Product Disclosure Statement Insurance Guide ING Life Limited

Transcription

1 Product Disclosure Statement Insurance Guide ING Life Limited Effective 1 October 2007 The Employer PDS is comprised of: Employer Guide Member Guide Investment Choice Guide Insurance Guide (this guide) The Member PDS is comprised of: Member Guide Investment Choice Guide Insurance Guide (this guide) The insurance cover outlined in this guide is provided by ING Life Limited ABN AFSL under policies issued by ING Life Limited to the Trustee.

2 Where an employer joins Integra Super, their employees become members of the ING MasterFund (ABN RSE R , SFN , SPIN MMF0146AU (Fund). ING Custodians Pty Limited (ABN , AFSL , RSE L ) (ING Custodians) is the Trustee of the Fund and the issuer of this combined Product Disclosure Statement (PDS) and Financial Services Guide. ING Custodians is a subsidiary of ING Australia Limited ABN (ING Australia). The Trustee invests all contributions in a master life policy issued by ING Life Limited ABN (ING Life) which then invests in selected investment fund(s). The master life policy is governed by the Life Insurance Act 1995 (Act) and is a contract between the Trustee and ING Life. ING Life is required to conduct its business in accordance with the Act and in the best interests of policyholders, invest all of the assets it receives from the Trustee in statutory funds approved by the Australian Prudential Regulation Authority (APRA), and must comply with prescribed capital and solvency standards. ING Life is also the administrator of the Fund. The Trustee is responsible for the operation of the Fund and compliance with the governing rules (which includes the Fund s Trust Deed). The Trustee has in place professional indemnity insurance which may insure it and the directors of the Trustee in case of loss due to a claim against the Trustee. An investment in the Fund is neither a deposit nor a liability of: Australia and New Zealand Banking Group Limited ABN or any of its related corporations (ANZ) ING Australia ING Bank (Australia) Limited ABN (ING Bank) ING Investment Management Limited ABN (INGIM) any other company in the ING Group (ING) other than ING Life in relation to the master policy. If the employer has selected insurance cover as part of Integra Super, the insurance cover is provided by ING Life under group policies issued to the Trustee. ING Life has given its written consent to be named in this PDS in the form and context in which it appears. ING Life has not withdrawn its consent before the date of this PDS. The Trustee reserves the right to change the insurers or vary the benefits or premium rates from time to time. This PDS should not be used as a substitute for financial advice and employers should speak to a licensed financial adviser before participating in Integra Super. This PDS will assist employers to determine whether this product is suitable for their employees needs and assist members to understand their superannuation benefits. Members should read all parts of this PDS. To the extent that any inconsistency arises between the PDS and the governing rules of the Fund, the governing rules prevail. The Trustee relies on a number of third parties for the provision of specialist services in respect of the Fund, such as ING Life to provide the master life policy and through it: INGIM to manage ING investment funds except ING Mortgages which is managed by ING Australia. INGIM is not a subsidiary of ING Australia INGIM to also manage specialist OptiMix Manage the Managers investment funds a range of external fund managers who manage the investment funds other than those managed by INGIM. The Trustee operates these relationships on an arms length basis. ING Custodians is responsible for the contents of this PDS except for information about external fund managers and externally managed investment funds. Information about each external fund manager and the investment strategy, objective, and asset allocation of any investment fund it manages, is based on information provided by the external fund manager. The external fund managers have provided consent to be named. The external fund managers have consented to the information they have provided being included in the PDS in the form and context in which it has been included and they have not withdrawn their consent. They take no responsibility for any other information in this PDS. The value of investments in managed funds, superannuation and retirement products rises and falls. Neither ING Custodians nor any company in ANZ or ING guarantees investment performance, earnings, or return of capital investment in the Fund unless otherwise stated. Past performance is not necessarily indicative of future performance. Where the Insurer imposes loadings or exclusions as a result of the member s health, pastimes or other individual circumstances, the insurer will write to the Trustee and provide specific details relating to the member s cover. The Trustee will advise the member where this occurs. In this PDS, the terms we, us, our and Trustee refer to ING Custodians. The Trustee can change any procedures or terms and conditions referred to in the PDS with reasonable notice. The invitation to invest in Integra Super in this PDS is only available to persons who are Australian residents and receive this PDS in Australia. It is not made, directly or indirectly, to persons in any other country. The Trustee is not bound to accept your application. ING Custodians Pty Limited 347 Kent Street Sydney NSW 2000 GPO Box 5306 Sydney NSW 2001 Phone Fax Website customer@ing.com.au

3 Contents Introduction 2 Available cover 2 Eligibility criteria 2 Maximum insurance cover 3 When cover commences 3 Establishing cover 3 Interim Accident Cover 5 Cover for non-australian residents 6 Benefits 7 Other important information 11 Insurance risks 12 Premiums 13 Exclusions 19 When cover ends 20 Cover during paid and unpaid leave 20 Cover whilst overseas 20 Continuation of cover 21 How to make a claim 23

