Active Living Insurance: Your Choice. Policy Wording and Product Disclosure Statement (PDS) Combined Insurance is a division of ACE Insurance Limited

Transcription

1 Active Living Insurance: Your Choice Policy Wording and Product Disclosure Statement (PDS) Combined Insurance is a division of ACE Insurance Limited

2 3 Active Living Insurance: Your Choice

3 Policy Wording and Product Disclosure Statement Active Living Insurance: Your Choice Contents 1. Key Features of the Active Living Insurance: Your Choice Policy About the Insurer Important information about this Policy Wording and PDS Your Duty of Disclosure Definitions Selecting Your Cover Benefits...5 Policy Wording and Product Disclosure Statement (PDS) General Advice Any general advice contained within this Policy Wording and Product Disclosure Statement (PDS) or accompanying materials does not take into account Your individual objectives, financial situation or needs. You need to decide if the limits, type and Level of Cover are appropriate for You. Preparation Date This PDS was prepared on 11 June Version 15PDSCIAALI02 8. Premiums General Conditions General Exclusions Cooling Off Period Cancellation of Your Policy Claims Privacy Statement Complaints and Dispute Resolution Financial Claims Scheme Updating Our PDS APPENDIX Benefits Table Premium Payments Table ACE Insurance Limited ABN AFSL Number Combined Insurance is a division of ACE Insurance Limited 1

4 Active Living Insurance: Your Choice 1. Key Features of the Active Living Insurance: Your Choice Policy This section contains some helpful summary information about Your Policy. Accordingly it cannot be relied on as a full description of the cover provided. Please refer to the rest of this PDS for its full terms, conditions and exclusions. What is the Active Living Insurance: Your Choice Policy? The Combined Insurance Active Living Insurance: Your Choice Policy has been designed to assist You in the event You suffer Bodily Injury due to an Accident. The Benefits offered are: Accidental Death Benefit Total Permanent Disability Benefit Minor Fracture Benefit Accident Recovery Assistance Benefit What will You be covered for? 1. Accidental Death due to Bodily Injury. 2. Total Permanent Disability Benefit due to Bodily Injury. 3. Minor Fracture Benefit Minor Fracture due to Bodily Injury. 4. Accident Recovery Assistance Benefit provides a Benefit for Total Disability due to Bodily Injury. The Benefit Period We will pay You for Total Disability is dependent on whether Bodily Injury was the result of a Major Fracture or not, and whether You have chosen Benefit Period option A or B. The Benefit Period options are summarised below. Accident Recovery Assistance Benefit Total Disability Benefit Period Cause of Bodily Injury Recovery from Major Fracture Recovery from other Bodily Injury Benefit Period A option Six (6) months maximum Two (2) months maximum Benefit Period B option Twelve (12) months maximum Four (4) months maximum The different Levels of Cover are set out in the Benefits Table on page 13 of this PDS. The Policy Application and Schedule We will provide to You will set out the specific Level(s) of Cover that You have selected. How much does the Active Living Insurance: Your Choice Policy cost? The cost for this Policy is dependent on the Level of Cover You choose, the Waiting Period You choose or the Benefit Period You choose. Please refer to the Policy Application and Schedule for the actual cost of Your Policy. If You choose to renew Your Policy, the premiums are not guaranteed to stay the same. 14 Day Cooling Off Period You have fourteen (14) days from the date that We confirmed in writing that You are covered under Your Policy to decide if the Policy meets Your needs. You may cancel Your Policy by contacting Us by , fax or in writing within those fourteen (14) days to cancel it. If You do this, We will refund any premiums You have paid during this period. The refund does not apply if We have paid, or are obliged to pay, a Benefit under this Policy during this period. 2. About the Insurer Since Our beginnings in 1919, Combined Insurance has grown to become a global brand that provides personal accident insurance. Our motto is Service, Strength and Security and Our goal is to help take better care of You and Your family by making it clear and easy to get the right policy benefits should You be unfortunate enough to suffer Bodily Injury. Combined Insurance is part of ACE Group, one of the leading global providers of insurance and reinsurance. Combined Insurance operates in Australia as a division of ACE Insurance Limited (ABN , AFS Licence No ) (ACE). In this PDS, Combined Insurance a division of ACE is called We, Our, or Us. The person named in the Policy Application and Schedule as the Insured is referred to as You, or Your. Our contact details are as follows: Street Address 51 Berry St North Sydney NSW 2060 Postal Address PO Box 403 North Sydney NSW 2059 Telephone (02) or Fax (02) customer@combined.com.au Website The Policy will not have a cash value on termination at any time. 2

