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Key Exclusions to Discuss with Clients

Overview

When advising clients on ALI Group's My Protection Plan, it's crucial to inform them about specific exclusions that may affect their coverage.

Pre-Existing Medical Conditions:

Claims arising directly or indirectly from pre-existing medical conditions will not be paid. A pre-existing condition is defined as any illness, injury, or condition that:

  • Was the subject of a medical consultation in the 5 years immediately before the policy start date or a benefit increase date.

  • The life insured was aware of, or a reasonable person in the circumstances could be expected to be aware of.

Qualifying Periods for Trauma Benefits:

Certain trauma conditions have a 90-day qualifying period. This means that if a condition first occurs, becomes reasonably apparent, or is first diagnosed within 90 days after:

  • The policy start date.

  • The policy reinstatement date.

  • The date of any benefit increase.

No benefit will be paid for trauma conditions that are directly or indirectly related to a condition not covered due to this 90-day qualifying period.

Type A and Type B Exclusions:

There are two types of exclusions that can apply to the Death Benefit, Terminal Illness Benefit, Trauma Benefit, and Accidental Injury Benefit:

  • Type A Exclusions: Relate to specific medical conditions and their history.

  • Type B Exclusions: Relate to family medical history and genetic conditions.

For full details on these exclusions, please refer to the Exclusions for Pre-Existing Conditions page and consult the Product Disclosure Statement (PDS).

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