Mlc Personal Protection Portfolio

Transcript

MLC Life Cover Super MLC Personal Protection Portfolio Product Disclosure Statement This product is closed and no longer available for sale. This PDS is only relevant to current policy holders under this product. 1. MLC Life Cover Super & MLC Personal Protection Portfolio Product Disclosure Statement 2. Policy fees at 20 May 2013 3. Upgrades to your insurance effective from 1 October 2012 8 5 2 6 2 M 0 3 1 3 For more information call MLC from anywhere in Australia on 132 652 or contact your adviser. Postal address: MLC Limited, PO Box 200 North Sydney NSW 2059 Registered office: Ground Floor, MLC Building 105–153 Miller Street North Sydney NSW 2060 Policy Fees These fees apply to: • MLCLife Cover Super, and • MLCPersonal Protection Portfolio The policy fee from20 May 2013 (payable at the same time as your premium) is: Yearly $80.08 Half-yearly $41.65 Monthly $7.15 The policy fee increases every year in line with the Consumer Price Index. The increase is applied on the policy reviewdate on or after 1 October each year. Any questions? To find out more about MLCinsurance, please get in touch with a financial adviser or call us on 132 652. Policy fees as at 20 May 2013 Making sure you’re well protected MLC Personal Protection Portfolio andMLC Life Cover Super Your insurance is now even better We constantly make improvements to the insurance we offer All upgrades are automatically passed on where they don’t affect your premiums. For some upgrades you’ll need to let us knowif you’d like to take advantage of the improvement, and your premium will increase as a result. You can check your policy schedule to see which upgrades are relevant to you. Please keep this document with your policy document for your records. Upgrades apply from1October 2012 onwards These upgrades only apply to claims for events that happened on or after 1 October 2012. They don’t apply to any claims resulting fromhealth conditions or events which began or took place before this date. You can choose to have a claimassessed under the pre-improvement wording, if you prefer. For the newpolicy wording, please go to mlc.com.au/upgrade Alternatively, you can call us on 132 652 and ask for a paper copy. Upgrades There are a number of improvements that include a change in our definitions. These newdefinitions are available on mlc.com.au/upgrade Typeof insurance Upgrade Howthisaffectsyou Total & Permanent Disability (TPD) insurance TPD TPD(Stand Alone) (PPP only) TPDdefinition We’re nowmore generous if you’re unemployed at the time of disability: • If you were gainfully employed at any time within the 12 months prior to disability you’ll be assessed on the TPDdefinition that you applied for. • If you were not gainfully employedfor the 12months prior todisability, you’ll be assessedon your inability towork at any occupation you are reasonably suited toby way of education, experience andtraining. If you were engagedin full-time domestic duties or childrearingat the time disability begins, we’ll continue to assess you on your inability toperformnormal physical domestic duties. Previously if you were not gainfully employed prior to disability we’d assess you on your inability to performnormal physical domestic duties. 4. Policy fees as at 21 May 2012 5. Upgrades to your insurance effective from 17 October 2011 6. Upgrades to your insurance effective from 12 November 2010 7. Policy fees as at 12 November 2010 8. Standard & Poor’s consumer credit ratings Insurance fromMLC Making your insurance even better MLC Life Cover Super and MLC Personal Protection Portfolio Effective from: 17 October 2011 MLC Insurance Preparation date: 24 August 2009 Issue date: 1 October 2009 Issue no: 7 This PDS was prepared by MLC Nominees Pty Limited ABN 93 002 814 959 AFSL 230702 RSE L0002998 Issuer of MLC Life Cover Super Trustee for The Universal Super Scheme ABN 44 928 361 101, R1056778 SFN 281440944 and MLC Limited ABN 90 000 000 402 AFSL 230694 Issuer of MLC Personal Protection Portfolio Life Insurance Company of the Year 2009 Life Cover Total & Permanent Disability Critical Illness Income Protection Business Expenses Premium Waiver Protecting your future MLC Life Cover Super MLC Personal Protection Portfolio Product Disclosure Statement This product is closed and no longer available for sale. This PDS is only relevant to current policy holders under this product. Policy Fees These fees apply to: • MLC Life Cover Super, and • MLC Personal Protection Portfolio The policy fee from 20 May 2013 (payable at the same time as your premium) is: Yearly $80.08 Half-yearly $41.65 Monthly $7.15 The policy fee increases every year in line with the Consumer Price Index. The increase is applied on the policy review date on or after 1 October each year. Any questions? To find out more about MLC insurance, please get in touch with a financial adviser or call us on 132 652. Policy fees as at 20 May 2013 Making sure you’re well protected MLC Personal Protection Portfolio and MLC Life Cover Super Your insurance is now even better We constantly make improvements to the insurance we offer All upgrades are automatically passed on where they don’t affect your premiums. For some upgrades you’ll need to let us know if you’d like to take advantage of the improvement, and your premium will increase as a result. You can check your policy schedule to see which upgrades are relevant to you. Please keep this document with your policy document for your records. Upgrades apply from 1 October 2012 onwards These upgrades only apply to claims for events that happened on or after 1 October 2012. They don’t apply to any claims resulting from health conditions or events which began or took place before this date. You can choose to have a claim assessed under the pre-improvement wording, if you prefer. For the new policy wording, please go to mlc.com.au/upgrade Alternatively, you can call us on 132 652 and ask for a paper copy. Upgrades There are a number of improvements that include a change in our definitions. These new definitions are available on mlc.com.au/upgrade Type of insurance Upgrade How this affects you Total & Permanent Disability (TPD) insurance TPD TPD (Stand Alone) (PPP only) TPD definition We’re now more generous if you’re unemployed at the time of disability: • If you were gainfully employed at any time within the 12 months prior to disability you’ll be assessed on the TPD definition that you applied for. • If you were not gainfully employed for the 12 months prior to disability, you’ll be assessed on your inability to work at any occupation you are reasonably suited to by way of education, experience and training. If you were engaged in full-time domestic duties or child rearing at the time disability begins, we’ll continue to assess you on your inability to perform normal physical domestic duties. Previously if you were not gainfully employed prior to disability we’d assess you on your inability to perform normal physical domestic duties. Upgrades (continued) Type of insurance Upgrade How this affects you Critical Illness insurance Critical Illness Plus Critical Illness Plus (Stand Alone) Child Support Benefit The list of Child Support Benefit conditions now includes Type 1 Diabetes. The definitions of the following critical conditions have been broadened and you are now more likely to be able to claim: • Encephalitis • Major brain injury, and • Malignant cancer. Critical Illness Standard Critical Illness Plus Critical Illness Plus (Stand Alone) Critical Illness definitions The definitions of the following critical conditions have been broadened and you are now more likely to be able to claim: • Malignant cancer • Where Critical Illness is an extension to Life Cover: – Any Occupation TPD, and – Own Occupation TPD. Critical Illness Plus Critical Illness Plus (Stand Alone) Critical Illness definitions The definitions of the following critical conditions have been broadened and you are now more likely to be able to claim: • Encephalitis, and • Major brain injury. Critical Illness Standard Critical Illness Plus Life Cover Buy Back Option The one-year buy back qualification period now begins when a valid claim form is received, or when you meet the definition for critical conditions other than TPD. (Previously this started after the Critical Illness benefit was paid). Please note: We’ll restore your Life Cover insurance up to the same amount as the benefit paid, if you survive 14 days after we pay your Critical Illness benefit due to TPD as a critical condition. Critical Illness Plus Critical Illness Plus (Stand Alone) Critical Illness Extra Benefit Option – Additional critical conditions The definitions of the following critical conditions have been broadened and you are now more likely to be able to claim: • Carcinoma in situ – female reproductive organs, and • Early stage melanoma. Income Protection insurance Income Protection Plus (PPP only) Income Protection Plus (Farmer Package) (PPP only) Child Support Income Benefit The list of Child Support Income Benefit conditions now includes Type 1 Diabetes. The definitions of the following critical conditions have been broadened and you are now more likely to be able to claim: • Encephalitis • Major brain injury, and • Malignant cancer. Income Protection Plus (PPP only) Income Protection Plus (Farmer Package) (PPP only) Income Protection Extra Benefits Option – Benefit during the waiting period You’ll now receive this benefit from day one (previously payable from day four). You’ll need to have been confined to bed for 72 hours or more and we’ll then backdate the benefit to day one. Income Protection Plus (PPP only) Income Protection Plus (Farmer Package) (PPP only) Income Protection Extra Benefits Option – Double benefits for specified conditions The following definitions have been broadened and you are now more likely to be able to claim under double benefits: • Encephalitis • Major brain injury, and • Malignant cancer. Premium Waiver insurance Premium Waiver Totally and Permanently Disabled definition We’re now more generous if you’re unemployed at the time of disability: • If you were gainfully employed at any time within the 12 months prior to disability you’ll be assessed on the Totally and Permanently Disabled definition. • If you were not gainfully employed for the 12 months prior to disability, you’ll be assessed on your inability to work at any occupation you are reasonably suited to by way of education, experience and training. If you were engaged in full-time domestic duties or child rearing at the time disability begins, we’ll continue to assess you on your inability to perform normal physical domestic duties. Previously if you were not gainfully employed prior to disability we’d assess you on your inability to perform normal physical domestic duties. Important information MLC Personal Protection Portfolio is issued by MLC Limited (ABN 90 000 000 402, AFSL 230694). MLC Life Cover Super is issued by MLC Nominees Pty Limited (ABN 93 002 814 959, AFSL 230702, RSE L0002998) which is the Trustee of The Universal Super Scheme (ABN 44 928 361 101, R1056778). This document has been printed on paper sourced from well-managed, environmentally sustainable plantation forests so there’s minimum effect on the environment. It’s part of our campaign to maintain our neutral carbon footprint and reduce global warming. Improvements you can take advantage of You’ll need to let us know if you’d like to take advantage of these improvements. Your premium will increase as a result. Type of insurance Upgrade How this affects you Life Cover, TPD, Critical Illness and Income Protection insurance Life Cover Plus Total & Permanent Disability Total & Permanent Disability (Stand Alone) (PPP only) Critical Illness Plus (PPP only) Critical Illness Plus (Stand Alone) (PPP only) Income Protection Plus Increases without further medical evidence Please note: For Income Protection Plus this isn’t available if you work in a special risk occupation. You can now increase your cover up to certain limits if your salary has increased by 10% or more in the previous 12 months. Life Cover Standard Life Cover Plus Total & Permanent Disability Total & Permanent Disability (Stand Alone) (PPP only) Business Safeguard Option We’ve increased the maximum limit for Life Cover insurance from $10 million to $15 million. Increases for Life Cover and TPD under this option are no longer limited by the amount of personal insurance you have elsewhere. Income Protection Standard Income Protection Plus Waiting Period Conversion Please note: This isn’t available if you work in a special risk occupation. If you have a two-year waiting period because of existing insurance under a Group Salary Continuance scheme, you can ask us to reduce it to 90 days without further medical evidence if: • you’ve left your employer, • your cover under that scheme ends, and • you don’t exercise a continuation option from that scheme. You have up to 60 days to tell us your Group Salary Continuance arrangement has ended. Income Protection Plus (LCS only) Extended Income Protection You now have the option to continue your Income Protection Plus insurance on altered terms until age 70 if: • you continue to work full-time, and • you are neither receiving nor entitled to receive benefits at the review date when you turn 65. Please note: This isn’t available if: • your insurance expires before age 65, or • you work in a special risk occupation. Provided you meet the terms and conditions, extended cover will be provided under a new policy and your existing policy will end. Any questions If you’d like to know more about these, or any of our insurance offers, speak with your financial adviser or call us on 132 652. How to contact MLC For more information call MLC from anywhere in Australia on 132 652 between 8am and 6pm (AEST/AEDT), Monday to Friday or contact your financial adviser. Postal address: MLC Limited, PO Box 200 North Sydney NSW 2059 Registered office: Ground Floor, MLC Building 105–153 Miller Street North Sydney NSW 2060 mlc.com.au 91442M1212 Policy Fees These fees apply to: • MLC Life Cover Super, and • MLC Personal Protection Portfolio The policy fee from 21 May 2012 (payable at the same time as your premium) is: Yearly $79.15 Half-yearly $41.16 Monthly $7.06 The policy fee increases every year in line with the Consumer Price Index. The increase is applied on the policy review date on or after 1 October each year. Any questions? To find out more about MLC insurance, please get in touch with a financial adviser or call us on 132 652. Policy fees as at 21 May 2012 Insurance from MLC Making your insurance even better MLC Life Cover Super and MLC Personal Protection Portfolio Effective from: 17 October 2011 Page 2 Making your insurance even better Making your insurance even better Page 3 Whenever we improve the features and benefits of our insurance products we automatically upgrade your policy with those improvements that don’t require an increase in premium rates. This means you can be confident that, long after the policy is purchased, we are working hard to help ensure that your cover stays up-to-date. We also improve our products by offering new optional product features that, if you decide to apply for them, may affect your premium. This flyer provides you with a summary of the key upgrades we’ve made as at 17 October 2011. These upgrades will only apply to events (for which a claim for benefits may be made) which happen on or after 17 October 2011. The upgrades are improvements to your insurance but you may choose to have a claim assessed under the pre-improvement wording should you prefer. If you’re not sure which upgrades apply to you, please refer to your most recent policy schedule for the name and title of the type of insurance and options you’ve chosen. For the new policy wording, please go to mlc.com.au/upgrade. Alternatively, please call us on 132 652 to request a paper copy of the new wording. If you’d like to know more about these improvements, or any of our other insurance offers, please speak with your adviser or call us on 132 652. Making sure you’re well protected We regularly review our insurance products to see where we can improve on the features and benefits you currently have. This is to make sure you have the best protection we can offer. Making your insurance even better Page 5 Page 4 Making your insurance even better Upgrades to MLC Life Cover, Total and Permanent Disability (TPD), Critical Illness and Premium Waiver insurance The products and types of insurance to which these upgrades apply are listed in the table below. Upgrades Check your policy schedule to see which of these upgrades are relevant to you. For more information refer to Life Cover Total and Permanent  Disability Critical Illness Premium Waiver LCS PPP LCS PPP PPP LCS PPP Std Plus Std Plus Ext. Ext. S/A Std Plus S/A Financial Planning Benefit page 9, 10, 13 ˜ ˜ ˜ ˜ ˜ ˜ ˜ Increases without further medical evidence page 9, 10, 13 ˜ ˜ ˜ ˜ ˜ ˜ ˜ TPD definition page 10, 12 ˜ ˜ ˜ ˜ ˜ ˜ ˜ Partial Payment Benefit page 11 ˜ ˜ ˜ ˜ ˜ Life Cover Buy Back Option page 11, 13 ˜ ˜ ˜ ˜ Child Support Benefit page 14 ˜ ˜ Critical Illness definitions page 15 to 16 ˜ ˜ ˜ Critical Illness Extra Benefits Option – Additional critical conditions page 17 to 18 ˜ ˜ Critical Illness Extra Benefits Option – Critical Illness Buy Back page 18 ˜ ˜ Summary of policy upgrades at a glance For definitions of the terms in this table please refer to your Product Disclosure Statement. ˜ Means an improvement applies LCS MLC Life Cover Super PPP MLC Personal Protection Portfolio Std Standard Ext. Extension S/A Stand-alone Page 6 Making your insurance even better Making your insurance even better Page 7 Upgrades to MLC Income Protection and Business Expenses insurance The products and types of insurance to which these upgrades apply are listed in the table below. Upgrades Check your policy schedule to see which of these upgrades are relevant to you. For more information refer to Income Protection Business Expenses LCS PPP PPP Std Plus Std Plus FP Child Support Income Benefit page 19 ˜ ˜ Increases without further medical evidence page 20 ˜ ˜ Claiming from another source page 21 ˜ ˜ No prior Total Disability required for certain specified conditions page 21 ˜ ˜ Income Protection Extra Benefits Option page 22 ˜ ˜ Death Benefit page 23 ˜ ˜ ˜ ˜ ˜ ˜ Net cost of a locum page 23 ˜ Extended Income Protection page 24 ˜ Summary of policy upgrades at a glance For definitions of the terms in this table please refer to your Product Disclosure Statement. ˜ Means an improvement applies LCS MLC Life Cover Super PPP MLC Personal Protection Portfolio Std Standard FP Income Protection Plus Farmer Package Page 8 Making your insurance even better Making your insurance even better Page 9 Product upgrades The upgrades are as follows: Improvements to Life Cover Increased! Financial Planning Benefit We’ve increased this benefit from $2,000 to $5,000. Improved! Increases without further medical evidence • The maximum amount you can apply for has been increased from $1 million to $2 million. • New! Asset Protection for businesses We’ve extended the list of Business Events to now include Asset Protection (Loan Guarantee). To take advantage of this feature please apply for the additional cover and please note your premium will change. Page 10 Making your insurance even better Making your insurance even better Page 11 Improvements to Total and Permanent Disability (TPD) Increased! Financial Planning Benefit We’ve increased this benefit from $2,000 to $5,000. Improved! Increases without further medical evidence • The maximum amount you can apply for has been increased from $1 million to $2 million. • New! Asset Protection for businesses We’ve extended the list of Business Events to now include Asset Protection (Loan Guarantee). To take advantage of this feature please apply for the additional cover and please note your premium will change. Improved! TPD definitions extended How TPD is defined depends on whether you choose to have an Any Occupation or Own Occupation TPD definition. The definition for TPD is now more generous: • The Any Occupation definition of TPD has been extended to include your inability to work at an occupation you’re reasonably suited to that will pay 25% or more of your earnings. • Improved! Qualifying period The qualifying period has been reduced from six months to three months for TPD and Loss of Independence definitions. • Improved! Survival period The survival period for TPD stand-alone insurance has been changed from six months to 14 days. New! Partial Payment Benefit We’ll pay a partial benefit if you lose the sight of one eye or the use of one foot or one hand. Improved! Life Cover Buy Back Option You can now buy back your Life Cover insurance for death, terminal illness and accidental injury (previously the restored insurance applied to death only). Please note: if you hold Life Cover Standard insurance the restored insurance will apply to death and terminal illness only as accidental injury is not covered under this insurance. Product upgrades Page 12 Making your insurance even better Making your insurance even better Page 13 Improvements to Premium Waiver Improved! TPD definition extended The definition for Totally and Permanently Disabled is now more generous: • The definition of Totally and Permanently Disabled has been extended to include your inability to work at an occupation you’re reasonably suited to that will pay 25% or more of your earnings. • Improved! Qualifying period The qualifying period has been reduced from six months to three months. Improvements to Critical Illness Increased! Financial Planning Benefit We’ve increased this benefit from $2,000 to $5,000. Improved! Increases without further medical evidence • The maximum amount you can apply for has been increased from $1 million to $2 million. • New! Asset Protection for businesses We’ve extended the list of Business Events to now include Asset Protection (Loan Guarantee). To take advantage of this feature please apply for the additional cover and please note your premium will change. Improved! Life Cover Buy Back Option You can now buy back your Life Cover insurance for death, terminal illness and accidental injury (previously the restored insurance applied to death and terminal illness only). Please note: if you hold Life Cover Standard insurance the restored insurance will apply to death and terminal illness only as accidental injury is not covered under this insurance. We’ll write to you and you’ll need to let us know that you want this feature. To take advantage of this feature, please note you’ll have to pay an extra premium. Product upgrades Page 14 Making your insurance even better Making your insurance even better Page 15 New! Child Support Benefit If you have Critical Illness insurance of at least $100,000, we’ll pay a lump sum of $10,000 if one of your children* suffers one of the following conditions for the first time or dies. This benefit won’t reduce your Critical Illness Plus or stand-alone benefit. Child Support Benefit Conditions Aplastic Anaemia Encephalitis Malignant Cancer Bacterial Meningitis Heart Attack Meningococcal Septicaemia Benign Brain Tumour Heart Valve Surgery Open Heart Surgery Blindness HIV contracted through medical procedures Out of Hospital Cardiac Arrest Cardiomyopathy Intensive Care Paralysis Chronic Kidney Failure Loss of Speech Pneumonectomy Chronic Liver Failure Major Brain Injury Primary Pulmonary Hypertension Coma Major Burns Stroke Deafness Major Organ or Bone Marrow Transplant * A child means a person who is under the age of 21, and is the natural child, stepchild, adopted child or a child under the legal guardianship of the Life Insured. Critical Illness additional and improved definitions New! Severe Diabetes The list of critical conditions has been extended to include Severe Diabetes. Improved! Critical Illness definitions The definitions of the following critical conditions are now more generous. Critical condition Critical Illness Standard Critical Illness Plus Critical Illness stand-alone Heart Attack • • • Malignant Cancer • • • Benign Brain Tumour • • Cardiomyopathy • • Chronic Liver Failure • • Coma • • Coronary Artery Angioplasty • • Dementia or Alzheimer’s Disease • • Encephalitis • • Intensive Care • • Loss of Speech • • Major Brain Injury • • Product upgrades The details of all these new definitions are on mlc.com.au/upgrade The details of all these new definitions are on mlc.com.au/upgrade Page 16 Making your insurance even better Making your insurance even better Page 17 Critical condition (continued) Critical Illness Standard Critical Illness Plus Critical Illness stand-alone Major Burns • • Major Organ Transplant (now called Major Organ or Bone Marrow Transplant) • • Motor Neurone Disease • • Multiple Sclerosis • • Muscular Dystrophy • • Out of Hospital Cardiac Arrest • • Parkinson’s Disease • • Severe Rheumatoid Arthritis • • Total and Permanent Disability • • Critical Illness Extra Benefits Option – Additional critical conditions New! Carcinoma in situ of the female reproductive organs The list of additional critical conditions now includes Carcinoma in situ of the female reproductive organs. Please note: Carcinoma in situ of the cervix is not covered. New! Orchidectomy (as required to diagnose Carcinoma in situ of the testicle) The list of additional critical conditions now includes Orchidectomy. Product upgrades The details of all these new definitions are on mlc.com.au/upgrade Page 18 Making your insurance even better Making your insurance even better Page 19 Page 18 Making your insurance even better Improved definitions The definitions of the following Extra Benefits Option additional critical conditions are now more generous. Extra Benefits Option additional critical condition Critical Illness Plus Critical Illness stand-alone Chronic Lymphocytic Leukaemia (now called Early stage chronic lymphocytic leukaemia) • • Facial reconstructive surgery and skin grafting • • Loss of one foot or one hand • • Melanoma (now called Early stage melanoma) • • Prostate Cancer (now called Early stage prostate cancer) • • Serious Accidental Injury • • Improved! Critical Illness Extra Benefits Option – Critical Illness Buy Back Twelve months after a partial Critical Illness insurance benefit has been paid, this enhanced option now means you can buy back the partial insurance amount (previously this only applied after the full benefit had been paid). Improvements to Income Protection New! Child Support Income Benefit We’ll pay you the lesser of three times the monthly benefit, or $25,000 as a lump sum, if one of your children* suffers one of the following conditions for the first time or dies. Child Support Benefit Conditions Aplastic Anaemia Encephalitis Malignant Cancer Bacterial Meningitis Heart Attack Meningococcal Septicaemia Benign Brain Tumour Heart Valve Surgery Open Heart Surgery Blindness HIV contracted through medical procedures Out of Hospital Cardiac Arrest Cardiomyopathy Intensive Care Paralysis Chronic Kidney Failure Loss of Speech Pneumonectomy Chronic Liver Failure Major Brain Injury Primary Pulmonary Hypertension Coma Major Burns Stroke Deafness Major Organ or Bone Marrow Transplant * A child means a person who is under the age of 21, and is the natural child, stepchild, adopted child or a child under the legal guardianship of the Life Insured. Product upgrades The details of all these new definitions are on mlc.com.au/upgrade The details of all these new definitions are on mlc.com.au/upgrade Page 20 Making your insurance even better Making your insurance even better Page 21 Improved! Claiming from another source The calculation for Partial Disability under Agreed Value Cover when you receive benefits from another source is now more generous. No reduction will apply that would reduce your overall benefit to less than 100% of pre-disability earnings (previously 75%). Improved! No prior total disability required for certain specified conditions You’ll be able to claim for partial disability more easily because the definitions of the following critical conditions are now more generous. Critical condition Motor Neurone Disease Multiple Sclerosis Muscular Dystrophy Parkinson’s Disease New! Increases without further medical evidence When certain changes in your life happen such as taking out a mortgage or having a child (see below), you can now apply to increase your Income Protection benefit by up to 20% once during any three year period without further medical evidence, subject to the maximum insurable amount. Please note: additional conditions apply to this maximum insurable amount. This feature is not available if you work in a special risk occupation. This applies if you: • or your spouse give birth to or adopt a child • get married or divorced • complete an undergraduate degree at a Government recognised university • have a dependent child who starts secondary school, or • take out or increase, a mortgage to purchase or improve your home. To take advantage of this feature please apply for the additional cover and please note your premiums will change. Product upgrades The details of all these new definitions are on mlc.com.au/upgrade Page 22 Making your insurance even better Making your insurance even better Page 23 Income Protection – Extra Benefits Option The following benefits under this option have been improved. Home Assistance This benefit has been increased from $85 to $150 per day. Double benefits for specified conditions You’ll be able to get double benefits more easily because the definitions of the following critical conditions are now more generous. Critical condition Benign Brain Tumour Cardiomyopathy Chronic Liver Failure Coma Dementia or Alzheimer’s Disease Heart Attack Major Brain Injury Major Burns Major Organ Transplant Malignant Cancer Motor Neurone Disease Multiple Sclerosis Muscular Dystrophy Parkinson’s Disease Improved! Death Benefit We’ll now pay a death benefit while the policy is in force. (Previously the benefit only applied if you were on claim.) Improvements to Business Expenses Improved! Death Benefit We’ll now pay a death benefit while the policy is in force. (Previously the benefit only applied if you were on claim). New! Net cost of a locum The list of covered expenses under Business Expenses has been extended to include the net cost of a locum. The details of all these new