Professionals Income Protection Plan

Transcription

1 Customer Services Phone Fax Postal address Customer Services GPO Box 5306 Sydney NSW 2001 Website Professionals Income Protection Plan This Plan is issued by: ING Life Limited ABN AFSL Kent Street Sydney NSW 2000 L4345/0209 Product Disclosure Statement 15 Februaury 2009

2 Features and Benefits Contact us ING Life Limited 347 Kent Street Sydney NSW 2000 Phone This Product Disclosure Statement (PDS) provides a summary of the significant features, benefits, risks and exclusions that we would like to bring to your attention. In this PDS you or your refers to the policy holder (and the life insured), and we, our, us or ING refers to ING Life Limited (ABN , AFSL ), the insurance company issuing this PDS. The Policy Document contains the full terms and conditions of this insurance product. You can obtain a copy of the Policy Document free of charge upon request. If there is any inconsistency between this PDS and the policy terms, the policy terms will prevail to the extent of any inconsistency. Words in bold are defined at the end of this document. Applications for this policy of insurance are only available to persons receiving this PDS in Australia. No offer is made directly or indirectly to persons in any other country. Auto-acceptance Cover is immediate if you meet the age, residency and eligibility requirements and we accept the application. Who can apply for cover? You can apply for cover if you are: a member of the professional organisation which has entered into arrangements with ING to distribute this product; between the ages of 21 and 55; either an Australian or New Zealand Citizen, or a holder of an Australian Permanent Residency Visa; currently residing within Australia at the time of your application; and currently employed. How much cover can I apply for? When you apply, you will be asked to nominate the monthly amount insured. The minimum monthly amount insured you can apply for is $2,000 per month. The maximum monthly amount insured you can apply for is: 75% of the first $20,000 per month of your monthly earnings; plus 50% of the next $10,000 per month of your monthly earnings. The overall maximum monthly amount insured is $20,000 per month. When you choose the amount that you wish to insure, it is in your interest not to insure more than the maximum you can be paid. Monthly amount insured payable The monthly amount insured payable will be the amount used to determine the monthly amount you will be paid under this policy while you are on claim. The monthly amount insured payable may be less than the monthly amount insured shown on the Policy Schedule depending on your pre-claim earnings less other payments. 2 3

3 The monthly amount insured payable is the lesser of: the monthly amount insured shown on the Policy Schedule or 75% of the first $20,000 per month of your pre-claim earnings; plus 50% of the next $10,000 per month of your pre-claim earnings; less other payments. At the time of claim we require you to provide satisfactory financial evidence for the purpose of determining your pre-claim earnings. Total Disability Benefit If due to illness or injury, you are assessed as totally disabled and unable to work in your regular occupation we will pay you the Total Disability Benefit (which is the monthly insured amount payable) for the benefit period from the end of the waiting period. To be eligible to receive this benefit you must have been: totally disabled throughout the waiting period and continuously totally disabled since the end of the waiting period (unless claiming as a recurring claim). We will stop paying the Total Disability Benefit when you are no longer totally disabled. Partial Disability Benefit If due to illness or injury, you are assessed as partially disabled, we will pay you the Partial Disability Benefit for the benefit period from the end of the waiting period. To be eligible to receive this benefit you must have been: totally disabled throughout the waiting period and continuously disabled since the end of the waiting period (unless claiming as a recurring claim). The monthly Partial Disability Benefit is calculated as: (A B) x C A Where: A = your pre-claim earnings B = your monthly earnings for the month in which you are partially disabled. If you are not working to your assessed capacity, then B will be the amount you could expect to earn if you were. When we assess capacity, consideration will be given to medical evidence and other factors related to your condition. C = the monthly amount insured payable. We will stop paying the Partial Disability Benefit when you are no longer partially disabled. Worked examples The following illustrations show in dollar terms how the significant benefits of the work. They are not intended to explain all possible benefits and features or cover all possible situations. The examples should be read in conjunction with the information that describes the benefits and features of the Plan in more detail. Claims are assessed based on the full terms and conditions of the policy and any benefits payable will depend on all the circumstances of each individual claim. Nadia runs her own business and decides to apply for income protection insurance under this Plan. Her gross annual income at the time of application is $200,000. Nadia elects to insure herself for $12,500 (the maximum amount she can claim of her current earnings), calculated as follows: Monthly amount insured = 75% x $200, months = $12,500 Five years after taking out the cover, Nadia makes a claim on her policy for the Total Disability Benefit. She has not altered her level of cover since the start date. The benefit that we pay depends on Nadia s pre-claim earnings immediately prior to her disability and her monthly amount insured. 4 5

