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Flexible Lifetime Protection Product Disclosure Statement (including Plan Rules) - PDF
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1 Flexible Lifetime Protection Product Disclosure Statement (including Plan Rules) Issued 19 May 2014 protect those you love with the one who s IMAGE AREA been there DS DS DS AWAR AWAR AWAR Legal particulars Supplied copy goes here Registered information trademark of AMP must Life appear Limited on the ABN same page 300 as 379 symbol. ABN particulars. DS DS DS AWAR AWAR AWAR2 About AMP AMP is a leading independent wealth management company in Australia and New Zealand. We help people and organisations build financial security and we ve been doing this since Today we are helping over four million retail customers in Australia and New Zealand own their tomorrow, and business clients across Asia, Europe, the Middle East and North America. We understand that insurance is all about peace of mind and are committed to being a financially responsible insurer. We want to ensure our customers are looked after should the unthinkable happen to them. AMP insurance exists to provide a safety net for our customers when they need it. In 2013, AMP paid $850.4 million in claims to our customers. We strive to provide insurance that secures your tomorrow by protecting what you have today. The issuers The insurance products referred to in this document are issued by AMP Life Limited ABN , AFSL No (AMP Life). The superannuation product referred to in this document (see page 25) is issued by AMP Superannuation Limited ABN , AFSL No (Trustee). AMP Life and the Trustee are the joint issuers of this Product Disclosure Statement (PDS). Each issuer takes full responsibility for the whole of this document. However, an issuer is not responsible for the products issued by the other issuer. No other company in the AMP Group guarantees the performance of AMP Life s or the Trustee s obligations to customers or assumes any liability to customers in connection with the products. The meaning of words used in this document Throughout this document: AMP Life, we, us and our means AMP Life Limited, and you, your and yourself means either: a. the plan owner ; or b. where cover is acquired through the AMP Superannuation Savings Trust, a Self-Managed Super Fund (SMSF) or small APRA superannuation fund the insured person, except that any benefit payment will be made by AMP Life to the AMP Superannuation Savings Trust or the trustee of the SMSF or small APRA superannuation fund (where applicable). We use other terms that have specific meanings which are highlighted throughout the PDS by the use of inverted commas. These words and their meanings are set out in the dictionary on pages 77 to 86. This offer is available only to persons receiving it (including electronically) within Australia. We can t accept cash or applications signed and mailed from outside Australia. Monies received or paid must always be in Australian dollars. Changes to the information in this document As the information in this document may change from time to time, you can obtain updated information simply by visiting amp.com.au/pdsupdates or by calling us on to request a free paper copy of the updated information. If the change to the information is materially adverse, we will issue a Supplementary Product Disclosure Statement.3 Flexible Lifetime Protection Supplementary Product Disclosure Statement This Supplementary Product Disclosure Statement (SPDS) contains important information and supplements the Flexible Lifetime Protection Product Disclosure Statement (PDS), issued 19 May The following table replaces the Fractures covered 1 table on page 47. We cover fracture of: Payment period (months) A thigh 3 A pelvis 3 A leg between the knee and foot 2 A kneecap 2 An upper arm 2 A shoulder blade 2 An ankle 2 The skull (not bones of the nose or face) 2 The jaw 1 A hand (requiring plaster cast or surgery) 1 A forearm above the wrist 1 A collar bone 1 A wrist 1 The following table replaces the Losses covered table on page 47. We cover permanent and irrecoverable loss of use of: Both lower limbs (paraplegia) or all four limbs (quadriplegia) due to a fracture of the spine Both feet (i), or both hands (i) The entire sight of both eyes Any two of, a foot (i), a hand (i), and the entire sight of one eye One leg at or above the knee One arm at or above the elbow One foot (i), or one hand (i), or the entire sight of one eye The entire thumb, and index finger, of the same hand at or above the first joint Payment period (months) 60 (ii) 24 (ii) 24 (ii) 24 (ii) 18 (ii) 18 (ii) (i) A foot means the whole foot below the ankle and a hand means the whole hand below the wrist. (ii) This period is restricted to the benefit period as outlined in your certificate of insurance. For example, if the plan has a benefit period of 1 year, only 12 months payments will be made under this feature On page 57, disregard the paragraph following the third bullet point under What does totally disabled mean?. Issue Number 1, 6 October 2014 Registered trademark of AMP Life Limited ABN4 On page 61, the following wording is added before the first paragraph under When we won t pay. We won t pay a benefit under the Income Protection Plan for an injury or illness to the insured person that occurs during any period of unemployment. However, you can put your cover on hold under the On Hold feature in order to maintain the plan. This will ensure that, once the insured person recommences employment, you will be able to continue their cover on your current plan conditions. If you stop paying your premiums, your plan will cease. Contact us If you would like to know more about how AMP can help you, please visit amp.com.au, or contact one of the following: phone web amp.com.au mail Customer Service AMP Life Limited PO Box 300 PARRAMATTA NSW 2124 What you need to know The insurance products referred to in this document are issued by AMP Life Limited ABN , AFSL No (AMP Life). AMP Life and the Trustee are the joint issuers of this Supplementary Product Disclosure Statement (SPDS). Each issuer takes full responsibility for the whole of this document. However, an issuer is not responsible for the products issued by the other issuer /145 Contents How to read this PDS 2 Section A About Flexible Lifetime Protection 3 The 5 steps to applying 5 Our commitment to you 6 Section B Life Protection Plan 7 About the Life Protection Plan 7 Plan Rules Life Protection Plans acquired 11 outside of superannuation Plan Rules Life Protection Plans acquired 25 through superannuation General information about the Life Protection Plan 32 acquired through the AMP Superannuation Savings Trust Section C Income Protection Plan 38 About the Income Protection Plan 38 Plan Rules Income Protection Plans acquired 41 outside of superannuation Plan Rules Income Protection Plans acquired 54 through a SMSF or small APRA superannuation fund