5 Policy Wording and Product Disclosure Statement Friendly and Reliable Service We pride ourselves on providing You with friendly and reliable service. If You have any questions, You can call Our Customer Service Hotline on or Us at and Our staff will be happy to help You. We are service orientated and will always endeavour to serve You with fast, friendly and efficient claims service. 3. Important information about this Policy Wording and PDS This document is a PDS and is also Our insurance Policy Wording. This document contains important information required under the Corporations Act 2001 (Cth) (the Act) and has been prepared to assist You in understanding the Active Living Insurance: Your Choice Policy and in making an informed choice about Your insurance requirements. It is up to You to choose the cover You need. It is important that You carefully read and understand this document before making a decision. Your Policy is made up of the following documents: (i) The Policy terms and conditions which are set out in this Policy Wording and PDS. (ii) The Policy Application and Schedule in which You have disclosed all relevant information and which shows the Level of Cover that You have selected. (iii) Any endorsement to this Policy, which is signed by Our Authorised Officer. Together these documents set out the full terms and conditions that apply to Your Policy. None of Our other representatives apart from Our Authorised Officer is authorised to amend or change Your Policy. In return for You paying Us a premium, as set out in Section 8, We will insure You for the events described in the Policy Wording and PDS, subject to the terms, conditions and exclusions of Your Policy. Please keep this document, Your Policy Application and Schedule and any other documents that We tell You form part of Your Policy in a safe place in case You need to refer to them in the future. Please check these documents to make sure all the information in them is correct. Please let Us know straight away if any alterations are needed or if You change Your address or payment details. Code of Practice We are a signatory to the General Insurance Code of Practice ( the Code ). The purpose of the Code is to raise standards of practice and service in the general insurance industry. Further information about the code is available at and on request. Appropriate Coverage It is important that You consider whether the terms, cover, and conditions of the Policy are relevant and suitable to Your needs and circumstances. You should continue to review Your cover for its relevance and suitability on a regular basis. 4. Your Duty of Disclosure Before you enter into an insurance contract, you have a duty of disclosure under the Insurance Contracts Act 1984 (Cth). If we ask you questions that are relevant to our decision to insure you and on what terms, you must tell us anything that you know and that a reasonable person in the circumstances would include in answering the questions. You have this duty until we agree to insure you. If you do not tell us something If you do not tell us anything you are required to tell us, we may cancel your contract or reduce the amount we will pay you if you make a claim, or both. If your failure to tell us is fraudulent, we may refuse to pay a claim and treat the contract as if it never existed. 5. Definitions Throughout this document, certain words begin with capital letters because they have special meanings. Please use this Definitions section to find the meaning of these words when they are used throughout this Policy Wording and PDS. Any reference to an Act, legislation or legislative instrument in this document also refers to that Act, legislation or legislative instrument as amended and as may be in force from time to time. Accident means a sudden, external and identifiable event that happens by chance and could not have been expected from Your perspective. The word Accidental will be construed accordingly. Accidental Death means death solely and directly from Bodily Injury sustained after the Commencement Date. Authorised Officer means an officer authorised by Us to amend Your Policy or sign an endorsement to Your Policy. Our employee representatives, and Authorised Representatives are not Authorised Officers. 3

6 Active Living Insurance: Your Choice Beneficiary means the person or persons You have nominated on the Policy Application and Schedule or in writing who will be paid the proceeds of this Policy in the event of Your Accidental Death. You may change Your Beneficiary at any time by writing to Us. Benefit means the Benefits offered under the Policy which You may choose to purchase if eligible. Benefit Period means the maximum period of time for which We will pay You a Benefit. Bodily Injury means: (a) a bodily injury that occurs during the Period of Insurance resulting solely and directly from an Accident; and (b) the Accident occurs at least fourteen (14) days after the Commencement Date of the Policy (with the exception of Accidental Death); and (c) the bodily injury occurs independently of any illness or other cause. It does not include: a sickness or illness or disease; or a Pre-existing Injury Condition; or post-traumatic stress. Important Note: For Total Disability under the Accident Recovery Assistance Benefit only, beginning twenty-four (24) months after the Commencement Date, Your preexisting injury will no longer be considered a Pre-existing Injury Condition, and cover will be available for loss relating to this injury that commences from that date on subject to the continuance of the Policy. Commencement Date means the date that cover commences as shown in the Policy Application and Schedule. FOS means the Financial Ombudsman Service Australia. FSG means the Financial Services Guide. IDR means Our free internal disputes resolution process. Insured means You, the person named as the Insured on the Policy Application and Schedule, and to whom benefits will be made payable. Level of Cover means the level of Benefits You have selected as shown on Your Policy Application and Schedule. Major Fracture means the breaking of any other bone of the body that is not considered a Minor Fracture and is medically diagnosed within thirty (30) days of the Accident causing the fracture. Maximum Age means (should You continue to renew Your Policy), age sixty-nine (69) up to and including the date You turn seventy (70). Medical Practitioner means a Medical Practitioner licensed in Australia, New Zealand, European Union Member States, the United States of America, or Canada and operating within the scope of his or her licence in the relevant country(ies), and is not related to You by blood or marriage and is acceptable to Us. Minor Fracture means the breaking of the nose, teeth, ribs, fingers, thumbs, or toes. PDS means the Product Disclosure Statement. Period of Insurance means one (1) calendar year from the Commencement Date or the Renewal Date, whichever is the later. Policy means Your Policy Wording and PDS, the Policy Application and Schedule and any other document that We tell You forms part of Your Policy describing the insurance contract between You and Us. Policy Application and Schedule means the document by which You apply for the Policy and shows the Level of Cover selected and the premium payments. Policy Wording means this document. Pre-existing Injury Condition means an injury condition for which You received medical advice or treatment within twenty-four (24) months prior to the Commencement Date, or showed symptoms within twenty-four (24) months prior to the Commencement Date that would have caused an ordinarily prudent person to seek medical advice or treatment. Important Note: Please refer to the definition of Bodily Injury for information on cover for loss that begins twentyfour (24) months after the Commencement Date of the Policy and whether We will consider such loss a Preexisting Injury Condition under the Accident Recovery Assistance Benefit. Premium Due Date means the due date for receipt of a renewal premium payable for this Policy. Renewal Date means one (1) calendar year from the Commencement Date and subsequent anniversaries of that date. Specialist means a duly qualified Medical Practitioner specialising in the medical discipline relevant to the Bodily Injury and is not related to You by blood or marriage. Totally Disabled means the inability to perform each of the substantial duties of Your business or occupation (or usual activities if You are not currently employed). 4

