Issued ₁₀ October ₂₀₁₇. Group Insurance. Product disclosure statement

Transcription

1 Issued ₁₀ October ₂₀₁₇ Group Insurance Product disclosure statement

2 Group Insurance Supplementary product disclosure statement This is a supplementary product disclosure statement (SPDS) for the Group insurance product disclosure statement (PDS), issued 10 October 2017 and should be read together with that document. PDS page reference: 3 PDS title reference: New section Instructions: Insert the following section before the section About AMP's Group Insurance. Changes to this PDS Information in the PDS may be amended from time to time. If the amendment is not materially adverse it may be updated and the information provided on amp.com.au/pdsupdates. You can obtain a PDS update free of charge by: visiting amp.com.au/pdsupdates contacting the Customer Contact Centre to request a paper copy of the PDS update at askamp@amp.com.au or asking your financial adviser. PDS page reference: 31 PDS title reference: Complaints resolution Instructions: Replace entire section with the wording below: If you need any additional information about the operation or management of your account, or if you have a concern or complaint, then please contact: your financial adviser call the Customer Contact Centre on us at askamp@amp.com.au, or write to us at: Operations Group Insurance Administration Group Insurance Manager GPO Box 4927VV MELBOURNE VIC 8001 Our customer service officers are available to answer your enquiries and respond to your complaints. We will try to resolve your enquiry or complaint as quickly as possible. To help us do this, please give us as much information as possible about your complaint. We have established procedures to deal with any complaints. If you make a complaint, we will: acknowledge its receipt and ensure an appropriate person properly considers the complaint, and respond to you as soon as we can. If your complaint cannot be resolved at first contact, then we will keep you advised at regular intervals of the status of your complaint. If we cannot resolve your complaint to your satisfaction or you have not had a response from us within 90 days, then you may have the right to lodge a complaint with the Superannuation Complaints Tribunal (SCT). The SCT is an independent tribunal set up by the Australian Government to resolve most complaints that members, former members (or beneficiaries in relation to death benefits) have with their superannuation funds. Issue date: 3 September 2018 This issuer of this SPDS is AMP Life Limited (AMP Life) ABN AFS Licence

3 The SCT reviews the decisions of superannuation trustees as they affect an individual member. It is independent from us. Even so, please try to resolve your complaint directly with us before contacting the SCT. Time limits apply to certain complaints to the SCT, for example in respect of total and permanent disablement claims. If you have a complaint, you should contact the SCT immediately to find out if a time limit applies. Contact details for the SCT are: Phone: (free call) Web: sct.gov.au info@sct.gov.au Mail: Locked Bag 3060, MELBOURNE VIC 3001 Financial Ombudsman Service (FOS) If you are not satisfied with our response, you may lodge a complaint: with the Financial Ombudsman Service Australia if lodged before 1 November 2018: Contact details for FOS are: Web: info@fos.org.au Telephone: (free call) Mail: GPO Box 3, Melbourne VIC 3001 with the Australian Financial Complaints Authority if lodged after 1 November A new complaints authority Australian Financial Complaints Authority The new Australian Financial Complaints Authority (AFCA) scheme will replace the Superannuation Complaints Tribunal (SCT), Financial Ombudsman Service (FOS) and Credit and Investments Ombudsman (CIO). AFCA will provide fair and independent financial services complaint resolution that is free to consumers and will accept customer complaints from 1 November The SCT will continue to operate until at least 30 June 2020 and if you have lodged a complaint with the SCT prior to 1 November 2018, it will continue to be handled by the SCT. Contact details for AFCA are: Web: afca.org.au info@afca.org.au Telephone: (free call) Mail: GPO Box 3, Melbourne VIC 3001 PDS page reference: 33 PDS title reference: Cardiac arrest Instructions: Replace current definition with the wording provided below: Cardiac arrest - that is the sudden breakdown of the heart's pumping function where it: is due to asystole or ventricular fibrillation as documented by electrocardiographic (ECG) changes, and is not associated with any clinical procedure, and occurs outside a hospital or other medical facility. If electrocardiogram changes are inconclusive or an ECG is not available, we will consider medical evidence which is acceptable to us that unequivocally confirms an out of hospital cardiac arrest has occurred. Examples of suitable evidence includes but is not limited to: Ambulance and Hospital Medical Reports confirming cardiac arrest or the administration of Cardiopulmonary Resuscitation (CPR) by an attending ambulance officer or trained first aid officer or Automated External Defibrillator (AED) data. 2

4 PDS page reference: 34 PDS title reference: Parkinson's disease Instructions: Replace current definition with the wording provided below: Parkinson's disease - means an unequivocal diagnosis of degenerative idiopathic Parkinson's disease confirmed by a consultant neurologist or geriatrician as characterised by the clinical manifestation of one or more of the following: rigidity tremor, and akinesia resulting from the degeneration of the nigrostriatal system. All other types of Parkinsonism are excluded (for example, secondary to medication). Contact us phone web mail amp.com.au GPO Box MELBOURNE VIC

