| 1.1 |
For purposes of this rule, "policyholder" includes a potential policyholder and "member" includes a potential member, where appropriate to the context. |
| 1.2 |
An insurer, at all times, must act with due skill, care and diligence when dealing with policyholders. |
| (a) |
in any engagement with a policyholder, and in all communications and dealings with a policyholder, act honourably, professionally and with due regard to the fair treatment of the policyholder; and |
| (b) |
at the start of any engagement initiated by the insurer clearly explain the purpose thereof. |
| 1.4 |
An insurer must have appropriate policies and procedures in place to achieve the fair treatment of policyholders. The fair treatment of policyholders encompasses achieving at least the following outcomes: |
| (a) |
policyholders can be confident that they are dealing with an insurer where the fair treatment of policyholders is central to the insurer's culture; |
| (b) |
products are designed to meet the needs of identified types, kinds or categories of policyholders and are targeted accordingly; |
| (c) |
policyholders are given clear information and are kept appropriately informed before, during and after the time of entering into a policy; |
| (d) |
where policyholders receive advice, the advice is suitable and takes account of their circumstances; |
| (e) |
policyholders are provided with products that perform as insurers or their representatives have led them to expect, and the associated service is both of an acceptable standard and what they have been led to expect; and |
| (f) |
policyholders do not face unreasonable post-sale barriers to change or replace a policy, submit a claim or make a complaint. |
Funds and Group schemes
| 1.5 |
For purposes of rules 1.2 to 1.4, "policyholder'' includes a member. |
| 1.6 |
Despite rule 1.5, in circumstances where an insurer can demonstrate that due to the nature of the fund or group scheme it is not reasonably practicable for the insurer to engage directly with the member in the normal course of business, rule 1.4 applies as follows: |
| (a) |
rule 1.4(a) entitles the member to have confidence that the fund or group scheme concerned is dealing with an insurer where the fair treatment of its members is central to the insurer's culture; |
| (b) |
for purposes of achieving rule 1.4(c) the insurer must have arrangements in place with the policyholder concerned that facilitate and support the provision of the required information by the policyholder to the member; |
| (c) |
in the case where advice is provided to the policyholder rather than the members, rule 1.4(d) requires that the advice should be suitable in relation to both the circumstances of the policyholder and the known or reasonably assumed circumstances of the members; |
| (d) |
rule 1.4(e) entitles the member to be provided with products that perform as either the member of the group scheme or the policyholder has been led to expect by the insurer or its representative, and services of the standard that either the member or the policyholder has been led to expect, in relation to the member's interest in the fund or group scheme; and |
[Rule 1.6(d) substituted by rule 5(a) of Notice No. 997, GG 41928, dated 28 September 2018]
| (e) |
for purposes of achieving rule 1.4(f) the insurer must have arrangements in place with the policyholder concerned that facilitate and support the member's ability to make changes in relation to the member's interest in the fund or group scheme (to the extent permitted in terms of the rules of the fund or group scheme) or to submit claims or make complaints without unreasonable barriers. |
| 1.7 |
All policies, procedures and arrangements required by rule 1.6 in relation to a fund policy or a group scheme must enable the insurer to monitor the extent to which fair treatment of members is being achieved. Where it"becomes apparent to the insurer that fair treatment is compromised, including as a result of non-compliance by the policyholder (excluding a member) concerned with agreed policies, procedures and arrangements, the insurer must take reasonable steps to mitigate the risks to members or future members. |
| 1.8 |
Despite rules 1.5 to 1.7 and any requirements in these rules specifically applicable to funds and group schemes— |
| (a) |
where any other provision of these rules prescribes a specific requirement in relation to members, that requirement must be complied with; and |
| (b) |
if a member is also a policyholder of the group scheme policy or fund policy relating to the group scheme or fund of which it is a member, all the requirements relating to policyholders contained in these rules apply in respect of such a member. |
Suitable advice
| 1.9 |
Where advice is provided by an intermediary other than the insurer's representative, rules 1.4(d) and 1.6(c) must be read to require the insurer to take reasonable steps to mitigate the risk of unsuitable advice. Such steps should take into account the nature of the business relationship between the insurer and the intermediary and any likelihood that such relationship may potentially influence the advice provided. |
Review of policies and procedures
| 1.10 |
An insurer must regularly review its policies and procedures referred to in this rule and document any changes thereto. |
Gas Regulator Levies Act, 2002
