MP9908 GESB Super Group Supplementary Income Protection
31
Policy Document Group Supplementary Income Protection Policy No. MP 9908 Attached to: Group Life Insurance Policy No. MP 9908 Issued to: Government Employees Superannuation Board ABN 43 418 292 917 For the Provision of Income Protection Insurance to Members of GESB Super Scheme Issued by: AIA Australia Limited ABN 79 004 837 861 AFSL 230043 19 June 2021
MP9908 GESB Super Group Supplementary Income Protection
MP9908 GESB Super Group Supplementary Income Protection Policy
DocumentPolicy Document
Group Supplementary Income Protection Policy No. MP 9908 Attached
to: Group Life Insurance Policy No. MP 9908
Issued to: Government Employees Superannuation Board ABN 43 418 292
917
For the Provision of Income Protection Insurance to Members of GESB
Super Scheme
Issued by: AIA Australia Limited ABN 79 004 837 861 AFSL
230043
19 June 2021
GROUP SUPPLEMENTARY INCOME PROTECTION POLICY ATTACHED TO GROUP LIFE
INSURANCE POLICY NO. MP 9908
FOR THE PROVISION OF INCOME PROTECTION INSURANCE TO MEMBERS OF GESB
SUPER SCHEME
This is an endorsement to the Group Supplementary Income Protection
Policy attached to the Group Life (Death and Total and Permanent
Disablement) Insurance Policy (the ‘Policy’), policy number MP
9908, issued by AIA Australia Limited (ABN 79 004 837 861, AFSL
230043) (the ‘Company’) to the Policy Owner described in the Policy
Schedule.
The Company and the Policy Owner wish to vary the Policy by
completely replacing the terms with these attached.
The terms of the Policy are varied with effect on and from 19 June
2021 to the extent required for the Policy to be in the form
attached.
The Policy Owner and the Company continue to be bound by the
Policy, as varied.
In consideration of payment to the Company of the first premium
stated in the Policy Schedule and provided that subsequent premiums
are duly paid and subject to the General Conditions hereof, the
Company will pay to the Policy Owner the benefits stated in the
Policy Schedule, immediately upon proof being given to the
satisfaction of the Company of:
(a) the happening of the events upon which such benefits are herein
expressed to become payable;
(b) the identity of the Insured Member upon whose disability the
Company is asked to make payment; and
(c) the correctness of the age of that Insured Member.
This Policy shall be deemed to be issued in the Commonwealth of
Australia and all monies payable in respect thereof whether by or
to the Company shall be payable in Australian currency.
The Company has caused this endorsement to be executed as of the
Effective Date, as shown in the Policy Schedule.
Person authorised by the Company to sign this endorsement:
_______________________________________________
EMPLOYEES SUPERANNUATION BOARD )
in the presence of )
.....................................................................
………………………………………….
Name of Director (block letters) Name of Director (block
letters)
Effective Date: 19 June 2021
Date of Issue:
3
Contents
3. Amount Insured ...............................................
9
General Conditions ............................................
11
3. Premium – Mis-statement of Age .................. 11
4. Premium Adjustments ................................... 12
6. Termination of Cover .....................................
12
7. Termination by the Policy Owner ................... 12
8. Monthly Review .............................................
12
14. Concurrent Disability .................................
13
15. Recurrent Disability ...................................
13
16. Consecutive Absence ................................ 13
17. Rehabilitation Expenses ............................ 14
18. Medical Examination ................................. 14
20. Worldwide Cover .......................................
14
24. Overseas Cover ........................................
15
25. Overseas Employees ................................ 15
27. Disabled Persons Provision ...................... 16
28. War & Terrorism Provision ........................ 16
29. Tax Imposts ...............................................
16
30. Transfer of Employer Group Cover ........... 16
31. Request to change to Professional and Executive Occupation
Category ................ 16
32. Interim Accident Cover .............................. 16
33. Alternative benefit for Medically Discharged WA Police Officers
.................................... 17
Definitions
.......................................................... 18
Policy Document
5
ABN 43 418 292 917
Plan GESB Super Scheme
Effective Date 19 June 2021
Categories of Membership
Category 2 Casual Employees
(a) the Amount Insured; and
(b) the Income Replacement Ratio applicable at the Date of
Disability, which is as follows:
Age Band Income Replacement Ratio
Insured members
Disability prior to
the Relevant Age.
Seventy-five per cent (75%) of Pre-Disability Income to be paid
directly to the Insured Member plus a Superannuation Top-Up Benefit
of up to an additional seventy-five per cent (75%) of
Pre-Disability Income to be paid directly into the Insured Member’s
superannuation account within the Plan.
Insured Members with a Date of Disability on or after the Relevant
Age.
Seventy-five per cent (75%) of Pre-Disability Income to be paid
directly to the Insured Member plus a Superannuation Top-Up Benefit
of up to an additional twenty-five per cent (25%) of Pre-Disability
Income to be paid directly into the Insured Member’s superannuation
account within the Plan.
Where the Amount Insured is more than seventy-five per cent (75%)
of the Insured Member’s Pre-Disability Income, the amount paid as
the Superannuation Top-Up Benefit will be based on the difference
between seventy-five per cent (75%) of the Insured Member’s
Pre-Disability Income and the Amount Insured. The amount is limited
to a maximum of: (i) seventy-five per cent (75%) of Pre-Disability
Income if the Insured Member's Date of Disability is prior to the
member attaining the Relevant Age; or (ii) twenty-five per cent
(25%) of Pre-Disability Income if the Insured Member's Date of
Disability is on or after the member attaining the Relevant
Age.
The Superannuation Top-Up Benefit will continue to be payable until
the earliest of: (i) the expiry of the Maximum Benefit Period; (ii)
the date the Insured Member is no longer Totally or Partially
Disabled; (iii) the death of the Insured Member; and (iv) the date
the Insured Member’s superannuation account within the Plan has
been closed. Where the Amount Insured is equal to or less than
seventy-five per cent (75%) of the Insured Member’s Pre-Disability
Income, no Superannuation Top-Up Benefit will be paid with respect
to that Insured Member.
Waiting Period
All Waiting Period options
30 days, 60 days, 90 days, 120 days or 180 days
An Insured Member may make an election in writing or by telephone
to reduce the Waiting Period subject to Evidence of Insurability
being submitted and accepted by the Company. An Insured Member may
make an election in writing or by telephone to increase the Waiting
Period without Evidence of Insurability being submitted to the
Company.
Maximum Benefit Period
(a) Subject to (b) below, the Maximum Benefit Period for an Insured
Member is:
(i) If an Insured Member’s Waiting Period ends prior to age
sixty-seven (67): The lesser of:
A) 2 years; and B) 6 months after attaining age 67.
(ii) If the Insured Member’s Waiting Period ends on or after age
67: 6 months
(b) For an Existing Insured Member who is an Insured Member: (i) no
benefit is payable beyond age sixty-five (65) where an Insured
Member’s Date of Disability occurs prior to 1 October 2019.
(ii) no benefit is payable beyond the lesser of: (A) 2 years; and
(B) 6 months after attaining age 65;
where the Date of Disability occurs between 1 October 2019 and the
Effective Date, if the Waiting Period ended prior to attaining age
sixty-five (65).
(iii) no benefit is payable beyond 6 months after the completion of
the Waiting Period where the Date of Disability is between 1
October 2019 and the Effective Date, if the Date of Disability
occurs before the Insured Member attains age sixty- five (65) and
the Waiting Period ends after attaining age sixty-five (65).
Maximum Amount Insured
Lesser of $30,000 per month and the Income Replacement Ratio
Any Insured Member who is classified as being in Occupation
Category 4 (Hazardous
Occupations) will in all instances be limited to a Maximum Amount
Insured of the
lesser of $10,000 per month and the Income Replacement Ratio. This
limit will also
apply to an Insured Member who is classified as being in Occupation
Category 3 (Blue
and Heavy Blue Collar) for the following occupations: ‘Ambulance
Officers and
Paramedics’, ‘Blasting workers’, ‘Chemical, Gas, Petroleum and
Power Generation
Plant Operators’, ‘Chemical, Petroleum and Gas Plant Operators’,
‘Drillers’, ‘Drillers,
Miners and Shot Firers’, ‘Forestry and Logging Workers’, ‘Guards
and Security
Officers’, ‘Miners’, ‘Mining Support Workers and Drillers
Assistants’,’ Power
Generation Plant Operators’, ‘Seafarers and Fishing Hands’, ‘Timber
and Wood
Process Workers’ and ‘Travel Attendants’. Also includes ‘Mining and
Material
Engineers’ and ‘Mining Engineers’ if any part of their role
requires them to be in an
underground mine at any time.