Section D Business Overheads Insurance Plan 62 About the Business Overheads Insurance Plan 62 Plan Rules 63 Section E Additional information applicable to all 69 Flexible Lifetime Protection Plans Plan Rules Premiums and fees 71 Plan Rules Claiming a benefit 73 Providing information to AMP 75 Your Privacy 75 Your Duty of Disclosure 75 Dictionary of defined terms 77 Interim Cover Certificate 87 Section A About Flexible Lifetime Protection Section B Life Protection Plan Section E Additional information Section C Income Protection Plan Section D Business Overheads Insurance Plan6 How to read this PDS Flexible Lifetime Protection offers the following insurance plans: Life Protection Plan (see Section B) Income Protection Plan (see Section C) and Business Overheads Insurance Plan (see Section D). Each of these plans contains certain in-built benefits and features as well as additional options that can be added for an extra premium. The availability of these plans and the availability of certain benefits, options and features will depend upon whether you acquire your plan through superannuation or outside of superannuation. This PDS is divided into five sections: Section A provides an overview of the different types of plans available through Flexible Lifetime Protection. Refer to page 3. Section B explains how the Life Protection Plan works both when acquired outside of superannuation and through superannuation, a SMSF or small APRA super fund. Refer to page 7. Section C explains how the Income Protection Plan works both when acquired outside of superannuation and through a SMSF or small APRA superannuation fund. Refer to page 38. Section D explains how the Business Overheads Insurance Plan works. This Plan cannot be acquired through superannuation. Refer to page 62. Section E tells you about important additional information, such as how premiums and fees are calculated and how you can lodge a claim. Refer to page 69. This PDS also contains Plan Rules. The Plan Rules together with your certificate of insurance form your contract of insurance once we have accepted your application for cover. 27 Section A About Flexible Lifetime Protection Flexible Lifetime Protection offers a range of plans that can be tailored to meet your personal insurance needs, helping secure your tomorrow by protecting what you have today. This summary will help you understand the types of insurance cover offered and what solution they offer if you need to make a claim. Life Protection Plan (see page 7) There are 3 types of cover available under the Life Protection Plan: Death cover, Total and Permanent Disablement (TPD) cover and Trauma cover. You can apply for one or more of the covers under one plan as well as the Children s Trauma cover option (see page 23). There are two types of cover available through a SMSF or small APRA super fund, Death cover and TPD cover. You can apply for one or both covers under one plan. Death cover or Death and TPD cover are also available through the AMP Superannuation Savings Trust. Type of cover Why do I need it? Key benefits payable Death cover You may want to take out Death cover to ensure that, if you die, the mortgage and other debts are paid off and loved ones are provided with the funds they need to continue their lifestyle. A lump sum is payable if the insured person dies. We will advance the Death cover insured amount if the insured person is diagnosed as being terminally ill. Total and Permanent Disablement (TPD) cover Trauma cover Income Protection Plan (see page 38) Money is the last thing you would want to think about when faced with a lifelong disability. An emotional strain can be placed on a family to provide support to someone who may need full-time care and may never be able to work again. Nobody likes to think about the possibility of experiencing a serious illness or injury in the future. You can t foresee this happening, but you can make plans to help support yourself should the unexpected happen. Trauma cover can help provide the funds to make lifestyle adjustments after experiencing a serious illness or injury. Type of cover Why do I need it? Key benefits payable Income Protection cover Income protection cover can help you continue paying your day-to-day living expenses while you are too ill or injured to go to work, so you can focus on your recovery. Business Overheads Insurance Plan (see page 62) Type of cover Why do I need it? Key benefits payable Business Overheads Insurance cover Business Overheads Insurance cover can help with business expenses to keep your business going while you are too ill or injured to go to work. A lump sum is payable if the insured person becomes totally and permanently disabled. A lump sum is payable if the insured person experiences a specified trauma condition, or undergoes a specified medical procedure, and survives 14 days. A monthly benefit is payable while the insured person is totally or partially disabled due to an illness or injury. Reimbursement of eligible business expenses while the insured person is totally or partially disabled due to an illness or injury. The above gives you a general idea about what each cover is designed to do. However, it is important that you read on so that you understand all of the terms and conditions of the cover. As Flexible Lifetime Protection is not a savings product, if you end a plan at any time after the 28 day money back guarantee period (see page 6), you won t receive any money back (except in the limited circumstances set out on page 71 Refund of premiums). Your plan does not entitle you to share in any profits of AMP Life. Section A About Flexible Lifetime Protection Section E Additional information Section C Income Protection Plan Section B Life Protection Plan Section A About Flexible Lifetime Section D Business Overheads Insurance Plan 38 Types of claims paid by AMP in 2013 In 2013, we paid more than $850.4 million in claims across our entire insurance range death, terminal illness, total and permanent disablement, trauma and income protection. Our claims philosophy We aim to be fair, ethical and transparent. We have a duty to you and each of our policy holders to thoroughly assess each claim application based on the terms and conditions of their plan and on thoughtful and reasonable assessment of the evidence presented at acceptance of insurance cover and at time of claim. Death claims Trauma claims Accidents 6.7% Bowel Cancer 2.4% Breast Cancer 2.9% Cancer 28.0% Central Nervous System Disease 1.8% Heart Attack 5.4% Heart Disease 7.3% Other and Natural Causes 32.2% Mental Illness 2.9% Other Disease of the 1.0% Digestive tract Respiratory System Disease 5.4% Stroke 1.2% Suicide 2.8% Accidents 0.9% Bowel Cancer 2.7% Breast Cancer 20.4% Other Cancers 33.6% Central Nervous System Disease 4.0% Heart Attack 9.4% Heart Disease 9.9% Prostate Cancer 8.1% Stroke 2.9% Other 8.1% Total and Permanent Disablement claims Accidents 22.2% Bowel Cancer 1.3% Breast Cancer 1.7% Other