5 Contents Insurance overview Group Life Insurance Policy: a snapshot Group Life Insurance Policy: the detail Group Salary Continuance Policy: a snapshot Group Salary Continuance Policy: the detail Additional information: Group Life and Group Salary Continuance Trauma definitions Definitions AMP Life Limited (AMP Life) ABN AFS Licence No

6 Insurance overview Definitions in this document This document contains defined terms which have a specific meaning. Terms that have a specific meaning are shown in italics. Please ensure that you refer to the Definitions section at the back of this document for full details on the defined terms. In this Product Disclosure Statement (PDS) and any relevant policy documentation, any references to us, we, our or the Insurer mean AMP Life Limited (AMP Life) ABN AFS Licence No AMP Life is the issuer of this PDS and financial products described in this PDS. When referring in this document to the policy, we mean: the policy the schedule any amendments to this policy including schedule amendments the application form and any other associated papers any special conditions, exclusions or endorsements to the policy after its commencement any notices issued or received by us under the policy, and any individual applications for cover by an eligible person, as the context requires. Unless otherwise specified, you or your refers to the policy owner who is either an employer that is a company or the trustee of a complying superannuation fund. Where the policy owner is the trustee of a complying superannuation fund, the employer refers to the employer sponsor of that fund. A person insured refers to a person who is either an insured employee of an employer where the policy is employer owned, or a member of a complying superannuation fund for a trustee-owned policy. Information contained in this booklet This booklet provides a summary of the important terms and conditions of the Group Insurance products available from AMP. There are sections specific to each product, as well as sections with information that apply to all products. This information will help you to decide whether these products will meet your needs, as well as assist you in comparing the types of cover available with others that you may be considering. You should read this information in conjunction with the Policy Document and Policy Schedule (issued once we provide you with a quotation), which sets out in detail the terms and conditions of the cover and features under your policy and forms the basis of the contract between you as the policy owner and us as the Insurer. Before acting on the information in this PDS, you should consider the appropriateness of this information and consult a financial adviser. About AMP s Group Insurance AMP is a specialist risk Insurer and a leader in the Australian group insurance marketplace. We have been a significant force in the life insurance industry for more than 160 years and have a proven track record in the market. We are committed to meeting our clients needs for group insurance in a challenging superannuation and life insurance marketplace. AMP s brand and reputation are acknowledged as a leader in the Australian financial services market. AMP provides group insurance cover for more than 1,200,000 Australians. In addition, in 2016 AMP paid a total of $1.058 billion in individual and group insurance claims. 1 One policy covers a number of people Our policies provide cover for a group of people with a shared commonality, such as a group of employees or complying superannuation fund members, and because these people are insured under the one contract of insurance, there can only be one policy owner. These are known as Group Insurance policies. Group Insurance policies vary in this way from the more common individual insurance policy. Rather than a contract existing between each person that is covered, there is only one contract between the policy owner and us. The terms and conditions of the insurance for persons insured are defined on a group basis rather than individually and the premiums are paid collectively to us. Which Group Insurance products are described in this document? Each product offered (Group Life (GL) insurance or Group Salary Continuance (GSC)) by AMP is a separate contract of insurance. You can combine the products you buy with a range of optional benefits. The two types of products available are: Group Life GL insurance includes death only or death and total and permanent disability cover. Death cover provides a lump-sum benefit upon death or terminal illness. Total and permanent disability (TPD) cover provides a lump-sum benefit if a person insured becomes totally and permanently disabled. GL insurance is outlined in the Group Life Insurance Policy section. 1 Source: Claims Paid 2016, AMP Life Limited. This figure includes insurance available through superannuation products and is net of tax. 3

