates to a condition which - If you make a Full Specified Illness you were already suffering from Claim, you will not be able to make a at the time of your application further Full or Partial Specified Illness and/or where you were under Claim. If you make a Partial Specified medical investigation, regardless Illness Claim, you will still be able to of whether you were aware of the make a Full Specified Illness Claim. condition at that time - If you are diagnosed with one of the • Relates to a condition which you Full Specified Illnesses within 30 days were already suffering from before of diagnosis of a Partial Specified the date that Specified Illness was Illness, a claim will be assessed on the introduced to the Scheme Full Specified Illness only. • If, in the Insurer’s opinion, the diagnosis has occurred directly - A Specified Illness Claim will only or indirectly as a result of taking be paid if the diagnosis/severity alcohol or drugs (other than meets the specific definition/ under the direction of a registered criteria outlined for that illness in the medical practitioner) Appendices on pages 40-65. • If, in the Insurer’s opinion, the diagnosis has occurred directly or indirectly as a result of failure to follow reasonable medical advice in relation to a cause or latent cause of sickness. 22 INMO Income Protection Scheme
Late notification clause: You must make a Specified Illness Claim Please see Appendices from page within 12 months of being diagnosed. 40-65 for more details. Failure to make a claim within this time The Benefit ceases at age 65. period may result in the Insurer declining to assess your claim. - There is a waiting (deferred) period Definition of Salary for Specified for some Specified Illnesses. Please Illness Benefit see Appendices on pages 40-65 for Please refer to page 12 for definition of more details. Salary. - There is a survival period for some Specified Illnesses. You must survive for a minimum period after the date of diagnosis or surgery took place, before a payment can be made. In the event of death within this period no benefit is payable. The relevant periods are: (a) 14 days for heart attack, coronary artery surgery, angioplasty (two arteries),cancer, coma, emphysema, stroke, kidney failure, heart valve surgery, aorta graft surgery, major organ transplant, benign brain tumour, multiple sclerosis, motor neurone disease, severe burns, Creutzfeldt-Jakob disease (CJD), HIV infection, paralysis of two or more limbs and severance of two or more limbs (b) 6 months for Parkinson’s Disease, Alzheimer’s Disease, transplant and loss of sight (c) 12 months for deafness and loss of speech (d) 14 days after surgery in cases where there has been pre- payment of part of the benefit. The balance of the benefit would be paid upon survival after this period. Visit cornmarket.ie 23
3. Cost The total Scheme premium is 2.33% of gross salary. This includes the 1% insurance levy. Scheme cost Income Tax Relief The breakdown of this premium is: The portion of your Scheme premium that is paid towards Disability Benefit is Disability Benefit 1.92% eligible for Income Tax Relief. Death Benefit 0.22% Below are some examples of cost for Specified Illness various salary amounts taking income 0.14% Benefit tax relief into account: Medical Immunity Income Weekly ‘Real’ weekly for Retired Members’ 0.05% premium premium Life Cover Plan* after tax relief Total Cost 2.33% €30,000 €13.40 €11.19* *Allows members to join Cornmarket’s Retired Members’ €40,000 €17.86 €11.97** Life Cover Plan, without medical underwriting. Terms & Conditions apply. €50,000 €22.33 €14.97** *If you are paying income tax at 20% your net premium rate will be 1.95% Warning: The current premium may **If you are paying income tax at 40% your net premium rate increase after the next Scheme will be 1.56%. review which will take place on/after 1st September 2019. Cornmarket’s Retired Members’ Life Cover Plan Medical Immunity 0.05% of your overall premium entitles For more details on this Plan, you to join Cornmarket’s Retired please contact us on Members’ Life Cover Plan when you retire, without any medical underwriting, (01) 470 8054 or email once you apply to join within a certain clientservices@cornmarket.ie time period of retiring. 24 INMO Income Protection Scheme
Payment Methods Your premiums may be paid via deduction at source from salary or direct debit. If you pay your premiums - Your premiums will reflect the through salary last gross salary you notified to The premium will be split under two Cornmarket or the last gross salary headings on your payslip. One heading that we estimated for you at the last reflects the Disability Benefit portion Scheme review. As a result, the salary of your premium and automatically covered by the Scheme will be based receives income tax relief, the other on either the salary covered by your heading reflects the premium for the premiums or the actual salary you are remaining benefits and does not receive earning at the end of the Deferred income tax relief. You are eligible for Period as confirmed by your employer, income tax relief at your highest rate whichever is lower. The onus is on you of income tax on the Disability Benefit to ensure you advise Cornmarket of premium. any salary