Section 8. Insurance in your super

8.1 What we cover

Hostplus insurance cover is provided by MetLife Insurance Limited ABN 75 004 274 882 AFSL 238096 (insurer) and the trustee of Hostplus owns this policy.
You have the opportunity to choose from Death and Total & Permanent Disability (TPD), Death Only or Salary Continuance insurance cover. Any death cover also includes Terminal Illness cover.

Your insurance premiums are used to cover the cost of the insurance policy as well as the cost of its administration, i.e. 0.745% of the insurance premiums are retained by the fund and goes towards the administration cost of providing insurance.

For more information please contact us on 1300 467 875 for a copy of our insurance policy.

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8.2 Automatic Death and Total & Permanent Disability (TPD) insurance cover for Industry members when you join (Default cover)

Generally, new Industry members joining Hostplus through a Participating Registered Hostplus Employer, (Participating Employer) will receive automatic unitised Death and TPD insurance cover at the standard scale. The number of automatic default units you will receive varies and is based on your age next birthday.

If you are currently aged 16 to 64 and eligible for insurance with Hostplus, you will automatically receive unitised Death and TPD insurance cover. If you are aged 11 to 15 or are aged 65 or over, and eligible for insurance, you will receive default unitised Death cover only.

You must be “At Work” on the date that your cover commences to receive Full Cover, otherwise you will receive Restricted Cover.

See section 8.3 for more details about Restricted Cover

Please note: If at the date your default cover commences with Hostplus (‘Cover Commencement Date’) you have a claim admitted (accepted by an insurer), are eligible to receive a benefit, are in a waiting period for a benefit, and/or in the process of claiming a benefit with respect to Terminal Illness and/or Total and Permanent Disablement from any source (‘Claiming Member’), you will be ineligible for some or all of the automatic default insurance cover as detailed below. However, you may apply for cover and be eligible for Cover if your application is accepted by the insurer. Please see the important note in Section 8.8.4 for more information.

If you are a Claiming Member in respect of Total & Permanent Disability you will only be covered for Death and Terminal Illness, and if you are a Claiming Member in respect of Terminal Illness you will not be covered for Death, Terminal Illness or Total & Permanent Disablement, unless your application has been accepted by the insurer. Acceptance remains subject to underwriting.

If you fail to inform us that you’re a Claiming Member either prior to or at the time you cover commences, then we’ll deduct the usual weekly premium even though you may not be able to claim a benefit.

To view what automatic Default Cover is applicable to Industry member see section 8.17 Industry Member Automatic Death & TPD Default Unitised Cover Table.

You may opt out or vary your insurance at any time by contacting us.

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8.3 Restricted Cover – Death and Total & Permanent Disability (TPD)

You will be provided with Restricted Cover if you’re not At Work on the date your cover commences (Cover Commencement Date). 

Restricted Cover covers you for an illness which became apparent to you or an injury that first occurs on or after the date your cover in Hostplus commences. It will not provide a benefit if you suffered from a Pre-Existing Condition i.e. illness or injury known to you for 2 years prior to your cover commencing.

This Restricted Cover will generally be replaced with Full Cover when you resume your normal duties with your employer for 30 consecutive days after the Cover Commencement Date**.

If however the first employer contribution made into your account by your Participating Employer is more than 6 months after the start of the contribution period to which it relates your cover will remain Restricted Cover unless varied by the insurer. Acceptance remains subject to underwriting.

Special rules apply to reinstatement and recommencement of insurance cover.

Please see Section 8.10.6 If your cover starts again, for more information

^{** For TPD cover this will also remain subject to you not having received or been entitled to receive a TPD benefit from any source.} 

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8.4 Special insurance offer on joining for new Industry members

As a new member aged under 65 joining through a Participating Employer you have a once off opportunity to increase your default Death and TPD insurance cover up to certain limits, when you apply within the later of 6 months of the date you commenced work with your Participating Employer or 60 days from the date you received your Hostplus welcome to the fund letter. Acceptance will remain subject to your application being approved by the insurer. We will notify you of the outcome of any such applications.

Cover provided under the Special insurance offer will commence from the date the application is accepted, and will remain subject to the same exclusions and other special insurance conditions (if any) which apply to you for other cover held.

See 8.12 Special insurance offer on joining for new Industry members for more information

Important note:  Members aged over 65 or over, and those that are not eligible for or have opted out of default cover, are not eligible for the Special insurance offer upon joining.

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8.5 Automatic Death and Total & Permanent Disability (TPD) insurance cover (Default cover - for Personal Super Plan members)

Hostplus Personal Super Plan members who are eligible for insurance will automatically receive unitised Death and Total & Permanent Disability (TPD) cover, which is subject to Pre-existing Conditions exclusion. As a Personal Super Plan member you will receive automatic unitised Death and TPD insurance cover at the standard scale. The number of automatic default units you will receive varies and is based on your age next birthday.

If you are currently aged 16 to 64 and eligible for insurance with Hostplus, you will automatically receive unitised Death and TPD insurance cover. If you are aged 11 to 15 or are aged 65 or over, and eligible for insurance, you will receive default unitised Death cover only.

Your cover will commence once money is received and your membership commences.

The insurer may elect not to cover certain occupations, so please refer to Excluded occupations.

Please note: If at the date your  cover  commences you have a claim admitted (accepted by an insurer), are eligible to receive a benefit, are in a waiting period for a benefit, and/or in the process of claiming a benefit with respect to Terminal Illness from any source, you will be ineligible for automatic default insurance cover under this section.  If you have previously received, had a claim admitted, or were eligible to receive a TPD benefit from any other source (including a superannuation fund or otherwise), your cover will be restricted to Death Only insurance cover at any time. If you fail to inform us of your full personal circumstances, either prior to or at the time you commenced your cover with Hostplus, then we’ll deduct the usual weekly premium, but you may not be covered for Death and/or TPD Cover unless your application has been accepted by the insurer. Acceptance remains subject to underwriting. 

Cooling-off period for Industry members
Please note as a new member you may cancel your cover within 14 days of receiving a confirmation of cover from Hostplus. We will refund any premiums you have paid. You may cancel your insurance at any time through your member online account, or by calling or writing to us, however no refund of premiums will be applicable after the 14-day period. Please note; no insurance benefits will be payable to you if you cancel during the cancellation period. 

8.5.1 Personal Super Plan Pre-existing conditions exclusion (Restricted Cover)

For Personal Super Plan members eligible for automatic unitised Death and Total & Permanent Disability cover, no benefit is payable where the cause of the death, terminal illness or total and permanent disablement is caused directly or indirectly, wholly or partially, as a result of a pre-existing condition.

A pre-existing condition is an injury, illness, condition or related symptom that, in the two years prior to the date your insurance cover commenced through Hostplus (Cover Commencement Date), you, or a reasonable person in your position:

• was aware of; or
• should have been aware of; or
• had a medical consultation for (where a medical consultation is any activity for the detection, treatment or management of an illness, injury, medical condition or related symptom, including but not limited to the application of prescribed drugs or therapy – whether conventional or alternative).

Personal Super Plan members are not eligible for the 8.12 Special insurance offer on joining for new Industry members as outlined in this PDS.

See Section 8.10.1 When does Death and Total & Permanent Disability insurance cover start? (Industry and Personal Super Plan Members) for important information.

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8.6 Making an insurance claim?

If you or your beneficiaries need to lodge an insurance claim with Hostplus please call us on 1300 467 875. We have a dedicated Claims Team who will assist you every step of the way with your claims enquiry and documentation required - at no cost to you - so there is no need for you to engage a third party person to do this on your behalf.

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8.7 How to Cancel your Insurance Cover

If you prefer not to have insurance cover, you can elect to cancel your cover upon joining, or cancel it at any time online or by sending us an email at info@hostplus.com.au or by writing to us at the address below. 

