Group Salary Continuance

Transcription

1 Group Salary Continuance Product Disclosure Statement 1 July 2011 TAL Life Limited ABN AFSL Number

2 Important information This Product Disclosure Statement (PDS) details the important terms and conditions of a Group Salary Continuance Policy issued by TAL Life Limited (TAL, we, us, our). Depending on your choice, cover is offered as a Standard Policy or an Executive Policy. We recommend that you read this PDS fully before making any decision to apply for this product. TAL takes full responsibility for the content of this PDS. The information within this PDS is current as at the date of issue. From time to time we may make changes or update information contained in this PDS, which is not materially adverse, by publishing a note of the change on our website com.au. You can also ask for a free paper copy of the updated information. This PDS does not form part of your Policy unless a Policy Schedule is attached and signed by us. Once we have agreed to issue you with group life insurance, this PDS together with the Policy Schedule and any Endorsements (for later amendments to the Policy) will form the Policy, as stated in Section 3.3. We will send you the Policy Schedule which will reflect the agreed terms and conditions. You will see there are a number of words in this PDS which are capitalised and are in bold. These words have a particular definition when used in the PDS. These definitions are found in Section 22 of this PDS. It is important you read these definitions carefully because their meanings are relevant to your decision to apply for this product and how the Policy works once issued by us. Please note we use Insured Person to refer to the person whose life is insured under the Policy. you and your refer to the Policy Owner. A Standard Policy provides insurance cover for Total Disability, Partial Disability, Interim Cover, Death Benefit and payment of rehabilitation expenses. Depending on your choice superannuation contributions may also be included in the amounts covered under a Standard Policy. In addition to the benefits provided under a Standard Policy, other valuable benefits are available under an Executive Policy. The Benefits applicable to your Policy will be set out in the Policy Schedule. Any information contained in this PDS is of a general nature only. It does not take into account individual financial situations, needs or objectives. Policy owned by a superannuation trustee Where the Policy Owner is the trustee of a superannuation fund, benefit payments are made through the fund and subject to restrictions under superannuation law. Rules relating to when superannuation benefits can be accessed are complex and you should obtain financial advice to assist you (see the next section). Need help? If you need help in deciding whether to purchase this product, and any financial products in general, we recommend that you speak to a licensed financial adviser. If you have any questions you can contact us on , or visit our website, If you do not have a financial adviser, please contact TAL and we can put you in touch with someone who can help. You can check to see if your financial adviser is licensed by visiting the MoneySmart website ( gov.au) established by the Australian Securities and Investments Commission (ASIC). Alternatively, ASIC can be contacted by telephone on or by at info.enquiries@asic.gov.au.

3 We take life (insurance) personally. Life insurance is an important part of a person s financial future. TAL provides high quality, comprehensive and flexible protection options. At TAL we re all about simple, innovative life solutions. TAL s offer at a glance Our easy reference table below provides a quick summary of our new product. You will need to read the terms and conditions for a full explanation of cover and limits. Benefit/Feature Brief Description Refer to Page Product enhancements No minimum hours Cover is available for eligible Permanent Employees regardless of the number 5 of hours they work each week. Contractors Cover is available for any Contractors with a written contract for services with an 5 Employer for a minimum of 15 hours per week for a continuous 6-month period. AAL uplifts Employees and members may automatically receive any increase in AAL, including those 7 that have been previously underwritten and have been declined, loaded or excluded for cover above the previous lower AAL, unless otherwise stated in the Policy Schedule. Underwriting loadings Premiums in respect of underwriting loadings are waived, reducing costs and simplifying administration. 9 Cover during paid and unpaid leave Worldwide cover Up to 24 months continuous cover whilst on employer approved leave, without the need to be approved by us. Cover is provided 24 hours a day, all year round, with no restrictions on location or time spent overseas, subject to meeting certain conditions. Product Features/Benefits Interim Cover Provides cover for both illness and injury during Underwriting. 10 Total Disability Benefit A monthly benefit will be paid if an Insured Person is unable to work due to 11 illness or injury. Partial Disability A portion of the Total Disability Benefit will be paid if an Insured Person has reduced 11 working capacity due to illness or injury. Superannuation Provides a benefit covering the cost of employer superannuation contributions for whom 12 Contribution Benefit we are paying either a Total Disability Benefit or Partial Disability Benefit. Recurring Disability A waiting period will not apply to a claim if it relates to the same or related illness or injury 13 from which a member has received a Total Disability or Partial Disability payment in the last 6 months. Rehabilitation We may pay some or all of the costs involved with a rehabilitation or return to work 13 program for an Insured Person. Death Benefit A lump sum of 3 times the Total Disability Benefit will be paid if an Insured Person dies 13 while receiving a Total Disability Benefit or a Partial Disability Benefit. Increase in claims benefit The Total Disability Benefit or a Partial Disability Benefit payable will increase each anniversary year of first payment by the lower of CPI and 5%

