1 ANZ Smart Choice Super Insurance Guide For employers and their employees INSURANCe GUIDE 11 NOVEMBER 2013
2 ANZ Smart Choice Super Entity details in this Insurance Guide Name of legal entity Registered numbers Abbreviated terms used throughout this Guide OnePath Custodians Pty Limited ABN , AFSL , RSE L OnePath Custodians, Trustee, us, we, our OnePath Life Limited ABN , AFSL OnePath Life, Insurer OnePath MasterFund (Fund) ABN , RSE , SFN Fund Australia and New Zealand Banking Group Limited ABN , AFSL ANZ Important information When an employer joins ANZ Smart Choice Super they may nominate employees to become members of the Fund. OnePath Custodians is the trustee of the Fund and the issuer of this Guide. OnePath Custodians is a wholly owned subsidiary of ANZ. ANZ is an authorised deposit taking institution (Bank) under the Banking Act 1959 (Cth). Although the issuer of this product is owned by ANZ, it is not a Bank. Except as described in this Guide, an investment in ANZ Smart Choice Super is not a deposit or other liability of ANZ or its related group companies and none of them stands behind or guarantees the issuer or the capital or performance of the investment. An investment in ANZ Smart Choice Super is subject to investment risk, including possible repayment delays and loss of income and principal invested. The information provided in this Guide is of a general nature and has been prepared without taking into account your objectives, financial situation or needs. You should obtain financial advice tailored to your personal circumstances. You should obtain a copy of the PDS for ANZ Smart Choice Super before making any decision about whether to acquire, or continue to hold, the product. You can obtain a copy of the PDS by contacting Customer Services on The Fund is governed by a trust deed (Trust Deed). Together with superannuation law, the Fund s Trust Deed sets out the rules and procedures under which the Fund operates and the Trustee s duties and obligations. If there is any inconsistency between the Trust Deed and the PDS or this Guide, the terms of the Trust Deed prevail. A copy of the Trust Deed is available from the Trustee free of charge. The Trustee invests all contributions in a master life policy issued by OnePath Life which then invests in selected investment funds. The master life policy is governed by the Life Insurance Act 1995 and is a contract between the Trustee and OnePath Life. OnePath Life is required to conduct its business in accordance with the law and give priority to the interests of policy holders, invest all of the assets it receives from the Trustee in statutory funds approved by the Australian Prudential Regulation Authority (APRA) and comply with the prescribed capital and solvency standards. Insurance cover within ANZ Smart Choice Super is provided by OnePath Life Limited under group policies issued to the Trustee. The Trustee reserves the right to change Insurer, or vary the benefits or premium rates from time to time. Where OnePath Life imposes loadings or exclusions as a result of your health, pastimes or other individual circumstances, OnePath Life will write to the Trustee and provide specific details relating to the your cover. The Trustee will advise you where this occurs. The Trustee is responsible for the contents of this Guide. Trustee contact details OnePath Custodians Pty Limited ABN AFSL RSE L Pitt Street Sydney NSW 2000 GPO Box 5107 Sydney NSW 2001 Phone Website anz.com/smartchoice
3 The following information in this document forms part of the Product Disclosure Statement (PDS) dated 11 November 2013 for ANZ Smart Choice Super. Its purpose is to give you more information about specific terms and conditions referred to in the PDS. You should consider all the information before making a decision about ANZ Smart Choice Super. If you invest in ANZ Smart Choice Super, you can access a copy of the PDS, this Insurance Guide and any matter that is applied, adopted or incorporated in the PDS from our website at anz.com/smartchoice. Alternatively, you can request a copy of this information free of charge by contacting Customer Services on In all cases, insurance cover is subject to the terms and conditions of the insurance policies issued by OnePath Life. In the event of any inconsistency between the terms and conditions of the insurance policies and this Guide, the relevant policy terms will prevail. This Insurance Guide sets out the terms and conditions of the ANZ Smart Choice Super Policy and is not a legally binding contract of insurance with the Insurer. When reading this Guide, some expressions (shown in bold) have a special meaning. This meaning is either explained in context or in the Definitions section on pages Contents Insurance in ANZ Smart Choice Super 4 What type of cover is available? 4 Your eligibility for Death, TPD and Income Protection Cover 4 When does cover commence? 4 What is Choose Your Own cover? 5 Payments of Benefits 6 When cover ceases 8 How to make a claim 12 Annual Insurance Fees 13 Definitions 17
4 Insurance in ANZ Smart Choice Super This Guide details the types of insurance that are available to you as a member of ANZ Smart Choice Super. No matter what life stage you are at, it makes sense to have a safety net in place. Insurance benefits can help pay your debts, and help cover the cost of any unexpected medical treatment that you may need. In the unfortunate event of your death or disablement, insurance can also help ensure the your family s financial future is looked after. Under ANZ Smart Choice Super, your employer can select either Lifestage cover or Tailored cover arrangements to apply to its plan. These arrangements are explained further below: Lifestage cover if you are eligible, you will automatically* receive Lifestage cover for Death (including Terminal Illness) and Total and Permanent Disability (TPD) (subject to eligibility). Your Lifestage is based on your age, with cover increasing for when you re likely to have greater commitments and lowering when you re less likely to. Tailored cover Your employer may have negotiated with the Trustee the type and terms of cover and the automatic amount of cover you are entitled to. We call this cover Tailored cover. A Participation Certificate will be issued to confirm the terms and conditions applicable to the Tailored cover. Choose Your Own cover Alternatively, as a member you can apply for your own level of Death and TPD cover. You also have the option to apply for Income Protection cover. We call this cover Choose Your Own cover. All applications for Choose Your Own cover will be assessed by the Insurer for approval. Legacy cover In some cases, your insurance cover may have been automatically transferred from an existing OnePath Super account into either Lifestage cover or Choose Your Own cover without the need for assessment. We call this cover Legacy cover. You will have received a Welcome letter setting out the terms applicable to your new insurance cover. Your new cover may differ in certain circumstances (such as the sum insured and the application of a Pre-Existing Condition exclusion). If you have not received a Welcome Letter please call Customer Services for more details. * You can opt out at any time by contacting Customer Services on You should also be aware that unless we have been advised by your employer of your occupation, your Insurance fees (premiums) will be based on Blue Collar rates and smoker status. If this is incorrect please contact Customer Services on What type of cover is available? A range of insurance options are available within ANZ Smart Choice Super. The following types of cover are available to you: 1. Death cover: The Insurer will pay a Death benefit to the Trustee on your behalf if you die or if you suffer from a Terminal Illness which the Trustee will then pay to you or your beneficiaries. 2. TPD cover: The Insurer will pay a TPD benefit to the Trustee on your behalf if you re Totally and Permanently Disabled by injury or Illness and unable to work again. Note that TPD cover is only provided in conjunction with Death cover and cannot be greater than the amount of Death cover. 3. Income Protection cover: Income Protection gives you the peace of mind that you may be able to cover your expenses if you are unable to work due to an injury giving you time to focus on your health and recovery. Income protection can cover up to 75% of your monthly income (subject to the Maximum Benefit Level), so that you can continue to meet day to day living expenses. Refer to the Benefits section on page 6 for more details on each cover type. Details of any insurance cover you have will be shown in your Welcome Pack and subsequent Annual Statements. Your eligibility for Death, TPD and Income Protection Cover You are eligible for Death, TPD and Income Protection insurance cover provided you live in Australia, are an Australian resident or relevant Visa holder and are aged over 15 and less than 65^, and are engaged in an occupation for which the relevant cover is available. If you do not meet the eligibility requirements set out above you will not be provided with Lifestage cover unless the Insurer otherwise approves. You may apply for Choose Your Own cover if you are eligible. ^ You must also be a member of ANZ Smart Choice Super, have not previously received Lifestage cover with your current employer and must have never claimed or be in the process of claiming, or not in a waiting period for or not be in receipt of, a terminal illness and/or total and permanent disablement benefit under any other policy issued by the Insurer or any other Insurer. When does cover commence? Lifestage Cover Lifestage cover starts from when you commence employment with your employer provided we receive a superannuation contribution into ANZ Smart Choice Super on your behalf. The first contribution must be received within 120 days of you commencing employment. If we do not receive a contribution within this period you will receive a notification giving you a further 60 days to make a contribution and if the contribution is not made during this 60 day period your cover will be cancelled. If your cover is cancelled, you may apply for Choose Your Own cover, if eligible. Choose Your Own cover Cover commences on the date the Insurer approves your application and once there are sufficient funds in your account to pay for the first month s insurance fee. A letter will be sent to you confirming the date that your cover commences. If you request a decrease in the amount of Lifestage cover, your Choose Your Own cover commences on the later of the date of your request or the date you specified in your request, unless your cover was subject to any exclusions. Whilst your application is being considered by the Insurer, you may be eligible for Interim Accident cover. Refer to page 10 for more information.
