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MLC MasterKey Business Super
Insurance Guide
Category E members
This Insurance Guide is for MLC MasterKey Business Super Insured Members who were transferred
into the MLC Super Fund from The Universal Super Scheme on 1 July 2016 and who are:
(a) Ex-Employer Super Insured Members, or
(b) Ex-Super Solutions Employer Service Insured Members.
Note: These are ex-Aviva members who became Insured Members in MLC MasterKey Business Super
in December 2012.
Preparation date Preparation date Preparation date Preparation date 30 September 2016
Issued by the Trustee Issued by the Trustee Issued by the Trustee Issued by the Trustee NULIS Nominees (Australia) Limited ABN ABN ABN ABN 80 008 515 633 AFSL AFSL AFSL AFSL 236465
The InsurerThe InsurerThe InsurerThe Insurer MLC Limited ABNABNABNABN 90 000 000 402 AFSLAFSLAFSLAFSL 230694
The FundThe FundThe FundThe Fund MLC Super Fund ABNABNABNABN 70 732 426 024
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This guide gives you information about the
insurance available through your super.
A financial adviser can help you decide if this
insurance is right for you.
Important information
The information in this document is general information only and doesn’t take into account your
objectives, financial situation or individual needs. Because of that, before acting on this information,
you should consider its appropriateness, having regards to your objectives, financial situation and
needs. For more information please contact us, speak with your financial adviser or go to the online
copy of this document on mlc.com.au/pds/mkbsop
Information in this document may change from time to time. Updates in relation to information that
are not materially adverse may be made available on mlc.com.au but you may not be directly
notified of these updates. You may, however, obtain a paper copy of these change communications
on request free of charge by contacting us.
Please read the latest applicable Product Disclosure Statement and any incorporated materials
before making any decision about a product.
Neither NAB, nor any of its related bodies corporate guarantees or accepts liability in respect of the
insurance cover offered in MLC MasterKey Business Super.
An interest issued by NULIS Nominees (Australia) Limited in the Fund does not represent a deposit or
liability with NAB or other related bodies corporate of NAB.
Any statement made by a third party or based on a statement made by a third party in this
document has been included in the form and context in which it appears with the consent of the
third party, which has not been withdrawn as at the date of this document.
References to mlc.com.au in the online copy of this document link directly to the additional
information available.
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Contents
Insurance with MLC Limited 4
Insurance you select yourself 5
Death insurance 7
Death and TPD insurance 8
Income Protection insurance 12
Insurance – the details 22
Definitions 29
For more information please contact us, speak with your financial adviser or go to the online copy of
this document on mlc.com.au/pds/mkbsop
MLC Master Policy
There are two applicable MLC Master Policies under which different aspects of the insurance cover
described in this Insurance Guide are provided.
You can find specific details about the terms and conditions of your insurance in the MLC Master
Policies.
A copy of each of the MLC Master Policies is available by contacting us.
This Insurance Guide summarises the terms and conditions that apply to a claim for a Benefit with a
Date of Claim occurring on or after 8 December 2012 under the MLC Master Policies. If your Date of
Claim precedes this date, different terms and conditions may apply. Please contact us for further
details.
MLC Limited (Insurer) is the insurer
and receives your insurance
premiums. We can change the
insurer at any time if we believe this
is in the best interests of members.
The information in this Insurance
Guide forms part of the
MLC MasterKey Business Super
Product Disclosure Statement dated
30 September 2016. Together with
the Fee Definitions Flyer and
Investment Menu, these documents
should be considered before making
a decision about whether to acquire
or continue to hold the product.
They are available at
mlc.com.au/pds/mkbsop
Proposed sale of MLC Limited
In 2015 the NAB Group announced a plan to sell 80% of its insurance business (MLC Limited) to
Nippon Life Insurance Company. The planned sale has not been finalised at this stage. It is
proposed this sale will take place on a date between 1 October 2016 and 31 December 2016.
There are no changes to the insurance benefits, terms and conditions detailed in the PDS and in this
document as a result of the proposed sale. In the future, should your benefits or terms and
conditions change, we'll notify you as required by law.
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Insurance with MLC Limited
With over 125 years of insurance experience in Australia, insurance with MLC Limited provides long-
term, sustainable insurance to customers.
Worldwide insurance
Your insurance travels with you, which means you’re covered 24 hours a day anywhere in the world.
However, some additional limits apply to Income Protection benefits if you are not continuously
resident in an Approved Country – see the Definitions section for details.
Affordable insurance
Insurance through super may be tax effective for you and may be a more affordable way for you to
take care of your beneficiaries.
Employer selected insurance
Your employer may have selected an insurance package for your Plan.
This can include Death and Total and Permanent Disablement (TPD) insurance, and Income
Protection insurance.
Your cover
We’ll tell you the amount of insurance you have each year in your Annual statement.
To confirm your monthly premium, please refer to your most recent Annual Statement, or log into
your account online at mlc.com.au. You can contact us to obtain a quote for the cost of insurance
that will apply if you wish to change your cover.
Insurance eligibility
You were deemed to have been eligible for insurance when you were transferred into MLC
MasterKey Business Super. So, we’ll automatically deduct premiums from your account for so long
as your cover remains in force.
If your cover is terminated due to non-payment of premiums, you may apply for your cover to be
reinstated. The Insurer may, at its discretion, reinstate cover on such terms as it determines subject
to underwriting.
Insurance definitions
Some words in insurance have specific meanings such as Illness. You can see more about these
terms in the Definitions section.
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Insurance you select yourself
Everybody has different needs and insurance is no exception.
That’s why we help you create an insurance solution to suit you and your family’s needs.
You can choose to apply for or change your:
� Death insurance
� Death and TPD insurance, and
� Income Protection insurance.
Your application for cover will be subject to you providing Evidence of Insurability and acceptance by
the Insurer, who may set such terms and conditions and request information as it reasonably
requires.
How much insurance do you need?
While nobody likes to dwell on the negatives, without enough insurance you could put your, and
your family’s, lifestyle at risk.
Your financial adviser can go through the types of insurance on offer, and assess how much you may
need. Alternatively, an insurance calculator is available on mlc.com.au
Then you can get on with enjoying life, rather than worrying about what may or may not happen.
Family matters
If members of your family join your Plan they can also take advantage of:
� Death insurance
� Death and TPD insurance, and
� Income Protection insurance.
Please see the How to Guide at mlc.com.au/howto/mkbs to find out more.
How much insurance can you apply for?
Insurance type You can apply for up to
Death Unlimited. The maximum benefit limit for Terminal Illness is $3 million.
Death and TPD Unlimited Death insurance and up to a maximum of $5 million of TPD
insurance. The maximum benefit limit for Terminal Illness is $3 million.
Income Protection Generally up to 75% of the first$40,000 of your Monthly Income, and up
to 50% of the next $40,000 of your Monthly Income.
The maximum you can apply for includes policies you have, including the insurance provided
through your account in the Fund.
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Insurance consolidation
You can apply to consolidate any existing insurance cover held by you through another
superannuation fund or issued by another insurer (Existing Insurance Cover) with your insurance
cover in MLC MasterKey Business Super. To do this, you can access the Consolidate your insurance
form available on mlc.com.au
Any application for consolidation of cover is subject to underwriting and you may be required to
provide medical or other insurability evidence as part of your application.
You must meet all of the following requirements to be eligible to apply for consolidation of
insurance cover:
� your Existing Insurance Cover must have been in place for at least 12 months,
� you must be age 55 or younger at the date your insurance consolidation application is
completed and dated,
� you must be At Work on:
� the date the insurance consolidation application is completed and dated, and
� the day immediately preceding the day the transferred insurance cover is due to start in
MLC MasterKey Business Super,
� you must not be eligible for, must not have received, and must not be applying for a total
and permanent disablement or disability type benefit, permanent or temporary incapacity
benefit, terminal illness benefit or a salary continuance benefit under any workers'
compensation scheme, superannuation fund or insurance policy.
If your insurance consolidation application is accepted by us and the Insurer, the following special
conditions will apply together with any other conditions as notified to you from time to time:
� you must cancel your Existing Insurance Cover immediately after the transferred cover is
issued,
� in the event you fail to cancel your Existing Insurance Cover, any benefit in relation to the
transferred cover that would otherwise have become payable by the Insurer will be reduced
by the amount that represents the benefit payable under the Existing Insurance Cover, and
� the same premium loadings and exclusions, if any, that applied to your Existing Insurance
Cover, will apply to the transferred cover.
Replacing your existing insurance
Before you consider cancelling any insurance, you need to make sure your insurance will be right for
you. Please wait for us to confirm you're insured before you cancel any other existing insurance
arrangements you may have.
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Death insurance
Helps your family pay their expenses when you can’t be there.
How does it work?
