Insurance and your PSSap super

Transcription

1 Insurance and your PSSap super Issued 22 June 2012 The information in this document forms part of the Product Disclosure Statement for the Public Sector Superannuation accumulation plan (PSSap), fourth edition, issued on 22 June Contents Income protection (IP) 2 Death and Total and permanent disability (TPD) 4 Underwriting and your insurance 10 How to make an insurance claim 11 Beneficiary nomination 14 Key terms 15 Contact us 16 Your Government Super at Work Any financial product advice in this document is general advice only and has been prepared without taking account of your personal objectives, financial situation or needs. Before acting on any such general advice, you should consider the appropriateness of the advice, having regard to your own objectives, financial situation or needs. You may wish to consult a licensed financial advisor. Commonwealth Superannuation Corporation (CSC) ABN: AFSL: RSEL: L Trustee of the Public Sector Superannuation accumulation plan (PSSap) ABN: RSE: R of 15

2 Things to remember when reading this document This information describes the main features of the insurance offerings to PSSap members and is intended as a general guide only. The information in this booklet is based on the terms and conditions of the insurance policies which Commonwealth Superannuation Corporation (CSC) (ABN , AFSL and RSE Licence No. L ) currently holds on behalf of members of the fund as at this Product Disclosure Statement (PDS) publication date. The policies which CSC currently holds are provided by AIA Australia Limited ( AIA Australia or the insurer ) (ABN , AFSL ). It is possible that the terms and conditions of the insurance policies held by CSC (including the premiums charged to members) may change from time to time due to AIA Australia changing these terms and conditions or if AIA Australia ceases to be the insurer. If this happens, the information in this section may become outdated. We will let you know about any significant changes to the terms and conditions of the insurance cover. The full terms and conditions relating to insurance are set out in the insurance policies and in the event of any dispute about insurance, the policies will take priority over the information in this section. Insurance can help you protect your current lifestyle and provide for your family in the event of your sickness, disablement, injury or death and is an important component of your superannuation benefit. The PSSap offers competitive income protection and death and total and permanent disability cover, designed to give adequate cover for the needs of the average person at different stages in their life. Income protection (IP) Income protection provides an income (based on a percentage of your base annual salary) when you are temporarily unable to work due to disability caused by sickness or injury. The PSSap offers a default monthly income stream of 75% of your base annual salary for a period of up to two (or to age 65 if earlier) with a 90 day waiting period, in the event that you are unable to work due to disability caused by sickness or injury. You receive default IP cover, from the date you start your new job, where you: > > are under 65 of age, > > join the PSSap within 120 after starting your new job, and > > are a permanent or non-ongoing employee with a contract of more than three months and work 15 hours or more per week. Flexible cover You can change your level of cover at any time to suit your needs. You have the option of: > > reducing the waiting period to 30 or 60 (subject to underwriting and acceptance by AIA Australia) or to increase the waiting period to 120 or 180, > > reducing the amount of the monthly benefit payable to you from 75% to 50% of your base annual salary, and > > opting out of income protection cover altogether. To do this, complete the PSSap insurance variation form and the Personal statement/member s declaration form where underwriting is required. The forms are available on our website. Underwriting is required where you apply to reduce your waiting period, after opting out of cover and wish to obtain cover, after reducing the default percentage of income (75%) and then seek to increase it, and after increasing the waiting period and then apply to reduce it. Your Government Super at Work 2 of 16

3 Income protection premiums The cost of your cover is based on your age next birthday and level of cover, as outlined below. Annual rates (payable in monthly instalments) per $100 monthly benefit Waiting period Waiting period Waiting period Benefit period Age next birthday Benefit period Age next birthday Benefit period Age next birthday Example: Jessica Jessica is aged 35. Her default income protection is 75% of her base salary with a 90 day waiting period. Her base annual salary is $60, At age next birthday each $100 a month costs $1.85. Jessica s annual sum insured is % x $60,000 = $45, Her monthly sum insured is $45,000/ 12 months = $3,750 per month The annual premium Jessica pays for her income protection is based on her age next birthday, $3,750 per month/100 x $1.85 = $ Monthly premium is $69.38/12 months = $5.78 per month We calculate the premiums applicable to your level cover at the end of each calendar month. Premiums are deducted from your PSSap super account by selling some of your units on the first business day of each calendar month or as soon as practicable thereafter. The premium may vary slightly from month to month, depending on the date you joined and how many in each month. If you have your super invested in different investment options, we pro rata the payment across these options. For example, if your investment options are 50% in Trustee Choice and 50% in Cash, then we deduct 50% of your premiums from the amount you have in Trustee Choice and 50% from the amount you have in cash. Joining the PSSap after 120 of starting your new job If you join the PSSap more than 120 after starting your new job, you will receive limited cover for the first 12 months from the date you join the PSSap (provided you are under 65 of age, work 15 hours or more per week, and are either a permanent employee or a non-ongoing employee with a contract of more than three months). You also need to be at work on the date your cover starts. If not, you receive new events cover until you are continuously at work for 3 consecutive months, then full cover will apply. The 3 consecutive months can start in the last three months of the 12 month limited cover period. Refer to Key terms on page 15 for an explanation of at work, new events cover and limited cover. Maximum cover Cover up to a monthly payment of $12,000 is automatically provided by the insurer. Cover over $12,000 is subject to an underwriting assessment by the insurer and can be provided up to a monthly benefit of $20,000. The maximum benefit period payable for nonongoing (contract) employees will be the lesser of two or the term of your contract. Your Government Super at Work 3 of 16