HOSTPLUS 
Locked Bag 5046
Parramatta NSW 2124

If you cancel your insurance cover and subsequently decide that you would like to re-apply for insurance cover down the track, you can do so by completing a new online insurance application online by clicking here. Any application for insurance made at this time will be subject to approval by the insurer and may require underwriting. We cannot reinstate your original cover once you have decided to cancel it.

If you cancel your insurance we are unable to refund the premiums paid up to the date you cancelled, unless your cancellation is received within 60 days of your cover first commencing. 

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8.8 Death and Total and Permanent Disability and Death Only insurance

8.8.1 What’s Death and TPD insurance cover?

Death and TPD insurance cover provides you with an insured benefit, payable to either you, if you become Totally and Permanently Disabled, or to your dependants or legal personal representative(s) in the event of your death. This is additional to your super account balance.

8.8.2 What’s a Death benefit?

In the unfortunate event of your death, a Death benefit provides a lump sum payout to your dependants (for example, your children or partner) or your legal personal representative (executor of your estate). It is designed to provide your dependants with financial support. 

Under legislation, in the event of your death, your Death benefit is only payable to your dependants or legal personal representative(s). Your benefit is paid in addition to your Hostplus account balance. For more information and to find out who you can nominate to receive your benefit if you die, see Section 2: How super works – Death benefit nominations.

8.8.3 What's a Terminal Illness benefit

If you are insured for Death cover, you will also be covered for a Terminal Illness benefit. 

A Terminal Illness benefit is payable, if you suffer a ‘terminal illness’, as defined in 8.16 Definitions.

You are unable to claim a TPD benefit if you lodge a claim for a Terminal Illness benefit. Your death benefit will be reduced by the amount of the Terminal Illness benefit paid to you.

8.8.4 What's a Total & Permanent Disability (TPD) benefit?

A TPD benefit provides a lump sum payout to you if you become totally and permanently disabled. It is designed to replace your future earning capacity via a lump sum payment and provide you and your dependants with the financial support you need.

If you apply for a TPD benefit, your assessment will depend upon your employment status on the date your illness or injury stops you working (Date of Disablement).  Where you were employed or had been unemployed for less than 12 months on the Date of Disablement, you will need to satisfy one of parts 1, 2, 3, 4 or 5 of the TPD definition to receive the TPD benefit. Otherwise, you will need to satisfy one of parts 2, 3, 4 or 5.  See 8.16 Definitions for an explanation of the TPD definitions.

Note: If you have previously received, had a claim admitted , or were eligible to receive a TPD benefit from any other source (including a superannuation fund or otherwise), your cover will be restricted to Death Only insurance cover at any time. However, you may apply for TPD Cover and be eligible for this cover, if your application is accepted by the insurer. If you fail to inform us that you’ve received a TPD benefit either prior to or at the time you commenced your membership with Hostplus, then we’ll deduct the usual weekly premium, but you will not be covered for TPD. In the event of an insurance claim you will only be covered for a Death benefit. Any insured benefit paid is in addition to your account balance.

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8.9 Understanding Unitised & Fixed Benefit Insurance Cover

8.9.1 Choosing unitised or fixed insurance cover

When applying for Death Only or Death & Total & Permanent Disability cover, you can choose either unitised cover or fixed benefit cover. You cannot have a combination of unitised and fixed cover. If you decide to move from unitised to fixed cover, you will be required to answer a health questionnaire from the insurer which will be used to assess your application.

8.9.2 Unitised insurance cover

With unitised cover, you pay a set price for each unit of cover you hold. The benefit value of each unit changes depending on your age. The benefit value of each unit decreases as your age increases, and the number of units you hold may change, however the amount you pay per unit remains the same.

8.9.3 Fixed insurance cover

With fixed insurance cover your insured benefit value stays the same but as you get older, the cost you pay will increase each year. However, your TPD benefit will reduce each year by 20% of the cover held at age 61, to zero at age 65.

The below example highlights how your insurance cover is reduced:

Your age	TPD benefit	Example, $100,000 sum insured Fixed benefit cover
60	100%	$100,000
61	80%	$80,000
62	60%	$60,000
63	40%	$40,000
64	20%	$20,000
65	0	0

 

See 8.18 Death Only and Total & Permanent Disability (TPD) Only insurance: Fixed benefit cover table

 

8.9.4 Switching between units of cover and fixed cover

You can switch from unitised to fixed cover at any time. However, you cannot switch back from fixed cover to unitised cover unless you are decreasing your insurance cover. If you decide to move from unitised to fixed cover, you will be required to answer a health questionnaire from the insurer which will be used to assess your application.

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8.10 Who’s eligible for Death and Total & Permanent Disability insurance cover with Hostplus? (Employer Sponsored and Personal Super Plan Members)

Default cover will be provided automatically for members who join with a Participating Employer or as a Personal Plan Member if on the Cover Commencement Date you are: 

• eligible for insurance ‘an Eligible Person’; and 
• not a ‘Claiming Member’. 

If you are a Claiming Member for TPD, you will be eligible to receive Death Only default cover. If you are a Claiming Member for Terminal Illness, you will not be eligible for any default cover.

See 8.16 For definitions of ‘Cover Commencement Date’, ‘At Work’ and ‘Claiming Member’

You are eligible for insurance cover if you are:

• an Industry or Personal Super plan member of Hostplus;
• aged 11 to 64 for TPD cover;
• aged 11 to 69 for Death cover;
• an Australian resident or a lawful non-citizen, within the meaning of the Migration Act 1958 (Cth) for whom  your employer is required to make employer contributions; and
• not an Excluded Member

An Excluded Member is a member who satisfies one or more of the following:

• is older than the maximum insurable age, being age 65 for TPD and age 70 for Death cover; 
• has previously opted out of cover under this or any previous Hostplus policy; or
• a Hostplus Personal Super Plan member whose occupation excludes them from being eligible for insurance.

Excluded members are ineligible for cover under the Hostplus policy except where accepted by the insurer at their absolute discretion. Acceptance remains subject to underwriting.  We will notify you of the outcome of any application made. 

8.10.1 When does Death and Total & Permanent Disability insurance cover start? (Industry and Personal Super Plan Members)

For Eligible Persons, your automatic default insurance cover commences on the Cover Commencement Date as defined in section 8.16 Definitions, provided there are sufficient funds in your account to pay for premiums.

Please note: For Personal Super Plan members, where we receive an employer contribution from a Participating Hostplus Employer that predates your application for the Personal Super Plan, you will obtain (if eligible) default cover applicable for Industry Members. See section 8.2 Automatic Death and Total & Permanent Disability (TPD) insurance cover for Industry members when you join (Default Insurance Cover); or contact us on 1300 467 875 for a copy of our insurance policy.

• Applications to increase cover:
  If you have applied to increase your insurance cover via an application, your increased cover will commence on the date your application is accepted by the Insurer and you have sufficient funds to pay the required insurance premiums. Acceptance is subject to underwriting. We will advise you in writing of the outcome of your application.

8.10.2 Duplicate accounts

You are only eligible to retain insurance in one account. Depending on your account, you may retain the highest level of insurance cover you hold or retain the original cover. Your insurance cover will automatically be transferred into adjusted once your accounts have been merged account unless you tell us otherwise. You must inform us immediately if you have more than one account with Hostplus.

Please note that if you are an existing member and have a duplicate account or have joined another division of Hostplus you are not entitled to the 8.12 Special insurance offer on joining for new members.

8.10.3 Exclusions

In the event of a war involving Australia or your country of residence the insurer may offer increased premium rates. No benefit is payable if the event giving rise to the claim is caused directly or indirectly by war as defined in the Insurance Policy. Personal Plan members are also subject to a pre-existing conditions exclusion. 

See 8.5.1 Personal Super Plan Pre-existing conditions exclusion section for more information

8.10.4 Going overseas?

If you travel or reside overseas, you are covered for claims, provided your insurance premiums continue to be paid from your account and you have sufficient funds in your super account to pay the premiums. In the event of a Total and Permanent Disability or Salary Continuance claim you may be required to return to Australia at your own expense to be assessed for a benefit.

