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
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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
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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:
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- 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.
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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.
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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.
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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.
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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.
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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.
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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.
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*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.
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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.
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AIA Australia