Insurance Cover (Salary Continuance)

Transcription

1 Reference Guide Insurance Cover (Salary Continuance) Many Australians insure their homes and cars but don t adequately insure some of their most important assets their life and ability to earn an income. Insurance cover may provide financial security for you and your family if something happens to you. THIS REFERENCE GUIDE WAS ISSUED ON 1 JULY The information in this document forms part of the Product Disclosure Statement (PDS) for Accumulate Plus dated 1 July The Reference Guide should be read in conjunction with the relevant PDS and is not intended to be read as a document in its own right. This Reference Guide was prepared and issued by Commonwealth Bank Officers Superannuation Corporation Pty Limited (ABN , AFSL ), the trustee of Commonwealth Bank Group Super (the fund) (ABN , SPIN OSF0001AU). We may change any of the matters about the fund as described in this Reference Guide at any time. If a change adversely affects you, we will notify you as required by law. If a change is not materially adverse, we may not update the Reference Guide but instead issue an update notice, either before or after the change occurs. You should check for any update notices, or the most up-to-date PDS or Reference Guide, which are available free of charge from oursuperfund.com.au/memberbooklets or by calling us on It s possible that changes can occur in the future, which may be without prior notice to you. The information in this Reference Guide is general information only and does not take into account your individual objectives, financial situation or needs. You should consider the information contained in the PDS and this Reference Guide and its appropriateness, having regard to your own objectives, financial situation and needs, before making a decision about this product. The PDS and all Reference Guides are available and can be obtained from our website or by calling us. You should seek professional advice tailored to your personal circumstances from an authorised financial adviser. Commonwealth Bank Group Super Accumulate Plus and Retirement Access members oursuperfund.com.au from 8am to 7pm (AEST) Monday to Friday oursuperfund@cba.com.au GPO Box 4758, Sydney NSW 2001 In this Reference Guide: Summary of Salary Continuance 2 Cover in Accumulate Plus 3 About the insurance policy 3 Important things to consider before applying for cover 3 Transferring cover from CBA Employee Income Protection 4 Transferring cover from another eligible super fund or policy 5 Applying for, changing or cancelling insurance cover 7 Cooling-off period 8 Automatic indexation of cover in some circumstances 8 Paying for insurance cover 9 Notifying us of an insurance claim 10 Eligibility for a Salary Continuance benefit, including definitions 10 Calculating and paying a monthly benefit 11 Exclusions when a benefit won t be paid 12 Privacy and the claims process 13 Cover generally applies worldwide 13 End of cover 13 Your duty of disclosure 14 Insurance risk 14 Definitions and terminology 15 Appendix 1: Female premium rates 16 Appendix 2: Male premium rates 17 (02)

2 Summary of Salary Continuance This is an overview of the features of cover in Accumulate Plus you should also refer to information in the other sections of this document. Ways in which you may obtain cover General eligibility to apply for cover Cover amounts Waiting period & benefit payment period When your cover and/ or premiums can change automatically Start & end of cover Claiming for an insurance benefit In some circumstances, you may have Salary Continuance or Income Protection cover through another source. You should confirm these arrangements before applying for cover in Accumulate Plus. Refer to page 3 for more information. Salary Continuance cover is not provided automatically in Accumulate Plus but you may be eligible to obtain cover as follows: Transfer cover from CBA Employee Income Protection policy upon leaving employment with the Commonwealth Bank Group (the Group) through a shorter application and assessment process that may not require you to provide full health and medical evidence (page 4). Transfer cover from another super fund together with your account balance through a shorter application and assessment process that may not require you to provide full health and medical evidence (page 5). Transfer cover from an eligible stand-alone CMLA policy through a shorter application and assessment process that may not require you to provide full health and medical evidence (page 5). Apply for cover through the insurer s standard application and assessment process, which may include the need to provide additional health and medical evidence (page 7). You must be under age 65. Additional eligibility criteria also apply, depending on how you are applying for cover: Requesting to transfer cover from CBA Employee Income Protection (page 4). Requesting to transfer cover from another eligible super fund or CMLA policy (page 5). Applying for new or varied cover (page 7). Policy minimum and maximums: You can choose any fixed dollar amount of cover subject to the following: Minimum cover of $100 per month Maximum cover of the lesser of (i) 75% of your monthly income or (ii) $25,000 per month. Important note: You will pay monthly premiums based on your accepted level of cover. In the event of a claim, your pre-disability income (page 11) will be used to determine any benefit amount payable. If your pre-disability income is less than the level of cover you are paying for, a benefit based on the lower amount will be paid (page 11). In this case, the excess premiums will not be refunded. It is therefore important that you notify us if your income changes to the extent that it is less than your accepted amount of cover. It is also important to review your level of cover if your income increases in the future to ensure that you have an adequate level of cover for your circumstances. Waiting period options refer to page 10: You can choose from two waiting periods for your cover: (i) 90 days or (ii) 30 days. A higher premium rate applies to cover with a 30-day waiting period. Benefit payment period options refer to page 12: You can choose from two benefit payment periods for your cover: (i) 2 years or (ii) until age 65. A higher premium rate applies to cover with a benefit period to age 65. Note: For cover transferred into Accumulate Plus, certain waiting and