8.10.5 When your Death and TPD insurance cover ends

Your insurance cover will cease, without the need for us to notify you, on the earliest of the following events: 

• the date you commence Active Duty with the military services of any country (other than the Australian Armed Force Reserve where you are not on Active Duty outside Australia),
• the date you cease to be a member of Hostplus,
• the date you reach age 65 for TPD, 
• the date you reach age 70 for Death cover,
• the date we receive your written request to cancel your insurance (or where the request specifies a later date, the later date specified),
• in the event of your death,
• the date you are paid a Terminal Illness benefit which is equal to the amount of your Death benefit,
• the end of the month in which your account balance has insufficient funds to pay the premium,
• by opting out of your insurance cover by selecting this option on your Membership application when joining Hostplus,
• the date the insurance policy ends, or
• your account is transferred to the Australian Tax Office or an Eligible Rollover Fund.

8.10.6 If your cover starts again (Death and TPD)

If your cover has lapsed, it may in certain circumstances be reinstated or recommenced. 

Where cover is reinstated, this means it continues from the day it previously ceased, at the same level as previously existed, subject to any exclusions, limitations or special conditions that applied previously.

Where cover recommences, this means it may start from a different date than when it previously ceased, it may be at a different level from what had previously existed (i.e. the cover will be Default Cover) and with restrictions, as described below. 

Reinstatement of Cover - Contribution within 30 days or employer contribution within 180 days of cover ceasing:

If your cover ceases as a result of insufficient funds in your account, it may be reinstated from the date your cover ceased (Cover End Date), at the same level and on the same terms (including occupational rating, exclusions and special conditions, if any) as that held by you immediately prior to the Cover End Date if: 

• we receive a contribution or rollover for you within 30 days of the Cover End Date; or
• We receive an employer contribution for you within 180 days of the Cover End Date which is for a period which includes the Cover End Date; and
• you are under age 65 for TPD and 70 for Death cover on the Cover End Date.

Recommencement of Cover – Industry Members

If you are an employee of a Participating Employer and your cover has ceased as a result of insufficient funds in your account, your cover will recommence at the automatic default level of cover, if: 

• we receive any contribution or rollover for you after 30 days of the Cover End Date; or
• we receive an employer contribution for you after 180 days of the Cover End Date; and
• you are an Eligible Person, under the age of 65 for TPD and 70 for Death cover on the Recommencement Date.

Where your cover recommences, it will do so on the Recommencement Date.

Because a recommencement may change the level of insurance you previously held and or your occupation rating, this may affect your premium.   

When your cover will be Restricted Cover: 

• If you are not At Work on the Recommencement Date, cover will be Restricted Cover until you are At Work for 30 consecutive days. After that time it will be Full Cover.
• If the contribution is an employer contribution and relates to a period more than 6 months after the start of the period to which the contribution relates, Restricted Cover will apply to you from the Recommencement Date. 

Please note: If before the Recommencement Date you have a claim admitted (accepted by an insurer), or are eligible to receive a Total and Permanent Disablement benefit from any source, you will only be eligible for default Death cover.
If you have had a claim admitted, are eligible for, in a waiting period or the process of claiming a Terminal Illness from any source, you will not be eligible for default cover.

Recommencement of Cover – Personal Super Plan Members: 

If you are a Personal Super Plan member and your cover has ceased as a result of insufficient funds in your account, your cover will recommence at the automatic default level of cover applicable to the Personal Superannuation Plan, if: 

• we receive a contribution or rollover for you more than 30 days after the date your cover ceased (Cover End Date); and 
• you are an Eligible Person, under the age of 65 for TPD and 70 for Death cover, on the Recommencement Date.

Where your cover recommences, it will do so on the Recommencement Date being the later of:

• 180 days prior to the date we receive an employer contribution in respect of you;
• the start date of the ‘contribution period’ to which the employer contribution received relates;
• the Cover End Date.

using the Heavy Blue Occupational Classification, until such time as this is varied in writing, to the insurers satisfaction. (This may affect your premium). Please note any Pre-Existing Condition exclusion will recommence from the Recommencement Date. Recommencement of cover will be subject to Restricted Cover.    

Recommencement of Cover - Active Duty outside Australia with the Australian Armed Forces Reserve

If your cover has ceased as a result of you having commenced Active Duty outside Australia with the Australian Armed Forces Reserve, you may have your cover recommenced up to the automatic default level of cover provided the period of that Active Duty did not exceed 12 consecutive months and your cover would not have otherwise ceased due to any other reason.

Upon recommencement, New Events Cover will apply for 12 consecutive months commencing on the later of you ceasing Active Duty outside Australia with the Australian Armed Forces Reserve, and the date you are first At Work with your Participating Employer. New Events Cover will continue to apply if you are not At Work after this 12 month period until you return to being At Work, unless you are accepted by the insurer for Full Cover. Acceptance remains subject to underwriting. 

Note: If the period of Active Duty (referred to under this section) exceeded 12 consecutive months, acceptance will remain subject to underwriting and approval by the insurer. 

 

8.10.7 Manage your Insurance online

To make it easy for you the Hostplus online insurance tool allows you to manage all your insurance needs all year round. You have the flexibility to change your level of insurance cover when your circumstances change.

Simply apply online now

8.10.8 How much insurance cover can I apply for?

You can apply for unlimited Death cover which includes Terminal Illness cover.  Underwriting conditions may apply.

You can apply for up to a maximum of $5 million in Total & Permanent Disability (TPD) cover. Underwriting conditions may apply.

8.10.9 Calculating how much insurance cover you need and cost of cover

To calculate the type and level of insurance cover you need click here to use our online insurance calculator.

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8.11 Understanding occupational ratings

Some members will be eligible to pay a lower premium based on their occupation and associated occupational rating set by the insurer.

The table below is a description of occupational ratings. If you require assistance determining your occupational rating you can contact Hostplus.

Please note: Depending on your occupation and the type of cover you select, you may be assessed on different occupation ratings. For example, a hospitality worker will be considered as Standard for Death and TPD but Heavy blue for Salary Continuance cover.

If you do not provide your occupational details and you are electing to take up fixed cover, you will automatically default to the Heavy Blue collar rating for Death and TPD insurance cover. 

Occupational Rating

To change your insurance scale you can apply online at hostplus.com.au by clicking here.

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8.12 Special insurance offer on joining for new Industry members

If you are a new Industry Fund Member aged under 65 years, joining through a Participating Employer and have obtained default Death and Total & Permanent Disability cover, you have a once off opportunity to:

• increase your unitised Death and Total & Permanent Disability cover up to a total of 16 units if you are aged 11 to 24, or 20 units if you are aged 25 to 64, or
• apply for fixed benefit Death and Total & Permanent Disability cover of up to $500,000 if you are aged under 65;
• you may also apply for Salary Continuance insurance cover for up to $4,000 per month for a benefit period of two years, with a waiting period of 30, 60 or 90 days if you aged under 65. See 8.19.9 Restricted Cover – Salary Continuance for more information.

This special offer is a one-off opportunity when you first complete your Hostplus Membership application form for industry members and selecting this option, when you join online at hostplus.com.au. If completing the paper application form, you must return the form within 6 months from the date you commenced work with your Participating Employer or within 60 days from the day you receive your Hostplus welcome letter, whichever is the later.

Please note, cover provided under the Special insurance offer (including answering some limited health questions) will commence from the date the application is accepted by the insurer, and will remain subject to the same exclusions and other special insurance conditions (if any) which apply to you for other cover held. 

Important Note:
If you are not At Work at the time of applying for the Special Offer, restricted cover will apply until you are back At Work for 30 consecutive days. Please refer to 8.3 restricted cover.

New Members aged 65 or over, those that fail to apply within the prescribed timeframes, or those that are not eligible for default insurance or that have opted out or cancelled their default cover will not be eligible to take up the Special Insurance Offer (for Death and TPD) upon joining. 

Current and or existing members of Hostplus regardless of division or product are also ineligible to take up the Special Insurance Offer. It’s important to note that if you don’t take the “Special Offer” up, if offered on the first application you have completed (either online or paper), you cannot complete a subsequent application to take advantage of the offer.