4 TAL s offer at a glance (continued) Benefit/Feature Brief Description Refer to Page Ancillary benefits available under the Executive Policy. Trauma Benefit A lump sum benefit will be paid if an Insured Person suffers one of the listed 15 Trauma conditions. Specific Injury Benefit A lump sum will be paid if an Insured Person suffers one of the listed Specific Injuries. 16 Nurse Care Benefit A benefit will be paid if an Insured Person is confined to bed and under the care of a 17 registered nurse, during the waiting period. Accommodation Benefit A benefit will be paid to cover accommodation costs if an Insured Person requires an 17 immediate family member to take care of them while the Insured Person is confined to bed and is staying more than 100 kilometres from home. Family Care Benefit An additional benefit will be paid where an Insured Person is Totally Disabled and 18 confined to bed, if a family member suffers a loss of income due to having to care for the Insured Person. Home Care Benefit An alternative to the Family Care Benefit, an additional benefit will be paid where an Insured Person is Totally Disabled and confined to bed, and decides to rely on a professional home carer instead of a family member. 18 Availability of cover The below table sets out the limits and choices that apply to TAL s Group Salary Continuance Life Insurance unless otherwise stated in the Policy Schedule: Minimum benefit entry age 16 Maximum benefit entry age 64 Maximum monthly benefit limit $30,000 Maximum benefit expiry age 70 Waiting periods available 30, 60, 90, 180 and 365 days Benefit periods 2 and 5 years benefits and To Age 65 cover Premium payment frequency Monthly, quarterly, half-yearly or annually

5 Table 0f Contents About TAL Section 1: Before your policy starts... 2 Section 2: When your policy starts... 3 Section 3: Policy information... 4 Section 4: Who can have insurance cover under the policy... 5 Section 5: When cover starts... 6 Section 6: Automatic acceptance... 7 Section 7: Takeover of insurance cover... 8 Section 8: Underwriting... 9 Section 9: Interim cover Section 10: Standard benefits Section 11: Additional benefits under the executive policy Section 12: Employer approved leave Section 13: Overseas cover Section 14: Restrictions on benefit payments Section 15: Extended cover Section 16: Continuation of cover option Section 17: When cover for an insured person ceases Section 18: When the policy ends Section 19: Claims Section 20: Premiums Section 21: Profit share and multinational pooling Section 22: Definitions Section 23: Trauma definitions Section 24: Additional information... 40

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7 About TAL TAL is one of Australia s leading independent life insurance specialists. Partners We are committed to making life insurance a well understood and valued part of people s lives. TAL s Group Life division is a recognised industry leader offering group insurance knowledge and expertise to all of our customers, their employees and members. The Group Life team is dedicated to the growth and development of our customers and the group insurance industry as a whole. Our focus is creating holistic solutions that enhance the insurance experience of our customers and their employees and members. Innovators TAL is committed to ensuring our customers obtain the life insurance cover that best suits their needs, quickly and easily. For the Group Life team, this means exploring all the available options to deliver the best insurance offering to our customers. We actively engage with our customers to understand their needs and the needs of their employees and members to find the solutions that work for them. Experience and depth Our Group Life team is comprised of industry experts, who have extensive experience in both the superannuation and life insurance industries. As one of the largest providers of group insurance in Australia, TAL s corporate client list extends to over 500 organisations throughout Australia. We understand the complexities of managing insurance through superannuation. Our broad experience means we are available to advise and offer product solutions to funds of any size or structure. Reliable TAL has enjoyed solid profit performance over the past several years. Awards TAL s approach to life insurance has seen us win several accolades over the past year including SuperReview s Group Insurer of the Year (2009 and 2010) and Australian Banking & Finance Magazine s Best Life Insurance Company (2009). This follows consecutive years of being finalists and winners of Money Management s Risk Company of the Year award, demonstrating our ongoing commitment to excellence in life insurance. Life Company of the Year Award 2010 WINNER Product Disclosure Statement 1

8 Section 1: Before your policy starts 1.1 Who can apply for group insurance Australian based organisations, including corporations, incorporated associations and superannuation funds can apply to TAL for a group life insurance policy to provide cover for their employees, members and their spouses. Where a Policy is issued, the applicant will be the Policy Owner. 1.2 What type of cover is available There are two types of group salary continuance policies available. There is a Standard Policy and an Executive Policy. The Policy Schedule will state whether you have a Standard Policy or an Executive Policy and what additional benefits apply to the Policy. 1.3 Content of this PDS This PDS sets out the terms and conditions relating to Benefits provided under any Policy issued by us. It explains who can be covered, when cover is provided automatically and when employees and members will need to apply for cover. This PDS also sets out the circumstances in which employees and members are entitled to apply to us for cover to continue under an individual insurance policy issued by TAL, when they are no longer covered under this Policy. 1.4 What information do we require to provide a quotation For us to provide you with group insurance we must first provide you with a quotation. So that we can provide you with a quotation, you will need to provide us with information on the group of persons to be insured. This information includes age, gender, occupation, location (including outside Australia if applicable), plan and claims history (if insured previously), as well as your insurance requirements for them. In addition, we may require further information to enable us to assess the risk more accurately and provide you with the most reasonable and sustainable price for your insurance. Once we have the information we require, we will issue you with a quotation. 1.5 Accepting our quotation To accept our quotation, you must complete the prescribed application form (including any information required by us) and submit it, together with the Deposit Premium requested by us, on or before your requested date for commencement of the Policy. Please make sure the completed application form is consistent with the quotation provided by us and accepted by you. 1.6 Other important information There are important risks which should be considered when deciding to purchase this product, including: Selected Benefits may not provide adequate financial protection for the Insured Persons covered under the Policy; Benefits may be reduced, excluded, limited or withheld under circumstances described in Section 14. The Policy or Insurance Cover may be avoided or terminated where there is a failure to comply with Section 3.8 (Policy owner obligations) or the Duty of Disclosure stated in Section 24.1, or under circumstances described in Section 18; and Any Special Conditions agreed between you and us will be stated in the Policy Schedule when it is issued. It is important you read this PDS together with any quotation you wish to accept prior to making an application for insurance with TAL. It is important that the information you provide is accurate. We reserve the right to alter or withdraw our quotation, should the information be found to be inaccurate or incomplete. You should also refer to Section 24.1 which has information about your duty of disclosure. 2 Product Disclosure Statement