7 Policy Wording and Product Disclosure Statement Waiting Period means the period You must be disabled for before any benefits for Disability will begin and is shown in the Policy Application and Schedule. We, Our, or Us means Combined Insurance a division of ACE Insurance Limited (ABN , AFS Licence No ). You or Your means the Insured named in the Policy Application and Schedule. With regard to the definitions, the singular includes the plural and vice versa. 6. Selecting Your Cover Who can be Covered? Certain eligibility criteria apply. We tell You when You apply whether You meet this criteria e.g. You must at least be sixteen (16) years old when You apply. You must not be sixty-five (65) years of age or over when You apply. You must qualify in accordance with Our underwriting standards. The Policy Application and Schedule will show which Level of Cover You selected and the Benefit Period option, either A or B. 7. Benefits Summary of Benefits A detailed description of the cover is set out below. The cover provided is subject to the terms conditions and exclusions contained in this Policy document. The different Levels of Cover are set out in the Benefits Table on page 13 of this PDS. The Policy Application and Schedule We will provide to You will set out the specific Level of Cover that You have selected. 7.1 Accidental Death Benefit We will pay the Benefit applicable to the Level of Cover as set out in Your Policy Application and Schedule in the event Your Accidental Death is caused by Bodily Injury where Your Accidental Death occurs within six (6) months of the Accident causing Bodily Injury. We will pay the Benefit applicable to the Level of Cover as set out in Your Policy Application and Schedule in the event Your Accidental Death is caused by Bodily Injury sustained while travelling between countries as a farepaying passenger on a fare-charging regularly scheduled service that departs or terminates in Australia, New Zealand, European Union Member States, the United States of America, or Canada. Vehicles included are planes, ships, trains, buses, coaches, or trams, that are licensed as common carriers (this excludes taxis). 7.2 Total Permanent Disability Benefit We will pay the Benefit applicable to the Level of Cover as set out in Your Policy Application and Schedule, if due to Bodily Injury sustained after fourteen (14) days from the Commencement Date of the Policy, You become Totally Disabled and You are permanently, totally, and irreversibly unable to perform at least three (3) of the six (6) Activities of Daily Living listed, without substantial physical assistance from an adult, either with or without the use of mechanical equipment, special devices or other aids and adaptions generally in use for disabled persons, as confirmed by an appropriate Specialist. Such disability has to continue without interruption for a period of twelve (12) months to establish that disability is permanent. The Activities of Daily Living are: Bathing the ability to wash oneself in a bathtub, shower or by sponge bath, with or without the aid of equipment. Dressing the ability to put on and remove necessary clothing including braces, artificial limbs or other surgical appliances. Toileting the ability to get on and off the toilet and maintain personal hygiene. Bladder and Bowel Continence the ability to manage bowel and bladder function with or without protective undergarments or surgical appliances so that a reasonable level of hygiene is maintained. Transferring the ability to move in and out of a bed, chair or wheelchair, with or without the use of equipment. Feeding the ability to consume food or drink that already has been prepared and made available, with or without the use of adaptive utensils. 7.3 Minor Fracture Benefit If, due to Bodily Injury sustained after fourteen (14) days from the Commencement Date of the Policy, You are medically diagnosed with a Minor Fracture, We will pay You the Benefit applicable to the Level of Cover as set out in Your Policy Application and Schedule. In the case of multiple Minor Fractures occurring as a result of any one (1) Accident, only one (1) Minor Fracture Benefit is payable. 5