changes so that we can adjust your premium accordingly so Your premiums will increase and that your cover is provided in line with decrease in line with your salary your current gross salary and you are changes and as a result, the salary paying the correct premium amounts covered by the Scheme will be your - You may incur charges from your salary as confirmed by your employer on bank. the last day of your Deferred Period. You must ensure that the premiums Remember... deducted from your salary are correct and reflect your salary. As this is an insurance policy, you must keep up your premiums in If you pay your premium by order to stay on cover. Failure to direct debit pay premiums, could result in your membership of the Scheme lapsing. - You will need to send a Premium This means you will no longer be a Statement to Revenue in order to member of the Scheme and you will claim income tax relief. If, throughout not be on cover for any benefits. In the course of your membership the event that you wish to become of the Scheme, you change your a member of the Scheme again, you cover and hence premium amount, would have to apply to be a member you should request an up-to-date and be medically underwritten. Premium Statement from Cornmarket Your application may be accepted, to send to Revenue so that Revenue declined, postponed or accepted can amend your income tax relief with exclusions. accordingly. Visit cornmarket.ie 25
4. Claims Roles Cornmarket’s Role Cornmarket’s role is to help guide members through the claims process. Cornmarket has considerable experience in this area and works closely with the claimant, Insurer and third parties to help get claims processed as efficiently as possible. Cornmarket has its own dedicated, in-house Claims Administration Team. The team members will do all they can to help in a member’s time of need. If you need to make a claim, it will be dealt with in a professional and sensitive manner. Our contact details for making a claim are: Phone: (01) 408 4018 In the interest of Customer Service we may record and monitor calls. Email: spsclaims@cornmarket.ie Post: SPS Claims Department, Cornmarket Group Financial Service Ltd, Christchurch Sq., Dublin 8 Our offices are open Monday-Friday 9:00 - 17:30. The Insurer’s Role The Insurer’s role is to medically assess claims and decide whether or not claims should be paid. If they decide that a claim is payable, they will calculate and pay the benefit. 26 INMO Income Protection Scheme
Disability and Specified Illness Benefit Claims How to make a Disability or Specified Illness Specified Illness Benefit claim Contact Cornmarket as soon as possible, as it may take a number of Disability weeks to process the claim. See Late Contact Cornmarket as soon as you Notification clause on page 23. think that your salary may reduce to half pay or cease altogether due to illness or It is not often possible for the Insurer injury because: to retrospectively assess the medical validity of a claim. If they cannot (i) Disability Benefit claims take medically assess a claim, the Insurer approximately three months reserves the right to decline to assess to process from the date your the claim. completed claim form is received. The exact length of time it will take Can I nominate someone to to process a claim is dependent contact Cornmarket on my upon how long it takes for the behalf in relation to a Disability Insurer to get data from third parties such as G.P.s, specialists, unions/ or Specified Illness Benefit associations and employers. With claim? that information they must be You can nominate someone to contact satisfied that: Cornmarket on your behalf and to - A member is a valid member of the assist you with your claim, for example, Scheme and a spouse, next of kin etc. If you wish to do so, please send us a letter, - A member is or was medically signed and dated by you, outlining incapable of working for the the name, address, and date of birth period being claimed for and of your nominated person. Please be - They are paying the correct aware that if you nominate someone benefit amount. to act in this capacity, they will have access to the information related to (ii) It is often not possible for the Insurer your claim such as your medical, salary to retrospectively assess the medical and financial details. However, they validity of a claim. If they cannot will not have the authority to make any medically assess a claim, the insurer changes, for example, to cancel your reserves the right to decline to assess membership of the Scheme. the claim. See Late Notification clause on page 23. Visit cornmarket.ie 27
