Insurance in your super Inside

Insurance
in your super
UniSuper Accumulation 1 members
The information in this document forms part of
the UniSuper Accumulation 1 Product Disclosure
Statement issued on 30 November 2013.
This document was prepared on 30 november 2013.
Inside
Insurance at UniSuper
1
Death and TPD cover
5
Income Protection cover
11
Important definitions
16
RMIT’s Design Hub
SuperRatings, a superannuation research company,
has awarded UniSuper a “Platinum” rating for its
Accumulation product.
Go to www.superratings.com.au for details of its rating
criteria. SuperRatings does not issue, sell, guarantee or
underwrite this product.
Chant West has awarded UniSuper a “5 Apples” rating
for its Accumulation products. For further information
about the methodology used by Chant West, see www.
chantwest.com.au.
Chant West has given its consent to the inclusion in
this document of the references to Chant West and the
inclusion of the logos and ratings or awards provided by
Chant West in the form and context in which they are
included.
This document includes information about insurance, including how to apply for cover, the level and type of cover available, the
cost of cover, eligibility and cancellation of cover, relevant definitions and the other terms and conditions including any exclusions
that may apply and may affect your entitlement to insurance cover.
Information contained in this document which is not materially adverse may change from time to time. Updated information can
be found on our website or by contacting us.
In this document, UniSuper is referred to as UniSuper or the Fund, ABN 91 385 943 850. UniSuper Limited is referred to as
UniSuper or the Trustee, ABN 54 006 027 121. UniSuper Management Pty Ltd is referred to as USM, ABN 91 006 961 799, AFSL
No. 235907.
Insurance in your super
1
ACCUMULATION 1
Insurance at UniSuper
At UniSuper, we don’t just help you to invest and
grow your superannuation savings, we also help you
to protect yourself and your family from the financial
consequences of injury, illness and death.
Who provides this insurance?
Insurance cover is provided to UniSuper members
through group insurance policies the Trustee has
taken out with TAL Life Limited, ABN 70 050 109
450 (referred to as ‘the Insurer’ throughout this
document).
The insurance component that is paid upon death
or disablement will be subject to the terms and
conditions in the group insurance policies. In
this document we’ve set out the main features of
insurance cover provided by the Insurer including
a summary of the key terms and conditions and
eligibility criteria in the group insurance policies,
which can be obtained on request by calling us
on 1800 331 685. The full terms and conditions
contained in the policies prevail over any
inconsistent information in this document.
Important definitions
What types of insurance
cover are available?
There are three types of insurance cover available for
Accumulation 1 members:
Death-only cover,
Death and Total & Permanent Disablement
(TPD) cover, and
Income Protection cover.
AA
AA
AA
What do we mean by ‘default insurance’
and ‘automatic cover’?
Some of our communications refer to ‘default
insurance’ or ‘automatic cover’.
When we refer to ‘default insurance’ or ‘automatic
cover’ we are referring to Death-only or Death and
TPD insurance cover you receive upon joining the
Fund.
Do you need insurance cover?
Having the right type and level of insurance cover to
protect yourself and your family is an important part
of planning for the future. Think about how you or
your family might cope financially if you were unable
to work temporarily or permanently due to injury or
illness or in the event that you die.
The ‘Important definitions’ section at the
end of this document explains the meaning
of certain important terms which appear in
italics within this document.
your STEPS TO FINANCIAL PROTECTION
To make the insurance choices for your UniSuper membership that will best suit your financial and
personal needs, simply follow these steps:
1. Read your Accumulation 1 Product Disclosure
guide to how much insurance cover you or
Statement (PDS) carefully together with this
your family may need to maintain your/their
Insurance in your super booklet referred to in
current lifestyle in the event that you die or
the UniSuper Accumulation 1 PDS.
become disabled. You many also want to seek
2. T hink about your family’s financial needs,
professional advice.
the level and type of insurance cover you
3. Decide if you want to apply for additional
already have, and whether you may need
units or fixed amounts of Death and TPD
additional cover. Our Insurance needs
cover.
calculator available from our website
4. Decide if you want to apply for Income
Protection insurance cover.
www.unisuper.com.au provides you with a
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Insurance in your super
ACCUMULATION 1
How do you obtain my
insurance cover?
There are two ways in which you can obtain your
insurance cover:
On joining the Fund (‘automatic cover’) and/or
Applying for insurance cover.
AA
AA
Automatic cover
Automatic cover is insurance you receive when you
become a member (provided you meet the eligibility
criteria) and you do not need to go through any
underwriting.
Members who meet the eligibility criteria will
receive:
Members aged less than 70:
one unit of Death and TPD cover
Members aged 70 to 74:
one unit of Death-only cover
You can opt out of automatic cover or choose to
reduce your Death and TPD cover to Death-only
cover when you join UniSuper by completing
the appropriate sections on the Accumulation 1
application form in the relevant PDS, or at any time
in the future by writing to us. However, if you wish
to take up cover at a later date, you will need to be
underwritten and accepted by the Insurer.
Applying for insurance
If you are not eligible for default insurance or would
like to increase your levels of cover, you can apply for
additional Death-only, Death and Total & Permanent
Disablement and Income Protection cover.
Additional Death and TPD cover without
medical evidence
Upon joining, members who are eligible for
automatic cover have the ability to increase their
amount of insurance cover. It can be increased
from one unit to either two units or three units of
the same type of cover without providing health
evidence to the Insurer. You need to apply within
180 days of first becoming eligible to join UniSuper
by completing the appropriate section on the
Accumulation 1 application form and:
an on-time employer contribution is made in
respect of you within 180 days of you becoming
first eligible to join UniSuper, and
you are in active employment on the date that
cover commences.
AA
AA
If you are not in active employment on the date cover
commences you will only be entitled to Limited TPD
cover for a 12-month period. Your cover will revert
to standard TPD cover on the date you are in active
employment after the end of the 12-month period.
If you meet the eligibility requirements for Death
and TPD cover but UniSuper does not receive an
employer contribution within 180 days of you being
first eligible to join UniSuper, you will be entitled
to one unit of Death cover from the first day of the
period for which your first employer contribution
relates, and limited TPD cover for a 12-month period.
Your cover will revert to standard TPD cover on the
date you are in active employment after the end of
the12-month period.
Income Protection cover without
medical evidence
You can apply for Income Protection cover without
the need to provide medical evidence if you apply
within the first 180 days of becoming first eligible to
join UniSuper by completing the appropriate section
of the Accumulation 1 application form and:
an on-time employer contribution is made in
respect of you within 180 days of you becoming
first eligible to join UniSuper; and
you are in active employment on the date that
cover commences UniSuper.
AA
AA
If you are not in active employment on the date
that cover commences, you will only be entitled to
Limited Income Protection cover for a 12-month
period. Your cover will revert to standard Income
Protection cover on the date that you are in active
employment after the end of the 12-month period.
If joining outside 180 days of being first eligible to
join UniSuper, full underwriting is required.
Insurance cover with medical evidence
You can apply to:
increase your Death and TPD cover or your
Income Protection cover, or
take out Death and TPD insurance cover if you
do not meet the eligibility criteria for automatic
cover, or
wish to take up Death and TPD cover if you
opted out when you first joined, or
take out Income Protection cover if you did not
elect to take up cover when you first joined.
AA
AA
AA
AA
You can apply by going to the insurance section of
MemberOnline, or by completing the insurance
application form, attached to this booklet or available
on our website.
All applications for insurance cover are subject
to acceptance by the Insurer. The Insurer has the
Insurance in your super
3
ACCUMULATION 1
ability to accept, decline or impose special conditions
such as restrictions, exclusions and/or loadings on
the insurance premiums. If the Insurer accepts your
application via underwriting subject to restrictions,
exclusions and/or loadings on the insurance
premiums, these conditions will apply immediately
from the date cover commences and you will be
notified in writing by UniSuper.
AA you can only increase your cover once for any life
event in any 12 month period
AA you can only ever increase your cover once for
each life event
AA you must apply to the Insurer within 90 days of
In some cases, the Insurer may also write to your
nominated treating doctor(s) for additional medical
information. You may also be required to provide
additional information about your circumstances
(such as financial information), undergo a medical
examination and/or have blood tests. The Insurer or
UniSuper will advise you of any further information
or health evidence that is required.
AA
AA
Reducing or cancelling your cover
You can reduce or cancel your cover. Reducing or
cancelling your cover will take effect from the later
of the date the Trustee (or the Insurer, in the case of
Death and TPD cover) receives notice in writing and,
where applicable, the date nominated by you is the
date you want your cover to reduce or cease.
Life Events cover
UniSuper provides a straightforward process for
members to increase their Death and TPD cover in
the following circumstances:
you purchase a home for your permanent
residence and take out a mortgage on that
residence, or
you get married, or
either you or your partner give birth to or adopt
a child.
AA
AA
AA
To be eligible to apply for a life event
To be eligible to obtain Death and/or TPD cover
through a life event without having to provide
medical evidence, the following must be satisfied:
at the date of application you are a member of
UniSuper
you have Death and/or TPD cover in force on the
date the life event occurred
you are less than age 55 on the date that you
apply for an increase in cover under this
condition
your cover under this policy is not subject to any
special conditions such as a premium loading,
restriction or exclusion
you must not have previously been declined
cover under this policy
AA
AA
AA
the life event or within 30 days of the date that a
special offer is communicated to you by us on the
terms agreed between UniSuper and the Insurer
from time to time
you must provide us with sufficient proof to our
satisfaction that the life event has occurred, and
your benefit cannot exceed the maximum
benefit.
Through our Life Events cover, members who are
under age 55 on the date they apply for the increased
cover are able to obtain the following additional
amount of the same type of cover, subject to the
maximum benefit limits, without any requirement to
provide health evidence to the Insurer:
Unitised cover – one additional unit
Fixed cover – the lesser of 25% of the existing
level of cover, or $200,000.
AA
AA
To apply for an increase to your existing cover using
our Life Events option, you must do so within 90 days
of the life event occurring. You’ll need to complete
the Life Events insurance cover application form
and you’ll need to provide sufficient evidence to the
Insurer’s satisfaction that the life event has occurred,
for example:
certified mortgage documents
certified marriage certificate
certified birth certificate or adoption papers
AA
AA
AA
If your application for Life Events cover is successful,
the additional cover will be added to your existing
Death and TPD or Death-only insurance cover
and will commence on the date the Insurer notifies
UniSuper in writing that it has agreed to provide
cover or, the date that UniSuper accepts cover on
behalf of the Insurer.
If you make a claim within the first six months of the
date your increased cover commences under Life
Events cover, the Life Events portion of your benefit
will only be payable if the claim is the result of an
‘Accident’ (which means accidental injury causing
death or TPD through visible, violent, external event
to the body).
AA
Commencing cover
AA
Automatic and additional automatic Death-only,
Death & TPD and Income Protection cover (i.e. cover
without medical evidence on first joining UniSuper)
commences on the first day of the period to which
the first employer contribution relates if you join the
fund within 180 days of becoming first eligible.
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Insurance in your super
ACCUMULATION 1
Unless otherwise indicated in the PDS, all other
Death-only, Death & TPD and Income Protection
cover generally commences on the date the Insurer
accepts your application for cover.
Maximum amount of cover
you can apply for
There is no limit to the amount of Death cover you
can apply for. The maximum amount of TPD cover
you apply for cannot exceed $3 million of your Death
cover. The maximum amount of terminal illness
cover you can have is $3 million. If the terminal
illness benefit paid out ends up being less than the
death benefit, your dependants and/or estate will
receive the remainder of your death benefit.
The maximum amount of Income Protection cover
you can apply for is the lesser of:
75% of your pre-disability monthly income,
and an additional amount of up to 10% of your
pre-disability monthly income as an employer
superannuation contribution, or
a maximum of $30,000 per month.