7 Group Salary Continuance GSC insurance provides a person insured with a replacement income benefit if they are totally disabled or partially disabled and unable to work due to sickness or injury. GSC insurance is outlined in the Group Salary Continuance Policy section. The Additional information Group Life and Group Salary Continuance section applies to both GL and GSC. The Trauma Definitions section applies to GSC (non-superannuation policies only). The Definitions section applies to both GL and GSC. When incorrect information is given to us We rely on the information provided to us in order to assess whether we will provide insurance cover for a person insured. If the information provided is not correct, in some circumstances we may be legally entitled not to pay the benefit. We may also be legally entitled not to pay the benefit if you have not complied with your duty of disclosure. The duty of disclosure is set out in the application form you complete for a group insurance policy with us, in the forms completed when each person insured applies for cover, and in this PDS. The duty of disclosure applies not only to you in respect of your completion of the Application form for cover but also to any application for cover by each person insured as well as to any increase in the cover of a person insured. Your duty of disclosure Read this if you are applying for insurance as the policy owner, or if you will be an insured person under a policy owned by someone else. What you need to tell us When you apply for insurance, and up until the insurer accepts your application, you have a duty to tell us anything that you know, or could reasonably be expected to know, may affect the insurer s decision to insure you and the terms of your insurance. This includes answering all the questions in the application honestly, making sure you include all the information we ask for. You have the same duty if anything changes, or you remember more information, while we re processing your application. If you want to change your insurance cover at any time, extend it or reinstate it, you ll also have the same duty at that time to tell us anything that may affect the insurer's decision to insure you and the terms of your insurance. Where a policy owned by one person covers the life of another person, it s important that the other person also gives us all the information that is required under the duty. If he or she doesn't, then it can be treated as a failure by the owner of the policy to tell us something that the owner must tell us. Therefore you must give us all the required information - whether you're the owner of the policy or a person insured under it. If you don t tell us something If you don t give all the required information, and the missing information would ve affected the insurer's decision to insure you or the terms of your insurance, the insurer may: treat the contract (or your cover) as if it never existed the insurer can only do this within three years of your cover starting. reduce the amount you've been insured for to reflect the premium you ve been paying. There is a link between the premium you pay and your level of cover. If you fail to tell us something, your premiums may have been too low. The insurer may reduce the amount you've been insured for, taking into account the premium you would've had to pay if you'd told us everything you should've. For Death cover the insurer can only reduce the amount you've been insured for within three years of your cover starting. vary your cover to take into account the information you didn t tell us and put the insurer in the same position as it would ve been if you d told us. Variations could mean, for example, that waiting periods, exclusions or premiums may be different. The insurer can't make variations to Death cover. Your total insurance cover forms one insurance contract. If you don't give us all the required information, the insurer may treat your different types of cover as separate contracts when it takes action to address this. It s fraudulent to deliberately leave out required information or give us incorrect information. In these situations the insurer may refuse to pay a claim and treat the contract (or your cover) as if it never existed. What you don't need to tell us You don t need to tell us anything: that reduces the insurer s risk, or that's common knowledge, or we know or should know as an insurer, or we ve told you that you don t need to tell us. 4

8 Group Life Insurance Policy: a snapshot This section relates to GL cover only and should be considered in conjunction with the Additional information Group Life and Group Salary Continuance section and the Definitions section. GL pays a lump-sum benefit in the event of death, terminal illness or TPD, which can be used for any purpose including: paying off the mortgage or any other debts that may affect a person insured s family s financial future paying for funeral costs paying for child care or home help providing a reserve to use as income should the family income stop paying for disability-related costs including rehabilitation, or paying for changes to the person insured s and/or dependant s lifestyle, for example, to refit their home. Group Life insurance benefits and options The table below provides a summary of the cover available: Benefit Benefit description Superannuation Non-superannuation Death benefit Provides a benefit payment in the event of death. Terminal illness benefit We will make an advance payment of the death benefit if a person insured is terminally ill and has less than 12 months to live. Extended cover Provides cover where a person insured leaves employment with the employer and ceases to be eligible for cover under the policy. Interim cover Provides limited cover where a person insured or an eligible person who has not yet been accepted for cover is being underwritten. Guaranteed renewable contract Provided the premiums are paid and the terms and conditions of the policy are met, we guarantee to renew the policy each year. 24 hour worldwide cover Cover for a person insured is provided 24 hours a day depending on the circumstances of overseas travel. The following options are available through GL at an additional cost: Optional benefit Benefit description Superannuation Non-superannuation TPD benefit Provides a benefit if a person insured becomes totally and permanently disabled. Life events cover Allows persons insured to increase their cover without underwriting when any of the following events take place: marriage, divorce, birth or adoption of a child, taking out a mortgage on a primary residence, increasing a mortgage on a primary residence for renovations/extension or a child turning 12. Continuation option Allows persons insured who leave employment and cease to be eligible for cover under your Group Insurance policy to continue their cover under an individual insurance policy with us. 5

9 Group Life Insurance Policy: the detail The policy GL pays a lump-sum benefit if a person insured dies or is diagnosed with a terminal illness and has 12 months or less to live. TPD is also available as an optional benefit. GL insurance policies can provide benefits through a complying superannuation fund (superannuation policy) where a superannuation trustee owns the policy or a non-superannuation policy (ordinary policy) where an employer (or like entity) owns the policy. Premiums for both superannuation and non-superannuation policies are paid into our No. 1 Statutory Fund. The policy has no cash surrender value and neither you, nor a person insured, have access to ownership or any rights over the assets of the statutory fund. Who can become a person insured? A person can become a person insured if they satisfy the eligibility criteria for cover under the policy, which you set (and we agreed), and the person is: a permanent employee, a contractor, or a casual The person must also: be aged 15 years or more, but less than age 70 for death cover and age 65 for TPD cover, on the day they were first eligible for cover, be an Australian resident, and meet the eligibility criteria as set out in the schedule. Cover will be granted in one of three ways: 1. the automatic acceptance terms, 2. the transfer terms, or 3. the underwriting terms. For further information on automatic acceptance terms, transfer terms and underwriting terms, please refer to the Additional information Group Life and Group Salary Continuance section of this PDS. Availability of cover Death benefits Entry age Maximum expiry age Maximum benefit amount Minimum number of persons insured per policy Minimum annual premium (i) (ii) 15th to 70th birthday 80th birthday Unlimited (i) 50 $10,000 pa (ii) Subject to automatic acceptance and underwriting terms. Exclusive of commission. Death benefit Death cover provides a lump-sum benefit in the event that a person insured dies. Terminal illness benefit If a person insured is diagnosed as terminally ill, we will make an advanced payment of the death benefit. The terminal illness benefit is an advance payment of the death benefit. The amount of the benefit we pay is what would have been applied when the person insured was first diagnosed as terminally ill. The benefit amount is that which applied on the benefit calculation date. For eligibility for cover under terminal illness, the sickness resulting in the terminal illness must occur, and the date any medical practitioner first certifies the person insured as being terminally ill must take place, while the person insured was covered under the policy. 6

