1. health and fitness
2. disease
3. cancer

Sickness Policy
Information Booklet
Combined Insurance is a division of ACE Insurance Limited
ACE Insurance Limited
Company No. 104656
FSP No. 35924
Please refer to ACE’s website at www.aceinsurance.co.nz
for the most up-to-date financial strength rating. Phone 0-9-520 9000 or 0800 COMBINED (266 246) Fax 0-9-520 9009
Email [email protected] Website www.combinedinsurance.co.nz
Street Address 105 Great South Road Epsom Auckland 1051
Postal Address Private Bag COMBINED Remuera Auckland 1541
The ACE Group of Companies ®
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Sickness Policy
Information Booklet
This document contains the Policy Terms and Conditions (“Policy Document”).
The Policy Document, together with the Policy Schedule, Application Form and any endorsements,
constitute the legal agreement between You and ACE Insurance Limited, operating through its
Combined Insurance division, and is the basis under which claims are paid.
Please read the enclosed material carefully and retain these documents.
Issue No: 6
Date of Issue: 4th July 2011
Issued By:
ACE Insurance Limited
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Form Number NZ22759
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CONTENTS
Welcome To Combined Insurance........................................................................................ 4
The Sickness Policy............................................................................................................... 4
Section 1: Terms and Conditions........................................................................................... 5
1.1Agreement................................................................................................ 5
1.2 Policy documents...................................................................................... 5
1.3 Variations to the terms and conditions...................................................... 5
1.4 Policy term................................................................................................ 5
1.5 Renewal term............................................................................................ 5
1.6 Paying Your premium................................................................................ 5
1.7 Non-payment of renewal premium or instalments..................................... 5
1.8Indexation................................................................................................. 5
Section 2: Definitions......................................................................................................... 6
Section 3: Benefits - Sickness Disability Plan...................................................................... 8
Section 4: Benefits - Sickness Hospital Plan....................................................................... 8
Section 5: Benefits - Cancer Disability Plan........................................................................ 8
Section 6: Benefits - Critical Illness Plan............................................................................. 9
Section 7: Exclusions......................................................................................................... 9
Section 8: Claims............................................................................................................. 10
8.1 How to make a claim.............................................................................. 10
8.2 Proof of loss............................................................................................ 10
8.3 Additional Information............................................................................ 10
8.4 Claim forms completed at Your expense.................................................. 10
8.5 Medical examination at Our expense...................................................... 10
8.6 How do We pay claims?........................................................................ 10
8.7 Who are benefits paid to?...................................................................... 10
8.8 Concurrent disability............................................................................... 10
8.9 Recurrent disability................................................................................. 10
8.10 Regular Medical Care............................................................................. 10
Section 9: General Policy Conditions............................................................................... 10
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9.1 Premium correction................................................................................ 10
9.2 Increasing Your cover.............................................................................. 10
9.3 Reinstatement of Your Policy................................................................... 11
9.4 Cancellation of Your Policy..................................................................... 11
9.5 Termination of Your Policy....................................................................... 11
9.6Fraud...................................................................................................... 11
9.7 Conformity with New Zealand Laws....................................................... 11
9.8Currency................................................................................................. 11
9.9Endorsement........................................................................................... 11
9.10 Taxation and special circumstances........................................................ 11
9.11 No surrender value................................................................................. 12
9.12 Changes to Your Policy............................................................................ 12
9.13 How We contact You............................................................................... 12
9.14 No financial advice................................................................................. 12
Section 10: Duty of Disclosure & Privacy........................................................................... 12
10.1 Your duty of disclosure............................................................................ 12
10.2 Privacy Statement.................................................................................... 12
10.3 Insurance Claims Register....................................................................... 12
Section 11: Complaint Resolution Procedure..................................................................... 13
11.1 How to resolve a complaint.................................................................... 13
11.2 External disputes resolution..................................................................... 13
Solvency Rating ............................................................................................................... 13
Company Address............................................................................................................... 13
Appendix: Benefit and Premium tables............................................................................. 14
Sickness Disability Plan................................................................................... 14
Sickness Hospital Plan..................................................................................... 16
Cancer Disability Plan..................................................................................... 17
Critical Illness Plan.......................................................................................... 18
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WELCOME TO COMBINED INSURANCE
Since our beginnings in 1919, Combined Insurance has
grown to become a global brand that provides quality
accident, disability and sickness insurance products to
individuals and families. Combined Insurance has been
operating in New Zealand since 1965.
2. SICKNESS HOSPITAL PLAN
There are three levels of cover:
• Bronze
• Silver
• Gold
Benefits are payable for:
Benefit C : In-patient Benefit
Our motto is “Service, Strength and Security” and our
goal is to help take better care of you and your family
should you be unfortunate enough to suffer a Covered
Sickness, Covered Cancer or a Covered Condition by
making it clear and easy for you to choose the right plan.
We take pride in our fast and efficient claims services.
Benefit D : Intensive Care In-patient Benefit
3. CANCER DISABILITY PLAN
You may select the:
• Individual Cancer Disability Plan; or
• Family Cancer Disability Plan
Combined Insurance is a division of ACE Insurance
Limited, which is part of the ACE Group of Companies®,
one of the leading global providers of insurance and
reinsurance.
Within these Plans there are three levels of cover:
• Bronze
• Silver
We are a service-orientated organisation, which prides
itself on a commitment to provide customers with
friendly and reliable service. We have a dedicated team
of customer service advisors available to assist You.
• Gold
Benefits are payable for:
Benefit E : In-patient Benefit - Cancer.
As a member of the Insurance Council of New Zealand
(“ICNZ”), We have made a commitment to the Fair
Insurance Code.
The Fair Insurance Code was developed by the ICNZ as
a set of principles which aims to continually improve
the standard of practice and service that member
companies provide to their customers. This set of
principles is in addition to those obligations created by
law.
Benefit F : Convalescent Benefit Following Hospital Confinement for Cancer.
Benefit G : Out-patient Treatment Benefit for Cancer
Benefit H : Convalescent Benefit Following
Out-patient Treatment for Cancer
Benefit I : Removal of Skin Cancer Benefit
4. CRITICAL ILLNESS PLAN
There are six levels of cover:
• Bronze
THE SICKNESS POLICY
• Silver
• Gold
Your Sickness Policy consists of four optional plans
(each a “Plan”):
• Platinum
• Platinum Plus
• Sickness Disability Plan
• Diamond
• Sickness Hospital Plan
Benefit is payable for:
• Cancer Disability Plan
Benefit J : Critical Illness Benefit.
• Critical Illness Plan
To be eligible to purchase the:
You may elect to purchase one or more of the Plans.
Your Policy provides benefits for sickness only, with
the exception of limited cover under the Critical Illness
Plan, for Paralysis, Dismemberment, Severe Burns or
Blindness that may result from an accident.
1. SICKNESS DISABILITY PLAN
There are four levels of cover:
• Bronze
• Silver
• Gold
• Platinum
Benefits are payable for:
Benefit A : Total Disability Benefit
Benefit B : Partial Disability Benefit
• Sickness Disability Plan: You must be aged between
16 years and 69 years inclusive.
• Sickness Hospital Plan: You must be aged between
1 year and 69 years inclusive.
• Cancer Disability Plan: You and Your Spouse (under
the Family Unit of this Plan), must be aged between
16 years and 69 years inclusive. Other Eligible
Persons covered under the Family Unit of this Plan
must be dependent on You and be aged 18 years or
under.
• Critical Illness Plan: You must be aged between 16
years and 64 years inclusive.
The benefits You can receive under the Plan(s) You have
selected and the cost of the Plan(s) are set out in the
Benefit and Premium Tables on Pages 14 - 19 of this
Policy Document, and the Policy Schedule that We will
send to You.
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SECTION 1: TERMS AND CONDITIONS
In this Policy document (“Policy Document”) We
explain the details of the legal agreement between the
Insured (“You” or “Your”) and ACE Insurance Limited,
operating through its division, Combined Insurance
(“We”, “Our”, “Us” or “Combined Insurance”).
Your Policy Document provides information concerning
the type and extent of the cover being provided,
restrictions, exclusions, special conditions and the
respective obligations of You and Combined Insurance.
Please read Your Policy Document carefully and retain
it in a safe place for future reference.
