lifePLUS insurance

Vishal's Income Protection Premium

Vishal has lifePLUS auto with a 90-day Waiting Period and a 5-year benefit payment period. He turned 45 last birthday, and his reported salary is $90,000.

For the first 2 years of the 5-year benefit payment period, the Income Protection component of Vishal's cover is 90.4% of his income.

This means, Vishal's annual amount insured is:

90.4% x $90,000 = $81,360.

For the remaining three years of the 5-year benefit period, the income protection component will be 65.4% of his income.

If Vishal has a successful Income Protection claim:

• For the first two years of his Income Protection claim, his benefit payment will be split into income (75%) and monthly contributions to his PSSap super account (15.4%); and
• For the remaining three years, his benefit payment will be split into income (50%) and monthly contributions (15.4%).

How we calculate Vishal's benefit payment:

Income Protection benefit payments are calculated on the lower of:

• Vishal's actual income at the time of any Total Disability; or
• Vishal's income advised to PSSap.

Would Vishal's Income Protection monthly benefit be reduced if he was receiving WorkCover/workers compensation?

PSSap Income Protection benefit payments will be reduced by any amount that a member is paid or must be paid:

• By workers compensation, motor accident compensation or other legislation that applies to illness or injury;
• By an employer while the member is receiving Income Protection benefit payments;
• For any sick leave entitlements from any source while the member is receiving Income Protection benefit payments; or
• By another insurance company (including through another super arrangement) for Income Protection benefit payments.

The 15.4% superannuation contribution component of the Income Protection benefit will not be reduced by any benefit offsets.

If a member makes a successful Income Protection claim, premiums will be put on hold while the member is entitled to receive Income Protection benefits. Premiums for any other benefit type a member may hold (Death and TPD), will continue to be charged to the member’s PSSap account.

Insurance offered in PSSap has been designed with the unique nature of APS employment and the diverse occupations in APS agencies in mind—this includes the ability for employees to move across APS employer agencies. CSC also takes into consideration the APS Gender Equality Strategy and focus.

Insurance offered in PSSap has been designed with the unique nature of APS employment and the diverse occupations in APS agencies in mind—this includes the ability for employees to move across APS employer agencies. CSC also takes into consideration the APS Gender Equality Strategy and focus.

Income Protection cover is based on the member’s reported salary, rather than a minimum number of units. PSSap default cover includes age-based levels of Death and Total Permanent Disablement (TPD) cover, which are higher than many other funds.

PSSap lifePLUS auto cover has a limited cover period that applies for at least the first 12 consecutive months from the cover start date.

Limited Cover applies to any illness or injury a member already has, suffers from, or is under treatment for prior to the commencement of their cover. Limited Cover means a member is covered only for new claims that arise from illnesses or injuries that were not related to a condition that occurred before their cover started.

After the period of Limited Cover is over, the member is covered for any illness or injury that a member had prior to the cover starting.

There are some situations when Income Protection or Death and TPD benefits won't be paid because certain events are excluded from cover.

Exclusions and restrictions that apply for Income Protection, Death and TPD are:

• any intentional self-inflicted injury or attempted suicide or self-destruction while sane or insane (if death or TPD is within 13 calendar months of the date a member has applied and been accepted for an increase in cover, the benefit payable under the policy is the amount insured before the increase);
• active service in the armed forces or peacekeeping forces (whether armed or unarmed) of any country or territory or foreign or international organisation; or
• participation in a combat or fighting force of any country or territory or foreign or international organisation.

Exclusions that apply to Income Protection only, in addition to the above:

• uncomplicated pregnancy, childbirth or miscarriage; and
• war or act of war, whether declared or not.

Members are notified as part of their 'welcome' experience of the actions they are required take to activate their cover. Members will receive a reminder to read their welcome experience, this will occur via email or SMS at 7 days and 21 days after their initial welcome experience was sent. Members must activate their cover within 60 days of receiving their welcome experience, and within 180 days of starting with their designated employer.

These changes don’t affect a current claim, and will remain unchanged until the member returns to work or their benefit payment period ends—whichever happens first. The benefit periods for the member are assessed as at the date of an event (date of disability).

Death Benefits cannot be converted to an income stream such as CSCri. CSC will distribute the super balance and any insurance benefit payable (if applicable and approved) to the member’s beneficiaries.

If a contributing member takes approved leave without pay or leave with partial pay, they must let us know the dates of their approved leave before their leave commences. As long as there's enough in their PSSap account to cover monthly insurance premium deductions and their insurance doesn't stop because of 'inactivity', cover will continue for up to 24 months.

A member is considered to be at work if they are on approved leave for reasons other than sickness or injury, and not taking into account the leave, they are capable of performing all the duties of their usual occupation without limitation due to sickness or injury. Limited cover only applies for the first 12 months from the date a member started employment with a designated employer.

If our insurer has assessed a member's claim and the claim is to be declined, CSC will review the insurer's decision and assess whether we agree with that decision. If we don't agree with the insurer's decision, we'll ask them to reconsider the claim or to arrange more medical evidence. If this occurs, the claim will go back through the assessment process.

Income is defined as the salary upon which a member's pay is based on when on sick leave. If a member has lifePLUS auto and they're employed full or part time, their employer must provide salary updates to CSC. If the member has lifePLUS choice, they must let us know their salary and they must tell us when it changes.

A member's occupation duties and tasks will be requested from their employer at the commencement of an Income Protection claim assessment. The duties of a member's own occupation are used for a disability assessment for the first two years of a benefit period (member must be unable to perform one important duty that involves at least 20% of their overall tasks). After the expiry of the first two years benefit period, the assessment for disability changes to become based on the inability to perform one or more duty of their own occupation and one or more duty of all occupations they are reasonably suited to by education, training or experience.

A member can return to work during the 24 consecutive month waiting period as part of any rehabilitation program as agreed by the Insurer, without recommencing the 24 consecutive month period, but only if the return to work is unsuccessful solely as a result of the same injury, sickness or disease (or any injury, sickness or disease directly caused by the same injury, sickness or disease) that they are claiming for.

We've used all of our experience to compare and choose an insurance provider and design an insurance offering that we think will serve the best interests of the majority of our PSSap members. But, we also know that not all of our members are the same. This is why members have total flexibility to tailor their cover through lifePLUS choice, or cancel their lifePLUS cover altogether.

For more information about changing or cancelling cover, call 1300 725 171.

A member can apply for or vary their cover by:

• Using the LIFEapp online application tool available through the CSC Navigator; or
• Completing the Application and variation form.

A member can cancel their cover by:

• Using the LIFEapp online application tool available through the CSC Navigator; or
• Completing the Cancellation of cover form.

Ancillary members can apply for lifePLUS choice cover. lifePLUS choice cover may provide members with the opportunity for benefits not available in PSS or CSS, such as Income Protection cover.

If a member is employed by an eligible employer and they’re receiving super guarantee contributions from them, members have the option to change their membership to a PSSap membership. If they make this change, they may be eligible for lifePLUS auto cover, subject to the standard eligibility rules for New Permanent Employees or New Casual Employees.