2 Matching cover Want to join MTAA Super and change your super fund without losing your existing levels of insurance cover? MTAA Super offers members the ability to apply to match their cover to the insurance design available. This means you may be able to consolidate your super accounts and not have to pay additional fees for keeping your insurance open in another fund. You must satisfy a number of conditions and these are outlined in the Matching insurance cover form on Page 33. Do not cancel your existing insurance until you have received written notification that your cover has been accepted. To apply, fill in the MATCHING INSURANCE COVER FORM on Page 33. This form outlines all conditions and any restrictions regarding cover. 2
3 Death and Total and Permanent Disablement cover Default cover Cover when you join MTAA Super New MTAA Super members are automatically provided with default cover (subject to terms and conditions). The level of cover provided to you is based on your age when you become a member and may change in line with your age. Some new members will not be eligible for default cover (see page 4). The table below sets out the cost and the number of units of cover that are provided for your age when you join: COVER WHEN YOU JOIN MTAA SUPER Your age next birthday when you join MTAA Super Death Units General Scale TPD Units General Scale Cost of Cover $4.82 per week $6.30 per week $8.52 per week There are different types of work scales depending on the type of work you do. We classify them as General; Non-manual and Professional. The amount of cover you are eligible to receive will be different depending on the work scale applicable to you. It s important you let the Fund know if you are eligible for nonmanual or professional cover. See page 6 for more information. How to calculate your default level of cover? Go to the unitised scales table on page 7 Look at the row corresponding to your age next birthday. Then, look at the box in the column that corresponds to the general work scale that applies to you (See page 6 to find out what the different work scales mean). The amount in that box is the level of cover per unit. Multiply the amount of cover in that box by the number of units you are eligible for. Not enough cover to meet your needs? Why not look at the other options available to you. The level of cover provided under the unitised benefit scales varies with age. Your insurance needs will vary with time, too, so we recommend that you review your insurance regularly to ensure that the level of cover provided remains sufficient to meet your needs. Max is aged 29 next birthday. He works in an office environment and is eligible to apply for the non-manual work scale. As a member of MTAA Super, he will receive 6 units of death and 3 units of TPD cover: Death Cover: $67,750 x 6 =$406,500 TPD Cover: $67,750 x 3 = $203,250 His default level of cover is $406,500 of Death and $203,250 of TPD insurance at a cost of $8.52 per week. Cover changes as you stay with MTAA Super Insurance can t be one size fits all and your needs change from when you are just entering the workforce to when you take out a mortgage and have children. This is why we have introduced aged based default insurance scales. This means: If you turn 21 while you are a member and you haven t changed your Death & TPD cover, your default level of death cover will increase to 3 units If you turn 26 while you are a member and you haven t changed your Death & TPD cover, your default level of Death cover will increase to 6 units. 3
4 When does default cover start? Your default cover will begin for eligible members on the earlier of: the start of the contribution period from which your first on-time employer contribution is received (up to a maximum of 180 days prior to the cash received date); or the effective date of your account balance with MTAA Super being greater than zero. It is important to ensure that your employer pays ongoing contributions to your account and on time. Are you eligible for default cover? To be eligible for the default death and total and permanent disability cover when you join, you must: be between 15 and 69 years of age have not received a TPD/Terminal illness benefit through a superannuation fund or insurance policy at any time previously; and not be currently claiming or be eligible to claim a TPD/Terminal illness benefit. Please contact MTAA Super if you are not eligible for default insurance cover for any reason other than age. Limited cover If you are an eligible Employer Supported Member who joins MTAA Super as a new member and you meet the following conditions: your employer s first employer contribution to your account is received within 6 months of you commencing employment with your employer; and you are in Active Employment for 30 consecutive days from the date default cover commenced; the default cover you receive will not be subject to Limited Cover. If you are an Employer Supported Member not in Active Employment for 30 consecutive days you will receive Limited Cover until you return to Active Employment. Once you return to Active Employment the Limited Cover restriction will be removed. For all other members who do not meet the conditions above you will receive Limited Cover for the first 24 months. Should you be in Active Employment after the expiry of this 24 month period the Limited Cover restriction will be removed. Employer Supported Member Any member who receives an employer (Superannuation Guarantee) contribution from their employer. Definitions Limited Cover Limited Cover means a member is covered only for an injury that first occurred or an illness that first became apparent on or after the day cover last commenced or was increased. Active Employment Employer Supported Members A person in Active Employment is a person who is employed by an employer and who, in the Insurer s opinion, is capable of performing their identifiable duties without restriction as a result of any illness or injury for at least 35 hours a week (whether or not they are actually working those hours). 4 Active Employment All other members A person in Active Employment is a person who in the Insurer s opinion is capable of performing their identifiable work duties without restriction as a result of any illness or injury for at least 35 hours a week (whether or not they are actually working those hours).