10 Extended cover If a person insured is no longer eligible for cover because they have left their employer and: the person insured did not cease work with the employer for reasons of injury or sickness, and we are not paying you, or you are not entitled to a benefit under the policy for the person insured, then we will automatically extend the person insured s existing cover free of charge. This is referred to as extended cover. Extended cover stops on the earliest of: 60 days after cover would have otherwise stopped the date the person insured attains the cover expiry age the date the person insured commences employment with a new employer the date the person insured makes a fraudulent claim, or the date a personal insurance plan issued by us under a continuation option (as described on page 8) commences in respect of the person insured. In addition to the above, the following also applies to superannuation policies: in the case of the person insured directing the employer to remit all or part of their employer superannuation contributions to a superannuation fund other than the fund through which cover is provided under the policy, extended cover will cease on the date the first contribution has been remitted to the person insured s fund of choice. We will not extend any cover described in the special conditions section of the schedule (if any). Interim cover If underwriting terms apply to an eligible person or a person insured because: automatic acceptance terms do not apply cover exceeds the automatic acceptance limit or the further underwriting limit, or they had applied for voluntary insurance or a voluntary increase to their cover, then we will provide them with interim cover in the event of accidental death or accidental total and permanent disablement whichever is applicable. Interim cover starts from the date we receive the written application, in the form approved by us, for all, or the relevant part of the cover that is subject to underwriting terms in respect of the person insured or eligible person. The amount of the benefit provided under interim cover is equal to the amount of the benefit that is applied for, up to a maximum amount of $1.5 million less the person insured s existing cover under the policy. Interim cover automatically ends as soon as one of the following happens: we accept or limit the application for the benefit which is subject to underwriting terms 20 business days after we decline the application for the benefit which is subject to underwriting terms you, the person insured or eligible person withdraw the application for the benefit which is subject to underwriting terms 60 days pass from the date interim cover commenced cover stops due to any of the events listed in When cover for a person insured stops section, or the policy ends. We won t pay where accidental death is caused by suicide, whether sane or insane, or where death is as a result of, or associated with: intentional self-injury, including intentionally contracted infection by bacteria or virus, or any attempt thereat, or making or attempting to make a flight in an aircraft (otherwise than as a passenger for whom a fare or fee has been paid, or as a passenger in an aircraft under charter), or taking intoxicating liquor or drugs, or an accident which occurred before the policy commencement date. We won t pay where accidental total and permanent disablement is caused by attempted suicide, or where total and permanent disablement is as a result of, or associated with: intentional self-injury, including intentionally contracted infection by bacteria or virus, or any attempt thereat, or making or attempting to make a flight in an aircraft (otherwise than as a passenger for whom a fare or fee has been paid, or as a passenger in an aircraft under charter), or taking intoxicating liquor or drugs, or an accident which occurred before the policy commencement date. In all other ways, the conditions of the policy apply to interim cover including the continued payment of the premium. Worldwide cover Cover for a person insured is available 24 hours a day, anywhere in the world, subject to the conditions outlined under Cover during overseas employment and travel section. Optional benefits The following benefits may be applied for at an additional cost: TPD cover Death cover continuation option, and TPD cover continuation option. 7

