Insurance Guide
PDS Supplement
we make it easy for you
Dated 10 November 2015 CARE Super Pty Ltd (Trustee) ABN 91 006 670 060 AFSL 235226
Insurance – CareSuper has you covered 2
Default insurance cover 4
Personal Plan members 6
Types of insurance 7
How much cover do you need? 12
Insurance – what do I need to know? 13
Claiming an insurance benefit 16
Definitions for insurance 19
Contents
The information in this Insurance Guide applies to Employee Plan members and Personal Plan members. It describes the insurance arrangements applicable from 10 November 2015.
PDS Supplement
The information in this
document forms part of the
CareSuper Member Guide
Product Disclosure Statement
dated 10 November 2015.
CareSuper insurance
CareSuper offers members access to death, total & permanent disablement and income protection insurance cover at competitive rates.
The insurance options available to you will depend on the type of membership you have with us.
Default... Eligible Employee Plan members receive the default level of insurance under CareSuper’s Group policy. See page 4 for details on default cover.
Personal Plan
members... Need to apply for insurance cover, as it’s not provided to you upon joining CareSuper. Refer to page 6 of this Insurance Guide for further information.
Note: You may also be able to transfer insurance cover from another super fund to CareSuper, subject to conditions. Refer to page 13 for details.
Which insurance arrangement applies to you?
the insurance options available to you will depend on what type of member you are
Getting advice
The advice in this Insurance Guide is of a general nature. It has been prepared without taking into account members’ particular financial needs, circumstances and objectives. We recommend that members assess their own financial situation before making a decision about their insurance cover. This may involve seeking the help of a licensed or authorised adviser.
how much or what type of insurance you need depends on your
circumstances
You wouldn’t think twice about insuring your car or house, yet you may not have thought about insuring your income, which could be one of your biggest assets.
If that was suddenly taken away, insurance cover could help reduce the impact on you or your family. CareSuper insurance premiums are paid from your super account so you won’t feel the impact on your take-home pay.
1
Death cover provides a lump sum payment to your beneficiaries if you die (certain restrictions apply). This can help you to ensure the ongoing wellbeing of family members, even if you are no longer around to provide for them. Early release of the death benefit may also be available if you are terminally ill (see definition of terminal illness on page 19).You must be aged under 70 and meet other eligibility criteria to obtain death cover.
2
Total & permanent disablement (TPD) cover provides a lump sum payment if you are never able to work again (specific definitions apply).This payment could be used to cover medical bills, rehabilitation expenses or medically required home
modifications, and to ensure the overall security of your family and your home. You must be aged under 65 and meet other eligibility criteria to obtain TPD cover.
If you have previously been paid a TPD payment of any type as a result of a TPD claim, you will only be eligible for death cover with CareSuper, not TPD or income protection cover. If you aren’t eligible for TPD or income protection cover, you will need to notify us or cancel your cover. Otherwise, premiums will continue to be deducted from your account.
3
Income protection cover provides a temporary replacement income if you are unable to work due to illness or injury (specific conditions apply). This means you can continue to pay your bills while taking the time to recover and rehabilitate. You must be aged under 65 and on an ongoing basis be earning at least $16,000 p.a. or working 15 hours or more per week to be eligible for income protection cover (other eligibility criteria applies).Each type of cover is explained in detail in the following pages.
CareSuper offers three types of insurance cover to eligible members:
death, total & permanent disablement (TPD) and income protection
Insurance – CareSuper has you covered
Did you know?
As the provider of an authorised MySuper product, CareSuper meets the minimum insurance requirements and is an eligible default fund for employers’
compulsory super contributions (where an employee does not choose their own fund).
It’s important to think about insurance while you’re fit and well, as it can be difficult to obtain if you’ve suffered an illness or injury.
Insurance cover through your super fund is purchased at group rates – which is usually cheaper than getting cover yourself.
All insurance cover (including default cover) is subject to the insurer’s terms and conditions summarised in the following pages.
How it works
Employee Plan members
• At CareSuper, each eligible Employee Plan member receives our default insurance cover under CareSuper’s Group policy, however limited default cover (‘limited cover’) may apply in certain circumstances. You are required to be in active employment before full cover commences. For more information on limited cover see pages 17 and 19.
Default cover is provided in
‘units’ of death and TPD cover.
The number of units you receive depends on your age and the amount of cover per unit depends on your age and occupation.
With unit-based cover, the same premium per unit applies each year, but your level of cover decreases from age 30.
• If you are an eligible new Employee Plan member under the age of 60, you can also increase this cover up to 7 times your annual salary to a maximum of $750,000, and/or add income protection cover, without the need to provide evidence of health if you do so within 90 days of the date on your Welcome letter or email. This cover is subject to a pre-existing condition exclusion. See page 19 for more information.
Personal Plan members
• At CareSuper, Personal Plan members are still eligible for great choices in cover, but it must be applied for and is subject to assessment and acceptance by the insurer. For details on tailoring your cover see page 6.
How much it costs
• The premium for 1 unit of death cover is $1.05 per week. The premium for 1 unit of TPD cover is $0.85 per week.
The premium for 1 unit of death and TPD cover is $1.90 per week. These are the premiums for all occupational categories. The General occupational category will apply until we are otherwise advised by you. Premiums are subject to change.
• Different premiums may apply for tailored cover.
• Insurance premiums are deducted from your account, unless paid for by your employer or you cancel your cover. Premiums paid by your employer may count towards your concessional contributions cap. Refer to the Member Guide PDS for more information.
• A portion of the premium is contributed to CareSuper’s General Reserve.
The Reserve is used to cover the administration and management of CareSuper’s insurance.
Tailoring your cover
You also have the option to choose fixed death and TPD cover, where your cover is set at a fixed dollar amount. The fixed cover you select must be in multiples of $1000.
With fixed cover, the amount you pay will increase with each birthday, but the amount of cover will remain the same.
Fixed cover can also be indexed to increase by 5% on 1 July each year, offering added security against the rising cost of living. Premiums will be based on the increased cover.
Further information about tailored cover for Employee Plan members and Personal Plan members is provided on the following pages.
CareSuper insurance
Insurance premiums are deducted from your account at the sell unit price. For information about investment unit prices see the Investment Guide available at caresuper.com.au/PDS.
Our default cover
CareSuper’s default insurance cover
Age Death
cover TPD
cover Cost per week 15–29 1 unit 4 units $4.45 30–64 4 units 4 units $7.60
65–69 4 units – $4.20
Every eligible Employee Plan member gets default cover at the time of joining CareSuper in accordance with CareSuper’s Group policy.
Your eligibility for default cover depends on your age and other conditions relating to the commencement of cover described on page 13 of this guide. In certain circumstances limited cover only will apply or you may not be eligible for default TPD cover (for example, if you have previously received a TPD benefit).
