Energy Super Insurance Guide. Prepared and issued 30 April 2013

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1 Energy Super Insurance Guide Prepared and issued 30 April 2013

2 Contents Insurance Overview 1 Death & Total and Permanent Disablement cover 1 Income Protection cover 9 Other insurance information 15 Definitions 16 About this Energy Super Insurance Guide The information in this document forms part of the Energy Super Member Guide Product Disclosure Statement (PDS) issued on 22 June 2012 by Electricity Supply Industry Superannuation (Qld) Ltd (ABN AFSL ) (the Trustee) as the Trustee for Energy Super (ABN ) (the Fund). If you would like a copy of the Energy Super Member Guide or this document, please contact Energy Super on ENERGY ( ). This information will be provided at no cost. This Energy Super Insurance Guide describes the features and benefits of the insurance cover provided to new Defined Contribution and Public Offer members whose employers do not have special insurance arrangements with Energy Super. It will help you decide whether the available cover will meet your needs and might also help you compare our cover with other products you are considering. This Energy Super Insurance Guide is not relevant to members joining the Fund under a corporate agreement arranged by their employer. This Energy Super Insurance Guide has been prepared for general information only. It does not take into account your financial objectives, financial situation or needs. Any statements of law or proposals are based on our interpretation of the law or proposals as at the date this Energy Super Insurance Guide was issued. If you require specific advice, we recommend that you seek qualified professional advice. Energy Super members have access to professional financial advice through ESI Financial Services Pty Ltd (ESI FS) (ABN , AFSL ). If there are any inconsistencies between the terms of the Energy Super Trust Deed and this Energy Super Insurance Guide, the terms of the Trust Deed prevail. The information in this Energy Super Insurance Guide is up-to-date at the date it is issued. Some of the information in this document can change from time-to-time and may not be up-to-date at the time you receive it. If a change is not materially adverse, we may not update this Energy Super Insurance Guide. Updated and new information will be published on our website. If you would like more information about Energy Super please contact us. We will provide you the information you reasonably require to make an informed assessment of the management, financial condition and investment performance of Energy Super. If you have any questions about being a member of Energy Super (the Fund), you can contact us from 8.30am to 5pm Monday to Friday (excluding Queensland and National holidays). Contact us Phone ENERGY ( ) In person Level Creek Street Brisbane Qld Fax (07) Mail Energy Super PO Box 1958 Milton QLD 4064 Website energysuper.com.au

3 Insurance Overview Death & TPD cover With Energy Super s insurance arrangements you have a convenient low cost solution for your personal insurance needs. Having the right level of personal insurance cover is an important part of your overall superannuation strategy. It is essential that you periodically review how much cover you have to ensure it is enough to meet your needs. Need help with your insurance cover? Our single issue advice service can give you personal advice over the phone at no additional cost to you. Simply call us on ENERGY ( ) or visit our website at energysuper.com.au to schedule an appointment with an adviser. Your Death & TPD cover is a valuable benefit should you die or become totally and permanently disabled through illness or injury. With Energy Super s Death & TPD insurance offer you have the flexibility to choose the cover that best suits your needs. You can choose units of insurance cover or a fixed-dollar amount of insurance cover. Furthermore, if you are transferring your super from another fund where you had Death and/or TPD cover, you may even be able to transfer the same level of insurance cover to us without having to provide evidence of your good health. See page 7 for details. The insurance cover you are initially eligible to receive automatically is determined by how you join Energy Super, either through an Energy Super employer or by applying directly to the Fund (as a Public Offer member). The types of insurance cover automatically available through Energy Super are: Death & Total and Permanent Disablement (TPD); Death Only; and Income Protection (IP). IBR Energy Super Insurance Guide 1

4 Joining Energy Super (two ways to join) Insurance features Joining through an Energy Super employer Joining as a Public Offer member Automatic cover Automatic Acceptance Limit (AAL) if you re eligible for insurance under AAL conditions you are not required to provide evidence of your good health. Optional or additional cover Paying for insurance cover Transferring cover If eligible, you will receive the default age-based number of units with an automatic life-stage increases feature. See page 3 for details. AAL means you can get the automatic cover (explained above) for Death & TPD if you are less than age 70 and you join Energy Super within 120 days of commencing work with an Energy Super employer. If you are less than age 65 when joining Energy Super, you may apply for even more cover than the default without having to provide evidence of your good health (up to 10 units in total) when you apply within 60 days of joining Energy Super. See the Member Application Form to apply. You can apply for additional insurance cover, up to the maximum limits of $10 million for Death and $3 million for TPD, by completing a Change of Insurance Form. If you choose fixed-dollar cover, the fixed-dollar cover will replace any units of Death & TPD cover you may have. To apply for cover if you are not eligible under the AAL or want more cover, please complete a Change of Insurance Form. You may need to complete a Personal Statement and undergo medical tests in some circumstances. The cost of your Death & TPD insurance cover is deducted from your Energy Super account monthly. If you are rolling over your super from another fund, where you also have insurance arrangements, you may be able to transfer the same level of cover under take over terms in Energy Super. For more information see Transferring your cover from another super fund on page 7. You do not receive an automatic level of cover when you join Energy Super. Any Death & TPD cover you apply for is subject to acceptance by the Insurer. You can apply for insurance cover (unit-based or fixed-dollar cover) on the Change of Insurance Form. Your insurance cover is optional (you do not have to take out cover). You can apply for insurance cover, up to the maximum limits of $10 million for Death and $3 million for TPD, by completing a Change of Insurance Form. You will need to complete a Personal Statement and undergo medical tests in some circumstances. The cost of your Death & TPD insurance cover is deducted from your Energy Super account monthly. When you join the Fund and apply for insurance cover we require you to either: make regular contributions into your Energy Super account; or open an Energy Super account with $1,000 or more. If you are rolling over your super from another fund, where you also have insurance arrangements, you may be able to transfer the same level of cover under take over terms in Energy Super. For more information see Transferring your cover from another super fund on page 7. 2 Energy Super Insurance Guide IBR

