Section 5 – Insurance Cover

Your insurance needs are dictated by your personal and financial circumstances. Through the course of your life your needs will change, so you should regularly review the amount of cover you have.

The TIC Plan offers you insurance options you can carry with you until retirement, subject to certain conditions relating to eligibility and your work. Members of TIC Employer Sponsored and Personal Super, who are Australian Residents, have access to Death cover, Death and Total and Permanent Disablement (TPD) cover and Salary Continuance cover through the Plan.

The Trustee has arranged insurance cover through a group policy with Hannover Life Re of Australasia Ltd (Hannover) ABN 37 062 395 484. Only the main features of the insurance policies relating to benefits are set out in this PDS. Other conditions may apply. You should be aware that the terms and conditions relating to the insurance cover provided through the Plan are set out in these insurance policies. While every effort has been made to ensure the information contained in this PDS is accurate, the terms and conditions of the insurance policies will prevail to the extent that they are inconsistent with the information in this PDS. For a copy of the full policy terms and conditions, please contact our Client Service Line (details on the inside front cover).

Premiums for Death, TPD and Salary Continuance cover are deducted from your Plan account.

About the Insurer

Hannover Life Re of Australasia Ltd (Hannover) has been writing life reinsurance business in Australia since 1958 and is part of the worldwide group of Hannover Re Group, one of the world’s largest reinsurance groups.

About Employer Group Cover

Employer Group Cover allows your employer to nominate the type and level of cover required for their employees. You may be eligible for reduced rates and/or automatic cover (ie. insurance without medical evidence), if your employer has an Employer Group Insurance arrangement with the Insurer.

Details of any Employer Group Cover arrangements available to your employer group will be provided when you join TIC Employer Sponsored Super.

Minimum cover under Choice of Fund legislation

The insurance cover offered in this PDS meets the minimum death insurance levels required for an employer fund under Choice of Fund legislation.

Death & TPD Cover Conditions

Subject to certain conditions, whether you are at work or elsewhere, your cover applies 24 hours a day (refer to ‘Insurance Conditions’ from page 36).

Payment of an insured benefit is subject to the terms and conditions of the insurance policy taken out by the Trustee to cover the TIC Plan.

If you die or are assessed as totally and permanently disabled by the Insurer, we will pay the insured amount plus the balance of your TIC Plan account to you or (if applicable) to your estate or beneficiaries (refer to Section 3 ‘Benefit Payments’).

If you claim a TPD benefit under the policy and subsequently claim a death benefit, your death cover will be reduced by the amount of claim already paid. Your insured benefit may be reduced if the Insurer does not pay out all or part of the insured benefit when an insurable event occurs.

Cover when you’re unemployed

Insuring through the TIC Plan enables you to maintain your cover during periods of unemployment, whether through retrenchment or by your choice. However if you do become unemployed, you should contact us immediately as this may change the terms and conditions of your cover.

Leaving the Service of Your Employer

Once you are an insured member of the TIC Plan, you are covered until an event occurs that ceases your cover (refer to "When your insurance stops" on page 38). If you are a TIC Employer Sponsored member and you change employer, you should contact us immediately as this may change the terms and conditions of your cover, including your premiums. If you change employer and your account is transferred to TIC Personal Super, your cover will continue at Tailored Cover rates (refer to page 31).

Permanent and contract employment

There is no requirement for you to work a minimum number of hours or be a permanent employee in order to be eligible for TPD cover. The Insurer’s TPD definition is split into two sections and is determined in accordance with your employment status and work hours in the six (6) months prior to the date of disability. This allows all members to be eligible for TPD cover.

Changing your cover

Once you are an insured member of the TIC Plan, you can apply to increase or decrease or opt out of your cover at any time. You can purchase extra units of Basic Cover, or vary your insured amount of Tailored Cover, subject to the maximum limits. Increases in cover are subject to the Insurer’s underwriting requirements and approval.

The value of each unit of Basic Cover decreases as you get older (refer to the table on page 30). You should therefore check whether your cover is adequate for your personal and financial circumstances. You can apply to increase or decrease or opt out of your cover by contacting our Client Service Line (details on the inside front cover).

Premiums
 

Premium payments

While you are a member of the TIC Plan, your premium payments are deducted from your account, provided your account balance is sufficient to cover your premiums. If your TIC Plan account does not have sufficient funds to pay your premiums as they become due, your cover will cease.

