PC-IP- 05/2026
Personal Cover - Income Protection Benefit
SECTION A - DEFINED TERMS
DEFINED TERMS
In this Policy certain words have particular meanings. These words are in Bold and the meanings set out below.
Interpretation Throughout this Policy ' We', 'Our ', ' Us ' or ‘ AIA New Zealand’ means AIA International Limited - New Zealand Branch, and/or any related and/or authorised companies and/or agents (including company officers acting in the scope of their authority). ' You ' or ' Your ' means the Policy Owner(s) . Benefit(s) Means the Benefit specified in the Policy Schedule (and subject to the terms and conditions of this Policy ). Capable of Earning Means the Life Assured’s Income, or the amount of Income the Life Assured is capable of earning while Partially Disabled , as determined by Us after an assessment of present and likely capabilities.
Civil Union Means a Civil Union as defined in the Civil Union Act 2004.
Consumer Price Index Increase Means any increase in the index published by the Statistics Department of New Zealand for “All Groups” as at 30 September each year (or the nearest equivalent index should this index be replaced). Criminal Act Means participation in an action that constitutes an offence under the Crimes Act 1961, whether or not a charge has been entered against the life assured and whether or not a conviction results. Full-Time Care Means having primary responsibility and actively undertaking, whether shared or alone, the day-to-day care of persons who cannot safely take care of themselves without supervision. Life Assured Means the person or people insured for the Benefit(s) as listed in Your Policy Schedule . Manifested Means that symptoms have arisen which cause an ordinarily prudent person to seek diagnosis, care or treatment, or that medical advice or treatment has been recommended by or received from a Medical Practitioner .
Marriage Means a Marriage as defined in the Marriage Act 1955.
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Medical Practitioner Shall mean any person approved by Us registered with the Medical Council of New Zealand to render medical or surgical services, and who holds an Annual Practising Certificate. For diagnoses made outside New Zealand, this definition covers any appropriately qualified medical professional approved by Us . This definition excludes any person who is himself/herself the Life Assured , the Policy Owner , the spouse, de facto spouse, Civil Union partner, lineal relative, or business partner/associate of the Life Assured or Policy Owner . Policy Means this contract of insurance between You and Us . It includes the following parts: • Your application for insurance; and • this Policy wording; and • the Policy Schedule ; and • any addendum to the Policy Schedule ; and • any other written notice that We give You ; and • any written notice that You give Us .
Policy Anniversary Date Means the anniversary of the Policy Commencement Date .
Policy Commencement Date Means the commencement date of the Policy as specified in Your Policy Schedule . Policy Owner Means the Policy Owner identified in the most recent Policy Schedule issued to You by Us . Policy Schedule Means the most recent Policy Schedule issued to You by Us , including any endorsements or special conditions. Policy Year Means the twelve (12) month period which starts from the Policy Commencement Date and ends on the First Anniversary Date . Each subsequent Policy Year is from Policy Anniversary Date to Policy Anniversary Date . Premium Means the Premium specified in Your Policy Schedule or in any subsequent notice issued to You by Us . Premium Guarantee Period Means the period of time specified in Your Policy Schedule during which the Premium Rates applicable to Your Policy are guaranteed not to increase. Premium Rates Means the underlying Premium Rates We use to calculate Your Premium based on factors including the age, health, occupation and circumstances of the Life Assured .
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Sum Assured Means the Sum Assured for the Benefit(s) as set out in Your Policy Schedule . Total Premium Means the sum of the Premium and policy fee together with any applicable GST as specified in Your Policy Schedule . Usual Occupation Means the occupation predominately performed by the Life Assured in the 12 months prior to the sickness or injury . If the Life Assured has been unemployed or on long service, maternity leave, paternity leave or leave without pay for more than 12 consecutive months immediately prior to the sickness or injury causing Disability , Usual Occupation will be deemed to mean any occupation for which the Life Assured is reasonably suited by way of education, training or experience.
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SECTION B - INCOME PROTECTION BENEFIT FEATURES
JURISDICTION AND CURRENCY
1
The laws of New Zealand apply to this Policy . The New Zealand courts have exclusive jurisdiction. All monetary amounts referred to in this Policy are expressed and payable in New Zealand dollars and include GST. A When You apply for insurance with AIA New Zealand and when You make a claim on the Policy , You have a legal duty of disclosure to AIA New Zealand . The duty of disclosure means that: 1. All the statements that You or any Life Assured make to AIA New Zealand (both written and oral), including the answers in: a. the application; b. any claim made by You ; and c. any other communication by You or any Life Assured with AIA New Zealand; must be complete, true and correct. 2. You and any Life Assured must disclose everything that You or any Life Assured know, or could reasonably be expected to know, that is relevant to AIA New Zealand’s decision whether: a. to accept Your application for insurance, on what terms AIA New Zealand will accept it and how much it will cost; or b. to accept Your claim on the Policy . 3. This duty of disclosure in relation to Your application for insurance continues from the time You complete the application until either: a. the Policy Commencement Date or the date AIA New Zealand accepts Your application for insurance, whichever is later; or b. AIA New Zealand declines Your application for insurance. 4. You and any Life Assured also have the same duty of disclosure to AIA New Zealand throughout the term of the Policy whenever You or any Life Assured communicate with AIA New Zealand and whenever You extend, vary or reinstate Your insurance. IMPORTANT If You or any Life Assured do not comply with Your duty of disclosure, AIA New Zealand may at its discretion do any or all of the following: 1. Decline any claim that You make; 2. Alter the terms of any Benefits under the Policy ; 3. Remove any Benefits under the Policy ; 4. Void Your Policy from the Policy Commencement Date ; 5. Retain all Premiums , policy fees and recover any Benefits paid; 6. Terminate this Policy . If You are not sure whether You are required to disclose a particular fact, please ask AIA New Zealand or Your insurance adviser.