4 Introduction This section details the types of insurance that are available for members through Integra Super. The Trustee has appointed ING Life (Insurer) to provide the insurance for Integra Super. The insurance is provided under policies of insurance issued to the Trustee. The Trustee may change insurers and/or terms of the insurance cover (including premium rates) from time to time. In all cases, insurance cover is subject to acceptance and to the terms and conditions of the insurance policies issued by ING Life. In the event of any inconsistency between the terms and conditions of the insurance policies and this PDS, the relevant policy terms will prevail. Available cover The employer may choose to make any of the following types of cover options available to members: 1. Death Only Cover (including terminal illness) or 2. Death (including terminal illness) and Total and Permanent Disablement (TPD) Cover refer to Standard and Tailored Cover below and/or 3. Group Salary Continuance (GSC) Cover either a: two year benefit period to age 65 benefit period. Note: TPD Only Cover is not available. TPD Cover cannot be greater than the Death Cover sum insured. GSC Cover is not available to family members in Integra Super Personal. Generally, if members are eligible for insurance, they will be covered 24 hours a day, 365 days a year, worldwide. For more information please refer to When cover commences on page 3. Details of any insurance cover will be shown on the member s Welcome Statement and subsequent Annual Statements. For Death and Total and Permanent Disablement insurance, the member s employer may choose between Standard and Tailored Cover. A brief explanation of each is provided below. Standard Cover Standard Cover is an age-based method of calculating the level of cover provided using a fixed premium. The amount of cover provided will be based on the member s age next birthday. The value of each unit of cover may decrease but the premium remains fixed as the member gets older. Cover is available in one, two or three units. The more units selected, the more cover the member has. For further details please refer to page 7. Please note: hazardous occupations are restricted to a maximum of one unit of Standard Death and TPD Cover. For the definition of hazardous occupations, refer to page 13 of this guide. Tailored Cover Tailored Cover allows the employer to design insurance cover, including how the amount of cover is calculated. Levels of cover will vary according to the insurance benefit design. The employer may select a fixed amount of cover or may determine the cover by a formula such as X times salary, or Y times salary less accumulation in the member s account. The premium is determined using an age based rate table. For further details please refer to pages 14 and 16. Eligibility criteria A member can become covered for insurance either under the default arrangements in the Integra Super Employer Division, or where the employer has selected one or more insurance options. Members need to meet all of the following criteria: Aged between 16 and 64 years. Australian citizen or permanent resident, or visa holder. For more information please refer to page 6. Reside in Australia (unless working overseas). Engaged in an occupation for which cover is available under the policies. Meet specified eligibility criteria established by the employer and agreed with the Insurer. Work at least 15 hours per week on a permanent basis for GSC Cover.

5 Maximum insurance cover $5 million for Tailored Death Only or 3 units of Standard Death Only Cover. $2 million for Tailored Death and TPD or 3 units of Standard Death and TPD Cover. $20,000 or 75% of salary per month, whichever is the lesser, for GSC Cover. When cover commences The time at which cover commences is generally the date the member commences employment with the employer and may vary depending upon the way the employer plan has established insurance cover. The differing ways in which insurance can be obtained are explained below. Establishing cover Depending upon whether the default insurance arrangements apply or if the employer has set up insurance cover for the plan and provided the member is eligible for cover, there are several ways insurance cover can be established: default cover automatic acceptance transfer terms individual member application. Default cover Upon joining their employer s plan, some members, regardless of their occupation, may have automatically received a default amount of insurance cover of either: one unit of Death Only Cover where the employer plan commenced on or after 1 July 2006 one unit of Death and Total and Permanent Disablement (TPD) Cover where the employer plan commenced on or after 1 October Members should check their Welcome Statement to determine whether default insurance cover automatically applies to them and the amount of cover provided. Automatic acceptance When the employer establishes insurance cover for the plan, they may have been provided with an Automatic Acceptance Level (AAL). An AAL is the maximum amount of cover available without the member needing to give evidence of good health. To be eligible, the employer must notify us of membership and remit an initial contribution to the employer's plan within 120 days of the member s commencement. The level of the AAL will depend on a number of factors, including but not limited to: the size of the plan the type of cover the employer selects being actively at work (as defined on page 4) on the employer plan s commencement date or the member s date of joining the employer s plan, whichever is relevant satisfying the eligibility criteria applicable to the employer plan. Cover under the AAL will commence for an insured member upon satisfying the factors above. To join the plan under the AAL, a member must not: have insurance cover which provides similar benefits be entitled to payment of an insurance benefit for sickness or injury, or be in a waiting period for such a benefit have previously been accepted for cover under the AAL of the employer plan. Transfer terms Transfer terms may be available if the employer had similar insurance with another insurer before transferring the insurance to Integra Super. Transfer terms (if applicable) apply only to those persons who were members of the previous plan at the date the plan transferred to Integra Super. If transfer terms apply, all eligible employees who were covered under the previous policy and were at work on the last normal business day prior to the plan joining Integra Super, will be covered for the insured benefit from the plan s commencement date. This will be subject to any premium loadings, restrictions, exclusions and limitations which applied under the previous policy and in accordance with the terms and conditions set by the Insurer.