Benefit Payments Refer to Schedule 1
Due Date of First Premium 19 June 2021
Frequency of Premium Payments
7
Rate Guarantee Period 1 October 2019 to 30 September 2022
Eligibility Conditions Some words in the Policy have a particular
meaning that are defined in the Policy. These words begin in
capital letters and their meanings are set out in the definitions
section of the Policy.
1. Existing Insured Members
(a) From the Effective Date, all Existing Insured Members will
continue to have the same Amount Insured as they did on the day
immediately prior to the Effective Date, subject to the
following:
(i) any individual conditions, exclusions, restrictions which
applied on the day immediately prior to the Effective Date will
continue to apply until such time as they expire according to their
terms;
(ii) if the Existing Insured Member’s Amount Insured was Limited
Cover or New Events Cover on the day immediately prior to the
Effective Date, the conditions attaching to Limited Cover or New
Events Cover under the Previous Insurance Arrangements will
continue to apply to that Amount Insured until such time as those
conditions expire according to their terms;
(iii) where an Existing Insured Member had a right under the
Previous Insurance Arrangements to opt-in for Cover or to obtain an
increase in Cover without Evidence of Insurability that could be
exercised within a specified period of time following the
occurrence of a specified event, then if:
- the specified event occurred prior to the Effective Date;
- the right is not available under the terms of the Policy
effective on the Effective Date; and
- the Cover or additional Cover would have been granted to the
Existing Insured Member had the Previous Insurance Arrangements
continued to apply,
the Company will grant the Cover or additional cover to the
Existing Insured Member on the terms that would have applied under
the Previous Insurance Arrangements, including as to whether or not
the Cover is Limited Cover and for how long, and once the Cover has
been granted the conditions of the revised Policy will apply to
that Cover except that conditions of any Limited Cover granted will
continue to apply until such time as those conditions expire
according to the terms on which it was granted.
(b) Where a claim arises and the Existing Insured Member’s Date of
Disability occurs before the Effective Date , the Previous
Insurance Arrangements will apply to the Existing Insured Member’s
claim, other than where a WA Police Officer is Medically Discharged
on or after 1 October 2019, in which case the alternative benefit
outlined in General Condition 33 of this Policy will apply.
1A. Special Conditions Cover
Schedule 3 sets out the main terms and conditions (including terms
of eligibility) of Special Conditions Cover, and forms part of the
terms of this Policy.
2. Eligibility for Cover
Permanent Employees, Contractors, Casual Employees and Sessional
Employees under the age of sixty-five (65) and in
receipt of SG contributions from a Participating Employer who are
eligible to join or re-join the Plan may be eligible to
receive default cover under the Policy.
Eligibility for default Income Protection cover under the Policy is
determined under the Eligibility Conditions at the time of
joining or re-joining the Plan upon receipt of their first SG
contribution by the Plan from a Participating Employer, or at
the
time of first commencing employment with a Participating Employer.
Eligibility for all other Income Protection Cover
provided under the Policy (except Special Conditions Cover) is
determined under the Eligibility Conditions when a member
applies for Cover. Eligibility for Special Conditions Cover is
determined under Schedule 3 on the date that any applicable
Special Conditions Cover is to commence.
Eligible employees who are not Insured Members or who are Insured
Members who only hold Voluntary Cover will receive
default Income Protection Cover in accordance with the terms of the
Policy based on the Category of Membership (as
defined in the Policy Schedule) that applies to the member:
(i) at the time of joining or re-joining the Plan, upon receipt of
their first SG contribution by the Plan from a Participating
Employer or
Policy Document
9
Eligible employees who are not Insured Members will receive Income
Protection Cover in accordance with Schedule 3 of
the Policy after they become eligible for Special Conditions
Cover.
Members who have previously cancelled or opted out of Income
Protection cover will not subsequently be eligible for any
Income Protection Cover under the Policy other than Voluntary
Cover. Any subsequent Cover under the Policy must be
Voluntary Cover and is subject to Evidence of Insurability being
submitted and accepted by the Company.
Members will not be eligible for Income Protection Cover other than
Voluntary Cover if the member has previously received
or was eligible to receive a TPD benefit or Terminal Illness
benefit under Group Life Insurance Policy No. MP9908
(including Previous Insurance Arrangements as defined under that
policy) or under Group Life Insurance Policy No.
MP9936 (including any previous insurance arrangements that applied
under that policy prior to 1 October 2019) issued to
the Policy Owner. Any subsequent Income Protection Cover under the
Policy must be Voluntary Cover and is subject to
Evidence of Insurability being submitted and accepted by the
Company.
For the avoidance of doubt, a member who changes their Category of
Membership does not automatically receive the
Income Protection Cover under the Policy that corresponds to their
new Category of Membership. However, a member who
changes their Category of Membership may become eligible for
Special Conditions Cover automatically from the Agreed
Date in accordance with Schedule 3. A member who is not an Insured
Person under this Policy may also become eligible
for Cover to commence or recommence under Schedule 3 – Special
Conditions in other circumstances where they meet the
eligibility criteria set out in Schedule 3.
(b) Category 2:
An eligible Casual Employee may elect to be provided with Cover
(“opt-in”) within ninety (90) days of the date the Casual
Employee’s first SG contribution is received by the Plan from a
Participating Employer without Evidence of Insurability being
required. The eligible Casual Employee must complete the relevant
application including an “At Work” declaration and the
requested Cover will commence from the date the Policy Owner
accepts the completed application.
Where a Casual Employee’s application is not accepted by the Policy
Owner or the election for Cover is made more than
ninety (90) days after the date the first SG contribution is
received by the Plan from a Participating Employer or where
the
Insured Member applies for full Cover whilst the one (1) year
Limited Cover period applies, Cover can be provided subject
to Evidence of Insurability being submitted and accepted by the
Company.
3. Amount Insured
Default Amount Insured
Full-time $4,200
Less than 0.4 FTE $1,600
(a) Default Cover for Category 1 members and Opt-In Cover for
Category 2 members
(i) A member in Category 1 who is eligible for default cover and
either;
i is not an Insured Member; or
ii is an Insured Member but only holds Voluntary Cover,
will receive the Default Amount Insured as stated in Column B
above, in accordance with the member's FTE level
at the date their Cover commences.
(ii) If an Insured Member in Category 1 has an Income which
supports a higher Default Amount Insured than that
provided based on their equivalent FTE level, the Insured Member
may increase their Default Amount Insured up
to the lesser of $4,200 and eighty-five per cent (85%) of their
Income (seventy-five per cent (75%) Income plus ten
per cent (10%) Superannuation Top Up benefit) without providing
Evidence of Insurability subject to an application
being submitted to the Policy Owner within ninety (90) days of the
date the Insured Member’s first SG contribution
is received by the Plan from a Participating Employer, and the
Insured Member being At Work on the date the
application is submitted.
(iii) A member in Category 2 who is eligible for default cover, and
either:
i is not an Insured Member; or
ii is an Insured Member but only holds Voluntary Cover,
and who is accepted for cover by the Company (after opting in
within ninety (90) days of the date the Casual
Employee’s first SG contribution is received by the Plan from a
Participating Employer) will receive a Default
Amount Insured of $2,000 (if the member is working at least 0.4
FTE) or $1,600 per month (if the member is
working less than 0.4 FTE) based on the information held by the
Policy Owner in relation to the member’s FTE
level on the date cover is to commence.
(iv) Where an eligible Casual Employee does not opt-in within
ninety (90) days of the date the Casual Employee’s first
SG contribution is received by the Plan from a Participating
Employer under sub-condition (iii) above, or the
application is not accepted by the Company under sub-condition
(iii) above, the Casual Employee may apply for
Income Protection Cover which is Voluntary Cover, subject to
Evidence of Insurability being submitted and
accepted by the Company.
