Progressive Care

Sovereign's Progressive Care is a severity-related trauma product designed to meet your clients' needs throughout their lives. Unlike traditional trauma products, which expire at a maximum age or following a single claim payment, Progressive Care has no expiry age and enables your clients to receive multiple claim payments if the severity of their medical condition worsens or if they suffer from unrelated medical conditions. These payments could be used to pay for specialist medical treatment, rehabilitation costs, or to provide financial breathing space during recovery.

Covering Childhood

With the Progressive Care entry age starting from 2 years old, parents have the option to take out trauma insurance for their children either as standalone or part of the family insurance with a maximum sum assured up to $250,000. This can help support the whole family through a difficult time such as allowing parents to take time off work to be there for their child.

Quick facts about Progressive Care

  • Eligible age:
    • Standalone Personal Progressive Care is available from age 2. Parents or legal guardians are required as the policy owner prior to age 16
    • Business Progressive Care and Accelerated Progressive Care are available from age 16
    • Optional benefits can be applied for once the life assured is 16 years or over
    • Individual consideration from age 70
  • Minimum sum assured: $50,000 (all ages)
  • Maximum sum assured: $1,500,000 for clients 16 years and over. $250,000 for children aged 2 to 15 years.
  • Premium structure options available from age 16: Rate for age, or fixed term premium (10 years or To age 65). If Progressive Care is selected with Life Cover as an accelerated benefit, indexation may apply.

Key features

    • When needed most - Severity level tiers mean that Progressive Care can provide partial claim payments at an earlier stage of the condition than traditional trauma products (subject to any previous claims paid under the policy). However, higher severity thresholds generally apply for full claim payments compared with traditional trauma products.

    • More than once - Clients can receive multiple claim payments for unrelated medical conditions or as medical conditions worsen (stand down periods and conditions apply).

    • For more conditions - Covers more than 60 medical conditions at various stages of severity and at various claim payment levels (grouped under five Categories of Conditions - Cancer, Heart and Arteries, Brain and Nerves, Loss of Function and Other Health Events).

    • A long-term customer relationship - The opportunity for multiple claim payments and no expiry age enables your clients to retain their cover for life (subject to cover remaining within at least one Category).

    • Broad range of coverage - More than 60 conditions covered at various stages of severity.

    • Future-proofing - Built-in options to increase cover, Guaranteed Enhancement wording and optional CPI indexing1

    • More cover than ever - The potential for a full claim payment in each of the five Categories effectively offers your clients a built-in buyback option.

    1. Special Event Increase Benefit and Future Insurability Benefit under the TotalCareMax Personal range are available once a life assured reaches the age of 16 and before age 55. Please read the detailed conditions in the policy document.

Built-in and Optional Benefits to support your clients' needs

  • If a child of the life assured suffers a covered condition of severity level 1, 2 or 3, the Children's Trauma Benefit will pay a benefit of 50% of the sum assured (up to $50,000). Importantly, the payment of the Children's Trauma Benefit will not reduce the amount of Progressive Care for a life assured.

    A stand down period, 14 day survival period, pre-existing condition exclusion and congenital condition exclusion apply

    Please note that Sovereign will pay only one claim per child under either the Newborn Children's Benefit or the Children's Trauma Benefit across all Sovereign policies.

    This benefit is included for the life of the policy.

    Why is this important?

    The Children's Trauma Benefit provides some trauma cover for their children aged 2 to 21 years within their standard premium cost. Should the worst happen, your clients can rely on the lump sum to contribute towards treatment costs or to take time off work to care for their child.

  • If the life assured's child is born with one of five specified congenital conditions and survives for thirty days after birth, the Newborn Children's Benefit will pay a benefit of 50% of the sum assured (up to $50,000). The payment of the Newborn Children's Benefit will not reduce the amount of any Progressive Care remaining for the life assured.

    Please note that Sovereign will pay only one claim per child under either the Newborn Children's Benefit or the Children's Trauma Benefit across all Sovereign policies. A 12 month stand down period and 30 day minimum survival period after birth applies.

    This benefit is included for the life of the policy.