6 Death Cover is provided for all members who transfer to Integra Super and who were insured under the previous policy, provided they meet the eligibility criteria under Integra Super from the transfer date. TPD Cover and GSC Cover will be provided from the transfer date for all transferring members insured under the previous policy who meet the eligibility criteria under Integra Super and who were at work on the last normal business day immediately before the transfer date. For any transferring member insured under the previous policy who was not at work on the last normal business day before the transfer date for reasons other than sickness or accident, the Insurer will take over the same TPD or GSC Cover provided that: on the day before the first day of the relevant absence, the transferring member was at work and during the period where the transferring member was not at work he or she was not disabled due to a sickness or accident prior to the transfer date. Transferring members insured under the previous policy who were not at work on the last normal business day before the transfer date due to sickness or accident will be provided with New Events Cover from the transfer date. When the transferring member returns to the predisability duties (without limitation) they last performed when they were at work, the New Events Cover will be replaced by TPD Cover. The member must not be entitled to a benefit under the former insurer s policy. The TPD Cover and/or GSC Cover (as relevant) will include cover for any disability arising from events that happened prior to the transfer date. New Events Cover means cover for an eligible person other than cover in relation to the medical condition or any directly or indirectly related condition arising from sickness or injury which has caused the insured member either: to be not at work on the working day immediately preceding the transfer date in respect of an event occurring in the period after the last working day and prior to the transfer date, to be absent from work or to be working in a reduced capacity on the transfer date. at work means the member or proposed member of the Integra Super Employer Division is an eligible person actively performing all the duties of his or her usual occupation on a full-time basis (if engaged full time) or part-time basis (if engaged part time), or is on approved leave other than leave which is taken for reasons related to injury or illness, and is not in receipt of and/or entitled to claim income support benefits from any source including workers compensation benefits, statutory transport accident benefits and disability income benefits. If the eligible person does not meet these requirements, he or she cannot qualify as at work and is correspondingly described as not at work. full time means a person is performing all the normal duties of his or her occupation and is working at least 30 hours per week. part time means a person is performing all the normal duties of his or her occupation and is working at least 15 hours per week for GSC Cover, but less than 30 hours per week. The member s Welcome Statement issued upon joining Integra Super will show the type and amount of cover that applies. If insurance cover is not shown on the Welcome Statement, then insurance cover can be obtained by following either the individual member insurance transfer process or the individual member application process. Both are outlined below. Individual member insurance transfer If a member previously held Death and TPD cover with another superannuation fund, they will be able to obtain this cover in Integra Super up to a limit of $800,000. The member will be required to submit a copy of a past statement from their previous superannuation fund as evidence of the cover held and complete an Individual Insurance Transfer Form that can be downloaded from the Member Super Centre at or a copy may be requested by calling Customer Services on

7 Individual member application The member will be required to submit an application for insurance if: automatic acceptance terms do not apply to the plan the member requires cover in excess of the AAL the member requires cover in excess of the amount accepted by the previous insurer and transferred to Integra Super s insurer under transfer or takeover terms the member s cover stops under the policy transfer terms do not apply to the plan the member requires cover in excess of the employer plan s benefit formula or the member joins Integra Super as a family member (eligible for Death Only or Death and TPD Cover). For the definition of family member please refer to the Member Guide, which forms a part of this PDS. To make an application, the member will need to complete the Short Form Personal Health Statement for all Standard Cover applications and for Tailored Cover applications up to and including $350,000. For GSC Cover and Tailored Cover applications over $350,000, the member will need to complete the Full Personal Health Statement. For all cover, additional health evidence may be required. The Short and Full Personal Health Statements can be downloaded from the Member Super Centre at or a copy may be requested by calling Customer Services on Please submit these forms to: Integra Super ING Life Limited GPO Box 5306 Sydney NSW 2001 If the member applies for insurance cover or any variation in cover and the application is assessed and accepted by the Insurer, the member s cover or variation in cover will commence on the date that the application is assessed and accepted by the Insurer. While the application is being processed, the member may be eligible for Interim Accident Cover. For further details please see below. Interim Accident Cover There is no separate premium for Interim Accident Cover. In the event that an application is accepted, premiums will be charged from the effective date of any cover the Insurer approves. If an application for cover is not accepted, no premium will be charged for the period in which Interim Accident Cover was provided. A benefit is only payable in the event of the member s accidental death or disablement during the period in which Interim Accident Cover applies and is not affected by any pre-existing condition. accident means a fortuitous, external event that occurs by chance causing death or disablement. It does not refer to an event which results in sickness, disease, injury or infirmity of the person insured, such that they would qualify for a death, TPD or GSC Benefit (as applicable) to be paid under the policy. Whether the death or disablement was caused by an unintended and unexpected characteristic or consequence of an intended act (such as the application of unintentionally excessive force, or the creation of unintended excessive pressure or strain) is irrelevant in determining whether death or disablement has arisen as a result of an accident. An accident must result in the death or disablement of the person insured for a benefit to be payable where liability is contingent on an event being caused by an accident or by accidental injury. For the avoidance of doubt, an accident shall specifically exclude death or disablement: arising out of, or contributed to in any way by, any pre-existing sickness, disease, injury, gradual physical or mental deformity, or infirmity known to the person insured at the effective date of their cover under this policy arising in circumstances where the person insured deliberately assumed the risk or courted disaster, irrespective of whether he or she intended or contemplated the results of his or her actions. Where there is doubt as to the cause of death or disablement sustained as a result of an accident, the cause will be characterised as being the result of a sickness.

8 Death Only Cover and Death and TPD Cover If the member makes an application for Death Only Cover (including terminal illness), Death (including terminal illness) and TPD Cover (if it applies) or an application for an increase in cover, Interim Accident Cover is provided to them at the same level as the cover applied for, or the difference between the level of increased cover applied for and the current level of cover, up to the maximum benefit level permitted. This cover starts: for an eligible member not previously accepted for cover, from the date an application for cover is received by the Insurer at their principal office in Sydney in relation to applications for increases in cover, from the date the increase in cover would have applied if an application was not required. Interim Accident Cover continues until the earlier of: the date we accept or reject the application for cover 90 days after the date Interim Accident Cover starts. Please note: This means that a benefit is not payable under Interim Accident Cover if the member is diagnosed as suffering from a terminal illness during the period of the Interim Accident Cover. Cover for non-australian residents Cover will be provided for an insured member who is not an Australian resident who holds a visa. Cover will apply whilst the insured member resides in Australia. All cover will cease immediately upon the insured member departing Australia, except in the case of overseas trips of three months or less. For GSC, benefit payments will end where the insured member is in receipt of benefit payments at the date of departure, or expiration or cancellation of their visa. visa means a current and valid visa issued in accordance with the Migration Act 1958 (Cth) or any amending or replacing Act. It can be a: Subclass 457 working visa Subclass 457 working visa (with an 8107 condition) spouse visa (spouse of a permanent Australian resident on a two year temporary stay visa) without a no work condition. Group Salary Continuance Interim Accident Cover provides a restricted level of cover whilst the member s application is being considered. It is provided for all or that part of the cover for which an application is required. Interim Accident Cover starts: for an eligible person not previously accepted for cover under the policy, from the date an application for cover is received by the Insurer at their principal office in Sydney from the date the increase in cover would have applied if an application was not required. Interim Accident Cover continues until the earlier of: the member is notified that their application for cover, or increase in cover, has been accepted or rejected 90 days after the date Interim Accident Cover starts.

