1 Insurance in your super The information in this document forms part of the: UniSuper Accumulation 1 Product Disclosure Statement issued on 3 January 2015 UniSuper Defined Benefit Division and Accumulation 2 Product Disclosure Statement issued on 3 January 2015 UniSuper Spouse Account Product Disclosure Statement issued on 3 January 2015 This document was prepared on 1 July Inside Introduction 1 Types of cover and eligibility 2 What insurance do you get upon joining UniSuper? 8 Exclusions and special conditions 15 Ceasing and recommencing insurance 19 How to make a claim 21 How and when your benefit is paid 22 Insurance premiums 24 Definitions 27 Safety gear, The Waite Research Institute, The University of Adelaide
2 1 Introduction Who provides insurance to UniSuper members? External insurance cover is provided to UniSuper Accumulation 1, Accumulation 2, Defined Benefit Division (DBD) and Spouse Account members through group insurance policies the Trustee has taken out with TAL Life Limited, ABN , AFSL (referred to as the Insurer throughout this document). TAL insurance products are only for offer within Australia. For information about inbuilt benefits provided to DBD members, which are self-insured by UniSuper, please refer to the Defined Benefit Division and Accumulation 2 Product Disclosure Statement (PDS). In this document we ve set out the main features of insurance cover provided by the Insurer including a summary of the key terms and conditions and eligibility criteria in the group insurance policies, which can be obtained on request by calling us on The full terms and conditions contained in the policies prevail over any inconsistent information in this document. Important definitions The Important definitions section at the end of this document explains the meaning of certain important terms which appear in italics within this document. Who should read this booklet? This booklet provides detailed information about the insurance options available to eligible: Accumulation 1 members, Accumulation 2 members, Spouse Account members, and Defined Benefit Division (DBD) members. Please note, this document only includes limited information about inbuilt benefits provided to DBD members, which are self-insured by UniSuper. Please read the Defined Benefit Division and Accumulation 2 PDS available from unisuper.com.au/pds for more information.
3 2 Types of cover and eligibility Types of cover available There are four types of insurance cover available to eligible UniSuper members: Death-only cover, Total and Permanent Disablement (TPD)-only cover, Death and TPD cover, and Income Protection cover (not available to members joining UniSuper as DBD members). Note that DBD members are eligible for inbuilt benefits (self-insured by UniSuper) that provide an income stream in the event of disablement and temporary incapacity. Death cover (including terminal illness cover) Offered as unitised and fixed cover Death cover provides a lump sum payment in the event that you are diagnosed with a terminal illness, or die. Your beneficiaries and/or your estate will receive your insured benefit in the event that you die. You will receive an insured terminal illness benefit if you are diagnosed with a terminal illness and satisfy any other applicable criteria. There s no limit on the amount of Death cover that you can apply for. Your terminal illness benefit aligns with your Death cover subject to the applicable maximum cover limit of $3 million. If a terminal illness benefit is paid and the Death cover is higher the remaining Death benefit is payable on death. Death cover ceases at age 75. TPD cover Offered as unitised and fixed cover TPD cover provides a lump sum payment in the event that, due to an illness or injury, you become totally and permanently disabled and you satisfy any other applicable criteria. The maximum amount of TPD cover you can apply for is $3 million. TPD cover ceases at age 70. Income Protection cover Offered as unitised cover Not available to members joining UniSuper as DBD members Income Protection cover gives you a monthly benefit for a benefit payment period applicable to your cover, in the event that you are assessed as temporarily unable to do your job because you suffer from a total disability or partial disability. The maximum amount of cover you can apply for is 69 units or $29,900 per month. Income Protection cover ceases at age 65. Please note Restrictions, exclusions, terms and conditions may apply to all types of cover, including default and additional default cover. In addition, in order to be eligible to receive cover you must satisfy certain policy terms and conditions please see page 7 for more information.
4 Insurance in your super Types of cover and eligibility 3 How we refer to cover DEFAULT COVER - DEATH AND TPD Default cover is Death and TPD insurance cover you receive from our Insurer when you first become a member of UniSuper, or when cover is recommenced (provided you meet the eligibility criteria) and you do not need to go through any underwriting. Note that default cover for members over age 70 and below age 75 is one unit of Death-only cover. Members over age 75 do not receive this cover. You can opt out of default cover or choose to reduce your Death and TPD cover to Death-only or TPDonly cover when you join UniSuper by completing the appropriate sections on the application form in the relevant PDS for your membership category, or at any time in the future by logging into MemberOnline at unisuper.com.au or by writing to us. However, if you wish to take up cover at a later date, you will need to be underwritten and accepted by the Insurer. Default cover you may be eligible for when you join UniSuper Type of cover Accumulation 1 (except if you join as a result of a family law split) Spouse Account DBD and Accumulation 2 Additional Default Cover Default cover you may be eligible for 1 unit of Death and TPD cover 1 unit of Death and TPD cover DBD members joining for the first time receive 1 unit of Death and TPD cover. If they then transfer to Accumulation 2, cover will continue and they may also receive transitioned cover. Please see the What happens to your inbuilt benefits if you choose Accumulation 2? information booklet for more information If you are eligible for default cover, you have the ability to apply for or increase the amount of Death and TPD insurance cover by up to two additional units without providing health evidence to the Insurer if you apply within 180 days of first becoming eligible to join UniSuper (or if you are a Spouse member, within 180 days of your sponsoring spouse first becoming eligible to join UniSuper) and you meet other eligibility requirements. If you choose to change your default Death and TPD cover to Death-only or TPD-only cover when you join UniSuper, any additional default cover will also be Death-only or TPD-only cover as applicable. You can apply by completing the relevant application form for your membership category. Additional Cover Additional cover refers to any insurance for which you apply and go through underwriting. You may choose to purchase additional cover if you are not eligible for default cover or would like to increase your levels of cover. Transitioned Cover For DBD members that decide to transfer to Accumulation 2 within the 24-month election period, the inbuilt benefits they receive as a DBD member will cease and they will instead receive external Death, TPD and Income Protection insurance cover. In summary, if you choose Accumulation 2 and provided you are under age 60 at the date of transfer, your inbuilt death benefit will be transitioned to external Death and TPD cover, so long as you meet the eligibility criteria under the group life policy. UniSuper will determine the level of Death cover you receive by calculating the dollar value of your inbuilt death benefit immediately prior to the date of transfer and then converting that dollar value into units of Death cover (or fixed Death and TPD cover if you have fixed cover). When transitioned Death cover is provided in units of cover, it will then be rounded up to the nearest whole unit to ensure you receive equivalent or better transitioned Death cover. This extra cover you receive from rounding up to the nearest whole unit is known as uplift cover. Subject to automatic acceptance limits (Ls), your transitioned external TPD cover will be the same number of units (or fixed cover if you have fixed cover) as your transitioned external Death cover. In some circumstances transitioned cover is also provided when members transfer from Accumulation 1 to Accumulation 2. In these circumstances, transitioned Death and TPD cover is calculated according to the dollar value of the inbuilt death benefit you would have been entitled to as a DBD member at the date of transfer.
