ACE JOURNEY ACCIDENT INSURANCE

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1 ACCIDENT & HEALTH ACE JOURNEY ACCIDENT INSURANCE SUMMARY OF KEY CHANGES Please note: This document provides a brief summary of the key changes made to the ACE Journey Accident Insurance Policy Wording and Product Disclosure Statement (PDS). This is not an exhaustive list of the changes made and does not form part of the PDS. For a full description of the terms, conditions and exclusions of the cover please refer to the PDS and any other supporting documents that we issue you. Description of Key Changes Change Policy Wording Reference Description New definition for "Benefit Period Means: the maximum period of time for which a benefit is payable under Events 20 and/or 21 as shown in the Schedule. New definition for "Claimant Means: the Policyholder, a Covered Person or any other person entitled to claim under the Policy. New definition for "Non-Scheduled Flights" Means: travel in an aircraft whose flights are not conducted in accordance with fixed flying schedules, over specific air routes, to and from fixed terminals. Amended definition of "Permanent Means: having lasted twelve (12) consecutive months from the date of the Bodily Injury and at the expiry of that period, being beyond hope of improvement. Amended definition of "Permanent Total Disablement Means: the disability having lasted twelve (12) consecutive months from the date of the Bodily Injury and at the expiry of that period, being beyond hope of improvement. New definition for "Pre-Existing Medical Condition Previously pre-existing bodily injuries were excluded under the former General Definition of Bodily Injury - "it does not mean (b) any pre-existing physical or congenital conditions (except illness or disease directly resulting from medical or surgical treatment rendered necessary by any Bodily Injury). The introduction of the Pre-Existing Medical Condition definition, below, facilitates the exclusion of Pre-Existing Medical Conditions whilst allowing for continuity of cover in specific circumstances. The new definition of Pre-Existing Medical Condition means: a) any physical defect or condition for which treatment, education or advice (including advice for treatment) has been received or prescribed by a Doctor or Dentist in the three (3) years immediately prior to becoming a Covered Person under the Policy; or

2 b) a condition of which a reasonable person in the circumstances would be expected to be aware of three (3) months prior to becoming a Covered Person under the Policy. Notwithstanding the above, any physical defector condition will not be deemed to be a Pre-Existing Medical Condition where the Covered Person has been employed by the Policyholder and covered under a journey accident insurance policy underwritten by Us and held by the Policyholder for the period or periods of insurance immediately prior to the Period of Insurance. The Preexisting Medical Condition exclusion will apply under the Policy in respect of a Covered Person if that Covered Person has not had continuous cover under a journey accident insurance underwritten by Us and held by the Policyholder immediately prior to the Policy Amended definition of "Professional Sport" New definition for "Renewal Period" New definition for "Renewal Policy" New definition for "Seek Employment New definition for "Specially Designated List" Amended definition of "Temporary Partial Disablement" General Definitions: Temporary Partial Disablement Professional Sport is defined by reference to the proportion of a Covered Person's income derived from their participation in the sport. Means: any sport for which a Cover Person receives a fee, allowance, sponsorship or monetary reward as a result of their participation, which in totality accounts for more than 15% of their annual income from all sources. Means: the period of insurance applicable to the Renewal Policy Means: the journey accident insurance policy underwritten by Us which takes effect immediately at the end of the Period of Insurance Means: the Covered Person being registered with the government agency or department in their Country of Residence which is responsible for providing unemployment services, (such as Centrelink in Australia) and/or a recruitment company and then providing Us with proof of a minimum of two (2) new job applications per week Means: Names of a person, entities, groups, or corporate specified on a list who are subject to trade or economic sanctions or other such similar laws or regulations of the United States of America, Australia, United Nations, European Union or United Kingdom. This definition facilitates the new "Sanctions Clause, contained within the General Provisions Applicable to the Policy. Means: where in the opinion of a Doctor, the Covered Person is temporarily unable to engage in a substantial part of their usual occupation or business duties resulting in their earnings post Bodily Injury of at least 25% less than their Salary. If the Covered Person ceases to be employed by the Policyholder after the Event(s) occurs, then Temporary Partial Disablement means disablement which prevents the Covered Person from engaging in any occupation for which they may be suited by way of their education, training or experience which reduces their capacity to undertake an occupation by at least 25%. In both instances the Covered Person must be under the regular care of and acting in accordance with the instructions or advice of a Doctor. ACE Journey Accident Insurance Summary of Changes 2