RESPONSIBILITY FOR TRUTHFULNESS
2
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B If the age of the Life Assured was misstated in the application, the amount payable under this Policy will be adjusted to the amount that the Premiums would have purchased if the correct age had been disclosed. No increase in Premium Rates will apply to this Policy as a result of change in the health, occupation or circumstances of the Life Assured . However, We have the right to review at any time and from time to time the Premium Rates and handling fees applicable to all Income Protection policies and to apply the reviewed rates and fees to this Policy at the commencement of the next Premium Guarantee Period . With Our agreement the annual Total Premium may be paid by equal fortnightly, monthly, quarterly or half-yearly instalments but with such handling fees as We shall determine from time to time. We may cancel this arrangement at any time in respect of future Total Premiums . The Policy Owner may apply to Us to change the Premium or Benefits attributable to this Policy . Subsequent to this, We may change the Premium and/or alter any Benefits under this Policy in accordance with this instruction. We will charge You a policy fee, which forms part of Your Total Premium. The policy fee is used to pay the ongoing administration costs of this Policy. The policy fee is specified in Your Policy Schedule . We may change this policy fee from time to time. If this occurs any such change will be notified to You in writing. The term of this Policy and the period of assurance covered by each annual Total Premium, or instalment of annual Total Premium, terminate on the due date of the next annual Total Premium or instalment. A thirty (30) day grace period is allowed after the due date for payment of each Total Premium . This Policy will automatically terminate if the Total Premium is not paid before the expiration of the grace period. In such an instance this Policy can be reinstated subject to: • Our consent; and • such evidence of continued good health of the Life Assured as We may require; and • the payment of all Total Premiums in arrears together with such interest thereon as We may decide. We may vary Your Benefits , charge additional Premiums or not allow You to reinstate the Policy if the health, occupation, financial position or pastimes of the Life Assured have changed.
PREMIUM RATES
3
PREMIUM PAYMENTS
4
POLICY FEE
5
PERIOD OF ASSURANCE
6
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CLAIM PROCEDURE
7
A Written proof of Total Disability (as defined in Clause One (1) “Total Disability” under Section D below) acceptable to Us must be given to Us within thirty (30) days after the Life Assured becomes Totally Disabled . B If the Life Assured does not provide written proof satisfactory to Us within that time, the Waiting Period may be deemed by Us to have commenced no earlier than thirty (30) days before We received written proof. C Any expense incurred in providing due proof of the existence of a claim or of Income shall be borne by the Life Assured . D We shall have the right and opportunity to call for an examination of the Life Assured by any Medical Practitioner or appropriately qualified health professional of Our choice at Our expense as often as We may reasonably require both during the initial assessment of a claim and during any ongoing claim. E If You have selected an Indemnity Contract the Life Assured shall provide to Us full details of the Life Assured's Income prior to and at the time of a claim and of the Life Assured's Income as reasonably required by Us . Such proofs shall be in a form acceptable to Us and may include statements from an employer, bank statements, income tax returns and accounts reports. F If the Life Assured suffers personal injury or sickness for which there is or may be cover under the Injury Prevention, Rehabilitation and Compensation Act 2001 (known as ACC) and any statutory re- enactment or modification thereof, the Life Assured must have taken all reasonable steps to pursue a claim to the Accident Rehabilitation and Compensation Insurance Corporation for compensation before any claim under this Policy will be considered by Us . G If the Life Assured suffers personal injury or sickness which is as a result of or in any way caused by any other person or party, then We shall be entitled at Our expense and in the name of the Life Assured to take any proceedings necessary to obtain recovery from any other party. The Life Assured must provide all reasonable assistance and co-operation in the prosecution of the claim. H Responsibilities during claims assessment and while in receipt of Income Protection Benefits : 1. Undergo assessment of present and likely capabilities for the purposes of rehabilitation, at the expense of AIA New Zealand . 2. Follow the advice of the treating Medical Practitioner , including recommended courses of treatment and rehabilitation. 3. Co-operate with AIA New Zealand in the development and implementation of a rehabilitation plan in order to endeavour to terminate or reduce the extent of any disability, impairment or incapacity.
4. The Life Assured must notify AIA New Zealand before he or she returns to any work, paid or unpaid, in any capacity.
5. The Life Assured must advise AIA New Zealand immediately if they increase work hours or receive an
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increase in pay or receive any other Income , including sick pay that may affect the Benefit amount.
6. If any of these responsibilities are not met when reasonably required by AIA New Zealand , We have the right to either suspend claim payments or decline Your claim. a. AIA New Zealand must give the Life Assured written notice of any proposed suspension not less than thirty (30) days before the proposed suspension date.
b.