5 Unit-based cover Features: insurance cover is based on multiples of units the benefit amount of each unit reduces with age the cost per unit remains the same. Automatic life-stage increases in cover The automatic life-stage increases feature is the default cover for members joining through an Energy Super employer. Members joining by direct application to Energy Super can select the automatic life-stage increases feature when they apply for Death & TPD insurance cover. The life-stage increases feature will automatically increase your units of cover by 1 unit when you move from one age bracket to another. The cost of your insurance will also automatically increase in line with the number of units. For example, if you select the life-stage increases feature only (i.e. you do not select any additional units of cover), your units of cover will automatically increase from 2 to 3 units when you turn 29 years of age (your age next birthday will be 30). Age next birthday To age to to to to 70 5 Units of cover This means that the amount of cover you have will automatically increase at a time when you are most likely to need it because of your greater commitment to work, debts and family. The maximum cover obtained under the life-stage increases feature is when your age next birthday is 35, i.e. your Death & TPD cover is equal to $332,000. Cover begins to reduce when your age next birthday is 40. This is demonstrated visually in the graph below. Life - stage increases feature Life - stage increases feature $350,000 $300,000 $250,000 $200,000 Total cover ($) otal cover ($) $150,000 $100,000 $50,000 $ Age next birthday Age next birthday IBR Energy Super Insurance Guide 3

6 How to calculate your unit-based cover Your insurance cover = number of units purchased x amount of cover per unit for your age next birthday Amount of cover per unit Age next Death & Death Only Age next Death & Death Only Age next Death & Death Only birthday TPD ($) ($) birthday TPD ($) ($) birthday TPD ($) ($) Up to ,600 48, ,800 28, ,400 13, ,400 47, ,000 27, ,800 12, ,400 46, ,300 26, ,300 11, ,300 46, ,000 24, ,000 11, ,300 46, ,200 23, ,400 10, ,000 43, ,600 22, ,200 9, ,400 42, ,300 21, ,000 8, ,700 41, ,100 20, ,700 8, ,400 39, ,300 19, ,400 4, ,800 37, ,700 17, ,100 3, ,400 35, ,300 17, ,000 2, ,400 33, ,000 16, ,900 1, ,000 32, ,000 15, ,700 1, ,200 30, ,300 14,300 Fixed-dollar cover While unit-based cover is the default offered by Energy Super, you can also apply for fixed-dollar cover by completing a Change of Insurance Form. This form is available online at energysuper.com.au Features: insurance is based on a fixed-dollar amount of cover nominated by you the cost increases annually with your age the benefit amount remains the same fixed cover replaces any unit-based cover you may have. With fixed-dollar cover you choose the amount of Death & TPD insurance cover you require and the cost is calculated based on your age next birthday and your level of cover. The fixed-dollar cover table on pages 5 and 6 disclose the annual cost of each $1,000 of your cover. How to calculate fixed-dollar cover If you select fixed-dollar cover, the dollar amount of Death & TPD cover that you apply for will remain the same over time until you reach age 61. Your fixed-dollar cover for TPD will reduce proportionally from age 61 through to turning age 70, when cover stops. Your fixed-dollar cover for Death will not be affected by this and will not reduce. The age based tapering that applies to fixed-cover for TPD is shown as a percentage of your insured amount in the following table: Age next birthday 62 90% 63 80% 64 70% 65 60% 66 50% 67 40% 68 30% 69 20% 70 10% Eligibility for cover % of fixed cover All members of Energy Super, under age 70, can apply for Death & TPD cover. However, the definition of TPD is applied differently depending on your age, employment status and the number of hours you were working in the six month period prior to you becoming disabled (see Qualifying for a TPD benefit on page 7). Maximum amount of cover You can apply for additional cover at any time (unit-based or fixed-dollar) up to the maximum benefit limits of $10 million for Death and $3 million for TPD. You should note, however, that you may be required to complete a Personal Statement and undergo other tests as required by the Insurer. 4 Energy Super Insurance Guide IBR

7 When your cover starts If you: are joining Energy Super through an Energy Super employer your automatic cover or cover up to the Automatic Acceptance Limit (AAL) starts on the first day of your employment, provided you are At Work on that day and join Energy Super within 120 days of joining your employer. If you are not At Work on your first day of employment, (see At Work on page 16), Limited cover will apply (see Limited cover on page 16). You will need to be At Work for 30 consecutive days before your full cover applies. Any additional cover you take out, above the AAL, will commence on the day the Insurer accepts your application in writing. are joining Energy Super as a Public Offer member any optional cover you take out will commence on the day the Insurer accepts your application in writing. Interim accident cover While your application for optional/additional cover is being assessed, you will be provided with interim accident cover for the amount of additional cover you applied for, subject to a maximum amount of $1.5 million. Some conditions apply. Where interim accident cover applies, a benefit will only be payable where total and permanent disablement or death is caused by an Accident (as opposed to illness or other disability). For the definition of Accident see page 16. Interim accident cover starts from the date your application for optional/additional cover is received by the Fund. Interim accident cover will expire on the earliest of the following: 90 days after the commencement of the interim accident cover; the date your application for insurance is accepted or declined; the date you cancel or withdraw your application for insurance; or the date you are no longer eligible for insurance cover with Energy Super. No interim accident benefit will be payable for: injury caused by engaging in hazardous pastimes or sports that would not be covered under the Insurer s normal assessment guidelines; or injury occurring prior to the date you became eligible for cover. The cost of cover The cost of your Death & TPD insurance cover depends on the amount of cover you choose and whether it is unit-based or fixed-dollar cover. You may be eligible for a discounted rate for your insurance if your occupation is within the definition of White Collar/ Professional (the discount applies to both the unit-based and fixed-dollar cover). See page 16 for the definition of White Collar/Professional. The cost of your insurance will be deducted monthly from your Energy Super account. Unit-based cover Death & TPD Standard cost: $0.99 per unit per week Discounted cost: $0.80 per unit per week (if applicable) Death Only Standard cost: $0.65 per unit per week Discounted cost: $0.52 per unit per week (if applicable) Fixed-dollar cover Standard cost (annual cost per $1,000 sum insured) Age next birthday Death & TPD ($) Death Only ($) Up to IBR Energy Super Insurance Guide 5

