TAL Accelerated Protection Adviser Guide_ 1 April 2017

92 Pages·2017·1.43 MB·English

ADVISER GUIDE
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Accelerated Protection
Adviser Guide | 1 April 2017

Contents
About this Guide 3 Second Occupation 38
Students – full-time / part-time 38
1 Overview 3 Unemployed 38
Working from Home 38
2 Ready Reckoner 4 Working in Remote Areas 39
Life, Critical Illness and TPD insurance 4
11 Occupation Classification Descriptions 40
Critical Illness insurance (CI) 6
TPD insurance (TPD) 8
12 Occupation Listing 41
Income Protection (IP) 9
Business Expense insurance (BEX)NS 12
13 Lifestyle Factors 68
3 Interim Cover 13 Height and Weight 68
Smoking 68
4 Policy Discounts 13 Pregnancy 68
Health Sense discount 14 Residency and Travel 69
Overseas Travel 69
5 Underwriting Philosophy 15 Sports, Pastimes, Hazardous Activities 70
The TAL Underwriting team 15
14 Completing the Application 78
Our fast and simple application process 15
Application form 15
15 Replacing Existing Business 78
Online applications 15
About Tele-Interviewing 16
16 Documentation Lifespan 78
About Tele-Underwriting 16
6 Medical Underwriting Requirements 17 17 Transfer Terms 79
Medical Requirements for Life, TPD and Critical Eligibility criteria 79
Illness 17
18 Questionnaires 80
Life and TPD cover 17
Critical Illness cover 18
19 Stamp Duty 80
Medical Requirements for Income Protection and
Business Expense insurance 19
20 Requirements for exercising the Guaranteed
7 Medical Services Information 20 Future Insurability Benefit under Life, Critical
Illness and TPD insurance 81
Paramedical Service Providers 20
Medical Examinations 20
21 Alternate Terms 82
Fast-Check Examination – Specialist 20
Specialist Medical Examination 20 Exclusions and Loadings 82
Blood Test Details 20 Declined Applications 82
Other Medical Test Details 21 Third Party Ownership of Income Protection
(excluding superannuation) 82
8 Financial Underwriting Guidelines 22
22 Policy Administration 83
Financial Underwriting for Life, TPD and Critical
Illness 22 General Policy Administration 83
Maximum benefits for Personal Cover 22 Changes in Cover Requiring Underwriting 84
Increased Benefits 23 Transfer of Ownership Process 85
Maximum Benefits for Home Duties 23 Conversion Options 85
Financial Requirements for Life, TPD and Health Sense discount 86
CI insurance 23
Financial Underwriting for Income Protection 26 23 Accelerated Commission 87
Financial Underwriting for Business Expense How We Pay Commission 87
insurance 30
24 Accelerated Protection for Platforms 89
9 Bankruptcy, Liquidation, Receivership or Cover Available 89
Administration 31 Premium Payment Options 89
How it works 89
10 Occupation Details – General Guidelines 32 How to apply 89
Apprentices 32 Rollover Process to Platform Partners 89
Employment – full-time and part-time eligibility Commission Payment Process 89
criteria 32 What happens if my client’s premium is
Farmers (owners) 33 dishonoured? 89
Home Duties (full-time) 35 Where should I direct questions in relation to
Newly Self-employed 35 Platform business? 89
Seasonal Workers 38
Adviser Guide 1
2 Adviser Guide
About this Guide
This guide will provide you with information about If you have any questions regarding Accelerated
Accelerated Protection, our underwriting guidelines and Protection please contact our Adviser Service Centre
requirements, to help you place risk insurance with us. using the details below:
We also encourage you to contact our experienced 1300 286 937
underwriters for a professional opinion on more complex
cases and to secure faster decisions for your clients. 1300 351 133
[email protected]
www.tal.com.au
GPO Box 5380, Sydney NSW 2001
1 Overview
Accelerated Protection is a contract of life insurance that The principal contracts under Accelerated Protection are:
is designed to provide financial assistance if an insured
event occurs. Insurance type Benefits payable if the life insured
If the policy is issued through superannuation only one Life insurance (LI) dies or is diagnosed with
life can be insured. a terminal illness
If the policy is not issued through superannuation up to Critical Illness suffers one of the insured events
insurance (CI) as defined in the policy conditions
five lives can be insured.
