ABT ASSOCIATES
AUSTRALIA PTY LTD
Expatriate Medical Cover (LTA’s)
Member Booklet
For the period:
30 September 2016 to
30 September 2017
POLICY NO: 0018374
CONTENTS
INTRODUCTION ...................................................................................................................................... 1
Contact Information.................................................................................................................................................. 1
GENERAL INFORMATION ...................................................................................................................................... 2
Who is Covered ....................................................................................................................................................... 2
What you are Covered for ........................................................................................................................................ 2
Maximum Benefits Limit ........................................................................................................................................... 2
Excess or Deductible ............................................................................................................................................... 2
Pre-existing Medical Conditions ............................................................................................................................... 2
SECTION 1 – MEDICAL EXPENSES ...................................................................................................... 3
Part A – Medical Expenses ...................................................................................................................................... 3
Table of Benefits ...................................................................................................................................................... 3
Exclusions applying to Section 1 – Medical Expenses............................................................................................. 5
Part B – Emergency Evacuation .............................................................................................................................. 6
SECTION 2 – PERSONAL ACCIDENT ................................................................................................... 7
Table of Benefits ...................................................................................................................................................... 7
General Conditions and Limitations ......................................................................................................................... 9
Exclusions applying to Section 2 – Personal Accident ............................................................................................. 9
SECTION 3 – EVACUATION COVER AND PERSONAL SAFETY....................................................... 10
Exclusions applicable to Section 3 – Evacuation Cover and Personal Safety ....................................................... 10
IMPORTANT INFORMATION (FOR AUSTRALIAN EXPATRATES) .................................................... 11
Medicare / Medicare Levy Surcharge .................................................................................................................... 11
Permanent Return to Australia ............................................................................................................................... 11
HOW TO CLAIM ..................................................................................................................................... 12
How to Claim Out-Patient Medical Expenses ........................................................................................................ 12
How to Arrange Hospital Inpatient or Day Surgery ................................................................................................ 12
Normal Hospitalisation in Home Country ............................................................................................................... 12
CLAIMS PROCESS ............................................................................................................................... 13
Claims Incurred Overseas ..................................................................................................................................... 13
Claims Incurred in Australia ................................................................................................................................... 14
FREQUENTLY ASKED QUESTIONS (AUSTRALIAN EXPATRIATES)................................................ 15
WHAT YOU ARE NOT COVERED FOR ............................................................................................... 17
General Exclusions ................................................................................................................................................ 17
GENERAL DEFINITIONS UNDER THE POLICY .................................................................................. 18
IMPORTANT NOTICES ......................................................................................................................... 22
Important Notice
This information booklet has been prepared as a summary of the scope of protection provided under the Insurances arranged
by Willis Australia Limited (ABN 90 000 321 237) in association with Accident & Health International Underwriting Pty Ltd
(ABN 26 053 335 952) on behalf of CGU Insurance Limited (ABN 27 004 478 371). It is not intended to alter or override the
Terms, Conditions and Limitations of the health fund Policy which sets out the basis of the insurance.
© Copyright 2016
All rights reserved. No part of this document may be reproduced or transmitted in any form by any means, electronic or
mechanical, including photocopying and recording, or by information storage or retrieval system, except as may be permitted,
in writing, by Willis Towers Watson.
Willis Towers Watson is a leading global insurance broker, developing and delivering professional insurance, reinsurance, risk
management, financial and human resource consulting and actuarial services to corporations, public entities and institutions
around the world. With over 300 offices in over 100 countries, its global team of 15,800 associates serves clients in some 180
countries. Additional information on Willis Towers Watson may be found on its web site: www.willis.com
INTRODUCTION
CONTACT INFORMATION
Welcome to the Abt Associates Australia Pty
Ltd Expatriate Medical Insurance Plan.
Abt Associates Australia Pty Ltd has
implemented this plan with the aim of
providing you and your accompanying
dependents with comprehensive medical
cover whilst you are on assignment.
This booklet explains what benefits you can
expect to receive. Whilst the benefits are
comprehensive, there are some restrictions
and special conditions that apply to any
medical treatment received by Australians on
temporary return to Australia.
Some of the key issues affecting Australian
citizens have been highlighted and we
recommend you read these pages carefully in
order to familiarise yourself with the issues
and ensure that you have made appropriate
arrangements to avoid penalties.
All benefits payable are subject to the
conditions of the insurance policy issued by
Accident & Health International Underwriting
Pty Ltd.
You should read the Product Disclosure
Statement (PDS) and the Schedule of
Benefits carefully to ensure you understand
the benefits provided and limitations to this
cover.
