Plum Superannuation Fund
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- Melvyn Taylor
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1 This guide gives you information about the insurance available through your super. A financial adviser can help you decide if this insurance is right for you. Or, you can assess if you have adequate insurance using our free advice calculator, available when you log in to plum.com.au Plum Superannuation Fund Plum Personal Plan Insurance Guide (new members transferring from the Worsley Alumina Superannuation Fund) Preparation date 11 May 2016 Issued by the Trustee PFS Nominees Pty Limited ABN AFSL The Insurer Insurance is issued by MLC Limited ABN AFSL The Fund Plum Superannuation Fund ABN
2 Contents Your insurance in the Plum Personal Plan 1 Death and TPD cover 3 SCI cover 6 Other things you need to know about insurance 9 Cost of insurance 10 Definitions 22 The information in this Insurance Guide forms part of the Product Disclosure Statement (PDS) (new members transferring from the Worsley Alumina Superannuation Fund) dated 11 May Together with the Investment Menu and Fee Definitions Flyer, these documents should be considered before making a final decision to invest. They are available when you log in to plum.com.au You can find specific details about the terms and conditions of your insurance in the Plum Personal Plan Group Life and Group Salary Continuance Policy documents. Some words in insurance have specific meanings. You can see more about these terms in the Definitions section of this guide. A copy of the policy documents are available from us. You can find specific details about the terms and conditions of your insurance in the Plum Personal Plan Group Life and Group Salary Continuance Policy documents. Some words in insurance have specific meanings. You can see more about these terms in the Definitions section of this guide. A copy of the policy documents are available from us.
3 Your Insurance in the Plum Personal Plan (Personal Plan) We offer flexible insurance in the Personal Plan so you can make sure you have the cover that suits your needs. MLC Limited (MLC) is the insurer (Insurer) for the Personal Plan and we deduct premiums to pay them for your insurance cover. Types of cover The following cover is available through the Personal Plan: death cover TPD cover, and Salary Continuance Insurance (SCI) cover, to protect your income. Overriding insurance policy Payment of an insured benefit is subject to the terms and conditions of the applicable insurance policy. This guide provides a summary of the main features of the insurance policy covering the Plan. Other conditions may apply. This guide should not be relied upon as a full and complete description of the terms and conditions of the insurance cover. Your benefit may be reduced if the Insurer refuses or restricts your cover or does not pay out all or part of the insured benefit when a claim is made. Contact us on for a copy of the Plan s insurance policy. Transfer of death and TPD cover We will automatically transfer your death and total and permanent disablement (TPD) insurance cover from the Worsley Alumina Superannuation Fund, when you join the Plum Personal Plan. Your death and TPD cover will remain a fixed dollar amount in the Personal Plan, unless you change it, or you turn 61 for TPD cover. This may be different to your previous insurance cover, which may have automatically changed according to your salary or age. We will write to you when you stop working for Worsley if your benefit is $2,000 or more. Insurance cover in the Worsley Alumina Superannuation Fund ceases 60 days after we write to you. Premiums become payable from your Personal Plan account when your insurance cover is transferred to the Personal Plan. Subject to eligibility, your insurance is transferred when we receive your Application form Plum Personal Plan. In order to continue your death and TPD cover in the Personal Plan, you must also meet the following criteria: you have not ceased employment with Worsley for reasons of disablement or ill health, and you have not commenced duty in the armed forces of any country Any special terms and conditions that applied to your insurance within the Worsley Superannuation Fund will continue to apply if your insurance is transferred to the Personal Plan. Making sure you re eligible for cover You are eligible for cover if you are: under age 65, and an Australian Resident at the time you become eligible for cover. To apply for SCI cover, you must also be working at least 15 hours per week. 1