    Why is this important?

    The Newborn Children's Benefit enables your client to take time off work to care for their child.

  • This enables your clients to increase their Progressive Care following major life changes for the life assured. The specified list of events includes significant milestones in a person's life known to result in increasing financial responsibilities. These significant events include: having a child, child starting secondary school, getting married, taking out or increasing a residential home loan, or making extensions to a residential property or residential investment, receiving a salary increase and other major events.

    The Special Events Increase Facility offers your clients the opportunity to increase their Progressive Care up to once per year without having to provide further medical information (maximum increase limits apply).

    This benefit is available once a life assured reaches age 16, and before age 55. Please note that these increases are not available if the life assured has already suffered a condition under Progressive Care. Where a claim of another type has been notified or accepted for the life assured, Sovereign will exercise its discretion in determining if the increase can be applied based on the nature of the claim.

    Why is this important?

    Life changing events can increase your clients' financial responsibilities. The Special Events Increase Facility allows your clients to increase their cover without having to provide further medical information for a life assured following a specified special event. Any increase under this benefit is subject to the conditions of the policy wording.

  • This benefit allows your clients to increase their cover at every third policy anniversary. The Future Insurability Benefit does not require any specific events to occur.

    The Future Insurability Benefit offers your clients the opportunity to increase their Progressive Care up to every three years without having to provide further medical information (maximum increase limits apply).

    This benefit is available once a life assured reaches age 16, and before age 55. Please note that these increases are not available if the life assured has already suffered a condition under Progressive Care. Where a claim of another type has been notified or accepted for the life assured, Sovereign will exercise its discretion in determining if the increase can be applied based on the nature of the claim.

    Why is this important?

    Life changing events can increase your clients' financial responsibilities. If your client does not experience one of the special events, they can still choose to increase their cover at every third policy anniversary.

  • All future enhancements to TotalCareMax will automatically be applied to your client's policy and the provision (or wording) that is most favourable to your client will be applied at claim time.

    Please note that any enhancements only apply in respect of those claims where the claim event date occurs after the date of enhancement.

    Why is this important?

    Your clients will automatically benefit from any favourable future changes to our TotalCareMaxproduct range. This helps to ensure that your clients' policies remain contemporary and continue to deliver value long after the policy was purchased.

  • With this benefit, your clients are able to be reimbursed for the cost of financial and legal advice from a Sovereign approved financial adviser or legal professional. Sovereign will reimburse cost of up to $2,500(including GST). This is a one-off payment across all Sovereign policies for each life assured.

    Why is this important?

    Navigating legal matters and managing short, medium or long term finances following a claim can be challenging. The Financial and Legal Advice Benefit provides your clients with an opportunity to obtain the advice they need to plan for their future.

  • This benefit enables the life assured to suspend their Trauma cover if they go on parental leave, or go on leave without pay for any reason for up to 12 months.

    Notification to suspend must be received within three months from the commencement of leave.

    Cover will be suspended from the date set out in Sovereign's written acknowledgement of the receipt of notification and relevant evidence.

    During the period that cover is suspended, no claim will be payable for any Trauma condition that occurs.

    A total of 12 months suspension may be accepted without the need to provide further medical evidence. The cover will automatically be reinstated at the end of the 12 months suspension, unless advised otherwise.

    Why is this important?

    Having time away from work or taking an unpaid break can leave finances stretched and often means that clients need to find a way to balance living on a reduced budget. Introducing this benefit gives clients financial freedom to redirect funds when their budget is tight whilst ensuring they retain the ability to reinstate cover without having the added complexity of reapplying.

  • We will pay a Bereavement Support Benefit if a child of your client dies, of up to $2,000 for children under the age of 10 years and $15,000 for children between the ages of 10 and 21 years.

    Why is this important?

    Losing a child is probably the singular most devastating event a parent could be asked to endure during their lifetime, regardless of the age of the child.

    In crisis, many families may find funding for a child's funeral is a challenge, and financial resources may not be quickly available to help support in this process.