benefit payment periods may automatically apply in the first instance but you may apply to change these after the transfer if required. Changes to your amount of cover and/or premiums: Premium rates are based on age and change on the first premium due date after your birthday each year (page 9). If you are a former Group employee or spouse member, your amount of cover is automatically indexed each year by the lesser of 7.5% or the CPI, unless you opt out (page 8). Premiums will increase accordingly. Start of cover: Cover begins as outlined below and once there is sufficient money in your account to cover your first monthly premium when due. You will be notified in writing of the outcome of your application and if accepted, the date your cover begins. For transfers from CBA Employee Income Protection and eligible CMLA policies, cover begins from the date we receive your completed request form. For transfers from another super fund, cover begins from the date we receive the transfer of your account balance. For applications for cover, cover begins from the date the insurer accepts your application. End of cover: Refer to page 13 for the circumstances in which your cover will end. Notification: You or your representative should notify us as soon as possible after becoming aware of a claim or potential claim so we can start the claims process. General claim criteria: Payment of any insurance benefit is subject to cover being in place and the insurer accepting a claim under the terms and conditions of the insurance policy. Some insured events have a particular meaning in the insurance policy and/or super law in order to be eligible for a benefit, e.g. total disability and partial disability (page 10). Exclusions: In some limited circumstances an exclusion may apply, which means a benefit may not be payable (page 12). 2

3 Looking for help or advice? As part of the services we offer to members, we have a team of financial advisers available to provide advice to you over the phone. As a member, there is generally no cost to you to use this service for advice relating to options about your Accumulate Plus account, e.g. super contributions, investment options or insurance cover. A fee may apply if advice is provided outside this scope, e.g. consolidating accounts the adviser will let you know these details beforehand if this is the case. To talk with this team, simply call us on and ask to speak with the Advice team 1. You also have the option to have the fees you agree with any licensed financial adviser of your choice for advice about your account in our fund deducted from your Accumulate Plus account balance (some conditions apply). This can be a tax-effective way to pay for financial advice, as fees are paid from your super account rather than your take-home pay. Cover in Accumulate Plus The following types of insurance cover are available to eligible Accumulate Plus members: Death and Total and Permanent Disablement (TPD) cover, where a lump sum benefit may be paid if you die, become terminally ill or become totally and permanently disabled. More information is provided in the separate Reference Guide: Insurance Cover (Death and TPD). Death-only cover, where a lump sum benefit may be paid if you die or become terminally ill. More information is provided in the separate Reference Guide: Insurance Cover (Death and TPD). Salary Continuance cover (also known as Income Protection), where a monthly benefit may be paid if you are disabled due to sickness or injury for longer than the waiting period. More information is provided in this Reference Guide. About the insurance policy Cover for Salary Continuance in Accumulate Plus is provided through an insurance policy that the trustee has with the insurer, The Colonial Mutual Life Assurance Society (ABN ) (CMLA). The trustee may change the insurer at its discretion. This Reference Guide provides a summary of the features of Salary Continuance and the terms and conditions of the insurance policy dated 1 October The full terms and conditions of cover are set out in the insurance policy this document is available upon request if needed. In some cases, different terms and conditions may apply, e.g. where a date of disablement occurred, before 1 October In addition, if you applied for cover before 1 October 2017, your start of cover eligibility requirements may have been different. Please contact us for more information if needed. The policy can be varied by agreement between the insurer and the trustee. In certain circumstances, the insurer can also change the eligibility criteria or premium rates. We will notify you of any changes. Important things to consider before applying for cover Are you covered under other salary or income insurance cover? Before applying for new Salary Continuance, you should confirm if you are covered for any salary continuance or income protection benefits through another source, e.g. arrangements through your employer or another super fund, or a policy held directly with an insurer. While you may choose to hold more than one policy for this type of cover, you should be aware that you may not receive the full benefit amount from one or more of those policies in the event of a claim. This is because any benefit payable will generally be reduced, or offset, by other sources of income, including other salary continuance or income protection policies (page 11). If you have cover through another super fund or certain standalone CMLA policies and would like to consider transferring that cover into Accumulate Plus, refer to page 5 for more information. Commonwealth Bank Employee Income Protection If you are a current Group employee, you may be eligible for cover that is funded by the Group under the CBA Employee Income Protection policy (CBA EIP). This is a separate arrangement to any cover offered through Accumulate Plus. To find out more about the features of CBA EIP, visit and search for income protection. To confirm if you are eligible for this cover, you will need to contact HR Direct. To help you maintain access to this type of cover if you leave the Group, you may be eligible to transfer your CBA EIP cover into Accumulate Plus without needing to provide full health and medical evidence to the insurer. Premiums will be deducted from your account for any transferred cover, therefore you need to ensure there are sufficient funds in your account. You must apply to transfer CBA EIP within 90 days of leaving employment. If we receive a request after 90 days from that date, the insurer s standard application and assessment process will apply. More information on transferring CBA EIP cover is provided on page 4. 1 Advice relating to Accumulate Plus is provided by the Advice Essentials team, operating under Commonwealth Financial Planning Limited (ABN , AFSL ). 3

