REST Super Insurance Guide

Transcription

1 REST Super Insurance Guide Effective 1 December 2017 The information in this document forms part of the REST Super Product Disclosure Statement (PDS) effective 1 December You should read the PDS in conjunction with this Insurance Guide. rest.com.au Live Chat at rest.com.au Monday to Friday 8am 10pm and Saturday 9am 6pm AEST Monday to Friday 8am 10pm AEST

2 Welcome to your insurance with REST REST believes that affordable and quality insurance is an important part of your super. We care about looking after you, that s why we provide most of our members with automatic insurance cover. Helping you build a brighter future is at the centre of everything we do, so we ve designed this guide to help you feel confident about: your insurance cover your insurance options changing your cover to suit your needs how REST can support you if you need to make a claim. 02

3 Contents The benefits of your insurance with REST 04 How your insurance with REST works 08 REST Super insurance in detail 19 Limits and exclusions to your cover 23 REST claims and rehabilitation 25 Frequently asked questions 27 Important information about your insurance 29 The cost of your insurance 35 This is the REST Super Insurance Guide. The information in this guide forms part of the REST Super Product Disclosure Statement (PDS), effective 1 December The PDS, the Additional information on fees and costs and Investment Guide contain important information you should read before making a decision to invest in this product. The information in this document is general information only and doesn t take into account your personal objectives or needs. You might like to have a chat with a financial adviser to obtain financial advice that s tailored to your personal circumstances. The information in this document is up to date at the time of preparation and it may change from time to time. The Trustee (we or us) may update information that is not materially adverse to you and make it available at rest.com.au/governance If you need any further information, including a copy of the PDS and other important information, or our trust deed, which are available free of charge, contact us. REST s current insurer is AIA Australia Limited (AIA), ABN , AFSL AIA has consented to the statement about its Privacy Policy in this Insurance Guide and being included in the Application for insurance REST Super form. AIA has not withdrawn this consent as at the issue date of this Insurance Guide. This offer is available only to persons receiving (including electronically) the PDS and other important information within Australia. Issued by Retail Employees Superannuation Pty Limited (Trustee) ABN AFSL Retail Employees Superannuation Trust (REST) ABN REST Super is a product of REST. Unique Superannuation Identifier RES0103AU. We re here to help Have any questions or want to know more about REST? Connect with one of our Customer Service Specialists via Live Chat at rest.com.au 8am 10pm Monday to Friday and 9am 6pm Saturdays AEST. Call REST Customer Service on , 8am 10pm AEST Monday to Friday. Ask Roger, our virtual agent at rest.com.au and he ll do his best to point you in the right direction. Download the REST App to make the most of your super on the go, and get rewarded for your great super habits. REST Super Insurance Guide 03

4 The benefits of your insurance with REST 04

5 This section shows you how having your insurance with REST can help you protect the things that matter the most. REST offers flexible insurance cover designed to protect you and your beneficiaries if you are unable to work for a long period due to sickness or injury, if you become totally and permanently disabled or die. Our insurance cover includes Death cover, Total and Permanent Disablement and Income Protection insurance. Overview of insurance at REST 1.4 Over million members are insured with REST In the 12 month period to June 2017, REST paid over 5,100 claims for Death, Total and Permanent Disablement and Income Protection insurance The total cover on our members: $286 billion Death cover $70 billion Total and Permanent Disablement cover $2.15 billion per year Income Protection cover REST Super s insurance provides cover for full-time, part-time and casual workers REST Super Insurance Guide 05

6 Insurance cover designed to suit you Everyone s insurance needs are different. Our membership base is our inspiration for designing an insurance product that can meet your needs. Cover if you re casually employed Just because your income changes from week to week, doesn t mean protecting it is any less important. That s why REST is one of the few super funds that provides insurance cover to those who are casually employed. Protecting your income We re also one of the few super funds that offers you default Income Protection insurance. Your monthly Income Protection benefit* could help you pay for things like: your monthly household expenses (including rent or mortgage repayments and utilities) financial support to assist with the general costs of living contributions into your super account so your retirement savings aren t negatively impacted by your loss of earnings. *Details about your monthly IP benefit can be found on page 21 06

7 This page shows some of the benefits of choosing insurance with REST. Default Cover If you re aged 18 or over, when you join REST Super and we receive your first employer contribution from a REST employer, you ll automatically receive our Default Cover for Death, Total and Permanent Disablement and Income Protection insurance (subject to eligibility). Plus, your cover will change with you as you go through the different stages of your life. See page 9 for more details. Default Income Protection One of the most important assets you ll have is your ability to earn an income. Whilst you may not need high levels of Death or Total and Permanent Disablement cover, we believe it s important to give you the option to replace your income in case you suffer from sickness or injury and are unable to work. See page 21 for more information. Age 25 reinstatement We recognise that everyone s needs are different, especially at a young age. So if you decide that Death, Total and Permanent Disablement and Income Protection cover isn t important for you now, we give you the option to cancel (opt-out) of cover and have it reinstated when you turn 25. See page 16 for details. Value for money REST provides insurance to our members at a group rate through AIA Australia Limited (AIA) a leading insurance company. We use our buying power to negotiate group insurance rates that generally compare favourably with what you may otherwise pay as an individual. See page 36 for details on the costs of your insurance. REST Super Insurance Guide 07

8 How your insurance with REST works 08

9 This section will help you understand your insurance with REST, how it works and what your options are. Insurance cover when you join REST Super If you join REST Super, are aged 18 or over, and are receiving mandatory employer contributions from a REST employer (such as Superannuation Guarantee contributions), you will receive our Default Cover package subject to meeting the terms and conditions on page 30. If you are not in Active Employment at the time that your Default Cover starts or restarts, you will have Limited Cover until you return to Active Employment for two consecutive months. See page 12 for more information. Our Default Cover is made up of: Default Death cover Default Total and Permanent Disablement (TPD) cover Default Income Protection (IP) cover. The total amount of cover you receive is designed to change as you grow older and your insurance needs change. If you are not receiving mandatory employer contributions from a REST employer or you re under 18, you can still apply for Default insurance by providing health and other underwriting information see page 14 for more information. What are units? REST Super s Default Cover is provided in blocks of cover called units. When you join REST Super through your employer, you will be allocated a number of units depending on your age and the type of cover we have given you. For example, as you can see from the table on page 37, if you joined REST at age 35, you would be given a Death cover sum insured of $374,000 the equivalent of five units of cover. This means that one unit would be $74,800 (divide $374,000 by five). You then have the option to decrease your Default Cover or increase the number of units you have by buying voluntary cover see pages 14 and 15 for more details. Some words in this guide have technical meanings and are explained on page 31. REST Super Insurance Guide 09