Factors affecting your premiums

The cost of insurance is generally based on your age, gender, health, type and level of cover, as well as the following criteria:

• Occupational classification; and
• Any applicable premium loadings applied by the Insurer based on underwriting criteria, if applicable. Your occupational classification is prescribed by the Insurer’s Occupation Guide. This guide may be amended from time to time.

Your classification will be one of:

• Professional,
• White Collar,
• Light Manual,
• Skilled,
• Unskilled.

The risk factors relating to these occupational classifications are reflected in the premiums provided in this PDS.

Occupational adjustment factors

Occupational adjustment factors apply to the cost of all cover you apply for. Your occupational classification is based on information you and/or your employer provide. The multiplication factors that apply to your occupation and a guide to the definitions are provided in the table on the previous page.

Death or Death & TPD Cover – TIC Employer Sponsored Super

As a member of TIC Employer Sponsored Super, you may be eligible for Death or Death & TPD cover through Basic Cover, which allows you to nominate multiple units of Death cover or Death & TPD cover for a set dollar premium.

Employer Group Cover, where your employer has established an Employer Group arrangement with the insurer may also be available to you (refer to Section 6). Details of any group arrangement will be provided when you join TIC Employer Sponsored Super.

About Basic Cover

Subject to certain conditions, Basic Cover allows you to nominate multiple units of Death or Death & TPD cover (refer to the Basic Cover table) for a set dollar premium. These conditions are:

• you must join the Plan within 120 days of becoming First Eligible1 and your application form must be received by the Plan within that time; and
• the Plan has received an On-Time2 employer contribution for you; and
• you are not applying for, entitled to, or have not been paid a Total and Permanent Disablement benefit from any superannuation fund or life insurance policy. If this condition is not satisfied, then you are only eligible for death cover; and
• you are employed by a Participating Employer3; and
• you are at work and performing your normal duties and hours without restriction due to illness or injury on the date that cover commences4.

Where these conditions are not met, cover is subject to underwriting and will commence from the date we advise in writing.

Default Basic Cover for Death & TPD

Subject to the conditions above, you may receive 2 units of Basic Cover for Death & TPD when you commence with your employer without needing to satisfy underwriting requirements.  

Additional Units of Basic Cover

Where you are eligible and have met the conditions for Default Basic Cover, you can apply for one additional unit of Basic Cover (up to a total of 3 units) without satisfying underwriting requirements, provided that your application form is received by the Plan within 120 days of becoming First Eligible1.

You may also apply for extra units of Basic Cover up to the maximum sum insured limits of $10 million for death and $3 million for TPD. Any extra units (i.e. more than three units) of Basic Cover are subject to underwriting and acceptance by the Insurer and will commence from the date we advise in writing.

The Cost of Basic Cover

Your Basic Cover premiums are based on a weekly, per unit cost throughout the life of your cover. Premiums will generally be calculated and deducted from your account each month.

The weekly, per unit cost will be determined by your occupational classification.

  Premiums include stamp duty.

Your occupational classification is prescribed by the Insurer’s Occupation Guide (see page 28).

 

CALCULATING YOUR PREMIUM

If you were a 32-year-old employer sponsored female, with a "skilled" occupational rating and you wanted 2 units of Death & TPD cover (ie. $234,000), your annual premium calculation would be:

Unit cost per week × number of units × 52 weeks

= $2.26 × 2 × 52

= $235.04 per annum

This is an example only. If any aspect of your insurance cover requires underwriting, your final premium is subject to assessment and confirmation by the Insurer.

1. First Eligible means members are first eligible to join the TIC Plan on the later of: a. when they first commence employment with a Participating Employer; or
   b. when their employer becomes a Participating Employer.
2. On-Time means an employer contribution that is received by The TIC Plan within 120 days of the date in respect of which the Employ er Contribution relates.
3. Participating Employer means an employer who makes or agrees to make contribution payments to the TIC Plan and abides by the ISARF Trust Deed.
   The employer must have at least five (5) employees in TIC Employer Sponsored Super.
4. If this condition is not satisfied, you are eligible for New Events Cover (see page 40 for definition).

Death or Death & TPD Cover – TIC Personal Super

As a member of TIC Personal Super, you can apply for Death or Death & TPD cover via Tailored Cover which allows you to choose the type and amount of cover required.