AA
AA
The maximum period an Income Protection benefit
will be paid is 24 months.
The minimum pre-disability monthly income that
can be insured is $100 per week.
Where your selected level of Income Protection
cover results in your insured income being less than
85% of your pre-disability monthly income, only the
portion above 75% will be payable as an employer
superannuation contribution. Your pre-disability
monthly income does not include your employer’s
superannuation contributions to UniSuper.
What are the eligibility criteria?
Eligibility criteria for automatic Death
and TPD cover and additional death-only
and death and TPD cover
You are generally eligible for this cover if you meet
the following criteria when you join UniSuper:
you are an Accumulation 1 member
you are an Australian citizen, a New Zealand
citizen residing in Australia, a holder of an
Australian permanent visa or a person who
resides in Australia on an approved working visa
you join UniSuper within 180 days of when you
are first eligible to join (and UniSuper receive
minimum member details within 180 days of you
becoming first eligible)
AA
AA
AA
AA UniSuper receives an on-time employer
AA
AA
AA
AA
contribution within 180 days of when you are
first eligible to join
you are in active employment on the date that
you are first eligible to join UniSuper
you are at least age 15 at your next birthday, but
under 75 years of age in respect of Death cover,
and under 70 in respect of TPD, when you join
UniSuper
you do not join UniSuper as a result of a Family
Law payment split under the Family Law Act,
and
you are not currently claiming for, or eligible to
claim for or have previously received an insured
terminal illness or TPD benefit.
If you meet the above eligibility criteria but you have
not received an employer contribution into your
account within the 180 day time frame, and/or you
are not in active employment on the date that cover
commences, then you are still eligible for automatic
cover. However, you will be provided with and start
to pay for one unit of Death cover and, for a period of
12 months, and one unit of Limited TPD cover.
Your cover will revert to standard Death and TPD
cover on the date you are in active employment after
the end of the 12-month period. The commencement
date of this cover will be the start date of your first
employer contribution.
Please note, your cover will be automatically
transferred to Death-only cover when you turn
70 and your Death-only cover will cease when
you turn 75.
Eligibility criteria for Income
Protection cover
To be eligible to apply for Income Protection
insurance UniSuper must have received an on-time
employer contribution in respect of you within 180
days of you first becoming first eligible to join and you
must:
be an Accumulation 1 member (and have become
an Accumulation 1 member within 180 days of
becoming first eligible to join UniSuper), and
sign and complete a membership form within
180 days of when you are first eligible to join,
be aged 15 at your next birthday or over, but
under 65 years UniSuper, and
be an Australian citizen, a New Zealand citizen
residing in Australia, a holder of an Australian
permanent visa or a person who resides in
Australia on an approved working visa.
AA
AA
AA
AA
If you apply for Income Protection cover and become
a member of UniSuper within 180 days from when
you are first eligible to do so, and an employer
contribution is received in respect of you in that
period and you are in active employment on the date
Insurance in your super
5
ACCUMULATION 1
that cover commences, you will not be required to
provide health evidence to the Insurer (subject to
cover limits).
If you are not in active employment on the date
that cover commences, you will only be entitled
to Limited Income Protection cover for the initial
12-month period. Your cover will revert to standard
Income Protection cover on the date you are in active
employment after the end of the 12-month period.
In other circumstances, you can still apply for this
cover however, evidence will be required.
Death and TPD cover
What is Death and TPD cover?
Death and TPD cover provides a lump sum payment
in the event that a member:
is unable to work as a result of TPD
is diagnosed with a terminal illness, or
dies.
AA
AA
AA
All applicants for Death and TPD cover, excluding
automatic cover and cover permitted without
providing health evidence to the Insurer, must be
assessed by the Insurer.
UniSuper can only pay an insured benefit once
the Insurer has accepted the claim, the insurance
proceeds have been received from the Insurer, and
a relevant condition of release has been met by the
member.
What is Death-only cover?
Death-only cover provides a lump sum payment in
the event that a member is diagnosed with a terminal
illness, or dies.
What does Death and TPD insurance
cover me for?
Death
Your beneficiaries will receive your insured benefit in
the event that you die.
Terminal illness
You will receive an insured terminal illness benefit
if you are diagnosed with a terminal illness and
satisfy any other applicable eligibility criteria. Your
terminal illness benefit aligns with your death cover
subject to the terminal illness maximum cover limits.
TPD
You will receive an insured benefit in the event that
you suffer TPD and you satisfy the eligibility criteria.
Exclusions and special conditions
The following exclusions and special conditions
apply to your additional Death-only cover or
additional Death and TPD cover.
War-related events
No benefit is payable where your death, terminal
illness or TPD is directly or indirectly caused by war
(whether declared or not) or war-like operation or
civil commotion.
Self-inflicted injury, infection or
attempted suicide
No benefit is payable where death, terminal illness or
TPD is caused by self-inflicted injury, self-inflicted
infection or attempted suicide.
Working overseas
Death and TPD cover will continue to be provided
while you are overseas subject to the following
conditions:
you remaining employed by that employer
the continued payment of premiums, and
the satisfaction of all other applicable eligibility
criteria.
AA
AA
AA
Leave
Death and TPD cover will be provided while you
take leave approved by your employer, subject to the
following conditions:
you remain employed by your employer
the continued payment of premiums, and
the satisfaction of all other applicable eligibility
criteria.
AA
AA
AA
Subject to prior approval by the Trustee, where you
take leave due to injury or illness, Death and TPD
cover may be provided while on leave, subject to
meeting all of the other conditions for continuation
of cover while on leave, on terms agreed between the
Trustee and the Insurer.
You leave your employer and retain
your Fund membership
If you leave your employer and retain your
superannuation benefit in UniSuper, but do not
recommence employment with a new employer,
your Death and TPD cover will continue while
your superannuation benefit in UniSuper is more
than $2,000 or you have received a contribution
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Insurance in your super
ACCUMULATION 1
or rollover in the previous 12 months from which
premiums can be deducted.
What does Death and TPD
cover cost?
cover provided by one unit of insurance, depending
on your age:
Death and TPD benefit per unit of cover†
Age
Age
You can purchase Death and TPD cover in one of two
ways – as unitised cover or as fixed cover.
Amount
of cover
($)
Amount
of cover
($)
15 to 35
232,000
56
28,000
36
222,000
57
26,000
Unitised cover
37
211,000
58
24,000
38
196,000
59
22,500
39
181,000
60
21,000
40
164,000
61
19,000
41
149,000
62
17,000
42
134,000
63
15,000
43
120,000
64
14,000
44
105,000
65
13,000
45
94,000
66
11,500
46
85,000
67
10,000
47
77,000
68
9,000
48
68,000
69
8,000
49
62,000
70
7,000
50
55,000
71
6,000^
51
49,000
72
5,000^
52
45,000
73
4,000^
53
40,000
74
3,200^
54
36,000
75
2,500^
55
32,000
(next birthday)
Unitised cover means the cost of each unit of cover
stays the same as you get older, however, the amount
of insurance you get for that cost reduces. Each unit
of Death and TPD cover costs $1.60 per unit per
week ($1.44 premium plus $0.16 administration
fee*). Each unit of Death-only cover costs $1.00
per unit per week ($0.91 premium plus $0.09
administration fee*).
The table below shows the amount of Death and TPD
(next
birthday)
* The administration fee covers costs associated with administering
the insurance arrangements. It is inclusive of GST and the benefit
of any tax credits that are applicable to the Trustee.
† If Death-only cover is selected, the amount of insured benefit per
unit of Death-only cover is the same as for Death and TPD in the
table, however, there is no cover for TPD where Death-only cover
is selected.
^ Death-only paid; no TPD benefit is payable.
Please note, insurance premiums and the level of insured benefits
are not fixed and can be expected to change from time to time.
Members are given written notice of any changes.
Unitised cover – an example
If you had one unit of Death and TPD cover,
were injured and your age next birthday is
52, assuming your claim for TPD benefit was
approved, you would receive a lump sum of
$45,000 ( based on your age next birthday
and subject to meeting eligibility criteria).
Insurance in your super
7
ACCUMULATION 1
Fixed cover
Fixed cover means that the cost of each unit of cover increases as you get older, however, the amount of insurance
you get for that cost stays the same. You can convert your unitised Death and TPD cover to fixed cover at any
time, provided you are under the age of 61. Once you have converted to fixed cover, you are not able to convert
back to unitised cover.
Fixed cover is offered in multiples of $1,000. All fixed cover will be rounded up to the nearest $1,000.
The table below shows the annual premium cost per $1,000 of insurance cover:
Fixed cover annual premium rates per $1,000 insured benefit
Age
(next birthday)
Death-only ($)
Death and
TPD ($)
Age
(next birthday)
Death-only ($)
Death and
TPD ($)
15-35
0.22
0.35
56
1.89
2.98
36
0.23
0.37
57
2.03
3.21
37
0.26
0.40
58
2.20
3.48
38
0.27
0.43
59
2.34
3.71
39
0.29
0.47
60
2.51
3.98
40
0.32
0.51
61
2.78
4.39
41
0.36
0.56
62
3.10
4.91
42
0.39
0.62
63
3.52
5.56
43
0.44
0.70
64
3.76
5.96
44
0.50
0.80
65
4.05
6.41
45
0.57
0.89
66
4.58
7.24
46
0.62
0.98
67
5.27
8.33
47
0.69
1.09
68
5.86
9.27
48
0.78
1.22
69
6.59
10.42
49
0.85
1.34
70
7.53
11.91
50
0.95
1.52
71
8.78
n/a^
51
1.08
1.70
72
10.55
n/a^
52
1.18
1.86
73
13.18
n/a^
53
1.32
2.09
74
16.47
n/a^
54
1.47
2.32
75
21.08
n/a^
55
1.64
2.61
^ Death-only paid; no TPD benefit is payable.
Premiums shown include an administration fee which covers the costs associated with administering the insurance arrangements. The
administration fee is inclusive of GST and the benefit of any tax credits that are applicable to the Trustee. Please note, insurance premiums are
not fixed and can be expected to change from time to time. Members are given written notice of any changes.
Fixed cover – an example
If you have $100,000 of Death and TPD cover
and your age next birthday is 52, the premium
payable would be $1.86 per $1,000 of cover
(based on your age next birthday). In this
example, the total cost would be $186 each
year (or $3.58 weekly).
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Insurance in your super
ACCUMULATION 1
Automatic reduction of TPD benefit
AA Your cover with the previous fund must not
If you have fixed cover, while your death benefit
does not change, your TPD sum insured will reduce
annually from your 61st birthday based on your age
next birthday as follows:
AA
(next birthday)
Age
Death
Benefit
TPD Benefit
62
100%
90%
63
100%
80%
64
100%
70%
65
100%
60%
66
100%
50%
67
100%
40%
68
100%
30%
69
100%
20%
70
100%
10%
71 to 75
100%
Nil
76
Nil
Nil
Other information about
insurance costs
The costs for both fixed cover and unitised cover are
deducted from your account monthly in arrears.
The number of weeks in the month is based on
the number of Fridays in the month. Insurance
premiums are not fixed and can be expected to
change from time to time. Members are given written
notice of any changes as required by law.
Costs shown for both fixed and unitised cover
include an administration fee, which covers the
costs associated with administering the insurance
arrangements. The administration fee is inclusive
of GST and the benefit of any tax credits that are
applicable to the Trustee.