5 Individual transfer terms If you hold insurance cover through another superannuation fund, you may apply to transfer this cover into ANZ Smart Choice Super as a fixed dollar amount of cover under Choose Your Own cover equal to the amount of cover held under the previous insurance cover as long as: the death and total and permanent disablement cover you wish to transfer is less than $1 million, and the Income Protection you wish to transfer is less than the Maximum Benefit Level the total amount of cover after the transfer is subject to the Maximum Benefit Level. You will be required to provide evidence of the insurance cover held through the other superannuation fund and complete an Individual Insurance Transfer Form. A copy of the Form may be requested by calling Customer Services on Any loadings, exclusions, restrictions or limitations that applied under the previous cover will continue to apply and cover is conditional upon the cancellation of the previous cover. Cover under individual transfer terms commences on the date the Insurer approves your application provided there are sufficient funds in your account to pay for the first month s insurance fee. A letter will be sent to you confirming the date that your cover commences. Group transfer terms Your employer may request cover for the employer plan held through another superannuation fund to be transferred into ANZ Smart Choice Super. Cover commences on the day the Insurer accepts the request in writing and is conditional upon cancellation of previous group cover. The terms and conditions relating to this cover will be set out in the Participation Certificate provided to your employer and in your Welcome Pack. What is Choose Your Own Cover? If you re eligible, you have the flexibility to apply for a fixed level of insurance cover for Death, TPD or Income Protection, which we call Choose Your Own cover. You may want to apply for Choose Your Own cover for the following reasons: 1. The level of Lifestage or Tailored Death and/or TPD cover is insufficient and you would like to increase your cover amount 2. You would like to apply for Income Protection or increase the level of Income Protection you currently hold 3. You would like to fix your amount of Death and/or TPD cover 4. You would like to remove the Pre Existing Condition (PEC) exclusion that the Insurer may have imposed on your Legacy cover If Choose Your Own Death and TPD cover is accepted by the Insurer, it will replace all cover previously held through ANZ Smart Choice Super and is subject to any restrictions, exclusions and medical loadings notified by the Insurer. If the Insurer imposes any restrictions, exclusions and medical loadings, the total amount of Choose Your Own cover will be subject to those restrictions, exclusions and medical loadings specified in the Decision Note. If you previously did not have any restrictions, exclusions or medical loadings on your cover, you may notify the Insurer of your non-acceptance of such cover within 30 days of the date of the Decision Note, in which case any existing cover you held prior to the application through ANZ Smart Choice Super will continue. If the Insurer does not accept your application for Choose Your Own cover, any existing cover you hold through ANZ Smart Choice Super will continue unaffected by the declined application. When you apply for Choose Your Own cover, you will have the choice to apply using a: Short form Personal Health Statement* For all applications up to $1 million (Death unlimited and TPD only up to $3 million). Full Personal Health Statement For all applications of cover over $1 million (Death and TPD) and for all Income Protection applications. * Note: You may need to complete a Full Personal Health Statement if the Insurer has reviewed your Short Form Personal Health Statement and requires further details to assess your application. Individual Insurance Transfer Form If you want to transfer Death only or Death and TPD cover from another provider up to $1 million of total cover with ANZ Smart Choice Super. To apply for Choose Your Own cover please contact Customer Services on Whilst the application is being processed, you may be eligible for Interim Accident cover (refer to page 10 for details). You should note that your cover in Lifestage and Tailored cover remains until a decision is made by the Insurer to approve your application for Choose Your Own cover. If your insurance cover is accepted, your Lifestage and if applicable your Tailored cover will cease on the day that Choose Your Own cover commences, unless you are only applying for Income Protection. If you are transferring your cover from another superannuation fund and the Insurer has approved the transfer, your existing Lifestage and if applicable Tailored cover will cease. Generally, you can elect to cancel or reduce your insurance cover at any time by contacting Customer Services on You would like to reduce your Death and/or TPD cover
6 Benefits Before you choose which type or types of cover to take, you should carefully review the benefits that each type of cover offers. Refer to page 4 regarding types of cover available. Who the benefit is paid to As the insurance policy is issued to the Trustee and cover is offered to you under the policy as a member of ANZ Smart Choice Super, the Insurer will pay benefits to the Trustee. Any claims made on the policy must be made through the Trustee as the policy owner. Before any insurance benefit can be paid by the Trustee to you or your beneficiary(ies), the claim must be accepted by the Insurer and approved by the Trustee. Under super law, the Trustee may only release a benefit (including any terminal illness, total and permanent disablement or Income Protection benefit paid to the Trustee by the Insurer) where a condition of release has been met. If the Trustee is unable to release your benefit, any proceeds will be credited to your super account and paid when you meet a condition of release. The Trustee will pay the death benefit to whomever you have nominated as a beneficiary in your non-lapsing death benefit nomination payment instruction (unless there is no nomination or your nomination is defective or has been cancelled). Payment of Benefits Death Benefit A Death benefit will be paid if you die whilst your cover is in force (see section headed When cover ceases on page 8 for more information). Terminal Illness Benefit The Terminal Illness benefit will be paid if you become Terminally Ill whilst your Death cover was in force. See definitions on page 20 for more information. A Terminal Illness benefit will be paid if you become Terminally Ill as long as: The policy is still in force Your Death cover has not ended; and You have not reached the Benefit Expiry Age of the Death benefit. The Terminal Illness benefit is the lesser of the Death cover sum insured and $2.5 million. If the insured Death benefit is greater than $2.5 million, the balance is paid on your death so long as: This is before the Benefit Expiry Age for the Death benefit Your cover has not ended (see section headed When cover ceases on page 8 for more information) Insurance fees have continued to be paid for the reduced insured benefit The policy is still in force. If you have been paid or are entitled to be paid a Terminal Illness Benefit, the Insured Amount for your Death and TPD Cover is reduced (to a minimum of zero) by the Terminal Illness Benefit paid or payable. TPD Benefit The TPD benefit will be paid if you become Totally and Permanently Disabled according to the TPD definition 1 or TPD definition 2 as applicable. TPD Definition 1 applies to you if: You are aged less than 60 years on the Event date; You are Gainfully Working on the day immediately prior to the Event date; and You have worked at least the Minimum Average Hours. TPD Definition 2 applies to you if: You are aged 60 years or more on the Event date; You are not Gainfully Working on the day immediately prior to the Event date; or You have not worked at least the Minimum Average Hours. TPD Definitions 1 and 2 are set out in the definitions table on pages If on the day you become entitled to be paid a benefit there are insufficient funds in your account to pay the insurance fee owing to the Insurer at that date, the Insurer may deduct the relevant Insurance fee owing to it from the benefit payable (subject to your cover still being in force). If you have been paid or are entitled to a TPD Benefit, the amount of Death Benefit or Terminal Illness Benefit is reduced (to a minimum of zero) by any amount of TPD Benefit paid or payable. Income Protection Benefit The Income Protection Benefit provides a Monthly benefit if you become disabled because of injury and are unable to continue working as a result. The Monthly benefit payable for Choose Your Own Cover is 75% of your Salary as at the date of your application for cover up to a maximum of $30,000 per month*. There are two types of Income Protection Benefits that you can be eligible for: Total Disability Benefit Partial Disability Benefit A Monthly benefit is payable if you become Totally Disabled because of injury and are unable to work. See definition of Totally Disabled for more detail. A proportion of the Monthly benefit is payable if you become Partially Disabled, following a period of Total Disability solely because of injury and you are on a reduced duties or working at a reduced capacity, and earning less than before you became disabled. See definition of Partially Disabled for more detail. If Total Disability or Partial Disability is caused by more than one Injury, a Benefit will only be paid in respect of one Injury at any one time.