4 Does (or will) your cover reflect your actual salary or income? Salary Continuance or income protection insurance is designed to replace a significant portion of your income if you have to stop work due to illness or injury, so it is important that you have an income to insure. The calculation of any benefit that may be payable will take into account your actual income at the time of your disablement, i.e. your pre-disability income (page 11). If you are not employed or earning a regular income, either now or at some time in the future, a benefit may not be payable from this type of insurance cover in the event of a claim. Similarly, it is important to make sure the amount of cover you have reflects the current income you are actually receiving. Your monthly premiums are calculated based on your accepted level of cover but in the event of a claim, your pre-disability income will be used to determine any benefit amount payable. If your pre-disability income is less than your level of cover, a lower benefit amount will be paid (page 11). In this case, any excess premiums paid for the higher level of cover will not be refunded. It is therefore important that you notify us if your income changes to the extent that it is less than your accepted amount of cover. It is also important to review your level of cover if your income increases in the future to ensure that you have an adequate level of cover for your circumstances. Transferring cover from CBA Employee Income Protection If you were covered under the CBA Employee Income Protection policy (CBA EIP) and are leaving (or have left) employment with the Group, you may be eligible to transfer your CBA EIP cover into Accumulate Plus without needing to provide full health and medical evidence to the insurer. This may make it easier for you to continue having access to this type of cover. Eligibility to transfer CBA EIP The following conditions apply in order to transfer CBA EIP into an existing Accumulate Plus account: You have left employment with the Group and were covered under the CBA EIP immediately before your date of exit. You are less than 65 years of age. You must apply to transfer cover within 90 days of leaving employment in order to take advantage of transferring cover without having to provide full health and medical evidence. Any request for cover that we receive after this 90-day window will not be eligible, therefore you will need to undergo the full application and assessment process, which may include provision of medical evidence. You must ensure there is sufficient money in your account to cover the applicable premium. You are not eligible to transfer cover into Accumulate Plus from CBA EIP if any of the following apply: You have received, been admitted for or are eligible for a terminal illness or permanent incapacity or TPD benefit from any super fund, insurance policy or any state or federal government body. You have previously had an application for Death, TPD and/or Salary Continuance declined. Due to injury, illness or impairment, you are either (i) not capable of working 35 hours a week, (ii) have had your duties or workplace modified in the last two years and have not resumed your pre-modified duties, or (iii) are in a role or occupation that has been designed or chosen to suit your medical needs. If you are not eligible to transfer insurance cover, you may still be eligible to transfer cover from another eligible fund or policy (page 5) and/or to apply for new cover or change any existing cover in Accumulate Plus through the insurer s standard application and assessment process (page 7). Important If you don t have an existing Accumulate Plus account, please keep in mind that you can only open a new account if you are an employee of the Group or its Associated Employers, or if you have another type of account in our fund, at the time of application. To open a new account, refer to the Member Guide (PDS) for Accumulate Plus, which includes an application form. It s important that you allow sufficient time for us to receive and process your completed application before your exit date from the Group. Once you have left employment, you will not be eligible to open an account in order to transfer your CBA EIP cover, or for any other purpose, unless you were to be re-hired as a Group employee in the future. Amount of cover you can transfer You can apply to transfer any amount of cover up to the full amount of cover that you hold in CBA EIP. Your requested cover amount will be applied to your Accumulate Plus account as follows: Existing Accumulate Plus cover Cover from CBA EIP New total cover in Accumulate Plus No existing cover $4,000 per month $4,000 per month $3,000 per month $4,000 per month $4,000 per month $3,000 per month $2,000 per month $3,000 per month 2 Any special conditions, such as an exclusion or loading, that applied to your CBA EIP cover immediately before it is transferred will continue to apply in Accumulate Plus. Note: If you have existing cover in Accumulate Plus that is limited or restricted in any way, that limitation or restriction will not apply to any transferred cover. 2 Although there is no change to your cover amount, your waiting and/or benefit payment periods may be affected if they are different to those that apply to CBA EIP. 4