Transferring Death and TPD cover
If you have had cover with a previous employersponsored superannuation arrangement or cover
with another insurer, you can generally transfer this
to UniSuper provided you meet all of the following
conditions:
AA Rollover your whole superannuation balance
from your previous fund to UniSuper,
AA Cancel the insurance cover from your previous
fund, not exercise a continuation option, or
reinstate the cover (now or in the future)
or transfer the cover to another division of
UniSuper,
AA
AA
have been subject to any loadings, restrictions
or exclusions in regard to medical or other
conditions,
You have provided satisfactory evidence to
us about the type and amount of cover which
applied to you under the cover you had with your
previous fund,
You have completed, to the Insurer’s satisfaction,
the application or other documents which the
Insurer requires, and
At the date of your application:
You must not have applied for, be entitled to,
or have been paid a TPD or terminal illness
benefit from any superannuation fund or
insured benefit arrangement,
You must not have been diagnosed by a
medical practitioner as suffering from an
illness that reduces your life expectancy to
less than 12 months, and
You must be gainfully employed and
physically capable of undertaking gainful
employment for at least 30 hours per week.
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Any cover you transfer will be provided by UniSuper
as fixed cover and will be rounded up to the nearest
$1,000. Any existing unitised cover you have with
UniSuper will also be converted to fixed cover.
To transfer cover, you will need to complete the
Transfer of insurance cover form, available from the
Forms and Documents section of our website.
Subject to meeting all of the conditions set out in
this section, the transferred cover will commence
on the date that UniSuper receives your completed
form if your UniSuper account balance on that date is
sufficient to deduct the premiums from your account.
What cover do you have while
your insurance application is
being assessed?
Interim accident cover
While your application for additional underwriting
cover is being assessed, interim accident cover will
be provided if you die or suffer TPD (if you requested
TPD cover) caused through a visible, violent external
event to the body if cover would have been made
available to you. The interim accident cover provided
will be the lesser of:
the amount of cover you are applying for, or
$2,000,000 less the amount of any insured
cover you already have under the policy.
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Whether you are covered for accidental injury for
Death and TPD or Death-only cover will depend
on the type of cover you have applied for. Interim
accident cover starts when UniSuper receives your
application form and will cease on the earlier of 120
days after it started, or on the date your application is
accepted, declined or withdrawn.
How do you reduce or cancel your
Death & TPD cover?
You can reduce or cancel your Death and TPD cover
at any time by advising us in writing or by completing
the Cancelling or decreasing your insurance cover
form available from the Forms and Documents
section of our website. It is important to note:
The cancellation will take effect from the date we
receive your notification. Cancellations cannot
be backdated.
If you cancel your Death & TPD insurance cover
and then wish to reapply subsequently, you will
need to provide health evidence to the Insurer.
The Insurer may then accept or decline your
application for cover or impose restrictions,
loadings or exclusions.
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How do you make a claim?
You must notify us as soon as reasonably possible of
any claim or potential claim. To make a claim, you or
your beneficiaries can call us on 1800 331 685. Any
information required by the Insurer to assess the
claim will also need to be provided, some of which
will need to be provided at your own cost. If you or
your beneficiaries do not agree with the Insurer’s
decision in relation to the claim, you may ask for it
to be reviewed by the Trustee. You can do this by
contacting our us on
1800 331 685 or writing to:
Complaints Officer
UniSuper
Level 35, 385 Bourke Street
Melbourne VIC 3000
Once the claim is approved by the Insurer, the
insurance proceeds will be paid to UniSuper and
released to you if you have satisfied a condition of
release. However, if you are claiming the benefit (and
not your beneficiaries) and would prefer ongoing,
regular payments, you may be eligible to use your
lump sum benefit from your insurance cover to
purchase a UniSuper Flexi Pension.
Is there a waiting period before
insured benefits are paid?
Death claims
There is no waiting period to make a death claim. If you
had Death cover at the date of your death, the insured
benefit will be paid to your beneficiaries as a lump sum.
Terminal illness claims
You will be eligible for a terminal illness benefit if
the Insurer is satisfied that you meet the definition
of terminal illness. There is no waiting period for a
terminal illness claim. Payment of a terminal illness
benefit is considered an advance payment of any
Death cover you may have. If your insurance death
benefit exceeds $3 million, the amount exceeding $3
million will be payable upon death, as a death benefit,
in instances where a terminally ill member continues
to be insured after the payment of a terminal illness
benefit and subject to the premium for the death
cover continues to be paid.
TPD claims
You will be eligible for a TPD benefit if the Insurer is
satisfied that you meet one of the criteria under the
definition of TPD. In some cases, a waiting period
of six months will apply. However, the Insurer will
waive the waiting period where a member suffers a
specific illness such as cancer, chronic renal failure,
coronary artery bypass surgery, heart attack, major
organ transplant surgery, stroke, transient ischaemic
attacks, chronic liver or lung disease, major head
trauma, severe burns or total deafness or blindness
as defined within the policy. Given that the insurer
must assess whether the condition is going to be
total and permanent, the Insurer can generally take
between three and six months to assess a lodged
claim, depending on the nature and complexity of the
claim.
Does cover continue if you make a
claim?
No. Your Death and TPD cover ceases when the
Insurer approves your claim. If you subsequently
return to work and wish to apply Death and TPD
or Death-only insurance cover again, you will need
to complete an application form and provide health
evidence to the Insurer. If you have received a TPD
benefit previously, you will only be eligible for Deathonly cover. If you lodge a claim for terminal illness
benefit, you cease to be eligible for TPD cover (if
applicable). If you have received a terminal illness
benefit and you die, your beneficiaries may be able
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to claim a residual death benefit amount. If you have
ever received a terminal illness benefit, you will be
ineligible to apply for Death and TPD insurance
cover.
When does your Death and TPD
cover cease?
Your Death and TPD cover will cease on the earlier
of the following events:
you cease to satisfy the eligibility criteria for
cover under the policy,
you cease to be a UniSuper member,
you advise UniSuper in writing that you want
to cancel your cover (cover will stop on the day
UniSuper receives your request or the date
nominated by you, whichever is later),
your account has insufficient funds to pay the
insurance premiums.
you join the armed forces of any country (the
Australian Defence Force Reserve is excluded
for this purpose),
the Insurer admits your claim for a benefit,
(unless it is a claim for a terminal illness benefit
and you continue to be covered for a residual
death benefit),
you cease to satisfy the relevant conditions
for continuation of cover whilst on employer
approved leave,
you reside overseas outside the Insurer’s agreed
conditions,
you cease to be an Australian citizen, a New
Zealand citizen residing in Australia, a holder of
an Australian permanent visa or a person who
resides in Australia on an approved working visa
you reach age 70 for TPD cover,
you reach age 75 for Death-only cover,
your superannuation benefit in UniSuper is
less than $2,000 and you have not received any
contributions or rollovers for 12 consecutive
months,
you die,
you are the subject of a fraudulent claim,
the Trustee gives the Insurer notice to the effect
that it would like cover in respect of you to cease,
or
the Trustee terminates the policy with the
Insurer.
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Reinstatement of Death and TPD
cover
If your cover ceases because your Accumulation
account has insufficient funds, or because your
superannuation benefit in UniSuper is under $2,000
and no contributions or rollovers have been received
for 12 consecutive months, your cover will be
reinstated to the same level and type of cover it was
previously.
If an employer contribution is received after 180
days of your cover ceasing and you are in active
employment on the date that cover recommences,
you will be provided with one unit of Death cover
and, for 12 months only, one unit of Limited TPD
cover. Your cover will revert to standard Death and
TPD cover on the date you are in active employment
after the end of the 12-month period. Please note
that this will be unitised cover, even if you previously
selected fixed cover.
If you are applying, entitled to or have been paid a
TPD benefit under any superannuation or insured
benefit arrangement, you will only be eligible
for Death-only cover. You will not be eligible for
reinstatement of Death-only or Death and TPD
cover at all if you are applying for, are entitled to, or
have been paid a terminal illness benefit from any
superannuation fund or insured benefit arrangement.
In all other circumstances where cover ceases,
reinstatement is subject to the receipt of any
information required by the Insurer.
Reinstated cover is subject to the imposition of
any terms, conditions or restrictions the Insurer
considers appropriate at the time of reinstatement.
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Income Protection cover
–– You must not have been diagnosed by a
What is Income Protection cover?
Income Protection insurance cover gives you a
monthly benefit(for up to two years) in the event that
you are assessed as temporarily unable to do your job
because you suffer from a total disability or partial
disability.
Refer to the start of this document for more
information on how to obtain, and eligibility for,
Income Protection cover.
Transferring Income Protection
cover
If you have had cover with a previous employersponsored superannuation arrangement or cover
with another insurer, you can generally transfer this
to UniSuper provided you meet all of the following
conditions:
Rollover your whole superannuation balance
from your previous fund to UniSuper,
Cancel the insurance cover from your previous
fund, not exercise a continuation option, or
reinstate the cover (now or in the future)
or transfer the cover to another division of
UniSuper.
Your cover with the previous fund must not
have been subject to any loadings, restrictions
or exclusions in regard to medical or other
conditions,
The total income protection cover that you have
under all policies including the Insurer’s policy
is less than or equal to 85% of your pre-disability
monthly income,
You have provided evidence satisfactory to us of
the type and amount of cover which applied to
you under the cover you had with your previous
fund,
You have completed, to the Insurer’s satisfaction,
the application or other documents which the
Insurer requires, and
At the date of your application:
You must not have received, been admitted
for, or have satisfied the requirements for a
TPD or terminal illness benefit,
You must not be claiming, or currently
entitled to claim, an income protection
benefit from any superannuation fund or
insured benefit arrangement,
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medical practitioner as suffering from an
illness that reduces your life expectancy to
less than 12 months, and
You must be gainfully employed and
physically capable of undertaking gainful
employment for at least 30 hours per week.
Where income protection cover is transferred, the
amount transferred will be the minimum number of
units to provide you with the lesser of:
The total cover you had under your previous
policy and under this policy,
$30,000 per month, and
85% of your pre-disability monthly income.
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The cover provided will be subject to the standard
90-day waiting period.
To transfer cover, you will need to complete the
Transfer of insurance cover application form,
available from the Forms and Documents section of
our website.
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Subject to meeting all of the conditions set out in this
section, transferred cover will commence on the later
of the date that the Insurer accepts your application
to transfer cover and the date of cancellation of your
cover under your previous policy.
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Exclusions and special conditions
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The following exclusions and special conditions
apply to Income Protection cover with UniSuper.
No Income Protection benefit will be payable if the
injury or illness is caused directly or indirectly by one
of the following:
self-inflicted harm or attempted suicide,
regardless of whether you were sane or insane at
the time,
normal and uncomplicated pregnancy or
childbirth. For the purposes of this exclusion,
multiple pregnancy, threatened or actual
miscarriage, participation in an IVF or similar
program, discomfort commonly associated with
pregnancy, such as morning sickness, backache,
varicose veins, ankle swelling or bladder
problems are not considered to be abnormal or
complications of pregnancy,
engaging in an excluded occupation that the
Insurer does not cover (where the Insurer has
not given prior approval),
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AA participation in a criminal act,
AA service in the armed forces (excluding the
Australian Defence Force Reserve),
AA active participation in militant activities,
AA war (whether declared or not), revolution,
invasion, rebellion or civil unrest, or
AA pandemic illness, subject to the Insurer
Income Protection cover – an example
If you have 19 units ($1,900 per week) of
Income Protection cover and your age next
birthday is 51, the annual premium payable
would be $18.30 per unit (that is, 1 unit is
$100 per week of cover). In this example, the
total cost would be $347.70 each year (or
$6.69 per week).
providing UniSuper with at least 14 days’ prior
notice.
Income Protection benefits will only be paid for a
maximum of six months while you are overseas,
unless otherwise agreed between the Trustee and
the Insurer. You must return to Australia at your own
expense for Income Protection benefits to continue.
You must advise UniSuper in writing about any
periods of employer-approved leave to ensure that
your Income Protection cover continues during these
periods.
If your Income Protection cover stops you will
generally need to re-apply (and provide health
evidence to the Insurer) on your return to work.