AIA New Zealand may decline to provide any Benefit for as long as the Life Assured unreasonably fails to comply with any requirement of the terms and conditions relating to the Life Assured’s claim or fails to meet their responsibilities outlined above.
We also have the right to recover overpayments from You , if these responsibilities are not met.
FORFEITURE OF PREMIUMS
8
If this Policy is avoided or is terminated under any of the terms and conditions of this Policy , all Total Premiums paid shall be absolutely forfeited to Us . Unless previously terminated, this Policy shall terminate on the earliest of: A The anniversary of the Policy Commencement Date following the Life Assured attaining the age of sixty-five (65) or the age of seventy (70) depending on the age specified in the Policy Schedule regardless of whether a claim is being paid; or B Written notification of cancellation from You to Us at any time; or
TERMINATION
9
C D
The death of the Life Assured ; or Non-payment of Total Premium as set out in Clause 6 “Period of Assurance” above. Cover under this Policy applies twenty-four (24) hours a day, anywhere in the world. If You are overseas during the period of a claim, Benefits will be paid in New Zealand currency. This Policy is the entire contract of insurance between You and AIA New Zealand . It comprises the following parts: • Your application for insurance; and • this Policy wording; and • the Policy Schedule ; and • any other written notice that AIA New Zealand gives You ; and • any written notice that You give Us . In the event of any changes in taxation after the Policy Commencement Date which affects the Benefits or Our liability, We may make such amendments or modifications to the Premium and Benefits and this Policy as We consider appropriate.
WORLDWIDE COVER
10
ENTIRE CONTRACT 11
TAX CHANGES
12
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DISABILITY BENEFITS WHERE MORE THAN ONE (1) LIFE ASSURED
13
If there is more than one (1) Life Assured shown in the Policy Schedule , We will pay the Income Protection Benefits for each Life Assured . The amount of the Benefit payable for a Total Disability will be the Benefi t payable for that person under this Policy . This Policy will end when all Lives Assured have suffered a Total Disability and to the extent an Income Protection Benefit is payable in respect to each of them, that Benefit has been paid. This Policy does not participate in bonus distributions or acquire a cash surrender, loan or maturity value. B Where this Policy refers to an Act of Parliament, this includes any Regulations made under it. It also includes any Act or Regulations enacted in substitution. C Your life insurance Policy is part of the AIA New Zealand Statutory Fund, effective 1 st September 2013. This is a requirement under the Insurance (Prudential Supervision) Act 2010, for policyholder protection. To enable You to consider the Policy in detail You will have a free look period of fourteen (14) days after You receive Your Policy document. During this period, if You decide that the Policy does not suit Your needs then You may return it to Us and receive a full refund of all Total Premiums paid and the Policy will be cancelled. Should You write to Us about this Policy , You must send the letter to Our head office in New Zealand as notified by Us to You from time to time.
GENERAL
14 A
FREE LOOK PERIOD
15
NOTICES
16
The postal address of AIA New Zealand head office is: AIA New Zealand Private Bag 300981 Albany AUCKLAND CITY 0752 The street address of AIA New Zealand head office is: AIA New Zealand Level 15 5-7 Byron Avenue Takapuna AUCKLAND CITY 0622
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SECTION C - INCOME PROTECTION BENEFITS
TOTAL DISABILITY BENEFIT
1
If, the Life Assured :
• has been Totally Disabled or Partially Disabled for the Waiting Period ; and
• is Totally Disabled at the end of the Waiting Period ,
We will pay you the monthly Benefit subject to Clause 5 “Offsets” under Section D of this Policy in advance from the end of the Waiting Period until the earliest of when:
• the Life Assured is no longer Totally Disabled ; or
the Benefit Period ends; or
•
• the Policy ends. Any payment for a period of less than one month is calculated on a pro-rata basis. Successive periods of disability resulting from the same or related cause within twelve (12) months of resuming work shall be considered a continuation of the same disability and no Waiting Period shall apply. Such periods of recurrent disability shall be added to the original Total or Partial Disability period for the purposes of applying the Benefit Period . We will pay a Partial Disability Benefit if the Life Assured is Partially Disabled (as defined in Clause 2 “Partial Disability” under Section D below) and the Waiting Period has elapsed. To allow Us to accurately assess the ongoing validity of a partial disability claim, the Partial Disability Benefit will be paid monthly in arrears from the end of the Waiting Period until the Life Assured is no longer Partially Disabled .