What will happen after I initially Items 2, 3 and 4 are at the Insurer’s contact Cornmarket to make expense and reasonable travel expenses will be covered, if travel is a Disability or Specified Illness necessary. Benefit claim? We will liaise with your employer, Following an initial phone call, if the Insurer and you throughout the appropriate, we will send you a claim assessment. form, information about the Scheme and details of the documentation you will need to provide. What happens after my Disability Benefit claim is You should return the forms and assessed? documentation to Cornmarket as soon as possible and we will send these to Following the assessment the Insurer will the Insurer. The Insurer will then start make a decision on your claim. Claims medically assessing your claim. can be admitted or declined. What will happen if my Disability Are all Disability and Specified Benefit claim is admitted? Illness Benefit claims medically - If your claim is admitted, and you assessed? have completed the relevant deferred All claims will be medically assessed by period, the Insurer will arrange for the Insurer. If you have been granted benefit to be paid to your bank Ill Health Early Retirement by your account. Disability Benefit will be employer, this does not mean that paid in arrears and may be paid on a you will be automatically entitled to monthly basis. Therefore, it may take Disability Benefit from the Scheme. up to four weeks after your claim is admitted to receive your first benefit. As part of their assessment the Insurer may require you to: - If your claim is admitted after you have been reduced to half-pay or 1. provide medical evidence from your your pay has ceased altogether, the Doctor (your Doctor may charge you benefit may be backdated to the for this) date when salary was first affected. 2. provide medical evidence from your Specialists - As benefit is subject to income 3. complete a Tele-claims Interview with tax, you can request the Revenue a nurse Commissioner to issue a Certificate 4. attend an Independent Medical of Tax to the Insurer. This will enable Examination (IME) to confirm that the Insurer to apply the correct tax you meet the definition of disability. rate for future benefits. However, the It generally takes about 3 weeks for first benefit may have emergency the IME report to be returned to the tax rates applied. Any overpayment Insurer. or underpayment of tax may be subsequently rectified. 28 INMO Income Protection Scheme
- In order to ensure you continue to of 5% per year or by the increase in meet the definition of disablement, the Consumer Price Index. the Insurer may seek completed - However, for new claims admitted continuation forms, certificate of on or after the 1st September 2016, continued disablement, medical the amount of Disability Benefit paid certificates from your Doctor, and/or will not increase after a claim is in require you to attend an independent payment for 12 months. medical examination and/or organise - If you plan to return to work or take up for a Health Claims Advisor to visit other paid work, you must inform the you. Claims in payment for greater Insurer immediately. than 10 years, will not be subject to ongoing medical assessments. - In the event that you fail to follow What will happen if my Disability medical advice, the Insurer may cease Benefit claim is declined? paying you benefits. - If your claim is declined, the Insurer - You will not be expected to pay will inform you of the reasons for the premiums towards the Scheme while decision in writing. claiming. However, if your benefit - You may appeal the decision stops for some reason other than by sending additional evidence reaching the ceasing date of the supporting the fact that your claim benefit, you will be expected to start should be admitted to the Chief paying premiums again in order to Medical Officer of the Insurer. You maintain your cover. If you continue must do this within 3 months of the to receive Disability Benefit up to decline decision being made. The the ceasing age of the benefit, you review of their decision may require can continue to avail of the other you to attend further Independent Scheme benefits without having to Medical Examinations. pay premiums for them up until the - If you do not appeal, premiums must ceasing age of those benefits. continue or restart in order for you to - While claiming Disability Benefit, any remain a member of the Scheme. Death Benefit or Specified Illness - If your appeal with the Insurer is Benefit that you have as a Scheme unsuccessful, you may bring your case member remains in force until the to the Financial Services and Pensions ceasing date of those benefits. In Ombudsman. the event that you will need to claim from these, the benefits will be based What happens after my on the salary you were earning at the time your Disability Benefit Specified Illness Benefit claim is commenced. assessed? - For claims admitted up to the 31st Following the assessment the Insurer will August 2016, if a claim is in payment make a decision on your claim. Claims for 12 months, the amount of Disability can be settled or declined. Benefit paid will increase by the lesser Visit cornmarket.ie 29