If you aren’t eligible for TPD cover, you will need to notify us or cancel your TPD cover. Otherwise TPD premiums will continue to be deducted from your account. Default insurance cover does not include income protection cover.
Insurance needs often change over the course of an individual’s working life.
Default insurance cover for Employee Plan members
Before 30, for instance, you might not have a lot of debt or anyone who relies on you financially, but you probably don’t have a lot of super to help if you suddenly stopped working.
Meanwhile, those over 30 are more likely to have dependants or bigger financial commitments.
For this reason, if you are aged 15 to 29 you receive default cover of 1 unit of death cover, and 4 units of TPD cover.
At age 30, death cover increases to 4 units, to match TPD cover. If you are 30 to 64, you will receive default cover of 4 units of death and TPD cover. If you are aged 65 to 69, 4 units of death cover only applies.
Default cover is subject to restrictions and exclusions described later in this guide. Refer to page 8 to see how much cover each unit provides.
Refer to page 13 for details on when your cover starts and other important terms and conditions.
It also pays to review all your insurance from time to time, to be sure that it changes with your needs.
adjust your cover to suit your needs
how much or what type of insurance you need depends on your
circumstances
Your insurance options
Available to eligible new Employee Plan members under age 60 within 90 days of the date on your Welcome letter or email Take up a New Member Option with no medical evidence required:
1. Add income protection, and/or
2. Increase death and TPD cover up to 7 times your annual salary, to a maximum of $750,000.
To qualify for a New Member Option without providing medical evidence, your application must be received before you reach age 60 and within 90 days of the date on your Welcome letter or email by completing the Insurance application form available at caresuper.com.au/forms. If you are not in active employment, limited cover may apply. See page 19 for details.
Available on specific life events
Increase your death and TPD cover by 1 unit or the equivalent amount of fixed cover (based on your age) for specific life events, without having to provide medical evidence (subject to eligibility). To qualify for cover available on specific life events, you must be an Employee Plan member and apply before age 60 and within 90 days of the event. See page 10 for more details.
Available any time after joining
• Increase your cover, either by nominating more units or adding a fixed cover amount, to a maximum of $10 million for death cover and $3 million for TPD
• Change your unit-based cover to fixed cover so the amount of cover stays the same
• Index fixed insurance cover
• Take up or increase income protection cover
• Change your level of cover to reflect your occupational category
• Transfer your cover from another super fund if you are under age 60.
If you would like to apply for tailored cover, your application will need to be assessed and approved by the insurer, and medical evidence may be required.
To apply, simply complete the relevant form available at caresuper.com.au/forms or log in to MemberOnline and go to the Insurance section.
To create a MemberOnline account, go to caresuper.com.au.
These options are discussed in more detail in the following pages.
The insurer may apply a medical exclusion and/or loading to your cover rather than decline your application. For more information call the CareSuperLine on 1300 360 149.
Tailoring your insurance cover
How much cover you need depends on your individual circumstances. While you’ll receive the default level of cover if you are eligible, it’s a good idea to assess your actual insurance needs and adjust your cover accordingly.
Default insurance cover
Important
New Member Options and life events cover are subject to a pre-existing condition exclusion.
See page 19 for more information.
Personal Plan members
Applying for insurance cover
If you are not linked to an employer and make your own contributions to your super, you are a Personal Plan member.
Personal Plan members do not receive default insurance, but can still apply for great cover.
How much cover you need depends on your individual circumstances.
It’s a good idea to assess your actual insurance needs.
It also pays to review all your insurance from time to time, to be sure that it changes with your needs.
You can apply for cover up to the maximum levels below.
Your insurance options (evidence of health required) Death Up to $10 million
(unit-based or fixed) TPD Up to $3 million
(unit-based or fixed) Income
protection Up to $40,000 per month*
(unit-based only)
it pays to review your
insurance from time to time...
* The maximum benefit is 85% of the first $423,530 income per annum for the entire benefit payment period, plus 60% of the next $200,000 of income per annum for the first 2 years of the benefit payment period.
You can apply for death only, TPD only or death and TPD cover. You can apply for income protection cover only or combine it with death or TPD or death and TPD cover. If you have previously received a payment of any type as a result of a TPD claim, you are only able to apply for death only cover.
Refer to page 8 to see how much cover each unit provides for your age and occupational category.
Additional choices
• Changing your unit-based cover to fixed cover so the amount of cover stays the same
• Indexing fixed insurance cover
• Applying for income protection cover
• Making sure you’re in the right occupational category so you receive the applicable level of cover
• Transferring your cover from another super fund if you are under age 60 (subject to additional maximum limits).
These options are discussed in more detail in the following pages.
Getting started
Once you have determined what type and how much cover you need, you can apply online via the insurance section of MemberOnline, or complete the Insurance application form available at caresuper.com.au/forms.
To create a MemberOnline account, go to caresuper.com.au.
All applications for cover are subject to assessment by CareSuper’s insurer.
Note: You are required to have a minimum CareSuper account balance of $1500 before cover commences.
Types of insurance
Types of insurance
If you have default cover, you can use the information on pages 8–12 to help determine how you can tailor your cover. If you don’t have default cover, this information provides a guide to what cover you can apply for, however evidence of health is usually required.
Death and TPD cover
How much cover do I need?
Once you understand the type and level of cover you require, check out our default cover (if applicable) to see if it meets your needs.
First determine your occupational category by answering the three simple questions at right. Then use the tables and examples on pages 8–9 (for death and TPD) and page 11 (for income protection) to calculate the extra cover you can apply for. On page 12 you can calculate how much cover you need, and the cost of this cover per week.
To tailor your cover (for example, by increasing your units, or fixing or indexing your cover), simply indicate your choices when filling out the Insurance application form available at caresuper.com.au/forms or, you can apply online via MemberOnline.
You will not be eligible for TPD cover if you have previously been paid a TPD benefit of any type.
Occupational categories
To reflect the different levels of risk associated with our members’ different roles and occupations, CareSuper has three different occupational categories. Each category has a different amount of cover per unit. The three categories are:
• General
• Office, and
• Professional.
Did you know?
Insurance premiums are paid from your super account so you won’t feel the impact on your take-home pay.
To determine your occupational category, answer the following questions:
1. Are the duties of your occupation limited to professional, managerial, administrative, clerical, secretarial or similar ‘white collar’ tasks which do not involve manual work and are undertaken entirely within an office environment (excluding travel time from one office environment to another)?
2. Are you earning (see definition of
‘earnings’ on page 19) in excess of
$80,000 p.a. from your profession?
3a. Do you hold a tertiary qualification, or are you a member of a
professional institute or registered by a government body?
or
3b. Are you in a management role?