9 Benefits The benefit amount will be different for each type of cover and will depend on various factors, including: whether default insurance cover applies the selection(s) made when the employer established the plan with Integra Super the member s salary, where the benefit is determined with reference to salary. For example, the monthly benefit under GSC Cover may be the monthly equivalent of 75% of their salary the member s age whether the member has applied for an increase in cover, and the increase has been accepted or declined whether the amount insured has been reduced by any other amount paid. For example, the Death Benefit is reduced by any Terminal Illness Benefit paid in respect of the member. The monthly benefit for GSC Cover may be reduced by workers compensation payments received in respect of the member any maximum limits which may apply. Note: If a benefit is calculated using the member s salary, the employer must notify us of all salary changes as they occur. If we are not notified of a change in salary and no additional premium has been paid, in the event of a claim we may pay a lower benefit based on the member s salary that was previously advised or the salary at the last review date. Standard Cover Benefit table for Death Only Cover and Death and TPD Cover Standard Cover allows for a fixed premium. Cover levels are shown below. Age next birthday 1 unit 2 units 3 units $100,000 $200,000 $300, $96,600 $193,200 $289, $94,500 $189,000 $283, $92,400 $184,800 $277, $85,100 $170,200 $255, $76,800 $153,600 $230, $71,300 $142,600 $213, $66,400 $132,800 $199, $60,700 $121,400 $182, $55,300 $110,600 $165, $54,400 $108,800 $163, $44,700 $89,400 $134, $39,900 $79,800 $119, $35,600 $71,200 $106, $34,100 $68,200 $102, $34,100 $68,200 $102, $25,800 $51,600 $77, $23,200 $46,400 $69, $20,900 $41,800 $62, $19,000 $38,000 $57, $19,000 $38,000 $57, $14,700 $29,400 $44, $13,200 $26,400 $39, $11,900 $23,800 $35, $11,400 $22,800 $34, $11,400 $22,800 $34, $8,900 $17,800 $26, $8,100 $16,200 $24, $7,300 $14,600 $21, $6,700 $13,400 $20, $6,300 $12,600 $18, $6,000 $12,000 $18, $6,000 $12,000 $18, $6,000 $12,000 $18, $6,000 $12,000 $18, $6,000 $12,000 $18,000

10 Death Only Cover Death Benefit and Terminal Illness Benefit The Death Benefit will be paid if the member dies and the Terminal Illness Benefit will be paid if the member becomes terminally ill: while this policy is in force before cover ends and before the benefit expiry age for the Death Benefit is reached. A person is regarded as terminally ill when they are diagnosed by two medical practitioners (one of whom is nominated by the Insurer) as having a terminal illness and is not expected to live for more than 12 months. The Death Benefit is the sum insured plus the member s account balance. The Terminal Illness Benefit is the lesser of the insured benefit outlined in the policy terms or $1 million. The insured benefit for death is reduced by the Terminal Illness Benefit paid. If the insured benefit is greater than $1 million, the balance is paid on the member s death as long as: this is before the benefit expiry age for the Death Benefit is reached the member s cover is still in place premiums continue to be paid for the reduced insured benefit the policy is still in force. Total and Permanent Disablement (TPD) Benefit The TPD Benefit (if it applies) will be paid if the member is totally and permanently disabled (refer to Definition 1). The member must have ceased work as a result of the injury or illness giving rise to total and permanent disablement while the policy is in force and before the first to occur of: the member s cover ending the member becoming terminally ill the policy ending and the member returning to work on a full or part-time basis or the benefit expiry age for the TPD Benefit is reached. The member will be requested to provide evidence of their disability to enable us to determine whether or not they qualify for the payment of the TPD Benefit. In order for the member to be considered for assessment for a TPD Benefit under Definition 1, they will be required to be permanently employed (including contractors, as defined on page 9) and have worked 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. The member will also be considered for assessment for a TPD Benefit under Definition 1 if they are permanently employed (including contractors) and worked for a period of less than six consecutive months. This will be conditional upon the member working an average of 15 hours or more per week in the period immediately prior to the date giving rise to the disablement. If the member does not satisfy the minimum number of hours or is not a permanent employee (or a contractor), they will still be considered for assessment of TPD Cover, however, it will be under a limited definition (refer to Definition 2) before a TPD Benefit will be paid. If the member leaves their employment and is transferred to Integra Super Personal, the definition of TPD that may apply will be dependent on whether they are working and if so, the number of hours worked with the new employer. Please refer to page 21 for more information. Definition 1 Totally and permanently disabled means: Unlikely to return to work. If the insured member is engaged in a gainful occupation, business, profession or employment when suffering an injury or illness and, as a result of that injury or illness, he or she is: OR totally unable to engage in any occupation, business, profession or employment for a period of six consecutive months and determined by the Insurer at the end of that six month period (or such later time the Insurer agrees with the Trustee), to be permanently incapacitated to such an extent as to render him or her unlikely ever to engage in any gainful occupation, business, profession or employment, for which he or she is reasonably suited by education, training or experience. Permanent impairment. If the insured member is engaged in a gainful occupation, business, profession or employment when suffering an injury or illness and, as a result of that injury or illness, he or she:

11 Definition 1 (cont) OR suffers a permanent impairment of at least 25% of whole person function as defined in the American Medical Association publication Guides to the Evaluation of Permanent Impairment (4th edition), or an equivalent guide to impairment approved by us and is disabled to such an extent that, as a result of this impairment, they are unlikely ever again to be able to engage in any gainful occupation, business, profession or employment for which they are reasonably suited by their education, training or experience. Specific loss. As a result of illness or injury, the insured member suffers the total and permanent loss of the use of: OR two limbs (where limb is defined as the whole hand or the whole foot) or the sight in both eyes or one limb and the sight in one eye. Loss of independent existence. As a result of illness or injury, the insured member suffers loss of independent existence. Loss of independent existence means we have determined the insured member is totally and irreversibly unable to perform at least two of the following five activities of daily living without the assistance of another adult person: OR bathing and/or showering dressing and undressing eating and drinking using a toilet to maintain personal hygiene getting in and out of bed, a chair or wheelchair, or moving from place to place by walking, wheelchair or with assistance of a walking aid. Cognitive loss. As a result of illness or injury, the insured member suffers cognitive loss. Cognitive loss means we have determined a total and permanent deterioration or loss of intellectual capacity has required the insured member to be under continuous care and supervision by another adult person for at least six consecutive months and, at the end of that six month period, they are likely to require permanent ongoing continuous care and supervision by another adult person. Definition 2 Totally and permanently disabled means: Specific loss. As a result of illness or injury, the insured member suffers the total and permanent loss of the use of: OR two limbs (where limb is defined as the whole hand or the whole foot) or the sight in both eyes or one limb and the sight in one eye. Loss of independent existence. As a result of illness or injury, the insured member suffers loss of independent existence. Loss of independent existence means we have determined the insured member is totally and irreversibly unable to perform at least two of the following five activities of daily living without the assistance of another adult person: OR bathing and/or showering dressing and undressing eating and drinking using a toilet to maintain personal hygiene getting in and out of bed, a chair or wheelchair, or moving from place to place by walking, wheelchair or with assistance of a walking aid. Cognitive loss. As a result of illness or injury, the insured member suffers cognitive loss. Cognitive loss means we have determined a total and permanent deterioration or loss of intellectual capacity has required the insured member to be under continuous care and supervision by another adult person for at least six consecutive months and, at the end of that six month period, they are likely to require permanent ongoing continuous care and supervision by another adult person. contractor means a person who is performing all the normal duties of his or her occupation and is working on a contracted basis for at least 15 hours per week and is under a fixed term contract of no less than one year.

12 Group Salary Continuance (GSC) Cover Total Disability Benefit The monthly benefit will be paid if the member is totally disabled for longer than the waiting period and while cover is still in force. The monthly benefit starts to accrue from the day after the end of the waiting period. The monthly benefit is payable monthly in arrears and stops at the earliest of: the end of either the two year or 'to age 65 benefit period, whichever applies the member reaching the benefit expiry age the member s death the member ceasing to be totally disabled for an insured member holding a visa (for more details please refer to page 6) the date the member s employment contract and/or visa expires or is otherwise terminated, or on the date they leave Australia. totally disabled means solely as a result of injury or illness, the member is incapable of performing one or more duties of his or her usual occupation necessary to produce income, and the member is not engaged in any occupation, and is under the regular treatment and following the advice of a medical practitioner. salary means the fixed annual component of income paid to an insured member by his or her employer, in respect of the insured member s employment. Partial Disability Benefit The Partial Disability Benefit begins to accrue from the day after the member is no longer totally disabled or after the end of the waiting period, whichever is the later. The Partial Disability Benefit is payable monthly in arrears and stops at the earliest of: the end of either the two year or to age 65 benefit period, whichever applies the member reaching the benefit expiry age the member s death the member ceasing to be partially disabled the member earning, or being capable of earning, a monthly salary equal to or greater than their pre-disability salary for an insured member on a visa (for more details please refer to page 6) the date the member s employment contract and/or visa expires or is otherwise terminated, or on the date they leave Australia. The Partial Disability Benefit will be paid if an insured member is partially disabled, as defined below. Further, the member must be totally disabled for at least 7 out of 12 consecutive days during the waiting period or following a period of total disablement for which a benefit has been paid after the waiting period, then a proportion of the monthly benefit will be paid. The proportion will be calculated as follows: A B A where: x monthly benefit A is the member s pre-disability salary B is the greater of the salary the member: earns for the month that the Partial Disability Benefit is payable is capable of earning for the month that the Partial Disability Benefit is payable. We will calculate the amount the member is capable of earning based on medical advice, which will include the opinion of the member s medical practitioner and all other relevant information. partial disability means, in relation to a member, all the following apply: the insured member has been totally disabled and is no longer totally disabled: for a period during which a Total Disability Benefit has been paid or for at least 7 out of 12 consecutive days during the waiting period then returns to work, or is then capable of returning to his or her usual occupation, but only in a limited capacity the salary the insured member is earning, or is capable of earning, is less than his or her predisability salary due to the injury or illness causing total disability. 10

