www.mtaasuper.com.au Phone: 1300 362 415 / Fax: 1300 365 142 Insurance Guide Date of issue: 1 December 2012 The information in this document forms part of the Product Disclosure Statement for MTAA Super dated 1 December 2012 issued by Motor Trades Association of Australia Superannuation Fund Pty Ltd (ABN 14 008 650 628, AFSL 238 718) of Level 3, 39 Brisbane Ave Barton ACT 2600, the Trustee of the MTAA Superannuation Fund (ABN 74 559 365 913). Insurance in your super MTAA Super offers a range of insurance options to protect you and your family from financial hardship if you are unable to work for a long period due to sickness or injury, or become permanently disabled or die. The benefits of insurance as part of your superannuation arrangements include the following: Cost savings. MTAA Super uses its purchasing power and has negotiated a group insurance policy on behalf of its members. Cover is tax-effective. You do not pay for it with your after-tax income since premiums are deducted directly from your superannuation account. Types of cover MTAA Super offers three types of cover to members. Death cover Death-only cover provides an insured lump-sum benefit in the event of your death or a terminal illness. Total and permanent disability (TPD) cover TPD cover provides for an insured lump-sum benefit if you become totally and permanently disabled or suffer a terminal illness. Income protection Income protection insurance will pay a benefit, usually monthly, if you are unable to work because of illness or injury. Contents Matching Cover...2 Death and TPD cover...3 Default cover...3 Limited Cover...4 Changing your cover...5 Work Scales...6 Unitised Cover...6 Fixed Cover...8 Income Protection Insurance...13 Calculating the cost of cover... 14 Income Protection unitised scales.15 Important information about your insurance cover...21 Privacy policy: group risk insurer... 23 Forms Application for additional Insurance...25 Application to change your work scale...31 Matching Insurance Cover...33 Application to increase cover on joining...37 1
Matching cover Want to join MTAA Super and change your super fund without losing your existing levels of insurance cover? MTAA Super offers members the ability to apply to match their cover to the insurance design available. This means you may be able to consolidate your super accounts and not have to pay additional fees for keeping your insurance open in another fund. You must satisfy a number of conditions and these are outlined in the Matching insurance cover form on Page 33. Do not cancel your existing insurance until you have received written notification that your cover has been accepted. To apply, fill in the MATCHING INSURANCE COVER FORM on Page 33. This form outlines all conditions and any restrictions regarding cover. 2
Death and Total and Permanent Disablement cover Default cover Cover when you join MTAA Super New MTAA Super members are automatically provided with default cover (subject to terms and conditions). The level of cover provided to you is based on your age when you become a member and may change in line with your age. Some new members will not be eligible for default cover (see page 4). The table below sets out the cost and the number of units of cover that are provided for your age when you join: COVER WHEN YOU JOIN MTAA SUPER Your age next birthday when you join MTAA Super Death Units General Scale TPD Units General Scale Cost of Cover ($0.50 per unit) 16-21 1 5 $3.00 per week 22-26 3 5 $4.00 per week 27-70 6 6 $6.00 per week There are different types of work scales depending on the type of work you do. We classify them as General; Non-manual and Professional. The amount of cover you are eligible to receive will be different depending on the work scale applicable to you. It s important you let the Fund know if you are eligible for nonmanual or professional cover. See page 6 for more information. How to calculate your default level of cover? Go to the unitised scales table on page 7 Look at the row corresponding to your age next birthday. Then, look at the box in the column that corresponds to the work scale that applies to you. (See page 6 to find out what the different work scales mean). The amount in that box is the level of cover per unit. Multiply the amount of cover in that box by the number of units you are eligible for. Not enough cover to meet your needs? Why not look at the other options available to you. The level of cover provided under the unitised benefit scales varies with age. Your insurance needs will vary with time, too, so we recommend that you review your insurance regularly to ensure that the level of cover provided remains sufficient to meet your needs. Max is aged 29 next birthday. He works in an office environment and is eligible to apply for the non-manual work scale. As a member of MTAA Super, he will receive 6 units of death and 6 units of TPD cover: $67,750 X 6 = $406,500. His default level of cover is $406,500 of Death and TPD insurance at a cost of $6.00 per week. Cover changes as you stay with MTAA Super Insurance can t be one size fits all and your needs change from when you are just entering the workforce to when you take out a mortgage and have children. This is why we have introduced aged based default insurance scales. This means: If you turn 21 while you are a member and you haven t changed your Death & TPD cover, your default level of death cover will increase to three units If you turn 26 while you are a member and you haven t changed your Death & TPD cover, your default level of Death and TPD cover will increase to 6 units. 3