(b) Voluntary Cover:
A person who is eligible for Cover (including a person not eligible
for default cover or Special Conditions Cover) can apply
to obtain Cover or additional Cover, subject to:
(i) the Maximum Amount Insured set out in the Policy
Schedule,
(ii) a limit of eighty-five per cent (85%) of their Income
(seventy-five per cent (75%) Income plus ten per cent (10%)
Superannuation Top Up benefit), and
(iii) Evidence of Insurability being submitted and accepted by the
Company.
If an application for Voluntary Cover is accepted by the Company,
the Insured Member’s Amount Insured will be rounded
down to the nearest even $200.
(c) Reducing or opting-out of cover:
If an Insured Member elects to reduce or opt-out of their insurance
Cover within thirty (30) days of their Cover creation date,
no premium will be due in respect of the Cover not accepted and any
premiums paid will be refunded to the member’s
account. Accordingly, reduced or no insurance Cover will be
provided during that thirty (30) day period.
All Insured Members can opt-out or reduce their Amount Insured by
request in writing or by telephone to the Policy Owner.
4. Commencement of Cover
For the avoidance of doubt, any Special Conditions Cover provided
to a member will commence in accordance with the
terms and conditions of Schedule 3 and not in accordance with the
terms and conditions of this condition 4.
(a) Category 1:
(i) Where within one hundred and twenty (120) days of first
commencing employment with a Participating Employer:
- an eligible employee joins or re-joins the Plan; or - the
employee’s first SG contribution is received by the Plan from a
Participating Employer; then: - where the employee’s first SG
contribution is received by the Plan from a Participating Employer
within sixty
(60) days of the employee first commencing employment with a
Participating Employer - default cover will commence on the date
the employee first commences employment with the Participating
Employer; or
- where the employee’s first SG contribution is received by the
Plan from a Participating Employer within sixty- one (61) and one
hundred and twenty (120) days (inclusive) of the employee first
commencing employment with a Participating Employer – default cover
will commence on the date the employee’s first SG contributions are
received by the Plan;
(ii) Where after one hundred and twenty (120) days of first
commencing employment with a Participating Employer:
- an eligible employee joins or re-joins the Plan; or - the
employee’s first SG contribution is received by the Plan from a
Participating Employer; then:
Policy Document
11
- default cover will commence on the date the employee’s first SG
contribution is received by the Plan from a Participating Employer
however, default cover is Limited Cover for the first one (1) year
and until such time as the Insured Member meets the At Work
criteria for at least thirty (30) consecutive days, after the first
(1st) year has transpired.
(iii) If an Insured Member is not At Work on the date default cover
commences, New Events Cover will be provided until such time the
Insured Member is At Work and performing their Normal Duties and
Work Hours for three (3) consecutive months, after which default
cover will no longer be limited to New Events Cover. This
Eligibility Condition 4(a)(iii) does not apply where Eligibility
Condition 4(a)(ii) applies;
(iv) Where an Insured Member increases their Default Amount Insured
as outlined in Eligibility Condition 3(a)(ii), the increase in the
Default Amount Insured commences on the date the application is
received by the Policy Owner and is subject to the Insured Member
being At Work on this date.
(b) Category 2:
Default cover for a Casual Employee commences on the date the
Policy Owner accepts the Casual Employee’s completed opt-in
application, so long as the completed opt-in application is made
within ninety (90) days of the date the Casual Employee’s first SG
contribution is received by the Plan from a Participating
Employer.
Default cover will be Limited Cover from the date cover commences
for one (1) year and until such time as the Insured Member meets
the At Work criteria for at least thirty (30) consecutive days
after the first (1st) year has transpired. Where the application is
accepted by the Policy Owner, it is deemed that the application has
also been accepted by the Company
(c) All Categories:
Where an application for Voluntary Cover, supported by the required
Evidence of Insurability, is accepted by the Company, the Insured
Member’s Voluntary Cover will commence on the date the Company
accepts the application for Voluntary Cover, subject to the Insured
Member’s acceptance of any special terms.
General Conditions
1. Premium – When Payable
Premiums are payable monthly in arrears by the Policy Owner within
five (5) Business Days of the due date of each premium.
If the premiums are not paid within thirty (30) days of the date
they fall due, the Company will give the Policy Owner written
notice of its intention to lapse the Policy. If the overdue
premiums have not been paid within a further thirty (30) days of
that written notice, the Policy will lapse and all Cover will
cease. If the event giving rise to a claim occurs within any period
for which no premiums have been remitted to the Company, no Amount
Insured in respect of such claim will be paid until the premium has
been remitted to the Company.
2. Premium – How Calculated
(a) At any time, the monthly premium due in respect of a particular
Insured Member shall be that part (if any) of that Insured Member's
current Amount Insured that has been accepted by the Company on
standard terms multiplied by the premium rates applicable to the
Insured Member’s age each month and multiplied by the relevant
occupational category factor outlined in Schedule 2 of this
Policy.
If any part of that Insured Member's current Amount Insured has not
been accepted by the Company on standard terms, then special
acceptance terms may be determined and issued by the Company.
(b) The premium due in respect of the Policy shall be the sum of
the premiums calculated in paragraph (a) of this condition in
respect of every Insured Member.
3. Premium – Mis-statement of Age
If the date of birth of an Insured Member proves to have been
incorrectly stated, then:
(a) where the age of the Insured Member has been understated, the
amount payable for the Insured Member under the Policy and every
benefit accruing under the Policy will be based on the Cover that
is commensurate to the premiums paid (based on the Insured Member’s
incorrect age);
(b) where the age of the Insured Member has been overstated, the
premium not required in respect of the Plan Year shall be refunded
as a premium adjustment to the Policy Owner in the following
monthly premium remittance;
(c) any corrections will be treated as part of the normal premium
adjustment.
4. Premium Adjustments
(i) new Insured Members;
(ii) increases and decreases in Amounts Insured during the
month;
(iii) any termination of insurance; and
(iv) premium waivers, in accordance with General Condition
13.
(b) Premium adjustment is calculated on a pro-rata basis from the
date a person becomes an Insured Member or date the Amount Insured
is increased or decreased during the month.
(c) Premium credits for an Insured Member withdrawing will be
calculated on the same basis as premiums are charged for a new
Insured Member.
5. Policy Termination and Reinstatement
If the Policy ceases to be in force it may be reinstated within
sixty (60) days of termination, with the Company's consent, upon
the payment of the overdue premium for the period during which the
premium is overdue, together with such Evidence of Insurability of
the continued good health and eligibility for insurance of the
Insured Members as the Company may require.
6. Termination of Cover
(a) Each month or as otherwise agreed, the Policy Owner shall give
notice to the Company of any person who has ceased to be an Insured
Member due to termination of their Cover in accordance with this
condition and shall advise the date upon which that person ceased
to be an Insured Member.
(b) The Income Protection Cover of an Insured Member shall
terminate at the end of the day on the earliest of:
(i) the Insured Member attains sixty-seven (67) years of age;
(ii) the date of receipt of notification in writing or by telephone
to cancel Cover by the Insured Member to the Policy Owner;
(iii) the date of termination of the Policy;
(iv) the date the Insured Member dies;
(v) the date the Insured Member ceases to be a member of the
Plan;
(vi) subject to General Conditions 23, 24 and 26, one hundred and
twenty (120) days after the last SG Contribution is received by the
Plan in respect to the Insured Member; and
(vii) subject to General Condition 26, the date on which the
premium due in relation to an Insured Member was not paid as a
result of the Insured Member’s account balance being
insufficient.
(c) For the avoidance of doubt, termination of an Insured Member’s
Cover, as outlined in this General Condition, will not affect the
Insured Member’s eligibility to make a claim where the Date of
Disability occurs during the period the Cover was in force.
7. Termination by the Policy Owner
The Policy Owner will cease to participate in this Policy under one
of the following conditions:
(a) Premiums for the Policy Owner are in arrears subject to General
Condition 1; or
(b) The Policy Owner gives the Company one hundred and twenty (120)
days’ notice in writing that it intends to cease to participate in
the Policy.
8. Monthly Review
Each month of the Plan Year, the Policy Owner must furnish the
Company with details of all Insured Members including persons who
have become Insured Members since the date of the last monthly
review. Such information shall be in a format agreed between the
Policy Owner and the Company.