Cancers 11.1% Central Nervous System Disease 5.7% Heart Attack 1.1% Heart Disease 2.3% Mental Illness 16.1% Musculoskeletal 17.3% Respiratory System Disease 1.9% Stroke 3.2% Other 16.1% Income Protection and Business Overheads Insurance claims Accidents 22.2% Bowel Cancer 1.5% Breast Cancer 2.4% Other Cancers 8.8% Central Nervous System Disease 3.3% Heart Attack 1.7% Heart Disease 2.3% Mental Illness 16.6% Musculoskeletal 16.9% Prostate Cancer 1.4% Respiratory System Disease 1.2% Stroke 2.0% Other 19.7% 49 The 5 steps to applying for Flexible Lifetime Protection Step 1 Making an informed decision Step 2 Finding out how much your insurance will cost Step 3 Completing your application for insurance Step 4 The underwriting process Step 5 The certificate of insurance This document sets out important information that you should know about Flexible Lifetime Protection, including the benefits, features and options available under each plan. You should consider this document before applying for a plan. The information in this document doesn t take into account your personal objectives, financial situation and needs. We encourage you to speak with your financial planner to help you decide which plan, and which insurance options, are fitted to your circumstances and needs. If you are applying for cover as the trustee of a SMSF or small APRA superannuation fund, you should be additionally aware of some important information which is set out on page 25. You can obtain an individual premium quote from your financial planner or by calling AMP on To apply for insurance we require you to complete an application. We also require a personal statement for each insured person. Before you apply for cover, it is important that you and the insured person have carefully read and understood your Duty of Disclosure (see page 76). We provide the following flexible options for you to complete the application and personal statement: Electronic Telephone Paper You can complete and lodge your application and personal statement electronically with your financial planner. Your financial planner can lodge your application and arrange for AMP to call you so that you can complete your personal statement over the phone at a time convenient to you. An application form and a personal statement are included at the back of this document. You can complete them in writing and send them to us at: AMP Life Limited PO Box 300 PARRAMATTA NSW 2124 The process of underwriting takes place after you have submitted your application. Underwriting ensures that everyone insured with AMP pays an appropriate premium. To properly assess your application AMP may obtain information from a range of sources such as your doctor or may require you to have a medical examination or blood tests. In some cases we may offer insurance that is different to what you applied for or we may decline your application for insurance. Interim Cover while we assess your application. We provide you with Interim cover at no extra cost, while your application is being assessed (see page 87). If we agree to issue a plan, we will issue a certificate of insurance. The certificate of insurance, together with the Plan Rules referred to in this document, is the contract of insurance between you and us. The certificate of insurance will set out the insured person(s), the type of cover for each insured person, the insured amounts, the options selected and other important information about the plan. Section A About Flexible Lifetime Protection Section E Additional information Section C Income Protection Plan Section B Life Protection Plan Section A About Flexible Lifetime Section D Business Overheads Insurance Plan 510 Our commitment to you Know exactly what you re getting 28 day money back period Keeping you informed Automatic plan enhancements Feel secure anywhere in the world Guaranteed renewable cover Supportive claims service Customer satisfaction Respecting your privacy We have included the Plan Rules in this document so that you know the exact terms of the insurance before you apply. These Plan Rules together with your certificate of insurance will form your contract of insurance with us once cover is accepted. If we accept your application for insurance cover, we will send you a certificate of insurance. You have 28 days to check that the insurance meets your needs. If it doesn t, simply write to us requesting that your plan be cancelled and return the certificate of insurance. Your premium will be refunded in full. You cannot return your plan if you have exercised any rights or powers available under it. If insurance cover is acquired through the AMP Superannuation Savings Trust, the refund must be paid to another complying superannuation fund (see page 71 for more information). Each year, we will send you an Annual Statement advising you about your insurance, fees and premiums for the next year. If you have changed occupation, ceased smoking or have experienced an improvement in health this may be an opportunity to be re-assessed and obtain a premium reduction. You can also get up-to-date information about your plan online. To register, visit amp.com.au and select My Portfolio from the online services menu. Our products are reviewed on a regular basis to ensure you receive competitive cover. If we enhance your plan without changing premium rates, we will automatically provide you the enhancements for which you are eligible at no extra charge. An insured person is covered worldwide, 24 hours a day, 7 days a week. For Income Protection and Business Overheads Insurance, benefit payments may stop after 3 months unless the insured person returns to Australia or New Zealand (see pages 43 and 56). As long as you pay premiums when they are due, we guarantee to continue cover until the cover ends, regardless of changes to the insured person s health, occupation or pastimes. Different rules apply to Income Protection Basic plans (see page 52). We are committed to paying all genuine claims in a professional empathetic manner and providing a supportive claims service. If you need to make a claim we have specially trained claims staff who will be ready to assist you. Either you or an authorised representative can call your financial planner or call us, to begin this process (see Claiming a benefit on page 73). If you have a question, please contact us. Our details are on the back cover. We aim to provide products and services that exceed your expectations. If we don t meet your expectations, please tell us. We hope that we can resolve the issue when you contact us. If we can t, we ll aim to give you a response within 10 working days. We will keep you advised at regular intervals of the status of your complaint. If we can t resolve your complaint to your satisfaction within 45 days, then you may have the right to lodge a complaint with the Financial Ombudsman Service: GPO Box 3 MELBOURNE VIC 3001 Phone: Fax: Website: fos.org.au If you have a plan acquired through the AMP Superannuation Savings Trust, please see page 36 for information about the Trustee s complaints process. Your privacy is important to us. See page 75 for information about how we handle your personal information. 