When does default cover start? Your default cover will begin for eligible members on the earlier of: the start of the contribution period from which your first on-time employer contribution is received (up to a maximum of 180 days prior to the cash received date); and the effective date of your account balance with MTAA Super being greater than zero. It is important to ensure that your employer pays ongoing contributions to your account and on time. Are you eligible for default cover? To be eligible for the default death and total and permanent disability cover when you join, you must: be between 15 and 69 years of age have not received a TPD benefit through a superannuation fund or insurance policy at any time previously; and not be currently claiming or be eligible to claim a TPD benefit. Please contact MTAA Super if you are not eligible for default insurance cover for any reason other than age. Limited cover If you are an eligible Employer Supported Member who joins MTAA Super as a new member and you meet the following conditions: your employer s first employer contribution to your account is received within 6 months of you commencing employment with your employer; and you are in Active Employment when default cover commences. The default cover you receive will not be subject to Limited Cover. If you are an Employer Supported Member not in Active Employment on the date the cover commences you will receive Limited Cover until you return to Active Employment. Once you return to Active Employment the Limited Cover restriction will be removed. For all other members who do not meet the conditions above you will receive Limited Cover for the first 24 months. Should you be in Active Employment after the expiry of this 24 month period Limited Cover will be removed. Employer Supported Member Any member who receives an employer (Superannuation Guarantee) contribution from their employer. Definitions Limited Cover Limited Cover means a member is covered only for an injury that first occurred or an illness that first became apparent on or after the day cover began. Active Employment Employer Supported Members A person in Active Employment is a person who is employed by an employer and who, in the insurer s opinion, is capable of performing their identifiable duties without restriction as a result of any illness or injury for at least 35 hours a week (whether or not they are actually working those hours). Active Employment All other members A person in Active Employment is a person who in the insurer s opinion is capable of performing their identifiable work duties without restriction as a result of any illness or injury for at least 35 hours a week (whether or not they are actually working those hours). 4
Changing your cover You can apply to increase, decrease or cancel your cover at any time. Increase your cover: without providing evidence of health You may be eligible to increase your cover without the need to provide evidence of health to the insurer in two ways: You first join MTAA Super When you first join MTAA Super you may be eligible to increase your cover without the need to provide health evidence. To apply, fill in the APPLICATION TO INCREASE COVER ON JOINING FORM on page 37. This form outlines all conditions and any restrictions regarding cover. Your life changes If you already have at least default cover with MTAA Super you can apply to increase your Death and TPD cover by up to 3 units on the General Scale within 60 days of one of the following events occurring: you get married you have a child or adopt a child you take out a mortgage to purchase or build your home you get divorced. If you are not in Active Employment at the time you apply for this increase, Limited Cover will apply to the amount of additional cover until you return to work, and have been in active employment. This increase in cover cannot result in you holding more death or TPD cover than your applicable Automatic Acceptance Limit, which for members aged 54 or less is $800,000. To apply, fill in the LIFE EVENTS COVER FORM on our website. This form outlines all conditions and any restrictions regarding cover. Increase your cover: when you need to As a member of MTAA Super you can apply for additional death or TPD cover at any time. The maximum total amount of cover you can apply for: Death cover: $5,000,000 TPD cover: $3,000,000 To increase your cover, please fill in the APPLICATION FOR ADDITIONAL INSURANCE on page 25. Reduce or cancel your cover You can reduce or cancel your insurance cover at any time by writing to MTAA Super. You can also elect to hold death-only or TPD only cover at any time. 5
Jenny is 35 years old and is an administration assistant. She works in an office and qualifies for the non-manual work scale. She has 6 units of death cover: Her age next birthday is 36. Given she is eligible for non-manual cover, if she applies to change this cover and the insurer accepts that she is eligible, her cover will increase without an increase to the amount deducted from her superannuation account each week. General work scale Jenny will receive $49,000 of death cover for each unit. She has 6 units of cover: $49,000 X 6 = $294,000 Jenny is insured for $294,000 Non-manual work scale Jenny will receive $69,600 of death cover for each unit. She has 6 units of cover: $69,600 X 6 = $417,600 Jenny is insured for $417,600 Jenny could get more death cover, for the same cost per week by filling in the APPLICATION TO CHANGE YOUR WORK SCALE on page 31. Why not look at the other options available to you. Work scales: General, Non-Manual or Professional? MTAA Super offers members three types of insurance benefit scales on which to base their benefit levels. What is the general work scale? This scale is available to everyone but is generally used by members who work in a trade environment. Unless you apply (and are accepted) for the non-manual or professional scale, the general scale will apply to your insurance cover. Are you eligible for the non-manual work scale? If you work entirely in an office environment, and do not perform manual duties or work in a hazardous environment, or do not spend more than 20 per cent of your working time outside an office environment, then you are eligible to apply for the non-manual scale. Are you eligible for the professional work scale? If you are a white-collar professional and perform no manual work (e.g doctor, lawyer, accountant) you may be eligible for the professional scale. Usually these occupations require tertiary