Your occupational category will be reviewed each time you complete a new application form or apply to vary your insurance cover, unless medical evidence is not required. You can apply to change your occupational category at any time by completing the Changing your occupational category form available at caresuper.com.au/forms.
If you answered no to all of the questions, you qualify for the General occupational category.
If you answered yes to Q1 you qualify for the Office occupational category.
If you answered yes to Q1 and Q2, and to either Q3a or Q3b, you qualify for the Professional occupational category.
If eligible, you will receive default insurance at the General occupational category level until you complete and lodge the Changing your occupational category form available at caresuper.com.au/forms.
Unit-based cover per unit of death and TPD ($)
Age General Office Professional
15 to 30 100,280 119,400 166,870
31 100,280 118,140 165,000
32 100,280 115,610 161,530
33 98,690 113,090 158,050
34 95,440 110,560 154,440
35 92,210 105,620 147,500
36 88,820 100,570 140,550
37 85,430 96,780 135,200
38 81,320 91,730 128,130
39 77,200 87,950 122,910
40 73,100 85,530 119,440
41 68,980 81,740 114,220
42 64,870 76,690 107,150
43 61,330 73,320 102,480
44 58,390 69,380 97,400
45 55,860 66,800 93,380
46 52,910 63,220 88,320
47 49,970 59,750 83,500
48 47,230 56,490 78,960
49 44,390 53,020 74,020
50 41,870 50,070 70,000
51 38,820 46,390 64,800
52 35,980 43,030 60,120
53 33,030 39,450 55,180
54 30,510 36,500 51,040
55 27,460 32,820 45,820
56 24,830 29,670 41,640
57 21,990 26,300 36,740
58 19,040 22,830 31,930
59 16,520 19,780 27,660
Example
John is aged 40 and qualifies for the General occupational category, so 1 unit provides
$73,100 of cover. He has determined that he needs
$550,000 of cover.
Therefore, John needs 8 units of death and TPD cover and will have to apply for some or all of this cover depending on whether he has existing cover.
how much or what type of insurance you need depends on your
circumstances
Types of insurance (continued)
= 7.52 units
$550,000 $73,100
How does unit-based cover work?
With unit-based cover, the amount of cover you have decreases as you age but your premium stays the same.
Types of insurance Premium per year per $1000 sum insured of fixed death and TPD cover ($)
Age General Office Professional
Death TPD Death
& TPD Death TPD Death
& TPD Death TPD Death
& TPD 15 to 30 0.55 0.44 0.99 0.46 0.37 0.83 0.33 0.27 0.60
31 0.55 0.44 0.99 0.46 0.37 0.83 0.33 0.27 0.60
32 0.55 0.44 0.99 0.47 0.38 0.85 0.34 0.27 0.61
33 0.56 0.45 1.01 0.48 0.39 0.87 0.35 0.28 0.63
34 0.57 0.46 1.03 0.50 0.40 0.90 0.36 0.29 0.65
35 0.59 0.48 1.07 0.52 0.42 0.94 0.37 0.30 0.67
36 0.62 0.50 1.12 0.55 0.44 0.99 0.39 0.32 0.71
37 0.64 0.52 1.16 0.57 0.46 1.03 0.41 0.33 0.74
38 0.67 0.54 1.21 0.60 0.48 1.08 0.43 0.35 0.78
39 0.71 0.57 1.28 0.62 0.50 1.12 0.45 0.36 0.81
40 0.75 0.61 1.36 0.64 0.52 1.16 0.46 0.37 0.83
41 0.80 0.64 1.44 0.67 0.54 1.21 0.48 0.39 0.87
42 0.85 0.68 1.53 0.72 0.58 1.30 0.51 0.41 0.92
43 0.89 0.72 1.61 0.75 0.60 1.35 0.54 0.43 0.97
44 0.94 0.76 1.70 0.79 0.64 1.43 0.56 0.45 1.01
45 0.98 0.79 1.77 0.82 0.66 1.48 0.59 0.47 1.06
46 1.04 0.84 1.88 0.87 0.70 1.57 0.62 0.50 1.12
47 1.10 0.89 1.99 0.92 0.74 1.66 0.66 0.53 1.19
48 1.16 0.94 2.10 0.97 0.78 1.75 0.69 0.56 1.25
49 1.24 1.00 2.24 1.03 0.84 1.87 0.74 0.60 1.34
50 1.31 1.06 2.37 1.10 0.88 1.98 0.78 0.63 1.41
51 1.41 1.14 2.55 1.18 0.95 2.13 0.85 0.68 1.53
52 1.52 1.23 2.75 1.27 1.03 2.30 0.91 0.74 1.65
53 1.66 1.34 3.00 1.39 1.12 2.51 0.99 0.80 1.79
54 1.80 1.45 3.25 1.50 1.21 2.71 1.07 0.87 1.94
55 2.00 1.61 3.61 1.67 1.35 3.02 1.20 0.97 2.17
56 2.21 1.78 3.99 1.85 1.49 3.34 1.32 1.06 2.38
57 2.49 2.01 4.50 2.09 1.68 3.77 1.49 1.21 2.70
58 2.88 2.33 5.21 2.40 1.94 4.34 1.72 1.39 3.11
59 3.32 2.68 6.00 2.77 2.24 5.01 1.98 1.60 3.58
60 4.04 3.26 7.30 3.36 2.72 6.08 2.40 1.94 4.34
61 5.11 4.13 9.24 4.28 3.45 7.73 3.06 2.47 5.53
62 6.36 5.13 11.49 5.32 4.30 9.62 3.80 3.07 6.87
63 6.36 5.13 11.49 5.32 4.30 9.62 3.80 3.07 6.87
64 6.36 5.13 11.49 5.32 4.30 9.62 3.80 3.07 6.87
65 to 69* 6.58 0.00 6.58 6.06 0.00 6.06 4.32 0.00 4.32
* Death only cover
Note: Your cover will cease when you reach age 70 for death cover (including terminal illness) and 65 for TPD cover. Fixed cover is available to all members on application to
Example
Anna is in the General occupational category and has applied for
$550,000 of fixed death and TPD cover (without indexation). Her premiums at various ages are shown below.
Age 40
$550,000 x 1.36 = $748.00 p.a.
$1000 Age 45
$550,000 x 1.77 = $973.50 p.a.
$1000 Age 50
$550,000 x 2.37 = $1303.50 p.a.
$1000 Age 55
$550,000 x 3.61 = $1985.50 p.a.
$1000
How does fixed cover work?
With fixed cover, your amount of cover stays the same but the premium you pay increases with age (and is determined by your age and occupational category).
You can choose to have your fixed cover indexed – meaning that it increases by 5%
on 1 July each year to account for inflation.