1.1AGREEMENT
Your Policy is a legal agreement between You
and Us. In return for the payment of the premium
applicable to the Plan(s) You have selected on the
Application Form, We will pay You, subject to the
terms, conditions and exclusions of the Policy, for
loss resulting from a Covered Sickness (Sickness
Disability and Sickness Hospital Plans), Covered
Cancer (Cancer Disability Plan) or Covered
Condition (Critical Illness Plan), a benefit as stated
in the Policy Schedule that We will send to You.
1.2 POLICY DOCUMENTS
Your Policy is made up of the following documents:
(i) The Policy Terms and Conditions which are set
out in this Policy Document.
(ii) The Application Form which is the basis on which
Your Policy is accepted by Us and in which You
are required to disclose all relevant information
and have selected Your level of cover.
(iii) The Policy Schedule that We will send to You,
showing the details of the Plan(s) You have
chosen.
(iv) Any endorsement to Your Policy, which is signed
by an Authorised Officer.
Together these documents set out the full terms and
conditions that apply to Your Policy.
1.3 VARIATIONS TO THE TERMS AND CONDITIONS
No term or condition of Your Policy may be waived
or modified unless this change is approved in
writing by an Authorised Officer of ACE Insurance
Limited.
Sales representatives of ACE Insurance Limited are
not Authorised Officers and are not authorised to
waive or modify the terms or conditions of Your
Policy.
1.4 POLICY TERM
Your Policy is issued for a term of one year starting on
the Commencement Date of the Policy, beginning
and ending at 12 noon at the place where You
reside.
1.5 RENEWAL TERM
At the expiry of the Policy Year, We may offer to
renew Your Policy with effect from the relevant
anniversary of the Commencement Date of the
Policy. Each renewal is issued for a term of one
year starting and ending in accordance with clause
1.4. We do not guarantee the premiums or benefits
at the renewal of Your Policy and will advise You
of any change to the premiums or benefits at least
30 days prior to the due date. In addition, the
premiums and benefits are indexed to increase
each year for a period of ten years in accordance
with clause 1.8. Your Policy is renewed by Your
payment of the first premium instalment relating to
the next Policy Year.
1.6 PAYING YOUR PREMIUM
The premium for Your Policy is fixed for the Policy
Year. This includes the indexation amount referred
to in clause 1.8. Your premium or first instalment (if
You pay Your premium at intervals of less than 12
months) is due on the Commencement Date of the
Policy. You may pay by cash, cheque or credit card.
Subsequent instalment premiums are due at the
intervals following the Commencement Date of
the Policy as shown in Your Policy Schedule and
must be paid in advance. Subsequent instalment
premiums or renewals may be paid by direct debit
from Your bank or financial institution account or
upon the receipt of a mail renewal notice by cash,
cheque or credit card.
If Your premium or first instalment is paid by a
cheque that is not honoured, or by a credit card
charge that is not paid, Your Policy will not come
into operation. This means You will not be covered
if You make a claim.
If any subsequent instalment premium or renewal
is paid by a cheque, credit card or direct debit
that is not honoured, Your Policy will terminate in
accordance with clause 1.7.
1.7 NON-PAYMENT OF RENEWAL PREMIUM OR INSTALMENTS
If an instalment remains unpaid for 31 days after
the Premium Due Date, Your Policy is cancelled
from midnight on the last day of that 31 day period.
If the Premium is received during this 31 day
period, We will not refuse to pay any claim solely
for the reason that the premium was not paid by
the Premium Due Date.
1.8INDEXATION
Both the benefits and premiums are indexed to
increase at the rate of 5% of the initial Policy benefit
and premium values each year Your Policy remains
in force, on the anniversary of the Commencement
Date of the Policy, for a period of ten years (i.e., the
increase is not compounded).
This does not limit Our right under clause 1.5 to vary
the rate of renewal premium for any renewal term.
The amount of benefit payable for a loss is the benefit
applicable at the date the claim was first incurred.
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SECTION 2: DEFINITIONS
Some words in Your Policy Documents are used
frequently and have a special meaning which is
explained in this section.
“Authorised Officer” means an officer duly authorised
by ACE Insurance Limited.
“Commencement Date” means the date this cover
commences as shown on the Application Form and
Your Policy Schedule.
“Covered Cancer” (Cancer Disability Plan only)
means the presence of a malignant tumour that was
contracted, commenced and originated after 30 days
from the Commencement Date of this Policy and is
characterised by the uncontrollable growth and spread
of malignant cells and the invasion and destruction of
normal tissue and is diagnosed by a Medical Practitioner
who is a consultant oncologist. This includes leukaemia,
lymphomas and Hodgkin’s disease, but excludes noninvasive cancer in situ, tumours in the presence of HIV,
all squamous cell carcinomas of the skin unless there
has been a spread to other organs, all hyperkeratoses
and basal cell carcinomas of the skin. Covered Cancer
does not include a Pre-existing Cancer or Skin Cancer.
“Covered Condition” (Critical Illness Plan only)
means one condition as described in this section that
is diagnosed and/or treated in accordance with the
requirements prescribed for each condition. A Covered
Condition excludes a Pre-existing Condition or any
condition for which you received medical advice or
treatment within 30 days after the Commencement
Date of this Policy, or, if it showed symptoms within 30
days after the Commencement Date of the Policy, that
would have caused an ordinarily prudent person to seek
medical advice or treatment.
1. “Cancer (Life-Threatening)” means a definite
diagnosis of a tumour or blood cell malignancy
characterised by the uncontrolled growth and
spread of malignant cells and the invasion of tissue.
The diagnosis of Cancer (Life Threatening) must
be made by a certified pathologist when tissue
is available. If a pathological or tissue diagnosis
is medically inappropriate, a clinical diagnosis
by a specialist, based on diagnostic imaging test
results will be acceptable. Pre-existing Cancer,
Carcinomas In-Situ, Stage A Prostate Cancer, Skin
Cancer, squamous cell carcinomas of the skin
(unless there has been a spread to other organs),
hyperkeratosis and basal cell carcinomas of the
skin are not considered Cancer (Life Threatening)
and are excluded.
2. “Heart Attack” means acute myocardial infarction,
acute coronary thrombosis, or acute coronary
occlusion which results in the death of a portion of
the heart muscle. The Heart Attack must be diagnosed
by a Medical Practitioner who is a consultant
cardiologist based upon an electrocardiogram
(ECG) and elevated cardiac enzymes.
3. “Heart Surgery” means the actual undergoing of
open heart surgery on the advice of a consultant
cardiologist to correct narrowing or blockage of
one or more coronary arteries with by-pass grafts.
Angiographic evidence of the underlying disease
must be provided. All other operations such as
the replacement or repair of one or more heart
valves via valvotomy, catheter, keyhole or similar
techniques are specifically excluded.
4. “Stroke” means a sudden cerebrovascular event
resulting in permanent neurological damage and is
diagnosed by a Medical Practitioner using standard
tests. Stroke does not mean head injury, transient
ischemic attack, or chronic cerebrovascular
insufficiency.
5. “Benign Brain Tumour” means a definite diagnosis
of a non-malignant tumour located in the cranial
vault and limited to the brain, meninges, cranial
nerves or pituitary gland. The tumour must require
surgical or radiation treatment or cause irreversible
objective neurological deficit(s). The diagnosis of
Benign Brain Tumour must be made by a Specialist,
based on diagnostic test results.
6. “Renal Failure” means end stage renal failure
presenting as chronic irreversible failure of both
kidneys to function as a result of which either
permanent dialysis or renal transplantation is
initiated.
7. “Major Organ Transplant - heart, kidney, liver, lung
or pancreas” means a medically necessary organ
transplant to replace Your heart, kidney, liver, lung or
pancreas, at a Hospital, by a Medical Practitioner.
8. “Multiple Sclerosis” means a progressive disease
of the nervous system which destroys part of
the nerves within the spinal cord and which is
diagnosed by a Medical Practitioner who is a
consultant neurologist on the basis of confirmatory
neurological investigation.
9. “Paralysis” means the complete and irrecoverable
loss of the motor functions of two or more Limbs
and which is diagnosed by a Medical Practitioner.
10. “Dismemberment” means the loss by actual and
complete severance of two or more Limbs.
11. “Severe Burns” means tissue injury caused by
thermal, electrical, or chemical agents causing third
degree burns to 20% or more of the body surface
area as measured by the “Rule of 9” of the Lund
and Browder Body Surface Chart.