5 How waiting periods and benefit periods apply to transferred cover The waiting and benefit payment periods that apply to your cover once transferred into Accumulate Plus will be the same as they were under CBA EIP: Waiting period: 90 days Benefit payment period: 2 years Accumulate Plus also offers options for a 30-day waiting period and/or a benefit payment period of up to age 65. After your cover is transferred, you can apply to increase your waiting and/or benefit payment period if required (page 7). This will be subject to the insurer s standard application and assessment process, which may be accepted or declined on that basis. A higher premium rate applies for cover with these options. Important note if you have existing cover in Accumulate Plus If your existing cover has a different waiting period and/or benefit payment period from those shown in this section, it is important for you to understand that any transferred cover will effectively cancel and replace existing cover. For example, you have previously applied for cover of $4,000 per month and elected to have a 30-day waiting period and a benefit payment period until age 65. If you transfer CBA EIP cover of $5,000 per month, your total cover in Accumulate Plus after the transfer will be $5,000 per month and the full amount will be subject to a 90-day waiting period and 2-year benefit payment period, i.e. the conditions that applied to CBA EIP, not your existing Accumulate Plus cover. You may apply to increase your waiting and/or benefit payment periods after cover is transferred. This will be subject to the insurer s standard application and assessment process and may be accepted or declined on that basis. You should carefully consider the implications on your existing cover before confirming any request to transfer CBA EIP cover. You should consider seeking professional advice from a licensed financial adviser. How to apply to transfer cover Please remember that any cover will be subject to the rules and premiums applicable to Accumulate Plus once transferred and these may be different to the rules and premiums that applied to CBA EIP. You should carefully consider the rules that apply to CBA EIP and to Accumulate Plus before deciding to transfer cover. To transfer cover from CBA EIP Complete our Request to transfer insurance cover from CBA EIP form (oursuperfund.com.au/forms) we must receive this form within 90 days of the date you left the Group, otherwise the insurer s standard application and assessment process will apply. Effective date for transferred cover If your transfer request is accepted, your cover will commence on the later of (i) as at the date we received your completed form, or (ii) the date your Accumulate Plus account is opened. Your monthly insurance premium will change based on your new level of cover, effective from the start date of your cover. Premium deductions will commence on the next premium due date after the start date of cover. A cooling-off period applies to any cover transferred into Accumulate Plus (page 8). Transferring cover from another eligible super fund or policy If you have a super account in another fund, you may be eligible to transfer any Salary Continuance or income protection associated with that account, together with your balance, into Accumulate Plus. This may make it easier for you to consider consolidating your super accounts. You may also be eligible to transfer certain stand-alone policies for Salary Continuance that you hold through the fund s insurer, CMLA. Eligibility to transfer cover To be eligible to transfer Salary Continuance from another eligible fund or policy, all of the following conditions must apply up until the date of transfer: You are less than 55 years of age. The cover you are applying to transfer is from the following eligible sources: i) cover you hold through another Australian super fund, providing you have held this cover for at least 12 months prior to the transfer date and you are also transferring your entire account balance from that fund into Accumulate Plus at the same time, or ii) cover you hold through an eligible stand-alone (i.e. non-super) policy with CMLA, e.g. Total Care Plan or Income Care, providing you have held this cover for at least 12 months prior to the transfer date. It will be at the insurer s discretion after receiving your request whether to accept the transfer from your policy. Note: You cannot transfer cover that you have held for less than 12 months as at the date of transfer, cover that you hold through a self-managed super fund or defined benefit arrangement, or cover that you hold through a stand-alone policy with an insurer other than CMLA. The cover you are applying to transfer has a waiting period of 90 days or less and/or a benefit period of 2 years or more, other than to age 65. Note: If you have existing Salary Continuance in Accumulate Plus, you can only transfer cover if your waiting period in your other fund or policy is equal to or less than your 5

6 existing waiting period and your other benefit period is equal to or greater than your existing benefit period. You are not eligible to transfer cover into Accumulate Plus if any of the following apply: You have received, been admitted for or are eligible for a permanent incapacity or TPD benefit from any super fund, insurance policy or workers compensation legislation. You have been diagnosed with a condition that reduces your life expectancy to less than 24 months. The insurer has previously declined an application to cover you or increase your cover in Accumulate Plus. You have or will exercise any continuation of cover option available through your previous fund. In the last 12 months, you have been advised to undergo treatment or to take medication prescribed by a medical practitioner that was intended to last for three months or longer, excluding the contraceptive pill, hormone replacements, inhaled asthma medication or cold, flu or hay fever medication. Due to injury, illness or impairment, you are either (i) not capable of working 35 hours a week, (ii) have had your duties or workplace modified in the last two years and have not resumed your pre-modified duties, or (iii) are in a role or occupation that has been designed or chosen to suit your needs. When requesting to transfer cover, you must provide us with satisfactory evidence from your other eligible fund or policy of the cover that applied to you immediately before the request to transfer. This evidence can generally be a document issued by your other eligible fund or policy that outlines the type and amount of cover that you hold, along with any premium loadings, exclusions or restrictions that apply to your cover. A valid document may be a benefit statement, certificate of currency or other confirmation document on the other eligible fund or insurer s letterhead and it must be dated no more than six months before the date we receive your request to transfer. If you are not eligible to transfer insurance cover, you may still be eligible to apply for new cover or change any existing cover in Accumulate Plus by applying through the insurer s standard application and assessment