About Tailored Cover

Tailored Cover allows you to nominate Death or Death & TPD cover as a fixed dollar amount (refer to the Tailored Cover table).

You will need to provide health information when you apply for cover (see ‘Personal Statement and Declaration of Health’ on page 93).

All Tailored Cover is subject to underwriting and acceptance by the Insurer and will commence from the date we advise in writing.

TPD Benefit Taper

A TPD taper applies to Tailored Cover. This means that when you reach your 61st birthday, your TPD cover reduces by 10% each year until you reach the Maximum Insurable Age (i.e. age 70).

The Cost of Tailored Cover

Your Tailored Cover premiums will be based on your age, gender and occupation and are subject to a minimum annual combined premium of $200*. Your occupational classification is prescribed by the Insurer’s Occupation Guide (see page 28).

  Premiums include stamp duty.

Premiums will generally be deducted from your account each month.

CALCULATING YOUR PREMIUM

If you were a 32-year-old female, with a "skilled" occupational rating and you wanted $300,000 of death & TPD cover, your annual premium calculation would be:

Premium = $(300,000 ÷ 1,000) x Premium for a female aged 33 at next birthday x skilled occupational adjustment factor

=$300 x 0.42 x 180%

=$226.80

This is an example only. If any aspect of your insurance cover requires underwriting, your final premium is subject to assessment and confirmation by the Insurer.

Salary Continuance Cover - TIC Employer Sponsored and Personal Super

Insuring your income can provide peace of mind to you and your family during periods when you are temporarily unable to work due to injury or illness.

The Plan’s Salary Continuance benefit pays a percentage1 of your annual income for up to either two, or five years. The maximum income payment you can receive is $25,000 per month.

Any claims for a Salary Continuance benefit are subject to a 30, 60 or 90 day waiting period. This means you will not start receiving payments until your time away from work exceeds your approved waiting period. The waiting period starts on the date you first receive medical advice from a Doctor about your condition that certifies that you are Totally Disabled.

Eligibility for Salary Continuance

All members of TIC Employer Sponsored Super and TIC Personal Super are eligible for Salary Continuance cover.

You can apply for Salary Continuance cover by completing a Membership Application form or by obtaining an Insurance Application form from our Client Service Line (details on the inside front cover).

On your application, you must indicate the monthly benefit you would like to insure, your required waiting and benefit payment periods.

You must have a sufficient account balance in the Plan to fund the on-going cost of insurance premiums. Cover will cease immediately if there are insufficient funds in your account to meet premium payments.

All Salary Continuance cover is subject to underwriting and will commence from the date we advise in writing.

Partial Disability Benefit

After the conclusion of the waiting period, the Insurer will pay a partial disability benefit where you:

• resume employment or are capable of returning to partial employment duties after 14 consecutive days of Total Disability; and
• are under the continuous and regular care of a Doctor and undergoing appropriate treatment and care; and
• as a result of the injury or illness that caused your Total Disability, receive or would in the Insurer’s opinion receive a post-disability income that is less than your monthly income.

No Partial Disability benefit is accrued or payable until the waiting period has ended.

The Partial Disability benefit is equal to the monthly benefit less any post-disability Income that accrues during the month, but cannot be more than 75%1 of your monthly income.

Rehabilitation Benefit

Whilst you are suffering disability, Approved Rehabilitation expenses, such as the cost of a rehabilitation course, device or course of treatment, may be paid if the Insurer considers this likely to assist your return to work. The Insurer’s prior approval is required in all cases before the cost is incurred.

The Insurer may pay these benefits for any single claim for no more than six (6) times your agreed monthly benefit or $60,000, whichever is the lesser.

Stamp Duty

Stamp Duty is payable in addition to premiums, based on the state of residence for individual members. Current rates of stamp duty are listed below. If these stamp duty rates change or any other taxes that must be paid under this policy alter, the Insurer reserves the right to alter the rates.

The Cost of Salary Continuance Cover

Your premiums will be based on your age, gender and occupational classification.

Your occupational classification is prescribed by the Insurer’s Occupation Guide (see page 28).

1. maximum 75% of annual income (85% but only where additional 10% is paid as superannuation contributions to the TIC Plan).