Abt Associates Australia Pty Ltd
Level 2
5 Gardiner Close
MILTON QLD 4064
Contact:
Phone:
Fax:
E-mail:
Amelia Beaumont
+64 7 3114 4647
+61 7 3114 4661
[email protected]
Accident & Health International
Underwriting Pty Ltd
GPO Box 4213
SYDNEY NSW 2001
Phone:
+61 2 9251 8700
Fax:
+61 2 9251 8755
E-mail:
[email protected]
For Emergency Evacuation or Return Home, please
contact AHI Assist on +61 2 9978 6666
POLICY NUMBER: 0018374
ABT ASSOCIATES AUSTRALIA PTY LTD
Members Booklet 2016 - 2017
Page 1
GENERAL INFORMATION
WHO IS COVERED
Cover is for any person nominated by the insured for the insurance cover selected.
Cover under the Policy applies twenty four (24) hours per day, three hundred and sixty five (365) days per year
whilst an Insured Person is expatriated overseas on the business of the Insured.
For family cover, eligible dependents include your:

Spouse / Partner means an Insured Person’s husband or wife and includes a de-facto and/or life partner who
is living with the Insured Person.

Dependent Child(ren) means an Insured Person’s unmarried dependent children, stepchildren or legally
adopted children who are living with the Insured Person and who are under nineteen (19) years of age or under
twenty-five (25) years of age if they are a full-time student and primarily dependent on the Insured Person for
maintenance and support.
Coverage is limited to Insured Persons who are under seventy (70) years of age, unless otherwise agreed by the
Insurer and the Policy endorsed to reflect the change.
Unaccompanying family members remaining in your home country during the period of your secondment are not
covered under this Plan.
WHAT YOU ARE COVERED FOR
Coverage is afforded in respect of Inpatient (hospital) and Outpatient medical expenses, dental, optical and other
ancillary expenses as well as medical evacuation and repatriation benefits.
Medical treatment covers necessary expenses for outpatient medical. Dental, optical and other ancillary expenses
are reimbursed for both necessary and routine treatment. There are various sub limits for dental, optical and
ancillary benefits.
Further information is provided within the Table of Benefits.
MAXIMUM BENEFIT LIMITS
Some of the benefits listed in this booklet provide “Full Reimbursement” up to the specified annual limit of
$1,000,000, while other benefits are covered to a certain monetary level.
EXCESS OR DEDUCTIBLE
The annual excess or deductible is $250 per single or couple /family.
This means that the first part of any claims incurred must be covered by you before the policy responds.
Until the excess amount has been paid, you will still need to remit the details of the paid account so the claims
department can maintain a tracking sheet of your claims. When your incurred claims amount has reached $250, the
Plan will cover the additional costs in line with the Table of Benefits.
Please ensure all medical expense claims are submitted within SIX MONTHS of being incurred.
PRE-EXISTING MEDICAL CONDITIONS
Pre-Existing Medical Conditions are individually underwritten and not automatically covered.
ABT ASSOCIATES AUSTRALIA PTY LTD
Members Booklet 2016 - 2017
Page 2
SECTION 1 – MEDICAL EXPENSES
PART A – MEDICAL EXPENSES
EXTENT OF COVER
If an Insured Person sustains an Injury or suffers a Sickness or disease and incurs Medical Expenses (as defined)
during the Period of Insurance, the Insurer will pay those expenses incurred outside the Insured Person’s Country of
Domicile as detailed in the Table of Benefits, provided the Policy is in force. All payments are subject to the local
legislation in the Country of Domicile.
TABLE OF BENEFITS
POLICY LIMIT: $1,000,000 PER PERSON, PER PERIOD OF INSURANCE
PART
BENEFIT
SPECIFIED LIMIT PER PERSON PER
PERIOD OF INSURANCE
1.
MEDICAL EXPENSES – HOSPITAL IN-PATIENT
As a standard Private or Public Hospital In Patient or Day Patient for the following treatment classifications
Surgical Charges
Accommodation and Ancillary Charges
Doctor, Specialist and Nursing Charges
Consultations and Diagnostic Procedures
Intensive Care
Theatre Fees
Medical Supplies
100% of expense up to the Policy Limit
Psychiatric
Rehabilitation
Nursing Care
Special Dressings / Disposables and Prosthetic Implants
Physiotherapy
Pharmaceutical
Anaesthetic
Elective Surgery following an Accident or Illness
(accident or illness must occur after the Insured Person’s
Effective Date of Coverage)
2.
