What is the Medical Free Cover Limit?
A Free Cover Limit (FCL) is the amount of cover that is provided on a Scheme to all eligible employees (members) without the requirement for any medical evidence. In the event that a member’s cover exceeds this level, underwriting will apply to the amount of cover above the FCL. If the member’s benefits are below the FCL, they will not be subject to underwriting provided that the member fulfils the eligibility conditions.
The FCL is set at Scheme inception and is usually available for Schemes above a certain membership size. It can be reviewed at renewal should the membership or the benefits offered have changed.
What are the possible underwriting decisions?
After review of evidence, one of the following decisions will be made:
- Acceptance on standard terms – the member is accepted for full benefits and the premium rates are the applicable policy rates.
- Acceptance with an exclusion – the member is accepted for full benefits for any condition apart from the condition(s) detailed in the exclusion and the premium rates are the applicable policy rates.
- Acceptance with pre-existing medical exclusion – the member is accepted at standard terms but, in this case, no benefit will be payable if the claim is as a result of any medical or related condition for which symptoms have appeared and which were first diagnosed, treated, advice sought or known to be in existence prior to the completion of the NMQ.
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This exclusion will be removed once the member has not sought any further advice, treatment or suffered any symptoms for a two year period from the date of acceptance.
- Postponed – the member’s cover is restricted for the time being and will be reviewed at a later date. This decision may be applied if the member has recently begun treatment for a condition which is under review. The underwriting will be carried out again when the member’s condition has improved and treatment is terminated or under control.
- Declined – based upon the evidence received, no cover will be provided for this member and no premium will be payable from the date of the decision. If there is a Free Cover Limit under the policy, the member is accepted up to the FCL and premium is payable for cover up to this benefit level.
Who pays for the medical underwriting costs?
Accounts in respect of medical underwriting will normally be paid to the surgery directly By Global Alliance Life.. In the event that a member has had to pay the medical cost, this will be reimbursed 100%.In order to obtain this refund, the member is required to send the medical invoice and receipt to Global Alliance Life, who will arrange for reimbursement. Please note that we will only reimburse the costs of the medical tests requested. Any other tests or costs incurred will not be reimbursed.
How do we communicate the level of cover in place?
Underwriting decisions are communicated directly to the employer by our underwriting team. In addition, we provide regular underwriting updates to the employer indicating the level of cover in place whilst underwriting is pending. The employer is responsible for advising the member concerned of their level of cover.
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Once acceptance terms have been confirmed, will the member need to be underwritten again?
A member will need to be underwritten upon joining the Scheme if their benefit is above the FCL or if there is no FCL, unless members are accepted on no worse terms basis at our discretion. Once the underwriting process has been completed and acceptance terms have been confirmed, the member will not need to be underwritten again unless they have a salary increase of over 15% or if this increase brings their benefit above the FCL. The member will then seek to obtain coverage for full benefits above the previously insured amount.
Confidentiality
Global Alliance Life’s underwriting team deals with the collection of the medical
information. The medical forms (PMA, SMR etc.) are issued by our underwriter directly to
the member’s medical practitioner or independent doctor and these forms should be returned to the Chief Medical Underwriter to ensure complete confidentiality.
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