4 Total Disability Benefit At claim time, in example 1 below, Nadia s pre-claim earnings are $300,000 immediately prior to her disability, while in example 2, she earns only $160,000. Pre-claim earnings Example 1 Example 2 (Nadia s pre-claim earnings are more than her monthly amount insured) $300, months = $25,000 per month (Nadia s pre-claim earnings are less than her monthly amount insured) $160, months = $13,333 per month Monthly amount insured as stated on the Policy Schedule $12,500 $12,500 Total Disability Benefit we pay at claim time $12,500* $10,000* * The figures arrived at are based on the lesser of the monthly amount insured as stated on the Policy Schedule or 75% of the first $20,000 per month of Nadia s pre-claim earnings; plus 50% of the next $10,000 per month of her pre-claim earnings; less other payments. The benefit is then calculated on a monthly basis. Partial Disability Benefit After 3 months of total disability, Nadia s condition improves and she is able to return to work on a part-time basis with monthly earnings of $10,000. Nadia qualifies as partially disabled and we calculate the Partial Disability Benefit as a proportion of the monthly amount insured payable using the Partial Disability Benefit formula: Where: A = her pre-claim earnings B = her monthly earnings for the month in which she is partially disabled. C = the monthly amount insured payable. (A B) x C A Example 1 (pre-claim earnings = $25,000 per month) ($25,000 $10,000) x $12,500 $25,000 Partial Disability Benefit payable = $7,500 Example 2 (pre-claim earnings = $10,000 per month) ($13,333 $10,000) x $10,000 $13,333 Partial Disability Benefit payable = $2,

5 Special Care Benefit If you are receiving the Total Disability Benefit, are confined to bed due to the illness or injury and a medical practitioner certifies that you require the care of a registered nurse or require a housekeeper (who is not an immediate family member) within your home, we will pay a benefit to you based on the costs of employing the registered nurse or housekeeper for a maximum of 6 months to the lesser of: Each child must be under the age of 12 at the time of your disability. This benefit is payable for a maximum of 3 months and is not payable during the waiting period. Recurring claims We will waive the waiting period if you suffer a relapse of your illness or injury within six months of your last benefit payment and you need to restart the claim. 8 The monthly amount insured shown in the Policy Schedule and $3,000 per month. This benefit is payable in addition to any monthly amount insured payable but is not payable during the waiting period. We can not pay any benefits that are regulated by the National Health Act 1953 or the Private Health Insurance Act 2007 or which can be paid or reimbursed from another source. Rehabilitation Expenses Benefit If you are receiving a Total Disability Benefit or Partial Disability Benefit, we will reimburse the costs associated with a rehabilitation program (approved by us) to assist you in returning to work, up to a maximum of $50,000. Any benefit payable under the Rehabilitation Expenses Benefit is in addition to the Total Disability Benefit or Partial Disability Benefit paid but is not payable during the waiting period. We can not pay any benefits that are regulated by the National Health Act 1953 or the Private Health Insurance Act 2007 or which can be paid or reimbursed from another source. Child Care Assistance Benefit If we are paying a Total Disability Benefit and the illness or injury means you require additional child care assistance, we will pay a benefit to you based on the monthly costs of child care fees that cannot be recovered from another source. The amount we pay is the lesser of: 5% of the monthly amount insured and $400 per month. Area of cover You are covered 24 hours a day, 365 days a year, anywhere in the world. Discounts If you pay your premiums annually, you will receive a discount of between 4% and 5% of the total annual premiums. Cancellation and cooling-off period You have the right to cancel and return your policy at any time. If you choose to cancel your policy during the 21 day cooling-off period (which begins on the 5th day after the acceptance date), we will return to you any premium payments you have made, provided no claim has been made. After the cooling-off period, where premiums are paid monthly and you cancel the policy, we will not refund any premiums. We will pay a pro rata refund where premiums are paid annually and you cancel the policy before the next annual payment is due. This policy provides insurance cover only. It does not have a savings, investment, cash or surrender value and does not participate in the profits or share in any surplus of ING. Benefit period The benefit period is the maximum period of time that you will be paid for any one illness or injury. The benefit period starts at the end of the waiting period and continues until the earlier of: 24 months of disability benefits have been paid for each claim (subject to the mental disorder limitation). the date the policy is cancelled or avoided in accordance with our rights at law 9