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8.13 Changing your level of cover after you have joined

You can change your level of cover and tailor it to suit your needs, at any time during your membership by applying online. You can take advantage of the following options to increase your cover.

8.13.1 Transferring your insurance cover into Hostplus

If you have insurance cover through another superannuation fund or otherwise for Death Only or Death and Total & Permanent Disability (TPD) cover (“Transferred Cover”) you may be able to transfer up to $1,500,000 of Death Only or Death and TPD insurance cover into Hostplus provided that:

• your Transferred Cover is of a similar nature to the cover provided via Hostplus,
• your Transferred Cover is still in force,
• you transfer your superannuation account balance to Hostplus if your Transferred Cover is held through superannuation,
• any loadings, restrictions and exclusions which apply on your Transferred Cover will also apply to your cover transferred to Hostplus, and
• you cancel your Transferred Cover once the transfer to Hostplus has occurred.

To apply to transfer your existing cover to Hostplus, please apply online by clicking here.  

Please note that any Death and/or TPD cover transferred to Hostplus will be in addition to the same insurance cover you hold under Hostplus. (subject to a limit of $5m for TPD cover). If you have fixed TPD Cover, the cover amount cannot exceed your Death Cover and it is reduced by 20% each year from your 61st birthday until you reach age 65, when it will reduce to zero.  Any Salary Continuance cover you transfer will replace any Salary Continuance cover you currently hold with Hostplus.

 

8.13.2 Specific life events cover - cover that keeps up with you

To help ensure your Death and Total & Permanent Disability (TPD) cover keeps up with you whenever you take a big step forward – like buying a new home or starting a family, you have the opportunity to take advantage of our life events cover. This feature, which is only accessible to Industry members, allows you to increase your unitised cover by four additional units or under fixed benefit cover, by 25% of your current sum insured up to a maximum of $200,000, without the need to complete lengthy paperwork or supply medical information.

To obtain the additional cover under this feature, you must apply within 6 months of: 

• getting married,
• the birth or adoption of a child/children,
• divorce,
• death of a spouse,
• taking on a mortgage or negotiating an increase to your existing mortgage (principle place of residence),
• completion of an undergraduate degree at an Australian university,
• a dependent child starting secondary school,
• becoming a carer for an immediate family member for the first time and you are financially responsible for such care and are physically providing such care,
• taking out a business loan in excess of $100,000,
• increasing an existing business loan, by at least $100,000 (excluding re-draw and refinancing).

You will need to provide proof that the event has occurred. If you have Death Only cover, the increase will be for Death Only cover. If you have Death and TPD cover, the increase will apply to both types of cover. You can take up one life event cover increase every 12 months and three increases in total in the lifetime of your membership. The same loadings, exclusions and limitations will apply to your life events cover that applied immediately before your life events application. 

If you have been previously declined in your application for insurance by the insurer you will not be eligible for the specific life events cover.

You can apply online by clicking here

8.13.3 Converting your unitised insurance cover to fixed benefit insurance cover

You have the option to replace your unitised cover with 8.9.3 Fixed insurance cover at any time by applying online by clicking here. You must be 60 years of age or less to be eligible for this offer. Where an application is made, you will have your unitised cover converted to an equivalent amount of fixed benefit cover, rounded up to the next $1,000.

Once you have converted to fixed cover, you cannot automatically revert back to unitised cover unless you are decreasing your cover only. You cannot have a combination of unitised cover and fixed benefit cover.

To revert back to unitised cover you will be required to complete a new online insurance application online by clicking here.

All applications made for increased cover will commence on the date the insurer approves your application and you have sufficient funds in your account to pay the associated insurance premiums. We will notify you of the insurer’s decision. You are covered by Interim Accident Cover while your application to increase your cover is being assessed by the insurer. 

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8.14 Interim Accident Cover

While the insurer is assessing your application for Death and TPD insurance cover, or an increase in your existing Death and TPD cover, or to amend your Death & TPD insurance cover, you are provided with Interim Accident Cover. If you die or suffer total and permanent disablement as a result of an accident during the period in which the Interim Accident Cover applies, the interim benefit will be at the same level as the cover applied for or in the case of increasing your cover, the difference between the level of increased cover applied for and the level of current cover, up to the maximum benefit level limit as below:

Interim Accident Cover commences when we receive your application and will continue until the earlier of: 

• the date the insurer accepts or rejects your application,
• 90 days after the date Interim Accident Cover starts, 
• the date that you withdraw your application for additional cover; or
• the date your cover otherwise ends as set out under 8.10.5 When your Death and TPD insurance cover ends.

‘Accident’ means a fortuitous, external event that occurs by chance causing death or total and permanent disablement. It does not refer to an event which results in sickness, disease, allergy or infirmity of the insured member, such that they would qualify for a Death or Total & Permanent Disability (TPD) benefit (as applicable) to be paid under the policy.

Whether the death or total and permanent disablement was caused by an unintended and unexpected characteristic or consequence of an intended act (such as the application of unintentionally excessive force, or the creation of unintended or excessive force, or the creation of unintended excessive pressure or strain) is irrelevant in determining whether death or total and permanent disablement has arisen as a result of an accident.

An accident must result in the death or total and permanent disablement of the insured member within 365 days of the accident for a benefit to be payable where liability is contingent on an event being caused by an accident or by accidental injury.

For the avoidance of doubt, an accident shall specifically exclude death or total and permanent disablement (if it applies):

• arising out of, or contributed to in any way by, any pre-existing sickness, disease, injury, gradual physical or mental deformity, or infirmity known to the insured member when their insurance cover commenced, or
• arising in circumstances where the insured member deliberately assumed the risk or courted disaster, irrespective of whether he or she intended or contemplated the results of his or her actions.

Where there is any doubt as to the cause of death or total and permanent disablement sustained as a result of an accident, the cause will be characterised as being the result of a sickness. See 8.16 Definitions.

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8.15 When should I make a claim for a benefit Death and Total and Permanent Disablement

You should advise us of a claim as soon as reasonably possible. If you don’t notify us within a reasonable time, the insurer may reduce or refuse to pay the insured benefit to the extent their assessment of your claim is prejudiced. 

If you make a claim, the insurer reserves the right to investigate the claim including but not limited to the use of investigative agents, conducting surveillance and requesting information and medical examinations.

It is important to note that if you make a claim, you will only be entitled to an insured benefit if you meet the eligible criteria (see section 8.10) under the terms of the fund’s insurance policy. The insured benefit is determined as at the date of the event occurring (e.g. for death event, date of death) and the level of insurance cover at that time. In circumstances where you are in the process of applying for additional cover but have not yet been accepted by the insurer, you will only be entitled to the lesser amount of cover applicable prior to the increase, in the event of a successful claim.

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8.16 Definitions

Total and Permanent Disablement (TPD):

“Totally and Permanently Disabled”, “Total and Permanent Disablement”, “Total and Permanent Disability” or “TPD” means:

1. Unlikely to return to work

If you are employed or engaged in a gainful occupation, business, profession or employment within 12 months of the date you cease to be so employed or engaged:

1.1. you have suffered an injury or illness and, as a result of that injury or illness:

1.1.1. are totally unable to be employed or engaged in that occupation, business, profession or employment for a period of six consecutive months, and

1.1.2. are determined by the insurer that at the end of that six month period (or such later time as agreed with the trustee), to be permanently incapacitated to such an extent as to render you unlikely ever to be employed or engaged in any gainful occupation, business, profession or employment for you are reasonably suited by education, training or experience.

NOTE: For the avoidance of doubt, the six month periods referred to in part 1 above does not apply to parts 2 to 5 below.

OR

2. Permanent impairment

You suffered an injury or illness and, as a result of that injury or illness you:

2.1. suffered a permanent impairment of at least 25% of whole person function as defined in the American Medical Association publication ‘Guides to the Evaluation of Permanent Impairment’, 4th edition, or an equivalent guide to impairment approved by the insurer, and

2.2. are disabled to such an extent, as a result of this impairment, that you unlikely ever again to be able to be employed or engaged in any gainful occupation, business, profession or employment for which you are reasonably suited by education, training or experience.