This insurance pays a lump sum to your beneficiaries if you die, or to you if you’re diagnosed with a
Terminal Illness.
If we pay a Terminal Illness benefit to you, your Death insurance will reduce by the amount of the
payment. Where your Death insurance is greater than the amount of the Terminal Illness benefit
paid, the residual Death insurance will continue, and your ongoing premiums will reduce
accordingly.
The amount of your benefit will be determined on the relevant Date of Claim.
Eligibility
The maximum insurable age is 70.
When benefits won’t be paid
Active service in the armed forces
A death benefit won't be payable if death results from active service in the armed forces (excluding
the Australian Defence Force Reserves not deployed overseas).
Self-harm
For all increases to cover on and from 5 December 2014 (except automatic increases to cover):
� No Death Benefit is payable where Death is due to suicide within the first 24 months of
starting or reinstating insurance.
� No part of an increase to a Death Benefit is payable where the death is due to suicide within
the first 24 months after the commencement of the increased cover.
For all cover (except Automatic Cover) or increases to cover, which commenced before 4 December
2014:
� No Death Benefit is payable where your death is due to suicide in the first 13 months after
your cover increases voluntarily or outside the normal formula based cover increases.
The restrictions outlined above in relation to self-harm do not apply to Terminal Illness Benefits.
Pre-existing Conditions
For all cover or increases to cover commencing on or after 5 December 2014:
No benefit will be payable for death or Terminal Illness caused directly or indirectly by any Pre-
existing Condition if, prior to the most recent date you became insured under the MLC Master Policy
you were paid, or were entitled to be paid, a TPD or Terminal Illness benefit from the Insurer or
another superannuation fund or insurer.
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Death and Total and Permanent Disablement (TPD)
insurance
Gives you financial security for the unexpected.
How does it work?
This insurance pays a lump sum if you die, are diagnosed with a Terminal Illness or become Totally
and Permanently Disabled.
If we pay a Terminal Illness benefit to you, your Death and TPD insurance will each reduce by the
amount of the payment. Where your Death or TPD insurance is greater than the amount of the
Terminal Illness benefit paid, the residual insurance will continue, and your ongoing premiums will
reduce accordingly.
If we pay a TPD benefit to you, your Death insurance will reduce by the amount of the payment.
Where your Death insurance is greater than the amount of the TPD benefit paid, the residual Death
insurance will continue, and your ongoing premiums will reduce accordingly.
Your TPD Benefit or Terminal Illness Benefit can't exceed the amount of your Death Benefit, except
where otherwise agreed by the Insurer.
The amount of your benefit will be determined on the relevant Date of Claim.
Eligibility
TPD insurance can continue up to age 70, subject to minimum working hours, reducing cover and
change in definition.
When benefits won’t be paid
Active service in the armed forces
Death and TPD Benefits will not be payable if death or TPD (as applicable) results from active service
in the armed forces (excluding the Australian Defence Force Reserves not deployed overseas).
Self-harm
For all increases to cover on and from 5 December 2014 (except automatic increases to cover):
� No Death Benefit is payable where Death is due to suicide within the first 24 months of
starting or reinstating insurance.
� No part of an increase to a Death Benefit is payable where the death is due to suicide within
the first 24 months after the commencement of the increased cover.
� No part of an increase to a TPD Benefit is payable where the TPD is due to self-inflicted
injury within the first 24 months after the commencement of the increased cover.
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For all cover (except Automatic Cover) or increases to cover, which commenced before 4 December
2014:
� No Death Benefit is payable where your death is due to suicide in the first 13 months after
your cover increases voluntarily or outside the normal formula based cover increases.
� No TPD Benefit is payable where the TPD is due to any intentional self-inflicted injury or
Sickness or any attempt at suicide.
The restrictions outlined above do not apply to Terminal Illness Benefits.
Pre-existing conditions
For all increases in cover on or after 5 December 2014:
No benefit will be payable for death, TPD or Terminal Illness cover caused directly or indirectly by
any Pre-Existing Condition if prior to the date of becoming insured under the MLC Master Policy, you
were paid, or were entitled to be paid, a TPD or Terminal Illness benefit from the Insurer or another
superannuation fund or insurer.
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Features of Death insurance and Death & TPD insurance
Terminal Illness benefits
We’ll pay you a Terminal Illness benefit if you’re diagnosed with a Terminal Illness. Your Terminal
Illness benefit is calculated as your Death Benefit less any TPD benefit you may have already
received, up to a maximum of $3 million. Your insurance (consisting of any cover you have for death,
Terminal Illness or TPD) will then be reduced by the amount of this payment. Where your Death or
TPD insurance is greater than the amount of the Terminal Illness benefit paid, the residual insurance
will continue, and your ongoing premiums will reduce accordingly.
You won’t have to repay the Terminal Illness benefit if you live longer than 24 months.
The amount of your Terminal Illness benefit will be determined on the relevant Date of Claim.
Leave of absence/parental leave
You can take up to 24 months’ Leave of Absence from your Employment with or without pay and
keep your insurance on the same terms and conditions as if you had remained in active
Employment, provided:
� you continue to pay your premiums,
� remain employed by your employer,
� continue to be an Insured Member of MLC MasterKey Business Super,
� do not join any armed forces (excluding the Australian Defence Force Reserves not deployed
overseas), and
� comply with the other terms of the MLC Master Policy.
Your employer's approval of your leave must be in writing and be provided to the Insurer on
request.
You can also apply to extend this period by giving us at least 60 days’ notice before your Leave of
Absence ends, which is subject to acceptance by the Insurer, at its discretion.
Any benefit payable will be based on the level of insurance notified to and accepted by the Insurer
before commencement of your Leave of Absence.
If you apply for additional cover while on Leave of Absence, your application will be subject to
underwriting and any additional cover will not commence until the Insurer provides written notice of
acceptance and you return to work.
If you do not return to your employment on or before the nominated return to work date as agreed
with your employer before you went on Leave of Absence and the Insurer has not granted an
extension, your insurance will continue provided premiums continue to be paid. However, your
insurance will be based on your Occupation and employment status immediately prior to the Date of
Claim.
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Interim Accident Insurance
While the Insurer considers whether to accept an application for increased cover (ie Death or TPD
benefits) outside Automatic Acceptance Limits or reinstatement of a person's cover after
termination for non-payment of premiums, the Insurer will provide Interim Accident Benefit cover
for Accidental Death or Accidental TPD.
You will be covered for an Interim Accident Benefit from the date the Insurer receives a fully
completed application for cover including a personal statement and health declaration in the form
required by the Insurer.
If you apply for Death or an increase in Death insurance and die as a result of, in the Insurer's
opinion, an injury occurring while your application is being assessed by the Insurer and within 365
days of the Injury occurring, a lump Interim Accident Benefit of the amount of Death insurance you
have applied for will be paid (up to a maximum of $10 million).
If you suffer from Accidental TPD while Interim Accident Benefit cover is in force, the Insurer will be
pay the amount of TPD insurance applied for (up to a maximum of $3 million.)
If your Accidental Death cover exceeds your Accidental TPD cover, the amount of Interim Accident
Benefits cover for Accidental Death will be reduced by any amount paid under the Interim Accident
Benefit paid for Accidental TPD.
An Interim Accident Benefit for Accidental Death will not payable where a Death Benefit would not
have been payable under the MLC Master Policy.
An Interim Accident Benefit for Accidental TPD will not be payable where:
� the cover applied for would have been declined under the Insurer's normal assessment
guidelines;
� the cover applied for would have been declined under the Insurer's normal assessment
guidelines
� the application is for an event or condition that would have been excluded under the
Insurer's normal underwriting process, or
� an Interim Accident Benefit for Accidental Death has been paid.
Cover for an Interim Accident Benefit will cease on the earlier of the following events:
� the Insurer accepting or declining the application;
� the withdrawal of the application;
� 180 days after the Insurer receives the fully completed application, personal statement and
declaration of health in the required form;
� the date the person ceases to be an Insured Member (if applying for an increase) or no
longer satisfies eligibility terms (if applying for reinstatement);
� the date the Insurer ceases to be liable under the MLC Master Policy.
The Interim Accident Certificate is available in the How to Guide on mlc.com.au/howto/mkbs
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Income Protection insurance
Helps you concentrate on getting better, without worrying about bills.
How does it work?
This insurance provides a monthly benefit of up to 75% of your Monthly Income while you’re Totally
Disabled or Partially Disabled.
If you are engaged in Permanent Full Time Employment or Permanent Part Time Employment, you
or your employer can choose a Benefit Period of:
� two years
� five years, or
� age 65,
or as agreed by the Insurer.