6 the policy expiry date the date you are no longer disabled the date of your death. A separate benefit period applies for each separate illness or injury for which you can claim under this cover, unless it is a recurring claim where the benefit period is reduced by any previous periods for which benefits were paid for that illness or injury. Waiting period The waiting period is 30 days. It is the period you must wait before benefits become payable under this policy. The waiting period starts the day you consult a medical practitioner and receive advice confirming that you are totally disabled. A separate waiting period applies for each separate illness or injury for which you are entitled to make a claim under this policy unless it is a recurring claim. One benefit payable You are only entitled to one monthly amount insured payable at any one time under this cover even if you suffer more than one illness or injury giving rise to the disability. Premiums You can obtain a premium estimate by calling us on At your request, we can also provide you with a table of premiums that apply to this insurance product. The premium is calculated based on your age, gender, smoker status and occupation at the time the insurance commences and is re-calculated on the policy anniversary date after your birthday each year. All other premium increases will only occur if premiums for all persons within your risk group (based on age, gender, smoker status and occupation) are changed and three months written notice is given by ING. You need to pay the premiums when due to keep your policy in force. If you do not pay the premiums when required, we may cancel the policy. Premiums can be paid monthly or annually by Direct Debit from a credit card or bank account. Please note, ING may incur a fee in operating the Direct Debit system and may pass this fee on to you. It is important to select a level of cover that is appropriate for your income. The premiums payable are based on this level of cover and if you are over insured, no refunds in premiums will be provided. The premiums for this policy are paid into ING Life No. 1 Statutory Fund. Premium examples Age Occupation Engineer Accountant Lawyer Doctor Monthly benefit selected $8,000 $11,000 $7,500 $18,000 Gender Male Female Male Female Male Female Male Female Monthly premium $68.49 $96.09 $ $ $ $ $ $ Note: All examples assume a non-smoker status and assume an 8% stamp duty calculation 10 11

7 When the cover ends Cover for the policy ends our liability to pay any benefit ends when the earliest of the following events occur: The policy anniversary date after you turn 65 the policy expiry date shown on the Policy Schedule the date we receive notice from you to cancel the policy the date we cancel the policy in accordance with our legal rights the date we cancel the policy because you have not paid the premium when due the date of your death. Risks There are a number of insurance risks you should be aware of, including: the insurance cover you select may not provide the appropriate cover for your needs the maximum amount of insurance cover you select may not be sufficient to cover your needs if we do not receive the premiums within 90 days of the due date, we may cancel or terminate the policy by writing to you and may not assess any claim which arises after the termination date Exclusions We will not pay your claim if your disability is caused directly or indirectly from: a pre-existing medical condition a pre-existing medical condition is an injury, illness, condition or related symptom that, in the five years prior to the acceptance date, you, or a reasonable person in your position: were aware of; should have been aware of; or had a medical consultation for. war (whether formally declared or not), hostilities, civil commotion or insurrection pregnancy, giving birth, miscarrying or having a pregnancy termination however, if you are totally disabled for more than three months from the date the pregnancy ends, we will pay benefits from the end of that three month period participation in or training for professional sports or speed contests your intentional or deliberate act or omission. Mental Disorder Limitation The maximum cumulative benefit period for any mental disorder or for any condition arising from or contributed to by a mental disorder which gives rise to the disability (as determined by a registered and qualified psychiatrist who is a medical practitioner) is 12 months. The 12 months benefit is for all such claims which occur during the life of the cover, regardless of the number of events or causes or the number of such claims. Misstatements If your application includes any misstatements, we may vary or avoid your policy or claim or decline to pay your claim as allowed by law. Taxation The Plan is only issued on the basis that the person who is insured is also the policy holder. The Plan is not issued to employers, superannuation funds or as key person insurance. The premium that you pay will generally be an allowable deduction from your assessable income and the benefits paid under the policy will be assessable as income. For your benefit, ING will send a premium statement at the end of each financial year showing all premiums paid for that year