qualifications or are senior management positions within your organisation and also earn at least $120,000 per annum. Unitised or Fixed cover You can choose to have your death or TPD cover as either unitised or fixed cover, although there are conditions you might have to satisfy. You cannot have a combination of unitised and fixed cover for death and TPD. Unitised cover Unitised cover is based on an insurance benefit scale that determines the amount of money you will receive if you become eligible to claim a benefit for death or TPD. The levels of cover vary according to your age, but the cost for each unit remains the same regardless of your age. See page 14 to find out how to calculate unitised cover. The cost of unitised cover The charges for unitised death and TPD insurance cover are as follows: Death only: Total & Permanent Disability: Death & TPD cover: $0.50 per unit per week $0.50 per unit per week $1.00 per unit per week Unitised Scales: Death and Total & Permanent Disability The table on page 7 shows the amount of insurance cover provided by a (1) unit of cover based on your age and your work scale. Your work scale depends on the sort of work you do. See the section Work Scales above for more information. 6
UNITISED SCALES: DEATH AND TOTAL & PERMANENT DISABILITY (1 UNIT OF COVER) Age Next Birthday General Work scale Non-Manual Work scale Professional Work scale 16-22 $27,500 $39,100 $59,100 23 $28,400 $40,300 $61,100 24 $30,500 $43,300 $65,600 25 $34,100 $48,400 $73,300 26 $39,400 $55,900 $84,700 27 $42,900 $60,950 $92,200 28 $45,900 $65,200 $98,700 29 $47,700 $67,750 $102,600 30 $48,900 $69,400 $105,100 31 $49,500 $70,300 $106,400 32 $49,600 $70,400 $106,600 33 $49,500 $70,300 $106,400 34 $49,500 $70,300 $106,400 35 $49,300 $70,000 $106,000 36 $49,000 $69,600 $105,400 37 $48,700 $69,200 $104,700 38 $48,000 $68,200 $103,200 39 $45,800 $65,000 $98,500 40 $43,400 $61,600 $93,300 41 $41,000 $58,200 $88,200 42 $38,800 $55,100 $83,400 43 $36,800 $52,300 $79,100 44 $34,600 $49,100 $74,400 45 $32,600 $46,300 $70,100 46 $30,400 $43,200 $65,400 47 $28,300 $40,200 $60,800 48 $26,100 $37,100 $56,100 49 $24,000 $34,100 $51,600 50 $21,800 $31,000 $46,900 51 $19,700 $28,000 $42,400 52 $17,500 $24,900 $37,600 53 $15,300 $21,700 $32,900 54 $13,700 $19,500 $29,500 55 $11,500 $16,300 $24,700 56 $9,460 $13,420 $20,340 57 $8,250 $11,770 $17,740 58 $7,260 $10,340 $15,610 59 $6,600 $9,400 $14,190 60 $5,850 $8,300 $12,580 61 $5,500 $7,810 $11,830 62 $5,170 $7,370 $11,120 63 $4,850 $6,900 $10,430 64 $4,400 $6,270 $9,460 65 $4,070 $5,830 $8,750 66* $3,750 $5,300 $8,060 67* $3,300 $4,730 $7,100 68* $2,970 $4,200 $6,390 69* $2,650 $3,800 $5,700 70* $2,200 $3,100 $4,730 Sam is a mechanic and aged 27 next birthday. He has 6 units of death cover. As a mechanic, he works in a manual environment and is eligible for the general work scale. Death cover is 6 units X $0.50 = $3.00 per week The total cost of cover is $3.00 per week 1 unit of death cover for his age next birthday (27) is $42,900 (on the general work scale) $42,900 x 6 units = $257,400 $3.00 per week covers Sam for $257,400 death cover * Activities of Daily Living (ADL) definition of TPD applies from 65th birthday. See Features of total and permanent disability insurance on page 11 for more information. 7
Fixed cover If you don t want your insurance cover to reduce each year, you can retain a fixed level of cover. Fixed cover allows you to choose the level of cover you want in multiples of $1,000. Your chosen level of cover will not vary with your age and will remain the same each year until you reach age 70 for death-only or death plus TPD cover. Your premium will, however, vary each year according to your age. If you are eligible to apply for the non-manual or professional scale, fill in the APPLICATION TO CHANGE YOUR WORKSCALE FORM on page 31. Please note that the insurer must accept that you are eligible in order for the non-manual or professional scale to apply. The cost of fixed cover To calculate the cost of fixed Death or TPD cover: The amount of cover / 1,000 X premium for your age (within your work scale) = weekly premium cost. Fixed Scales: Death and Total & Permanent Disability The table on page 9 shows the weekly cost for $1,000 of fixed Death and TPD cover based on your age and your work scale. Your work scale depends on the sort of work you do. See page 6 for more information. 8
FIXED SCALES: DEATH AND TOTAL & PERMANENT DISABILITY Age Next Birthday General Work scale Non Manual Work scale Professional Work scale Death TPD Death TPD Death TPD 16-22 $0.0182 $0.0182 $0.0128 $0.0128 $0.0085 $0.0084 23 $0.0176 $0.0176 $0.0124 $0.0124 $0.0082 $0.0082 24 $0.0164 $0.0164 $0.0115 $0.0116 $0.0076 $0.0076 25 $0.0147 $0.0146 $0.0103 $0.0104 $0.0068 $0.0068 26 $0.0127 $0.0127 $0.0089 $0.0090 $0.0059 $0.0059 27 $0.0117 $0.0116 $0.0082 $0.0082 $0.0054 $0.0054 28 $0.0109 $0.0109 $0.0077 $0.0076 $0.0051 $0.0050 29 $0.0105 $0.0105 $0.0074 $0.0074 $0.0049 $0.0048 30 $0.0102 $0.0102 $0.0072 $0.0072 $0.0048 $0.0047 31 $0.0101 $0.0101 $0.0071 $0.0071 $0.0047 $0.0047 32 $0.0101 $0.0101 $0.0071 $0.0071 $0.0047 $0.0047 33 $0.0101 $0.0101 $0.0071 $0.0071 $0.0047 $0.0047 34 $0.0101 $0.0101 $0.0071 $0.0071 $0.0047 $0.0047 35 $0.0101 $0.0102 $0.0071 $0.0072 $0.0047 $0.0047 36 $0.0102 $0.0102 $0.0072 $0.0072 $0.0047 $0.0048 37 $0.0103 $0.0102 $0.0072 $0.0073 $0.0048 $0.0048 38 $0.0104 $0.0104 $0.0073 $0.0074 $0.0048 $0.0049 39 $0.0109 $0.0109 $0.0077 $0.0077 $0.0051 $0.0051 40 $0.0115 $0.0115 $0.0081 $0.0081 $0.0054 $0.0053 41 $0.0122 $0.0122 $0.0086 $0.0086 $0.0057 $0.0056 42 $0.0129 $0.0129 $0.0091 $0.0090 $0.0060 $0.0060 43 $0.0136 $0.0136 $0.0096 $0.0095 $0.0063 $0.0063 44 $0.0145 $0.0144 $0.0102 $0.0102 $0.0067 $0.0067 45 $0.0153 $0.0154 $0.0108 $0.0108 $0.0071 $0.0072 46 $0.0164 $0.0165 $0.0116 $0.0115 $0.0076 $0.0077 47 $0.0177 $0.0176 $0.0124 $0.0125 $0.0082 $0.0082 48 $0.0192 $0.0191 $0.0135 $0.0135 $0.0089 $0.0089 49 $0.0208 $0.0209 $0.0147 $0.0146 $0.0097 $0.0097 50 $0.0229 $0.0230 $0.0161 $0.0162 $0.0107 $0.0106 51 $0.0254 $0.0254 $0.0179 $0.0178 $0.0118 $0.0118 52 $0.0286 $0.0285 $0.0201 $0.0201 $0.0133 $0.0133 53 $0.0327 $0.0327 $0.0230 $0.0231 $0.0152 $0.0152 54 $0.0365 $0.0365 $0.0256 $0.0257 $0.0169 $0.0170 55 $0.0435 $0.0435 $0.0307 $0.0306 $0.0202 $0.0203 56 $0.0529 $0.0528 $0.0373 $0.0372 $0.0246 $0.0246 57 $0.0606 $0.0606 $0.0425 $0.0425 $0.0282 $0.0282 58 $0.0689 $0.0688 $0.0484 $0.0483 $0.0320 $0.0321 59 $0.0758 $0.0757 $0.0532 $0.0532 $0.0352 $0.0353 60 $0.0855 $0.0854 $0.0602 $0.0603 $0.0397 $0.0398 61 $0.0909 $0.0909 $0.0640 $0.0640 $0.0423 $0.0422 62 $0.0967 $0.0967 $0.0678 $0.0679 $0.0450 $0.0449 63 $0.1031 $0.1031 $0.0725 $0.0724 $0.0479 $0.0480 64 $0.1136 $0.1137 $0.0797 $0.0798 $0.0529 $0.0528 65 $0.1229 $0.1228 $0.0858 $0.0857 $0.0571 $0.0572 66* $0.1333 $0.1334 $0.0943 $0.0944 $0.0620 $0.0621 67* $0.1515 $0.1515 $0.1057 $0.1057 $0.0704 $0.0704 68* $0.1684 $0.1683 $0.1190 $0.1191 $0.0782 $0.0783 69* $0.1887 $0.1887 $0.1316 $0.1316 $0.0877 $0.0877 70* $0.2273 $0.2272 $0.1613 $0.1613 $0.1057 $0.1057 Tony is aged 32 next birthday and would like to apply for $500,000 worth of death cover. Tony is an accountant and meets the eligibility criteria for the professional work scale. Tony has calculated the cost of his cover as: $500,000 / 1,000 X $0.0047 = $2.35 per week Tony will pay $2.35 per week for $500,000 of death cover. It s important to note, that if Tony fixes his level of cover the insurance premium deducted from his account will increase each year. * Activities of Daily Living (ADL) definition of TPD applies from 65th birthday. See Features of total and permanent disability insurance on page 11 for more information. 9
What happens after you apply for cover? You will receive confirmation it is under consideration. This confirmation will be in the form of either a letter or a phone call, and will generally be received within 6 business days. You may be contacted directly by phone or letter by the Fund s insurer MetLife and/ or their medical provider United Health Group (UHG) seeking further information or to arrange a medical examination or blood test. (Note that medical examinations required by the insurer are usually paid for by the insurer). If you wish to supply additional information to support your application, this will be at your own expense. Cover will not become operative until all the information the insurer requires has been received, considered and accepted by the insurer. During this post-application process you will be covered for up to 90 days of interim accident cover while the insurer is making its determination. See below for more information. You will receive a letter informing you whether or not cover has been granted. If your cover has been granted, the date that the cover begins and any special terms that apply will be noted. You have a 14-day period from notification of acceptance of additional insurance cover in which to review the terms and conditions of coverage. You can cancel your additional insurance by writing to MTAA Super during this period. Any insurance charge paid during that time will be refunded to your MTAA Super account. Interim death and TPD accident cover When you apply for additional insurance, you will be covered for interim accident cover from the date MTAA Super receives your application. Interim accident cover provides you with accident cover for any increased cover amount for which you have applied above your current cover with MTAA Super. Interim Accident cover will cease on one of the following events occurring: your application is withdrawn, accepted or rejected, 90 days has passed since MTAA Super received your application. Where interim accident cover applies, we will provide cover for the increased insured amount but only if the condition which gives rise to a benefit is the sole and direct result of accidental bodily injury occurring whilst the interim accident cover is in force and is not affected by a pre-existing condition. Please note: Interim accident cover is subject to the lesser of the amount applied for and $2m for Death and TPD. 10
Definitions What is Death cover? Death cover provides for an insurance benefit that is payable to your dependants or your legal personal representative on your death, so long as you are a member of MTAA Super and receiving insurance cover at the time of your death. Death insurance is not available to members aged 70 years or more. Your death cover can also be paid to you should you suffer a terminal illness. What is total and permanent disability (TPD) cover? TPD cover provides for an insurance benefit if you become totally and permanently disabled. Before paying any TPD insurance benefit, the Trustee must be satisfied that the amount is able to be released from the Fund under superannuation legislation. TPD insurance is not available to members who are aged 70 years or more. The definition of total and permanent disability varies according to your employment status and age at the time of becoming disabled: If you were employed at any time during the six months before your date of disablement and aged less than 65: total and permanent disability means: The member having, as a result of injury or illness, been unable to work for an initial period of six consecutive months and in the insurer s opinion, having become incapacitated to such an extent as to render the member unlikely ever to engage in or work for reward in any occupation or work he or she is reasonably capable of performing by reason of education, training or experience. The Activities of Daily Living (ADL) definition states that if the insured member was not employed at any time during the six months before the Date of Disablement or the member is aged from 65 to 69, total and permanent disability means: As a result of injury or illness, the member has become permanently unable to perform the basic activities normally undertaken as part of everyday life. This will be evidenced by the insurer being satisfied that the member is permanently unable to engage in any two of the following activities: bathing to shower or bathe dressing to dress or undress toileting to use the toilet, including getting onto it and off feeding to eat and drink mobility to get into or out of bed or a chair or wheelchair continence to control bladder and bowel function. If the insured person can perform the activity on their own by using special equipment, they will be considered able to perform that activity. Where the insured member is engaged in full-time unpaid domestic duties in their own residence, total and permanent disability means: As a result of illness or accident, the member is under the care of a medical practitioner and is unable to perform their normal domestic duties or leave their residence unaided and has not engaged in or worked for reward in any occupation or work for six consecutive months. 11