8 Active Living Insurance: Your Choice 7.4 Accident Recovery Assistance Benefit The Accident Recovery Assistance Benefit covers You, subject to the Policy terms and conditions, for Total Disability due to Bodily Injury. The maximum Benefit Period during which We will pay a Total Disability Benefit depends on whether You sustained a Major Fracture or not and whether You selected Benefit Period option A or B Total Disability Benefit Recovery from Major Fracture If due to Bodily Injury sustained after fourteen (14) days from the Commencement Date of the Policy You suffer a Major Fracture and as a result are Totally Disabled, We will pay You the Total Disability Benefit applicable to the Level of Cover as set out in Your Policy Application and Schedule. Depending on Your Waiting Period selection, We will pay You either from the first, eighth, fifteenth or thirty-first day of Total Disability and for up to a specified Benefit Period of either six (6) or twelve (12) months while You remain Totally Disabled. Total Disability due to Bodily Injury must begin within three (3) months of the Accident Total Disability Benefit Recovery from Other Bodily Injury If due to Bodily Injury sustained after fourteen (14) days from the Commencement Date of the Policy You are Totally Disabled and such disability is not due to Major Fracture, We will pay You the Total Disability Benefit applicable to the Level of Cover as set out in Your Policy Application and Schedule. Depending on Your Waiting Period selection, We will pay You either from the first, eighth, fifteenth or thirty-first day of Total Disability and for up to a specified Benefit Period of either two (2) or four (4) months while You remain Totally Disabled. Total Disability due to Bodily Injury must begin within three (3) months of the Accident. 8. Premiums We take a number of factors into account when calculating Your premium which could include the Level of Cover You choose, the Waiting Period You choose or the Benefit Period You choose. Your premium includes any amounts payable that take into account Our obligation to pay any relevant compulsory government charges, taxes, levies (including stamp duty and GST) in relation to the Policy. We will tell You, when You apply, the amount of premium payable for the cover You have chosen, when it needs to be paid and how it can be paid. The premium payments for Your Policy are set out in the Premium Payment Table on page 13. Your first premium payment for the Period of Insurance is due on the Commencement Date of Your Policy. If Your premium payment remains unpaid for at least fourteen (14) days after the Commencement Date of Your Policy, Your Policy will be void from its beginning. Subsequent premium payments are due on the Renewal Date. We may change Your premium from the Renewal Date if We notify You of a change in writing prior to that date. 9. General Conditions Commencement and Period of Your Policy Subject to You paying the premium when due, Your Policy begins at twelve (12) noon Eastern Standard time on the Commencement Date or on the latest Renewal Date, whichever is the later, and continues for one (1) calendar year (being the Period of Insurance) after which it expires, or until it is cancelled. Renewal of Your Policy This insurance may be renewed for further consecutive yearly periods upon payment of the premium. Payment of Your premium is deemed to be acceptance of an offer of renewal for a further yearly period. If You continue to pay Your premium, then unless Your Policy is cancelled or We advise You prior to the Renewal Date that We will not be renewing Your Policy, a policy on the same terms and conditions automatically comes in to existence for one (1) year from the Renewal Date. Expiry of Your Policy Your Policy expires at the end of the Period of Insurance. We may decide not to renew Your Policy. If We decide not to renew Your Policy, We will send You an expiry notice at least fourteen (14) days before the expiry of Your Policy. If Your Policy is cancelled or otherwise terminated, the Period of Insurance will be from the Commencement Date or Renewal Date, whichever is the later, up to and including the date of cancellation or termination. Notification of Variation from Standard Cover This Policy varies from the standard cover specified in the Insurance Contracts Act 1984 (Cth), ( Standard Cover ) for sickness and accident insurance contracts. In particular, it is important for You to note that: (a) Policy Benefits are as specified in the Policy document and the amounts in the Benefits Table on page 13 which You can cross refer to the Level of Cover in the Policy Application and Schedule We will provide to You. 6