8 Taxation information in this material is based upon our interpretation and the continuation of legislation in place as at the date this PDS is issued. This information is of a general nature and may not apply to your individual circumstances. You should seek professional advice on your own taxation position. Complaint resolution Please contact our Customer Service team on if you are dissatisfied with any matter relating to your policy or the manner in which a claim is handled. If you are unhappy with ING s response, you can contact the Financial Ombudsman Service, an independent body whose services are available to you at no cost, on , or info@fos.org.au or write to GPO Box 3, Melbourne Vic Privacy We are committed to ensuring the confidentiality and security of personal information. The Privacy Policy details how we manage personal information. It is available without charge on request or may be downloaded from If you have any further questions you would like answered about privacy, please contact ING s Privacy Officer on or privacy@ing.com.au Changes to the PDS The information in this PDS has been prepared by ING and is up to date at the time of its preparation but may be updated from time to time. If there is any omission of information or a materially adverse change to the information as disclosed in this document, we will issue a supplementary or replacement PDS. Should you require a copy of the supplementary or replacement PDS or any other notice published as a result of change, we will provide a copy without charge when you request it. If there is a change in information that is not materially adverse, these updated changes will be placed on the ING website at under `Important notices. Alternative Form of Remuneration Register ING Australia Limited maintains an Alternative Form of Remuneration Register (Register) in accordance with the Investment and Financial Services Association (IFSA) Industry Code of Practice on Alternative Forms of Remuneration in the Wealth Management Industry. The Register outlines the alternative forms of remuneration which are paid and received from givers and receivers of such remuneration. The Register is publicly available and can be accessed by contacting ING. This insurance product does not pay or receive any alternative remuneration. Definitions Acceptance date: the date we accept your application for insurance Additional child care assistance: Care by a licensed government or non-government external child care provider and not by you or an immediate family member of the child. Existing child care arrangements (eg licensed nanny, crèche) are excluded. Disabled/disability means totally disabled or partially disabled. Employed: means that as at the application date for this policy, you are employed or self-employed, for salary, reward or profit, for at least 12 months and currently working more than 30 hours per week. Illness: an illness or disease which becomes reasonably apparent during the period of cover. Injury: a bodily injury which occurs during the period of cover. Immediate family member means: a partner/spouse a son, daughter, father, mother, father-in-law or mother-in-law, brother or sister a person in a bona fide domestic living arrangement and is financially interdependent. The policy holder must provide us with satisfactory evidence that there is an established and ongoing interdependency

9 16 Life insured: the person who is named in the Policy Schedule. Medical consultation: any activity undertaken for the detection, treatment or management of a medical condition or symptom, including but not limited to the application of prescribed drugs or therapy (whether conventional or alternative). Medical practitioner: a registered and qualified medical practitioner, approved by ING, in Australia or in another country. We may require that the medical practitioner be an appropriate specialist. A medical practitioner cannot be the life insured or their partner/spouse, business partner or an immediate family member. Mental disorder: any mental disorder classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM), Volume IV, published by the American Psychiatric Association (or such replacement or successor publication we approve, or if none then a comparable publication as selected by us) which is current at the start of the period of disability. Such mental disorders include, but are not limited to: stress (including post traumatic stress), anxiety, depression, psychoneurotic, psychotic, personality, emotional or behavioural disorders, or disorders related to substance abuse and dependency which includes alcohol, drug or chemical dependency. Mental disorders do not include dementia (except where the dementia is related to substance abuse or dependency), Alzheimer s disease or head injuries. Monthly earnings: if you are employed your monthly income earned from personal exertion by way of total remuneration package including fringe benefits, and any other type of remuneration, calculated on a monthly basis; or if you are self-employed or a working director the gross income generated by the business as a result of your personal exertion calculated on a monthly basis after allowing for the costs and expenses incurred in deriving that income. Other payments are: workers compensation or accident compensation compensation for motor vehicle injury payments made under statute, regulation or ordinance damages paid under common law whether modified or not by statute payments received from any other disability income, illness or injury policies, including group insurance policies sick leave payments received. This does not include an entitlement to sick leave when it is not received or taken by the life insured. If any of the other payments are paid in a lump sum, we convert to its equivalent in terms of monthly income. We calculate this based on actuarial advice, by looking at the circumstances in which the payments were made. Other payments do not include: any business expenses disability insurance indemnifying against business expenses payments made to dependent children total and permanent disability benefits, trauma benefits, terminal illness benefits or superannuation benefits (that are not disability income policies) payments of sums awarded by a court for pain and suffering. Partner/spouse: a spouse, de facto spouse or person living in a bona fide domestic living arrangement where one or each of them provides the other with financial support, domestic support and/or personal care. Partially disabled and partial disability means that due to illness or injury you are: unable to perform some of the usual duties of your regular occupation necessary to produce income but have returned to work in your regular occupation or are working in another occupation and have monthly earnings less than your preclaim earnings; or 17