What is the cost of
Income Protection cover?
Income Protection insurance cover is unit based and
is provided in multiples of $100 per week of cover.
The premiums are based on your age and the level of
cover you apply for.
Age
Premiums are deducted from your account monthly
in arrears. The number of weeks in the month is
based on the number of Fridays in the month. You
cannot claim a tax deduction for the insurance
premiums that are paid from your superannuation
account. The premiums are paid to the Insurer by the
Trustee on your behalf and are not payments made
directly by you to the Insurer.
Insurance premiums and the amount of insurance
you get are not fixed and can be expected to change
from time to time. Members are given written notice
of any changes as required by law.
How do you cancel your Income
Protection cover?
You can cancel your Income Protection cover at any
time by advising UniSuper in writing. Your cover will
stop on the day UniSuper receives your request or the
date nominated by you, whichever is later).
(next birthday)
Annual premium1
($) per unit of cover
15-39
4.59
40-44
7.57
45-48
12.16
49-51
18.30
52-54
24.25
55-57
36.42
Interim accident cover
58-60
48.52
61-63
72.78
64
48.52
65
15.08
While your application is being assessed you will be
covered if you suffer total disability as a result of an
injury occurring during this interim accident cover
period. If this happens, you will receive a monthly
benefit (for up to two years) equal to the lesser of:
the level of cover you have applied for,
$15,000 per month less any amount payable for
the same event under another condition of the
policy, and
85% of your pre-disability monthly income.
Premiums shown include stamp duty and an administration fee,
which covers the costs associated with administering the insurance
arrangements. The administration fee is inclusive of GST and the
benefit of any tax credits that are applicable to the Trustee.
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Premiums are waived if you are receiving a total
disability benefit. Premiums remain payable if you
are receiving a partial disability benefit.
What cover do you have while your
application is being assessed?
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ACCUMULATION 1
Your interim accident cover starts when UniSuper
receives your application form. It ceases on the
earlier of 120 days after it started, and the date your
application is accepted, declined, cancelled or you
withdraw it.
There is no interim accident cover if you suffer
partial disability during this period.
Waiting period
There is a waiting period of 90 consecutive days.
The waiting period commences on the date a medical
practitioner examines you and certifies that you are
totally disabled or partially disabled.
At the end of the waiting period subject to meeting
the eligibility criteria, a monthly benefit will be paid
in arrears for each month for which you are entitled
to it.
Where you suffer one of the specific illnesses listed
below during the waiting period, you will also be
entitled to one times your monthly insured benefit
(known as a ‘specific illness benefit’). These specific
illnesses are:
cancer
chronic renal failure
coronary artery bypass surgery
heart attack
major organ transplant surgery
stroke
transient ischaemic attacks
chronic liver disease
chronic lung disease
major head trauma
severe burns
total deafness or
total blindness
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Each specific illness is defined in the policy.
Please note that an employer superannuation
contribution benefit is not payable in respect of a
specific illness benefit.
What if you return to work during
the waiting period?
If you return to work during the waiting period
and it proves unsuccessful because of the illness or
injury causing total disability, the waiting period will
continue as though there was no return to work as
long as you do not return to work for more than nine
days in total. If the return to work is for more than
nine days, then the waiting period will recommence.
If you return to partial work, or are capable of
doing so, after 14 consecutive days of suffering total
disability, a partial disability benefit may be payable
once the waiting period has ended, provided you
meet the criteria listed in the definition for partial
disability.
How will your insured benefit be
paid?
If your claim is accepted, your insured benefit will be
paid monthly in arrears. Income Protection benefits
may be paid for a period of up to two years.
Income Protection benefits are indexed every 12
months by the lesser of the annual Consumer Price
Index and 7.5%, in cases where total disability or
partial disability benefits have been paid for more
than 12 continuous months.
If you make a claim and it is accepted, you will
receive a monthly benefit that is the lesser of:
the amount represented by the number of units
the Insurer last accepted for you,
85% of your pre-disability monthly income (with
any amount above 75% of your pre-disability
monthly income to be paid as a superannuation
contribution),
the maximum that can be purchased under the
policy (i.e. $30,000 per month)
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If you are receiving a total disability or partial
disability benefit and you die, the Insurer will pay a
lump sum benefit of $10,000 when the Insurer has
been provided with evidence to its satisfaction that
you have died.
The Insurer may also pay a rehabilitation benefit
in addition to benefits otherwise provided. Prior
approval is required from the Insurer in these
circumstances. The maximum rehabilitation benefit
that will be paid in respect of a disability claim will
be the lesser of four times your monthly benefit and
$100,000, less the amount of any such expense
to which you are entitled to reimbursement from
another source. This amount will be paid in addition
to the disability benefit.
A pro-rata insured benefit will be paid if a benefit
is payable for less than a whole month. The insured
benefit is paid monthly in arrears by electronic funds
transfer to your nominated financial institution
account. The employer superannuation contribution
of up to 10% will be paid into your UniSuper account.
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If you are partially disabled, you will receive a portion
of the monthly benefit that takes into account any
income you are earning.
PAYG tax will be deducted from each monthly
benefit payment.
Reduced Income Protection benefit
Your monthly income may be reduced by any other
income you are earning (whether it is received or
not) while receiving a benefit and any other disability
income payments that you or your employer receive
on your behalf. These include payments such as
workers compensation payments, social security,
accident, disability, and income replacement benefits.
However, it does not include income earned from
investments, any lump sum TPD or superannuation
benefit or lump sum trauma or terminal illness style
of benefit or annual leave, sick leave or long service
leave entitlements.
A monthly benefit will not be paid if this other
income exceeds 75% of your pre-disability monthly
income.
Will I receive an insured benefit
if my disability recurs?
If you have been receiving a total disability or partial
disability insured benefit and you return to your full
pre-disability duties, but within six months of the claim
ending as a result of commencing active full time work
the same disability recurs, it will be considered to be a
continuation of your earlier claim (provided you still
have Income Protection insurance cover in place).
The waiting period will not apply and the insured
benefit period will be reduced by the number of days
you were paid under the earlier claim.
When will my Income
Protection benefit be paid?
Your first disability payment is effective from the
day after the waiting period ends. As insured benefit
payments are made in arrears, you will not receive
your first payment for a month after the effective date.
When does my Income
Protection cover cease?
Income Protection insurance cover ceases when:
you cease to be a UniSuper member,
you permanently retire from the workforce,
you advise us in writing that you wish to cancel
your cover (your cover will cease on the day
UniSuper receives your request or the date
nominated by you, whichever is later),
you cease to be an Australian citizen, a New
Zealand citizen residing in Australia, a holder of
an Australian permanent visa or a person who
resides in Australia on an approved working visa,
your account has insufficient funds to pay your
premiums,
you turn 65 (the cover cessation age),
you join the armed forces of any country (the
Australian Defence Force Reserve is excluded
for this purpose),
you cease to satisfy the relevant conditions
for continuation of cover whilst on employer
approved leave,
you reside overseas outside the Insurer’s agreed
conditions,
your superannuation benefit in UniSuper is
less than $2,000 and you have not received any
contributions or rollovers for 12 consecutive
months,
you are the subject of a fraudulent claim,
the Trustee gives the Insurer notice to the effect
that it would like cover in respect of you to cease,
the Trustee terminates the policy with the
Insurer,
you have been in receipt of Income Protection
benefits for a period of 24 months, or
you die.
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Even if your cover has ceased, in some circumstances
you may still be entitled to a benefit if the waiting
period for payment of a benefit commenced before
your cover ceased and you were a member of
UniSuper.
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ACCUMULATION 1
Reinstatement of Income
Protection cover
If your cover ceases because your account has
insufficient funds to pay premiums, or because
your superannuation benefit in UniSuper is under
$2,000 and no contributions or rollovers have been
received for 12 consecutive months, your cover will
be reinstated without underwriting to the same level
and type of cover it was previously if:
you were a member of the Fund immediately
prior to your cover ceasing,
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AA an employer contribution is received within 180
days of your cover ceasing, and
AA you are in active employment with a UniSuper
employer on the date that cover recommences.
Cover recommences with effect from the date the
employer contribution is received by UniSuper.
In all other circumstances, reinstatement cover is
subject to the imposition of any terms, conditions or
restrictions the Insurer considers appropriate at the
time of reinstatement.
Other things you should know
Important definitions
your duty of disclosure
Active employment
You have a duty under the Insurance Contracts
Act 1984 to disclose to the Insurer every matter
that you know, or could reasonably be expected to
know, is relevant to the Insurer’s decision whether
to accept the risk of insurance and, if so, on what
terms. You have the same duty to disclose those
matters to the Insurer before you renew, extend,
vary or reinstate your insurance cover. However,
your duty does not require disclosure of a matter
that:
diminishes the risk to be undertaken by the
Insurer
is common knowledge
the Insurer knows or, in the ordinary course
of its business, ought to know, or
the Insurer has waived.
For the purposes of Death and TPD cover, ‘active
employment’ means:
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Non-disclosure
If you fail in your duty of disclosure and the
Insurer would not have provided insurance cover
if the failure had not occurred, the Insurer may
avoid paying the insured benefit under the policy.
The Insurer may also avoid paying an insured
benefit at any time if your non-disclosure is
fraudulent. When the Insurer is entitled to avoid
paying an insured benefit, the Insurer may elect
to reduce the sum insured in accordance with a
formula that takes into account the insurance
premium that would have been payable if you had
disclosed all relevant matters to the Insurer.
Incorrect information or
misrepresentation
If you provide incorrect information or fail to
comply with your duty of disclosure (for example,
you fail to disclose a medical condition that you
were aware of before obtaining Death and TPD
cover with the Insurer), the Insurer may be legally
entitled to avoid or vary any benefit payable to or
in respect of you.
for any person who is:
employed with an employer; the person is:
actively performing or capable of actively
performing all of the duties and work
hours of his or her usual occupation with
his or her employer; or
on employer approved leave for reasons
other than illness or injury, and capable of
performing their usual occupation
free from any limitation due to illness or
injury; or
unemployed or self-employed; the person
is actively performing or capable of actively
performing all of the duties and work hours
of his or her usual occupation free from any
limitation due to illness or injury; or
engaged exclusively in unpaid domestic duties;
the person is actively performing or capable
of performing all of their full time unpaid
domestic duties free from any limitation due
to illness or injury; and
the person is not entitled to or receiving
income support benefits relating to illness
or injury from any source including but not
limited to Workers’ Compensation benefits,
statutory transport accident benefits and
disability income benefits.
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Australian resident
means an Australian citizen, a New Zealand
citizen residing in Australia, a person who is the
holder of an Australian permanent visa within the
meaning of section 30 of the Migration Act 1958
(Cth), or a person who resides in Australia on an
approved working visa, acceptable to the Trustee
and the Insurer.
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Cognitive loss
means, in the opinion of the Insurer, you have
suffered a total and permanent deterioration or
loss of intellectual capacity which requires you to
be under the continuous care and supervision by
another adult person for at least six consecutive
months and, at the end of that six-month period,
you are likely to require permanent ongoing
continuous care and supervision by another adult
person.
Condition of release
AA permanent retirement from the workforce on
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or after reaching your preservation age if less
than 60,
termination of employment on or after you
reach age 60 but before age 65,
attaining age 65,
permanent incapacity,
death,
terminal medical condition,
temporary incapacity, or
terminating employment with an employer
who contributed to UniSuper on your behalf
and your benefit is less than $200.
Date of disability
For the purposes of Income Protection cover,
date of disability means the date that a medical
practitioner examines the insured member and
certifies that he or she is totally disabled.
Employer contribution
means a superannuation contribution by an
employer in respect of a member.