7 * For the purposes of the Monthly benefit your Salary is the lesser of: the Salary which was used to calculate your sum insured as stated in your Decision Note; and Salary as at the Event Date advised to us as the time of claim; divided by 12. When is an Income Protection benefit paid? 1. Benefit payment requirements and reductions In order to be paid an Income Protection benefit, you will be required, as at the day before the Event date, to be Gainfully Working for an average of 15 hours or more per week over a period of six consecutive months in the period immediately prior to the date giving rise to the disablement (or if you were on approved leave as at the Event date, the six consecutive months immediately prior to the start date of the paid or unpaid approved leave). If you do not satisfy the Minimum Average Hours, you will not be eligible for assessment for the Income Protection Benefit. In addition in order for an Income Protection benefit to be payable the Waiting Period must have expired and you must have exhausted any paid leave entitlement in connection with your employment, including sick leave, annual leave, long service leave as evidenced to the Insurer s satisfaction. If, on the date immediately before the Event Date, you are self-employed and on leave or not self-employed and on Employer Approved Leave, the Monthly benefit is calculated on your Salary immediately before the start of that leave. If a benefit is payable for part of a month, the amount of the benefit will be calculated on a pro rata basis for the number of days you are entitled to the benefit, divided by the number of days of that month. 2. Waiting and Benefit Period If you apply for Income Protection cover you can choose (subject to acceptance by the Insurer) a Waiting Period and a Benefit Period (refer to the table below). The insurance fee you need to pay and the cover offered will vary depending on your choices. A separate Waiting Period applies for each separate injury which causes disability for which you can claim.this does not apply if you suffer a Recurring Disablement, in which case the Insurer will treat the subsequent claim as a continuation of the earlier claim and you will not be subject to a Waiting Period for the Recurring Disablement. In this case, the Benefit Period will be the remaining Benefit Period of the earlier claim. The benefit payable to you will be reduced by other payments or benefits received by you or any other person in respect of you by way of workers compensation, in respect of loss of income (whether as a result of the relevant disability or not), any benefit under any statutory accident compensation scheme or similar legislation, any benefit under any other disability, injury insurance policy issued by the Insurer or another insurer (except for lump sum total and permanent disablement, trauma or terminal illness benefits under such an insurance policy), or any payment made in respect of you in relation to your reduced incomeearning capacity arising from illness or injury, and whether paid directly to you or otherwise. Waiting Period Benefit Period You can choose a Waiting Period of 30, 60 or 90 days. You can choose a Benefit Period of 2 years* or to age 65. * But not beyond the Benefit Expiry Age. If on the day you become entitled to be paid a benefit there are insufficient funds in your account to pay the insurance fee owing to the Insurer at that date, the Insurer may deduct the relevant Insurance fee owing to it from the benefit payable (subject to cover still being in force). 3. Total Disability Benefit The Monthly benefit will be paid if you are Totally Disabled for longer than the Waiting Period, or if you have been receiving a Partial Disability benefit and then become Totally Disabled immediately after ceasing to be Partially Disabled due to the same or related cause, and while your cover is still in force. The Monthly benefit starts to accrue from the day after the end of the Waiting Period (subject to you exhausting any paid leave entitlement in connection with your employment). The Monthly benefit is paid monthly in arrears and stops at the earliest of: The end of the Benefit Period The date you reach the Benefit Expiry Age the date of your death the date you cease to be Totally Disabled The expiry of six consecutive months from the day you depart Australia (though if you then return, and provided cover is still in force and the Insurer receives satisfactory medical evidence, the Monthly benefit may continue to be paid at the Insurer s discretion) If you are holding a Visa, the expiry of 30 consecutive days from the day your Visa expires or is cancelled The day you are Imprisoned Partial Disability Benefit You are entitled to a Partial Disability benefit if you are Partially Disabled and, as at the date of Partial Disability, you have been Totally Disabled for longer than the Waiting Period or at least 7 out of 12 consecutive days during the Waiting Period or, after having been Totally Disabled for a period for which a Monthly benefit was payable, you are no longer Totally Disabled.
