Welcome to the AYSF Group Insurance Plans.

Transcription

1 An introduction to Group Insurance Plans - Members Booklet Welcome to the AYSF Group Insurance Plans. Important note: This document is provided by AYSF and has been prepared with the assistance of Certainty Financial Pty Ltd which is the appointed adviser firm to the AYSF Group Salary Continuance and Group Life Plans. The purpose of this document is to help you gain a basic understanding of the features and benefits of the insurance Plans. It is a summary only and does not contain the full details of the plan. It does not convey any legal entitlement under the Plans. For a full description of the terms and conditions of the plan, you should refer to the Policy document held by your AYSF superannuation team. Alternatively, you can contact Certainty Financial offices as per the contact details provided. This document is current as at May

2 Introduction Australian YMCA Superannuation Fund (AYSF) believes the provision of these plans to be an important benefit of employment with the organisation. Membership of this plan is automatic upon your commencement of service with AYSF and upon joining the staff superannuation plan (AYSF). They offer valuable benefits if you die or become seriously disabled, and also protects your income in the event that you are unable to work due to injury or illness. It is important that you read this booklet to get a basic understanding of the benefits available to you. This document does not contain the full details of the contract between AYSF and the insurer, Tower and offers a general guide only to the insurance offered. It conveys no legal entitlement to a claim under the policy. The insurance is provided under a contract between the AYSF and Tower Australia Ltd (formerly known as PrefSure) ABN For a full description of the terms and conditions of cover, you should refer to the Policy Document held by your AYSF superannuation team. Alternatively, at the end of this booklet are details of who to call if you have any questions. To assist in your ease of understanding, this booklet has adopted a question and answer approach about your membership entitlements and is broken up into three parts: 1. Group Salary Continuance Policy 2. Group Life / TPD Plan 3. General Information & Contact Details 2

3 Section 1. Group Salary Continuance Policy (Income Protection Insurance) I just want to know what is salary continuance insurance? Salary continuance (also known as income protection) is a form of insurance that provides up to 75% of your base salary in the event that you are unable to work due to injury or illness. Unlike workers compensation, income continuance covers you seven days a week, 24 hours per day, anywhere in the world. The benefit is payable monthly in arrears, and becomes payable after you have been unable to work due to illness of injury for a period of 90 days (known as the waiting period). For example, if you were off work for a total of 100 days, you would receive 10 days worth of benefit. The benefit can be payable for up to 2 years, should your injury or illness continue to prevent you from working. who is eligible for cover? All Full Time and Part Time employees upon commencement of service who are presently working for AYSF and are a member of the staff superannuation plan and who commenced employment before age 65, are eligible for cover. This is provided the person works at least 15 hours per week. It does not include persons employed on a "casual" basis. when does cover commence? Cover is automatic for all Full Time and Part Time employees of AYSF on a permanent basis for at least 15 hours per week. You must be in active employment on the commencement date to be entitled to cover up to the Automatic Acceptance Limit (AAL). If you are not in active employment, then limited cover will apply. If you are eligible for cover in excess of the Automatic Acceptance Limit (AAL) or you have joined outside of the eligibility conditions (and therefore have no cover), you will need to be underwritten and accepted by Tower. who pays the premium? The premiums are deducted from member accounts at 30 June each year, or on exit from AYSF. If at any time AYSF ceases to be the plan sponsor, the plan will end. If that occurs you will be notified and given the opportunity to take up, at your own expense, your own income continuance insurance plan. do I need a medical? Not to join the plan, but possibly to access maximum benefit entitlements. In line with the benefit design, you are eligible for cover under this group insurance policy for up to 75% of your base salary subject to a maximum insured benefit of $20,000 per month. This means that every member earning a base salary of up to $320,000 per annum could be in receipt of 3