If you’re engaged in Fixed-term Contract Employment and have a:
� two or five-year Benefit Period, as selected or agreed by the Insurer, your Benefit Period will
end of the earlier of:
� the end of your 2 year or 5 year Benefit Period (as applicable),
� the end of your contracted period of employment last agreed with the employer before
the date of the event leading to a claim for the benefit, or
� you attaining the age of 65;
� Benefit Period until age 65, as selected or agreed by the Insurer, your Benefit Period will end
on the later of:
� 2 years, and
� the expiry of your contracted period of employment last agreed with the employer
before the date of the event leading to a claim for the benefit,
but subject to the maximum insurance age of 65.
You can also choose from a range of Waiting Periods, being the period that you are Totally Disabled
or Partially Disabled during which no Total Disability or Partial Disability Benefits are payable. The
Waiting Period starts on the Date of Claim and requires the Insured Member to be Totally Disabled
for at least 14 consecutive days from the start of the Waiting Period.
Waiting Periods include 30, 60 and 90 days, and you can also choose a waiting period of 180 days if
you have a Benefit Period of 5 years or to age 65.
A Total Disability Benefit is only payable in the event you were in Covered Employment on the last
working day prior to the Date of Claim, were Totally Disabled for the first 14 consecutive days of the
Waiting Period, Totally or Partially Disabled for the remainder of the Waiting Period and Totally
Disabled at the end of the Waiting Period.
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A Partial Disability Benefit is only payable in the event you were in Covered Employment on the last
working day prior to the Date of Claim, were Totally Disabled for the first 14 consecutive days of the
Waiting Period, Totally or Partially Disabled for the remainder of the Waiting Period and Totally or
Partially Disabled at the end of the Waiting Period.
An Income Protection Benefit other than a Bereavement Benefit is payable monthly in arrears. An
Income Protection Benefit payable for only part of a month will be payable at a rate of one-thirtieth
of the monthly benefit payable.
An Income Protection Benefit payable in relation to a particular Illness or Injury will cease on expiry
of the Benefit Period applicable to the Insured Member, but only in relation to that Illness or Injury.
You may also have a Superannuation Contribution Benefit, subject to you, the Trustee or your
employer having submitted an application that is acceptable to the Insurer. A Superannuation
Contribution Benefit provides an additional benefit paid into your MLC MasterKey Business Super
account or another complying superannuation fund of your choice, while you’re Totally Disabled or
Partially Disabled.
Maximum monthly benefit payable
The maximum monthly benefit payable to you is the lesser of the following:
� up to 75% of the first $40,000 of your Monthly Income, and up to 50% of the next $40,000 of
your Monthly Income; and
� the insured percentage of your Monthly Income (which may not exceed 75%)
If you have a Superannuation Contribution Benefit, an additional amount may be paid into your
super account, up to a maximum of 15% of your Monthly Income.
The maximum monthly benefit payable is subject to an overall total maximum benefit of $50,000
per month for the first two years of your Benefit Period, including any Superannuation Contributions
Benefit.
If your benefit payment continues beyond two years, the overall total maximum benefit payable is
$30,000 per month for the remaining Benefit Period including any Superannuation Contribution
Benefit.
Total Disability Benefit
If your Date of Claim is prior to 1 July 2016, the Total Disability Benefit will be your monthly benefit.
If your Date of Claim is on or after 1 July 2016, the Total Disability Benefit will be the lesser of your
monthly benefit or 1/12th of your Pre-Disability Income in the 12 months prior to your Total
Disability.
A Total Disability Benefit will commence from the expiration of the Waiting Period.
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Partial Disability Benefit
The Partial Disability Benefit will be calculated using the following formula:
(Monthly Income – Actual Monthly Income)
x monthly benefit
Monthly Income
A Partial Disability Benefit will commence at the latest of the expiration of the Waiting Period or the
date you cease to be Totally Disabled if you are Partially Disabled at that date.
Making sure you’re eligible
To be eligible for Income Protection insurance you must be between ages 15 and 64 and must not be
engaged in Excluded Employment.
To be eligible for an Income Protection Benefit, you must be:
� engaged in Covered Employment, and
� not engaged in Excluded Employment,
on the last working day prior to the Date of Claim.
Income Protection insurance ends at age 65.
When will benefits be reduced?
Any Total or Partial Disability Benefit payable will be reduced to the extent you are, during the
period of Total Disability or Partial Disability:
� receiving any regular income (including sick leave but excluding payments made pursuant to
statutory or contractual annual leave accrued prior to the date you ceased working, long
service leave or redundancy entitlements) from your employer;
� receiving payments made under any other similar policies, and
� entitled to payments made under workers’ compensation and/or similar legislation. This
doesn’t include Centrelink payments or benefits at common law, where such benefits are
payable on a periodic basis (whether paid or not).
The reduction will be sufficient to ensure that:
� the Total Disability Benefit or Partial Disability Benefit payable, together with the aggregate
of the other payments or entitlements, will not exceed your insured percentage of Monthly
Income.
� the amount the Insurer pays in Total Disability Benefits or Partial Disability Benefits,
together with the aggregate of the other payments or entitlements (including arising under
the Policy other than rehabilitation expenses and Superannuation Contribution Benefits),
will not exceed the amount derived by your Income Protection benefit formula.
Any income from other sources which is in the form of a lump sum or is commuted for a lump
sum will be treated as a monthly sum equivalent to one percent of the lump sum over a period
of 7 years, to calculate the reduction in Monthly Benefits.
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Income from other sources does not include:
� income earned from investments; and
� any lump sum total and permanent disablement benefit.
When your worker's compensation entitlement is in dispute, the Insurer will pay the full amount of
the Total Disability Benefit or the Partial Disability Benefit on a conditional basis until the dispute is
resolved. If you are successful and are declared entitled to workers' compensation benefits, it is a
condition of this insurance cover that:
� you will repay to the Insurer that part of any Total Disability Benefit or Partial Disability
Benefit which would otherwise not have been paid if not for the conditional payment; and
� the Insurer may at any time recover this amount by offsetting it against any amounts that
may subsequently become due in respect of you under the Policy including any TPD Benefit
or Terminal Illness Benefit.
When won’t Income Protection benefits be paid?
Income Protection Benefits won’t be paid to you for Total or Partial Disability due to:
� an intentional self-inflicted Injury or any attempt to commit suicide irrespective of whether
you are sane or insane;
� normal and uncomplicated pregnancy or childbirth;
� any act of war (whether declared or not) or service in armed forces (not including Australian
Defence Force Reserves not employed overseas); or
� any other event or matter in the Policy or notified by the Insurer.
Benefits are available worldwide, however payment is limited to one year if you are not continuously
a resident in Australia or an Approved Country.
Pre-existing conditions
Where automatic acceptance applies, if you do not have New Events Cover, the Insurer will pay
Income Protection Benefits for Total Disability resulting from a Pre-existing Condition. Where
applicable, the Insurer will pay Income Protection Benefits in excess of the automatic acceptance
limit provided the Pre-existing Condition has been disclosed to and accepted by the Insurer.
For all cover commencing or increases to cover commencing on or after 5 December 2014:
No Income Protection Benefit will be paid for Total Disability or Partial Disability caused directly or
indirectly by any Pre-existing Condition if prior to the most recent date you became insured under
the Policy, you were paid, or are entitled to be paid, a TPD or Terminal Illness benefit from us or
another superannuation fund or insurer.
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When payments cease
Payment of any monthly benefit for Total Disability will end at the earliest of:
� the end of your Benefit Period;
� when you are no longer Totally Disabled;
� when you attain 65 years of age;
� on your death;
� when you are no longer under the regular and continuous care of a Doctor;
� the date there is a failure to provide the Insurer with all requested information and other
evidence reasonably required to assess your claim; or
� you make a fraudulent claim.
Payment of any Partial Disability Benefit will end at the earliest of:
� when you are no longer Partially Disabled;
� the occurrence of any of the events that would cause a monthly benefit for Total Disability
to cease (except the end of your Total Disability); or
� you earn a level of income equal to or greater than your Pre-Disability Income that you were
earning immediately prior to the start of your Total Disability or Restricted Monthly Income
(whichever is lesser).
Other
Overseas Travel
Cover for Income Protection Benefits applies worldwide. However, Income Protection Benefits will
be limited to 12 months if you are not continuously resident in an Approved Country.
The 12 month limited period commences from:
� if you ceased to be continuously resident in an Approved Country after the start of your
Total Disability, the later of the date when you last continuously resided in an Approved
Country and the end of your Waiting Period; or
� if you were not residing in an Approved Country as of the start of your Total Disability, the
end of the Waiting Period.
After the 12 month limited period, no Income Protection Benefits will be payable unless and until
you return to an Approved Country. If you return to an Approved Country and are still Totally or
Partially Disabled, your Income Protection Benefits may be reinstated effective from the date of your
return to the Approved Country and will be payable while you are continuously resident in an
Approved Country.