Employer-sponsored superannuation
arrangement
means an arrangement in which your
employer makes contributions to a regulated
superannuation fund for the benefits of its
employees.
Excluded occupation
Some of the following occupations are excluded
from Income Protection cover:
air traffic controller,
earth drilling, mineral exploration, miner or
person working with explosives,
professional entertainer such as actor, dancer,
musician and stage performer,
fireman, police, ambulance officer and
paramedic, fisherman,
forestry worker,
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AA sex worker,
AA workers in the horse racing industry such as
trainer, jockey and strapper,
AA workers whose work requires them to work at
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heights such as rigger, scaffolder, roof worker
and antenna erector,
offshore oil rig worker,
commercial pilot,
professional and semi-professional sport
person,
security guard, doorman, bouncer and person
employed in crowd control,
sheltered workshop employee,
seasonal worker or employees in industries
with casual workforce, and
underground or underwater worker.
The full listing of the excluded occupations can be
found in the policy by calling us.
First eligible
means the date you first commenced employment
with a UniSuper participating employer.
Fixed cover
means that the cost of each unit of cover increases
as you get older, however the amount of insurance
you get for that cost stays the same.
Illness
means a sickness, disease or disorder.
Injury
means bodily injury caused by violent, external
and visible means.
Limited Income Protection cover
means cover for an illness first became apparent
or an injury that first occurred on or after the date
your cover last commenced, recommenced or
increased, as applicable.
Limited TPD
means cover for an illness first became apparent
or an injury that first occurred on or after the date
your cover last commenced, recommenced or
increased.
Loading
means a multiplier may be applied to your
premium by the Insurer depending on your
health evidence or other information provided.
If a loading is applied then your premium will be
increased. You will be notified if this applies to
you.
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Medical practitioner
Partial disability
means a person who is registered and practising as
a medical practitioner in Australia or as otherwise
approved by the Insurer. That person may not be
you, your partner, parent, child or sibling, or your
business partner, associate or employee.
means that the following applies to the member:
directly before suffering partial disability you
suffered total disability continuously for a
period of 14 consecutive days,
you have been unable to return to performing
all of the duties of your usual occupation
because of that injury or illness,
you are under the regular care of a medical
practitioner, and are following that medical
practitioner’s advice, and
you earn a monthly income that is less than
your pre-disability income.
On-time employer contribution
AA
AA
means an employer contribution received before
the last date by which employers are required to
make superannuation contributions for the period
to which that employer contribution relates to
avoid becoming liable for the superannuation
guarantee change under the Superannuation
Guarantee (Administration) Act 1992 (Cth).
AA
Pre-disability income
depends on when you were born. See the table
below:
means
Where you do not directly or indirectly
own part of the business or practice making
the employer contributions with respect to
you - 1/12th of your current annual pre-tax
salary excluding director’s fees, commissions,
overtime payments, bonuses, penalty or
shift allowances, investment income, income
received from deferred compensation plans,
disability income policies or retirement
plans or income not derived from vocational
activities, unless expressly agreed by the
Insurer.
Where you directly or indirectly own part
or all of the business or practice making
employer contributions with respect to you
(e.g. self-employed persons) - 1/12th of the
annual share of the income of that business or
practice generated by your personal exertion
(in the previous 12-month period) less your
share of expenses in generating that income .
Where you are not a permanent employee
working for 15 hours or more per week in the
six months prior to the date of disability - your
average monthly income over the 12-month
period immediately prior to your date of
disability,
AA
AA
AA
unless the Insurer has expressed agreed
otherwise.
AA
Preservation age
Your date of birth
Preservation
age
Before 1 July 1960
55
1 July 1960 – 30 June 1961
56
1 July 1961 – 30 June 1962
57
1 July 1962 – 30 June 1963
58
1 July 1963 – 30 June 1964
59
1 July 1964 or after
60
Terminal illness
means:
two medical practitioners have certified in
writing, that you suffer from an illness, or have
incurred an injury, that is likely to result in
your death within a period (‘the certification
period’) that ends not more than 12 months
after the date of the certification,
at least one of the registered medical
practitioners is a specialist medical
practitioner practicing in an area related to
the illness or injury,
the illness or injury and certification referred
to above occur while you have cover under the
policy;
for each of the certificates, the certification
period has not ended, and
AA
AA
AA
AA
the Insurer is satisfied, on medical or other
evidence, that despite reasonable medical
treatment, the illness or injury will lead to
your death within 12 months of the date of the
certification.
18
Insurance in your super
ACCUMULATION 1
–– after consideration of all relevant
Total disability
means solely as a result of an injury or illness, you
are:
unable to perform at least one pre disability
income-producing duty of your occupation
(which produced at least 20% of your predisability income), and
not working in any occupation whether for
reward or not for reward, and
under the regular care of a medical
practitioner and undergoing appropriate
treatment and care.
evidence, you are disabled to such an
extent as to render you unlikely to ever
again be engaged in any occupation for
which you are reasonably suited by your
education, training or experience;
AA
or
AA
AA
––
––
––
––
TPD
means:
In the Insurer’s opinion, solely because of
illness or injury, you have suffered ill-health
(whether physical or mental) that makes
it unlikely that you will engage in gainful
employment for which you are reasonably
qualified by education, training or experience;
or
In the Insurer’s opinion, you meet one or more
of the following definitions in Parts A, B, C, D,
E , F or G, as applicable:
A. solely because of illness or injury, you have
suffered the permanent loss of:
the use of two limbs;
the total sight in both eyes; or
the use of one limb and the total sight in
one eye;
where:
limb means the whole hand below the
wrist or whole foot below the ankle; and
permanent loss of total sight in an eye
means the complete loss of functional
sight which is permanent;
or
B. solely because of illness or injury you have:
suffered at least 25% Whole Person
Impairment;
are not engaged in any occupation; and
are disabled to such an extent as to
render you unlikely to ever be engaged
in any occupation for which you are
reasonably suited by education, training
or experience;
or
C. solely because of illness or injury you are
unlikely ever to be able to perform at least
two of the ‘activities of daily living’;
or
D. where at the date of disablement, you were
gainfully employed or on employer approved
leave without pay, and due to illness or injury
you:
are absent from employment for 6
consecutive months; and
AA
––
AA
or
––
––
––
––
F. solely because of illness or injury you
have become so disabled that the Insurer is
satisfied that you are:
permanently unable to perform at
least two of the five ‘everyday working
activities’ without the physical assistance
of another person and despite the use of
appropriate assistive aids, as supported
with medical evidence, and this
permanent inability has lasted for at least
6 consecutive months following the date
of disablement; and
unlikely ever to return to any occupation
for which you are reasonably suited by
your education, training or experience.
––
––
––
––
––
––
E. where at the date of disablement, you were
not gainfully employed and were engaged in
domestic duties, and due to illness or injury
you are:
under the care of a medical practitioner;
unable to perform those domestic duties;
unable to leave your home unaided; and
absent from performing domestic duties
or employment for 6 consecutive months;
and
at the end of the period of 6 months, after
consideration of all relevant evidence, you
are disabled to such an extent as to render
you unlikely to perform domestic duties
or engage in any gainful employment
for which you are reasonably suited by
education, training or experience;
––
or
G. you suffer cognitive loss.
Activities of daily living
dressing – the ability to put on and take off
clothing without assistance
bathing – the ability to wash or shower
without assistance
toileting – the ability to use the toilet
including getting on and off without
assistance.
mobility – the ability to get in or out of bed
and a chair without assistance
feeding – the ability to get food from a plate
into the mouth without assistance,
AA
AA
AA
AA
AA
where ‘assistance’ means the assistance of another
person.
Insurance in your super
19
ACCUMULATION 1
Date of disablement
For the purposes of Death and TPD cover, date of
disablement means the earlier of:
the date on which you suffered the loss of sight
in both eyes or the loss of use of two limbs or
loss of sight in one eye and loss of use of one
limb (Part A of the TPD definition);
the date you suffered loss of sight of an eye or
loss of use of a limb, having already suffered
the loss of sight of an eye or loss of use of a
limb (Part A of the TPD definition); or
the date on which you suffer at least 25%
Whole Person Impairment (Part B of the
TPD definition);
the date on which you suffer from an inability
to perform the Activities of daily living that
results in TPD (Part C of the TPD definition);
the date on which the 6 consecutive month
period of absence from work resulting in TPD
began (Part D of the TPD definition);
the date on which the 6 consecutive month
period where you were unable to perform
domestic duties and were not engaged in any
gainful employment began (Part E of the TPD
definition);
the date on which the 6 consecutive month
period where you suffered from an inability to
complete everyday working activities resulting
in TPD began (Part F of the TPD definition);
or
the date on which the 6 consecutive months
that results in you suffering in cognitive loss
began (Part G of the TPD definition).
AA unable to perform Communicating means:
–– you cannot speak in your first language
AA
––
AA
AA
AA
AA
AA
AA
AA
AA
AA
AA
Everyday working activities
means, Mobility, Communicating, Vision, Lifting
and Manual Dexterity, where:
unable to perform Mobility means:
you cannot walk more than 200m on
a level surface without stopping due to
restricted movement or breathlessness; or
you cannot bend, kneel or squat to
pick something up from the floor and
straighten up again after bending,
kneeling or squatting; nor can you get in
and out of a standard sedan car;
AA
––
––
so that you are understood in a quiet
room; nor can you hear (with a hearing
aid or other aid) an instruction given in
a normal voice in your first language in a
quiet room; or
you cannot understand a simple message
in your first language, and relay that
message to another person;
unable to perform Vision means you cannot,
with glasses or contact lenses, read ordinary
newsprint nor pass the standard eyesight test
for a car driver’s licence;
unable to perform Lifting means you cannot
lift, carry or move objects weighing 5kg using
either or both hands;
unable to perform Manual Dexterity means
you cannot use either or both hands or
your fingers to manipulate small objects
with precision (such as picking up a coin or
fastening shoelaces or buttons, using cutlery,
or using a pen or keyboard to write a short
note).
UniSuper employer
means an employer that has signed a formal
agreement with the Trustee. To find out if your
employer is a UniSuper employer, please call us on
1800 331 685.
Unitised cover
means the cost of each unit of cover stays the same
as you get older, however the amount of insurance
you get for that cost reduces.
This page has been intentionally left blank.
Death and Total & Permanent Disablement
insurance application form — Accumulation 1
and Spouse Account members
Eligibility to apply for insurance cover
Before you complete this form please read the Insurance in your
Super booklet for detailed information on eligibility criteria and
special conditions for Death and Total & Permanent Disablement
(TPD) insurance cover.
Insurer
Death and TPD insurance cover is provided by TAL Life Limited,
(ABN 70 050 109 450). Application may be subject to medical
underwriting and must be approved by the Insurer.
Your duty of disclosure
Information about your duty of disclosure is provided in
the Insurance in your super booklet.
I have read and understood the duty of disclosure
Further information
If you need further information or help to complete this form:
email [email protected], or
call us on 1800 331 685.
Privacy statement
UniSuper recognises the importance of protecting your personal
information and we’re committed to complying with our privacy
law obligations.
We collect your personal information to administer your account,
improve our products and services and to provide you with, and
promote, UniSuper membership benefits, services and products.
You consent to our collecting sensitive information about you,
where collecting that information is reasonably necessary for us
to perform one or more of our functions or activities. We usually
collect personal and sensitive information directly from you,
however, it may also be collected from third parties, such as your
employer.
We may also collect this information from you because we are
required or authorised by or under an Australian law or a court/
tribunal order to collect that information.
If you do not provide this information, we may not be able to
administer your account, or provide you with a product or service.
We may disclose your information to any service provider we
engage (for example mail-houses, auditors, insurers, actuaries,
lawyers) to carry out or assist us to provide your membership
benefits, services and products. This includes overseas entities.