4 their full entitlement of insurance cover ($320,000 x 75% per annum / 12 = $20,000 per month). You are automatically entitled to a portion of that cover irrespective of any previous medical condition or injury, and irrespective of any sporting or pastime pursuits (eg. martial arts, flying, rock climbing, scuba diving, motor vehicle racing, etc). This is $10,000 per month which relates to a base salary of $160,000 ($160,000 x 75% = $120,000 / 12 Months = $10,000). Thus, any member earning in excess of $160,000 is required to submit medical evidence for assessment on the benefit entitlement in excess of $10,000 per month. If your base salary does exceed $160,000, you should contact AYSF s appointed advisers, Certainty Financial to arrange the necessary documentation for additional cover. what do I need to do to increase my cover? Any staff member earning in excess of $160,000 per annum who wants to increase their cover to the maximum 75% of their base salary is required to submit medical evidence for assessment on the benefit entitlement in excess of $10,000 per month. Thus, if your base salary exceeds $160,000, you should contact AYSF s appointed advisers, Certainty Financial to arrange the necessary documentation for the additional cover, with this additional cover to be also funded by the staff member via salary sacrifice. how are my benefits provided? Your benefits are made available through a group insurance policy owned by AYSF and underwritten by Tower. how does the plan work? If you become totally disabled or partially disabled in accordance with the terms and conditions of the Policy, you may become eligible for a monthly disability benefit. This benefit of up to 75% of your base salary becomes payable after you have been unable to work due to illness of injury for a period of 90 days, and continues to be payable up to 2 years, should your injury or illness continue to prevent you from working. what is total disability? The definition of Total Disability is as follows: Solely because of sickness or injury, you: are unable to perform at least one income producing duty of your own occupation; and are not working in any occupation whether or not for reward; and are under the regular care of, and following the advice of a medical practitioner. It is important to note that your income replacement benefits are not paid in addition to any sick leave entitlements. 4

5 are benefits paid for partial disability? Yes, they begin to accrue the day following the end of the waiting period if you: have been totally disabled for at least 14 consecutive days; are unable to work in your own occupation at full capacity immediately after you became totally disabled because of the sickness or injury that caused your total disability; are working in a reduced capacity; earn a monthly income that is less than your pre-disability income; and are under the regular care of, and following the advice of, a medical practitioner. The partial benefits are calculated by offsetting any income, you earn from personal exertion while disabled, from your monthly benefit. are benefits reduced if I receive compensation from elsewhere? Yes. The amount of benefits you receive will be reduced by other disability income you receive. This is any income, commutation of income either paid or payable that you receive as a result of the sickness or injury and, workers compensation benefits, or other income replacement policy (excludes sick leave payments). This will apply only where the total monies received exceed 75% of your base salary. when do benefits for disability start and stop? If you are still disabled after the end of the waiting period, benefits will begin accruing from the day after the end of the waiting period. The benefits are paid monthly in arrears and stop on the earlier of: you cease to be disabled; your death; you turn 65; the end of the benefit period (up to 2 years). what is my benefit amount? If you are totally disabled, a monthly benefit in arrears would be payable after the 90 day waiting period of up to 75% of your base salary advised at the time of the last plan review, subject to a maximum insured benefit of $20,000 per month. If you are partially disabled, a proportion of the monthly benefit will be paid to you based on the reduction in your income earned before total disability and the income earned whilst you are partially disabled, according to the formula set out in the Policy*. 5

6 The benefit for either total disability or partial disability may be reduced by other compensation received. *Please contact the AYSF superannuation team to obtain a copy of the Policy document. how do I make a claim under the plan? If you feel that you may be eligible to claim under this policy, please speak with your AYSF superannuation team to organise the relevant paperwork via the firm s appointed advisers, Certainty Financial. Additional information, including medical information, may be required at your expense at regular intervals until the disability ceases or benefits are terminated. Claim benefits are paid monthly in arrears. are there any other benefits? Yes. There is a range of other valuable benefits included in the policy. Briefly these include: Rehabilitation Expense Benefits Tower will meet the rehabilitation expenses for a member who is disabled if: (a) Tower and your medical practitioner approve the rehabilitation expenses in writing before the program is undertaken; and (b) The expenses are incurred to directly assist you to return to work in a gainful occupation. Death Benefit If you die whilst receiving claim payments from Tower, an additional lump sum amount equal to one quarter of the annual total disability benefit will be paid for 1 year. do I have to re-qualify if a disability re-occurs? Not necessarily. If a disability re-occurs from the same or related cause within six months of the previous claim ending, it will be considered to be a continuation of the previous claim and the waiting period will not be applied again. are benefit payments indexed to maintain their value? Yes. While you are on claim, at the end of each consecutive 12 month period for which benefits are payable, the monthly benefit will be indexed by the Consumer Price Index up to a maximum of 7.5%. are there any limitations on benefits? Yes. There are certain events in which benefits will not be paid under the policy. These are described in detail under the policy and include war, service in the armed forces (other than the Australian Armed Forces Reserve), an intentional self-inflicted act, pregnancy or childbirth. 6