OR

3. Specific loss

As a result of illness or injury, you suffered the total and permanent loss of the use of: 

• two limbs (where ‘limb’ is defined as the whole hand or the whole foot), or 
• the sight in both eyes, or 
• one limb and the sight in one eye

and are disabled to such an extent, as a result of this impairment, that you are unlikely ever again to be able to be employed or engaged in any gainful occupation, business, profession or employment for which you are reasonably suited by education, training or experience.

OR

4. Loss of independent existence

As a result of illness or injury, you suffered loss of independent existence and are disabled to such an extent, as a result of this impairment, that you are unlikely ever again to be able to be employed or engaged in any gainful occupation, business, profession or employment for which you are reasonably suited by education, training or experience.

‘Loss of independent existence’ means the insurer has determined you are totally and irreversibly unable to perform at least two of the following five ‘activities of daily living’ without the assistance of another adult person: 

• bathing and/or showering. 
• dressing and undressing. 
• eating and drinking. 
• using a toilet to maintain personal hygiene. 
• getting in and out of bed, a chair or wheelchair, or moving from place to place by walking, wheelchair or with assistance of a walking aid.

OR

5. Cognitive loss

As a result of illness or injury, you suffered cognitive loss and are disabled to such an extent, as a result of this impairment, that you are unlikely ever again to be able to be employed or engaged in any gainful occupation, business, profession or employment for which you are reasonably suited by education, training or experience.

‘Cognitive loss’ means the insurer has determined that a total and permanent deterioration or loss of intellectual capacity has required you to be under continuous care and supervision by another adult person for at least six consecutive months and, at the end of those six consecutive months, you are likely to require permanent ongoing continuous care and supervision by another adult person.

Other Definitions

Active Duty
Full-time occupation as part of a military force, as opposed to reserve duty.

At Work
Actively performing all your normal duties of your occupation, working your usual hours free from any limitation due to illness or injury and not entitled to or receiving income support benefits of any kind.

Where you own all or part of the business from which you earn your regular income, At Work means you are capable of, and in fact performing without restriction due to injury or illness, all of the usual identifiable duties of the occupation for which you earn your regular income. 

Claiming Member
You:
(a) have had a claim admitted (accepted by an insurer);  
(b) are eligible to receive a benefit;  
(c) are in a waiting period for a benefit; and/or    
(d) are in the process of claiming a benefit

for terminal illness or total and permanent disablement (TPD) from any source, on or before the date your cover commenced, would have commenced or recommenced (as appropriate) with Hostplus under the policy.

If you are a Claiming member you may be accepted by the insurer for cover subject to underwriting.

Cover Commencement Date
The later of:

(a) 180 days prior to the date Hostplus receive an employer contribution in respect of you from your Participating Employer;    
(b) the start date of the contribution period to which the employer contribution, received from a Participating Employer, relates;    
(c) the date you first commenced work with your Participating Employer (provided you were eligible for employer contributions).

For a Personal Super Plan Member, Cover Commencement Date means the date the first Contribution for you is received and there are sufficient funds to pay the required premiums.

Cover End Date
The end of the month in which your account balance has insufficient funds to pay premiums.

Eligible Person
You are an Employer Sponsored or Personal Super Plan Member who is:

(a) a member of the industry Division of the Fund;
(b) at least 11 years old and under 70 years of age for Death and Terminal Illness Cover;    
(c) aged at least 11 years and under 65 years of age for TPD cover;    
(d) an Australian resident or a lawful non-citizen, within the meaning of the Migration Act 1958 (Cth) for whom your employer is required to make employer contributions,
(e) not an Excluded Member; and
(f) not an insured member of the Executive Division of the Fund.

Full Cover
Cover that is neither New Events Cover nor Restricted Cover.

Industry Members/Employer Sponsored Member(s)
A member who is an employee of a Participating Registered Hostplus Employer and has been registered/joined with Hostplus through this employer. The Participating Employer is attached your account within the Fund, at the Cover Commencement Date.

New Events Cover
You are only covered for an illness that first becomes apparent, or an injury that first occurs, on or after the date cover commenced.

Participating Registered Hostplus Employer (Participating Employer)
An employer, is an employer who has completed an employer application form to register with Hostplus and makes Superannuation Guarantee Contribution on behalf of employees through the Industry product.

Personal Super Plan Member
you are a member who has chosen to become a member of Hostplus and has completed a personal super plan application form.

Pre-existing Condition
An injury or illness, condition or related symptom suffered by you in the two years prior to the date you first commenced cover under the Policy or the Previous Policy which you, and any reasonable person in your position:

• was aware of; or
• should have been aware of; or
• had a Medical Consultation for.

Recommencement Date
The later of:

(a) 180 days prior to the date we receive an employer contribution in respect to you;
(b) the start date of the contribution period to which the employer contribution received from your Participating Employer relates; or
(c) the Cover End Date.

Where cover recommences due to the receipt of a Contribution for a person that is not an Employer Contribution, Recommencement Date means the date the Contribution for the person is received.

 

You are only covered for an illness that first becomes apparent, or an injury that first occurs, on or after the date cover commenced provided the Injury or Illness is not a Pre-Existing Condition.

Salary
Where you are Employed, the following annual remuneration (including mandated employer superannuation contributions) which you received from your occupation, before the deduction of income tax:

• Cash salary
• Regular overtime (averaged over the previous three years, or since you started in your current occupation, if less);
• The monetary value of non-cash benefits or fringe benefits provided by your employer in direct substitution of salary (as long as the fringe benefits continue to be provided to you after disability benefit payment have commenced) and
• Performance related commission bonuses and other monetary benefits, averaged over the previous three years, or since you started his or her current position, if less;

OR

Where you directly or indirectly owns all or part of the business from which you earns his or her income, the total amount earned by the business over the financial year as a direct result of your personal exertion or activities through your usual occupation, less your share of business expenses, but before the deduction of income tax, for that business (or the relevant proportion for part of a financial year).

Senior Manager
The most senior staff of an organisation or business, including the heads of various divisions or departments reporting to the chief executive (or equivalent title).

Terminal Illness

(a) Two Medical Practitioners, one of whom specialises in the your illness, certifies in writing that despite reasonable medical treatment the illness will lead to your death within 24 months of the date of the certification, and    

(b) The insurer is satisfied, on medical or other evidence that despite reasonable medical treatment the illness will lead to your death within 24 months of the date of the certification referred to in paragraph (a).

The illness which you suffer, must occur and the date of the first and second certifications referred to in paragraph (a) must be made while you are covered for death cover with Hostplus.

See 2.13.9 Types of benefits

Tertiary education

Tertiary education includes but is not limited to mean diplomas, undergraduate and graduate certificates, and associate's, bachelor's, master's and doctoral degrees obtained at any type of education pursued beyond the high school level.

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8.17 Industry Member Automatic Death & TPD Default Unitised Cover Table

The table below shows the level of default Death and TPD cover eligible Industry (employee) members receive upon joining Hostplus. The level of default cover applied is based on your age next birthday.

Cost Of Unitised Death & TPD Cover

The rates shown have been rounded up to two decimal places for ease of use, the actual premium rates applied to your account are to four decimal places.

Your unitised cover premiums will be calculated based on your applicable occupation rating, number of units held and type of cover. 

Please note the ‘Standard’ occupational rating classification will apply to you until such time as you this is varied under the terms of the policy, in writing with Hostplus.

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8.18 Death Only and Total and Permanent Disability Only insurance Fixed benefit cover table

Management/Clerical (White collar) premium rates are shown per $1,000 sum insured.

The rates shown have been rounded up to two decimal places for ease of use, the actual premium rates applied to your account are to four decimal places.

Fixed Death and TPD Cover is calculated by adding the Death Only and TPD Only premium rates together.