9 Policy Wording and Product Disclosure Statement (b) Total Disability must commence within three (3) months of the Accident. (c) (d) (e) Exclusions set out the circumstances in which this Policy will not cover a loss. The Accident Recovery Assistance Benefit in this PDS is expressed as a monthly amount. We calculate the daily Benefit by dividing the monthly Benefit by thirty (30) days. The definition of Bodily Injury in Section 5 varies from the standard cover definition of Accidental Injury in the Insurance Contracts Regulations 1985 (Cth). Misrepresentations and Non-Disclosure Subject to the provisions of the Insurance Contracts Act 1984 (Cth), if You do not comply with Your duty of disclosure provided for by the Insurance Contracts Act 1984 (Cth) and outlined in this Policy, then We, at Our option, can reduce Our liability under the Policy or void the Policy as if it never commenced. Remuneration/Commission Our employees and Authorised Representatives may be remunerated by Us in several different ways, including via salary, commission, volume bonus, incentive prizes and awards. In certain cases, We may have a relationship with a third party who We may pay for referring You to Us. For more information relating to payments to third parties, commission amounts or other benefits, please refer to the FSG. Concurrent Disability If You suffer Total Disability as the result of more than one (1) Bodily Injury, Benefits will be paid as if Your disability were the result of only one (1) Bodily Injury. Recurrent Disability Successive periods of Total Disability will be considered to be one period of disability, unless such periods are separated by at least six (6) months, or the disabilities resulted from a different or unrelated Bodily Injury. Significant Tax Implications Generally, Your premiums are not tax deductible and claims payments are not assessable income for tax purposes unless You purchase Your Policy for business purposes. This tax information is a general statement only. See Your tax adviser for information about Your personal circumstances. Australian Law Your Policy is governed by the laws of the State or Territory in which You normally reside. Any dispute of action in connection with Your Policy shall be conducted and determined in the courts of the State or Territory of Australia in which You normally reside. Change of Beneficiary You can change Your Beneficiary at any time by giving Us written notice. We do not require Your Beneficiary s consent to make this change. Australian Currency All payments by You to Us and Us to You or someone else under Your Policy must be in Australian currency. Confirmation of Transaction The Corporations Act 2001 (Cth) requires Us to provide You with written or electronic confirmation of the premium payments for Your Policy as soon as is reasonably practicable after the payment transaction or, alternatively, We are required to inform You about Our facility by which You can, for yourself, get a written confirmation of the transaction. Our customer service staff are able to provide You with written confirmation of any payment transaction upon request. If You wish to obtain written confirmation of Your payment including details such as the date, premium payable and Your fourteen (14) day cooling off period, call Our number to obtain this information at no cost to You. If You would prefer to use an alternative facility as a means of obtaining confirmation, please write to Us or telephone Us and We will provide You with written confirmation as soon as reasonably practicable after each payment transaction. 10. General Exclusions There are certain times when this insurance may not provide cover. This means that You will not be covered under this Policy for loss that is in any way caused or contributed to by: (i) illness or disease; (ii) (iii) (iv) (v) any self-inflicted injury, or committing or attempting to commit suicide; a Pre-existing Injury Condition; being under the influence of, or being affected (temporarily or otherwise) by alcohol or drugs, except those as prescribed by a Medical Practitioner and taken in accordance with medical instructions; engagement in any professional sport (meaning 7

10 Active Living Insurance: Your Choice (vi) Your livelihood is substantially dependent on income received as a result of playing sport); Bodily Injury sustained while outside of Australia, New Zealand, European Union Member States, the United States of America, or Canada. (In limited circumstances for Accidental Death only, coverage may be afforded in transit situations as set out in Section 7.1). Where You are and remain outside of Australia while disabled, then Benefits will not be payable under this Policy for more than three (3) months, unless You return permanently to Australia. Health Insurance Exclusion The Policy is not a life insurance policy, income protection policy, nor a health insurance policy. Your Policy does not cover any event or occurrence where providing such cover would constitute the carrying on of a Health Insurance Business as defined under the Private Health Insurance Act 2007 (Cth) or any succeeding legislation to that Act or any Benefit that would breach the Health Insurance Act 1973 (Cth) or any succeeding legislation to that Act including the payment of medical expenses in Australia in respect of the rendering of a professional service for which a Medicare Benefit is payable. These general exclusions are in addition to the general conditions outlined in Section Cooling Off Period You have fourteen (14) days from the date We confirmed, electronically or in writing, that You are covered under Your Policy to decide if the Policy meets Your needs. You may cancel Your Policy by writing or ing Us within those fourteen (14) days to cancel it. If You do this, We will refund any premiums You have paid during this period. These cooling off rights do not apply if You have made or You are entitled to make a claim during this period. 12. Cancellation of Your Policy Your Policy may be cancelled in one of three (3) ways: 1. When You can cancel You can cancel Your Policy at any time by telling Us in writing. If You cancel Your Policy, the cancellation will take effect at twelve (12) noon Australian Eastern Standard time on the day We receive Your notice of cancellation. We will refund the premium for Your Policy, less an amount which covers the period for which You were insured less a fixed cancellation fee of 15% of the annual premium. However, We will not refund any premium if We have paid or are obliged to pay a Benefit under Your Policy. 2. When We can cancel We can cancel Your Policy by giving You written notice to the address on file and in accordance with the Insurance Contracts Act 1984 (Cth), in circumstances where You have: (a) breached the Duty of Disclosure; (b) (c) breached a provision of Your Policy (including one requiring payment of premium); made a fraudulent claim under any policy of insurance. If We cancel for a reason other than non-payment of a premium, We will refund the premium for Your Policy less an amount to cover the period for which You were insured less a fixed cancellation fee of 15% of the annual premium. 3. Automatic cessation in other circumstances Your Policy will cease automatically in the following circumstances: (a) You die; (b) (c) upon the first Premium Due Date after You attain the Maximum Age; upon payment in respect to Your Total Permanent Disability. 13. Claims How to make a claim on Your Policy If You need to make a claim, You should tell Us about the circumstances giving rise to Your claim under Your Policy as soon as possible and complete a claim form within thirty (30) days after Your loss has occurred, or as soon as reasonably possible. Our claim form is available from Our staff, from Our Authorised Representatives, from Our Website or by calling Us on Our number If You cannot complete Our claim form, You should still provide Us with whatever proof and documentation supporting this claim as We may reasonably require. Your failure to furnish Us with notice within the time provided under Your Policy will not invalidate any claim but We may reduce Our liability under the Policy to the extent to which We have suffered any prejudice due to such failure. 8