7 will I be covered if I travel outside Australia? Yes. The policy can cover you while travelling anywhere in the world and whilst you continue to be a full, part time, or fixed term employee with AYSF. If you intend to reside outside Australia for longer than 13 weeks travelling to a non G7 country, cover must be approved by Tower in writing. Tower may impose special conditions for cover outside Australia. While a member is outside Australia, benefit payments will only be paid for a maximum of six months, unless the insured person has returned permanently to Australia or another country acceptable to Tower. This timeframe is increased to 12 months within a G7 country. G7 countries include Canada, France, Germany, Italy, Japan, UK, and the USA. what happens if I take maternity/paternity leave or leave without pay? You are covered for up to 12 months after your leave commences provided that: you are not taking leave due to injury or illness; AYSF approves your leave, before you go; if the leave period exceeds three months, Tower must be notified; the premium is continued to be paid. what happens to my cover if I change jobs? If you should leave the service of AYSF before age 60 for reasons other than retirement or disability, and you continue employment elsewhere: You will be given the option to continue your cover under an individual policy without providing any medical information. It is subject to you exercising the option within 60 days of leaving service, there may be certain details required in relation to your occupation and pastimes. Also, any special conditions which may apply to your membership in this plan would continue. It is important to note that it is your responsibility to contact Certainty Financial within the 60 days if you wish to take up your Continuation Option. 7

8 Section 2. Group Life / TPD Plan (Death and Total & Permanent Disability Insurance) I just want to know what is death (life) and TPD insurance? Death cover is a form of insurance that provides a lump sum payment in the event of your death. TPD cover provides a lump sum benefit to you if you have been absent from all employment for six consecutive months and in the event that you have been medically certified to be unlikely to ever return to work in your current occupation. The coverage is provided under a Group Life Policy issued to AYSF by Tower (formerly known as PrefSure) ABN As AYSF is the owner of this cover, Tower will pay any benefits that become payable for an insured person under the Policy to AYSF. The company will then pay those benefits to the member, or his or her estate, at its discretion. who is eligible for cover? All Full Time and Part Time employees upon commencement of service who are presently working for AYSF and are a member of the staff superannuation plan and who commenced employment before age 65, are eligible for cover. This is provided the person works at least 15 hours per week. It does not include persons employed on a "casual" basis. when does cover commence? Cover is compulsory for Full Time and Permanent Part Time employees of AYSF and becoming a member of the AYSF staff plan. If you choose not to be a participant in the AYSF staff superannuation plan, you will not be granted Death/TPD Cover. do I need a medical? No. You are automatically covered under the group insurance policy arranged by AYSF for the following benefits: Full Time employees $100,000 Part Time employees $50,000 Automatic acceptance means that you have the above coverage irrespective of any previous medical condition or injury, and irrespective of any sporting or pastime pursuits (eg. martial arts, flying, rock climbing, scuba diving, motor vehicle racing etc). This is $100,000 for your Death/TPD Cover if you are a full time employee, or $50,000 for your Death/TPD Cover if you are a part time employee. how are my benefits provided? Your benefits are made available through a group insurance policy owned by AYSF and underwritten by Tower. 8

