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11.4 Termination and Replacement of Group Scheme Policy by Policyholder

If a policyholder terminates or intends to terminate a group scheme policy, the insurer of the policy being terminated must notify the Authority of the termination or intended termination as soon as reasonably possible after becoming aware of the termination or proposed termination. An insurer must before entering into a group scheme policy determine whether […]

11.3 Termination of Group Schemes Policies by Insurer

If an insurer intends to terminate a group scheme policy, the insurer, despite any terms and conditions provided for in a policy, must – Give the policyholder and the Authority at least 31 days’ written notice of the intended termination. Be able to demonstrate that it has taken reasonable steps to provide the members of […]

11.2 Termination of Individual Policy by Insurer

If an insurer intends to terminate a policy because of circumstances other than the following, the insurer, despite any terms and conditions provided for in a policy, must give the policyholder at least 31 days’ written notice of the intended termination: Non-payment of a premium, subject to the insurer complying with the provisions of the […]

11.1 Introduction

Material change refers to any change in circumstances that results in a policyholder or beneficiary not being entitled to claim a policy benefit under a policy. Termination in relation to a policy, means that a policy comes to an end, for any reason, and includes the following: The cancellation or lapsing of a policy. The […]

10.11 Reporting Complaints Information

An insurer must have appropriate processes in place to ensure compliance with any prescribed requirements for reporting complaints information to any relevant designated authority or to the public as may be required by the Authority.

10.10 Engagement with Ombud

An insurer must – Have appropriate processes in place for engagement with any relevant ombud in relation to its complaints. Clearly and transparently communicate the availability and contact details of the relevant ombud services to complainants at all relevant stages of the insurance relationship, including at point of sale, in relevant periodic communications, and when […]

10.9 Communication with Complainants

An insurer must ensure that its complaint processes and procedures are transparent, visible and accessible through channels that are appropriate to the insurer’s policyholders and beneficiaries. An insurer may not impose any charge for a complainant to make use of complaint processes and procedures. All communications with a complainant must be in plain language. An […]

10.8 Record Keeping, Monitoring and Analysis of Complaints

An insurer must ensure accurate, efficient and secure recording of complaints-related information. The following must be recorded in respect of each reportable complaint: All relevant details of the complainant and the subject matter of the complaint. Copies of all relevant evidence, correspondence and decisions. The complaint categorisation. Progress and status of the complaint, including whether […]

10.7 Decisions Relating to Complaints

Where a complaint is upheld, any commitment by the insurer to make a compensation payment, goodwill payment or to take any other action must be carried out without undue delay and within any agreed timeframes. Where a complaint is rejected, the complainant must be provided with clear and adequate reasons for the decision and must […]

10.6 Complaints Escalation and Review Process

An insurer must establish and maintain an appropriate internal complaints escalation and review process. Procedures within the complaints escalation and review process should not be overly complicated or impose unduly burdensome paperwork or other administrative requirements on complainants. The complaints escalation and review process should – Follow a balanced approach, bearing in mind the legitimate […]