RECURRENT DISABILITY BENEFIT
2
PARTIAL DISABILITY BENEFIT
3
This Partial Disability Benefit equals:
(A - B) / A) * C where
A = Average monthly Pre-disability Income B = Average monthly Post-disability Income C = The monthly Benefit amount
We will then subtract the total of any other income replacement or any other form of employer remuneration or sick leave entitlements being received for the Life Assured from any other sources in relation to the same disability. Payment of the Partial Disability Benefit is always subject to Clause 5 “Offsets” under Section D of this Policy . During a period of Total Disability , Recurrent Disability or Partial Disability for which We have accepted a claim, all Total Premiums due will be waived by Us . If the Policy Schedule shows You have selected this option, the Income Protection Benefit will increase on each anniversary of the Policy Commencement Date by an amount equal to the Consumer Price Index Increase for the year ended 30 September
WAIVER OF PREMIUM
4
INFLATION ADJUSTABLE OPTION
5
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for which figures are available at the date the monthly Benefit is to be increased. You may decline any Consumer Price Index Increase . This option expires upon termination of the Policy in accordance with Clause 9 “Termination” under Section B above. This option will cease once the maximum total annual Sum Assured of $360,000 has been reached. If the Policy Schedule shows that You have selected this option, the Income Protection Benefit will remain at the amount specified in the Policy Schedule . If Your Policy Schedule shows You have selected this option, where the Life Assured is Totally Disabled , We will pay You an extra Benefit for up to three (3) months following the cessation of the selected Waiting Period . This Benefit is calculated as one-third of the Total Disability Benefit after any applicable Offsets have been deducted. We will pay You an extra Benefit of one-third of the Total Disability Benefit payable until expiry of the Benefit Period , if the Life Assured has been absent from any employment as a result of injury or illness for six (6) consecutive months, and is totally and irreversibly unable to perform at least two (2) of the five (5) Activities of Daily Living without the standby assistance of another person. Activities Of Daily Living i) BATHING - The inability to wash oneself either in the bath or shower or by a sponge bath. The Life Assured will be considered to be able to bathe even if the above tasks can only be performed by using equipment or adaptive devices. ii) DRESSING - The inability to put on and take off all garments and medically necessary braces or artificial limbs usually worn, and to fasten and unfasten them. The Life Assured will be considered able to dress even if the above tasks can only be performed by using modified clothing or adaptive devices such as tape fasteners or zipper pulls. iii) TOILETING - The inability to get to and from and on and off the toilet, to maintain a reasonable level of personal hygiene, and to care for clothing. The Life Assured will be considered able to toilet even if it involves the use and ability to empty a colostomy bag, and/or catheter, or an alternative means of bowel or urine elimination device, or use a commode, bedpan or urinal, and able to empty and clean it without the standby assistance of another person. iv) MOBILITY - The inability to move from place to place. The Life Assured will be considered able to move even if it requires the use of equipment including but not limited to canes, quad canes, walkers, crutches, wheelchairs, including mechanical or motorised devices. v) EATING - The inability to get nourishment into the body by any means once it has been prepared and made available.
LEVEL BENEFIT OPTION
6
BOOSTER BENEFIT OPTION
7
SEVERE DISABILITY BENEFIT
8
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INFLATION ADJUSTABLE CLAIM BENEFIT
9
If You are receiving a Benefit under this Policy at the anniversary and each subsequent anniversary of the Policy Commencement Date , We will increase the monthly Benefit payable by the most recent Consumer Price Index Increase . When You are no longer disabled You can choose to keep the higher levels of Benefit . The Premium will increase accordingly. This Benefit does not apply if you have selected the Level Benefit Option as per Clause 6 “Level Benefit Option” above.
This Benefit expires upon termination of the Policy in accordance with Clause 9 “Termination” under Section B above.
MENTAL HEALTH DISORDER LIMITATION OPTION
10
If the Policy Schedule shows that You have selected this option, then if during the term of this Benefit , the Life Assured is Totally or Partially Disabled as a direct or indirect result of a Mental Health Disorder as defined under Clause 9 “Mental Health Disorder” under Section D below, the total Benefit Period for all claims arising out of this disability will be twelve (12) months from the end of the Waiting Period irrespective of the Benefit Period shown in the Policy Schedule . If the Life Assured is Totally Disabled and undertakes a programme of occupational retraining while receiving an Income Protection Benefit then, subject to written approval from Us , an additional lump-sum payment by way of reimbursement will be made for the cost of this training up to a maximum of twelve (12) times the monthly Benefit . This Benefit will be reduced by any costs recovered from any other source. If the Life Assured dies during the term of this Benefit , We will pay You, three (3) times the monthly Benefit specified in the Policy Schedule up to a maximum of $30,000. If the Life Assured is outside of New Zealand and suffers, for the first time, a Total Disability and We have accepted the claim, We will pay the lesser of: A. Three (3) times the monthly Benefit specified in the Policy Schedule ; or B. A single standard economy air fare to New Zealand by the most direct route available plus any transport costs to an AIA New Zealand approved medical facility in New Zealand where necessary. A Return to Home Benefit can only be paid once in any 12 month period. In total the maximum We will pay over the life of the Policy under the Return Home Benefit is $10,000. No payment will be made if the Life Assured is covered for the same event with a travel insurance provider. If this Income Protection Benefit has been continuously in force for three (3) years and no claim has been made or is eligible to be made, We will: Double the Death Benefit payable; and Double the maximum amount payable under the Occupational Retraining Benefit and Rehabilitation Equipment Expense Benefit.
OCCUPATIONAL RETRAINING
11
DEATH BENEFIT
12
RETURN TO HOME BENEFIT
13
NO CLAIM BENEFIT 14
A B
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INCREASING INCOME BENEFIT
15
You can apply to increase the Income Protection Benefit at any time while Your Policy remains in force without needing to provide further medical evidence if: • the Life Assured is under age 55 at the time of the option to increase; and • no Benefit is being received or payable under this Income Protection Benefit and premiums are not being waived; and • the Income Protection Benefit is less than $12,000 per month.