Your Fixed Cover premiums will be calculated based on your age next birthday, your applicable Occupation Rating Factor, type of cover and the dollar value of your cover. 

If you do not provide your occupational details and you take up fixed cover, you will automatically default to the Heavy Blue collar rating for Death and TPD insurance cover, until such time as you vary this under the terms of the policy, in writing with Hostplus. 

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8.19 Salary Continuance insurance cover

Salary Continuance insurance helps to protect your income if you can’t work because of illness or injury (temporarily and totally) by providing regular monthly payments to help you meet your living expenses.

You can apply for cover of up to 90% of your monthly pre-disability salary (where, in the event of a successful claim, 75% of your monthly pre-disability salary is paid to you and 15% of your monthly pre-disability salary is paid into your account with Hostplus), capped at $30,000 per month, with a waiting period of either 30, 60 or 90 days and you can choose to receive monthly benefits for either up to two years or up to the age of 65.

8.19.1 When your Salary Continuance cover starts

Your Salary Continuance insurance cover commences on the date your application is accepted by the insurer and your insurance premium is paid. Acceptance is subject to underwriting. We will advise you, in writing, of the outcome of your application.

8.19.2 When your Salary Continuance cover ends

Your Salary Continuance insurance cover will cease on the earliest of the following events:

• the date you commence Active Duty with the military service of any country (other than the Australian Armed Forces Reserves and are not on Active Duty outside Australia).
• the date you cease to be a member of Hostplus.
• the date you reach age 65.
• the date we receive your written request to cancel your insurance (or where the request specifies a later date, the later date specified).
• the date that you permanently retire from the workforce.
• in the event of your death.
• the end of the month in which your account balance has insufficient funds to pay the premium.
• the date the insurance policy ends
• your account is transferred to the Australian Tax Office or an Eligible Rollover Fund.

8.19.3 Who’s eligible for Salary Continuance insurance cover with Hostplus?

You are eligible for insurance cover if you are:

• a member of the Industry Division of the Fund;
• at least 15 years old and under 65 years of age;
• an Australian resident or a lawful non-citizen, within the meaning of the Migration Act 1958 (Cth) for whom the employer is required to make employer contributions;
• not an Excluded Member; and
• not an insured member of the Executive Division of the Fund.

An Excluded Member is a member who satisfies one or more of the following:

• is older than the maximum insurable age, being age 65;
• works in an excluded occupation; or  
• has previously declined or opted out of cover under this or any previous Hostplus policy; or
• is eligible to receive or has received a lump sum benefit for total and permanent disability from any source.

Excluded members are ineligible for cover under the Hostplus policy except where accepted by the insurer at their absolute discretion. Acceptance remains subject to underwriting.  We will notify you of the outcome of any application made. 

8.19.4 Excluded occupations

An excluded occupation is an occupation that the Fund’s insurer will not cover for Salary Continuance insurance. Refer to Excluded occupations.

8.19.5 Salary Continuance Cover Exclusions

No benefit will be payable if the injury or illness is caused directly or indirectly by one of the following: 

• your intentional, self-inflicted act, or any attempt to commit suicide,
• pregnancy unless you are disabled for more than three months after the end of the pregnancy, in which case the waiting period is deemed to start on the later of the date total disablement begins and the end of the pregnancy, or
• war or act of war as defined in the insurance policy.

In addition to the above, the insurer may refuse to pay any benefits:

• while you are imprisoned.
• if the premium has not been paid in respect of all members insured under the insurer’s policy.
• if you do not comply with the requirements made of you by the insurer in the course of considering your claim.
• where the insurer’s assessment of the claim is prejudiced.

No Partial Disability Benefit will be payable where you cease to be employed for reasons other than illness or injury.

8.19.6 Salary Continuance cover how your benefit is calculated

With Salary Continuance cover, you first decide how much of your pre-disability salary you would like to insure. You can apply for up to a maximum of 90% of your pre-disability salary. If insured for that amount, in the event of a successful claim, 75% of your monthly pre-disability salary is paid to you and 15% of your monthly pre-disability salary is paid into your Hostplus account. You may, of course, choose to have Salary Continuance insurance cover that is less than 90% of your pre-disability salary.

Where your Salary Continuance benefit is up to 75% of your pre-disability salary, we will pay that benefit to you. Where your Salary Continuance benefit is from 75% to 90% of your pre-disability salary, we will pay a maximum of 75% of you pre-disability salary to you and the remained is paid into your Hostplus account. 

Click here to calculate the level of insurance cover you need

8.19.7 Your choice of waiting periods and benefit periods

Hostplus offers three waiting periods: 30, 60 or 90 days. A waiting period is the period during which you must be totally or partially disabled before any Salary Continuance benefit is payable. You do not receive a monthly benefit for the waiting period.

The benefit period is the maximum period of time that a benefit will be paid for any one illness or injury while you are totally disabled or partially disabled. You can choose a benefit period of two years or up to age 65.

Premiums vary depending on which waiting period or benefit period you choose. Generally, the longer the waiting period and the shorter the benefit period, the lower the premium. See section 8.19.26 Salary Continuance insurance annual premiums table.

If you want to change the waiting period from:

• 90 days (the default waiting period) to 60 days or 30 days, or
• 60 days to 30 days,

you will need to complete a new online insurance application. Similarly if you want to change the benefit period from 2 years to, to age 65 you will need to apply.

During the waiting period, you can return to work once, for up to 10 consecutive days, without having to start a new waiting period. If this occurs, the number of days you have worked will be added to the waiting period.

8.19.8 Special Insurance Offer – Increase your Salary Continuance insurance when you join Hostplus

Eligible new Industry members joining Hostplus through a Participating Employer, have a once off opportunity to obtain Salary Continuance insurance to up to $4,000 per month for a benefit period of two years, and a default waiting period of 90 days (unless you nominate otherwise) with limited health questions. 

This special offer is a one-off opportunity when you first complete your Hostplus Membership application form and select this option when you join. If completing the paper application form, you must return the form by the later of 6 months from the date you commenced work with your Participating Employer or within 60 days from the day you receive your Hostplus welcome letter, whichever is the later.

See 8.12 Special insurance offer on joining for new Industry members for more information

Important Note:
You must be At Work on the date that your cover commences to receive Full Cover, otherwise you will receive Restricted Cover.

See section 8.19.9 Restricted Cover – Salary Continuance for more information

If at the date the cover which is available to you under this section commences with Hostplus (Cover Commencement Date), you have a claim admitted, are eligible to receive a benefit, are in a waiting period for a benefit, and/or in the process of claiming a benefit with respect to Terminal Illness and/or Total and Permanent Disablement from any source (Claiming Member) you will not be eligible for this cover. However, you may apply for Salary Continuance cover and be eligible for cover, if your application is accepted by the insurer.

If you fail to inform us that you’re a Claiming Member either prior to or at the time your cover commences, then we’ll deduct the usual weekly premium even though you may not be able to claim a benefit. 

Where you are provided with cover under this section, your cover will commence on the date your application is accepted.

8.19.9 Restricted Cover – Salary Continuance

Cover available to you under section 8.19.8 will be Restricted Cover if you’re not At Work on the date cover commenced (Cover Commencement Date).

See 8.16 Definitions for more information

Restricted Cover covers you for an illness which became apparent to you or an injury that first occurs on or after the date your cover commences. It will not provide a benefit if you suffered from a Pre-Existing Condition i.e. illness or injury known to you for 2 years prior to your cover commencing.

This Restricted Cover will generally be replaced with Full cover when you resume your normal duties with your employer for 30 consecutive days. If however the first employer contribution made into your account by your Participating Employer is more than 6 months after the start of the contribution period to which it relates, your cover will remain Restricted Cover unless varied by the insurer. Acceptance remains subject to underwriting. 