process (page 7). Amount of cover you can transfer You can apply to transfer any amount of cover up to the full amount of cover that you hold in your other eligible fund or policy. You can transfer cover associated with multiple super funds or accounts and/or eligible CMLA policies, subject to your total insurance cover in Accumulate Plus after the transfers not exceeding the policy maximums (page 2). If you request to transfer cover from another eligible fund or policy and this transfer will make your total Salary Continuance in Accumulate Plus greater than $10,000 per month, the maximum amount that may be approved under the transfer of cover terms will be $10,000. For any additional portion of cover that you wish to transfer that would take your total cover above this limit, you will need to complete our Insurance application and acceptance of this additional portion will be subject to the insurer s standard assessment process. How the transferred amount is applied When cover is transferred from another eligible fund or policy, cover will be applied or increased in Accumulate Plus to equal your other cover, subject to product maximums (page 2) and transfer limits (see previous section). If you have existing cover in Accumulate Plus that is higher than your other cover, no change to the amount of cover will apply, i.e. the higher amount will continue to apply. For example: Existing Accumulate Plus cover Cover from other eligible fund/policy New total cover in Accumulate Plus No existing cover $4,000 per month $4,000 per month $3,000 per month $4,000 per month $4,000 per month $3,000 per month $2,000 per month $3,000 per month (no change) Any special conditions, such as an exclusion or loading, that applied to your other cover immediately before it is transferred will continue to apply in Accumulate Plus. If your existing cover in Accumulate Plus is limited or restricted in any way, the relevant limitation or restriction will also apply to any cover transferred from another eligible fund or policy. How waiting periods and benefit periods apply to transferred cover If you do not have existing Salary Continuance in Accumulate Plus, the waiting and benefit periods applied to your transferred cover will be as follows: If the period in your other eligible fund or policy was: Waiting period of 30 days or less Waiting period of more than 30 days Benefit payment period to age 65 (or higher) Benefit payment period of any other length (other than to age 65) The period in Accumulate Plus will be: 30-day waiting period 90-day waiting period Age 65 benefit payment period 2-year benefit payment period If you have existing Salary Continuance in Accumulate Plus, the waiting period and benefit payment period that applies to your transferred cover will be the same as those that apply for your existing cover. 6

7 How to apply to transfer cover Please remember that any cover will be subject to the rules and premiums applicable to Accumulate Plus once transferred and these may be different to the rules and premiums that applied to your other eligible fund or policy. You should carefully consider the rules that apply to your other cover and to Accumulate Plus before deciding to transfer cover. It is important that you do not close your account or cancel your existing cover in your other eligible fund or policy until you have received confirmation in writing from us that your request to transfer cover into Accumulate Plus has been accepted by the insurer. To transfer cover from another eligible super fund Complete our Request to transfer super and insurance cover form (oursuperfund.com.au/forms) you will need to complete both parts of this form, Part A: Request to transfer my super balance and Part B: Request to transfer insurance cover. To transfer cover from an eligible CMLA policy Complete our Request to transfer insurance cover from a CMLA policy form (oursuperfund.com.au/forms) Effective date for transferred cover If your request to transfer from another super fund is accepted, your cover will commence as at the date we receive your transferred account balance. For accepted transfers from an eligible CMLA policy, your cover will commence as at the date we received your completed request form. Your monthly insurance premium will change based on your new level of cover, effective from the start date of your cover. Premium deductions will commence on the next premium due date after the start date of cover. A cooling-off period applies to any cover transferred into Accumulate Plus (page 8). Applying for, changing or cancelling insurance cover As your personal circumstances change from time to time, it s important to re-evaluate and make sure you have insurance cover that suits you. You can apply for new cover or change or cancel any existing cover at any time, subject to the rules set out in the PDS and this Reference Guide. There is no fee to change your cover but your monthly insurance premium will change based on your new level of cover once accepted by the insurer. Eligibility to apply for new or increased cover The following general eligibility criteria apply to any application for new or varied cover: You are less than 65 years of age. You are employed on a permanent basis (page 15), including a fixed term arrangement. If you are self-employed, you will also need to provide proof of income for at least the last 12 months. You work in an occupation and/or industry that the insurer considers to be white collar. Note: This condition applies only in the case of an application for new or increased cover; if you work in a non-white collar occupation and/or industry, this will not otherwise affect, or reduce any benefit entitlement from, any existing cover provided to you previously while you were in a white-collar occupation or industry. In addition to these general eligibility criteria, the insurer will consider any application for new or increased cover on the basis of any medical evidence that you are requested to provide (refer to the following section). If we determine that an application form is incomplete, we will not send it to the insurer until we receive completed information from you. To cancel your insurance cover To decrease your insurance cover To apply for new or increased insurance cover Call us on us at oursuperfund@cba.com.au using the address that you have provided to us for your account Complete our Decrease/Cancel insurance cover form (oursuperfund.com.au/forms) Complete our Decrease/Cancel insurance cover form (oursuperfund.com.au/forms) Complete our Insurance application form (oursuperfund.com.au/forms) Medical evidence is required for new, increased or varied cover If you apply for new, increased or varied cover, you will need to provide information about your health, which may include medical tests, in order for the insurer to assess your application. The information required will depend on your age, health and medical history, and the amount of cover you have applied for. The minimum requirements that the insurer generally requests for Salary Continuance applications are outlined in the following table. The insurer may change these requirements without notice or request additional information depending on your circumstances. Accordingly, you should only use this information as a guide. 7