    Introduction of this built-in benefit for Sovereign customers and alignment of the benefit offered across the Sovereign & AIA range gives better support for parents who suffer the loss of a child to assist them with the costs associated with the loss of a child.

  • Sovereign will pay up to $10,000 towards the cost for your client, plus one support person, to return home from overseas should they have suffer a critical condition for the first time covered under the policy.

    Why is this important?

    Nobody has control over when and how they become ill.

    This benefit provides reimbursement for the unexpected costs to return home to NZ if a customer suffers a covered trauma condition while overseas and their travel insurance policy hasn't provided the coverage they need to get home.

  • Sovereign will pay up to $2,500 (GST included) to cover the cost of a Psychiatrist or Psychologist consultation and counselling for your client and/or their family where the treatment directly relates to a claim made under the policy.

    Why is this important?

    This benefit provides assistance for the life assured, or their support network, to help them deal with the emotional impacts following diagnosis of a covered Trauma condition and enables them to work through personal challenges and changes that are impacting in their lives with a fully trained Psychiatrist or Psychologist.

  • Upon reaching 21 years of age the Built-in Children's Trauma Benefit or Optional Children's and Maternity Benefit can be converted to a standalone Progressive Care Benefit adult policy with no further medical evidence required, except where there is an increase in cover. The request for conversion must be made within 60 days of the child turning 21, and cannot occur if a claim has been made under the original policy.

    Why is this important?

    Built-in Children's Trauma Benefit to a standalone trauma option when a child reaches 21.

    It also formalises client's current ability to convert the Built-in Children's Trauma Benefit or Optional Children's & Maternity Benefit to a standalone Progressive Care Benefit adult policy when a child reaches 21.

  • Your client may convert their Standalone Progressive Care Benefit to Accelerated Progressive Care Benefit with an equal amount of Life Cover without any further medical evidence provided. Conditions apply.

    Why is this important?

    This benefit provides clients flexibility with product options to meet their needs.

  • Your client can convert all or part of their Progressive Care Benefit from the Premium specified in their Policy Schedule to a Level Premium structure (prior to reaching age 65 years), without further medical underwriting.

    Why is this important?

    This benefit provides customers flexibility with premium options to help manage affordability.

  • This optional benefit provides additional children's trauma cover of up to a further 50% of the sum assured (up to $75,000) per child of the life assured (for up to 10 children).

    The children's benefit is paid if a named child of the life assured suffers any covered condition under Progressive Care except for the Optional Total Permanent Disablement condition (if applicable). This optional benefit is paid once per child across all Sovereign policies and is paid in addition to the Built-in Children's Trauma Benefit. If both parents have taken the optional benefit under separate policies then two payments may be made. This optional benefit can be added to either Progressive Care or Comprehensive Living Assurance, but not both for the same life assured.

    This optional benefit is paid once per child per benefit and is paid in addition to the built-in Children's Trauma Benefit. This optional benefit can be added to either Progressive Care or Comprehensive Living Assurance, but not both for the same life assured.

    This benefit also provides cover for three defined serious pregnancy complications, with benefit of $10,000

    A 3 month stand down period and a 14 day survival period applies. Exclusions apply for any pre-existing or congenital conditions.

  • Your clients have the option to add cover for "own occupation" Total Permanent Disablement (TPD) as a claimable condition under Progressive Care.

    If your clients select this option, an "own occupation" TPD condition is added as a severity level 1 condition (i.e. 100% payment) under the Progressive Care "loss of function" category. This enables them to claim under the "loss of function" category for a wider set of conditions not otherwise covered under Progressive Care, which may lead to total and permanent disability.

    Consider the example below:

    Mary had $250,000 of standalone Progressive Care cover and had selected the optional TPD condition.

    Mary suffered major burns in an accident which qualified her for a severity level 3 payment (50% payment) under the "loss of function" category. Mary received a claim payment of $125,000 ($250,000 x 50%). The remaining cover under the "loss of function" category was reduced to $125,000 ($250,000 -$125,000).

    Five years later, Mary became totally and permanently disabled as a result of an unrelated mental health issue.

    Mary received a claim payment of $125,000 for the optional TPD condition under the "loss of function" category. The remaining cover under the "loss of function" category reduced to nil.