Special rules apply to reinstatement and recommencement of insurance cover. Please see 8.19.12 If your Salary Continuance cover starts again

8.19.10 Maximum monthly benefit payable

The maximum monthly benefit that will be paid by the insurer in the event of a claim is the lower of:

• the benefit represented by the number of units of cover for which the insurer has agreed to cover you.
• 90% of your monthly pre-disability salary, a maximum of 75% is payable to you and the balance as a contribution to your Hostplus super account up to a maximum of $30,000 per month.

8.19.11 Salary Continuance Interim Accident Cover

While the insurer is assessing your application for Salary Continuance insurance cover, or an increase in your existing Salary Continuance cover or to amend your Salary Continuance insurance cover, you are provided with Interim Accident Cover. In the event that you suffer total disability or partial disability as a result of an accident during the period in which the interim accident cover applies, the interim accident benefit will be for the same level as the cover applied for or in the case of increasing your cover, the difference between the level of increased cover applied for and the level of current cover, up to a maximum monthly benefit limit of $20,000 for the benefit period selected in the application.

The interim accident cover commences when we receive your application and will continue until the earlier of:

• the date the insurer accepts or rejects your application;
• you withdraw your application;
• 90 days after the date interim accident cover starts; or
• the date your cover otherwise ends as set out under the heading 8.19.2 When your Salary Continuance cover ends.

‘Accident’ means a fortuitous, external event that occurs by chance causing total or partial disability. It does not refer to an event which results in sickness, disease, allergy or infirmity of the insured member, such that they would qualify for a total or partial disability benefit (as applicable) to be paid under the insurer’s policy.

Whether the total or partial disability was caused by an unintended and unexpected characteristic or consequence of an intended act (such as the application of unintentionally excessive force, or the creation of unintended or excessive force, or the creation of unintended excessive pressure or strain) is irrelevant in determining whether total or partial disability has arisen as a result of an accident.

An accident must result in the total or partial disability of the insured member for a benefit to be payable where liability is contingent on an event being caused by an accident or by accidental injury.

For the avoidance of doubt, an accident specifically excludes total or partial disability:

• arising out of, or contributed to in any way by, any pre-existing sickness, disease, injury, gradual physical or mental deformity, or infirmity known to the insured member when their insurance cover commenced.
• arising in circumstances where the insured member deliberately assumed the risk or courted disaster, irrespective of whether he or she intended or contemplated the results of his or her actions.

Where there is any doubt as to the cause of death or total and permanent or partial disability sustained as a result of an accident, the cause will be characterised as being the result of a sickness.

8.19.12 If your Salary Continuance cover starts again

If your cover has lapsed, it may in certain circumstances be reinstated or recommenced.

Where cover is reinstated, this means it continues from the day it previously ceased, at the same level as previously existed.

Where cover recommences, this means it may start from a different date than when it previously ceased, at a different level from what had previously existed and with restrictions, as described below. 

Reinstatement of Cover - Contribution within 30 days or employer contribution within 180 days of cover ceasing:

If your salary continuance cover ceases as a result of insufficient funds in your account, it may be reinstated from the date your cover ceased (Cover End Date), at the same level and on the same terms (including occupational class, exclusions and special conditions (if any) and waiting and benefit periods) as that held by you immediately prior to the Cover End Date if: 

• we receive any contribution or rollover for you within 30 days of the Cover End Date; or
• we receive an employer contribution for you within 180 days of the Cover End Date which is for a period which includes the Cover End Date; and
• you are under age 65.

Recommencement of Cover - Active Duty outside Australia with the Australian Armed Forces Reserve 

If your salary continuance cover has ceased as a result of you having commenced Active Duty outside Australia with the Australian Armed Forces Reserve, you may have your cover recommenced up to the Special Offer cover provided the period of that Active Duty did not exceed 12 consecutive months and your cover would not have otherwise ceased due to any other reason.

Upon recommencement, New Events Cover will apply for 12 consecutive months commencing on the later of you ceasing Active Duty outside Australia with the Australian Armed Forces Reserve, and the date you are first At Work with your Participating Employer.  New Events Cover will continue to apply if you are not At Work after this 12 month period until you return to being At Work, unless you are accepted by the insurer for Full Cover. Acceptance remains subject to underwriting. 

8.19.13 Total disability benefit

The insurer will pay a total disability benefit if you are totally disabled (see 8.19.27 Salary Continuance cover definitions) after the end of the waiting period that is applicable to you and provided that the insurer has admitted your claim. The monthly benefit starts to accrue from the day after the end of the waiting period.

The monthly benefit is payable in arrears and stops at the earlier of:

• the end of the benefit period.
• the date you attain age 65.
• the date of your death.
• the date you are no longer totally disabled.

8.19.14 Partial disability benefit

The insurer will pay a partial disability benefit (a proportion of the total disablement) if you are partially disabled (see 8.19.27 Salary Continuance cover definitions) except where you had ceased to be employed for reasons other than illness or injury.

The partial disability benefit will be calculated as follows:

   (A – B)              
________        x disability monthly benefit
        A

Where

A is your monthly pre-disability salary (see 8.19.27 Salary Continuance cover definitions)

B means any income earned by you from personal exertion while disabled or partially disabled when the income is from your occupation, or any other occupation. 

Disability monthly benefit means the lesser of: 

• the benefit you are covered for, 
• 75% of your pre-monthly disability income, 
• the level of cover agreed to between the insurer and you, and 
• $30,000. 

The partial disability benefit begins to accrue from the day after you are no longer totally disabled or after the waiting period, as the case may be.

The partial disability benefit is payable in arrears and stops at the earliest of:

• the end of the benefit period.
• the date you attain age 65.
• the date you cease to be partially disabled.
• the date you are earning, or are capable of earning, monthly salary or wages equal to or greater than your pre-disability salary, or engaging in any occupation on a full-time basis (if working full-time prior to disability) or part-time basis (if working part-time prior to disability) or casual basis (if working casually prior to disability).
• the date that you fail to comply with the insurer’s request to return to Australian for ongoing assessment - See 8.19.20 - Travelling overseas?
• the date of your death.

8.19.15 Death benefit while claiming Salary Continuance

If you die while a total disability or partial disability benefit is being paid, the insurer will pay an amount equal to the monthly benefit you were receiving at the date of your death, for one month.

8.19.16 Recurring disability

If you suffer a recurrence of disability for was the same or a related cause of an earlier claim, within six months of that earlier claim ending, the insurer will treat this subsequent claim as a continuation of the first claim and will waive the waiting period with the if for the same hours per week as the payment of benefits over all periods for the same or related Illness or Injury shall not exceed the length of the benefit period.

8.19.17 How do Salary Continuance payments work?

Salary Continuance benefits are payable monthly in arrears once your claim has been accepted.

Once payment of your Salary Continuance benefits begin, your benefits will be adjusted annually in line with the increase in the CPI to protect your payments from the effects of inflation. However, they will not increase by more than 5% in any year.

When you return to work and your Salary Continuance benefit has ceased, the monthly benefit that you are covered for will revert to the pre-disability monthly benefit level.

8.19.18 Retraining Expense Benefit

Whilst you are in receipt of a Salary Continuance benefit, the insurer may pay all or some of the expenses incurred in relation to you participating in a return to work program if the insurer is of the opinion that the program may help you return to work. Any payments will be made to the service provider and at the insurer’s discretion and must be approved before incurred.

8.19.19 What happens if you are suffering from more than one injury or illness?

You can only claim one Salary Continuance benefit if you suffer from different types of injuries or illness that exist at the same time. For example, if you receive a monthly benefit for the benefit period due to a broken arm, you cannot also claim a monthly benefit during the same period if you suffer from another injury.

8.19.20 Travelling overseas?

The cover provided insures you while you are overseas. However, if you are overseas for more than 6 months after you commence to receive Salary Continuance benefits, the insurer may require you to return to Australia for claim assessment. If you fail to do so, the insurer may, in its discretion, refuse to continue payments.