Total and Permanent is totally and permanently disabled
Disability insurance as defined in the policy conditions
(TPD)
Minimum Policy Premium
Income Protection is unable to work due to sickness
(IP) or injury
Premium New
Frequency Business Increases Policy Fee Business Expense is self-employed and unable to work due
Monthly $20.00 $10.00 $7.00 insurance (BEX) to sickness or injury
Quarterly $60.00 $30.00 $21.00 All plans and options provide cover 24 hours a day,
Half-Yearly $110.00 $55.00 $38.50 worldwide, subject to the normal policy conditions.
Yearly $220.00 $110.00 $77.00
Adviser Guide 3
2 Ready Reckoner
Life, Critical Illness and TPD insurance
Critical Illness
Life insurance insurance TPD insurance
• • •
Available as Life Insurance Plan Critical Illness Insurance TPD Insurance Plan (stand-alone)
•
Plan (stand-alone) TPD Benefit Attached to the
•
Critical Illness Benefit Attached Life Insurance Plan
•
to the Life Insurance Plan TPD Benefit Attached to the
•
Critical Illness Insurance Plan Critical Illness Insurance Plan
•
Linked to the Life Insurance Plan. TPD Insurance Plan Linked to the
Life Insurance Plan.
•
Superlink TPD Attached to the
Life Insurance Plan
Available through Yes No Yes – please see page 8 for
superannuation limitations.
Minimum Entry Age 16 16 16
(next birthday)
• • •
Maximum Entry Age 75 for stepped premiums 62 for stepped premiums 62 for stepped premiums
• • •
(next birthday) 60 for level premiums 60 for level premiums 60 for level premiums
•
62 for Premium Relief Option and
Business Insurance Option
Minimum Benefit Subject to minimum premium per policy (see page 3)
•
Maximum Benefit Any financially justifiable amount. $2,000,000 $5,000,000
Note: This maximum limit includes (Limitations apply. Please see
all Critical Illness insurance with TAL page 8.)
and any other organisation.
• • •
Benefit Expiry Age Policy anniversary prior to 100 Policy anniversary prior to 70 Policy anniversary prior to 65
• • •
(next birthday) If effected through When Attached or Linked to LI: When Attached or Linked to LI:
superannuation, contributions Policy anniversary prior to 100 Policy anniversary prior to 100
to meet minimum payments can (Loss of Independent Existence (Loss of Independent Existence
only be paid while eligible under (permanent) only definition to (permanent), Loss of use of
superannuation law. apply after age 70). Limbs (permanent) and Blindness
(permanent and irreversible) only
definitions to apply after age 65).
Benefit Indexation CPI with minimum of 5% per annum
• •
Indexation Expiry Age Policy anniversary prior to 100 Policy anniversary prior to 70 Policy anniversary prior to 65
• •
(next birthday) When Attached or Linked to LI: When Attached or Linked to LI:
Policy anniversary prior to 100. Policy anniversary prior to 100.
Renewability Guaranteed renewable
• • •
Premium Type1 Stepped Stepped Stepped
• • •
Level to age 65 Level to age 65 Level to age 65
• • •
Level to age 70 Level to age 70 (except where Level to age 70 (except for TPD
stand-alone Critical Illness has an stand-alone or where Double
attached TPD) TPD Option is selected)
1 Where Level to age 65 is selected, the premium reverts to Stepped premium on the Policy anniversary prior to age 65. Where Level to age 70 is
selected, the premium reverts to Stepped premium on the Policy anniversary prior to age 70.