For two year and five year Benefit Periods, the Benefit Period will only accrue while Income
Protection Benefits are being paid.
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Features of Income Protection insurance
Choice of waiting period
You pay a lower premium the longer the Waiting Period. You can select a 30, 60 or 90-day Waiting
Period when you apply. You also have the option of a 180-day Waiting Period if you have a Benefit
Period of 5 years or to age 65.
Interim Disability Accident Insurance
If you are eligible for Income Protection insurance and apply for Income Protection insurance or an
increase in Income Protection insurance and suffer a Total Disability which in the Insurer's opinion is
a result of an Injury occurring during the period of interim cover, you will be paid an Interim
Disability Accident Benefit.
You will be covered for an Interim Disability Accident Benefit from the date the Insurer receives a
properly completed statement and declaration of health to the earliest of the following dates:
� the date the Insurer gives notice that it accepts (on any terms) or rejects the application;
� the date you that your application for cover (or an increase in cover) is cancelled or
withdrawn;
� the date you cease to be eligible for Income Protection insurance;
� the date cover otherwise ceases under the MLC Master Policy; or
� 90 days after the commencement of interim cover.
The Interim Disability Accident Benefit provides a benefit of up to the monthly benefit applied for,
subject to the maximum monthly benefit applicable to Income Protection insurance. For Insured
Members whose cover commenced after 1 April 2009 a maximum of $50,000 per month applies.
The Interim Disability Accident Benefit is payable for as long as the Total Disability continues or to
the end of the Benefit Period, whichever occurs first, subject to a maximum of 2 years.
An Interim Disability Accident Benefit is not payable:
� for an Injury is caused by the Insured Member engaging in an Uninsurable or Special Risk
Occupation pastime or sport that would not be covered under the Insurer's normal
assessment guidelines; or
� where cover would have been declined under the Insurer's normal assessment guidelines; or
� where a claim is lodged for an event or condition that would have been excluded under the
Insurer's normal underwriting process; or
� where the Injury occurs before the person becomes an Eligible Member.
The Insurer will not pay more than one Benefit under this Interim Disability Accident Benefit for any
one Accident to any person.
The Interim Accident Certificate is available in the How to Guide on mlc.com.au/howto/mkbs
18
Returning to work during the waiting period
Prior to 29 November 2013
You can return to work during the Waiting Period for up to five days at Full Capacity without your
Waiting Period being restarted. Your Waiting Period will be extended by the amount of days you
return to work at Full Capacity. If you return to work for more than five days at Full Capacity, your
Waiting Period will start again. These days don’t have to be consecutive.
On and from 29 November 2013
You can return to work during the Waiting Period, for up to:
� five days if your Waiting Period is not more than 30 days, or
� ten days if your Waiting Period is more than 30 days,
� without your Waiting Period being restarted.
Your Waiting Period will be extended by the amount of days you return to work at Full Capacity. If
you return to work at Full Capacity for more than the maximum days above, your Waiting Period will
start again. These days don’t have to be consecutive.
Salary-linked insurance increases
Your insurance may increase in line with any salary increase you receive, by up to 30% within any 12-
month period provided the increase remains within automatic acceptance limits or forward
underwriting limits (where applicable) and the evidence of salary increase is considered sufficient by
the Insurer. The Insurer may not require you to provide Evidence of Insurability.
Where your salary increase exceeds 30% or would otherwise cause the level of Income Protection
Benefits to exceed the automatic acceptance limits or forward underwriting limits (where
applicable), any increase will be subject to underwriting.
Insuring super contributions (Superannuation Contributions Benefits)
You can insure the super contributions your employer makes for you, up to 15% of your Monthly
Income, subject to you, the Trustee or your employer having submitted an application that is
acceptable to the Insurer.
A Superannuation Contribution Benefit provides an additional benefit paid into your MLC MasterKey
Business Super account or another complying superannuation fund of your choice, while you’re
Totally Disabled or Partially Disabled.
The Superannuation Contribution Benefit payable is:
� for Total Disability, an amount equal to the Super Contribution Benefit Percentage of your
Monthly Income; or
� for Partial Disability, an amount equal to the Super Contribution Benefit Percentage of your
Monthly Income less your Actual Monthly Income in that month.
19
The amount of the Superannuation Contribution Benefit will not exceed:
� 15% of your Monthly Income; or
� the maximum monthly benefit when combined with the Total Disability Benefit.
The Superannuation Contribution Benefit shall cease to be payable when you cease to be entitled to
a Total Disability or Partial Disability Benefit.
CPI-linked benefits
If you have a '5 year' or 'to age 65' Benefit Period and you receive monthly benefits for 12
consecutive months, the monthly benefits will be increased (indexed) annually by the lesser of 5%
and the percentage increase (if any) in the CPI for the previous 12 months. This does not apply for
the two-year Benefit Period.
If Total Disability or Partial Disability Benefits cease to be payable, for the purposes of any future
payments, Total Disability and Partial Disability Benefit entitlements will revert to the original
percentage of Monthly Income or other amount replaced or varied in accordance with the other
clauses of the MLC Master Policy.
Rehabilitation expenses benefit
Where you are being paid a Total Disability or Partial Disability Benefit, where permitted by law, the
Insurer will pay for expenses which are:
� incurred to directly assist you to return to work in a gainful occupation or in undertaking a
vocational retraining program because of your Total or Partial Disability;
� approved in advance in writing by the Insurer; and
� approved by your Doctor,
such as the cost of a formal rehabilitation course or the cost of special equipment such as a
motorised wheelchair to help you return to work.
The Insurer will not pay any money directly or indirectly to you or the Fund, but will pay the
rehabilitation expenses to the service providers directly or provide the rehabilitation services itself.
The maximum amount of rehabilitation expenses payable is six times the monthly benefit (less any
amount that may be claimed from any other source as reimbursement), or such greater amount as
the Insurer determines in its absolute discretion. Evidence of the cost of the rehabilitation program
or other expense will be required.
Bereavement Benefit
If you die whilst in receipt of a Total Disability Benefit or Partial Disability Benefit and no Death
Benefit is payable under this insurance cover, subject to the expiry of the Benefit Period, the Insurer
will pay an amount after the date of death of:
� 3 months of Total Disability Benefits (Benefit Period of 2 or less years or of 5 or less years),
or
� 6 months of Total Disability Benefits (Benefit Period to age 65).
20
Recurring disability
Your Waiting Period will not recommence if your Total Disability or Partial Disability recurs within six
months of the date you ceased to be Totally or Partially Disabled due to returning to your usual
Occupation or a different Occupation, provided that the cause of the recurrent Total Disability or
Partial Disability is the same or related to the cause of the original Total Disability. The Policy and
your Income Protection cover must both be in force when the Total or Partial Disability recurs.
Regardless of whether a Total Disability or Partial Disability recurs within the 6 month period, the
same Benefit Period will apply to the entire period of Total Disability and Partial Disability including
the original claim and any recurrent claim where the cause of the recurrent Total Disability or Partial
Disability is the same or related to the cause of the original Total Disability.
If you become an Insured Member after 1 July 2016 and have a 2 or 5 year Income Protection
Benefit Period, once your Benefit Period expires, a new Benefit Period will only commence if:
� you suffer an Injury or Illness which is different to that which caused or contributed to your
Total or Partial Disability in the previous Benefit Period; and
� you returned to Covered Employment prior to the Date of Claim applicable to the new
Benefit Period.
Waiver of premiums
While you receive monthly benefits, you don’t pay any Income Protection insurance premiums. On
cessation of payment of the Total or Partial Disability Benefit, premiums will be charged again unless
your Income Protection cover has ended.
Leave of absence/parental leave
You can take up to 24 months’ Leave of Absence from your Employment with or without pay and
keep your insurance on the same terms and conditions as if you had remained in active
Employment, provided:
� you continue to pay your premiums,
� remain employed by your employer,
� continue to be an Insured Member of MLC MasterKey Business Super,
� do not join any armed forces (excluding the Australian Defence Force Reserves not deployed
overseas), and
� comply with the other terms of the MLC Master Policy.
Your employer's approval of your leave must be in writing and be provided to the Insurer on
request.
You can also apply to extend this period by giving us at least 60 days’ notice before your Leave of
Absence ends, which is subject to acceptance by the Insurer, at its discretion.
Any benefit payable will be based on the Monthly Income notified to and accepted by the Insurer
before commencement of your Leave of Absence.
21
If you apply for additional cover while on Leave of Absence, your application will be subject to
underwriting and any additional cover will not commence until the Insurer provides written notice of
acceptance and you return to work.
If you do not return to your employment on or before the nominated return to work date as agreed
with your employer before you went on Leave of Absence and the Insurer has not granted an
extension, your insurance will continue provided premiums continue to be paid. However, your
insurance will be based on your Occupation and employment status immediately prior to the Date of
Claim.