5 Changing your cover You can apply to increase, decrease or cancel your cover at any time. Increase your cover: without providing evidence of health You may be eligible to increase your cover without the need to provide evidence of health to the Insurer in two ways: You first join MTAA Super When you first join MTAA Super you may be eligible to increase your cover without the need to provide health evidence. To apply, fill in the APPLICATION TO INCREASE COVER ON JOINING FORM (FOR EMPLOYER SUPPORTED MEMBERS ONLY) on page 37. This form outlines all conditions and any restrictions regarding cover. Your life changes If you already have at least default cover with MTAA Super you can apply to increase your Death and TPD cover by up to 3 units on the General Scale within 60 days of one of the following events occurring: you get married you have a child or adopt a child you take out a mortgage to purchase or build the home that you intend to immediately reside you get divorced. For any cover accepted above default cover, Limited Cover will apply for 24 months and at the end of that period if you are not in Active Employment for 30 consecutive days Limited Cover will continue to apply. This increase in cover cannot result in you holding more death or TPD cover than your applicable Automatic Acceptance Limit (AAL), which for members aged 54 or less is $600,000 for Death and $300,000 for TPD. To apply, fill in the LIFE EVENTS COVER FORM on our website. This form outlines all conditions and any restrictions regarding cover. Increase your cover: when you need to As a member of MTAA Super you can apply for additional death or TPD cover at any time. The maximum total amount of cover you can apply for: Death cover: $5,000,000 TPD cover: $3,000,000 To apply for additional cover, complete the ONLINE APPLICATION on the MTAA Super website or fill in the APPLICATION FOR ADDITIONAL INSURANCE on page 25. Reduce or cancel your cover You can reduce or cancel your insurance cover at any time by writing to MTAA Super. You can also elect to hold death-only or TPD only cover at any time. 5
6 Work scales: General, Non-Manual or Professional? MTAA Super offers members three types of insurance benefit scales on which to base their benefit levels. What is the general work scale? This scale is available to everyone but is generally used by members who work in a trade environment. Unless you apply (and are accepted) for the non-manual or professional scale, the general scale will apply to your insurance cover. Are you eligible for the non-manual work scale? If you work entirely in an office environment, and do not perform manual duties or work in a hazardous environment, or do not spend more than 20 per cent of your working time outside an office environment, then you are eligible to apply for the non-manual scale. Are you eligible for the professional work scale? If you are a white-collar professional and perform no manual work (e.g doctor, lawyer, accountant) you may be eligible for the professional scale. Usually these occupations require tertiary qualifications or are senior management positions within your organisation and also earn at least $120,000 per annum. If you are eligible to apply for the non-manual or professional scale, fill in the APPLICATION TO CHANGE YOUR WORKSCALE FORM on page 31. Please note that the Insurer must accept that you are eligible in order for the non-manual or professional scale to apply. Unitised or Fixed cover You can choose to have your death or TPD cover as either unitised or fixed cover, although there are conditions you might have to satisfy. You cannot have a combination of unitised and fixed cover for death and TPD. Unitised cover Unitised cover is based on an insurance benefit scale that determines the amount of money you will receive if you become eligible to claim a benefit for death or TPD. The levels of cover vary according to your age, but the cost for each unit remains the same regardless of your age. See page 14 to find out how to calculate unitised cover. The cost of unitised cover The charges for unitised death and TPD insurance cover are as follows: Death only: $0.74 per unit per week Total & Permanent Disability: $1.36 per unit per week Death & TPD cover: $2.10 per unit per week Unitised Scales: Death and Total & Permanent Disability The table on page 7 shows the amount of insurance cover provided by a (1) unit of cover based on your age and your work scale. Your work scale depends on the sort of work you do. See the section Work Scales above for more information. 6