8 Initial medical evidence for Salary Continuance cover Age 18 to If requested cover is: You will need to provide: Up to $10,000 per month A A $10,001 to $15,000 per month A B $15,001 to $20,000 per month B C $20,001 to $25,000 per month C D Key to initial medical evidence requirements in the table: A Insurance Application B Insurance Application, HIV, Hepatitis B & C serology & MBA20 C Insurance Application, HIV, Hepatitis B & C serology & PMAR D Insurance Application, HIV, Hepatitis B & C serology, MBA20, Medi Lite & PMAR Note: The Insurance application form is available from our website. The following additional information may help you understand these medical evidence requirements: MBA20 (Multiple Biochemical Analysis): This is a fasting blood test that analyses 20 different chemicals in the blood and also includes an analysis of HDL/LDL cholesterol. MediLite: This is a basic medical check performed by a trained nurse. Blood pressure readings, height, weight and a urine test are obtained. It is a convenient, fast alternative to a GP medical examination. HIV: This is a blood test to identify the presence of the human immunodeficiency virus. PMAR (Personal Medical Attendant s Report): This is a report completed by your usual doctor. It is requested directly from your doctor by United Healthcare Group (UHG), which is a medical provider used by the insurer. Your doctor would complete this form using data from your patient records. You won t need to attend any appointments. You do not have to arrange any additional tests before you apply for cover. Generally, upon receiving your application, the insurer will give your contact details to UHG, which is a mobile health evaluation service provider. A UHG nurse consultant will then contact you directly to arrange to conduct the tests at a time and place that suits you. There is no cost to you for this service. Alternatively, you can ask your local doctor, pathologist or health service provider to conduct the tests and send us the results with your application for cover. The insurer may accept or reject your application based on the information you supply and the results of any medical tests. The insurer may also impose special conditions or restrictions when accepting your application. The insurer may also request and pay for a detailed medical report from your usual doctor for an application for any level of cover. The insurer will generally pay the costs of any medical examination or medical report that they request. However, the insurer will not pay for any other costs, such as the cost of travelling to or from an appointment or any fee if you do not attend an arranged appointment. Your new, increased or varied level of cover will begin if and when the insurer accepts your application and there are sufficient funds in your account to cover your first monthly premium when due. Your monthly insurance premium will change based on your new level of cover effective from the start date of your cover. Premium deductions will commence on the next premium due date after the start date of cover. No interim cover is provided while an application for new or increased Salary Continuance is being assessed by the insurer. Cooling-off period If you apply for new or increased cover, you have 60 days from the date you receive our written acceptance to check that any change in cover meets your needs. This cooling-off period applies to cover you have applied for (page 7) or cover that you have transferred into Accumulate Plus from CBA EIP (page 4) or from another eligible fund or policy (page 5). To cancel the change in cover, you must advise us in writing or by phone before the end of the 60-day period. We will refund your account with any premiums you have paid, from the date the cover commenced or increased. Automatic indexation of cover in some circumstances If you are a former Group employee or a spouse member, your amount of cover for Salary Continuance will be automatically indexed each year by the lesser of 7.5% or the CPI (subject to a maximum cover of $25,000 per month), unless you opt out of indexation. Your monthly premiums will increase accordingly with indexation. Please call us on if you require more information on opting out of indexation if required. Note: Automatic indexation does not apply if you are a current Group employee. 8

9 Paying for insurance cover Premiums apply to all cover in Accumulate Plus Insurance premiums apply for any cover that you hold in Accumulate Plus, including any cover that you have applied for (page 7) and cover transferred from CBA EIP (page 4) or another eligible fund or CMLA policy (page 5). Your insurance premiums will be influenced by the amount of cover, the waiting period and benefit payment periods you choose, your age, sex, and any special circumstances that apply to you. Premium rate tables for Salary Continuance are provided in Appendix 1 and 2 on pages 16 and 17. The fund is entitled to a tax benefit for the premiums we pay to the insurer for our insurance policies. We pass this tax benefit on to you by reducing your premiums. The premium rates in Appendix 1 and 2 provide the gross premium rate before the tax benefit is applied, as well as the net premium rate that will be deducted from your account after the tax benefit is applied. Premium rates for Salary Continuance exclude any stamp duty that may be payable, which varies depending on your state, therefore the insurance premium deducted from your account may be higher. Salary Continuance premiums will be waived if you are receiving