100% of expense to a maximum of $2,000
MEDICAL EXPENSES – NON HOSPITAL
Doctors Charges
Same Day Surgery / Anaesthetic
Tropical Screens
Specialist Consultations, Diagnostic Procedures and
Treatments
100% of expense up to the Policy Limit
Medical Imaging / Laboratory Examinations / X-ray /
Radiotherapy / Chemotherapy
Pathology Tests / Blood Tests and other approved medical
tests
Medical Supplies provided by Doctor, Nurse, Hospital or
Medical Clinic
Physician prescribed medicines including vaccinations and
immunisations following physician’s consultation.
100% of expense to a maximum of $1,000
ABT ASSOCIATES AUSTRALIA PTY LTD
Members Booklet 2016 - 2017
Page 3
PART
BENEFIT
3.
AMBULANCE SERVICE
SPECIFIED LIMIT PER PERSON PER
PERIOD OF INSURANCE
The arrangement for transport by road, aircraft or special air
ambulance to an appropriate medical centre if this is
required for treatment, accompanied if necessary by a
doctor or nurse.
4.
100% of expense up to the Policy Limit
MATERNITY CARE – PREGNANCY AND CHILDBIRTH
The pregnancy and childbirth benefits specified are only available if the child was conceived within the
Period of Insurance and after the Effective Date of the person being noted as an Insured Person under the
Policy.
5.
i)
Maternity Care including routine pre-natal, childbirth
and post-natal charges for the care of the mother
100% of expense to a maximum of $10,000
ii)
Emergencies and Complications (relating to pregnancy
and childbirth events)
100% of expense to a maximum of $10,000
iii)
Routine New Born Child expenses for the child from
birth to six (6) months of age (at which time the child
becomes a Dependant Child under the Policy)
100% of expense to a maximum of $10,000
DENTAL SERVICES
Dental Services
6.
85% of expense to a maximum of $1,200
SPECIAL DENTAL SERVICES (EMERGENCY DENTAL)
Dental Services and Treatments including Oral Surgery
required as the result of an Injury following an accident
during the Period of Insurance.
7.
100% of expense to a maximum of $3,000
OPTICAL BENEFITS
Eye Examination, Spectacles and Contact Lenses
8.
85% of expense to a maximum of $300
ANCILLARY SERVICES
Acupuncture/Naturopathy/Hypnotherapist
100% of expense to a maximum of $500
Chiropody/Podiatry
100% of expense to a maximum of $500
Chiropractor/Osteopath
$100 per visit to a maximum of $1,000
Dietician
100% of expense to a maximum of $500
Physiotherapy
$100 per visit to a maximum of $1,500
Home Nursing
$750 per week to a maximum of four (4)
weeks
Prostheses (not surgically implanted), hearing aids and
similar appliances, artificial aids, blood glucose meter,
nebuliser, orthotics, wheelchair, crutches, CPAP and similar
devices
9.
REHABILITATION AND OCCUPATIONAL THERAPY
Rehabilitation Expenses and Occupational Therapy
10.
100% of expense to a maximum of $1,000
100% of expense to a maximum of $10,000
PSYCHOLOGY AND PSYCHIATRY
Psychology and Psychiatry related claims
50% of expense to a maximum of $1,000
per single or per family
ABT ASSOCIATES AUSTRALIA PTY LTD
Members Booklet 2016 - 2017
Page 4
ADDITIONAL BENEFITS
Emergency Return Home
In the event of the unexpected death of the Insured Person’s Spouse/Partner Or Dependant Child(ren) or in the event
of them becoming Very Seriously ill, necessitating the Insured Person returning to their earlier Country of Domicile,
then subject to prior approval being obtain from the Insurer and/or AHI Assist, the Insurer will pay reasonable travel
and accommodation expenses incurred.
The maximum amount payable shall be $5,000.
Travel for Treatment
Non-emergency travel expenses are covered where treatment is not available in the Insured Person’s country of
assignment or where it is recommended that treatment be obtained outside of country of expatriation or return for
follow up treatment post evacuation, subject to such expenses being authorised by the emergency assistance
provider AHI Assist or the Insurer prior to such travel being undertaken.
Maximum limit $25,000 per person per policy period.