4 Adviser Guide
Critical Illness
Life insurance insurance TPD insurance
• •
Included Benefits Death Benefit Standard: TPD Benefit
•••••• TARIPGnerdeuferpvlammaaartantiiinrunociatmenaletd PI eiFl oPrldrnonae Fet yeBeusmzescten uetB iBernoeefetnni ntIBe nBeefsefinutintereaffibtitility •••••• CPDIPGnarruefeiralatamaitrclthayiiauno sBl tminIsuel lPy SenF-ruderoBep sFtaepseuc zoBctkeruet BtiBrno eeBeenn enIf neBnietsfeefuiintftrietafbitility •••••• IPGBFAnirceunfecnlaamaoerntamfiicunoitimatmnel oP PeFdrdlroaae Fntteeuinozctiennut iBgrBoe eeBn nIne nBeenseffeuinitftreiNatfSbNitSility
•••• BFAGCicehrnicniealodefnm f’cCsiti moCaulr oPintdlsiacaenatlillno iInilnnlgn gB Be eBsenesnen BefeefiftintiNtNeSNSfSitNS •••• BFAGCicehrnicniealodefnm f’cCsiti moCaulr oPintdlsiacaenatlillno iInilnnlgn gB Be eBsenesnen BefeefiftintiNtNeSNSfSitNS ••• AGCDdhreiviaeladtfhn ’Cs cB oCeeurdnin tPesicafeiaytlllm1 iInlelgnn Betse Bsne BenefeintfNeitSfNiStNS
Premier Benefits N/A All ‘Standard’ benefits plus: N/A
•
Advancement Benefit;
•
Female Critical Illness Benefit;
•
Needlestick Benefit.
Restricted availability Where the policy is structured Not available when structured Where the policy is structured
through superannuation (except for through superannuation through superannuation (except for
a self-managed super fund) and the a self-managed super fund) and the
life insured is aged 65-74, the life life insured is aged 65-74, the life
insured must have worked at least insured must have worked at least
40 hours in a period of not more 40 hours in a period of not more
than 30 consecutive days during than 30 consecutive days during
the financial year in which the the financial year in which the
contribution is made. contribution is made.
Premium Relief When the life insured is unable to work or produce an income due to sickness or injury for three consecutive
Option months, the premiums due, including any benefit options, are waived until the earlier of:
•
the life insured returning to work or earning an income; or
•
the policy anniversary prior to the life insured’s 65th birthday.
Business Insurance Available for business insurance purposes only, this option allows an increase of the sum insured (for the
OptionNS applicable cover), without medical underwriting, on the occurrence of a business event. Not available on stand-
alone or Linked TPD/CI insurance.
NS means not available through superannuation.
1 Not available when structured through a retail superannuation platform, self-managed super fund, self-owned, company, trustee or other/joint
owned. Not available when TPD is Attached or Linked to Life Insurance or Critical Illness insurance.
Adviser Guide 5
2 Ready Reckoner continued
Critical Illness insurance (CI)
Critical Illness insurance provides a lump sum benefit if If Attached or Linked to LI, the CI cover cannot exceed the
the life insured suffers a Critical Illness. Critical Illness LI cover.
insurance can be:
If CI is Attached or Linked to LI, then the LI cover will be
• purchased as a stand-alone policy reduced by any CI amount paid in the event of a claim.
• Attached to LI as an additional benefit; or If the CI cover is stand-alone, then a CI claim will have no
• Linked to LI as a Plan effect on any other cover.
Critical Illness Events are:
Heart conditions
• •
Angioplasty1,2 Heart Valve Surgery1
• •
Aortic Surgery Open Heart Surgery1
• •
Cardiomyopathy (permanent and irreversible) Coronary Artery Bypass Surgery1
• •
Heart Attack1 Out of Hospital Cardiac Arrest1
•
Primary Pulmonary Hypertension
•
Triple Vessel Angioplasty1
Neurological conditions
• •
Coma (of specified severity) Multiple Sclerosis (with multiple episodes of neurological deficit
•
Dementia including Alzheimer’s Disease (permanent and and persisting neurological abnormalities)
•
irreversible) Muscular Dystrophy
• •
Encephalitis and Meningitis (resulting in permanent neurological Paralysis (total and irreversible)
•
deficit) Parkinson’s Disease (permanent)
• •
Major Head Trauma (with permanent neurological deficit) Progressive and Debilitating Motor Neurone Disease
• •
Meningococcal Disease (resulting in permanent impairment) Stroke (resulting in neurological deficit) 1
Permanent conditions
• •
Blindness (permanent and irreversible) Loss of use of a Single Limb (permanent)
• •
Loss of Hearing (permanent) Loss of Speech (permanent)
•
Loss of Independent Existence (permanent)
Organ disorders
• •
Chronic Kidney Failure (requiring transplantation or dialysis) Pneumonectomy
• •
Chronic Liver Failure (resulting in permanent symptoms) Severe Burns (covering at least 20% of the body’s surface area)
• •
Chronic Lung Failure (requiring permanent oxygen therapy) Severe Diabetes3
•
Major Organ Transplant
Blood disorders
• •
Aplastic Anaemia (requiring treatment) Occupationally-Acquired HIV
• •
Medically-Acquired HIV (contracted from a medical procedure Occupationally-Acquired Hepatitis B or C3,4
or operation)
Cancer
• •
Benign Brain Tumour (resulting in irreversible neurological Cancer (excluding early stage cancers)1
deficit)
Other events
• •
Prolonged Intensive Care Severe Rheumatoid Arthritis (with significant impairment)3
1 Some restrictions apply to these conditions. Refer to the Policy Document for more information. These conditions are also not covered under
Accelerated Protection Interim Cover. Please refer to the PDS for further details.