8 The Partial Disability benefit begins to accrue from the day after you are no longer Totally Disabled or the day after the end of the Waiting Period, whichever is the later (subject to you exhausting any paid leave entitlement in connection with your employment). The Partial Disability benefit is paid monthly in arrears and stops at the earliest of: The end of the benefit period The date you reach the Benefit Expiry Age The date of your death The date you cease to be Partially Disabled The date you are earning or are capable of earning, a monthly Salary equal to or greater than your Pre-Disability Salary The expiry of six consecutive months from the day you depart Australia (though if you then return, and provided cover is still in force and the Insurer receives satisfactory medical evidence, the Monthly benefit may continue to be paid at the Insurer s discretion) If you are holding a Visa, the expiry of 30 consecutive days from the day your Visa expires or is cancelled. The Partial Disability is a proportion of the Monthly benefit and is calculated as follows: A-B x Monthly benefit A Where: A is your Pre Disability Salary B is the greater of: The Salary you earn for the month that the Partial Disability benefit is payable; or the monthly income which in the Insurer s opinion you are capable of earning for the month that the Partial Disability benefit is payable. The Insurer will calculate the amount you are capable of earning based on medical advice, which will include the opinion of your Medical Practitioner and all other relevant information. 5. Death Benefit If you die while a Total or Partial Disability benefit is being paid, one additional month s benefit will be paid after your death excluding any arrears. 6. Insurance fee waiver Any Insurance fee which falls due while you are entitled to receive the Total or Partial Disability benefit, will be waived. 7. Return to work program Once we receive notice of an injury which may give rise to a claim for a Total or Partial Disability benefit, we will notify the Insurer and if the Insurer is of the opinion that participation in a return to work program may help you return to work, some or all of the expenses incurred for the participation in that program will be paid. The Insurer will pay only where they have provided written approval for the program expenses and will make payments directly to the relevant service provider. They will also deduct any expenses for which you are entitled to be reimbursed from another source (eg your employer). If you return to work during the Waiting Period as part of a return to work or rehabilitation program approved by the Insurer in writing, the Waiting Period will not recommence regardless of the number of attempts to return to work. In all other cases: If you return to work during the Waiting Period on more than one occasion the Waiting Period recommences; If you return to work once during the Waiting Period for no more than five consecutive days the Waiting Period will not recommence but the number of days you have returned to work will be added to the Waiting Period; and If you return to work for more than five consecutive days during the Waiting Period the Waiting Period recommences. 8. Benefit Escalation Benefit escalation may apply to your Monthly benefit where: i. your Benefit Period is to age 65 ; ii. you have been in receipt of a Total Disability benefit or Partial Disability benefit for 12 consecutive months; iii. your Participation Certificate states that you are entitled to benefit escalation; and iv. your cover has not ended as at the expiry of the 12 month period for which you have received a Monthly benefit and at each subsequent anniversary. In this case, after the expiry of the first 12 consecutive benefit payments, your Monthly benefit will be increased by the lesser of the Consumer Price Index (CPI) and the escalation factor (currently set at 5%). The adjusted benefit will be similarly increased after each subsequent 12 month period for which a Total or Partial Disability benefit is continuously paid in respect to you. 9. Superannuation Contributions Benefit for Income Protection If you have written confirmation from the Insurer that states that a Superannuation Contribution Benefit is payable to you and you become entitled to be paid a Total Disability or Partial Disability benefit, the Insurer will pay, in addition to the monthly income protection benefit a Superannuation Contribution benefit of up to the current applicable Superannuation Guarantee Contribution rate of your annual Salary divided by 12. If the Superannuation Contribution benefit is payable due to a Partial Disability benefit, the amount of the Superannuation Contribution benefit will be reduced in proportion to the reduced amount of the Monthly benefit for that month. When cover ceases Cover will end, without the need for you to be notified by the Trustee or the Insurer, on the earliest of the following events:
9 Scenarios Death Cover TPD Cover Income Protection Cover The date you instruct the Trustee to cancel your cover The date you die The date you reach the Benefit Expiry Age The date you cease to be a member of ANZ Smart Choice Super The date you become entitled to a TPD benefit The date you are entitled to a Terminal Illness benefit which is equal to the full amount of your Death benefit The date you permanently retire from the workforce The 61st day after the due date of any outstanding insurance fees which remain unpaid. We will notify you and request payment within 30 days of the date that it was due before cancelling cover. The date you commence active service with the armed forces of any country (except where you are a member of the Australian Defence Forces Reserves, in which case, cover will cease only when the Reservist becomes the subject of a call out order under the Defence Act 1903 (Cth)) The date the Insurer cancels and/or avoids the Policy or your cover in accordance with its legal rights The date you have been overseas for more than two years (or three months for Visa holders) and do not have prior written consent from the Insurer for cover to continue beyond two (or three months for Visa holders) The date you have been overseas for more than five years working for your participating employer and do not have prior written consent from the Insurer for cover to continue beyond five years 30 days after the date you permanently depart Australia or, if you are a Visa holder, 30 days after you cease to hold a valid Visa. * N/A N/A N/A N/A Scenarios The date, if you are an Australian Resident, and you have been on Employer leave for more then 2 years, have not returned to work and do not have prior written consent from the Insurer for cover to continue beyond the 2 year period The day you transfer to the Pension Division or Transition to Retirement Division of ANZ Smart Choice Super and Pension or another superannuation fund which is not ANZ Smart Choice Super and Pension For Lifestage cover, and Tailored (if applicable) Cover, the 181st day after you commenced employment if your employer has not made an initial contribution to ANZ Smart Choice on your behalf The date the policy between the Insurer and the Trustee is terminated The day you transfer to the retail division of ANZ Smart Choice Super and Pension Death Cover TPD Cover Income Protection Cover N/A N/A N/A * Only if the TPD benefit is for an amount equal to the full insured amount of your Death Cover. Otherwise the excess Death cover continues. No reinstatement of cover If you cancel your Lifestage cover and you want to reapply for insurance cover, you may only apply for Choose Your Own cover. Occupation requirements Certain occupations are not eligible for Lifestage Death and TPD cover (classified as excluded occupations) but you may apply for Choose Your Own Cover where a full assessment will be undertaken by the Insurer. The list of excluded occupations changes from time to time. A current list of occupations is set out in the Occupation Guide which is available by contacting Customer Services on Exclusions The Insurer may not pay a claim if: The event giving rise to the claim is caused directly or indirectly from War involving Australia, New Zealand or your country of residence; you are Imprisoned on the Event Date or the date that a benefit would otherwise be payable. For Income Protection a benefit is not payable for the period of Imprisonment. Provided cover has not otherwise ceased, the Insurer will recommence a benefit payment after the Imprisonment has ended subject to the receipt of satisfactory evidence and any remaining Benefit Period; or 8 9