Policy Document
13
9. Claims
The Policy Owner shall give notice to the Company of the Total
Disability (through injury or sickness) of any Insured Member which
gives rise to a claim within a reasonable period of time of such an
occurrence.
Upon receipt of a notice of claim, or as soon thereafter as is
reasonably possible, the Company will furnish to the Policy Owner
such claim forms as are usually furnished by the Company when in
receipt of the notice of claim.
The Company maintains the right to fully investigate and assess any
claims to its satisfaction prior to the settlement of any such
claim.
All ongoing claim requirements will be furnished by the Policy
Owner to the Company as required.
In respect of claims that arise whilst the Insured Member is
overseas, the Company may require the Insured Member to return to
Australia for medical treatment and assessment. The Company will
not pay costs relating to the Insured Member’s return to
Australia.
The Company will continue to pay benefits the Insured Member is
entitled to under this Policy, if the Insured Member who is Totally
Disabled or Partially Disabled travels overseas, provided the
Company is advised in advance of his/her travel and approves of
such travel. The Company may require the Insured Member to return
to Australia at his/her expense where necessary for medical
treatment or assessment.
10. Statutory Fund
This Policy forms part of AIA Statutory Fund No 1.
11. Rates Guarantee
The Company guarantees the Applicable Table of Rates for the Rate
Guarantee Period specified in the Policy Schedule and subject to
General Conditions 28 and 29. The guarantee may terminate earlier
if the Policy Owner undertakes a successor fund transfer of the
current fund arrangements to another fund or if the number of
Insured Members fluctuates by more than twenty-five percent (25%)
in any twelve (12) month period.
12. Profit Share
This Policy is non-participating.
13. Waiver of Premium
The Company will waive the payment of any premiums of an Insured
Member falling due during a period for which benefits are
payable.
14. Concurrent Disability
Where an Insured Member is totally disabled because of more than
one injury or sickness, or from both, whether related or not,
benefits are payable in respect of only one injury or sickness, as
the Company shall determine, based on medical evidence.
15. Recurrent Disability
If a further claim is made by an Insured Member arising from the
same or related cause as the first claim, the further claim:
(a) will be treated as a separate claim if it occurred after the
Insured Member returned to work for at least twelve (12)
months;
(b) will be deemed to be a continuation of the original claim if
made within twelve (12) months from the ceasing of payments from
the earlier claim. A further Waiting Period will not apply in this
case, however the maximum claim period will be adjusted to take
into account prior claim payments.
16. Consecutive Absence
Where a thirty (30) day Waiting Period applies, an Insured Member
is permitted to return to work for up to five (5) consecutive days
during the Waiting Period without recommencing the Waiting Period.
For Waiting Periods in excess of thirty (30) days, an Insured
Member is permitted to return to work for up to ten (10)
consecutive days during the Waiting Period without recommencing the
Waiting Period.
Where either of the above applies, any days worked will be added to
the Insured Member’s original Waiting Period.
17. Rehabilitation Expenses
Rehabilitation expenses approved by the Company will be reimbursed
and are limited to six (6) monthly benefit payments. Rehabilitation
expenses will relate to rehabilitation programs designed to
rehabilitate the disability of an Insured Member or return the
Insured Member to work.
18. Medical Examination
The Company shall have the right to arrange for the Insured Member
to be examined by a Registered Medical Practitioner at the
Company's expense when and as often as the Company may reasonably
require for the duration of a claim.
19. Proof of Loss
Written proof of Total Disability or Partial Disability under this
Policy must be furnished to the Company's reasonable satisfaction
within a reasonable period of the Insured Member suffering
loss.
Proof must be established by such reports, written declarations or
by other means as the Company may reasonably require.
20. Worldwide Cover
Cover under this Policy applies worldwide subject to General
Conditions 24 and 25. However, the period during which Income
Protection benefits are payable will be limited to twelve (12)
months unless the Insured Member continuously resides in Australia,
New Zealand, Sweden, the United Kingdom, the United States of
America or in any other country to which the Company may agree in
writing.
21. Underwriting
Any underwritten Cover accepted by the Company will commence on the
date of acceptance by the Company.
Where modified terms are offered by the Company, cover will
commence on the date the Company notifies the Policy Owner,
following agreement to the modified terms by the Insured
Member.
Policy Document
15
22. Exclusions
This Policy does not cover any loss, fatal or non-fatal, caused by
or resulting from:
(a) any intentional self-inflicted injury or attempted suicide or
self-destruction, regardless of the Insured Member’s state of
mind;
(b) uncomplicated pregnancy, childbirth or miscarriage;
(c) declared or undeclared war or any act of war; or
(d) Active Service of the Insured Member.
23. Leave from Employment without Pay
Subject to General Condition 33, where an Employer approves a
period of leave without pay for an Insured Member of up to
twenty-four (24) months, the Insured Member’s Cover will continue
to the approved return to work date, subject to the continued
payment of premiums for the period of leave.
Where an Insured Member’s period of leave without pay is longer
than twenty-four (24) months, the Insured Member may apply in
writing to the Company prior to the expiry of the leave without pay
to extend such Cover beyond twenty-four (24) months. If the request
for extension is accepted by the Company, the Insured Member’s
cover will continue to the approved return to work date, subject to
the continued payment of premiums for the period of leave.
Notwithstanding the above, Cover during leave without pay may cease
one hundred and twenty (120) days after the last employer
contribution is received by the Plan in respect of the Insured
Member, as outlined in General Condition 6(b)(vi), unless the
Insured Member makes an election to the Policy Owner before the
expiry of the one hundred and twenty (120) day period for cover
during leave without pay to continue. Where the Policy Owner does
not receive this election and Cover ceases as a result of General
Condition 6(b)(vi), the Insured Member may, before the agreed
return to work date, request cover to be reinstated by providing
documented evidence of the approved leave without pay and the
agreed return to work date is within the twenty-four (24) month
period (or where an extension beyond the twenty-four (24) months is
approved by the Company, within the extended period of approved
leave without pay). Cover will be reinstated from the date the
Insured Member commenced leave without pay, subject to the payment
of premiums during this period.
If an Insured Member who made an election to the Policy Owner for
Cover during leave without pay to continue has not returned to work
on the agreed return to work date, Cover will cease thirty (30)
days after the agreed return to work date, unless an employer
contribution is received by the Plan in respect of the Insured
Member within thirty (30) days after the Insured Member’s agreed
return to work date. If Cover ceases, re-application must be made
by the Insured Member to the Company for any subsequent
reinstatement of Cover.
Where an Insured Member suffers a Partial Disability or Total
Disability during the period of leave without pay and the Date of
Disability is within the twenty-four (24) month period (or, where
an extension of Cover beyond the twenty-four (24) months is
approved by the Company, within the extended period of leave
approved by the Company), the Insured Member’s Pre-Disability
Income will be determined as the average monthly Income earned by
the Insured Member in the twelve (12) months immediately prior to
commencing leave without pay (or if the Insured Member has been
employed for less than twelve (12) months, over the Insured
Member’s period of employment immediately prior to commencing leave
without pay). If a Total Disability or Partial Disability benefit
is payable, benefit payments will commence on the date immediately
after the expiry of the Waiting Period.
24. Overseas Cover
Cover will continue automatically for an unlimited period of time
where an Insured Member travels or works overseas subject to the
payment of premiums for that Insured Member.
25. Overseas Employees
Cover is available to non-Australian citizens who are not permanent
residents of Australia during their stay in Australia and whilst
employed by a Participating Employer of the Plan. In the event of a
claim, the Company reserves the right to request that the Insured
Member remains in Australia for claims assessment.
26. Re-instatement of Terminated Cover
(a) Where an Insured Member’s Cover has terminated under General
Condition 6(b)(vii), Cover will be re-instated from the date Cover
was terminated (without Evidence of Insurability being submitted to
the Company) where, within ninety (90) days of the date the last
premium was paid, all outstanding premiums have been paid.
(b) Where the Insured Member’s Cover has terminated under General
Condition 6(b)(vi), Cover will be re-instated from the date Cover
was terminated where the Insured Member’s Date of Disability is
within one hundred and twenty (120) days of the last SG
Contribution being received by the Plan in respect of the Insured
Member.