2 This condition has a maximum payment of $50,000, unless a benefit is payable under Triple Vessel Angioplasty.
3 This condition only applies under Critical Illness insurance Premier.
4 These conditions only apply under the Needlestick Benefit.
6 Adviser Guide
Child’s Critical Illness Option
Amount to be
This benefit covers the children of the life insured for Advancement Benefit Events paid
death, terminal illness and certain critical illness events • Loss of Hearing in one ear (permanent), or 10% of the
for a minimum of $50,000 and maximum of $200,000 • Loss of Sight in one eye (permanent) Benefit Amount
per child. The level of cover under the Child’s Critical to a maximum of
Illness Option must be equal or lower than the cover on $100,000
the parent CI policy. The monthly cost of this benefit is • Carcinoma In Situ1 25% of the
$8.50 per $50,000 per child (plus stamp duty in South • Diagnosed Benign Brain Tumour Benefit Amount
•
Australia only). If this option is taken, all children of the Early Stage Chronic Lymphocytic to a maximum of
life insured in the qualifying age bands must be covered • Leukaemia $100,000
Early Stage Melanoma (excluding
unless they fall outside the standard life classification. To
Melanoma In Situ), or
qualify, children must be dependent, ie not working, and •
Early Stage Prostate Cancer
be aged (next birthday) 2-15. Cover expires on the policy
•
anniversary prior to the insured child’s 19th birthday. Adult onset insulin dependent 20% of the
diabetes mellitus diagnosed after age 30 Benefit Amount
When both parents select the Child’s Critical Illness •
Severe Ulcerative Colitis (requiring to a maximum of
Option, we will sum the payment per child together.
permanent immunosuppressive $100,000
The sum of all payments per child under the Child’s medication), or
•
Critical Illness Option and Child’s Critical Illness Benefit Severe Crohn’s Disease
(where applicable), including cover with TAL and other •
Partial Dementia which is paid if the Life 25% of the
organisations will be limited to $250,000.
Insured is unequivocally diagnosed with Benefit Amount
Dementia including Alzheimer’s disease, to a maximum of
as confirmed by a specialist Medical $50,000
Practitioner, and if the meaning defined in
Double CI Option Part 11 of the Policy Document is not met.
Double CI is only available if CI insurance is Attached to
LI. If Double CI applies, the LI cover is not reduced in the 1 The payment amount for Carcinoma In Situ of the Cervix Uteri
classified as Cervical Intraepithelial Neoplasia grade 3 (CIN-3), will be
event of a CI claim and all future LI premiums equal to the
a portion of the Advancement Benefit of 10% of the Benefit Amount
CI benefit paid are waived. to a maximum of $100,000. If the life insured is subsequently
diagnosed with a grading higher than CIN-3, any remaining portion
of Advancement Benefit will be paid.
CI Reinstatement Option
Female Critical Illness Benefit
The Critical Illness Reinstatement Option allows the life
insured to buy back the amount of the Critical Illness (Applies to ‘Premier’ Critical Illness. Please refer to the PDS
claim paid out, 12 months after a Critical Illness Event for further details.)
(including partial payment events). Depending on the
The Female Critical Illness Benefit will be paid upon the
original Critical Illness Event, exclusions apply to the
occurrence of a Medical Condition listed below. The
bought-back cover.
payment for each Event is 20% of the Benefit Amount,
up to a maximum of $50,000. Only one Medical Condition
can be paid under each Event listed below. The Benefit
Needlestick Benefit Amount will be reduced by the amount paid under the
(Applies to Critical Illness ‘Premier’. Please refer to the PDS Female Critical Illness Benefit.
for further details.)