5 4 Insurance in your super Types of cover and eligibility To receive transitioned Income Protection insurance cover you must be under age 64 years and 9 months on the date of transfer. If you also satisfy the eligibility criteria under the external Income Protection policy you will be provided with Income Protection cover of up to 85% of the salary we have recorded for you on the date of transfer. The default waiting period for transitioned Income Protection cover is 90 days and the default benefit payment period is 5 years. After transferring to Accumulation 2 you can vary both the benefit payment and waiting periods. Note that increasing your benefit payment period or decreasing your waiting period will require underwriting. All or some of your transitioned cover will be subject to the pre-existing condition exclusion. Refer to page 16 for more information about how this exclusion works. Transitioned Death and TPD cover will be added to any existing external insurance cover you may have (including any default cover) when applying the automatic acceptance limits that apply under the group policies. For detailed information about the differences between the inbuilt benefits and the external cover you receive as an Accumulation 2 member and how UniSuper determines the value of your transitioned cover, you should read the What happens to your inbuilt benefits if you choose Accumulation 2? information booklet available at unisuper.com.au/pds. How Death and TPD cover is provided Death and TPD cover is provided as unitised cover by default. You may choose to convert to fixed cover. You cannot have a combination of both fixed and unitised Death and/or TPD insurance. Here s how both options work. UNITISED COVER Unitised cover means the cost of each unit of cover stays the same as you get older, however, the amount of cover you get reduces over time. The table below shows the amount of Death and TPD cover provided by one unit of cover, depending on your age next birthday: Death and tpd benefit per unit of cover Age (next birthday) Amount of cover ($) Age (next birthday) Amount of cover ($) , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,000^ 51 49, ,000^ 52 45, ,000^ 53 40, ,200^ 54 36, ,500^ 55 32,000 If Death-only cover is selected, the amount of insured benefit per unit of Death-only cover is the same as for Death and TPD in the table, however, there is no cover for TPD where Death-only cover is selected. ^ Death-only paid; no TPD benefit is payable. The cost of unitised cover (premium tables) can be found on page 24.
6 Insurance in your super Types of cover and eligibility 5 Unitised cover: an example If you had one unit of Death and TPD cover, and your age next birthday is 52, you would be covered for a lump sum of $45,000, subject to meeting eligibility criteria and any cover restrictions which may apply. FIXED COVER Fixed cover means that the cost increases as you get older, however, the amount of insurance you get stays the same over time. You can convert your unitised Death and TPD cover to fixed cover at any time, provided you are under the age of 61. Once you have converted to fixed cover, you are not able to convert back to unitised cover. Fixed cover is offered in multiples of $1,000. All fixed cover will be rounded up to the nearest $1,000. If you have fixed cover, while your Death benefit does not change, your TPD sum insured will reduce annually from your 61st birthday as follows: Age (next birthday) Death Benefit % 90% % 80% % 70% % 60% % 50% % 40% % 30% % 20% % 10% 71 to % Nil Cover ceases at age 75 TPD Benefit How Income Protection cover is provided Income Protection cover is provided as unitised cover and provides a monthly benefit if you re assessed under the policy as being unable to work because you suffer from a total disability or partial disability. Insurance cover is unit based and is provided in multiples of $100 per week of cover. You can apply for a range of flexible benefit payment periods. These are two years, five years or to age 65. We also offer flexible waiting periods of 30, 60 or 90 days. Any variation in benefit period or waiting period changes the premiums you pay for Income Protection cover. Please see the Income Protection premium tables on page 26 for more information. If you make a claim and it is accepted, you will receive a monthly benefit that is the lesser of: the amount represented by the number of units the Insurer last accepted for you, and 85% of your pre-disability monthly income (with up to 10% paid as a superannuation contribution). Note the maximum that can be purchased under the policy is $29,900 per month or 69 units of cover. The cost of cover will depend on your age, the waiting period (30, 60 or 90 days) and the benefit payment period (two years, five years to age 65) that you choose as well as any premium loadings which may apply on underwritten cover. Please refer to page 26 for more on the cost of cover. The cost of fixed cover can be found on page 25.
7 6 Insurance in your super Types of cover and eligibility Income Protection cover: an example Peter has a salary of $80,000 p.a. and has 14 units of Income Protection cover. His 14 units of cover will provide a maximum monthly benefit of $6, (14 units x $100 x 52 weeks 12 months). However, Peter s monthly benefit would be limited to $5, ($80,000 x 85% 12 months) as his benefit cannot exceed 85% of his pre-disability income. Peter s $5, monthly benefit, including his superannuation contribution, would be made up of the following: Income $80,000 x (75% 12 months)= $5, superannuation contributions $80,000 x (10% 12 months)= $ = total payment $80,000 x (85% 12 months)= $5, Opting out You can opt out of insurance cover at any time by logging into MemberOnline at unisuper.com.au or by writing to us. However, if you wish to take up cover at a later date, you will need to be underwritten and accepted by the Insurer. General insurance eligibility requirements that apply to all insurance cover If you meet the eligibility criteria you will receive default cover and have the option to elect additional default cover without providing medical evidence to the Insurer. You will also be able to apply for additional cover by providing medical evidence to the Insurer. To be eligible for insurance at UniSuper, you need to meet the following general eligibility requirements: you are a UniSuper member you are age 15 next birthday or over you are an Australian resident.