611 Section B About the Life Protection Plan The Life Protection Plan offers flexible solutions to provide insurance that secures your tomorrow by protecting what you have today. You can structure your plan to meet your needs and help you build a secure future. Flexibility to tailor a plan that meets your needs The Life Protection Plan gives you choices so you have the flexibility to tailor a plan that suits your needs. This section sets out the choices available to you. Cover is subject to us accepting your application for insurance. What cover suits your needs? There are 3 types of cover available under the Life Protection Plan. You can include any one or more of the following types of cover under the one Life Protection Plan: Death cover (see pages 11 and 25) Total and Permanent Disablement (TPD) cover Trauma cover (see pages 13 and 27) Standard Optimum (see page 17) (see page 17) If the Life Protection Plan is acquired through the AMP Superannuation Savings Trust, the plan must include Death cover, and may also include TPD cover. Trauma cover is not available through the AMP Superannuation Savings Trust or where the Life Protection Plan is owned by the trustee of a SMSF or a small APRA superannuation fund. Who can own the plan? The Life Protection Plan can be owned by: An individual Two individuals (as joint tenants) A company If you want a benefit paid under the Life Protection Plan to form part of your superannuation, you can select a superannuation trustee to own the plan. The trustee can be: AMP Superannuation Limited, the trustee of the AMP Superannuation Savings Trust A trustee of a SMSF or a small APRA superannuation fund If you choose AMP Superannuation Limited to be the owner of the Life Protection Plan, you must first become a member of the AMP Superannuation Savings Trust (see page 25). If you choose the trustee of a SMSF or a small APRA superannuation fund to be the owner of the Life Protection Plan, please read the important information on page 25. Who can be an insured person? The insured person must be within the ages set out in the table on page 10 when you apply for cover. There can be more than one insured person under the Life Protection Plan (up to a maximum of 19 covers). If the Life Protection Plan is acquired through the AMP Superannuation Savings Trust, there can only be one insured person. How do you want to structure your plan? If you select more than one type of cover for the same insured person under the Life Protection Plan, you can choose to make the covers either standalone or linked. Standalone cover generally has a higher premium than linked cover. Standalone If we pay a benefit under one type of cover (for example Trauma cover), it does not reduce the insured amount of any other cover (for example Death cover) for the insured person under the Life Protection Plan. Linked How much cover can you apply for? If we pay under one type of cover (for example Trauma cover), the insured amount of each remaining type of cover (for example Death cover) for that insured person is reduced by the amount we pay. The maximum insured amount that you can currently apply for is: Death cover TPD cover Trauma cover No maximum $5 million $2 million The above amounts are inclusive of all cover you may have with any insurer at the time you apply for cover or an increase in cover. The insured amounts may increase above these maximums during the term of your plan under the Indexation feature (see pages 21 and 30). Minimum insured amounts The minimum insured Trauma cover amount that you can currently apply for is $10,000. There is no minimum insured amount for Death cover or TPD cover. Section A About Flexible Lifetime Protection Section E Additional information Section D Business Overheads Section C Income Protection Plan Section B Life Protection Plan Insurance Plan 712 What type of premium works for you? You can choose either a stepped premium or level premium (see page 71). If you choose a level premium, the premium will automatically change to stepped from the plan anniversary after the insured person turns 64. Do any optional benefits and features suit your needs? Additional premium options can be added to your plan. The optional benefits and features available under each type of cover are set out as follows: Death cover pages 11 and 26 TPD cover pages 13 and 27 Trauma cover page hour, worldwide cover Subject to the terms and conditions of the plan, on acceptance of your plan we will cover the insured person 24 hours a day anywhere in the world. If the insured person becomes sick or injured outside Australia or New Zealand, we may require additional medical documentation and/or medical examinations by a doctor chosen by us to support the claim. 813 Life Protection Plan Snapshot Features and benefits Death cover Death cover where acquired through the AMP Superannuation Savings Trust, a SMSF or a small APRA superannuation fund Death benefit Terminal Illness benefit Funeral benefit Nomination of beneficiaries (ii) TPD cover TPD cover where acquired through the AMP Superannuation Savings Trust, a SMSF or a small APRA superannuation fund TPD benefit TPD Partial benefit TPD Plus option (i) Own Occupation option (i) Trauma benefit Partials Package option (i) Optimum Trauma Reinstatement option (i) Trauma cover (not available through the AMP Superannuation Savings Trust or where the Life Protection Plan is owned by the trustee of a SMSF or a small APRA superannuation fund) Optimum Buy Back option (i) Financial Planning benefit Guaranteed Future Insurability feature Indexation feature Business Safeguard option (i) Waiver of Premium option (i) Accommodation benefit Death Benefit feature Children s Trauma cover option (i) (i) This is an additional premium option. It only applies if it is shown in the certificate of insurance for the insured person. (ii) Not available where the cover is held by the trustee of a SMSF or small APRA superannuation fund. Section A About Flexible Lifetime Protection Section E Additional information Section D Business Overheads Section C Income Protection Plan Section B Life Protection Plan Insurance Plan 914 Life Protection Plan Facts Entry ages and cover expiry age Cover type Entry age of the insured person Expires on the plan anniversary after the insured person turns Stepped premiums Level premiums Death cover acquired outside of superannuation, or through a SMSF or small APRA superannuation fund Death cover through the AMP Superannuation Savings Trust TPD cover acquired outside of superannuation, or through a SMSF or small APRA superannuation fund TPD cover through the AMP Superannuation Savings Trust Trauma cover Standard Trauma cover Optimum Option Entry age of the insured person Expires on the plan anniversary