GROUP PERSONAL INJURY INSURANCE

Transcription

1 CHUBB INSURANCE COMPANY OF AUSTRALIA LIMITED A.B.N A.F.S. Licence No: Level 1, 225 St Georges Terrace, Perth WA 6000 PO Box Z5471 St Georges Terrace, Perth WA 6831 Telephone: Facsimile: DX: 207 Perth GROUP PERSONAL INJURY INSURANCE

2 SECTION A - POLICY SCHEDULE Policyholder Kingsway Christian College /T As Kingsway Christian College Policy Number c/- Safeguard Insurance Solutions (WA) 10/152 Balcatta Road, Balcatta Western Australia Australia Type of Policy GROUP PERSONAL INJURY INSURANCE Period of Insurance From: 31st March P.M. Local Standard Time To: 31st March 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 $2,000,000 (b) Non Scheduled Air Travel Single-engine Multi-engine Not Insured Not Insured Helicopter Not Insured Premium & Charges Premium: $12, GST: $1, Stamp Duty: $1, Total Premium: $15, In witness whereof, the Company has caused this Policy to be signed by its Authorised Representative. 19th June 2014 Authorised Representative Date Chubb Policy Form Number GPI 0511 Page 1

3 CATEGORIES Category: Insured Persons: Operation of Cover: A All Registered Kindergarten, Pre-Primary, Primary and/or Secondary Students of the Policyholder. The insurance under this Policy shall apply to the Insured Person during a school hours and school sanctioned events only basis during the Period of Insurance. Coverage Section Refer to Endorsement Chubb Policy Form Number GPI 0511 Page 2

4 ENDORSEMENT NUMBER : DOMESTIC HELP BENEFIT This endorsement is applicable to: Non Income Earners 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 85% 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 52 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 3

5 ENDORSEMENT NUMBER : STUDENT TUTORIAL BENEFIT This endorsement is applicable to: All 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 85% of the actual cost of Home Tutorial Expenses certified as necessary by a qualified Physician subject to a maximum of $ per week not exceeding 52 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 4

6 ENDORSEMENT NUMBER : NON MEDICARE MEDICAL EXPENSES BENEFIT This endorsement is applicable to: All Insured Persons injured whilst involved in school activities authorised by the Policyholder ONLY: 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 $50.00 of each and every claim; 4. More than 85 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 $3, for Non Medicare Medical Expenses in respect of any one Accidental Bodily Injury. Chubb Policy Form Number GPI 0511 Page 5

7 ENDORSEMENT NUMBER : It is hereby declared and agreed that this policy is extended to include the following benefit : Emergency Transport Benefit : In the event that the Insure Person suffers Accidental Bodily Injury, We will reimburse the cost of such reasonable emergency road, air or water transportation costs up to a maximum of $4,000 per accident. Provided always that We will not be liable for : a) Any costs that We are prohibited by law from paying; b) Any costs that are recoverable from any other source. Chubb Policy Form Number GPI 0511 Page 6

8 ENDORSEMENT NUMBER : It is hereby declared and agreed coverage afforded under this policy is extended to include the following benefit : Bed Care Benefit : If as a result of Accidental Bodily Injury, an Insured Person becomes a Bed Care Patient, We will pay the amount of $200 for each week (up to a maximum of 52 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 7

9 ENDORSEMENT NUMBER : It is hereby declared and agreed that the TABLE OF EVENTS in respect of Coverage Section 1 Capital Benefits is deleted and replaced as follows: TABLE OF EVENTS THE EVENTS Accidental Bodily Injury as defined, resulting in: The Benefit Amount (each Insured Person) 1 Death $ 20, Permanent Paraplegia or Permanent Quadriplegia $ 500, Permanent and incurable loss of mental powers resulting in total inability to $ 500, work except in a sheltered workshop. 4 Permanent Total Loss of sight in one eye or loss of one lens 5 Permanent Total Loss of sight in both eyes or loss of both lens $ 500, Permanent Total Loss of use in one limb 7 Permanent Total Loss of use in both limbs $ 500, Permanent Total Loss of use in both feet 9 Permanent Total Loss of one foot $ 50, Permanent Total Loss of use in both hands 11 Permanent Total Loss of one hand $ 50,000,00 12 Third Degree Burns $ 300, Permanent Total Loss of Hearing in Both Ears Permanent Total Loss of Hearing in One Ear Permanent Total Loss of use of four fingers and thumb of either hand Permanent Total Loss of use of four fingers of either hand Permanent Total Loss of use of the thumb of either hand (a) both joints (b) one joint 18 Permanent Total Loss of use of Fingers of either hand (a) three joints (b) two joints (c) one joint 19 Permanent Total Loss of use of Toes of either foot (a) all one foot (b) great one joint (c) other than great each toe 20 Shortening of leg by at least 5cm 21 Permanent Partial Disablement not otherwise provided for under Events Listed 22 Broken or Fractured Bones** (a) Finger, toe, hand or foot (b) Arm, elbow, wrist, leg, ankle, or knee: - Simple Fracture - Compound Fracture (c) Collarbone (d) Breastbone (e) Rib (f) Shoulder, cheekbone or nose (g) Jaw (h) Neck, scull, spine, pelvis or hip $ 375, $ 75, $ 75, $ 50, $ 35, $ 25, $ 50, $ 25, $ 5, $ 35, Refer to Policy Wording $ $ $ $ $ $ $ $ $ 5, Benefits are limited to $5, per Accident** 23 Loss or Damage to Sound and Natural Teeth*: Permanent or second teeth (not being dentures or dental fillings) (a) loss of teeth (b) capping or damaged teeth (c) other damage Milk or First Teeth: Loss of teeth $ per tooth* $ per tooth* $ per accident* $ per tooth* Benefits are limited to $5, per Accident* Chubb Policy Form Number GPI 0511 Page 8