GROUP PERSONAL INJURY INSURANCE

Transcription

1 CHUBB INSURANCE COMPANY OF AUSTRALIA LIMITED A.B.N A.F.S. Licence No: Citigroup Centre, Level 29, 2 Park Street, Sydney 2000 Telephone: Facsimile: DX: DX Sydney Market Street GROUP PERSONAL INJURY INSURANCE

2 SECTION A - POLICY SCHEDULE Policyholder Policy Number Scout Association of Australia (NSW Branch) and/or subsidiary and/or related companies and all parties for whom the Policyholder undertakes to insure for their respective rights and interests. c/- Willis Australia Ltd Level Elizabeth Street New South Wales Australia Type of Policy GROUP PERSONAL INJURY INSURANCE Period of Insurance From: 30th November P.M. Local Standard Time To: 30th November P.M. Local Standard Time Age Limits The Insured Person must be under sixty five (65) years of age. Aggregate Limits of Liability (a) Any one Accident or Occurrence $5,000,000 (b) Non Scheduled Air Travel Single-engine $150,000 Multi-engine $150,000 Helicopter $150,000 Premium & Charges Premium: $82, GST: $8, Stamp Duty: $0.00 Total Premium: $90, In witness whereof, the Company has caused this Policy to be signed by its Authorised Representative. 19th December 2012 Authorised Representative Date Chubb Policy Form Number GPI 0511 Page 1

3 CATEGORIES Category: Insured Persons: Operation of Cover: A All uniformed warranted, non-warranted un-warranted Leaders, non-warranted Voluntary Assistants including Committee Members, Instructors/Examiners, Parents, Pilots, Pilots who are and including the new Community Holiday Vacation Care Program who are commissioned within the Association and Adult (members aged 13 years and over) and youth members of the Policyholder The coverage afforded by this policy shall only apply whilst an Insured Person is engaged in official activities authorised and under the control of the Policyholder including necessary direct travel to and from such activities. Coverage Section Sums Insured Each Insured Person 1. Capital Benefits Event 1 Death $100,000 Event 2 Permanent Total Disablement $100,000 Events 3 15 Other Permanent Disablement $100, Weekly Injury Benefit Event 16 Temporary Total Disablement 75.00% of Income to a maximum of $1,250 Deductible and/or Excess Amounts: Benefit Period 7 days 104 weeks 3. Weekly Sickness Benefit Event 18 Temporary Total Disablement Not Insured 4. Broken Bones $8,000 If no amount is inserted against any one or more Coverage Sections 1-4, this Policy does not provide cover under such Coverage Section (s). Chubb Policy Form Number GPI 0511 Page 2

4 Category: Insured Persons: Operation of Cover: B Youth Members of the Policyholder (members aged 13 years and under) The coverage afforded by this policy shall only apply whilst an Insured Person is engaged in official activities authorised and under the control of the Policyholder including necessary direct travel to and from such activities. Coverage Section Sums Insured Each Insured Person 1. Capital Benefits Event 1 Death $20,000 Event 2 Permanent Total Disablement $20,000 Events 3 15 Other Permanent Disablement $20, Weekly Injury Benefit Event 16 Temporary Total Disablement 75.00% of Income to a maximum of $1,250 Deductible and/or Excess Amounts: Benefit Period 7 days 104 weeks 3. Weekly Sickness Benefit Event 18 Temporary Total Disablement Not Insured 4. Broken Bones $8,000 If no amount is inserted against any one or more Coverage Sections 1-4, this Policy does not provide cover under such Coverage Section (s). Chubb Policy Form Number GPI 0511 Page 3

5 ENDORSEMENT NUMBER : AGE LIMITS MODIFIED This endorsement is applicable to: All Categories It is hereby declared and agreed that the Age Limits in the Schedule is amended to read as follows: Age Limits: The Insured Person must be under 90 years of age. It is further agreed that in respect of Insured Persons over Sixty-five (65) years of age, Event 2, Section 1 is deleted and replaced as follows: Coverage Section 1 Capital Benefits The Events The Benefit Amount Accidental Bodily Injury resulting in: 2. Permanent Paraplegia or Permanent Quadriplegia 100% It is further agreed that the following Definitions are now included in the Policy. Paraplegia means total paralysis of both legs and part or whole of the lower half of the body. Quadriplegia means total paralysis of both arms and both legs. Chubb Policy Form Number GPI 0511 Page 4

6 ENDORSEMENT NUMBER : NON MEDICARE MEDICAL EXPENSES BENEFIT This endorsement is applicable to: All Categories It is hereby declared and agreed that Non Medicare Medical Expenses is included under this Policy: Non Medicare Medical Expenses means expenses that are not subject to any full or partial Medicare rebate nor recoverable by the Insured Person or by the Policyholder from any other source and incurred within twelve (12) calendar months of the Insured Person sustaining Accidental Bodily Injury and paid by the Insured Person or the Policyholder on the Insured Person s behalf for treatment certified necessary by a Physician to a registered Private Hospital, physiotherapist, chiropractor, osteopath, nurse or similar provider of medical services, excluding the cost of dental treatment unless such treatment is necessarily incurred to sound and natural teeth, excluding dentures, and is caused by Accidental Bodily Injury. Non Medicare Medical Expenses does not include any or part of any expenses for which a Medicare benefit is paid or is payable including the balance of monies due or payable by the Insured Person after deduction of any Medicare benefit or rebate from the actual expense incurred. (Commonly referred to as the Medicare Gap ). Provided that We shall not be liable to make any refund in respect of: 1. Any expenses recoverable by the Insured Person or by the Policyholder from any other insurance, scheme or plan providing medical, physiotherapy or similar coverage or from any other source except for the excess of the amount recoverable from such other insurance/plan or source; 2. Any expense to which Section 67 of the National Health Act 1953 (as amended) or any of the regulations made there under apply; 3. The first $0.00 of each and every claim; 4. More than 75 percent (%) of each and every claim made under this section after deduction of the amount applicable in number 3 above. The Benefit Amount Provided always that Our liability under this section shall not exceed $5, for Non Medicare Medical Expenses in respect of any one Accidental Bodily Injury. Chubb Policy Form Number GPI 0511 Page 5