11 Total and permanent disability benefit Availability of cover TPD benefits Entry age Maximum expiry age Maximum benefit amount 15th to 65th birthday Age 80 (i), (ii), (iii), (iv), (v) $5 million (i) A maximum benefit amount of $3 million may be paid when a person insured satisfies part (a) Unlikely to work as per the TPD definition. (ii) When the benefit is greater than $3 million, the amount in excess of $3 million may only be paid when the person insured satisfies parts (b) Specific Loss or (c) Future Care, of the TPD definition. (iii) The TPD sum insured may be reduced from the 60th to 70th birthdays. See the conditions outlined under Reduction of TPD benefits for more details. (iv) From the person insured s 65th birthday, the maximum TPD benefit is $3 million. (v) From the person insured s 70th birthday, the maximum TPD benefit is $250,000, and it will only be paid when the person insured satisfies parts (b) or (c) of the TPD definition. If a person insured meets the definition of TPD as outlined below, we will pay a TPD benefit. The person insured is TPD if they: 1. are unlikely to work ( any occupation or own occupation ) 2. have suffered a specific loss, or 3. require future care. Part (a) of the TPD definition is only available to persons insured who are permanently employed and who work at least 15 hours per week, and contractors in specific circumstances. For a contractor to be eligible for part (a) of the TPD definition, they must have worked an average of 15 hours or more per week over a period of 12 consecutive months up to the date they became totally and permanently disabled. If a contractor has worked for a period of less than 12 consecutive months, the contractor will still be eligible for TPD cover provided they worked an average of 15 hours or more per week from the date the contract with the employer commenced to the date they became totally and permanently disabled. For non-superannuation policies the following definition applies: Total and permanent disablement means the person insured, while covered for total and permanent disablement: suffers an injury or illness that first commences while engaged in regular remunerative work as a full-time employee or a full-time contractor and is aged 65 or under at the date of disablement, and meets Parts (a), (b) or (c); or otherwise meets Parts (b) or (c). a. Unlikely to work is dependent upon which version of the TPD definition applies under the policy and means: If an any occupation version applies: Means the person insured: 1. has continued to remain absent from all work (whether or not for reward) since the date of disablement solely due to the injury or illness that originally stopped them from working; and 2. is under regular and ongoing care; and 3. is determined by us that: i. as at date of disablement and ii. for the TPD waiting period; and iii. continuously since then, and after considering all evidence which we believe is necessary to reach our view, in our opinion the person insured has become incapacitated by injury or illness (whether physical or mental) to such an extent that he or she is unlikely to ever be able to work in any business, occupation or regular duties, whether paid or unpaid, for which he or she is reasonably fitted by education, training or experience. For the purpose of this definition it is immaterial whether the person insured can perform the business, occupation or regular duties on either a full-time, part-time or casual basis, even if they worked on a full-time basis immediately prior to the cessation of work. If an own occupation version applies: Means the person insured: 1. has continued to remain absent from all work (whether or not for reward) since the date of disablement solely due to the injury or illness that originally stopped them from working; and 2. is under regular and ongoing care; and 3. is determined by us that: i. as at date of disablement and ii. for the TPD waiting period; and iii. continuously since then, and after considering all evidence which we believe is necessary to reach our view, in our opinion the person insured has become incapacitated by injury or illness (whether physical or mental) to such an extent that he or she is unlikely to ever be able to work in their own occupation. Own occupation means the occupation or regular duties in which the person insured has spent the most amount of time engaged in with the employer during the 12 months prior to the last day at work. 8

12 For the purpose of this part of the definition, it is immaterial whether the person insured can perform their occupation or regular duties on a full-time, part-time or casual basis even if they worked on a full-time basis immediately prior to the cessation of work. OR b. suffers a specific loss Means the person insured: 1. suffered an injury or illness which first became apparent while he or she was a person insured; and 2. because of the injury or illness, has suffered the total loss of (or total loss of the use of): both hands or feet; or one hand and one foot; or the sight of both eyes; or one hand or foot and the sight in one eye, in circumstances where the loss will never be regained. OR c. requires future care Means the person insured: because of an injury or illness, in our opinion, the person insured is permanently unable to perform at least two of the five Activities of Daily Living (listed below), without assistance from another person. If the person insured can perform the activity by using special equipment they will be considered able to undertake that activity. The permanent inability to perform at least two of the five Activities of Daily Living must have first occurred after becoming a person insured. The five Activities of Daily Living are: bathing/showering, dressing/undressing, eating/drinking, using the toilet to maintain personal hygiene, getting in and out of bed, a chair, a wheelchair or moving from place to place by walking, a wheelchair or with a walking aid. Total and permanent disablement, totally and permanently disabled and TPD shall have a corresponding meaning. For superannuation policies, the following TPD definition applies: Total and permanent disablement means the person insured, while covered for total and permanent disablement: suffers an injury or illness that first commences while engaged in regular remunerative work as a full-time employee or a full-time contractor and is aged 65 or under at the date of disablement, and meets Parts (a), (b) or (c); or otherwise meets Parts (b) or (c). a. Unlikely to work Means the person insured: 1. has continued to remain absent from all work (whether or not for reward) since the date of disablement solely due to the injury or illness that originally stopped them from working; and 2. is under regular and ongoing care; and 3. is determined by us that: i. as at date of disablement and ii. for the TPD waiting period; and iii. continuously since then, and after considering all evidence which we believe is necessary to reach our view, in our opinion the person insured has become incapacitated by injury or illness (whether physical or mental) to such an extent that he or she is unlikely to ever be able to work in any business, occupation or regular duties, whether paid or unpaid, for which he or she is reasonably fitted by education, training or experience. For the purpose of this definition it is immaterial whether the person insured can perform the business, occupation or regular duties on either a full-time, part-time or casual basis, even if they worked on a full-time basis immediately prior to the cessation of work. OR b. suffers a specific loss Means the person insured: 1. suffered an injury or illness which first became apparent while he or she was a person insured; and 2. because of the injury or illness, has suffered the total loss of (or total loss of the use of): both hands or feet; or one hand and one foot; or the sight of both eyes; or one hand or foot and the sight in one eye, in circumstances where the loss will never be regained; and after considering all evidence which we believe is necessary to reach our view, in our opinion the person insured has become incapacitated by injury or illness (whether physical or mental) to such an extent that he or she is unlikely to ever be able to work in any business, occupation or regular duties, whether paid or unpaid, for which he or she is reasonably fitted by education, training or experience. OR c. requires future care Means: 9