8 Insurance in your super Types of cover and eligibility 7 ELIGIBILITY REQUIREMENTS YOU MUST MEET TO RECEIVE COVER UPON JOINING UNISUPER Death and TPD cover You are generally eligible to receive default Death and TPD cover or apply for additional default Death and/or TPD cover if you meet the general insurance eligibility requirements described above and the following criteria: you are under 75 years of age in respect of Death cover, and under age 70 in respect of TPD cover, you do not join UniSuper as a result of a Family Law payment split under the Family Law Act 1975 (Commonwealth), you are not currently claiming for, or eligible to claim for or have previously received an insured terminal illness or TPD benefit. Additional criteria for Accumulation 1 and DBD members (including DBD members that transfer to Accumulation 2): for default cover, UniSuper receives an application form or minimum details within 180 days of you becoming first eligible to join, if you apply for additional default cover, UniSuper receives your completed application form within 180 days of you becoming first eligible to join, and you have not previously opted out of Death or TPD cover. Note if you are not in active employment on the date that cover commences your cover will be restricted. Please see the information on pre-existing condition exclusions on page 16 for more information. Additional criteria for Spouse Account members: if you apply for additional default cover, UniSuper receives your completed application form within 180 days of your sponsoring spouse becoming first eligible to join, and you are not receiving or entitled to claim support benefits from any source including Workers Compensation, TAC and disability benefits. Income Protection cover Accumulation 1 and Spouse Account members who are under age 65 can apply for Income Protection cover without providing medical evidence when joining UniSuper by completing the appropriate section of the Application form. Note that DBD members may not have access to Income Protection cover. DBD members receive inbuilt temporary incapacity and disablement benefits. For details, refer to the Defined Benefit Division and Accumulation 2 PDS. Additional criteria for Accumulation 1 members: Within 180 days of becoming first eligible to join: UniSuper receives a fully completed and signed application form, and an on-time employer contribution is made to your account. Additional criteria for Spouse Account members: Within 180 days of your sponsoring spouse becoming first eligible to join: UniSuper receives a fully completed and signed application form an employer contribution or voluntary member contribution is made to your account you are gainfully employed you are actively performing all the duties of your usual occupation on the day cover commences, and you are not in receipt of or entitled to claim support benefits from any source including Workers Compensation, TAC and disability benefits when cover commences. All applications for Income Protection cover outside of the 180 days require full underwriting by the Insurer. Please note, your Death and TPD cover will be automatically transferred to Death-only cover when you turn 70 and your Death-only cover will cease when you turn 75.
9 8 What insurance do you get upon joining UniSuper? Default cover and additional default cover Members who meet the eligibility criteria will receive default cover of one unit of Death and TPD cover. For DBD and Accumulation 1 members, this cover commences on the first day of the period to which the first employer contribution relates, which will generally be the date you joined UniSuper. For Spouse Account members, cover commences from the date the first employer or voluntary member contribution is received into your account. All members also have the option to elect additional default cover of up to another two units of Death and TPD cover provided you make the election within 180 days of becoming first eligible to join, or for Spouse Account members, within 180 days of the sponsoring spouse being first eligible to join. If you opt out of default cover, you will not be able to elect additional default cover. Instead you will have to apply for cover and provide health evidence to the Insurer. DBD members electing contribution flexibility If you join UniSuper as a DBD member and on joining you elect to reduce your standard contributions under UniSuper s contribution flexibility arrangements, you can receive default and additional default cover but must satisfy the following: you need to elect to receive default cover within 30 days of joining, and we need to receive a contribution into your accumulation component within 120 days of you joining. Please see the Defined Benefit Division and Accumulation 2 PDS for information on contribution flexibility. Income Protection cover without underwriting for Accumulation 1 and Spouse Account members Accumulation 1 members and Spouse Account members who are eligible for default cover have the ability to apply for Income Protection insurance cover without underwriting to the Insurer. The amount of cover you can get is the lesser of 23 units per month or the number of units which equate to 85% of your salary. Accumulation 1 members can apply within 180 days of being first eligible to join by completing the appropriate section of the Accumulation 1 application form. Spouse Account members can apply within 180 days of their sponsoring spouse becoming first eligible, an employer or voluntary member contribution is made to the Spouse Account, and the Spouse Account member is gainfully employed for reward. Any Income Protection cover applied for without underwriting will have a waiting period of 90 days and a benefit payment period of two years. You can apply to change your waiting period to 30 or 60 days, or apply to change the benefit period to five years or to age 65, but you will need to go through underwriting. The waiting period and benefit period you select will determine your premium. Please see the Income Protection cover premium tables on page 26. please note If you re a DBD member considering transferring to Accumulation 2 within your first 24 months of membership, it s important that you read the What happens to your inbuilt benefits if you choose Accumulation 2? information booklet available from unisuper.com. au/pds. Any cover you already have will count toward your transitioned cover automatic acceptance limit. A pre-existing exclusion will apply to some or all of your transitioned cover.
