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What you need to know about your policy exclusions & waiting periods

Posted  September 11, 2018

Do the exclusions and waiting periods on your policy confuse you? Don’t worry – we’ve looked at these in detail to give you all the info you need.

Nearly all insurance policies have general exclusions and waiting periods. If you claim because of an event that is excluded or that event occurs in a waiting period, your claim may be rejected. So it’s important to know what exclusions and waiting periods apply when.

ExclusionsAn exclusion on a policy means that if something happens as a result of an excluded event a claim won’t be paid. For example, if you are killed while taking part in a criminal activity such as hijacking or burglary, the death claim on your life policy will be rejected.

There are two kinds of exclusions – general exclusions that apply to all similar policies and specific exclusions that apply only to your policy.

General exclusions
These most often apply when a life assured is harming themselves, taking part in criminal and illegal activities or engaging in dangerous behaviour such as drinking too much alcohol, taking dangerous drugs or participating in risky activities such as cliff jumping.

This table shows the exclusion and which policies they apply to:

Dread Disease exclusions and survival period
Various dread diseases such as cancer and heart attacks have further exclusions that you can find in your 1Life policy book. These relate to diagnoses for specific diseases, for example stage 0 cancers.

It’s also important to know that 1Life will only consider a dread disease claim 28 days from the date that it was diagnosed.

The bottom line: Avoid illegal and criminal activities, injuring yourself, hazardous dangerous activities and follow reasonable medical advice to get your claim paid. If you are going to take up a dangerous sport, notify your insurer.

Specific exclusions
A specific exclusion may be applied to your life, dread disease, disability or Expense Protector policy based on your personal health and lifestyle information.

They exclude claims for certain events or illnesses such as a heart attack because these events are so high risk, insuring them would be prohibitively expensive, and in some cases, insurers may not be able to carry this risk.

Specific exclusions usually fall into health or activity categories. If you have a severe chronic illness such as cancer or heart failure, then claims resulting from these may be excluded. If you regularly take part in risky activities such as cliff jumping, your insurer may exclude claims as a result of this.

If a specific exclusion is applied on our policy, you will be notified and asked to accept this condition when you take out the policy. Specific exclusions can be reviewed so if you stop taking part in dangerous activities or your health improves you can apply to have the exclusion removed.

You can find details of any specific exclusions in your policy schedule.

Waiting periodsWaiting periods are similar to exclusions in that claims made for certain events in a waiting period won’t be paid.

You can find details of waiting periods in your policy schedule.

Exclusions and waiting periods when your policy changes
If you increase your cover on any 1Life policy or add a life assured to a funeral policy, the exclusions and waiting periods that applied when you first took out the policy apply to the new cover and life assured from the date of the change.

So, if you add a life assured to a funeral policy you have had for two years, the new life assured cannot claim for the first six months from the time they are covered on the policy.

If your policy is reinstated, the exclusions and waiting periods apply from the date of reinstatement. Policies that have been cancelled because premiums weren’t paid can be reinstated so that you continue to have cover. Your insurer will tell you what you need to do to reinstate a policy and what terms and conditions apply.

Long term insurance products cover our basic need to provide for our loved ones when we cannot. The terms and conditions make insurance policies affect claims, so it’s worth taking some time every few months to go through your policy and make sure you understand what it covers and how and when you can claim.

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