after the insured person turns Own Occupation option Children s Trauma cover option (ii) Business Safeguard option (i) (with Death cover) Business Safeguard option (i) (with TPD cover) Waiver of Premium option acquired outside of superannuation, or through a SMSF or small APRA superannuation fund Waiver of Premium option through the AMP Superannuation Savings Trust (iii) (iii) TPD Plus option Partials Package option (with Trauma cover Standard) Partials Package option (with Trauma cover Optimum) Optimum Buy Back option Optimum Trauma Reinstatement option The entry ages also apply to increases in cover and additions to existing plans. (i) The Business Safeguard option is only available if the insured person s Death cover and/or TPD cover insured amount is $500,000 or more. This option is not available for an insured person with a premium loading or exclusion for health reasons. (ii) The Children s Trauma cover option will convert to Death cover with linked Trauma cover Standard at expiry age (see page 24). (iii) If we are waiving premiums for an insured person at the plan anniversary after their 59th birthday, we will continue to waive premiums until the plan anniversary after their 70th birthday, as long as they remain totally disabled (see pages 22 and 30). Taxation information Are premium payments deductible? Generally, Life Protection Plan premiums are not tax deductible. However, where a business arranges the Life Protection Plan to cover loss of revenue (profits), should an employee be covered under the plan, premiums may be tax deductible. Are benefit payments assessable for income tax? Generally, payment of the Death cover, TPD cover or Trauma cover insured amount will not attract income tax or capital gains tax (CGT). However: when we pay the Death cover amount, CGT may apply if the plan owner at the date of death is not the same person or entity as the plan owner when the Life Protection Plan began, CGT applies to TPD cover and Trauma cover amounts we pay if the plan owner is not the insured person, or a relative (as defined for taxation purposes) of the insured person, where a business arranges the Life Protection Plan to cover loss of revenue (profits), should an employee be covered under the plan, the amounts we pay will attract income tax. Please see page 35 for information about the tax laws that apply to cover acquired through superannuation. We recommend that you speak to your accountant or tax adviser about your personal tax circumstances. 1015 Plan Rules Life Protection Plans acquired outside of superannuation The Plan Rules together with your certificate of insurance form your contract of insurance once we have accepted your application for cover. The following Plan Rules contained in pages 11 to 24 set out the terms and conditions that apply to a Life Protection Plan acquired outside of superannuation. Death cover Benefits and features at a glance The benefits and features of Death cover are listed below and are explained in detail on the pages listed below. In-built benefits and features are shown below like this: Additional premium options can be added to Death cover. These options will only apply if they are shown in the certificate of insurance for the insured person, and are shown below like this: Some words and expressions used in the Plan Rules have a specific meaning. These words and expressions are defined in the dictionary (see pages 77 to 86). Key benefit Death benefit (see page 11) Advanced payment benefits We may advance payment of the Death cover insured amount under these benefits: Terminal Illness benefit (see page 11) Additional benefits Funeral benefit (see page 12) The Financial Planning benefit and Accommodation benefit are in-built benefits and may be paid in addition to the above benefits. The Children s Trauma cover option is an additional premium option which can be added to Death cover, TPD cover or Trauma cover under a Life Protection Plan. Financial Planning benefit (see page 20) Children s Trauma cover option (see page 23) Accommodation benefit (see page 22) Features Increasing cover features These features allow the Death cover insured amount to be increased without providing evidence of the insured person s health or pastimes. Indexation feature (see page 21) Other features Nomination of beneficiaries (see page 12) Guaranteed renewable cover Guaranteed Future Insurability feature (see page 20) Business Safeguard option (see page 21) Waiver of Premium option (see page 22) As long as you pay premiums when they are due, we guarantee to continue Death cover until the cover ends (see page 13), regardless of changes in the insured person s health, occupation and pastimes. Benefits and features explained When we pay We only pay a benefit under Death cover if the insured event happens after cover starts and before cover ends (see page 13). We won t pay a benefit under Death cover in some circumstances (see When we won t pay on page 12). Also, you must satisfy our claim requirements before we pay a benefit (see page 73). Otherwise, we will pay a benefit under Death cover in the circumstances set out in this section and on page 20. Death benefit We pay the Death cover insured amount if the insured person dies. Terminal Illness benefit We advance payment of the Death cover insured amount if the insured person, after the cover starts and before the cover ends, becomes terminally ill. What does terminally ill mean? Terminally ill means that, as a direct result of any condition caused by an illness or injury, the insured person has a life expectancy of 12 months or less. Section A About Flexible Lifetime Protection Section E Additional information Section D Business Overheads Section C Income Protection Plan Section B Life Protection Plan Insurance Plan 1116 12 The prognosis must be: based on clinical findings and reports, provided in writing by an appropriately qualified doctor who is approved by us, and supported by additional evidence that we may require to agree with the prognosis. We will only pay if you become terminally ill: after this plan commences before this plan ends, and before you reach the benefit expiry age for this plan. The amount we pay under the Terminal Illness benefit is the Death cover insured amount on the date we agree with the doctor s prognosis. On payment of the Terminal Illness benefit, Death cover for the insured person under the Life Protection Plan will end. If you have linked TPD cover and/or Trauma cover for the insured person, their TPD cover and/or Trauma cover insured amount(s) will be reduced by the amount of the Terminal Illness benefit payable. You don t have to pay any more premiums for an insured person under the Life Protection Plan if we have paid the Terminal Illness benefit for that insured person. Funeral benefit We advance $20,000 (or the Death cover insured amount, if less) if: the Funeral benefit is claimed, and we receive a certified copy of the insured person s death certificate. The