10 Insurance in your super What insurance do you get upon joining UniSuper? 9 Accumulation 2 members who transfer from the DBD generally receive Income Protection cover. Refer to the section titled Transitioned cover on page 3. Note that DBD members may not be able to access Income Protection cover. DBD members are generally provided with inbuilt benefits. Refer to the Defined Benefit Division and Accumulation 2 PDS for details. please note The cover you receive by default may have restrictions or exclusions imposed. Please see page 15 for more information. When else could you get cover? APPLYING FOR UNDERWRITTEN COVER Default cover may not provide you with enough cover to suit your own personal situation. UniSuper offers you the ability to apply for increased levels of cover to better protect yourself and your family. If you wish to apply for or increase your level of Death, TPD or Income Protection cover, your application must be assessed by the Insurer. Changes to your Income Protection cover that involves decreasing your waiting period or increasing your benefit payment period will also need to be assessed by the Insurer. All applications for insurance cover are subject to acceptance by the Insurer. The Insurer has the ability to accept, decline or impose restrictions, exclusions and/or loadings on the insurance premiums. If the Insurer accepts your application via underwriting subject to restrictions, exclusions and/or loadings on the insurance premiums, these conditions will apply immediately from the date cover commences and we will notify you in writing. Interim accident cover While your application for additional cover is being assessed, interim accident cover will be provided if you meet certain conditions. Death and TPD Interim accident cover will be provided if you die or suffer TPD (if you requested TPD cover) as a result of an accident (accidental injury causing death or TPD through visible, violent, external event to the body). The interim accident cover provided will be the lesser of: the amount of cover you are applying for, or A A $2,000,000 less the amount of any insured cover you already have under the policy. Duty of disclosure Your duty of disclosure You have a duty under the Insurance Contracts Act 1984 to disclose to the Insurer every matter that you know, or could reasonably be expected to know, is relevant to the Insurer s decision whether to accept the risk of insurance and, if so, on what terms. You have the same duty to disclose those matters to the Insurer before you renew, extend, vary or reinstate your insurance cover. However, your duty does not require disclosure of a matter that: diminishes the risk to be undertaken by the Insurer is common knowledge the Insurer knows or, in the ordinary course of its business, ought to know, or the Insurer has waived. Non-disclosure If you fail in your duty of disclosure and the Insurer would not have provided insurance cover if the failure had not occurred, the Insurer may avoid paying the insured benefit under the policy. The Insurer may also avoid paying an insured benefit at any time if your non-disclosure is fraudulent. When the Insurer is entitled to avoid paying an insured benefit, the Insurer may elect to reduce the sum insured in accordance with a formula that takes into account the insurance premium that would have been payable if you had disclosed all relevant matters to the Insurer. Incorrect information or misrepresentation If you provide incorrect information or fail to comply with your duty of disclosure (for example, you fail to disclose a medical condition that you were aware of before obtaining Death and TPD cover with the Insurer), the Insurer may be legally entitled to avoid or vary any benefit payable to or in respect of you. Cover generally commences on the date the Insurer accepts your application for cover.
11 10 Insurance in your super What insurance do you get upon joining UniSuper? Whether you are covered for interim accident cover for Death and TPD or Death-only cover will depend on the type of cover you have applied for. Interim accident cover starts when UniSuper receives your application form and will cease on the earlier of 120 days from the date you applied for additional cover, or on the date your application is accepted, declined, withdrawn, or the date the interim accident cover is cancelled by the Insurer. Income Protection Interim accident cover will be provided if you suffer total disability as a result of an accident occurring during the interim accident cover period. If this happens, you will receive a monthly benefit of up to 85% of your salary equal to the lesser of: the units of cover you have applied for, and A A $15,000 per month less any amount payable for the same event under another condition of the policy. Your interim accident cover period starts when UniSuper receives your application for additional cover and ceases on the earlier of 120 days from the date you applied for additional cover, the date your application is accepted, declined, cancelled, withdrawn or the date the interim accident cover is cancelled by the Insurer. There is no interim accident cover if you suffer partial disability during this period. The interim accident benefit will continue to be paid until the earlier of the date you cease to be totally disabled, expiration of the applicable benefit payment period, you reach age 65, or you die. What are inbuilt benefits? Inbuilt benefits are provided to DBD members and calculated according to a formula set out in the Trust Deed. Please see the Defined Benefit Division and Accumulation 2 PDS for further information. TRANSFERRING BETWEEN MEMBERSHIP CATEGORIES There are several reasons why UniSuper members may change membership categories. You may have started as a DBD member and have chosen to transfer to Accumulation 2. Your employment situation may change (i.e. you move from being a contractor to a permanent employee or vice versa), thereby automatically changing your UniSuper membership category. Depending on which membership category you transfer to and from, your insurance may stay the same or it may change. This section provides an overview of what happens to your insurance. When transferring between membership categories, members generally keep any existing insurance cover they have with the same restrictions, loadings and exclusions, provided they continue to meet the eligibility requirements and other criteria. The table on the opposite page illustrates how cover changes when you transfer between membership categories. Where transitioned cover is provided to a member with existing fixed insurance cover, the transitioned cover will also be fixed, rounded up to the next $1,000. Accumulation 1 members who had previously elected to transfer to Accumulation 2 from the DBD may be transferred back to Accumulation 2 if their employment circumstances change. Accumulation 1 members who have Income Protection cover and are transferred back to Accumulation 2 will be able to elect to retain any Income Protection cover they had as an Accumulation 1 member by notifying us in writing within 90 days of becoming an Accumulation 2 member. If the member does not make an election, they will be automatically provided with the transitioned Income Protection cover. Members transferring from the DBD to Accumulation 2 should refer to the What happens to your inbuilt benefits if you choose Accumulation 2? information booklet for details about how inbuilt benefits are transitioned to external cover including the restrictions, terms and conditions that may apply.