10 Default Cover frequently asked questions Here are some of the most common questions that our members ask about Default Cover. You can also see other frequently asked questions on page 28 of this guide. What is Default Cover? If you join REST Super, are aged 18 or over and are receiving mandatory employer contributions from a REST employer, you will automatically receive our Default Cover package made up of Death, TPD and IP cover, subject to the terms and conditions on page 30. Why do we provide you with cover? We believe that insurance cover is important because it provides you with financial protection if the unexpected happens. Your Death and TPD cover is also provided as a minimum insurance requirement under MySuper. Do I really need insurance? Your insurance with REST helps you to protect the things that matter the most. Unexpected events, including sickness or injury, could significantly impact your ability to earn an income, your lifestyle and the people closest to you. Your ability to earn an income is one of your most important assets. Can I change or cancel my cover? Whilst insurance is important, we know everyone s needs for insurance cover are different. This guide will walk you through your options for increasing, reducing or cancelling (opting-out) your cover. What if I don t get Default Cover? Even if you don t get Default Cover, it s easier to get cover through underwriting (providing your health evidence) when you re younger. As time goes on, your medical history grows with each sickness or injury. It doesn t have to be really serious a simple back injury can be an insurance issue. Your chance to get the right level of cover at competitive rates may never be better than it is today. So don t put it off take care of your insurance as soon as you can. 10

11 Overview our insurance cover REST offers you two types of cover: a lump sum for your beneficiaries if you pass away (Death cover) financial protection that replaces some of your income if you re unable to work due to sickness or injury (IP cover) and/or provide a lump sum benefit (TPD cover). Death cover Death cover provides your beneficiaries with a lump sum or, if chosen, a pension in the event of your death. Our life stage approach to Death cover means that your sum insured (the amount you are insured for) will change automatically depending on the stage of your life and your expected need for Death cover. Death cover also includes an advanced payment of your death benefit in the unfortunate event you become terminally ill. In the 12 months to 30 June 2017, REST paid 1,083 Death claims, of which 167 claims were for Terminal Illness to our members. TPD and IP insurance Our combination of TPD and IP insurance provides you with financial support if you are unable to work due to sickness or injury. In the event of a significant sickness or injury that results in your Total and Permanent Disablement, you may be eligible for a lump sum TPD payment to help you with the serious financial impacts of never being able to work again. It is important to note that your TPD and Death Cover are linked, so any TPD payments will reduce your Death benefit by the amount paid. If your sickness or injury meets the Total Disability requirements, you may also be eligible for monthly income replacement payments (our IP insurance) as we support you in recovery and your return back to work. Our IP has a 60 day Waiting Period and pays up to age 60 (or a 2 year benefit, or to age 65 if earlier, if you are 58 or older). For a detailed explanation of each type of insurance and our life stage approach, see pages In the 12 months to 30 June 2017, REST s IP policy has provided more than 3,000 members with a benefit to replace their income, with a further 1,001 Total and Permanent Disablement claims approved. REST Super Insurance Guide 11

12 How do I know if I have cover? Knowing if you have cover is really important. One of the most common questions our members ask about is their eligibility for Default Cover. Here s a simple way to understand whether or not you have cover in place and if any restrictions apply. When your REST Super account was opened (or more recently re-opened), were you in Gainful Employment with a REST employer and receiving contributions from them? YES That s great news, you should receive our Default Cover under the policy. To check if there are any restrictions on your cover: On the day you started work were you in Active Employment? Active Employment means you were: employed by a REST employer to perform identifiable duties and attending work without any restrictions caused by sickness or injury, and capable of carrying out the identifiable duties of your usual occupation for at least 20 hours a week (even if you didn t work 20 hours a week). NO If you weren t employed by a REST employer when your account was opened, you just need to apply for cover using the insurance application form on our website at rest.com.au/forms YES You should have Default cover that is not subjected to a Limited Cover exclusion. NO Your Default cover is subject to a Limited Cover condition until you return to Active Employment for two consecutive months. This means you will only be eligible to claim for health events that are not related to health conditions that existed before your cover started. Some words in this guide have technical meanings and are explained on page

13 When does my cover start? There are a few things that need to happen for your insurance cover to be activated. When your cover starts Default Cover Will start on the latest of: the date you last joined REST the date your most recent employer joined REST 180 days before we received the first mandatory employer contribution for your most recent period of employment with your REST employer when the first mandatory employer contribution is made which relates to your most recent period of employment with a REST employer the date you started employment with the REST employer that made the first mandatory employer contribution for your most recent period of employment. It is important to note that your Default Cover does not start when you transfer or rollover your super from another fund into REST Super. Default Cover will not start or re-start unless we receive a mandatory employer contribution for you. The following contributions do not count as contributions for the purpose of assessing your eligibility for Default Cover: non-compulsory contributions by your employer contributions made to another super fund that are subsequently transferred to REST payments by the Australian Taxation Office for a shortfall component personal contributions, spouse contributions or payments resulting from a Family Law Split. Non-automatic Cover Will start on: the latest of the date you select your cover and the date Default Cover commences. the date your application is accepted by our insurer for insurance you choose via online underwriting, an Application for insurance or Insurance transfer form. If you are not employed by a REST employer, you must meet the minimum account balance requirements for cover to apply (see page 14). Insurance will not start any earlier than described under any circumstances, even if we deduct insurance premiums for a period before the start of insurance cover. However, such insurance premiums will be refunded. REST Super Insurance Guide 13