8 Discounted cost* (annual cost per $1,000 sum insured) Age next birthday Death & TPD ($) Death Only ($) Up to *You may be eligible for a discounted rate for your insurance if your occupation is within the definition of White Collar/ Professional. See page 16 for definition. Increasing, reducing or cancelling cover You can apply to increase your Death & TPD cover at any time by completing a Change of Insurance Form. However, if you apply to increase your cover it must be within the maximum allowable limits (see Maximum amount of cover on page 4). Your increased cover will not commence until your application has been accepted by the Insurer. You can reduce or cancel your cover at any time by completing a Change of Insurance Form, which can be found on our website - energysuper.com.au. You can also cancel your cover over the phone by contacting us on ENERGY ( ). However, if at a later date you want to reinstate or increase your cover, you may need to complete a Personal Statement and undergo medical tests as required by the Insurer. Life changing events If you have a life changing event such as: getting married taking out your first mortgage the birth or adoption of a child; or getting a divorce, you are able to increase your Death & TPD cover by up to 2 units, or the equivalent amount of fixed-dollar cover, for each event (up to a maximum of 4 units in total) without having to provide any further health evidence to the Insurer as long as you are At Work on the date of your application. You must provide evidence of the event to the Insurer within 90 days of the event occurring. Proof of the event must be accepted by the Insurer before your cover is increased. Rewarding loyalty Once you have been a member of Energy Super for 10 years continuously, you may be eligible to receive additional Death & TPD insurance cover, without having to provide evidence of health to the Insurer. You will need to apply to the Fund s Insurer for the cover within 90 days of the event occurring or within 90 days of receiving your next Annual Statement or Record of Contributions, whichever occurs first, following your 10 year anniversary. For example, if you joined Energy Super in June 2011, and have been a member continuously since then, you will be eligible to apply to Energy Super to receive this cover from June If at the time of application you have unit-based insurance cover, you can apply for up to an additional 2 units, or the equivalent amount of fixed-dollar Death & TPD insurance cover. Limits on increases for life changing events and rewarding loyalty If your life changing events or rewarding loyalty application is accepted by the Insurer, your increased cover will only commence from the date of the Insurer s written acceptance, and will be subject to the same acceptance terms as your previous cover, including any premium loadings or exclusions. If at the time of application you have fixed-dollar cover, you will receive the equivalent of up to 2 additional units of cover as at your current age. Increasing your cover under life changing events or rewarding loyalty is subject to a maximum of four (4) additional units, or the equivalent amount of fixed-dollar cover, in total and is subject to maximum benefit limits (see Maximum amount of cover). For example, if you apply for 2 units when you get married then another 2 units when you reach your 10 year anniversary of Energy Super membership, you are unable to apply for any further cover under life changing events or rewarding loyalty. 6 Energy Super Insurance Guide IBR

9 Transferring your cover from another super fund If you are rolling over your super from another fund, where you also have Death & TPD insurance cover, you may be able to transfer that cover under take over terms to Energy Super. This means you can keep the same amount of cover (subject to the maximum allowable limits of $10 million for Death cover and $3 million for TPD cover) without having to complete questionnaires and undergo medical tests. Before we can set up cover in this way, you will need to provide us with written evidence from your previous fund of the amount of cover provided including any restrictions, additional premium loadings or exclusions applied. Unless agreed otherwise, those same terms will continue to apply to the transferred portion of your insurance cover with Energy Super. Before applying to transfer cover, you should note that: you must be At Work (see page 16) on the date you apply to Energy Super to transfer your cover from your previous fund; once cover has been approved with Energy Super, the equivalent amount of cover must be immediately cancelled with your previous fund; once cover has been transferred to Energy Super, if you wish to apply for further increases in cover you will need to complete a Change of Insurance Form; and if your application is accepted, your cover will commence on the date the Insurer accepts your application in writing. Your current and transferred cover will be on the basis of fixed-dollar and the cost for this cover will be based on the age rates set out on pages 5-6. If you wish to take up this option contact us on ENERGY ( ). Qualifying for a TPD benefit The definition of TPD is made up of four parts A, B, C and D (see below). The part that will apply to you will depend on your age and the hours you worked in the six month period prior to you becoming disabled, as follows: If at the time of becoming TPD you are: Less than age 65 and employed for at least 15 hours per week. Less than age 65 and employed for less than 15 hours per week or your occupation is classified as Home Duties. Parts* A B C D n/a n/a Aged 65 years or more n/a n/a * You may be declared TPD if you meet any of the four parts of the definition that applies to your circumstances. PART A: Own / similar occupation definition You have been absent from your occupation solely through injury or illness for a period of three consecutive months and are incapacitated to such an extent that, in the Insurer and Trustee s opinion, after consideration of medical and other relevant evidence, you were, at the end of the period of three consecutive months absence from employment, unlikely to ever engage in or work for reward in your own occupation and any similar occupation for which you are reasonably suited by education, training or experience. PART B: Specific loss You suffer the permanent loss of use of two limbs or the sight of both eyes; or the permanent loss of use of one limb and the sight of one eye (where limb is defined as whole hand or the whole foot) in circumstances where the loss will never be regained. PART C: Activities of daily living You are incapacitated to such an extent that, in the Insurer and Trustee s opinion, after consideration of medical and other relevant evidence, you are unlikely to ever be able to perform at least two activities of daily living without the physical help of someone else. For the purpose of this definition, activities of daily living means: bathing and/or showering; or dressing; or moving from place-to-place including in and out of bed and in and out of a chair; or eating or drinking; or using the toilet. PART D: Home Duties Where your occupation is classified as home duties, you have been absent from your occupation solely through injury or illness for a period of six consecutive months and you are incapacitated to such an extent that, in the Insurer and Trustee s opinion, after consideration of medical and other relevant evidence you were, at the end of the period of six consecutive months absence from employment, unlikely to ever again attend to at least two normal physical domestic household duties. For the purpose of this definition, normal physical domestic household duties means: cleaning the family home; or shopping for food and household items; or meal preparation and laundry services; or leaving the house without the assistance of another person; or looking after dependent child/children under 16 years of age or in full-time secondary education, where applicable; or providing full time care for a disabled person(s) who is a member of your immediate family, where applicable. Continued on page 8 IBR Energy Super Insurance Guide 7

