Changes to your terms and conditions

Transcription

1 Changes to your terms and conditions As explained earlier, the Insurer is making changes to some of the terms and conditions of your insurance. The key changes, and what they will mean for you, are outlined below. You can also find the full details of the Plan s insurance arrangements in the Insurance Guide. Your Insurance Guide will be available from 1 November The details shown below come into effect on 1 November What s changing What this means for you Automatic increase to your insurance cover (and addition of SCI cover) At work requirement means a person: (a) (b) (c) is actively performing or capable of performing all the duties and work hours of their usual occupation free from any illness or injury that limits their ability to do so; and is, in the insurers opinion, not restricted by injury or illness from being capable of performing the duties of their usual occupation on Full Time Basis (even if not then working on a full time basis); and is not entitled to or receiving income support benefits relating to an illness or injury from any source including but not limited to workers compensation benefits, statutory transport accident benefits and disability income benefits. At work requirement explained If you have a pre-existing medical condition on the transfer date (1 November 2016) and the new insurance design results in you getting an uplift in Death & TPD or SCI Insurance cover, then you will need to be At work for 60 consecutive days before that increase in cover will be applicable to you for a claim relating to the pre-existing condition. If you were to die or become disabled for a reason not related to the pre-existing medical condition, then the full insured amount including the uplift would be payable to you or your beneficiaries. More information on pre-existing medical conditions can be found on the following page.

2 Pre-existing existing medical condition at the transfer date What is a pre-existing medical condition? It means an illness or injury, the side-effect, sign or symptoms of which the person, at the time of the application, commencement or reinstatement of cover: (a) was aware, or a reasonable person in their position should have been aware (whether diagnosed or not); and 1. should have sought advice or treatment (conventional or alternative) from a Medical Practitioner or other allied health professional (in circumstances where a reasonable person in their position would have sought such advice or treatment); or 2. has had a medical consultation or been prescribed medication or therapy. Note: Any medical condition that a person has suffered from or been treated for irrespective of whether a complete recovery has occurred is still treated as a Pre- Existing Condition. Also included is any medical condition that is related to the illness or injury. How is your new insurance impacted if this applies to you? Where an Insured Member s Sum Insured on the transfer date is greater than the cover they had immediately prior to the transfer, a Pre-Existing Condition exclusion applies to the difference between the previous cover and the Insured Member Sum Insured under the Policy. If a Pre-Existing Condition exclusion is applicable to an Insured Member s cover that exclusion will cease the day after the Insured Member has been At Work for 60 consecutive days from the commencement of or increase to cover as applicable whilst the cover has been continuously in force. What it means? You will only be covered for SCI cover and the increase in Death and TPD cover if: 1) You don t have a pre-existing medical condition at 1 November 2016, or, 2) You do have a pre-existing medical condition but you then are At work for 60 consecutive days after 1 November Otherwise, your insurance cover will be restricted to the level of cover you had prior to the transfer to the new plan. If the reason for the claim is unrelated to the pre-existing condition, the new cover would apply.

3 An example to help explain how a pre-existing condition may impact you For example Existing Cover = $178,000 (Prior to the transfer) Uplift Cover = $300,000 (Provided to you as a result of the transfer) New Cover = Existing Cover + Uplift Cover = $178,000 + $300,000 = $478,000 If disablement occurs after 1 November 2016 due to cancer that first became apparent prior to that date and if 60 consecutive days had not been completed at work, then the amount paid would not include the uplift cover. ie the amount paid would be $178,000. If 60 consecutive days had been completed the amount paid would be $478,000. If disablement occurs any time after 1 November 2016 due to cancer that first became apparent after 1 November 2016, then the amount paid would include the uplift. Ie the amount paid would be $478, day window to increase your cover without underwriting You can increase your default level of cover from 15% to 20% or 25% before 30 November 2016 An Insured Member who receives cover on transfer will be able to select a higher cover of 20% or 25% within 30 days from 1 November 2016 without having to supply Evidence of Insurability, only if the new Sum Insured calculated under the selected optional Benefit Design is not greater than the Automatic Acceptance Limit subject to the terms of the Policy. What it means? If you require more insurance cover than the default level of: 15% x Future Service to Age 65 x Fixed Remuneration then you can request the Trustee to increase this cover to 20% or 25%, provided you elect to increase this cover prior to 30 November 2016, this cover will be provided to you up to a maximum of $1.5 million without the requirement to sit further medical tests. You will still need to meet the At work requirement described above if you have a pre-existing condition.

4 TPD Definition Changes to the definition of TPD to help those that are able to get back to work Total & Permanent Disablement means your Date of Disablement occurs whilst you have a valid Total & Permanent Disablement cover within the policy; you (A): (a) at the Date of Disablement, were working 10 or more hours per week immediately prior to the Date of Disablement averaged over the three consecutive months prior to the Date of Disablement (or shorter period if the member has been employed for less than three consecutive months); and (b) your claim has been submitted, in writing, within five years immediately following the Date of Disablement. Then Definition 1 applies OR (B): (a) at Date of Disablement were working less than 10 hours per week immediately prior to the Date of Disablement averaged over the three consecutive months prior to the Date of Disablement (or shorter period if the member has been employed for less than three consecutive months); or (b) your claim has been submitted, in writing, more than five years immediately following the Date of Disablement. Then Definition 2 applies only.