12 Insurance in your super What insurance do you get upon joining UniSuper? 11 transferring from: Transferring to: Accumulation 1 Accumulation 2* DBD Accumulation 1 N/A Death and TPD insurance cover already in place continues with any existing restrictions, loadings or exclusions. Income Protection cover already in place may continue or transitioned Income Protection cover is provided. Death and TPD insurance cover already in place continues with any existing restrictions, loadings or exclusions. PLUS, if applicable^ Transitioned Death and TPD insurance cover, based on the dollar value of the inbuilt death benefits you would have been entitled to if you were a DBD member at the date of transfer. In addition, transitioned Income Protection cover with a 90-day waiting period and fiveyear benefit payment period is generally provided based on your salary. PLUS Inbuilt benefits automatically provided. AND Income Protection cover ceases. Transitioned cover is subject to eligibility and Ls. See a detailed example on how this is calculated on page 12. N/A Accumulation 2 Insurance cover already in place continues with any existing restrictions, loadings or exclusions. Insurance cover already in place continues with any existing restrictions, loadings or exclusions. N/A DBD AND Inbuilt benefits cease. # Insurance cover already in place continues with any existing restrictions, loadings or exclusions. PLUS Inbuilt benefits cease and you receive transitioned Death and TPD insurance cover, based on the dollar value of inbuilt death benefits you were entitled to as a DBD member immediately prior to the date of transfer. In addition, transitioned Income Protection cover is generally provided based on your salary with a 90-day waiting period and a five-year benefit payment period. N/A Transitioned cover is subject to eligibility conditions, PEC and Ls. Spouse Account Refer to the What happens to your inbuilt benefits if you choose Accumulation 2? information booklet for details. N/A N/A As per transferring from Accumulation 1 to DBD. ^ Members will receive Death, TPD and Income Protection cover subject to eligibility and other criteria when transferring from Accumulation 1 to Accumulation 2 if they were last an Accumulation 2 member before 3 January 2015, or have no insurance cover when recommencing Accumulation 2. # Inbuilt benefits can continue for up to 90 days after ceasing employment. * Please note a pre-existing condition (PEC) exclusion will apply to some or all of your transitioned insurance cover. Please see page 16 for details.
13 12 Insurance in your super What insurance do you get upon joining UniSuper? Transitioned Income Protection cover: an example Vivian is aged 40, working full-time with a salary of $100,000 and has a service fraction of 100%. Vivian started her UniSuper membership in Accumulation 2, then transferred to Accumulation 1. Due to her employment circumstances changing she is transferred back to Accumulation 2. She already has 12 units of Income Protection insurance cover with a 60-day waiting period and benefit period to age 65 from her Accumulation 1 membership. Her 12 units of Income Protection cover provide a monthly benefit of up to $5,200 per month. The inbuilt death benefit she would have been eligible to receive as a DBD member is $420,000. Each unit of Death and TPD cover at age 40 (age 41 next birthday), equals $149,000 so Vivian receives three units of Death and TPD cover: 420, ,000 = 2.8 units, which is rounded up to three units. Based on her salary, Vivian is provided with 17 units of transitioned Income Protection cover which provides a monthly benefit of up to $7,367 per month with the default benefit period of five years and a waiting period of 90 days. She can choose to keep her existing Income Protection cover by notifying UniSuper within 90 days. please note When deciding whether to elect to retain your existing Income Protection cover, you should consider the restrictions, loadings or exclusions that apply to both your existing Income Protection cover and the transitioned Income Protection cover. For information on the restrictions and exclusions relating to transitioned cover, please refer to the What happens to your inbuilt benefits if you choose Accumulation 2? booklet available from unisuper.com.au/pds. TRANSFERRING COVER FROM ANOTHER FUND If you have cover with another superannuation fund or cover with another insurer and you are less than age 61, you may be able to transfer this cover to UniSuper provided you meet all of the following conditions: you rollover your whole superannuation balance from your other superannuation fund to UniSuper, you cancel the insurance cover from your other superannuation fund, not exercise a continuation option, or reinstate the cover (now or in the future) or transfer the cover to another superannuation fund, your cover with the other superannuation fund must not have been subject to any loadings, restrictions or exclusions in regard to medical or other conditions, you have provided satisfactory evidence to us about the type, amount of cover and the waiting period and benefit payment period in respect of Income Protection cover which applied to you under the cover you have with your other fund, you have completed, to the Insurer s satisfaction, the application or other documents which the Insurer requires, and at the date of your application, in respect of Death and TPD cover: you have never been paid or are eligible to be paid, or are currently in the process of submitting a claim for any illness or injury through a superannuation fund, insurance policy, workers compensation, or Government benefits (such as sickness benefit, invalid pension) providing terminal illness, total and permanent disablement or Income Protection cover, including accident or sickness cover you have not been diagnosed with, or suffer from, an illness or injury that may cause permanent inability to work or which reduces or is likely to reduce your life expectancy to less than 12 months from the date of your application you have never had an insurance application for death, total and permanent disablement, or Income Protection cover (including accident or sickness cover) declined, postponed or offered on non-standard or modified terms such as a loading and/or exclusion, including but not limited to pre-existing condition exclusions you are not, at the date of this application, due to injury or illness, off work or restricted or unable to fully perform without limitation all of the duties of your current or usual occupation for at least 30 hours per week, even though your actual employment may be on a full-time, parttime or casual basis or you may be unemployed