If you suffer a Total Disability and you are entitled to cover whilst on Leave of Absence, the Insurer
will pay a benefit at the rate of your Total Disability Benefit or Partial Disability Benefit as applicable.
Payment of any benefit will start from the later of:
� your nominated return to work date as agreed to by the employer before you go on Leave of
Absence, or the date last agreed to by the employer prior to your Total Disability; and
� the end of the Waiting Period,
and end in accordance with the 'When payments cease' section above.
22
Insurance – the details
How to apply for increases
Everybody has different needs and insurance is no exception.
That’s why we help you create an insurance solution to suit you and your family’s needs.
You can apply to change your cover. Your application for a change in cover will be subject to you
providing Evidence of Insurability and acceptance by the Insurer, who may set such terms and
conditions and request information as it reasonably requires.
How to apply
To apply for insurance, or to apply to increase your insurance, please log in to your account online,
or complete the Short form insurance application available on mlc.com.au.
Your financial adviser can help you alter your insurance.
During the application process for new or additional cover, you will be required to provide
information about your occupation, lifestyle, leisure activities and medical history.
We'll let you know if the Insurer has accepted or declined your application, or if the Insurer is only
willing to accept your application subject to special terms and conditions.
Any increase or decrease that has been accepted will take effect from the date of the Insurer's
written acceptance.
You can contact us or your financial adviser to find out what the additional premiums will be.
Cancelling your insurance
If you want to cancel your insurance, please call us on 132 652.
What you need to tell us
It’s important you disclose every matter you know, or could reasonably be expected to know, that
could be relevant to the decision to accept your application. If the Insurer is provided with an
incorrect date of birth, the Insurer may revise the Insured Member's benefits. In the event of any
failure to comply with a duty of disclosure, or a misrepresentation being made to the Insurer, the
Insurer may avoid or vary the Insured Member's cover.
You must also let us know if any of the information you provide changes prior to your application
being accepted (for example you have an Accident) or if your existing insurance is extended, varied
or reinstated. If you don’t, your insurance may not be valid.
23
About your premium
Premiums are deducted from your account balance in your investment options other than MySuper.
If you have no balance in those investment options, it’s deducted from your balance in MySuper.
Your insurance cover is shown in your Annual Statement each year. You can see your premium paid
and insurance cover at any time by going to mlc.com.au and logging in to view your account online.
It’s calculated based on the type and amount of insurance you have, depending on your individual
circumstances such as age and Occupation.
The latest Occupation ratings guide for insurance is available on mlc.com.au/occupation
If we ask you to provide evidence of your health, your premium can also be influenced by factors
such as your:
� medical history, and
� lifestyle and leisure activities.
How often do you pay your premiums?
Premiums are deducted monthly from your account.
Will premiums change?
Your premiums may be adjusted for:
� your age
� changes to your insurance, or
� changes in your circumstances, such as changes to your Occupation.
The Insurer may also make changes to premium rates, which could increase or decrease your
premiums. We’ll tell you about any material increases to premium rates at least 30 days before they
take effect. Notification of any non-material changes may be made available online on mlc.com.au,
but you may not be directly notified of these updates. You may, however, obtain a paper copy of
these change communications on request free of charge.
Fees may be charged if you request a service not currently offered. To the extent that the premiums
do not incorporate any applicable taxes or charges, these taxes and charges may be deducted from
your account in addition to the premiums. The Insurer may change the premium rates at any time in
the event of a change in any government charge, licence fee, tax or other impost that relates directly
to the premiums, sums insured or risks of the Policy and in the event of invasion or outbreak of war.
We may charge members or the Fund generally, with actual or estimated costs of running the Fund.
These may include costs resulting from government legislation or fees that are charged by third
parties.
24
Keep your details up to date
You need to let us know about changes to your personal details, such as a change in your Occupation
within 130 days.
If you don’t notify us within this time, any claims may be declined.
Different TPD definitions may apply and Income Protection cover may change or may cease to be
available if you change your Occupation and/or your working capacity.
If you change from an Insurable Occupation to an Uninsurable Occupation, you may retain your
Death and TPD cover (if any). However, in the event of a claim for TPD, you will be assessed under
the Activities of Daily Living definition.
When your insurance will end
Your insurance will end on the earlier of any of the following events:
� except in respect of a Death Benefit, Interim Accident Benefit or Bereavement Benefit, on
your death
� you’re no longer eligible for insurance
� you don’t have enough funds in your account to cover the cost of insurance as at a premium
due date. You’ll continue to be covered for 30 days after the premium due date as long as
you are a member of the Plan
� you take a Leave of Absence for more than 24 months (or such other period as accepted by
the Insurer) without getting approval for continued insurance or you stop paying premiums
during the period of Leave of Absence
� on the day before you commence duty with any armed services of any country, except for
the Australian Defence Force Reserves not deployed overseas
� you reach the maximum insurable age
� in respect of a Death Benefit, Terminal Illness Benefit, TPD Benefit or Interim Accident
Benefit, the benefit is paid
� when the total of any Terminal Illness Benefit, TPD Benefit or Interim Accident Benefit (for
Quadriplegia, Major Brain Injury or the total and irreversible inability to perform at least two
of the Activities of Daily Living as a result of Injury occurring during the period of interim
cover) is equal to or exceeds your Death cover
� in respect of an Income Protection Benefit payable in relation to a particular Illness or Injury,
on the expiry of the applicable Benefit Period, but only in relation to that Illness or Injury
� you cease to be a member of the Fund
� you cancel your insurance or your insurance or the MLC Master Policy is otherwise cancelled
or terminated for any reason
� any other event or matter referred to in the MLC Master Policy as bringing about the
cessation of cover occurs.
If your Policy or cover is cancelled, the Insurer will only pay a claim if the claimant was an Insured
Member at the date of cancellation, the Date of Claim of the Insured Event which gave rise to the
claim occurred before the date of cancellation and any arrears of Premiums have been paid up to
the date of cancellation.
25
If you have Income Protection insurance with either the two year or five year Benefit Period, it will
end on the date the Insurer pays a lump sum TPD or Terminal Illness benefit, subject to the
following:
� Where your Total Disability commenced on a Date of Claim prior to the date the TPD or
Terminal Illness benefit was paid and you were entitled to an Income Protection Benefit on
that date, or at the end of the Waiting Period after that date, Income Protection Benefits will
continue to be payable while you continue to be Totally Disabled or Partially Disabled due to
the same Illness or Injury during the Benefit Period but your Income Protection cover will
cease in all other respects.
The Insurer's liability to pay any benefits which have not already accrued will cease on the date a
fraudulent claim is made, in respect of the claim for that benefit.
Cessation of your cover does not affect the Insurer's liability to pay a benefit that has accrued prior
to the date of cessation of the cover.
More detail on when your insurance will end can be found in the MLC Master Policy. Please call us if
you’d like a copy.
What happens when you leave your employer?
Once your employer tells us you're no longer their employee, we'll transfer your account to MLC
MasterKey Personal Super where all of your insurances will continue and will become fixed amounts.
You can apply to increase these amounts. Your premiums may be higher in MLC MasterKey Personal
Super.
Continuation option
Death only cover
The continuation option can only be exercised where:
� you are under age 65; and
� you cease to be an Insured Member other than as a result of TPD; and
� you provide such appropriate information (including blood tests) as shall be acceptable to
the Insurer; and
� if the premium of the policy selected is subject to your smoking habits, you provide such
declaration as the Insurer may determine necessary.
Term life and income protection cover
If:
� you are an Insured Member and employment with your Participating Employer ends, or you
are a 'Family Insured Member' who ceases to meet that definition and does not transfer out
of the Fund; and
� you are not eligible for cover under MLC MasterKey Personal Super; and
26
� your cover has not ceased because of duty with any armed forces (excluding the Australian
Defence Force Reserves not deployed overseas),
you may apply to exercise an option for continuation of your cover. If accepted, the cover will
be of a type available from the Insurer at the time of the exercise of the option.
The following conditions apply in relation to term life insurance continuation policies:
� you must be at least 5 years younger than the Maximum Insurable Age for the relevant type
of cover applied for;
� none of the Trustee, Participating Employer (on your behalf) or you may be claiming,
receiving or entitled to receive or claim insurance payments for total and permanent
disablement or any Illness or Injury under MLC Master Policy or any other insurance policy
issued by any insurance company; and
� you must have had cover for TPD Benefits under MLC Master Policy immediately prior to
becoming eligible to exercise the continuance option, and if you were an employee of a
Participating Employer under MLC Master Policy you must engage in Permanent Part Time
Employment acceptable to the Insurer within 90 days of ceasing employment with the
Participating Employer. The Insurer may require the person to supply satisfactory
occupation and earnings information.