4 Waiting periods A default waiting period of 90 applies before income protection benefits are payable, unless you elect to change it to 30, 60, 90, 120 or 180. The waiting period commences from the date you are first examined and certified by a doctor as totally disabled (in relation to the condition giving rise to the claim) provided you have ceased work for a continuous period, due to that condition. A partial disability benefit may also be payable after the waiting period if a member has been totally disabled for at least 10 out of 14 consecutive within the waiting period and meets the definition of partial disability. Rehabilitation expenses (programs designed to rehabilitate the disability or return the member to work), subject to approval by AIA Australia, will be reimbursed up to 6 monthly benefit payments. IP cover and other income sources IP benefits will continue to be paid if you receive a benefit for TPD. IP benefits will be reduced by any amount paid or required to be paid for workers compensation, continued income received from an employer, transport accident compensation, IP benefits from any other insurance arrangement or similar legislation in relation to your sickness or injury and other ongoing income or sick leave entitlements from any source. Total and partial disability definitions Total disability Total disability means that due to sickness or injury, the insured member: > > is unable to perform one or more important duties of their occupation (refer to Key terms on page 15 for an explanation of important duties) > > remains under the regular care, attendance and following the advice of a registered doctor in relation to that sickness or injury, and > > is not engaged in any occupation (whether or not for reward). Partial disability Partial disability means that due to sickness or injury, which directly caused the total disability, the insured member: > > is unable to perform one or more important duties of their occupation (refer to Key terms on page 15 for an explanation of important duties) > > is capable of working (whether or not for reward) > > is earning a monthly income from their occupation or another occupation at a monthly rate of less than their pre-disability income > > remains under the regular care, attendance, and is following the advice of a registered doctor in relation to the injury or sickness, and > > has been totally disabled for at least 10 out of 14 consecutive within the waiting period. Ineligibility to receive cover IP is not available to persons who: > > are over 65 of age > > do not work 15 hours or more per week > > are neither permanent employees nor nonongoing employees with a contract of more than three months. Exclusions to IP cover No IP benefit will be paid for: > > any intentional self-inflicted injury or attempted suicide or self-destruction while sane or insane > > uncomplicated pregnancy, childbirth or miscarriage > > any injury or illness resulting from active service in the armed forces of any country or international organisation, or > > war or act of war (whether declared or not). Cessation of Income Protection cover Your IP cover ceases on the earliest of the: > > date you turn 65 > > date you cancel the cover > > date you stop being in active and continuous employment for at least 15 hours per week with a Designated Employer > > date of your death > > date you permanently retire from the workforce > > day after you stop being a member of the PSSap > > 60 after the PSSap receives your last contribution from your employer, or > > 60 after a premium due is not paid (for example, due to insufficient funds). Cover for income protection will also stop on termination of the policies by us. We would give you 30 notice before taking such action. Any replacement policy may not offer the same cover or the same terms as those described in this section. Other insurance conditions and considerations There are other circumstances which may cease or impact on your insurance cover. Refer to Other insurance conditions and considerations on page 9 for more information. Death and Total and permanent disability (TPD) Death and TPD cover protects you or your family in the event of your death or if you become totally and permanently disabled. Information on how to nominate your family members to be your beneficiaries in the event of your death is available on page 14. Your Government Super at Work 4 of 16

5 Level of death and TPD cover The default level of cover you receive is called Basic cover. The level of Basic death and TPD cover (the amount of cover you automatically get if you are under 65) varies and changes automatically depending on your age (shown below). Death and TPD insurance cover scale Age next birthday Minimum basic cover Basic cover Maximum basic cover Age next birthday Minimum basic cover Basic cover Maximum basic cover $50,000 $150,000 $225, $14,000 $180,000 $270, $50,000 $200,000 $300, $7,000 $168,500 $252, $50,000 $200,000 $300, $7,000 $157,500 $236, $50,000 $250,000 $375, $7,000 $145,000 $217, $50,000 $250,000 $375, $7,000 $133,500 $200, $50,000 $250,000 $375, $7,000 $122,500 $183, $50,000 $250,000 $375, $7,000 $107,500 $161, $50,000 $250,000 $375, $7,000 $97,500 $146, $35,000 $250,000 $375, $7,000 $87,500 $131, $35,000 $250,000 $375, $7,000 $75,500 $113, $35,000 $250,000 $375, $7,000 $65,500 $98, $35,000 $250,000 $375, $7,000 $55,500 $83, $35,000 $250,000 $375, $7,000 $45,500 $68, $20,000 $250,000 $375, $7,000 $35,500 $53, $20,000 $250,000 $375, $7,000 $25,000 $37, $20,000 $250,000 $375, $7,000 $15,000 $22, $20,000 $250,000 $375, $7,000 $12,500 $18, $20,000 $250,000 $375, $7,000 $12,500 $18, $14,000 $235,000 $352, $7,000 $12,500 $18, $14,000 $220,000 $330, $7,000 $12,500 $18, $14,000 $205,000 $307, $7,000 $12,500 $18, $14,000 $192,500 $288, $7,000 $12,500 $18,750 Maximum cover A maximum of $50 million death cover can be provided, subject to underwriting by AIA Australia. A maximum of $3 million can be insured for TPD, also subject to underwriting by AIA Australia. To apply to receive this cover you will need to complete the Personal statement/member s declaration form available on our website. This cover is subject to underwriting and acceptance by the insurer. A terminal illness benefit (part of death and TPD cover) can pay up to 100% of your death benefit, up to a maximum of $500,000, if you are diagnosed and considered by AIA Australia to be terminally ill and deemed incapacitated according to the Superannuation Industry (Supervision) Act Changing your death and TPD cover You can apply to change your death and TPD cover at any time, however cannot opt out of cover entirely. You can increase your level of cover without underwriting up to the applicable Maximum Basic cover (refer to Death and TPD insurance cover scale above) within 60 of the date of your welcome letter. You will need to be under age 64 and at work at the time of applying for this increase. You can also request to increase your level of cover after 60 (or more than one request within 60 ) from the date of the PSSap Welcome Letter, however will need an underwriting assessment by the insurer. You can decrease your cover to any amount equal to or higher than the Minimum Basic cover (refer to Death and TPD insurance cover scale above) at any time and do not need an underwriting assessment from the insurer. Where you elect, within 60 of the Welcome Letter, to decrease your Basic cover, the reduction in your cover will be backdated to your commencement date and no premiums will be payable in respect of the cover terminated. If you elect to decrease your cover more than 60 of the date of your Welcome Letter, the reduction in your cover will be terminated effective from the date of your written notification to the fund and premiums for this additional cover will not be backdated. To vary your insurance cover, complete the Insurance Variation form available on our website. A Personal statement/member s declaration form will need to be completed if you wish to increase your cover after 60 (or more than one request within 60 ) from the date of the PSSap Welcome Letter. Your Government Super at Work 5 of 16