9 Section 2: When your policy starts 2.1 Cooling off period We offer a 14 day cooling off period. This period starts on the date from which we agree to provide you with group insurance. This will be the Policy Commencement Date stated in the On Risk Letter and the Policy Schedule we will issue you. If you decide to cancel the policy before the end of the cooling off period, and you have not made a claim, you can provide us with a written request to cancel the Policy from the Policy Commencement Date and we will refund any premium paid. If you terminate the Policy during the cooling off period, no claim can be made and no Benefits will be payable in respect of that period. 2.2 Start of cover Insurance Cover for Eligible Persons starts as outlined in Section When insurance cover will be provided under the policy Insurance Cover will be provided under the Policy from the Policy Commencement Date once all the following events have occurred: We have issued you an On Risk Letter, advising the Policy Commencement Date; We have issued you the Policy Schedule, signed by us; and You have paid us the requested Deposit Premium. Product Disclosure Statement 3

10 Section 3: Policy information 3.1 The insurer TAL Life Limited (ABN ) (AFSL ) which is referred to in the Policy as TAL, we, us, the insurer and/or our, is registered as a life insurer under the Life Insurance Act 1995 (Cth) and is the provider of Insurance Cover under the Policy. 3.2 The policy owner All Benefits payable under the Policy are paid to the Policy Owner, unless otherwise instructed in writing by the Policy Owner. We refer to the Policy Owner as, you, or, your. 3.3 The policy Your Policy is a legal contract of insurance between you and us. The documents issued by us that make up your Policy are: This Product Disclosure Statement as at the Policy Commencement Date; The Policy Schedule signed by us; Any Endorsements or written amendments to the terms and conditions of the Policy agreed between you and us and issued by us. Whether the Policy is superannuation or non-superannuation business will be shown in the Policy Schedule as Policy Type. 3.4 Benefits This Policy provides insurance cover for Total Disability and Partial Disability. The Policy also provides for Interim Cover, Death Benefit and payment of rehabilitation expenses as built in benefits. A Superannuation Contribution Benefit may also be provided where this is stated in the Policy Schedule. In addition, other ancillary benefits may be available under an Executive Policy. 3.5 Changes to the policy Once the Policy Schedule is issued by us, any subsequent changes or variations to the terms and conditions of the Policy must be agreed and issued by us in the form of an Endorsement. 3.6 How to interpret this document In this document: words expressed in the singular include the plural and vice versa; headings have been included for ease of reference - they do not form part of the terms and conditions of the Policy; and some terms are shown in bold. Their particular meaning is explained in Section 22 and the Policy Schedule. 3.7 Policy owner acknowledgement In accepting the Policy, you acknowledge; we have relied on information provided by you and your appointed representative; you have the authority to enter into the Policy; your appointed representative (if applicable) is your agent in entering into this Policy; and if entering into the Policy as a trustee, the trust instrument authorises entry into this Policy. 3.8 Policy owner obligations Under the terms and conditions of the Policy, you agree to: comply with the Duty of Disclosure set out in Section 24.1; pay premiums in accordance with Section 20; abide by the Eligibility Conditions of the Policy set out in Section 4.1; provide us in writing on or before the next Annual Review of details of all Employees who meet the Eligibility Conditions (if details of particular Employees are not provided, they will not be eligible for cover under Automatic Acceptance); provide us in writing details of each person who no longer meets the Eligibility Conditions on or before the next Annual Review; notify us in writing of a change in any Eligible Person s employment status which results in a change from their current Membership Category on or before the next Annual Review; provide us in writing any request for a change to the Eligibility Conditions of the Policy; provide us in writing any request to provide cover for the Employees of any new company or business acquired by the Employer; supply us with all information we ask for at the commencement of the Policy, at each Annual Review, and on termination of the Policy, within 30 days of receiving our request; and provide us with all information and notices we require from you under the Policy. Where you do not comply with these obligations we may provide you with notice to terminate the Policy in accordance with Section Policy assignments The Policy can be assigned in accordance with the Life Insurance Act 1995 (Cth) with our prior written consent. If we allow the assignment, the assignee will be recorded as the new Policy Owner with all the rights, powers, duties, obligations and privileges of the original Policy Owner. 4 Product Disclosure Statement