Premiums will be based on the increased cover. You must apply for a minimum of
$10,000 of fixed cover and it must be in multiples of $1000.
To determine what your annual premium would be for fixed cover, divide your required level of cover by $1000, and multiply by the premium that corresponds to your age and occupational category.
Insurance premiums are deducted from your account at the sell unit price. For
information about unit prices see the Investment Guide available at caresuper.com.au/PDS.
Income protection cover
Who can apply?
Anyone aged under 65 earning on an ongoing basis at least $16,000 p.a.
or working 15 hours or more per week is eligible to apply for income protection insurance, including contractors, part- time employees and casual employees.
You will not be eligible for income protection cover if you have previously been paid a TPD benefit of any type.
How much income protection cover do I need?
You can tailor income protection insurance to suit your circumstances, with the following options to choose from:
• A waiting period of 30, 60 or 90 days, and
• A benefit period of either 2 or 5 years.
The maximum amount of income protection cover you can apply for is determined by your salary. How much you decide you need depends on your estimation of your required income if you are not working. Your cover will automatically increase by 5% on 1 July each year to account for inflation.
Premiums will be based on the increased cover.
Types of insurance (continued)
The maximum benefit is 85% of the first
$423,530 of income per annum for the entire benefit payment period, plus 60% of the next
$200,000 of income per annum for the first 2 years of the benefit payment period.
Each unit of income protection cover provides a benefit of $425 per month of which $375 (less tax) is payable as a benefit to you and $50 is payable to your CareSuper account as a super contribution.
Continued contributions to super help to keep you on track to meet your retirement goals and help maintain a sufficient balance in your account to continue covering your insurance premiums.
The maximum income protection cover you can apply for with no evidence of health required (if you are under age 60 and your application is received within 90 days of the date of your Welcome letter or email) depends on your occupational category, as below:
General category: a salary of up to
$72,000 p.a. (or 12 units) can be covered Office category: a salary of up to
$102,000 p.a. (17 units) can be covered Professional category: a salary of up to
$144,000 p.a. (24 units) can be covered.
Please note, this cover is subject to a pre-existing condition exclusion if obtained without evidence of health. See page 19 for more information.
If you need more cover, tailored income protection cover allows you to apply for as many units as you like up to the maximum monthly benefit.
Tailored cover will be subject to assessment and acceptance by our insurer. Premium loadings and/or exclusions may apply to some members.
How much does income protection cover cost?
The cost of income protection cover is based on your age, your occupational category, the waiting period you select (30, 60 or 90 days) and the benefit period you choose (2 or 5 years).
The cost decreases if you wait longer to receive your benefit. If you do not make a selection the default waiting period is 30 days.
The cost increases if you choose the 5-year benefit period. If you do not indicate a benefit period on your application form, the 2-year (default) benefit period will apply.
Using the number of units you have determined you need (see page 12), use the tables on page 11 to calculate your weekly premium. The premiums are deducted from your CareSuper account and your account receives a 15% contributions tax rebate.
This means you can pay for your insurance using your super so it doesn’t impact on your take-home pay.
• Your child’s first day at primary or secondary school
• Death of your spouse.
The total amount of insured cover which
and you must be in ‘active employment’
at the time of your application. See page 19 for a definition of active employment.
Life events cover is subject to a Life events cover makes it easy for
you to increase your existing death and TPD insurance cover for specific life events by 1 unit or the equivalent amount of fixed cover (determined by
easy upgrade on specific life events
Premium per week per unit of income protection cover (2-year benefit period) Waiting
period
General Office Professional
30 days 60 days 90 days 30 days 60 days 90 days 30 days 60 days 90 days
Current age $ $ $
15–24 0.44 0.32 0.17 0.29 0.20 0.11 0.24 0.17 0.09
25–29 0.46 0.32 0.18 0.31 0.22 0.11 0.25 0.18 0.09
30–34 0.52 0.37 0.18 0.36 0.24 0.12 0.29 0.20 0.10
35–39 0.69 0.48 0.24 0.46 0.32 0.16 0.37 0.27 0.13
40–44 0.90 0.64 0.37 0.59 0.41 0.24 0.49 0.34 0.19
45–49 1.21 0.86 0.59 0.80 0.56 0.40 0.65 0.46 0.32
50–54 1.71 1.20 0.96 1.13 0.79 0.64 0.91 0.64 0.52
55–59 2.44 1.71 1.53 1.60 1.13 1.00 1.32 0.92 0.82
60–64 2.65 2.01 1.55 1.74 1.32 1.02 1.43 1.09 0.84
Premium per week per unit of income protection cover (5-year benefit period) Waiting
period
General Office Professional
30 days 60 days 90 days 30 days 60 days 90 days 30 days 60 days 90 days
Current age $ $ $
15–24 0.59 0.44 0.24 0.39 0.29 0.16 0.32 0.24 0.14
25–29 0.64 0.49 0.27 0.42 0.32 0.18 0.35 0.26 0.15
30–34 0.79 0.59 0.31 0.51 0.39 0.19 0.42 0.32 0.17
35–39 1.06 0.80 0.41 0.70 0.52 0.27 0.58 0.43 0.23
40–44 1.46 1.10 0.67 0.96 0.72 0.44 0.78 0.59 0.37
45–49 2.10 1.57 1.11 1.37 1.04 0.73 1.13 0.84 0.59
50–54 3.13 2.35 1.83 2.05 1.55 1.20 1.69 1.27 0.98
55–59 4.62 3.51 2.91 3.05 2.32 1.92 2.50 1.89 1.56
60–64 3.83 3.06 2.28 2.52 2.01 1.51 2.06 1.65 1.23
Note: Income protection cover will automatically increase by 5%
on 1 July each year to account for inflation. Pro-rata premiums will apply to the increased cover.
Insurance premiums are deducted from your account at the sell unit price. For information about investment unit prices see the Investment Guide available at caresuper.com.au/PDS.
Types of insurance
Cost of income protection cover
Important questions Example
#Your calculation
How much insurance cover would you need to meet your commitments in theevent of your death or disablement? Consider your current financial needs – mortgage repayments, car loans, credit cards, school fees, food, clothing, etc.
Keep in mind other assets, such as savings or super, which might be accessed to assist in meeting your commitments.
$400,000 (A)
Determine your occupational category using the information on page 7. Make sure you’re in the correct category to match your occupation type. All eligible Employee Plan members are allocated to the General occupational category unless they apply to change their occupational category.
In this example the member is aged 40 and qualifies for the Office category.
Changing occupational category will change the amount of cover per unit from $73,100 for General to $85,530 for Office.