Event Medical Conditions
If the Income Protection occupation class of the Life
•
Insured is AA+ the Needlestick Benefit may be payable Female Eclampsia of pregnancy
•
when the Life Insured suffers Occupationally Acquired Pregnancy • Disseminated Intravascular Coagulation
Complications Ectopic Pregnancy
Hepatitis B or C. The amount payable is the Benefit •
Hydatidiform Mole
Amount to a maximum of $1 million. The Benefit Amount • Still birth
will be reduced by the amount paid.
•
Congenital Down’s Syndrome
•
Abnormalities1 Spina Bifida Myelomeningocele
•
Tetralogy of Fallot
•
Advancement Benefit Transposition of Great Vessels
•
Congenital Blindness
(Applies to ‘Premier’ Critical Illness. Please refer to the PDS • Congenital Deafness (permanent and
for further details.) irreversible)
•
The Advancement Benefit is payable only once for each of Other Events Osteoporosis
•
Lupus
these Events. The Benefit Amount will be reduced by the
amount paid the Advancement Benefit.
1 The child must survive 30 days or longer from birth.
Adviser Guide 7
2 Ready Reckoner continued
TPD insurance (TPD)
Available through superannuation – see below for Death Buy Back Option
limitations
The policy owner may elect the Death Buy Back Option at
TPD insurance provides a lump sum benefit if the life time of application. If the life insured makes a claim under
insured is Totally and Permanently Disabled. TPD may be: a TPD Benefit Attached or Linked to LI, the Death Benefit
• purchased as a stand-alone policy; amount is reduced by the amount of the TPD benefit paid.
Within 30 days of the 12-month anniversary of the claim
• Attached to LI or CI as an additional benefit; or payment, an amount of death cover equivalent to the TPD
• Linked to LI as a Plan. Benefit paid may be repurchased.
Any, Own Occupation (for selected occupations) or ADL Note: Where CI is Attached or Linked to LI, the TPD benefit
definitions of TPD are available. Own Occupation is not amount must be greater than the CI benefit amount for
available when TPD is structured through superannuation. this option to be available. This is because a Death Buy-
Back Benefit is included in CI.
Loss of Independent Existence (permanent), Loss of use
of Limbs (permanent) and Blindness (permanent and
irreversible) are the only definitions to apply after age 65.
Maximum Benefit
If Attached or Linked to LI or Attached to CI, the level of
TPD cover cannot exceed the amount of LI or CI cover. The maximum benefit which may be applied for is:
If TPD is Attached or Linked to LI or Attached to CI, then • $5,000,000 under an Own Occupation, Any Occupation
the LI or CI cover will be reduced by the TPD amount paid or ADL definition:
in the event of a claim. If the TPD cover is stand-alone,
– where the Life Insured applies prior to their 60th
then a TPD claim will have no effect on any other cover.
birthday; and
If Superlink TPD Insurance is, reduced or increased under – the occupation class of the Life Insured is AAA, AA+
one Policy, Superlink TPD Insurance on the other Policy or AA.
will be, reduced or increased (as applicable) at the same • $5,000,000 with a maximum of $3,000,000 under an
time. If TPD is cancelled under the superannuation Own Occupation or Any Occupation definition
Policy, the non-superannuation Policy will also be
– where the Life Insured applies after their 60th
cancelled; however, where TPD is cancelled under the
birthday; and
non-superannuation Policy, cover will continue under
– the occupation class of the Life Insured is AAA, AA+
the superannuation Policy, and Superlink TPD will no
or AA
longer apply.
• $5,000,000 with a maximum of $3,000,000 under an
Own Occupation or Any Occupation definition
– where the occupation class of the Life Insured is A,
Double TPD Option
BBB, BB+, BB, B or SRA
Double TPD is only available if TPD insurance is Attached Please note: These maximum limits include all TPD and/
to LI. If Double TPD applies, the LI cover is not reduced in or ADL optional insurance under Life insurance or Critical
the event of a TPD claim and all future LI premiums equal Illness insurance with TAL and any other organisation. It
to the TPD Benefit paid are waived. does not include TPD and/or ADL insurance as a built-in
feature of any Critical Illness insurance.
If applying for an increase over $3,000,000 on an existing
TAL policy from a series prior to Accelerated Protection,
please contact your underwriter as restrictions may
apply.
8 Adviser Guide