The maximum increase is 10% per year of the Income Protection Benefit in addition to any Consumer Price Index Increase .
The total of all increases in the Income Protection Benefit cannot exceed the original Income Protection Benefit at the Policy Commencement Date . You must apply in writing to Us and provide evidence satisfactory to Us of the Life Assured’s increased income within 60 days of the increase in income. This is likely to be confirmation of the increase in salary from the Life Assured’s employer or confirmation in writing by the Life Assured’s accountant that there has been an increase in income. We will pay a Home Care Benefit in addition to the Income Protection Benefit , if the Life Assured is Totally Disabled and an appropriate registered Medical Practitioner certifies that the Life Assured requires Full-Time Care at home because of the Life Assured’s Total Disability . The Full-Time Care must be provided by either a person whose profession it is to provide nursing or similar services or a direct family member who is in paid work for at least 28 hours per week immediately before the Life Assured became Totally Disabled and who has given up that work to care for the Life Assured . The amount of the Home Care Benefit each month will be the lesser of: • the monthly Benefit specified in the Policy Schedule ; or • $2,500 per month; or • The cost of the care, if it is provided by a person whose profession it is to provide nursing or similar services. Where the Home Care Benefit is paid for an incomplete month, payment will be at the rate of 1/30th (one-thirtieth) of the monthly Benefit per day. This Benefit starts from the expiry of the first three successive nights of the Life Assured receiving Full-Time Care at home until the earlier of: • an appropriate registered Medical Practitioner certifying that Full-time Care is no longer required; or • We have paid this Benefit for six consecutive months.
HOME CARE BENEFIT
16
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BED CONFINEMENT BENEFIT
17
If the Life Assured is Totally Disabled and confined to bed on direction of a Medical Practitioner and under the Full-Time Care of a Registered Nurse (holding an Annual Practising Certificate issued by the Nursing Council of New Zealand) before the Waiting Period has elapsed and has been so for more than three (3) days, the Benefit payable after the third day will be a daily Benefit equivalent to 1/30 of the monthly Total Disability Benefit which will commence and will continue until the Life Assured leaves bed or until the Waiting Period has elapsed, whichever is sooner. The normal conditions apply after the Waiting Period has elapsed.
LEAVE WITHOUT PAY AND SUSPENSION OF COVER
18
You can apply to suspend cover for a Life Assured for a period of up to twelve (12) months if they:
• Take a period of Leave Without Pay from all regularly remunerated occupations; • Take employer approved parental leave; • Become redundant, or unemployed; • Have a reduction in pay of at least 20% (comparing the most recent payslip against a previous payslip from the same year); or • If self-employed, have a reduction in revenue of at least 30% (by comparing one month’s revenue against the same month for the previous year), provided the request is made in writing by You to Us and has been accepted by Us . We will resume cover without requiring evidence of health for any insured person when the requested suspension period expires. Once cover is reinstated, Total Premiums must recommence. We will not pay any Benefits under this Policy following reinstatement of cover, in respect of any claim event that first meets the criteria for an eligible claim while cover is suspended. A Benefit is payable of twelve (12) times the monthly Benefit to cover costs of purchasing specialist equipment or completing home alterations which are necessary as a result of disability. This Benefit is payable at Our sole discretion where it is deemed the Benefit will assist the Life Assured with a return to independence and the workforce. We shall be entitled to arrange for an appropriately qualified health professional to assess any recommendation for specialist equipment or home alterations. This Benefit will be reduced by any costs recovered from other sources such as other insurers or the ACC. We will waive the Total Premium under this Policy for up to six (6) months at any stage between the second trimester and six (6) months after the Life Assureds pregnancy finishes if the Life Assured becomes pregnant while this Policy is in force provided: • the Life Assured provides Us with a confirmation of pregnancy from an appropriate Medical Practitioner ; and
REHABILITATION EQUIPMENT EXPENSE BENEFIT
19
PREGNANCY PREMIUM WAIVER
20
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• the birth of the child does not occur within twelve (12) months of: - the Policy Commencement Date ; or - the most recent reinstatement of this Policy ; and • the Life Assured is on maternity leave from their Usual Occupation . You must notify Us in writing when the Total Premium is to be waived. This Waiver will cease when a total of six (6) months Total Premium , including any Total Premiums waived during an earlier pregnancy, have been waived. If the Policy Schedule shows that You have selected the Involuntary Redundancy Benefit option, during the term of this Benefit We will pay a Benefit for each full month following the Involuntary Redundancy (as defined in Clause 10 “ Optional Involuntary Redundancy Benefit ” under Section D below) of the Life Assured up to a maximum period of six (6) months, or until the Life Assured has commenced alternative employment whichever is the earlier. This Benefit is a monthly Benefit paid in arrears and will commence after the first thirty (30) days of any period of total unemployment. Benefit payments will be made upon receipt of proof acceptable to Us that the Life Assured remains unemployed and is registered with Work and Income New Zealand, or any subsequent Government Employment Agency and is actively seeking employment. The maximum monthly payment is the monthly Benefit specified in the Policy Schedule or $2,500 whichever is the lesser (Per Life Assured ). If You have more than one (1) Optional Involuntary Redundancy Benefit this will be subject to a maximum monthly payment of the monthly Benefit specified in the Policy Schedule or $2,500 (Per Life Assured ) whichever is the lesser. The Life Assured must return to work for a period of at least twelve (12) consecutive months prior to making another claim on the Optional Involuntary Redundancy Benefit . The Optional Involuntary Redundancy Benefit is payable for a total maximum of twelve (12) months per Policy . The annual Total Premium or instalment of the Total Premium is payable for the entire duration of the Benefit together with any increases in premium applicable for the Inflation Adjustable Benefit . If the Policy Schedule shows that You have selected a Level Premium , We will not do any age recalculation during the duration of the Policy . In all other cases, Your Income Protection Benefit Premium specified in the Policy Schedule will be recalculated every year in accordance with the Premium Step specified in the Policy Schedule , based on the age of the Life Assured at that time.