4 Changing your cover You can change or cancel your insurance cover at any time, simply complete the Insurance form for the Personal Plan available on plum.com.au. Insurance type Death Death and TPD SCI You can apply for up to Unlimited Unlimited, including up to a maximum $5 million of TPD $50,000 per month for 2 years The maximum cover you can apply for includes any existing policies you have. Any request to increase your cover will be subject to health evidence being provided to and accepted by the Insurer. To provide health evidence you will need to complete the personal statement available on plum.com.au or contact us on If we need any further information from you we will let you know. Your new level of cover will commence from the date the Insurer accepts your application. The Insurer may decline or place conditions or restrictions on your insurance cover as result of its assessment of the health evidence you provide. If you cancel your cover your insurance will cease on the day we receive your request. If you decrease or cancel your insurance cover and later change your mind, you can reinstate your insurance, but you will need to provide satisfactory health evidence. About your premium Premiums are deducted monthly by equal instalments from your account balance. Changing your level of cover will change the level of insurance premiums deducted from your account. If the Insurer accepts your request for cover, the insurance premiums will be payable from the date your new level of cover commences. If you reduce your cover we will reduce your premiums from the date we receive your request. If your salary decreases or you cease to be eligible for SCI insurance, you should let us know as soon as possible so we can reduce or cancel your cover and premiums. Premium refunds will not be payable if you have not advised us of information that will reduce your SCI entitlements. Details of premiums are available in the Cost of insurance section in this guide. 2
5 Death and TPD cover Death and TPD cover can help you and your family remain financially secure if the unexpected happens. Death and TPD cover provides a lump sum benefit to your beneficiaries if you die or to you if you are diagnosed with a Terminal Illness or suffer Total and Permanent Disablement. Transferring your Death and TPD cover You will retain the same level of death and TPD insurance cover that applied to you in the Worsley Superannuation Fund, up to the maximum insured benefit limit as described above in the Changing your cover section, subject to your eligibility. To find out if you re eligible for automatic transfer of cover, refer to Making sure you re eligible for cover section. This cover will remain a fixed amount in the Personal Plan, unless you change it, or you turn 61 for TPD cover. Reduction of TPD cover from age 61 Your TPD cover will reduce after you turn 61 to the following percentages of your cover at 60: Examples of death and TPD benefits Example of a death benefit John is aged 30 (31 next birthday) and his account balance is $60,000. He has death cover of $382,500. John s death benefit would be: Death cover $382,500 Account $60,000 Death benefit $442,500 Example of a TPD benefit John is aged 30 (31 next birthday) and his account balance is $60,000. John has TPD cover of $400,000. John s TPD benefit would be: TPD cover $400,000 Account $60,000 TPD benefit $460,000 Age TPD cover amount % 61 80% 62 60% 63 40% 64 20% 65 Nil Voluntary cover You can apply for additional death and TPD insurance cover up to the maximum insured benefit limit noted in the Changing your cover section. When a benefit might not be paid Please note that a death or TPD benefit will not be paid to you if you have similar cover provided under extended cover provisions with another insurer. 3
6 Additional features of death and TPD insurance Cover while overseas If you are an Australian resident your cover will generally continue while you are overseas provided premiums continue to be paid. You may be required by the Insurer to return to Australia at your own expense where necessary for medical treatment or assessment. Insurance consolidation You can apply to transfer your death and TPD cover that you hold with another superannuation fund, group insurer or retail policy into your account subject to the maximum benefit limits of the insurance policy. Interim Accident cover To transfer insurance, you must read, complete and sign the Transfer your insurance form available at plum.com.au and provide all the requested details. Any exclusions, premium loading or special conditions which apply to the existing insurance will continue to apply to the insurance offered under the Plum Personal Plan. Once the Insurer confirms acceptance of your Transfer of Insurance Application, you must cancel your existing insurance within 60 days. If you do not cancel your existing insurance, any benefit that is payable on the occurrence of an event under the insurance policy (eg your death) will be reduced by any benefit that you are entitled to receive for the same event under the existing insurance. MLC won t accept a Transfer of Insurance application if you are currently claiming or you are entitled to claim on any other existing insurance or similar insurance policy. If you die as a result of Accidental Injury while the Insurer is assessing your application for death cover, the Insurer will pay you a lump sum benefit equal to the amount of death cover you ve applied for up to the maximum benefit limit. If you suffer from any of the following conditions as a result of Accidental Injury while the Insurer is assessing your application for TPD cover, the Insurer will pay you a lump sum benefit equal to the amount of TPD cover you ve applied for, subject to a maximum of $500,000: Quadriplegia; or Major Brain Injury; or The total and irreversible inability to perform at least two Activities of Daily Living, as outlined in the Definition of TPD section of this Guide. Interim Accident cover will commence from the date the Insurer receives a fully completed Personal Statement and declaration of health from you. Interim Accident cover will cease on the earliest of 90 days from the date the Insurer receives your fully completed application, the day your request for cover is withdrawn or cancelled, approved or declined by the Insurer or you are no longer eligible for cover. The Insurer will not pay more than one benefit for any one Accident to any person. 4