14 What if I don t want cover? Life changes and so do your insurance needs. You may decide you don t need all of the Default Cover we provide to you, or you may decide you don t need cover at all. This section explains how you can change or cancel your cover. Reducing your cover You can reduce your insurance cover at any time by reducing the total number of units you currently have. If you have voluntary cover (any voluntary cover you have chosen on top of your Default Cover), you must cancel your voluntary cover before you can reduce your Default Cover. Default Cover can only be reduced if there is no Voluntary Cover (ie Voluntary Cover is cancelled). Cancelling cover (opting out) Insurance cover with REST is not compulsory and you can cancel your cover at any time. However, if you cancel your cover now and decide that you want it back in the future, you will need to provide medical evidence and be assessed by the insurer (this is known as underwriting). To reduce or cancel your cover, please consider your needs carefully and either login to MemberAccess at rest.com.au or call Cancelling your cover We recognise that not everyone wants or needs insurance which is why we give you the option to opt-out. If you make a decision to opt-out of any insurance cover, you may need to apply in writing for cover to be reinstated at a later point. This cover may be subject to our insurer s underwriting process. (See page 16 for more information about underwriting). It s important to note that any cover that you apply for which requires underwriting, may exclude cover for any pre-existing health conditions you have or be subject to other limits or conditions. How do I apply for insurance cover? The information in this section will be helpful to you if: Default Cover wasn t provided to you and you would like to apply you want to apply for voluntary cover you chose to opt-out of cover and would now like to have cover again you have insurance elsewhere and would like to transfer it to your REST Super account. Applying for cover If you didn t get cover as part of your REST Super account, you can apply for cover by logging into MemberAccess and answering some health questions at rest.com.au You will need to have a minimum account balance of $1,000 if you are applying for insurance. Special offer for new members If you re a new member (within your first 120 days of joining REST Super), are aged 18 or older and are receiving mandatory employer contributions from a REST employer, you can take advantage of a special limited offer to increase your level of Default Cover by an additional one or two units without needing to provide any health evidence (limits and conditions apply). Simply visit rest.com.au/calculators to explore your different cost and cover options. 14

15 Duplicate accounts Generally, you may only have one super account with REST and conditions apply. If you apply to join REST Super and we find that you already have a REST Super account, these accounts will be merged into one account. If a duplicate account is not identified prior to you suffering a claim event, the accounts will be merged at claims stage and only one Death, Terminal Illness, TPD or IP benefit will be payable. If the cover amounts are not identical between the accounts, the higher cover amount will be the insured amount. If you have paid insurance costs on both accounts we will refund the insurance costs paid on the duplicate account. Increasing your cover You can apply for voluntary cover if you would like to be covered for more than our age-based Default Cover. You can apply for one or a combination of Death cover, TPD and IP insurance, on top of your Default Cover. The cost of voluntary cover is based on your age, gender and occupation category, and is set out in the tables on pages In three simple steps you can calculate how much cover you need, get a quote and apply for increased cover - simply login to MemberAccess at rest.com.au and click on the Insurance tab to see your insurance options. How much cover do I need? We recommend you seek independent financial advice before making your insurance decisions. You can also visit rest.com.au/calculators and use our online REST Super insurance needs calculator. REST Advice can help: REST Advice is all about helping you make good decisions with your super and money. So if you d like to have a chat about the right level of insurance cover for you, a REST Adviser can help. Our over-the-phone service makes getting advice easy and convenient, and allows you to make decisions in your own time. For simple advice such as your insurance needs or making the right investment choice, there s usually no extra charge to you it s part of being a member of REST. For advice on more complex situations, such as pre-retirement planning, you ll be charged a fee which you may be able to pay for out of your super. We ll always talk to you about this fee first. Visit rest.com.au/advice to book a phone appointment with a REST Adviser. Accidental cover during assessment of your application While your application for insurance cover is being assessed by the insurer, you will be given interim Accidental Death, TPD and IP insurance cover. This interim Accidental cover will apply at the increased level of cover being sought, to a maximum of $1,000,000 for Death or TPD cover and/or $10,000 per month for IP cover and will continue until the earliest of: the date your online underwriting application or Application for insurance is either accepted or declined by the insurer 90 days from the date we receive your online underwriting application or Application for insurance the date you cancel your online underwriting application or Application for insurance the date that a benefit becomes payable. Do you have insurance cover elsewhere? If you have insurance somewhere else, it may impact your ability to claim on the insurance we provide to you. You can transfer any existing Death or TPD insurance cover that you have with another super fund to your existing REST Super account (subject to limits, conditions and approval). Visit rest.com.au/forms to download an Insurance transfer form and for more details. REST Super Insurance Guide 15

16 Understanding the underwriting process Underwriting is the process of evaluating the information you provide on your application. Our insurer considers all the risk factors that may increase the likelihood of your death or disability before a certain time such as: age and gender occupation medical history, current health and habits family medical history pastimes (including hazardous sports) residency. The more information that is available to the insurer, the better placed they may be to understand your current situation. You will only be eligible for underwritten insurance cover after providing the required information to the insurer, who will assess and subsequently accept or decline your request for cover. The underwriting process Please be aware that if you are granted Voluntary Death Cover, your Default Death Cover will no longer increase with age. You may not be covered, or your request for cover may be declined, if you do not provide all the medical or other information requested by the insurer, or if the information you provide is not a full, complete or honest disclosure that meets your obligations under the law. If the insurer accepts your application, they may accept you on standard terms or special acceptance terms. The most common example of special acceptance terms is cover being accepted with an exclusion. We do not offer cover with premium loadings. If you choose to cancel your insurance cover and decide to apply for cover at a later date, you will need to again provide information about your health and financial circumstances to the insurer for assessment. The amount of cover you apply for will impact the amount of health and financial information that our insurer will need from you. Complete application for insurance or to increase insurance. Personal statement Assessment Insurer s underwriters assess risk, taking into account factors such as: age, gender, occupation, history and pastimes. Insurer may request further information or medical examinations. Further evidence Decision Decline Accept as standard Accept with exclusions. Does my cover ever change? If you have our Default Cover package, you ll find that your insurance will change each year. This section describes the times that your cover may change. Insurance cover changes on your birthday Your Default Death, TPD and IP insurance will automatically change each year on your birthday. Depending on your age, your cover may increase or decrease as you pass through each age band. Default Cover reinstatement at age 25 We all make decisions when we re young that are right for us at the time. But once you cancel insurance, you usually can t get it back without having to go through an underwriting process that involves you giving the insurer satisfactory medical evidence. We make it easy to get cover again later when it may be more relevant to you. For members who turn 25 and have no insurance cover (zero units of Death, TPD and IP), no matter what your employment status is, we will automatically reinstate Default Cover when we receive the first mandatory employer contribution for you. The mandatory employer contribution we receive will need to relate to your period of employment, starting on or after the beginning of the month in which you turn 25 and before you turn 26. If we don t receive a mandatory employer contribution before you turn 26, then this offer will expire and be unavailable to you in the future. 16