Definitions At the end of the six months, the member continues to be so disabled that he or she is, in the insurer s opinion, unlikely to perform his or her normal domestic duties at any time in the future and is unlikely at any time in the future to ever engage in or work for reward in any occupation or work he or she is reasonably capable of performing by reason of education, training and experience. In all cases a member will be considered for a total and permanent disability benefit if he or she permanently suffers the loss of the use of two limbs or the loss of the sight of both eyes or the loss of the use of one limb and a loss of sight in one eye (where limb is defined as the whole hand or whole foot). Date of Disablement means the later of: The date when a medical practitioner examines the insured member and certifies in writing that the member is disabled; and the date the insured member ceases all work. This date does not apply should a member suffer the loss of the use of two limbs or the loss of sight of both eyes or the loss of the use of one limb and the loss of sight of one eye. What is Terminal Illness? A member who is insured for death or Total and Permanent Disablement suffers from a sickness which: (a) Two medical practitioners, specialising in the insured member s sickness, certifies in writing, will despite reasonable medical treatment lead to the insured member s death within 12 months of the date of the certification and (b) the insurer is satisfied, on medical or other evidence, will despite reasonable medical treatment lead to the insured member s death within 12 months of the date of the certification referred to in paragraph (a). The sickness from which the insured member suffers must occur, and the date of the certification referred to in paragraph (a) must be made, while the insured member is covered under the policy and must be current at the time the claim is lodged. The Terminal Illness Benefit will be based on the member s higher insured cover for Death or Total and Permanent Disablement at the time they meet the Terminal illness definition defined above. Eligibility for Terminal Illness or Total and Permanent Disability (TPD) In order to be considered for a Terminal Illness or TPD benefit, a member must complete and return the relevant claim forms. Domestic duties means: Duties normally performed by a person who remains at home and is not working in regular employment for income. 12
Income Protection Insurance Why consider income protection? It is highly probable that your most important financial asset is your ability to earn an income. But, although most people insure their homes, cars and other valuables, few consider insuring their income. Income protection insurance will pay a benefit for a specified benefit period, usually monthly in arrears, if you are unable to work after the qualifying period because of illness or injury. This can provide security in a person s time of need. Who can apply? MTAA Super members who are actively engaged in full-time, part-time, casual or contracted employment, either as an employee or as a self employed person and are performing normal occupational duties are eligible to apply for income protection insurance. A member who is not at work on their commencement date with their employer will still be considered to be performing normal occupational duties if the member is employed and the absence is for reasons other than illness or injury. You are not eligible if you are: working less than 15 hours per week aged 65 years or more not an Australian citizen or permanent resident engaged in an occupation that the insurer does not cover. If this is the case, the insurer will notify you. Members of MTAA Super can apply for income protection cover with the following features: up to 85 per cent of your pre-disability income (with up to 75 per cent of your predisability income paid directly to you (less PAYG) and any balance (up to 10 per cent) payable as superannuation contributions to your MTAA Super account), subject to a maximum benefit of $25,000 per month. a benefit period of two years, five years or until age 65. cover in units of $250 per month, with a minimum of three units required waiting periods of 30 days, 60 days and 90 days The cost of cover is dependent on your age, insured benefit amount, occupational category (general, non-manual or professional), chosen waiting period and chosen benefit period. See page 16 for more information. A rehabilitation expense benefit which pays the costs of a rehabilitation program that a medical practitioner certifies is necessary for your rehabilitation and that, in the insurer s opinion, may help you return to employment. The age 65 benefit period also provides indexation of your monthly benefit on the anniversary of your first benefit payment. Your benefit will be increased by the lesser of CPI and 5%. It is very important that you read this document carefully to understand the costs involved, any exclusions or limitations, and when an income protection claim may be payable under the policy. 13
