As an employee of Geelong Grammar School, you may now have Income Protection Insurance provided by CommInsure.
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- Ross Payne
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1 Introduction The Income Protection Insurance set out in this flyer provides cover for eligible employees of Geelong Grammar School (who request cover and are accepted by CommInsure). As an employee of Geelong Grammar School, you may now have Income Protection Insurance provided by CommInsure. In this flyer, you and yours refers to a person who is an employee of Geelong Grammar School and is eligible for or has (as the context may apply) Income Protection Insurance cover. Who owns the Policy? As the Income Protection Insurance Policy is a Group Insurance Contract the insurance contract ("the Policy") is with Geelong Grammar School, who is the Policy owner. The obligations and responsibilities under the Policy are therefore between CommInsure and Geelong Grammar School. As such CommInsure will deal directly with Geelong Grammar School in relation to matters relating to Income Protection Insurance. What is Income Protection? The below table outlines a brief summary of the Income Protection cover offered under this Policy. Income Protection Insurance What is its purpose? How much does it cover? Income protection provides a replacement income when you are unable to work at full capacity or at all, due to sickness or injury. It can replace 75% of your Monthly Income (plus Superannuation) if you are unable to work because of illness or injury (subject to a maximum of $20,000 per month). You will need it if Who is eligible for cover? In the event of illness or injury: To help protect the income you earn and the lifestyle you live. Your family relies on your regular income. You don t want to rely on just your savings, your family, or the public health system in the event of illness and sickness. Employees and other persons in an employment relationship with the Policy owner are eligible for cover. In addition you must be: working on a permanent basis; and aged between 16 and 64 (inclusive); and working at least 20 hours per week What if I want more information? This flyer sets out the important things you need to know about Income Protection Insurance. However, insurance can be quite complex, and your individual circumstances should be considered before deciding what type of cover and how much insurance is most appropriate for your needs. If you need help with this product, we suggest that you initially speak to your financial adviser. Important terms used in the flyer Phrase At Work Active Employment Automatic acceptance limit Meaning Being in Active Employment or an employer-approved leave of up to 12 consecutive months except leave which is caused by sickness or injury. Being employed on a permanent basis to carry out identifiable duties and actually performing those duties at least 20 hours per week. This is the amount of cover you will receive without requirement of medical evidence.it is the lesser of $9,000 per month, or the Monthly Benefit. If the Monthly Benefit exceeds this amount, you will need to apply to CommInsure in writing. 1
2 Benefit Period Up to age 65 after the waiting period. Continued Cover The continuation of cover for a member after termination of this policy, but only for claims arising from: a sickness which became apparent; or an injury that occurred; before the termination of this policy Cover Expiry Date The earlier of your death or age 65. Current Income Important Duties Income Limited Cover Monthly Benefit Own Occupation Pre-disability income Review Date Waiting Period Relates to Partial Disability Benefit. Current income is the monthly income that you earn from any occupation whilst you are considered to be Partially Disabled (please see below for further information). The duties of your Own Occupation that could reasonably be regarded as necessary to producing your Pre-disability Income (see below). How you perform your Own Occupation will be taken into account when determining the important duties. The amount of annual salary you earn from working for your employer that CommInsure confirm with them in writing, on the later of the commencement of your cover and the most recent Review Date. Cover only for claims arising from: a sickness which first became apparent; or an injury which occurred; on or after the date you first became eligible for cover. Cat A: 75% of Income (refer above) divided by 12, plus 9.4% of income divided by 12 as employer super contributions, subject to a maximum of $20,000 per month. Cat B: 75% of income divided by 12, plus 9% of income divided by 12 as employer super contributions. Subject to a maximum of $20,000 per month. The normal occupation or work carried out by you immediately before becoming disabled. The monthly Income that you earn from your Own Occupation before becoming disabled. 1 July each year. The period of time (90 days) you have to be Totally or Partially Disabled before you can qualify for any Disability Benefits. Section 1- Benefits and features What benefit do you receive? Total Disability Benefit Partial Disability Benefit Rehabilitation Expenses Benefit Recurrent Disability Benefit When is a Total Disability Benefit payable? The Total Disability Benefit is paid if you are Totally Disabled for longer than the Waiting Period. Benefits can continue, provided you continue to be Totally Disabled, but not beyond age 65. The amount of Total Disability Benefit you will receive is up to 75% of your Income as at the Review Date to a maximum of $20,000 per month. Total Disability means that because of sickness or injury, you are: unable to perform one or more of the important duties (as defined in the Policy) of your occupation; under the regular care of, and following the treatment recommended by a registered medical practitioner satisfactory to CommInsure; and not working in any occupation, whether or not for reward; and earning less than your Pre-disability income. The Total Disability Benefit CommInsure pay is the Monthly Benefit. To illustrate, if you become entitled to the Total Disability benefit and you have the following cover: Monthly Benefit: $3,000 Waiting Period: 90 days CommInsure will pay a benefit of $3,000 per month provided that you continue to be Totally Disabled, after you have waited 90 days (the Waiting Period) up to the date you reach age 65. 2