7 UNITISED SCALES: DEATH AND TOTAL & PERMANENT DISABILITY (1 UNIT OF COVER) Age Next Birthday General Work scale Non-Manual Work scale Professional Work scale $27,500 $39,100 $59, $28,400 $40,300 $61, $30,500 $43,300 $65, $34,100 $48,400 $73, $39,400 $55,900 $84, $42,900 $60,950 $92, $45,900 $65,200 $98, $47,700 $67,750 $102, $48,900 $69,400 $105, $49,500 $70,300 $106, $49,600 $70,400 $106, $49,500 $70,300 $106, $49,500 $70,300 $106, $49,300 $70,000 $106, $49,000 $69,600 $105, $48,700 $69,200 $104, $48,000 $68,200 $103, $45,800 $65,000 $98, $43,400 $61,600 $93, $41,000 $58,200 $88, $38,800 $55,100 $83, $36,800 $52,300 $79, $34,600 $49,100 $74, $32,600 $46,300 $70, $30,400 $43,200 $65, $28,300 $40,200 $60, $26,100 $37,100 $56, $24,000 $34,100 $51, $21,800 $31,000 $46, $19,700 $28,000 $42, $17,500 $24,900 $37, $15,300 $21,700 $32, $13,700 $19,500 $29, $11,500 $16,300 $24, $9,460 $13,420 $20, $8,250 $11,770 $17, $7,260 $10,340 $15, $6,600 $9,400 $14, $5,850 $8,300 $12, $5,500 $7,810 $11, $5,170 $7,370 $11, $4,850 $6,900 $10, $4,400 $6,270 $9, $4,070 $5,830 $8,750 66* $3,750 $5,300 $8,060 67* $3,300 $4,730 $7,100 68* $2,970 $4,200 $6,390 69* $2,650 $3,800 $5,700 70* $2,200 $3,100 $4,730 Sam is a mechanic and aged 27 next birthday. He has 6 units of death cover. As a mechanic, he works in a manual environment and is eligible for the general work scale. Death cover is 6 units X $0.74 = $4.44 per week The total cost of cover is $4.44 per week 1 unit of death cover for his age next birthday (27) is $42,900 (on the general work scale) $42,900 x 6 units = $257,400 6 units X $0.74 = $4.44 per week covers Sam for $257,400 death cover * Activities of Daily Work (Definition B) will apply for 100% of the benefit of TPD from 65th birthday. See Features of total and permanent disability insurance on page 11 for more information. 7
8 To apply for additional cover, complete the ONLINE APPLICATION on the MTAA Super website insurance or fill in the APPLICATION FOR ADDITIONAL INSURANCE on page 25. Fixed cover If you don t want your insurance cover to reduce each year, you can retain a fixed level of cover. Fixed cover allows you to choose the level of cover you want in multiples of $1,000. Your chosen level of cover will not vary with your age and will remain the same each year until you reach age 70 for death-only or death plus TPD cover. Your premium will, however, vary each year according to your age. The cost of fixed cover To calculate the cost of fixed Death or TPD cover: The amount of cover / 1,000 X premium for your age (within your work scale) = weekly premium cost. Fixed Scales: Death and Total & Permanent Disability The table on page 9 shows the weekly cost for $1,000 of fixed Death and TPD cover based on your age and your work scale. Your work scale depends on the sort of work you do. See page 6 for more information. To apply, fill in the APPLICATION FOR ADDITIONAL INSURANCE on page 25. This form outlines all conditions and restrictions regarding cover. What happens after you apply for additional cover? You will receive confirmation it is under consideration. This confirmation will be in the form of either a letter or a phone call, and will generally be received within 6 business days. You may be contacted directly by phone or letter by the Fund s Insurer MetLife and/or their medical provider United Health Group (UHG) seeking further information or to arrange a medical examination or blood test. (Note that medical examinations required by the Insurer are usually paid for by the Insurer). If you wish to supply additional information to support your application, this will be at your own expense. Cover will not become operative until all the information the Insurer requires has been received, considered and accepted by the Insurer. During this post-application process you will be covered for up to 90 days of interim accident cover while the Insurer is making its determination. See below for more information. You will receive a letter informing you whether or not cover has been granted. If your cover has been granted, the date that the cover begins and any special terms that apply will be noted. You have a 14-day period from notification of acceptance of additional insurance cover in which to review the terms and conditions of coverage. You can cancel your additional insurance by writing to MTAA Super during this period. Any insurance charge paid for the additional cover during that time will be refunded to your MTAA Super account. 8
9 FIXED SCALES: DEATH AND TPD WEEKLY PREMIUM RATES PER $1,000 SUM INSURED General Member Non-Manual Member Professional Member Age Next Birthday Death TPD Death TPD Death TPD 16 $0.027 $0.049 $0.019 $0.035 $0.013 $ $0.027 $0.049 $0.019 $0.035 $0.013 $ $0.027 $0.049 $0.019 $0.035 $0.013 $ $0.027 $0.049 $0.019 $0.035 $0.013 $ $0.027 $0.049 $0.019 $0.035 $0.013 $ $0.027 $0.049 $0.019 $0.035 $0.013 $ $0.027 $0.049 $0.019 $0.035 $0.013 $ $0.026 $0.048 $0.018 $0.034 $0.012 $ $0.024 $0.045 $0.017 $0.031 $0.011 $ $0.022 $0.040 $0.015 $0.028 $0.010 $ $0.019 $0.035 $0.013 $0.024 $0.009 $ $0.017 $0.032 $0.012 $0.022 $0.008 $ $0.016 $0.030 $0.011 $0.021 $0.007 $ $0.016 $0.029 $0.011 $0.020 $0.007 $ $0.015 $0.028 $0.011 $0.020 $0.007 $ $0.015 $0.027 $0.011 $0.019 $0.007 $ $0.015 $0.027 $0.011 $0.019 $0.007 $ $0.015 $0.027 $0.011 $0.019 $0.007 $ $0.015 $0.027 $0.011 $0.019 $0.007 $ $0.015 $0.028 $0.011 $0.019 $0.007 $ $0.015 $0.028 $0.011 $0.020 $0.007 $ $0.015 $0.028 $0.011 $0.020 $0.007 $ $0.015 $0.028 $0.011 $0.020 $0.007 $ $0.016 $0.030 $0.011 $0.021 $0.008 $ $0.017 $0.031 $0.012 $0.022 $0.008 $ $0.018 $0.033 $0.013 $0.023 $0.008 $ $0.019 $0.035 $0.013 $0.025 $0.009 $ $0.020 $0.037 $0.014 $0.026 $0.009 $ $0.021 $0.039 $0.015 $0.028 $0.010 $ $0.023 $0.042 $0.016 $0.029 $0.011 $ $0.024 $0.045 $0.017 $0.031 $0.011 $ $0.026 $0.048 $0.018 $0.034 $0.012 $ $0.028 $0.052 $0.020 $0.037 $0.013 $ $0.031 $0.057 $0.022 $0.040 $0.014 $ $0.034 $0.062 $0.024 $0.044 $0.016 $ $0.038 $0.069 $0.026 $0.049 $0.017 $ $0.042 $0.078 $0.030 $0.055 $0.020 $ $0.048 $0.089 $0.034 $0.063 $0.022 $ $0.054 $0.099 $0.038 $0.070 $0.025 $ $0.064 $0.118 $0.045 $0.083 $0.030 $ $0.078 $0.144 $0.055 $0.101 $0.036 $ $0.090 $0.165 $0.063 $0.116 $0.042 $ $0.102 $0.187 $0.072 $0.132 $0.047 $ $0.112 $0.206 $0.079 $0.145 $0.052 $ $0.126 $0.232 $0.089 $0.164 $0.059 $ $0.135 $0.247 $0.095 $0.174 $0.063 $ $0.143 $0.263 $0.100 $0.185 $0.067 $ $0.153 $0.280 $0.107 $0.197 $0.071 $ $0.168 $0.309 $0.118 $0.217 $0.078 $ $0.182 $0.334 $0.127 $0.233 $0.085 $ * $0.197 $0.363 $0.140 $0.257 $0.092 $ * $0.224 $0.412 $0.156 $0.288 $0.104 $ * $0.249 $0.458 $0.176 $0.324 $0.116 $ * $0.279 $0.513 $0.195 $0.358 $0.130 $ * $0.336 $0.618 $0.239 $0.439 $0.156 $0.288 Tony is aged 32 next birthday and would like to apply for $500,000 worth of death cover. Tony is an accountant and meets the eligibility criteria for the professional work scale. Tony has calculated the cost of his cover as: $500,000 / $1,000 x $.007 = $3.50 Tony will pay $3.50 per week for $500,000 of death cover. It s important to note, that if Tony fixes his level of cover the insurance premium deducted from his account will increase each year. * Activities of Daily Work (Definition B) will apply for 100% of the benefit definition of TPD from 65th birthday. See Features of total and permanent disability insurance on page 11 for more information. 9
10 Interim death and TPD accident cover When you apply for additional insurance, you will be covered for interim accident cover from the date MTAA Super receives your application. Interim accident cover provides you with accident cover for any increased cover amount for which you have applied above your current cover with MTAA Super. Interim Accident cover will cease on one of the following events occurring: your application is withdrawn, accepted or rejected, 90 days has passed since MTAA Super received your application. Where interim accident cover applies, the Insurer will provide cover for the increased insured amount but only if the condition which gives rise to a benefit is the sole and direct result of accidental bodily injury occurring whilst the interim accident cover is in force and is not affected by a pre-existing condition. Please note: Interim accident cover is subject to the lesser of the amount applied for and $2m for Death and TPD. Definitions What is Death cover? Death cover provides for an insurance benefit that is payable to your dependants or your legal personal representative on your death, so long as you are a member of MTAA Super and receiving insurance cover at the time of your death. Death insurance is not available to members aged 70 years or more. Your death cover can also be paid to you should you suffer a terminal illness. What is total and permanent disability (TPD) cover? TPD cover provides for an insurance benefit if you become totally and permanently disabled. Before paying any TPD insurance benefit, the Trustee must be satisfied that the amount is able to be released from the Fund under superannuation legislation. TPD insurance is not available to members who are aged 70 years or more. Total and Permanent Disablement (TPD) definition Total and permanent disability has two parts: Definition A and Definition B and is dependent on your age and your employment status at the time of becoming disabled. Under age 65 and Employed If you are under age 65 immediately prior to your Date of Disablement 1, and you have been Employed at any time in the 6 months immediately prior to your Date of Disablement, you are required to meet Definition A and B in order to receive 100% of your insured benefit. If you meet Definition A but not Definition B you will only receive 80% of your insured benefit. Note: You must satisfy Definition A and Definition B at the same time. If your claim has been assessed and approved under Definition A only, your claim will not later be re-assessed under Definition B. If you receive any portion of your insured benefit, all cover will then cease. For example, if you have death and TPD cover and you have been approved under Definition A and paid 80% of your TPD sum insured, the remaining 20% of your TPD sum insured and your death cover will cease. Age 65 and over or not Employed in the last 6 months If you are aged 65 and over immediately prior to your Date of Disablement, or you have NOT been Employed at any time in the 6 months immediately prior to your Date of Disablement, you are required to meet Definition B in order to receive 100% of your insured benefit Date of Disablement means the later of the date on which a medical practitioner examines and certifies in writing that the Covered Person is disabled and the date the Covered Person ceases all work (whether or not for reward).