definitions are on mlc.com.au/upgrade Product upgrades Page 24 Making your insurance even better New! Extended Income Protection Following your policy review date, at age 65, we’ll give you the option to continue your Income Protection Plus insurance on altered terms until age 70, if you continue to work full-time and aren’t receiving, or entitled to receive benefits at the review date when you turn 65. Please note: this feature is not available if: • your insurance expires before age 65, or • you work in a special risk occupation. If approved, extended cover will be provided under a new policy and your existing policy will end. Please see your adviser for more information. If you’d like to know more about these, or any of our other insurance offers, speak with your adviser or call us on 132 652. Product upgrades Important information MLC Life Cover Super is issued by MLC Nominees Pty Limited (ABN 93 002 814 959, AFSL 230702, RSE L0002998) which is the trustee of The Universal Super Scheme (ABN 44 928 361 101 R1056778). MLC Personal Protection Portfolio is issued by MLC Limited (ABN 90 000 000 402, AFSL 230694). This has been printed on paper sourced from well managed, environmentally sustainable plantation forests so there’s a minimum effect on the environment. It’s part of our campaign to maintain our neutral carbon footprint and reduce global warming. Insurance from MLC How to contact MLC: For more information call MLC from anywhere in Australia on 132 652 Monday to Friday, 8 am to 6 pm AEST/AEDT or contact your adviser. For clients outside Australia, please call + 61 3 8634 4721. Postal address: MLC Limited, PO Box 200 North Sydney, NSW 2059 mlc.com.au 70748M0812 Making your insurance even better We’ve made a number of improvements you may want to take advantage of such as: • keeping your insurance up with inflation • better protection for total and permanent disability, and • higher income protection. These improvements may change your current premium. Keeping up with inflation* You can choose to keep your insurance in line with inflation for the following insurances through your MLC Life Cover and Personal Protection Portfolio: • MLC Life Cover • Total and Permanent Disability (TPD), and • Critical Illness insurance. If you choose this option, we'll automatically increase your benefits each year by the greater of the Consumer Price Index (CPI) or 5%; and you won't have to have any additional medicals. Previously the minimum CPI increases for these insurances was 3%. Better protection for total and permanent disability* We’re increasing the Total and Permanent Disability (TPD) and Loss of Independence insurance benefit for your MLC Life Cover Super and Personal Protection Portfolio: If you’re in a white collar profession (such as surgeons, doctors, solicitors) the maximum TPD benefit you can apply for has increased from $3 million to $5 million. The new limit also applies if you have TPD as part of the Business Safeguard Option. If you’re over 65 (for all occupations), and you lose your independence we’ll pay you a Loss of Independence benefit. This benefit will be the same amount as your TPD benefit, subject to a limit of $3 million. Previously this limit was $500,000. This change if you’re over 65 takes effect immediately. Further information If you’d like to know more about these, or any of our other insurance offers, please speak with your adviser or call us on 132 652. Higher income protection If you’re in a white collar profession (such as surgeons, doctors, solicitors) you can now apply for up to $60,000 per month of MLC Income Protection insurance through your Personal Protection Portfolio. Changes to income protection monthly benefit calculation* We’ve changed the calculation we use to determine the maximum monthly benefit for MLC Income Protection insurance. Now depending upon your occupation and eligibility, you can apply for a higher monthly benefit than was previously available. From To 75% of the first $240,000 of annual earnings 75% of the first $320,000 of annual earnings plus 50% of the next $240,000 of annual earnings plus 50% of the next $240,000 of annual earnings plus 25% of the next $240,000 of annual earnings plus 20% of the remainder up to the maximum $60,000 monthly benefit plus 20% of the next $240,000 of annual earnings * These improvements are available from 12 November 2010. Upgrades to your insurance effective from 12 November 2010 Policy Fees These fees apply to: • MLC Life Cover Super, and • MLC Personal Protection Portfolio The policy fee from 12 November 2010 (payable at the same time as your premium) is: Yearly $76.40 Half-yearly $39.73 Monthly $6.82 The policy fee increases every year in line with the Consumer Price Index. The increase is applied on the policy review date on or after 1 October each year. Any questions? To find out more about MLC insurance, please get in touch with a financial adviser or call us on 132 652. Policy fees as at 12 November 2010 Standard & Poor's consumer credit ratings In recent letters to financial institutions, Standard & Poor’s withdrew their consent to use their credit ratings for consumer documents, including Product Disclosure Statements and Financial Services Guides. This was in response to changes in the law concerning how financial services organisations use credit ratings when selling their products. These changes were effective from 1 January 2010. What does this mean for you? When you read the following documents, you’ll need to disregard the references we’ve made to Standard & Poor’s. We’re also in the process of updating all our references on the website so, if you do see a reference to Standard & Poor’s please disregard it. Document Product Reference Product Disclosure Statement page 6 MLC Personal Protection Portfolio MLC Life Cover Super All this, along with Standard & Poor’s AA rating means you can be confident, when it comes to claim time, you really can depend on us. Any questions? If you have any questions on this, or any other issue, please speak with your financial adviser, or call us on 132 652. This page has been left blank intentionally Before you read this PDS The information in this Product Disclosure Statement (PDS) may change from time to time. Changes that are not materially adverse will be updated and made available to you at mlc.com.au. Alternatively, you can call the MLC Client Service Centre on 132 652 for a free paper copy. MLC and the Trustee are the joint issuers of this PDS. Each issuer takes full responsibility for the whole of the PDS. The full legal terms and conditions for each product are contained in their respective policy documents. Copies of the policy document(s) may be obtained free of charge, upon request. The products described in this PDS are only offered to residents of Australia who receive this PDS in Australia. Applications for each product will only be accepted on the Application Form accompanying this PDS or via its online equivalent through your financial adviser. Any information in this PDS has been prepared without taking account of your objectives, financial situation or needs. Because of this, you should, before acting on any information in this PDS, consider whether it is appropriate to your objectives, financial situation and needs. To obtain advice or more information about the products offered in this PDS you should speak with a financial adviser. The benefits available under MLC Life Cover Super and MLC Personal Protection Portfolio are paid out of MLC’s No. 1 Statutory Fund. This life insurance is designed purely for protection and is not a savings plan. It will never have a surrender or cash value. MLC and the Trustee are part of the National Australia Group’s wealth management division. An MLC Personal Protection Portfolio policy and an interest in an MLC Life Cover Super policy held through the Scheme do not represent a deposit with or liability of MLC Nominees Pty Limited, National Australia Bank Limited (ABN 12 004 044 937) (AFSL 230686) or any of their related bodies corporate (other than a liability of MLC Limited as insurer). Neither National Australia Bank Limited, nor any of its related bodies corporate (other than MLC Limited as insurer) guarantees or accepts liability in respect of MLC Life Cover Super and MLC Personal Protection Portfolio. The following terms are used in this PDS: For MLC Life Cover Super (LCS) MLC/we/us refers to MLC Limited either in its capacity as insurer or in its capacity as administrator of the Scheme on behalf of the Trustee MLC Nominees / the Trustee refers to MLC Nominees Pty Limited in its capacity as the Trustee of The Universal Super Scheme (the Scheme) and issuer of MLC Life Cover Super the Scheme refers to The Universal Super Scheme you/your/ member refers to a member of MLC Life Cover Super and the life insured For MLC Personal Protection Portfolio (PPP) MLC/we/us refers to MLC Limited in its capacity as insurer and issuer of MLC Personal Protection Portfolio you/your assumes that you are both the policy owner and the life insured Any words shown in italics are explained in the Definitions section of this PDS. What you need to know about the risks The insurance cover and benefit amounts you select may not always be adequate for your needs. It is important that you and your financial adviser thoroughly assess your needs and ensure that you choose a type and amount of insurance that is suitable and adequate for your current circumstances. It is also prudent to consider your future insurance needs now because you may not be eligible for some insurance if your circumstances change. MLC Life Cover Super and MLC Personal Protection Portfolio PDS Page 01 Welcome to MLC At MLC we protect you today, so you don’t have to worry about what might happen tomorrow. Page 02 MLC Life Cover Super and MLC Personal Protection Portfolio PDS MLC’s winning ways Our track record Life Insurance Company of the Year 2009, 2008, 2006, 2004 Australia & New Zealand Insurance Industry Awards Income Protection Product of the Year 2008, 2007 AFR Smart Investor Blue Ribbon Awards Income Protection Product of the Year 2008, 2007 Asset Innovation Awards Income Protection Product of the Year 2007 Plan for Life / AFA Best Life Insurance Company 2006, 2004 Australian Banking & Finance Magazine Best Term and TPD Risk Insurance 2006 Money Magazine Best Income Protection Insurance 2005 Money Magazine Business Overheads Product 2006, 2005 Money Management Insurance Company of the Year 2005, 2004, 2003, 2002 Personal Investor Income Protection Product of the Year 2005, 2003 Personal Investor Term Life Product of the Year 2003 Personal Investor Trauma Product of the Year 2004, 2003 Personal Investor MLC Life Cover Super and MLC Personal Protection Portfolio PDS Page 03 1 You’re making the right choice with MLC Why MLC is the right choice 6 Insurance you can depend on 6 Choosing your insurance 6 Tailoring your insurance 6 Choice of benefit and premium structures 6 2 The types of insurance offered Protect yourself 10 Life Cover insurance 11 Total and Permanent Disability (TPD) and Loss of Independence insurance 14 Critical Illness insurance 17 Information common to Life Cover, Total and Permanent Disability (TPD) and Critical Illness 23 Income Protection insurance 27 Business Expenses insurance 37 Premium Waiver insurance 40 3 How it all works Setting up your insurance 44 How to apply 44 How to pay 46 Your cooling-off rights 50 Contributing to MLC Life Cover Super 51 The Universal Super Scheme 52 Using your insurance 53 How to claim 53 Beneficiaries 54 Accessing your MLC Life Cover Super benefit 59 Taxation 60 Changing, replacing, transferring, renewing or terminating your insurance 63 Adding to or changing your insurance 63 Replacing insurance 63 Transferring insurance (within MLC) 63 Renewing your insurance 63 Terminating insurance 63 Converting MLC Life Cover Super to non-superannuation insurance 64 Transfers out of MLC Life Cover Super to rollover funds 65 Complaint resolutions 66 Privacy Notification 67 4 Definitions General Definitions 70 Total and Permanent Disability (TPD) and Loss of Independence Definitions 73 Critical Illness Definitions 75 Interim Accident Insurance Certificate 83 Contents Page 04 MLC Life Cover Super and MLC Personal Protection Portfolio PDS 2. MLC Life Cover Super and MLC Personal Protection Portfolio PDS Page 05 You’re making the right choice with MLC Page 06 MLC Life Cover Super and MLC Personal Protection Portfolio PDS At MLC we believe insurance should be affordable for the long-term. So we actively look for the most cost and tax-effective ways for our customers to purchase their insurance. We offer the following ways: 1. MLC Life Cover Super (LCS), where you can purchase insurance through superannuation. 2. MLC Personal Protection Portfolio (PPP), where you can purchase insurance directly in your own name. Insurance you can depend on With over 120 years of protecting Australians' wealth, it’s no surprise we provide more personal insurance to Australians 1 than any other company. We keep insurance simple so you know the benefits stated in your policy are the benefits you’ll receive. In 2009 we were voted Life Insurance Company of the Year at the Australian and New Zealand Insurance industry awards. All this along with Standard & Poor’s AA rating means you can be confident, when it comes to claim time, you really can depend on us. Keeping your insurance up to date We continuously look for ways to improve the features and benefits of our insurance offer so you’ll receive better protection. Where it won’t affect your premiums, we automatically upgrade your insurance whenever we improve our products. We also keep you informed of any innovations or enhancements we make that you can take advantage of. Why MLC is the right choice Choosing your insurance 1 As at 31 March 2008, DEXXR & R league tables MLC Life Cover Super and MLC Personal Protection Portfolio PDS Page 07 Y o u ’ r e m a k i n g t h e r i g h t c h o i c e w i t h M L C Tailoring your insurance We also understand different people have different needs, so we offer a comprehensive range of insurance options for you to choose and tailor. You have two options for your insurance: 1. Standard. This is our basic insurance at an affordable price. 2. Plus. This incorporates a wider range of benefits and options. Connected benefits This is a flexible way of structuring insurance and may result in reducing the overall cost of your insurance package. Specifically, it allows you to purchase Total and Permanent Disability or Critical Illness as an extension to your existing Life Cover, but have the policies structured with different owners. And, it doesn't matter if the Life Cover is held inside or outside of superannuation. Choice of benefit and premium structures When you take out insurance, there are three ways you can pay your premiums: 1. A level premium based on your age when your cover commences. Your premiums will only vary if a change is made to MLC's premium rates. 2. A stepped premium that increases as you age, while your cover stays the same each year. 3. A decreasing cover where your premium stays the same each year while your benefit varies each year, depending on your age and MLC's premium rates at the time. Please see pages 47 and 63 for further details. What you can do next Please take the time to read this Product Disclosure Statement carefully and, if you have any questions, we recommend you speak with your financial adviser. If you don’t have an adviser, then we can put you in contact with one. Just visit mlc.com.au and go to the Advice section on our personal page. Page 08 MLC Life Cover Super and MLC Personal Protection Portfolio PDS This page has been left blank intentionally. MLC Life Cover Super and MLC Personal Protection Portfolio PDS Page 09 The types of insurance offered Page 10 MLC Life Cover Super and MLC Personal Protection Portfolio PDS MLC provides a range of insurance products to meet your personal and business needs. The flexible design of our products means you can protect all members of your family and/or business under the one policy or tailor our products to suit your particular needs if required. Here is a summary of the insurance solutions that we offer. Your need The MLC Solution Protect your family by making sure they’re financially secure should you die. Life Cover 1 Having the comfort of knowing you have financial security if you suffer a total and permanent disability and can’t work. Total and Permanent Disability 1 The relief of knowing that your finances are protected should you suffer a critical illness. Critical Illness If you can’t work due to sickness or injury, the comfort of knowing your rent, mortgage or living costs are covered. Income Protection 1 Keeping your business going by paying your fixed expenses if you become totally disabled and can’t work. Business Expenses Helping you maintain your policy if you’re suffering financial hardship through disablement or retrenchment. Premium Waiver 1 1 These can be purchased through superannuation. Protect yourself MLC Life Cover Super and MLC Personal Protection Portfolio PDS Page 11 T h e t y p e s o f i n s u r a n c e o f f e r e d Life Cover insurance Life Cover insurance pays an agreed lump sum if you die or if you are diagnosed with a terminal illness. Life Cover at a glance Life Cover Super Personal Protection Portfolio Standard Plus Standard Plus What are you covered for? Death • • • • Terminal Illness • • • • What features are built in? Advance Death Benefit • • Accidental Injury • • Financial Planning Benefit • • Continuation Option for level premium • • • • Increases without Medical Evidence • • What options can you choose at an additional cost? Terminal Illness Support Option • • • • Business Safeguard Option • • • • Total and Permanent Disability (TPD) and Loss of Independence as part of Life Cover or as a Connected Benefit (not available with decreasing cover) • • • • Critical Illness as part of Life Cover • • Critical Illness as a Connected Benefit with Life Cover (not available with decreasing cover) • • • • At what age can you apply for Life Cover insurance? Level premium 15–59 15–59 Stepped premium or decreasing cover 15–64 10–69 Terminal Illness Support Option (stepped and level premium) 18–59 18–59 To what age can you renew your insurance? Level premium guaranteed renewable up to age 65 (then a continuation option is offered for stepped premium) Stepped premium or decreasing cover guaranteed renewable up to age 100 What amount can you apply for? Minimum amount insurable $25,000 Maximum amount insurable no general maximum (special terms may apply for amounts greater than $15,000,000) For more information on Financial Planning Benefit, Continuation Option, Increases without Medical Evidence and Business Safeguard Option please read the ‘Information common to Life Cover, Total and Permanent Disability (TPD) and Critical Illness’ section on pages 23 to 26. Page 12 MLC Life Cover Super and MLC Personal Protection Portfolio PDS When will MLC pay? Death If you die MLC will pay your specified Life Cover benefit. Terminal Illness If you are diagnosed with a terminal illness MLC will pay the Life Cover benefit. You will not have to return the Terminal Illness benefit to MLC if you survive the 12 month terminal illness period. Advance Death Benefit (for PPP only) If your Life Cover benefit is $20,000 or more and you die, MLC will pay one advance of $20,000 in proportionate shares to any remaining policy owners or nominated beneficiaries who are entitled to the Life Cover benefit. The Life Cover benefit will then be reduced by $20,000. MLC must receive a written request, with a certified copy of your birth certificate and death certificate, or an extract of death registration to pay the advance. Payment of the Advance Death Benefit is not an admission of liability by MLC to pay the Life Cover benefit, and may be recovered by MLC if the Life Cover claim is denied. Accidental Injury Cover (for Life Cover Plus only) 1 If you have an accident and lose: • the use of both hands or both feet, or • the sight in both eyes, or • the use of one hand and one foot, or • the use of one foot or hand and the sight in one eye MLC will pay the full Life Cover benefit up to a maximum of $2,000,000. OR if you lose: • the use of one hand or foot, or • the sight in one eye MLC will pay 25% of your Life Cover benefit, up to a maximum of $500,000. Any loss must be complete and permanent, be a direct result of the accident and occur within six months of the accident. Terminal Illness Support Option (for stepped and level premium) 1 If you are diagnosed with a terminal illness and live for 30 days after MLC is notified, MLC will pay the lesser of 50% of the Life Cover benefit or $250,000. You are eligible for this benefit up until the review date after you turn 65. This Terminal Illness Support benefit is in addition to any Life Cover benefit paid due to terminal illness, and you will not have to return the money to MLC if you survive the 12 month terminal illness period. The Terminal Illness Support benefit can be used to pay for your immediate or future needs when diagnosed with a terminal illness (such as medical bills or a family holiday). 1 The maximum amount stated is the most you will be paid, no matter how many MLC insurance policies (inside or outside superannuation) cover you. If you have more than one policy where the total of all MLC policies is greater than the maximum amount, each policy will proportionally contribute to the maximum amount. For LCS, the Trustee will not be able to release the Accidental Injury benefit to you unless you satisfy the criteria for permanent incapacity in the superannuation legislation. Please see ‘Accessing your MLC Life Cover Super benefit’ on page 59 for further guidance on when the Trustee can release the benefits to you. Life Cover insurance MLC Life Cover Super and MLC Personal Protection Portfolio PDS Page 13 T h e t y p e s o f i n s u r a n c e o f f e r e d When do Life Cover and Terminal Illness Support insurance end? Your insurance will end when: • the insurance is cancelled at your written request (cover ceases on the next paid-to date and MLC will not refund any premium paid up to then) • the insurance is cancelled because you stop paying premiums • the policy is cancelled because you make a fraudulent claim • MLC pays your full Life Cover benefit or your full Terminal Illness Support benefit (where applicable) • MLC pays your full TPD or Loss of Independence benefit and/or Critical Illness benefit, if they were part of or connected to Life Cover and the benefit paid equals the Life Cover insurance • for LCS, the policy is converted to non-superannuation insurance (insurance will continue as detailed on page 64) • you reach the expiry age for your type of insurance and premium structure • you reach the termination date shown on your Schedule • for Terminal Illness Support Option, your Life Cover insurance ends • you die. Expiry ages: • cover for level premium and Terminal Illness Support stepped premium ceases on the next review date after you turn 65 • 75 for stepped premium or decreasing cover for Life Cover in LCS • cover for stepped premium or decreasing cover for Life Cover in PPP ceases on the next review date after you turn 100. How does a claim affect your insurance? Your Life Cover insurance will be reduced by any Accidental Injury benefit paid. If you also have Terminal Illness Support insurance, the amount of that type of insurance will be reduced to the lesser of $250,000 or 50% of the reduced Life Cover insurance. MLC will reduce the premiums payable in line with the reduced insurance for both the Life Cover and Terminal Illness Support Option. When won’t MLC pay? MLC will not pay a benefit: Life Cover if you commit suicide within 13 months after this type of insurance began or was last reinstated; this also applies to the amount of any increase made to the Life Cover insurance in the 13 months before suicide. Accidental Injury (or may pay a smaller amount) if you had already lost the use of one hand, foot or eye before this type of insurance began or was last reinstated. for accidental injury arising from war or warlike operations. Terminal Illness Support Option for any terminal illness arising from or contributed to by: • intentional self-inflicted injury or attempted suicide • any injury that occurred, or sickness that first appeared, before the policy commenced or was last reinstated (unless disclosed to, and accepted by, MLC as part of the application or reinstatement process). Page 14 MLC Life Cover Super and MLC Personal Protection Portfolio PDS Total and Permanent Disability (TPD) and Loss of Independence insurance You will receive a lump sum if you suffer total and permanent disability or loss of independence. MLC will insure you for TPD until the review date after you turn 65. After that date, MLC will insure you only for loss of independence. You can be covered under different definitions of TPD, which include Any Occupation, Own Occupation and ‘not gainfully employed’. For more detail on TPD and Loss of Independence definitions, please see ‘Total and Permanent Disability (TPD) and Loss of Independence Definitions’ on pages 73 to 74. TPD and Loss of Independence at a glance Life Cover Super Personal Protection Portfolio How can you structure this insurance? either TPD and Loss of Independence as part of Life Cover • • or TPD and Loss of Independence as a Connected Benefit (not available with decreasing cover) • • or TPD and Loss of Independence as stand-alone insurance (not available with decreasing cover) • What features are built in? Financial Planning Benefit • Continuation Option for level premium • • Increases without Medical Evidence • • What options can you choose at an additional cost? Own Occupation Definition (eligible occupations only) • • Life Cover Buy Back (not applicable to stand-alone) • • Business Safeguard Option • • At what age can you apply for TPD insurance? Level premium 15–54 Stepped premium or decreasing cover 15–59 What amount can you apply for? Minimum amount insurable $25,000 Maximum amount insurable $3,000,000 For more information on Financial Planning Benefit, Continuation Option, Life Cover Buy Back, Increases without Medical Evidence and Business Safeguard Option please read the ‘Information common to Life Cover, Total and Permanent Disability (TPD) and Critical Illness’ section on pages 23 to 26. MLC Life Cover Super and MLC Personal Protection Portfolio PDS Page 15 T h e t y p e s o f i n s u r a n c e o f f e r e d When will MLC pay? To claim under this insurance all terms of the policy definition must be met. Diagnosis and certification must be provided by a doctor who is an appropriate specialist and confirmed by MLC’s medical adviser. TPD Until the review date after you turn 65, if you become totally and permanently disabled MLC will pay your full TPD benefit. Loss of Independence Following the review date after you turn 65, if you lose your independence MLC will pay your full Loss of Independence benefit, up to a maximum of $500,000. After you turn 75, your premium will be set and your benefit will be reduced each year in line with MLC’s premium rates at the time for this type of insurance. Stand-alone TPD and Loss of Independence For a claim to be payable for stand-alone TPD and Loss of Independence you must survive for at least: • six months to claim for TPD or loss of independence • 14 days to claim for TPD based on the total and irrecoverable loss of limbs or sight. If you die within 14 days after becoming totally and permanently disabled, MLC will pay a benefit of $5,000. How can you structure TPD and Loss of Independence insurance? a) as part of your Life Cover The amount of TPD and Loss of Independence insurance you choose must not exceed your Life Cover insurance. When you also choose Critical Illness insurance as part of your Life Cover, the combined amount must not exceed your Life Cover insurance. b) as a Connected Benefit You can have TPD and Loss of Independence insurance, and Life Cover, as separate policies with different owners, but take advantage of connecting the TPD insurance to your Life Cover. For example you or your business could own TPD as a PPP policy (outside super), and connect it to Life Cover taken in LCS (inside super). When you also choose Critical Illness insurance as a Connected Benefit with TPD, the combined amount must not exceed your Life Cover insurance. Note: stand-alone TPD insurance cannot be connected to Life Cover insurance. c) as stand-alone insurance In PPP (not available with decreasing cover) you can choose to hold this insurance separately from your Life Cover. Special waiting periods apply to claims for stand-alone TPD and Loss of Independence insurance. For LCS, the Trustee will not be able to release the TPD or Loss of Independence benefit to you unless you satisfy the criteria for permanent incapacity in the superannuation legislation. Please see ‘Accessing your MLC Life Cover Super benefit’ on page 59 for further guidance on when the Trustee can release the benefits to you. Page 16 MLC Life Cover Super and MLC Personal Protection Portfolio PDS When does TPD and Loss of Independence insurance end? Your insurance will end when: • the insurance is cancelled at your written request (cover ceases on the next paid-to date and MLC will not refund any premium paid up to then) • the insurance is cancelled because you stop paying premiums • the policy is cancelled because you make a fraudulent claim • MLC pays your full TPD or Loss of Independence benefit • MLC pays your full TPD or Loss of Independence benefit and/or Critical Illness benefit, if they were part of or connected to Life Cover and the benefit paid equals the Life Cover insurance • MLC pays your full Life Cover benefit or your Life Cover insurance ends, if your TPD and Loss of Independence insurance is part of or connected to Life Cover • for LCS, the policy is converted to non-superannuation insurance (insurance will continue as detailed on page 64) • you reach the expiry age for your type of insurance and premium structure • you reach the termination date shown on your Schedule • you die. Expiry ages: • cover for level premium ceases on the next review date after you turn 65 • 75 for stepped premium or decreasing cover in LCS • cover for stepped premium or decreasing cover in PPP ceases on the next