How much cover can you apply for? The maximum amount you can apply for is a benefit equal to the lesser of: 75 per cent of your pre-disablement monthly income, and 10 per cent of your pre-disablement monthly income paid as a contribution to your MTAA Super account $25,000 a month. The minimum level of cover available is three units. Calculating the cost of cover To calculate the level of cover you want, take the following steps. Step 1 Calculate the figure that corresponds to 85% of your monthly average gross income. If this amount exceeds $25,000, use the figure $25,000 instead. See the definition of income on page 16 to find out what is classified as income. Step 2 Divide the figure from step 1 by $250. This gives you the number of units you need in order to receive the maximum benefit you are eligible for. Write the number of units down. Round up to the nearest unit. Step 3 Choose the benefit scale that applies to you: general non-manual professional If you are unsure, see page 6. Step 4 Choose the benefit period you would like to be covered for: 2 years 5 years Aged 65 Step 5 Select your age band from the table that applies to you. Step 6 Select your preferred waiting period: 30 days 60 days 90 days. Step 7 Write down the cost per unit of cover per week for your age band that falls within your preferred waiting period. Step 8 Multiply the figure from step 7 by the number of units you determined in step 2. The answer is the standard weekly premium for the income protection cover you want. You can adjust the cost of your premium by choosing a different waiting period or benefit period or by changing the number of units you select. When you reach a birthday that moves you into the next age band your insurance cost will change. 14
Income Protection unitised scales WEEKLY COST PER $250 MONTHLY BENEFIT 2 YEAR BENEFIT Age Next Birthday General Work scale Non Manual Work scale Professional Work scale 30 days 60 days 90 days 30 days 60 days 90 days 30 days 60 days 90 days 16 to 20 $0.1848 $0.0955 $0.0640 $0.1060 $0.0546 $0.0430 $0.0851 $0.0441 $0.0346 21 to 25 $0.1984 $0.1029 $0.0640 $0.1123 $0.0546 $0.0430 $0.0902 $0.0441 $0.0346 26 to 30 $0.2121 $0.1092 $0.0640 $0.1187 $0.0619 $0.0430 $0.0955 $0.0494 $0.0346 31 to 35 $0.2583 $0.1228 $0.0714 $0.1523 $0.0683 $0.0430 $0.1218 $0.0546 $0.0346 36 to 40 $0.3444 $0.1712 $0.0998 $0.1984 $0.1029 $0.0567 $0.1585 $0.0818 $0.0462 41 to 45 $0.4631 $0.2394 $0.1428 $0.2646 $0.1365 $0.0787 $0.2121 $0.1092 $0.0630 46 to 50 $0.6552 $0.3412 $0.2499 $0.3706 $0.2048 $0.1428 $0.2961 $0.1638 $0.1144 51 to 55 $0.9460 $0.5324 $0.4284 $0.5355 $0.3077 $0.2499 $0.4284 $0.2456 $0.1995 56 to 60 $1.4090 $0.7990 $0.7286 $0.7938 $0.4641 $0.4284 $0.6352 $0.3717 $0.3423 61 to 65 $1.9119 $1.1266 $0.9996 $1.0845 $0.6489 $0.5922 $0.8683 $0.5187 $0.4746 5 YEAR BENEFIT Age Next Birthday General Work scale Non Manual Work scale Professional Work scale 30 days 60 days 90 days 30 days 60 days 90 days 30 days 60 days 90 days 16 to 20 $0.2981 $0.1911 $0.1355 $0.1386 $0.0892 $0.0640 $0.1113 $0.0714 $0.0515 21 to 25 $0.3108 $0.1984 $0.1281 $0.1460 $0.0892 $0.0567 $0.1165 $0.0714 $0.0462 26 to 30 $0.3245 $0.1984 $0.1144 $0.1460 $0.0892 $0.0504 $0.1165 $0.0714 $0.0399 31 to 35 $0.4032 $0.2394 $0.1281 $0.1848 $0.1092 $0.0567 $0.1480 $0.0871 $0.0462 36 to 40 $0.5428 $0.3213 $0.1785 $0.2446 $0.1439 $0.0787 $0.1953 $0.1144 $0.0630 41 to 45 $0.7475 $0.4578 $0.2856 $0.3370 $0.2121 $0.1281 $0.2698 $0.1691 $0.1029 46 to 50 $1.0447 $0.6761 $0.4851 $0.4767 $0.3077 $0.2216 $0.3811 $0.2456 $0.1775 51 to 55 $1.5150 $1.0310 $0.8358 $0.6950 $0.4715 $0.3854 $0.5554 $0.3770 $0.3087 56 to 60 $2.2952 $1.6316 $1.4426 $1.0521 $0.7444 $0.6573 $0.8410 $0.5953 $0.5250 61 to 65 $2.8306 $2.0064 $1.7702 $1.2904 $0.9145 $0.8063 $1.0321 $0.7318 $0.6457 TO AGE 65 BENEFIT PERIOD (ANNUAL INDEXATION AT THE LESSER OF CPI & 5%) Age Next Birthday General Work scale Non Manual Work scale Professional Work scale 30 days 60 days 90 days 30 days 60 days 90 days 30 days 60 days 90 days 16 to 20 $0.5796 $0.4924 $0.2825 $0.3034 $0.2583 $0.1480 $0.2278 $0.1932 $0.1113 21 to 25 $0.6373 $0.5418 $0.2866 $0.3339 $0.2835 $0.1501 $0.2499 $0.2132 $0.1123 26 to 30 $0.7245 $0.6152 $0.2909 $0.3790 $0.3223 $0.1523 $0.2845 $0.2415 $0.1144 31 to 35 $0.9428 $0.8011 $0.3507 $0.4935 $0.4200 $0.1837 $0.3706 $0.3149 $0.1376 36 to 40 $1.2852 $1.0919 $0.4715 $0.6730 $0.5722 $0.2468 $0.5050 $0.4284 $0.1848 41 to 45 $1.7639 $1.4982 $0.7308 $0.9240 $0.7854 $0.3832 $0.6929 $0.5890 $0.2866 46 to 50 $2.3760 $2.0191 $1.1413 $1.2452 $1.0573 $0.5984 $0.9334 $0.7938 $0.4483 51 to 55 $3.1372 $2.6658 $1.7408 $1.6432 $1.3965 $0.9124 $1.2327 $1.0478 $0.6835 56 to 60 $3.6822 $3.1016 $2.3320 $1.9287 $1.6243 $1.2221 $1.4468 $1.2179 $0.9166 61 to 65 $2.8306 $2.1335 $1.8154 $1.3828 $1.1171 $0.9512 $1.0373 $0.8379 $0.7129 15
Your circumstances will probably change with time, so it is wise to regularly review the number of income protection insurance units you have, to make sure your level of cover is sufficient to provide the protection you need. What waiting period is best for me? In choosing your waiting period you might wish to consider: how long you could afford to be without an income for example, if you qualify for sick leave or have other forms of savings or income on which you could rely; the amount you are willing to pay and to have deducted from your MTAA Super account in income protection insurance premiums. Generally, the longer the waiting period, the lower the premium. No benefit is payable during the waiting period. Once insurance is in place, if you want to reduce your waiting period say, from 90 days to 30 days you must complete a new application form, and be assessed by the insurer. You can choose a longer waiting period simply by writing to the Fund. The waiting period you nominate begins when a doctor who has examined you certifies that you are Disabled, as defined on page 18. You need to be Disabled or Partially Disabled on each day during the waiting period. The calculation of the waiting period is also subject to the following rules: you must be Disabled for at least 7 out of the first 12 working days of the waiting period to qualify for an income protection benefit; if you return to work at full capacity during the waiting