Check what cover you may already have. If you have default cover, see page 4 for the number of units you receive. Refer to the table on page 8 and locate the benefit payable for the cover that applies to your age and occupational category. If the benefit amount (B) is less than the amount of your commitments (A), then you may not have enough insurance cover. This may depend on what other insurance cover you have directly or via another super fund. At this point, you might like to consider applying for tailored cover to meet any shortfall – for example, a fixed amount of cover (see page 9), or alternatively, please continue for unit-based cover.
$85,530# x 4
= $342,120 (B)
Work out the difference between your existing cover and the cover you want.
Refer to the table on page 8 and locate the benefit payable for one unit of cover for your age and occupational category (C). To work out the number of units required, calculate A ÷ C. Round this figure up if not whole.
$85,530 (C) A ÷ C
$400,000 ÷ $85,530
= 4.7 units rounds up to 5 units
How many units of death and TPD cover are required?
(including the existing cover (A))
5 units of cover are required, providing cover of 5 x $85,530 = $427,650 How much will it cost? Unit-based cover is $1.90 per week per unit of death and
TPD cover. In this example, for an extra cost of $1.90 per week, the member can increase their cover by $135,250 (comprising an extra $49,720 by correcting their occupation category AND $85,530 for an additional unit of cover.
5 x $1.90
= $9.50 per week
# In this example the member has default cover, is 40 years old and can obtain cover under the Office occupational category (that is, the member has 4 units of death and TPD). Remember, unit-based cover decreases with age, so you should take this into consideration.
Income protection insurance
How to calculate your income protection benefit and premium
You can use the following table to calculate the number of units needed to meet your insurance requirements for income protection, as well as the weekly cost of this cover. Refer to page 11 for premiums.
3
How much cover do you need?
Death and TPD insurance
How to calculate your death and TPD benefit and premium
If you have default cover you can use the following table to calculate the number of units of cover needed to meet your insurance requirements for death and TPD, as well as the weekly cost of this cover. If you are a Personal Plan member you can also use the following table as a guide, keeping in mind that default cover does not apply and the cost of cover for the Personal Plan members may be different. Refer to page 8 for the unit-based benefit table. Refer to page 3 for premiums applicable to unit-based cover. If you would like fixed cover, refer to page 9 for the premium table.
Important questions Example
*Your calculation
On average, how much income do you earn before tax each month? $2200
2
Multiply this by 85%.**The result is the maximum benefit amount you could receive per month if you made a claim.
$2200 x 0.85
= $1870
3 1 2 1
4
5
6
Transferring your insurance
If you are under age 60, you may be able to transfer your current super insurance arrangement to CareSuper without having to provide medical evidence. You must provide an up-to- date statement or certificate of currency as evidence of cover held. We must receive this within 6 months of the date of issue of the statement or certificate of currency. To transfer your existing cover, please complete the Transfer your insurance form available at caresuper.
com.au/forms and provide the required documentation. This option is available to both Employee Plan members and Personal Plan members. Loadings, exclusions and/or limited cover may apply.
The maximum death only or death and TPD cover that can be in place in CareSuper without underwriting following a transfer is $2 million (inclusive of any existing death only or death and TPD cover you already have in CareSuper).
If you want to transfer cover that would result in your total cover being greater than $2 million, you will need to be assessed and accepted by our insurer.
If the insurer accepts your application, your existing amount of death/TPD cover (subject to maximum limits) as at the transfer date under your former super fund will be added to any existing death/TPD cover held with CareSuper by allocation to your CareSuper account of sufficient units rounded up to the next whole unit (if you currently have unit-based cover in CareSuper), or sufficient fixed cover rounded up to the nearest $1000.
The maximum income protection cover that can be transferred is $10,000 per month. The waiting period and benefit payment period will be adjusted in line with CareSuper’s insurance design. For example, if the income protection cover transferred has a ‘to age 65’ benefit period, you will be provided with a 5-year benefit period under CareSuper.
The waiting period will be rounded up to the next highest waiting period under CareSuper (for example, a 45-day waiting period will be rounded up to 60 days under CareSuper).
Transferred income protection cover is not added to any current CareSuper income protection cover. Transferred cover will replace any existing income protection cover you have in CareSuper.
However, if the amount of the existing cover exceeds the amount of transferred cover, the existing cover will continue and the transferred cover will be invalid.
Transferred cover will commence in CareSuper on the date all of the following are satisfied:
• The date the insurer accepts your application, and
• You cancel your existing insurance cover under your former super fund, and
• The whole account balance from your former fund has been transferred to CareSuper. Before you leave your other fund, you should check if it is the right decision for you. You may lose any insurance entitlements you have with that fund. You should also check to see whether your other fund will charge you an exit fee or any other fees.
What do I need to know?
Insurance – what do I need to know?
• The first day of the period for which the first Superannuation Guarantee (SG) employer contribution is paid by your employer (usually the date you commence work with your employer), or
• The date your employer becomes a participating employer of CareSuper.
In some instances, this will be the date on which CareSuper receives the first SG employer contribution on your behalf, or
• The date 130 days before we receive your first SG employer contribution.
peace of mind knowing your dependants
will be covered
When does my default insurance cover commence?
Provided you are eligible, default cover commences on the later of:
Any tailored or transferred cover which is applied for by a member who has default cover commences on the date we advise you in writing.
The first insurance premium payment deducted from your account will include all amounts accrued since your commencement date.
Please refer to the Exclusions and restrictions section on pages 17 and 18 for further information about commencement of cover.
When does Personal Plan insurance cover commence?
For Personal Plan members, cover commences on the date you are advised in writing that cover has been accepted. Personal Plan members are also required to have a minimum balance of $1500 before cover commences.
Can I change my cover later?
Yes. You can apply to change the amount of cover you have at any time.
For information about your insurance options, refer to page 5.
Employee Plan members under age 60 can increase death and TPD cover based on specific life events without having to provide medical evidence, provided the request is made within 90 days of the relevant event and other conditions are met (see page 10).
If you would like to increase your insurance cover at times other than on a specific life event, you will need to be approved by the insurer. Your occupational category will be reviewed each time you complete a new application or apply to vary insurance cover, unless medical evidence is not required. Applications may be subject to premium loadings and/or exclusions.
To apply for an increase in insurance cover you can complete the Insurance application form at caresuper.com.au/forms, or apply online. To apply online log in to MemberOnline and go to the
Remember, if you do reduce or opt out of cover and you wish to increase or recommence cover at a later date, you will need to meet the insurer’s assessment requirements and you may be required to provide evidence of health.
See page 15 for more information on recommencing cover.
Is there a cooling off period?
There is a cooling off period for tailored insurance cover, including life event increases and transferred cover. You have 21 days, from the date you are advised that you have been accepted for insurance, to review the terms and conditions to ensure they meet your needs – this is known as the ‘cooling off period’.
