Calculation:
is confined to home or a medical institution; and
after considering the advice of a registered medical practitioner , the child requires continuous nursing care;
Take the lower of:
a) 1/12 x $45,000 = $3,750 per month; or
then Sovereign will pay a Children’s Benefit.
b) 75% x ($5,000 – $3,000) = 75% x $2,000 = $1,500 per month
The amount of the Children’s Benefit is the lower of $500 per month or 50% x 1/12 th of the benefit amount shown in the schedule . The Children’s Benefit will be paid monthly in advance after the child has been so confined for eight weeks until the child is no longer so confined or attains the age of 18 or the end of the benefit payment period is reached, whichever is earlier.
Therefore, the amount payable in this example, after subtracting ACC entitlements, is:
$1,500 - $500 = $1,000 per month
6.
What is the Partial Disability Bridging Benefit and when will Sovereign pay it?
9.
How to make a claim
Sovereign will pay you a Partial Disability Bridging Benefit if:
To make a claim, the relevant procedures in the section of your TotalCare Max policy entitled ‘How to make a claim’ must be followed. In addition, for an Essential Disability Income Benefit claim, Sovereign will require: the life assured to be examined by a registered medical practitioner acceptable to Sovereign, before accepting liability for a claim; and a Sovereign claims form completed by the life assured and a registered medical practitioner (at your expense); and other information which Sovereign may reasonably request to help assess the claim, which may include evidence of monthly earnings, taxable income, business accounts, Accident Compensation Corporation details or similar; and the life assured to undergo medical and/or surgical treatment (including any operation or vocational, medical and/or social rehabilitation programme) at your expense which the life assured’s registered medical
you have been receiving a Total Disability Income Benefit under this appendix ; and
the life assured is no longer totally disabled ; and
based on the information provided to, and requested by Sovereign, we reasonably expect that a Partial Disability Income Benefit (as set out in Section 4) 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 1/3 rd (33.3%) of the final monthly Total Disability Income 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 Income Benefit was paid for the life assured. Payment of the Partial Disability Bridging Benefit does not affect the amount of the Partial Disability Income Benefit (as set out in Section 5). The Partial Disability Bridging Benefit is payable once for all claims resulting from the same or a related injury or illness.
practitioner or a registered medical practitioner approved by Sovereign considers necessary; and
any other information that Sovereign may deem relevant to the assessment of the claim.
7.
What is the Recurrent Disablement Benefit?
The waiting period will be waived if in Sovereign’s opinion, after considering the advice of a registered medical practitioner and other relevant information, the life assured becomes totally disabled again and this is caused by the same or a related illness or injury as the original period of total disablement , not later than 12 months after benefit payments related to the original claim ceased. The provisions of Sections 1, 2, 3, 4 and 5 of this appendix will apply to any benefit claimed. If the benefit payment period is five years all claims resulting from the same or a related illness or injury will be considered to be the same claim in respect of the benefit payment period .
10. Ongoing Claim Requirements
For ongoing claims Sovereign will require:
Completion of a monthly medical certificate by a registered medical practitioner (at your expense) in a form from time to time approved by Sovereign for the purposes of determining ongoing entitlement to payment of an Essential Disability Income Benefit. Completion of a monthly individual declaration by the life assured in a form from time to time approved by Sovereign, which may include completion of daily activity logs detailing the life assured’s functional activities for the purposes of determining ongoing entitlement to payment of an Essential Disability Income Benefit. Proof of any remunerated or non-remunerated work completed during the claim period.
8.
Children’s Benefit
If any child of a life assured (either by birth or legal adoption) aged between 3 and 18 years of age, solely by reason of sickness or injury:
809 TCP-EDI version 6 Effective 21 May 2019
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