12. “Blindness” means the permanent and total loss of
sight of both eyes as a result of disease, illness or
injury, measured as visual acuity of 20/20 or worse,
corrected, in each eye and which is diagnosed by a
Medical Practitioner.
“Covered Sickness” (Sickness Disability and Sickness
Hospital Plans only) means a bodily illness or disease
that was contracted, commenced and originated after
30 days from the Commencement Date of this Policy,
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but does not include bodily injuries or a Pre-existing
Condition. We will cover You for loss caused by a Preexisting Condition where Your loss begins after You have
held this Policy for 24 months from the Commencement
Date of the Policy, unless You have been issued with an
endorsement to this Policy which excludes You from
claiming for a Pre-existing Condition.
“Carcinoma In-Situ” means a definite diagnosis of
Cancer wherein the tumour cells lie within the tissue of
the site of origin without having invaded neighbouring
tissue.
“Disability” means Total Disability or Partial Disability
(as applicable) and “Disabled” has the corresponding
meaning.
“Eligible Person” or “Eligible Persons” (Cancer
Disability Plan, Family Unit only) means Your qualified
Spouse (as set out in clause 5.6) and any of Your
unmarried children who qualify for the Policy (as set
out in clause 5.6), are dependent on You for care and
financial support, and are aged 18 years or younger.
“Family Unit” means the Family level of cover under
the Cancer Disability Plan.
“Hospital” means an institution which meets the
following requirements:
(1) Operates pursuant to law;
(2) Operates primarily for the care and treatment of
sick or injured persons as In-patients;
(3) Provides for 24 hour nursing service;
(4) Has facilities available for diagnosis and surgery
either on its own premises or in facilities available
to the hospital on a pre-arranged basis;
(5) Has a staff of at least one Medical Practitioner
available at all times.
Hospital does not include a nursing home, hospice or
convalescent care facility, whether such a facility is
independent or associated with a hospital.
“In-patient” means overnight hospital confinement that
the relevant Hospital classifies as In-patient. It does not
mean confinement on an Out-patient basis.
“Insured” means the person named as the insured on
the Application Form and to whom benefits will be
made payable, as well as Eligible Persons under the
Cancer Disability Plan, Family Unit.
“Intensive Care Unit” means that part of a Hospital
(other than the patient’s room, operating room or
recovery room), where patients receive full-time
nursing care and is commonly known as the Intensive
Care Unit.
“Limb” means an entire hand or foot at or above the
wrist or ankle.
“Medical Practitioner” means a licensed Medical
Practitioner operating within the scope of his or her
licence and who is not a member of Your immediate
family.
“Out-patient” means treatment by a Medical Practitioner
in the practitioner’s office, clinic, emergency room or
free standing surgical facility, and while not Hospital
confined as an In-patient.
“Partially Disabled” means the ability to perform one
or more, but not all, of the substantial duties of Your
business or occupation (or usual day to day activities
if You are not currently employed) as certified by a
Medical Practitioner and “Partial Disability” has the
corresponding meaning.
“Policy” means the contract of insurance between You
and Combined Insurance, and any renewal of it, and
comprises the documents set out in Clause 1.2.
“Policy Year(s)” means twelve months from the
Commencement Date of the Policy and, where
applicable, twelve months computed from each
subsequent anniversary of the Commencement Date of
the Policy.
“Pre-existing Cancer” means a Cancer for which You
received medical advice or treatment within 5 years prior
to the Commencement Date of the Policy, or showed
symptoms within 5 years prior to the Commencement
Date of the Policy that would have caused an ordinarily
prudent person to seek medical advice or treatment.
“Pre-existing Condition” means a bodily illness or
disease for which You received medical advice or
treatment within 24 months prior to the Commencement
Date of the Policy, or showed symptoms within 24
months prior to the Commencement Date of the Policy
that would have caused an ordinarily prudent person to
seek medical advice or treatment.
“Premium Due Date” means the due date for receipt of
renewal or instalment premiums payable for this Policy.
If the Premium Due Date is the 29th, 30th or 31st of
a month and there is no such date in the month the
premium is payable, the Premium Due Date is the last
day of that month.
“Skin Cancer” means a cutaneous neoplasm or lesion
that does not metastasise to other body sites.
“Spouse” means Your partner in a legally recognised
marriage or de-facto relationship.
“Stage A Prostate Cancer” means a tumour node
metastasis Classification T1 (as histologically described),
or equivalent staging.
“Totally Disabled” means the inability to perform each
of the substantial duties of Your business or occupation
(or usual day to day activities if You are not currently
employed) as certified by a Medical Practitioner and
“Total Disability” has the corresponding meaning.
“Waiting Period” means the period You must be
Disabled for before any benefits under the Sickness
Disability Plan will begin. The Waiting Period is shown
on Your Policy Schedule.
“We”, “our”, “us” or “Combined Insurance” means
ACE Insurance Limited, operating through its Combined
Insurance division.
“You” or “your” means the Insured named in the Policy
Schedule.
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SECTION 3: BENEFITS
SICKNESS DISABILITY PLAN
The following benefits apply to the Sickness Disability
Plan only if you have selected this Plan on your
application form and if the Plan remains in force. We
will pay amounts under this Plan in accordance with
Your Policy Schedule.
3.1 SICKNESS DISABILITY BENEFIT
The Sickness Disability Plan covers You, subject to
the terms and conditions within, for both Total and
Partial Disability due to a Covered Sickness. The
monthly benefits payable for Disability will be set
out in Your Policy Schedule.
3.1.1 BENEFIT A
TOTAL DISABILITY BENEFIT
We will pay You the benefit set out in Your Policy
Schedule if You are Totally Disabled due to a Covered
Sickness while this Plan is in force. Depending on
Your selected Waiting Period, We will pay You
either from the first, fifteenth, or thirty first day
of Total Disability and for a period of up to twelve
months while You remain Totally Disabled.
3.1.2 BENEFIT B
PARTIAL DISABILITY BENEFIT
We will pay You the benefit set out in Your Policy
Schedule if You are Partially Disabled due to
a Covered Sickness while this Plan is in force.
Depending on Your selected Waiting Period, We
will pay You either from the first, fifteenth or thirty
first day of Partial Disability and for a period of up
to two months while You remain Partially Disabled.
Should a period of Partial Disability immediately
follow a period of Total Disability for which You
have already been subject to a disability Waiting
Period, then We will pay You the Partial Disability
benefit from the first day of such disability.
SECTION 4: BENEFITS
SICKNESS HOSPITAL PLAN
The following benefits apply to the Sickness Hospital
Plan only if You have selected this Plan on your
application form and if the Plan remains in force. We
will pay amounts under this Plan in accordance with
Your Policy Schedule
4.1 BENEFIT C
IN-PATIENT BENEFIT
We will pay You the daily benefit set out in Your
Policy Schedule if due to a Covered Sickness
You are confined overnight as an In-patient in a
Hospital while this Plan is in force. We will pay
You this daily benefit for each day of Your Hospital
confinement starting with the first day and for up to
Your lifetime.
4.2 BENEFIT D
INTENSIVE CARE IN-PATIENT BENEFIT
We will pay You the daily benefit set out in Your
Policy Schedule if due to a Covered Sickness You
are confined to an Intensive Care Unit during a
period of hospitalisation while this Plan is in force,
for which benefits are payable under Benefit C.
We will pay You for each day You are confined to
an Intensive Care Unit, in addition to the benefit
payable under Benefit C, starting with the first day
you are so confined and for up to Your lifetime.
SECTION 5: BENEFITS
CANCER DISABILITY PLAN
The following benefits apply to the Cancer Disability
Plan only if You have selected this Plan on your
application form and if the Plan remains in force. We
will pay amounts under this Plan in accordance with
Your Policy Schedule.
5.1 BENEFIT E
IN-PATIENT BENEFIT - CANCER
We will pay You the daily benefit set out in Your
Policy Schedule if due to a Covered Cancer
You are confined overnight as an In-patient in a
Hospital while this Plan is in force. We will pay
You this daily benefit for each day of Your Hospital
confinement starting with the first day and for up to
Your lifetime.