10 PART D: Home Duties If you are able to perform the normal physical domestic household duties with the assistance of another person or with the use of assistive devices, you are deemed to be able to perform these duties. You must be under the regular care and attention and following the advice of a doctor for that injury or illness. Evidence that you carried out the duties on a daily basis prior to your period of disability will be required. Terminal illness Under certain circumstances a member may be declared terminally ill. If this was to apply to you, you will not have to serve any waiting period to become eligible to receive a terminal illness benefit. The definition of terminal illness is: you suffer from an illness which in the Insurer s opinion, after consideration of medical evidence, would reasonably be expected to reduce your life expectancy to less than 12 months; at least one of the registered medical practitioners is a specialist practicing in an area related to your illness or injury; and for each of the certificates, the certification period has not ended. The reduced life expectancy must occur while you are covered. The maximum benefit payable on being diagnosed as terminally ill is $3 million. If your Death cover is higher than $3 million, the benefit paid on your death will be reduced by the amount of the terminal illness benefit already paid. To be eligible to access your money you must meet the terminal illness condition of release. Overseas residence and travel Death & TPD cover applies 24 hours a day, 7 days a week, on a worldwide basis for Australian residents. You are considered to be an Australian resident for insurance purposes if you: have always lived in Australia or have come to Australia to live; and are eligible to work in Australia. When your cover ends Your Death & TPD cover with Energy Super will end on the earliest of the following: 60 days from the date your account balance is insufficient to cover the cost of the insurance premium; 60 days from the date you are no longer eligible for insurance cover, or are no longer a member of Energy Super; the date you exercise a continuation option (see right); the date you reach age 70; the date you die; the date you are paid a Death or TPD benefit; the date you are paid a Terminal Illness benefit that is not less than your Death and/or TPD benefit; the day before you commence service in the armed forces (other than the Australian Army Reserve) of any country; the date you cancel your insurance cover; and when cover for every member ceases under the group insurance policy because the insurance policy is cancelled. Please note: If you cease work with an employer but remain a member of Energy Super, your Death & TPD cover continues until you meet the above criteria. The cost of cover is deducted from your account. You can cancel or reduce your cover by contacting Energy Super. Continuation option If you cease employment with your employer and leave Energy Super, you can apply to continue your insurance under an individual policy with the Fund s Insurer. You must be under age 60 and submit the application within 60 days of ceasing employment. You will be applying for an individual policy under retail conditions, which is guaranteed to be renewed annually. The continuation option applies only when your previous cover in Energy Super ceases. The following conditions apply: your cover must have ceased as a consequence of you ceasing employment with your employer and not for reasons of ill health. Continuation of cover is not available where you leave Energy Super and there is no change in your employment; for TPD insurance you must commence full-time employment within 90 days of ceasing employment; you have not ceased to be an insured member because of duty in the armed forces (not including the Australian Army Reserve); the benefit will be no more than your insurance cover under Energy Super. Any special terms and conditions applying to your cover under Energy Super, including premium loadings or exclusions, will also apply under the individual policy; the cover will be provided on the terms, conditions and rates that are current for this type of insurance at the time, and must satisfy the Insurer s underwriting criteria in relation to occupation, pastimes, smoking status and residency status; the individual policy premium will be subject to the Insurer s normal minimum premium; you must not have received, nor be eligible to receive, any TPD payments (under a group life policy) or similar payments under any other policy; you must be a permanent resident of Australia. The Insurer may decline to provide cover under the continuation option where the Insurer has no retail product available to cover the occupational risk. The cost of your insurance will be based on the Insurer s standard pricing for similar policies that applies at the time of your application taking into account your age, sex, occupation and other matters. If you wish to apply for a continuation option contact us on ENERGY ( ). 8 Energy Super Insurance Guide IBR