OPTIONAL INVOLUNTARY REDUNDANCY BENEFIT
21
PREMIUM
22
Please note that the underlying Premium Rates are not guaranteed and are subject to review with effect from the next
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Period of Assurance, regardless of whether an age recalculation takes place at that point or not.
RENEWAL
23
The Income Protection Benefit may be renewed up to the anniversary of the Policy Commencement Date following the Life Assured attaining the age of sixty-five (65) or age seventy (70) as per the Policy Schedule , regardless of changes in the health or occupation of the Life Assured . AIA New Zealand understands that under the current tax legislation, Premiums payable for Agreed Value Income Protection Policies are not deductible for tax purposes and claim payments are not taxable. In the event of a change in tax legislation where Premiums become deductible and claim payments become taxable, then AIA New Zealand will allow the monthly Benefit to be increased to an amount agreed by Us to reflect the change in tax treatment. Your Premium will be adjusted to reflect the increase in Benefit and will be based on Premium rates applicable at that time.
TAX
24 A
We will accept the increase on the same terms that the original Policy was issued without further medical or financial underwriting.
B
AIA New Zealand will notify the Policy Owner in writing as soon as We are aware of any change in tax legislation in relation to Agreed Value Income Protection Policies . The Policy Owner must then make a written request to AIA New Zealand to adjust the monthly Benefit . We must receive any adjustment request within sixty (60) days of AIA New Zealand’s notification of the change in tax legislation. If We make future enhancements to Our Policy wordings We will pass back the enhanced Benefit , feature and/or condition automatically to You . The enhanced Benefit , feature and/or condition will only apply to claimable events which occur after the date We pass back the enhanced Benefit , feature and/or condition to You . Any underwriting exclusion or special terms that apply to this Policy will not be altered by any enhanced Benefit , feature and/or condition. This Benefit is to ensure that You will be better off as a result of the enhanced Benefit , feature and/or condition. If You are inadvertently disadvantaged in anyway then the previous Policy wording will apply.
GUARANTEED PASS BACK OF BENEFIT ENHANCEMENTS
25
EXCLUSIONS
26
No Benefits shall be paid under this Policy if the injury or sickness resulting in Total Disability directly or indirectly was caused by or resulted from: A Intentionally self-inflicted injury whether the Life Assured is sane or insane. B Participation in any Criminal Act . C Pregnancy, childbirth, abortion or miscarriage unless the Total Disability lasts for more than ninety (90) days after the end of pregnancy, at which time the Waiting Period will commence.
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D In the case of a Policy with a Benefit Period of two (2) years, any injury, sickness, or related condition in respect of which twenty-four (24) months of Income Protection Benefits have already been paid. E In the case of a Policy with a Benefit Period of five (5) years, any injury, sickness, or related condition in respect of which sixty (60) months Income Protection Benefits have already been paid. F In the case of a Policy where the Mental Health Disorder Limitation option has been selected, any Mental Health Disorder or related Mental Health Disorders in respect of which twelve (12) months Income Protection Benefits have already been paid in total. G In the case of a Policy where the Optional Involuntary Redundancy Benefit has been selected, no Involuntary Redundancy Benefit will be paid where; 1. The Life Assured is made redundant within six (6) months following the Policy Commencement Date ; or 2. The redundancy or possible redundancy was known to the Life Assured prior to the Policy Commencement Date ; or 3. The Life Assured was on a fixed term contract of employment or an interim contract; or 4. The Life Assured is made redundant as a direct or indirect result of a strike or labour dispute; or 5. The Life Assured was self-employed, in part-time, seasonal or casual employment; or 6. The Life Assured is employed by and made involuntarily redundant by a close or lineal relation. We will pay a Childcare Support Benefit in the following circumstances: • The Life Assured is Totally Disabled or Partially Disabled and is receiving a monthly Benefit ; and • As a direct result of the Life Assured’s Total Disability or Partial Disability , additional childcare costs are incurred over and above any childcare arrangements which existed prior to the Life Assured becoming Totally Disabled or Partially Disabled , in respect of any dependent child who is under the age of fourteen (14); and • These additional childcare services are not being provided by You or an immediate family member. The amount We will reimburse under the Childcare Support Benefit is the lesser of: • The actual additional childcare costs; or • $800 per month per dependent child under the age of fourteen (14). This Childcare Support Benefit is payable until the earlier of: • The Life Assured no longer being Totally Disabled or Partially Disabled ; or • Six (6) monthly Childcare Assistance Benefit payments have been made; or • The Benefit Period ends.