review date after you turn 100. How does a claim affect your insurance? If you have TPD and Loss of Independence insurance as part of your Life Cover or as a Connected Benefit: • your Life Cover insurance will be reduced by the claim amount paid for TPD or Loss of Independence and, if applicable, your Terminal Illness Support insurance will also be reduced to the lesser of 50% of the reduced Life Cover insurance or $250,000 • when MLC pays some or all of your Life Cover insurance for Terminal Illness or Accidental Injury, your TPD and Loss of Independence insurance will be reduced by the claim amount paid. MLC will reduce your future premiums in line with the reduced insurance. If you have stand-alone TPD and Loss of Independence insurance: • your Life Cover and Terminal Illness Support insurance will not be reduced by the claim amount paid for TPD or Loss of Independence • your TPD and Loss of Independence insurance will not be reduced by any claim paid under your Life Cover insurance, including claims paid for Terminal Illness or Accidental Injury. When won’t MLC pay? MLC will not pay: TPD and Loss of Independence (including stand-alone) a benefit for any total and permanent disablement or loss of independence arising from or contributed to by: • intentional self-inflicted injury or attempted suicide • any injury that occurred, or sickness that first appeared, before the policy commenced or was last reinstated (unless disclosed to, and accepted by, MLC as part of the application or reinstatement process). Stand-alone TPD and Loss of Independence the death benefit of $5,000 if you commit suicide within 13 months after this insurance began or was last reinstated. Total and Permanent Disability (TPD) and Loss of Independence insurance MLC Life Cover Super and MLC Personal Protection Portfolio PDS Page 17 T h e t y p e s o f i n s u r a n c e o f f e r e d Critical Illness insurance Critical Illness insurance pays you a lump sum if you suffer a critical condition. Critical Illness at a glance Personal Protection Portfolio Standard Plus How can you structure this insurance? either Critical Illness as part of Life Cover • • or Critical Illness as a Connected Benefit (not available with decreasing cover) • • or Critical Illness as stand-alone insurance • What are you covered for? A range of critical conditions limited wide and Critical conditions and definitions on renewal may change cannot be changed What features are built in? Financial Planning Benefit • • Continuation Option for level premium • • Increases without Medical Evidence • What options can you choose at an additional cost? Total and Permanent Disability (TPD) as a Critical Condition (not available under stand-alone) • • Life Cover Buy Back (not applicable to stand-alone) • • Extra Benefits Option: • Additional critical conditions for which a partial benefit is payable • Critical Illness Buy Back • • At what age can you apply for Critical Illness insurance? Level premium, stepped premium or decreasing cover 18–59 To what age can you renew your insurance? Level premium guaranteed renewable up to age 65 (then a continuation option is offered for stepped premium) Stepped premium or decreasing cover guaranteed renewable up to age 75 What amount can you apply for? Minimum amount insurable $25,000 Maximum amount insurable $2,000,000 For more information on Financial Planning Benefit, Continuation Option, Life Cover Buy Back and Increases without Medical Evidence please read the ‘Information common to Life Cover, Total and Permanent Disability (TPD) and Critical Illness’ section on pages 23 to 26. Page 18 MLC Life Cover Super and MLC Personal Protection Portfolio PDS What is a critical condition? You are deemed to meet a critical condition when the condition is first diagnosed as meeting its definition or, for surgical conditions, when the surgery is actually performed. An appropriate specialist and MLC’s medical adviser must agree that your condition meets all the terms of MLC’s detailed definitions (see ‘Critical Conditions Definitions’ on pages 75 to 79). In some cases a condition must progress to a certain point before it meets the definition. Qualifying periods Some critical conditions are covered only after a period of time known as a qualifying period. This means that you are not covered for those conditions when they first appear, first happen or are first diagnosed within the qualifying period after this insurance began, was last reinstated or increased. For surgical procedures this means that you are not covered when the underlying condition requiring the surgical intervention first appears, first happens or is first diagnosed within the qualifying period. However, MLC will cover you for a future occurrence of those critical conditions if they appear, happen or are diagnosed after the qualifying period and are independent of, and not related to, the earlier occurrence of the conditions. If the policy replaces similar insurance, the qualifying period will be waived for the amount of benefit that would have applied under the replaced policy had it continued. Which critical conditions are covered by Critical Illness Standard and Plus? The following table sets out the critical conditions covered by Critical Illness Standard and Plus (see ‘Critical Conditions Definitions’ on pages 75 to 79 for detailed definitions). How can you structure Critical Illness insurance? a) as part of your Life Cover The amount of Critical Illness insurance you choose must not exceed your Life Cover insurance. When you also choose TPD insurance as part of your Life Cover, the combined amount must not exceed your Life Cover insurance. b) as a Connected Benefit You can have Critical Illness insurance and Life Cover as separate policies with different owners, but take advantage of connecting the Critical Illness insurance to your Life Cover. For example you could have your Life Cover insurance in LCS (inside super) and, as Critical Illness is not available inside super, you could own Critical Illness insurance as a PPP policy (outside super) connected to that Life Cover. When you also choose TPD insurance as a Connected Benefit with Critical Illness insurance, the combined amount must not exceed your Life Cover insurance. Note: stand-alone Critical Illness insurance cannot be connected to Life Cover insurance. c) as stand-alone insurance With Critical Illness Plus you can choose to hold this insurance separately from your Life Cover. Critical Illness insurance MLC Life Cover Super and MLC Personal Protection Portfolio PDS Page 19 T h e t y p e s o f i n s u r a n c e o f f e r e d Critical condition Critical Illness Standard Critical Illness Plus Qualifying period Aorta repair • 3 months Aplastic anaemia • Bacterial meningitis • Benign brain tumour • Blindness • Cardiomyopathy • Chronic kidney failure • Chronic liver failure • Chronic lung failure • Coma • Coronary artery angioplasty 1 • 3 months Coronary artery angioplasty – triple vessel 2 • 3 months Coronary artery bypass surgery • • 3 months Deafness • Dementia or Alzheimer’s disease • Encephalitis • Heart attack • • 3 months Heart valve surgery • 3 months HIV contracted through medical procedures • HIV contracted through your work • Intensive care • Loss of independence • • Loss of speech • Major brain injury • Major burns • Critical condition Critical Illness Standard Critical Illness Plus Qualifying period Major organ transplant • Malignant cancer • • Standard: 6 months Plus: 3 months Meningococcal septicaemia • Motor neurone disease • Multiple sclerosis • Muscular dystrophy • Open heart surgery • Out of hospital cardiac arrest • Parkinson’s disease • Paralysis (includes paraplegia, quadriplegia, hemiplegia, diplegia, tetraplegia) • Pneumonectomy • Primary pulmonary hypertension • Severe osteoporosis • Severe rheumatoid arthritis • Stroke • • 3 months Total and permanent disability (TPD) (optional – not available with stand-alone cover) • • 1 Coronary artery angioplasty benefit will only apply if your Critical Illness benefit is $100,000 or more. The benefit payable for Coronary artery angioplasty is 10% of the Critical Illness benefit up to a maximum of $20,000. You can claim for this condition only the first time you have this operation. 2 The benefit payable for Coronary artery angioplasty—triple vessel is 100% of your Critical Illness benefit. It is only available the first time you have this operation. Page 20 MLC Life Cover Super and MLC Personal Protection Portfolio PDS Conditions covered by Critical Illness Standard and their definitions may change As advances are made in treatment and diagnostic techniques, MLC may need to change the definitions used to ensure that they: • remain appropriate with regard to medical terminology and classification • take into account effective cures, vaccines and modern diagnostic procedures • include some conditions considered appropriate in the future • exclude some conditions that are no longer considered critical. As a result, if you choose Critical Illness Standard, MLC may continue your insurance on the same or different conditions and definitions on renewal. MLC does not guarantee to renew your current policy terms and conditions for this type of insurance. Where a change is necessary, the change will apply to all insurances of a similar type. MLC cannot single you out for a change. MLC will notify you of any changes to your critical conditions or definitions. You may accept the new conditions by continuing to pay your premiums and you will in effect be entering into a new policy. You may choose to reject these changes by not making further premium payments and your policy will lapse. When will MLC pay? Critical Illness If you suffer a critical condition MLC will pay you a lump sum. Stand-alone Critical Illness If you live for 14 days after suffering a critical condition, MLC will pay the full Critical Illness benefit. If you die within 14 days after suffering a critical condition, MLC will pay a benefit of $5,000. Qualifying periods and exclusions apply for certain critical conditions. Critical Illness insurance How does a claim affect your insurance? If you have Critical Illness insurance as part of your Life Cover or as a Connected Benefit: • your Life Cover insurance will be reduced by the claim amount paid for Critical Illness and, if applicable, your Terminal Illness Support insurance will also be reduced to the lesser of 50% of the reduced Life Cover insurance or $250,000 • your Critical Illness insurance will be reduced by the claim amount paid for your Life Cover benefit for Terminal Illness or Accidental Injury. MLC will reduce your future premiums in line with the reduced insurance. If you have stand-alone Critical Illness insurance: • your Life Cover and Terminal Illness Support insurance will not be reduced by the claim amount paid for Critical Illness • your Critical Illness will not be reduced by any claim paid under Life Cover insurance for Terminal Illness or Accidental Injury. What options can you choose at an additional cost? Total and Permanent Disability (TPD) as a Critical Condition If you choose Critical Illness as part of your Life Cover or as a Connected Benefit, you can add the following TPD definitions to the critical conditions under Critical Illness insurance: • Any Occupation • Own Occupation (for eligible occupations only). The following entry ages apply: • 18 to 54 for level premium • 18 to 59 for stepped premium or decreasing cover. Extra Benefits Option (for Critical Illness Plus) If you choose Critical Illness Plus you can add one or both of the following extra benefits: • additional critical conditions for which a partial benefit is payable • Critical Illness Buy Back—an option to buy back your Critical Illness insurance. MLC Life Cover Super and MLC Personal Protection Portfolio PDS Page 21 T h e t y p e s o f i n s u r a n c e o f f e r e d Additional critical conditions for which a partial benefit is payable If you suffer any of the following additional critical conditions MLC will pay you 20% of the Critical Illness benefit, subject to a minimum of $10,000 and the maximum partial benefit payable for each additional critical condition in the following table. Only one claim will be paid for each of the additional critical conditions. See ‘Critical Conditions Definitions – Extra Benefits Option’ on pages 80 to 82 for detailed definitions. Additional critical conditions Qualifying period Maximum partial benefit payable Adult onset insulin dependent diabetes mellitus $100,000 Advanced endometriosis Carcinoma in situ of the breast 3 months Chronic lymphocytic leukaemia 3 months Deafness in one ear Diagnosed motor neurone disease Diagnosed multiple sclerosis Diagnosed muscular dystrophy Diagnosed Parkinson’s disease Facial reconstructive surgery and skin grafting Placement on waiting list for major organ transplant Prostate cancer 3 months Serious accidental injury Loss of one foot or one hand $200,000 Loss of sight in one eye Congenital abnormalities of a child 1 year $50,000 Inability of a child to gain independence 1 year Death of a child 1 year $20,000 Melanoma 3 months Specified complications of pregnancy 1 year How does a claim under the Extra Benefits Option affect your insurance? If you are covered for additional critical conditions under the Extra Benefits Option with Critical Illness, as part of your Life Cover or as a Connected Benefit, MLC will reduce your Critical Illness benefit and your Life Cover insurance by the amount of any Critical Illness benefit MLC pays you under the option. Your Terminal Illness Support insurance (if applicable) will also be reduced to the lesser of 50% of the reduced Life Cover insurance or $250,000. MLC will reduce your future premiums in line with the reduced insurance. If you take this option with stand-alone Critical Illness insurance, any Life Cover you have will not be affected. Critical Illness Buy Back Until the review date after you turn 75, this option allows you to apply to restore your original Critical Illness insurance one year after MLC pays your full Critical Illness benefit. You may restore up to 100% of the original Critical Illness insurance, but you must apply within 30 days after the one year waiting period ends. The restored insurance will not cover a critical condition: • for which a benefit or partial benefit has been paid • which is related to, arises from or is contributed to by (directly or indirectly, or wholly or partly) any critical condition for which a benefit or partial benefit has been paid. TPD will not be available under the restored Critical Illness insurance. The Financial Planning Benefit will not be available under the restored Critical Illness insurance if it has been paid previously. If you have Critical Illness as part of your Life Cover or as a Connected Benefit, you must buy back your Life Cover (if you have this option) when you restore your Critical Illness insurance. If you do not have the option to buy back your Life Cover you can be issued stand-alone Critical Illness insurance. If your Critical Illness insurance was issued as a Connected Benefit and your Life Cover is restored at the same time under Life Cover Buy Back, the owner of the original connected Life Cover policy will own the restored Life Cover insurance. Page 22 MLC Life Cover Super and MLC Personal Protection Portfolio PDS MLC will base the premium for the restored insurance on MLC’s normal Critical Illness rates and your age at the time, taking into account the insured benefit, your premium structure and any special conditions on your original Critical Illness insurance. When won’t MLC pay? MLC will not pay: Critical Illness (including stand-alone) a benefit for any critical conditions arising from or contributed to by: • intentional self-inflicted injury or attempted suicide • any injury that occurred, or sickness that first appeared, first happened or was first diagnosed before the policy commenced or was last reinstated—or, for Critical Illness Plus Extra Benefits Option, before the option began or was last reinstated— (unless disclosed to, and accepted by, MLC as part of the application or reinstatement process). Stand-alone Critical Illness the death benefit of $5,000 if you commit suicide within 13 months after this insurance began or was last reinstated. When does Critical Illness insurance end? Your insurance will end when: • the insurance is cancelled at your written request (cover ceases on the next paid-to date and MLC will not refund any premium paid up to then) • the insurance is cancelled because you stop paying premiums • the policy is cancelled because you make a fraudulent claim • MLC pays your full Critical Illness benefit • MLC pays your full Critical Illness benefit, and/or TPD or Loss of Independence benefit, if they were part of or connected to your Life Cover and the benefit paid equals the Life Cover insurance • MLC pays your full Life Cover benefit or your Life Cover insurance ends, if your Critical Illness insurance is part of or connected to Life Cover • you reach the expiry age for your type of insurance and premium structure • you reach the termination date shown on your Schedule • you die. Expiry ages: • cover for level premium ceases on the next review date after you turn 65 • cover for stepped premium or decreasing cover ceases on the next review date after you turn 75 • cover for TPD as a Critical Condition option ceases on the next review date after you turn 65. Critical Illness insurance MLC Life Cover Super and MLC Personal Protection Portfolio PDS Page 23 T h e t y p e s o f i n s u r a n c e o f f e r e d Life Cover Buy Back This option is available if you choose TPD or Critical Illness as part of your Life Cover insurance or as a Connected Benefit until the review date after you turn 75. If you purchase the Life Cover Buy Back option for TPD or Critical Illness insurance, MLC will restore your Life Cover insurance up to the original insurance amount if you: • survive 14 days after MLC pays your full TPD or Loss of Independence benefit • survive 14 days after MLC pays your full Critical Illness benefit due to TPD as a Critical Condition • apply one year after MLC has paid your full Critical Illness benefit where the benefit is not paid due to TPD as a Critical Condition (you must apply within 30 days after the one year waiting period ends). Limitations For TPD: • your restored insurance will only apply to death, not to Terminal Illness or Accidental Injury • if you take out TPD under LCS, in certain cases you may need to take new insurance outside the Scheme. For Critical Illness: • your restored insurance will only apply to death and Terminal Illness (unless paid previously), not to Accidental Injury. If the Terminal Illness Support Option and the Financial Planning Benefit have been paid previously they will not be available under the restored Life Cover. If your TPD or Critical Illness insurance was issued as a Connected Benefit, the owner of the original connected Life Cover policy will also own the restored Life Cover insurance. MLC will base the premium for the restored insurance on MLC’s normal Life Cover rates and your age at the time, taking into account the insured benefit, your premium structure and any special conditions on your original insurance. Financial Planning Benefit (for PPP only) When MLC pays a lump sum benefit of at least $100,000, you or your beneficiary can claim up to $2,000, for a fully documented financial plan prepared by a qualified financial adviser. If there is more than one beneficiary of the lump sum benefit, the Financial Planning Benefit will be divided equally between those who each receive at least $100,000. The reimbursement must be claimed: • within six months of the date when we pay the lump sum benefit • only once for all MLC policies covering you. MLC reserves the right to increase the minimum lump sum benefit amount of $100,000. MLC will let you know when this happens. Continuation Option (for level premium after age 65 only) Level premium Life Cover, TPD and Loss of Independence, and Critical Illness insurances end when you turn 65. If the policy is claim free, the Continuation Option lets you continue with the nearest equivalent MLC insurance available at the time, up to the same insurance amount, on a stepped premium. New terms and conditions may apply. For TPD and Loss of Independence, continued cover is for loss of independence only. You must apply for continuation within 30 days of the termination date of your existing insurance. For TPD and Loss of Independence and for Critical Illness you must exercise your Life Cover Continuation Option at the same time. Information common to Life Cover, Total and Permanent Disability (TPD) and Critical Illness Page 24 MLC Life Cover Super and MLC Personal Protection Portfolio PDS Increases without Medical Evidence (for Life Cover Plus, TPD and Critical Illness Plus only) Until the review date after you turn 55, you can apply to increase your Life Cover, TPD and Critical Illness insurance (as applicable) without further medical evidence due to specified personal and business events. You must apply for the increase at any time between the event and 30 days after the first review date following a personal event and within 30 days after the first review date following a business event. Your premiums will rise in line with the increased insurance. Personal events You can apply to increase your Life Cover, TPD and Critical Illness insurance by up to 25% of your original insured benefit (your insured benefit at the date the policy began), up to a maximum of $200,000 per event, if any of these personal events occur: • you or your spouse adopt or give birth to a child • you get married or divorced • you complete an undergraduate degree at a government-recognised university • you have a dependent child who starts secondary school. If you take out, or increase, a mortgage to buy or improve your home, the maximum increase MLC allows in your Life Cover, TPD and Critical Illness insurance is the lowest of: • 50% of your original insurance • the value of your new mortgage • the value of the latest increase to your existing mortgage • $200,000. Business events You can apply to increase your Life Cover, TPD and Critical Illness insurance if the insurance is used for one of the following purposes: • a written ownership (buy/sell), share purchase or business continuation agreement under which you are a partner, shareholder or unit holder in the business • revenue protection (key person) insurance if you are a key person in the business (for PPP only) The increase will be in proportion to the increase in value over the year of your financial interest in the business or of the key person to your business (as agreed by MLC). The maximum increase allowed is the lowest of: • 25% of your original insurance • the increase, averaged over the last three years, in the net value of your share of the business • $200,000. What conditions apply for personal and business events? Number and frequency of increases Until the review date, after you turn 55, you can apply for increases as many times as the listed events occur while you have the policy. However, you may only apply for an increase for one personal and one business event each year. Limitations The maximum by which you can increase each insurance (Life Cover, TPD or Critical Illness as applicable) without medical evidence is the lesser of the original amount of each insurance or $1,000,000. If more than one MLC insurance policy covers you, these maximums apply to the combination of all MLC policies covering you, and each policy that provides Increases without Medical Evidence for Life Cover, TPD or Critical Illness as applicable will proportionally contribute to any such increase. However, the maximum amount of all increases in the Life Cover, TPD and Critical Illness insurance (as applicable) under this right for all MLC policies covering you is the lesser of: • the total of your Life Cover, TPD and Critical Illness insurances (as applicable), or • $1,000,000. If you have TPD and/or Critical Illness as part of your Life Cover or as a Connected Benefit, MLC’s maximum benefit limits for them still apply and they can’t collectively exceed your Life Cover. Information common to Life Cover, Total and Permanent Disability (TPD) and Critical Illness MLC Life Cover Super and MLC Personal Protection Portfolio PDS Page 25 T h e t y p e s o f i n s u r a n c e o f f e r e d During the first six months after certain increases, increased amounts cover you only for the following specified events caused by accident: Type of insurance: Reason for increase: In the first six months the increase covers only: Life Cover marriage, divorce or mortgage death caused by accident Critical Illness marriage, divorce or mortgage death and critical conditions caused by accident TPD all specified event reasons TPD caused by accident You can apply to increase your Life Cover, TPD and Critical Illness insurance only if: • MLC originally insured you without any additional loading due to your health, occupation or pastimes • your Life Cover insurance was not restored by the Life Cover Buy Back option under TPD and/or Critical Illness • your Critical Illness insurance was not restored by the Critical Illness Buy Back option under the Critical Illness Plus Extra Benefits Option. The increased insurance does not cover you for any TPD claim caused by an accident or sickness that first occurred within six months prior to the increase date. You cannot apply to increase your Life Cover, TPD and Critical Illness insurance (as applicable) when a claim is made or is entitled to be made. Business Safeguard Option (for Life Cover and TPD only) For an additional cost, Business Safeguard Option lets you increase your Life Cover and TPD insurance (if applicable) without further medical evidence if the insurance is used for one of the following purposes: • an ownership (buy/sell) agreement where your share of the business is purchased by any remaining partners when certain events occur (for example, your death or disability) • asset protection (loan guarantee) insurance • revenue protection (key person) insurance (for PPP only) and the value of your financial interest in the business, loan guarantee, or the value of the key person to your business increases. You must apply for the increase within 30 days either side of the review date. Your premiums will rise in line with the increased insurance. Page 26 MLC Life Cover Super and MLC Personal Protection Portfolio PDS How do you apply for Business Safeguard increases? To apply for an increase, write to MLC and provide a valuation of your business or of the key person to your business as performed by an independent qualified accountant or business valuer, or evidence of the loan guarantee, and any other contractual or financial evidence MLC may request to satisfy itself that the value of your financial interest is at least equal to the increase you request. At what age can you apply for Business Safeguard Option? Stepped and level premium Life Cover 18–59 Stepped premium TPD 18–59 Level premium TPD 18–54 When does this option end? At the review date after you turn 65 If not used within three consecutive review dates (policy years) Maximum benefit increase Life Cover three x original insured amount up to $10,000,000 This maximum includes Life Cover or TPD from all sources covering you. TPD three x original insured amount up to $3,000,000 This option is not available for decreasing cover Life Cover. What conditions apply to Business Safeguard Option? Any insurance increase must be approved by MLC. For TPD insurance as part of Life Cover insurance, Business Safeguard Option is only available where you have selected it with your Life Cover. Limitations For TPD insurance as part of your Life Cover or as a Connected Benefit, the TPD insurance cannot be more than your Life Cover insurance, so you may need to increase your Life Cover insurance to increase your TPD insurance. You do not have to increase your TPD insurance if you increase your Life Cover. The total amount of the Life Cover or TPD benefit (if applicable) for all policies from all sources under Business Safeguard Option cannot exceed the value (as applicable) of: • your financial interest in the business • the loan guarantee • the key person to the business (PPP only). If your original Life Cover or TPD insurance was less than 100% of the value of your financial interest in the business, the loan guarantee or the key person to the business, your insurance can only increase under this option to an equivalent percentage of their value at the time you apply for an increase. During the first six months after an increase for a loan guarantee, the increase amount covers you only for death and TPD (if applicable) caused by an accident. If the Business Safeguard Option is not exercised within any 3 consecutive review dates (policy years), no further application for increases can be made unless the value of your financial interest in the business, loan guarantee, or the value of the key person to your business has not increased during the period. You cannot apply for a benefit increase under this option when a claim is made or is entitled to be made under your Life Cover insurance or TPD insurance. Information common to Life Cover, Total and Permanent Disability (TPD) and Critical Illness MLC Life Cover Super and MLC Personal Protection Portfolio PDS Page 27 T h e t y p e s o f i n s u r a n c e o f f e r e d Income Protection insurance Income Protection insurance pays a benefit each month that you are totally or partially disabled or under rehabilitation. This benefit is usually payable monthly in arrears from the end of the waiting period you choose. Income Protection at a glance Professional, Clerical and General Occupations Special Risk Occupations Farmers under the Farmers Package Your policy type: Life Cover Super Personal Protection Portfolio Life Cover Super Personal Protection Portfolio Personal Protection Portfolio Standard Plus Standard Plus Standard Plus Standard Plus Plus What are you covered for? Total Disability: Own Occupation definition • • • • • 2 years Own Occupation, then Any Occupation definition • • • • Partial Disability or Rehabilitation • • • • • • • • • Death benefit • • • • • • • • • What features are built in? World-wide coverage, 24 hours a day, 7 days a week • • • • • • • • • Choice