Personal Accident INSURED Harness Racing Australia Inc (HRA) and it s Members (State Controlling Bodies excluding Harness Racing New South Wales), Australian Mini Trotting Clubs (as below), Junior Member participants as per schedule including subsidiary or controlled companies now or previously existing or hereafter formed or acquired. Queensland Mini Trotting Clubs Queensland Junior Harness Racing Assoc Inc Queensland Mini Trotting Sporting Assoc Inc Western Australia Mini Trotting Clubs WATA Be Active Pony Trots Albany Pony Trots Busselton Pony Trots Total Pony Trots Victoria Mini Trotting Clubs Pony Trots Victoria Tasmania - Mini Trotting Club Tasmanian Pacing Club Carrick Park Pacing Club South Australia - Mini Trotting Club SA Pony Association POLICY NUMBER 0029453 BENEFICIARIES AGE LIMIT GEOGRAPHICAL SCOPE Junior Members of the Insured 5 to 16 years (excluding Queensland) Queensland Age Limit 5 to 18 years Australia PERIOD OF INSURANCE From: 1 September 2015 at 4 PM Local Standard Time To: 1 September 2016 at 4 PM Local Standard Time and any further period for which the Insurer agrees to provide cover. SCOPE OF COVER Whilst engaged in any recognised and sanctioned activity under the control of the organisation, including direct travel to and from such activities. AGGREGATE LIMIT OF LIABILITY $2,000,000 Schedule of Benefits PART A LUMP SUM BENEFITS FOR INJURY Insured Persons Aged 5 up to 16 years (excluding Queensland) Insured Persons Aged 5 up to 18 years (Queensland only) EVENTS 1 Maximum benefit is $ 50,000 EVENTS 2-19 Maximum benefit is $500,000 EVENTS 1 Maximum benefit is $ 50,000 EVENTS 2-19 Maximum benefit is $500,000
PART B WEEKLY BENEFITS FOR INJURY This section is not insured. TABLE OF EVENTS THE EVENTS Injury resulting directly in the following Event(s), which occur within twelve (12) months of the date of the Injury: THE BENEFIT Being a percentage of the amount shown in the Schedule against Part A or B for each Insured Person. PART A LUMP SUM BENEFITS 1) Accidental Death 100% 2) Permanent Total Disablement 100% 3) Permanent and Incurable paralysis of all limbs 100% 4) Permanent Total Loss of sight of both eyes 100% 5) Permanent Total Loss of sight of one eye 100% 6) Permanent Total Loss of use of two limbs 100% 7) Permanent Total loss of use of one limb 100% 8) Permanent and incurable insanity 100% 9) Permanent Total Loss of hearing in: a) both ears b) one ear 100% 20% 10) Permanent Total Loss of four fingers and thumb of either hand 75% 11) Permanent Total Loss of the lens of one eye 60% 12) Third degree burns and/or resultant disfigurement which covers more than 40% of the entire external body 50% 13) Permanent Total Loss of use of four fingers of either hand 40% 14) Permanent Total Loss of use of one thumb of either hand: a) both joints b) one joint 15) Permanent Total Loss of use of fingers of either hand: a) three joints b) two joints c) one joint 16) Permanent Total Loss of use of toes either foot: a) all - one foot b) great both joints c) great one joint d) other than great - each toe 30% 15% 15% 10% 5% 15% 5% 3% 1% 17) Fractured leg or patella with established non-union 10% 18) Shortening of leg by at least 5cm 7.5%
19) Permanent Disability not otherwise provided for under insured Events 5 to 18 inclusive. Such percentage of the Sum Insured as the Insurers shall in their absolute discretion determine and being in their opinion not inconsistent with the benefits provided under Events 5 to 18 inclusive. Limited to a maximum amount of 75% of the amount shown in the Schedule against Part A Lump Sum Benefits. ADDITIONAL BENEFITS Funeral Expenses Up to a maximum of $5,000. Non-Medicare Medical Expenses ($50 excess applies) Up to a maximum of $5,000. Emergency Home Help Clause Student Tutorial Cost Up to a maximum of $250 per week payable on the 8 th day of treatment by a Doctor for an aggregate period not exceeding 52 weeks. Up to a maximum of $500 per week payable on the 8 th day of treatment by a Doctor for an aggregate period not exceeding 52 weeks. ENDORSEMENTS: EMERGENCY HOME HELP Person and engaging in voluntary work on behalf of the Policyholder, a Covered Person who is retired, unemployed or not in receipt of a Salary suffers from Event 25 and/or 26 described in Part B of the Table of Events and is unable to carry out Domestic Duties, We will pay for the cost of reasonably and necessarily incurred Domestic Duties expenses as a result of that Bodily Injury up to the $250 per week payable from the 8th day of treatment by a Doctor for a maximum of fifty-two (52) weeks. Definitions Under Emergency Home Help Domestic Duties means the usual and ordinary domestic duties undertaken by someone as a homemaker and could include child-minding and home help services. Conditions Applying to Emergency Home Help 1. Childminding and home help services must be carried out by persons other than the Covered Person's Close relatives or persons permanently living with the Covered Person. 2. Childminding and home help services must be certified by a Doctor as being necessary for the recovery of the Covered Person. FUNERAL EXPENSES Person, the Covered Person suffers an Accidental Death the Policy extends to cover the expenses of burial or cremation OR the cost of returning the Covered Person's body or ashes to a place nominated by the legal representative of the Covered Person s estate, up to a maximum of $5,000. NON-MEDICARE MEDICAL EXPENSES If during the Period of Insurance and whilst engaged on behalf of the Policyholder, a Covered Person suffers from a Bodily Injury, We will