10 able to perform all duties of your regular occupation necessary to produce income but due to illness or injury are not able to work at the same capacity that you were able to work at before the illness or injury (including when no work is available) and have monthly earnings less than your preclaim earnings, and following the advice of a medical practitioner. Policy: the contract between the policy holder and ING, comprising the Policy Document, Policy Schedule and any other notice we give the policy holder in writing. Policy anniversary date: the anniversary of the policy as specified on the Policy Schedule. Policy expiry date: the expiry date specified in the Policy Schedule (this is the policy anniversary date following your 65th birthday). Policy holder: the owner of the policy and the life insured, as referred to in the Policy Schedule. Policy Schedule: the document entitled Policy Schedule issued by ING confirming the details of your cover. Pre-claim earnings: the highest average of monthly earnings for a period of 12 consecutive months immediately prior to you becoming totally disabled. If you are on unpaid maternity, paternity or sabbatical leave and become disabled, the pre-claim earnings will be the highest average of the monthly earnings for a period of 12 consecutive months immediately before the leave commenced. At the time of claim, we require you to provide satisfactory financial evidence of your pre-claim earnings. Regular occupation: the occupation in which you were regularly engaged at the time you suffer an illness or injury. If your occupation is limited to a recognised speciality within the scope of your degree or licence, your speciality is your occupation. For periods of total disability which occur while you are unemployed or on maternity, paternity or sabbatical leave, your regular occupation means the last occupation you performed before unemployment, maternity leave, paternity leave or sabbatical leave. Totally disabled and total disability means that due to illness or injury you are unable to perform the usual duties of your regular occupation necessary to produce income as confirmed by a medical practitioner, and not engaged in your regular occupation nor any other gainful occupation, and following the advice of a medical practitioner. Unemployed/unemployment means that you are not engaged in any gainful occupation for salary, reward or profit. It does not include sabbatical, maternity or paternity leave

11 Direct Debit servicing agreement Our commitment to you We will: arrange for funds to be debited from your account as authorised in the Direct Debit Request give you at least 14 days notice in writing before changing the terms of the debiting arrangements, unless the changes are made at your request keep information relating to your Direct Debit Request private and confidential. If the date on which we usually debit your account falls on a weekend or public holiday, your account will be debited on the next working day. Your commitment to us It is your responsibility to: ensure your nominated account can accept Direct Debits and that all account holders on the nominated account agree to the debiting arrangements ensure that the account details that you have provided are correct by checking them against a recent account statement advise us if the nominated account is transferred or closed, or the account details have changed ensure there are sufficient funds available in the nominated account to meet each Direct Debit check with your financial institution before completing the Direct Debit Request, in the event that you have any queries about how to complete the Direct Debit Request. If there are insufficient funds in your account, you may be charged a fee by your financial institution. We will not charge a fee. Your rights You may defer, alter or cancel the debiting arrangements you hold with us at any time by providing notice to us. Such notice should be received at least 14 days before the next debit is due. When you consider that a debit has been initiated incorrectly, you should contact ING directly. We will then investigate your query. If we find that your account has been incorrectly debited, we will arrange for your financial institution to adjust your account (including interest and charges) accordingly. We will also notify you in writing of the amount by which your account has been adjusted. If we find your account has not been incorrectly debited, we will provide you with reasons and any evidence for this finding. If we can not resolve this matter, you can still refer it to your financial institution, which may lodge a claim on your behalf

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