of waiting periods • • • • • • • • • Choice of benefit periods • • • • • • • • • Rehabilitation Expenses • • • • • Rehabilitation Bonus • • • Premium waived while you receive benefits • • • • • • • • • Return to work during waiting period • • • • • • • • • Recurring Disability Benefit • • • • • • • • • Extended Leave Cover • • • • • • • • • Elective Surgery Benefit • • • • • • • • • Style of benefit Indemnity Benefit (see page 32) • • • • Agreed Value Benefit (see page 32) • • • • • What options can you choose to lower the cost? Indemnity Option • • • • HIV/AIDS Exclusion Discount • • • • • • • • • Non-Occupational Cover Discount • • • • What option can you choose at extra cost? Indexed Claim Benefits • • • • • • • • • Short waiting period for  accidental injury • • Extra Benefits Option • • • Occupational HIV, Hepatitis B or C Lump Sum Benefit (certain professions) • Page 28 MLC Life Cover Super and MLC Personal Protection Portfolio PDS What type of occupations are covered under Income Protection? Professional, Clerical and General Occupations Covers people in most occupations. Special Risk Occupations Covers people who work in certain special risk occupations which are hazardous or present special assessment difficulties, such as armed security guards. For this type of insurance, MLC will review your Income Protection insurance each year and may offer, but does not guarantee, its renewal. The maximum benefit period available is five years. Farmers (under the Farmers Package) Covers principal farm owners whose farm has been in operation for a minimum of two years and has a positive balance sheet (total assets exceeding total liabilities) over the two financial years prior to application. The benefit is based on the gross farm turnover (the total revenue received by the farm business throughout the financial year prior to application). MLC or your financial adviser can tell you your occupation category. Life Cover Super Personal Protection Portfolio At what age can you apply for Income Protection insurance? Professional and Clerical Occupations 18–59 18–59 General Occupations 18–54 18–54 Special Risk Occupations 18–54 18–54 Farmers under the Farmers Package n/a 18–54 To what age can you renew your insurance? Professional and Clerical Occupations, General Occupations and Farmers under the Farmers Package guaranteed renewable up to age 65 Special Risk Occupations not guaranteed renewable up to age 65 What benefit can you apply for? Minimum benefit $500 per month Maximum benefit Professional, Clerical and General, and Special Risk Occupations maximum 75% of your earnings up to $30,000 per month based on: • 75% of the first $240,000 per annum of earnings • plus 50% of the next $240,000 per annum of earnings • plus 25% of the next $240,000 per annum of earnings Farmers (under the Farmers Package) either up to $5,000 per month for a two year maximum benefit period or up to $5,000 per month or up to 30% of gross farm turnover, whichever is less, for a five year maximum benefit period For example, if your earnings were $60,000 per annum and you are in a professional, clerical and general or special risk occupation, the maximum Income Protection benefit you could apply for would be $3,750 per month, being 75% of the monthly equivalent of $60,000 per annum ($60,000/12). Income Protection insurance MLC Life Cover Super and MLC Personal Protection Portfolio PDS Page 29 T h e t y p e s o f i n s u r a n c e o f f e r e d Partial Disability and Rehabilitation MLC will pay you a reduced monthly benefit if you remain continuously unable to fully perform the duties of your own occupation as a direct result of the injury or sickness which caused your total disability, but you do one of the following: • return to work in your own or another occupation • begin a vocational rehabilitation programme approved by government or MLC. The Partial Disability or Rehabilitation benefit must follow total disability of at least 14 days or from the end of your waiting period, whichever is later. For PPP only, where partial disability or rehabilitation is due to one of the following specified conditions, a prior period of total disability is not required to be eligible for those benefits: • diagnosed motor neurone disease • diagnosed muscular dystrophy • diagnosed multiple sclerosis • diagnosed Parkinson’s disease. The specified condition must satisfy all of the terms of its definition, be diagnosed by an appropriate specialist and be confirmed by MLC’s medical adviser. These specified conditions are defined in ‘Critical Conditions Definitions – Extra Benefits Option’ on pages 80 to 82. When will MLC pay? Total Disability The definition of total disability depends on the Income Protection insurance you choose. LCS and PPP Standard You are totally disabled if, during the first two years of disability, you are continuously unable to do at least one of the important duties of your occupation necessary to producing your income. After the two years, you are totally disabled only if you are unable to do the important duties of any occupation you are suited to by way of education, training or experience. LCS and PPP Plus You are totally disabled if you are continuously unable to do at least one of the important duties of your occupation necessary to producing your income. Your inability to work must be due to injury or sickness. If you are working for earnings, payment or profit, you will not be eligible for Total Disability benefits but you may be eligible for Partial Disability or Rehabilitation benefits. MLC will pay benefits for total and partial disability and rehabilitation only while a doctor is regularly treating you. MLC will review the benefit regularly and may require further proof of continued disability. Page 30 MLC Life Cover Super and MLC Personal Protection Portfolio PDS The maximum period of time MLC will pay Partial Disability or Rehabilitation benefits depends on the Income Protection insurance you choose. LCS and PPP  Standard MLC will pay Partial Disability or Rehabilitation benefits for up to a maximum of six months. If you are paid less than the full monthly benefit over the six months, MLC will extend the benefit period while your partial disability or rehabilitation continues until the benefit paid equals six times the full monthly benefit. LCS and PPP Plus MLC will pay Partial Disability or Rehabilitation benefits up to the end of the benefit period. MLC will pay benefits for total and partial disability and rehabilitation only while a doctor is regularly treating you. MLC will review the benefit regularly and may require further proof of continued disability. The Partial Disability or Rehabilitation benefit is calculated as follows: Professional, Clerical and General, and Special Risk Occupations insured under LCS and PPP, Standard and Plus: The Partial Disability or Rehabilitation benefit is calculated in proportion to your reduction in earnings. Farmers insured under the Farmers Package (Plus): The Partial Disability or Rehabilitation benefit is calculated as 50% of your monthly benefit for up to two years of partial disability or rehabilitation. Then, beyond two years, if you have a five year benefit period, 50% of your monthly benefit or a part of the monthly benefit in proportion to your level of whole person impairment, whichever is less. Whole person impairment is based on medical advice that may include regular occupational or medical assessment by a medical adviser appointed by MLC, which may be requested at any time. It will be required following two years of partial disability or rehabilitation and every six months thereafter while partial disability or rehabilitation continues or until the end of the benefit period, whichever is earlier. This assessment is in addition to any other information or examination required to assess the claim. No benefit will be payable for any period of partial disability or rehabilitation with an assessed whole person impairment of less than 25%. One benefit paid at a time MLC only pays one benefit at a time except for the: • rehabilitation expense benefit under PPP Standard • rehabilitation expense benefit and rehabilitation bonus under PPP Plus • double benefits for specified conditions, home assistance benefit, transportation benefit and accommodation benefit under the Extra Benefits Option under PPP Plus. When do the benefits end? Any benefit you are paid under Total Disability, Partial Disability or Rehabilitation ends if any of these occur: • you cease to be totally disabled, partially disabled or in rehabilitation (as applicable) • your maximum benefit period ends • your Income Protection insurance ends. If you die while receiving a benefit we’ll pay an additional six months benefit as a lump sum, to a maximum of $60,000. For LCS, the Trustee will not be able to release the Income Protection benefit to you unless you satisfy the criteria for temporary incapacity in the superannuation legislation. Please see ‘Accessing your MLC Life Cover Super benefit’ on page 59 for further guidance on when the Trustee can release the benefits to you. Income Protection insurance MLC Life Cover Super and MLC Personal Protection Portfolio PDS Page 31 T h e t y p e s o f i n s u r a n c e o f f e r e d What features are built in? Choice of waiting periods You select a waiting period when you apply. This is the initial period of your disability during which MLC does not pay benefits. You pay a lower premium the longer the waiting period you select. You can choose a period of: Professional, Clerical and General Occupations Special Risk Occupations Farmers (Farmers Package) 14 days 14 days 1 month 1 month 1 month 3 months 3 months 3 months 12 months 12 months 24 months Choice of benefit periods MLC will pay a benefit each month until you recover for up to the maximum benefit period you choose. You pay a lower premium the shorter the benefit period you select. You can choose a maximum benefit period of: Professional, Clerical and General Occupations Special Risk Occupations Farmers (Farmers Package) 2 years 2 years 2 years 5 years 5 years 5 years up to age 65 Rehabilitation Expenses (for PPP only) In addition to any Rehabilitation benefit payable, we will pay up to six times your monthly benefit (Standard) or 12 times your monthly benefit (Plus) for approved rehabilitation expenses, such as the cost of a rehabilitation course or special equipment, to help you return to work. Rehabilitation Bonus (for PPP Plus only) While MLC pays you Rehabilitation benefits MLC may approve a benefit increase of 50% for up to 12 months unless double benefits for specified conditions are payable under the Extra Benefits Option during the same period. Premium waived while you receive benefits We will refund any premium paid (including premiums paid during the waiting period) for Income Protection insurance while you are disabled and receiving benefits. Premiums will still be due for other types of insurances and other people insured. When benefits stop, we will start charging you premiums again, unless your Income Protection insurance ends. Return to work during the waiting period You can return to work during the waiting period. The days you work do not have to be consecutive. The waiting period will be extended by the number of days you return to work. However, the waiting period will start again if: • you select a waiting period of 14 days or one month and you return to work for more than five consecutive work days • you select a waiting period longer than one month and you return to work for more than 10 consecutive work days. Recurring Disability Benefit If the same disability recurs while this insurance is in force and within: • six months (if your benefit period is five years or less) • 12 months (if your benefit period is more than five years) of your return to full-time work, MLC will consider it a continuation of the original disability. You can claim as soon as the disability recurs, with no new waiting period. The cause of the disability must be the same as, or related to, the cause of the original disability. If the disability recurs after this time, MLC will treat it as a new claim. Page 32 MLC Life Cover Super and MLC Personal Protection Portfolio PDS What options can you choose to lower the cost? Indemnity Option (for Plus, except under the Farmers Package) To lower the cost of Income Protection Plus you can select the Indemnity Option instead of an Agreed Value Benefit. As for Standard cover (Indemnity Benefit), if your earnings decrease after taking out Income Protection Plus insurance, MLC will reduce your monthly benefit when you claim so that you receive no more than 75% of your earnings before disability. HIV/AIDS Exclusion Discount MLC will discount your premium if you do not want cover for HIV/AIDS and are prepared to accept this exclusion. Non-Occupational Cover Discount (for Special Risk Occupations only) This option lets you pay a lower premium for Income Protection insurance that will not cover you for disabilities caused at work or as a result of work, or for which you can claim benefits under any Workers Compensation Act or similar legislation. What options can you choose at extra cost? Indexed Claim Benefits So that your benefits keep pace with inflation, MLC will apply the Consumer Price Index (CPI) increase to: • your monthly benefit, each year after benefits have been paid for a full year • your pre-disability earnings, when calculating your Partial Disability or Rehabilitation benefit. Short waiting period for accidental injury (for PPP Plus except farmers under the Farmers Package) If you choose a 14 day or one month waiting period, this option enables you to receive benefits while you are totally disabled during the waiting period, unless you are already eligible for benefits during the waiting period under the Extra Benefits Option. Benefits are payable from the fourth consecutive day of your total disability during the waiting period. Your total disability must be caused by an accident and begin within 30 days of the accident. Extended Leave Cover Your cover continues for up to a year while you are on extended leave (you are not doing paid work), except as a direct result of disability or sabbatical leave. MLC may approve longer periods in writing. For professional and clerical occupations, if you are on sabbatical leave, the insurance can continue for up to two years. You must continue to pay premiums during this time. Elective Surgery Benefit MLC will pay you the monthly benefit if you are unable to work as a result of undergoing elective surgery performed by an appropriately qualified doctor to donate an organ to another person, to improve your appearance as a result of injury or sickness, or on the advice of a medical practitioner. The surgery must take place more than six months after your Income Protection insurance began or was last reinstated. MLC will not pay any increase to your Income Protection benefit for surgery within six months of the increase. Style of benefit For both LCS and PPP, subject to all the terms and conditions of your insurance and provided that your proposal is accurate, complete and acceptable to us when you apply, if your earnings decrease after your policy is issued an: • Agreed Value Benefit (Plus only) means that the monthly benefit issued will be the amount upon which your benefits are based when you claim eg your Total Disability benefit will not be reduced because your earnings are lower when you claim than they were when your policy was issued. • Indemnity Benefit (Standard and under the Plus Indemnity Option) means that the monthly benefit issued may be reduced when you claim so that it does not exceed more than 75% of your earnings before disability. Income Protection insurance MLC Life Cover Super and MLC Personal Protection Portfolio PDS Page 33 T h e t y p e s o f i n s u r a n c e o f f e r e d Double benefits for specified conditions MLC will pay you double the normal monthly benefit for total or partial disability or rehabilitation for up to six months if you are disabled by any of the following conditions, defined in ‘Critical Conditions Definitions’ on pages 75 to 79. • Aorta repair • Aplastic anaemia • Benign brain tumour • Cardiomyopathy • Chronic kidney failure • Chronic liver failure • Chronic lung failure • Coma • Coronary artery bypass surgery • Deafness • Dementia or Alzheimer’s disease • Encephalitis • Heart attack • Heart valve surgery • HIV contracted through medical procedures • HIV contracted through your work • Major brain injury • Major burns • Major organ transplant • Malignant cancer • Motor neurone disease • Multiple sclerosis • Muscular dystrophy • Open heart surgery • Parkinson’s disease • Pneumonectomy • Primary pulmonary hypertension • Stroke The specified condition must satisfy all of the terms of its definition, be diagnosed by an appropriate specialist and confirmed by MLC’s medical adviser. Extra Benefits Option (for PPP Plus only) Extra Benefits Option offers: • Benefit during the waiting period • Accommodation benefit • Double benefits for specified conditions • No claim bonus • Advance payment for certain injuries • Home assistance • Transportation benefit. Benefit during the waiting period MLC will pay you the daily proportion of your monthly benefit for each day during the waiting period that you are totally disabled, confined to bed, and receiving full-time registered nursing care (not provided by a member of your immediate family) under a doctor’s direction. The benefit applies from the fourth day of such care for the duration of the waiting period up to 180 consecutive days. Accommodation benefit If you are totally disabled, confined to bed and receiving full-time registered nursing care (not provided by a member of your immediate family) under a doctor’s direction, more than 100 kilometres from your usual place of residence, MLC will pay an additional benefit of $500 per day if one of your immediate family members requires hotel or motel accommodation to be near you. The benefit applies from the fourth day of your confinement to bed for a maximum of 30 days in any 12 month period. Page 34 MLC Life Cover Super and MLC Personal Protection Portfolio PDS If you completely fracture these bones (so that they require a pin, traction, a plaster cast or other immobilising structure, diagnosed within 30 days of the injury that caused the fracture): the advance benefit period is: thigh (shaft) 3 months pelvis (except the coccyx) 3 months skull (except the face or nose bones) 2 months upper arm (shaft, including the elbow and shoulder) 2 months shoulder blade 2 months lower leg (shaft, including the ankle but excluding the foot and toes) 2 months kneecap 2 months collar bone 1.5 months forearm (shaft, including the wrist but excluding the elbow) 1.5 months jaw 1.5 months If you are diagnosed with: the advance benefit period is: paralysis (the total and permanent loss of the function of two or more limbs caused so that the total you the total you receive is not more that 75% of your earnings before disability your benefit period or 60 months, whichever is less If your waiting period is greater than one month, the advance benefit will equal your monthly benefit for the period in the table minus your waiting period. MLC will pay your monthly Income Protection benefits after the advance benefit period while you are totally or partially disabled or under rehabilitation as a result of your injury up to the earliest of the following: • MLC pays your chosen maximum benefit (taking into account any advance benefits) • you turn 65 • you die. No claim bonus Every year that you do not claim under Income Protection insurance, MLC increases your monthly benefit for the first year of a claim: Continuous years without a claim Increase in monthly benefit 1 0 2 5% 3 10% 4 15% 5 20% 6+ 25% Advance payment for certain injuries For certain injuries, MLC will pay your monthly benefit in advance as a lump sum for the periods indicated in the following tables. If one injury causes more than one of the losses shown in the following tables, MLC will pay only for the loss with the largest benefit. If, within 181 days of the injury, you completely and permanently lose the use of: the advance benefit period is: both hands or both feet or the sight in both eyes 24 months a hand and a foot 24 months a hand or foot and the sight in one eye 24 months an arm or leg 18 months a hand or foot or the sight in one eye 12 months thumb and index finger on the same hand 6 months Income Protection insurance MLC Life Cover Super and MLC Personal Protection Portfolio PDS Page 35 T h e t y p e s o f i n s u r a n c e o f f e r e d Home assistance If MLC is paying you Total Disability benefits under Income Protection insurance and you are at home, confined to bed or the house, and dependent on home assistance or nursing care, MLC will pay you a further benefit to help cover this care. The benefit for home assistance is the daily proportion of your monthly benefit if your spouse stops working full-time to care for you at home, unless your spouse worked for you or your employer before your disability. The benefit for nursing care is $85 per day for a hired private registered nurse who is not a member of your immediate family. The maximum benefit is the lesser of your monthly benefit or $2,500 per month, for up to six months. Transportation benefit If you become totally disabled for at least one month while you are: • outside Australia, MLC will reimburse the cost of transportation back to Australia • inside Australia, more than 100 kilometres from home, MLC will reimburse the cost of transportation back to your home. MLC will only pay this benefit once in any 12 calendar- month period, after deducting any reimbursements you are entitled to receive from other sources, and the most MLC will pay is an amount equivalent to three times your monthly benefit. Occupational HIV, Hepatitis B or C Lump Sum Benefit (for certain occupations only under PPP Plus) This option is only available for Income Protection Plus for certain medical occupations (such as doctors, surgeons, dentists, nurses and ambulance officers) if you also choose the Extra Benefits Option. MLC or your financial adviser can tell you if you are eligible. MLC will pay you a lump sum if, while the policy is in force, you acquire HIV (Human Immunodeficiency Virus), Hepatitis B or Hepatitis C as a result of an occupational accident while you are performing the normal duties of your occupation in the health industry. The minimum benefit you can select is $25,000 and the maximum benefit you can select is 100 times your monthly benefit to a maximum of $500,000. You (or someone representing you) must tell MLC you may become infected within 14 days of the incident or that you have become infected within 14 days of diagnosis. MLC will send a claim form and/or instructions for submitting proof of benefit entitlement. Documented proof must be provided by you to MLC that: • the incident did happen at work and involved a definite source of infection, including copies of the incident report, the names of the witnesses to the incident and confirmation of the source of infection • the HIV, Hepatitis B or Hepatitis C is a new infection and that seroconversion from the relevant negative antibodies or antigens to positive antibodies or antigens has taken place within six months of the incident, based upon blood or body fluid samples tested by Australian Government approved pathology laboratories. MLC must be allowed to independently retest the samples and/or take further samples for testing at MLC’s cost. MLC will not pay benefits for any Hepatitis B infection commencing within six months after this insurance began or was last reinstated. MLC will not pay for any HIV, Hepatitis B or C infection: • arising from intentionally self-inflicted infection • first diagnosed after you die • commencing after the appropriate government body has recommended a preventative vaccine for use in your occupation, but you have not taken this vaccine • commencing after the appropriate government body has approved a treatment which makes infection inactive and non-infectious • occurring, or sickness first appearing, before the policy commenced or was last reinstated (unless disclosed to, and accepted by, MLC as part of the application or reinstatement process). MLC will continue your Occupational HIV, Hepatitis B or C infection lump sum insurance until the benefit is paid or your Income Protection Plus insurance ends. Page 36 MLC Life Cover Super and MLC Personal Protection Portfolio PDS What if you can claim from another source? If you are paid a regular income benefit under government legislation, such as workers compensation, MLC will reduce the amount we pay so the total you receive is not more than 75% of your earnings before disability (or not more than the monthly benefit, for farmers under the Farmers Package). If you receive a lump sum benefit from such a source, MLC will treat it as though it was paid as a monthly benefit payable over eight years and adjust your benefits accordingly (dividing the lump sum into equal monthly instalments over an eight year period (1/96) to calculate the amount to be offset monthly). No offset applies for social security payments or common law benefits of either a regular income or lump sum nature. In addition to the above, the following applies: Income Protection Standard Income Protection Plus MLC will reduce the amount it will pay if you receive any benefit from: • a superannuation or pension plan or any policy of income protection, salary continuance or disability insurance • any income provided or arranged by an employer, partnership or business, including sick leave. If at the time of application you have over 90 days accumulated sick leave or have disability insurance arrangements through your employer, your policy may include a condition that will reduce the benefit payable so that the total you receive is not more than 75% of your earnings before disability. Time limits to claim From the time your total disability begins you have: • 30 days to inform MLC • 90 days to return the claim form MLC sends you. When won’t MLC pay? MLC will not pay a benefit for any disability arising from or contributed to by: All Income Protection policy types • intentional self-inflicted injury or attempted suicide • normal and uncomplicated pregnancy or childbirth • war or warlike operations (does not apply to any benefit payable on your death) • any injury that occurred, or sickness that first appeared, before the policy commenced or was last reinstated (unless disclosed to, and accepted by, MLC as part of the application or reinstatement process). Income Protection Standard (additional exclusions) • chronic fatigue syndrome or fibromyalgia • mental disorder and/or alcohol, drug or chemical abuse or dependency except where you are confined indoors and, under the direction of an appropriately qualified doctor, are receiving full-time nursing care or continuous supervision (not provided by a member of your immediate family) to protect yourself or other people. When does Income Protection insurance end? Your insurance will end when: • the insurance is cancelled at your written request (cover ceases on the next paid-to date and MLC will not refund any premium paid up to then) • the insurance is cancelled because you stop paying premiums • the policy is cancelled because you make a fraudulent claim • for LCS, the policy is converted to non-superannuation insurance (insurance will continue as detailed on page 64) • for Special Risk Occupations, renewal is declined by MLC • you cease working for more than 12 months (or 2 years if you are on sabbatical from a professional or clerical occupation), except as a direct result of disability or if MLC approves an extension in writing • you turn 65 • you retire, or stop work and do not intend to work any more, for reasons other than disability • you reach the termination date shown in your Schedule • you die. Income Protection insurance MLC Life Cover Super and MLC Personal Protection Portfolio PDS Page 37 T h e t y p e s o f i n s u r a n c e o f f e r e d For PPP (outside super) only, Business Expenses insurance reimburses certain business expenses incurred while you are totally disabled, if you are self-employed or in a small partnership. Business Expenses at a glance Personal Protection Portfolio What are you covered for? Monthly reimbursement of covered business expenses during total disability (as defined in Income Protection Plus on page 29) • 3 months extra benefits up to a maximum of $30,000 if you die while receiving  benefits • What features are built in? World-wide coverage, 24 hours a day, 7 days a week • Your choice of 14 day or 1 month waiting period • Business Expenses premium refund during disability • What options can you choose? HIV/AIDS Exclusion Discount • At what age can you apply for Business Expenses insurance? General Occupations 18–54 Professional or Clerical Occupations 18–59 To what age can you renew your insurance? General Occupations and Professional or Clerical Occupations guaranteed renewable up to age 65 What amount can you apply for? Minimum benefit (per month) $500 Maximum benefit (per month) $60,000 MLC or your financial adviser can tell you your occupation category. Business Expenses cover is not available if you work in a special risk occupation. Business Expenses insurance Page 38 MLC Life Cover Super and MLC Personal Protection Portfolio PDS What is a business expense? The covered expenses are the reasonable and regular normal operating expenses of the business you own and manage, including: • rent or mortgage payments • property rates and taxes • equipment or vehicle lease costs • electricity, heating and water costs • cleaning and laundry costs • depreciation on office equipment and premises that the business owns • salaries of employees not generating business income • costs of accounting services • fees for memberships of professional associations • business insurance premiums. When will MLC pay? MLC reimburses the monthly expenses you actually incur after your waiting period ends and while you are totally disabled, up to your chosen monthly benefit, for up to one year. If you are entitled to benefits because you are disabled for part of a month, MLC will reduce the covered expenses and monthly benefits proportionally based on a 30 day month. If