10 you do not satisfy the Insurer s claims requirements. See further details on page 12. The Insurer will not pay a claim: For anything that has been specifically excluded from your cover (by written notice from the Insurer); For Legacy Death or Legacy Death and TPD cover and lifestage cover (subject to a PEC exclusion applying), if the death and total and permanent disablement or Terminal Illness arises directly or indirectly, wholly or partially from a Pre-Existing Condition which existed on the day your cover commenced. We will advise you in your Welcome Pack if a PEC exclusion applies to your Legacy cover. If the event giving rise to the claim arises directly or indirectly, wholly or partially as a result of your Intentional Self-Inflicted Act. For Death and TPD, this restriction only applies to acts that occur within 13 months of the date your Choose Your Own cover commenced. If Choose Your Own cover commences because you increased the amount of your existing cover, this exclusion applies only to the increased portion of the type of cover that was increased. The exclusion does not apply if Choose Your Own cover commenced because you decreased your cover from your existing Lifestage cover amount. If for Lifestage and Legacy cover you were not an eligible person at the date cover was to commence (in which case all insurance fees will be refunded). Overseas Cover If you are an Australian Resident temporarily living overseas and working for your participating employer, you will be provided 24 hours worldwide cover for five years, however if you are overseas but not working for your participating employer your cover will only continue for 24 consecutive months. If you are a Visa holder, cover continues for a period of up to three months from the date you first leave Australia, provided your Visa is still in force and you have not stopped residing in Australia. Interim Accident Cover Whilst your application for Choose Your Own cover is being assessed, you will receive Interim Accident Cover as long as you are an Australian Resident or a Visa holder, are residing in Australia and are over 15 and less than 65. This means that whilst applicable, the Insurer will honour any claim arising solely due to an injury from an Accident, however any benefit will only be paid once during the life of your policy and the Event Date must be within 30 days of the day the Accident occured. If you are applying for an increase in cover, Interim Accident cover is only provided in respect of the increased portion of cover. The amount of benefit under Interim Accident Cover is the lesser of: The sum insured applied for in respect of Choose Your Own cover; An amount which the Insurer would potentially accept according to their underwriting rules, which may be nil. This cover begins on the date the completed application for insurance is received by the Insurer and ends on the earliest of: The date your application is accepted or declined; The date you cease being a Member of ANZ Smart Choice Super; The date your application is withdrawn; 30 days from the date the Insurer offers non-standard terms and conditions of acceptance; 90 days after the commencement of Interim Accident Cover The date the Insurer cancels Interim Accident Cover as allowed by law; The date you reach the Benefit Expiry Age relevant to the cover applied for the date the policy is terminated. There is no separate Insurance fee for Interim Accident Cover. In the event that an application is accepted, insurance fees will be charged from the commencement of any cover the Insurer approves. Interim Accident Cover is not provided if the cover applied for would normally be declined or deferred by the Insurer. If an application for cover is not accepted, no Insurance fees will be charged for the period in which Interim Accident Cover was provided. Interim Accident Cover is not payable if the claim event arises directly or indirectly from: War Imprisonment an Intentional Self-Inflicted Act, or a Pre-Existing Condition. Life events cover for Choose Your Own Cover (Death or Death and TPD) only To help you adjust your levels of insurance cover as your circumstances change throughout your life, you (within 30 days of the Specific Life Event occurring) may apply for an increase in your existing insurance cover (Death Only Cover or Death and TPD Cover). This application may occur, without underwriting once in any 12-month period on the occurrence of a Specific Life Event (provided you provide the Insurer with the relevant evidence for each event). You may only apply for one Specific Life Event in any 12 month period, up to a maximum of three accepted Life Events applications, however any benefit is paid only once during the life of this policy. Specific Life Events are: Your marriage (limited to once throughout the term of this insurance policy) The birth or adoption of a child by you or your spouse Your child starting secondary school Taking out a mortgage (from an accredited mortgage provider) for the purchase of your first home The maximum increase of Death Only Cover or Death and TPD Cover in relation to Specific Life Events (upon the Insurer s receipt of the required evidence) is the lesser of:
11 25% of the your sum insured for the type of cover held (as at the day prior to the increase being approved), and $200,000, Subject to the total sum insured for the type of Cover held by you after the increase in cover not exceeding the relevant Maximum Benefit Level. Life Events Cover is not available under this option if: At the time of the application you have claimed or are in the process of claiming, in a Waiting Period for or in receipt of, a terminal illness, TPD or income protection type benefit under the policy or any policy issued by the Insurer or any other Insurer, or You are aged 55 years or older as at the date of the occurrence of the Specific Life Event, or If you have previously had a Life Events Cover Option accepted by the Insurer for marriage, and your are applying again to increase their cover for marriage Your cover has ended under this policy. The increase in cover will apply from the date the application is accepted in writing. you are not entitled to claim, nor in the process of claiming, have never claimed (or be in a waiting period for), and not in receipt of, a benefit under the ANZ Smart Choice Super policy or any other policy issued by the Insurer or any other Insurer, which provides death and total and permanent disablement cover; and you have not joined, and do not intend to join, Active Service with the armed forces of any country; and have not obtained cover under another group insurance policy offered through another super fund by exercising an insurance transfer option. If your application is accepted by the Insurer, you will be offered an individual retail policy for death only cover up to the same sum insured under the ANZ Smart Choice Super policy, at retail insurance premium rates. Any current restrictions, limitations and any premium loadings will be applied to your individual retail policy. No cover is provided for the period from when cover ceases under the ANZ Smart Choice Super policy and when cover commences under the retail policy. A copy of the Continuation Option Form may be requested by calling Customer Services on If your application is accepted, the increase will be on the same acceptance terms that currently apply. Continuation of cover Leaving an employer If your employer notifies us that you have left your employment, and you have Lifestage or Choose Your Own cover, your cover will continue with the same insurance fees and terms and conditions. If your insurance cover is Tailored cover, your cover amount will be fixed on the date you leave your employer at the equivalent sum insured that you held prior to you leaving your employer and will become Choose Your Own cover. Your Insurance fees may change as they will be aligned to the Choose Your Own Insurance fees outlined in this Insurance Guide. You can use your ANZ Smart Choice Super account with your new employer by using the Choice of Fund Nomination form that we can give you or by downloading it from ANZ Internet Banking. Continuation Option Death Cover only If you decide to close your ANZ Smart Choice Super account you may apply to have death only cover continue under a retail policy, without underwriting, provided that: your cover under ANZ Smart Choice Super did not cease due to reasons relating to injury or illness at the date you apply you are less than age 60 and either an Australian Resident or a holder of a Visa; and you are residing in Australia you submit an application within 60 days from the day your existing cover under ANZ Smart Choice Super ceases; and Cover during paid and unpaid leave If you are an Australian Resident, provided Insurance fees continue to be paid, cover continues when you are on: paid leave, including sick leave, parental leave, annual leave and long service leave, or unpaid leave for a period of up to two years from the start date of your leave, provided that all such leave has been approved by your employer. Cover automatically ceases on the day immediately after the date which is 2 years after the start date of your leave unless cover has already ceased at an earlier date, you have returned to work before that date or the Insurer has, prior to that date, agreed to extend the period for which cover is to continue Transfer of cover within ANZ Smart Choice If you become a member of ANZ Smart Choice Super and Pension, you may request to transfer your Choose Your Own Death Only Cover or Death and TPD Cover to the Smart Choice Retail Policy without an application. Note TPD cover is not available in either Pension or Transition to Retirement (TTR). Any transfer of Choose Your Own cover to the Retail Division will include any previous restrictions, limitations and/or Premium loadings. Income Protection cover cannot be transferred to the ANZ Smart Choice Super and Pension Retail division. Repayment of benefits If, for any reason, it is determined that a benefit paid was not actually payable under the terms of the insurance policy(ies), all or part of the benefit must be repaid.