Where information is transferred overseas, we will seek to ensure
the recipient of the data has security systems to prevent misuse,
loss or unauthorised disclosure in line with Australian laws and
standards.
SECTION 1 — Member details
Please use BLACK or BLUE BALL POINT PEN and
print in CAPITAL LETTERS. Cross where required
UniSuper member number
■■■■■■■■■■
If you are unsure of your member number, refer to your most
recent UniSuper correspondence or call us on 1800 331 685.
Title
Mr
■Mrs ■Ms ■Dr ■Professor ■
■■■■■■■■■■■■■■■
Surname
■■■■■■■■■■■■■■■■■
Given name
■■■■■■■■■■■■■■■■■
Other
Date of birth (DDMMYYYY)
■■■■■■■■
What phone number do you want us to call you on if there is a
question we need to ask you regarding this form?*
Contact number (during business hours)
( ■■)■■■■■■■■■■
Email address*
■■■■■■■■■■■■■■■■■
@ ■■■■■■■■■■■■■■■■
Residential address, number and street (not PO Box)
■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■
Suburb/Town
■■■■■■■■■■■■■■■■■
Postcode ■■■■
State ■■■
Country (if not Australia)
■■■■■■■■■■■■■■■■■
* Mandatory
Our Privacy Policy contains information about how you may
access any personal information held by us, how to correct your
information and how to make a complaint about a breach of the
Privacy Act. Our Privacy Policy is available from our website at
www.unisuper.com.au or by calling us on 1800 331 685 between
8.30am and 7.00pm Monday to Thursday and 8.30am and
6.30pm Friday (Melbourne time).
Fund:
Trustee:
Administrator:
UNISF00013 0314
UniSuper ABN 91 385 943 850
March 2014
UniSuper Limited ABN 54 006 027 121
Level 35, 385 Bourke Street, Melbourne VIC 3000
UniSuper Management Pty Ltd ABN 91 006 961 799 AFSL 235907
ÊF00013À0314IŠ
SECTION 1 — Continued
SECTION 2 — Continued
Is your postal address different from your residential address?
Type of policy
■
■
No. Go to Section 2.
Yes. Please provide your postal address below.
Benefit amount
Postal address, number and street (or PO Box if applicable)
■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■
Suburb/Town
■■■■■■■■■■■■■■■■■
Postcode ■■■■
State ■■■
From (DDMMYYYY)
■■■■■■■■
State any loadings/exclusions
Country (if not Australia)
■■■■■■■■■■■■■■■■■
Reason for decision
SECTION 2 — General details
■■■ cms
Weight ■■■ kgs
Height
OR
OR
■ ■ ft ■■ ins
■■ st ■■ lbs
Are you an Australian citizen, a New Zealand citizen residing
in Australia, a holder of an Australian permanent visa or a
person who resides in Australia on an approved working visa?
■
■
No
Yes
Other than this application, do you have or are you applying
for any Life, TPD, Disability Income or Group Salary
Continuance insurance with any other company?
■
■
■■■ %
Is cover to be replaced
■
■
No
Yes
Have you claimed on any type of disability, trauma, accident
and sickness or such benefits as Workers Compensation or
Motor Vehicle Third party?
No
■
■
Yes. Provide the following details
Company name
Recovery
No
Yes. If yes please provide details below.
Company name
Type of policy
Type of policy
Benefit amount
If this current application is successful, do you intend
to continue your insurance cover with the company
above?
■
No
■
Yes
Have you ever held or applied for any life, disability, accident
and sickness or trauma insurance, that was declined,
postponed, had the premium increased or modified, or had a
current policy cancelled or renewal refused?
■
■
Benefit amount
From (DDMMYYYY)
■■■■■■■■
Reason for decision/claim and duration of claim
No
Yes. If yes please provide details below.
Company name
Recovery
■■■ %
Please complete a separate sheet if required.
Page 2 of 9
SECTION 3 — Employment and income details
SECTION 5 — Converting unitised insurance cover
to fixed cover or increasing fixed cover
See the Insurance in your super booklet, for more
information and definitions.
Are you employed with an employer and actively performing
or capable of actively performing all of your duties and work
hours of your usual occupation or on employer approved leave
for reasons other than illness or injury today?
■
No. Provide details of why:
■■ unit(s)
Would you like to apply for, convert your unitised insurance cover
to fixed cover, or increase your existing fixed cover?
■
Yes. This is a once-only election only available if you
are under age 61, you will be unable to elect unitised
cover in the future.
■ Fixed Death and TPD cover
■ Fixed Death-only cover
Go to SECTION 6
■ No.
■
If you have UniSuper insurance cover already, How many units
of cover do you currently have?
Yes
What is your current occupation and what duties do you
perform (including % of time spent in each)?
Please note, your request will take effect when your form is
received.
If yes, what is the amount of fixed insurance you are applying
for? (This must be rounded to the nearest $1,000 and includes any
unitised cover you already have that will be converted to fixed cover.)
$ ■■■,■■■
What is your gross annual salary?
(including employer superannuation contributions and packaged
items but excludes bonuses/commission)
(Refer to the Insurance in your super booklet for the fixed
cover premiums.)
Go to SECTION 7
$ ■■■,■■■
SECTION 6 — Insurance cover details
■■■
Please indicate which insurance cover you wish to apply for.
(Refer to Section 4 of this form. Select one box only)
How many hours per week do you work?
SECTION 4 — Eligibility for insurance cover
See the Insurance in your super booklet for more
information about eligibility for insurance cover.
Are you less than 70 years of age?
No. Are you aged 75 or over?
No. You can only apply for Death-only
insurance cover, as you are aged 70
to 74 inclusive.
Yes. you are ineligible to apply for insurance
cover.
Yes. Have you previously made, or do you currently
have, or are you eligible for an insured TPD claim?
■
■
■
■
■
■
No. You may apply for Death and TPD
insurance cover as you are under
age 70 and do not have a previous
or current insured TPD benefit claim.
Yes. You may apply for Death-only
insurance cover as you are under age 70 and
have previously made or currently have an
insured TPD claim.
■
■
Death and TPD cover (at $1.60 per unit per week)
Death-only cover (at $1.00 per unit per week)
How many units of cover do you want in total, including any
units you may have already? (Select one box only)
■ 1 unit
■ 4 units
■ 7 units
■ 10 units
■ 2 units
■ 5 units
■ 8 units
■ Other units
■ 3 units
■ 6 units
■ 9 units
If other units, please specify
The amount of Death insurance cover you can apply for is
unlimited and the maximum possible amount of TPD cover
from all sources is limited to $3 million.
Page 3 of 9
SECTION 8 — Personal statement
SECTION 7 — Habits and activities
Please answer all questions in this section.
Do you drink alcohol?
■
■
No
Yes. State type, number of standard drinks per day and
number of days per week when alcohol is consumed:
■
■
Standard drink = 1 nip spirit, 1 wine glass (100ml), 10oz/285ml beer.
Condition, medications, treatments and time off work:
No
Yes. Complete a drug use or alcohol consumption
questionnaire. Please contact us for this.
No
Yes. Complete a sports and pastimes statement. Please
contact us for this.
Do you intend travelling outside Australia within the next two
years?
■
■
■■■■■■■■
■■■■■■■■
Name/address of doctor, hospital or clinic:
Yes. State daily quantity:
Do you currently, or do you intend to engage in any hazardous
pastime and/or sporting activity such as aviation (other than
as a fare paying passenger travelling over recognised routes),
motor racing, diving, football, parachuting, hang-gliding or any
other sport?
■
■
Yes. Provide details:
To (DDMMYYYY)
No
Have you ever used or injected yourself with any drug not
prescribed by a doctor, or received counselling or treatment
for the use of alcohol or drugs?
■
■
No
From (DDMMYYYY)
Have you smoked tobacco in the past 12 months?
■
■
Within the last three years have you consulted, been
examined, treated by, or received advice from any doctor,
psychologist, psychiatrist, counsellor, chiropractor,
physiotherapist or any other health care professional
(naturopath etc) or been in a hospital or been advised to have
an operation or taken any medication, drugs, stimulants,
sedatives or tranquilisers?
No
Recovery
■■■ %
Have you ever had an ECG, x-ray, transfusion, mammogram,
ultrasound, surgery or any other investigation?
■
■
No
Yes. Provide details:
■■■■■■■■
■■■■■■■■
Name/address of doctor, hospital or clinic:
From (DDMMYYYY)
To (DDMMYYYY)
Yes. Provide details (where, when, duration and
reason):
Condition, medications, treatments and time off work:
Recovery
Page 4 of 9
■■■ %
SECTION 8 — Continued
Have you ever had any blood tests which revealed an
abnormality e.g. raised blood sugar, liver function, renal
function results, or anaemia etc?
■
■
No
Yes. Provide details:
From (DDMMYYYY)
To (DDMMYYYY)
■■■■■■■■
■■■■■■■■
Name/address of doctor, hospital or clinic:
Condition, medications, treatments and time off work:
Recovery
■■■ %
Do you contemplate seeking any medical examination, advice,
treatment or surgery for any other current health condition, in
the future?
■
■
No
Yes. Provide details:
From (DDMMYYYY)
To (DDMMYYYY)
■■■■■■■■
■■■■■■■■
Name/address of doctor, hospital or clinic:
Condition, medications, treatments and time off work:
Recovery
■■■ %
Page 5 of 9
SECTION 9 — Personal statement (General medical
questions)
SECTION 9 — Continued
Please provide details for all ‘Yes’ answers in the General
medical questionnaire in Section 10.
1. Have you ever had, been advised that you
had or received advice or treatment for any
of the following:
No
A. High blood pressure, raised cholesterol,
chest pain, heart attack, rheumatic fever,
stroke or circulatory disorder?
B. Bowel, stomach or intestinal problem,
gall bladder, hepatitis or liver disease?
C. Epilepsy, stroke, paralysis, multiple
sclerosis, fainting attacks?
■ ■
■ ■
■
■
D. Depression, anxiety, panic attacks, stress,
chronic fatigue, fibromyalgia, or any mental
or nervous condition?
E. Diabetes, sugar in urine, pancreatic or
thyroid problem?
F. Cancer, tumour, melanoma, sunspots,
mole or growth of any kind?
G. Disease, injury, or disorder of joints,
neck, back or bones, gout, arthritis or a
repetitive strain injury or tendonitis?
H. Impairment of sight, hearing or speech?
I. Asthma, bronchitis, sleep apnoea, or any
lung compliant?
J. Leukaemia, haemochromatosis, anaemia,
or any blood problems?
K. Kidney, prostate, or bladder problems?
L. Psoriasis, eczema, or any skin problem?
Yes
Females only
No
P. Have you ever had any gynaecological
conditions (e.g. endometriosis, abnormal
Pap smear, etc)?
Q. Have you ever had any complication of
pregnancy or childbirth?
R. Are you currently pregnant?
If yes, what is the expected delivery date?
(DDMMYYYY)
■■■■■■■■
S. Have you ever had a breast lump (even if
you have not seen a doctor about it)?
Yes
■ ■
■ ■
■ ■
■ ■
■ ■
■ ■
■
■
■ ■
■
■
■
■
■
M. Any other disability, congenital
abnormality, deformity, or symptoms of ill
health, illness or injury?
N. Has the virus which causes AIDS (the
Human Immunodeficiency Virus) ever
infected you or are you carrying antibodies
to that virus?
O. Have you ever engaged in any activity/
ies reasonably accepted to having an
increased risk of exposure to the HIV/
AIDS virus?
■
■
■
■
■
2. Family history
Has any of your immediate family (mother, father, brother
or sister), suffered from diabetes, heart disease, cancer,
kidney disease, high blood pressure, mental health condition,
haemophilia, Huntington’s disease or any other hereditary
disease?