7 Additional features of death and TPD insurance Life events cover You may be able to increase your death or TPD cover without providing medical evidence, if you apply within 90 days of one of the following life events occurring: Life event you have or adopt a child Document required A certified copy of the birth certificate or adoption papers you get married or divorced you complete your first undergraduate degree at a government recognised institution you have a child who starts secondary school you are granted a home loan on the initial purchase of a principal place of residence home renovation on principal place of residence A certified copy of your marriage certificate or divorce papers A certified copy of the graduation confirmation from the Australian university A certified copy of the enrolment confirmation from the secondary school A certified copy of the loan documents from the mortgage lender, including the amount of the drawdown loan A letter from a lender confirming the amount of the drawdown loan to cover the cost of the renovation. You can increase your cover by the greater of 25% of your current death or TPD cover and $200,000. The total amount of all life event increases is $1 million. Cover is subject to proof of the event taking place being provided to and accepted by the Insurer. You are able to apply for life events cover once in any 12 month period, and up to three times in total while you remain a member of the Personal Plan. To apply for life events cover you will need to complete the Increase without medical evidence form available at plum.com.au or contact us on Terminal Illness benefit The Insurer will pay your insured death cover if you are diagnosed with a Terminal Illness, subject to a maximum of $2 million. Where you have an insured death benefit which is higher than $2 million, the difference between $2 million and your insured amount will become your new death cover. Premiums will be required to be paid on the reduced level of insurance cover. You must remain a member of the Fund to maintain the residual death insurance cover. Terminal illness means an illness or injury that, in the opinion of the Insurer, after consideration of medical evidence, including certification by two medical practitioners (at least one of which is a specialist in the relevant area), would reasonably be expected to reduce your life expectancy to less than 24 months. Your reduced life expectancy must occur while you are covered by the insurance policy and for each of the certificates, the certification period has not ended. 5
8 SCI Cover SCI cover protects your income while you are temporarily unable to work due to illness or injury. SCI Cover You can apply for SCI cover through the Personal Plan if you are permanently employed for more than 14 hours per week and you are under age 65, subject to health evidence being provided to and accepted by the insurer. SCI cover provides you with a replacement income of up to: 75% of Monthly Income. up to a maximum of $30,000 per month, then 50% of your monthly income up to $50,000 per month. This is paid monthly in arrears while you are Totally Disabled for up to your nominated benefit period following the end of your nominated waiting period. Replacement income above $30,000 per month is paid for a maximum of two years. It is important that you regularly review your SCI cover to ensure it is aligned with your salary. You may be paying premiums for higher cover than you are eligible to claim. Variable waiting and benefit period You can select your SCI cover from the options below: Waiting period 30, 60 or 90 days 2 years 30, 60, 90 or 180 days 5 years Benefit period 30, 60, 90 or 180 days To age 65 Your nominated waiting period starts from the date you first get medical advice and you are confirmed to have a Total Disability by a Doctor. Any increase in your SCI cover or changes to your waiting period or benefit period will be subject to health evidence being provided to and accepted by the Insurer, including if you reduce your cover and subsequently reinstate it. Example of SCI benefit From our earlier example, John has an insured salary of $55,000 pa. If John were to become Totally Disabled, his insured benefit would be: 75% x $55,000 = $41,250 pa ($3, per month) Claiming SCI You are considered to be Totally Disabled (and therefore eligible to apply for a SCI benefit) if after your nominated waiting period the Insurer is satisfied that because of Injury or Illness you are continuously: unable to perform your Occupation, and not otherwise gainfully employed or engaged in any gainful business or activity. Financial evidence will be required to confirm your salary and other benefit entitlements at the time of a claim. To be eligible