6 Fixing your death and TPD cover You can apply to fix your existing level of insurance cover at any time without the need of an underwriting assessment from the insurer (provided you are under age 61 at the time of applying). From age 61, the TPD fixed amount reduces linearly at each birthday to reach zero at age 70. You can also switch your Fixed cover back to Basic cover (including Minimum Basic cover and Maximum Basic cover) at any time, provided that your current level of Fixed cover is greater than or equal to your equivalent age based Basic cover. The Basic cover provided to you will be the Basic cover amount which is equivalent to your age at the time of applying. To vary your insurance cover, complete the Insurance Variation form available on our website. Death and TPD cover premiums The cost of your cover is based on your level of cover and age at next birthday, as outlined below. Age next birthday Annual rates (payable in monthly instalments) per $ 000 insured Death and TPD Age next birthday Death and TPD Age next birthday Death and TPD * * * * * Example: Emily Emily is a permanent employee, aged 35. Under Basic cover her death and TPD cover would be $250,000. The annual premium Emily pays for her cover is, according to her age next birthday, 0.63 x $250,000/1,000 = $ Monthly premium = $157.50/12 = $ If Emily chose Maximum basic cover her death and TPD cover would be $375,000. The annual premium Emily would pay for her cover is, according to her age next birthday, 0.63 x $375,000/1,000 = $ Monthly premium = $236.25/12 = $ Death and TPD insurance cover scales Sum insured $400,000 $350,000 $300,000 $250,000 $200,000 $150,000 $100,000 $50,000 $ Age next birthday Minimum basic cover Basic cover Maximum basic cover We calculate the premiums applicable to your level of death and TPD cover at the end of each calendar month. Premiums are deducted from your PSSap super account by selling some of your units on the first business day of each calendar month or as soon as practicable thereafter. The premium may vary slightly from month to month, depending on the date you joined and how many in each month. If you have your super invested in different investment options, we pro rata the payment across these options. For example, if your investment options are 50% in Trustee Choice and 50% in Cash, then we deduct 50% of your premiums from the amount you have in Trustee Choice and 50% from the amount you have in cash * TPD cover is based on the activities of daily living. Refer to Total and permanent disability and terminal illness definitions on page 8. Your Government Super at Work 6 of 16

7 Commencement of Death and TPD cover You receive Basic death and TPD cover, effective from the date you start your new job, provided you are under 65 of age and join the PSSap within 120 after starting your new job. If you are not at work on the date your cover or increased cover starts, you receive new events cover until you are continuously at work for 3 consecutive months, then full cover will apply. Refer to Key terms on page 15 for an explanation of at work and new events cover. If you are over 65 and under 70 of age, you will need to apply for this cover and be underwritten by AIA Australia who will then decide whether to accept your application for cover (refer to Underwriting and your insurance on page 10 for more information). If you join the PSSap more than 120 after starting your new job, you will receive Basic death and TPD cover from the date you join the PSSap but for the first 12 months it will be limited cover only. Full cover will not be available within the initial 12 month period and you must satisfy the at work criteria for a consecutive three month period before full cover will apply. The three consecutive months can start in the last three months of the 12 month limited cover period. Cessation of death and TPD cover Your cover for death and TPD will stop on the earliest of: > > the date you turn 70 > > the date your claim for death or TPD benefits is paid by AIA Australia, or the day you die (where the death amount is greater than the TPD amount, the remaining balance is payable on death unless any of the other events in this section occur) > > a terminal illness benefit is paid by AIA Australia (where the death and/or TPD amount is greater than $500,000, the remaining balance is payable on death and/or TPD unless any of the other events in this section occur) > > the date you take out a continuation option (refer to Other insurance conditions and considerations on page 9) > > 60 after you stop being a member of the PSSap > > 60 after the PSSap receives the last contribution from your employer > > 60 after you leave the employment of the Australian Government or participating PSSap employer, or > > 60 after a premium due is not paid (for example due to insufficient funds). Cover for death and TPD can also stop on termination of the policies by us. We would give you 30 notice before taking such action. Any replacement policy may not offer the same cover or the same terms as those described in this section. Exclusions to death and TPD cover No benefit will be paid for death or TPD caused wholly or partly, directly or indirectly by active service in the armed forces of any country or international organisation. Or, as a result of any intentional, self-inflicted act, while either sane or insane, within 13 months from the date of acceptance of any underwritten cover or where limited cover applies. Your Government Super at Work 7 of 16