You may cancel your tailored insurance by completing the Request to reduce or opt out of insurance cover form, available by calling CareSuper on 1300 360 149. All premiums paid during the cooling off period will be refunded to your CareSuper account. If you wish to reduce your level of cover or opt out of insurance altogether after the cooling off period, you will need to call the CareSuperLine on 1300 360 149 and request the relevant form.
There is no cooling off period for default cover.
Tax on death, TPD and income protection benefits
For more information about taxation of insured benefits, go to ato.gov.au.
When does cover stop?
Death, TPD and income protection cover
• The date of your death
• The date a TPD benefit is paid where the amount paid is greater than or equal to your death benefit amount. If your death cover is greater than your TPD cover, your death cover will continue when a TPD benefit is paid. Your death cover will be reduced by the amount of TPD cover paid to you
• In the case of income protection cover, the date you commence duty with the armed services of any country, other than the Australian Army Reserve (during scheduled Army Reserve exercises, but not if called up for active service)
• The date the policy is terminated or cancelled for any reason
• The date we receive your completed Request to reduce or opt out of insurance cover form
• If there are insufficient funds in your account to meet premiums, on the last Friday for which a premium deduction can be made from your CareSuper account.
Maximum insurable age
Death cover(including terminal illness) – 70 years TPD cover – 65 years
Income protection cover – 65 years
What happens if I leave or change my employer?
Generally, your insurance cover is designed to continue regardless of any changes in employment as long as you remain a member of CareSuper, subject to the terms of CareSuper’s insurance policy (including terms relating to eligibility and cessation of cover). If you become unemployed, your ability to claim
Insurance – what do I need to know? (continued)
What do I need to know?
What happens if I was a member of a Corporate insurance arrangement?
If you have transferred into the CareSuper Employee Plan from a Corporate insurance arrangement, the amount of cover you had under that arrangement has been converted to fixed cover and continues while there is a sufficient balance in your account to cover ongoing premium deductions as you are responsible for paying the premiums. All other terms and conditions as set out in this guide, apply to you.
Can I recommence my cover?
Employee Plan members
If you have previously opted out of cover, you will not be eligible for reinstatement of past levels of cover, and all future applications for cover will need to be assessed and accepted by our insurer. If accepted, insurance cover begins when we confirm acceptance to you in writing.If your CareSuper account balance reaches $0, you have 28 days from the date we notify you that cover has ceased to make a contribution or roll-in to allow cover to be reinstated.
The contribution can be a personal or employer contribution, or a rolled in amount. Cover will recommence from the date your cover last ceased. The amount of cover will be the amount you had immediately prior to the cover lapsing. For income protection, the amount of cover, waiting period and benefit period will be the same as you had immediately prior to cover ceasing.
If your CareSuper account balance reaches $0 and a contribution is not received within 28 days from the date we notify you, your cover may be reinstated if:
– A SG contribution is received within 6 months from the end of the month that cover ceased
– The commencement period of the contribution is within 6 months from the end of the month that cover ceased, and
– The SG contribution is paid on time according to legislative requirements.
Cover will recommence from the beginning of the period covered by the SG contribution to the amount of cover you had immediately prior to the cover ceasing. For income protection, the amount of cover, waiting period and benefit period will be the same as you had immediately prior to cover ceasing.
You are required to be in ‘active employment’ on the date cover recommences. If you are not in active employment on the date cover recommences you will receive limited cover until you return to active employment for 2 consecutive months, at which point full cover will apply.
See page 19 for a definition of active employment.
In all other circumstances, cover will be reinstated to the amount of default cover. For income protection, the amount of cover, waiting period and benefit period will be the same as you had immediately prior to cover ceasing.
Cover will recommence from the date the SG contribution is received by the Fund.
Personal Plan members
If your cover ceases (for example, you cancel your cover or there are insufficient funds in your account to pay for premiums), you must reapply and be accepted by the insurer to receive cover again.Note
Depending on the circumstances, there may be a period between the date cover ceases and the date cover recommences where you won’t be covered.
Am I covered worldwide?
Yes. Generally, there are no restrictions on worldwide cover. However, income protection benefit payments are restricted to 12 months while overseas (unless otherwise agreed in writing). You are not required to advise the Fund or insurer before you travel overseas.
How do I qualify for a death or TPD benefit?
A death benefit will be paid if you die (while insured) before reaching the maximum insurable age, unless the circumstances of your death are subject to the conditions set out on pages 17 and 18.
If you become terminally ill you may apply for early release of your insured death benefit (see page 19 for the policy definition of terminal illness).
You may qualify for a TPD benefit if you suffer (while insured) an illness or injury that meets the definition of total and permanent disablement in the insurer’s opinion (see page 20). You will not qualify for a TPD benefit if you have previously received a TPD payment of any type. This will be the case even if TPD insurance premiums have been deducted from your account. If you aren’t eligible for TPD cover, you will need to notify us or cancel your TPD cover.
Otherwise TPD premiums will continue to be deducted from your account.
If you have submitted a TPD claim and you die before the claim is finalised, your TPD claim may continue to be assessed as a posthumous TPD claim. A
posthumous TPD claim is a TPD benefit that is paid to your beneficiaries after your death. In the event that your death cover is higher than your TPD cover, it will be assessed as a death claim and the death cover will be paid subject to eligibility.
How do I qualify for an income protection benefit?
You may qualify for an income protection benefit if you suffer (while insured) an illness or injury that meets the definition of total disability (see page 20) and have been unable to work for the applicable waiting period.
You will not be eligible for income protection cover if you have previously been paid a TPD benefit of any type.
If you qualify for a benefit, it will remain payable for up to 2 or 5 years (depending on the applicable benefit period) from the date payments commence, provided you continue to meet the benefit conditions.
At the time of claim, members will receive the lesser of the following amounts:
a) The amount provided by the number of units of cover you have in place, and b) 85% of the first $423,530 of income per
annum for the entire benefit payment period, plus 60% of the next $200,000 of income per annum for the first 2 years of the benefit payment period.
No benefits are payable during the waiting period. After this, benefits will begin to accrue and will be payable monthly in arrears if you have met the requirements.
The waiting period commences on the first day you are unable to work due to your total disability, and your condition is certified by a medical practitioner. If you are entitled to a benefit for part of a month, you will be paid 1/365th of the benefit for each day you are entitled to a payment.
Did you know?
If you are eligible for a TPD or permanent incapacity benefit (for example, as a result of an illness or injury), you may be able to start a CareSuper Pension with your lump sum and draw a regular income. Call the CareSuper PensionLine on 1300 664 781 to find out more.
Claiming an insurance benefit
Are there any exclusions or restrictions?
For all types of cover (death (including terminal illness), TPD and income protection), the following applies:
• If you have two or more accounts with CareSuper, you will not be entitled to insurance cover from more than one account. In this instance, the account with the highest insured benefit will be used in determining any claim.
