Insurance arrangementsInsurance arrangements

Insurance arrangements

18. For the purposes of this Prudential Standard, ‘insurance arrangement’ means:

(a) where an RSE licensee makes available insured benefits as described in paragraph 5(a) – an insurance policy document9; or

(b) where an RSE licensee makes available insured benefits as described in paragraph 5(b) – appropriate documentation of the terms and conditions of the insured benefits;

and any agreement between the RSE licensee and the insurer or any other party, to the extent that the agreement concerns making available insured benefits.10

19. At a minimum, the insurance arrangement must address:

(a) the level and type of insured benefits made available, including any exclusions;

(b) the term of the insured benefits;

(c) automatic acceptance limits (to the extent relevant);

(d) availability of opt in and/or opt out cover;

(e) requirements for the beneficiaries’ eligibility for, cessation of, and any reinstatement of entitlements to insured benefits where available;

(f) premium structure, including any variable components;

(g) procedures for notification and payment of claims;

(h) dispute resolution arrangements;

(i) agreed service standards;

(j) reporting requirements for monitoring agreed service standards;

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8 Refer to Prudential Standard SPS 521 Conflicts of Interest for details of conflicts management requirements.

9 For the purposes of this Prudential Standard, a reference to ‘an insurance policy document’ is a reference to a contract of insurance issued by an insurer.

10 An agreement that meets the definition of outsourcing in Prudential Standard SPS 231 Outsourcing must meet the requirements of that Prudential Standard.