No medical questionnaire does not mean no conditions
Fidelity Life describes its Automatic Acceptance Level as a pre-approved level of cover for eligible employees. Its current group-trauma material says that, in most cases, it will not ask for medical information or apply non-standard terms below that level.
Its published product conditions still include requirements relating to eligibility, age, occupation, residency, active-at-work status, waiting periods and joining windows. The exact conditions depend on the employer’s policy.
Cover above the agreed limit can require underwriting
Within the limit
An eligible employee may receive the calculated benefit without providing individual medical evidence, subject to all scheme conditions.
Above the limit
The additional amount can require a personal health statement or other evidence. The insurer decides the terms and commencement date.
The limit is scheme-specific. It can vary by insurer, product, group size, participation, benefit formula and workforce profile. Avoid quoting a generic dollar amount as though it applies to every employer.
Separate acceptance of cover from whether a future claim is payable
Automatic acceptance can be valuable for employees who would otherwise need individual underwriting. But it is unsafe to say that it automatically covers every pre-existing condition.
A claim must still satisfy the policy definition, exclusions, waiting periods and commencement rules. The result can also differ between life, income protection, trauma, TPD and medical insurance products.
Employee communication should describe the actual policy rather than promise “full cover regardless of health”.
Health schemes use their own pre-existing-condition rules
Do not apply a group-life automatic acceptance explanation to medical insurance without checking the medical policy. For example, nib currently says its Premier Health Business product covers specified pre-existing conditions immediately for groups of 15 policies or more, subject to the product’s terms, conditions, exclusions and waiting periods.
Southern Cross separately says a member of an employer work scheme may be entitled to cover for pre-existing conditions. These are product examples—not market-wide promises—and the current quote, plan, eligibility window and written policy terms must be checked.
Make eligibility and notification dates operational
- Record the eligible employee classes and benefit formula
- Confirm age, at-work, participation and joining conditions
- Notify the insurer when employees join, leave or change salary
- Identify benefits above the automatic acceptance limit
- Give employees policy-specific wording and support contacts
Do not assume a universal 30, 60 or 90-day joining window. Use the current policy schedule, insurer administration guide and adviser instructions for the employer’s scheme.