11 Making a claim You should notify us as soon as is reasonably practical if you think you may be eligible to make a claim. You should not leave this decision for too long. If your claim is submitted more than one year after the event giving rise to the claim, and the delay prejudices the Insurer s ability to assess the claim, it may cause the Insurer to decline or reduce the amount it will pay in respect of your claim. If you have been off work for more than three months and you are unlikely to recover from your disability, or if you have been diagnosed with a terminal illness, you should discuss this with your doctor, your employer and Energy Super. To find out more about making a claim, call us on ENERGY ( ). If you leave Energy Super Your insurance cover will stop when you leave the Fund. However, the Insurer may consider your claim if: you die within 60 days of leaving Energy Super; or you become totally and permanently disabled within 60 days of leaving the Fund and you were previously eligible for a TPD benefit under the policy. Income Protection cover Energy Super s Income Protection (IP) insurance means you can still have a fortnightly income for up to two years (and then until you reach age 65 if you choose - subject to approval by the Insurer) if you are unable to work temporarily because of either total or partial disability. You must be disabled for a continuous period of 14 days (from the date your doctor or medical practitioner certifies you unfit for work). Energy Super has arranged your IP through a group policy which means you pay for your chosen level of cover at rates that are competitive and generally less than if you had taken out the same level of cover independently. IP is compulsory for all members who join Energy Super on starting work with a registered or participating employer. Eligibility for cover Where you join through an Energy Super employer, you are eligible for automatic IP cover, provided you are Actively at Work on the day you start work. Other members are eligible to apply for IP cover provided they are Actively at Work and earning an Income. You are not required to provide evidence of your good health when you apply. However, cover for any Pre-existing sickness (see page 16 for definition) is available so long as you, on the advice of your doctor, have ceased all treatment for six months during the period you are insured. Maximum amount of cover The monthly benefit for IP is the lesser of: The level of cover you received automatically or applied for; or 90% of your Income. You will also receive 10% of your Income as a superannuation contribution into your Energy Super account. Joining Energy Super (two ways to join) Insurance features Automatic cover Optional/ Additional cover Waiting period Income Protection to age 65 Paying for insurance cover Joining through an Energy Super employer You will receive automatic cover of up to $2,205 per week. You can apply for additional insurance up to a maximum of 90% of your Income plus 10% of your Income as a superannuation contribution, limited to $7, of total cover per week. For more information see Maximum amount of cover above. The waiting period is 14 days. You can extend the payment period of your IP benefit beyond 2 years. You can apply for this option on your Member Application Form and a Personal Statement is required. The cost of your IP insurance cover is deducted from your Energy Super account monthly. Joining as a Public Offer member You do not receive an automatic level of cover when you join Energy Super. You can apply for IP insurance cover without having to provide evidence of your good health on your Member Application Form. Pre-existing sickness conditions will apply. Your insurance cover is optional (you do not have to take out cover). You can apply for a level of cover up to a maximum of 90% of your Income plus 10% of your Income as a superannuation contribution, limited to $7, of total cover per week. For more information see Maximum amount of cover above. The waiting period is 14 days. You can extend the payment period of your IP benefit beyond 2 years. You can apply for this option on your Member Application Form and a Personal Statement is required. The cost of your IP insurance cover is deducted from your Energy Super account monthly. When you join the Fund and apply for insurance cover we require you to either: make regular contributions into your Energy Super account; or open an Energy Super account with $1,000 or more. IBR Energy Super Insurance Guide 9

12 When your cover starts Where you join through an Energy Super employer, your automatic IP cover starts on the day you start work if: Energy Super is your employer s default fund; and you do not elect to join another fund; and a contribution is made for you within 120 days of starting work, provided you are Actively at Work on the day you start work. If you choose another super fund when you start work with your participating or registered employer, then decide to join Energy Super at a later date, you will need to complete the Member Application Form to apply for cover. Pre-existing sickness conditions will apply. Cover for other members starts on the day your application for cover is accepted, provided you are Actively at Work and a contribution is paid. Pre-existing sickness conditions will apply. (See page 16 for definitions of Actively at Work and Pre-existing sickness ). Payment periods Your standard IP benefit payment period is generally up to two years and commences after your waiting period (14 days) has expired. The cost of cover Two year benefit payment period The cost you pay for your insurance depends on the level of cover you choose and whether or not you are covered by a Workers Compensation scheme (such as WorkCover Queensland). The cost of your IP insurance cover in Energy Super is subject to your eligibility for Workers Compensation cover which can be claimed if the injury or illness related to your IP insurance claim is work related. Most employees are eligible for Workers Compensation cover in the state in which they work, but some individuals such as directors, sole traders and some contractors are not eligible. If you are not covered by a Workers Compensation scheme, the cost of your IP insurance cover is higher. If you are uncertain about whether you are covered by a Workers Compensation scheme anywhere in Australia talk to your employer or contact the WorkCover authority in your state. WorkCover Queensland can be contacted on Please note: If your relevant Workers Compensation scheme decides to cease weekly Statutory Benefits to you but you have not returned to work, the Trustee may request that you be examined by an independent medical specialist to determine the status of your disablement. If you also select and pay for the option to extend your insurance cover to age 65 (and you are under age 65 at the end of your standard two year benefit period) your benefit payments will generally further continue until you reach age 65. The maximum period that your IP benefits will be paid depends on your age. Maximum benefit period (if you have standard cover) Age attained Benefit period 64 and under 2 years or until you turn 65, whichever happens first 65 and over (if you are not on claim when you turn 65) On claim when you turn weeks (for sickness benefit) or 52 weeks (for injury benefit) or until you turn 70, whichever happens first An additional 12 weeks (for sickness benefit) or 52 weeks (for injury benefit) to a maximum of 2 years total benefit period Maximum benefit period (if you have extended your cover to age 65) Age attained Benefit period 64 and under To age 65 Payments may cease before the maximum benefit periods in certain circumstances. Please refer to the Income Protection payments section on page 13 for more information. 10 Energy Super Insurance Guide IBR

13 Cost of cover for a benefit period of 2 years The benefit levels and costs are as follows: Cost Benefit level up to 1 : Income needed to get full benefit 2 Covered by Workers Compensation Not covered by Workers Compensation $ per week $50,960 per annum $7.72 per week $12.35 per week $1, per week $63,700 per annum $9.92 per week $15.88 per week $1, per week $76,440 per annum $13.23 per week $21.17 per week $1, per week $101,920 per annum $17.64 per week $28.22 per week $2, per week $127,400 per annum $22.05 per week $35.28 per week $3, per week $191,100 per annum $39.69 per week $63.50 per week $4, per week $254,800 per annum $52.92 per week $85.00 per week $5, per week $318,500 per annum $66.15 per week $ per week $6, per week $382,200 per annum $79.38 per week $ per week $7, per week $445,900 per annum $92.61 per week $ per week 1 You can choose any benefit level you wish but keep in mind that the actual benefit payable will be the lesser of: the benefit level chosen; and 90% of your Income. A contribution of 10% of your Income is also payable to your Energy Super account. So if you choose a benefit level and your Income is less than the amount in the Income needed to get full benefit column, the actual benefit payable will be less than the level you chose. 2 Calculated by multiplying the benefit level by 52 and dividing by 90%. Example: Tom earns $127,400 a year and currently has the default IP with a benefit of up to $2,205 per week. He is covered by Workers Compensation, so the cost of this cover is currently $22.05 per week. If he was eligible to claim a benefit under this cover he would receive a weekly benefit of $2,205 per week and a $245 super contribution. Extending the payment period past two years Energy Super gives you the flexibility to extend the payment period of your IP benefit after the two year default period has elapsed to age 65. You are eligible to apply for the extended payment period providing you are a member of Energy Super and are Actively at Work earning an Income. You must also be under age 65, engaged in regular employment and be working an average of at least 14 hours or more per week. In addition, you must be an Australian resident. An Australian resident is defined as a person who has always lived in Australia or has come to Australia to live and is eligible to work in Australia. The optional benefit is subject to medical evidence and will need approval by the Insurer. The cost of extending your benefit period to age 65 depends on the level of cover you choose, your age and whether you are eligible for a White Collar/Professional discount. Maximum amount of cover The monthly benefit for IP cover to age 65 is the lesser of: The level of cover you applied for; or 85% of your Income. You will also receive 15% of your Income as a superannuation contribution into your Energy Super account. IBR Energy Super Insurance Guide 11

