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

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Death and TPD cover

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Income Protection cover

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Important definitions

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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.

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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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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

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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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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

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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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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).

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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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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.

–– –– ––

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.

AA AA

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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.

AA AA

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.

AA AA AA AA AA AA AA AA AA AA AA AA AA AA AA AA

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,

––

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.

AA AA AA

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.

AA AA

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.

AA

Exclusions and special conditions

AA

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),

AA

AA

AA

AA

AA

–– ––

AA

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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.

1

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?

AA AA AA

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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

AA AA AA AA AA AA AA AA AA AA AA AA AA

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)

AA AA AA

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.

AA AA AA AA AA AA AA AA AA AA AA AA AA AA AA

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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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,

AA

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:

AA AA AA AA

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.

AA

–– ––

AA

AA

AA

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 AA AA AA AA AA AA AA

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,

AA AA AA AA AA

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 AA AA AA AA AA AA AA

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.

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–– 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.

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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.

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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

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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?

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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

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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?



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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?

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No Yes. Provide details:

Relationship to member:

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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

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Question

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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

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Question

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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

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Signature of applicant

Date (DDMMYYYY)

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Postal address, number and street (or PO Box if applicable)

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Signature

Returning your form: UniSuper Level 35, 385 Bourke Street Melbourne VIC 3000 together with any additional documentation.

7 Date (DDMMYYYY)

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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