11 Policy Wording and Product Disclosure Statement Proof of loss After advising Us of Your claim, You (or in the event of Your Accidental Death, the Beneficiary) should provide Us with proof of Your loss within the following timelines: Benefit Accidental Death Benefit Total and Permanent Disability Benefit Minor Fracture Benefit Accident Recovery Assistance Benefit Timeline for Proof of Loss Within six (6) months of Your Accidental Death. Within six (6) months of You becoming Totally and Permanently Disabled. Within three (3) months of the date of Minor Fracture. Within three (3) months of the end of each period of Your disability. Types of Proof required (not exclusive) A registered copy of the death certificate, completion of a claim form, Coroners report and toxicology report and hospital report (if applicable). Completion of a claim form, a Specialist report confirming Total Permanent Disability and a toxicology report (if applicable). Completion of a claim form by yourself and a Medical Practitioner and a copy of any medical report verifying a Minor Fracture. Completion of a claim form by yourself and a Medical Practitioner and in the case of the Total Disability Benefit- Recovery from Major Fracture, an X-Ray report. We may also request copies of medical, hospital or Specialist reports or a toxicology report and may send You a claim progress form or a continuing claim form where disability is ongoing. If You are unable to provide Us with the proof We require within the time frame specified, You must provide it as soon as reasonably possible. However, the proof must be received by Us no later than one (1) year from the time specified, or We may refuse the claim. Claim forms completed at Your expense While a claim continues, any claim form or progress form completed by a Medical Practitioner or Specialist to support the claim will be supplied at Your own expense. Medical examination at Our expense We may request that You undergo one (1) or more medical examination(s) at Our expense at a time and by any Medical Practitioner or Specialist We may choose. Failure to comply with Our request may result in the claim being refused. How do We pay claims? Benefits for loss covered by the Policy will be paid when We receive written proof satisfactory to Us of the loss. For ongoing Total Disability, We will pay Benefits on a monthly basis upon the receipt of written proof, satisfactory to Us, of continuing disability. Monthly Benefits are calculated on the basis of a thirty (30) day month. That is the daily Benefit is calculated by dividing the monthly Benefit by thirty (30). Benefits for any other loss covered by the Policy will be paid when We receive written proof satisfactory to Us of the loss. In the event You disappear and death is presumed to be the result of an Accident, for the purposes of claiming under this Policy, Accidental Death will not be presumed unless You have been missing for more than one year. In this instance, claim payment will be based upon a Coroner s findings. Who are Benefits paid to? Benefits are paid to You. In the event of Your Accidental Death, any benefit will be payable to Your Beneficiary as nominated on the Policy Application and Schedule. You should advise Us as soon as possible of an occurrence or event which could lead to a claim. Making claims after Your Policy is cancelled If Your Policy is cancelled this does not affect Your rights to make a claim under Your Policy if the Accident and Bodily Injury occurred before the date of cancellation. If we accept a claim and pay a Benefit under the Policy, we may deduct the balance of any outstanding premium from the claim payment. 14. Privacy Statement We are committed to protecting Your privacy. This document provides You with an overview of how We handle Your personal information. Our Privacy Policy can be accessed on Our Website at Personal Information handling practices Collection, Use and Disclosure We and Our Authorised Representatives, collect Your personal information (which may include sensitive information such as health information) when You are applying for, changing or renewing an insurance policy with Us or when We are processing a claim, in order to help Us properly administrate Your insurance application, policy or claim. Personal information may be obtained by Us directly from You or, sometimes, via a third party such as Your employer or an immediate member of Your family. 9