3 Amended definition of "Temporary Total Disablement" Amendment to the Insuring Clause Amendment to Events 2 and 3 Permanent Total Disablement Paraplegia or Quadriplegia Amendment to Event 9 (b) Loss of hearing in one ear General Definitions: Temporary Total Disablement Extent of Cover Bodily Injury Part A - Lump Sum Benefits Part A - Lump Sum Benefits Means: where in the opinion of a Doctor, the Covered Person is temporarily unable to engage in any aspect of their usual occupation or any of their business duties. If the Covered Person ceases to be employed by the Policyholder after the Event(s) occurs, then Temporary Total Disablement means disablement which prevents the Covered Person from engaging in any occupation for which they may be suited by way of their education, training or experience. In both instances the Covered Person must be under the regular care of, and acting in accordance with the instructions or advice of a Doctor. The requirement that the Event occurs within twelve months of the date of the Bodily Injury is maintained. The definition is amended such that, with respect to Events 20 and/or 21 (weekly benefits), the Event must also occur during the Period of Insurance or any Renewal Period. Therefore, if the Event (i.e. the Covered Person temporarily ceasing work due to a Bodily Injury) first occurs outside a current policy period, then there is no cover. Any amount payable under Events 2 or3 will be reduced by any benefits payable under Events 20 or 21 [weekly benefits] for any period greater than fifty-two weeks. The percentage of the sum insured has been increased from 20% to 30%. Addition of Events Part A - Lump Sum Benefits Events have been added to the Table of Events Any amount payable under Event 19 will be reduced by any benefits payable under Events 20 or 21 [weekly benefits] for any period greater than fifty-two weeks. Amendment to Event 21 (Event 11 under the former wording) Temporary Partial Disablement Part B Weekly Benefits Bodily Injury We now stipulate: If a Covered Person is able to return to work in a reduced capacity (whether or not with the Policyholder) yet elects not to do so, then the benefit payable shall be 25% of the Covered Person s Salary. New Additional Benefits Additional Cover Under The Policy The following benefits have been added. They may be payable in addition to some Events claimed. The sums insured are shown in the Schedule. Return to Work Assistance In the case of weekly benefits being payable, we at our absolute discretion may elect to assist the Covered Person in arranging for professional assistance to improve their physical and/or emotional condition in order to return to their usual occupation. Assistance includes but is not limited to special equipment for and/or modifications to the Covered Person s usual workplace. Tuition or Advice Expenses in the case of weekly benefits being payable, we will cover expenses for the Covered Person to attend a vocational school if deemed medically necessary. Replacement Staff / Recruitment Costs In the event of a Covered Persons accidental death or PTD we ll cover reasonable costs incurred for the recruitment of a replacement employee. ACE Journey Accident Insurance Summary of Changes 3

4 Corporate Image Protection In the event of a Covered Persons accidental death or PTD we ll cover reasonable costs incurred for the engagement of image and/or public relations consultants; and/or the release of information through the media to protect and/or positively promote the Policyholder s business and image Funeral Expenses In the event of a Covered Persons accidental death, we ll cover the reasonable funeral, burial or cremation and associated expenses. Modification Expenses A benefit available to modify the Covered Person s home and/or vehicle, or costs associated with relocating the Covered Person to a more suitable home as medically necessary Chauffeur Services In the case of weekly benefits being payable, we will cover costs for a chauffeur or taxi service to and from the Covered Persons usual place of work and their home if they recover sufficiently to return to work but is medically unfit to drive a vehicle or travel on public transport. Amendment to Condition 4 Amendment to Condition 9 Condition 4 Condition 9 Amended to specify that the Policyholder must provide documentation in the case of a workers compensation top-up claim and other amounts that will be offset against weekly benefit amounts claimed. The amount of any benefit payable for Temporary Total Disablement and Temporary Partial Disablement will be reduced by the amount of any: a) periodic compensation benefits payable under any workers compensation or accident compensation scheme. Where We are making payments for a topup amount above the workers compensation weekly amount up to the benefit amount payable under the Policy as stated in the Policy Schedule, the Policyholder must provide copies of all documentation in respect of the related workers compensation claim; and b) common law entitlement or other income protection insurance; and c) sick pay received, or at the discretion of the Policyholder sick leave entitlement, monies paid or payable for the notice period in the event of a redundancy, or any disability entitlement; Amended to allow for offset of the benefit payable under Events 2, 3 and 19 where weekly benefits have been paid for longer than a 52 week period. If as a result of Bodily Injury, the Covered Person is entitled to a benefit under Events 20 and/or 21 and subsequently becomes entitled to a benefit under Events 2, 3 or 19, all benefits payable under Events 20 and 21 shall cease from the date of such entitlement. In addition, any weekly benefit amounts paid under Events 20 or 21 for any period greater than fifty two (52) weeks shall be offset against the benefit amount payable under Events 2, 3 or 19. An example of the offset calculation is in the PDS. ACE Journey Accident Insurance Summary of Changes 4