5.2 BENEFIT F
CONVALESCENT BENEFIT FOLLOWING
HOSPITAL CONFINEMENT FOR CANCER
We will pay You the daily benefit set out in Your
Policy Schedule if due to a Covered Cancer, You are
Totally Disabled following a period of confinement
as an In-patient in a Hospital while this Plan is in
force, for which benefits are payable under Benefit
E. We will pay You this daily benefit for each day
You remain Totally Disabled for a maximum period
of up to twice the number of days of Your Hospital
In-patient confinement.
5.3 BENEFIT G
OUT-PATIENT TREATMENT BENEFIT FOR
CANCER
We will pay You the daily benefit set out in Your
Policy Schedule if due to a Covered Cancer
You require surgery, chemotherapy or radiation
treatment as an Out-patient while this Plan is in
force. We will pay You this daily benefit for each
day of such surgery or treatment for up to 365 days
in total for the life of the Policy.
5.4 BENEFIT H
CONVALESCENT BENEFIT FOLLOWING OUTPATIENT TREATMENT FOR CANCER
We will pay You the daily benefit set out in Your
Policy Schedule if due to a Covered Cancer, You
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are Totally Disabled following a period of Outpatient treatment while this Plan is in force, for
which benefits are payable under Benefit G. We
will pay You this daily benefit for each day You
remain Totally Disabled for a maximum period
of up to twice the number of days of Your Outpatient treatment.
5.5 BENEFIT I
REMOVAL OF SKIN CANCER BENEFIT
We will pay You the lump sum benefit set out in
Your Policy Schedule upon the medical removal of
Skin Cancer while this Plan is in force. Skin Cancer
is defined on page 7. Only one benefit under this
Plan will be payable during any six month period.
5.6 FAMILY UNIT COVERAGE PERIOD FOR
ELIGIBLE PERSONS
We will cover each of Your children, if they are
insured under the Family Unit of this Plan, until
the child reaches the age of 21, marries, ceases
to be dependent on You for care and financial
support, or until this Plan lapses, whichever comes
first. Coverage of Your Spouse, if insured under the
Family Unit of this Plan, will end upon your Spouse
turning 75 years old, the divorce or separation of
You and Your Spouse, or when the Plan lapses,
whichever comes first. Any of Your children born
while this Plan is in force will be automatically
covered under this Plan.
5.7 DIAGNOSIS OF CANCER
In order to qualify for benefits under Benefits E, F,
G and H of this Plan, We will first require a copy
of the pathology report as proof of diagnosis of a
Covered Cancer.
5.8 POST-MORTEM DIAGNOSIS
If a positive diagnosis of a Covered Cancer is
first made post-mortem, the benefit payable
under Benefit E will be limited to the period of
time beginning with the date of Your terminal
confinement to a Hospital bed.
SECTION 6: BENEFITS
CRITICAL ILLNESS PLAN
The following benefits apply to the Critical Illness Plan
only if You have selected this Plan on your application
form. We will pay a lump sum payment under this Plan
in accordance with Your Policy Schedule.
6.1 BENEFIT J
CRITICAL ILLNESS BENEFIT
We will pay You the lump sum benefit set out in
Your Policy Schedule if, while this Plan is in force,
You suffer one of the following Covered Conditions
that is contracted, commenced or originated after
30 days from the Commencement Date of this
Policy:
(1) Cancer (Life Threatening);
(2) Heart Attack;
(3) Heart Surgery;
(4) Stroke;
(5) Benign Brain Tumour;
(6) Renal Failure;
(7) Major Organ Transplant;
(8) Multiple Sclerosis;
(9) Paralysis;
(10) Dismemberment;
(11) Severe Burns; or
(12) Blindness.
The above Covered Conditions are defined on
page 6.
The following conditions are not covered:
(1) Carcinomas In-Situ;
(2) Stage A Prostate Cancer;
(3) Skin Cancer;
(4) squamous cell carcinomas of the skin (unless
there has been a spread to other organs);
(5) hyperkeratosis and basal cell carcinomas of the
skin.
SECTION 7: EXCLUSIONS
Exclusions are those events and happenings for which
cover is not included in Your Policy. This means that You
are not covered under this Policy for loss that is in any
way caused or contributed to by:
(i) Bodily injuries (with the exception of Paralysis,
Dismemberment, Severe Burns and Blindness
under the Critical Illness Plan only).
(ii) Mental or emotional disorder.
(iii)
Normal and uncomplicated pregnancy or
childbirth.
(iv) Any complications of pregnancy or childbirth that
commence and originate within 12 months after
the Commencement Date of this Policy.
(v) A Pre-existing Condition (as defined on page 7).
(vi) A Pre-existing Cancer (as defined on page 7).
Also specifically excluded from coverage under this
Policy is a Covered Sickness or a Covered Cancer
where medical treatment, hospitalisation or Disability
occurs outside of New Zealand, Australia, European
Union Member States, the United States of America or
Canada.
Under the Critical Illness Plan, a Covered Condition
will be excluded unless medical reports and evidence
are given by suitably qualified Medical Practitioners
or Hospitals in New Zealand, Australia, European
Union Member States, the United States of America or
Canada.
Also, specifically excluded from coverage under the
Critical Illness Plan are claims which arise directly or
indirectly by an intentional self-inflicted act.
9
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SECTION 8: CLAIMS
8.1 HOW TO MAKE A CLAIM
You must advise Us of Your claim in writing as soon
as possible but in any event within 30 days after
Your loss has occurred.
Claim forms are available on Our website or from
Our Customer Services Department.
If You cannot complete Our Claim form, You
must still provide Us with whatever proof and
documentation supporting this claim as We may
reasonably require.
8.2 PROOF OF LOSS
To claim for Disability, written proof of loss must
be provided to us within 90 days after the end of
each period of Disability for which We are liable.
To claim for any other event or condition giving
rise to loss, written proof must be provided within
90 days of such loss occurring.
8.3 ADDITIONAL INFORMATION
To assess Your claim, or once We have accepted
Your claim and are paying You a benefit, We may
require You to provide further information, such
as:
• Monthly progress claim forms and/or medical
certificates from Your Medical Practitioner,
which You (and Your Medical Practitioner) will
need to fill out
• A statement from Your employer
• More detailed medical information from Your
Medical Practitioner
• Clarification of any conflicting medical
information from Your Medical Practitioner.
8.4 CLAIM FORMS COMPLETED AT YOUR EXPENSE
Claim forms and monthly progress claim forms
are to be completed by You and Your Medical
Practitioner, at Your own expense.
8.5 MEDICAL EXAMINATION AT OUR EXPENSE
We may request that You undergo an independent
medical examination at Our expense at a time and
by any Medical Practitioner We may choose.
Failure to comply with Our request may result in
Your claim being refused.
8.6 HOW DO WE PAY CLAIMS?
For ongoing Disability and Hospitalisation, We will
pay benefits on a monthly progressive basis upon
the receipt of written proof of Your continuing
disability or hospitalisation and once we have
confirmed You are eligible for payment.
Monthly benefits are calculated on the basis of a 30
day month. That is, the daily benefit is calculated
by dividing the monthly benefit by 30.
Benefits for any other loss covered by Your Policy
will be paid when We receive written proof of Your
loss and we confirm You are eligible for payment.
8.7 WHO ARE BENEFITS PAID TO?
Benefits are paid to You. Where you have selected
the Cancer Disability Plan Family Unit, benefits
will be paid to You and not to any Eligible Person.
In the event of Your death, any remaining benefit
will be payable to Your Estate.
8.8 CONCURRENT DISABILITY
If You suffer Disability as the result of more than
one Covered Sickness, benefits will be paid as if
Your Disability were the result of only one Covered
Sickness.
8.9 RECURRENT DISABILITY
Successive periods of Total or Partial Disability will
be considered one period of Disability unless such
periods are separated by at least 180 consecutive
days or the Disabilities resulted from different or
unrelated sicknesses.
8.10 REGULAR MEDICAL CARE
During a period of loss for which You are claiming,
You must be receiving and complying with
treatment or advice as recommended by a Medical
Practitioner who has personally assessed You and
has been provided with full clinical details of the
case. You must continue to be reviewed in these
circumstances on at least a monthly basis unless the
Medical Practitioner specifies otherwise. Failure to
receive and comply with such treatment or advice
may result in Us denying payment of Your claim.
SECTION 9:
GENERAL POLICY CONDITIONS
9.1 PREMIUM CORRECTION
In the event that the premium amount written in the
application form does not correspond to the Plan
selected in the application form, We will correct
the amount of premium to correspond to the Plan
selected in the application form, and advise You
of any correction and, if applicable, seek payment
from You.