14 Insurance in your super What insurance do you get upon joining UniSuper? 13 you have not, in the last 12 months been absent from work or unable to fully perform: i) the duties of your usual occupation (whether employed or unemployed); or ii) your unpaid domestic duties, if you are unemployed and your sole occupation is the performance of unpaid domestic duties; due to illness or injury (other than cold or flu) for more than 10 days. at the date of your application, in respect of Income Protection cover: you have not been diagnosed with, or suffer from, an illness that reduces your life expectancy to less than 12 months you are gainfully employed (or self-employed) and are physically capable of undertaking gainful employment for at least 30 hours per week you have not received, have not been admitted for, and have not satisfied the requirements for a total and permanent disablement or terminal illness benefit from any superannuation fund or life policy issued to a superannuation fund or a life insurer, and you are not claiming or currently entitled to claim an Income Protection benefit from any superannuation fund or life policy issued to a superannuation fund or a life insurer. the insured cover, including existing and transferred cover, cannot be more than: the maximum cover limit, and 85% of the member s salary. Any Death and TPD cover you transfer will be provided by UniSuper as fixed cover and will be rounded up to the nearest $1,000. It is important to note that any existing Death and TPD unitised cover you have with UniSuper will also be converted to fixed cover. Once your cover is fixed, you cannot revert it back to unitised cover. The total amount of cover transferred and any existing cover cannot exceed the maximum cover limits. To transfer cover, you will need to complete the Transfer of insurance cover form, available from the Forms and Documents section of our website, unisuper.com.au. Subject to meeting all of the conditions set out in this section, the transferred cover will commence on the later of the following: the date the Insurer accepts your application to transfer cover, and the date of cancellation of your existing cover with the other superannuation fund. Note cover will not commence if there are insufficient funds from which premiums can be deducted. DBD members cannot transfer Income Protection cover from another fund. LIFE EVENTS COVER UniSuper provides a straightforward process for members under age 55 to increase their Death and/or TPD cover in the following circumstances: Life event Purchasing a home for their permanent residence and taking out a mortgage Getting married Giving birth to or adopting a child Commencing a de facto relationship Divorcing or terminating a de facto relationship Death of a spouse including a de facto Dependent child starting tertiary education Evidence required with your application within 90 days of the event Certified mortgage documents Certified marriage certificate Certified birth certificate or adoption papers. Statutory declaration form One of the following: for legal marriages, divorce orders for de facto, Statutory declaration form Death Certificate Enrolment details or acceptance letter from school Specific eligibility criteria for Life Events cover To be eligible to obtain an increase in your existing external Death and/or TPD cover through a life event without having to provide medical evidence, you must satisfy the following: you are less than age 55 on the date that you apply for an increase in cover under the life event provisions, your cover under the policy is not subject to any special conditions such as a premium loading, restriction or exclusion (other than a PEC), you must not have previously been declined cover under the policy, you must apply within 90 days of the life event, provide sufficient evidence that the life event has occurred, you have not applied for Life Events cover in the previous 12 months, and your cover does not exceed maximum cover limits.
15 14 Insurance in your super What insurance do you get upon joining UniSuper? You must not have applied for this cover for the same occurrence of the life event. For example, you can apply for Life Events cover when your first child starts tertiary education and apply once more when your second child starts tertiary education. The amount of Life Events cover will be: Unitised cover one additional unit of the same type of cover Fixed cover the lesser of 25% of the existing level of cover, or $200,000. Are there any restrictions? If you make a claim within the first six months of the date your increased cover commences under Life Events cover, the Life Events portion of your benefit will only be payable if the claim is the result of an Accident (which means accidental injury causing death or TPD through visible, violent, external event to the body). How to apply If you want to apply for Life Events cover, please read the Life Events and Salary Increase cover fact sheet and complete the form available at unisuper.com.au. If your application for Life Events cover is successful, the additional cover will be added to your existing Death and/or TPD insurance cover and will commence on the date the Insurer notifies UniSuper in writing that it has agreed to provide cover. INCOME PROTECTION AUTOMATIC UPDATE (ACCUMULATION 2 MEMBERS ONLY) In the event of a salary increase, our automatic update option can help you to ensure you have enough units of Income Protection cover to provide you with up to 85% of your salary in the event of illness or injury. Conversely, if you decide to work less hours, you may need less cover to make sure you re not over-insured and paying for cover you don t need. Subject to you meeting certain eligibility requirements, we will automatically update your Income Protection cover each six months to ensure that cover is kept up-to-date. If you don t want us to automatically update your cover, you can opt out of this process by completing the Application for insurance at UniSuper form attached to this booklet or the Changing your insurance cover form available from the Forms and brochures section of our website. Please note that Income Protection is subject to an automatic acceptance limit (L) of 34 units. Automatic updates will never increase your cover above 34 units but may in fact decrease your cover to or below the L of 34 units. Automatic updates will not occur in the following circumstances: within six months of receiving salary increase cover if your cover is subject to loadings or exclusions (other than a pre-existing condition (PEC) exclusion) if you re on claim or entitled to a claim under the policy if you re no longer an Accumulation 2 member if you don t already have Income Protection cover if you ve previously had an application to increase your Income Protection cover declined if you re not in active employment. SALARY INCREASE COVER If you receive an increase in salary, you may apply to increase your Income Protection cover by one unit with limited underwriting (outside the six-monthly automatic update for Accumulation 2 members see above) if you receive a salary increase, subject to the maximum cover limit. This is known as salary increase cover. You will be eligible for salary increase cover without having to meet full underwriting requirements if: you are in active employment on the date of application; A date of your application; A A you already have Income Protection cover on the you are under age 55 on the application date; your cover is not subject to any special conditions such as premium loadings, restrictions or exclusions (other than a pre-existing condition (PEC) exclusion); you have not previously had an application to increase your Income Protection cover declined; you have not applied for salary increase cover in the previous 12 months; we receive your completed application form for salary increase cover within 90 days of your salary increase occurring; you provide us with evidence of your salary increase, and if the automatic update would increase your cover above the maximum cover limit. Salary increase cover will commence if and when your application is accepted by our Insurer. If a claim arises within the first six months of your salary increase cover, you will only receive a benefit for the salary increase cover amount if the claim is as a result of an accident.