(c) Subject to paragraphs (a) and (b) of this General Condition,
where an Insured Member’s Cover has terminated, any re- instatement
of that Cover will be subject to Evidence of Insurability being
submitted and accepted by the Company.
27. Disabled Persons Provision
The Company will provide Cover for Disabled Persons joining or
re-joining the Policy but only for events that arise after the date
Cover commences and that are unrelated to any conditions that
existed prior to the date Cover commenced.
28. War & Terrorism Provision
In the event of war, acts of terrorism, civil commotion or any act
of invasion (whether declared or undeclared) in which the
Commonwealth of Australia's armed forces are involved in activities
including combat, defence or other military and operational
activities (other than low risk training activities), or the
country of residence of the majority of Insured Members is involved
(including temporary residence), then the Company reserves the
right to alter the premium rates under the Policy where it is
reasonable to do so. Without limiting the Company’s right under
this General Condition, the Company will provide information which
is reasonable to provide in respect of the Company’s alteration to
the extent there is an increase in premium rates, and will provide
ninety (90) days’ notice to the Policy Owner of the Company’s
alteration of premium rates under this General Condition.
29. Tax Imposts
Where the Company is, or believes that it will become, liable for
any tax or other imposts levied by any Commonwealth or State
government, authority or body in connection with the Policy, the
Company may vary or otherwise adjust any amounts (including but not
limited to premiums, charges and benefits) under the Policy, in the
manner and to the extent the Company determines to be appropriate
to take account of the tax or impost.
30. Transfer of Employer Group Cover
On acceptance by the Company, members or groups of members who have
insurance cover provided outside the Plan may have their Income
Protection insurance arrangements transferred into the Plan on
terms and conditions agreed between the Policy Owner and the
Company.
31. Request to change to Professional and Executive Occupation
Category
An Insured Member of the Plan may at any time apply to the Policy
Owner to change their occupation category to a Professional or
Executive by completing the relevant form provided they satisfy the
eligibility criteria within the form.
Where the Policy Owner deems that the Insured Member does not meet
the eligibility criteria to become a Professional or Executive
Insured Member, the Insured Member’s current occupation category
will continue.
The Professional or Executive category premium rates will commence
from the date the Policy Owner accepts the application. Where the
application is accepted by the Policy Owner, the application is
deemed to have been accepted by the Company.
32. Interim Accident Cover
When Cover or an increase in the Amount Insured is subject to
Evidence of Insurability, upon receipt of an applicant’s personal
statement by the Company, Disablement by Accident cover will be
provided to the applicant. This cover will be provided for up to a
maximum of ninety (90) days from the date of receipt of the
member’s personal statement and for the benefit increase applied
for, but not exceeding $15,000 per month.
Interim accident cover automatically ends as soon as one of the
following occurs:
(a) the Company accepts, limits or rejects the cover;
(b) the Company advises the Policy Owner that the cover has been
cancelled; or
(c) the application by the eligible person for membership is
withdrawn.
No benefit will be payable in respect of disablement resulting from
hazardous pursuits and past-times, where the Company would normally
exclude such events from benefits to which a member would otherwise
be eligible.
Where cover or an increase in the Amount Insured is subject to
Evidence of Insurability, the Waiting Period and Maximum Benefit
Period applied for by the member will apply for the purpose of
interim accident cover.
Policy Document
17
33. Alternative benefit for Medically Discharged WA Police
Officers
(a) Medical Discharge occurs on and from 1 October 2019 but prior
to the Effective Date:
For the avoidance of doubt, where an Insured Member is a WA Police
Officer and has their employment terminated due to
Medical Discharge occurring on and from 1 October 2019 but prior to
the Effective Date, then their entitlement to an
alternative benefit for Medical Discharge will be determined In
accordance with General Condition 33 in the Previous
Insurance Arrangements during that period, instead of under this
General Condition 33.
(b) Medical Discharge occurs on and from the Effective Date: Where
an Insured Member is a WA Police Officer and
has their employment terminated due to Medical Discharge from the
Effective Date, then their entitlement to an alternative
benefit for Medical Discharge will be determined under this General
Condition 33 as set out below:
Where the Medical Discharge was prior to the Insured Member
attaining age 67, then their Date of Disability (being the
date
the Waiting Period commences) and last day of their Waiting Period
will be the date of their employment termination due to
Medical Discharge.
On the date of employment termination due to Medical Discharge, the
definition of Totally Disabled at or above the Minimum FTE under
this policy will have been deemed to have been met.
Where an Insured Member is employed in any occupation other than as
a WA Police Officer and is in receipt of an Income from employment
other than as a WA Police Officer, the Insured Member will be
assessed against the Partial Disability definition at or above the
Minimum FTE. Subject to this definition being met, benefits will be
paid in accordance with the Partial Disability formula outlined in
Schedule 1 of this Policy.
If any Total Disability Benefit or Partial Disability benefit is
payable, the Monthly Benefit will be reduced by any amount
previously paid for the same or related sickness or injury by the
Company as a benefit under:
(a) this Policy; or
(b) Group Supplementary income protection policy MP9936;
for the WA Police Officer in his or her role as a WA Police Officer
(“Previous Benefit”), over the duration of the payment of
the benefits after being Medically Discharged. The reduction will
be effected by reducing each Monthly Benefit by an
amount equal to:
(Previous Benefit) / 24
until such Monthly Benefit ceases to be paid.
For the avoidance of doubt, for Insured Members who are Medically
Discharged WA Police Officers:
a. the terms outlined under Benefits and Offset Benefits in
Schedule 1 of this Policy will apply, this includes if an
Insured Member is in receipt of any other benefits during the same
period the Company is paying a Monthly
Benefit following a Medical Discharge other than any amounts
payable from a Medically Disabled Officer
Compensation Scheme;
b. for Partial Disability, the Insured Member is not required to be
Totally Disabled for at least seven (7) out of ten (10)
consecutive days as specified in the Partial Disability definition;
and
c. General Condition 16 does not apply.
Definitions In the Policy:
Active Service means, whether in Australia or overseas,
participation in the armed forces of any country or organisation,
war service or engagement in a theatre of war but excludes
operations authorised by the Australian Commonwealth Government to
provide natural disaster and humanitarian relief where these
operations are not undertaken while on war service or in a theatre
of war. For the avoidance of doubt, an Insured Member who is
enrolled in the Australian Defence Force Reserve is only on 'Active
Service' where they have been called up for service, and then only
if such service otherwise satisfies this definition of 'Active
Service'.
Amount Insured means that amount certified from time to time by the
Policy Owner as the Insured Member's Amount Insured in the relevant
list under General Condition 8, subject to the conditions as
outlined in Eligibility Condition 3.
Applicable Table of Rates means the table of premium rates set out
in Schedule 2 or any revision thereof.
At Work
a) Category 1: means the Insured Member:
(i) is actively performing or capable of performing (if currently
unemployed) all the duties of his or her usual occupation with the
Participating Employer; and
(ii) is not in receipt of, or entitled to claim, any income support
benefits from any source including (but not limited to) workers’
compensation benefits, statutory transport accident benefits and
disability income benefits.
A person who does not meet these requirements is correspondingly
described as “not At Work”.
b) Category 2: means that on the day of signing the relevant form,
the Insured Member:
(i) is actively performing or capable of performing (including if
currently unemployed) all the full and normal duties of his or her
usual occupation with the Participating Employer;
(ii) is not in receipt of, or entitled to claim, any income support
benefits from any source including (but not limited to) workers’
compensation benefits, statutory transport accident benefits and
disability income benefits; and
(iii) in the Insurer’s opinion is not restricted by sickness or
injury from actively performing or being capable of performing
(including if currently unemployed) the full and normal duties of
his or her usual occupation with the Participating Employer for at
least twenty (20) hours each week (even if not working at least
twenty (20) hours each week).
A person who does not meet these requirements is correspondingly
described as “not At Work”.
Business Day means any day except a Saturday, Sunday or a public
holiday in Perth, Western Australia.
Casual Employee means a person who is engaged by a Participating
Employer who is paid at an hourly rate and who is not entitled to
be paid annual leave and sick leave in his or her employment or any
other person not defined as a Contractor, Permanent Employee or
Sessional Employee.
