Document ID: chunk:federal_register_of_legislation:F2022L00741:body:0:p5
Version: federal_register_of_legislation:F2022L00741
Segment Type: other
Provision Reference: 
Character Range: 11501–14658

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;

 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.

(k)          the provision of complete claims information to the RSE licensee on an annual basis which, at a minimum, includes the information required to be maintained by the RSE licensee under paragraph 15;

(l)            liability and indemnity arrangements;

        (m)          review and renewal provisions for the insurance arrangement; and

(n)          termination provisions for the insurance arrangement which, where relevant, include a right for the RSE licensee to terminate the insurance arrangement, or the relevant part of the insurance arrangement, if the RSE licensee is not satisfied that the arrangement is in the best financial interests of the beneficiaries.11

    20.         An RSE licensee must be able to satisfy itself, and demonstrate to APRA, that the rules for attributing any status to a beneficiary, (including a class or cohort of beneficiaries) in connection with the provision of insurance, are fair and reasonable.

    21.         An RSE licensee must notify APRA as soon as practicable of any issues that it considers might materially affect its ability to make insured benefits available to beneficiaries.

    22.         Where an insurance arrangement is terminated, an RSE licensee must notify APRA as soon as practicable and provide a statement about the transition arrangements and future strategies for continuing to make insured benefits available to beneficiaries.

Selection and monitoring of insurers

    23.         An RSE licensee must:

(a)          develop and implement a selection process for choosing an insurer that includes, at a minimum, consideration of the prospective insurer's terms of cover and exclusions, claims philosophy, the reasonableness of the premiums to be charged and terms of any delegation to any other person of functions associated with making available insured benefits;

(b)          undertake a due diligence review of the selected insurer; and

(c)          be able to demonstrate to APRA the appropriateness of the selection process and due diligence review and how it is applied.

    24.         An RSE licensee must be able to satisfy itself, and demonstrate to APRA, that the engagement of an insurer is conducted at arm's length and is in the best