16 15 Exclusions and special conditions Exclusions and special conditions for Death-only, TPD-only and Death and TPD cover In addition to the pre-existing condition (PEC) exclusion (refer to page 16), the following exclusions and special conditions apply to your Death and TPD, Death-only cover, or TPD-only cover. War-related events No benefit is payable in respect of additional cover where your death, terminal illness or TPD is directly or indirectly caused by war (whether declared or not) or war-like operation or civil commotion. Self-inflicted injury, infection or attempted suicide No benefit is payable in respect of additional cover where death, terminal illness or TPD is caused by self-inflicted injury, self-inflicted infection or attempted suicide. Working overseas Death and/or TPD cover will continue to be provided while you are overseas subject to the following conditions: your cover has not ceased under the policy you remain employed by that employer you remain a member of UniSuper, and the continued payment of premiums. Employer-approved leave Death and/or TPD cover will continue to be provided to you while you take leave approved by your employer, subject to the following conditions: you had insured cover immediately prior to commencement of your leave and your cover has not ended under the policy, the leave has been approved by your employer, you remain to be employed by your employer and remain a member of UniSuper, and the continued payment of premiums. Exclusions and special conditions for Income Protection cover In addition to the pre-existing condition exclusion (refer to page 16), the following exclusions and special conditions apply to Income Protection cover with UniSuper. No Income Protection benefit will be payable if the injury or illness is caused directly or indirectly by one of the following: self-inflicted harm or attempted suicide, regardless of whether you were sane or insane at the time, normal and uncomplicated pregnancy or childbirth. For the purposes of this exclusion, multiple pregnancy, threatened or actual miscarriage, participation in an IVF or similar program, discomfort commonly associated with pregnancy, such as morning sickness, backache, varicose veins, ankle swelling or bladder problems are not considered to be abnormal or complications of pregnancy, engaging in an excluded occupation that the Insurer does not cover (where the Insurer has not given prior approval), participation in a criminal act, service in the armed forces (excluding the Australian Defence Force Reserve), A active participation in militant activities, A rebellion or civil unrest, or A A war (whether declared or not), revolution, invasion, A pandemic illness, subject to the Insurer providing UniSuper with at least 14 days prior notice.
17 16 Insurance in your super exclusions and special conditions Working overseas If you re working overseas, Income Protection cover will continue to be provided while you are overseas subject to the following conditions: your residence overseas is not due to injury or illness your cover has not ceased under the policy you remaining employed by that employer you remain a member of UniSuper, and the continued payment of premiums. Income Protection benefits will only be paid for a maximum of six months while you are overseas, unless otherwise agreed between UniSuper and the Insurer. You must return to Australia at your own expense for Income Protection benefits to continue. employer-approved leave If you take employer approved leave, Income Protection cover will continue to be provided to you, subject to the following conditions: you had insured cover immediately prior to commencement of your leave and your cover has not ended under the policy, the leave has been approved by your employer, you remain employed by your employer and remain a member of UniSuper, the continued payment of premiums. You must advise UniSuper in writing about any periods of employer-approved leave to ensure that your Income Protection cover continues during these periods. Note that periods of leave without pay can impact your Income Protection benefit if you have no salary on record, no Income Protection benefit is payable. If your Income Protection cover stops you will generally need to re-apply (and provide health evidence to the Insurer) on your return to work. Pre-existing condition (PEC) exclusions The PEC exclusion means that if you had an illness or injury which was pre-existing prior to the cover commencing or recommencing, you won t be covered for that illness or injury until the PEC exclusion is removed. PEC exclusions apply for a pre-defined period, typically 12 months or up to three years, depending on how you get the cover, and we refer to the period that a PEC exclusion applies as the PEC period. PEC on transitioned cover A PEC exclusion period will apply to some or all of your cover if you receive cover on transferring to Accumulation 2 from either the DBD or Accumulation 1. DBD members transferring to Accumulation 2 If you have a PEC exclusion remaining on your inbuilt benefits when you transfer to Accumulation 2, it will continue to apply to your transitioned Death, TPD and Income Protection cover from the date you transfer and you will be required to serve the balance of your three-year PEC exclusion period. This means no Death, TPD or Income Protection benefit will be payable during the remainder of your PEC period in relation to the pre-existing illness or injury that existed at any time prior to when you first became a DBD member. If you have already served the three-year PEC period on your inbuilt benefits when you transfer to Accumulation 2, a 12-month PEC exclusion will apply to the increased cover (uplift cover) you receive as a result of the conversion from your inbuilt death benefit to external Death and TPD insurance cover, and to all of your transitioned Income Protection cover. This means that, for 12 months from the transfer date, no Death or TPD benefits will be payable on uplifted cover and no Income Protection benefits will be payable for pre-existing conditions (i.e. conditions or injuries that existed at the time your cover was transitioned). Refer to the What happens to your inbuilt benefits if you choose Accumulation 2? information booklet for details.
18 Insurance in your super exclusions and special conditions 17 Accumulation 1 members transferring to Accumulation 2 If you are an Accumulation 1 member transferring to Accumulation 2 and you receive transitioned cover, a three-year PEC period will generally apply to your transitioned Death, TPD and Income Protection cover from the date you transfer. When else may a PEC apply? Typical circumstances where a 12-month PEC period will apply to TPD cover include where: your default cover recommences after 180 days of cover ceasing you meet the eligibility requirements for default cover however UniSuper does not receive an employer contribution within 180 days of you being first eligible to join UniSuper or in the case of a Spouse account member, UniSuper does not receive an employer contribution or voluntary member contribution within 180 days of the sponsoring spouse becoming first eligible to join the Fund you are not in active employment when cover commences in the case of a Spouse Account member, the member is not actively performing all duties of their usual occupation on the date of commencement of default insurance or additional default insurance you apply for up to two units of additional default insurance cover however UniSuper does not receive an employer contribution within 180 days of you being first eligible to join UniSuper or in the case of a Spouse Account member, UniSuper does not receive an employer contribution or voluntary member contribution within 180 days of the sponsoring spouse becoming first eligible to join the fund. The PEC exclusion will be removed at the end of the 12-month period. However, if you are not in active employment at the end of the 12-month period, the exclusion will continue to apply until you ve returned to active employment for two consecutive months. Note: A PEC exclusion can be removed at any time subject to the completion of medical evidence and acceptance by the Insurer or if you make an application for additional cover with underwriting and it is accepted without any individual conditions, exclusions, restrictions or loadings. Waiting periods Waiting periods refer to the time period in which you are unable to work due to illness or injury before your insurance claim can be assessed. Death claims If you had Death cover at the date of your death, the insured benefit will be paid to your legal personal representative and/or your beneficiaries as a lump sum. No waiting period applies to Death or terminal illness claims. TPD claims If you re eligible, generally a six-month waiting period applies, but this is waived if: you have cancer, chronic renal failure, coronary artery bypass surgery, heart attack, stroke, transient ischaemic attacks, chronic liver or lung disease, major head trauma, severe burns or total deafness or blindness as defined in the policy; you suffer Whole Person Impairment within the meaning of the policy; or for members who commence cover on or after 1 July 2014, your TPD is caused by the permanent loss of the use of two limbs; the total sight in both eyes; or the use of one limb and the total sight of one eye. An exception also applies if your cover ceases after your date of disablement but prior to having served the six-month waiting period if you were less than 65 and gainfully employed prior to the date of disablement and you have not performed any form of gainful employment since your cover ceased. In this case the Insurer will waive the requirement that you must be absent from gainful employment for six consecutive months prior to cover ceasing. Income protection claims The default waiting period for Income Protection cover is 90 days, however you can choose to elect a waiting period of 30 or 60 days. The waiting period you select will determine your premium. Please see the Income Protection cover premium tables on page 26. If you choose to decrease the waiting period applicable to your cover, you must complete an application form and satisfy the Insurer s underwriting requirements. The waiting period commences on the date you first receive medical advice from a doctor about your injury or illness and the doctor certified on that day that you are totally disabled. At the end of the waiting period, a benefit will be paid in arrears for each month for which you are entitled to it and you still meet the required total and partial disability definition.