13 because of an injury or illness, in our opinion, the person insured is permanently unable to perform at least two of the five Activities of Daily Living (listed below), without assistance from another person. If the person insured can perform the activity by using special equipment they will be considered able to undertake that activity. The permanent inability to perform at least two of the five Activities of Daily Living must have first occurred after becoming a person insured. The five Activities of Daily Living are: bathing/showering, dressing/undressing, eating/drinking, using the toilet to maintain personal hygiene, getting in and out of bed, a chair, a wheelchair or moving from place to place by walking, a wheelchair or with a walking aid, and after considering all evidence which we believe is necessary to reach our view, in our opinion the person insured has become incapacitated by injury or illness (whether physical or mental) to such an extent that he or she is unlikely to ever be able to work in any business, occupation or regular duties, whether paid or unpaid, for which he or she is reasonably fitted by education, training or experience. Total and permanent disablement, totally and permanently disabled and TPD shall have a corresponding meaning. Immediate assessment conditions If the person insured has been diagnosed by a medical practitioner as suffering from one of the listed medical conditions below, we will waive the TPD waiting period when assessing a claim made under part (a) Unlikely to work, as per the TPD definition. The medical conditions are: Alzheimer s disease and other dementias Cardiomyopathy Diplegia Hemiplegia Lung disease Major head injury Motor neurone disease Multiple sclerosis Muscular dystrophy Paraplegia Parkinson s disease Permanent blindness Permanent deafness Permanent loss of speech Primary pulmonary hypertension Quadriplegia Severe rheumatoid arthritis Tetraplegia. Life events cover The option to increase Death and/or TPD cover is available as an optional feature as part of the GL policy. When a person insured can increase their cover The person insured can increase their cover if they experience one of the following life events: get married or registers a de facto relationship on the first anniversary of a marriage or de facto relationship where that anniversary is on or after the date the person insured was first covered by the policy get divorced or registers a separation from a registered de facto relationship on the first anniversary of separating from a marriage or de facto relationship where that anniversary is on or after the date the person insured was first covered by the policy have a child (including through adoption) take out a mortgage on the initial purchase of a primary residence increase an existing mortgage on their primary residence for renovations/extension (increase for renovations/ extension must be for at least $50,000), or have a child and the child turns

14 The required evidence which is required to be provided to us is set out in the table below: Event Event date Evidence (i) Marriage or registers a de facto relationship The date of marriage specified in a marriage certificate or the date of registration of a de facto relationship First anniversary of a marriage or de The date of the first anniversary of a facto relationship marriage or de facto relationship Certified copy of marriage certificate or certified copy of the registration certificate For marriage, a certified copy of the marriage certificate, or For a de facto relationship, a statutory declaration in the approved form declaring: the status of the de facto relationship, the 12-month duration of the de facto relationship, the commencement date of the de facto relationship, and the names of the parties in the de facto relationship Divorces or registers a separation from a marriage or registered de facto relationship First anniversary of separation of a marriage or de facto relationship Date of divorce or date the person insured registers the separation of a marriage or registered de facto relationship The date of the first anniversary of separation from the marriage or de facto relationship A certified copy of the divorce order or a certified copy of the separation order A statutory declaration in the approved form declaring: the status of the marriage or de facto relationship, the date the person insured separated from the marriage or de facto relationship, the 12 month separation from the marriage or de facto relationship, and the names of the parties in the former marriage or de facto relationship Birth or Adoption of a child Taking out a Mortgage on the initial purchase of a primary residence The date of the child s birth or adoption The date the loan is first drawndown Certified copy of child s birth certificate or adoption certificate with name of the person insured appearing as mother/father Letter from lender showing the identity of the lender and confirming: 1. the amount of the loan to purchase the person insured s principal place of residence, and 2. the loan has been drawndown (not just approved), and a statutory declaration declaring that the mortgaged property is the person insured s principal place of residence Increasing Existing mortgage on primary residence for renovations/extension Child turns 12 The date the loan is first drawndown The date of the child s 12th birthday Letter from lender showing the identity of the lender and confirming: 1. the amount of the increase in the loan to extend or renovate the principal place of residence of the person insured, and 2. the loan has been drawndown (not just approved), and a statutory declaration declaring that the mortgaged property is the person insured s principal place of residence and that the increase is for renovations/extension Certified copy of child s birth certificate or adoption certificate with name of the person insured appearing as mother/father. (i) Evidence must be certified as a true copy of the original by an authorised person, including one the following: Justice of the Peace Commissioner of Declarations Lawyer Notary Doctor CPA or Chartered Accountant Bank Manager. It is the policy owner's responsibility to obtain and retain the above evidence and to supply it to us together with the request to increase cover. We will not approve increases under this clause if we do not consider that the evidence which has been provided to us is satisfactory. 11