8 Total and permanent disability and terminal illness definitions Different definitions of TPD apply depending on your age and the average hours per week for which you are employed in the 13-week period immediately before the last day you are at work before disablement. The waiting period for a TPD claim is six months. The waiting period commences from the date you are first examined and certified by a doctor as totally and permanently disabled or terminally ill (as below). Situation 15 hours or more employment per week and under age 65 Less than 15 hours employment per week or aged 65 or over Terminal illness Definition a. The insured member, while insured under the policy, has suffered the total and irrecoverable loss of the: > > sight of both eyes > > use of two limbs > > sight of one eye and use of one limb. Or b. The insured member, while insured under the policy, as a result of injury, sickness or disease: > > has not performed any work for an uninterrupted period of at least six consecutive months solely due to the same injury, sickness or disease and > > is attending a registered medical practitioner and has undergone all reasonable and usual treatment including rehabilitation of the injury, sickness or disease and > > after consideration of all medical and such other evidence as AIA Australia may need, has become incapacitated to such an extent as to render the insured member unlikely ever to be able to engage in his or her own occupation and any occupation for which he or she is reasonably suited by education, training or experience. Or c. The Insured Member, while insured under this Policy, having been for a period of six (6) consecutive months after the occurrence of the illness, accident or injury, is continuously, totally and permanently unable to perform at least two (2) of the following activities of daily living as certified by a registered medical practitioner: > > bathing: the ability to wash themselves either in the bath or shower or by sponge bath without the standby assistance of another person; > > dressing: the ability to put on and take off all garments and medically necessary braces or artificial limbs usually worn, and to fasten and unfasten the same without standby assistance of another person; > > eating: the ability to feed themselves once food has been prepared and made available, without the standby assistance of another person; > > toileting: the ability to get to and from and on and off the toilet without the standby assistance of another person and the ability to manage bowel and bladder functions through use of protective undergarments or surgical appliances if appropriate; > > transferring: the ability to move in and out of a chair without the standby assistance of another person. a. The insured member, while insured under the policy, has suffered the total and irrecoverable loss of the: > > sight of both eyes > > use of two limbs > > sight of one eye and use of one limb. Or b. The insured member, while insured under the policy, having been for a period of six consecutive months after the occurrence of the illness, accident or injury, is continuously, totally and permanently unable to perform at least two of the following activities of daily living as certified by a registered medical practitioner: > > bathing: the ability to wash themselves, either in the bath, or shower by sponge bath without the standby assistance of another person; > > dressing: the ability to put on and take off all garments and medically necessary braces or artificial limbs usually worn, and to fasten and unfasten them without the standby assistance of another person; > > eating: the ability to feed themselves once food has been prepared and made available, without the standby assistance of another person; > > toileting: the ability to get to and from and on and off the toilet without the standby assistance of another person and the ability to manage bowel and bladder functions through use of protective undergarments or surgical appliances (if appropriate); > > transferring: the ability to move in and out of a chair without the standby assistance of another person. As part of your death and TPD cover, you may also be eligible for a terminal illness benefit. Terminal illness means you have been certified by two registered medical practitioners (one being a specialist practising in an area related to the illness or injury) as suffering from an illness or incurred an injury that is likely to result in your death within 12 months regardless of any treatment undertaken. Your Government Super at Work 8 of 16

9 Other insurance conditions and considerations There are other circumstances which may cease or impact on your death and TPD and income protection insurance cover (outlined below). Continuation option Disabled persons Persons on approved leave without pay or on partial pay Former PSS members Death and TPD If you are a permanent employee under 60 who leaves employment for reasons other than illness or injury, you may apply to continue your death and TPD cover directly with AIA Australia under an individual policy without being subject to underwriting. You must apply direct to AIA Australia within 60 of leaving employment to be eligible. Cover will be continuous for a permanent employee or non-ongoing employee if they cease employment with a PSSap employer and recommence employment with a newpssap employer within 60. Income protection You cannot apply to continue your income protection cover after ceasing employment with a PSSap employer. Disabled persons will receive cover only for events that arise after the date cover starts and that are unrelated to any conditions that pre-existed the date the cover started. Disabled persons, for the purposes of the policies, are persons employed under policies which promote employment opportunities for disabled persons. If you are on approved leave without pay and continue to pay premiums from your PSSap super account, your cover continues during your leave for up to 12 months (or longer subject to underwriting and approval by AIA Australia), but if you do not return to work by your expected return date or cease your employment in this period, your cover will end 30 after the date of your expected return (or a later date subject to underwriting and approval by AIA Australia) or on which you ceased employment (as applicable). If your cover ceases, you will need to reapply for any subsequent reinstatement of cover. Cover will continue on approved leave with full pay, subject to the payment of premiums. Death and TPD If you transfer to the PSSap from the PSS, and at the date of transfer you have not already received and are not in the process of applying for, a PSS invalidity benefit, you will receive death and TPD cover under the PSSap. Your death and TPD cover under the PSSap will be the greater of: > > an amount calculated on the basis of the invalidity benefit that would have been payable to you had you ceased PSS membership due to invalidity (i.e. you were unable to perform your duties because of a mental or physical condition) on the day you transferred out of the PSS (Existing Cover Amount), or > > the PSSap Basic cover for your age upon transfer to the PSSap. Calculation of your Existing Cover Amount: > > includes any additional death and invalidity cover you had as a member of the PSS prior to joining the PSSap (PSS Additional death and invalidity cover) > > excludes any benefit that will be payable to you or your beneficiaries in respect of any amounts you may have preserved in the PSS upon joining the PSSap > > if you are under 60, is based on your PSS benefit entitlement had you worked to age 60 (provided you were a full benefits member of the PSS at the time you transferred to the PSSap) > > if you are 60 or over, is based on the final benefit that would have been payable to you had you ceased PSS membership due to invalidity. If your death and TPD cover is based on your Existing Cover Amount, that amount will become Fixed cover until you reach 61, at which time your death and TPD cover will reduce linearly to reach zero at age 70. Any exclusions or premium loadings that were applicable to your PSS Additional death and invalidity cover will apply to your death and TPD cover under the PSSap (in addition to the other premiums and exclusions described in this document). If your death and TPD cover is the PSSap Basic cover, you will be provided with the Basic cover for your age under the conditions described in this document. If you satisfy the at work requirement at the date of transfer, you will receive full cover from that date. If you are not at work on the date of transfer, limited cover applies until you have met the at work requirement for three consecutive months, after which full cover will apply. Be aware that as a PSSap member, you are responsible for paying insurance premiums, not your employer. Income protection If you transfer to the PSSap from the PSS, you will be provided with default cover. The cover provided for the first 12 months will be limited cover which means that you are only covered for events or conditions occurring after your cover commences. Full cover will be provided after 12 months if you meet at work requirements. Refer to Key terms on page 15 for an explanation of at work and limited cover. You can apply to change your insurance cover at any time using the Insurance variation form available on our website. Your Government Super at Work 9 of 16