11 Section 4: Who can have insurance cover under the policy 4.1 Eligibility conditions Insurance Cover will be provided under the Policy for all members and Employees who meet the Eligibility Criteria, the Age Criteria and the conditions for the relevant types of cover provided under the Policy, detailed in Section 4.2. This Insurance Cover is only granted if you provide us with the relevant information with respect to that member or Employee. 4.2 When insurance cover is available Generally, a person must be a Permanent Employee, or a Contractor working a minimum of 15 hours each week for a continuous 6-month period, in order to be an Eligible Person. The Eligibility Criteria applicable to your Policy will be stated in the Policy Schedule. Where the person meets all these conditions they will be an Eligible Person under this Policy. Cover for Eligible Persons starts in accordance with Section 5. Case Study Over time I began to experience some pain in my wrists. I always thought it would just clear up, but it progressively got worse. I initially saw a doctor about five years ago and was diagnosed with carpal tunnel syndrome. I found out 18 months later that the doctor had gotten it wrong. They then thought I actually had an untreated fracture in my wrist, which was now causing pain every time I even tapped a tile into place. The pain was becoming intolerable. Finally I saw an orthopaedic surgeon who diagnosed severe osteoarthritis in my wrists. He told me I wouldn t be able to work for at least six months. That sounded pretty good to begin with, but after only two months I was climbing the walls. I was going stir crazy and I knew that the longer I was away from my business the longer it would take to rebuild. After six months, with the pain not getting better, the surgeon told me that I wouldn t be able to return to tiling at all. I was really knocked around. Tiling was all I knew. What would I do? During my time off I d spoken to my TAL case manager on numerous occasions. When I told her I couldn t return to my profession she immediately started talking about retraining. It took me a little while to realise that was what I had to do. I was only 43 and now had to start over. I applied to study for a Diploma of Building Design at TAFE and was accepted. My case manager was really excited for me and I was rapt when she told me that my insurance would cover all the fees as well as my regular income protection payment. I m now six months from finishing my two years of study and really looking forward to getting on with my life. Peter TAL Income Protection insurance policy holder * * This claim s scenario is based on an actual claim received by TAL s Claims team. We have changed certain details to protect the individual s privacy. Claims are assessed against the policy terms and condiitions. Product Disclosure Statement 5

12 Section 5: When cover starts 5.1 Commencement of insurance cover TAL will provide Insurance Cover for an Eligible Person from the latest of the following: The date they first become an Eligible Person and meet the conditions for Automatic Acceptance (see Section 6); If the Policy is owned by a superannuation fund, the date of the start of the period to which the first superannuation contribution relates where it is received on time under the Superannuation Guarantee Administration Act 1992 (Cth) or the date the first superannuation contribution is received where it is not received on time under the Superannuation Guarantee Administration Act 1992 (Cth); The Takeover Date if we have agreed to provide them Insurance Cover under Takeover Terms (see Section 7); The date we advise you they have been Underwritten and accepted for Insurance Cover (see Section 8); or The date from which there is an increase in their Insurance Cover (in respect of the increased amount). Where the Eligible Person obtains cover under this Policy they will be an Insured Person. To make life insurance a well understood and valued part of people s lives 6 Product Disclosure Statement

13 Section 6: Automatic acceptance 6.1 What is automatic acceptance Automatic Acceptance means TAL will provide Eligible Persons with Insurance Cover up to an Automatic Acceptance Limit (AAL) without Underwriting. 6.2 Conditions for automatic acceptance of cover For Automatic Acceptance to be provided the following conditions must apply: The Insurance Cover is calculated according to the Insurance Formula; The Eligible Person is in a Membership Category for which an AAL applies as provided in the Policy Schedule; An AAL (other than nil ) is stated in the Policy Schedule; At least 75% of Eligible Persons have been nominated by you (and are covered) for Insurance Cover under the Policy; The Special Conditions stated in the Policy Schedule (if any) regarding the provision of Automatic Acceptance are satisfied; and If the Policy is owned by a superannuation fund, that fund is the Employer s Default Superannuation Fund. 6.3 When are eligible persons entitled to automatic acceptance Automatic Acceptance applies to Eligible Persons at the earliest of: the Policy Commencement Date where the Eligible Person was entitled to be covered at the date; or the date the Eligible Person became an Eligible Person although you must inform us at the next Annual Review of the Policy that the person had become an Eligible Person. However, where the Eligible Person is Not At Work at the Policy Commencement Date or at the date that they first become an Eligible Person under the Policy (whichever is the later), they will be provided Limited Cover. Limited Cover will apply from that date until they have returned to work and have remained At Work for 60 consecutive days, from which time Full Cover will be provided. Any Eligible Person who does not obtain cover under Automatic Acceptance by not meeting the conditions of this section will need to be Underwritten and accepted by us in writing before Insurance Cover can commence. 6.4 Future automatic increases in insurance cover Where an increase in an Insured Person s Insurance Cover is activated by the Insurance Formula, the increase in the Insurance Cover will be restricted to the higher of the AAL and any Forward Underwriting Limit that we have granted to the individual. 6.5 When the automatic acceptance limit can be changed Subject to this Section 6.5 the AAL will apply for the duration of the Premium Rate Guarantee Period. However, if there has been a change of 25% or more in the number or occupational profile of Insured Persons under the Policy or a particular Membership Category, we reserve the right to increase or decrease the amount of the AAL, by written notice to you. Any Insurance Cover already provided will not be reduced or adversely affected by any change in the AAL. 6.6 How do changes in automatic acceptance limit affect existing insurance cover Where there has been an increase in the AAL, the AAL applicable for all existing Insured Persons may be automatically increased to the new level subject to the following condition: If the cover an Insured Person receives under Automatic Acceptance increases as a result of the increase in the AAL, any existing exclusions or loadings will only apply to any cover above the new AAL. Product Disclosure Statement 7