9.2 INCREASING YOUR COVER
Subject to our underwriting qualification and
acceptance, if You do not hold the maximum cover
offered by Combined Insurance from time to time,
We will allow You to increase Your cover to the limit
offered by Combined Insurance. The additional
cover will take effect from the Commencement Date
of the Policy stated in the revised Policy Schedule
that We will send to You. The additional cover
will also be subject to the terms and conditions
of the Policy, including, without limitation, that
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the 30 day period referred to in the definition of
Covered Cancer, Covered Condition and Covered
Sickness will apply to the additional cover from the
Commencement Date of the Policy stated in the
revised Policy Schedule.
9.3 REINSTATEMENT OF YOUR POLICY
Your Policy may be reinstated within 12 months of it
having lapsed, subject to You satisfying Us that You
are in good health and subject to Our acceptance
of Your application.
No benefit shall be payable under Your Policy for
loss sustained before the date of reinstatement.
Reinstatement is also subject to Our maximum
and minimum benefit limits in force at that time.
Your application for reinstatement may be made
by writing to Us. We can refuse to reinstate Your
Policy, or may offer to reinstate it on special terms.
If We in error accept a premium payment (or part of
a premium payment) when the Policy has lapsed,
this does not mean that We have waived any of
these Policy provisions or agreed to a reinstatement
and We will refund the amount received.
9.4 CANCELLATION OF YOUR POLICY
After You have applied for the Policy and paid
Your first premium, You have 14 days from the
Commencement Date of the Policy to check that
the Policy meets Your needs. This is known as the
14 day free look period.
If You decide that the Policy does not meet Your
needs, We will cancel the Policy and refund Your
money without any charges, as long as You notify
Us in writing at our address set out on page 13
within 14 days of the Commencement Date of the
Policy. If your Policy is cancelled, it will be treated
as though it never existed.
Sales representatives of ACE Insurance Limited are
not authorised to cancel Your Policy.
You cannot exercise this right of cancellation if a
claim has been made during a period of cover to
which this 14 day free look period applies.
of Our intention not to offer to renew Your Policy.
9.5 TERMINATION OF YOUR POLICY
Your Policy will terminate when the first of the
following events occur:
(i) You do not pay an instalment premium and
Your Policy lapses in accordance with clause
1.7; or
(ii) Your Policy is cancelled in accordance with
clause 9.4; or
(iii) at the expiry of the one year term of this Policy
or any subsequent renewal term if We do not
offer to renew this Policy, or should You choose
not to renew this Policy for a further term; or
(iv)You die (in which case any benefit payments
due to You that have not been paid will be paid
to Your estate); or
(v) upon the first Premium Due Date after You
attain age 75; or
(vi)in relation to the Critical Illness Plan, upon
the payment of the lump sum benefit amount
set out in Your Policy Schedule for a Covered
Condition – only the Critical Illness Plan will
terminate.
(vii)
Your Policy is otherwise cancelled in
accordance with the terms and conditions set
out in this Policy Document.
9.6 FRAUD
If You act fraudulently in connection with Your
Policy or any claim under Your Policy, We may
avoid the Policy from the date of the breach and any
premiums paid after this date will be refundable on
a pro-rata basis. This means that Your policy will
not operate from the date of the breach.
9.7 CONFORMITY WITH NEW ZEALAND LAWS
Your Policy is governed by the laws of New
Zealand.
9.8 CURRENCY
All monetary amounts referred to in this Policy are
in New Zealand dollars.
After the 14 day free look period, You may cancel
Your Policy at any time by advising Us in writing.
If You are paying premiums six monthly or yearly,
We will refund any unearned premium on a prorata basis and cancellation will take effect on the
date that Your written instruction is received at
our address as previously notified. We will not
refund any remaining premium if You are paying
by monthly instalment and cancellation will take
effect from the next premium due date.
9.9 ENDORSEMENT
In some instances if You suffer from, or have suffered
from, a chronic health problem, You may still be
eligible for the Policy. However, as a condition of
the Policy We may issue You with an attachment
to the Policy known as an endorsement which
precludes You from claiming for the nominated
condition, or any similar condition for either a
period of time after You have recovered from the
condition, or for the term of the Policy. If We do not
issue You with an endorsement, You are still subject
to the Pre-existing Conditions or Pre-existing
Cancer Exclusions.
We may cancel Your Policy at the expiry of the
Policy Year or any subsequent renewal term by
giving You not less than 30 days’ notice in writing
9.10 TAXATION AND SPECIAL CIRCUMSTANCES
Should there be any change in the law or taxation
affecting this Policy or change in circumstance
11
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which renders it impracticable or impossible to
give effect, in whole or in part, to these Policy
provisions then these provisions and benefits
conferred may be varied by Combined Insurance in
such a manner that it deems appropriate to enable
these provisions to take effect as early as possible.
Goods and Service Tax (GST) is payable in addition
to the premium for this Policy.
9.11 NO SURRENDER VALUE
This is not an investment policy and does not have
a cash value on termination at any time.
9.12 CHANGES TO YOUR POLICY
We may change or update the terms and conditions
of your Policy from time to time. If we make any
such changes, we will give you 30 days’ prior
notice in writing.
9.13 HOW WE CONTACT YOU
Notices and other information concerning this
Policy will be sent to You at the address last advised
to us. It is important that we be advised of any
changes in Your contact information.
9.14 NO FINANCIAL ADVICE
Nothing in this Policy Document should be taken
to constitute personalised financial advice and,
in particular, it does not take into account Your
particular financial situation or financial goals.
SECTION 10:
DUTY OF DISCLOSURE & PRIVACY
10.1 YOUR DUTY OF DISCLOSURE
To help Us decide whether to insure You and under
what conditions or whether to pay a claim, You
need to:
(i) tell Us any facts that may affect Our decision,
whether or not a specific question is asked;
and
(ii) ensure that You have provided complete,
accurate and relevant information.
Please ask Us for advice if You are unsure what
information is relevant. If You do not tell Us
all relevant facts, We may refuse to pay Your
claim or even cancel Your insurance from the
Commencement Date of Your policy. If We have
already paid Your claim or claims, We can recover
any amounts We have paid.
10.2 PRIVACY STATEMENT
ACE Insurance Limited (“ACE”) is committed to
protecting your privacy. ACE collects, uses and
retains your personal information in accordance
with the principles in the Privacy Act 1993.
ACE collects your personal information (which may
include health information) when you are applying
for, changing or renewing an insurance policy
with us or when we are processing a claim. We
collect the information to assess your application
for insurance, to provide you or your organisation
with competitive insurance products and services
and administer them and to handle any claim that
may be made under a policy. If you do not provide
us with this information, we may not be able to
provide you or your organisation with insurance or
to respond to any claim. We may disclose the information we collect to
third parties, including contractors and contracted
service providers engaged by us to deliver our
services or carry out certain business activities
on our behalf (such as actuaries, loss adjusters,
claims investigators, claims handlers, professional
advisers including doctors and other medical
service providers, credit reference bureaus and call
centres), other companies within the ACE Group,
insurance and reinsurance intermediaries, other
insurers, our reinsurers, and government agencies
(where we are required to by law). These third
parties may be located outside New Zealand. You agree to us using and disclosing your personal
information as set out above. This consent remains
valid unless you alter or revoke it by giving written
notice to our Privacy Officer. From time to time, we may use your personal
information to send you offers or information
regarding our products that may be of interest to
you. If you do not wish to receive such information,
please contact our Privacy Officer using the contact
details provided below. If you would like to access a copy of your personal
information, or to correct or update your personal
information, please contact our Privacy Officer on
+64 (9) 3771459 or email Privacy.NZ@acegroup.
com.
If you have a complaint or want more information
about how ACE is managing your personal
information, please contact the Privacy Officer,
ACE Insurance Limited, PO Box 734 Auckland, Tel:
+64 (9) 3771459 or email Privacy.NZ@acegroup.
com.
10.3 INSURANCE CLAIMS REGISTER
Certain claims related information e.g. type of
claim, date of claim, may be passed on to Insurance
Claims Register (“ICR”) Limited, where it will be
retained and be available to other participating
insurance companies, who are members of the
Insurance Council of New Zealand, to access it
when underwriting new business and processing
12
2012 Sickness Policy Inner.indd 12
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Financial Services Complaints Limited
13th Floor, 45 Johnston Street
PO Box 5967
Lambton Quay
Wellington 6145
Tel: 0800 347 257 or (04) 472 3725
claims, for the specific purpose of preventing
undisclosed or fraudulent claims.