CHILD CARE SUPPORT BENEFIT
27
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You will need to provide evidence satisfactory to Us each month of the additional childcare fees that have been paid before We will
make a payment under the Childcare Support Benefit. This payment is additional to the monthly Benefit.
WAITING PERIOD REDUCTION
28
If this Income Protection Benefit has a Waiting Period of 26, 52 or 104 weeks the Life Assured can reduce this Waiting Period , without providing any further medical evidence, if the Life Assured’s Business Continuation Cover, Farmers Revenue Protection Cover or New to Business Cover is cancelled due to the Life Assured no longer being Actively Involved in the business or the business is sold or the business is no longer Actively Trading . The Waiting Period for this Income Protection Benefit will reduce to align with the Waiting Period on the cancelled Cover. The reduced Waiting Period on this Income Protection Benefit will apply to the lesser of: the monthly benefit for the Business Continuation Cover, Farmers Revenue Protection Cover or New to Business Cover at the time it was cancelled; or the monthly Benefit for this Income Protection Benefit . For example: A Life Assured has the following: • Income Protection Benefit with a $2,500 per month Benefit and a 52 week Waiting Period ; and • New to Business Cover with a $1,000 per month Benefit with a 13 week Waiting Period . When New to Business Cover is cancelled the Income Protection Benefit Waiting Period would be reduced to a: • 52 week Waiting Period with a $1,500 per month benefit; and • 13 week Waiting Period with a $1,000 per month benefit. within sixty (60) days of the cancellation of cover the Life Assured must notify Us in writing, with supporting evidence that they are no longer Actively Involved in the business or the business has been sold or the business is no longer Actively Trading ; • the Life Assured must be no longer Actively Involved in the business due to reasons other than retirement, redundancy, ill health or incapacity; • the Life Assured must be under the age of sixty (60); • if the Life Assured has had a claim paid or is entitled to be paid a claim under any policy with Us or any other insurance company, the request will be referred to an AIA New Zealand underwriter and full underwriting terms and conditions may apply; • the payment of premiums must be up to date and are not being waived for any reason. The following conditions apply: •
If We agree to reduce the Waiting Period , the following applies: • premiums will increase with any reduction in Waiting Period ;
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• only one reduction in Waiting Period under this Benefit is allowed without evidence of health; • any loadings, exclusions or special terms on the cancelled policy will be applied to the reduced Waiting Period Benefit . If the Life Assured is Totally Disabled or Partially Disabled and able to receive an Income Protection Benefit under this policy, and they also hold a Business Continuation Cover, Farmers Revenue Protection Cover or New to Business Cover, then the Waiting Periods applicable to the Life Assured under each policy will be served concurrently from the disablement date. If during the Waiting Period under this policy, the Life Assured should suffer a recurring disability under their Business Continuation Cover, Farmers Revenue Protection Cover or New to Business Cover policy, after returning to full-time work, the portion of their Waiting Period for their Income Protection Benefit under this policy will be considered to have been continuous and only the remaining period will apply. We will pay You a Partial Disability Bridging Benefit if: • You have been receiving a Total Disability Benefit under this Policy ; and • the Life Assured is no longer Totally Disabled ; and • based on the information provided to, and requested by Us , We reasonably expect that a Partial Disability Benefit (as defined in Clause three (3) “Partial Disability Benefit” under Section C) will be payable for that Life Assured for the first month after the Life Assured ceased to be Totally Disabled . The Partial Disability Bridging Benefit is a lump-sum payment equivalent to 1/3rd (33.3%) of the final monthly Total Disability Benefit paid before the Life Assured ceased to be Totally Disabled . The Partial Disability Bridging Benefit is paid at the end of the final month in respect of which a Total Disability Benefit was claimed for by the Life Assured . Payment of the Partial Disability Bridging Benefit does not affect the amount of the Partial Disability Benefit (as defined in Clause three (3) “Partial Disability Benefit” under Section C) and does not affect the amount of the Enhanced Partial Disability Income Benefit (as defined in Clause thirty one (31) “Enhanced Partial Disability Income Benefit” under section C). The Partial Disability Bridging Benefit is payable once for all claims resulting from the same or a related injury or illness. The Partial Disability Bridging Benefit is not payable where a lump sum payment has been made in lieu of monthly Benefit payments. We will pay You an Enhanced Partial Disability Income Benefit if: • the Life Assured has been receiving a Total Disability Benefit under this Policy ; and • the Life Assured is no longer Totally Disabled ; and • the Life Assured is entitled to a Partial Disability Benefit (as defined in Clause three (3) “Partial Disability Benefit” under Section C) for that Life Assured .