12 Multiple accounts If you have multiple accounts with insurance cover, the Insurer will only pay on one cover amount (being the highest insured amount) and any other cover will be cancelled the day you become entitled to the benefit. We will refund the insurance fees for the other account. Tax implications Where a tax deduction is available under the applicable laws in respect to the Insurance fee, the benefit of that deduction will be passed on to you provided that the Fund received the benefit of that deduction and you remain a member of the Fund at the time the benefit is credited to your account. The insurance cover provided under ANZ Smart Choice Super is input taxed for GST purposes, meaning no GST is payable on the insurance fees you pay. Income Protection is generally considered to be income replacement, and treated as assessable income. Therefore, the appropriate Pay As You Go (PAYG) tax will be deducted before any payment is made to you. This information is a guide only and is not tax advice. You should seek professional tax advice specific to your individual circumstances. Stamp duty All stamp duty is included in the Insurance fees that apply to the Trustee. How to make a claim If you want to know more about making a claim please contact Customer Services on The Trustee must be notified in writing of any claim as soon as it is reasonably possible for you to do so and, for any TPD or Income Protection claim, within 30 days of the Event Date. If notice is not received within the time specified, the benefit may be reduced or refused to the extent assessment of the claim is prejudiced. You, or in the case of your death, your estate, will be sent claim forms within seven days of us receiving notice of a claim. Our sending the claim forms does not constitute an admission of liability for any claim lodged. Medical information and evidence will generally be requested to assess a claim. During the course of assessing a TPD or Income Protection claim you may be required to be interviewed and attend vocational assessments and rehabilitation. The Insurer will require information in order to determine your eligibility for all benefits. Once we receive the proceeds from the Insurer we will invest these in an operating bank account. Any interest payable on the benefit amount will be paid to you. If you submit a claim whilst overseas, the Insurer may require you to return to Australia (at your own expense) in order for your claim to be assessed. Payment of the claim for TPD and Income Protection Cover For a claim to be paid, proof in a form which is subject to our verification must be provided for all of the following: Where you were accepted under Lifestage Cover or transfer terms, proof that both you and your employer met all of the relevant requirements your disability or other entitlement to claim the applicable insured benefit your age and gender (as relevant) your Salary and, if applicable, Pre-Disability Salary any relevant payments during the period benefits are payable (e.g. workers compensation). Payment of the claim is conditional upon you or the employer establishing entitlement by: providing medical reports from a treating Medical Practitioner when reasonably required by the Insurer (and at the Insurer s expense) being examined by a Medical Practitioner the Insurer nominates providing pathology, blood tests, x-ray or other appropriate evidence providing financial information reasonably required providing ongoing claim documentation, and providing an authority to obtain further information reasonably required. When reasonably required by the Insurer (and at the Insurer s expense), you may be required to: undergo vocational assessment and/or rehabilitation be interviewed agree to an audit of your financial circumstances. Insurance risks Where insurance applies to your superannuation arrangements i.e. Death only cover, Death and TPD cover or Income Protection cover under ANZ Smart Choice Super, there are a number of insurance risks you should be aware of: If you have transferred to an eligible rollover fund, your cover will cease. The amount or type of insurance cover selected by your employer may not be sufficient to provide adequate insurance cover in the event of an Illness or death. Your Insurance fee or benefit may be adjusted if your age is misstated. If you or your employer do not disclose to the Insurer every matter known or that which they could reasonably be expected to know, that would be relevant to the Insurer s decision whether to accept the risk of the insurance and if so, on what terms, the Insurer may avoid your cover within three years of entering into it. If you or your employer s non-disclosure is fraudulent, the Insurer may avoid the cover at any time. Duty of disclosure Before you become insured under a contract of life insurance, both you, your employer and the Trustee have a duty of disclosure to the Insurer under the Insurance Contracts Act 1984 to disclose every matter that they know, or could reasonably be expected to know, that is relevant to the Insurer s decision whether to accept the risk of insurance and, if so, on what terms.
13 This duty of disclosure applies where you establish cover under an individual member application process such as Choose Your Own cover, and includes changing your insurance cover, or applying for new cover. In order to fulfil your duty of disclosure you must disclose all of these matters to us, so that we may then disclose them to the Insurer. You have the same duty to disclose these matters before you renew, vary, extend or reinstate a contract of life insurance. The Trustee, however, does not require disclosure of a matter that: diminishes the risk to be undertaken by the Insurer; is of common knowledge; the Insurer knows or, in the ordinary course of its business, ought to know; as to which compliance with the duty is waived by the Insurer. The duty of disclosure continues after the Trustee notifies you in writing that it accepts or declines the cover (or any change in cover) for which you have applied. Non-disclosure If you fail to comply with the duty of disclosure outlined above, and the Insurer would not have provided the insurance cover on any terms if the failure had not occurred, the Insurer may avoid the contract within three years of entering into it. If the non-disclosure is fraudulent, the Insurer may avoid the contract at any time. An Insurer who is entitled to avoid insurance cover may, within three years of entering into it, elect not to avoid it but to reduce the sum that you have been insured for in accordance with a formula that takes into account the insurance fee that would have been payable if all relevant matters had been disclosed to the Insurer. Where can I get more information about insurance? ANZ Smart Choice Super has two policies that contains the full terms and conditions relating to insurance cover available in ANZ Smart Choice Super, including all definitions. The two policies are: ANZ Smart Choice Super Group Life (for Death and TPD cover) ANZ Smart Choice Super Income Protection In the event of any inconsistency between the PDS (including any material incorporated by reference), this Insurance Guide and the insurance policy, the insurance policy will prevail. As a member of ANZ Smart Choice Super you may request a copy of the ANZ Smart Choice Super Policies by calling Customer Services on Annual Insurance Fees Payment of Insurance fees Insurance fees for cover offered through ANZ Smart Choice Super are calculated daily and deducted monthly from your ANZ Smart Choice Super account in advance. Your insurance fee is based on the type of insurance cover provided, amount of cover applicable to your age, as well as your gender, smoker/non-smoker status, occupation and any applicable medical loadings the Insurer applies. Details of the current annual insurance fees for Lifestage and Choose Your Own cover are outlined on pages of this guide. You should be aware that the Insurance fees in this Insurance Guide do not relate to Tailored cover. As these Insurance fee rates will be different for each plan, we have not provided the insurance fee rate table applicable to you in this Guide. The actual insurance fee you pay will be advised in your Welcome Pack when you join ANZ Smart Choice Super and then for each subsequent year in your Annual Statement. Alternatively, you can contact Customer Services on The cost of cover may change in the future and we will notify you if this occurs. If you cancel your insurance cover or leave ANZ Smart Choice Super you will be entitled to a refund of a proportion of your last fee payment (provided your insurance fee payments are up to date). The refund is calculated based on the date of account termination to the first business banking day of the following month. Any outstanding insurance fees will be collected by the Insurer prior to your account being closed. Smoker Rates For Lifestage cover only, your Insurance fees are based on smoker rates. If you are a non-smoker you are entitled to a 10% discount on your Death and TPD Insurance fees. When we are informed that you are a non-smoker we will adjust the Insurance fees the next business day after receiving a non-smoker declaration, whether verbal or written. Note: Your smoker status is not relevant for Tailored cover, however when you leave your employer and retain your Insurance cover you may be defaulted to smoker rates (if we have not been advised of your status). All insurance fees will be deducted by redeeming units across your investment in line with your investment strategy for investing new money. If your employer currently pays your Insurance fees on your behalf, your Insurance fees will first be deducted from your account balance and then a reimbursement will be made into your account from your employer s additional contribution. If you leave your employer or you have been approved for Choose Your Own cover prior to your employer s monthly Insurance fee payment being made, you will not receive the reimbursement from your employer
14 When we can change the premiums The Insurer may at any time change the Insurance fees on the following events regardless of any Insurance fee guarantees: If your country of residence is at War, in which case the trustee will write to you and inform you of the increased Insurance fees. A change in the Insurance fees is required due to legislative changes such as new taxes, duties or new government charges. Where there is a fundamental change in the risk that the Insurer priced. Where the Insurer is unable to secure reinsurance. The Insurer may also change your Insurance fees if your age, smoking status, occupational status, and gender have been misstated. What are the occupational categories (classifications) Occupational categories are the classification the Insurer applies to the nature of your occupation. The following descriptions will assist you and the Insurer to determine your correct occupational category. Please note that if we are not provided with your occupation will automatically assume that you are Blue Collar occupation category. There are different occupation categories in ANZ Smart Choice Super that are used to assess your eligibility for Lifestage and Choose Your Own cover, shown in the table below. Excluded occupations Some occupations are considered excluded occupations and will not be eligible for cover. The list of excluded occupations changes from time to time. A current list of excluded occupations is set out in the Occupational Guide which is available by contacting Customer Services on Lifestage Levels of cover Below are the automatic levels of cover for Lifestage cover based on age next birthday. Note that for Tailored cover the automatic levels of cover are generally calculated based on your Salary. If you have Tailored cover and would like to know the levels of cover you are entitled too, either contact your employer or Customer Services on Age Next Birthday Death Cover (Levels of cover) TPD (Levels of cover) , , , , , , , , , , , , , , , , , , ,000 70, ,000 Nil They help you determine which Insurance fee table to look at later in this section (we have provided examples of how to calculate Insurance fees) when working out your annual insurance fee. Refer to pages Descriptions of occupation categories for Life stage and Choose Your Own Cover White Collar Blue Collar Heavy Blue Collar Professional, clerical or administrative white collar workers, duties are office based and who do not perform any manual work, or sales people not involved in deliveries (e.g. accountant, doctor, solicitor, administrative worker, travel consultant) Supervisors of blue collar workers whose supervising duties may include up to 10% of time on light manual work, certain skilled technicians involved in light manual work, or fully qualified trades people. (e.g. carpenter, dental hygienist, electrician, hairdresser, plumber, factory production manager) Skilled or semi-skilled manual workers. Includes some occupations that may be exposed to high risk via Accidents or health hazards (e.g. qualified wall/ floor tiler, glazier, bulldozer driver, forklift driver, bricklayer, cleaner, roof carpenter/plumber, Truck driver) Unskilled workers and labourers are not included in this category for Total and Permanent Disability or Income Protection benefits.