a monthly benefit in the event of an accepted claim. In some cases, when accepting an application for cover or increased cover, the insurer may also determine that a loading, i.e. an additional premium, applies to your insurance premiums due to your occupational, personal or medical circumstances. This will be advised to you if and when your application is accepted. Premiums are deducted monthly Insurance premiums are paid in advance and deducted from your Accumulate Plus account at the beginning of each month. Premiums are calculated based on your amount of cover, your age at your next birthday and the premium rates applying at the date your premium is deducted. If you have selected more than one investment option for your account, you can give instructions for one option from which your insurance premiums and administration fees are deducted. If you don t nominate an option or if there are insufficient funds in the option you nominate, insurance premiums and administration fees will be deducted according to the trustee s default investment option order, which is generally from the most conservative of your investment options first. If required, please call us for more information about the current default order. Important note: Your insurance cover may lapse if there is not enough money in your account to cover your premium when due. We will notify you after the first unsuccessful attempt to deduct your premium so that you have the opportunity to top up your account. If, after 90 days from the first unsuccessful attempt, there remains insufficient money in your account to cover the current premium and premiums for the missed months, your cover will lapse. If you receive a notice from us advising that your cover has lapsed and you subsequently want to continue your cover, you will need to apply subject to the insurer s standard application and assessment process. The insurer may accept or decline your application for cover. Estimating annual insurance premiums Premiums for Salary Continuance are based on an annual rate per $100 of monthly cover, therefore your annual premium is calculated as: [(Annual insured amount 12) $100)] x applicable premium from Appendix 1 or 2 Circumstances in which premiums will change automatically There are times when your insurance premiums will change even if you have not requested a change to your amount of cover. This may happen in the following situations: On the first premium due date after your birthday each year your premium rate will change based on your new age next birthday. If you are not a current Group employee, including where you are a spouse member, your Salary Continuance cover is automatically indexed each year by the lesser of (i) 7.5% or (ii) CPI, subject to the policy maximum (page 2). When indexation of your cover occurs prior to the first premium due date in July in year, your premiums will increase accordingly. You can choose to opt out of automatic indexation but you cannot opt back in at a later date. Contact us for more information on opting out if required. Premium rates may change from time to time Insurance premium rates may change from time to time and may be changed without your consent. If the insurer increases premium rates, we will give you advance notice within the time period specified by law, which is generally at least 30 days before the change is to take effect. To give deduction instructions for premiums and fees Complete our Investment selection form (oursuperfund.com.au/forms) You can also give these instructions on our Insurance application form at the same time as you apply for any new or increased cover. 9

10 Notifying us of an insurance claim You or your representative must notify us as soon as possible after becoming aware of a claim or potential insurance claim. You must provide us or the insurer with any requirements reasonably considered to be necessary in order to properly assess your claim, at your own expense if required. Payment of any insurance benefit is subject to the relevant cover being in place at the time of disablement and the trustee and insurer accepting your claim under the terms and conditions of the trust deed and the insurance policy. The insurer may pay a Salary Continuance benefit in conjunction with a Total and Permanent (TPD) benefit if you have both types of cover and you meet the conditions for both benefits. Refer to the separate Reference Guide: Insurance Cover (Death and TPD) for more information on TPD cover and benefits. Eligibility for a Salary Continuance benefit, including definitions Waiting period A waiting period will apply to any claim for a Salary Continuance benefit. The waiting period is a continuous period of 90 or 30 days, depending on the option you selected when applying for cover, in which you must be totally or partially disabled, as defined in the following section and table, to be eligible for a benefit. You must also be totally disabled for at least 14 of the first 19 consecutive days of the waiting period to qualify for a benefit. The waiting period will restart if you return to work at full capacity, unless the return to work happens once and is for no more than five consecutive days, in which case the number of days worked are added to the waiting period. If you become disabled again from the same or a related cause within six months of last receiving a Salary Continuance benefit, another waiting period will not apply. However, the insurer will treat this as a continuation of the original claim and add both periods of disability, and any subsequent periods, to determine when the benefit payment period ends. Definitions of disablement For the purposes of assessing whether a Salary Continuance benefit is payable, the definitions of disablement that apply under the trustee s insurance policy are outlined in the following table. Definition Total disability Partial disability For the purposes of Salary Continuance, this definition means... You will be totally disabled if, because of sickness or injury, you have ceased to be gainfully employed and all of the following apply to you: you are unable to perform at least one income-producing duty of your own occupation, you are under the regular care of, and following the advice of, a medical practitioner, you are not working in any occupation, whether or not for reward; where: income producing duty is a duty of your occupation immediately before you became totally