for any Salary Continuance benefits, you must have been employed for 14 hours or more per week at the Date of Claim, averaged over the 13 week period immediately preceding the Date of Claim. The monthly SCI benefit payable will be the lesser of: the monthly benefit for which premiums have been paid for, and 75% of your salary at the time of disablement. When will benefits be reduced? Your SCI benefit will be reduced proportionately by benefits received or amounts that you are expected to receive from other sources, so that your total benefit does not exceed 75% of your insured annual salary (as applicable). Therefore, any benefits you may be entitled to from other sources such as (but not limited to) other disability benefits, workers compensation, or other compensation benefits will be considered when determining the amount of your SCI benefit. When won t a SCI benefit be paid? Benefits are not payable if your disability is directly or indirectly caused by: any intentional self-inflicted injury or any attempt to commit suicide normal and uncomplicated pregnancy or childbirth service in the armed forces of any country you have similar cover under an Extended Cover provisions with another insurer war or warlike operations, or any other event or matter referred to in the insurance policy. less John s applicable rate of pay as you go (PAYG) tax. 6
9 When do SCI payments cease? If payable, your benefit will continue until the earliest of the following: the date you are no longer Totally Disabled or Partially Disabled the date you turn 65 you are no longer under the care of a Doctor nominated benefit payments have been made for your benefit period the date of your death subject to payment of the Bereavement benefit you fail to provide all requested information reasonably required to continue your claim, or you make a fraudulent claim. 7
10 Additional features of SCI insurance Bereavement benefit Cover while overseas Interim Accident cover Partial Disability benefit Recurring disability benefit Rehabilitation expenses benefit Waiver of premiums Payable on your death during receipt of a SCI benefit. This benefit will be paid as a lump sum amount equivalent to two times your monthly benefit from the date of your death, subject to the expiry of your nominated benefit period. Your cover will generally continue while you are overseas provided premiums continue to be paid. Your benefit will only be provided in full if you are continuously residing in Australia or one of the Approved countries listed below. For other countries, SCI benefits will be paid for up to 12 months only, unless and until you return to Australia or an Approved Country. Approved Countries: Hong Kong, New Zealand, Singapore, Japan, Switzerland, Belgium, Denmark, France, Germany, Italy, Netherlands, Sweden, the United Kingdom, the United States of America, Canada, or any other country agreed by the Insurer in writing. After the 12 month period, no further payments will be made until you return to Australia. If you suffer a Total Disability as a result of Accidental Injury while the Insurer is assessing your application for cover, the Insurer will pay the monthly benefit you ve applied for, subject to a maximum of $10,000 per month. Interim accident cover will commence from the date the Insurer receives a fully completed personal statement and declaration of health from you. Interim accident cover will cease on the earliest of; 90 days from the date the Insurer receives your fully completed application, or the day your request for cover is withdrawn, approved or declined by the Insurer. The Insurer will pay you a Partial Disability benefit if you resume employment after 14 consecutive days of Total Disability if you are only capable of returning to work on a restricted basis at reduced earnings, after the end of your waiting period. Your partial benefit is calculated as follows: A B x C A Where: A is your earned monthly income, up to your insured benefit, immediately prior to becoming Totally Disabled B is the actual monthly income earned by you during the month in which you are Partially Disabled, and C is your insured monthly benefit. This benefit will be payable for up to the maximum benefit period you nominated while you remain Partially Disabled. If you were paid a SCI benefit and your disability from the same or a related illness or injury recurs within six months of your return to full time work, the Insurer will waive your waiting period and treat your disability as a continuation of the original disability. Benefits will be payable for up to the remainder of your nominated benefit period while you remain disabled. Whilst you are suffering a disability the Insurer will reimburse you for rehabilitation expenses, such as the cost of a rehabilitation course or special equipment, to help you return to work. The maximum amount reimbursed is equal to six times your monthly benefit. The Insurer must approve these rehabilitation expenses in writing. Your premiums will be waived while you are in receipt of an SCI benefit. 8