15 Annual insurance fees for Lifestage and Choose Your Own (Death and TPD) SIxRxOCxS Where: SI = (Sum Insured)/1000 R = Rate applicable to gender, age next birthday and type of cover OC = Occupational Class Factor S = Smoker Factor Example: A Lyn is a 40 year-old registered nurse (Light blue occupation), non-smoker. Based on her age (41 at next birthday) she wants to know what the insurance fees would be if she applied for $400,000 of Death and TPD Cover. Assuming the Insurer approves her application with no medical loadings or exclusions her annual insurance fees would be: Death cover = ($400) x0.37x1.30x0.90 = $ TPD cover = ($400) x0.53x1.75x0.90 = $ Total Annual Insurance Fee = $ Smart Choice Super Death and TPD Insurance fees per $1000 of Sum Insured (Standard Smoker White Collar) Age Next Birthday Death Death TPD TPD Smart Choice Super Death and TPD Insurance fees per $1000 of Sum Insured (Standard Smoker White Collar) Age Next Birthday Death Death TPD TPD Occ Category White Collar Blue Collar Heavy Blue Collar / Death Only / TPD Cover Smoker Status Factor Smoker Non- Smoker
16 Current annual insurance fees for Choose Your Own (Income Protection) On pages 16 and 17 are the Insurance fees for Choose Your Own Income Protection. The formula for calculating your insurance fees is: (NB/100)xRxOC Where: NB = (Nominated Monthly benefit up to 75% of Salary)/12 R = Rate applicable to gender, age, Waiting Period and Benefit Period OC = Occupational Class Factor Example: A Sonia is a 30 year-old registered Nurse (Light Blue occupation). Based on her age (31 at next birthday) she wants to know what the insurance fees would be if she applied for Income protection cover. Sonia s Salary is $65,000 per year and she would like to insure the maximum of her Salary (75% under this policy). She has nominated a 30 day wait and a benefit period to age 65. Assuming the Insurer approves her application with no medical loadings or exclusions her annual insurance fees would be: Income Protection = (($4,062.50)/100)x13x2.20 = $1, Total Annual Insurance Fee = $1, Age NB 30 day 2 year Benefit Period 60 day 90 day 30 day 60 day 90 day Age NB 30 day 2 year Benefit Period 60 day 90 day 30 day 60 day 90 day Age NB 30 day To Age 65 Benefit Period 60 day 90 day 30 day 60 day 90 day
17 Age NB 30 day To Age 65 Benefit Period 60 day 90 day 30 day 60 day 90 day Age NB 30 day To Age 65 Benefit Period 60 day 90 day 30 day 60 day 90 day Occ Category Factor White Collar 1.00 Blue Collar 2.20 Heavy Blue Collar Insurance definitions of terms used in this section of the guide ANZ Smart Choice Super and Pension Insurance cover has some words and terms that have special meaning. These meanings are defined in the Definitions table below. Accident Active Service Australian Resident Benefit means a fortuitous, external event which in the Insurer s opinion, was unexpected and unintended causing death or Total and Permanent Disablement. The following situations are not accidents, and any claims arising from these situations are excluded: a. any one or more of the following was a contributing cause of injury or death: i. illness; ii. disease; iii. allergy; and/or iv. any gradual onset of a physical or mental infirmity. b. the injury or death was the result of an intentional act or omission of the Insured Member. c. the applicant was injured or died as a result of an activity in respect of which he or she assumed the risk or courted disaster, irrespective of whether he or she intended injury or death. refers to a member s occupation as part of the military force (including but not limited to the army, the navy and the air force). Reserve duty is excluded, except in the case where an Insured Member is subject to a call out order under the Defence Act 1903 (Cth). means an Australian citizen, or a New Zealand citizen or an Australian permanent resident within the meaning of the Migration Act 1958 (Cth) and Migration Regulations 1994 (Cth). means the amount payable to you under the ANZ Smart Choice Super insurance policy with respect to your Cover.
18 Benefit Expiry Age For Death cover, 75 years old. For TPD cover, 65 years old. For Income Protection, 65 years old. CPI means the consumer price index (all groups and all capital cities) published by the Australian Bureau of Statistics. If no such consumer price index is published, the CPI will be a figure determined by the Insurer at their discretion. Decision Note means a document the Insurer issues which contains specific terms and conditions which apply to your cover, including but not limited to the following: a. the type and level of benefits provided to you (if any); b. the date that cover starts; and c. special conditions, insurance fee loadings and/or specific exclusions applying to you. Employer Approved Leave means leave that has been approved by your participating employer prior to the commencement of that leave. Event Date means: a. For TPD definition 1, the first day you, in the Insurer s opinion, solely because of injury or illness, have not worked in any Gainful Employment; b. For TPD definition 2, the first day of the six consecutive month period that, in the Insurer s opinion, solely because of injury or illness, you are totally unable to perform at least two Activities of Daily Living without the assistance of another adult person or suitable aids. c. For Income Protection benefit, the later of: i. the date that a Medical Practitioner certifies and agreed by the insurer that you have no capacity to perform one or more duties of your usual occupation necessary to produce income, which cannot be before the date the medical consultation by that Medical Practitioner; and ii. the date you stop working in your usual occupation. Full-time means a person is working at least 30 hours per week. Full Personal Health Statement means an application form issued by the Insurer for the purposes of assessing applications for Choose Your Own Cover. Gainful Employment means any occupation or work for reward or financial benefit, whether Full-time or Part-time or whether on a permanent or temporary basis Gainfully Working means a person is: a. engaged in Gainful Employment; or b. engaged in Gainful Employment and on paid Employer Approved Leave; or c. engaged in Gainful Employment and on unpaid Employer Approved Leave for a period up to 12 consecutive months; or d. engaged in self-employment in an occupation or work for reward or financial benefit, whether Full-time or Part-time or whether on a permanent or temporary basis. Imprisoned means being incarcerated in an Australian correctional services facility or an equivalent institution in another country. Insurer means OnePath Life Limited ABN Intentional Self-Inflicted Act means an intentional or deliberate self-inflicted act, including but not limited to attempted suicide and suicide. Maximum Benefit Level For Death cover, unlimited. For TPD cover, up to $3 million. For Income Protection cover, the lesser of: a. The amount stated in your latest Decision Note or Participation Certificate, which is up to 75% of your Salary as at the date of application for Cover, divided by 12, plus Superannuation Contributions Benefit (if any); and b. $30,000 per month. Medical Consultation means any activity undertaken for the detection, treatment or management by a Medical Practitioner or allied health provider of an illness, injury, medical condition or related symptom, including but not limited to the application of prescribed drugs or therapy (whether conventional or alternative).