disabled that generates or generated 20% or more of your income; own occupation means the normal occupation or work you carried out immediately before becoming disabled; gainfully employed means employed or self-employed for gain or reward in any business, trade, profession, vocation, calling, occupation or employment, including where you have ceased temporarily to receive any gain or reward under a continuing arrangement for you to be gainfully employed. You will be partially disabled if you are not totally disabled but, because of sickness or injury, all of the following apply to you: you have been totally disabled for at least 14 days, you are unable to work in your own occupation at full capacity immediately after ceasing to be totally disabled and the inability to work at full capacity is due to the sickness or injury that caused your total disability, you are working in your own occupation in a reduced capacity or working in another occupation, you earn a monthly income that is less than your pre-disability income, you are under the regular care of, and following the advice of, a medical practitioner; where: own occupation means the normal occupation or work you carried out immediately before becoming disabled, pre-disability income is as defined on page

11 Calculating and paying a monthly benefit Important Salary Continuance premiums are calculated based on the monthly amount of cover that has been accepted by the insurer. At the time of a claim, if the amount of benefit payable to you based on the criteria below is less than the level of cover you are paying for, you will not be refunded for the excess premiums you have paid on your accepted monthly cover amount. Therefore it is important that you notify us if your income changes to the extent that it is less than your accepted amount of cover. It is also important to review your level of cover if your income increases in the future to ensure that you have an adequate level of cover for your circumstances. Monthly benefit amount If you are totally or partially disabled for a continuous period of longer than your waiting period and a disability claim is accepted, you will receive a monthly benefit payment paid to your nominated Australian bank account. For total disability, the monthly benefit to be paid in arrears is calculated as the lesser of the following amounts: $25,000 75% of your monthly pre-disability income, as defined in the following section your fixed amount of cover as accepted by the insurer that applied at the time your disability occurred. For partial disability, the insurer will pay a proportion of this monthly benefit, as calculated above, based on how much your income has been reduced as a result of the disability.. The insurer will only pay a Salary Continuance benefit in relation to one disability at a time. Calculating your pre-disability income The calculation of any benefit amount will take into account your actual level of income immediately before your disablement. If your pre-disability income is less than your amount of cover, any payment to you will be based on the lower pre-disability income amount. If your date of disablement is on or after 1 July 2017, the definition of income for the purposes of calculating your pre-disability income, and therefore any monthly Salary Continuance benefit amount, will generally depend on your type of employment: Employment Employed on a permanent basis (page 15) Definition of income The monthly value of the regular income 3 you received from your employer(s) immediately before becoming totally disabled, as confirmed by your employer(s) or otherwise established to the insurer s satisfaction. If you become disabled while on a period of approved leave without pay (LWOP) from your employer that does not exceed 12 months, the monthly value of the regular income 3 you received from your employer immediately before your leave without pay commenced will apply. If you become disabled while on a period of LWOP of longer than 12 months, your pre-disability income may be determined to be nil and therefore no benefit would be payable. Employment Not employed on a permanent basis (page 15) Directly/ indirectly own part or all of a business or practice (from which a regular income is earned) Definition of income The total monthly value of regular income 3 you received from all regular occupations averaged over the most recent 12 months immediately before becoming totally disabled or the actual period if less, subject to a minimum averaging period of 3 months. The total monthly amount earned 4 by your share of the business over the financial year immediately before becoming disabled as a direct result of your personal exertion or activities of your usual occupation (i.e. business earnings that would stop if you could not work due to illness or injury), less your share of business expenses and mandated superannuation contributions (but before the deduction of income tax) for that business (or the relevant proportion for part of a financial year). A benefit may be reduced if you receive other payments or income If you are entitled to a benefit, the insurer may reduce the monthly amount, as calculated in the section on this page, by the amount of any payments that you receive in respect of your injury or sickness, or any other income you receive, including: sick leave payments amounts payable under workers compensation or motor accident compensation benefits payable under any other salary continuance or income protection policies income earned from personal exertion while disabled income you could reasonably be expected to earn in your occupation while disabled. Generally this offset process would only apply to ensure that any benefit payable to you, combined with any other income you receive, does not exceed 75% of your pre-disability income. 3 Such income may also include (as may be applicable to your circumstances) salary sacrifice amounts, fees, commissions, bonuses (generally averaged over the preceding three years), regular overtime and fringe benefits, but excludes profit distributions, compulsory employer superannuation entitlements, director s fees, investment income and any other non-regular payments. 4 Amounts earned in this case exclude bonuses, commission, superannuation entitlements and director s fees, and any income produced through investments or other forms of passive income generation or non-regular payments. 11