HIV / AIDS
AHI will not pay for any medical expenses or other expenses which relate to HIV/AIDS being contracted from a
sexually transmitted disease, otherwise cover will apply as follows;
-
Compensation will only be payable if the Insured Person is positively diagnosed within 180 days of the event
giving rise to the HIV infection
-
Compensation shall not be payable unless any event leading to or likely to lead to a positive diagnosis of
HIV is reported to the Insurer and medical tests are carried out by a registered and legally qualified medical
practitioner no more than 48 hours from the time and date of the event giving rise to the HIV infection
-
The medical tests (to be made by recognised laboratory and clinical tests) carried out in connection with this
benefit must prove conclusively that the Insured Person was not HIV positive at the time and date of the
event giving rise to the HIV infection. No compensation is payable if you fail to comply with or to provide the
required level of proof
Exclusions applicable to Section 1
The Insurer shall not pay for any claim under this section of the Policy if the claim arises directly or indirectly out of
any of the following:
1.
childbirth or pregnancy unless the Insured Person’s pregnancy commenced during the Period of Insurance and
after the Effective date of them being noted as an Insured Person under the Policy;
2.
medical expenses in Australia for which the Insured Person is eligible to claim Medicare benefits or able to
claim other benefits from any registered health fund of which the Insured Person is a member;
3.
medical expense in Australia for which the Insured Person is eligible to claim Medicare benefits which are
above the Government Schedule Fee or the “Medicare Gap” incurred for outpatient services;
4.
pharmaceutical supplies available through the Pharmaceutical Benefits Scheme (PBS) of Australia;
5.
non-prescription medicines available over the counter
6.
sterilisation, reversal or sterilisation and infertility treatment;
7.
elective surgery (any surgery which does not result from an injury or illness, including cosmetic, plastic and
reconstructive) except if it relates to birth and congenital malformations.
ABT ASSOCIATES AUSTRALIA PTY LTD
Members Booklet 2016 - 2017
Page 5
PART B – EMERGENCY EVACUATION
EXTENT OF COVER
Emergency Evacuation
1. The Insurer will pay for expenses related to an Emergency Evacuation if the Insured Person suffers a medical
condition and requires transportation to another location to receive necessary and appropriate medical attention
provided such evacuation is recommenced by a legally qualified medical practitioner and is authorised by the
Emergency Assistance Company or Accident & Health International Underwriting Pty Ltd.
a)
Payment of this benefit is subject to the Insured Person having sought and obtained the Insurer’s and the
emergency assistance company’s prior written agreement to pay for the cost of the transportation. To
facilitate this process written certification from the Insured Peron’s treating Doctor or Specialist should be
submitted to the emergency assistance company stating that the Injury or Sickness is of a critical nature
and it is necessary that specialised treatment or surgery is necessary and the treatment is not obtainable in
their current location.
b)
The emergency assistance company must be allowed to make the necessary transportation arrangements
on the Insured Person’s behalf. Failure to do so may result in the Insurer being prejudiced, in which case,
the Insurer may choose to pay what it would have cost the Insurer had the emergency assistance company
organised the transportation.
c)
Subject to medical clearance from the Insurer’s medical advisers, the Insurer may choose to repatriate the
Insured Person back to their Country of Domicile.
PART B – EMERGENCY EVACUATION
POLICY LIMITS
SPECIFIED LIMIT PER ANNUM
Emergency Evacuation of Insured Person
100% of expenses up to the Policy Limit
Accompanying Person for a Dependant Child
Reasonable return Airfare Charges for one (1) adult to
accompany an Insured Person under sixteen (16) years of
age requiring an Emergency Evacuation.
ABT ASSOCIATES AUSTRALIA PTY LTD
Members Booklet 2016 - 2017
Page 6
SECTION 2 – PERSONAL ACCIDENT
SUM INSURED
DEATH AND CAPITAL BENEFITS – EVENTS 1 - 19
EMPLOYEE: 7 x annual salary to
a maximum of
$500,000
EXTENT OF COVER
If as a result solely and directly of:
1. Injury, the Insured Person suffers from Temporary Total Disablement or any of the following Insured Events set
out in the Table of Benefits;
The Insurer will pay the compensation set out in that Table. However, all Insured Events including Disablement
must occur within twelve (12) months of the Injury or Sickness (as the case may be).
TABLE OF BENEFITS
INSURED EVENTS
THE COMPENSATION
being a percentage of the sum
insured stated in the Schedule
Injury resulting direct in:
1.
Death
100%
2.
Permanent Total Disablement
100%
3.
Permanent and incurable paralysis of all limbs
100%
4.
Permanent Total Loss of sight of both eyes
100%
5.
Permanent Total Loss of sight of one eye
100%
6.
Permanent Total Loss of use of two limbs
100%
7.
Permanent Total Loss of use of one limb
100%
8.
Permanent and incurable insanity
100%
9.
Permanent Total Loss of hear in:
a. both ears
b. one ear
100%
20%
10.
Permanent Total Loss of four fingers and thumb of either hand
80%
11.
Permanent Total Loss of the lens of one eye
60%
12.
Permanent Total Loss of use of four fingers of either hand
50%
13.
Third degree burns and/or resultant disfigurement which covers more
than 40% of the entire external body
50%
14.