You have the right to access the information held
about You at any time and, if warranted, seek
change to that information.
There is no cost to you to use the services of
Financial Services Complaints Limited.
SECTION 11:
COMPLAINT RESOLUTION PROCEDURE
11.1 HOW TO RESOLVE A COMPLAINT
While We make every effort to get things right,
problems may sometimes occur. We have in place
a complaints procedure that is intended to resolve
any problem quickly and fairly.
In order to avoid delay in solving a problem to Your
satisfaction, please advise Our Customer Service
Department of Your complaint immediately. Our
contact details are set out below.
If You remain dissatisfied with the outcome, please
write to:
The Disputes Officer
Combined Insurance
Private Bag COMBINED
Remuera
Auckland 1541
Alternatively, please ask a Customer Service advisor
to refer Your complaint to the Disputes Officer.
Outline Your concerns and the reasons why You
feel that We should review the original decision.
Our Disputes Officer has the authority to review
the original decision, ensuring that the correct
procedures were followed. In handling Your
dispute, Our Disputes Officer is obliged to be fair
and timely. In most cases, You will receive a reply
within fifteen business days from the receipt of Your
complaint.
SOLVENCY RATING
Please refer to ACE Insurance Limited’s website at
www.aceinsurance.co.nz for the most up to date
financial strength rating.
COMPANY ADDRESS
Our contact details are:
Address:
105 Great South Road, Epsom, Auckland 1051
Postal Address:
Private Bag COMBINED, Remuera, Auckland 1541
Phone: 0-9-520 9000 or
0800 COMBINED (266 246)
Fax: 0-9-520 9009
Email : [email protected]
Website: www.combinedinsurance.co.nz
Signed for and on behalf of ACE Insurance Limited
11.2 EXTERNAL DISPUTES RESOLUTION
We will endeavour to come to a reasonable solution,
however sometimes disputes can not be resolved.
If this occurs We will advise You in writing that the
matter is in “deadlock”.
We will refer you to the Financial Services
Complaints Limited Scheme, an approved dispute
resolution scheme of which we are a member for
the purposes of the Financial Service Providers
(Registration and Dispute Resolution) Act 2008.
You can contact Financial Services Complaints
Limited at:
Des Bosnic
Executive Vice President
ACE Insurance Limited & Combined Insurance
Australia & New Zealand
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APPENDIX
SICKNESS DISABILITY PLAN - BENEFITS AND PREMIUMS
SICKNESS DISABILITY PLAN BENEFITS
BRONZE
SILVER
GOLD
PLATINUM
Benefit A - Total Disability Benefit - per Month for up to 12 months
$400
$800
$1,200
$1,600
Benefit B - Partial Disability Benefit - per Month for up to 2 months
$200
$400
$600
$800
(¹refer to note below)
BENEFITS FROM 1st DAY
Premiums for Sickness Disability Plan
cover payable from the FIRST DAY OF
DISABILITY Code 24420 (²'³ Refer to
notes below)
DIRECT DEBIT
MAIL RENEWAL
Two Months
first payment
only
Monthly
instalment
payment for
the first year
Six Monthly
instalment
payments for
the first year
Annual
instalment
payment for
the first year
Six Monthly
instalment
payments for
the first year
Annual
instalment
payment for
the first year
Age at Entry 16 - 39
$32
$16
$92
$176
$96
$192
Age at Entry 40 - 49
$40
$20
$115
$220
$120
$240
Age at Entry 50 - 59
$48
$24
$138
$264
$144
$288
Age at Entry 60 - 69
$68
$34
$195
$375
$204
$408
Age at Entry 16 - 39
$64
$32
$184
$352
$192
$384
Age at Entry 40 - 49
$80
$40
$230
$440
$240
$480
Age at Entry 50 - 59
$96
$48
$276
$528
$288
$576
Age at Entry 60 - 69
$136
$68
$390
$750
$408
$816
Age at Entry 16 - 39
$96
$48
$276
$528
$288
$576
Age at Entry 40 - 49
$120
$60
$345
$660
$360
$720
Age at Entry 50 - 59
$144
$72
$414
$792
$432
$864
Age at Entry 60 - 69
$204
$102
$585
$1,125
$612
$1,224
Age at Entry 16 - 39
$128
$64
$368
$704
$384
$768
Age at Entry 40 - 49
$160
$80
$460
$880
$480
$960
Age at Entry 50 - 59
$192
$96
$552
$1,056
$576
$1,152
Age at Entry 60 - 69
$272
$136
$780
$1,500
$816
$1,632
Bronze
Silver
Gold
Platinum
The benefits you can receive under the Plan or Plans you have selected and the cost of the Plan or Plans are set out in the Benefits and
Premium Tables.
1 The descriptions of the benefits in the Benefit Tables are only a brief overview and do not include definitions and
exclusions. MAKE SURE YOU READ YOUR POLICY DOCUMENTS FOR DETAILS.
2 To calculate instalment premiums after the first Policy Year, just add 5% to the premium plus GST. We will send you an
Annual Renewal Statement advising you of the increase.
3 The above premiums do not include Goods and Services Tax (GST). GST is applied in the following manner: For example,
GST is levied on the premium for a 37 year old Insured who purchases the Sickness Disability Plan (Silver Level - Benefits
from 15th day, Direct Debit renewal) with an annual premium of $286 at the rate of 15%, or $42.90. The total premium
including GST is $328.90.
Premium Indexation Example
The Sickness Disability Plan (the same example as above) has an annual premium of $286 (excluding GST). The premium for the first
Policy term is $286. In the second year and subsequent years, should you renew the Policy each year, the premium automatically increases
by $14.30 or the 5% indexation factor to $300.30 (excluding GST). Indexation ceases to apply after 10 renewal periods (11 years).