11 Age under 65 and Employed and suffer a Later Illness or Injury If you are under age 65 immediately prior to your Date of Disablement, and you have been Employed at any time in the 6 months immediately prior to your Date of Disablement, and: Definitions you are unable to work (whether or not for reward) due to an Injury 2 or Illness 3 ( Previous Injury or Illness ); and whilst off work (whether or not for reward), you suffer a different Injury or Illness ( Later Illness or Injury ) which does not have the same cause as the Previous Illness or Injury, you are required to meet Definition B in order to receive 100% of your insured benefit. Total and permanent disability Definition A - Education Training and Experience with Retraining (ETE-R) definition The Insured Member has, solely due to Illness or Injury, been unable to work (whether or not for reward) for 6 consecutive months commencing from the Date of Disablement and due to that same Illness or Injury also satisfies the following: a) has continued to remain absent from all work (whether or not for reward) since the Date of Disablement; b) is under Regular and Ongoing Care; and c) the Insurer determines that: (i) as at the Date of Disablement; and (ii) for the following 6 consecutive months; and (iii) continuously since then; the Insured Member is unable to ever engage in or work, whether or not for reward, in any occupation or work for which he or she is or may become reasonably suited by education, training or experience and in making this determination, the Insurer will consider any future retraining or rehabilitation that the Insured Member could reasonably undertake or has undertaken. Definition B - Activities of Daily Working (ADW) definition Total and Permanent Disablement means the Insured Member satisfies all of the following: a) the Insured Member has been unable to perform 3 of the everyday working activities listed below for 6 consecutive months solely as a result of Illness or Injury; and b) the Insurer determines that the Insured Member has, since the end of the 6 consecutive months, been and will continue to be permanently and irreversibly unable to perform those everyday working activities solely as a result of Illness or Injury; and c) the Insured Member is under the Regular and Ongoing Care of a medical practitioner who specialises in the Illness or Injury; and d) the Insurer determines that, as a result of the same Injury or Illness, the Insured Member is unable to ever engage or work in, whether or not for reward, any occupation or work for which he or she is or may become reasonably suited by education, training or experience and in making this determination, the Insurer will consider any future retraining or rehabilitation that the Insured Member could reasonably undertake or has undertaken. The Insured Member will only be considered unable to perform an everyday working activity if they are unable to perform the task: a) on their own even with the use of special equipment available; and b) without the assistance of another person. Disabilities for which the relevant specialists cannot give a clear prognosis are not covered. 2. Injury means bodily injury which is caused solely and directly by external, violent and accidental means and is independent of any other cause. 3. Illness shall include sickness, disease or disorder. 11
12 Everyday working activities means: Definitions 1. Walking and Bending: The ability to walk more than 200m on a level surface without stopping due to breathlessness, angina or severe pain elsewhere in the body; and The ability to bend, kneel or squat to pick something up from the floor and straighten up again; and the ability to get into and out of a standard sedan car. 2. Vision (reading): The ability to read, with visual aids, to the extent that an ophthalmologist can certify that: (a) visual acuity is equal to, or better than, 6/48 in both eyes; or (b) constriction is within or greater than 20 degrees of fixation in the eye with the better vision. 3. Lifting: The ability to pick up an object weighing 2kg at table height and hold for 60 seconds before replacing the object on the table. 4. Manual dexterity: The ability, with reasonable precision and success, to: (a) use at least one hand, its thumb and fingers, to manipulate small objects; or (b) use a keyboard if the person was required to use a keyboard in his/her previous job. 5. Communication: They cannot: (a) clearly hear (with a hearing aid or other aid if normally used) conversational speech in a quiet room in their first language, or (b) speak with sufficient clarity to be clearly understood in their first language Regular and Ongoing Care means the person: a) is under the regular and ongoing care of a medical practitioner who has given a clear prognosis that the Injury or Illness will continue throughout the life of the Insured Member (including after the expiry of cover and the commencement of retirement) without any prospect of an improvement which would lead to a return to work (whether or not for reward) in any capacity; and b) is complying with reasonable medical advice and treatment; and c) has, in the Insurer s opinion reached the maximum level of medical improvement possible for that Insured Member based on their Illness or Injury. Date of Disablement means the later of: The date when a medical practitioner examines the insured member and certifies in writing that the member is disabled; and the date the insured member ceases all work (whether or not for reward), due to Illness or Injury. What is Terminal Illness? A member who is insured for death or Total and Permanent Disablement suffers from a sickness which: (a) Two medical practitioners, specialising in the insured member s sickness, certifies in writing, will despite reasonable medical treatment lead to the insured member s death within 12 months of the date of the certification and (b) the Insurer is satisfied, on medical or other evidence, will despite reasonable medical treatment lead to the insured member s death within 12 months of the date of the certification referred to in paragraph (a). The sickness from which the insured member suffers must occur, and the date of the certification referred to in paragraph (a) must be made, while the insured member is covered under the policy and must be current at the time the claim is lodged. The Terminal Illness Benefit will be based on the member s higher insured cover for Death or Total and Permanent Disablement at the time they meet the Terminal illness definition defined above. Eligibility for Terminal Illness or Total and Permanent Disability (TPD) In order to be considered for a Terminal Illness or TPD benefit, a member must complete and return the relevant claim forms. 12