you are paid less than the full benefit over a year (for example, if your expenses are sometimes less than your chosen benefit), MLC will extend the benefit period while your disability continues for up to another 12 months until you have been reimbursed the full 12 months benefit. MLC pays benefits only while a doctor is regularly treating you. MLC will review the benefit regularly and may require further proof of disability if it continues. If you die while receiving a benefit we'll pay an additional three months benefit as a lump sum to a maximum of $30,000. What if the same disability recurs? If the same disability recurs within six months of your return to full-time work, and while this insurance is in force, MLC will consider it a continuation of the original disability. You can claim as soon as the disability recurs, with no new waiting period. The cause of the disability must be the same as, or related to, the cause of the original disability. If the disability recurs after six months, MLC will treat it as a new claim. Time limits to claim From the time your total disability begins you have: • 30 days to inform MLC • 90 days to return the claim form MLC sends you. Your choice of waiting periods When you apply, you choose a waiting period of 14 days or, for a lower premium, one month. Payment begins one month after your waiting period ends. Return to work during the waiting period You can return to work during the waiting period. The days you work do not have to be consecutive. The waiting period will be extended by the number of days you return to work. However, the waiting period will start again if you return to work for more than five consecutive work days. Premium refund during disability When you have been disabled for longer than your waiting period, MLC will refund any Business Expenses premium paid while you are disabled and receiving benefits (including any paid during the waiting period). Premiums will still be due for other types of insurance and other people insured. When benefits stop being paid, MLC will charge you premiums again, unless this insurance ends. HIV/AIDS Exclusion Discount MLC will discount your premium if you do not want cover for HIV/AIDS and are prepared to accept this exclusion. Business Expenses insurance MLC Life Cover Super and MLC Personal Protection Portfolio PDS Page 39 T h e t y p e s o f i n s u r a n c e o f f e r e d When does Business Expenses insurance end? Your insurance will end when: • the insurance is cancelled at your written request (cover ceases on the next paid-to date and MLC will not refund any premium paid up to then) • the insurance is cancelled because you stop paying premiums (unless MLC is paying you benefits) • the policy is cancelled because you make a fraudulent claim • you turn 65 • you reach the termination date in your Schedule • you cease working for more than 12 months, except as a direct result of disability or if MLC has agreed in writing to extend this period • you retire, or stop work and do not intend to work any more, for reasons other than disability • you die. How does Business Expenses insurance work for your business? If your business continues to generate income while you are disabled, MLC will not reduce your benefits. If there is more than one owner of the business MLC will pay your share of the covered expenses. If you own and operate your business through a company, MLC will treat covered expenses paid by the company as if they were paid by you. If you change businesses the policy is portable. Simply apply it to your new business. If you have a break in employment you can continue your cover for up to a year while you are on extended leave, unless it is a direct result of disability. MLC can approve longer periods. You must continue to pay premiums during this time. When won’t MLC pay? MLC does not cover you for expenses incurred during a disability arising from or contributed to by: Business Expenses insurance does not reimburse: • intentional self-inflicted injury or attempted suicide • normal and uncomplicated pregnancy or childbirth • war or warlike operations (this exclusion does not apply to any benefit payable on your death) • any injury that occurred, or sickness that first appeared, before the policy commenced or was last reinstated (unless disclosed to, and accepted by, MLC as part of the application or reinstatement process). • expenses that you can claim from another source • payment or other benefits of any kind to you, or to your replacement in the business • any expense that was not normally paid before the disability • repayment of the principal of a loan or mortgage that started less than one year before the disability • the cost of equipment or merchandise for your business. Page 40 MLC Life Cover Super and MLC Personal Protection Portfolio PDS Premium Waiver insurance However, if you purchase Premium Waiver insurance with Life Cover, TPD and Critical Illness, and you also have Income Protection and/or Business Expenses insurance as part of the policy, then the retrenchment provision of Premium Waiver insurance will apply to all benefits. Only one life insured can be nominated for Premium Waiver per policy. If that person becomes eligible to have their premiums waived under this insurance, premiums will be waived for all benefits on all lives insured under the policy while the nominated person remains eligible to have premiums waived. Premium Waiver insurance enables all premiums on a policy to be waived where the life insured is disabled or retrenched. Premium Waiver insurance is only available for Life Cover, Total and Permanent Disability (TPD) and Critical Illness insurance. Income Protection and Business Expenses insurance already includes a built-in premium waiver benefit so that premiums are waived while the life insured is receiving benefits for disability. This waiver benefit does not cover retrenchment. Premium Waiver at a glance Life Cover Super and Personal Protection Portfolio When does MLC waive your premiums? While you are totally and permanently disabled under the Any Occupation definition up to age 65 • While you are receiving Income Protection benefits for Total Disability (as defined in Income Protection Plus on page 29) after you have been so disabled for six months, up to age 65 • For 12 months after you are retrenched, as long as you have had this type of insurance and have been employed full-time by the same employer continuously for the 12 months before your retrenchment Note: This benefit is available only once in any five year period. • At what age can you apply for Premium Waiver insurance? General, Professional or Clerical Occupations 18–54 To what age can you renew your insurance? General, Professional or Clerical Occupations guaranteed renewable up to age 65 MLC or your financial adviser can tell you your occupation category. Premium Waiver is not available if you work in a special risk occupation. MLC Life Cover Super and MLC Personal Protection Portfolio PDS Page 41 T h e t y p e s o f i n s u r a n c e o f f e r e d When does Premium Waiver insurance end? Your insurance will end when: • the insurance is cancelled at your written request (cover ceases on the next paid-to date and MLC will not refund any premium paid up to then) • the insurance is cancelled because you stop paying premiums (unless MLC is paying you benefits) • the policy is cancelled because you make a fraudulent claim • you reach the review date after you turn 65 • you reach the termination date in your Schedule • your Life Cover insurance ends • you die. When won’t MLC waive? MLC will not waive premiums: due to disability or retrenchment arising from, or contributed to by: • intentional self-inflicted injury or attempted suicide • normal and uncomplicated pregnancy or childbirth • war or warlike operations • any injury that occurred, or sickness that first appeared, before the policy commenced or was last reinstated (unless disclosed to, and accepted by, MLC as part of the application or reinstatement process). due to retrenchment if you are: • self-employed • an independent contractor • employed by a member of your immediate family, your family company or family trust • a partner in a partnership • retrenched more than once from the same employment. for any insurance increase you obtain in the 12 months prior to retrenchment (MLC waives only the premiums which applied before the increase). for any benefits or types of insurance which you add after you are retrenched or suffer an injury or sickness causing your disability, except for increases under the Inflation Linked Option. Page 42 MLC Life Cover Super and MLC Personal Protection Portfolio PDS MLC Life Cover Super PDS and MLC Personal Protection Portfolio PDS Page 43 How it all works Page 44 MLC Life Cover Super and MLC Personal Protection Portfolio PDS You must let MLC know if any information you give on your application changes before MLC has issued a policy (for instance, if you become ill or have an accident). If you do not, the insurance policy may not be valid. This also applies to applications to extend, vary or reinstate the policy. Interim Accident Insurance When your application is submitted to MLC, you will be covered by the Interim Accident Insurance Certificate on terms as detailed on pages 83 to 85. How do you appoint your authorised representative? You may appoint an authorised representative to access information about the policy on your behalf with a written request, or by completing the Change of Policy Details Form. This person is not permitted to perform any other actions in respect of the policy. The appointment is valid until changed or cancelled in writing by you (in a form acceptable to MLC), or until the policy is cancelled. It is your responsibility to change your authorised representative if your circumstances change. What payment will your financial adviser receive? Your premium includes provision for your financial adviser’s commission, but the actual remuneration your financial adviser receives depends upon your financial arrangement with them, which will be specified in the statement of advice they must provide to you. The commission is not an additional cost to you. The premium will not be less, if you don’t have a financial adviser. How do you apply for insurance? Your financial adviser can prepare a recommendation based on your financial needs. Read this PDS, then apply for LCS and PPP using the current application (the Trustee will use the application to apply for an LCS insurance policy on your behalf) and send it with your payment details to MLC. For more efficient processing MLC prefers this payment by direct debit request or credit card authority. A LCS policy can only cover one life insured. The insurances form a part of a policy issued by MLC Limited to MLC Nominees Pty Limited as the Trustee of the Scheme. A PPP policy can cover up to six lives and each life insured can have different types of insurance and levels of cover. How is your application assessed? After receiving your application MLC assesses it, taking into account your occupation, lifestyle, leisure activities and medical history, to decide whether, and on what terms or conditions, insurance can be offered to you. In some cases you may not be eligible for the insurance you request or MLC may offer you insurance at a higher premium or with an exclusion (for instance, if you have an existing health problem or participate in a hazardous sport). MLC may telephone you to help assess and process your application. To process your application MLC may require you to provide additional medical information. You may be requested to undergo a medical examination or other test. If this is required, you will be notified and the appropriate forms will be sent to you. MLC will pay for medical information requested during the assessment process, unless you are advised otherwise. MLC may also need to write to your doctor for additional information (authorised by you). MLC will contact you if financial information is required from you or your accountant for insurances such as Income Protection, Business Expenses or high amounts of Life Cover, Critical Illness and Total and Permanent Disability insurance. How to apply Setting up your insurance Need help? Call your financial adviser or the MLC Client Service Centre any business day between 8 am and 6 pm AEST/AEDT on 132 652. MLC Life Cover Super and MLC Personal Protection Portfolio PDS Page 45 H o w i t a l l w o r k s Non-Disclosure If you fail to comply with your Duty of Disclosure and MLC would not have entered into the contract on any terms if the failure had not occurred, MLC may avoid the contract within 3 years of entering into it. If your non-disclosure is fraudulent, MLC may avoid the contract at any time. Even if MLC is entitled to avoid a contract of life insurance MLC may, within three years of entering into it, elect not to avoid it but reduce the sum for which you have been insured in accordance with a formula that takes into account the premium that would have been payable if you had disclosed all relevant matters to MLC. Your Duty of Disclosure continues until the contract of life insurance has been accepted by MLC and a policy is issued. It also applies if the contract is extended, varied or reinstated. Disclosure – MLC Transfer Applications If you apply to transfer your insurance from your existing MLC policy to a new MLC policy without increasing your benefits, our assessment of your application will rely on the information you provided to us for your existing MLC policy. Guarantee of upgrade Whenever MLC improves the benefits of a type of insurance you have chosen as part of LCS or PPP without any increase in rates or without charging an extra premium, MLC will add those improvements to the policy. MLC will notify you of the effective date of any improvements to the policy. The improvements will apply only to future claims and not to past or current claims or any claims resulting from health conditions or events which began or took place before the effective date of the improvements. What you must tell MLC and the Trustee – Your Duty of Disclosure Before you enter into a contract of life insurance with MLC, you have a duty, under the Insurance Contracts Act 1984, to disclose to MLC every matter that you know, or could reasonably be expected to know, is relevant to MLC’s decision whether to accept the risk of the insurance and, if so, on what terms. You have the same duty to disclose those matters to MLC before such a contract of life insurance is extended, varied or reinstated. Your duty, however, does not require disclosure of a matter: • that diminishes the risk to be undertaken by MLC • that is of common knowledge • about which MLC knows or, in the ordinary course of business, ought to know • for which your duty of compliance is waived by MLC. If you take out LCS the Trustee obtains life insurance from MLC on you. Because the Trustee is taking out a life policy at your request, the Trustee requires you to make full disclosure to it on the same basis. When does your insurance start? If MLC approves your application you will receive: • a copy of the insurance policy issued to the Trustee which includes the Schedule and a letter of confirmation for LCS • a policy document which includes your Schedule for PPP. All the terms of your insurance are effective from the policy start date printed on your Schedule, which outlines the specific insurances that apply to you. You should read the policy documents and Schedules carefully to ensure the policy meets your needs. You will need these policy documents to make a claim, so keep them with this PDS in a secure, accessible place. If your application is declined, you will be notified. Page 46 MLC Life Cover Super and MLC Personal Protection Portfolio PDS The premium for both your initial cover and for subsequent changes, excluding policy fees, will be at least: Frequency of premium payments Minimum premium (for new applications) Minimum premium (for increases to existing insurance) Minimum premium (for TPD and Critical Illness as a Connected Benefit) Monthly $20 $10 $10 Half-yearly $130 $65 $65 Yearly $250 $125 $125 How can you pay premiums? All premiums must be paid in advance. For LCS premiums that are paid by deduction from eligible MLC MasterKey superannuation products only one deduction may operate on any account. Your premium will be higher the more frequently you pay. MLC can change these percentages at any time and will notify you and the Trustee (for LCS) of any change. Frequency of premium payments Payment methods available Current loading on frequent payments direct debit credit card cheque BPAY ® MLC MasterKey (LCS only) Monthly • • • yearly plus 7% Half-yearly • • • • • yearly plus 4% Yearly • • • • • yearly Premiums What is your premium? You pay premiums to purchase your insurance. The premium for the types of insurance and the amount of insured benefits you initially apply for will be calculated by your financial adviser and confirmed by MLC. If you don’t have a financial adviser please contact the MLC Client Service Centre on 132 652 for a quotation before completing an application. Your premium will differ according to your individual circumstances as the life insured, including but not limited to your: • age at policy commencement and chosen premium structure – in a stepped premium structure premiums generally increase with age, while in a level premium structure premiums are based on your age when the policy begins How to pay Setting up your insurance • sex • occupation – MLC or your financial adviser can provide you with more information • smoking status – premiums are higher for smokers than non-smokers • medical history – your state of health and/or your family’s medical history • lifestyle and leisure activities – the greater the risk of the activities you undertake, the higher the premium. • frequency of premium payments and applicable policy fee • the financial arrangement agreed with your financial adviser. Your initial premium will be stated in the Schedule. MLC Life Cover Super and MLC Personal Protection Portfolio PDS Page 47 H o w i t a l l w o r k s What happens if your premiums are not paid? If your premium is not paid in full by the due date and it is still not paid in full by the end of the notice period: • MLC will cancel the policy and your insurance will cease • MLC will deduct any unpaid premium from any benefits that have been paid during the notice period • for LCS, your interest in LCS will cease and, if it is your only interest in the Scheme, your membership of the Scheme will also cease. If the policy is cancelled due to non-payment of premiums, you or the Trustee (for LCS) can apply to have it reinstated on terms set by MLC up to 6 months after the date the policy was cancelled. However: • the policy will not be reinstated until MLC approves the reinstatement • MLC is under no obligation to approve the application for reinstatement • you must tell MLC (in writing) about any event that could influence MLC’s decision to reinstate the policy as part of your Duty of Disclosure • payment of overdue amounts does not automatically reinstate the policy. If the policy is not reinstated: • MLC will refund any premiums you sent after the policy was cancelled • for LCS, the Trustee will not accept a contribution if MLC does not accept the premium, so the money will be returned to you or to the MLC MasterKey account from which it was deducted. How is your first premium treated? Any premium paid by direct debit, credit card or cheque stays in a trust account while your application is being considered until your application is accepted or declined (in which case the premium is refunded). Any interest earned on monies in the trust account will be retained by MLC. Selecting a benefit and premium structure For certain insurance benefits you can choose from three insured benefit and premium structures: • Level premium Your insured benefit stays the same and the premium will be based on your age at the time you take out your policy. When you renew your policy, your premiums will only vary if a change is made to MLC’s premium rates • Stepped premium Your insured benefit stays the same, while the premiums vary each year with the age of those insured and MLC’s premium rates at the time you renew your policy • Decreasing cover (not available for TPD stand-alone, Income Protection or Business Expenses) Your premium stays the same, while your insured benefit varies each year with the age of those insured and MLC’s premium rates at the time you renew your policy. Stepped and level premium rates are subject to any Inflation Linked Option variations (see ‘Policy fee and other charges on pages 48 to 49’) and other increases to the level of benefits. You can make different selections for different types of insurance. However, if you purchase Critical Illness or Total and Permanent Disability and Loss of Independence insurance as part of your Life Cover or as a Connected Benefit, the premium structure(s) chosen must be the same as for Life Cover. You can also choose to split your cover between different premium structures for the one type of insurance. Page 48 MLC Life Cover Super and MLC Personal Protection Portfolio PDS Setting up your insurance Policy fee and other charges All the charges of the policy (other than the premium) are fully described in this section. MLC undertakes not to apply any other charges without your specific consent. Policy fee A policy fee applies to each policy for which you apply. However if you have purchased Total and Permanent Disability and/or Critical Illness insurance as a Connected Benefit where the Life Cover is issued on a separate policy, only one policy fee will apply and the policy fee will be applied to the policy with the Life Cover. Note: if the connected Life Cover policy is cancelled and the connected policy remains in force the current policy fee applicable at the time will be reinstated. The premiums charged include the policy fee, which will increase every year in line with the CPI at the review date on or after 1 October each year. The latest policy fee information for new policies is available at mlc.com.au The policy fee at the preparation date of this PDS is: Frequency of premium payments Policy fee Annual equivalent Monthly $6.61 $79.32 Half-yearly $38.54 $77.08 Yearly $74.11 $74.11 Can premiums change? MLC may change (increase or decrease) how it sets premiums at any time. As a result, your premiums change. However, MLC will: • give you one month’s written notice before it changes your premiums • only change your premiums as at the review date following any change • not single you out for a change in premiums. Premium rates for each type of insurance are available upon request by calling the MLC Client Service Centre on 132 652. MLC Life Cover Super and MLC Personal Protection Portfolio PDS Page 49 H o w i t a l l w o r k s Government charges MLC and the Trustee (for LCS) reserve the right to recover from you the cost of any duty, tax, excise or other charge of the Australian Government or any state or territory government as they may apply to the policy from time to time. There is no Goods and Services Tax (GST) payable by you on the policy premium for PPP or the premium payable by the Trustee to MLC for LCS. Family Law charges The Family Law Act enables superannuation, life insurance and other investments to be divided between parties in the event of marriage breakdown. MLC and the Trustee may be obliged to provide information to other parties and manage your policy in line with court orders. MLC and the Trustee may charge a fee for any costs we incur. Trustee fees For LCS at the date of preparation of this PDS, the Trustee does not charge a fee for acting as Trustee. The Trustee will notify you at least three months before introducing a fee. Inflation Linked Option Inflation may erode the value of your insured benefits. MLC offers inflation-linked increases, so each year your benefits can increase in line with the CPI. The increase is available regardless of any claims you make on the policy, or any changes in the health of those insured. You will be notified of the increase one month prior to the review date. For all premium structures, including level premium, the premium rate applicable to the increased benefits due to CPI will be based on your age when the increase is effective. To accept the increase, simply pay the corresponding additional  premium, which will vary with the increased benefit and your age. To decline the inflation-linked increase for a particular year, notify MLC in writing within two months after the review date, and MLC will not increase your benefits according to inflation for that year. Type of insurance Inflation-linked increase Life Cover the CPI increase or 3%, whichever is higher Total and Permanent Disability Critical Illness Income Protection the CPI increase Business Expenses Total and Permanent Disability as part of Life Cover or as a Connected Benefit the same as your connected Life Cover’s increase Critical Illness as part of Life Cover or as a Connected Benefit Terminal Illness Support Option not available Decreasing cover premium structure Page 50 MLC Life Cover Super and MLC Personal Protection Portfolio PDS Setting up your insurance Your commitment to MLC It is your responsibility to: • ensure your nominated account can accept direct debits • ensure there are sufficient funds available in the nominated account to meet each drawing on the due date • advise MLC if the nominated account is transferred or closed, or the account details change • arrange an alternate payment method acceptable to MLC if MLC cancels the drawing arrangements • ensure that all account holders on the nominated financial institution account sign the Direct Debit Request Schedule. Your rights Your drawing arrangements are detailed in the Direct Debit Request Schedule of your application. They are also governed by the terms and conditions of your MLC policy. You should contact the MLC Client Service Centre on 132 652, providing at least seven days notice, if you wish to alter the drawing arrangements. You can: • alter the Schedule • cancel the Schedule • stop an individual drawing • defer a drawing • suspend future drawings. Your cooling-off rights When you receive your policy document, you have 14 days to reconsider whether you want to continue with your policy. Within this period, you may cancel your policy or part of it (if you wish to cancel one or more types of insurance cover that you applied for) by advising us in writing. This notification must be signed by the relevant life insured (for LCS) or policy owner (for PPP) in respect of the policy or insurance to be cancelled. We will return all money paid, or part of the money paid referable to the type of insurance to be cancelled, other than government fees and charges. An alteration or claim made on the policy within the 14 day period will confirm your acceptance of the policy. Payments by Direct Debit Direct Debit Request Service Agreement This Direct Debit Request Service Agreement is issued by MLC Limited and MLC Investments Limited (ABN 30 002 641 661) (AFSL 230705). This Service Agreement and the Direct Debit Request Schedule your application contain the terms and conditions on which you authorise MLC to draw (debit) money from your account and the obligations of MLC and you under this Agreement. You should read through them carefully to ensure you understand these terms and conditions before signing the Schedule. Please direct all enquiries about your direct debit to the MLC Client Service Centre on 132 652. MLC’s commitment to you MLC will give you at least 14 days notice in writing if there are changes to the terms of the drawing arrangements. MLC will keep the details of your nominated financial institution account confidential, except where provided to MLC’s bank or as required to conduct direct debits with your financial institution. Where the due date is not a business day, MLC will draw from your nominated financial institution account on the business day before or after the due date in accordance with the terms and conditions of your MLC policy. MLC will not charge you for any dishonours. However: • if your account dishonours, your financial institution may charge you a fee • MLC reserves the right to cancel drawing arrangements if drawings are dishonoured by your financial institution. MLC Life Cover Super and MLC Personal Protection Portfolio PDS Page 51 H o w i t a l l w o r k s Contributing to MLC Life Cover Super Your premiums are treated as superannuation contributions. There are limits on the amount of contributions, that you can make into superannuation in any financial year and penalties apply if you exceed the limits. MLC and the Trustee need your Tax File Number to accept contributions. Please read the ‘Taxation‘ section on pages 60 to 62 for further details. Who can contribute to superannuation? Most commonly, contributions can be made by you, your spouse or your employer to your super account. Contributions may be made to LCS subject to your age and certain work related conditions as shown in the table. Note: LCS does not accept superannuation lump sum rollovers, Directed Termination Payments, personal injury contributions, small business sale proceeds or transfers from overseas funds. Check your eligibility The type of contribution, and whether it can be accepted, will depend on your age and work status. Here is a quick guide to help you decide whether you or others can contribute to your super account. Eligibility to contribute Your age Employer Contributions Contributions from you Contributions from your spouse Mandated Voluntary Under 18 • • • • 18 to 64 • • • • 65 to 69 • • • • 70 to 74 • • • not eligible 75 and over • not eligible not eligible not eligible 1 LCS does not accept premiums from age 75 and above. Read on for more details. If you are aged under 18, special conditions and application requirements may apply, please call the MLC Client Service Centre on 132 652. If you are aged between 65 and 75 all contributions, except mandated employer contributions, can only be made provided you have been gainfully employed on at least a part-time basis. This means having worked for at least 40 hours over a 30 day period in the financial year in which the contribution is made. When you turn 75 the LCS