3 When is a Partial Disability Benefit payable? If you are Partially Disabled after the Waiting Period has ended, some of the Total Disability Benefit will be paid, based on the reduction in your Pre-disability Income. This is called the Partial Disability Benefit. This benefit can continue until the end of the Benefit Period, provided you continue to be Partially Disabled, but not beyond age 65. Partial Disability means that because of sickness or injury, you are: only able to perform your occupation in a reduced capacity; or working in another occupation; and under the regular care of a registered medical practitioner acceptable to CommInsure. If you are Partially Disabled, the Monthly Benefit will be reduced and will follow the formula below: monthlybenefit pre To illustrate, if you suffer a Partial Disability which results in your Monthly Income decreasing from $4,000 to $1,000 per month and your Monthly Benefit is $3,000, CommInsure will calculate the Partial Disability Benefit to which you may be entitled as follows: $3,000 ($1,000 X 3,000) = $750 $4,000 Partial Disability Benefit = $3,000 $750 Rehabilitation Expenses Benefit = $2,250 per month. A Rehabilitation Expenses Benefit is payable if you are Totally or Partially Disabled and you participate in a rehabilitation or vocational retraining program approved in advance by CommInsure in writing. The benefit they will pay reimburses the cost of the approved rehabilitation program (subject to a maximum of six times your Monthly Benefit). Approved rehabilitation programs exclude programs providing hospital treatment or ancillary health benefits (as defined in the National Health Act 1953) as those laws prevent CommInsure paying a benefit for these programs. For example, if you undergo an approved rehabilitation program costing $20,000, and you have the following cover: Monthly Benefit: $3,000 Waiting Period: 90 days A maximum Rehabilitation Benefit of $18,000 (6 x 3,000) will be paid. This benefit is paid in addition to the Disability Benefit. Recurrent Disability Benefit Income disability income This means that you won t have to go through the Waiting Period again if you suffer a recurrence of the same, or a related, sickness or injury within six months of the end of payment of a Disability Benefit. The recurrence of your sickness or injury will be treated as a continuation of the original claim. X monthlybenefit Indexation of benefit payments At the end of every consecutive 12 month period that a Total or Partial Disability Benefit has been received, CommInsure will increase your Monthly Benefit and Pre-disability Income by the percentage increase of the consumer price index (Weighted Average of 8 Cities Combined Index). The indexation of benefit payments is designed to help offset the impact of inflation. Waiver of Premium Your employer will not be required to pay any premiums on your behalf which fall due while a Total Disability Benefit is payable. Your employer must continue to pay premiums throughout the Waiting Period. Waiting Period The Waiting Period is the period of time you have to be Totally or Partially Disabled before you can qualify for any Monthly Benefit. The Waiting Period starts from the day when you first consult a registered medical practitioner (satisfactory to CommInsure s requirements) about the condition that is causing the disability. Benefit Period Benefits are payable after the completion of the Waiting Period while you continue to be disabled. The benefit will cease if the following occurs: you are no longer disabled; the benefit payment period ends; you turn 65; if you die. Section 2 - Limitations and exclusions You need to be aware of the following limitations and exclusions which may affect the cover provided by this Income Protection Insurance Policy. CommInsure will only pay benefits for one sickness or injury at a time. A benefit will not be paid if a sickness or injury is directly or indirectly caused by: intentional self-inflicted injury, whether or not sane at the time; or normal and uncomplicated pregnancy or childbirth including multiple pregnancy, caesarean birth, threatened miscarriage, participation in in-vitro fertilisation or other medically assisted fertilisation techniques and normal discomforts of pregnancy (such as morning sickness, backache, varicose veins, ankle swelling and bladder problems). 3
4 Worldwide Cover Your cover is available outside Australia up to the Automatic Acceptance Limit. CommInsure may apply exclusions or special conditions to cover for a member above the Automatic Acceptance Limit. Extended overseas travel requires notification to be provided to Comminsure through Geelong Grammar School s Human Resources department prior to departure and requires Comminsure s acceptance of maintaining cover for such travel. Benefit offsets Your Monthly Benefit will be reduced if you receive other disability payments during the same period from: any other insurance Policy that provides income benefits upon disability; any sick leave entitlements; any applicable social security payments; worker s compensation; any other legislation that provides for income benefits to ensure that the Disability Benefit plus these amounts will not be greater than 75% of your Pre-disability income. Section 3 - Applying for cover Who is eligible for cover? Income Protection Insurance cover is compulsory if you are employed on a permanent basis at all times for at least 20 hours per week. You must be between the ages of 16 and 64 (inclusive). Cover will cease at age 65. Geelong Grammar School will apply to Comminsure for coverage if you are an eligible employee. When will cover commence? Cover commences on the date CommInsure accept the application for cover from your employer. Written confirmation of the commencement date of cover will be given to your employer, and this will be forwarded on to you. If you are not At Work on this date you will only receive Limited Cover until you return to