14 Section 7: Takeover of insurance cover 7.1 What are takeover terms Takeover Terms generally apply for a new group of Eligible Persons who have previously been provided cover by another insurer. Under Takeover Terms the levels of cover under the previous policy may be continued without further Underwriting. TAL s usual practice is to adhere to FSC Group Insurance Takeover Terms under FSC Guidance Note No However, there may be certain circumstances where alternate Takeover Terms may be required. In either case, where Takeover Terms apply to any Transferring Members, the terms will be stated in the Policy Schedule. 7.2 Conditions for providing takeover terms Where Takeover Terms apply, the provision of Insurance Cover under Takeover Terms will be subject to all of the following conditions: You providing us with all the information we need about the operation and terms of the previous policy in writing including, but not limited to, names, type and amount of insurance cover and any individual underwriting acceptance terms provided by the previous insurer no later than 90 days after the Takeover Date, unless we agree otherwise; The terms and conditions of the Policy including our Maximum Benefit Limit and conditions for Automatic Acceptance of cover stated in Section 6.2 will apply; Where the AAL applicable to the previous policy is the same as the AAL applicable to this Policy, any specific exclusions and loadings applied to Insurance Cover provided by the previous insurer will continue to apply under the Policy; and Where the AAL applicable to the previous policy is lower than the AAL applicable to this Policy, the AAL applicable for all persons insured under the previous policy may be automatically increased to the new AAL level and any specific exclusions and loadings which applied to Insurance Cover provided by the previous insurer will only apply to cover above the AAL applicable to this Policy. 7.3 Waiver of underwriting premium loadings on takeover For Insurance Cover subject to Takeover Terms, TAL will not charge any additional premiums for any loadings on Underwritten Insurance Cover based on the Insurance Formula. However, any applicable loadings will continue to be recorded and additional premiums may be charged for these loadings for other purposes such as for a Continuation Option. You providing us with the names of Eligible Persons who are Not At Work due to an illness or injury on the last working day immediately prior to the Takeover Date, unless we agree otherwise; 8 Product Disclosure Statement

15 Section 8: Underwriting 8.1 When underwriting is required An Eligible Person must be Underwritten for Insurance Cover under any one or more of the following circumstances: No AAL is applicable to them under the Policy; An AAL applies but they do not satisfy the conditions for Automatic Acceptance stated in Sections 6.2 and 6.3; or They are seeking cover based on the Insurance Formula above the AAL (including when cover above the AAL is being reinstated under Section 13.3) or any Forward Underwriting Limit, in which case Underwriting will only apply to cover above that amount. 8.2 Applications for insurance cover requiring underwriting If Underwriting is required the Eligible Person must complete a Personal Statement and provide us with any information or undergo any medical examinations we request. Subject to Section 9, while being Underwritten, an Eligible Person will be provided Interim Cover. Underwriting will be completed once we have received all the additional information we might request to assess the application. A loading has been applied to any of the Insurance Cover which has been Underwritten, including any Forward Underwriting Limit; Any specific exclusion has been applied to the Insurance Cover which has been Underwritten; or We decline the application. We will also notify you in writing if: the Underwriting has not been proceeded with due to the request of the Eligible Person; or if Underwriting has been discontinued because we did not receive the information we had requested to allow us to assess the application. 8.4 Waiver of underwriting premium loadings TAL will not charge any additional premiums in respect of any loadings advised for Underwritten Insurance Cover based solely on the Insurance Formula. Any applicable loadings however, will continue to be recorded and additional premiums may be charged for these loadings for other purposes, such as for a Continuation Option. TAL will pay all costs associated with obtaining the Underwriting information we have requested, provided these costs are incurred in Australia. Any Underwriting costs incurred outside Australia will not be paid by TAL. We may, however, reimburse some or all of these costs at our discretion. 8.3 Acceptance terms of underwritten insurance cover Once Underwriting is completed we will notify you in writing of the outcome. When we do this you will also be advised if any of the following applies: The Insurance Cover which has been Underwritten has been provided without any special conditions; Any Forward Underwriting Limit has been provided; Product Disclosure Statement 9