Settled How does Ill Health Early - If your claim is settled, the Insurer will Retirement Pension (IHERP) arrange for a cheque to be sent to affect my Disability Benefit you. claim? - If you claimed from the Full Specified If you are making a claim and decide Illness Benefit, you will no longer be not to apply for IHERP, perhaps because covered for Specified Illness Benefit you intend to return to work, and the and you will no longer be required Insurer agrees that there is a reasonable to pay for it and we will reduce your expectation for you to return to work, premium accordingly. In the event that then the Insurer may pay a benefit you pay your premiums by salary and of 75% of salary less any State Illness your employer is unable to facilitate Benefit or Temporary Rehabilitation the reduced premium, you may need Remuneration for a maximum of 2 to switch to paying your premiums by years. This means no deduction will be direct debit. made from the Benefit for an amount - If you claimed from the Partial equivalent to IHERP, as no IHERP is being Specified Illness Benefit, you can still claimed. make a claim under the Full Specified However, after 2 years a pension Illness Benefit and so your premiums amount will be deducted from the will not reduce. benefit regardless of whether or not you Declined are in receipt of same. This is referred - If your claim is declined, you will be to as Notional Early Retirement Pension informed of the reasons for that (NERP). decision in writing. If you retire subsequently and an IHERP - You may appeal the decision is paid, the additional amount that by sending additional evidence was paid under the Scheme since the supporting the fact that your claim effective date of early retirement must should be admitted to the Chief naturally be repaid to the Insurer. Medical Officer of the Insurer. You must do this within 18 months of the decline decision being made. The review of their decision may require you to attend further Independent Medical Examinations. - If your appeal with the Insurer is unsuccessful, you may bring your case to the Financial Services and Pensions Ombudsman. 30 INMO Income Protection Scheme
What if I am on a Fixed Term What happens if I return to work Contract and make a Disability after making a Disability Benefit Benefit claim? claim? If you are unable to work due to illness If you return to your normal occupation or injury and your contract ends before at your normal hours, or to full salary the expiry date of the Deferred Period, (e.g. you take annual leave), you must (13 weeks in any 12 month period), your ensure that premiums restart in order for claim will be considered subject to the you to remain a member of the Scheme. usual medical evidence requirement. For If you return to your normal occupation example, if you suffer an illness with 3 at reduced hours, or to a different months remaining on your contract, and occupation at reduced pay, the Insurer you remain unable to work due to illness may continue to pay you a benefit but or injury to the end of the Deferred at a proportionately reduced amount. Period, your claim will be considered in This will be subject to medical evidence the normal manner. supporting the view that you are only partially fit for work. If my illness is due to an injury at If you return to work but have to stop work, how does this affect my working again due to illness or injury you may not have to complete the Disability Benefit claim? Deferred Period again. Please refer to Please inform the Cornmarket Claims the Deferred Period on page 12. Administration team as soon as possible, if this applies to you. If, as a result of your workplace injury, you are entitled to an additional payment, it may mean that your income remains higher than 75% of your salary and hence there will be no Disability Benefit payable from the Scheme. Visit cornmarket.ie 31
32 INMO Income Protection Scheme
Tax Return Service for members making a Disability Benefit Claim Cornmarket’s Tax Return Service is available to claimants who are in receipt For more of Disability Benefit for a continuous period of 3 months or more. Only information, please claimants who submitted their claim after 1st January 2014 are eligible to call (01) 408 4106 avail of this service. Cornmarket’s Tax Return Service will prepare and file your tax return and act on your behalf with Revenue, to ensure that you do not pay any more tax than is necessary while you are receiving income from multiple sources. We will also reclaim any overpayments of tax which may have been made by you during the period of your claim. The service includes PAYE returns and up to two rental properties, where relevant. Additional properties or returns for non- PAYE income may attract extra charges, and/or may not be offered within this service. Cornmarket Group Financial Services Ltd. is a member of the Irish Life Group Ltd. which is part of the Great-West Lifeco Group of companies. Cornmarket’s Tax Return Service is not a regulated financial product. Telephone calls may be recorded for quality control and training. Visit cornmarket.ie 33
Death Benefit Claims How to make a Death How long will it take to process a Benefit claim Death Benefit claim? Depending on the type of death claim If your estate is being processed through being made, you or your Estate/Next of the Probate Office, this may result in Kin/Solicitor should contact Cornmarket. delays in the processing of the claim. These delays could take over 12 months. After initial contact is made, if Once the Insurer receives all the required appropriate, Cornmarket will advise of documentation and information and the documentation required to process the Insurer decides to admit the claim, the claim. benefit is usually paid to the estate/ trustees within 10 working days. 34 INMO Income Protection Scheme