14 Additional cost of cover for a benefit payment period to age 65 The benefit levels and costs are as follows: Benefit level up to: With white collar discount Cost (per week) Without white collar discount 14 yrs & 9 mnths to 36 to to to yrs & 9 mnths to 36 to to to 65 $ per week $5.35 $8.03 $18.35 $29.73 $7.64 $11.47 $26.22 $42.50 $1, per week $6.69 $10.03 $22.93 $37.17 $9.56 $14.33 $32.78 $53.13 $1, per week $8.03 $12.04 $27.52 $44.61 $11.47 $17.20 $39.33 $63.75 $1, per week $10.71 $16.05 $36.69 $59.47 $15.29 $22.93 $52.43 $85.00 $2, per week $13.37 $20.07 $45.86 $74.34 $19.11 $28.67 $65.54 $ $3, per week $20.07 $30.10 $68.80 $ $28.67 $43.00 $98.32 $ $4, per week $26.76 $40.13 $91.73 $ $38.22 $57.33 $ $ $5, per week $33.44 $50.16 $ $ $47.77 $71.66 $ $ $6, per week $40.13 $60.20 $ $ $57.33 $86.00 $ $ $7, per week $46.82 $70.23 $ $ $66.89 $ $ $ Example: Tom earns $127,400 a year, is 56 years old and has IP with a benefit of up to $2,205 per week. He currently receives the white collar discount, so the cost of his extended IP cover is $74.34 per week. Including the cost of his standard IP cover, the total cost of Tom s IP cover is $96.39 per week. If Tom was eligible to claim a benefit, he would receive a weekly benefit of $2,205 per week and a $245 super contribution for the first two years he was eligible to claim. If he was still unable to work after the initial two year benefit period had ended, Tom would then receive a weekly benefit of $2, per week and a $ super contribution until he reached age 65. Please note: The actual extended IP benefit payable to members is the lesser of the weekly benefit outlined above or 85% of Income averaged over the last 12 months plus 15% super contribution. Increasing or reducing cover You are able to increase your IP cover at any time. However, if you increase your cover it must be within the maximum amount of cover. Pre-existing sickness conditions will apply for the amount of the increase. IP is compulsory for all members working for an Energy Super employer. If your employer pays for your automatic IP cover you cannot reduce your cover below this level. However, if your employer does not pay for your IP cover and the automatic cover is more than 90% of your Income, you can reduce the amount of cover by providing proof of your Income. If you have previously increased your cover, you can later reduce the cover to no less than the automatic level of cover by notifying Energy Super in writing. Other members can reduce or cancel their cover at any time by notifying Energy Super in writing. They can also cancel their cover over the phone by contacting Energy Super on ENERGY ( ). If you wish to change your level of IP cover, please complete a Change of Insurance Form. Our single issue advice service can give you personal advice about your IP cover over the phone at no additional cost to you. Simply call us on ENERGY ( ) or visit our website at energysuper.com.au to schedule an appointment with an adviser. 12 Energy Super Insurance Guide IBR

15 Income Protection payments If you qualify for an IP payment, your standard IP benefit will be paid for up to two years. Payments will be made fortnightly in arrears and will stop: if you resume work or are deemed fit to resume work; or if you die; or at the expiry of the maximum benefit period (see the Payment periods section for more information). If you choose cover to age 65, pay for that option and qualify for an IP payment, your extended IP benefit will be paid until you reach age 65. Payments will be made monthly in arrears and will stop if: you are no longer totally or partially disabled; or you die; or you reach age 65; or you are no longer under the regular and continuous care of a doctor; or you fail to provide the Insurer with all requested information and other evidence reasonably required to assess your claim. Qualifying for an Income Protection benefit You may qualify for an IP benefit if: as a result of an injury or sickness you are prevented from engaging in your usual occupation with your employer or your usual occupation if you are a selfemployed person that generates your primary source of personal exertion Income and you are still a member of Energy Super. You must have been Actively at Work at the time your injury or sickness occurred, and must be under the regular care of and acting in accordance with the instructions or professional advice of a medical practitioner (who is not yourself); or you are partially disabled as a result of an injury or sickness and you are prevented from engaging in a substantial part of your usual occupation and you are still a member of Energy Super. You must have been Actively at Work at the time your injury or sickness occurred, and you must be under the regular care of and acting in accordance with the instructions or professional advice of a medical practitioner (who is not yourself). Injury means a physical injury caused by a violent, external and visible means which occurs while cover is in force and which results in payment of any benefits within 36 months from the date of its occurrence, but does not include any condition which is also a sickness. If injury or sickness occurs within 60 days of you ceasing employment, you may still qualify under the above criteria if you can show evidence that you have alternative employment which would have commenced within the 60 day period with another employer and you remain a member of Energy Super. If you cannot provide this evidence or you have been unemployed for a period of more than 60 days at the time of injury or sickness, and are still a member of Energy Super and have IP cover, you may be eligible to claim if you are not able to engage in any occupation which you could reasonably be expected to perform based on your education, training and experience. However, you cannot claim if you have been continuously unemployed for six months or more. To qualify for an IP benefit, any injury or sickness must have occurred or been contracted when the insurance cover was in force. Please see the definitions of injury and sickness for more information. Exclusions The following exclusions apply to your standard IP cover with a benefit period of up to two years: Benefits are not payable where the disability arises from: any consequences of war, invasion or civil war; or any intentional self-inflicted injury, including any attempt at suicide; or uncomplicated pregnancy, childbirth or miscarriage; or joining the Armed Forces (except the Reserves in Australia). The following exclusions apply to your IP cover with a benefit period to age 65: Benefits are not payable where the disability arises from: any consequences of war, invasion or civil war; or any intentional self-inflicted injury, including any attempt at suicide; or uncomplicated pregnancy, childbirth or miscarriage; or service in the armed forces of any country (not including the Australian Army Reserve). Pre-existing sickness conditions For members who do not have automatic cover, IP insurance is not payable where the disability arises from a Pre-existing sickness during the first two years of cover. If your cover recommences after having ceased for some reason, disability arising from a Pre-existing sickness is excluded for two years from recommencement of cover. If you increase your cover, the amount of the increase is not payable for a disability arising from a Pre-existing sickness for two years. Partial income benefit If, after receiving at least one IP payment, you return to work on reduced ordinary Income you may be eligible for a partial IP benefit. The reduction of ordinary Income must result from the same injury or illness and you must be working on a restricted basis or in a different occupation. IBR Energy Super Insurance Guide 13