In addition, the following conditions apply in relation to income protection continuation policies:
� you must be under 60 years old;
� you must have had Income Protection cover in place immediately prior to ceasing
employment with a Participating Employer;
� you must have started Permanent Part Time Employment in a similar Occupation in a
capacity acceptable to the Insurer for income protection insurance;
� if you apply for cover after 21 November 2011, you have not ceased to be an Australian
Resident; and
� none of the Trustee, Participating Employer (on your behalf) or you may be claiming,
receiving or entitled to receive or claim any Total Disability or Partial Disability Benefits
under MLC Master Policy or similar benefits under any other insurance policy issued by any
insurance company, and you must not have previously received Total Disability Benefits for
the Insured Member's Maximum Benefit Period.
The Insurer may refuse to provide cover under the continuation option in the event the Insurer does
not market a term life insurance continuation policy or income protection policy which covers the
occupational risk of the person applying for the continuation option.
What happens if you leave the Fund?
If you transfer your super to another fund, your insurance will continue for up to 60 days. During
this time, you can let us know if you wish to apply for similar insurance with a personal MLC
insurance policy.
27
Making a claim
The Trustee must promptly notify the Insurer of an event giving rise to a claim under the Policy. The
Insurer will then provide you with a claim form which must be fully completed and returned as soon
as possible. Your Occupation category and employment type at the Date of Claim will be
determined by the Insurer to assess your eligibility for cover, type of cover and applicable Policy
terms.
If there is a delay of more than one year after the event giving rise to the claim before the claim
form is provided to the Insurer, then the Insurer's liability will be reduced to the extent the delay
prejudices the Insurer's interests.
Prior to paying a claim, the Insurer must receive satisfactory:
� proof of age; and
� proof of the occurrence of the Insured Event, including:
� the completed claim form;
� evidence to substantiate the claim and additional evidence reasonably required by the
Insurer, at your expense;
� evidence obtained from medical examinations or assessments the Insurer reasonably
requires you to participate in, at the Insurer's expense;
� for Death Benefit claims, a post-mortem examination report if required by the Insurer;
� for Terminal Illness and TPD claims, medical reports from two treating Doctors,
and payment will be subject to any other terms and conditions of the MLC Master Policy.
Income Protection claims
Income Protection Benefits are only payable while you are under the regular care and attendance of
an appropriately qualified Doctor and comply with reasonable advice for treatment given by that
Doctor.
Where a claim is ongoing, Income Protection Benefit entitlements will be regularly reviewed and:
� any further evidence is to be provided by you as the Insurer requires; and
� the Insurer may conduct a reconciliation of benefits to determine any overpayment or
underpayment in each year; and
� from 1 July 2016, where an overpayment is identified that arises from, or is contributed to
by, you providing incorrect information or failing to provide information:
� the Insurer will provide us with written notice that it wishes to seek recovery of the
overpayment and evidence as reasonably required that the overpayment arose from, or was
contributed to, by you providing incorrect information or failing to provide information; and
� subject to the Insurer proving to our reasonable satisfaction that the overpayment arose
from, or was contributed to, by you providing incorrect information or failing to provide
information, either:
� we may at our discretion either:
28
� appoint the Insurer as our agent to recover at the Insurer's discretion the amount of the
overpayment (irrespective of when the overpayment arose) and the Insurer may retain any
such amounts it recovers; or
� pay the Insurer the amount of the overpayment; or
� the Insurer may, after consulting with us, instead recover the amount of the overpayment by
offsetting it against any amounts that may subsequently become due in respect of you
under the Policy, including any TPD or Terminal Illness Benefit.
29
Definitions
Introduction
You can find the specific details about the terms and conditions of your insurance in the MLC Master
Policy. Just call us and we’ll send you a copy.
Accident
Means an event where bodily Injury is caused directly and solely by external and visible means,
independent of all other causes.
Accidental Death
Means death directly and independently of any other cause from an unforeseen and unintended
accident happening to the Insured Member and caused by violent, external and visible means.
Accidental TPD
Means total and permanent disablement arising directly and independently of any other cause from
an unforeseen and unintended accident happening to the Insured Member and caused by violent,
external and visible means.
Activities of Daily Living
Means:
(a) bathing and showering
(b) dressing and undressing
(c) eating and drinking
(d) using a toilet to maintain personal hygiene;
(e) moving from place to place by walking, wheelchair or with assistance of a walking aid.
Actual Monthly Income
Means, for Ex-Employer Super Insured Members, Ex-Employer Super Personal Option Insured
Members, Ex-Super Solutions Employer Service Insured Members and Ex-Super Solutions Employer
Service Personal Option Insured Members:
i. where you are self-employed, a working director or a partner in a partnership, the income
generated by the business or practice due your personal exertion or activities less your share
of necessarily incurred business expenses, during the relevant previous 28 days; or
ii. otherwise, the total value of remuneration paid to you by an employer, including salary,
fees, regular commission, regular bonuses, regular overtime and fringe benefits earned,
during the relevant previous 28 days.
30
Approved Country
Means Australia, Belgium, Canada, Denmark, France, Germany, Hong Kong, Italy, Japan,
Netherlands, New Zealand, Singapore, Sweden, the United Kingdom, the United States of America or
any other country which the Insurer may agree in writing.
At Work
Means:
i. for cover commencing, or increases to cover occurring, before 5 December 2014:
You are at work for your normal daily hours of work and are actively performing the full
duties of your normal Occupation for which you were employed or would have been had the
day not been a day of leave (other than due to Illness or Injury), public holiday or weekend
day.
ii. for new cover commencing, or increases to existing cover occurring, on or after 5 December
2014:
You are actively performing, or capable of actively performing all of the duties of your usual
occupation with your employer for at least 30 hours per week and are performing your
duties free from any limitation due to Illness or Injury.
Australian Resident
Means a person who is an Australian citizen, or has come to Australia to live and has a current and
valid Australian visa permitting employment in Australia.
(A person who goes overseas temporarily is an Australian Resident for the purpose of this
definition.)
Automatic Cover
Means cover provided without Evidence of Insurability except for cover provided under the Future
Insurance Benefit terms.
Benefit
Means any of the Death, Terminal Illness, TPD, Interim Accident and Income Protection Benefits
(comprising Total Disability, Partial Disability, Rehabilitation Expense, Superannuation Contribution,
Bereavement and Interim Disability Accident Benefits) payable under the Policy.
Benefit Period
Means, in respect of Income Protection Benefits, the maximum period for which Total Disability
Benefits and Partial Disability Benefits combined may be payable. The Benefit Period commences
on the first day of the Insured Member's Total or Partial Disability after the end of the Insured
Member's Waiting Period.
31
Benefit Review Date
Means, in respect of Income Protection Benefits, the anniversary of the commencement of the
continuous payment of the Total Disability Benefits and Partial Disability Benefits combined in
respect of an Insured Member.
Casual Employment
Means being engaged in employment of a temporary nature (other than on a contract basis through
an employment agency) where continuity of employment is not guaranteed by the employer,
regardless of hours worked or the period of employment.
Covered Employment
Means, for Income Protection Benefits cover, the Insured Member is engaged in:
(a) Permanent Full Time Employment;
(b) Permanent Part Time Employment working at least 15 hours per week; or
(c) Fixed-term Contract Employment working at least 15 hours per week,
in an Occupation that is not a Special Risk Occupation or Uninsurable Occupation.
CPI
Means the Consumer Price Index (weighted average of eight capital cities combined) as published by
the Australian Bureau of Statistics or its successor.
This is based on the 12-month period concluding at the end of the last quarter prior to the Benefit
Review Date. If the index is not published, the increase shall be calculated by reference to another
retail price index that most nearly replaces it (in the Insurer’s opinion).
Date of Claim
Means, for a:
Terminal Illness Benefit
� On and from 1 April 2016, the date, or if two different dates, the later of the dates, on which
two registered medical practitioners, at least one of whom is a specialist practicing in an area
related to the Illness or Injury suffered by you, certify that your life expectancy is reduced to
less than 24 months;
� From 1 July 2014 to 1 April 2016, the date, or if two different dates, the later of the dates, on
which two registered medical practitioners, at least one of whom is a specialist practicing in an
area related to the Illness suffered by you, certify that your life expectancy is reduced to less
than 12 months; or
� Prior to 1 July 2014, the date the Insurer receives medical evidence which supported the view
that your life expectancy is reduced to less than 12 months. However, if:
(a) you suffer an Illness which would be reasonably expected to reduce your life
expectancy, to less than 12 months, while covered for an Insured Death
Benefit; and
32
(b) the Insurer receives the medical evidence (referred to earlier) after cover has ceased
in respect of you, then the Date of Claim will be taken to be the date cover ceased.
Death Benefit: the date of your death.
Interim Accident Benefit: the date of the accident directly and independently causing the Death.