13 medical practitioner means a medical practitioner who is legally qualified and properly registered in Australia, and not related to the relevant insured member. Premium waiver Any premium which falls due while the member is receiving the Total or Partial Disability Benefit, will be waived. Return to work program pre-disability salary means the total monthly value of salary received by the insured member from his or her usual occupation, averaged over the most recent 12 month period the insured member was at work prior to becoming disabled, or the actual period of work if less. Benefit period The benefit period is the length of time or age until which cover will continue, provided the member continues to meet the definition or any eligibility criteria. Integra Super offers either a two year or to age 65 benefit period. The member s Welcome Statement and any subsequent Annual Statements will indicate any GSC Benefit applicable and the benefit period. The benefit period is selected by the employer and accepted by the Insurer. Waiting period The waiting period is the length of time between when the member is totally or partially disabled and when benefits start being paid, provided the date of disability is after cover has started. A benefit is only payable where the member is totally or partially disabled for at least the waiting period. The waiting period is selected by the employer and accepted by the Insurer. The member s Welcome Statement and any subsequent Annual Statements will indicate any GSC Benefit and the waiting period applicable. If the member returns to work during the waiting period, the waiting period starts again, unless the return to work only happens once and is for no more than five consecutive days. In this case, the Insurer will add the number of days worked to the waiting period. Death Benefit If the member dies while a disability benefit is being paid, one additional month s benefit will be paid after the member s death. Once the Trustee receives notice of an injury or illness which may give rise to a claim for a Total or Partial Disability Benefit, if the Insurer is of the opinion that participation in a return to work program may help the member return to work, some or all of the expenses incurred for the member s participation in that program will be paid. The Insurer will only pay where the Trustee has approved the program expenses. Recurring disablement If an insured member returns to work after a period of disability and suffers the same disability again within six months of that earlier claim ending, the further claim will be regarded as a continuation of the earlier claim, and the waiting period will not apply. Both the member s cover and the policy must still be in force. Benefits will be limited to the unexpired portion of the two year or to age 65 benefit period, whichever applies. Other important information Benefit limitations It is important to be aware of the limitations which could affect insurance. Benefit reductions Benefits payable will be reduced in the following circumstances: For Death and TPD, if the member s cover ends because they do not satisfy the eligibility criteria for a continuous period of 30 days and they become covered by another policy from another insurer providing similar benefits, we may reduce or refuse to pay any benefit which may become payable by the amount paid by the subsequent policy. For GSC, the Total or Partial Disability Benefit is reduced by other payments (including settlement or commutation amounts) received by, or in respect of, the member: by way of workers compensation by way of social security or other statutory or government payments in respect of loss of income (whether under legislation or otherwise) 11

14 under any statutory accident compensation scheme as benefits under any other disability, injury or sickness insurance policy (except for lump sum benefits received for total and permanent disablement under such an insurance policy). Note: Annual leave, sick leave, long service leave entitlements and investment income are not taken into account. To calculate the reduction of the GSC Cover to be paid, any lump sum payment is converted to an equivalent monthly amount at the rate of 1/60th of the lump sum per month, for a maximum of five years or the length of the benefit period, whichever is the lesser. Benefit escalation Where an employer has chosen to include benefit escalation to their employer plan, the monthly benefit will be increased by the lesser of the annual CPI increase and the escalation factor. This will apply 12 months after a Total or Partial Disability Benefit has been continuously paid. The adjusted benefit will be similarly increased after each 12 month period for which a Total or Partial Disability Benefit is continuously paid in respect of the member. At the end of the period of claim, the monthly benefit reverts to the level which applied before the benefit escalation. Pre-existing conditions If GSC Cover or TPD Cover is accepted under automatic acceptance or transfer terms, cover for pre-existing conditions does not apply if a similar benefit can be claimed under a policy from another insurer or under another plan. If the member is not eligible for automatic acceptance or transfer terms, they must disclose pre-existing conditions with their initial application for cover and for any subsequent applications for increases or alterations to their cover. pre-existing condition means an injury which first occurred or an illness which first became apparent before the person became an insured member or, in relation to an increase in cover, before the increase commenced. Who the benefit is paid to The insurance cover is provided by ING Life. The insurance policies are issued to the Trustee and are offered to members of Integra Super. Any claims must be made through the Trustee as the policy owner. If the Insurer rejects, reduces or defers a death, TPD or GSC claim, the Trustee may reduce the benefit payable to take into account the Insurer s refusal, reduction or deferral. Under superannuation law, the Trustee may only release a benefit if a condition of release is met. If the Trustee is unable to release the member s benefit, any proceeds will be credited to their member account and paid when they meet a condition of release. For more information on 'Conditions of release' please refer to the Member Guide, which forms a part of this PDS. Insurance risks Where insurance applies to the member s superannuation arrangements, i.e. Death Only Cover, Death and TPD Cover or GSC Cover under Integra Super, there are a number of insurance risks members should be aware of: If the member s account balance is insufficient to meet the cost of premiums, cover will cease. If the member is transferred to an Eligible Rollover Fund (ERF), their cover will cease (for more details please refer to the Member Guide, which forms a part of this PDS). The amount or type of insurance cover selected by the employer may not be sufficient to provide adequate insurance cover in the event of a member s injury or illness. The member's premium or benefit may be adjusted if the member's age is mis-stated. If a benefit is calculated using the member s salary while they are in the employer s plan, we are reliant upon the employer s notification of any salary changes. Where we are not notified of a change in salary and no additional premium is paid, in the event of a claim we may pay a lower benefit based on the salary that was previously advised or salary at the last review date. If the member or employer do not disclose to the Insurer every matter known or 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 void the contract within three years of entering into it. If the member s or employer s non-disclosure is fraudulent, the Insurer may void the contract at any time. 12