16 Recurrent disability If you suffer from the same disability again within six months immediately following a period of disability, either from the same or related cause, it will be considered a continuation of the original claim, no waiting period will apply and the maximum benefit period will apply to the original claim including the continuation. If the new period of disability is caused by a new injury or illness, the waiting period will apply. If you are on unpaid leave If you are an Australian resident, your standard IP cover with a benefit period of up to two years will remain in place for up to 12 months if you are on unpaid leave that is approved by your employer and your insurance premiums continue to be paid. If you are not an Australian Resident, your standard IP cover will remain in place for up to 90 days if you are on unpaid leave that is approved by your employer and your insurance premiums continue to be paid. IP payments will start on the latter of: the date your waiting period expires; or the date your unpaid leave is due to cease. For standard IP cover, an Australian resident is a person who resides in Australia and is either an Australian citizen or is a holder of a permanent visa. Overseas residence and travel Your standard IP cover with a benefit period of up to two years applies worldwide, with the following exception: If the country you are travelling to is subject to an Australian Government advisory notice advising against all travel to that country the day before you leave Australia (if the advisory warning is subsequently downgraded your cover will resume). If you become totally disabled while travelling overseas or travel overseas after becoming disabled, you will receive IP benefits for up to 12 weeks while you remain overseas. Upon your return to Australia, your benefits may recommence. Your IP cover with a benefit period to age 65 (if applicable) applies worldwide. However, unless you are continuously residing in Australia or in a country approved by the Insurer, your benefits will be subject to the following conditions: payment of benefits will be limited to 12 months; and after 12 months, no benefits will be payable to you unless you return to Australia or a country approved by the Insurer. Upon your return to Australia or an approved country, your benefits may recommence. Additional benefits The following benefits, which are at the sole discretion of the Insurer as to whether or not they will assist, may be paid to help you with your rehabilitation or return to work. Both these benefits will be limited to 24 times your insured monthly benefit. Rehabilitation assistance will help you with arranging for training or advice from a licensed vocational school, provided such training or advice is undertaken with the agreement of your attending medical practitioner. Assistance may also include family counselling to help you and your family cope with your disability and to enable you to live an independent life. Return to work assistance will help you with arranging for professional assistance to improve your physical and/or emotional condition. Assistance includes special equipment for and/or modifications to your normal home or workplace. The Rehabilitation Assistance and the Return To Work Assistance will be paid to the service provider and may be reduced if the expense can be claimed or reimbursed from another source. When your eligibility to claim ends You may be ineligible to claim your standard IP cover with a benefit period of up to two years in the following situations: 60 days after ceasing to be a member of Energy Super; or if you cease to be Employed for a continuous period of 6 months; or when you reach age 70; or if you die; or 30 days after there is insufficient funds in your account to pay insurance costs due; or when you have been on unpaid leave for more than 12 months; or if you join the armed forces (excluding Reserves residing in Australia); or when cover for every member ceases under the group insurance policy. You may be ineligible to claim your IP cover with a benefit period to age 65 in the following situations: 60 days after ceasing to be a member of Energy Super; or If you retire or cease to be Employed ; or when you reach age 65; or if you die; or 60 days after there are insufficient funds in your account to pay insurance costs due; or if you join the armed forces (excluding Reserves residing in Australia); or you cancel your cover. Please note: If you cease working for your employer, but remain a member of Energy Super, your IP cover will continue. The cost of this cover is deducted from your Energy Super account. You can reduce or cancel your cover by calling Energy Super. 14 Energy Super Insurance Guide IBR