17 This means that you do not have to apply or provide medical evidence. You must be in Active Employment on the day your cover starts. If you are not in Active Employment on this date, Limited Cover will apply until you return to Active Employment for two consecutive months. Automatic reinstatement does not apply if you already have any insurance cover. REST Super insurance has paid thousands of claims to members under the age of 25. For the 12 months to 30 June 2017, 146 Death claims were paid to members 25 years or younger. Currently, 227 disability claims are being paid to members under the age of 25. What if I go on leave or change jobs? We know that things change, for example, you may go on a career break, maternity leave or just on a holiday. We also know that it s more than likely you will change jobs as you progress through your career. This is why we ve made our insurance cover flexible, so that you can maintain your cover as your life changes. Worldwide Cover Subject to the terms and conditions in this guide, you are covered 24 hours a day, 7 days a week. You may also travel or work in any part of the world without restriction to your insurance cover. However, the insurer reserves the right to ask you to return to Australia at your own cost to assess any Terminal Illness, TPD or IP claim for you. Cover while on leave without pay (including parental leave) Your insurance cover will continue on the same terms and conditions if you go on leave without pay that has been approved by your REST employer, or if you go on parental leave (maternal, paternal and adoption leave) from your REST employer provided you are not still on leave without pay beyond the earliest of: your agreed and scheduled return to work date two years. Your cover will be provided automatically on the condition that your employer has approved the leave in writing, before you go on leave. You may also be asked for documented evidence of the approval for your agreed leave and scheduled return to work date. Cover will continue until any of the events described in When does my cover end on page 18 applies to you. However, if you don t return to work within the periods set out above, the TPD definition used to assess a claim made by you may differ. Conditions may apply and you will also need to make sure there is enough money in your account to pay your insurance costs during the period of leave. IP benefits will not start accruing until the end of the 60 day Waiting Period or the date you are due to go back to work (whichever is later). Cover continues when you re in between or change jobs REST keeps you covered whilst you are changing employers or in between jobs. Any insurance cover will continue until the last Friday of the month in which your account balance is insufficient to meet that month s insurance costs in full and will end without notice. You are responsible for making sure your account balance has enough to maintain your insurance cover. If your account balance is too low to meet your monthly insurance costs, your cover will end without notice. This is referred to as your cover having lapsed. REST Super Insurance Guide 17

18 When you re-start employment If your cover has ended because your account balance was too low to maintain cover, we will provide you with the new level of Default Cover relevant to your age when a new employer makes a mandatory employer contribution to REST Super for you. However, if you maintained your insurance cover when you ceased employment, then the cover type and the number of units you have currently will automatically continue. Change is a part of life, so it s important that you review your insurance regularly - for example, if you get married, have a family or buy a home. If you change jobs, it s important that you let us know as this could impact your continued eligibility for insurance. When does my cover end? Your insurance cover will end on the earliest of: the last Friday of the month in which your account balance is insufficient to meet that month s insurance costs in full the date REST receives a request from you for your cover to end the date you turn age: - 70 for Death and/or TPD cover - 65 for IP cover the date you stop being a member of REST the date a TPD benefit becomes payable (except where your Death cover is higher than your TPD cover, in which case you will remain insured for the balance of your Death cover until the earlier of any other cessation condition) the date a Terminal Illness Benefit becomes payable (except where you hold higher TPD cover than the Terminal Illness benefit paid to you, in which case you will remain insured for the balance of TPD cover until the earlier of any other cessation condition), and the day you die. Any insurance costs which are deducted for a period after cover ends will be refunded. 18

19 REST Super insurance in detail REST Super Insurance Guide 19

20 This section will go through each of our insurance cover types and the differences between Default Cover and voluntary cover. Death cover REST has designed its Default Cover to provide your dependants with financial support in the event of your death. It also provides you with financial support in the unfortunate event you become terminally ill. Default Death cover Our life stage approach for Death cover provides a level of cover in line with different life stages, based on typical scenarios. Default Death cover starts lower when you are younger, automatically increases when the need for cover may be higher, and then reduces again as you get older. For example, younger people under 25 are more likely to be single, have no dependants and have lower debt levels, meaning they may have less need for a high level of Death cover. As you get older, life changes. For example, finding a partner, having children and taking on the responsibility of a mortgage. With these changes often comes increased financial commitments and a need for a corresponding increase in the level of insurance cover. Life typically changes again when debts are paid off, the children have left home and you re starting to think about retirement. At this time, the need for insurance cover generally reduces again. The cost of Default Death cover and the amount of cover provided depends on your age (see page 37). You should consider your own circumstances, as not everyone fits into the typical life stages on which Default Death cover is modelled. We recommend you seek independent financial advice before making your insurance decisions. You can also visit rest.com.au/calculators Voluntary Death cover Voluntary Death cover is a fixed amount of cover you can apply for on top of your Default Death cover. This amount of cover does not change with your age, so you have more control over the level of insurance and can tailor the amount to suit your needs. Each voluntary unit of Death cover provides $10,000 of cover. Cover ends at age 70. Subject to approval by the insurer, you can apply for any amount of Death cover on top of your existing Default Death cover. The cost of voluntary units (see page 37) is based on your age, gender and occupation category (see page 40). When you think about how much voluntary Death cover to apply for, consider how your Default Cover will change as you age and how this meets your expectations about how much cover you will need at each stage in life. Terminal Illness benefit While we hope this will never be a situation you have to face, if you are diagnosed with an illness that means you have a life expectancy of less than 24 months, a Terminal Illness benefit may be payable. The definition of Terminal Illness is, in the opinion of the insurer if you have an injury or illness that is likely to result in death within 24 months. To be approved, the insured member must provide certification of the Terminal Illness by two registered medical practitioners (one being a specialist in that particular medical field) acceptable to the insurer and the certification period has not ended. The amount payable for Terminal Illness would be the same as your Death cover. Terminal illness isn t a stand-alone benefit and any payment made in the event of you being diagnosed as terminally ill will reduce your TPD insurance by the same amount. Your Death cover will cease once a terminal illness benefit is paid. The most commonly claimed health conditions across Death, TPD and IP include: musculoskeletal for example, back pain mental health cancer. 20