13 Income Protection Insurance Why consider income protection? It is highly probable that your most important financial asset is your ability to earn an income. But, although most people insure their homes, cars and other valuables, few consider insuring their income. Income protection insurance will pay a benefit for a specified benefit period, usually monthly in arrears, if you are unable to work after the qualifying period because of illness or injury. This can provide security in a person s time of need. Who can apply? MTAA Super members who are actively engaged in full-time, part-time, casual or contracted employment, either as an employee or as a self employed person and are performing normal occupational duties are eligible to apply for income protection insurance. A member who is not at work on their commencement date with their employer will still be considered to be performing normal occupational duties if the member is employed and the absence is for reasons other than illness or injury. You are not eligible if you are: working less than 15 hours per week aged 65 years or more not an Australian citizen or permanent resident engaged in an occupation that the Insurer does not cover. If this is the case, the Insurer will notify you. Members of MTAA Super can apply for income protection cover with the following features: up to 85 per cent of your pre-disability income (with up to 75 per cent of your predisability income paid directly to you (less PAYG) and any balance (up to 10 per cent) payable as superannuation contributions to your MTAA Super account), subject to a maximum benefit of $25,000 per month. a benefit period of two years, five years or until age 65. cover in units of $250 per month, with a minimum of three units required waiting periods of 30 days, 60 days and 90 days The cost of cover is dependent on your age, insured benefit amount, occupational category (general, non-manual or professional), chosen waiting period and chosen benefit period. See page 16 for more information. The age 65 benefit period also provides indexation of your monthly benefit on the anniversary of your first benefit payment. Your benefit will be increased by the lesser of CPI and 5%. To apply for income protection cover, complete the ONLINE APPLICATION form on the MTAA Super website or fill in the APPLICATION FOR ADDITIONAL INSURANCE on page 25. It is very important that you read this document carefully to understand the costs involved, any exclusions or limitations, and when an income protection claim may be payable under the policy. 13
14 Samantha is aged 30 next birthday, works in an office and meets the eligibility criteria for the Non- manual scale. Her income before tax is $54,000 and she would like to have the maximum cover for her income plus her superannuation contributions if she is temporarily unable to work due to an illness or injury. Samantha has at least 2 months sick leave so she has chosen to have a 60 day waiting period before she would be able to receive the Income Protection benefit and if she is unable to work, for the benefit to continue to be paid for up to 5 years. Using the scales on page 15, Samantha s calculation of the premium is: $54,000 divided by 12 = $4,500 per month. 85% of that is $3, Samantha would need $3,825 divided by $250 per month = 15.3 units of cover. Samantha is able to round up to take 16 units of cover 16 units at 8.92 cents per unit per week will cost Samantha $1.43 per week. Samantha will receive 75% of the benefit ($3,375 per month before tax) and 10% ($450 per month) would be paid into her superannuation account. How much cover can you apply for? The maximum amount you can apply for is a benefit equal to the lesser of: 75 per cent of your pre-disablement monthly income, and 10 per cent of your pre-disablement monthly income paid as a contribution to your MTAA Super account $25,000 a month. The minimum level of cover available is three units. Calculating the cost of cover To calculate the level of cover you want, take the following steps. Step 1 Calculate the figure that corresponds to 85% of your monthly average gross income. If this amount exceeds $25,000, use the figure $25,000 instead. See the definition of income on page 16 to find out what is classified as income. Step 2 Divide the figure from step 1 by $250. This gives you the number of units you need in order to receive the maximum benefit you are eligible for. Write the number of units down. Round up to the nearest unit. Step 3 Choose the benefit scale that applies to you: general non-manual professional If you are unsure, see page 6. Step 4 Choose the benefit period you would like to be covered for: 2 years 5 years Aged 65 Step 5 Select your age band from the table that applies to you. Step 6 Select your preferred waiting period: 30 days 60 days 90 days. Step 7 Write down the cost per unit of cover per week for your age band that falls within your preferred waiting period. Step 8 Multiply the figure from step 7 by the number of units you determined in step 2. The answer is the standard weekly premium for the income protection cover you want. You can adjust the cost of your premium by choosing a different waiting period or benefit period or by changing the number of units you select. When you reach a birthday that moves you into the next age band your insurance cost will change. 14