19 18 Insurance in your super exclusions and special conditions Where you suffer one of the specific illnesses listed below during the waiting period, you will also be entitled to one times your monthly insured benefit (known as a specific illness benefit ). These specific illnesses are: cancer chronic liver disease chronic lung disease chronic renal failure coronary artery bypass surgery heart attack major head trauma severe burns stroke total blindness total deafness or transient ischaemic attacks Each specific illness is defined in the policy. What if you return to work during the waiting period? If you return to work during your waiting period and it proves unsuccessful because of the illness or injury causing total disability, the waiting period will continue as though there was no return to work as long as you do not return to work for more than nine days in total. If the return to work is for more than nine days, then the waiting period will recommence. If you return to partial work, or are capable of doing so, after 14 consecutive days of suffering total disability, a partial disability benefit may be payable once the waiting period has ended, provided you meet the criteria listed in the definition. Maximum cover levels Death and TPD There is no limit to the amount of Death cover you can apply for. The maximum amount of TPD cover you can apply for is $3 million. The maximum amount of terminal illness cover you can apply for is $3 million. If the terminal illness benefit paid out is less than the Death benefit, your dependants and/or estate will receive the remainder of your Death cover, subject to the premiums continuing to be paid for the remainder of the Death cover. Income protection The maximum amount of Income Protection cover you can apply for is 69 units or $29,900 per month. The maximum period an Income Protection benefit can be paid is the lesser of the period that applies to you (if you have elected a two year or a five year benefit payment period) and to age 65. The minimum monthly benefit payment that can be insured is one unit which equals $433 per month or $100 per week. Where your selected level of Income Protection is less than 85% of your salary, your selected level of Income Protection cover will apply, If 85% of your salary is less than your selected level of Income Protection Cover only the portion above 75% may be payable as an employer superannuation contribution.
20 19 Ceasing and recommencing insurance Reducing, cancelling and opting out You can reduce, cancel or opt out of your cover at any time. The change to your cover will take effect from the later of the date the Trustee (or the Insurer) receives notice in writing and, where applicable, the date nominated by you is the date you want your cover to reduce or cease (as long as it is not more than 30 days from the date UniSuper receives your request to reduce, cancel or opt out cover). You will need to complete the Cancelling or decreasing your insurance cover form available from the Forms and documents section of our website, or log in to MemberOnline at unisuper.com.au. Please note that DBD members cannot opt out of their inbuilt benefits. When else does cover cease? Insurance cover will cease on the earlier of the following events: you cease to be a UniSuper member, you cease to satisfy the eligibility conditions, your account has insufficient funds to pay the insurance premiums, you join the armed forces of any country (the Australian Defence Force Reserve is excluded for this purpose), you cease to satisfy the relevant conditions for continuation of cover whilst on employer approved leave, you reside overseas outside the Insurer s agreed conditions, you cease to be an Australian resident, your superannuation benefit in UniSuper is less than $2,000 and UniSuper has not received any contributions or rollovers for 12 consecutive months in respect of you, UniSuper gives the Insurer notice to the effect that it would like cover in respect of you to cease, UniSuper terminates the policy with the Insurer, or you die. Death and TPD In addition to the above, Death and TPD cover ceases in the following circumstances: the Insurer admits your claim for a benefit, (unless it is a claim for a terminal illness benefit and you continue to be covered for a residual Death benefit), you reach age 70 for TPD cover, or you reach age 75 for Death (including terminal illness) cover. Income protection In addition to the above, Income Protection cover ceases in the following circumstances: you permanently retire from the workforce, or you have been in receipt of Income Protection benefits for the full benefit payment period applicable to your Income Protection cover, or you reach age 65. Even if your cover has ceased, in some circumstances you may still be entitled to a benefit if the date of your illness or injury occurred before the date cover ceased and you were a member of UniSuper. How does cover reinstate or recommence? Your cover may cease because your accumulation account has insufficient funds to pay for your insurance premiums, or because your superannuation benefit in UniSuper is less than $2,000 and no contributions or rollovers have been received into your account for 12 consecutive months. If your cover ceases in these circumstances, it may be reinstated or recommenced depending on whether both an employer contribution is received into your account and your accumulation account balance reaches $2,000 within 180 days or after 180 days of cover ceasing. Note: If your cover ceased prior to 3 January 2015 the rules regarding reinstatement or recommencement existing at the time of your cover ceasing will apply.
Your super when you leave your job Issued January 2015 by UniSuper Limited ABN 54 006 027 121 Dr Ann McNeill, the University of Adelaide Prepared by UniSuper Management Pty Ltd (ABN 91 006 961 799, AFSL
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