insurance policy terminates and no more contributions are accepted. However, before you turn 75 you may be able to replace LCS insurance with a non-superannuation policy on similar terms by conversion. The rules around contributions may change, so you should speak to your financial adviser. Alternatively you can visit apra.gov.au, ato.gov.au or call us. 1 Some useful definitions Mandated employer contributions are those required to be paid under the Superannuation Guarantee laws, a certified award or a registered workplace agreement. Voluntary employer contributions include salary sacrifice contributions. Page 52 MLC Life Cover Super and MLC Personal Protection Portfolio PDS The Universal Super Scheme Which superannuation fund is used? When you obtain LCS insurance you become a member of the Scheme. The Scheme is a complying superannuation fund under section 40 of the Superannuation Industry (Supervision) Act 1993. Who is the Trustee? MLC Nominees Pty Limited is the Trustee of the Scheme. What are the Trustee’s responsibilities? The Trustee officially holds your money and is responsible for the operation of the Scheme, including management and administration. The Trustee is subject to many duties under the legislation, including the duty to: • act honestly • exercise care and diligence • exercise its powers in the best interests of members generally. The Trustee also has the responsibility and authority to: • apply to MLC on your behalf (and at your request) for any variation to or claim on the insurance policy • determine whether any benefit received from MLC can be released under superannuation law • generally manage the Scheme in the interest of the members as a whole • invest in policies issued by certain member companies of the National Australia Group unless MLC consents to the Trustee investing otherwise • amend the Trust Deed • terminate the Scheme • determine the Scheme’s earnings and allocate them to accounts • be appointed as each member’s attorney • recover tax from recipients of benefits. Setting up your insurance The Trust Deed The rights and obligations of members are governed by the Scheme’s Trust Deed, the insurance policy and this PDS, but are also affected by other laws including the Superannuation Industry (Supervision) Act 1993 and the Corporations Act 2001. The Trust Deed: • details the nature of your account, what may be debited from and credited to it, when your benefit may be transferred out of the Scheme and what you are entitled to receive when the Scheme is wound up • sets out the powers and duties of the Trustee • deals with the liabilities of the Trustee in relation to the Scheme and when the Trustee can be reimbursed out of the Scheme’s assets for those liabilities. Service provider relationship The Trustee is a wholly owned subsidiary of MLC. The Trustee is responsible for the management of the Scheme. The Trustee has appointed MLC to carry out the day-to-day management, investment and administration of LCS. MLC receives the premiums for the insurance outlined in this PDS, which includes the cost of these services. The Trust Deed of the Scheme, the insurance policy and this PDS contain the full legal terms of LCS which govern your interest in the Scheme. This PDS summarises those terms. You should keep it for future reference. Copies of the Trust Deed are available from the Trustee free of charge by phoning the MLC Client Service Centre on 132 652. MLC Life Cover Super and MLC Personal Protection Portfolio PDS Page 53 H o w i t a l l w o r k s How to claim Using your insurance The amount of benefit you are entitled to for each type of insurance is shown in the Schedule. MLC will pay this benefit when MLC has proof: • that all the events entitling you to a benefit have happened, and • of the life insured’s age. The insurance must have been in force when the events leading to the claim occurred and (unless a claim is made for Life Cover insurance after the death of the life insured) when the claim is made. If MLC does not accept the claim, MLC will state its reason for non-acceptance. When must your claim be lodged? You should lodge a claim as soon as possible after the occurrence of the event entitling you to payment of a benefit, unless you or the Trustee (for LCS) are not legally capable of providing the information required during that period. That is: • within 12 months, generally • within 30 days of becoming Totally Disabled, for Income Protection and Business Expenses insurance (and you must return the claim form MLC sends you within 90 days of becoming Totally Disabled). If you delay making a claim MLC may not be able to accept your claim or pay benefits. MLC’s claims philosophy MLC aims to treat all clients with respect and compassion and to make the claim process as simple and convenient as possible. Whilst protecting the interests of all clients, MLC will assess claims promptly and fairly, maintaining open and honest communication regarding issues of concern, and is committed to acting ethically and observing the principles of privacy and confidentiality. How do you lodge a claim? You or your financial adviser must notify MLC in writing or by phone that a claim is to be made, and provide MLC with the: • policy number(s) • full name of the policy owner(s) • full name of the life insured who is the subject of the claim • date of the claim event • cause/nature of the claim • name, address and telephone number of the person to whom correspondence is to be sent. MLC will then send you or your financial adviser the necessary forms and instructions for completion and return of the claim forms. MLC may ask for any further proof or information it needs to satisfy itself that you are entitled to the benefit. Different types of insurance may have special claim requirements. Any proof or information you provide is at your cost. If MLC requires a financial audit or medical examination by a person it appoints, MLC will pay for it. For information on how to claim contact the MLC Client Service Centre on 132 652. Page 54 MLC Life Cover Super and MLC Personal Protection Portfolio PDS MLC Personal Protection Portfolio How can you control who receives your PPP death benefit? You may nominate a beneficiary to receive the Life Cover benefit in the event of your death. You may nominate up to six people to each receive a share of the Life Cover benefit in the proportions you nominate. Benefits paid for Terminal Illness and Accidental Injury will be paid to you. You can nominate beneficiaries on your application, and you may vary or cancel your nomination at any time by completing a Beneficiary Nominations Form. The latest written nomination received by MLC will apply. Note: nominations cannot be made where the policy owner is a trustee of a trust or self-managed superannuation fund. The interest of a Nominated Beneficiary is purely personal and it cannot be sold or otherwise assigned or passed to their estate. If a Nominated Beneficiary dies before the life insured, the nomination is cancelled. If you assign the policy, any nomination will be cancelled automatically. Nomination of a beneficiary is only available for any insurance taken out for non-business purposes. Generally, non-business purposes means that the beneficiary does not pay an amount of money or other consideration to become nominated. What happens if you don’t nominate any beneficiaries? If you die while your Life Cover policy is in force, and you have no nominated beneficiaries, MLC will pay the amount to your estate unless MLC is legally required to pay the benefit to someone else. What happens if there is more than one policy owner? If there is more than one owner, they all own the policy jointly and if one owner dies, the remaining owners still own the policy jointly. Benefits will be paid to the policy owner(s) you nominate or, if you don’t make a nomination, to the remaining owners. If all the policy owners have died, MLC will pay any benefits to the estate of the owner who died last, unless legally required to pay someone else. Please consult your financial adviser or the policy document for details. Beneficiaries Using your insurance It is important to keep your beneficiary nomination up to date with changes in your personal circumstances. You can cancel or change your nomination at any time by completing the Beneficiary Nominations Form available from mlc.com.au or by calling the MLC Client Service Centre on 132 652. You should speak to your financial adviser, estate planner or legal representative to determine which type of nomination will best suit your circumstances and how the complex tax rules about death benefits and beneficiaries may affect you. MLC Life Cover Super and MLC Personal Protection Portfolio PDS Page 55 H o w i t a l l w o r k s MLC Life Cover Super How can you control who receives the LCS benefit if you die? If you die, the Trustee will generally pay a death benefit to your eligible beneficiaries and/or to your legal personal representative as described below. If you are diagnosed with a terminal illness MLC will pay the Trustee the relevant insured benefit. Superannuation payment rules may prevent the Trustee from releasing this benefit to you. Please read ‘Accessing your MLC Life Cover Super benefit’ on page 59 in this PDS. You have three ways to nominate a beneficiary. The process and outcome will differ depending on your situation and the type of nomination you make. Option Result Make a non-lapsing binding death benefit nomination If valid, and unless there are contrary court orders, the Trustee will pay your benefit to those you nominated in your latest nomination, in the proportions you requested. OR Make a category selection under the MLC Super Estate Optimiser facility The Trustee must pay your benefit as a lump sum or an account-based pension according to the rules set out in that category. In that sense, your selection is binding on the Trustee. OR Make a non-binding death benefit nomination In the event of your death, the Trustee will determine who receives your benefit, taking into account your nominated beneficiaries and other factors. You can notify MLC and the Trustee of your choice on your application. If you have not nominated one of the above, the Trustee will have discretion over who receives the benefit in the event of your death. Who can you nominate? Whether you make a non-lapsing binding or non-binding death benefit nomination you can only nominate: • your spouse • children including step and adopted children • individuals who are financially dependent on you at the time of your death • your legal personal representative (either the executor under your Will or a person(s) granted letters of administration for your estate if you die without having left a valid Will) • someone in an interdependency relationship with you. If you do not have any such beneficiaries at the time of your death, then the Trustee may pay the benefit to another person. When nominating your beneficiary you should take these restrictions into account. Why use a non-lapsing binding nomination Non-lapsing binding death benefit nominations are designed to help you with your estate planning. This means that you can choose who to leave your benefit to, as long as you have made a valid nomination. How do you make a valid non-lapsing binding death benefit nomination? In order to make a valid non-lapsing binding death benefit nomination, it must: • be in writing, stating the full name and, unless the nomination is to your legal personal representative, the date of birth of eligible beneficiaries and their relationship to you • be signed and dated by you in the presence of two adult witnesses who are not nominated beneficiaries • contain a signed and dated declaration from the witnesses that your beneficiary nomination was made in their presence • for multiple beneficiaries, specify the proportions of the benefit to go to each beneficiary (the total must add up to no more than 100%). The Trustee must confirm it's acceptance of your nomination. Page 56 MLC Life Cover Super and MLC Personal Protection Portfolio PDS Using your insurance Can you change your non-lapsing binding death benefit nomination? Yes. You can change the beneficiaries of your non-lapsing binding death benefit nomination or cancel it at any time. You can also replace your non-lapsing binding death benefit nomination with a non-binding death benefit nomination. Can your non-lapsing binding death benefit nomination become invalid? Yes. Your non-lapsing binding death benefit nomination can become invalid for any beneficiary who is not an eligible beneficiary at the time of your death. In this case the Trustee will have discretion over who receives the benefit amount allocated to that beneficiary. Do you need to review your nomination regularly? Yes. It is important that you review your nomination regularly to ensure you still want the Trustee to pay the person(s) you have nominated. If you make a non-lapsing binding death benefit nomination your nomination will not automatically become invalid in the event of marriage, divorce or any other life-changing event. In these circumstances, your last valid nomination may no longer reflect your intentions and, unless you update it, the Trustee will still pay the person named in the nomination so long as they are still an eligible beneficiary. We will confirm the details of your nomination each year via your annual statement. MLC Super Estate Optimiser If you have Life Cover under LCS, MLC Super Estate Optimiser can provide you with greater certainty as to how your death benefit will be paid and to whom. You select from categories to determine how the death benefit will be paid (as a lump sum or an account-based pension) and to which class of beneficiaries (your spouse, dependent children or estate). With this facility you do not nominate specific individuals to receive your death benefits. Instead, the benefit will be paid in equal portions to all beneficiaries that meet the criteria for the nominated category. Once selected, the Trustee must pay your death benefit according to your category selection. In that sense, your selection is binding on the Trustee. If your personal circumstances change you should update your category selection. What are the key advantages of MLC Super Estate Optimiser? The advantages of this facility are that: • you exercise greater control of your estate planning (note that ex-spouses are excluded, but your Dependent and Minor Children are included) • certainty is provided about who will receive the benefits (assuming you update your selection if your circumstances change) • future beneficiaries are automatically included if they meet the category definition at the date of your death (for example, future children for child related categories) • your nomination does not expire and is effective until you change or cancel your selection • the need to set up a Testamentary Trust may be reduced, potentially saving legal and associated fees. MLC Life Cover Super and MLC Personal Protection Portfolio PDS Page 57 H o w i t a l l w o r k s Who do the categories include? Spouse – is the spouse (of the same or opposite gender to you) who lived with you as husband/wife/partner immediately before your death. This also includes a de facto spouse, but does not include a spouse or de facto spouse from whom you were separated at the time of your death. Minor Children – are your children aged under 18 at the date of your death. This includes step children and adopted children. Note: If an account-based pension is paid to a minor child, it must be cashed out as a lump sum at age 25 unless the child is disabled at that time. Dependent Children – are children of yours who are dependent (in most cases financially dependent) on you and aged 18 or over at the date of your death. This includes step children and adopted children. Estate – for the purpose of payment will be the executor or administrator of your estate. What if there is more than one eligible child? Where there is more than one eligible child the payment will be made to those children in equal shares. What if your beneficiaries don’t meet the eligibility criteria? Important benefit default provisions apply where the person(s) you have nominated does not (do not) meet the definition for the category nominated at the date of your death or do not survive you: • if a lump sum would have been payable to your Dependent Children or Minor Children, but neither exists at the date of your death, then the lump sum is paid to your spouse, or if none, to your Estate • if a pension would have been payable to your Minor Children and there are no Minor Children at the date of your death, then the pension is paid to your Spouse, or if none, as a lump sum to your Estate • if a benefit would have been payable to your Spouse and there is none at the date of your death, then the benefit is paid as a lump sum to your Estate. Who should use MLC Super Estate Optimiser? You will find this facility particularly useful if you want peace of mind that your death benefit will be paid to the groups of beneficiaries selected by you and in the manner specified by you (lump sum or pension). How does MLC Super Estate Optimiser work? You determine who will receive your superannuation death proceeds by selecting one of the eight categories below. The Trustee will pay your death benefits according to your selected category. What are the categories? 1. Lump Sum – Spouse 2. Lump Sum – Minor Children 3. Lump Sum – Spouse/Minor Children (50/50) 4. Lump Sum – Dependent Children and Minor Children 5. Lump Sum – Estate 6. Account-Based Pension – Spouse 7. Account-Based Pension – Minor Children 8. Account-Based Pension – Spouse/Minor Children (50/50) Page 58 MLC Life Cover Super and MLC Personal Protection Portfolio PDS Using your insurance Default pensions If a pension is selected, the Trustee will pay a pension according to the current terms. The current default pension is MLC MasterKey Pension Fundamentals. How do you make a category selection under MLC Super Estate Optimiser? To make a category selection under MLC Super Estate Optimiser, complete the Super Estate Optimiser questions in your application and send it to MLC with your application for LCS. To assist the Trustee in administering a claim you may name Children and/or your Spouse in the Selection Form, but all persons who fulfil the category at the date of your death will receive the death benefit whether or not they are named on the Selection Form. How do you change your category selection under MLC Super Estate Optimiser? You can change your category selection at any time by completing the Super Estate Optimiser questions in your application. Of course you should also regularly update your Will. What is the impact of super splitting under the Family Law Act? You should be aware that in certain circumstances upon the breakdown of your marriage, your MLC Super Estate Optimiser death benefit category selection may be overridden in whole or in part and the payment of benefits may be delayed by various actions taken under the superannuation provisions of the Family Law Act. Should your marriage break down, you should review your current category selection under the MLC Super Estate Optimiser. MLC Life Cover Super and MLC Personal Protection Portfolio PDS Page 59 H o w i t a l l w o r k s Are your Life Cover, TPD and Income Protection benefits under LCS restricted? Benefits payable by MLC under LCS are paid to the Trustee, who then passes the benefit to you. The Trustee is restricted from passing benefits to you if you do not satisfy a superannuation condition of release. If you do not satisfy a condition of release, the Trustee must hold your benefit in the Scheme as a preserved benefit until you do satisfy a condition of release. Typically, TPD, Income Protection and Terminal Illness benefits paid under LCS may be affected by this restriction: • for TPD benefits paid to the Trustee, you must satisfy the condition of release of permanent incapacity, which means that the Trustee is satisfied that you are unlikely, because of health reasons, to engage in gainful employment for which you are reasonably qualified by your education, training and experience • for Income Protection benefits paid to the Trustee, you must satisfy the condition of release of temporary incapacity, which means that you have ceased to be gainfully employed or ceased temporarily to receive any gain or reward due to ill health. The Trustee may not be able to pass benefits to you or may reduce benefits if you receive any income provided or arranged by an employer, partnership or business, including fully paid leave such as sick leave, or if government regulations otherwise limit the benefit that can be paid. A benefit can not be paid for longer than the period of temporary incapacity. • for Terminal Illness you must have a terminal medical condition and have two medical practitioners (at least one of them a specialist in the area of the illness or injury) certify that you are suffering from an illness, or have incurred an injury, which in the normal course would result in death within 12 months from the date of certification (known as the ‘certification period’). Other conditions of release are set out on this page under the 'Conditions of release'. The Trustee will write to you if it is unable to release benefits to you and will explain your options in relation to any preserved benefits. You may transfer your preserved benefits to any other complying superannuation fund, approved deposit fund or retirement savings account. How can you access your LCS benefits? This type of benefit Can be withdrawn Preserved benefit when you satisfy a condition of release Unrestricted non-preserved benefit at any time Conditions of release You may generally withdraw your benefits from the superannuation environment if you: • reach age 65 • cease employment with an employer after age 60 • reach your preservation age and permanently retire • are permanently incapacitated – the definition for release of preserved benefits on the grounds of permanent incapacity is different to that used for TPD insurance, so you may not be able to access this benefit held for you by the Trustee (if, for example, you are still employed) • are suffering from a terminal medical condition • qualify on the grounds of severe financial hardship – to find out if you qualify contact your financial adviser or the MLC Client Service Centre on 132 652 • are granted access on compassionate grounds approved by APRA • are a temporary resident holding a specified class of visa and have permanently departed Australia, unless one of the following applies, you: – are a New Zealand citizen – become an Australian permanent resident/citizen – hold an eligible retirement visa. If you don’t meet any of these conditions of release and you are over your preservation age, you may be able to use your benefit, including preserved benefits, to commence a transition to retirement pension. In some cases, benefits may only be withdrawn as a lump sum. Please see your financial adviser for more information. What is your preservation age? The preservation age is 55 years for individuals born before 1 July 1960 and progressively increases to 60 years for individuals born between 1 July 1960 and 1 July 1964. Accessing your MLC Life Cover Super benefit Page 60 MLC Life Cover Super and MLC Personal Protection Portfolio PDS Taxation Using your insurance Financial Planning Benefit For non-business purposes, the Financial Planning Benefit is generally not taxable. However, seek tax advice specific to your circumstances. For business purposes, seek tax advice specific to your circumstances. Income Protection and Business Expenses If you are self-employed or an employee, the premium is likely to be tax deductible and the benefit is likely to be assessable as income. Where the life insured dies while receiving Income Protection benefits, the lump sum benefit paid is not likely to be assessable as income. Premium Waiver and Policy Fee Where your policy covers a number of benefits, the cost of Premium Waiver and Policy Fees for each benefit may be deductible, partly deductible or non-deductible depending on whether your premium for that benefit is deductible, partly deductible or non-deductible. MLC Personal Protection Portfolio Generally, whether a PPP premium is tax deductible or a benefit payment is assessable depends on who is insured and whether it is for business or non-business purposes. Life Cover For non-business purposes, the premium is not tax deductible but the benefit is tax free whether paid to you or a nominated beneficiary. For business purposes, if you insure a key employee to protect against a revenue loss, the premium is likely to be tax deductible and the benefit is likely to be assessable as income to the business. Total and Permanent Disability, Terminal Illness Support, Critical Illness and Occupational HIV, Hepatitis B or C lump sum benefit For non-business purposes: • if you insure yourself, your spouse or a qualifying relative, the premium is not tax deductible but the benefit is tax free in your hands • if you insure anyone else, the premium is not tax deductible but a taxable capital gain may arise when a benefit is paid to you. For business purposes: • if you insure a key employee to protect against a revenue loss, the premium is likely to be tax deductible and any benefit would likely be assessable as income to the business • in other circumstances the premium may not be tax deductible and a benefit may give rise to a capital gain when paid. This section gives a brief summary of the way LCS and PPP are treated for tax purposes as at the preparation date of this PDS. The information is of a general nature only, and is written as though you are the policy owner. MLC recommends that you seek professional tax advice regarding your own taxation position. In addition, you can obtain information from the Australian Taxation Office at ato.gov.au MLC Life Cover Super and MLC Personal Protection Portfolio PDS Page 61 H o w i t a l l w o r k s MLC Life Cover Super When is your first premium reported? The first premium is reported to the Australian Tax Office only when an application is accepted so, if you intend to claim a tax deduction for your premium, you should note that the first premium for an application received towards the end of the tax year may not be reported until the application is accepted in the following tax year. How are LCS contributions classified for tax purposes? While you can contribute as much as you like, you will incur additional tax if contributions exceed certain limits. The two main limits are shown in the following tables. Concessional contributions Generally, these are contributions made by: • your employer (including any salary sacrifice contributions) • you, for which you are claiming a tax deduction. Age on the last day of the financial year Annual Limit 2009/2010 Less than 50 $25,000 50 and over $50,000 applies to 30 June 2012. From 1 July 2012 the limit will be the same as for those aged less than 50. Non-concessional contributions Generally, these are contributions made by: • personal contributions for which you are not claiming a tax deduction • contributions made for you by your spouse. Age on the first day of the financial year Annual Limit 2009/20010 Less than 65 $150,000 annually or $450,000 over a 3 year period. 