21 Total and Permanent Disablement cover REST s TPD insurance is designed to support you if you are unable to ever work again due to Total and Permanent Disablement from sickness or injury. Death and TPD are linked benefits, which means that a payment of a: TPD benefit reduces your Death cover by the same amount Terminal Illness benefit reduces your Death and TPD cover by the same amount. For example, if your Death and TPD cover are for equal amounts and you are paid a TPD benefit, your Death and TPD cover will cease. However, if your Death cover is higher than your TPD cover and you are paid a TPD benefit, you will continue to be insured for the balance of your Death cover. Default TPD cover Our TPD benefit aims to help protect you against the financial costs associated with Total and Permanent Disablement. Default Cover is a fixed sum insured of $28,600 at most ages. The cost of Default TPD and the amount of cover provided depends on your age (see page 38). Voluntary TPD cover Each voluntary unit of TPD cover provides $10,000 of cover to age 59 and then starts to reduce until cover is nil at age 70. Subject to approval by the insurer, you can take out up to $5 million of TPD cover ($1 million if aged 65 to 69). The cost of voluntary units (see page 38) is based on your age, gender, and occupation category (see page 40). Income Protection cover Your ability to earn an income is one of your most important assets. REST s long term Income Protection insurance is designed to support you when you are unable to work due to sickness or injury. Default IP cover Like our Death cover, our Default IP cover follows a life stage approach. It is lowest when you are young and typically on a lower salary. It automatically increases as you get older, gain experience and start to earn more. The cover amount and cost of Default IP cover depends on your age (see page 39 for more information on the costs of IP). Voluntary IP cover Each voluntary unit of IP cover provides $1,000 cover per month until age 65. Subject to approval by the insurer, you can take out up to $30,000 per month of IP cover on top of your Default IP cover. The maximum benefit payable is 77% of your Pre-Disability Income plus a super component of 12% of the monthly income benefit. So it s important to ensure that you don t apply for more cover than you need. The cost of voluntary units (see page 39) is based on your age, gender and occupation category (see page 40). REST Super Insurance Guide 21

22 Income Protection insurance in detail REST s IP insurance provides an income in times of prolonged absence from work due to sickness or injury. Our IP benefit is life stage based, with the levels of cover increasing as you get older to reflect salary increases generally related to age. You are eligible to receive an IP benefit due to Total Disability for more than the Waiting Period of 60 days. The benefit starts accruing after the end of the 60 day Waiting Period and ends on the earliest of: when you are no longer totally or partially disabled when you reach age 60, if your Waiting Period ends prior to age 58 the end of a two-year benefit period (or at age 65 if this occurs earlier), if your Waiting Period ends on or after age 58 your death. You will need to make sure that the Default IP cover we provide to you, or any additional cover you apply for, does not exceed your actual income. This is so that you don t pay for cover you can t claim on. The IP benefit is made up of an income component (monthly income benefit) and a super component and is paid monthly in arrears. The monthly income benefit provides cover up to 77% of your Pre-Disability Income. Bonuses, allowances, commissions and overtime are only included in your Pre-Disability Income if they are paid regularly. The monthly income benefit payable to you (less tax) will be paid directly into your bank account. In addition, an amount equal to 12% of the monthly income benefit payable to you will be paid as super to your REST Super account. Your superannuation component must be paid into your REST Super account. If you close this account, the superannuation component of any IP benefit payable to you will end. In the event of claim, the maximum payable to you will be the lesser of: a) 77% of your Pre-Disability Income plus super component of 12% of this amount b) the amount you are insured for c) Default IP Cover plus $30,000 per month voluntary cover. Where b) or c) apply this includes the super component. Here is an example of the calculation where cover is based on Pre-Disability Income: Pre-Disability Income per month: Monthly income benefit = ($1,000 x 77%) Super component = (Monthly income benefit x 12%) $1,000 $770 (paid to you, before tax) $92.40 (paid to your REST Super account) Claims Indexation To try to keep your claim payments up to date with inflation, on the anniversary of your claim and every 12 months from then on, your Total Disability benefit will be indexed by the lesser of 3.5% and the annual change in the Consumer Price Index (CPI). If CPI is zero or negative, there will be no indexation that year. The anniversary of your claim is the date 12 months after the end of your Waiting Period. Offsets The monthly income benefit is limited so that it and any other income payments as a result of your Total Disability are not more than 77% of your Pre-Disability Income from personal exertion (this cap is set at 100% for Partial Disability). Therefore, if you are claiming an IP benefit and are receiving, or are required to be paid income benefits from other sources, such as: sick leave workers compensation motor accident compensation social security benefits benefits from another insurance policy they may be offset against the income component of your IP benefit. However, the superannuation component of the benefit will continue to be paid and will not be subject to any offsets. Some words in this guide have technical meanings and are explained on page

23 Limits and exclusions to your cover REST Super Insurance Guide 23

24 This section explains any limits and exclusions that apply to your cover and should be read carefully to understand their impact on your cover. Exclusions Exclusions are conditions under which a benefit will not be paid due to certain circumstances. The insurer may impose special conditions or exclusions in relation to a particular member, but there are also general exclusions, the main ones of which are summarised below. You would be advised in writing if these applied to you. General exclusions No Death, Terminal Illness, TPD or IP benefit will be payable if the benefit claim has been made arising directly from active service in the armed forces of any country or international organisation (other than the Australian Defence Forces Reserve). Other exclusions on your cover Death cover There is no payment of voluntary Death cover benefits in respect to death by suicide within 13 months of the date cover commenced, recommenced, was reinstated or increased. Total and Permanent Disablement cover There is no payment of voluntary TPD cover benefits for Total and Permanent Disablement caused by intentional self-inflicted injury, whether or not sane at the time. Income Protection cover There is no payment of Income Protection benefits for: a disability due to intentional self-inflicted injury (whether illegal or not) or any such attempt by the insured member, whether or not sane at the time normal pregnancy and childbirth. Limitations to cover Death and TPD cover A member who has received or is eligible to receive, a benefit on his or her Total and Permanent Disablement or for Terminal Illness, whether under the current policy held by REST with AIA, another policy issued to REST or pursuant to any other insurance or superannuation arrangement of any kind, or has been employed under a preferential employment program before the most recent date the member joined REST, will only be eligible for Default Death and TPD cover on a Limited Cover basis. IP cover A member who has received, been admitted, or is eligible for a TPD benefit from REST or from another superannuation entity or life insurance policy or has been employed under a preferential employment program before the most recent date that the member joined REST, will only be eligible for Limited Cover consisting of five units of Default IP cover. 24