Income Protection Benefit: the later of:
� the first day of the first period of 14 consecutive days that you are Totally Disabled; and
� the date on which you first receive medical advice and are confirmed by a Doctor to suffer
from an Illness or Injury that is the cause of the Total Disability.
TPD Benefit or Interim Accident Benefit for Accidental TPD
� Under the 'Specific Loss' TPD definition, the date on which the Insured Member first suffered
the Specific Loss;
� under the 'Activities of Daily Living' TPD definition, the date on which the Insured Member
becomes totally and permanently unable to perform at least two of the five Activities of Daily
Living;
� under the 'Cognitive Impairment' TPD definition, the date on which the Insured Member first
suffers total and irreversible cognitive impairment requiring ongoing continuous care and
supervision of another adult; or
� for all other TPD definitions, the first day of the six consecutive month period that the Insured
Member is absent from his/her Occupation through Sickness or Injury.
Death Benefit
A lump sum paid in the event of your death or Terminal Illness, subject to the provisions in the MLC
Master Policy. The amount of the Death Benefit will be determined on the relevant Date of Claim.
Employed/Employment
Means you are engaged in Permanent Full-time Employment, Permanent Part-time Employment,
Fixed-term Contract Employment, or (on and from 21 November 2011) Casual Employment, or (on
or from 29 November 2013) Seasonal Employment or Contract Employment.
Evidence of Insurability
Means a completed personal statement or other form as the Insurer may require and any other
evidence of health or insurability that the Insurer may require such as medical examinations and
reports, medical tests and health and activity statements and information about Occupation,
location, finances, lifestyle and leisure activity.
Excluded Employment
Means, for Income Protection cover, you are:
(a) engaged in Employment working less than 15 hours per week;
(b) engaged in Casual Employment;
33
(c) engaged in Seasonal or Contract Employment, unless you commenced cover prior to 31
October 2000;
(d) engaged in a Special Risk Occupation or Uninsurable Occupation;
(e) a Homemaker
Fixed-term Contract Employment
Means a person engaged for a fixed period of employment of at least three months’ duration, which
was determined at the start of your employment.
You must also be entitled to conditions and benefits such as leave, sick leave and superannuation
normally associated with Permanent Full-time Employment.
Full Capacity
Means engaging in the normal level and nature of work undertaken by you prior to suffering from a
Total Disability.
Heath Condition
Means any physical or mental condition, Illness or Injury however arising or caused.
Homemaker
Means an Insured Member who:
(a) is not in paid Employment and has been classified by the Insurer as occupation category
Homemaker when underwritten; or
(b) permanently or temporarily ceases work for the purpose of performing all Normal Physical
Domestic Household Duties and not due to Injury, Illness or unemployment and who has not
resumed paid Employment.
Illness
Means a sickness, disease or disorder.
Important Duties
Means the duties essential in producing a Salary.
Income Protection Benefit
Means one or more of a Total Disability, Partial Disability, Interim Disability Accident, Bereavement,
Superannuation Contribution or Rehabilitation Expense Benefit.
The amount of the Total Disability or Partial Disability Benefit will be determined based on your
agreed benefit, subject to the maximum monthly benefit, your Monthly Income at the Date of Claim
and your Benefit Period.
Insurable Occupation
Means an Occupation that is not an Uninsurable Occupation.
34
Insured Member
Means a person who has been accepted for insurance by the Insurer under the terms of the MLC
Master Policy and whose cover has not ceased.
Interim Accident Benefit
Means the Interim Accident Benefit described in the section of this Insurance Guide titled 'Interim
Accident Insurance'.
Interim Disability Accident Benefit
Means the Interim Disability Accident Benefit described in the section of this Insurance Guide titled
'Interim Disability Accident Insurance'.
Leave of Absence
Means maternity leave, paternity leave, or other employer approved extended leave, but does not
include leave to join any armed forces, excluding the Australian Defence Force Reserves not
deployed overseas, or leave leading to engagement in other gainful employment or business activity,
unless otherwise specified in the Policy or agreed to in writing with the Insurer.
Major Brain Injury
Means physical head injury that results in permanent loss of at least 25% of either the brain's mental
function or its physical control function.
Medical Practitioner or Doctor
Means:
i. prior to 5 December 2014, a registered medical practitioner who is acceptable to the Insurer
and who is not you or your spouse, family member, business partner, employee or
employer;
ii. on and from 5 December 2014, a registered medical practitioner who is qualified in an
appropriate specialty and who is not you or your Relative, business partner, employee or
employer.
Monthly Income
Means, for Ex-Employer Super Insured Members, Ex-Employer Super Personal Option Insured
Members, Ex-Super Solutions Employer Service Insured Members and Ex-Super Solutions Employer
Service Personal Option Insured Members:
i. where you are self-employed, a working director or a partner in a partnership, 1/12th of the
income generated by the business or practice due to your personal exertion or activities less
your share of necessarily incurred business expenses, for the previous 12 months prior to
you becoming disabled; or
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ii. otherwise, 1/12th of the total value of remuneration paid to you by an employer, including
salary, fees, regular commission, regular bonuses, regular overtime and fringe benefits
earned, over the last 12 months prior to you becoming disabled.
New Events Cover
Means cover for a Health Condition which is not a Pre-existing Condition.
Normal Physical Domestic Household Activities
Means:
(a) cleaning the family home;
(b) shopping for food or household items;
(c) meal preparation and laundry services;
(d) looking after dependent children under the age of 16 years or in full time secondary
education, where applicable.
Occupation
Means your profession, trade, line of work, vocation, calling or other occupation at the relevant
time, or if you have more than one such occupation, the main occupation at the relevant time
(whether engaged in with one or more employers). If you are not Employed, it means the main
occupation you engaged in immediately prior to not being Employed.
Partial Disability
Means, solely by reason of Illness or Injury, you are working in a restricted capacity in your usual
Occupation or a different Occupation, earning Actual Monthly Income less than your Pre-Disability
Monthly Income and under the regular care and following the regular and reasonable advice for
treatment from, a Doctor in relation to that Illness or Injury.
Permanent Full-time Employment
Means being engaged in permanent employment for a minimum of 30 hours per week where the
employer guarantees continuity of employment and where that person is entitled to conditions and
benefits normally associated with full time employment.
Permanent Part-time Employment
Means being engaged in permanent employment for only part of the normal working day or week
(irrespective of the number of hours worked) and being entitled to conditions and benefits normally
associated with Permanent Full- time Employment but on a pro-rata basis.
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Pre-Disability Income
Means for Ex- Employer Super Insured Members, Ex- Employer Super Personal Option Insured
Members, Ex-Super Solutions Employer Service Insured Members and Ex-Super Solutions Employer
Service Personal Option Insured Members:
i. where you are self-employed, a working director or a partner in a partnership, the income
generated by the business or practice due your personal exertion or activities less your share
of necessarily incurred business expenses, prior to you becoming disabled; or
ii. otherwise, the total value of remuneration paid to you by an employer, including salary,
fees, regular commission, regular bonuses, regular overtime and fringe benefits earned,
prior to you becoming disabled.
Pre-existing Condition
Means a Health Condition that existed prior to the commencement of your insurance or variation in
insurance, of which you were aware before becoming insured or before the variation in your
insurance, or of which a reasonable person in the circumstances could have been expected to have
been aware.
Quadriplegia
Means the permanent and total loss of use of both arms and both legs resulting from an Injury.
Relative
Means parent, child, spouse, de facto spouse, brother or sister
Restricted Monthly Income
Means (in respect of the Income Protection Benefit terms) only that part of the Monthly Income that
has been taken into account to derive either the maximum monthly benefit where the maximum
monthly benefit applies to you or the automatic acceptance limit where your monthly benefit is
restricted to that limit.
Seasonal or Short-term Contract Employment
Means you are not in Fixed-term Contract Employment but are employed or contracted:
� in your own name;
� in your business name; or
� through an agency;
to complete a specific job without guarantee of continuity of employment, irrespective of the hours
worked or the period of employment.
Sickness
Means a sickness, disorder or disease suffered by the Insured Member.
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Special Risk Occupation
Means a hazardous occupation or an occupation which presents special difficulties in assessing the
Insurer's risk as described in the most recent 'Occupation Guide', as amended and published by the
Insurer from time to time.
Superannuation Contribution Benefit
Means a benefit paid monthly in arrears into your MLC MasterKey Business Super account or
another complying superannuation fund of your choice, while you are Totally Disabled or Partially
Disabled. The amount of monthly benefit will be determined based on your agreed benefit, subject
to the maximum monthly benefit and your Monthly Income at the Date of Claim.
Super Contribution Benefit Percentage
Means the percentage equal to the percentage paid by the participating employer as the
superannuation contribution in respect of you, as nominated by the employer and accepted by the
Insurer.