■
■
No
Yes. If yes, provide details:
Relationship to
member:
■ ■
■ ■
■ ■
Page 6 of 9
Medical
condition
(e.g. breast
cancer, heart
attack, type 2
diabetes):
Age when
diagnosed
Age at
death (if
applicable)
SECTION 10 — General medical questionnaire
Please provide detail for all ‘Yes’ answers in Section 9 A to S. Please complete a separate sheet if required.
Question number
Question
■■
Question
■■
Specific condition
Date symptoms first started
and description of symptoms
What was the condition and
which part and side of the
body was affected?
What was the medical
diagnosis including results of
x-rays and investigations?
What was the frequency
(daily, weekly etc) of attacks
or symptoms?
What was the severity
(mild/moderate/severe)
and duration of attacks or
symptoms?
How long were you unable to
work or perform your normal
duties/activities?
If a hospital visit was
required, please provide date
and duration of your stay.
Date treatment/medication
ceased.
When did you last suffer from
any symptoms?
What advice/treatment did
you receive?
Are you still receiving
treatment? If so, please
advise nature and frequency
of treatment.
Degree of recovery (%)
Please supply the name
and address of all doctors,
hospitals or other
practitioners consulted.
Page 7 of 9
Question
■■
Question
■■
SECTION 11 — Doctor’s details
SECTION 11 — Continued
Please provide details of your usual doctor.
Please give details of your last consultation with any doctors
and, if applicable, outcome or degree of recovery.
Name of usual doctor
Name of doctor
Surname
Surname
Postal address, number and street (or PO Box if applicable)
Postal address, number and street (or PO Box if applicable)
Contact number (during business hours)
Contact number (during business hours)
Email address
Consultation details
■■■■■■■■■■■■■■■■■
Given names
■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■
Suburb/Town
■■■■■■■■■■■■■■■■■
Postcode ■■■■
State ■■■
■■■■■■■■■■■■■■■■■
Given names
■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■
Suburb/Town
■■■■■■■■■■■■■■■■■
Postcode ■■■■
State ■■■
( ■■)■■■■■■■■■■
( ■■)■■■■■■■■■■
■■■■■■■■■■■■■■■■■
@ ■■■■■■■■■■■■■■■■
Date of last consultation (DDMMYYYY)
■■■■■■■■
Reason for consultation
How long have you been attending this doctor?
■■ Years ■■ Months
If less than one year (12 months), please advise the name and
address of the doctor who has details of your medical history.
Name of doctor
Outcome or degree of recovery
Surname
■■■■■■■■■■■■■■■■■
Given names
■■■■■■■■■■■■■■■■■
Postal address, number and street (or PO Box if applicable)
■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■
Suburb/Town
■■■■■■■■■■■■■■■■■
Postcode ■■■■
State ■■■
Contact number (during business hours)
( ■■)■■■■■■■■■■
Email address
■■■■■■■■■■■■■■■■■
@ ■■■■■■■■■■■■■■■■
Page 8 of 9
SECTION 12 — Member declaration and signature
SECTION 13 — An authorisation to doctor
Please read this declaration before you sign and date
your form.
To be completed and signed by the applicant.
Please sign this authorisation.
• I declare that the information I have given on this form (and
any accompanying pages) is true and correct.
• I acknowledge that I have received, read and understood the
information in my UniSuper membership PDS and in the
Insurance in your super booklet, and I understand that:
-- I have read and understand the ‘Duty of Disclosure’.
• I understand that all insurance cover is subject to the terms
and conditions of the policy.
• I acknowledge that if I fail to provide all or part of the
information required or consent to the Insurer obtaining
such information, as required, this application will not be
assessed and processed.
• I consent to UniSuper, on behalf of the Insurer, seeking
health evidence from any medical practitioner that I have
consulted either before or after the date of this application,
and hereby authorise the release of any such medical
information. A photocopy of this authorisation shall be as
valid as the original.
• I acknowledge that I have read the duty of disclosure and
understand my obligations under the Insurance Contracts
Act 1984 as explained in the Insurance in your super booklet.
• I acknowledge that I have read and understood the
privacy information contained in the PDS relevant to my
UniSuper membership category and consent to my personal
information being used in accordance with UniSuper’s
Privacy Policy.
• I consent to my health and sensitive information being
collected, used and disclosed in accordance with UniSuper’s
Privacy Policy to enable the Insurer to underwrite my
application for Death and TPD insurance cover.
• I acknowledge that I have read and understood the
‘Commencement of Cover’ information in the Insurance in
your super booklet.
Signature
7
To Doctor
I hereby authorise you to release details of my personal
medical history to TAL Life Limited (ABN 70 050 109 450)
or any organisation duly appointed by TAL Life Limited. A
photocopy (or similar) of this authorisation shall be as valid as
the original.
My name
■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■
Date of birth (DDMMYYYY)
■■■■■■■■
Signature of applicant
Date (DDMMYYYY)
■■■■■■■■
Postal address, number and street (or PO Box if applicable)
■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■
Suburb/Town
■■■■■■■■■■■■■■■■■
Postcode ■■■■
State ■■■
Email address
■■■■■■■■■■■■■■■■■
@ ■■■■■■■■■■■■■■■■
Date (DDMMYYYY)
Returning your form:
■■■■■■■■
UniSuper
Level 35, 385 Bourke Street
Melbourne VIC 3000
together with any additional documentation.
Page 9 of 9
This page has been intentionally left blank.
Income Protection insurance
application form — Accumulation 1
and Spouse Account members
Eligibility to apply for insurance cover
Before you complete this form please read the Insurance in your
Super booklet for detailed information on eligibility criteria and
special conditions for Income Protection insurance cover.
SECTION 1 — Member details
Please use BLACK or BLUE BALL POINT PEN and
print in CAPITAL LETTERS. Cross where required
Insurer
UniSuper member number
Income Protection insurance cover is provided by TAL Life
Limited, (ABN 70 050 109 450).
■■■■■■■■■■
If you are unsure of your member number, refer to your most
Your duty of disclosure
Information about your duty of disclosure is provided in the
Insurance in your super booklet.
I have read and understood the duty of disclosure.
Further information
If you need further information or help to complete this form:
email [email protected], or
call us on 1800 331 685.
Privacy statement
UniSuper recognises the importance of protecting your personal
information and we’re committed to complying with our privacy
law obligations.
We collect your personal information to administer your account,
improve our products and services and to provide you with, and
promote, UniSuper membership benefits, services and products.
You consent to our collecting sensitive information about you,
where collecting that information is reasonably necessary for us
to perform one or more of our functions or activities. We usually
collect personal and sensitive information directly from you,
however, it may also be collected from third parties, such as your
employer.
We may also collect this information from you because we are
required or authorised by or under an Australian law or a court/
tribunal order to collect that information.
If you do not provide this information, we may not be able to
administer your account, or provide you with a product or service.
We may disclose your information to any service provider we
engage (for example mail-houses, auditors, insurers, actuaries,
lawyers) to carry out or assist us to provide your membership
benefits, services and products. This includes overseas entities.
Where information is transferred overseas, we will seek to ensure
the recipient of the data has security systems to prevent misuse,
loss or unauthorised disclosure in line with Australian laws and
standards.
recent UniSuper correspondence or call us on 1800 331 685.
Title
Mr
■Mrs ■Ms ■Dr ■Professor ■
■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■
Given name
■■■■■■■■■■■■■■■■■
Other
Surname
Date of birth (DDMMYYYY)
■■■■■■■■
What phone number do you want us to call you on if there is a
question we need to ask you regarding this form?*
Contact number (during business hours)
( ■■)■■■■■■■■■■
Email address*
■■■■■■■■■■■■■■■■■
@ ■■■■■■■■■■■■■■■■
Residential address, number and street (not PO Box)
■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■
Suburb/Town
■■■■■■■■■■■■■■■■■
Postcode ■■■■
State ■■■
Country (if not Australia)
■■■■■■■■■■■■■■■■■
* Mandatory
Our Privacy Policy contains information about how you may
access any personal information held by us, how to correct your
information and how to make a complaint about a breach of the
Privacy Act. Our Privacy Policy is available from our website at
www.unisuper.com.au or by calling us on 1800 331 685 between
8.30am and 7.00pm Monday to Thursday and 8.30am and
6.30pm Friday (Melbourne time).
Fund:
Trustee:
Administrator:
UNISF00017 0314
UniSuper ABN 91 385 943 850
March 2014
UniSuper Limited ABN 54 006 027 121
Level 35, 385 Bourke Street, Melbourne VIC 3000
UniSuper Management Pty Ltd ABN 91 006 961 799 AFSL 235907
ÊF00017À0314aŠ
SECTION 1 — Continued
SECTION 3 — Amount of Income Protection cover
Income Protection insurance cover is unit-based and
provided in multiples of $100 worth of cover per week.
The premiums are based on age and level of cover
required. See the Insurance in your super booklet for more
detailed information.
Is your postal address different from your residential address?
■
■
No. Go to Section 2.
Yes. Please provide your postal address below.
Postal address, number and street (or PO Box if applicable)
■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■
Suburb/Town
■■■■■■■■■■■■■■■■■
Postcode ■■■■
State ■■■
Country (if not Australia)
■■■■■■■■■■■■■■■■■
OR
Height ■■■ cms
■■ft ■■ ins
OR
Weight ■■■ kgs
■■ st ■■ lbs
Are you an Australian citizen, a New Zealand citizen residing
in Australia, a holder of an Australian permanent visa or a
person who resides in Australia on an approved working visa?
■
No
■
■■
Please note, eligible members can select cover up to $30,000 per
month of Income Protection insurance cover. Note, however, that
cover cannot exceed 85% of your pre-disability monthly income
(any amount above 75% to be paid directly into the insured
member’s superannuation account).
SECTION 4 — Other insurance details
Other than this application, do you have or are you applying
for any Life, TPD, Disability Income or Group Salary
Continuance insurance with any other company?
No
■
■
Yes. Provide the following details
Yes
Type of policy
See the Insurance in your super booklet, for more
information and definitions.
Benefit amount
Are you employed with an employer and actively performing
or capable of actively performing all of your duties and work
hours of your usual occupation or on employer approved leave
for reasons other than illness or injury today?
■
Number of units
Company name
SECTION 2 — Employment details
■
How many $100 weekly units of cover do you wish to apply for?
(Refer to the Insurance in your super booklet.)
No. P
rovide details of why:
Yes
If this current application is successful, do you intend to
continue your insurance cover with the company above?
■
■
No
Yes
Have you ever held or applied for any life, disability, accident
and sickness or trauma insurance, that was declined,
postponed, had the premium increased or modified, or had a
current policy cancelled or renewal refused?
■
■
No
Yes. If yes please provide details below.
Company name
What is your current occupation and what duties do you
perform (including % of time spent in each)?
Type of policy
Benefit amount
What is your gross annual salary?
(including employer superannuation contributions and packaged
items but excludes bonuses/commission)
$ ■■■,■■■
From (DDMMYYYY)
■■■■■■■■
How many hours per week do you work?
■■■
Page 2 of 8
SECTION 4 — Continued
SECTION 5 — Usual doctor or medical centre details
State any loadings/exclusions
Provide details of your usual doctor or medical centre.
Name of usual doctor
Surname
■■■■■■■■■■■■■■■■■
Given names
■■■■■■■■■■■■■■■■■
Reason for decision
Postal address, number and street (or PO Box if applicable)
Recovery
■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■
Suburb/Town
■■■■■■■■■■■■■■■■■
Postcode ■■■■
State ■■■
■■■ %
Is cover to be replaced
■
No
■
Yes
Have you claimed on any type of disability, trauma, accident
and sickness or such benefits as Workers Compensation or
Motor Vehicle Third party?
■
■
Contact number (during business hours)
( ■■)■■■■■■■■■■
No
Email address
Yes. If yes please provide details below.