15 Conditions of acceptance of an increase The date of the life event must be on or after the date the person insured was first covered by this policy. To be eligible to apply for a benefit increase the person insured must be under the age of 65 on the date of the event. The application for an increase, including all required evidence, must be received by the policy owner in the required format, as agreed by us and the policy owner, within two months of the event occurring. Alternative application periods may apply as agreed by us. When a person insured increases their cover because they have increased their mortgage for renovations/an extension, for the first six months from the date the benefit was increased, only cover for accidental death and accidental total and permanent disability will be provided on the amount of the increase. Persons insured may increase their cover up to a maximum of three times under this option. Where a person insured increases their cover by a fixed dollar amount, the amount of their TPD benefit will reduce as described under the section Reduction of TPD benefits. The policy owner or person insured must not have made or be eligible to make a claim for TPD, total disability or terminal illness on any policy held with us. The policy owner or person insured must not have been previously rejected for cover through underwriting terms where the rejection was due to medical reasons. Persons insured may only apply for a cover increase as the result of one event in a 12 month period. In the case of life events for marriage, registering a de facto relationship or on the first anniversary of a marriage or de facto relationship, only one life event is allowed for marrying or establishing a de facto relationship with the same person. In the case of life events for divorce, registering a separation or on the first anniversary of a separation, only one life event is allowed for divorcing or separating from the same person. Amount of cover increases The maximum amount of each increase is contained in the additional options section of the policy schedule. Each increase is limited to the lesser of 25% of the person insured s existing cover and $150,000. The total amount of cover increases under this option is limited to $450,000 over the lifetime of each person insured. It is the policy owner's responsibility to ensure the person insured has not increased their cover more than three times under life events cover. If a person insured increases their cover more than three times under life events cover, we will decline to pay the part of the benefit which relates to more than three increases, even if we have been receiving premiums. We will refund all premiums received in relation to the declined part of the cover. Application of automatic acceptance limits and further underwriting limits Persons insured under the automatic acceptance limit. Persons insured under the automatic acceptance limit can exercise the option to increase cover. The automatic acceptance limit will continue to apply. Persons insured whose increase will increase their cover over the automatic acceptance limit. Persons insured may increase their cover over the automatic acceptance limit without underwriting terms. Any further increases are subject to underwriting, unless they are again for a life event. Persons insured restricted to the automatic acceptance limit due to non-receipt of health evidence. Persons insured limited to the automatic acceptance limit due to non-receipt of medical evidence previously subject to underwriting terms, are eligible for the life events increase. Any further increases will be subject to underwriting terms unless they are again for a life event. Persons insured limited to the automatic acceptance limit due to previous underwriting. Persons insured who have been restricted to the automatic acceptance limit due to medical reasons, are not eligible for life events increases. Persons insured who have had loadings or exclusions applied to their cover, may increase their cover but the same loadings and exclusions will apply to the increase in cover. Persons insured with further underwriting limits. Where the further underwriting limit is higher than the existing cover plus the life events increase, the person insured may increase their cover and the existing further underwriting limit will continue to apply. Where the further underwriting limit is lower than the existing benefit plus the life events increase, the person insured may increase their cover for the full amount of the life events increase without underwriting terms. Any further increases will be subject to underwriting terms unless they are again for a life event. Persons insured who have had loadings or exclusions applied to their cover, may increase their cover. However, the same loadings and exclusions will apply to the increase in cover. Effective date of increase The increase in cover due to a life event applies from the date that all acceptable and completed documentation, together with any supporting evidence that we require is received by us. 12

16 Death cover continuation option The option to continue death cover under an Individual Insurance plan is available as an optional feature of the GL policy. It is available to persons insured aged less than 65 who have ceased employment with the employer. The following conditions apply for a continuation option: the person insured must apply for an Individual Insurance plan with us within 60 days of the date cover ceases under the GL insurance policy (had extended cover not applied) the person insured has stopped working for the employer, and the amount of the cover applied for is not more than the amount of the benefit which applied to the person insured under the GL policy immediately before cover stopped. As part of the application process, we will ask questions and seek disclosure from the person insured for any information we consider relevant which does not relate to medical information in regard to the person insured, and based on our assessment, we may refuse the application. We may offer insurance on any terms acceptable to us, including equivalent special terms or premium loadings equivalent to those that applied under the GL policy. A continuation option will not apply: if the person insured has stopped working for the employer in any business, occupation or regular duties because of injury or sickness if we have been given notice by the policy owner that the policy will be ended, or has ended if we have given the policy owner notice that the policy will be ended, or has ended if we are paying, or the person insured is entitled to or becomes entitled to, a benefit under the GL policy if the person insured is aged 65 or greater if the person insured has previously taken out similar insurance with us under a continuation option if the person insured s premium amount under the Individual Insurance plan applied for is less than the minimum premium we set for the purpose of this option from time to time to the amount of the benefit under the GL policy for the person insured that is more than the maximum amount we set for the purpose of the continuation option from time to time, or if we have given written notice to you that this option is to cease operating. TPD cover continuation option In addition to the conditions for the death cover continuation option, the following also applies to exercising a TPD continuation option: the person insured must be aged 55 or less, and must be at work at the time of applying for the Individual Insurance plan and permanently employed to work at least 25 hours per week. Additional information Renewal guaranteed We will guarantee to renew the policy annually, subject to: the minimum number of persons insured and the minimum premium, that we advise from time to time, being met any premium due being paid to us in accordance with the policy terms and conditions, and you abiding by the terms and conditions of the policy. Limitations The GL policy may contain certain exclusions or limitations. As each policy is catered to the needs of different groups, you should carefully check your policy schedule and policy document to see if any exclusions or limitations apply. Exclusion for war We will not pay a benefit if the person insured s death, accidental death, terminal illness or TPD was caused by an act of war while the person insured was overseas for the purposes of their employment. Exclusions for voluntary cover We will not pay a benefit or part of a benefit if, within 13 months from the date the person insured s voluntary insurance cover, or increase to the person insured s amount of voluntary insurance, commenced: the person insured s death, accidental death, terminal illness or TPD or accidental TPD was caused by suicide or attempted suicide, or the person insured s sickness or injury was caused by the person insured on purpose. Reduction of TPD benefits Where the benefit formula for total and permanent disablement does not reduce the amount of the total and permanent disablement cover for a person insured, from a person insured s 60 th birthday, the amount of the total and permanent disablement benefit under Part (a) of the total and permanent disability definition will be reduced by 1/120 th of the amount of the total and permanent disablement benefit, times the number of completed and partial months since the person insured s 60 th birthday up to the benefit calculation date. If TPD tapering applies, the amount of the total and permanent disablement benefit assessable under Parts (b) and (c) of the total and permanent disability definition will be reduced by the amount of reduction nominated in the previous paragraph. 13