25 REST claims and rehabilitation REST Super Insurance Guide 25

26 This section helps you understand our claims process and how REST supports you in getting back to work with rehabilitation. Payment of insured benefits We do our best to pay eligible members as quickly as possible. The timely payment of insured benefits depends on the insurer receiving information from you, your employer(s) and medical practitioners. Any delay in receiving this information may result in the payment of benefits being delayed. REST s claim assessment process We are here to assist you at every stage of lodging your claim for a REST insurance benefit. Our claims assessment process involves: Submission of claim form If you think you are eligible to make a claim, call us and our specialist claim representatives will assist with your initial paperwork and submission to the insurer. Insurer assessment REST s insurer will assess your claim and may request more information from you to assist with the review of your claim. Trustee decision REST Trustee will make a decision on the claim. Decision notice You will be notified of the outcome and if your claim is approved, benefits will be payable as per the terms of the benefit. For more information about our claims process, eligibility, and instructions on how to submit a claim, visit rest.com.au/insurance-claims or call us on REST rehabilitation We believe work is good for your general wellbeing. For those members who are eligible for an IP benefit, REST and its insurer (AIA) will offer you the option for a rehabilitation program. The program is designed to support you during your recovery and helps you return to work. What rehabilitation does REST offer? REST will work with AIA and your employer to find ways to support you in returning to work and wellness. Using the expertise of our insurer, REST is able to offer you access to a range of specialists who can support your rehabilitation from sickness or injury, as well as providing you with access to vocational expertise to help you retrain into a new occupation. Here are some recent examples of the rehabilitation programs offered to REST members: a physical conditioning program to develop work capacity. This could be home based exercise or a physiotherapist or exercise physiologist developing an upgrading program a graded Return To Work program assisting members to return to their original occupation assistance with specialised ergonomic equipment to assist a return to work vocational counselling to identify suitable work options short courses, for example, MYOB, office courses and computer courses to develop new skills. Do I have to do it? Rehabilitation isn t mandatory but it can provide some positive outcomes. The claims team can discuss these benefits with you. Do I need to pay for it? Rehabilitation is provided in addition to your monthly IP benefit, so you do not need to pay for the services provided by AIA and its partners. How do I know if I am eligible? During the initial claims process, the AIA team will discuss your rehabilitation options with you and whether you are a suitable candidate for rehabilitation. Does it work? We believe rehabilitation has many benefits for a member s physical and mental wellbeing. Many of our REST members have benefited from a rehabilitation program which has helped them return to work successfully. 26

27 Frequently asked questions REST Super Insurance Guide 27

28 Questions about cover Can I change my cover? Yes, your insurance cover is flexible. You can keep Death, TPD and IP cover, or choose the types of insurance cover that suits your needs. You can also increase your cover (sum insured) by applying for additional cover, decrease your cover by varying your Default Cover units down, and cancel your cover. You can change your insurance cover online through MemberAccess at rest.com.au or by calling us on I am a parent of a REST member, why don t they have insurance? Our insurance design for younger members starts at 18 and offers a modest amount of Death, TPD and IP cover, which is in line with the requirements under the MySuper legislation. Members under 18 can apply for insurance if they wish in MemberAccess, or by downloading the Application for insurance form on our website at rest.com.au/forms Parent or guardian consent may be required and the insurer may require health evidence. I accidentally cancelled my insurance cover, can you reinstate it? You can go to MemberAccess and apply for cover. Your application for cover may be subject to our underwriting process. See page 16 for more details. What is the difference between Limited Cover and Default Cover? Limited Cover is a restriction imposed upon Default Cover which means that you are only allowed to claim for new sicknesses that have become apparent since you joined REST Super. What is the Active Employment condition? Many members are employed on a part-time or casual basis. REST has negotiated with its insurer to provide cover to members who work less than 20 hours a week and not on a permanent basis. However, this cover requires you to be capable of working 20 hours a week without being restricted by sickness or injury. Questions about Claims Where can I find more information about making a claim? You can find out more information about making a claim by visiting rest.com.au/insurance-claims What amount will I receive if my claim is approved? If you re eligible for a claim, the benefit applicable is determined based on the Incident Date, not when a claim is submitted or accepted when benefits may have changed. How long will it take for my claim to be approved? We work together with our insurer to assess and pay approved claims as quickly as possible, however, there are some factors that can affect this process. For more information about these factors and our claims requirements, visit rest.com.au/insurance-claims Why do I have to wait to be paid a benefit to replace my income? A Waiting Period is a part of all IP policies. It is the amount of time you need to wait before an insurance policy can start paying out a benefit and may be longer or shorter under different super fund rules. REST has chosen a 60 day Waiting Period to keep our insurance costs down and because most of our members have access to some savings and sick or annual leave to support themselves immediately after stopping work. Can I change the Waiting Period? No, the 60 day Waiting Period is set and cannot be reduced. I can t do my job but I am not eligible for a TPD claim why is this? Our TPD definition is based on you being unable to do any occupation for which you are reasonably suited, however, there are cases where in the opinion of the Insurer, you could work in another reasonably suitable job. In determining the suitability of another job, the Insurer will consider the skills you have acquired through education, training and experience. 28