Company means AIA Australia Limited (ABN 79 004 837 861, AFSL
230043).
Contractor means any person who has been provided a written
contract of employment for a specified period by a Participating
Employer and is entitled to be paid annual leave and sick
leave.
Cover means cover under this Policy, being Income Protection
Cover.
Income Protection Cover or IP Cover means the income protection
cover provided under this Policy, and unless otherwise specified,
includes income protection cover that is default Cover, Voluntary
Cover and Special Conditions Cover.
Date of Disability means the day the Waiting Period
commences.
Policy Document
19
Disabled Persons means those persons who are employed under
policies which promote employment opportunities for disabled
persons and who are identified as such by the Policy Owner and/or
Participating Employers.
Disablement by Accident means disablement caused directly and
independently of any other cause from an unforeseen and unintended
accident happening to the Insured Member and caused by violent,
external and visible means.
Effective Date means the date specified as such in the Policy
Schedule.
Employer means a Participating Employer or any employer that
provides employment to an Insured Member for the Insured Member’s
remuneration or reward.
Evidence of Insurability means such evidence of health and such
other particulars of an Insured Member as the Company may require
at the time the member first becomes an Insured Member and at any
subsequent time when the Amount Insured of that Insured Member is
increased or reinstated to enable the Company to determine whether
an Insured Member is to be accepted for any insurance and the terms
of such acceptance.
Executive means the Insured Member is:
(a) earning a gross income of $100,000 per annum or more or where
the Insured Member is working at least 0.6 FTE and earning an
equivalent pro-rata income of $100,000 per annum; and
(b) part of the Executive Management Team of the Participating
Employer; and
(c) working in an office environment and sedentary capacity no less
than 80% of the time (excluding travel time from one office to
another).
Executive Management Team means the Insured Member is the Chief
Executive Officer or equivalent with a Participating Employer or
reports directly to the Chief Executive Officer or is anyone who is
in the Senior Executive Service as determined by the Policy
Owner.
Existing Insured Member means an Insured Member immediately prior
to the Effective Date.
Income means:
(a) For non-self-employed Insured Members shall mean the basic wage
or income earned by the Insured Member. Income includes the total
remuneration package, salary and fees of the Insured Member, but
does not include bonuses, overtime earnings, SG Contributions,
additional commissions and unearned income such as investment or
interest income.
(b) For self-employed, working directors or partners in a
partnership shall mean the income generated by the business or
practice due to his or her personal exertion or activities, less
his or her share of necessarily incurred business expenses.
Insured Member means a member of the Plan with Income Protection
Cover greater than nil under the Policy.
Limited Cover means insurance cover which applies only in respect
of events or conditions which arise entirely after the date cover
commences with respect to an Insured Member.
Maximum Benefit Period means the period in the Policy Schedule.
Subject to the provisions of this Policy, it is the maximum period
benefits will be paid in respect of an Insured Member for any one
period of Total Disability, or if applicable, any one period of
Total Disability and Partial Disability.
Medical Discharge or Medically Discharged means that a WA Police
Officer has had their employment terminated on medical grounds
under section 33ZE of the Police Act 1892 (WA) (or any replacement
of it), and that termination has not been revoked.
Medically Disabled Officer Compensation Scheme means a compensation
scheme for WA Police Officers to
compensate such persons for termination of their employment as WA
Police Officers due to work related sickness or injury,
that is passed through legislation in Western Australia.
Minimum FTE means at least 0.4 full-time equivalent (FTE) and is
working a minimum of thirteen (13) hours per week for the
Employer.
Monthly Benefit is the amount calculated in accordance with the
formula shown in the Policy Schedule.
New Events Cover means cover other than cover in relation to the
medical condition or any directly or indirectly related condition
arising from sickness or injury which has caused the Insured Member
to be not At Work on the date that cover commences under the
Policy.
New Events Cover applies to Insured Members working in a reduced
capacity and/or reduced salary due to a sickness or injury.
Normal Duties and Work Hours are recognised either:
(a) Immediately, where the Insured Member is working in a bona fide
position with a Participating Employer, and is not being supported
by workers’ compensation, rehabilitation benefits or other income
support benefits and is free from any limitation due to a medical
condition; or
(b) After a period of three (3) calendar months, where the Insured
Member had New Events Cover and returns to full normal duties and
has not been in receipt of workers’ compensation, rehabilitation
benefits or other income support benefits for the whole of that
period; or
(c) After a period of six (6) calendar months, where the Insured
Member had New Events Cover and has been continuously working in a
reduced/alternative bona fide position with a Participating
Employer due to a medical condition for the whole of the period and
has not been in receipt of workers’ compensation, rehabilitation
benefits or other income support benefits for the whole of that
period.
Any disability claim subsequent to the recognition of Normal Duties
and Work hours will be assessed on the incapacity of the Insured
Member to perform those normal duties and work hours.
Partial Disability or Partially Disabled where the Date of
Disability is on or after the Effective Date means subject to
General Condition 33:
Partial Disability means that solely due to the sickness or injury
which directly caused the Total Disability, the Insured
Member:
(a) remains under the regular care, attendance, and following the
advice of a Registered Medical Practitioner in relation to that
sickness or injury; and
(b) is able to perform one or more important duties* of his or her
own occupation, but unable to perform all of the duties; and
(c) is earning an Income from his or her occupation or another
occupation at a monthly rate of less than his or her Pre-
Disability Income or is capable of working, whether paid or
unpaid.
*An important duty is one that involves 20% or more of the Insured
Member’s overall tasks.
If an Insured Member is Partially Disabled beyond the Waiting
Period and has been Totally Disabled for at least seven (7) out of
ten (10) consecutive days, a Partial Disability benefit will be
payable.
For claims where the Date of Disability is prior to the Effective
Date the terms of the Policy that applied on the Date of Disability
continue to apply to the Insured Member’s claim.
Participating Employer means an employer that is eligible to make
contributions to the Plan.
Policy Document
21
Permanent Employee means any person permanently employed by a
Participating Employer and who is entitled to be paid annual leave
and sick leave. A board member is also to be considered under this
Policy as a Permanent Employee.
Plan Year means the period of twelve (12) months commencing on the
Policy Commencement Date and each subsequent period of twelve (12)
months commencing on every anniversary of the Policy Commencement
Date thereafter or such other period as may be agreed between the
Company and the Policy Owner.
Policy means this policy, any riders or endorsements therein, any
amendments thereto signed by the Company following agreement in
writing by the Policy Owner.
Policy Commencement Date means the date specified as such in the
Policy Schedule.
Policy Owner shall be the entity stated as such in the Policy
Schedule or its legal successors in title.
Policy Schedule means the schedule starting on page 6 of this
Policy as updated from time to time with the agreement of the
Policy Owner.
Pre-Disability Income means the average monthly Income earned by
the Insured Member over the twelve (12) months (or if the Insured
Member has been employed for less than twelve (12) months, over the
Insured Member’s period of employment):
(a) immediately prior to the date of commencement of Total
Disability; or
(b) where the Insured Member is a WA Police Officer who has been
Medically Discharged, immediately prior to the date the WA Police
Officer ceased their usual duties as a WA Police Officer due to the
relevant sickness or injury causing the Total Disability.
Previous Insurance Arrangements means the insurance arrangements
the Policy Owner had in place to insure member benefits immediately
prior to the Effective Date of this Policy.
Professional means the Insured Member is:
(a) earning a gross income of $100,000 per annum or more or where
the Insured Member is working at least 0.6 FTE and earning an
equivalent pro-rata income of $100,000 per annum; and
(b) holding a tertiary qualification or is a member of a
professional institute or body; and
(c) working in an office environment and sedentary capacity no less
than 80% of the time (excluding travel time from one office to
another).
Professional institute or body shall be determined by the Company
and includes, but is not limited to the following:
(i) Australian Medical Association
(ii) Institute of Chartered Accountants
(iii) Australian Institute of Management
(iv) Australian Institute of Actuaries.
Registered Medical Practitioner means a legally qualified and
properly registered medical practitioner. It does not include the
Insured Member’s Employer, the Insured Member, or an employee of
the Insured Member’s Employer or the Insured Member’s immediate
family or business partner.