CALCULATING YOUR PREMIUM

If you were a 32-year-old male from NSW, with a "skilled" occupational adjustment factor and earning $80,000, the maximum salary continuance cover that you could obtain (including the additional 10% paid as a superannuation contribution to the TIC Plan1) would be $68,000 per annum ($80,000 x 85%1). This would give you a monthly benefit of $5,666 ($666 of which would be paid as a Superannuation Contribution to the TIC Plan1) for the approved Benefit Period after completion of the approved Waiting Period. The annual premium for this level of cover would be calculated as follows:

$(68,000 ÷ 1,000) × (premium for male aged 33 next birthday, 2 year benefit, 60 day waiting period) × ("skilled" occupational adjustment factor*) PLUS Stamp Duty at NSW rate (refer to table above)

= $68 × 3.69 × 180%

= $451.66 + Stamp Duty ($451.66 × 5%)

= $451.66 + $22.58

= $474.24 per annum

This is an example only. If any aspect of your insurance cover requires underwriting, your final premium is subject to assessment and confirmation by the Insurer.

Your Salary Continuance premiums are subject to a minimum annual combined premium of $200*.

*includes premiums for Death, TPD and Salary Continuance cover.

Insurance Conditions

Benefits

Interim Accident Cover

Where an application for cover is being assessed, the Insurer will provide accidental cover for the type of cover being applied for, but only where a claim is as a result of an injury solely by visible, violent and external means.

The amount of accidental cover provided will be:

a. Death cover, the lesser of the requested benefit or $1,000,000, and

b. TPD cover, the lesser of the requested benefit or $500,000, and

c. Salary Continuance cover, the lesser of requested benefit or $10,000 per month. For Salary Continuance, the total benefit period payable under accidental cover would be a maximum of 12 months.

Accidental cover will be provided until acceptance, withdrawal, refusal, policy termination or 90 days immediately following the date from which the cover is sought.

Terminal Illness Benefit

Where you are insured for Death cover and the Insurer is satisfied you have been diagnosed with a Terminal Illness, they will pay a Terminal Illness benefit subject to:

a. you will be eligible for a Terminal Illness benefit where the date of diagnosis of the Terminal Illness is on or after the date that your cover commenced under the Policy. No Terminal Illness benefit will be considered where the date of diagnosis is prior to this date.

b. a Terminal Illness benefit will be the lesser of your approved benefit or $2,000,000. Provided you remain a member of the Plan and the Insurer continues to receive premium for your cover, they will pay the residual death balance calculated as the approved benefit as at your date of death, less any Terminal Illness benefit that has already been paid.

c. If a Terminal Illness benefit is paid, all cover under this policy will cease from that date. However, subject to b) above any residual death balance will be payable on your death.

d. If the policy has terminated, you will no longer be eligible for a Terminal Illness benefit from that date.
Where a Terminal Illness benefit is paid it will be considered as an advance payment of your death benefit.

From the date a Terminal Illness claim has been lodged, you will no longer be eligible for any increase in cover under the policy without the Insurer’s prior approval.

You must supply, at your own expense, supporting medical evidence from your treating specialist. The Insurer will require this information in a form of their choosing and reserve the right to ask for any additional information that they feel is appropriate. Where the Insurer asks for additional information, they will incur the cost of obtaining this information.

Salary Continuance Benefits on Admittance of TPD

If you are in receipt of Salary Continuance benefits and you are subsequently admitted for a TPD benefit, your Salary Continuance benefits will continue until the expiration of the agreed Benefit Period or until one of the termination conditions are met (refer to ‘When your insurance stops’ on page 38).

Funeral Benefit

Where you are insured for Death cover and subsequently die, the Insurer will pay a funeral benefit for the lesser of your agreed benefit or $10,000 within 48 hours of receiving a certified death certificate. The remainder of the agreed death benefit will be paid upon completion of assessment under the standard claims procedures.
A funeral benefit is not available where you are covered under Interim Accident Cover.

Increases in cover

Indexation of Benefits for TIC Personal Super

Subject to the Insurer’s policy Maximum Cover limits, they will allow your benefits under the Plan’s policy to increase at each Annual Review Date (1 December each year) by the lesser of the annual CPI percentage increase or 5%.