29 Important information about your insurance REST Super Insurance Guide 29

30 This section outlines the important terms and conditions of your insurance, our privacy statements and explains some of the terms used in this guide. Important information about your insurance contract A member s eligibility for insurance cover and the terms and conditions that apply to cover are set out in REST s contract with its insurer. Where REST and/or its insurer accepts insurance costs for a type or level of cover for which a member is ineligible, the relevant insurance premiums will be refunded and no insurance cover will apply for any period. The insurance information in this guide relates to the insurance contract with effect from 1 December This document does not contain full details of the contract between REST and its insurer and only offers a general guide to the insurance offered by REST. The insurance is provided under a contract between the Trustee and AIA Australia Limited (AIA). If there is any conflict between this document and the insurance contract with AIA, the insurance contract will prevail. Insurance costs, benefit levels and conditions of cover are not guaranteed and may be varied from time to time without notice. When REST confirms your insurance, please check the amount and type of insurance cover we have recorded for you. If you believe it is less than you expected, you must contact us immediately or the cover recorded will be the cover assessed should you make a claim. This material is current as at 1 December 2017 but may be subject to change. This material has been prepared without taking into account your objectives, financial situation or needs. Before making a decision based on this material, you should consider the appropriateness of the advice having regards to your objectives, financial situation and needs. You should read the Product Disclosure Statement for REST Super available at rest.com.au/pds before making any decision about whether to acquire or continue investing in the product. When you become a member of REST Super you join the Retail Employees Superannuation Trust ABN REST Super is issued by the Trustee, Retail Employees Superannuation Pty Limited ABN , AFSL All services are provided in REST s capacity as Trustee. The Trustee has no relationships or associations with any other product issuer that might reasonably be expected to influence us in the provision of the advice. Any advice is provided by REST s employees who are paid a salary and may receive a performance related bonus. No commissions or fees are paid for the financial product advice provided, either to representatives or to third parties. Cooling-off period Where you apply for insurance cover online or by completing the Application for insurance form, and the insurer accepts your application, we will write to you to confirm the type, level, cost of cover and any special acceptance terms. You will have 14 days from the date of our confirmation letter to cancel your application and have your previous level of cover (if any) reinstated, provided you have not exercised any rights under additional cover. Any difference in insurance costs between the old and the new cover will be adjusted. Any requests for reduction in your cover received after 14 days from the date of our confirmation letter will be effective from the date REST receives your request. Any previous types or levels of cover will not be reinstated and no retrospective adjustment to your insurance costs will apply. Explanation of the terms in this guide Active Employment Means you: a. are employed by an employer on a casual, temporary or permanent basis to perform identifiable duties; b. are attending that employment or are on fully paid leave except leave caused by sickness or injury; and c. in the insurer s opinion you are not restricted by sickness or injury from being capable of performing the identifiable duties of that employment or the duties of your usual occupation for at least 20 hours each week (even if not working at least 20 hours each week). 30

31 Gainful Employment means you are employed for gain or reward in any business, trade, profession or employment for at least 10 hours per week. Gainful Employment means you are being paid for work under a formal agreement for at least 10 hours a week and you receive money for your work. Incident Date For Death cover, the Incident Date is your date of death. For TPD cover, the Incident Date means, for Part 1 of the definition of TPD, the first day of the three month period referred to in that Part and otherwise, the date on which the member satisfies the definition in Part 2 or 3, as applicable (see page 32 for the definition of TPD). For a Terminal Illness Benefit, the Incident Date is the later of the dates that two medical practitioners (one being a specialist in that particular medical field) certify you as being terminally ill and the certification period has not ended. For IP cover, the Incident Date is the first day of the 60 day Waiting Period. Limited Cover means you are only covered for claims arising from a sickness that became apparent, or an injury that occurred, on or after the date your cover most recently commenced. Limited Cover means you are only covered for new sickness or injuries and won t be able to claim for anything that existed before your cover started. Pre-Disability Income means the average gross monthly income earned by you over the 12 months (or if you have been employed for less than 12 months, over your period of cover) immediately before becoming totally disabled, indexed annually on the anniversary of the claim by the lesser of 3.5% and the annual change in the Consumer Price Index (CPI). If the change in CPI is zero or negative, there will be no indexation for that year. Total Disability (for IP) Total Disability means that, solely due to sickness or injury, you: a. for the first two years of the benefit period are unable to perform any of the Important Duties* of your own occupation b. after expiry of the two years, and for the balance of the benefit period, are unable to perform any of the Important Duties* of your own occupation and any other occupation for which you are reasonably able to perform by reason of education, training or experience c. remain under the regular care, attendance and following the advice of a registered medical practitioner in relation to that sickness or injury d. are not engaged in any occupation (whether or not for reward). The skills, education, training and experience you acquire through rehabilitation in connection with the IP benefit will be considered in determining any reasonably suited occupation. Total Disability is if you re sick or injured and can t perform the main tasks of your current job. Then after two years, the meaning changes to if you can t do your current job or any other job that you may have done (or might be able to do) based on your work history, education or previous experience. Partial Disability (for IP) If you are partially disabled beyond the end of the Waiting Period and have been totally disabled for at least 7 out of 12 consecutive days during the Waiting Period, a Partial Disability benefit will be payable. This benefit will be a proportion of the full monthly benefit. Partially disabled means that due to the sickness or injury that caused Total Disability, you: a. are unable to perform one or more Important Duties* of your own occupation b. are capable of working, whether or not for reward c. are earning a monthly income that is less than his or her Pre-Disability Income d. remain under the regular care, attendance and following the advice of a registered medical practitioner in relation to that sickness or injury. * An Important Duty is one that involves 20% or more of your overall occupational tasks. REST Super Insurance Guide 31

32 Total and Permanent Disablement TPD means disablement where the insurer is satisfied on medical or other evidence that you: Part 1 Part 2 Part 3 a. have been absent from employment for three consecutive months because of sickness or injury; and b. are so disabled at the start of those three months and continuously since that time, that you are unlikely to ever engage in any reasonably suitable occupation. In determining whether an occupation is reasonably suitable for you, the insurer considers the skills you have acquired through education, training and experience. OR If you also have REST IP cover, voluntary TPD cover claims will not be considered until after completion of any relevant rehabilitation in connection with the IP benefit. The skills, education, training and experience acquired through this rehabilitation will be considered in determining any reasonably suited occupation. suffer the total and permanent loss of the use of: a. two hands*, or b. two feet*, or c. one hand* and one foot*, or d. one hand* and the sight in one eye, or e. the sight in both eyes, or f. one foot* and the sight in one eye. * hand means the whole hand below the wrist and foot means the whole foot below the ankle. OR have become so disabled by bodily injury or sickness that you will never be able to perform at least two of the following activities of daily living: i. Dressing the ability to put on and take off clothing without assistance* ii. Bathing the ability to wash or shower without assistance* iii. Toileting the ability to use the toilet including getting on and off without assistance* iv. Mobility the ability to get in and out of bed and a chair without assistance* v. Feeding the ability to get food from a plate into the mouth without assistance*. *assistance means with the help of another person. Where you: a. have been in Gainful Employment at any time during the 13 months prior to the Incident Date, you are considered TPD if you meet any one of Part 1, Part 2 or Part 3. b. have not been in Gainful Employment at any time during the 13 months prior to the Incident Date, or have not returned to work after a period of approved leave without pay or parental leave, you are considered TPD if you meet either of Part 2 or Part 3. c. In the case of Part 2 or Part 3 where the Incident Date is on or after 1 July 2014, the Insurer must also be reasonably satisfied that your ill-health (whether physical or mental) makes it unlikely that you will engage in Gainful Employment for which you are reasonably qualified by education, training or experience. For the purposes of TPD cover, the Incident Date means, for Part 1, the first day of the three-month period referred to in that Part and otherwise, the date on which the member satisfies the definition in Part 2 or 3, as applicable. 32