15 Income Protection unitised scales WEEKLY COST PER $250 MONTHLY BENEFIT 2 YEAR BENEFIT Age Next Birthday General Work scale Non Manual Work scale Professional Work scale 30 days 60 days 90 days 30 days 60 days 90 days 30 days 60 days 90 days 16 to 20 $ $ $ $ $ $ $ $ $ to 25 $ $ $ $ $ $ $ $ $ to 30 $ $ $ $ $ $ $ $ $ to 35 $ $ $ $ $ $ $ $ $ to 40 $ $ $ $ $ $ $ $ $ to 45 $ $ $ $ $ $ $ $ $ to 50 $ $ $ $ $ $ $ $ $ to 55 $ $ $ $ $ $ $ $ $ to 60 $ $ $ $ $ $ $ $ $ to 65 $ $ $ $ $ $ $ $ $ YEAR BENEFIT Age Next Birthday General Work scale Non Manual Work scale Professional Work scale 30 days 60 days 90 days 30 days 60 days 90 days 30 days 60 days 90 days 16 to 20 $ $ $ $ $ $ $ $ $ to 25 $ $ $ $ $ $ $ $ $ to 30 $ $ $ $ $ $ $ $ $ to 35 $ $ $ $ $ $ $ $ $ to 40 $ $ $ $ $ $ $ $ $ to 45 $ $ $ $ $ $ $ $ $ to 50 $ $ $ $ $ $ $ $ $ to 55 $ $ $ $ $ $ $ $ $ to 60 $ $ $ $ $ $ $ $ $ to 65 $ $ $ $ $ $ $ $ $ TO AGE 65 BENEFIT PERIOD (ANNUAL INDEXATION AT THE LESSER OF CPI & 5%) Age Next Birthday General Work scale Non Manual Work scale Professional Work scale 30 days 60 days 90 days 30 days 60 days 90 days 30 days 60 days 90 days 16 to 20 $ $ $ $ $ $ $ $ $ to 25 $ $ $ $ $ $ $ $ $ to 30 $ $ $ $ $ $ $ $ $ to 35 $ $ $ $ $ $ $ $ $ to 40 $ $ $ $ $ $ $ $ $ to 45 $ $ $ $ $ $ $ $ $ to 50 $ $ $ $ $ $ $ $ $ to 55 $ $ $ $ $ $ $ $ $ to 60 $ $ $ $ $ $ $ $ $ to 65 $ $ $ $ $ $ $ $ $
16 Your circumstances will probably change with time, so it is wise to regularly review the number of income protection insurance units you have, to make sure your level of cover is sufficient to provide the protection you need. What waiting period is best for me? In choosing your waiting period you might wish to consider: how long you could afford to be without an income for example, if you qualify for sick leave or have other forms of savings or income on which you could rely; the amount you are willing to pay and to have deducted from your MTAA Super account in income protection insurance premiums. Generally, the longer the waiting period, the lower the premium. No benefit is payable during the waiting period. Once insurance is in place, if you want to reduce your waiting period say, from 90 days to 30 days you must complete a new application form, and be assessed by the Insurer. You can choose a longer waiting period simply by writing to the Fund. The waiting period you nominate begins when a doctor who has examined you certifies that you are Disabled, as defined on page 18. You need to be Disabled or Partially Disabled on each day during the waiting period. The calculation of the waiting period is also subject to the following rules: you must be Disabled for at least 7 out of the first 12 working days of the waiting period to qualify for an income protection benefit; if you return to work at full capacity during the waiting period, the waiting period starts again unless you return to work only once and it is for a period of no more than 5 consecutive days. If you return to work only once for a period of 5 consecutive days or less, the number of days worked will be added to the waiting period. What benefit period is best for me? In choosing your benefit period you might want to consider the following: whether it will take a short period (two years) or a medium period (five years) for you and your family to adjust your budget and finances in order to survive without your income; alternatively you may not want your family to adjust and would like a income for the long term (aged 65) the amount you are willing to pay and have deducted from your MTAA Super account in income protection insurance premiums. The shorter the benefit period, the lower the premium. Definitions Income and monthly income definitions Income means the total monthly value of income received by the insured member from his or her usual occupation, averaged over the most recent 12-month period or since the insured member started their occupation, if the period is less than 12-months. Salary package items taken instead of cash are included as salary where the insured member, would be required to pay for that item in the event of total or partial disability. Regular over-time and shift allowances will be averaged over the previous 12-month period or since the insured member started their occupation, if the period is less than 12 months. 16
17 Definitions Performance related commission, bonuses and other monetary benefits will be averaged over the lesser of previous 3 years, or since the insured member started his or her current occupation. Where the insured member directly or indirectly owns all or part of the business from which he or she earns his or her usual income, income will be calculated as the total amount earned by the business over the financial year as a direct result of the insured member s personal exertion or activities through his or her usual occupation, less his or her share of business expenses, but before the deduction of income tax, for that business (or the relevant proportion for part of a financial year). The income calculated in accordance with these principles is divided by 12 to get the monthly income. For casual and contract workers, salary will be averaged over the previous 6 month period, rather than 12 months. When does cover for income protection commence? Your cover will commence when the Insurer has accepted your application for cover. Interim Disability by Accident cover If you apply for income protection cover but you are not eligible for cover automatically, you may be eligible for interim disability by accident cover while the Insurer considers your application. The Insurer will pay you a disability by accident benefit if you suffer an injury which results in your being Disabled or Partially Disabled during this period. The amount payable will be equivalent to the Disability benefit, Partial Disability benefit or superannuation contribution benefit as applicable, except that the amount of the benefit will be the lesser of: 85% of your monthly income; or the amount of cover you requested in the fully completed application for cover; or $15,000 per month. No Disability by Accident benefit will be payable if any of the following occurred before you suffer the injury: the Insurer has accepted (on any terms) or rejected your application for income protection cover; or you withdraw your request for income protection cover; or 90 days have passed from the date the Insurer receives your application for income protection; or an exclusion to cover applies (see the section Are there any exclusions? on page 20). Payment of the interim disability by accident benefit is subject to all the relevant terms and conditions of MTAA Super s Policy with MetLife. 17