10 Other insurance conditions and considerations (continued) Persons on unauthorised leave from employment Overseas cover Overseas employees in Australia If you continue to pay premiums from your PSSap super account, your cover will continue for a period not exceeding 30. If you do not return to work within 30 from the commencement of leave, your cover will automatically ceases and you will need to reapply for any subsequent reinstatement of cover. If you continue to pay premiums from your PSSap super account, your death and TPD and income protection insurance cover will continue to apply while you are overseas but no applications may be made to increase cover. PSSap members who are not Australian citizens are eligible to receive insurance cover during their stay in Australia while they are employed by an eligible employer in Australia. AIA Australia may require overseas members to remain in Australia for a period of time for claims assessment purposes. Underwriting and your insurance Some members will need to be individually underwritten and accepted for insurance by AIA Australia. Underwriting allows the insurer to assess and evaluate the risk of insuring you and determines the insurance premiums you will pay. Where a member applies to reinstate cover after it has lapsed, this will also be subject to underwriting. Underwriting may result in a member being declined insurance or offered insurance on modified terms and conditions. Underwriting process An underwriter reviews and evaluates certain factors to develop your risk profile. Your risk profile relates to your life expectancy, medical history and/or risk of injury or illness. Depending on your risk profile and the approval of your insurance cover, you will either pay standard premiums, or increased premiums to cater for your associated risk. Life insurance underwriters typically use factors that equate with the risk of death, injury or illness, including: > > age > > gender > > height and weight > > smoking status > > lifestyle factors > > pursuits and pastimes > > medical history, and > > family history. You may be asked questions about your health to help determine your risk profile. For example AIA Australia may request a Personal Medical Attendants Report (PMAR) to gain further comprehensive medical information held by your personal doctor. You may also be requested to conduct a blood test to check your current health situation. Please note that we hold all personal information in strict confidence in accordance with privacy legislation. Medical examinations In many cases you will not be required to undertake a medical examination. However, depending on your age, height to weight ratio and previous medical history, you may need to undergo a medical examination by a doctor or nurse. Samples of your blood and urine may also be taken at this time. The insurer may also check your health history with your doctor or specialists and may conduct other investigations where necessary. The higher the amount of insurance cover you are applying for, the more detailed and extensive the investigation. You must disclose all personal and medical information an underwriter may require when assessing your insurance application. If you do not inform the insurer of all the personal information they require, any subsequent claim may not be paid due to non-disclosure and the insurer may cancel your cover under the policy. No cost to you You will not be charged to be underwritten. All costs associated with obtaining medical information will be at the expense of the insurer. Commencement of cover and interim cover Your application can only commence after AIA Australia has accepted to provide the cover. However, you may be given interim accident cover for accidental death and TPD for a period of up to 90 from the date the insurer receives your personal health statement (subject to a maximum benefit of $1,000,000). No benefit will be payable under interim accident cover in respect of disability resulting from hazardous pursuits and pastimes or where AIA Australia would normally exclude certain events. This cover ends once AIA Australia has made a decision, you withdraw your application or you are no longer eligible for cover under the PSSap. Your Government Super at Work 10 of 16