11 Other things you need to know about insurance When might you need to provide health evidence? You may, in certain circumstances, be required to provide health evidence to the Insurer, including: if you apply for cover or apply to increase your cover if you cease to be a member of the Personal Plan and then subsequently re-join the Personal Plan and apply for cover if your insured amount is reduced to nil for a period of time, and later reinstated if you change your SCI waiting and benefit period, or any other circumstances outlined in the policy. We will advise you if health evidence is required. This may be in the form of a personal medical statement and/or various medical examinations as required. The Insurer may decline or place conditions or restrictions on your insurance cover as a result of this medical evidence. Your sum insured could be reduced or a benefit declined by the Insurer if you provide inadequate medical evidence or false or misleading information to the Insurer. Cessation of insurance cover Death, TPD and SCI cover ceases immediately under the insurance policy, on the earliest of the following: you reach age 65 the day you cease to be a member of the Personal Plan the date of your death for death and TPD cover, 12 months after the payment of a Terminal Illness benefit for death and TPD cover, the date you are paid a death or TPD benefit your account balance becomes insufficient to pay a premium instalment the day before you commence duty with the armed forces of any country for SCI cover, you are unemployed for SCI cover, you permanently retire from the workforce you make a fraudulent claim the date we receive a request from you to cancel your cover, and any other terms under the group insurance policy. If you have SCI cover with either the two year or five year benefit period, it will end on the date the insurer pays a lump sum Total and Permanent Disablement (TPD) or Terminal Illness benefit. Any existing SCI claim will continue to be paid if you continue to be disabled due to the same Illness or injury but after the end of your current claim, no further claim will be paid How to make a claim In the event of your death, if you are diagnosed with a Terminal Illness or if you become TPD or Partially or Totally Disabled, you or a representative acting on your behalf should notify the Trustee or the Insurer as soon as is reasonably practicable. The Insurer will generally send the Trustee or in the case of your death, your legal personal representative, claim forms once receiving notice of a potential claim. You should complete your claim form and respond to any requests by the Insurer for medical information and evidence to enable your claim to be assessed. If any claim is notified in writing to the Insurer more than one year after an event giving rise to a claim, the Insurer may reduce or decline your claim. The Insurer aims to make the claims process as simple, quick and efficient as possible, while treating all beneficiaries with respect and sympathy. If you would like more information about making a claim for an SCI benefit contact us on Duty of disclosure When you apply for a life insurance policy, you have a duty to tell us anything that you know, or could reasonably be expected to know, may affect our decision to insure you and on what terms. You have this duty until we agreed to insure you. You have the same duty before you extend, vary or reinstate the policy. You do not need to tell us anything that: reduces the risk we insure you for, is common knowledge, we know or should know as an insurer we waive your duty to tell us about. If someone other than you will be the life insured under the policy, any failure by that person to comply with the above duty will be treated as failure by you. If you request life insurance inside super, the Trustee obtains this insurance from us in relation to you. In this circumstance, we rely on the disclosures that you or the Trustee makes to us. 9
12 Cost of insurance The premiums associated with your insurance cover are deducted monthly by equal instalments from your account. Premiums are based on the type and amount of insurance cover and your age. The actual premium calculated for you may vary slightly due to rounding and is inclusive of any statutory charges including stamp duty. Your insurance premiums include a fee up to 10% of the total cost of insurance for administering the Personal Plan s insurance arrangements including underwriting, policy renewal and claims processing. Premium rates may be varied at any time. We will provide you with at least 30 days notice of any material increase in your premiums. Death and TPD premiums Death and TPD premiums are calculated as follows: (Amount of cover $1,000) x Age next birthday premium x Gender factor Annual cost of each $1,000 cover Age next birthday Death TPD Age next birthday Death TPD Gender Factor Male 1.00 Female 0.80 Example of death and TPD premiums Death cover In our earlier example John, aged 30 (31 next birthday) had death cover of $382,500. John s death cover premium would be calculated as follows: ($382,500 $1,000) x $0.542 x 1.00 = $ pa TPD cover ($17.28 per month) In our earlier example John, had TPD cover of $400,000. John s TPD cover premium would be calculated as follows: ($400,000 $1,000) x $0.230 x 1.00 = $92.00 pa ($7.67 per month) 10