14
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BENEFITS FROM 15th DAY
Premiums for Sickness Disability Plan
cover payable from the FIFTEENTH
DAY OF DISABILITY Code 24420 (²'³
Refer to notes on page 14)
DIRECT DEBIT
MAIL RENEWAL
Two Months
first payment
only
Monthly
instalment
payment for
the first year
Six Monthly
instalment
payments for
the first year
Annual
instalment
payment for
the first year
Six Monthly
instalment
payments for
the first year
Annual
instalment
payment for
the first year
Age at Entry 16 - 39
$26
$13
$74
$143
$78
$156
Age at Entry 40 - 49
$32
$16
$92
$176
$96
$192
Age at Entry 50 - 59
$40
$20
$115
$220
$120
$240
Age at Entry 60 - 69
$60
$30
$172
$331
$180
$360
Age at Entry 16 - 39
$52
$26
$148
$286
$156
$312
Age at Entry 40 - 49
$64
$32
$184
$352
$192
$384
Age at Entry 50 - 59
$80
$40
$230
$440
$240
$480
Age at Entry 60 - 69
$120
$60
$344
$662
$360
$720
Age at Entry 16 - 39
$78
$39
$222
$429
$234
$468
Age at Entry 40 - 49
$96
$48
$276
$528
$288
$576
Age at Entry 50 - 59
$120
$60
$345
$660
$360
$720
Age at Entry 60 - 69
$180
$90
$516
$993
$540
$1,080
Age at Entry 16 - 39
$104
$52
$296
$572
$312
$624
Age at Entry 40 - 49
$128
$64
$368
$704
$384
$768
Age at Entry 50 - 59
$160
$80
$460
$880
$480
$960
Age at Entry 60 - 69
$240
$120
$688
$1,324
$720
$1,440
Bronze
Silver
Gold
Platinum
BENEFITS FROM 31st DAY
Premiums for Sickness Disability Plan
cover payable from the THIRTY FIRST
DAY OF DISABILITY Code 24420 (²'³
Refer to notes on page 14)
DIRECT DEBIT
MAIL RENEWAL
Two Months
first payment
only
Monthly
instalment
payment for
the first year
Six Monthly
instalment
payments for
the first year
Annual
instalment
payment for
the first year
Six Monthly
instalment
payments for
the first year
Annual
instalment
payment for
the first year
Age at Entry 16 - 39
$20
$10
$57
$110
$60
$120
Age at Entry 40 - 49
$24
$12
$69
$132
$72
$144
Age at Entry 50 - 59
$30
$15
$86
$165
$90
$180
Age at Entry 60 - 69
$46
$23
$132
$253
$138
$276
Age at Entry 16 - 39
$40
$20
$114
$220
$120
$240
Age at Entry 40 - 49
$48
$24
$138
$264
$144
$288
Age at Entry 50 - 59
$60
$30
$172
$330
$180
$360
Age at Entry 60 - 69
$92
$46
$264
$506
$276
$552
Age at Entry 16 - 39
$60
$30
$171
$330
$180
$360
Age at Entry 40 - 49
$72
$36
$207
$396
$216
$432
Age at Entry 50 - 59
$90
$45
$258
$495
$270
$540
Age at Entry 60 - 69
$138
$69
$396
$759
$414
$828
Age at Entry 16 - 39
$80
$40
$228
$440
$240
$480
Age at Entry 40 - 49
$96
$48
$276
$528
$288
$576
Age at Entry 50 - 59
$120
$60
$344
$660
$360
$720
Age at Entry 60 - 69
$184
$92
$528
$1,012
$552
$1,104
Bronze
Silver
Gold
Platinum
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SICKNESS HOSPITAL PLAN - BENEFITS AND PREMIUMS
SICKNESS HOSPITAL PLAN BENEFITS
BRONZE
SILVER
GOLD
Benefit C - In-patient Benefit - per day for up to your lifetime
$70
$105
$140
Benefit D - Intensive Care In-patient Benefit - per day for up to your lifetime
$140
$210
$280
(¹refer to notes on page 14)
PREMIUM ALTERNATIVES
Silver
Gold
MAIL RENEWAL
Two Months
first payment
only
Monthly
instalment
payment for
the first year
Six Monthly
instalment
payments for
the first year
Annual
instalment
payment for
the first year
Six Monthly
instalment
payments for
the first year
Annual
instalment
payment for
the first year
Age at Entry 1 - 15
$24
$12
$69
$132
$72
$144
Age at Entry 16 - 39
$32
$16
$92
$176
$96
$192
Age at Entry 40 - 49
$44
$22
$126
$242
$132
$264
Age at Entry 50 - 59
$68
$34
$195
$375
$204
$408
Age at Entry 60 - 69
$88
$44
$253
$485
$264
$528
Age at Entry 1 - 15
$36
$18
$103
$198
$108
$216
Age at Entry 16 - 39
$48
$24
$138
$264
$144
$288
Age at Entry 40 - 49
$66
$33
$190
$364
$198
$396
Age at Entry 50 - 59
$102
$51
$293
$563
$306
$612
Age at Entry 60 - 69
$132
$66
$380
$728
$396
$792
Age at Entry 1 - 15
$48
$24
$138
$264
$144
$288
Age at Entry 16 - 39
$64
$32
$184
$353
$192
$384
Age at Entry 40 - 49
$88
$44
$253
$485
$264
$528
Age at Entry 50 - 59
$136
$68
$391
$750
$408
$816
Age at Entry 60 - 69
$176
$88
$506
$971
$528
$1,056
Code 24419 (²'³ Refer to notes on page
14)
Bronze
DIRECT DEBIT
The descriptions of the benefits in the Benefit Tables are only a brief overview and do not include definitions and exclusions. MAKE SURE
YOU READ YOUR POLICY DOCUMENTS FOR DETAILS.
16
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CANCER DISABILITY PLAN - BENEFITS AND PREMIUMS
INDIVIDUAL AND FAMILY
CANCER DISABILITY PLAN BENEFITS
(¹refer to notes on page 14)
BRONZE
SILVER
GOLD
Benefit E - In-patient - Cancer - per day for up to your lifetime
$120
$240
$360
Benefit F - Convalescent Benefit following in-patient treatment - per day for up to twice the number
of days of in-patient confinement
$120
$240
$360
Benefit G - Out-patient Treatment Benefit for Cancer - per day for up to 365 days
$120
$240
$360
Benefit H - Convalescent Benefit following Out-patient Treatment - per day up to twice the number
of days of out-patient treatment
$120
$240
$360
Benefit I - Removal of Skin Cancer Benefit - lump sum 1 benefit during any 6 month period
$120
$240
$360
PREMIUM ALTERNATIVES
DIRECT DEBIT
MAIL RENEWAL
Two Months
first payment
only
Monthly
instalment
payment for
the first year
Six Monthly
instalment
payments for
the first year
Annual
instalment
payment for
the first year
Six Monthly
instalment
payments for
the first year
Annual
instalment
payment for
the first year
Age at Entry 16 - 39
$22
$11
$63
$121
$66
$132
Age at Entry 40 - 49
$32
$16
$92
$176
$96
$192
Age at Entry 50 - 59
$60
$30
$172
$331
$180
$360
Age at Entry 60 - 69
$106
$53
$305
$585
$318
$636
Age at Entry 16 - 39
$44
$22
$126
$242
$132
$264
Age at Entry 40 - 49
$64
$32
$184
$352
$192
$384
Age at Entry 50 - 59
$120
$60
$344
$662
$360
$720
Age at Entry 60 - 69
$212
$106
$610
$1,170
$636
$1,272
Age at Entry 16 - 39
$66
$33
$189
$363
$198
$396
Age at Entry 40 - 49
$96
$48
$276
$528
$288
$576
Age at Entry 50 - 59
$180
$90
$516
$993
$540
$1,080
Age at Entry 60 - 69
$318
$159
$915
$1,755
$954
$1,908
Age at Entry 16 - 39
$42
$21
$120
$231
$126
$252
Age at Entry 40 - 49
$60
$30
$172
$331
$180
$360
Age at Entry 50 - 59
$114
$57
$328
$629
$342
$684
Age at Entry 60 - 69
$198
$99
$570
$1,092
$594
$1,188
Age at Entry 16 - 39
$84
$42
$240
$462
$252
$504
Age at Entry 40 - 49
$120
$60
$344
$662
$360
$720
Age at Entry 50 - 59
$228
$114
$656
$1,258
$684
$1,368
Age at Entry 60 - 69
$396
$198
$1,140
$2,184
$1,188
$2,376
Age at Entry 16 - 39
$126
$63
$360
$693
$378
$756
Age at Entry 40 - 49
$180
$90
$516
$993
$540
$1,080
Age at Entry 50 - 59
$342
$171
$984
$1,887
$1,026
$2,052
Age at Entry 60 - 69
$594
$297
$1,710
$3,276
$1,782
$3,564
Code 24425 (²'³ Refer to notes on page 14)
Bronze
Individual
Silver
Gold
Bronze
Family
Silver
Gold
The descriptions of the benefits in the Benefit Tables are only a brief overview and do not include definitions and exclusions. MAKE SURE YOU READ
YOUR POLICY DOCUMENTS FOR DETAILS.