17 If the cover expiry age is greater than age 70, the reduction process will cease on the person insured s 69 th birthday. Where TPD cover for a person insured under the policy commences after the person insured's 60 th birthday, the amount of the reduction will be consistent with that which would have applied had the person insured been covered since the start of the TPD benefit reduction process. We may apply a reduction for a period longer or shorter than 10 years or ceasing prior to age 70 if requested by you and agreed to by us. If we do this we will notify you in writing of the terms of any such agreement. In such cases, the rate of TPD benefit reduction shall be adjusted proportionately, but shall not be less than the reduction that would have applied had the standard conditions been applied. Where underwriting terms apply to the TPD benefit for a person insured and the amount of benefit has been restricted to a fixed dollar amount (as notified by us in writing), any reduction in the benefit is applied to the lesser of this restricted fixed dollar amount or the amount of benefit calculated by the benefit formula for the person insured. When cover for a person insured stops Cover for a person insured will stop as soon as one of the following happens: the person insured attains the cover expiry age the person insured ceases to be employed by the employer the date a death benefit, terminal illness benefit or TPD benefit becomes payable for the person insured under the GL policy the person insured no longer meets the eligibility criteria you do not pay the premium for the person insured when due when the person insured is on unpaid leave as described under section Unpaid leave or employed/travels overseas as described under section Cover during overseas employment and travel for longer than the period of time that we have agreed to provide cover, except where the reason why the person insured has not returned to work is because they had made a claim under the policy or is eligible to do so the person insured makes a fraudulent claim the date the policy is terminated, or when the policy ends. In addition to the above, the following also applies under superannuation policies: in the case of the person insured directing the employer to remit all or part of their employer superannuation contributions to a superannuation fund other than the fund through which cover is provided under the policy, cover will cease on the date the first contribution has been remitted to the person insured s fund of choice. In some circumstances extended cover may apply. When a benefit will not be paid We will decline to pay, or reduce a benefit which we may otherwise pay to you by the amount that represents the extent to which we have been prejudiced in each of the following circumstances: where we have not received notice as soon as reasonably possible after the person insured first became disabled if the policy claim requirements have not been complied with by you, an employer or a person insured if the person insured is in jail, or otherwise detained, as a result of a criminal act if the person insured makes a fraudulent claim if a premium due for all persons insured has not been paid by the premium due date and where payment of a benefit would expose us, you, or the person insured to any sanction, prohibition or restriction under United Nations resolutions or the trade or economic sanctions, laws or regulations of the European Union, Australia or United States of America. We will not pay the part of the benefit which was obtained under Life events cover, if, within 13 months from the date the additional cover commenced: the person insured s death, accidental death, terminal illness, total and permanent disablement or accidental total and permanent disablement was caused by suicide or attempted suicide, or the person insured s illness or injury was caused by the person insured on purpose. The policy owner can end the policy The policy owner can end the policy by giving us one month s written notice on their company letterhead, or we can agree on an earlier time in writing. We can end the policy We can end the policy, or cover in respect of a person insured, by giving you one month s written notice, as soon as any of the following happens: the annual premium falls below the minimum annual premium the number of persons insured falls below the minimum number of persons insured we are not provided, within 30 days of us advising you in writing, with all of the information we need to verify cover for a person insured and premiums paid or payable you do not pay the relevant premium or any adjustment premiums within 45 days of the due date less than 75% of eligible persons are covered under the policy, or you do not provide any other information we require to operate the policy effectively. You must inform the persons insured of the notice to terminate as soon as possible, but in any event within 10 working days of receipt of our written notice to you. 14