• The insurer will not pay a benefit caused directly or indirectly by an act of war.
• If you have previously been paid a TPD benefit of any type from any source including another super fund or a personal insurance policy as a result of a TPD claim, you will only be eligible for death cover with CareSuper; not TPD or income protection cover.
For exclusions or restrictions applicable to specific types of cover, see the following page.
For Employee Plan members, the following exclusions and restrictions also apply:
• Default cover is automatically accepted by the insurer (subject to eligibility). However, automatic acceptance of cover may only occur once while you are a member of CareSuper. If you have received automatic acceptance on more than one occasion, the insurer may adjust the cover accordingly.
• Limited cover will apply when cover commences:
1. If you are not in active employment, until you return to active employment for at least 2 consecutive months 2. If we do not receive employer
contributions on your behalf within 6 months of you being first eligible for cover, until 2 years have passed and you return to active employment for at least the 2 consecutive months immediately prior to the expiry of that 2-year period. Otherwise limited cover will continue until you have returned to active employment for at least 2 consecutive months. See page 19 for the definitions of active employment and first eligible.
• When limited cover applies, including for non-default insurance cover, intentional self-inflicted injury or infection, suicide or attempt at suicide (whether it is determined that you were or were not sane at the time) will not be covered within the first 12 months of cover commencing, increasing or recommencing.
• You are able to apply to have limited cover removed at any time subject to the insurer’s assessment requirements.
• Premium loadings and/or exclusions may apply to some members.
You must be employed (including self- employment) in order to apply for income protection cover. If after being accepted for cover you become unemployed (but wish to continue your cover to avoid reapplying), a benefit will not be paid should you become temporarily incapacitated during this time, unless you meet another condition of release. If you no longer require income protection cover, you must notify CareSuper.
What if I am receiving income from other sources?
Your income protection benefit will be reduced by the amount of income you receive from any one of the following sources:
a) Any income (other than benefits received under CareSuper’s policy) or commutation (lump sum payment) of income, paid or payable to you as a result of your sickness or injury including:
• Sick leave payments
• Any amounts payable under legislation such as workers’
compensation or motor accident compensation
• Any benefits payable under other income protection insurance policies, and
b) Any super contributions from your employer while disabled, and c) Any income that, in the opinion of
the insurer, you could reasonably be expected to earn in your occupation while disabled. However, where you are fit to return to work in a reduced capacity but such work is not available with the existing employer, the insurer will not offset any income you should be able to earn from this employer.
Any income described in paragraph a) which is in the form of a lump sum (or is exchanged for a lump sum) is treated as a monthly amount equivalent to 1/60th of the lump sum over a period of 60 months.
Important
Some restrictions or exclusions can only be determined or assessed at the time a claim is made.
Claiming an insurance benefit
What happens if I die while receiving a benefit?
Your income protection benefits will cease upon your death, with a final payment equal to 3 times the monthly benefit.
What happens if my disablement reoccurs?
If you have been receiving income protection benefits, subsequently recover and therefore cease benefits, then within 6 months of your recovery become totally disabled again due to the same cause or a related cause, this period of total disability will be treated as a continuation of the previous claim and there will be no further waiting period, provided you are still a member. After 6 months back at work, normal waiting periods apply. The period in which benefits were paid previously will form part of the maximum benefit period for the relevant condition.
What happens if I return to work and earn less?
If you return to work and are earning an income that is less than your pre- disability income, as a result of being recently totally disabled, you may be eligible for a partial disability benefit. You must have satisfied the definition of total disability for at least 14 days and still have a reduced income at the end of the waiting period.
Death and TPD cover specific
In addition to the ‘all cover’exclusions and restrictions outlined on the previous page, the following also apply to death, terminal illness and TPD cover.
• In the event of pandemic outbreak, the insurer reserves the right to alter when cover commences for new members, in order to exclude any pandemic illness that could cause the member to die within 30 days of the date his or her cover commenced, provided the condition was present at the date the cover commenced.
• The insurer will not pay a benefit for you if your death, terminal illness or TPD is caused directly or indirectly by an act of war.
However, this condition will not disentitle you to a benefit should you die on war service. The war exclusion is only applicable to wars occurring during the policy period.
Income protection cover specific
In addition to the ‘all cover’exclusions and restrictions outlined on the previous page, the following also apply to income protection cover.
• Income protection must be applied for and is subject to acceptance by the insurer.
• No benefit is payable under CareSuper’s income protection
Exclusions or restrictions (continued)
insurance policy if your illness or injury is directly or indirectly caused by:
– Intentional self-inflicted injury or infection, or attempt at suicide (whether it is determined that you were or were not sane at the time)
– Your service in the armed forces of any country
– Normal pregnancy or childbirth, or
– War.
• CareSuper’s insurer will not make a payment under the policy if the payment would cause them to infringe the Health Insurance Act 1973 (Cth) or the National Health Act 1953 (Cth) or any succeeding legislation in connection with health insurance.
• Benefits will only be paid for you for one disability at a time.
• The maximum length of time a benefit for disability resulting from any one or related cause will be paid is the number of months in the benefit payment period. The number of months in the benefit payment period will include any months in which the benefit is reduced or is calculated to be $0.
• The maximum time in total a benefit will be paid for while you are outside Australia is 12 months, unless otherwise agreed in writing.
Premium loadings and/or exclusions may apply to any cover that you apply for and have assessed by the insurer.
Definitions for insurance
Definitions for insurance
Active employment
Active employment means the person is employed to carry out identifiable duties, is actually performing those duties and, in the insurer’s opinion, is not restricted by sickness or injury from carrying out those duties on a full-time (where full-time means 35 hours per week) basis, or the duties of his or her usual occupation on a full-time basis (even if not then working on a full-time basis).
Dependant or Interdependency relationship
For the definition of ‘dependant’
or ‘interdependency relationship’, see Nominating your
beneficiaries at caresuper.com.au/PDS.
Note: a different definition of ‘dependant’
applies for taxation purposes.
Earnings (for determining occupational category)
The total salary package value of
remuneration received from your employer averaged over the most recent 12 months (including overtime, commission, bonuses and shift allowances, but excluding employer contributions).
If you have been working with your employer for a period of less than 12 months, then the total value of remuneration received since you last commenced employment with your employer should be converted up to an annual figure.
If you are self-employed, the total annual value of pre-tax income that is generated by you or the business as a result of your personal exertion (i.e. income that would stop if you could not work due to illness or injury), and:
1) includes any allowances or fringe benefits paid to you which you may convert into cash salary at your option, or which the insurer agrees to treat as part of your income, but
2) does not include any necessary business expenses incurred in producing that income.