12 Active Living Insurance: Your Choice When information is provided to Us via a third party We use that information on the basis that You have consented or would reasonably expect Us to collect Your personal information in this way and We take reasonable steps to ensure that You have been made aware of how We handle Your personal information. The primary purpose for Our collection and use of Your personal information is to enable Us to provide insurance services to You. Sometimes, We may use Your personal information for Our marketing campaigns, in relation to new products, services or information that may be of interest to You. We may disclose the information We collect to third parties, including service providers engaged by Us to carry out certain business activities on Our behalf (such as assessors and call centres in Australia). If You agree, We may also disclose to potential customers of Combined Insurance Your name and occupation and the fact that You are a customer of Combined Insurance. In some circumstances, in order to provide Our services to You, We may need to transfer personal information to other entities within ACE Group, (such as the regional head offices of ACE located in Singapore, UK or USA) or third parties with whom We, or those other ACE Group entities, have sub-contracted to provide a specific service for Us and these may be outside of Australia. In particular, certain business process functions of ACE are performed by a dedicated servicing unit located in the Philippines. Please note that no personal information is disclosed by Us to any overseas entity for marketing purposes. In all instances where personal information may be disclosed overseas, in addition to any local data privacy laws, We have measures in place to ensure that those parties hold and use that information in accordance with the consent You have provided and in accordance with Our obligations to You under the Privacy Act 1988 (Cth). Your Choices In dealing with Us, You agree to Us using and disclosing Your personal information as set out in this statement and Our Privacy Policy. This consent remains valid unless You alter or revoke it by giving written notice to Our Privacy Officer. However, should You choose to withdraw Your consent it is important for You to understand that this may mean We may not be able to provide You or Your organisation with insurance or to respond to any claim. If You have previously provided Us with permission to show Your name and occupation for marketing purposes, You may revoke this permission at any time in writing to Us, or by calling Our customer service centre on How to Contact Us If You would like a copy of Your personal information, or to correct or update it, please contact Our customer service centre on or customer@combined.com.au. If You have a complaint or would like more information about how We manage Your personal information, please review Our Privacy Policy for more details or contact the Privacy Officer, ACE Insurance Limited, GPO Box 4907, Sydney NSW 2001 Tel: or Privacy.AU@acegroup.com 15. Complaints and Dispute Resolution We take the concerns of our customers very seriously and have detailed complaint handling and internal dispute resolution procedures that you can access. Please note however that if we have resolved your complaint to your satisfaction by the end of the 5 th business day after we have received it, and you have not requested that we provide you a response in writing the below-mentioned complaint handling and internal dispute resolution process 1 does not apply: Stage 1 Complaint Handling Procedure If you are dissatisfied with any aspect of your relationship with Combined Insurance including our products or services and you wish to make a complaint, please contact us by phone, fax or post (as below) or us at: complaints@combined.com.au The Complaints Officer Combined Insurance PO Box 403 North Sydney NSW 2059 Phone: Fax: (02) The members of our complaint handling team have been carefully selected and trained to handle complaints fairly and efficiently. Please provide us with your claim or account number (if applicable) and as much information as you can about the reason for your complaint. We will investigate your complaint and keep you informed of the progress of our investigation. We will respond to your complaint in writing within 15 business days provided we have all necessary information and have completed any investigation required. In cases where further information or investigation is required, we will work with you to agree reasonable alternative time frames The exemption to the Complaints Process does not apply to Complaints regarding a declined claim, the value of a claim, or about financial hardship.