Death cover insured amount reduces by the amount we pay under the Funeral benefit. We pay the balance of the Death cover insured amount (if any) if we accept the claim for the Death benefit. We pay the Funeral benefit to: you, or if you have died, to your estate or to any person we are permitted to pay under the Life Insurance Act (which currently includes your spouse, de facto, child, parent, sibling, niece or nephew or a person who satisfies us that they are entitled to your property under your Will or otherwise by law). Nomination of beneficiaries If you are both the sole plan owner and sole insured person of the Life Protection Plan, you can nominate one or more beneficiaries to receive the Death benefit under the Life Protection Plan. Your nomination will automatically be revoked if: you cease to be the sole plan owner or the sole insured person of the Life Protection Plan, or a nominated beneficiary dies before you (even if there are other surviving beneficiaries). You can cancel your nomination at any time by writing to us. Who we pay Plan owner If your plan has a sole plan owner with no nominated beneficiary If your plan has a sole plan owner with a nominated beneficiary(ies). If your plan is owned by two individuals as joint tenants Who we pay When we won t pay If you are alive, we pay the Terminal Illness benefit or Death benefit to you. If you have died, we pay the Funeral benefit or Death benefit to your estate. We pay the Terminal Illness benefit to you. We pay the Funeral benefit or Death benefit to your nominated beneficiary(ies). If both plan owners are alive, we pay the Terminal Illness benefit or Death benefit to the joint plan owners. If a plan owner has died, we pay the Funeral benefit, Terminal Illness benefit or Death benefit to the surviving plan owner. Unless Death cover is Replacement cover (see below), we won t pay a benefit under Death cover for an insured person if they die, or become terminally ill, by their own hand (whether sane or insane at the time) within 13 months of the date the Death cover starts or the date the Death cover was last reinstated. Also, if we increased the Death cover insured amount for the insured person because you asked us to, we won t pay the increased portion of the Death cover insured amount if the insured person dies, or becomes terminally ill, by their own hand (whether sane or insane at the time) within 13 months of the date of the increase. This does not apply to increases under the Indexation feature. We won t pay a benefit under Death cover for an injury or illness the insured person was diagnosed with, had any symptoms of, or was treated for, prior to the date the Death cover starts or the date the Death cover was last reinstated unless attributed to a sickness or disability that: you or the insured person were not aware of, and a reasonable person in the circumstances could not have been expected to be aware of, at the time. The sooner we are notified of your claim, the more effectively we will be able to assess your claim. If we are not notified as soon as possible, we may reduce the amount of any benefit paid to the extent that we have been prejudiced by this delay. Replacement cover If Death cover replaces Death cover issued by us, or another insurer, the 13 month period will not apply (but only up to the insured amount under the previous cover) if: you would have been entitled to claim under the previous cover had it not been replaced, and the previous cover was in place at the time we issued the Death cover, and the previous cover was in place for a continuous period of at least 13 months. For this exception to apply, we will require satisfactory evidence of the above at the time of any claim.17 When Death cover ends The Death cover under your Life Protection Plan for an insured person ends when one of the following happens: the insured person dies, we receive your written request to cancel the Death cover for that insured person, the insured person s Death cover reduces to nil because another benefit (for example, the Terminal Illness benefit or other linked benefits) becomes payable, the end date for the insured person s Death cover shown on the certificate of insurance, the plan anniversary after the insured person s 99th birthday, or your Life Protection Plan ends (see page 24). Total and Permanent Disablement (TPD) cover Benefits and features at a glance The benefits and features of TPD cover are listed below and are explained in detail on the pages listed below. In-built benefits and features are shown below like this: Additional premium options can be added to TPD cover. These options will only apply if they are shown in the certificate of insurance for the insured person, and are shown below like this: Some words and expressions used in the Plan Rules have a specific meaning. These words and expressions are defined in the dictionary (see pages 77 to 86). Key benefits TPD benefit (see page 13) Additional benefits TPD Partial benefit (see page 15) The Financial Planning benefit and Accommodation benefit are in-built benefits and may be paid in addition to the above benefits. The Death Benefit feature is an in-built feature. The Children s Trauma cover option is an additional premium option which can be added to Death cover, TPD cover or Trauma cover under a Life Protection Plan. Financial Planning benefit (see page 20) Accommodation benefit (see page 22) Children s Trauma cover option (see page 23) Death Benefit feature (see page 22) Features Increasing cover features These features allow the TPD cover insured amount to be increased without providing evidence of the insured person s health or pastimes. Indexation feature (see page 21) Other features TPD Plus option (see page 15) Guaranteed renewable cover Guaranteed Future Insurability feature (see page 20) Own Occupation option (see page 15) Business Safeguard option (see page 21) Waiver of Premium option (see page 22) As long as you pay premiums when they are due, we guarantee to continue TPD cover until the cover ends (see page 15), regardless of changes to the insured person s health, occupation and pastimes. Benefits and features explained When we pay We only pay a benefit under TPD cover if the insured event happens after cover starts and before cover ends (see page 15). We won t pay a benefit under TPD cover in some circumstances (see When we won t pay on page 15). Also, you must satisfy our claim requirements before we pay a benefit (see page 73). Otherwise, we will pay a benefit under TPD cover in the circumstances set out in this section and on page 22. TPD benefit When we pay We pay you the TPD benefit if the insured person becomes totally and permanently disabled. The insured person must survive for 8 days from the occurrence of the illness or injury that directly or indirectly caused them to become totally and permanently disabled. What does totally and permanently disabled mean? An insured person is totally and permanently