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5. Frequently Asked Questions How can I apply to join - a claim will not be paid and the the Scheme? Insurer will not refund any premiums you have paid You can apply to join the Scheme: - you may find it difficult to purchase (i) Over the phone - call (01) 470 8054 another Life Insurance product. (ii) With your Cornmarket Consultant (iii) By printing and completing an application form at cornmarket.ie. What happens if my application is accepted? To apply, you must complete an application form. Your cover begins from the date the Insurer accepts your application. Applications may require underwriting (medical assessment) which may - You will be sent a formal acceptance include providing medical information letter. by telephone to a nurse or attending - You will have 30 days after the date a medical examination at the Insurer’s the acceptance letter is sent to you expense. Following the underwriting to cancel your membership of the period, the Insurer may accept your Scheme and receive a full refund of application, postpone your application, any premiums paid. decline your application or offer you - Premiums should start as soon as membership of the Scheme with certain possible after you are accepted as a specified conditions excluded from member. cover. During the application process it is What happens if my application important that you tell the Insurer all is not accepted? relevant medical information. This means information that the Insurer If your application is postponed, would regard as likely to influence the declined, or if you are offered assessment and acceptance of your acceptance with certain specified application. If you do not: conditions excluded, you may request details for the reasons for the decision - your membership of the Scheme to be sent from the Insurer to your could be void; you will not be covered own doctor and you may appeal the under the Scheme decision. 36 INMO Income Protection Scheme
What if I have unearned What if I am placed on income? administration/special/ In general, investment and rental income gardening leave? will not be taken into account when Please contact us on (01) 408 4195 as making a claim under the Scheme. soon as possible. What if I plan to take a Career When does membership of the Break or Unpaid Leave? Scheme cease? If you plan to take a Career Break • Your 60th/62nd for the Disability or Unpaid Leave please contact us Benefit. INMO members who entered/ to discuss the options that may be re-entered the Public Service before available to you by calling (01) 408 4195 1st April 2004 are covered until age or emailing spsadmin@cornmarket.ie. 60. INMO members who entered/ If you wish to avail of the Career Break re-entered the Public Service after options you must apply within 4 months 1st April 2004 are covered until age of taking a Career Break. Otherwise your 62. If you re-entered service after membership of the Scheme will cease. 1st April 2004 with a break of more You must remain a member of the INMO than 26 weeks, that was not due to a union for the duration of your Career career break or unpaid leave, you are Break. deemed to be a new entrant. If you wish to avail of the Unpaid • Your 65th birthday for the Death Leave options you must notify us Benefit and Specified Illness. at least 4 weeks in advance of the Cover for all benefits cease in the commencement of unpaid leave. following situations: Additionally, if you plan to do any of the • If you retire (other than on grounds of following, please contact us in advance ill health) or in order to ensure your membership • If you resign or of the Scheme does not lapse, and • If you no longer fulfil the eligibility so that we can offer you any cost requirements or and/or benefit options which may be • If you leave the INMO Union or applicable: • If your premiums cease or - Acquire a second job • If you become unemployed or - Go on Secondment • If you die. - Change my role/job Remember - Cornmarket will not be - Change my terms of employment automatically informed if some of - Start Job sharing/work sharing the above events occur so please (i.e. work 50% or less of the normal ensure we are advised at the earliest working week). opportunity. Visit cornmarket.ie 37
Can I cancel my membership of What commission does the Scheme? Cornmarket receive? Yes. You may cancel your membership Initial charge paid by Insurer of the Scheme at any time by clearly €400 to Cornmarket instructing Cornmarket to do so in writing. Please ensure your name, Premium Deduction Charge 2.5% address and date of birth is included on Renewal charge paid by the cancellation instruction. 