period, the waiting period starts again unless you return to work only once and it is for a period of no more than 5 consecutive days. If you return to work only once for a period of 5 consecutive days or less, the number of days worked will be added to the waiting period. What benefit period is best for me? In choosing your benefit period you might want to consider the following: whether it will take a short period (two years) or a medium period (five years) for you and your family to adjust your budget and finances in order to survive without your income; alternatively you may not want your family to adjust and would like a income for the long term (aged 65) the amount you are willing to pay and have deducted from your MTAA Super account in income protection insurance premiums. The shorter the benefit period, the lower the premium. Definitions Income and monthly income definitions Income means the total monthly value of income received by the insured member from his or her usual occupation, averaged over the most recent 12-month period or since the insured member started their occupation, if the period is less than 12-months. Salary package items taken instead of cash are included as salary where the insured member, would be required to pay for that item in the event of total or partial disability. Regular over-time and shift allowances will be averaged over the previous 12-month period or since the insured member started their occupation, if the period is less than 12 months. 16
Definitions Performance related commission, bonuses and other monetary benefits will be averaged over the lesser of previous 3 years, or since the insured member started his or her current occupation. Where the insured member directly or indirectly owns all or part of the business from which he or she earns his or her usual income, income will be calculated as the total amount earned by the business over the financial year as a direct result of the insured member s personal exertion or activities through his or her usual occupation, less his or her share of business expenses, but before the deduction of income tax, for that business (or the relevant proportion for part of a financial year). The income calculated in accordance with these principles is divided by 12 to get the monthly income. For casual and contract workers, salary will be averaged over the previous 6 month period, rather than 12 months. When does cover for income protection commence? Your cover will commence when the insurer has accepted your application for cover. Interim Disability by Accident cover If you apply for income protection cover but you are not eligible for cover automatically, you may be eligible for interim disability by accident cover while the insurer considers your application. The insurer will pay you a disability by accident benefit if you suffer an injury which results in your being Disabled or Partially Disabled during this period. The amount payable will be equivalent to the Disability benefit, Partial Disability benefit or superannuation contribution benefit as applicable, except that the amount of the benefit will be the lesser of: 85% of your monthly income; or the amount of cover you requested in the fully completed application for cover; or $15,000 per month. No Disability by Accident benefit will be payable if any of the following occurred before you suffer the injury: the insurer has accepted (on any terms) or rejected your application for income protection cover; or you withdraw your request for income protection cover; or 90 days have passed from the date the insurer receives your application for income protection; or an exclusion to cover applies (see the section Are there any exclusions? on page 20). Payment of the interim disability by accident benefit is subject to all the relevant terms and conditions of MTAA Super s Policy with MetLife. 17
Definitions What does Disabled and Partially Disabled mean for the purposes of income protection cover? An insured person is Disabled if, solely as a result of injury or illness, occurring while income protection cover is in force: The insured person is unable to perform at least one duty of the insured person s occupation which generates at least 20% of the insured person s monthly income, as confirmed by a medical practitioner. The insured person is not engaged in any occupation, whether or not for reward. The insured person is receiving regular treatment from and following the advice of a medical practitioner. An insured person is Partially Disabled if they: have been Disabled for at least 7 days out of the first 12 working days of the waiting period; and are unable to work in their occupation at full capacity as a result of the Illness or Injury resulting in Disability; and are working in their occupation or any other occupation but only in a limited capacity; and are earning an income less than their monthly income (as calculated in accordance with the policy terms); and are under the regular care and following the advice of a medical practitioner. How will my benefit be calculated? Your income protection benefit will be the lesser of: the maximum benefit of $25,000 a month; or the amount accepted and agreed to in writing by the insurer; or 85 per cent of your pre-disability income (with 75 per cent of that income being payable directly to you (less PAYG) and the balance being payable as superannuation contributions to your MTAA Super account). The benefit will be subject to any other terms and conditions specified in this document. When will I receive my monthly disability benefit? If you are Disabled for longer than your waiting period and meet the eligibility requirements, you will receive your monthly disability benefit. If you are Partially Disabled for longer than your waiting period and meet the eligibility requirements, you will receive your monthly partial disability benefit. Also, if you are Disabled or Partially Disabled for longer than your waiting period and meet the eligibility requirements, you will receive your superannuation contribution benefit (if applicable). See above for the definitions of Disabled and Partially Disabled. You are eligible to make a claim if: you satisfy all the insurer s claim requirements; the waiting period you chose has expired; and cover has not ceased in accordance with the terms of the policy. The first monthly benefit payment is paid one month after the end of the waiting period; further payments are subsequently paid monthly in arrears. The insurer will waive income protection premiums while an income protection benefit is being received by you. Please note that while an income protection benefit is being paid, the insurer may require medical reports and examinations to verify your continued disability. 18