65 to 74 $150,000 annually 75 and over Non-concessional contributions cannot be made. Limits may be increased periodically except when the three year limit is being used. To find out the current limits go to apra.gov.au or ato.gov.au There are a number of specific inclusions and exclusions. If other contributions are being made to an LCS insurance policy you need to check how they may affect your contribution limits and tax. Please note that if you have more than one fund, all concessional and non-concessional contributions made to all your funds are added together and count towards your limits. What deductions or concessions are available for contributions to LCS? Generally, personal contributions may be claimed as a tax deduction if you are under age 75 and receive less than 10% of your assessable income and reportable fringe benefits from eligible employment. Your spouse may be entitled to a tax offset on contributions they pay to your super account depending on your level of income and provided you are not permanently living apart. This is a complex area. You should seek professional tax advice about the types of contributions that fall into each category and the limits that may apply. LCS does not accept contributions from overseas funds, small business sale proceeds, Directed Termination Payments or personal injury payments, so please discuss these with your financial adviser. How are LCS contributions taxed? Tax on contributions Contributions are generally either tax free or taxed at a rate of 15%. The main types of contributions that are taxed at a rate of 15% are concessional contributions. In LCS, generally, contributions pay for the cost of insurance cover which is fully deductible to the Scheme, so the net effect is that no contributions tax applies. Page 62 MLC Life Cover Super and MLC Personal Protection Portfolio PDS Should you provide your Tax File Number? Yes. Whilst you’re not legally required to provide your Tax File Number, if you do not provide your Tax File Number your application for LCS cannot be accepted. In the event an LCS policy is issued and a Tax File Number is not provided by you on request, MLC may cancel the policy. You should also be aware that: • MLC and the Trustee are authorised to collect your Tax File Number under the Superannuation Industry (Supervision) Act 1993. • It is not an offence to decline to notify MLC and the Trustee of your Tax File Number. • If you do not notify MLC and the Trustee of your Tax File Number, they may not be able to now or in the future locate or amalgamate and identify your benefits in order to pay you any benefits. • MLC and the Trustee are allowed to use your Tax File Number only for lawful purposes, in particular if paying out monies, identifying and amalgamating superannuation benefits for surcharge purposes and for other approved purposes. The approved purposes and the consequences of not notifying a Tax File Number may change in the future as a result of legislative changes. • Your Tax File Number will be disclosed to the Commissioner of Taxation. Your Tax File Number will also be passed to another superannuation provider if your benefits are being transferred, unless you inform MLC and the Trustee in writing not to pass on your Tax File Number. Your Tax File Number will not otherwise be disclosed to any other person. Using your insurance Penalty tax on excessive contributions If you exceed the contribution limits, significant penalty taxes may be charged by the Australian Taxation Office at the rate of 31.5% for excessive concessional contributions and 46.5% for excessive non-concessional contributions. Also, excess concessional contributions count towards your non-concessional contribution limit, so if you exceed both limits then both lots of penalty tax may be charged. If you are issued with a tax assessment from the Australian Taxation Office you will need to pay the amount due to the Australian Taxation Office within 21 days. It is your responsibility to pay the tax liability to the Australian Taxation Office on time. How are LCS benefits taxed? Generally, any benefits received by you from age 60 or paid to your dependents on your death are tax free. Tax may be payable by you if you receive a benefit before age 60 or payable by your beneficiary if a death benefit is paid to a non-dependant. Where required to by law, MLC will deduct any tax, duty, impost or the like from a benefit payment and forward it to the relevant authority. Are benefit payments from MLC Super Estate Optimiser taxed? Any tax that may apply to a death benefit payable to beneficiaries depends on a number of factors such as the form of the benefit (lump sum or pension), timing and the dependency status of your beneficiaries. In general, if a death benefit is paid as a lump sum to a tax dependant (which includes a Spouse, Minor Child and Dependent Child) the full amount is tax free. If the death benefit is instead paid as a pension to a tax dependant, the income received from the pension will be tax free if either the deceased or the recipient is aged 60 or over. Otherwise, the pension income payments will generally be taxed at the recipient’s marginal rate less a 15% tax offset. As the tax rules for death benefits are complex, you should seek professional tax advice about which option (lump sum or account-based pension) is preferable for your beneficiaries. MLC Life Cover Super and MLC Personal Protection Portfolio PDS Page 63 H o w i t a l l w o r k s Renewing your insurance Adding to or changing your insurance Changing, replacing, transferring, renewing or terminating your insurance Generally, MLC will renew the policy each year (as long as you continue to pay the premiums), even if you make claims or your health worsens. However: • MLC does not renew Income Protection insurance for special risk occupations automatically, but assesses whether it can renew the cover on a case by case basis • MLC will renew a Critical Illness Standard policy on terms and conditions that apply to Critical Illness Standard insurance at the time of renewal (see ‘Conditions covered by Critical Illness Standard and their definitions may change’ in the ’Critical Illness’ section on page 20). Terminating insurance You can cancel any insurance or the policy at any time by notifying MLC in writing. Your insurance may also end because your full benefit is paid, you reach your policy’s expiry age or termination date, you die, or because the policy is cancelled due to a fraudulent claim or failure to pay premiums, as stated in ‘When does insurance end?’ for each type of insurance. To add to or change your insurance, complete the ‘Application for Increase/Alteration/Reinstatement’ form and send it to MLC, who will accept or decline the change. The change is not effective until MLC acknowledges the acceptance of the change. The terms applicable to your additional insurance will be those prevailing at that time. Premiums for the policy may alter if you add to or change your cover. Replacing insurance If you are replacing insurance, you should compare the differences between the existing and replacement policies and only cancel your policy when the new insurance is in place, because there is a risk that: • the new insurance may not provide you with benefits that would have been available under your existing policy (including benefits for conditions which are considered as pre-existing under the new policy) • you may be without protection if the new insurance is not issued and your existing policy has lapsed or been cancelled. However, once replacement insurance is in place, you must cancel your existing policy. If you do not cancel the replaced policy, any benefit that becomes payable under the new insurance will be reduced by any similar benefit that you, your estate or a nominated beneficiary is entitled to receive under the policy that MLC and the Trustee understood was to be replaced. Transferring insurance (within MLC) If you apply to transfer your insurance from your existing MLC policy to a new MLC policy without increasing your benefits, our assessment of your application will rely on the information you provided to us for your existing MLC policy. Page 64 MLC Life Cover Super and MLC Personal Protection Portfolio PDS Converting MLC Life Cover Super to non-superannuation insurance How does conversion work? On conversion, MLC cancels the LCS insurance policy held by the Trustee for you and MLC issues a non-superannuation policy with similar types of insurance and amounts of insured benefits. The policy terms and conditions will be determined at the date of conversion. If LCS is your only interest in the Scheme, your membership of the Scheme and your entitlement to receive a benefit from the Scheme will also cease. In determining eligibility for benefits, insurance under the new policy will be taken to have started on the later of: • the date similar insurance began under the superannuation insurance policy • the date the superannuation insurance policy was last reinstated. The amount of insured benefits under the new policy will not be more than it was under the old policy at the date of conversion. Premiums under the new policy will be calculated in line with MLC’s base premium rates at the time, taking into account the amount of insured benefits, your age and acceptance terms of the policy. What is conversion? Conversion means that the insurance policy in superannuation ends and a new policy is issued outside superannuation. When does conversion happen? With MLC’s approval you may convert the LCS policy to a non-superannuation policy at any time before you turn 75. MLC must convert the LCS policy to a non-superannuation policy if: • you are aged 65 to 74, and • you do not satisfy the work test. If MLC must convert the LCS policy to a non-superannuation policy, this is how it works: If you pay your premiums via deduction from your MLC MasterKey Superannuation account, and the balance no longer covers the premiums: MLC will cancel the insurance policy held by the Trustee for you and you will be offered the opportunity to convert to a non-superannuation policy. If you wish to convert, you must complete the appropriate forms to select your preferred payment method for the new policy. If you pay your premiums via direct debit, credit card, cheque or BPAY  ® : MLC will cancel the insurance policy held by the Trustee for you and it will be automatically converted to a non-superannuation policy. You will not need to complete any forms. However, if you do not want MLC to automatically convert the insurance policy, you or the Trustee must notify MLC in writing. MLC will terminate the policy. What is the work test? To satisfy the work test, you must be gainfully employed on at least a part-time basis, having worked for at least 40 hours during a period of 30 consecutive days in the financial year in which the contribution is made. If you do not respond when MLC writes to you and asks if you satisfy the work test, MLC will assume you do not satisfy the work test. Changing, replacing, transferring, renewing or terminating your insurance MLC Life Cover Super and MLC Personal Protection Portfolio PDS Page 65 H o w i t a l l w o r k s Transfers out of MLC Life Cover Super to rollover funds Transfers to an eligible rollover fund The Trustee may transfer your benefit to an eligible rollover fund if we lose contact with you and cannot locate you. The Trustee will advise you of our intention to transfer your benefit to an eligible rollover fund in writing at your last known address and will proceed with transferring your benefit if you don’t respond with details of an alternative superannuation fund. Transfer to an eligible rollover fund may be detrimental to you as the eligible rollover fund may have a different fee structure, different investment strategies and may not offer insurance benefits. The eligible rollover fund we currently use is the Australian Eligible Rollover Fund and they can be contacted on 1800 677 424. What happens to unclaimed money? If you don’t claim your benefit, it is treated as unclaimed money and the Trustee must pay it to the Australian Taxation Office. A benefit becomes unclaimed money if: • you have reached eligibility age (currently 65 years) or you die, and • you or another person are entitled to a benefit, and • MLC and the Trustee are unable to locate you, or the person who is entitled to receive your benefit. To seek payment, you or the person entitled to receive your benefit must apply to the Australian Taxation Office which can be contacted at: Telephone: 131 020 Website: ato.gov.au The Australian Taxation Office website also has an online SuperSeeker service that enables you to search for your unclaimed money (also known as lost superannuation) using your Tax File Number. You can phone SuperSeeker on 132 865. Page 66 MLC Life Cover Super and MLC Personal Protection Portfolio PDS Complaint resolutions Time limits on legal actions Neither you nor the Trustee may take legal action for the payment of benefits under the Policy: • less than 60 days after MLC receives all proof or information that MLC needs to properly consider the claim • more than 3 years after MLC first asked for that proof or information. In most cases we can deal with your complaint over the telephone. You can speak to a customer service consultant by calling the MLC Client Service Centre on 132 652. If we cannot resolve your complaint please write to us at the following address and mark your envelope ‘Notice of complaint’: The Manager MLC Complaint Resolutions PO Box 1086 North Sydney NSW 2059 If we are unable to resolve your complaint within the timeframe specified below or if you are dissatisfied with the outcome, you may seek assistance from the following independent bodies: If you are insured under an LCS policy: Timeframe: 90 days Superannuation Complaints Tribunal Telephone: 1300 780 808 Website: sct.gov.au If you are insured under a PPP policy: Timeframe: 45 days Financial Ombudsman Service Telephone: 1300 780 808 Email: [email protected] Website: fos.org.au MLC Life Cover Super and MLC Personal Protection Portfolio PDS Page 67 H o w i t a l l w o r k s Using and disclosing your personal information MLC Limited and its subsidiaries are members of the National Australia Group (the Group). The Group includes banking, financing, funds management, financial planning, superannuation, insurance, broking and e-commerce organisations. This statement is an outline of certain matters relating to the collection and handling of your personal information by Group organisations. Collecting your personal information Group organisations will collect personal information for the purposes of: • providing you with a product or service (including assessing your application) • managing and administering the product or service • identifying you and protecting against fraud • verifying your authority to act on behalf of a customer • determining whether a beneficiary will be paid a benefit upon a person’s death • letting you know about products or services from across the Group that might better serve your financial, e-commerce and lifestyle needs or promotions or other opportunities in which you may be interested. If you provide MLC with incomplete or inaccurate personal information, the Group organisation may not be able to process your requests and applications or manage or administer your products or services. It may also not be possible to tell you about other products or services from across the Group that might better serve your financial, e-commerce and lifestyle needs. Group organisations may disclose your personal information to other organisations: • involved in providing, managing or administering the products and services the Group offers, including third- party suppliers (eg printers, posting services), other Group organisations, its advisers and loyalty and affinity program partners • who are your financial or legal advisers or representatives and their service providers • involved in maintaining, reviewing and developing the Group’s products, business systems, procedures and infrastructure including testing or upgrading the Group’s computer systems • involved in a corporate re-organisation or involved in a transfer of all or part of the assets or business of a Group organisation • involved in the payments system including financial institutions, merchants and payment organisations • which are Group organisations which wish to tell you about their products or services that might better serve your financial, e-commerce and lifestyle needs or promotions or other opportunities, and their related service providers, except where you tell the Group not to • as required or authorised by law and/or where you have given your consent. Your personal information may also be used in connection with such purposes. Because the Group operates throughout Australia and overseas, some of these uses and disclosures may occur outside your state or territory and outside Australia. Gaining access to your personal information Subject to some exceptions allowed by law, you can gain access to your personal information. If access is denied, you will be given reasons for this. In some cases, your request may be dealt with over the telephone. For more information about your personal information and privacy, please call the MLC Client Service Centre on 132 652. Privacy Notification Page 68 MLC Life Cover Super and MLC Personal Protection Portfolio PDS This page has been left blank intentionally. MLC Life Cover Super PDS and MLC Personal Protection Portfolio PDS Page 69 Definitions Page 70 MLC Life Cover Super and MLC Personal Protection Portfolio PDS General Definitions Accident An event where bodily injury is caused directly and solely by violent, external and visible means, independently of all other causes. Business day A day, other than a Saturday or Sunday, or a public or Bank holiday. Complying superannuation fund A regulated superannuation fund that qualifies for concessional tax rates. A complying superannuation fund must meet the requirements that are set out in law. Concessional contributions These include, but are not limited to, contributions from your employer (including salary sacrifice) or if you are eligible, personal contributions for which you claim a tax deduction. There are a number of specific inclusions and exclusions and if contributions other than these are being made to your account you need to check the impact these may have on your concessional contributions limit. Consumer Price Index (CPI) The ‘Consumer Price Index: All Groups Index Weighted Average for Eight Capital Cities’ published by the Australian Bureau of Statistics or, if that is not available, any reasonable substitute chosen by MLC. Contributions tax A tax of 15% applied to deductible personal contributions, employer contributions (including salary sacrifice) and some other types of contributions. Dependant Includes a spouse, a child of any age, a financial dependant, or a person in an interdependency relationship. Directed Termination Payment (DTP) A transitional termination payment that you direct your employer to contribute to a complying superannuation fund, approved deposit fund, retirement savings account or to purchase a qualifying annuity. Tax otherwise payable on a transitional termination payment is not withheld on a Directed Termination Payment but contributions tax of 15% is payable on the taxable component at the time the Directed Termination Payment is contributed. Disabled For the purposes of the death benefit restriction for child beneficiaries, a disabled person is defined in s8(1) of the Disability Services Act as a person with a disability that is attributable to an intellectual, psychiatric, sensory or physical impairment or a combination of such impairments. The disability must be permanent or likely to be permanent and result in a substantially reduced capacity of the person for communication, learning or mobility and the need for ongoing support services. Doctor This is a registered medical practitioner, who is not the life insured, policy owner or any member of their families. Earnings Where you are self-employed (directly or indirectly own part of a business), ‘earnings’ means the income of the business generated by your personal efforts after the deduction of your share of business expenses in generating that income. Where you are an employee, ‘earnings’ means the total remuneration paid by the employer to you including salary, commissions, fees, regular bonuses, regular overtime, fringe benefits and regular superannuation contributions paid by the employer on your behalf. Earnings do not include investment income and are calculated before tax. Eligible MLC MasterKey superannuation product Premiums can be deducted monthly from the following MLC MasterKey superannuation products: • MasterKey Super Fundamentals • MasterKey Super • MasterKey Superannuation (Gold Star / Five Star). Eligible rollover fund (ERF) A regulated superannuation fund or approved deposit fund which has formally elected to be an eligible rollover fund. An eligible rollover fund is required to treat all members as protected members. Farmers Package An Income Protection Plus plan available under PPP, which may be available to farmers when they do not qualify for Income Protection insurance due to difficulty of assessing earnings. MLC Life Cover Super and MLC Personal Protection Portfolio PDS Page 71 D e f i n i t i o n s Gainfully employed Working for earnings, payment or profit. Key person / revenue protection insurance A method used by a business or employer to protect against financial loss that may result from the loss of service of a key person in the event of death, sickness or injury. A key person is a person without whose knowledge or expertise the business would suffer financial loss. Inflation The increase in the price of goods and services as measured by the Consumer Price Index (CPI). The effect of inflation is that something you buy today will cost more in the future. Insured benefit The amounts shown in the Schedule for LCS which are the maximum amounts that will be paid to the Trustee by MLC under each type of insurance provided. Interdependency relationship Broadly, an ‘interdependency relationship’ exists where two persons: • have a close personal relationship • live together • one or each provides financial support to the other, and • one or each provides domestic support and financial care to the other. If a close personal relationship exists but the other requirements of an interdependency relationship are not satisfied because of physical, intellectual or psychiatric disability, then an interdependency relationship may still exist. Mental disorder A mental disorder is defined as any disorder classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association (APA) which is current at the start of the period of total disability. Such disorders include, but are not limited to, stress (including post traumatic stress); physical symptoms of a psychiatric illness; mental disorders due to a general medical condition; anxiety, depression, psychoneurotic, psychotic, personality, emotional or behavioural disorders; and disorders related to substance abuse and dependency which include alcohol, drug or chemical abuse dependency. If the DSM is discontinued, MLC will use the manual chosen as its replacement by the APA. Non-concessional contributions These contributions most commonly include your personal contributions for which you do not claim a tax deduction and contributions made by your spouse on your behalf. There are a number of specific inclusions and exclusions and if contributions other than these are being made to your account you need to check the impact these may have on your non-concessional contributions limit. Normal physical domestic duties Cleaning, cooking meals, doing the laundry, shopping for groceries and taking care of dependent children. Paid-to date The date premiums are paid up to in whole months in line with the review date. The following will apply: • if you pay your premiums monthly, your insurance cover will end as at the next paid-to date • if your premiums are deducted from your eligible MLC MasterKey superannuation product account, MLC will cease deducting premiums on the date the policy is cancelled and your insurance cover will end as at the next paid-to date, as outlined above for premiums paid monthly • if you pay your premiums half-yearly or yearly, your insurance cover will end on the next monthly paid-to date following receipt of your cancellation request. Any premium paid by you for cover after that paid-to date will be refunded. Page 72 MLC Life Cover Super and MLC Personal Protection Portfolio PDS General Definitions Personal injury payments The amounts derived from: • a structured settlement payment • an order for a personal injury payment, or • a workers compensation payment, taken as a lump sum. Premium The amount of money charged by MLC for the insurance cover provided. Preserved benefits Benefits that must be kept in a superannuation fund and cannot be withdrawn until you have met a condition of release. Retrenchment When your employer terminates your full-time employment because your position is no longer needed; for the business. Review date The date stated in the Schedule on which MLC reviews the insured benefits and premiums each year. Typically, this is the anniversary of the date the policy was issued or reinstated. Sabbatical Leave that is taken for study or travel and study as a normal part of the life insured’s occupation. Salary sacrifice ‘Before tax’ salary that can be contributed to your superannuation account via an arrangement with your employer. These contributions are treated as employer contributions. Schedule The Schedule issued for LCS and PPP with the policy which details the types of insurance and the amount of insured benefits under the policy. An updated Schedule will be issued each year or at any time there is a change in the benefits or types of insurance. The updated Schedule will replace the previous Schedule. Small business sale proceeds Amounts that relate to the disposal of certain small business assets. These contributions are sometimes referred to as the ‘Capital Gains Tax retirement exemption’, which is subject to a lifetime limit of $500,000, and the ‘Capital Gains Tax 15 year exemption’. Spouse A person living together with another person as husband, wife or de facto partners on a genuine domestic basis, including same-sex partners. Note this definition does not apply to the MLC Super Estate Optimiser facility. Statement of Advice A document that must be given to a client by their financial adviser in relation to the provision of personal advice in accordance with Div 3C and 3D of Part 7.7 of the Corporations Act. Superannuation lump sum rollover The amount of your superannuation benefits that you move directly to and from another resident complying superannuation fund, approved deposit fund, retirement savings account or qualifying annuity. Tax Dependant Generally a dependant but expressly excludes a child over 18 who was not financially dependent on, or in an interdependency relationship with, the member at the time of the member’s death. Termination date The date when cover under a type of insurance ends. The termination date may vary for different types of insurance. Terminal Illness Any illness that, in the opinion of an appropriate specialist physician approved by MLC, is likely to lead to your death within 12 months from the date MLC is notified in writing by the approved physician. Transition to Retirement Pension An income stream benefit with restrictions on income payments and lump sum withdrawals which permit a person who has reached their preservation age to access part or all of their accumulated benefits including preserved benefits. Transitional Termination Payment A payment which is subject to the transitional arrangements that may apply to certain payments made in consequence of termination of employment between 1 July 2007 and 30 June 2012. Unrestricted non-preserved benefits Benefits that have previously met a condition of release and therefore can be withdrawn from a superannuation fund at any time (subject to the rules of the fund). MLC Life Cover Super and MLC Personal Protection Portfolio PDS Page 73 D e f i n i t i o n s What is Total and Permanent Disability? Total and Permanent Disability (TPD) and Loss of Independence Definitions You are totally and permanently disabled if you have a disability resulting from an injury or illness and as a result of your disability you have been completely unable, and are unlikely ever to be able, to work according to your Occupation Definition at the time of claim, and these circumstances have existed continuously for at least six months. or you suffer a permanent impairment of at least 25% of whole person function so that you are completely unable, and are unlikely ever to be able, to work according to your Occupation Definition (‘whole person function’ is defined in the American Medical Association’s ‘Guide to the Evaluation of Permanent Impairment’, 4 th edition, or an equivalent approved by MLC). or You are totally and permanently disabled if you suffer the total and irrecoverable loss of either the use of both hands or the use of both feet or the sight in both eyes or the use of one hand and one foot or the use of one foot and the sight in one eye or the use of one hand and the sight in one eye What are the TPD Occupation Definitions? How your inability to work is defined depends on whether or not you are gainfully employed (working for earnings, payment or profit) when your disability begins, and whether you are insured under the Any Occupation or Own Occupation definition. If you are gainfully employed when your disability begins, ‘unable to work’ means your inability to: work at your usual occupation or any other occupation you are reasonably suited to by way of education, experience or training for the Any Occupation definition work at your own occupation for the Own Occupation definition and not be working in any occupation for a continuous period of at least six months. If you are not gainfully employed when your disability begins, ‘unable to work’ means your inability to: do any normal physical domestic duties (cleaning, cooking meals, doing the laundry, shopping for groceries and taking care of dependent children) Eligibility for ‘Own Occupation’ definition of TPD For an additional cost you can choose an Own Occupation definition if the occupation in which you are engaged when you apply is eligible under the AAA, ACT, ML or certain AA, A, BB occupation categories, which include professional occupations such as accountants, doctors and solicitors. MLC or your financial adviser can tell you your occupation category. The Own Occupation definition of TPD varies according to your employment status. When you claim, the Own Occupation definition lets you choose to be assessed according to: • your occupation when you applied, or • your occupation immediately prior to your date of disability, as long as that occupation is eligible for the Own Occupation definition. Page 74 MLC Life Cover Super and MLC Personal Protection Portfolio PDS What is Loss of Independence? There are three categories of loss of independence criteria. You have lost independence if, as a result of illness or injury, you are permanently unable to do any two or more of the following groups of daily activities without physical help from someone else: • bathing or showering • dressing • moving from place to place, in and out of bed, and in and out of a chair • eating and drinking • using the toilet. or have suffered from the total and irrecoverable loss of: • the use of both hands, or • the use of both feet, or • the sight in both eyes, or • the use of one hand and one foot, or • the use of one foot and the sight in one eye, or • the use of one hand and the sight in one eye. OR You have lost independence if you suffer severe permanent cognitive impairment (if you obtain a score of 15 or less out of 30 in a ‘Mini Mental State Examination’), so that you need continuous supervision to protect yourself or other people. A Mini Mental State Examination is a test which samples various functions including arithmetic, memory and orientation to assess cognition. The loss of independence circumstances must have existed continuously for at least six months. Total and Permanent Disability (TPD) and Loss of Independence Definitions MLC Life Cover Super and MLC Personal Protection Portfolio PDS Page 75 D e f i n i t i o n s Critical Illness Definitions Critical Conditions Definitions Your Critical Illness insurance requires the following precise medical definitions: Aorta repair The correction of narrowing, dissection or aneurysm of the aorta through the chest or abdominal wall. It does not include angioplasty, intra-arterial procedures or other non-surgical procedures. Aplastic anaemia Means bone marrow failure which results in anaemia, neutropenia and thrombocytopenia requiring as a minimum one of the following treatments: • marrow stimulating agents • bone marrow transplantation • blood product transfusions • immunosuppressive agents. Bacterial meningitis Severe inflammation of the membrane that surrounds the brain and spinal cord which results in a permanent impairment of at least 25% of whole person function. Bacterial meningitis occurring in