12.50% Insurer to Cornmarket If you cancel within 30 days of the acceptance letter being sent to you, we will cancel your membership of the What if I travel abroad? Scheme and refund you any premiums In order to remain on cover under this you have paid. Scheme you must remain a resident If you cancel your membership of the within Ireland. Scheme, and then wish to become a If you travel briefly for normal holiday member again, you will have to apply purposes this will not affect your cover for membership again and provide under the Scheme. However, if you information about the state of your decide to reside or work abroad you health. If your health deteriorated must contact Cornmarket immediately. between the time you cancelled your In such circumstances, the Insurer membership of the Scheme and re- may decide to vary your premium and applied, you may not be accepted as a benefits accordingly or cease your member again or you may be accepted membership of the Scheme. with an exclusion. If you are in receipt of Disability Benefit from the Scheme, the Insurer will pay this What happens if I cease to be a benefit to you if you are living anywhere member of the INMO union? in the world for a maximum of 6 months. If you leave the union you must inform The Insurer reserves the right for Cornmarket in writing. Cornmarket will claimants to come back to Ireland for then cancel your membership of the an Independent Medical Examination Scheme. during this 6 month period. If during the 6 months you are required to attend a Is there a surrender or medical assessment you must return to cash-in value associated Ireland for it, the expense of which must be agreed between you and the Insurer with the Scheme? in advance. Only reasonable expenses No. There is no surrender or cash-in will be covered by the Insurer. value associated with this Scheme; it is After 6 months, you must reside in not a savings plan. Ireland or the UK. In exceptional cases where a beneficiary is forced to live abroad, the Insurer will consider this on a case-by-case basis. 38 INMO Income Protection Scheme
Are all claims paid? If you are dissatisfied with the outcome The great majority of claims are paid. of your complaint through Cornmarket, you may submit your complaint to When claims are not paid it is usually the Financial Services and Pensions due to one or more of the following Ombudsman, 3rd Floor, Lincoln House, reasons: Lincoln Place, Dublin 2, or log onto - Medical opinion is that the member is www.fspo.ie not disabled from carrying out his or her normal occupation. General Scheme Information Full Scheme Name: INMO Income - When applying to join the Scheme, Protection Scheme. the member did not give all relevant, requested medical information The Scheme owner is Irish Nurses & (information that the Insurer would Midwives Organisation. regard as likely to influence the The current Scheme broker is assessment and acceptance of your Cornmarket Financial Services Ltd.. application). This is called non- The current Scheme Insurer is Irish Life. disclosure. In addition to being the The current policy number for this reason for a claim not being paid, Scheme is 9236. non-disclosure may also result in membership of the Scheme being This is a group protection Scheme. cancelled. If this occurs, premiums will This means that the costs and benefits not be refunded. cannot be changed by any individual member. Instead, the Scheme owner - A claim is notified late, for example, reviews the Scheme periodically with a approximately three months after Broker and Insurers and then decides salary is affected/diagnosis has the best combination of benefits, cost, occurred and hence the Insurer is restrictions, limitations and features no longer in a position to medically for all the members of the Scheme. At assess the claim. a review it may be decided that the - The illness or injury is a result of one of Scheme should move Brokers and/or the general exclusions that exist on insurers. In the event that this occurs, the Scheme. all Scheme membership data will be - The member attempts to claim for an transferred to the new Broker and/or illness or injury for which they received insurer. Additionally, at a review, it may a specific exclusion. be decided to terminate the Scheme altogether. In the event that this occurs, What if I wish to make any members who are already receiving a complaint about the a Disability Benefit will continue to receive that benefit under the terms service I have received from of the Scheme. Decisions taken by the Cornmarket? Scheme owner will be binding on all Please write to: members. Compliance Department, The next Scheme review is due on or Cornmarket Group Financial Services after 1st September 2019. Ltd, Christchurch Square, Dublin 8. Visit cornmarket.ie 39
6. Specified Illnesses Appendices Explanation of each Specified Illness and its pre-existing conditions
APPENDIX 1: Explanation of each Specified Illness (Full Payment) and its pre-existing conditions This section outlines: A claim can be made if the life covered has • The policy definition of the Specified Illnesses been diagnosed by a consultant neurologist or that are covered under the Scheme consultant geriatrician as having Alzheimer’s • A simple explanation of each illness. Disease and their judgement, understanding The notes in the sections headed `In simpler and rational thought processes have been terms’ are meant to provide a less technical seriously affected. explanation of the illness definitions, and Pre-existing conditions some of the medical terms used in that If you have been diagnosed with Alzheimer’s definition. They are not an alternative Disease prior to the commencement date definition of the illness and will not be used of cover, you can never claim for Alzheimer’s to assess claims. If there is any dispute, the Disease under the Specified Illness Benefit. illness `definition’ overrules the `In simpler terms’ explanation If you have a history of arteriosclerotic • Information on related conditions which, if dementia, amnesia or memory loss prior to the present before joining the Scheme, means commencement date of cover and you are the member is not covered for the Specified found to have Alzheimer’s Disease within the first Illness if diagnosis occurs within the first 2 2 years of cover no benefit will be payable under years of cover the Specified Illness Benefit and you will cease to be covered for Alzheimer’s Disease. 