Indexation of benefit will happen automatically unless you advise the Plan that you do not wish benefit indexation to apply. Where you decline benefit indexation 3 times, this facility will no longer be available to you.
Indexation of benefits will not apply to TPD cover if your TPD cover is being tapered in the last 10 years prior to the Maximum Insurable Age. Indexation of benefits will also not apply to Basic Cover in TIC Employer Sponsored Super.

Where CPI means the Consumer Price Index (all groups and all capital cities) published by the Australian Bureau of Statistics. If no such Consumer Price Index is published, the CPI will be a figure determined by the Insurer at their discretion.

Lifetime Events

This benefit allows you to increase your cover by:

a. for an TIC Employer Sponsored Super member with unitised Basic Cover, one (1) unit of cover,or

b. for an TIC Personal Super member with Tailored Cover, an amount equal to the lesser of:

• 25% of their approved benefit, or
• $200,000, or
• the increase in mortgage (if existing), or the amount of the mortgage (if new), without providing medical evidence,

if one of the following nominated ‘events’ happens:

a. you purchase a home for your permanent residence and take out a mortgage or renegotiate to increase a mortgage on that home,

b. you get married,

c. you or your ‘partner’ give birth or adopt a child.

A partner is a legal spouse or a person living with you as your spouse on a bonafide domestic basis, they may be the same sex as you.

When one of these events occurs, you can increase your cover subject to the following:

a. you must be less than age 55 when you apply for the cover,

b. you can only increase your cover for one ‘event’ in any 12 month period,

c. you can only ever increase your cover once for each defined ‘event’ outlined above,

d. you must apply to us within 90 days of the nominated ‘event’ happening and the Insurer will require proof that the nominated ‘event’ occurred.

The additional cover will commence from the date that the Insurer advises in writing.

You are not eligible for this benefit if the Insurer has imposed any special conditions on your cover such as a premium loading, restriction or exclusion or if you have been declined cover.

If a claim arises within the first 6 months of cover increasing under this benefit, the Insurer will only pay the increased cover if the claim is as a result of ‘accidental bodily injury’. Where, accidental bodily injury occurs as a result of visible, violent and external means.

Additional Underwriting

If your insurance cover ceases after your acceptance by the Insurer, you will need to satisfy underwriting requirements for any future application for cover.
Once your application for cover is accepted, your cover is renewed automatically each year (subject to payment of premium) until you meet one of the termination provisions*, regardless of your state of health.

Death & TPD

Once your application for cover is accepted by the Insurer, you will only be asked to satisfy underwriting requirements if you choose to increase the level of your death and TPD cover.

Salary Continuance

If your application for Salary Continuance cover requires underwriting, the amount of cover being underwritten will take effect when the Insurer accepts your application.
Once the Insurer accepts your application for Salary Continuance cover, you will only be asked to satisfy additional underwriting requirements if your level of cover increases by more than $1,000 per month since your cover was last accepted (subject to being at work and medically fit to carry out all the duties of your occupation on the date your cover increases).

Pre-existing conditions for salary continuance

The Insurer will generally only provide Salary Continuance cover on claims for pre-existing conditions if they were aware of your condition and agreed to cover you for this in writing at the time they assessed your application for Salary Continuance cover.

Tax on Salary Continuance Benefits

Salary continuance insurance benefits are paid as taxable income and, like salary and wages, attract Pay-As-you- Go tax at your marginal tax rate. The tax is deducted by the Plan and remitted to the Australian Taxation Office before the benefit is paid. Higher tax applies if the Plan does not hold your TFN.

Exclusions

The Insurer reserves the right to impose an extra premium in the event of war.
Listed below are the various exclusions that will apply. In addition, at the time of underwriting we will advise any further exclusion as a result of being underwritten:

Default Basic Cover

No standard exclusions apply to Default Basic Cover under the policy. Where cover is underwritten, please refer to the terms below for Additional Basic Cover and Tailored Cover.

Additional Basic Cover and Tailored Cover

The below exclusions will apply to Additional Basic Cover and Tailored Cover:

• Death - no benefits are payable when a claim arises directly or indirectly as a result of,
  a. 13 months suicide exclusion,
  b. Participation in a criminal act.
• TPD - no benefits are payable when a claim arises directly or indirectly as a result of,
  a. Intentional self-inflicted injury or illness or intended self harm,
  b. War whether declared or not,
  c. Participation in a criminal act.