Company name
■■■■■■■■■■■■■■■■■
@ ■■■■■■■■■■■■■■■■
Type of policy
How long have you been attending this doctor?
■■ Years ■■ Months
If less than one year (12 months), please advise the name and
address of the doctor who has details of your medical history.
Benefit amount
Name of doctor
Surname
From (DDMMYYYY)
■■■■■■■■■■■■■■■■■
Given names
■■■■■■■■■■■■■■■■■
■■■■■■■■
Reason for claim and duration of claim
Postal address, number and street (or PO Box if applicable)
Recovery
■■■ %
Please complete a separate sheet if required.
Please note if you have answered yes to any question in Section
4 you will need to disclose this information in Section 9.
■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■
Suburb/Town
■■■■■■■■■■■■■■■■■
Postcode ■■■■
State ■■■
Contact number (during business hours)
( ■■)■■■■■■■■■■
Email address
■■■■■■■■■■■■■■■■■
@ ■■■■■■■■■■■■■■■■
Page 3 of 8
SECTION 5 — Continued
SECTION 6 — Habits and activities
Please give details of your last consultation with any doctors
and, if applicable, outcome or degree of recovery.
Please answer all questions in this section.
Do you drink alcohol?
Name of doctor
Surname
■■■■■■■■■■■■■■■■■
Given names
■■■■■■■■■■■■■■■■■
Postal address, number and street (or PO Box if applicable)
■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■
Suburb/Town
■■■■■■■■■■■■■■■■■
Postcode ■■■■
State ■■■
Contact number (during business hours)
( ■■)■■■■■■■■■■
Consultation details
Date of last consultation (DDMMYYYY)
■■■■■■■■
Reason for consultation
■
■
No
Yes. State type, number of standard drinks per day and
number of days per week when alcohol is consumed:
Standard drink = 1 nip spirit, 1 wine glass (100ml), 10oz/285ml beer.
Have you smoked tobacco in the past 12 months?
■
■
No
Yes. State daily quantity:
Have you ever used or injected yourself with any drug not
prescribed by a doctor, or received counselling or treatment
for the use of alcohol or drugs?
■
■
No
Yes. Complete a drug use or alcohol consumption
questionnaire. Please contact us for this.
Do you currently, or do you intend to engage in any hazardous
pastime and/or sporting activity such as aviation (other than
as a fare paying passenger travelling over recognised routes),
motor racing, diving, football, parachuting, hang-gliding or any
other sport?
■ No
Yes. Complete a sports and pastimes statement. Please
■
contact us for this.
Outcome or degree of recovery
Do you intent intend travelling outside Australia within the
next two years?
■
■
If you have more than one usual doctor please
provide details on a separate piece of paper, sign and
attach it to this form.
Page 4 of 8
No
Yes. Provide details (where, when, duration and
reason):
SECTION 7 — Personal statement
SECTION 7 — Continued
Within the last three years have you consulted, been
examined, treated by, or received advice from any doctor,
psychologist, psychiatrist, counsellor, chiropractor,
physiotherapist or any other health care professional
(naturopath etc) or been in a hospital or been advised to have
an operation or taken any medication, drugs, stimulants,
sedatives or tranquilisers?
Have you ever had any blood tests which revealed an
abnormality e.g. raised blood sugar, liver function, renal
function results, or anaemia etc?
■
■
From (DDMMYYYY)
No
Yes. Provide details:
From (DDMMYYYY)
To (DDMMYYYY)
■■■■■■■■
■■■■■■■■
■
■
No
Yes. Provide details:
To (DDMMYYYY)
■■■■■■■■
■■■■■■■■
Name/address of doctor, hospital or clinic:
Name/address of doctor, hospital or clinic:
Condition, medications, treatments and time off work:
Condition, medications, treatments and time off work:
Recovery
Recovery
Do you contemplate seeking any medical examination, advice,
treatment or surgery for any other current health condition, in
the future?
■■■ %
Have you ever had an ECG, x-ray, transfusion, mammogram,
ultrasound, surgery or any other investigation?
■
■
No
Yes. Provide details:
From (DDMMYYYY)
To (DDMMYYYY)
■■■ %
■■■■■■■■
■■■■■■■■
■
■
No
Yes. Provide details:
From (DDMMYYYY)
To (DDMMYYYY)
■■■■■■■■
■■■■■■■■
Name/address of doctor, hospital or clinic:
Name/address of doctor, hospital or clinic:
Condition, medications, treatments and time off work:
Condition, medications, treatments and time off work:
Recovery
Recovery
■■■ %
Page 5 of 8
■■■ %
SECTION 9 — Personal statement (General medical
questions)
SECTION 9 — Continued
Please provide details for all ‘Yes’ answers in the General
medical questionnaire in Section 10.
1. Have you ever had, been advised that you,
or received advice or treatment for any of
the following:
No
A. High blood pressure, raised cholesterol,
chest pain, heart attack, rheumatic fever,
stroke or circulatory disorder?
B. Bowel, stomach or intestinal problem,
gall bladder, hepatitis or liver disease?
C. Epilepsy, stroke, paralysis, multiple
sclerosis, fainting attacks?
■ ■
■ ■
■
■
D. Depression, anxiety, panic attacks, stress,
chronic fatigue, fibromyalgia, or any mental
or nervous condition?
E. Diabetes, sugar in urine, pancreatic or
thyroid problem?
F. Cancer, tumour, melanoma, sunspots,
mole or growth of any kind?
G. Disease, injury, or disorder of joints,
neck, back or bones, gout, arthritis or a
repetitive strain injury or tendonitis?
H. Impairment of sight, hearing or speech?
I. Asthma, bronchitis, sleep apnoea, or any
lung compliant?
J. Leukaemia, haemochromatosis, anaemia,
or any blood problems?
K. Kidney, prostate, or bladder problems?
L. Psoriasis, eczema, or any skin problem?
Yes
Females only
No
P. Have you ever had any gynaecological
conditions (e.g. endometriosis, abnormal
Pap smear, etc)?
Q. Have you ever had any complication of
pregnancy or childbirth?
R. Are you currently pregnant?
If yes, what is the expected delivery date?
(DDMMYYYY)
■■■■■■■■
S. Have you ever had a breast lump (even if
you have not seen a doctor about it)?
Yes
■ ■
■ ■
■ ■
■ ■
■ ■
■ ■
■
■
■ ■
■
■
■
■
■
M. Any other disability, congenital
abnormality, deformity, or symptoms of ill
health, illness or injury?
N. Has the virus which causes AIDS (the
Human Immunodeficiency Virus) ever
infected you or are you carrying antibodies
to that virus?
O. Have you ever engaged in any activity/
ies reasonably accepted to having an
increased risk of exposure to the HIV/
AIDS virus?
■
■
■
■
■
2. Family history
Has any of your immediate family (mother, father, brother
or sister), suffered from diabetes, heart disease, cancer,
kidney disease, high blood pressure, mental health condition,
haemophilia, Huntington’s disease or any other hereditary
disease?
■
■
No
Yes. Provide details:
Relationship to
member:
■ ■
■ ■
■ ■
Page 6 of 8
Medical
condition
(e.g. breast
cancer, heart
attack, type 2
diabetes):
Age when
diagnosed
Age at
death (if
applicable)
SECTION 10 — General medical questionnaire
Please provide details for all ‘Yes’ answers in Section 9 A to S. Please complete a separate sheet if required.
Question number
Question
■■
Question
■■
Specific conditions
Date symptoms first started
and description of symptoms
What was the condition and
which part and side of the
body was affected?
What was the medical
diagnosis including results of
x-rays and investigations?
What was the frequency
(daily, weekly etc) of attacks
or symptoms?
What was the severity
(mild/moderate/severe)
and duration of attacks or
symptoms?
How long were you unable to
work or perform your normal
duties/activities?
If a hospital visit was
required, please provide date
and duration of your stay.
Date treatment/medication
ceased.
When did you last suffer from
any symptoms?
What advice/treatment did
you receive?
Are you still receiving
treatment? If so, please
advise nature and frequency
of treatment.
Degree of recovery (%)
Please supply the name
and address of all doctors,
hospitals or other
practitioners consulted.
Page 7 of 8
Question
■■
Question
■■
SECTION 12 — Member declaration and signature
SECTION 13 — An authorisation to doctor
Please read this declaration before you sign and date
your form.
To be completed and signed by the applicant.
Please sign this authorisation.
• I declare that the information I have given on this form and
any accompanying pages is true and correct.
• I acknowledge that I have received, read and understood the
information in my UniSuper membership PDS and in the
Insurance in your super booklet and I understand that:
-- I have read and understood the ‘Duty of Disclosure’..
• I understand that all insurance cover is subject to the terms
and conditions of the policy.
• I confirm that at the date of this application I am not absent
from work for reasons of illness or injury.
• I acknowledge that if I fail to provide all or part of the
information required or consent to the Insurer obtaining
such information, as required, this application will not be
assessed and processed.
• I consent to UniSuper, on behalf of the Insurer, seeking
health evidence from any medical practitioner that I have
consulted, either before or after the date of this application
and hereby authorise the release of any such medical
information. A photocopy of this authorisation shall be as
valid as the original.
• I acknowledge that I have read the duty of disclosure and
understand my obligations under the Insurance Contracts
Act 1984 as explained in the Insurance in your super booklet.
• I acknowledge that I have read and understood the
privacy information contained in the PDS relevent to my
UniSuper membership category and consent to my personal
information being used in accordance with UniSuper’s
Privacy Policy.
• I consent to my health and sensitive information being
collected, used and disclosed in accordance with UniSuper’s
Privacy Policy to enable the Insurer to underwrite my
application for Income Protection insurance cover.
• I acknowledge that I have read and understood the
‘Commencement of Cover’ information in the Insurance in
your super booklet.
To Doctor
I hereby authorise you to release details of my personal
medical history to TAL Life Limited (ABN 70 050 109 450)
or any organisation duly appointed by TAL Life Limited. A
photocopy (or similar) of this authorisation shall be as valid as
the original.
My name
■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■
Date of birth (DDMMYYYY)
■■■■■■■■
Signature of applicant
Date (DDMMYYYY)
■■■■■■■■
Postal address, number and street (or PO Box if applicable)
■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■
Suburb/Town
■■■■■■■■■■■■■■■■■
Postcode ■■■■
State ■■■
Signature
Returning your form:
UniSuper
Level 35, 385 Bourke Street
Melbourne VIC 3000
together with any additional documentation.
7
Date (DDMMYYYY)
■■■■■■■■
Page 8 of 8
CONTACT US
Helpline
1800 331 685
8.30am to 7.00pm Monday to
Thursday
8.30am to 6.30pm Friday
(Melbourne time).
AA
AA
Fax
+61 3 9910 6141
Website
www.unisuper.com.au
Email
[email protected]
Address
UniSuper
Level 35, 385 Bourke Street
Melbourne Vic 3000
Australia
IMPORTANT INFORMATION
This document has been prepared and issued by UniSuper Limited ABN
54 006 027 121 (referred to throughout this document as either UniSuper or the
Trustee) as Trustee of UniSuper ABN 91 385 943 850 (referred to throughout
this document as the Fund). The information in this document is of a general
nature only and does not take into account your individual objectives, financial
situation or needs. You should consider the appropriateness of the information
having regard to your personal circumstances and consider consulting a licensed
financial adviser before making an investment decision based on information
contained in this document. The value of your investments can go up or down
and investment returns can be positive or negative. The Trustee does not
guarantee the performance of the Fund’s investment options. To the extent that
this document contains any information which is inconsistent with the UniSuper
Trust Deed and Regulations (together, the Trust Deed) the Trust Deed will
prevail.
© UniSuper Limited 2013
UNISIBR0005 1113
`