1. Alzheimer’s Disease - resulting in permanent Survival period: 6 months. symptoms Policy definition 2. Aorta Graft Surgery – for disease or A definite diagnosis of Alzheimer’s Disease traumatic injury by a Consultant Neurologist, Psychiatrist or Policy definition Geriatrician. There must be permanent clinical loss of the ability to do all of the following: The undergoing of surgery for disease to the • remember aorta with excision and surgical replacement of • reason a portion of the diseased aorta with a graft. • perceive, understand, express and give effect The term aorta includes the thoracic and to ideas. abdominal aorta but not the branches. For the above definition, the following are not For the above definition, the following are not covered: covered: • Other types of dementia. • Any other surgical procedure, for example the insertion of stents or endovascular repair. In simpler terms Alzheimer’s Disease occurs when the nerve cells We also cover surgery for traumatic injury in the brain deteriorate over time and the brain to the aorta needing excision and surgical shrinks. There are various ways in which this replacement of a portion of the aorta with a can affect someone, for example, severe loss of graft. memory and concentration and mental ability gradually failing. Visit cornmarket.ie 41
In simpler terms In simpler terms The aorta is the main artery of the body. It Aplastic anaemia is a failure of the bone supplies blood containing oxygen to other marrow to produce enough blood cells for the arteries. The aorta can become narrow (often circulation. When this function of the marrow because of a buildup of fatty acids on its walls) reduces, the main parts of the blood (red cells, or it may become weakened because of a split white cells and platelets) reduce or stop being (dissection) in the internal wall. produced and you gradually have to depend The aorta may also weaken because of an more on blood transfusions. ‘aneurysm’. This means that the artery wall You can claim if a Consultant Haematologist becomes thin and expands. You might need a diagnoses permanent bone marrow failure graft to bypass the narrowed or weakened part which is treated by having a blood transfusion, of the artery. drugs to stimulate the bone marrow, You can claim if you have had surgery to remove immunosuppressive drugs or a bone-marrow and replace a part of the thoracic or abdominal transplant. aorta, to correct narrowing or weakening, with a Pre-existing conditions: None. graft. Surgery to the branches of the aorta is not covered as this surgery is generally less critical. Pre-existing conditions 4. Bacterial Meningitis – resulting in permanent symptoms If you have had aorta graft surgery prior to the commencement date of cover, you can never Policy definition claim for aorta graft surgery under the Specified A definite diagnosis of bacterial meningitis Illness Benefit. causing inflammation of the membranes of If you have a history of aortitis, Marfan’s the brain or spinal cord resulting in permanent syndrome, Ehlers-Danlos syndrome or peripheral neurological deficit with persisting clinical artery disease prior to the commencement date symptoms.* The diagnosis must be confirmed by of cover and you require aorta graft surgery a Consultant Neurologist. within the first 2 years of cover, no benefit will For the above definition, the following are not be payable under the Specified Illness Benefit covered: and you will cease to be covered for aorta graft • All other forms of meningitis including viral surgery. meningitis. * permanent neurological deficit with persisting 3. Aplastic Anaemia – of specified severity clinical symptoms is defined as: Policy definition – Symptoms of dysfunction in the nervous A definite diagnosis by a Consultant system that are present on clinical Haematologist of permanent bone marrow examination and expected to last failure which results in anaemia, neutropenia throughout the insured person’s life. and thrombocytopenia requiring treatment with – Symptoms that are covered include at least one of the following: numbness, hyperaesthesia(increased • Blood transfusion sensitivity), paralysis, localised weakness, • Marrow stimulating agents dysarthria(difficulty with speech), aphasia • Immunosuppressive agents (inability to speak), dysphagia(difficulty in • Bone marrow transplant. swallowing), visual impairment, difficulty in walking, lack of coordination, tremor, For the above definition, the following are not seizures, dementia, delirium and coma. covered: The following are not covered: • All other types of anaemia. • An abnormality seen on brain or other scans without definite related clinical symptoms 42 INMO Income Protection Scheme
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