Salary Continuance Cover

No benefits are payable when a claim arises directly or indirectly as a result of:

a. Self inflicted harm or attempted suicide, regardless of whether the member was sane or insane at the time,

b. Normal and uncomplicated pregnancy or childbirth. For the purposes of this exclusion multiple pregnancy, threatened or actual miscarriage, participation in an IVF or similar programme, discomfort commonly associated with pregnancy such as morning sickness, backache, varicose veins, ankle swelling or bladder problems are not considered abnormal or complications of pregnancy,

c. Participation in a criminal act,

d. Service in the armed forces,

e. War whether declared or not,

f. if your occupation is an Excluded Occupation and the Insurer has not given its prior approval.

Excluded Occupations

Unless the Insurer has expressly agreed in writing to provide cover for them under the policy, any of the following occupations which include the following duties are an Excluded Occupation,

a. Working as a support person, domestic helper or carer (whether in a paid capacity or not) for an organisation which provides such services to persons suffering from Acquired Immune Deficiency Syndrome (AIDS),

b. Air traffic controller,

c. Earth drilling, mineral exploration, miner or person working with explosives,

d. Professional entertainer such as actor, dancer, musician or stage performer,

e. Fireman, police, ambulance officer or paramedic,

f. Fisherman,

g. Forestry worker,

h. Sex worker,

i. Workers in the horse racing industry such as trainer, jockey or strapper,

j. Workers whose work requires them to work at heights such as rigger, scaffolder, roof worker or antenna erector,

k. Offshore oil rig worker,

l. Commercial pilot,

m. Professional and semi professional sport person,

n. Security guard, doormen, bouncer and person employed in crowd control,

o. Sheltered workshop employee,

p. Seasonal worker or employees in industries with casual workforce,

q. Underground or underwater worker.

Maintaining your cover

Choosing another fund

As a member of TIC Employer Sponsored Super, if you instruct your employer to pay your future Superannuation Guarantee contributions to another super fund (Choice of Fund), but retain an account balance in the Plan, that account balance will be transferred to TIC Personal Super and your cover will continue at Tailored Cover rates (refer to page 31) unless you elect not to have insurance cover.
If you need more information on whether this applies to you, please call the Client Service Line (details on the inside front cover).

Maintaining cover in TIC Personal Super

If you are a TIC Personal Super member transferring into TIC Employer Sponsored Super and you prefer to maintain your TIC Personal Super insurance cover, you can contact our Client Service Line to discuss the implications for the terms and conditions of your cover.

When your insurance stops

Your Death or Death & TPD Cover ceases:

• when you reach your Maximum Insurable Age, cease to be a member of the Plan, join the armed forces of any country other than the Australian Defence Force Reserves, cease to be an Australian Resident, or are no longer an eligible person, or
• subject to Terminal Illness conditions, on the date we admit a claim for a benefit for you,
• on the date your account balance is insufficient to pay premiums,
• when you are the subject of a fraudulent claim under the policy,
• on the date you die,
• on the date the TIC Plan wishes cover to cease for you,
• on the date all cover for every member under the policy ceases, whichever occurs first. Your Salary Continuance cover ceases:
• when you reach your Maximum Insurable Age, cease to be a member of the TIC Plan, join the armed forces of any country other than the Australian Defence Force Reserves, cease to be an Australian Resident, or are no longer an eligible person, or
• on the date your account balance is insufficient to pay premiums,
• when you are the subject of a fraudulent claim under the policy,
• when you die,
• when you retire permanently from the workforce,
• on the date the TIC Plan wishes cover to cease for you,
• on the date all cover for every member under the policy ceases, whichever occurs first.

Your Salary Continuance cover ceases:

• when you reach your Maximum Insurable Age, cease to be a member of the TIC Plan, join the armed forces of any country other than the Australian Defence Force Reserves, cease to be an Australian Resident, or are no longer an eligible person, or
• on the date your account balance is insufficient to pay premiums,
• when you are the subject of a fraudulent claim under the policy,
• when you die,
• when you retire permanently from the workforce,
• on the date the TIC Plan wishes cover to cease for you,
• on the date all cover for every member under the policy ceases, whichever occurs first.

Leaving or changing your job can affect your cover

If you leave your employment to accept another job, or take a break from work (even if on approved extended leave), you should notify the Plan in writing as soon as possible as your insurance cover may be affected. You may not be covered if your occupation changes and you have not advised us.