5 Amendment to Condition 10 New Condition 11 Deletion of General Exclusion New General Exclusion New General Exclusion Amendment to Age exclusion New General Provision "Age Limitations" Amended General Provision "Currency" Condition 10 Condition 11 Previously Exclusion 4 Exclusion 5 Exclusion 6 Exclusion 8 Amended to stipulate the maximum benefit payable in the case of a non-salary earning employee With respect to Part A - Lump Sum Benefits, where the Lump Sum Benefit is Salary linked and the Employee is not in receipt of a Salary, the benefit amount shall be limited to fifty percent (50%) of the Lump Sum Benefit shown in the Schedule against their respective category of Covered Person to a maximum of $250,000. Included to stipulate that benefits shall only be payable under one ACE policy. Should a benefit be payable under this section of the policy that is also payable under any other insurance policy with ACE, then only one (1) policy can be claimed against (i.e. the policy with the greatest benefit). The following exclusion has been deleted: results from the use, existence or escape of nuclear weapons material or ionising radiation from or contamination by radioactivity from any nuclear fuel or nuclear waste or from the combustion of nuclear fuel. The policy now specifically excludes any loss, damage, liability, Event or Bodily Injury which is covered by: Medicare; any workers compensation legislation; any transport accident legislation; any common law entitlement; any government sponsored fund, plan or medical benefit scheme; any other insurance policy required to effected under law. The policy now specifically excludes Pre-Existing Medical Conditions (as defined). The age limit under the policy has been increased from 65yrs to 85yrs. Note: an Age Limitations clause has been introduced as per (see below) Covered Persons aged 75yrs - 79yrs: Events 1-19 maximum sum insured is $50,000 (or Schedule amount if less) Covered Persons aged 80yrs - 84yrs: Events 1-19 maximum sum insured is $25,000 (or Schedule amount if less) Furthermore, there is no cover for Events, 20 and 21 (weekly benefits) for Covered Persons aged 75 years or over at the time of loss. The reference to currency being in AUD is removed. The applicable currency is to be specified on the Schedule. ACE Journey Accident Insurance Summary of Changes 5

6 New General Provision "Sanctions Clause" Amended General Provision "Subrogation" The international operations of the ACE Group necessitates the inclusion of this clause: This insurance does not cover or pay claims arising directly or indirectly from, caused by, a consequence of, arising in connection with or contributed to by any loss or expenses with respect to a specially designated person, entity, group or company on the Specially Designated List or to the extent that trade or economic sanctions or other laws or regulations prohibit us from providing insurance, including but not limited to, the payment of claims. All other terms and conditions of the Policy remain unchanged. The following wording is added to the existing subrogation clause: We will not be liable for a loss where the Claimant is a party to an agreement that excludes or limits Our rights to recover damages from a third party in respect of that loss, whenever that agreement was made, i.e. before or after the loss occurred. The effect of this provision is that the Claimant may prejudice the Claimant s rights with regard to a claim if the Claimant makes or has made any agreement with a third party that will prevent Us from recovering the loss from that party or another party. ACE Group is an American company which necessitates the inclusion of this clause. ACE Journey Accident Insurance Summary of Changes 6

7 About ACE ACE Group is one of the world s largest multiline property and casualty insurers. With operations in 54 countries, ACE provides commercial and personal property and casualty insurance, personal accident and supplemental health insurance, reinsurance and life insurance to a diverse group of clients. ACE Limited, the parent company of ACE Group, is listed on the New York Stock Exchange (NYSE: ACE) and is a component of the S&P 500 index. ACE, via acquisitions by its predecessor companies, has been present in Australia for over 50 years. ACE s operation in Australia (ACE Insurance Limited) provides specialised and customised coverage s, including Marine, Property, Liability, Energy, Professional Indemnity, Directors & Officers, Financial Lines, Utilities, as well as Accident & Health insurance, to a broad client base. ACE is a major insurer of many of the country s largest companies. With five branches and 400 staff in Australia, it has a wealth of local expertise backed by its global reach and breadth of resources. More information can be found at CONTACT US Australia Head Office and New South Wales Branch Tel: (02) Fax: (02) Queensland Branch Level 27, 10 Eagle Street Brisbane, QLD 4000 Tel: (07) Fax: (07) South Australia Branch Level 7, 147 Pirie Street Adelaide SA 5000 Tel: (08) Fax: (08) Victoria Branch Level 16, 600 Bourke Street Melbourne VIC 3000 Tel: (03) Fax: (03) Western Australia Branch Level 26, 44 St. George s Terrace Perth WA 6000 Tel: (08) Fax: (08) The Journey Accident Insurance is issued by ACE Insurance Limited (ABN ; AFSL ). Any information provided is factual only. Potential purchasers should read the policy wording and Product Disclosure Statement available online at to decide if the product is right for them ACE Group. ACE, ACE logo, and ACE insured are trademarks of ACE Limited. ACE

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