16 Section 9: Interim cover 9.1 What is interim cover If an Eligible Person needs Underwriting, TAL will provide Interim Cover for the amount being Underwritten. Interim Cover means we will provide an Insured Person with Limited Cover for Standard Benefits for up to 90 days while they are being Underwritten. The cover will be for an illness or injury which first occurs during the Underwriting process. 9.2 Interim cover limits The Interim Cover will be limited to the lesser of the amount Underwritten and $15,000 per month, less any amount of Insurance Cover already provided under this Policy to the Eligible Person. 9.3 When interim cover starts Interim Cover starts in respect of an Eligible Person on the date we receive a completed Personal Statement from them. 9.4 When interim cover ceases Interim Cover ceases in respect of an Eligible Person on the earlier of: 90 days after we receive a completed Personal Statement from them; the date we provide notice to you of our Underwriting decision in respect of the Underwritten cover; 9.5 Duration of interim cover benefit A Total Disability Benefit and/or Partial Disability Benefit and any Superannuation Contribution Benefit under Interim Cover is payable once for a continuous period of up to the Benefit Period applicable to the Eligible Person. All other Benefits are payable only once under Interim Cover. 9.6 When interim cover benefits will be reduced Any Benefits payable under Interim Cover will be reduced by any applicable amounts outlined in Sections 10 and When an interim cover benefit isn t payable A Benefit under Interim Cover is not payable: for a claim arising directly or indirectly from an illness or injury which occurred or was diagnosed, or the signs or symptoms leading to diagnosis became apparent to the Eligible Person or would have become apparent to a reasonable person in the position of the Eligible Person, at any time prior to the date we receive a completed Personal Statement; or for a claim in respect of the Eligible Person which is caused directly or indirectly by suicide or self-inflicted illness or injury. the date they withdraw their application for insurance; the date they cease to be an Eligible Person; the date they reach the Benefit Expiry Age; the date a Benefit under Interim Cover becomes payable to them; the date they die; and the Policy Termination Date. 10 Product Disclosure Statement

17 Section 10: Standard benefits All Standard Benefits apply to both the Standard Policy and Executive Policy Total disability benefit A Total Disability Benefit provides financial support to an Insured Person where they are temporarily unable to work because of illness or injury and are not earning an income. When the benefit is payable We will pay a Total Disability Benefit monthly in arrears where the Insured Person has been Totally Disabled for at least 7 out of 12 consecutive days during the Waiting Period and he or she is either: Totally Disabled immediately after the end of the Waiting Period; or after receiving a Partial Disability Benefit, Totally Disabled immediately after ceasing to be Partially Disabled as a result of the same or a related cause. The Total Disability Benefit is payable for so long as the Insured Person remains Totally Disabled. The maximum period in respect of which a Total Disability Benefit is payable for the same or related illness or injury is the Benefit Period. Where a Total Disability Benefit is payable for a part of a month, we will pay 1/30th of the benefit for each day a Total Disability Benefit is payable. A Total Disability Benefit is not payable with respect to a month for which the Insured Person is claiming a Specific Injury Benefit. Amount of the benefit The amount of the Totally Disability Benefit is the percentage of Salary stated in the Policy Schedule divided by 12, subject to Section The Total Disability Benefit is reduced by any income or amounts paid or payable in respect of the relevant month to the Insured Person, including settlement or commutation amounts, in respect of any of the following: Worker s compensation or similar legislation or common law; Motor accident compensation or similar legislation or common law; Statutory or other government payments, but not including CentreLink or its successors; Sick leave; Payment by the Employer excluding annual leave, long service leave, termination payments and paid parental leave; or Income replacement benefits from another insurance policy or a superannuation fund. The Total Disability Benefit will only be reduced in respect of any lump sum payment if any portion of such a payment relates to loss of income. Any lump sums, including commutation amounts, will be divided into 1/60th for the purpose of calculating a reduction in the Total Disability Benefit. This reduction in the Total Disability Benefit will then apply over the 60 month period or the Benefit Period, whichever is the shorter. When benefit payments end Total Disability Benefit payments will end on the earliest of the following: the date the Insured Person is no longer Totally Disabled; the end of the Benefit Period for which a Total Disability Benefit and/or Partial Disability Benefit has been payable for the same or related illness or injury; the date the Insured Person dies; the date the Insured Person reaches the Benefit Expiry Age; in the case of an Insured Person who is residing or travelling outside Australia, the date 6 months after the end of Waiting Period where a Total Disability Benefit or Partial Disability Benefit has been paid or payable for those 6 months, unless they can provide supporting medical evidence to our satisfaction of continued Total Disability and/or Partial Disability from a Medical Practitioner Partial disability benefit A Partial Disability Benefit compensates the Insured Person for the reduction in income the Insured Person suffers as a result of illness or injury. When the benefit is payable If the Insured Person has been Totally Disabled for at least 7 out of 12 consecutive days during the Waiting Period, we will pay a Partial Disability Benefit monthly in arrears if either: the person is Partially Disabled immediately after the end of the Waiting Period; or the person, after receiving a Total Disability Benefit, is Partially Disabled immediately after ceasing to be Totally Disabled as a result of the same or a related cause. The Partial Disability Benefit is payable for so long as the Insured Person remains Partially Disabled. The maximum period in respect of which a Partial Disability Benefit is payable for the same or related illness or injury is the Benefit Period. Product Disclosure Statement 11