disabled if they satisfy one of the parts of the definition of totally and permanently disabled in the table below. However: part 2 of the definition of totally and permanently disabled only applies if the Own Occupation option is shown in the certificate of insurance for the insured person, and on and from the plan anniversary after the insured person s 64th birthday, the insured person is only totally and permanently disabled if they satisfy either part 4, 5 or 6 of the definition of totally and permanently disabled. Section A About Flexible Lifetime Protection Section E Additional information Section D Business Overheads Section C Income Protection Plan Section B Life Protection Plan Insurance Plan 1318 Part 1 Unlikely to work The insured person is totally and permanently disabled if: they suffer an illness or injury, and the illness or injury wholly prevents them from engaging in regular remunerative work for at least 3 months (i) in a row, and since they became ill or injured, they have been under ongoing care for that illness or injury, and in our opinion, the illness or injury means that they are unlikely to ever work in regular remunerative work for which they are reasonably fitted by education, training or experience, that allows them to earn greater than 25% of their pre-disability income. Part 2 Unlikely to work Own occupation Part 2 only applies if the Own Occupation option is shown in the certificate of insurance for the insured person. The insured person is totally and permanently disabled if: they suffer an illness or injury, and the illness or injury wholly prevents them from engaging in their own occupation for at least 3 months (i) in a row, and since they became ill or injured, they have been under ongoing care for that illness or injury, and in our opinion, the illness or injury means that they are unlikely to ever work in their own occupation. Part 3 Home Duties The insured person is totally and permanently disabled if: they suffer an illness or injury, and the illness or injury wholly prevents them from engaging in their home duties for at least 3 months (i) in a row, and since they became ill or injured, they have been under ongoing care for that illness or injury, and in our opinion, the illness or injury means that they are unlikely to ever: a. engage in their home duties ; or b. work in any occupation for which they are reasonably fitted by education, training or experience. Part 4 Loss of use of limbs and/or sight The insured person is totally and permanently disabled if they suffer from the total and irrecoverable loss of: the use of 2 limbs, or the sight of both eyes, or the use of one limb and the sight of one eye, where a limb means the whole hand below the wrist or the whole foot below the ankle. The loss must be unable to be remedied. Part 5 Loss of independent living The insured person is totally and permanently disabled if they become totally and permanently unable to perform at least 2 activities of daily living without assistance from someone else. We will not pay for total and permanent disablement caused directly by alcohol or drug abuse. Part 6 Loss of cognitive functioning The insured person is totally and permanently disabled if they: suffer significant and permanent cognitive impairment with a loss of intellectual capacity, and are required to be under the continuous care and supervision of someone else. We will not pay for total and permanent disablement caused directly by alcohol or drug abuse. (i) Upon admittance of your claim, we will refund any TPD cover premiums falling due during this 3 month period that have been paid for the insured person. If the insured person satisfies the definition in Part 1, 2 or 3 as a result of one of the listed medical conditions, we will waive the 3 month qualifying period. The listed medical conditions are: Alzheimer s disease and other dementias Blindness Cardiomyopathy Paralysis diplegia Paralysis hemiplegia Paralysis paraplegia Paralysis quadriplegia Paralysis tetraplegia Loss of hearing Loss of speech Lung disease Major head trauma Motor neurone disease Multiple sclerosis Muscular dystrophy Parkinson s disease (advanced) Primary pulmonary hypertension Severe rheumatoid arthritis Each of the listed medical conditions are defined in the Trauma definitions section from page 77. Amount we pay If we accept the claim because the insured person has satisfied either Parts 1, 2 or 3 of the definition of totally and permanently disabled If we accept the claim because the insured person has satisfied either Parts 4, 5, or 6 of the definition of totally and permanently disabled The TPD benefit we pay is a lump sum equal to the TPD cover insured amount that applies on the date 3 months after the insured person stopped performing home duties, regular remunerative work or their own occupation (as applicable). The TPD benefit we pay is a lump sum equal to the TPD cover insured amount that applies on the date the insured person satisfies either parts 4, 5, or 6 of the definition of totally and permanently disabled (as applicable). We only pay the TPD cover insured amount once in respect of an insured person, even if the insured person satisfies two or more Parts in the definition of totally and permanently disabled. If you have linked Death and/or Trauma cover for the insured person, their Death and/or Trauma cover insured amount(s) will be reduced by the amount of the TPD benefit payable and your premium will be reduced having regard to the reduced insured amount(s). If you have any combination of linked Death, TPD and Trauma cover for the insured person and you are eligible for a benefit under two or all three types of cover at the same time for the same condition, we only pay a benefit under one type of cover. If the insured amounts are not equal, we pay a benefit under the cover which has the highest insured amount. 1419 TPD Partial benefit When we pay We pay you the TPD Partial benefit for an insured person if they suffer total and irrecoverable loss of: the use of one limb (where a limb means the whole hand below the wrist or the whole foot below the ankle), or the sight of one eye, where visual acuity has reduced to 6/60 or less and the loss is unable to be corrected by glasses or any other means. The loss must be unable to be remedied and the insured person must survive for 8 days after the loss. We only pay the TPD Partial benefit once for each insured person. If the insured person s loss satisfies the conditions of both the TPD benefit and the TPD Partial benefit, we only pay you the TPD benefit. Amount we pay The TPD Partial benefit we pay is a lump sum equal to 25% of the TPD cover insured amount (up to a maximum of $500,000). If the TPD Partial benefit is payable: the TPD cover insured amount for the insured person, and the insured amount(s) under any linked Death cover and/or Trauma cover, will be reduced by the TPD Partial benefit payable, and your premium will be reduced having regard