11 Acceptance of cover AIA Australia can accept or decline the level of cover, or may accept cover subject to special acceptance terms such as premium loadings or placing an exclusion on the cover provided. The policy commences from the date you are notified (including cover subject to special acceptance terms). You must accept the cover within 30 from the date of notification for the cover to continue. If you do not or you decide to decline the cover, the cover will be terminated and no premium will be payable. How to make an insurance claim Death claim Step 1: Your family or employer need to contact us following your death. Step 2: PSSap will request a death certificate and the contact details for the estate. No information will be released until we receive a death certificate. Step 3: When we receive a death certificate, we ll forward a requirements letter to the handler of the estate. This letter will outline the information, identification and evidence required to determine a beneficiary. The letter will outline if you have insurance, a binding nomination and the interest held in your PSSap account. AIA Australia will assess all the information you have provided and confirm your eligibility. Step 4: PSSap will contact your employer and confirm your pay and leave history. Step 5: Our insurer, AIA Australia, will assess all the information you have provided and confirm your eligibility, including: > > confirmation that you were at work and performing your normal duties on the date your insurance cover commenced or increased > > your age and sum insured at the date of death (most death claims can be paid at this point) > > examination of your original application to make sure you disclosed everything about your health, if you applied for additional cover. Step 6: AIA Australia will make a decision to either accept or decline the claim. We will advise you of their decision and facilitate payment if the claim is accepted. TPD or terminal illness claim Step 1: Contact us to request a claim form. You will be advised of additional documentation required at this point (for example, identification, medical assessments). Step 2: Send the completed form and any further documentation requested back to us. We will conduct an eligibility check to ensure that you are insured for the type of cover you are claiming, contact your employer and confirm your pay and leave history, your premiums are up to date and that your waiting periods have been met. All of your claim documentation will then be forwarded to our insurer, AIA Australia. Step 3: AIA Australia will assess all the information you have provided and confirm your eligibility, including: > > confirmation that you were at work and performing your normal duties on the date your insurance cover commenced or increased > > your age and sum insured at the date of claim > > determination that your disability (for TPD claims) continues beyond your waiting period > > examination of your original application to make sure you disclosed everything about your health, if you applied for additional cover. Step 4: AIA Australia will then assess your TPD claim from a medical and occupational point of view. Terminal illness claims are assessed from a medical point of view. Claimants suffer from a wide range of injuries and illnesses. Some conditions are straightforward and can be assessed quickly. Other claims may be for conditions that do not necessarily mean that the claimant is unable to work. These claims may take longer as AIA Australia may need to speak with or obtain further information from your doctor about your condition. AIA Australia may also need to speak with your employer about your work duties. It is for this reason that your doctor and your employer should help you to fully complete the claim forms and provide as much information as possible upfront. Step 5: If AIA Australia chooses, they may send you for an independent medical assessment(s) with a specialist of their choice. Step 6: AIA Australia will make a decision to either accept or decline your claim. We will advise you of AIA Australia s decision and facilitate payment if the claim is accepted. Your Government Super at Work 11 of 16

12 lp claim Step 1: Contact PSSap to request a claim form. You will be advised of additional documentation required at this point (for example, identification, medical assessments). Step 2: Send the completed form and any further documentation requested back to us. PSSap will conduct an eligibility check to ensure that you are insured for the type of cover you are claiming, contact your employer and confirm your pay and leave history, your premiums are up to date and that your waiting periods have been met. All of your claim documentation will then be forwarded to our insurer, AIA Australia. Step 3: AIA Australia will assess the information provided and confirm your eligibility, including: > > confirmation that you were at work and performing your normal duties on the date your insurance cover commenced or increased > > your age and sum insured at the date of claim > > determination that your disability continues beyond your waiting period > > whether you have lodged and/or are in receipt of benefits from a third party such as WorkCover or Centrelink. Benefits from third parties may reduce the sum payable under your IP claim. > > a look at your original application to make sure you disclosed everything about your health, if you are applied for additional cover. Step 4: AIA Australia will then assess your IP claim from a medical and occupational point of view. Claimants suffer from a wide range of injuries and illnesses. Some conditions are straight forward and can be assessed quickly. Other claims may be for conditions that do not necessarily mean that the claimant is unable to work. These claims may take longer as AIA Australia may need to speak with or obtain further information from your doctor about your condition. AIA Australia may also need to speak with your employer about your work duties. It is for this reason that your doctor and your employer should help you to fully complete the claim forms and provide as much information as possible upfront. Step 5: If AIA Australia chooses, they may send you for an independent medical assessment(s) with a specialist of their choice. Step 6: AIA Australia will make a decision to either accept or decline your claim. As your cover is provided through CSC, we ll advise you of AIA Australia s decision. On acceptance of an IP claim, your benefit payments will be paid directly to you by AIA Australia. Benefits are payable monthly in arrears net of tax. For death, terminal illness and TPD claims, the insurance claim is only part of your overall benefit, as your total benefit also includes your superannuation account balance. We will make a combined payment to you for the insurance claim (excluding IP) together with the superannuation account balance. This may take two to four weeks as we will also need to approve your claim. This may take longer for death claims if beneficiaries are still being determined. Making an insurance claim can be a stressful and emotional time for you and your family. Completing paperwork is probably the last thing on your mind. We strive to make the process of submitting a claim as simple and as efficient as possible and work hard to maintain open and honest communication with you throughout the process. AIA Australia s simplified claim forms, available on our website, removes the need for you or your family arranging Employer statements for death and terminal Illness claims, which would have traditionally lengthened the claims process. Responsibilities when making a claim When you complete an application for insurance, you are required by law to answer all the questions truthfully and to include any information which may affect the insurer s decision to insure you. Your duty, however, does not require disclosure of a matter: > > that diminishes the risk to be undertaken by the insurer > > that is of common knowledge > > that your insurer knows or, in the ordinary course of business, ought to know, or > > the insurer has waived. If you fail to comply with your duty of disclosure (or make a misrepresentation to us), the insurer may rescind or cancel your entitlements under the insurance policy at any time. It is also your responsibility to make sure that your personal details and information (such as postal address, bank account details) are up to date and correct. If any of your details do or will change, please contact us as soon as possible. Initial and ongoing review The time to review and make decision on your claim depends on your type of claim, your medical condition and information required from other parties, such as your doctor. If AIA Australia accepts your IP claim, it will review your claim on an ongoing basis to determine your ongoing eligibility for income protection benefits. Your Government Super at Work 12 of 16