19 Medical Practitioner Member Minimum Average Hours Monthly benefit Part-time Partial Disability and Partially Disabled Participation Certificate Pre-Existing Condition (PEC) means, unless otherwise agreed by the Insurer: a. A person who is legally and medically qualified and properly registered in Australia and practising as a medical practitioner, b. Where the cause of claim is mental health related, a person who is legally and medically qualified and properly registered in Australia as a practicing psychiarist, and c. The person must not a be related or connected by personal relationship to you, your business partner, associate, employer or employee. means a member of the MySuper Division or the Employer Investment Choice Division in the ANZ Smart Choice Super section of the Fund For TPD Cover: means 15 hours per week averaged over either of the following periods: a. where you are not absent from work as at the Event Date, the six consecutive months immediately prior to the Event Date including any period that the person was not working or Gainfully Working; or b. where you are on paid or unpaid Employer Approved Leave as at the Event Date, the six consecutive months immediately prior to the start date of the paid or unpaid Employer Approved Leave. For income protection cover: means 15 hours per week averaged over either of the following periods: a. where you are not absent from work as at the Event Date, the six consecutive months immediately prior to the Event Date including any period that the person was not working or Gainfully Working; or b. where you are on paid or unpaid Employer Approved Leave as at the Event Date, the six consecutive months immediately prior to the start date of the paid or unpaid Employer Approved Leave, including the period that the person was not working or Gainfully Working where the person has worked for less than six months in the period immediately prior to the start date of the Employer Approved Leave. means the amount of the Total Disability Benefit which is the lesser of: a. 75% of, or a percentage (where specified in a Participation Certificate or Decision Note) of, the Insured Member s Salary divided by 12, where the Insured Member s Salary is: i. for Legacy Cover, the lesser of: a. the Salary last advised to us; and b. the Salary as at the Event Date advised to us at the time of claim; ii. for Choose Your Own Cover, the lesser of: a. the Salary which was used to calculate the Insured Amount stated in the Decision Note; and b. the Salary as at the Event Date advised to us at the time of claim; and b. the Maximum Benefit. means a person is working less than 30 hours per week. means, in the Insurer s opinion based on the satisfactory evidence available to it at the relevant time solely because of injury or illness, you: a. are under the regular care of a Medical Practitioner, and following that Medical Practitioner s advice; and b. are not capable of performing all of the duties of your usual occupation, but: i. are working in an occupation that is not your usual occupation, and are not earning a monthly income that is equal to or more than your Pre-Disability Salary; or ii. are capable of working (or are working) in your usual occupation in reduced capacity and/or reduced hours, and are not capable of earning (or are not earning) a monthly Salary that is equal to or more than your Pre-Disability Salary. means a document the Insurer issues (which may not be titled Participation Certificate ), which contains any specific terms and conditions in respect of a particular employer plan or a sub-plan of a Participating Employer. means an injury, illness, condition or related symptom, whether it was diagnosed by a Medical Practitioner or not, which in the Insurer s opinion: You (or a reasonable person in your position) were aware of or should have been aware of; You had, or were intending to have, a Medical Consultation in respect of; or A reasonable person in your circumstances would have had a Medical Consultation in respect of, as at the date Cover is to commence
20 Pre-Disability Salary means the amount of the Salary divided by 12. Recurring Disablement Salary (Income Protection) Short Form Personal Health Statement Terminal Illness or Terminally Ill Total & Permanent Disability (TPD) or Totally and Permanently Disabled as the context requires TPD Definition 1 applies when you satisfy all of the following: a. you are aged less than 60 years on the Event Date, and b. Gainfully Working on the day immediately prior to the Event Date, and c. have worked at least the Minimum Average Hours. TPD Definition 2 applies you when you satisfy one or more of the following a, b or c: a. You are aged 60 years or more on the Event Date, b. You are not Gainfully Working on the day immediately prior to the Event Date, or c. You have not worked at least the Minimum Average Hours. means where you, after being in receipt of a Benefit with respect to an Income Protection claim return to work, are Gainfully Working and performing your normal duties and usual hours of work prior to receipt of the Benefit, whether Full-time or Part-time; or in the Insurers opinion, are capable of returning to work and performing your normal duties and usual hours of work prior to receipt of the Benefit, whether Full-time or Part-time; and you suffer Total Disability or Partial Disability due to the same or related illness or injury which was the cause of the earlier claim, within six months of the date the Benefit was last payable. means: a. where you are Gainfully Employed, the annual remuneration components paid for you by your employer, for your personal exertion including base payment (salary or wages) excluding mandatory superannuation contributions, bonuses, commissions, temporary additions to base payments and unearned income such as investment or interest earnings, unless otherwise specified in the latest Decision Note; or b. where you directly or indirectly own or have an interest all or part of a business from which you earn your usual income, the total amount earned by the business over the financial year as a direct result of your personal exertion or activities through your usual occupation, less your share of business expenses before the deduction of income tax, or the relevant proportion for part of a financial year. means an application form issued by the Insurer for the purposes of assessing applications for Death and TPD Cover less than $1 million. means a condition where: a. You are certified by two Medical Practitioners (one of whom must be a specialist Medical Practitioner who may be appointed by the Insurer) as having an illness which is likely to lead to your death within 12 months from the date of their written certification, despite reasonable medical treatment (for the avoidance of doubt, you will be considered to be Terminally Ill on the date of the last medical certificate satisfactory to the Insurer); and b. in the Insurer s opinion, on medical and other evidence available, that you are suffering from an illness which is likely to lead to your death within 12 months from the date of the written certification, despite reasonable medical treatment. TPD Definition 1 means: In the Insurer s opinion based on medical or other evidence satisfactory to the Insurer, solely because of injury or illness, you have: a. ceased working for at least six consecutive months from the Event Date, and b. as at the Date of Disablement you are unlikely ever to return to any Gainful Employment for which you are reasonably qualified by education, training or experience. TPD Definition 2 means: In the Insurer s opinion based on medical or other evidence satisfactory to the Insurer, solely because of injury or illness, you are: a. as at the Event Date, or such later date as the Insurer may agree in writing, totally and irreversibly unable to perform, without the assistance of another adult person or suitable aids, at least two of the Activities of Daily Living; and b. as at the Date of Disablement, unlikely ever to engage in any Gainful Employment for which you are reasonably qualified by education, training or experience. Activities of Daily Living means: a. Bathing bathing and showering b. Dressing dressing and undressing c. Feeding eating and drinking d. Mobility mobility, to the extent of being able to get in and out of bed or a chair, and move from place to place without using a wheelchair e. Toileting the ability to use a toilet. Date of Disablement means the first day after the expiry of 6 consecutive months immediately after the Event Date.
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