5 Definition 1: Any occupation suited by education, training or experience means in the insurers opinion, solely and directly as a result of an illness or injury, that you: A. have been continuously absent from engaging in your occupation and any other occupation for an uninterrupted period of six consecutive months immediately following the Date of Disablement and continuing up to the date the insurer forms their opinion; B. is regularly attending and under the ongoing and appropriate care and treatment of a Medical Practitioner, including compliance with regular advice and treatment given by that Medical Practitioner, continuing up to the date the insurer forms their opinion; C. has exhausted all reasonable treatment options (medical or otherwise) which the insurer requires and is not expected to attain any further improvement or recovery from the illness or injury; and D. is disabled to such an extent as to render you incapable of ever engaging in any occupation for which you are: (i) at the end of the six consecutive month period immediately following the Date of Disablement; and (ii) by the time the insurer forms their opinion, or can be expected following the time the insurer forms their opinion, to become, reasonably suited by education, training or experience. In forming their opinion, the insurer will have regard to factors including but not limited to: (a) any rehabilitation, retraining, re-skilling, work or voluntary work that has been undertaken by the time the insurer forms their opinion, or could reasonably be expected to be undertaken by you following the time the insurer forms their opinion; (b) the Insured Member s personal attributes and transferrable skills (vocational and personal) available by the time the insurer forms their opinion; and (c) all evidence available to us, the insurer, (medical or otherwise for the period up to the time the insurer forms their opinion. For the purposes of paragraph C. and D. above, all reasonable treatment options (medical or otherwise), rehabilitation, training, retraining or re-skilling which the insurer requires will not exceed a period of 12 consecutive months from the later of: 1) the date that the insurer notifies you of the rehabilitation, training, retraining or re-skilling that the insurer require them to undergo; or 2) the commencement of the rehabilitation, training, retraining or re-skilling that the insurer consider to be necessary.

6 Definition 2: Everyday working activities means, in the insurer s opinion, solely and directly as a result of an illness or injury that you: A. are regularly attending and under the ongoing and appropriate care and treatment of a medical practitioner, including compliance with regular advice and treatment given by that medical practitioner, continuing up to the date the insurer forms their opinion; B. have exhausted all reasonable treatment options, medical or otherwise, which the insurer requires and is not expected to attain any further improvement or recovery from the illness or injury; and C. are permanently and irreversibly unable to perform at least three of six everyday working activities without the physical assistance of another person, despite the use of appropriate assistive aids and appropriate prescribed medication and that permanent inability has lasted for at least an uninterrupted period of six consecutive months or more immediately following the Date of Disablement. Everyday working activities means Mobility, Rising/Sitting, Communicating, Vision, Lifting and carrying, and Manual Dexterity. (i) Mobility means the ability to walk more than 200m on a level surface without stopping due to breathlessness or severe pain in the body; (ii) Rising/Sitting means the ability to rise and sit using a chair with arms; (iii) Communicating means the ability to hear and speak with sufficient clarity to be able to hold a conversation in a quiet room in your first language; (iv) Vision means visual ability such that when tested, vision is measured at greater than 6/60 in the better eye using a Snellen eye chart; (v) Lifting and carrying means the ability to lift (from bench height) and carry a 2 kg weight, 10m and place back down at bench height; and (vi) Manual Dexterity means you can use either or both hands or fingers to manipulate small objects with precision (such as picking up a coin or fastening shoelaces or buttons, using cutlery, or using a pen or keyboard); and D. is Permanently Incapacitated. In forming their opinion, the insurer will have regard to factors including but not limited to: (a) any rehabilitation, re-training, re-skilling, work or voluntary work that has been undertaken by the time the insurer forms their opinion, or could reasonably be expected to be undertaken by the member following the time the insurer forms their opinion; (b) the insured member s personal attributes and transferrable skills (vocational and personal) available by the time the insurer forms their opinion; and (c) all evidence available to us, the insurer, (medical or otherwise) for the period up to the time the insurer forms their opinion.

7 For the purposes of paragraph B. and D. above, all reasonable treatment options (medical or otherwise), rehabilitation, re-training or re-skilling which the insurer require will not exceed a period of 12 consecutive months from the later of: (i) the date that the insurer notifies the member of the rehabilitation, re-training or re-skilling that the insurer requires them to undergo; or (ii) the commencement of the rehabilitation, re-training or re-skilling that the insurer consider to be necessary. Terminal illness Increase the ability to access superannuation death benefits in the event of terminal illness from 12 months to 24 months Means: (a) two medical practitioners have, separately or jointly, certified in writing that the insured member suffers from an illness, or has incurred an injury, that is likely to result in their death within a period ( the certification period ) that ends not more than 24 months after the date of the certification; and (b) at least one of the registered medical practitioners is a specialist medical practitioner practicing in an area related to the illness or injury suffered by the insured member; and (c) the certification referred to in paragraph (a) occurs while the insured member continues to have cover under the policy; and (d) the certification period for each of the certificates has not expired at the time the claim is lodged; and (e) the insurer is satisfied, on medical or other evidence, that despite reasonable medical treatment, the illness or injury is likely to result in the insured member s death within 24 months of the date of the certifications.

8 Cost of Death and TPD Insurance cover Annual cost of each $1,000 insurance Death and Total & Permanent Disablement Age Next B day Male Female Age Next B day Male Female ($) ($) ($) ($) Your occupation does not affect the premium you pay in the Plan.

9 Cost of Salary Continuance Insurance cover Annual cost of each $1,000 insurance Age Next B day Male ($) Female ($) Age Next B day Male ($) Female ($) Your occupation does not affect the premium you pay in the Plan.