13 At least once a month, you will be required to give AIA Australia medical evidence and any other information they consider necessary, to make sure that you are still eligible. This may include undertaking independent medical examinations from time to time. If you are overseas and claim either a terminal illness, TPD or income protection claim you may be required to return to Australia (at your own expense) whilst your claim is being assessed by AIA Australia. Payments of your benefit may be suspended if you do not undertake examinations or give reasonable information requested by AIA Australia. In addition to the monthly progress reports, AIA Australia may also conduct further investigations if you are receiving an income protection benefit to assess your continuing disability and eligibility for the benefit. If AIA Australia does not accept your claim and you wish to have the decision reconsidered or lodge a complaint, please refer to Contact us on page 16. Tax and your claim Income protection payments are taxed as normal income. When you lodge your claim, you will have to complete a tax file number declaration. You do not have to complete this form; however, if you do not, a higher rate of PAYG tax may be required to be deducted from your monthly benefit in the event that AIA Australia accepts your income protection claim. We will forward your tax file number to AIA Australia together with your application for benefit, and AIA Australia will set you up as a payee on its payroll system in preparation for AIA Australia accepting your claim. We will also send the tax file number declaration to the Australian Taxation Office where CSC, as the owner of the policy, is registered as a PAYG withholder in respect of income protection benefits. If AIA Australia accepts an income protection claim, AIA Australia will withhold the relevant PAYG tax before paying the benefit to you. The tax will be recorded against the CSC account with the ATO and you will receive a payslip with each month s pay. At the end of the financial year, you will receive a payment summary (to your nominated postal address) to submit with your tax return. If you do not complete the tax file number declaration, AIA Australia is required by law to withhold tax at the highest marginal tax rate. Your privacy We are committed to protecting your privacy. We collect personal information from you only for the purposes of establishing and administering your super and insurance, to send you information about new products or services (provided by us or others) and to invite you to participate in member research. Your personal information will be disclosed to our administrator (for the purposes of establishing, administering and releasing your super) and our insurer AIA Australia (for the purposes of establishing, administering and paying your insurance) but is not disclosed to any other party without your consent, or if required by law. A full copy of our privacy policy is available on our website or call us on You can find a full copy of AIA Australia s privacy policy at Further important information about making a claim In the event of any incomplete questions/answers on the claim form and in the absence of any required supporting documentation, AIA Australia will return the claim form to you. We encourage you to be particularly thorough to ensure you provide all the requested information. As part of the eligibility check, AIA Australia will make sure that you were at work and performing your normal duties on the date your insurance cover commenced or increased. This is to make sure you weren t sick or injured at the date you first received cover or your cover increased, as you may not be able to claim if you were already disabled before your cover started or increased and your claim is for this pre-existing condition. You can start gathering your medical evidence before your waiting period expires, but please do not complete claim forms too early, as we may require you to complete further up to date forms. Documents required to prove death, TPD, IP or terminal illness claims Death claims The insurer requires the following information and documentation to assess your death claim: > > certified copy of the birth certificate of the deceased > > certified copy of the death certificate of the deceased > > coroner s report (if applicable) > > certified copy of the deceased member s will > > certified copy of Probate or Letters of Administration (if estate more than $50,000) and you do not have a valid nominated beneficiary > > certified copy of the birth certificate(s) of the nominated beneficiaries (if you have nominated beneficiaries). You need to be aware that further information, including an employer statement form, may be requested at any time during the assessment of a claim by AIA Australia. PSSap will be the point of contact for all enquiries about the claim. Your Government Super at Work 13 of 16

14 TPD claims The insurer requires the following information and documentation to assess your TPD claim: > > Total and permanent disablement claim form (which includes a Medical attendant s statement and a Privacy statement) > > Employer statement form > > certified proof of age (e.g. a driver s licence or a passport) > > CV or resume. You need to be aware that further information may be requested at any time during the assessment of a claim by AIA Australia. PSSap will be your point of contact for all enquiries about your claim. IP claims The insurer requires the following information and documentation to assess your IP claim: > > Income protection claim form (including medical attendant s statement and a Privacy statement) > > Tax file number declaration form > > Certified proof of age (e.g. a driver s licence or a passport) > > Electronic Funds Transfer authority form Your employer will need to provide: > > Employer statement form > > Leave and pay history (last 12 months). You need to be aware that further information may be requested at any time during the assessment of a claim by AIA Australia. PSSap will be your point of contact for all enquiries regarding your claim. Terminal illness claims AIA Australia requires the following information and documentation to assess your terminal illness claim: > > Terminal illness claim form which includes a Medical attendant s statement and Privacy statement. Beneficiary nomination You can nominate a beneficiary to receive your superannuation benefit in the event of your death. Superannuation law restricts the beneficiaries you can nominate to dependants, who are: > > your spouse, including a de facto spouse of the same sex or opposite sex, who lives with you on a genuine domestic basis > > your children of any age, including adopted children, foster children and those by a previous relationship > > any person with whom you have an interdependency relationship, and > > your legal personal representative (the executor of your will, or the administrator of your estate). An interdependency relationship is defined under superannuation law as between two people who: > > have a close personal relationship > > live together > > one or each of them gives the other financial support, and > > one or each of them gives the other domestic support and personal care. An interdependency relationship may also exist if there is a close personal relationship between the two persons, but one or more of the other requirements for interdependency are not satisfied because of a physical, intellectual or psychiatric disability. Having control of your benefit You can make a binding nomination to ensure that we act upon your nomination. To do this, complete a Binding nomination form available on our website, or we can post you a copy. When completing the form you need to make sure that your binding nomination is valid and follow the instructions, as there are strict rules prescribed under the Superannuation Industry (Supervision) Act 1993 and the Regulations made under that Act that need to be met to ensure that your nomination is valid. To meet these conditions you need to: > > nominate either your dependant (as previously defined) or your legal personal representative > > record the proportion of the benefits payable to each person in whole numbers and they must add up to 100% > > date and sign the nomination in the presence of two witnesses both of whom must be over the age of 18 and not listed as beneficiaries in the nomination (the nomination must contain declarations from each of the two witnesses confirming that you signed and dated the nomination before them) > > keep the nomination up to date and review it every three. Your Government Super at Work 14 of 16