CONCURRENT WAITING PERIOD
29
PARTIAL DISABILITY BRIDGING BENEFIT
30
ENHANCED PARTIAL DISABILITY INCOME BENEFIT
31
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The Enhanced Partial Disability Income Benefit is the lower of: • 25% of the monthly Partial Disability Benefit (as defined in Clause three (3) “Partial Disability Benefit” under Section C); or • 1/12th of the Benefit amount shown in the schedule less the monthly Partial Disability Benefit (as defined in Clause three (3) “Partial Disability Benefit” under Section C). This Benefit is paid monthly in arrears for a maximum period of twelve (12) months per claim. We will cease paying this Benefit if the Life Assured is no longer entitled to a Partial Disability Benefit . On receiving notification of a new or potential claim, We will appoint the Life Assured a Case Manager, who will work with the Life Assured to understand their personal situation and assist them with the claims process. They will work with the Life Assured to consider what rehabilitation or functional support could assist the Life Assured's return to work or improve their capacity to work, either during or after the Waiting Period as appropriate in Our opinion. Acceptance of any costs associated with the agreed rehabilitation and functional support by Us does not mean that We will accept liability for any other Benefit under this policy and are accepted at the sole discretion of Us .
REHABILITATION AND SUPPORT
32
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SECTION D - INCOME PROTECTION BENEFIT DEFINITIONS
TOTAL DISABILITY 1
Means a period of injury or sickness commencing when the Life Assured first received advice from a Medical Practitioner for that injury or sickness provided that: A The Life Assured is under the regular and personal care of a Medical Practitioner ; and B
The Life Assured’s injury or sickness is supported by clinical evidence and approved by Us ; and The Life Assured is unable to: • perform at least one important income producing duty of their Usual Occupation and is not working in their Usual Occupation ; or • engage in their Usual Occupation for more than ten (10) hours per week; and The Life Assured is not working or engaged in any other occupation or business.
C
D
Totally Disabled has a corresponding meaning.
PARTIAL DISABILITY
2
Means a disability resulting from a serious injury or sickness which results in the Life Assured having returned to work in a reduced capacity. The reduction in work capacity must be as a result of the continuation of the disability. The Partial Disability must be supported by an appropriate diagnosis from a Medical Practitioner and evidence acceptable to Us and is subject to the following conditions: A
The Life Assured’s monthly Income is less than 75% of their Pre- Disability Income ; and The Life Assured is under the regular and personal care of a Medical Practitioner ; and The Life Assured is not Totally Disabled. Shall mean any person approved by Us registered with the Medical Council of New Zealand to render medical or surgical services, and who holds an Annual Practising Certificate. For diagnoses made outside New Zealand, this definition covers any appropriately qualified medical professional approved by Us . This definition excludes any person who is himself/herself the Life Assured , the spouse, de facto spouse, Civil Union partner, lineal relative, or business partner/associate of the Life Assured .
B
C
MEDICAL PRACTITIONER
3
BENEFIT
4
Means the annual Benefit , paid monthly, will be:
A The Benefit specified in the Policy Schedule for an “Agreed Value Contract”; or B The Benefit specified in the Policy Schedule or 75% of the average annual Pre-Disability Income of the Life Assured , whichever is the lesser, for an “Indemnity Value Contract”. A The Benefit will be reduced by an amount equal to the total of any other income replacement or any other form of employer remuneration, sick leave entitlements, disability compensation or other entitlement received from ACC, excluding welfare payments being received by the Life Assured from any other sources in relation to the same disability.
OFFSETS
5
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B The Benefit will be reduced by any Income You receive or are entitled to receive as a result of the Life Assured’s personal exertion subsequent to the disablement date. A Where the Life Assured does not directly or indirectly own the business or professional practice from which they earn their regular income, income is defined as the total monthly value of the Life Assured’s remuneration in respect of the performance of the Life Assured’s regular occupation. Income includes: • salary • fees • commission • bonuses • and fringe benefits Income is determined by calculating the amount the Life Assured could be expected to receive if the Life Assured’s total remuneration was received as a salary or wage (before income tax is deducted). B Where the Life Assured directly or indirectly owns all or part of the business or professional practice from which they earn their regular income, income is defined as that earned by the business directly due to the Life Assured’s personal exertion or activities less the Life Assured’s share of the necessarily incurred business expenses and costs for that business or professional practice, calculated on a monthly basis. C Does not include unearned Income or Income derived from past or previous services from employment of the Life Assured . Including but not limited to interest earnings, rental income, royalties, or renewal commissions. Means the Life Assured’s Income during any one (1) continuous twelve (12) month period elected by You during the three (3) years immediately prior to the Total Disability . Means the Life Assureds Income, or the amount of Income the Life Assured is Capable of Earning while Partially Disabled , as determined by Us after an assessment of present and likely capabilities. Is as defined by Us as a past or present history of symptoms suggestive of, and/or diagnosis or treatment of, the following non- limiting list of mental health related problems: • Anxiety, depression, behavioural disorder, psychoneurosis, psychosis, or somatoform disorders; • Stress, fatigue, exhaustion, chronic fatigue syndrome; • Any psychiatric complication of physical disorders; • Post-Traumatic Stress Disorder, drug or alcohol abuse; • Any other physical disorder related or attributable to stress or any other mental or nervous disorder. Involuntary Redundancy is defined as: Termination of the Life Assureds permanent contract of employment by the Life Assureds employer due to the fact that:
INCOME
6
PRE-DISABILITY INCOME
7
POST-DISABILITY INCOME
8
MENTAL HEALTH DISORDER
9
OPTIONAL INVOLUNTARY REDUNDANCY BENEFIT
10
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