13 Policy Wording and Product Disclosure Statement We will also keep you informed about the progress of our response at least every 10 business days, unless you agree otherwise. If we cannot agree, you may request us to treat your complaint as a Stage 2 complaint and refer it to our internal dispute resolution team. Stage 2 Internal Dispute Resolution Procedure If you advise us that you wish to take your complaint to Stage 2, your complaint will be reviewed by members of our internal dispute resolution team as they are independent from our complaint handling team, and are committed to reviewing disputes objectively, fairly and efficiently. You may contact our internal dispute resolution team by phone, fax or post (as above) or us at: complaints@combined.com.au Internal Dispute Resolution Service Combined Insurance PO Box 403 North Sydney NSW 2059 Phone: Fax: (02) Please provide us with your claim or account number (if applicable) and as much information as you can about the reason for your dispute. We will keep you informed of the progress of our review of your dispute at least every 10 business days and will respond to your dispute with a written letter within 15 business days provided we have all necessary information and have completed any investigation required. In cases where further information or investigation is required, we will work with you to agree reasonable alternative time frames. If we cannot agree, you may refer your dispute to the Financial Ombudsman Service Australia (FOS) as detailed below. Stage 3 External Dispute Resolution If you are dissatisfied with our internal dispute determination or we are unable to resolve your complaint or dispute to your satisfaction within 45 days, you may refer your complaint or dispute to FOS. FOS is an independent external dispute resolution scheme approved by the Australian Securities & Investments Commission (ASIC). We are a member of this scheme and we agree to be bound by its determination about a dispute. Where a dispute is covered by the FOS Terms of Reference, the General Insurance Division of the FOS offers a free and accessible dispute resolution service to consumers. You may contact FOS at any time at: Financial Ombudsman Service Australia GPO Box 3 Melbourne VIC 3001 Phone: or (03) Fax: (03) info@fos.org.au Website: If you would like to refer your dispute to the FOS you must do so within 2 years of the date of our internal dispute determination. FOS may still consider a dispute lodged after this time if FOS considers that exceptional circumstances apply. If FOS advises you that the FOS Terms of Reference do not extend to you or your dispute, you can seek independent legal advice or access other external dispute resolution options that may be available to you. 16. Financial Claims Scheme We are an insurance company authorised under the Insurance Act 1973 (Insurance Act) to carry on general insurance business in Australia by the Australian Prudential Regulation Authority (APRA) and are subject to the prudential requirements of the Insurance Act. The Insurance Act contains prudential standards and practices designed to ensure that, under all reasonable circumstances, financial promises made by Us are met within a stable, efficient and competitive financial system. Because of this: the protection provided under the Financial Claims Scheme legislation applies in relation to Us and the Policy. If ACE were to fail and were unable to meet Our obligations under the Policy, a person entitled to claim under insurance cover under the Policy may be entitled to payment under the Financial Claims Scheme (access to the Scheme is subject to eligibility criteria). Information about the Financial Claims Scheme can be obtained from the APRA website at and the APRA hotline on ; and We are exempted by the Corporations Act 2001 from the requirement to meet the compensation arrangements Australian financial services licensees must have in place to compensate retail clients for loss or damage suffered because of breaches by the licensee or its representatives of Chapter 7 of that Act. We have compensation arrangements in place that are in accordance with the Insurance Act. 11

14 Active Living Insurance: Your Choice 17. Updating Our PDS We may update the information contained in Our PDS when necessary. A paper copy of any updated information is available to You at no cost by calling Us or can be accessed on Our Website at We will issue You with a new PDS or a supplementary PDS where the update is to rectify a misleading or deceptive statement or when an omission is materially adverse from the point of view of a reasonable person deciding whether to buy this product. 12

15 This Benefits Table is only a brief overview of the benefits and does not include definitions and exclusions. MAKE SURE TO READ YOUR POLICY FOR DETAILS. Benefits Table ACTIVE LIVING INSURANCE: YOUR CHOICE BENEFITS LEVEL 1 LEVEL 2 LEVEL 3 Accidental Death Benefit $10,000 $20,000 $30,000 Total Permanent Disability Benefit $100,000 $200,000 $300,000 Minor Fracture Benefit $100 $200 $300 Accident Recovery Assistance Benefit (Disability) Total Disability Major Fracture (Option A: maximum 6 months) $1,000 (maximum of $6,000) $2,000 (maximum of $12,000) $3,000 (maximum of $18,000) Total Disability Major Fracture (Option B: maximum 12 months) $1,000 (maximum of $12,000) $2,000 (maximum of $24,000) $3,000 (maximum of $36,000) Total Disability other Bodily Injury (Option A: maximum 2 months) $1,000 (maximum of $2,000) $2,000 (maximum of $4,000) $3,000 (maximum of $6,000) Total Disability other Bodily Injury (Option B: maximum 4 months) $1,000 (maximum of $4,000) $2,000 (maximum of $8,000) $3,000 (maximum of $12,000) Premium Payment Table (including GST, excluding State/Territory Stamp Duty) ACTIVE LIVING INSURANCE: YOUR CHOICE (CODE 28710) Selected Waiting Period before You can claim for Disability LEVEL 1 LEVEL 2 LEVEL 3 Benefit Period Disability (Option) A B A B A B 0 Day Waiting Period - Annual Payment $ $ $1, $1, $2, $2, Day Waiting Period Annual Payment $ $ $1, $1, $2, $2, Day Waiting Period Annual Payment $ $ $1, $1, $2, $2, Day Waiting Period Annual Payment $ $ $1, $1, $1, $2, Important Note: Option B provides Total Disability Benefits for double the Benefit Period of Option A. 13

16 ACE Insurance Limited ABN AFSL Number Combined Insurance is a division of ACE Insurance Limited Customer Service Phone customer@combined.com.au Website Street Address 51 Berry Street, North Sydney NSW Australia 2060 Postal Address PO Box 403, North Sydney NSW Australia 2059 Version: 15PDSCIAALI /15