Changing jobs may mean a premium adjustment based on whether there is a change in risk associated with your new job. If your job functions do not change substantially, there is likely to be no change to your premiums.

Employer Secondment Overseas

If you are working overseas for your employer the following conditions apply:

Cover will continue if you are working overseas for your employer provided:

a. you remain a member of the Plan throughout the period of overseas residence, and

b. the period of overseas residence is no longer than three (3) years duration; and

c. Premiums continue to be paid for you throughout the period of overseas residence, and

d. At the time of your departure the country where you will reside is not subject to a Commonwealth Department of Foreign Affairs and Trade travel advisory Level 5 warning – “Advised not to travel’, and

e. the Plan provides the Insurer with any other information about you that the Insurer considers necessary to enable it to decide whether cover will continue.

While overseas, continuation of cover after 3 years is subject to the Insurer’s prior approval in all cases.

Travelling overseas

You can be covered by insurance even when travelling overseas on holidays.
The Insurer reserves the right to require you to return to Australia (at your own expense) in the event that you submit a claim for TPD, Salary Continuance or Terminal Illness.

For Salary Continuance cover, the Insurer will pay benefits only for a period of three months if you remain overseas. However, if you return to Australia, the Insurer will recommence benefit payments from the date you arrive in Australia.

You should advise us well in advance, in writing, if you will be temporarily residing overseas. This advice should preferably be at least a month in advance of your departure date. The Insurer will confirm whether you will be covered and if so, whether cover will be limited or an additional premium applies.

Employer-approved leave

Your cover will continue while you are on employer-approved leave provided that:

a. you continue to be employed by your employer and your premiums continue to be paid; and

b. the period of leave is no longer than two (2) years; and

c. for salary continuance, the Insurer will not be liable to pay a benefit in respect of a period during which you were not otherwise due to receive an income from your employer while on employerapproved leave e.g. maternity (paid or unpaid) leave or other leave without pay.

Cover may continue after one year on terms permitted by the Insurer with their prior approval.

If you do not wish your cover to continue whilst on employer-approved leave you should notify the Plan prior to the commencement of any such leave.

Making a Claim

In the event of a claim, notify the Client Service Team on 1300 339 040 or by writing to:
TIC Retirement Plan
PO Box 281
Collins Street West
Melbourne VIC 8007

Upon receipt of a notice of claim, the Trustee will provide you with the relevant claim forms.

If you are on claim or make a claim from outside Australia, the Insurer may require that you return to Australia at your own expense for assessment of the claim.

The Insurer has the right to arrange for you to be examined by a registered Medical Practitioner at their expense as often as they may reasonably require while the claim is being assessed. They may also request any information required to assess a claim.

However, if you are on a Salary Continuance claim while outside Australia, the Insurer will pay Total Disability or Partial Disability Benefit for up to a period of 3 months unless you have, at your own expense, returned to Australia.

Insurance Definitions

Annual Income for Salary Continuance cover means:

a. your current annual pre-tax salary from your employer averaged over the 12 months prior to the date that disablement commenced, but not including any 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; or

b. if you directly or indirectly own part or all of a business or practice which is your employer, your annual pre-tax salary as income generated by the business or practice generated by your personal exertion after the deduction of your share of expenses in generating that income, averaged over the previous 12 months prior to disability. less,

Any income which you derive, whether actually received or not and includes, any benefit under any workers compensation, motor accident compensation or other similar State, Federal or Territory legislation, or any other income derived as a result of incapacity under any other insurance policy.

Approved Rehabilitation means a program, device or course of treatment certified by a Doctor or other health professional to be necessary for your rehabilitation but excluding any program providing hospital treatment or an ancillary health service within the meaning of the National Health Act 1953 or any other program which might cause this policy to cease to be exempt from the National Health Act 1953 or Health Insurance Act 1973 or any similar legislation in connection with health insurance.

Australian Resident means an Australian citizen or a person who is the holder of an Australian permanent visa within the meaning of Section 30 of the Migration Act 1958 or residence in Australia on a 457 working visa.

Doctor means a qualified medical practitioner registered to practice in Australia or New Zealand or as otherwise agreed by the Insurer. That person may not be you, your business partner, a member of your immediate family or your employer.