patients with HIV infection is not covered. Benign brain tumour The presence of a non-cancerous tumour of the brain resulting in at least 25% permanent impairment of the whole person function. The following are not included: • intracranial cysts, granulomas and haematomas • intracranial malformation in or of the arteries and veins • tumours of the pituitary gland or the spinal cord. Blindness The permanent loss of all sight in both eyes, whether aided or unaided, due to sickness or injury to the extent that visual acuity is 6/60 or less in both eyes, or to the extent that the visual field is reduced to 20 degrees or less of arc. Cardiomyopathy The inability of the heart muscle to function properly resulting in permanent physical impairment to the degree of at least Class 3 of the New York Heart Association classification of cardiac impairment. Cardiomyopathy caused by alcohol or drug abuse is not covered. Chronic kidney failure The final stage of kidney disease that requires permanent dialysis or a transplant. Chronic liver failure The final stage of liver disease with permanent jaundice, ascites (abnormal retention of fluids within the abdominal cavity), deteriorating liver function tests and encephalopathy (related brain disease). Liver disease caused by alcohol or drug abuse is not covered. Chronic lung failure The final stage of lung disease, needing a permanent extra oxygen supply and with lung function tests known as FEV1 consistently showing results of less than one litre. Coma A total loss of consciousness and responsiveness that: • lasts at least 96 hours • requires the continuous use of a life support system for that time, and • results in permanent loss of at least 25% of either the brain’s mental function or its physical control function. Coma caused by alcohol or drug abuse is not covered. Coronary artery angioplasty An operation to correct narrowing or obstruction of one or more coronary arteries. Intra-arterial investigation procedures are not included. Coronary artery angioplasty – Triple Vessel The actual undergoing for the first time of an operation to correct narrowing or obstruction of three or more coronary arteries within the same procedure when considered the necessary and appropriate treatment. Page 76 MLC Life Cover Super and MLC Personal Protection Portfolio PDS Coronary artery bypass surgery The surgical grafting of a bypass to a coronary artery to overcome narrowing or obstruction. It does not include coronary artery angioplasty, intra-arterial procedures or other non-surgical procedures. Deafness Permanent loss of all hearing in both ears. Dementia or Alzheimer’s disease The permanent failure of brain function resulting in significant cognitive impairment with the need for continuous supervision to protect yourself or other people. The diagnosis of Dementia or Alzheimer’s disease must be certain, with no other recognisable cause, and be supported by clinical evidence and standardised testing. Encephalitis Severe inflammation of brain substance which results in permanent loss of at least 25% of either the brain’s mental function or its physical control function. Encephalitis occurring in patients with HIV infection is not covered. Heart attack The death of part of the heart muscle because of inadequate blood supply. The diagnosis must be based on electrocardiogram changes and either: • higher levels of cardiac enzyme (CK-MB) than normal, or • an elevation (other than as a result of cardiac or coronary intervention or angina) of Troponin I in excess of 2.0 µg/L (micro-grams per litre) or Troponin T in excess of 0.6 µg/L. If a diagnosis based on the above criteria is inconclusive, then MLC will consider a claim based on conclusive evidence that the life insured has been diagnosed as having suffered a heart attack, resulting in either one of the following: • new pathological Q waves, or • a permanent left ventricular ejection fraction of 50% or less, measured 3 or more months after the event. Heart valve surgery The surgical repair or replacement of a defective heart valve or valves. It does not include intra-arterial procedures or other non-surgical procedures. HIV contracted through medical procedures Accidental infection with Human Immunodeficiency Virus (HIV) as a direct result of one of the following medical procedures: • blood transfusion, or transfusion with blood products • organ transplant to the life insured • assisted reproductive techniques • any other procedure or operation performed by a medical practitioner or dentist. The procedure must have occurred in Australia and have been performed by a recognised and registered medical practitioner or dentist. Any event that might lead to a claim must be reported to MLC within 14 days. The claim must be supported by a negative HIV antibody test on a blood sample taken immediately after the event. MLC must have access to the blood sample tested and must be able to take further samples if MLC thinks this is needed. Seroconversion must occur within 6 months of the event. A benefit will not be paid if any of the following are true: • the HIV infection has any other cause, including sexual activity or recreational intravenous drug use • the Australian Government has approved a treatment which makes HIV inactive and non-infectious. Critical Illness Definitions MLC Life Cover Super and MLC Personal Protection Portfolio PDS Page 77 D e f i n i t i o n s HIV contracted through your work Infection with Human Immunodeficiency Virus (HIV) as a result of an injury while you are working at your normal occupation. Any injury that might lead to a claim must be reported to MLC within 14 days. The claim must be supported by a negative HIV antibody test on a blood sample taken immediately after the injury. MLC must have access to the blood sample tested and must be able to take further samples if MLC thinks this is needed. Seroconversion must occur within six months of the injury. A benefit will not be paid if any of the following are true: • the HIV infection has any other cause, including sexual activity or recreational intravenous drug use • before the injury the Australian Government has recommended an HIV vaccine for use in your occupation, but you have not taken this vaccine • the Australian Government has approved a treatment which makes HIV inactive and non-infectious. Intensive care Mechanical ventilation by means of tracheal intubation for 10 consecutive days (24 hours per day) in an intensive care unit of an acute care hospital. Intensive care as a direct or indirect result of drug or alcohol intake is excluded. Loss of independence As a result of injury or sickness you are permanently unable to do any two or more of the following groups of activities of daily living without physical help from someone else: • bathing or showering • dressing • moving from place to place, in and out of bed, and in and out of a chair • eating and drinking • using the toilet. You also lose your independence if you have severe permanent cognitive impairment (with a score of 15 or less out of 30 in a Mini Mental State Examination) which leads to a need for continuous supervision to protect yourself or other people. A Mini Mental State Examination is a test which samples various functions including arithmetic, memory and orientation to assess cognition. The loss of independence circumstances must have existed continuously for at least six months. Loss of speech Total and permanent loss of all ability to speak. A claim can only be made once the initial diagnosis is reconfirmed after six months. Major brain injury Physical head injury that results in permanent loss of at least 25% of either the brain’s mental function or its physical control function. Major burns Third degree burns to 20% or more of the body surface, or to the whole of the face or the whole of both hands requiring surgical debridement and/or grafting. Major organ transplant The transplant of any of the following whole organs from a human donor to you: • kidney • lung • liver • pancreas • heart • bone marrow • small bowel. Page 78 MLC Life Cover Super and MLC Personal Protection Portfolio PDS Malignant cancer The presence of one or more malignant tumours, leukaemia or lymphomas (including Hodgkin’s Disease). The following are not included: • chronic lymphocytic leukaemia in its early stages (RAI stages 0 or 1) • prostate cancer which is histologically described as TNM classification T1 or another equivalent or lesser classification • carcinoma in situ (including cervical dysplasia CIN1, CIN2, and CIN3), or premalignant tumours. Carcinoma in situ of the breast is included where it leads to the removal of the breast by a mastectomy. The procedure must be performed as a direct result of the carcinoma in situ and specifically to arrest the spread of malignancy, and be considered the necessary and appropriate treatment • skin cancer other than melanoma at least 1.5 mm thick or at least Clark Level 3 of invasion • hyperkeratosis or basal cell skin carcinoma • squamous cell skin carcinoma unless it has spread to other organs. Meningococcal septicaemia Severe infection in the blood stream that causes blood poisoning which results in a permanent impairment of at least 25% of whole person function. Motor neurone disease The progressive weakening and wasting of the muscles of the body. The diagnosis of motor neurone disease must be certain and supported by neurological investigations. There must be permanent loss of at least 25% of the brain’s physical control function. Multiple sclerosis The progressive destruction of the insulating layer of myelin in the brain and spinal cord. The diagnosis of multiple sclerosis must be certain and supported by neurological investigations. There must be more than one episode of brain dysfunction with persistent abnormalities and loss of at least 25% of either the brain’s mental function or its physical control function. Muscular dystrophy The progressive weakening and associated loss of muscle tissue resulting in a permanent loss of at least 25% of whole person function. Open heart surgery Open heart surgery for the treatment of a cardiac defect, cardiac aneurysm or benign cardiac tumour. Out of hospital cardiac arrest Cardiac arrest which is not associated with any medical procedure and is documented by an electrocardiogram, occurs out of hospital and is due to cardiac asystole or ventricular fibrillation with or without ventricular tachycardia. Cardiac arrest as a direct or indirect result of alcohol or drug intake is excluded. Parkinson’s disease A degenerative disease of the central nervous system, the most common symptom of which is a rhythmic tremor of the limbs. The diagnosis of Parkinson’s disease must be certain and supported by neurological investigations. The disease must be at a stage where it can no longer be controlled with medication and has resulted in the permanent loss of at least 25% of either the brain’s mental function or its physical control function. Paralysis Total and permanent loss of the function of two or more limbs caused by damage to the nervous system. Pneumonectomy The removal of an entire lung when considered the necessary and appropriate treatment. Primary pulmonary hypertension A condition associated with right ventricular enlargement established by cardiac catheterisation resulting in permanent physical impairment to the degree of at least Class 3 of the New York Heart Association classification of cardiac impairment. Critical Illness Definitions MLC Life Cover Super and MLC Personal Protection Portfolio PDS Page 79 D e f i n i t i o n s Severe osteoporosis The life insured: • before the age of 50, suffers at least two vertebral body fractures and/or a fracture of the neck of femur, due to osteoporosis, and • has bone mineral density reading with a T-score of less than -2.5 (ie 2.5 standard deviations below the young adult mean for bone density). This must be measured in at least two sites by dual energy x-ray absorptiometry (DEXA). Severe rheumatoid arthritis The unequivocal diagnosis of severe rheumatoid arthritis by a Rheumatologist. The diagnosis must be supported by, and evidence, all of the following criteria: • at least a six week history of severe rheumatoid arthritis which involves three or more of the following joint areas: – proximal interphalangeal joints in the hands – metacarpophalangeal joints in the hands – metatarsophalangeal joints in the foot – wrist, elbow, knee, or ankle joints. • simultaneous bilateral and symmetrical joint soft tissue swelling or fluid (not bony overgrowth alone) • typical rheumatoid joint deformity • rheumatoid nodules • erosions seen on x-ray imaging • the presence of either a positive rheumatoid factor or the sensological markers consistent with the diagnosis of severe rheumatoid arthritis. Stroke An incident in the blood vessels of the brain or bleeding in the brain leading to neurological effects that last for at least 24 hours. There must be clear evidence on a CT, MRI or similar scan that a stroke has occurred. Transient ischaemic attacks, symptoms due to migraine, vascular disease of the optic nerve, physical head injury, reversible neurological deficit or any blood vessel incident outside the cranium, except embolism resulting in stroke, are not included. Page 80 MLC Life Cover Super and MLC Personal Protection Portfolio PDS For the purposes of the Critical Illness Extra Benefits Option child means your natural, adopted or step child. If you have chosen the Extra Benefits Option your Critical Illness Plus insurance requires the following precise medical definitions: Adult onset insulin dependent diabetes mellitus The diagnosis after the age of 30 of Type 1 diabetes mellitus for which insulin is required for survival. Advanced endometriosis The presence of endometrial tissue (normal lining of the uterus) outside the uterus, usually in the pelvic cavity. Advanced endometriosis is a partial or complete obliteration of the cul-de-sac (Pouch of Douglas) by endometriotic adhesions, and/or the presence of endometriomas (cysts containing endometriotic material), and/or the presence of deep endometriotic deposits involving the pelvic side wall, cul-de-sac and broad ligaments, or involving the wall of the bladder, ureter and bowel for which surgical treatment is required. Carcinoma in situ of the breast The presence of histologically proven localised pre-invasive cancer in the breast, where cancer cells do not penetrate the basement membrane nor invade the surrounding tissues or stroma. This includes, but is not limited to, pre-invasive cancer of the milk ducts or lobules. Chronic lymphocytic leukaemia (CLL) The presence of chronic lymphocytic leukaemia diagnosed as RAI stage 1 (characterised by lymphocytosis and enlarged lymph nodes). Congenital abnormalities of a child If the life insured or life insured’s spouse gives birth to a child that survives for at least 28 days and is diagnosed with one of the following: • Down’s syndrome – a specific genetic abnormality caused by an extra chromosome 21 that causes mental retardation and physical abnormalities. • Spina bifida – defective closure of the spinal column due to neural tube deficit with a meningomyelocele or meningocele and resulting in neurological deficit. • Tetralogy of Fallot – an anatomical abnormality with severe or total right ventricular outflow tract obstruction and a ventricular septal defect allowing right ventricular deoxygenated blood to bypass the pulmonary artery and enter the aorta directly. The diagnosis must be supported by an echocardiogram, and invasive surgery must be performed to correct the condition. • Transposition of great vessels – a congenital heart defect where the aorta arises from the right ventricle and the pulmonary artery from the left ventricle. The diagnosis must be supported by an echocardiogram, and invasive surgery must be performed to correct the condition. • Congenital blindness – complete absence of the sense of sight from birth. • Congenital deafness – complete absence of the sense of hearing from birth. Congenital abnormalities that first appeared in a child, before this Extra Benefits Option commenced or was last reinstated, are not covered for any existing or future children. Benefits are not payable if payment has been made under ‘Inability of a child to gain independence’ or ‘Death of a child’. Deafness in one ear The total, irreversible and irreparable loss of hearing in one ear, whether aided or unaided. Death of a child If the life insured has a child that dies whilst the policy is in force, MLC will pay you a partial benefit. Benefits are not payable: • if the death of an existing or future child is caused or contributed to by an injury that occurred or sickness that first appeared before this Extra Benefits Option commenced or was last reinstated, and • if payment has been made under ‘Congenital abnormalities of a child’, ‘Specified complications of pregnancy’, or ‘Inability of a child to gain independence’. Diagnosed motor neurone disease The diagnosis of motor neurone disease which is the progressive weakening and wasting of the muscles of the body. The diagnosis must be certain and supported by neurological investigations. Critical Conditions – Extra Benefits Option Definitions Critical Illness Definitions MLC Life Cover Super and MLC Personal Protection Portfolio PDS Page 81 D e f i n i t i o n s Diagnosed multiple sclerosis The diagnosis of multiple sclerosis which is the progressive destruction of the insulating layer of myelin in the brain and spinal cord. The diagnosis must be certain and supported by neurological investigations. Diagnosed muscular dystrophy The diagnosis of muscular dystrophy which is the progressive weakening and associated loss of muscle tissue. The diagnosis must be certain and supported by muscle biopsy or neurological investigations. Diagnosed Parkinson’s disease The diagnosis of Parkinson’s disease which is a degenerative disease of the central nervous system. The diagnosis must be certain and supported by neurological investigations. Facial reconstructive surgery and skin grafting The undergoing of skin grafting and plastic or reconstructive surgery above the neck which is deemed medically necessary for the treatment of facial disfigurement as a direct result of an accident requiring inpatient hospital treatment of the life insured. An accident or injury as a direct or indirect result of alcohol or drug intake is excluded. The accident must occur whilst the policy is in force. Inability of a child to gain independence The life insured’s child, as a result of injury or sickness, will be permanently unable to do any two or more of the following groups of activities of daily living without physical help from someone else: • bathing or showering • dressing • moving from place to place, in and out of bed and in and out of a chair • eating and drinking • using the toilet. The life insured’s child also suffers an inability to gain independence which results in permanent loss of at least 25% of either the brain’s mental function or its physical control function which leads to a need for continuous supervision of the child to protect them or other people. A claim can only be made once the initial assessment or diagnosis is reconfirmed after six months. Benefits are not payable: if the inability of an existing or future child to gain independence is caused or contributed to by an injury that occurred or sickness that first appeared before this Extra Benefits Option commenced or was last reinstated, and if payment has been made under ‘Congenital abnormalities of a child’, or ‘Death of a child’. Loss of one foot or one hand The total and irrecoverable loss, or loss of the use, of the following: • one foot • one hand. Loss as a direct or indirect result of alcohol or drug intake is excluded. Loss of sight in one eye The permanent loss of sight in one eye, whether aided or unaided, due to sickness or injury to the extent that visual acuity is 6/60 or less. Melanoma The presence of one or more malignant melanomas. The melanoma must be between 1.0 mm and 1.5 mm Breslow thickness and also less than Clark Level 3 depth of invasion as determined by histological examination. The malignancy must be characterised by the uncontrollable growth of malignant cells. Placement on waiting list for major organ transplant The life insured has been placed on an Australian waiting list, approved by MLC, for an organ transplant (as listed under the Major Organ Transplant definition) from a human donor. Prostate cancer The presence of prostate cancer histologically described as TNM classification T1 (or another equivalent classification) and with a Gleeson score of at least six. Page 82 MLC Life Cover Super and MLC Personal Protection Portfolio PDS Serious accidental injury The life insured suffers a serious accidental injury resulting in confinement to an acute care hospital for a period of 30 consecutive days (24 hours per day) under the full-time care of a registered doctor. Injury as a direct or indirect result of alcohol or drug intake is excluded. Specified complications of pregnancy The life insured is diagnosed with one of the following: • Disseminated Intravascular Coagulation (DIC) where there is a pregnancy related cause of the DIC which has resulted in a life threatening haemorrhage from multiple sites. • Ectopic pregnancy – pregnancy in which implantation of a fertilised ovum occurs outside the uterine cavity. The ectopic pregnancy must be terminated by laparotomy or laparoscopic surgery. • Hydatidiform mole – the development of fluid-filled cysts in the uterus after the degeneration of the chorion during pregnancy which results in death of the embryo. • Stillbirth – the birth of an infant after at least 28 weeks of pregnancy, which shows no signs of life after birth. Elective termination of pregnancy is specifically excluded. Benefits are not payable if payment has been made under ‘Death of a child’. Critical Illness Definitions MLC Life Cover Super and MLC Personal Protection Portfolio PDS Page 83 D e f i n i t i o n s MLC will pay the lowest of: • $600,000 • the Critical Illness benefit you applied for on that life insured • the Critical Illness benefit MLC would allow for that life insured under its normal assessment guidelines. The definitions of each critical condition that will apply are the definitions for those conditions set out in the current PPP policy document, and as outlined in the Product Disclosure Statement (PDS). Interim cover will only be provided for those conditions that are covered under the terms of the insurance for which you have applied. Income Protection insurance If you have applied for Income Protection insurance for a life insured, and that life insured is totally disabled as a result of a bodily injury which is caused by accidental means during the term of this insurance, MLC will pay you the lowest of: • $10,000 a month • the benefit you applied for • the Income Protection benefit MLC would allow under its normal assessment guidelines. MLC will pay this benefit each month that the life insured is continuously totally disabled after the end of the waiting period you applied for, up to a maximum of 12 months. If the life insured is disabled for part of a month the benefit will be reduced proportionately. Conditions Other than as varied by these terms, the following (as set out in this PDS and the policy document), shall apply to this Interim Accident Insurance: • the Any Occupation definition of totally and permanently disabled • the definition of totally disabled under Income Protection Plus • the standard conditions, waiting periods, limitations and exclusions, subject to any options you applied for in your application for LCS and/or PPP. In applying the definitions to your Interim Accident Insurance, in respect of an application for LCS, a reference to the Trustee as set out in the insurance policy issued by MLC for LCS should be read as a reference to you. Interim Accident Insurance Certificate MLC is pleased to provide this Interim Accident Insurance, at no extra cost, while your application for LCS and/or PPP, whether for a new policy or an addition to an existing policy, is being considered. This insurance is provided separately to LCS and is not part of the Scheme. The Trustee has no liability or obligation to you for this Interim Accident Insurance. The terms and conditions of this Interim Accident Insurance Certificate are set out below. When will MLC pay? MLC will pay you the benefits of the Interim Accident Insurance if the life insured dies, is totally and permanently disabled, suffers a critical condition, or becomes totally disabled, as a result of a bodily injury caused by accidental means, which occurs while that life insured is covered by this Interim Accident Insurance. Details are as follows: Life Cover insurance and Total and Permanent Disability insurance If you applied for any of these insurances for a life insured, and that life insured dies within 12 months, or is totally and permanently disabled, as a result of a bodily injury which is caused by accidental means during the term of this insurance, MLC will pay you the lowest of: • $1,000,000 • the benefit you applied for • the benefit MLC would allow under its normal assessment guidelines. Critical Illness insurance (applicable for PPP only) If you applied for Critical Illness insurance for a life insured, and that life insured suffers one of the following critical conditions, as a result of bodily injury which is caused by accidental means during the term of this insurance: • coma 1 • major burns 1 • major brain injury 1 • blindness 1 • paralysis 1 • loss of independence This information is provided by MLC Limited ABN 90 000 000 402 AFSL 230694 (MLC), the issuer of this Interim Accident Insurance. 1 These conditions are not covered if you have applied for Critical Illness Standard. Page 84 MLC Life Cover Super and MLC Personal Protection Portfolio PDS Benefit Limits If you are applying to replace an existing policy, the amount of any benefit will be limited to the amount (if any) by which the sum proposed to be insured under the LCS and/or PPP application exceeds the sum insured under the policy to be replaced. When won’t MLC pay? In addition to MLC’s standard exclusions (as set out in the current LCS and/or PPP policy document and outlined in the PDS), MLC will not pay under this insurance for death or disability arising from or contributed to by: • any condition that you or any life insured knew about before applying for LCS and/or PPP • the life insured engaging in any occupation, sport or pastime that MLC would not cover under MLC’s normal assessment guidelines. Furthermore, MLC will not pay if: • the cover applied for would have been declined under MLC’s current assessment guidelines, or • you lodge a claim for an event or condition that would have been excluded under the normal underwriting process. When does Interim Accident Insurance end? MLC will cancel your Interim Accident Insurance by notice in writing on the earliest of the following: • 90 days after the start of this Interim Accident Insurance unless before then MLC tells you a different date • the date MLC issues a Schedule following MLC’s acceptance of your application for LCS and/or PPP (or in the case of additional insurance, when MLC issues a revised Schedule to you) • when MLC advises you that your application has not been accepted • when MLC advises you that your Interim Accident Insurance has ended • when you withdraw your application. When does Interim Accident Insurance start? Unless MLC nominates an earlier date, Interim Accident Insurance will start when MLC or the Trustee receives an application for LCS or PPP at any of its offices together with one of the following: • one full instalment of the premium • a fully completed Direct Debit Request Schedule or Credit Card Deduction Authority or Direct Payment • a MasterKey Superannuation Deduction Authority (in respect to LCS). If the application is submitted electronically, Interim Accident insurance will start upon submission. If your application is not accepted, any premium received by MLC will be refunded, less any government charges or taxes, to you or to the Trustee for LCS members. Your Interim Accident cover is void if the premium payment for LCS and/or PPP is dishonoured. Your Duty of Disclosure Interim Accident Insurance will only be available if you and the lives insured nominated in the application for LCS and/or PPP have completed the application accurately and honestly and have complied with your Duty of Disclosure as set out in your application. Your Duty of Disclosure does not end on completion of your application and personal statement. Your duty continues until MLC accepts your application and issues a Schedule and a policy document to you. MLC will not pay more than one benefit MLC will not pay more than one benefit under this Interim Accident Insurance for any one accident to any life insured. Interim Accident Insurance Certificate MLC Life Cover Super and MLC Personal Protection Portfolio PDS Page 85 Your application for LCS and/or PPP If you claim under your Interim Accident Insurance for any life insured, MLC will take this into account in considering your application for LCS and/or PPP on that life insured. MLC may decide not to accept your application on this basis. MLC may accept or reject your application as MLC sees fit. No insurance will take effect (apart from this Interim Accident Insurance) before MLC accepts your application and issues a policy to you (or in the case of additional insurance, when MLC issues a revised Schedule to you). No financial adviser or other person is authorised to change these conditions, whether in writing or otherwise. No changes will be binding upon MLC. This document has been printed on paper sourced from well managed, environmentally sustainable plantation forests and has been printed by an FSC accredited organisation so there is a minimum effect on the environment. It is part of our campaign to reduce our carbon footprint and reduce global warming. 62395M1011 MLC Insurance Registered Office for MLC Nominees Pty Limited and MLC Limited Ground Floor 105–153 Miller Street North Sydney NSW 2060 Website: mlc.com.au Telephone: 132 652 (inside Australia) + 61 3 8634 4721 (outside Australia) Fax: 1800 550 081 (inside Australia) + 61 2 9964 3163 (outside Australia) Postal address: PO Box 200 North Sydney NSW 2059