INMO Income Protection Scheme - Prismic

 
INMO Income Protection Scheme - Prismic
INMO Income
Protection Scheme
INMO Income Protection Scheme - Prismic
2   INMO Income Protection Scheme
INMO Income Protection Scheme - Prismic
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.

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INMO Income Protection Scheme - Prismic
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
INMO Income Protection Scheme - Prismic
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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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20   INMO Income Protection Scheme
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.

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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.
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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
Visit cornmarket.ie   35
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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