18 Section 10: Standard benefits (continued) Where a Partial Disability Benefit is payable for a part of a month, we will pay 1/30th of the benefit for each day a Partial Disability Benefit is payable. A Partial Disability Benefit is not payable with respect to a month for which the Insured Person is claiming a Specific Injury Benefit. Amount of the benefit Subject to Section 10.9, the amount of the Partial Disability Benefit payable is calculated as follows: Partial Disability Benefit = A - B x C A Where: A = The Insured Person s annual Salary at the Date of Disablement /12 B = The monthly amount earned by the Insured Person excluding annual leave, long service leave, termination payments and paid parental leave C = The Total Disability Benefit. The Partial Disability Benefit will be reduced by any income or amounts paid or payable in respect of the relevant month to the Insured Person, including settlement or commutation amounts, in respect of any of the following: Worker s compensation or similar legislation or common law; Motor accident compensation or similar legislation or common law; Statutory or other government payments, but not including CentreLink or its successors; Sick leave; or Income replacement benefits from another insurance policy or a superannuation fund. The Partial Disability Benefit will only be reduced in respect of any lump sum payment if any portion of such a payment relates to loss of income. Any lump sums, including commutation amounts, will be divided into 1/60th for the purpose of calculating a reduction in the Partial Disability Benefit. This reduction in the Partial Disability Benefit will then apply over the 60 month period or the Benefit Period, whichever is the shorter. When benefit payment ends Partial Disability Benefit payments will end on the earliest of the following: the date the Insured Person is no longer Partially Disabled; the end of the Benefit Period for which a Total Disability Benefit and/or Partial Disability Benefit has been payable for the same or related illness or injury; the date the Insured Person dies; the date the Insured Person reaches the Benefit Expiry Age; in the case of an Insured Person who is residing or travelling outside Australia, the date 6 months after the end of Waiting Period where a Total Disability Benefit or Partial Disability Benefit has been paid or payable for those 6 months, unless they can provide supporting medical evidence to our satisfaction of continued Total Disability and/or Partial Disability from a Medical Practitioner Additional benefits to cover employer superannuation contributions. You may elect to have an additional Superannuation Contribution Benefit to cover Employer superannuation contributions for your employees or members who are Eligible Persons. This benefit is only payable whilst the Insured Person is receiving a Total Disability Benefit or Partial Disability Benefit and is paid monthly in arrears in addition the Total Disability Benefit or Partial Disability Benefit. Where a Total Disability Benefit or Partial Disability Benefit is payable for a part of a month, we will pay 1/30th of the Superannuation Contribution Benefit for each day a Total Disability Benefit or Partial Disability Benefit is payable. If you have elected this option, a Superannuation Contribution Benefit will be stated in the Policy Schedule. Any Superannuation Contribution Benefit payable will only be paid directly to a complying superannuation fund and will be subject to any conditions of release under Superannuation Law. A Superannuation Contribution Benefit is not payable with respect to a month for which the Insured Person is claiming a Specific Injury Benefit. 12 Product Disclosure Statement

19 Amount of the benefit Where the Insured Person is claiming a Total Disability Benefit, the amount of the monthly Superannuation Contribution Benefit is determined by applying the percentage of Superannuation Contribution Benefit specified in the Policy Schedule to the Insured Person s Salary and then dividing by 12. Where the Insured Person is claiming a Partial Disability Benefit, the amount of the monthly Superannuation Contribution Benefit is determined by applying the percentage of Superannuation Contribution Benefit specified in the Policy Schedule to the Partial Disability Benefit amount. When benefit payment ends Superannuation Contribution Benefit payments will end on the date a Total Disability Benefit or Partial Disability Benefit is no longer payable with respect to the Insured Person Concurrent injuries and/ or illnesses If an Insured Person has more than one illness or injury causing their Total Disability or Partial Disability, even if they are related, only one Total Disability Benefit or Partial Disability Benefit will be payable during any overlapping periods of Total Disability and/or Partial Disability Recurring disability If an Insured Person has a recurrence of a Total Disability or Partial Disability as a result of the same or related injury or illness previously claimed then we will consider the recurring disability to be a continuation of the previous claim, and the Insured Person will not need to satisfy the Waiting Period again, subject to all of the following conditions: The recurrence of the Total Disability or Partial Disability occurs within 6 months of the date they were last entitled to receive a Total Disability or Partial Disability Benefit; The successive periods of Total Disability and/or Partial Disability will be regarded as continuous for the purpose of determining the remaining portion of the Benefit Period. Where the recurrence of the Total Disability and/or Partial Disability as a result of the same or related injury or illness previously claimed occurs more than 6 months after the date the Insured Person was last entitled to receive the benefit: the Insured Person will need to satisfy the Waiting Period again; we will consider the recurring disability to be a continuation of the previous claim; and the successive periods of Total Disability and/or Partial Disability will be regarded as continuous for the purpose of determining the remaining portion of the Benefit Period Rehabilitation We may agree to pay some or all of the costs involved with a rehabilitation or return to work program, approved in writing by us, for an Insured Person who has been unable to work because of an illness or injury. Any such payments will be made directly by us to the provider of any associated services or equipment and is in addition to the benefits we pay to replace the Insured Person s income Death benefit We will pay a Death Benefit if an Insured Person dies whilst a Total Disability Benefit or Partial Disability Benefit is payable. A Death Benefit is not payable if: the date of death is within 3 months of a Trauma Benefit being payable to the Insured Person; or the Insured person is receiving a Specific Injury Benefit. The amount of the Death Benefit is 3 times the Total Disability Benefit and any Superannuation Contribution Benefit which is last paid or payable for a full month. The cause of the recurring disability is the same or related to the reasons for the previous claim; and Their Insurance Cover has not ceased. Product Disclosure Statement 13