17 Making a claim To avoid delays, you can submit your claim before the waiting period is complete. However, payments will only be calculated from the end of your waiting period. You must notify Energy Super as soon as is practicable and not more than 12 months after you have suffered an illness or injury that may result in an insurance claim being made. To find out more about making a claim, call us on ENERGY ( ). When your Income Protection benefit will be reduced Your standard IP benefit (with a benefit period of two years) will be reduced by sick leave payments you receive, other not at work related payments you receive, or should receive and Workers Compensation or other statutory benefits you are entitled to receive. The Insurer will pay you the difference between the sick leave payments, other not at work related payments, Workers Compensation payments and your insured amount. Your IP benefit to age 65 will be reduced by any Income you are entitled to from other sources (whether that Income was actually received or not). Income from other sources includes: any benefits payable under other IP policies; any benefits payable under Workers Compensation or other legislation; and any benefits payable in respect of any claim for past or future economic loss arising from any personal injury claim you have made. The Insurer will pay you the difference between the Income from other sources, and your insured amount. Your IP benefit may also be reduced to equal the proportion of which your injury or illness contributes to you being unable to work. Indexation of benefits whilst on claim If you have been paid a benefit for a continuous 12 month period, the amount of the benefit payable will be increased by the lesser of 5% or the percentage increase in CPI over the 12 months period. This will apply to all benefit payments after the first 12 months of continuous benefit payments. Other insurance information Insurance claims If you (or your beneficiaries) wish to make a claim for any insured benefit provided by Energy Super, you (or your beneficiaries) need to contact Energy Super. If you make a claim, the Trustee may conduct investigations to assess the value and validity of your claim. This may involve the use of investigation agents, legal advisers and the collection of personal data that the Insurer believes is relevant. Your duty of disclosure Before you enter into a contract for personal insurance cover with an Insurer, 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, that is relevant to the Insurer s decision whether to accept the risk of insuring you and, if so, on what terms. You also have the same duty of disclosure if you wish to renew, extend, increase or reinstate your insurance cover. Your duty however, does not require a disclosure of a matter: that is of common knowledge; that your Insurer knows or, in the ordinary course of business, ought to know; for which your duty of compliance is waived by the Insurer. If you fail to comply with your duty of disclosure and the Insurer would not have entered into the contract on any terms if the failure had not occurred, the Insurer may void the contract within three years of entering into it. If your non-disclosure is fraudulent, the Insurer may void the contract at any time. An Insurer who is entitled to void a contract of life insurance may elect not to void it but to reduce the sum insured in accordance with a formula that takes into account the premium that would have been payable if you had disclosed all relevant matters to the Insurer. IBR Energy Super Insurance Guide 15

18 Definitions Accident means an event where bodily injury is caused directly and solely by external and visible means, independent of all other causes. At Work means you are at work for the normal daily hours of work and you are actively performing the full, unrestricted or unmodified duties of your normal occupation for which you were employed, or would have been had the day not been a day of leave (other than due to illness or injury) public holiday or weekend day. Actively at Work For employed members: means the member is actively performing all the duties of their usual occupation with the Employer. A member who is on paid annual leave or long service leave shall also be considered to be Actively at Work provided that leave is not in connection to an injury or a sickness. For self-employed members: means the member was either at work genuinely performing their usual occupation or the Insurer, after reasonable examination of appropriate evidence, is unable to form the view that the member was fully capable of performing all the duties of their regular occupation, i.e. they were not suffering an injury or sickness that prevented them working. Automatic cover means the cover you will receive automatically when you join Energy Super that is not subject to underwriting (medical assessment) by the Insurer. CPI means the Consumer Price Index (All Groups Index Weighted Average for Eight Capital Cities, published by the Australian Bureau of Statistics) in respect of the 12 months prior to commencement of benefit payments. Defined Contribution member means a member who makes voluntary regular or lump sum contributions or have them made on their behalf to an accumulation-style superannuation account. Employed means working in any occupation for gain or reward. Energy Super employer means an employer who has completed an employer application form and/or participation agreement with the Fund. Illness means sickness, disease or medical disorder. Income Employee: means the average weekly income before personal deductions and income tax, and including all overtime and all allowances actually paid to you which was earned from personal exertion from your usual employment, during the (52) week period immediately preceding the last pay period prior to the injury or illness resulting in payment of benefits to you under the IP policy. Please note: At the time of claim, a member may elect that their overtime and allowances are averaged over the past three years and provide suitable proof of income. If a member does not elect this, overtime and allowances are averaged over 12 months only. Self-employed: means the gross income earned less all business expenses incurred in earning that income for the financial year completed immediately before the date of disability commencing (insured members will be required to supply their last year s tax assessment). Injury (in relation to IP cover) means a physical injury caused by a violent, external and visible means which occurs while cover is in force and which results in payment of any benefits within 36 months from the date of its occurrence, but does not include any condition which is also a sickness. Insurer means in respect of Death & TPD cover, MLC Limited ABN AFSL (MLC) or any replacement insurer with whom the Trustee arranges Death & TPD cover and in respect of IP cover means Australian Income Protection Pty Ltd ACN AFSL in respect of cover for up to two years and then MLC or any replacement insurer with whom the Trustee arranges IP Cover. Limited cover means you are covered only for claims arising from an illness that first became apparent, or an injury which first occurred, on or after the date that you first became eligible for cover. Optional/additional cover the insurance cover a member can apply for in addition to any automatic cover received when a member joined Energy Super. Optional/additional cover may be subject to evidence of good health or a pre-existing sickness exclusion subject to the type of insurance cover. Pre-existing sickness means any sickness that you are having or have had treated, or have received advice for treatment, in the six calendar months prior to the date of commencement, recommencement or increase of your IP cover. However, a Pre-existing sickness may be covered if: You have, with the agreement of a legally qualified medical practitioner, ceased all treatment or advice for at least six months since the commencement of your cover, or You have been insured for two years continuously under the IP policy at the time of your total disablement and have been Actively at Work for the two consecutive months prior to the disablement which led to the claim. Public Offer member means a member who has not joined the Fund through an Energy Super employer. Sickness (in relation to IP cover) is defined as a state of being ill which is first contracted, or which you first become aware of, while cover is in force and which continues for a period of not less that the waiting period and excludes any Preexisting sickness or Injury. Waiting period means the period of continuous disability commencing from the first day of total disability during which no benefits are payable. The Waiting Period starts on the date you first get medical advice and are confirmed to be totally disabled by a doctor. White Collar/Professional means a member who is engaged in an occupation with minimal manual duties or very light skilled duties. These members have no exposure to unusual occupational hazards and spend at least 90% of working hours in an office environment. Employees with technical skills/expertise may be required to use their skills and judgement in a variety of tasks outside the office environment. These members may have some exposure to unusual occupational hazards. 16 Energy Super Insurance Guide IBR

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20 Issued by Electricity Supply Industry Superannuation (Qld) Ltd (ABN AFSL ) the Trustee for Energy Super (ABN ). IBR

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