| 15.1 |
A premium payable under a policy may only be reviewed if the policy provides for a review and states the frequency at which and the circumstances in which a review will take place. |
| 15.2 |
Where a policy provides for a review an insurer may only undertake the review at the frequency stated in the policy and when the circumstances contemplated in the policy prevail. |
| 15.3 |
The circumstances referred to in rules 15.1 and 15.2 may not— |
| (a) |
give an insurer the discretion to increase profitability margins beyond those assumed at the outset of the policy; |
| (b) |
allow an insurer to adjust premiums that were not based on assumptions that meet the standard in rule 6.1; and. |
| (c) |
directly or indirectly aim to achieve any of the purposes in rule 15.5; |
| 15.4 |
Any review of a premium payable under a policy— |
| (a) |
must reasonably balance the interests of the insurer and the reasonable benefit expectations of policyholders or members; |
| (b) |
must be justified with reference to the extent to which the assumptions on which the premium was based have been met; and |
[Rule 15.4(b) substituted by rule 9(a) of Notice No. 997, GG 41928, dated 28 September 2018]
| (c) |
in the case of a policy that has an investment component and a risk component, must take into account the reasonable benefit expectations of the policyholder or member in respect of both components. |
| 15.5 |
A review of a premium payable under a policy will not comply with 15.4 if the primary purpose or effect of the review is to— |
| (a) |
allow the insurer to recoup its losses on the policy incurred prior to the date of the review; |
| (b) |
increase profitability margins beyond those assumed at the outset of the policy; |
| (c) |
unfairly target a particular group of policyholders or members for an increase in premium; |
| (d) |
seek to cover losses or increased expenses arising in the business not related to the profitability of the product concerned; |
| (e) |
allow for the adjustment of a low initial premium consciously based on overly optimistic assumptions about investment performance; or |
| (f) |
in case of a policies with both an investment and a risk component, allow for an increase in investment management charges to compensate for the fact that the cost of risk benefits has increased where this cost has not accurately been reflected in the risk benefit charge. |
| 15.6 |
An insurer must timeously and in writing inform a policyholder of a pending review and the timing of the review if the review is expected to result in a premium increase. |
| 15.7 |
If a premium payable under a risk policy will be increased as a result of a review, an insurer must take reasonable steps to afford a policyholder alternatives (such as the option to terminate the policy, to reduce the policy benefit or to enter into an alternative policy) to mitigate the impact of the increase on the policyholder. |
| 15.8 |
Rules 15.1 to 15.3 do not apply to existing policies. |
Contingency Fees Act, 1997