Relevant Age means:
(a) if the Insured Member was born before 1 July 1960, the Relevant
Age is 55
(b) if the Insured Member was born between 1 July 1960 and 30 June
1961, the Relevant Age is 56
(c) if the Insured Member was born between 1 July 1961 and 30 June
1962, the Relevant Age is 57
(d) if the Insured Member was born between 1 July 1962 and 30 June
1963, the Relevant Age is 58
(e) if the Insured Member was born between 1 July 1963 and 30 June
1964, the Relevant Age is 59
(f) if the Insured Member was born after 30 June 1964, the Relevant
Age is 60
Retirement Purposes means where the Insured Member can access
benefits in their superannuation account having met a retirement
condition of release with a nil cashing restriction, or having met
the attaining preservation age condition of release as defined in
Part 1 of Schedule 1 of the Superannuation Industry Supervision
Regulation (SISR).
Sessional Employee means an employee, not employed under a contract
of employment, who is paid for undertaking work within a specific
period or an ad hoc arrangement to meet varying agency needs for a
Participating Employer.
SG contribution means
(a) a superannuation contribution which an employer is required to
make in respect of an employee pursuant to the Superannuation
Guarantee (Administration) Act 1993 (Cth), in order to avoid the
imposition of the Superannuation Guarantee Charge, other than a
voluntary salary sacrifice contribution; or
(b) any similar or equivalent contribution (other than a voluntary
salary sacrifice contribution) which a Participating Employer is
required under law, to contribute in respect of an employee who is
a member of the Plan.
Special Conditions Cover means cover provided in accordance with
Schedule 3.
Superannuation Guarantee Charge means the charge imposed by the
Superannuation Guarantee Charge Act 1992 (Cth).
Superannuation Top-Up Benefit means the difference between
seventy-five per cent (75%) of the Insured Member’s Pre- Disability
Income and the Amount Insured. This superannuation contribution
will be paid by the Company to the Insured Member’s superannuation
account within the Plan and will be subject to the preservation
requirements under the State Super Regulations (SSR).
Total Disability or Totally Disabled where the Date of Disability
is after the Effective Date means that subject to General Condition
33:
In respect of any Insured Member means that solely as a result of
sickness or injury, the Insured Member:
(a) is unable to perform one or more important duties* of his or
her own occupation;
(b) remains under the regular care, attendance and following the
advice of a Registered Medical Practitioner, in relation to that
sickness or injury; and
(c) is not engaged in any occupation, whether paid or unpaid.
*An important duty is one that involves 20% or more of the Insured
Member’s overall tasks.
For claims where the Date of Disability is prior to the Effective
Date the terms of the Policy that applied on the Date of Disability
continue to apply to the Insured Member’s claim.
Voluntary Cover means cover obtained under Eligibility Condition
3(b) of this Policy.
Waiting Period means subject to General Condition 16, the number of
continuous days, as shown in the Policy Schedule, which must elapse
before benefits begin to accrue.
The Waiting Period:
(a) commences from the date the Insured Member is first examined
and certified by a Registered Medical Practitioner as Totally
Disabled in relation to a condition that gave rise to a claim and
the Insured Member ceased work, due to that condition; or
(b) both commences and ceases on the date the Insured Member is
Medically Discharged in respect of a WA Police Officer.
Policy Document
23
WA Police Officer means a person who is entitled to leave and
allowances under regulation 1304 of the Police Force Regulations
1979 (or any amendment or replacement of it).
Schedule 1
Total Disability Benefit
(a) Subject to the Maximum Benefit Period as specified in the
Policy Schedule, the Company will pay a Monthly Benefit in arrears
if the Insured Member’s Date of Disability occurs prior to
attainment of age sixty-seven (67) and as a result the Insured
Member suffers Total Disability through injury or sickness. The
benefit paid will be based on the Insured Member's Monthly Benefit
calculated at the Date of Disability.
(b) The Monthly Benefit will be paid at the end of each month in
which the Insured Member is entitled to be paid. For a part month,
the Company will pay one-thirtieth of the benefit for each day of
disability.
Partial Disability Benefit
(a) In the event of the Partial Disability of an Insured Member,
the Partial Disability Benefit will be paid monthly in
arrears.
(b) The Partial Disability Benefit will be a proportion of the
Monthly Benefit, determined in accordance with the following
formula:
(A – B) x C
Where, A is the Insured Member's Pre-Disability Income
B is the Insured Member's actual Income during the month of Partial
Disability
C is the Monthly Benefit determined at the Date of
Disability.
When Benefits cease
In respect of an insured Member, the Total Disability Benefit or
Partial Disability Benefit (as applicable to the Insured Member)
will continue to be payable under the earliest of:
(a) the expiry of the Maximum Benefit Period;
(b) the date the Insured Member is no longer Totally Disabled or
Partially Disabled (as applicable);
(c) the death of the Insured Member; and
(d) in respect of a WA Police Officer, the date a Medical Discharge
is revoked.
Payments
The Company will pay benefits to the Policy Owner, or if the Policy
Owner directs, directly to the Insured Member as a non commutable
income stream (as defined in the Superannuation Industry
(Supervision) Act 1993).
Offset Benefits
Subject to General Condition 33, the benefit payable to an Insured
Member will be reduced for any amount which is paid, or required to
be paid, under workers’ compensation, social security or transport
accident compensation or similar legislation in relation to the
injury or sickness of the Insured Member. The benefits will also be
reduced by income protection benefits* from other insurance
companies or any eligible sick leave entitlements from any
source.
Where an Insured Member receives continued income from their
employer while on claim, any such amounts will also offset benefit
entitlements.
If any of the above payments are paid in the form of a commuted
lump sum, the Company will convert these to an equivalent monthly
payment deemed to be 1/60th of the lump sum payment.
*Where an Insured Member is Totally Disabled and holds income
protection type cover with another insurer, the Company
agrees not to offset any amount which is paid or required to be
paid by that policy except to the extent that the income
replacement or compensation amounts from all sources (including the
benefit otherwise payable to the Insured Member and
any Benefit Offsets) is more than 75% of the Insured Member’s
Pre-Disability Income.
Policy Document
25
*Where an Insured Member is Partially Disabled and holds income
protection type cover with another insurer, the Company
agrees not to offset any amount which is paid or required to be
paid by that policy except to the extent that the income
replacement or compensation amounts from all sources (including the
benefit otherwise payable to the Insured Member and
any Benefit Offsets) is more than 100% of the Insured Member’s
Pre-Disability Income.
Transitional Rules Members entitled to benefits as at the Effective
Date
Where an Insured Member’s Date of Disability occurs prior to the
Effective Date, any benefits payable for a period prior to
the Effective Date will continue to be subject to the Offset
Benefit terms under the Previous Insurance Arrangement
immediately prior to the Effective Date. However, any benefit
payable on or after the Effective Date will be subject to the
Offset Benefits terms under this policy Effective Date.
Schedule 2 Income Protection Premium Rates
Annual premium rates per $1,000 monthly Amount Insured
Premium rates are non-participating and inclusive of stamp duty.
Nil administration fee and nil commission applies
Waiting Period 90 days
Claims Escalation Nil
27
Claims Escalation Nil
Category 2 - Light blue collar occupations 1.50
Category 3 - Blue and heavy blue collar occupations 2.101
Category 4 - Hazardous occupations 2.602
Category 5 – Professional and Executive 0.90
* This is based on the Australian and New Zealand Standard
Classification of Occupations (ANZSCO) and Australian Standard
Classification of Occupations (ASCO). The Company reserves the
right to review occupations in order to correctly assess these for
insurance purposes.
1 at a minimum the rates for Voluntary Cover approved above $4,200
per month will be 1.5 times the premium rates for the following
Category 3 occupations: ‘Ambulance Officers and Paramedics’,
‘Blasting workers’, ‘Chemical, Gas, Petroleum and Power Generation
Plant Operators’, ‘Chemical, Petroleum and Gas Plant Operators’,
‘Drillers’, ‘Drillers, Miners and Shot Firers’, ‘Forestry and
Logging Workers’, ‘Guards and Security Officers’, ‘Miners’, ‘Mining
Support Workers and Drillers Assistants’,’ Power Generation Plant
Operators’, ‘Seafarers and Fishing Hands’, ‘Timber and Wood Process
Workers’ and ‘Travel Attendants’. Also includes ‘Mining and
Material Engineers’ and ‘Mining Engineers’ if any part of their
role requires them to be in an underground mine at any time.