13 SCI premiums The cost of your SCI cover depends on the benefit and waiting period selected by you, your level of cover, age, gender and occupation. The tables below set out the rates that apply based on the cover you have selected, your gender and your occupation. SCI premiums are calculated as follows: (SCI cover $1,000) x Age next birthday premium Your occupation rating is described as white collar, default or blue collar. collar occupations should meet the following requirements: have no exposure to unusual occupational hazards, and an emphasis on mental rather than physical work. This classification includes office staff and salespeople not engaged in heavy lifting or deliveries. or Light-blue collar occupations include jobs with less than 20% light manual work or direct supervision of manual workers. collar consist mainly of certified or licensed tradesmen doing skilled specialised manual work. Annual Cost of each $1000 cover for maximum 2 year benefit period, waiting period 30 days Male Age next birthday Age next birthday Annual Cost of each $1000 cover for maximum 2 year benefit period, waiting period 30 days Female Age next birthday Age next birthday
14 Annual Cost of each $1000 cover for maximum 2 year benefit period, waiting period 60 days Male Age next birthday Age next birthday Annual Cost of each $1000 cover for maximum 2 year benefit period, waiting period 60 days Female Age next birthday Age next birthday
15 Annual Cost of each $1000 cover for maximum 2 year benefit period, waiting period 90 days Male Age next birthday Age next birthday Annual Cost of each $1000 cover for maximum 2 year benefit period, waiting period 90 days Female Age next birthday Age next birthday
16 Annual Cost of each $1000 cover for maximum 5 year benefit period, waiting period 30 days Male Age next birthday Age next birthday Annual Cost of each $1000 cover for maximum 5 year benefit period, waiting period 30 days Female Age next birthday Age next birthday
17 Annual Cost of each $1000 cover for maximum 5 year benefit period, waiting period 60 days Male Age next birthday Age next birthday Annual Cost of each $1000 cover for maximum 5 year benefit period, waiting period 60 days Female Age next birthday Age next birthday
18 Annual Cost of each $1000 cover for maximum 5 year benefit period, waiting period 90 days Male Age next birthday Age next birthday Annual Cost of each $1000 cover for maximum 5 year benefit period, waiting period 90 days Female Age next birthday Age next birthday
19 Annual Cost of each $1000 cover for maximum 5 year benefit period, waiting period 180 days Male Age next birthday Age next birthday Annual Cost of each $1000 cover for maximum 5 year benefit period, waiting period 180 days Female Age next birthday Age next birthday
20 Annual Cost of each $1000 cover for benefit period to age 65, waiting period 30 days Male Age next birthday Age next birthday Annual Cost of each $1000 cover for benefit period to age 65, waiting period 30 days Female Age next birthday Age next birthday
21 Annual Cost of each $1000 cover for benefit period to age 65, waiting period 60 days Male Age next birthday Age next birthday Annual Cost of each $1000 cover for benefit period to age 65, waiting period 60 days Female Age next birthday Age next birthday
22 Annual Cost of each $1000 cover for benefit period to age 65, waiting period 90 days Male Age next birthday Age next birthday Annual Cost of each $1000 cover for benefit period to age 65, waiting period 90 days Female Age next birthday Age next birthday
23 Annual Cost of each $1000 cover for benefit period to age 65, waiting period 180 days Male Age next birthday Age next birthday Annual Cost of each $1000 cover for benefit period to age 65, waiting period 180 days Female Age next birthday Age next birthday Example of SCI premiums In our earlier example John, aged 30 (31 next birthday) had SCI cover of $41,250 pa. John had selected a two year benefit period and a 90 day waiting period. John s occupation is classified as a occupation. John s SCI premium would be calculated as follows: ($41,250 $1,000) x $1.416 = $58.41 pa ($4.87 per month) 21
24 Definitions You can find the specific details about the terms and conditions of your insurance in the Plum Personal Plan policy documents. Accidental Injury Means an injury which first occurred after your cover began under the insurance policy, including any Interim Accident cover, and is caused directly and solely as a result of an accidental event which is not related to any loss from, or connected with war or warlike operations. For SCI cover, if your Total Disability does not start until 30 days after the date of an Accidental Injury, the Insurer will treat the cause as an Illness. Australian Resident Means you: have always lived in Australia or have come to Australia to live, and are eligible to work in Australia. Date of claim (SCI cover) Means the date you last worked prior to your disability. Doctor Means a registered medical practitioner who is not you or your family member. Injury Means bodily injury. Illness Means a sickness, disease or disorder. Major Brain Injury Means physical head injury that results in permanent loss of at least 25% of either the brain s mental function or its physical control function. Medical Practitioner means a registered Medical Practitioner who is qualified in an appropriate specialty in the Insurer s opinion. This can t be you, your spouse or a family member, business partner, employee or employer.