to the reduced insured amount(s). TPD Plus option This is an additional premium option which is available if the insured person s TPD cover is linked to Death cover. It only applies if it is shown in the certificate of insurance for the insured person. Under this option, we will automatically restore the Death cover insured amount for an insured person to the amount that it was before it was reduced by payment of the TPD benefit. This option does not restore an insured amount because of a payment of the TPD Partial benefit. You will not pay a premium for the restored amount for the remaining term of your Life Protection Plan, from the date we make the TPD benefit payment. However, you must still pay the premium for any amount of Death cover that exceeds the TPD amount. We do not restore the Death cover insured amount if: the insured person dies within 8 days after we pay the TPD benefit, or we have paid a Terminal Illness benefit for the insured person. The option ceases on the plan anniversary after the insured person s 64th birthday. Own Occupation option This is an additional premium option. It only applies if it is shown in the certificate of insurance for the insured person. This option is only available to certain occupations which include professional, white collar workers and light blue collar (trade and light manual) workers. Under this option, you can claim the TPD cover insured amount if the insured person meets Part 2 in the definition of totally and permanently disabled (see page 14). When we won t pay We will not pay a claim if the insured person s : total and permanent disablement (for a TPD benefit), or total and irrecoverable loss of the use of a limb or the sight of an eye (for a TPD Partial benefit), was caused directly or indirectly by an intentional or deliberate act by you or the insured person. We won t pay a TPD benefit or a TPD Partial benefit arising from an injury or illness the insured person was diagnosed with, had any symptoms of, or was treated for, prior to the date the relevant benefit starts or the date the benefit was last reinstated unless attributed to a sickness or disability that: you or the insured person were not aware of, and a reasonable person in the circumstances could not have been expected to be aware of, at the time. The sooner we are notified of the insured person s illness or injury, the more effectively we will be able to work with the insured person through the claims process. If we are not notified of the insured person s illness or injury as soon as possible, we may reduce the amount of any benefit paid to the extent that we have been prejudiced by this delay. When TPD cover ends The TPD cover under your Life Protection Plan for an insured person ends when one of the following happens: the insured person dies, the TPD benefit for the insured person becomes payable, we receive your written request to cancel the TPD cover for the insured person, the insured person s TPD cover reduces to nil because another linked benefit becomes payable, the end date for that insured person s TPD cover shown on the certificate of insurance, the plan anniversary after the insured person s 99th birthday, or your Life Protection Plan ends (see page 24). Section A About Flexible Lifetime Protection Section E Additional information Section D Business Overheads Section C Income Protection Plan Section B Life Protection Plan Insurance Plan 1520 Trauma cover Benefits and features at a glance The benefits and features of Trauma cover are listed below. In-built benefits and features are shown below like this: Additional premium options can be added to Trauma cover. These options will only apply if they are shown in the certificate of insurance for the insured person, and are shown below like this: The benefits and features of Trauma cover are explained in detail on the pages listed below. Some words and expressions used in the Plan Rules have a specific meaning. These words and expressions are defined in the dictionary (see pages 77 to 86). Key benefits Trauma benefit (see page 16) Additional benefits Partials Package option (see page 18) The Financial Planning benefit and Accommodation benefit are in-built benefits and may be paid in addition to the above benefits. The Death Benefit feature is an in-built feature. The Children s Trauma cover option is an additional premium option which can be added to Death cover, TPD cover or Trauma cover under a Life Protection Plan. Financial Planning benefit (see page 20) Features Death Benefit feature (see page 22) Increasing cover features Children s Trauma cover option (see page 23) Accommodation feature (see page 22) These features allow the Trauma cover insured amount to be increased without providing evidence of the insured person s health or pastimes. Indexation feature (see page 21) Guaranteed Future Insurability feature (see page 20) Other features Optimum Trauma Reinstatement option (Trauma cover Optimum only) (see page 18) Guaranteed renewable cover Optimum Buy Back option (Trauma cover Optimum only) (see page 19) Waiver of Premium option (see page 22) As long as you pay premiums when they are due, we guarantee to continue Trauma cover until the cover ends (see page 20). Benefits and features explained When we pay We only pay a benefit under Trauma cover if the insured event happens after cover starts and before cover ends (see page 20). We won t pay a benefit under Trauma cover in some circumstances (see When we won t pay on page 19). Also, you must satisfy our claim requirements before we pay a benefit (see page 73). Otherwise, we will pay a benefit under Trauma cover in the circumstances set out in this section and on page 22. Trauma benefit When we pay We pay you the Trauma benefit if the insured person : experiences a listed trauma condition or undergoes a listed medical procedure, and survives for 14 days from the date of the diagnosis of the trauma condition or the date of the medical procedure. If the relevant trauma condition is coma, the insured person must survive for the additional period included within the definition of this condition (see page 78). The trauma conditions and medical procedures covered differ depending on whether you have Trauma cover Standard or Trauma cover Optimum for the insured person : Trauma cover Standard covers 15 trauma conditions and medical procedures (see page 17), and Trauma cover Optimum covers 50 trauma conditions and medical procedures (see page 17). The trauma conditions and medical procedures are defined on pages 77 to View more
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Product Disclosure Statement For NAB Mortgage Protect Preparation Date: 23 June 2012 Issue No. 1 This Product Disclosure Statement (PDS) is issued by: MLC Limited, ABN 90 000 000 402 AFSL 230694 You ve More information Includes Tips & Tricks that could save you substantial $$$ and help make sure your claims get paid.
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