15 Premiums The premium applying will depend on a variety of factors including: the type and level of cover the member s age any relevant rating factors applicable to the employer s plan the member s occupation and occupational category any applicable insurance commission arrangements with the employer s financial adviser the member s health and pastimes (where they apply individually). Premiums are calculated and deducted monthly in arrears from the member s Integra Super account. The actual premium payable will be advised in the Welcome Statement provided upon joining Integra Super, and then for each subsequent year in the Annual Statement issued as at 30 June. Taxes and expenses The premiums are inclusive of any: Federal, State or Territory taxes, stamp duty in the member s State or Territory of residence (GSC Cover only) or other government charges expenses incurred in administering any function required by a Federal, State or Territory government under any legislation in relation to the policy. Standard Cover premiums The gross (before tax) premium applicable for each occupational category is as follows. Occupational factors and premiums Occupational category White Collar (WC 1 & 2) Maximum units available Male and Female premium per week per unit Death Only Cover Death and TPD Cover 3 $0.72 $1.20 Light Blue (LB) 3 $0.94 $1.78 Heavy Blue (HB) 3 $1.22 $2.86 Hazardous occupations 1 $1.80 $3.60 White Collar 1 (WC 1): Professional white collar workers who possess university qualifications (e.g. lawyers, doctors, accountants). Also includes individuals employed by an independent employer who are executives or senior managerial white collar workers with salary packages in excess of $100,000 p.a. White Collar 2 (WC 2): Clerical or administrative white collar workers who do not perform any manual work, or sales people not involved in deliveries. Light Blue (LB): Certain skilled technicians and proprietors in nonhazardous industries involved in light manual work, e.g. jewellers, computer technicians, café/coffee shop proprietors etc. Also includes supervisors of blue collar workers provided that no more than 10% of their time is spent performing light manual work, and fully qualified tradespeople. Details of qualifications must be provided. Heavy Blue (HB): Skilled or semi-skilled manual workers and heavy machinery operators who are not exposed to high-risk accidents or health hazards. Unskilled workers and labourers are not included in this occupation class. Hazardous occupations: Skilled or semi-skilled manual workers and heavy machinery operators who are exposed to high-risk accidents or health hazards. Any unskilled workers and labourers. Note: Hazardous occupations are restricted to a maximum of one unit of Standard Death and TPD Cover. 13

16 Tailored Death Only and Death and TPD cover premiums Plans with up to 50 members If the employer plan has up to 50 members, then the premiums that will apply are set out opposite. These premium rates are based on the white collar occupational category (WC 1 and WC 2) and are inclusive of 20% commission (exclusive of GST) and excluding any other premium loadings. As outlined earlier, premiums will vary for individual members based on member and plan factors. Plans with more than 50 members If there are more than 50 members in the employer plan, then a rating factor will need to be applied. The plan rating factor and premium rate guarantee is determined and set by the Insurer and assessed on a case by case basis. The plan rating factor will be a factor which is applied to the individual premium that is set out opposite. The premium that applies will be set out in the member s Welcome Statement. Tailored Cover Premium tables for Death Only Cover and TPD Cover The tables opposite and on page 16 show the gross (before tax) annual premium rate applicable for each $1,000 of cover provided in respect of Death Only Cover (including terminal illness) and Death (including terminal illness) and TPD Cover. The premium rates will differ depending on whether the member joins Integra Super as a member of an employer plan or as a family member. These premium rates are based on the white collar occupational class and are inclusive of 20% commission (exclusive of GST) excluding any other premium loadings. The premium applicable may vary from these premium rates depending on various factors, including the occupational class (refer to Occupational factors on page 15), any health or other loadings applicable and any variation of insurance commission paid to the employer plan s financial adviser. Note: Hazardous occupations are unable to obtain cover under Tailored Cover. Premium table for Tailored Death Only Cover and Death and TPD Cover for members of an employer plan Age next birthday Male Death Female Death Male TPD Female TPD Note: TPD Cover ceases when a TPD Benefit is paid or on the member s 64th birthday (whichever occurs first). 14

17 Occupational factors The occupational factors that apply to Tailored Cover for members of an employer plan are outlined below. Occupation category White Collar (WC 1 & 2) Male and Female Death Only Cover Light Blue (LB) Heavy Blue (HB) Hazardous occupations Not available Male and Female TPD Cover Not available White Collar 1 (WC 1): Professional white collar workers who possess university qualifications (e.g. lawyers, doctors, accountants). Also includes individuals employed by an independent employer who are executives or senior managerial white collar workers with salary packages in excess of $100,000 p.a. White Collar 2 (WC 2): Clerical or administrative white collar workers who do not perform any manual work, or sales people not involved in deliveries. Light Blue (LB): Certain skilled technicians and proprietors in nonhazardous industries involved in light manual work, e.g. jewellers, computer technicians, café/coffee shop proprietors etc. Also includes supervisors of blue collar workers provided that no more than 10% of their time is spent performing light manual work, and fully qualified tradespeople. Details of qualifications must be provided. Heavy Blue (HB): Skilled or semi-skilled manual workers and heavy machinery operators who are not exposed to high-risk accidents or health hazards. Unskilled workers and labourers are not included in this occupation class. Death Only Cover or Death and TPD Cover may not be available for some occupational classes. Hazardous occupations: Skilled or semi-skilled manual workers and heavy machinery operators who are exposed to high-risk accidents or health hazards. Any unskilled workers and labourers. Note: Hazardous occupations are restricted to a maximum of one unit of Standard Death and TPD Cover. Example David is a 34 year old qualified tradesperson and is a member of his employer s plan in Integra Super. David would like Death and TPD Cover for $400,000. His premium for Death and TPD Cover would be calculated as follows: Death and TPD Cover premium rate (age next birthday = 35 years) x Occupational factor (LB) Death 0.46 x 1.30 = TPD 0.36 x 1.75 = $1.228 x $400,000 1,000 = $ p.a. or $40.93 per month = Premium per $1,000 of cover David s annual premium will be $ p.a. before the application of any applicable plan loading factor. 15