20 Section 10: Standard benefits (continued) 10.8 Waiting period The Waiting Period is the number of consecutive days stated in the Policy Schedule during which an Insured Person must be Totally Disabled and/or Partially Disabled before we start paying the Total Disability Benefit or Partial Disability Benefit and any Superannuation Contribution Benefit and two of the Executive Benefits (Family Care Benefit and Home Care Benefit). The Waiting Period will commence on the later of the following: the date an Insured Person is first certified by a Medical Practitioner in writing as being Totally Disabled; and the date an Insured Person ceases work because of illness or injury. The Insured Person must be Totally Disabled 7 out of 12 consecutive days within the Waiting Period to claim a Total Disability Benefit or a Partial Disability Benefit. The Insured Person may return to work for up to 5 days during the Waiting Period without the Waiting Period recommencing. Any days during the Waiting Period on which the Insured Person returned to work will be added to the Waiting Period. The Waiting Period will recommence if the Insured Person returns to work for more than 5 days during the Waiting Period Increasing claims benefit If a Benefit Escalation Percentage, other than nil, is stated in the Policy Schedule, and we have been paying a Total Disability Benefit and/or Partial Disability Benefit and any Superannuation Contribution Benefit for an Insured Person continuously for 12 months, we will increase the Total Disability Benefit and/or Partial Disability Benefit and any Superannuation Contribution Benefit by the lesser of: the Benefit Escalation Percentage stated; and the Indexation Percentage. Any increase to the Total Disability Benefit and/or Partial Disability Benefit and any Superannuation Contribution Benefit will be applied at the end of each consecutive 12 month period for which the relevant Benefit is paid. When we cease paying a Benefit for the Insured Person and they have returned to work, any future Benefit payable after their return to work will be based on their Salary, subject to the terms and conditions of the Policy. However, where an Insured Person becomes Totally Disabled or Partially Disabled during a period of unpaid leave, the Total Disability Benefit or the Partial Disability Benefit and any Superannuation Contribution Benefit will start to accrue from the later of: the day after the expiry of the Waiting Period; and the return to work date agreed with the Employer. 14 Product Disclosure Statement

21 Section 11: Additional benefits under the executive policy Whether any or all of the following Executive Benefits are provided under an Executive Policy will be stated in the Policy Schedule. The following Benefits are available under an Executive Policy: Trauma Benefit; Specific Injury Benefit; Nursing Care Benefit; Accommodation Benefit; Family Care Benefit; and Home Care Benefit Trauma benefit An Insured Person can claim a Trauma Benefit where they suffer a Trauma condition as listed. When is the benefit payable A Trauma Benefit is payable where an Insured Person is first diagnosed as having suffered a Trauma condition, as listed in the table below entitled Trauma Conditions, provided all of the following conditions are satisfied: Trauma Conditions The Trauma must have first occurred after the date they became an Insured Person for a Trauma Benefit under the Policy; The Trauma must be diagnosed by a Medical Practitioner and supported by appropriate clinical, histological and laboratory evidence; and Any specific treatment forming part of the definition of the Trauma condition must have been undertaken. A Trauma Benefit will be paid once only with respect to an Insured Person during the life time of the policy and will be paid as a lump sum. If the Insured Person suffers more than one listed Trauma condition at the same time, he or she will only be entitled to be paid for the Trauma condition which provides the greatest benefit amount. A Trauma Benefit is paid in addition to other Benefits payable, with the exception of the Death Benefit and Specific Injury Benefit. Should the Insured Person die within 3 months of a Trauma Benefit being payable, no Death Benefit as described under Section 10.7 will be payable. Heart conditions Neurological conditions Permanent conditions Organ disorders Angioplasty Alzheimer s Disease Blindness Chronic Kidney Failure Aortic Surgery Coma Loss of Hearing Chronic Liver Failure Cardiomyopathy Dementia Loss of Independent Existence Chronic Lung Failure Coronary Artery Bypass Surgery Encephalitis and Meningitis Loss of a Single Limb Major Organ Transplant Heart Attack Major Head Trauma Loss of Speech Pneumonectomy Heart Valve Surgery Meningococcal Disease Severe Burns Primary Pulmonary Hypertension Triple Vessel Angioplasty Motor Neurone Disease Multiple Sclerosis Muscular Dystrophy Paralysis Parkinson s Disease Stroke Severe Diabetes Blood disorders Cances Other events Aplastic Anaemia Benign Brain Tumour Intensive Care Medically Acquired HIV Cancer Severe Rheumatoid Arthritis Occupationally Acquired HIV Occupationally Acquired Hepatitis B or C Definitions of Trauma Conditions can be found in Section 23. Product Disclosure Statement 15