    The optional TPD condition expires at age 65 and does not apply to any children under the Children's Trauma Benefit or the Optional Children's and Maternity Benefit.

  • Sovereign offers its Specialist and Diagnostic Testing Benefit with Best Doctors* as an optional benefit with Progressive Care. This benefit can make a real difference to the timeliness and choice of your clients' specialist medical advice. The Specialist and Diagnostic Testing Benefit provides coverage of up to $5,000 per year for specialist consultations, diagnostic imaging and tests. In addition, Best Doctors offers your clients the opportunity to seek a second opinion from an international network of medical specialists. Some specialists and diagnostic tests are not covered.

    Please note that this add-on benefit is subject to its own terms and conditions which differ from Progressive Care. Please refer to the applicable policy document.

    * Best Doctors is a trademark of Best Doctors, Inc., in the United States and other countries, and is used under licence.

    Why is this important?

    • The New Zealand public health system provides quality emergency care and treatment for serious conditions. However, rising health care costs continue to put pressure on the public system's ability to offer prompt access to specialist consultations and diagnostic tests. Sovereign's Specialist and Diagnostic Testing Benefit enables your clients to access timely specialist advice so that their medical conditions can be promptly diagnosed.

    • Best Doctors' offers your clients and their families remote access to over 53,000 leading medical specialists worldwide. They have all been nominated by their peers as top experts in their field, and are there to help your clients.

      Access an Expert: Easy access to the world's best medical minds for advice and guidance on any medical condition.

      Find an Expert: Face to face consultations with a broad range of medical specialists in your clients' area.

      DocOnline: Unlimited access for clients to send medical questions to experienced, local GPs, with a response within 48 hours.

      Multimedia medical library: Access to hundreds of articles, videos and blogs on a wide range of medical conditions.

    * Best Doctors is a trademark of Best Doctors, Inc., in the United States and other countries, and is used under licence.

  • Accidental Injury Cover is an optional benefit that can be added to our core TotalCareMax (TCM) Personal and Business range (issued after February 2004 Illustrations version 8.3 or later) and provides customers an up-front lump sum payment, should they be injured accidentally. They can use this lump sum for whatever they need: covering treatment costs, getting taxis to work, hiring someone to help with children or running their business, or simply taking time off work to recover.

    Key product features:

    • Can be taken out with any of our core TCM products giving flexibility to you and your clients.
    • Sum assured can be anywhere between $500 - $5,000 a month with no proof of income required and flat rate pricing based on gender and smoking status.
    • Easy to understand insurance with four simple claim categories.
    • Once approved, claims are paid as a lump sum giving your clients quick access to funding to deal with the accidental injury they're facing.
    • There are no offsets against ACC or other insurances so your clients get the financial support they need, relevant to their situation.
    • Application is easy. For new customers, there are no extra questions than what is required for their core TCM products. For eligible existing customers there is a new, simple form to endorse it on to their existing policy.

    For more information please read the Accidental Injury Cover Personal Policy Wordings or Business Policy Wordings.

A note on exclusions

Some built-in and optional benefits under Living Assurance are subject to specific exclusions or stand-down periods. These are noted throughout this page. The policy wordings have a complete list of exclusions.

In addition, the following general stand-down periods and exclusions apply:

  1. Some covered conditions are subject to a three month stand-down period. This means Sovereign will not pay a claim for any of these conditions, if signs or symptoms relating to that condition, occur within three months of policy commencement. Please see the policy wordings for a complete list.
  2. Sovereign will not pay a claim where any of the following causes or contributes to the claim:
    1. An insured person (who may be a life assured or insured child of a life assured) deliberately injuring themselves, or attempting to do so;
    2. An insured person engaging in criminal conduct;
    3. A condition, or signs or symptoms leading to a condition, which an insured person has prior to policy commencement; or
    4. In relation to any insured person under the age of 21, an intentional act by a parent, guardian or other person who lives with or supervises that insured person.

The information on this page is provided as a sales support tool to be used in conjunction with the appropriate policy wording.