15 If the conditions are not met, the form will be invalid and we are required to make the decision about who receives your benefit and how to divide the benefit. We may at our discretion pay your death benefit to: > > one or more dependants and/or > > your legal personal representative or > > if we cannot find a dependant or your legal personal representative, to any individual we decide. In exercising our discretion, we will usually consider any application made by your spouse, your child or a person in an interdependency relationship with you or any other person who considers they have a claim. We may also take account of any beneficiaries nominated in an expired or invalid binding nomination or in your will. Please note that if a nominated person is no longer a dependant at the time of your death, we are not required to pay your benefit according to your nomination. We may also use other available avenues to identify other potential recipients. For this purpose, we may: > > ask your employer for help in identifying family members > > contact your family and/or solicitor to identify possible beneficiaries > > advertise in newspapers for potential claimants where we cannot identify family members. Please note that we cannot make payment under a binding nomination instruction if we are subject to a court order (such as a Family Court of Australia order) preventing payment of the benefit or aware that you are subject to a court order that prohibits or restricts you from giving a binding nomination or requires you to amend or revoke such a nomination. Keeping your nomination current It is important to keep your binding nomination current. A binding nomination is only valid for three from when you make, confirm or amend it. To keep your binding nomination current you must renew it in writing before it expires (that is, within three from the date you originally signed it or within three of the date it was last confirmed). You can also change or cancel your nominations at any time. To renew, change or cancel your beneficiaries, complete a new Binding nomination form. You can also view your nominated beneficiaries by logging into Your account available on our website. Nominating beneficiaries and your will A valid binding nomination only requires us to pay your PSSap death benefit to the persons you nominate. It has no bearing on how your other assets will be dealt with in the event of your death. For this reason, you should not see a binding nomination for your super as a substitute for having a legally enforceable will. You should seek advice from a licensed professional to decide whether you need to make a will in relation to other aspects of your estate. Getting advice Nominating beneficiaries is an important decision only you can make. However there are considerations, such as the different tax implications on the distribution of benefits if you intend to nominate your legal personal representative. A licensed professional, such as a solicitor, can help you with identifying considerations that may apply to your personal situation. Key terms At work At work means: > > you are engaged in your normal duties and work hours, without limitation or restriction due to sickness or injury and are working normal hours on the day cover starts and > > you are not in receipt of and/or entitled to, claim income support benefits from any source including workers compensation benefits, statutory transport accidents and disability income benefits. Fixed cover Fixed cover is a level of death and TPD cover that does not change unless specified elsewhere in this document. Important duty An important duty is one that involves 20% or more of the insured member s overall tasks. Limited cover Limited cover means that, during the period in which limited cover applies, you are only covered for events or conditions which arise entirely after your cover commences. New events cover New events cover is cover that excludes any medical condition, or any directly or indirectly related condition arising from sickness or injury, which has caused you not to be at work on the date cover or increased cover commences. New events cover applies to you if you are working in a reduced capacity and/or on a reduced salary due to a sickness or injury. Waiting period A waiting period is the specified period of time that must expire before you are eligible for a benefit to be paid (as stated in the policy). Waiting periods apply to total and permanent disability (TPD) and income protection claims, as these claims typically relate to a disability which prevents you from working for a period of time beyond the expiry of your waiting period. The waiting periods are six months for TPD and between 30 and 180 for Income Protection. Your Government Super at Work 15 of 16

16 About AIA Australia Limited AIA Australia Limited has been operating in Australia for over 40. AIA Australia is a subsidiary of the AIA Group and a specialist provider of life insurance products aimed at protecting the financial health and welfare of Australians. AIA Australia has given and not withdrawn its consent to the information in this document referable to AIA Australia and the insurance policies it has issued in the form and context in which that information appears. AIA Australia has not issued, or caused the issue, of this document and is not responsible for any other statements in this document, other than those to which it has consented. Contact us If you have any questions call us on or contact us using the following details: members@pssap.com.au PSSap, Locked Bag 9300, Wollongong BC NSW If you are not satisfied with the way we have handled your application, then please call us on If you are not satisfied with the response, you may ask to speak to a supervisor. If you still feel we have not explained or resolved the issue to your satisfaction, ask to be transferred to the Complaints Officer: complaints@pssap.com.au PSSap Complaints Officer, Locked Bag 9300, Wollongong BC NSW 2500 If you wish to have your claim reconsidered, we will forward your application to AIA Australia for reconsideration and will then notify you of AIA Australia s decision. If you are still not satisfied If you are still not satisfied with your complaint, you may wish to contact the Superannuation Complaints Tribunal (SCT), an independent arbitrator set up by the Australian Government to resolve members complaints. You can lodge a complaint with the SCT free of charge if you are dissatisfied with our response or we cannot resolve your situation within 90. info@sct.gov.au Superannuation Complaints Tribunal, Locked Bag 3060, Melbourne VIC phone fax post members@pssap.com.au web overseas callers PSSap Locked Bag 9300 Wollongong BC NSW of 16