Active Employment for two consecutive months. When CommInsure consider your application for cover under Income Protection Insurance, for example if you require cover above the Automatic Acceptance Limit, they may apply an exclusion, or other special conditions as a condition for accepting your application. CommInsure may in some circumstances not agree to provide cover. your death; 30 days after you are no longer At Work; you reach age 65; you cease to be eligible for this insurance; the Policy held with CommInsure terminates; or you cancel your cover (as explained in this section) In the situation where cover ceases as a result of you no longer being an employee, or the Income Protection Insurance Policy is terminated (see below), any benefit payable to you (before you ceased to be an employee or the Policy was terminated) will continue in accordance with the relevant Policy conditions. You may cancel your cover at any time by writing to Geelong Grammar School. The cover provided under the Policy will end on the day CommInsure receive notice of your cancellation from Geelong Grammar School. If you are eligible to exercise the continuation option, and you become disabled within 60 days of cover ending under this Policy, but before you exercise a continuation option and you remain disabled for longer than the waiting period, CommInsure will pay a disability benefit subject to the Policy. In what circumstances will the Policy terminate? If any amount of premium in respect of Income Protection Insurance cover remains unpaid for more than 30 days beyond the premium due date, all cover (including your cover) under the Income Protection Insurance Policy will cease except for Continued Cover. CommInsure will give prior written notice to Geelong Grammar School of such cancellation. If an insured event happens within 30 days after a premium due date, CommInsure will pay the benefit but only after the overdue premiums are paid in full. Also, Geelong Grammar School may terminate the Policy at any time by notifying CommInsure in writing. All cover under the Policy will then cease. Cover when the Policy terminates If you are not At Work on the date of termination of this policy and CommInsure receive written confirmation of this from Geelong Grammar School within one month of that date, they will provide Continued Cover until the first of the following occurring: you are At Work; CommInsure make a decision on any claim under Continued Cover; you are no longer employed on a permanent basis by Geelong Grammar School, or no longer working 20 hours per week; you reach age 65; or 12 months have passed since the date that the policy terminated. In what circumstances will cover cease? Your cover will cease automatically in the event of one of the following occurring: 4
5 Continuation Option If you are no longer employed by your employer, you have the option within 30 days of termination of service to apply for an individual disability income Policy without having to produce evidence of health. The following conditions apply: you must be less than 60 years of age at the time your cover ends under Geelong Grammar School; the individual disability income Policy will be an indemnity value Policy (i.e. the policy will compensate you for your lost income, up to your insured amount) owned by yourself, and will be based on the standard benefits and terms that are made available by CommInsure to the public at that time. the Monthly Benefit, Waiting Period, and Benefit Period under the individual disability income Policy will be limited to the amount provided to you under the Geelong Grammar School Policy; the premium that will apply will be the standard current individual Policy rates for your new occupation; any exclusions or special conditions applicable to you under Geelong Grammar School Policy will apply to the individual disability income Policy issued by CommInsure; you must not be eligible for a benefit under the Geelong Grammar School Policy. This policy must be still in-force; and CommInsure s minimum policy issue requirements are met. The income protection cover will be issued without evidence of health; however it will be subject to CommInsure s underwriting requirements for occupation, residence and pastimes. Once you have exercised a continuation option, you will not be eligible for any future cover under this Policy unless CommInsure agree in writing. Leave Without Pay Cover will continue for up to 13 months if you go on leave without pay, provided you are on employer approved leave without pay other than leave caused by sickness or injury. CommInsure may agree to provide cover for a longer period however this will need to be agreed in writing with CommInsure. The insurance premiums for your cover must continue to be paid. If a Disability Benefit becomes payable during the leave without pay, the amount of the Monthly Benefit will be reduced by the monthly income CommInsure consider that you are able to earn form your Own Occupation while disabled. Section 4 - Important information How do you make a claim? You should notify Geelong Grammar School of any claim within 30 days or as soon as possible after you become aware of any claim or potential claim. Before CommInsure pay any benefit under the Policy you must: provide them with satisfactory proof of age, if required; complete any relevant claims forms and provide supporting evidence of the claim; provide them with such medical, income or other evidence as they require from time to time (at your expense); undergo any medical or other examination which they reasonably require (at their expense); and undergo any medical treatment or rehabilitation program, which a registered medical practitioner, (satisfactory to CommInsure) considers reasonable. The benefits start the day after the Waiting Period has ended. Benefit payments are payable monthly in arrears and are calculated for the part of the month they are payable. All initial certificates and evidence (including any medical evidence) required by CommInsure for the claim will be provided at your expense. Generally, once the claim is approved, payments will be made directly to you. 5
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