Terminal Illness
Means:
(a) for a Date of Claim on or after 1 April 2016:
i. you suffer a Sickness or Injury that two registered medical practitioners (at least one
of whom is a specialist practising in an area related to the Sickness or Injury suffered
by you) have certified, jointly or separately, is likely to result in your death within a
period (Certification Period) that ends not more than 24 months after the date of
the certification; and
ii. the Certification Period in each of the certificates has not yet expired; and
iii. the reduced life expectancy occurs while you are covered for an insured Death
Benefit under the Policy.
(b) for a Date of Claim between 1 July 2014 and 1 April 2016:
i. you suffer a Sickness that two registered medical practitioners (at least one of
whom is a specialist practising in an area related to the Sickness or Injury suffered
by you) have certified, jointly or separately, is likely to result in your death of the
person within a period (Certification Period) that ends not more than 12 months
after the date of the certification; and
ii. the Certification Period in each of the certificates has not yet expired; and
iii. the reduced life expectancy occurs while you are covered for an insured Death
Benefit under the Policy.
(c) for a Date of Claim before 1 July 2014, you suffer a Sickness which in the Insurer’s opinion,
after consideration of medical evidence, would reasonably be expected to reduce your life
expectancy to less than 12 months.
The reduced life expectancy must occur while you are covered for an insured Death Benefit under
the Policy.
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Total Disability
Means:
� if you ceased work before 1 April 2009 by reason of Illness or Injury, in the Insurer's opinion,
you being continuously:
� unable to perform your Occupation solely by reason of Illness or Injury; not otherwise
gainfully employed or engaged in any gainful business activity; and are under the care of
and following the regular and continuous advice for treatment from a Doctor in relation
to that Illness or Injury;
� if your cover commenced before 12 December 2011 and you cease work on or after 1 April
2009 by reason of Illness or Injury, in the Insurer's opinion, you being continuously:
� unable solely by reason of Illness or Injury to perform the Important Duties of your
Occupation; not otherwise gainfully employed or engaged in any gainful business
activity; and under the care of and following the regular and continuous advice for
treatment from a Doctor in relation to that Illness or Injury;
� if your cover commenced on or after 12 December 2011 and you ceased work between 12
December 2011 and 1 July 2016, in the Insurer's opinion, you being continuously:
� unable solely by reason of Illness or Injury to perform the Important Duties of your
Occupation; not otherwise employed or engaged in any Occupation (whether paid or
unpaid); and under the care of and following the regular and continuous advice for
treatment from a Doctor in relation to that Illness or Injury;
� if your cover commenced on or after 12 December 2011 and you cease work by reason of
Illness or Injury on or after 1 July 2016, in the Insurer's opinion, you being continuously:
� unable to perform the Important Duties of your Occupation solely by reason of Illness or
Injury; not otherwise employed or engaged in any Occupation (whether paid or unpaid);
and under the care of and following the regular and continuous advice for treatment
from a Doctor in relation to that Illness or Injury.
Total and Permanent Disablement Benefit or TPD Benefit
A lump sum benefit payable in the event of you becoming Totally and Permanently Disabled, subject
to the provisions of the MLC Master Policy. At the time of the claim, the Insured Member will be
assessed on the TPD definition applicable prior to the Sickness or Injury which caused the disability.
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Totally and Permanently Disabled
Ex-Aviva Members
Category 1 - Permanently and Gainfully Employed for at least 15 hours per week
You can be assessed under any definition which applies to you.
In relation to cover commencing on or before 20 November 2012, where the
Date of Claim is:
� at any time:
� Specific loss: TPD means you have suffered the total and irrecoverable
loss of the sight of both eyes, or the use of two limbs or the sight of one
eye and the use of one limb. Limb is defined as one whole hand or one
whole foot.
� Activities of Daily Living: TPD means, as a result of Sickness or Injury,
you are totally and permanently unable to perform at least two of the
Activities of Daily Living.
� Cognitive impairment: TPD means you are totally and irreversibly
suffering a cognitive impairment requiring ongoing continuous care and
supervision of another adult.
� before 5 December 2014:
� Any occupation – ETE: TPD means you have been absent from your
Occupation solely through Injury or Sickness for six consecutive months
and being incapacitated to such an extent that based on medical and
other relevant evidence, as at the end of the six month period you were
unlikely ever to engage in any gainful profession, trade or occupation for
which you are reasonably qualified by reason of education, training or
experience.
� Any occupation – ETER: TPD means you:
� have been absent from your occupation solely through Injury or
Sickness for six consecutive months;
� have been regularly attending an appropriately qualified Medical
Practitioner and undertaking medical treatment reasonably
recommended by an appropriately qualified Medical Practitioner
with respect to that Sickness or Injury since ceasing work in your
occupation solely through Sickness or Injury; and
� are incapacitated to such an extent that, in the Insurer's opinion,
after consideration of medical and other relevant evidence, you
were, at the end of the initial six consecutive month period of
absence from your occupation, unable to ever engage in work in any
occupation on a full-time or part-time basis, for which you are
reasonably suited by education, training or experience.
For the purposes of this definition ‘medical and other relevant evidence’
includes, but is not limited to:
(i) the prospect of improvement in your capacity after treatment and
rehabilitation that could reasonably be expected to be undertaken
by you, and
(ii) whether reasonable retraining or reskilling would render you able
to engage in or work in any occupation on a full-time or part-time
basis.
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Category 2 -
Under age 65 AND
Permanently and Gainfully Employed at least 15 hours per week AND
have a professional occupation class of AAA or clerical occupation class of AA; AND
accepted for 'Own Occupation' definition
You can be assessed under any definition which applies to you.
In relation to cover commencing on or before 20 November 2012, where the
Date of Claim is:
• at any time:
• Specific loss: TPD means you have suffered the total and irrecoverable loss
of the sight of both eyes, or the use of two limbs or the sight of one eye
and the use of one limb. Limb is defined as one whole hand or one whole
foot.
• Own Occupation: you are unable to perform your own occupation for an
uninterrupted period of at least six months due to Sickness or Injury and
the Insurer believes, after consideration of medical and any other
evidence, that you are so disabled that you are unlikely ever to be able to
perform your own occupation. Own occupation for this purpose means
the occupation you were engaged in immediately prior to becoming totally
and permanently disabled.
• Activities of Daily Living: TPD means, (as a result of Sickness or Injury),
you are totally and permanently unable to perform at least two of the
Activities of Daily Living.
• Cognitive impairment: TPD means you are totally and irreversibly suffering
a cognitive impairment requiring ongoing continuous care and supervision
of another adult.
Category 3 –
Employed on a basis other than permanently and Gainfully Employed for at least 15 hours per week (including casual employment); OR
aged 65 or over
You can be assessed under any definition which applies to you.
In relation to cover commencing on or before 20 November 2012:
� Specific loss: TPD means you have suffered the total and irrecoverable loss
of the sight of both eyes, or the use of two limbs or the sight of one eye and
the use of one limb. Limb is defined as one whole hand or one whole foot.
� Activities of Daily Living: TPD means, (as a result of Sickness or Injury), you
are totally and permanently unable to perform at least two of the Activities
of Daily Living.
� Cognitive impairment: TPD means you are totally and irreversibly suffering
a cognitive impairment requiring ongoing continuous care and supervision
of another adult.
Category 4 –
Not Gainfully Employed
You can be assessed under any definition which applies to you.
In relation to cover commencing on or before 20 November 2012, where the
Date of Claim is at any time:
� Specific loss: TPD means you have suffered the total and irrecoverable loss
of the sight of both eyes, or the use of two limbs or the sight of one eye and
the use of one limb. Limb is defined as one whole hand or one whole foot.
� Home duties: You have, for an uninterrupted period of six months, been
under medical supervision with complete inability to perform the majority
of Normal Physical Domestic Household Duties and the Insurer believes,
after consideration of medical and any other relevant evidence, you are
unlikely ever to recover.
� Activities of Daily Living: TPD means, as a result of Sickness or Injury, you
are totally and permanently unable to perform at least two of the Activities
of Daily Living.
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Uninsurable Occupation
Means an Occupation so hazardous that the Insurer is unable to accept the risk, as notified by the
Insurer to the Trustee from time to time.
Waiting Period
Means the period that you are Totally Disabled or Partially Disabled during which no Total Disability
or Partial Disability Benefits are payable. The Waiting Period starts on the Date of Claim and
requires the Insured Member to be Totally Disabled for at least 14 consecutive days from the start of
the Waiting Period.
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For more information visit mlc.com.au or
call us from anywhere in Australia on 132 652 or
contact your financial adviser.
Postal address
PO Box 200
North Sydney NSW 2059
Registered office
Ground Floor, MLC Building
105 – 153 Miller Street
North Sydney NSW 2060
Website
mlc.com.au