pay the Non-Medicare Medical Expenses incurred up to a maximum of $5,000. An Excess of $50 applies to each and every claim under Non-Medicare Medical Expenses. Definitions Under Non-Medicare Medical Expenses Non-Medicare Medical Expenses means expenses: (a) incurred within twelve (12) months of sustaining a Bodily Injury; and (b) paid by a Covered Person or by the Policyholder for Doctor, Physician, Surgeon, Nurse, Physiotherapist, Chiropractor, Osteopath, Hospital and/or Ambulance Services for the following treatments: Medical Surgical X-ray Chiropractor Osteopathic Physiotherapy Hospital Nursing Treatment But does not include: Dental Treatment, unless such treatment is necessarily required, to teeth other than dentures and is caused by the Bodily Injury referred to in (a) above. Conditions Applying to Non-Medicare Medical Expenses 1. The benefit payable is less recovery made from any Private Health Insurance Fund with respect to the expense. 2. No benefit is payable in respect of the Medicare gap, being the difference between the payment made by Medicare and the Medicare Benefits Schedule fee for the expense. STUDENT TUTORIAL COSTS Person and on behalf of the Policyholder, a Covered Person who is a student, suffers from Event 25 and/or 26 described in Part B of the Table of Events and is unable to attend registered classes, We will pay the cost of reasonably and necessarily incurred home tutorial services as a result of that Bodily Injury up to $500 per week for a maximum of fifty-two (52) weeks. CONDITIONS APPLYING TO STUDENT TUTORIAL COSTS 1. The Covered Person must be registered as a full time student. 2. Home tutorial services must be carried out by persons other than the Covered Person s Close Relatives or persons permanently living with the Covered Person. DIFFERENCE IN CONDITIONS To the extent of cover that Your previous Group Personal Accident insurance policy a benefit existed which does not exist under this policy or was a larger benefit than the similar benefit which exists under this policy (the difference in conditions benefit), We will pay
You the amount that represents the difference in conditions benefit as if that benefit existed under this policy. ENDORSEMENTS FUNERAL EXPENSES It is hereby noted and agreed that where an Insured Person suffers an Accidental Death this Policy extends to cover the expenses of burial or cremation OR the cost of returning the Insured Person s body or ashes to their country of residence up to a maximum of $5,000. NON MEDICARE MEDICAL EXPENSES With respect to Non-Medicare Medical Expenses endorsement, the maximum amount payable is $5,000. Excess $50. EMERGENCY HOME HELP CLAUSE With respect to Emergency Home Help the maximum amount payable is $250 per week, payable from the 8 th day of treatment by a Doctor for an aggregate period not exceeding 52 weeks. STUDENT TUTORIAL COST With respect to the Student Tutorial Cost endorsement the maximum amount payable is $500 per week, payable from the 8 th day of treatment by a Doctor for an aggregate period not exceeding 52 weeks. DRUG AND ALCOHOL EXCLUSION The policy shall not apply to any Event resulting directly or indirectly from a Covered Person being under the influence of intoxicating liquor, including having a blood alcohol content over the prescribed legal limit whilst driving, or being under the influence of any other drug unless it was prescribed by a Doctor and taken in accordance with a Doctor s advice. CHAUFFER SERVICES Person, the Covered Person sustains a Bodily Injury or Sickness for which benefits are payable under Events 25, 26, 27 or 28, We agree to pay up to a maximum of $2,000 for a chauffeur or taxi service to and from the Covered Person s usual place of work and the Covered Person s usual place of residence if the Covered Person recovers sufficiently to return to work but is certified by a Doctor as being unable to drive a vehicle or travel on public transport. BED CARE/EXTRA CASH Person and engaging in voluntary work of the Policyholder, the Covered Person is confined to bed (other than in a hospital or other medical facility) as a result of a Bodily Injury, for a period in excess of forty-eight (48) hours, and the Covered Person presents Us with a written opinion of a Doctor that verifies that the Bodily Injury caused the Covered Person to be confined to bed, We will pay the Covered Person $50 per day up to a maximum of 712 consecutive days.
PREMIUM BREAKDOWN Premium $7,938.00 FSL $0.00 UW Fee $0.00 Premium GST $793.80 Stamp Duty $874.97 Total Premium $9,606.77 IN WITNESS WHEREOF, this Policy has been countersigned by an authorised officer of A & H International on behalf of the Company at MELBOURNE this 21st DAY OF SEPTEMBER 2015. VWGPA PDS/WRD 01/14 ST Sydney Melbourne Brisbane Perth ABN 26 053 335 952 Level 4, 33 York Street Suite 1507 Exchange Tower Level 20 Level 7, AFS Licence No:238261 SYDNEY NSW 2000 530 Lt Collins Street 260 Queen Street 189 St Georges Terrace Email: enquiries@acchealth.com.au GPO Box 4213, SYDNEY MELBOURNE VIC 3000 BRISBANE QLD 4000 PERTH WA 6000 Website: www.acchealth.com.au NSW 2001 T: +61 2 9251 8700 T: +61 3 9909 7322 T: +61 7 3221 1919 T: +61 8 6555 0344 Freecall 1800 618 700 F: +61 2 9251 8755 Freefax 1800 618 755