8.19.21 Reduction of benefits

Your Salary Continuance payments may also be reduced by other payments (including settlement or commutation amounts) as set out below, where such benefits combined with the benefit payable under the policy would exceed 75% of your pre-disability salary:

• by way of workers’ compensation, similar legislation or any settlement in common law.
• under any statutory accident compensation scheme.
• any amounts payable in respect of loss of income (whether legislated or otherwise). 
• paid sick leave.
• as benefits under any other disability, injury or sickness insurance policy (except for lump sum benefits received from total and permanent disablement under a policy).

Any lump sum payment (such as settlement or commutation amounts) will be converted to an equivalent monthly amount by dividing the lump sum payment by the lesser of the number of months in the benefit period and 60.

If your monthly benefit is reduced because you are in receipt of other payments, as set out above, or where you are entitled to a partial disability benefit, the 15% of your pre-disability salary which is paid into your Hostplus account, will also be reduced proportionally.

8.19.22 When should I make a Salary Continuance claim?

You should advise us of a claim as soon as reasonably possible. If you don’t notify us within a reasonable time, the insurer may reduce or refuse to pay the insured benefit to the extent their assessment of your claim is prejudiced. 

If you make a claim, the insurer reserves the right to investigate the claim including but not limited to the use of investigative agents, conducting surveillance and requesting information and medical examinations. 

It is important to note that if you make a claim, you will only be entitled to an insured benefit if you meet the eligible criteria (see section 8.19.3) under the terms of the fund’s insurance policy. The insured benefit is determined as at the date of the event occurring (e.g. for partial disability, date of injury or illness occurred) and the level of insurance cover at that time. In circumstances where you are in the process of applying for additional cover but have not yet been accepted by the insurer, you will only be entitled to the lesser amount of cover applicable prior to the increase, in the event of a successful claim. See also interim accident cover in section 8.19.11.

8.19.23 Transfer your Salary Continuance insurance cover into Hostplus

You have the opportunity to transfer your existing Salary Continuance cover from another life insurance policy without underwriting (whether as a member of a superannuation fund or otherwise) for Total Disability (“Transferred Cover”) to Hostplus provided that the combined level of cover upon transfer is limited to the lesser of:

• the number of units to cover 90% of your pre-disability salary (of which a maximum of 75% is payable to you and the balance paid as a contribution to Hostplus), or
• the maximum cover of $10,000 per month.

Any amount above $10,000 will be assessed by the insurer. Generally, Salary Continuance insurance cover will be matched on the same waiting period and benefit period to that which was previously provided under the transferred cover. If the waiting period is not available, the next longest waiting period will be provided. Your transferred cover will replace any existing Salary Continuance cover you have with Hostplus (as long as any monthly benefit does not exceed 90% of your salary). 

You cannot transfer cover that is held by a self-managed superannuation fund trustee, or cover that is subject to a waiting period that is greater than 90 days.

Conditions and other limitations apply. All applications are subject to the approval of the insurer and for your application to be considered; you must provide proof of your external cover and the terms upon which it was granted, provided that:

• Your Transferred Cover is of a similar nature to the cover provided via Hostplus
• your Transferred Cover is still in force,
• you transfer your superannuation account balance to Hostplus if your Transferred Cover is held through superannuation,
• any loadings, restrictions and exclusions which apply on your Transferred Cover will also apply to your cover transferred to Hostplus, and
• you cancel your Transferred Cover with the previous insurer once the transfer to Hostplus has occurred.

To transfer your existing Salary Continuance cover to Hostplus, please apply online by clicking here or complete the Insurance transfer form available at hostplus.com.au/forms-and-brochures.

8.19.24 Update your salary continuance insurance online

To make it easy for you and to ensure you have adequate insurance cover when your circumstances change, you can also apply to increase or take out other forms of insurance cover online.

8.19.25 Calculating your Salary Continuance insurance cover

To calculate the type and level of insurance cover you need click here to use our online insurance calculator.

8.19.26 Salary Continuance insurance annual premiums table

Rates are shown per $100 monthly cover Management/Clerical (White collar) scale. Premium rates include estimated 9% stamp duty.

If you are electing to take up Salary Continuance cover under the Special insurance offer (see Section 8.19.8) and do not provide full occupational information you will not be eligible for this cover.

8.19.27 Salary Continuance cover definitions

Definitions

Pre-disability salary

Where you are employed, the total monthly gross income from an employer for personal exertion you receive from your usual occupation, averaged over the most recent 12 month period (that may include any period of unemployment since you last worked or the actual period of work if less) before the deduction of income tax, and includes: 

• cash salary, 
• regular overtime (averaged over the previous three years, or since you started your current occupation, if less), 
• the monetary value of non-cash benefits or fringe benefits provided by your employer in direct substitution of salary (as long as the fringe benefits continue to be provided to you after disability benefit payments have commenced), 
• performance related commissions, bonuses and other monetary benefits, averaged over the previous three years, or since you started your current occupation (if less), or

Where you directly or indirectly own all or part of the business from which you earn your income, the total amount earned by the business over the financial year as a direct result of your personal exertion or activities through your usual occupation, less your share of business expenses, but before the deduction of income tax, for that business (or the relevant proportion for part of a financial year).

Employed persons who have been absent from employment due to being on employer approved leave for up to 24 months. 

Where you have been on employer approved leave for up to 24 months (for example maternity or study leave) it is the total monthly regular gross income you received from an employer for personal exertion for your usual occupation before the employer approved leave commenced and averaged over the 12 month period before the employer approved leave commenced. 

If you have been on employer approved leave for a period of more than 24 months you are not eligible to receive a Salary Continuance benefit. 

Totally disabled

Members who are employed or have been unemployed for fewer than six months.

In the opinion of the insurer after consideration of medical evidence, that solely as a result of injury or illness, you are incapable of performing one or more of the duties of your regular occupation necessary to produce income and you:

• are not engaging in any work, for wages or profit.
• are under the care of a medical practitioner and following treatment recommended by a medical practitioner.

Members who have been unemployed for six months or more.

In the opinion of the insurer after consideration of medical evidence, that solely as a result of injury or illness, you are incapable of performing any gainful occupation, business, profession or employment, for which you are reasonably suited by education, training or experience and you:

• are not engaging in any work, for wages or profit.
• are under the care of a medical practitioner and following treatment recommended by a medical practitioner.

For all members

Partially disabled :

You:
a) have been totally disabled:
i. for a period during which a total disability benefit has been paid, or
ii. for at least 7 days out of 12 consecutive days during the waiting period, and
b) then return to work in a limited capacity or you are capable of returning to work but only in a limited capacity, and
c) are earning, a monthly Disability income is less than your monthly pre-disability salary due illness or the injury and
d) are under the regular care and following the advice of a Medical Practitioner. 

Other Definitions: 

Claiming Member 

You:
(a) have had a claim admitted (accepted by an insurer);
(b) are eligible to receive a benefit;
(c) are in a waiting period for a benefit; and/or
(d) are in the process of claiming a benefit;

for terminal illness or total and permanent disablement (TPD) from any source, on or before the date your cover commenced, would have commenced or recommenced (as appropriate) with Hostplus under the policy. 

If you are a claiming member you may be accepted by the insurer for Special Offer cover subject to underwriting.

Cover End Date
The end of the month in which your account balance has insufficient funds to pay premiums. 

Participating Registered Hostplus Employer (Participating Employer)
An employer who has completed an employer application form to register with Hostplus and makes Superannuation Guarantee Contribution on behalf of employees through the Industry product.

Pre-existing Condition 

An injury or illness, condition or related symptom suffered by you in the two years prior to the date you first commenced cover under the Policy or the Previous Policy which you, and any reasonable person in your position: 

• was aware of; or 
• should have been aware of; or
• had a Medical Consultation for. 

Restricted Cover: 
You are only covered for an illness that first becomes apparent or an injury that first occurs, on or after the date cover commenced provided the injury or illness is not a Pre-Existing Condition. 

^{Host-Plus Pty Limited ABN 79 008 634 704, AFSL No. 244392, RSEL No. L0000093, MySuper No. 68657495890198, Hostplus Superannuation Fund ABN 68 657 495 890, RSE No. R1000054.}

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