9 how does the plan work? If you die, your dependent/s or estate will become eligible for the benefit which is paid to the policy owner (AYSF). If you become totally and permanently disabled, you will become eligible for the benefit which is paid to the policy owner (AYSF). what is Total & Permanent Disablement? To claim benefits for TPD you need to satisfy the following definitions. Solely because of sickness or injury: you suffer the total and permanent: (i) use of two limbs; or (ii) sight of both eyes; or (iii) use of one limb and the sight of one eye. OR you have been absent from all employment for 6 consecutive months from the date of disablement and Tower consider, on the basis of medical and other evidence satisfactory to them, you will not ever be able to resume any occupation, whether or not for reward. OR for 6 consecutive months, from the date of disablement, been totally unable to perform without the physical assistance of another person any two of the following activities of daily living and will be permanently and irreversibly unable to do so for life: o dressing o toileting o mobility o continence o feeding who pays the premiums? The premiums are deducted from member accounts at 30 June each year, or on exit from AYSF. If at any time AYSF ceases to be the plan sponsor, the plan will end. If that occurs you will be notified and given the opportunity to take up, at your own expense, your own income continuance insurance plan. how do I (TPD) or my dependent/s or estate (death) make a claim under the plan? To make claim under this policy, you or your dependent/s or estate will need to speak with AYSF s superannuation team, who will organise the relevant claim paperwork via the firm s appointed Advisers (Certainty Financial). are there any other Tower pay an Interim Accidental Death Cover, when an application for an increase in cover is subject to underwriting, for up to a maximum of 90 9

10 benefits? days from the date of receipt of the member s application and for the benefit increase applied for, but not exceeding the maximum of $100,000 for full time employees and the maximum of $50,000 for part time employees. are there any limitations on benefits? Yes. There are certain events in which benefits will not be paid under the policy. These are described in detail in the Policy but include war, service in the armed forces, and an intentional self-inflicted act. will I be covered if I travel outside Australia? Yes. The policy can cover you while travelling anywhere in the world and whilst you continue to be a full, part time, or fixed term employee with AYSF. If you intend to reside outside Australia, for longer than 5 years and travelling to a non G7 country, cover must be approved by Tower in writing. Tower may impose special conditions for cover outside Australia. While a member is outside Australia, benefit payments will only be paid for a maximum of twelve months, unless the insured person has returned permanently to Australia or another country acceptable to Tower. This timeframe is increased to 12 months within a G7 country. G7 countries include Canada, France, Germany, Italy, Japan, UK, and the USA. what happens to my cover if I change jobs? If you leave AYSF before the age of 60 for reasons other than retirement or disability, and you continue employment elsewhere, you will be given the option to continue your cover under an individual policy without providing any medical information. It is subject to you exercising the option within 60 days of leaving service. There may also be certain details required to be provided in relation to your occupation and pastimes. Notably, any special conditions which may apply to your membership in this plan would continue. It is important to note that it is your responsibility to contact Certainty Financial within the 60 days if you wish to take up your Continuation Option. 10

11 Section 3. General Information & Contact Details I just want to know what do I do if I have any questions? Please contact AYSF s appointed advisers Certainty Financial, at the contact points detailed below. who is Certainty Financial? Certainty Financial is an advisory firm that specialises in corporate superannuation and group insurance solutions. It is privately owned, and not aligned with any financial institution. It operates under its own Australian Financial Services Licence Established in 1980, it has offices in Melbourne and Sydney, and services employers and members Australia wide. In addition, it also has a private client division that provides financial planning and personal insurance advice to individuals. Members of this plan are entitled to discounted fees for these services. For further information on Certainty Financial you can request a copy of its Financial Services Guide. how to contact Certainty Financial? Melbourne Office: Suite 2, 670 Canterbury Road Surrey Hills Vic 3127 PO Box 113 Canterbury Vic 3126 David Wilson Director Corporate Risk Tel: dwilson@certainty.com.au Sydney Office: Ground Floor, 221 Miller Street North Sydney NSW 2060 PO Box 852 North Sydney NSW 2059 Dina Apostolou Administrator Corporate Services Tel: dapostolou@certainty.com.au 11