18 Definitions What does Disabled and Partially Disabled mean for the purposes of income protection cover? An insured person is Disabled if, solely as a result of injury or illness, occurring while income protection cover is in force: The insured person is unable to perform at least one duty of the insured person s occupation which generates at least 20% of the insured person s monthly income, as confirmed by a medical practitioner. The insured person is not engaged in any occupation, whether or not for reward. The insured person is receiving regular treatment from and following the advice of a medical practitioner. An insured person is Partially Disabled if they: have been Disabled for at least 7 days out of the first 12 working days of the waiting period; and are unable to work in their occupation at full capacity as a result of the Illness or Injury resulting in Disability; and are working, or are capable of returning to work, in their occupation or any other occupation but only in a limited capacity; and are earning an income less than their monthly income (as calculated in accordance with the policy terms), or are capable of earning an income; and are under the regular care and following the advice of a medical practitioner. How will my benefit be calculated? Your income protection benefit will be the lesser of: the maximum benefit of $25,000 a month; or the amount accepted and agreed to in writing by the Insurer; or 85 per cent of your pre-disability income (with 75 per cent of that income being payable directly to you (less PAYG) and the balance being payable as superannuation contributions to your MTAA Super account). The benefit will be subject to any other terms and conditions specified in this document and the terms of the insurance policy. When will I receive my monthly disability benefit? If you are Disabled for longer than your waiting period and meet the eligibility requirements, you will receive your monthly disability benefit. If you are Partially Disabled for longer than your waiting period and meet the eligibility requirements, you will receive your monthly partial disability benefit. Also, if you are Disabled or Partially Disabled for longer than your waiting period and meet the eligibility requirements, your superannuation contribution benefit will be paid (if applicable). See above for the definitions of Disabled and Partially Disabled. 18 You are eligible to make a claim if: you satisfy all the Insurer s claim requirements; the waiting period you chose has expired; and cover has not ceased in accordance with the terms of the policy. The first monthly benefit payment is paid one month after the end of the waiting period; further payments are subsequently paid monthly in arrears. The Insurer will waive income protection premiums while an income protection benefit is being received by you. Please note that while an income protection benefit is being paid, the Insurer may require medical reports and examinations to verify your continued disability.
19 What if I am on leave without pay? If an insured member becomes sick or injured while on leave without pay, no income protection benefit will be paid until the later of: the time when the member s leave without pay is to cease (in accordance with their employer s written notification); or the expiry of the waiting period. If the employer does not provide a written notification on cessation of the leave without pay period, the Insurer will assume that the leave without pay period is 24 months. What happens if I return to work after I am disabled? If you return to work after you become disabled you might be eligible to receive a partial disability benefit. To receive a partial disability benefit, you must be Partially Disabled after the waiting period has ended. See the above definition of Partially Disabled above. If you are eligible for a partial benefit the benefit will be calculated in proportion to the income you are losing as a result of your limited capacity to engage in your normal occupation and the monthly benefit you would receive if you were totally disabled. The proportion will vary according to the number of units chosen and your income at the time of your claim. A partial disability benefit will cease to be payable when you are capable of earning your pre-disability salary, you return to normal duties or if one of the other events listed below in the section When does the benefit period end? occurs. When does the benefit period end? The benefit period will end on the earlier of: the end of the benefit period you selected when you reach age 65 when you are no longer totally or partially disabled. when you die What happens if the disability returns? If, after being totally disabled or partially disabled, you return to work and within six months the same disablement recurs, this will be regarded as a continuation of the same claim and no waiting period will apply. The benefit period will, however, be limited to the unused portion of the benefit period that applied in respect of the earlier claim. If, after being totally disabled or partially disabled, you return to work and subsequently experience a different disablement, you will need to submit a new claim. The maximum length of time a benefit for a disability or partial disability from any one or related illness or injury will be limited to the benefit period selected. 19