17
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18
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Gold
$30,000
Silver
$20,000
Bronze
$10,000
$48
$54
$66
Age at Entry 25 - 29
Age at Entry 30 - 34
Age at Entry 35 - 39
Age at Entry 60 - 64
$216
$168
$42
Age at Entry 20 - 24
Age at Entry 55 - 59
$30
Age at Entry 16 - 19
$126
$144
Age at Entry 60 - 64
Age at Entry 50 - 54
$112
Age at Entry 55 - 59
$84
$84
Age at Entry 50 - 54
$102
$68
Age at Entry 45 - 49
Age at Entry 45 - 49
$56
Age at Entry 40 - 44
Age at Entry 40 - 44
$44
Age at Entry 35 - 39
$28
Age at Entry 20 - 24
$32
$20
Age at Entry 16 - 19
$36
$72
Age at Entry 30 - 34
$28
$56
Age at Entry 55 - 59
Age at Entry 60 - 64
Age at Entry 25 - 29
$21
$42
Age at Entry 50 - 54
$108
$84
$63
$51
$42
$33
$27
$24
$21
$15
$72
$56
$42
$34
$28
$22
$18
$16
$14
$10
$36
$17
$14
$28
$34
Age at Entry 40 - 44
$11
$9
$8
$7
$5
Monthly
instalment
payment for
the first year
$591
$456
$342
$279
$228
$180
$150
$132
$117
$81
$394
$304
$228
$186
$152
$120
$100
$88
$78
$54
$197
$152
$114
$93
$76
$60
$50
$44
$39
$27
Six Monthly
instalment
payments for
the first year
DIRECT DEBIT
Age at Entry 45 - 49
$18
$22
$16
Age at Entry 25 - 29
Age at Entry 35 - 39
$14
Age at Entry 30 - 34
$10
Age at Entry 16 - 19
Age at Entry 20 - 24
Code 22941 (²'³ Refer to notes on page Two Months
first payment
14)
only
PREMIUM ALTERNATIVES
MAIL RENEWAL
$1,140
$879
$660
$537
$441
$348
$288
$255
$225
$156
$760
$586
$440
$358
$294
$232
$192
$170
$150
$104
$380
$293
$220
$179
$147
$116
$96
$85
$75
$52
Annual
instalment
payment for
the first year
$657
$507
$381
$309
$252
$201
$168
$147
$129
$90
$438
$338
$254
$206
$168
$134
$112
$98
$86
$60
$219
$169
$127
$103
$84
$67
$56
$49
$43
$30
Six Monthly
instalment
payments for
the first year
$1,266
$978
$732
$597
$489
$387
$324
$282
$249
$174
$844
$652
$488
$398
$326
$258
$216
$188
$166
$116
$422
$326
$244
$199
$163
$129
$108
$94
$83
$58
Annual
instalment
payment for
the first year
$306
$234
$174
$144
$114
$96
$78
$66
$60
$42
$204
$156
$116
$96
$76
$64
$52
$44
$40
$28
$102
$78
$58
$48
$38
$32
$26
$22
$20
$14
Two Months
first payment
only
$10,000
Benefit J - Critical Illness Benefit - lump sum
NON SMOKER
BRONZE
CRITICAL ILLNESS PLAN BENEFITS (¹refer to note on page 14)
$153
$117
$87
$72
$57
$48
$39
$33
$30
$21
$102
$78
$58
$48
$38
$32
$26
$22
$20
$14
$51
$39
$29
$24
$19
$16
$13
$11
$10
$7
Monthly
instalment
payment for
the first year
$40,000
PLATINUM
$834
$636
$474
$393
$312
$261
$213
$180
$162
$117
$556
$424
$316
$262
$208
$174
$142
$120
$108
$78
$278
$212
$158
$131
$104
$87
$71
$60
$54
$39
Six Monthly
instalment
payments for
the first year
$1,227
$1,608
$927
$708
$528
$348
$438
$291
$237
$201
$180
$129
$618
$472
$352
$292
$232
$194
$158
$134
$120
$86
$309
$236
$176
$146
$116
$97
$79
$67
$60
$43
Six Monthly
instalment
payments for
the first year
$759
$915
$60,000
DIAMOND
$1,788
$1,362
$1,017
$843
$669
$561
$456
$387
$348
$249
$1,192
$908
$678
$562
$446
$374
$304
$258
$232
$166
$596
$454
$339
$281
$223
$187
$152
$129
$116
$83
Annual
instalment
payment for
the first year
MAIL RENEWAL
$50,000
PLATINUM
PLUS
$603
$504
$411
$348
$312
$225
$1,072
$818
$610
$506
$402
$336
$274
$232
$208
$150
$536
$409
$305
$253
$201
$168
$137
$116
$104
$75
Annual
instalment
payment for
the first year
SMOKER
$30,000
GOLD
DIRECT DEBIT
$20,000
SILVER
CRITICAL ILLNESS PLAN - BENEFITS AND PREMIUMS
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$144
$25
$35
$40
$288
$50
$70
Age at Entry 60 - 64
Age at Entry 16 - 19
Age at Entry 20 - 24
$84
$132
$168
$204
$252
$336
$432
Age at Entry 35 - 39
Age at Entry 40 - 44
Age at Entry 45 - 49
Age at Entry 50 - 54
Age at Entry 55 - 59
Age at Entry 60 - 64
$85
$216
$168
$126
$102
$84
$66
$54
$48
$42
$30
$180
$140
$105
$1,182
$2,280
$1,758
$1,320
$912
$1,074
$558
$882
$696
$576
$510
$450
$312
$1,900
$1,465
$1,100
$895
$735
$580
$480
$425
$375
$260
$1,520
$1,172
$880
$716
$588
$464
$384
$340
$300
$208
$684
$456
$360
$300
$264
$234
$162
$985
$760
$570
$465
$380
$300
$250
$220
$195
$135
$788
$608
$456
$372
$304
$240
$200
$176
$156
$108
Six Monthly
instalment
payments for
the first year
$1,314
$1,014
$762
$618
$504
$402
$336
$294
$258
$180
$1,095
$845
$635
$515
$420
$335
$280
$245
$215
$150
$876
$676
$508
$412
$336
$268
$224
$196
$172
$120
Six Monthly
instalment
payments for
the first year
$2,532
$1,956
$1,464
$1,194
$978
$774
$648
$564
$498
$348
$2,110
$1,630
$1,220
$995
$815
$645
$540
$470
$415
$290
$1,688
$1,304
$976
$796
$652
$516
$432
$376
$332
$232
Annual
instalment
payment for
the first year
MAIL RENEWAL
$612
$468
$348
$288
$228
$192
$156
$132
$120
$84
$510
$390
$290
$240
$190
$160
$130
$110
$100
$70
$408
$312
$232
$192
$152
$128
$104
$88
$80
$56
Two Months
first payment
only
$306
$234
$174
$144
$114
$96
$78
$66
$60
$42
$255
$195
$145
$120
$95
$80
$65
$55
$50
$35
$204
$156
$116
$96
$76
$64
$52
$44
$40
$28
Monthly
instalment
payment for
the first year
$1,668
$1,272
$948
$786
$624
$522
$426
$360
$324
$234
$1,390
$1,060
$790
$655
$520
$435
$355
$300
$270
$195
$1,112
$848
$632
$524
$416
$348
$284
$240
$216
$156
$3,216
$2,454
$1,830
$1,518
$1,206
$1,008
$822
$696
$624
$450
$2,680
$2,045
$1,525
$1,265
$1,005
$840
$685
$580
$520
$375
$2,144
$1,636
$1,220
$1,012
$804
$672
$548
$464
$416
$300
Annual
instalment
payment for
the first year
SMOKER
Six Monthly
instalment
payments for
the first year
DIRECT DEBIT
The descriptions of the benefits in the Benefit Tables are only a brief overview and do not include definitions and exclusions. MAKE SURE YOU READ YOUR POLICY DOCUMENTS FOR DETAILS.
Diamond
$60,000
$96
$108
$84
Age at Entry 20 - 24
Age at Entry 30 - 34
$60
Age at Entry 16 - 19
Age at Entry 25 - 29
$280
$210
Age at Entry 50 - 54
$360
$170
Age at Entry 45 - 49
Age at Entry 60 - 64
$70
$140
Age at Entry 55 - 59
$55
$110
Platinum Plus Age at Entry 35 - 39
$50,000
Age at Entry 40 - 44
$45
$80
$90
Age at Entry 25 - 29
$112
$168
$224
$68
Age at Entry 55 - 59
$136
Age at Entry 45 - 49
$56
$44
$36
$32
$28
Age at Entry 50 - 54
$88
$112
Age at Entry 40 - 44
Age at Entry 30 - 34
Age at Entry 35 - 39
$72
Age at Entry 25 - 29
$20
Monthly
instalment
payment for
the first year
Annual
instalment
payment for
the first year
NON SMOKER
DIRECT DEBIT
Age at Entry 30 - 34
Platinum
$40,000
$56
$64
Age at Entry 20 - 24
$40
Age at Entry 16 - 19
Code 22941 (²'³ Refer to notes on page Two Months
first payment
14)
only
PREMIUM ALTERNATIVES
$1,854
$1,416
$1,056
$876
$696
$582
$474
$402
$360
$258
$1,545
$1,180
$880
$730
$580
$485
$395
$335
$300
$215
$1,236
$944
$704
$584
$464
$388
$316
$268
$240
$172
Six Monthly
instalment
payments for
the first year
$3,576
$2,724
$2,034
$1,686
$1,338
$1,122
$912
$774
$696
$498
$2,980
$2,270
$1,695
$1,405
$1,115
$935
$760
$645
$580
$415
$2,384
$1,816
$1,356
$1,124
$892
$748
$608
$516
$464
$332
Annual
instalment
payment for
the first year
MAIL RENEWAL
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