What if I am on leave without pay? If an insured member becomes sick or injured while on leave without pay, no income protection benefit will be paid until the later of: the time when the member s leave without pay is to cease (in accordance with their employer s written notification); or the expiry of the waiting period. If the employer does not provide a written notification on cessation of the leave without pay period, the insurer will assume that the leave without pay period is 24 months. What happens if I return to work after I am disabled? If you return to work after you become disabled you might be eligible to receive a partial disability benefit. To receive a partial disability benefit, you must be Partially Disabled after the waiting period has ended. See the above definition of Partially Disabled above. If you are eligible for a partial benefit the benefit will be calculated in proportion to the income you are losing as a result of your limited capacity to engage in your normal occupation and the monthly benefit you would receive if you were totally disabled. The proportion will vary according to the number of units chosen and your income at the time of your claim. A partial disability benefit will cease to be payable when you are capable of earning your pre-disability salary, you return to normal duties or if one of the other events listed below in the section When does the benefit period end? occurs. What is the rehabilitation expense benefit? The rehabilitation expense benefit is payable if you become totally or partially disabled, the insurer approves the rehabilitation expenses before they are incurred and if the rehabilitation expenses are incurred directly to assist you to return to work in any gainful occupation or to undertake vocational retraining. The amount of the rehabilitation expense benefit is up to six times your disability monthly benefit and it will be paid directly to the providers of rehabilitation services to reimburse costs. When does the benefit period end? The benefit period will end on the earlier of: the end of the benefit period you selected when you reach age 65 when you are no longer totally or partially disabled. when you die What happens if the disability returns? If, after being totally disabled or partially disabled, you return to work and within six months the same disablement recurs, this will be regarded as a continuation of the same claim and no waiting period will apply. The benefit period will, however, be limited to the unused portion of the benefit period that applied in respect of the earlier claim. If, after being totally disabled or partially disabled, you return to work and subsequently experience a different disablement, you will need to submit a new claim. The maximum length of time a benefit for a disability or partial disability from any one or related illness or injury will be limited to the benefit period selected. 19
What happens if I am overseas while receiving an income protection benefit? If you reside outside Australia benefits will be payable for a maximum period of 12 months. However, if you reside in Canada, New Zealand, the United Kingdom, the USA or any other country to which the insurer agrees, benefits will be payable to the length of your chosen benefit period. Are there any exclusions? No income protection benefit is payable to you if your injury or illness is caused directly or indirectly by one of the following: any act of war whether or not declared including war, terrorism, civil commotion, act or invasion, rebellion or revolution service in any armed forces an intentional self-inflicted injury or any attempt to commit suicide normal and uncomplicated pregnancy, caesarean birth, threatened miscarriage, participation in in-vitro fertilisation or other medically assisted fertilisation techniques and normal discomforts of pregnancy, including but not limited to morning sickness, back ache, varicose veins, ankle swelling and bladder problems. The insurer may reduce or refuse to pay a benefit in any of the following circumstances: if premiums have not been paid for your cover if you or MTAA Super do not comply with the insurer s claim requirements if the insurer s assessment or management of the claim is prejudiced by not receiving or delaying notice of a claim. The insurer may also refuse to pay a benefit for an undisclosed pre-existing condition in some circumstances. Offsets for other payments If you receive a payment or payments (including settlement or commutation amounts) from any of the following sources, the amount of the benefit will be reduced by the amount of the other payment(s): any amount of income (other than benefits under the MTAA Super income protection policy) and the commutation of any income paid or payable in respect of your Disability, Partial Disability or Disability by Accident, including any amounts payable: through workers compensation social security or other statutory or government payments paid sick leave in respect of loss of income, whether under legislation or otherwsie under any statutory accident compensation scheme any disability, injury or illness policy (other than lump sum total and permanent disablement) the amount of income the insurer believes you could reasonably be expected to earn in your occupation while Disabled or Partially Disabled. 20