33 Case Study meets TPD definition Peter works for a mining company and has been driving a crane full time for the past 30 years ever since he left school at the age of 16. Eight months ago, Peter injured his back when getting out of the crane and ruptured some discs in his spine. He has had an operation to repair the damage, but now has pain, restricted movement and is not capable of driving a crane or doing other manual jobs any more. His doctor says he has a 30% whole person impairment but could do an office job if he was given some training to develop his computer skills. Does Peter meet the definition? YES - Peter meets part 1 of the TPD definition because he has been absent from his job longer than three months and is unlikely to be able to return to a job suited to his education, training and experience (that is, he would need to re-train in order to work again). Case Study does not meet TPD definition Liz is 50 and was working casually as a traffic controller at the zebra crossing of her local school for the last two years for less than 10 hours per week. However, during that time, she has experienced chronic back pain from a bulging disc from a prior injury. It is unlikely Liz will work again due to her injuries. Does Liz meet the TPD definition? NO In order to meet Part 1 of the definition, Liz must be in Gainful Employment (working at least 10 hours per week in the 13 months before making a claim). In the case study we can see she has worked less than 10 hours per week for the last 2 years. Since this is not considered to be Gainful Employment, she must meet either Part 2 or 3 of the definition. She does not meet part 2 as she has not lost any limbs or sight and she does not meet part 3 as she can still do activities of daily living. That means Liz does not meet the definition of TPD. Waiting Period (for IP) means the sixty (60) consecutive day period that must expire after you become Totally Disabled before payment of the monthly benefit commences. The Waiting Period begins on the earlier of the date: a. you first consult a medical practitioner about the condition that is causing your Total Disability b. you first stopped work due to the Total Disability provided this is not more than 7 days before you first consulted a medical practitioner and you provide reasonable medical evidence about when the Total Disability began. You may return to work for up to 10 days during the Waiting Period without re-commencing the Waiting Period. The Waiting Period is the period of time you are unable to work before a claim can be made to replace your income. REST Super Insurance Guide 33

34 AIA Australia Privacy Statement Your privacy is important to AIA Australia Limited ( AIA ). The privacy policy of AIA sets out how your personal information is managed by them, and is available at aia.com.au REST Privacy Statement Your privacy is also important to REST. Our privacy policy sets out how your personal information is managed by us, and is available at rest.com.au We re here to listen REST is committed to providing the highest standard of client service and maintaining our reputation for honesty and integrity. If our service or product quality fails to meet your expectations please tell us about your concerns. REST s complaint management process aims to ensure your concerns are treated seriously and addressed promptly and fairly. Have concerns? We re here to help If you have a concern, please contact us to see if we can solve your problem immediately. If you are not happy with our initial response, then you can make a formal complaint. How do I make a complaint? You can make a formal complaint to REST by , letter or phone, noting that you wish to lodge a complaint. To lodge your complaint by contact@rest.com.au with the subject line: Complaint To lodge your complaint by letter: Please address your concerns to: The Trustee Services Officer REST Industry Super PO Box 350 Parramatta NSW 2124 Please write Complaint on the envelope and the letter. How long will we take to respond to your complaint? REST is required to consider your complaint or dispute within 90 days of receiving it. We will acknowledge your complaint in this time, however, in some circumstances it may not be possible to completely resolve it within this period. If the Trustee has not made a decision within 90 days of receipt of your complaint, you may write and request written reasons for REST s failure to make a decision within that period. Written reasons for not making a decision within 90 days of your inquiry or complaint must be given within 28 days of receipt of your request. In the case of a decision as to payment of Death benefits the Trustee must give the member written reasons for our decision. In the case of a decision on other complaints the member may request written reasons. The Trustee must give the member the reasons within 28 days of receipt of the member s request. If we fail to respond to you within 90 days, or you are not satisfied with the outcome, you may be able to seek an independent ruling from the Superannuation Complaints Tribunal. Who is the Superannuation Complaints Tribunal? The Superannuation Complaints Tribunal (SCT) is an independent body set up by the Federal Government to settle certain disputes between members and their super funds. The SCT can only become involved after the Trustee s efforts at reaching agreement have failed (you must first use REST s dispute procedures). While sincere attempts will be made to help resolve differences between members and funds, in some instances the SCT may need to make a binding ruling. The SCT does not charge members for its service and can be contacted on To lodge your complaint by phone: Call us on between 8am and 10pm each weekday. 34

35 The cost of your insurance REST Super Insurance Guide 35

36 This section looks at the costs of your Default Cover and voluntary cover, and how these costs are deducted from your account What is the cost of my cover and how do I pay for it? Your insurance costs will depend on the type of cover you have (Death, TPD or IP) and whether you have Default or voluntary cover: Default Cover is priced based on your age and the level of Default Cover you have voluntary cover is priced based on your age, gender and occupation. required insurance costs. If your cover ends, you will need to provide satisfactory evidence of your health to the insurer before you can take up insurance again in the future. You can keep up to date with your account balance by checking it online in MemberAccess at rest.com.au How much cover do I need? To work out how much Death, TPD or IP cover you might need for your situation, check out our REST Super insurance needs calculator at rest.com.au/calculators Paying insurance costs Insurance costs are deducted from your account balance. If your account balance isn t enough to cover your insurance costs, your cover will end without notice. It s your responsibility to ensure your account always has enough to pay the Example calculating the cost of your cover Jess is 26, has recently joined REST Super and received Default Death cover. Below is a calculation of the cost of her cover (see Table 1 on the next page): Age last birthday = 26 Default cover = $166,800 = 3 units of Death Cover Cost is $0.34 per week per unit, so the cost for 3 units = $0.34 x 3 = $1.02 per week Therefore Jess s Death cover costs $1.02 per week or $53.04 per year. 36