First eligible
The later of the date your employer selects CareSuper to be the default super fund to receive employer contributions, and the date you commence your employment with that employer.
Income
(for the calculation of income protection benefits) Means:a) The total salary package value of remuneration received by the insured member from his or her employer averaged over the most recent 12 months immediately prior to becoming disabled (including overtime, commission, bonuses and shift allowances, but excluding employer contributions).
b) If the insured member has been working with their employer for a period of less than 12 months immediately prior to becoming disabled, then the total monthly value of remuneration will be averaged over the period since the insured member last commenced employment with their employer.
c) If the insured member is unemployed immediately prior to becoming disabled, the total monthly value of remuneration will be averaged over the lesser of the most recent 12-month period immediately prior to becoming disabled or the period since they last commenced employment with their most recent employer.
d) If the insured member is self-employed then the total monthly value of
remuneration means the pre-tax income that is generated by the insured member or the business as a result of the insured member’s personal exertion (i.e. income that would stop if they could not work due to illness or injury), and:
(i) includes any allowances or fringe benefits paid to the insured member which he or she may convert into cash salary at her or his option, or which the insurer agrees to treat as part of the insured member’s income, but
(ii) does not include any necessary business expenses incurred in producing that income.
Paragraphs b) and c) above will be subject to a minimum averaging period of 3 months for casual employees. No minimum averaging period applies to permanent employees.
Limited cover
Limited cover means the insured member is only covered for claims arising from:
• A sickness which first became apparent, or
• An injury which first occurred on or after the date the cover last commenced, recommenced or increased for the member in CareSuper.
Pre-existing condition
A pre-existing condition means any illness, injury, medical condition or related symptom:
a) of which the insured member first became aware, or
b) for which the insured member sought or intended to seek medical help, or c) for which a reasonable person in the
insured member’s circumstances should have been aware or would have sought medical help
at any time during the 5 years before the insured member’s cover commenced, recommenced or increased.
Salary
(for the calculation of 7 times salary for New Member Option)• Salary for permanent employees will be the gross annual salary (including overtime, commission, bonuses and shift allowances, but excluding employer contributions).
• Salary for casuals/contractors will be annualised based on the total gross salary earned within the last 3 months immediately prior to application.
• Where a member has multiple employment arrangements the salaries (which may be either permanent or casual) will be combined to provide a total gross annual salary figure.
Terminal illness
An insured member with a terminal illness will be able to apply for early release of their insured death benefit if the insured member suffers from an illness which:
a) Two medical practitioners, with at least one specialising in the person’s terminal illness, certify in writing that despite reasonable medical treatment the illness will lead to the person’s death within 12 months of the date of certification, and
b) CareSuper’s insurer is satisfied on medical or other evidence that despite reasonable medical treatment the illness will lead to the person’s death within 12 months of the date of certification.
The illness from which the person suffers must occur, and the date of the certification referred to in a) must take place, while the person is insured under the policy. See page 16 for important information about terminal
Total & permanent disablement
Means:
For persons who are or have been employed or self-employed within the 12 months prior to the onset of an injury or illness leading to permanent incapacity, an insured member is totally and permanently disabled if the insured member:
Has suffered:
• The permanent loss of two or more limbs – a limb being the whole hand or foot, or
• The complete and irrecoverable loss of sight in both eyes, or
• The loss of one limb and the complete and irrecoverable loss of sight in one eye And
• In the insurer’s opinion, on the basis of satisfactory medical and other evidence, the insured member is unlikely to be able to engage in any occupation whether or not for reward
Or
• Is aged less than 65 years and as a result of sickness or injury, has been absent from all employment for 3 consecutive months from the date of disablement, and the insurer is satisfied on the basis of medical and other evidence that the insured member is unlikely ever to be able to engage in any occupation, whether or not for reward.
Or
• All of the following paragraphs (i – iv) apply to the insured member:
(i) the person was, on the date of disablement, aged less than 65 years (ii) the person is absent from all work as a result of suffering cardiomyopathy, primary pulmonary hypertension, major head trauma, motor neurone disease, multiple sclerosis, muscular dystrophy, paraplegia, quadriplegia, hemiplegia, diplegia, tetraplegia, dementia and Alzheimer’s disease,
Or
For persons unemployed for a continuous period of 12 months before the onset of total disability leading to the permanent incapacity, an insured member is totally and permanently disabled if the insured member:
Has suffered:
• The permanent loss of two or more limbs – a limb being the whole hand or foot, or
• The complete and irrecoverable loss of sight in both eyes, or
• The loss of one limb and the complete and irrecoverable loss of sight in one eye, and
in the insurer’s opinion, on the basis of satisfactory medical and other evidence, is unlikely to be able to engage in any occupation whether or not for reward.
Or
• The insured member has, in the opinion of the insurer, after consideration of medical and/or other evidence become permanently incapacitated to such an extent as to prevent him/her from engaging in any occupation, whether
or not for reward, and
• The insurer is satisfied that the insured member has become so disabled by bodily injury or illness that he/she will never be able to perform at least two of the following activities of daily living:
– Dressing – the ability to put on and take off clothing without assistance
– Bathing – the ability to wash or shower without assistance
– Toileting – the ability to use the toilet, including getting on and off without assistance
– Mobility – the ability to get in and out of bed and a chair without assistance – Feeding – the ability to get food from a
plate into the mouth without assistance, and
in the insurer’s opinion, on the basis of
• The complete and irrecoverable loss of sight in both eyes, or
• The loss of one limb and the complete and irrecoverable loss of sight in one eye, and in the insurer’s opinion, on the basis of satisfactory medical and other evidence, the insured member is unlikely to be able to engage in any occupation whether or not for reward.
Or
• Has been unable to perform their unpaid domestic duties for 3 consecutive months and in the opinion of the insurer, after consideration of medical and/or other evidence, is incapacitated to such an extent that it is unlikely that he or she will again be able to engage in their unpaid domestic duties, or in any occupation, whether or not for reward, and
• Is so incapacitated that they are unable to leave their place of residence without the assistance of another person.
Where:
‘Assistance’ means the help of another person.
‘Occupation’ means an occupation or gainful employment for which the member is reasonably qualified by education, training or experience.
Total disability/disablement (income protection)
An insured member is totally disabled if he or she:
a) has ceased to be gainfully employed because of sickness or injury and is unable to perform at least one income producing duty of his or her own occupation, and
b) is under the regular care of, and following the advice of, a medical practitioner, and
c) is not working in any occupation, whether or not for reward.
Or, if the paragraph above does not apply:
An insured member is totally disabled if he or she:
a) has a sickness or injury and (on the basis of medical or other evidence) in the insurer’s opinion he or she is permanently incapacitated because of that sickness or injury, and b) is under the regular care of, and following the
advice of, a medical practitioner, and