* Monthly Income (SCI cover) Means one-twelfth of your Salary, advised by you to the Trustee and Insurer. Occupation Means the employment or activity in which you are principally employed. Quadriplegia Means the permanent and total loss of use of both arms and both legs resulting from an Injury. Terminal Illness Terminal illness means an illness or injury that, in the opinion of the Insurer, after consideration of medical evidence, including certification by two medical practitioners (at least one of which is a specialist in the relevant area), would reasonably be expected to reduce your life expectancy to less than 24 months. Your reduced life expectancy must occur while you are covered by the insurance policy and for each of the certificates, the certification period has not ended. Total Disability or Totally Disabled (SCI cover) Means you have a disability caused by Injury or Illness; and you: are unable to perform in your Occupation; and you are not otherwise gainfully employed or engaged in gainful business activity 22
25 Definition of Total and Permanent Disablement (TPD) You are considered to be Totally and Permanently Disabled if the Insurer is satisfied that at least one of the following options is applicable to you: Employment status Permanently at least 14 hours per week Definition of TPD (a)* You 1. have been absent from your Occupation solely through injury or Illness for six consecutive months, 2. have been regularly attending an appropriately qualified Medical Practitioner and undertaking medical treatment reasonably recommended by an appropriately qualified Medical Practitioner with respect to that injury or Illness since ceasing work in your Occupation solely through injury or Illness, and 3. are incapacitated to such an extent that, in the Insurer s opinion, after consideration of medical and other relevant evidence, you were at the end of the initial period of six consecutive months absence from your Occupation, unable to ever engage in or work in any Occupation on a full-time or part-time basis, for which you re reasonably suited by education, training or experience For the purpose of this definition medical and other relevant evidence includes, but is not limited to: the prospect of improvement in your capacity after treatment and rehabilitation that could reasonably be expected to be undertaken by you, and whether reasonable retraining or reskilling would render you able to engage in or work in any Occupation on a full-time or part-time basis. Less than 14 hours per week (b) You have been absent from your Occupation solely through injury or illness for six consecutive months and are incapacitated to such an extent, that in the Insurer s opinion after consideration of medical and other relevant evidence, you were, at the end of the period of six consecutive months absence from employment, unlikely to ever be able to perform at least two Activities of Daily Living without the physical help of someone else. Activities of Daily Living means: bathing and/or showering dressing moving from place to place including in and out of bed and in and out of a chair eating or drinking, or using the toilet. OR (c) Where your Occupation is classified as Home Duties, you have been absent from your Occupation solely through injury or illness for a period of six consecutive months and are incapacitated to such an extent that in the Insurer s opinion, after consideration of medical and other relevant evidence, you were, at the end of the six consecutive months absence from employment, unlikely to ever again attend to at least two normal physical domestic household duties. Normal physical domestic household duties means: cleaning the family home shopping for food and household items meal preparation and laundry services leaving the house without the assistance of another person looking after dependent child/children under 16 years of age or in full time secondary education, where applicable, or providing full time care for a disabled person(s) who is a members of your immediate family, where applicable. If you are able to perform the normal physical domestic household duties with the assistance of another person or with the use of assistive devices, you are deemed to be able to perform these duties. You must be under the regular care and attention and following the advice of a Doctor for that injury or Illness. Evidence that you carried out the duties on a daily basis prior to your disability will be required. 23
26 Contact us For more information visit plum.com.au or call us on between 8am and 7pm AEST (8pm daylight savings times), Monday to Friday. Postal address Plum Superannuation Fund GPO Box 63 Melbourne VIC 3001 Registered office Plum Superannuation Fund Level 4, 500 Bourke Street Melbourne VIC 3000 PFS Nominees Pty Limited ABN AFSL Part of the National Australia Bank Group of Companies. An investment with PFS Nominees Pty Limited is not a deposit or liability of, and is not guaranteed by National Australia Bank Limited ABN AFSL (NAB). NAB does not guarantee or otherwise accept any liability in respect of this product. PLRD3721M0516
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