7 ENDORSEMENT NUMBER : BED CARE BENEFIT This endorsement is applicable to: All Categories It is hereby declared and agreed coverage afforded under this Policy is extended to include the following benefit: If as a result of Accidental Bodily Injury, an Insured Person becomes a Bed Care Patient, We will pay the amount of $ for each week (up to a maximum of 26 weeks), that an Insured Person remains a Bed Care Patient beginning with the second day of confinement. A daily rate of 1/7th of the weekly Bed Care Patient Benefit will be paid where an Insured Person remains a Bed Care Patient for less than seven days. DEFINITION: BED CARE PATIENT: means the Insured Person is necessarily confined to bed (such confinement commencing during the Period of Insurance) for a continuous period of not less than 24 hours and the confinement is certified as necessary by a qualified Physician, be under the continuous care of a registered nurse (other than the Insured Person or a member of the Insured Person s immediate family). Bed Care does not include the Insured Person as a patient in any institution used primarily as a nursing or convalescent home, a place of rest, a geriatric ward, a mental institution, a rehabilitation or extended care facility or a place for care or treatment of alcoholics or drug addicts. Chubb Policy Form Number GPI 0511 Page 6

8 ENDORSEMENT NUMBER : DOMESTIC HELP BENEFIT This endorsement is applicable to: All Categories It is hereby declared and agreed that in respect of Non Income Insured Persons, the coverage afforded is extended to include Domestic Help as follows: Domestic Help (Non-Income Earners) Should the Insured Person be a non-income earner prior to sustaining Accidental Bodily Injury the Compensation payable under Event 16 and/or 17 (Weekly Injury Benefit) shall be limited to 75% of the actual cost of hiring domestic help including childcare and outdoor household activities certified as necessary by a qualified Physician, subject to a maximum of $ per week not exceeding 26 weeks for any one event, subject to the Deductible Amount stated in The Schedule, provided that the domestic help is performed by a person who is not a relative of the Insured Person. Chubb Policy Form Number GPI 0511 Page 7

9 ENDORSEMENT NUMBER : STUDENT TUTORIAL BENEFIT This endorsement is applicable to: All Categories It is hereby declared and agreed that the coverage afforded to Insured Persons is extended to include Student Tutorial Benefit as follows: Should the Insured Person be a full time student the Compensation payable under Event 16 and/or 17 (Weekly Injury Benefit) shall be limited to 75% of the actual cost of Home Tutorial Expenses certified as necessary by a qualified Physician subject to a maximum of $ per week not exceeding 26 weeks for any one event, subject to the Deductible Amount stated in The Schedule provided that the Home Tutorial is performed by a person who is not a relative of the Insured Person. Chubb Policy Form Number GPI 0511 Page 8

10 ENDORSEMENT NUMBER : AGE LIMITS MODIFIED This endorsement is applicable to: All Insured Persons over the age of 65 It is hereby declared and agreed that Section 1, Event 2 is deleted and replaced as follows: Coverage Section 1 Capital Benefits The Events The Benefit Amount Each Insured Person Accidental Bodily Injury resulting in: 2. Permanent Paraplegia or Permanent Quadriplegia 100% It is further agreed that the following Definitions are now included in the Policy. Paraplegia Quadriplegia means total paralysis of both legs and part or whole of the lower half of the body. means total paralysis of both arms and both legs. Chubb Policy Form Number GPI 0511 Page 9

11 ENDORSEMENT NUMBER : Notwithstanding anything contained herein it is hereby declared and agreed that the policy is extended to included cover as follows: Dental Benefit It is hereby declared and agreed that Section 1 Capital Benefits is extended to cover Dental Benefits defined as follows; Accidental Bodily Injury resulting directly in the following Broken or lost teeth which occur within eighteen (24) months of the day of Accidental Bodily Injury Maximum Benefits Payable Each Payable Person Permanent or Second Teeth (Not Being Dentures or Dental Fillings) 1. Loss of Teeth $1,500 per tooth 2. Capping of Damage Teeth $1,500 per tooth 3. Damage to teeth not provided for by 1. or 2. $ 200 per accident Cover only applies for sound and natural teeth and excludes Milk/First Teeth. The Maximum Benefit Payable for broken or lost teeth with respect to any one Accidental Bodily Injury is $4,000. Chubb Policy Form Number GPI 0511 Page 10

12 ENDORSEMENT NUMBER : It is hereby declared and agreed the Benefit payable for any claim resulting in Paraplegia or Quadriplegia to an Insured Person under the age of 65 years is $175,000. Chubb Policy Form Number GPI 0511 Page 11

13 ENDORSEMENT NUMBER : It is hereby declared and agreed the following Broken Bones benefits are payable: Neck or Spine (full break) - $8,000 Hip or Pelvis - $8,000 Skull or Shoulder Blade - $1,600 Collar Bone or Upper Leg - $1,300 Upper Arm, Kneecap, forearm or elbow - $1,300 Lower leg, Jaw, Wrist, Cheek, Ankle, Hand or Foot - $500 Finger, Thumb or Toe - $400 Chubb Policy Form Number GPI 0511 Page 12

14 ENDORSEMENT NUMBER : Non Scheduled Pilot Activities It is hereby declared and agreed General Exclusion 1 of the policy is deleted. Chubb Policy Form Number GPI 0511 Page 13