New Events Cover means cover other than cover in relation to the medical condition or any directly or indirectly related condition arising from illness or injury which has caused you either:

a. to be not in at work performing your normal duties and hours without restriction due to illness or injury on your last scheduled working day immediately preceding the Commencement Date,

b. in respect of an event that occurs in the period after your last scheduled working day immediately preceding the Commencement Date, to be absent from work or to be working in a reduced capacity on the Commencement Date.

Terminal Illness is a disease or condition that, in the opinion of a specialist Medial Practitioner approved by the Insurer, is likely to lead to your death within 12 months from the date you notify us of your condition.

Total and Permanent Disablement (TPD)

The TPD definition is split into two sections and is determined in accordance with your employment status and work hours in the six (6) months prior to the date of your disability.

1. Where a you are less than 65 and gainfully employed as a Permanent Employee and working fifteen (15) or more hours each week within the six (6) months prior to the date of disablement, you suffer total and permanent disablement if you,

• Are unable to do any work as a result of injury or illness for six (6) consecutive months and in the Insurer’s opinion, at the end of that six (6) months you continue to be so disabled that you are in our opinion unable to resume your previous occupation at any time in the future and will be unable at any time in the future to perform any Other Occupation, or
• Suffer Cognitive Loss, or
• Suffer the permanent loss of the use of two (2) limbs, or the sight of both eyes, or the permanent loss of the use of one (1) limb and the sight of one (1) eye. Section 5 – Insurance Cover

2. For all other members, you suffer total and permanent disablement if you,

• Suffer an illness or injury that wholly prevents you from performing two (2) of the Activities of Daily Living without the assistance of someone else for at least six (6) consecutive months, and
  i.   Since you suffered the illness or injury you have been under the regular care and attention of a Doctor for
       that illness or injury, and
  ii. In the Insurer’s opinion, the illness or injury means that you are unable to ever again perform at least two
       (2) of the Activities of Daily Living without the assistance of someone else, or
• Suffer Cognitive Loss, or
• Suffer the permanent loss of the use of two (2) limbs or the sight of both eyes, or the permanent loss of the use of one (1) limb and the sight of one (1) eye.

TPD benefits are payable in a lump sum.

Defined terms in relation to TPD definition:

a. Loss of sight means the complete loss of functional sight which is permanent,

b. Loss of the use of a limb means the permanent loss of the use of a leg from at or above the ankle or an arm from at or above the wrist, which is permanent.

c. Other Occupation means any occupation you are qualified to perform by your education, training or experience at the time the Insurer assesses the claim, and includes

• Part-time occupations, and
• An occupation which may be perceived by you to be of lower status than your previous occupation or an occupation in which you do not earn as much income as you did in the previous occupation.

d. Permanent Employee means an employee who is employed on a permanent basis under an ongoing contract that:

• Is for an indefinite duration or a fixed term of more than 12 months, and
• Requires the employee to perform identifiable duties for a regular number of hours each week, and
• Provides the employee with paid annual leave, sick leave, leave loading and long service leave.

e. Activities of Daily Living means;

• Bathing–the ability to wash or shower without assistance.
• Dressing–the ability to put on and take off clothing without assistance.
• Feeding–the ability to get food from a plate into the mouth without assistance.
• Mobility-the ability to get in and out of bed and a chair without assistance.
• Toileting–the ability to use the toilet including getting on and off without assistance.

f. Cognitive loss means a total and permanent deterioration or loss of intellectual capacity that has required the member to be under continuous care and supervision by another adult person for at least six (6) consecutive months and in the Insurer’s opinion, at the end of that six (6) months they are likely to require permanent ongoing continuous care and supervision by another adult person.

g. Doctor means a validly qualified medical practitioner registered to practice in Australia or New Zealand or as otherwise agreed by us. That person may not be the member, the member’s business partner, a member of the member’s immediate family or their employer.

Total disability means you have a disability caused by an injury or illness and are:

• unable to perform your occupation or any other occupation for which you are reasonably capable of performing by reason of education, training or experience; and
• not otherwise employed or engaged in business activity; and
• under the continuous and regular care of a Doctor and undergoing appropriate treatment.

Note: The Insurer will regularly review your disablement and income status to ensure you are still eligible for salary continuance payments during the approved benefit period.