2 at a minimum the rates for Voluntary Cover approved above $4,200
per month will be 1.5 times the premium rates.
Waiting Period (WP) factors
rates x WP factor)
30 day wait 3.20
60 day wait 1.85
90 day wait 1.00
120 day wait 0.90
180 day wait 0.80
#Default of 90 day Waiting Period applies under all circumstances
unless otherwise agreed.
Policy Document
29
Schedule 3 – Special Conditions
This Schedule 3 sets out the terms under which a member of the Plan
who is not an Insured Member may receive
automatic cover once they satisfy the eligibility conditions set
out in sub-condition 3.2 'Eligibility for Special Conditions
Cover' of Schedule 3 of the Policy. Cover provided under this
Schedule 3 is Special Conditions Cover.
The terms of this Schedule 3 apply as terms of the Policy. To the
extent of a contradiction or inconsistency between the
terms of this Schedule and the other terms of the Policy, the terms
of this Schedule will prevail only to the extent necessary
to affect the cover of members eligible for Special Conditions
Cover under this Schedule.
For the avoidance of doubt, where a member is eligible for default
cover under the general Eligibility Conditions set out in
Eligibility Conditions 1, 2, 3 and 4 of the Policy, those terms
apply rather than this Schedule 3. Where a member is entitled
to the reinstatement of Cover under General Conditions 23 or 26
that condition will apply to the member rather than this
Schedule 3.
For the avoidance of doubt, this means that if, after Special
Conditions Cover has commenced, a member becomes
entitled to reinstate Cover under General Conditions 23 or 26 of
the Policy, the member's reinstated Cover will replace any
Special Conditions Cover held by the member.
3.1 Commencement or recommencement of Special Conditions
Cover
(a) Subject to sub-condition 3.1(b) of this Schedule 3, the Policy
Owner and the Company will agree a date each calendar
month on which Special Conditions Cover will commence (Agreed Date)
for any members who have become eligible
for Special Conditions Cover prior to the Agreed Date under
condition 3.2 of this Schedule 3. The first Agreed Date will
be 12 September 2020 and each subsequent Agreed Date will occur not
more than 45 days after the previous Agreed
Date unless sub-condition 3.1(b) of this Schedule 3 applies.
(b) The Policy Owner may, in its absolute discretion elect to
suspend for any length of time the process by which an
Agreed Date is determined by giving notice to the Company in
writing and during any such period of suspension sub-
condition 3.1(a) of this Schedule 3 will not apply. The Policy
Owner may also extend or reduce any period of
suspension by giving notice to the Company in writing and any
period of suspension will end automatically on the next
date that the Policy Owner and the Company agree that Special
Conditions Cover will commence.
(c) Special Conditions Cover will commence for an eligible member
of the Plan on the first Agreed Date that occurs after
the member satisfies the eligibility conditions set out in
sub-condition 3.2 'Eligibility for Special Conditions Cover' of
this
Schedule 3.
3.2 Eligibility for Special Conditions Cover
A member of the Plan who is currently employed by a Participating
Employer in Category 1 on the Agreed Date (based on
the information held by the Policy Owner in relation to the member
on the Agreed Date) who is not an Insured Member on
the Agreed Date, will be eligible to receive Special Conditions
Cover and is deemed to be a Category 1 Insured Member
under the Policy with effect on and from the Agreed Date subject to
the following:
(a) A member will not be eligible to be deemed to be a Category 1
Insured Member under this condition 3.2 of this
Schedule 3 and thereby not receive cover under this Schedule 3 if,
on the Agreed Date the member:
(i) was already an Insured Member; or
(ii) has previously elected to cancel or opt-out of Cover under
this Policy (including any previous insurance
arrangements that applied under this Policy prior to the Effective
Date), or Group Supplementary Income
Protection Policy No. MP9936 (including any previous insurance
arrangements that applied under that policy prior
to 1 October 2019); or
(iii) has not had an SG contribution (in respect of the member's
Category 1 employment) received by the Plan from a
Participating Employer in the thirty-five (35) days immediately
prior to the Agreed Date; or
(iv) is sixty-five (65) years or over; or
(v) is not a member of the Plan; or
(vi) prior to the Agreed Date has previously received or was
eligible to receive a TPD benefit or Terminal Illness benefit
or Income Protection Benefit under this Policy (including any
previous insurance arrangements that applied under
this Policy prior to the Effective Date), or Group
Supplementary Income Protection Policy No. MP9936 (including any
previous insurance arrangements that
applied under that policy prior to 1 October 2019), Group Life
Insurance Policy No. MP9908 (including any
previous insurance arrangements that applied under that policy
prior to the "Effective Date" as defined under that
policy) or Group Life Insurance Policy No. MP9936 (including any
previous insurance arrangements that applied
under that policy prior to 1 October 2019) issued to the Policy
Owner; or
(vii) is eligible for default cover under the general Eligibility
Conditions (Eligibility Conditions 1, 2, 3 and 4 of the
Policy);
or
(viii) has a date of death that occurs prior to the Agreed
Date.
3.3 Special Conditions Cover Amount Insured, cover limits and
options
A member who is eligible for Special Conditions Cover will receive
cover subject the following terms, conditions and limits:
(a) The Waiting Period that will apply to Special Conditions Cover
will be the Default Waiting Period of 90 days.
(b) The member’s Special Conditions Cover Amount Insured will be
the amount stated in Column B of the Default Amount
Insured table in Eligibility Condition 3 of the Policy that
corresponds with the member's Employment status - Full Time
Equivalent (based on the information held by the Policy Owner in
relation to the member’s FTE level on the Agreed
Date).
(c) The member’s Income Protection Special Conditions Cover will
commence on the Agreed Date subject to the following;
(i) If the member was not At Work for the thirty (30) consecutive
days immediately prior to the Agreed Date, the
member’s Income Protection cover is Limited Cover and Limited Cover
will continue to apply until such time as the
Insured Member meets the At Work criteria for thirty (30)
consecutive days. This sub-condition 3.3(c)(i) of this
Schedule 3 does not apply when sub-condition 3.3(c)(ii) of this
Schedule 3 applies;
(ii) If the Policy Owner is satisfied that:
A. an SG contribution has been made in respect of the member in
relation to a period the member has
been employed by a Participating Employer within the 12 months
immediately prior to the Agreed
Date applicable to the member; and
B. the SG contribution was made into a superannuation fund or
scheme other than the GESB
Superannuation Scheme or the West State Superannuation
Scheme;
then cover is Limited Cover for the first one (1) year from the
Agreed Date and until such time as the Insured
Member meets the At Work criteria for thirty (30) consecutive days
after the first one (1) year of Limited Cover has
transpired since the Agreed Date;
(iii) The At Work test that applies for the purposes of these
sub-conditions 3.3(c)(i) and 3.3(c)(ii) of this Schedule 3 of
the Policy is the At Work test that applies to Category 1 members
(i.e. the test at condition '(a)' of the 'At Work'
definition).
(d) If the member elects to reduce or opt-out of the cover provided
on the Agreed Date under this Schedule 3 within thirty
(30) days of the Agreed Date, no premium will be due in respect of
the cover not accepted and any premiums paid in
respect of that cover will be refunded to the member’s account.
Accordingly, reduced or no insurance cover will be
provided during that thirty (30) day period.
(e) If the member has an Income which supports a higher Amount
Insured than that provided on the Agreed Date based
on their equivalent FTE level, the member may increase their Amount
Insured up to the lesser of $4,200 and eighty-five
per cent (85%) of their Income (seventy-five per cent (75%) Income
plus ten per cent (10%) Superannuation Top Up
benefit) without providing Evidence of Insurability subject to an
application being submitted to the Policy Owner within
ninety (90) days of the Agreed Date and the Insured Member being At
Work on the date the application is submitted.
Any conditions that would apply to cover provided under this
Schedule 3 will also apply to any increased Amount
Insured pursuant to this sub-condition 3.3(e) of this Schedule
3.
Error! Unknown document property name.
AIA Australia