18 Premium table for Death Only Cover and Death and TPD Cover for members in Integra Super Personal* Age next birthday Male Death Female Death Male TPD Female TPD Note: TPD Cover ceases when a TPD Benefit is paid or on the member s 64th birthday (whichever occurs first). Occupational factors The occupational factors that apply to Death Only and Death and TPD Cover for members in Integra Super Personal* are outlined below. Occupation category White Collar (WC 1 & 2) 1.00 Light Blue (LB) 1.50 Heavy Blue (HB) 2.00 Hazardous occupations Male and Female TPD Not available White Collar 1 (WC 1): Professional white collar workers who possess university qualifications (e.g. lawyers, doctors, accountants). Also includes individuals employed by an independent employer who are executives or senior managerial white collar workers with salary packages in excess of $100,000 p.a. White Collar 2 (WC 2): Clerical or administrative white collar workers who do not perform any manual work, or sales people not involved in deliveries. Light Blue (LB): Certain skilled technicians and proprietors in nonhazardous industries involved in light manual work, e.g. jewellers, computer technicians, café/coffee shop proprietors etc. Also includes supervisors of blue collar workers provided that no more than 10% of their time is spent performing light manual work, and fully qualified tradespeople. Details of qualifications must be provided. Heavy Blue (HB): Skilled or semi-skilled manual workers and heavy machinery operators who are not exposed to high-risk accidents or health hazards. Unskilled workers and labourers are not included in this occupation class. * These rates apply to family members and members who wish to apply for insurance cover once they have transferred from the employer division to Integra Super Personal and did not previously have insurance cover. 16

19 Group Salary Continuance Cover Premium tables The tables opposite and on page 18 show the gross annual premium rates applicable for each $100 of monthly benefit provided in respect of GSC Cover for males and females up to the age of 65 (next birthday) for either a two year or to age 65 benefit period, whichever applies. These premium rates are based on the white collar occupational class (WC 2) with 20% insurance commission (exclusive of GST) and without any other premium loadings. The premium applicable may vary from these premium rates depending on various factors, including the occupational class (refer to Occupational factors on page 18), any health or other loadings applying, and any variation of insurance commission paid to the employer plan s financial adviser. Stamp duty based on the member s State or Territory of residence must also be added. For more information relating to stamp duty in the member s state please call Customer Services on Group Salary Continuance Cover is not available for family members. Note: Hazardous occupations are unable to obtain GSC Cover. Plans with up to 50 members If the employer plan has up to 50 members, then the premiums that will apply are set out on this page and page 18. Plans with more than 50 members Plans with more than 50 members will be referred to the Insurer for consideration. A plan rating factor which may effectively increase the premiums may apply. The plan rating factor will be a factor which is applied to the individual premiums that are set out on this page and page 18. The premium that applies will be set out in the member's Welcome Statement and subsequent Annual Statements. Premium table for Group Salary Continuance Cover two year benefit period* Age next birthday Male Male Male Female Female Female 30 day wait 60 day wait 90 day wait 30 day wait 60 day wait 90 day wait

20 Premium table for Group Salary Continuance Cover to age 65 benefit period* Age next birthday Male Male Male Female Female Female 30 day wait 60 day wait 90 day wait 30 day wait 60 day wait 90 day wait Occupational factors The occupational factors that apply to GSC are outlined in the table below. Occupation category White Collar 1 (WC 1) 0.91 White Collar 2 (WC 2) 1.00 Light Blue (LB) 2.20 Heavy Blue (HB) 3.20 Hazardous occupations GSC Cover Not available White Collar 1 (WC 1): Professional white collar workers who possess university qualifications (e.g. lawyers, doctors, accountants). Also includes individuals employed by an independent employer who are executives or senior managerial white collar workers with salary packages in excess of $100,000 p.a. White Collar 2 (WC 2): Clerical or administrative white collar workers who do not perform any manual work, or sales people not involved in deliveries. Light Blue (LB): Certain skilled technicians and proprietors in nonhazardous industries involved in light manual work, e.g. jewellers, computer technicians, café/coffee shop proprietors etc. Also includes supervisors of blue collar workers provided that no more than 10% of their time is spent performing light manual work, and fully qualified tradespeople. Details of qualifications must be provided. Heavy Blue (HB): Skilled or semi-skilled manual workers and heavy machinery operators who are not exposed to high-risk accidents or health hazards. Unskilled workers and labourers are not included in this occupation class. Group Salary Continuance Cover may not be available for some occupational classes. Hazardous occupations: Skilled or semi-skilled manual workers and heavy machinery operators who are exposed to high-risk accidents or health hazards. Any unskilled workers and labourers. Note: Hazardous occupations are restricted to a maximum of one unit of Standard Death and TPD cover. * These rates also apply to members who wish to apply for insurance cover once they have transferred from the employer division to Integra Super Personal and did not previously have insurance cover. 18