Permanent Total Loss of use of one thumb of either hand
a. both joints
b. one joint
30%
15%
Permanent Total Loss or use of fingers of either hand
a. three joints
b. two joints
c. one joint
10%
8%
5%
Permanent Total Loss of use of toes of either foot
a. all – one foot
b. great – both joints
c. great – one joint
d. other than great, each toe
15%
5%
3%
1%
15.
16.
ABT ASSOCIATES AUSTRALIA PTY LTD
Members Booklet 2016 - 2017
Page 7
INSURED EVENTS
THE COMPENSATION
being a percentage of the sum
insured stated in the Schedule
17.
Fractured leg or patella with established non-union
10%
18.
Shortening of leg by at least 5cm
7.5%
19.
Permanent Disability not otherwise provided for under Insured Events
9 to 18 inclusive
Such percentage of the Sum
Insured as the Insurer shall in
their
absolute
discretion
determine being in their opinion
not
inconsistent
with
the
compensations provided under
Insured Events 9 to 18
inclusive.
The maximum
amount payable is $50,000
20.
Temporary Total Disablement caused directly and solely by Injury
During such Disablement, the
Weekly
compensation
as
specified or 85% of Your Salary
as defined whichever is the
lesser
21.
Temporary Partial Disablement caused directly and solely by Injury
40% of the amount payable for
Insured Event 20
22.
Broken Bone Benefits caused directly and solely by Injury
a. Neck or spine (full break)
b. Hip, pelvis
c. Skull, shoulder blade
d. Collar bone, upper leg
e. Upper arm, kneecap, forearm, elbow
f. Lower leg, jaw, wrist, cheek, ankle, hand, foot
g. Ribs
h. Finger, thumb, toe
Maximum compensation any one accident
$2,000
$500
$200
$200
$150
$100
$100
$50
$2,000
An example of a claim under Death & Capital Benefits, Events 1-19:
If an Insured Person selected $50,000 sum insured for Death & Capital Benefits Events 1-19 and suffered an Injury
result directly in death (Insured Event 1) the benefit received would be 100%, equalling $50,000
Should an Insured Person suffer an Injury resulting in permanent total loss of four fingers of either hand (Insured
Event 12), the benefit received would be 50%, equalling $25,000
ADDITIONAL BENEFITS
1.
Exposure
If as a result of an Injury occurring during the Period of Insurance You are exposed to
the elements and suffer from any of the Insured Events set out in the Table of
Benefits as a direct result of that exposure, the Insurer will pay compensation
accordingly.
2.
Disappearance
If You disappear following the disappearance, sinking or wrecking during the Period
of Insurance of a conveyance in which You were then travelling and Your body has
not been found within one (1) year after the date of disappearance, the Insurer will
pay a compensation on the assumption that You died as a result of an Injury at the
time of the disappearance, sinking or wrecking of the conveyance.
ABT ASSOCIATES AUSTRALIA PTY LTD
Members Booklet 2016 - 2017
Page 8
GENERAL CONDITIONS AND LIMITATIONS
1.
Compensation shall not be payable for more than one of the Insured Events 1-19 in respect of the same
Injury, in which case the highest compensations will be payable.
2.
Any compensation payable for Insured Events 1-19 shall be reduced by any sum already paid for Insured
Events 20 and 21 in respect of the same Injury.
3.
Compensation payable to Insured Persons under nineteen (19) years of age for Insured Events 1-19 shall
be 10% of the minimum sum Insured stated in the Table of Benefits unless otherwise specified.
4.
Weekly compensation for Temporary Total Disablement shall be limited to the Sum Insured stated in the
Schedule of 85% of Your Salary, whichever is the lesser. If You receive benefits from any other source the
Insurer’s payments will be reduced by those benefits and they will pay the difference up to 85% of Your
Salary. If you redeem or commute or settle your entitlement to benefits/income from any other source, the
Insurer payments under this Policy will immediately cease.
5.
The Insurer will pay one-seventh (1/7 ) of the Weekly compensation for each day of Disablement where
Disablement lasts for less than a week. However, no compensations are payable for Temporary Total
Disablement resulting from Sickness unless You have been disabled for not less than seven (7)
consecutive days.
6.
The Weekly compensation payable for Temporary Total Disablement shall be reduced by the amount of
any Workers’ Compensation entitlement or any other payment which You are entitled to receive from any
insurance policy.
7.
No Weekly compensation shall be payable for Disablement during the Deferral Period.
8.
No further compensation will be payable under this Policy and all cover under this Policy will cease if the
Insured Person:
8.1 becomes entitled to the payment of a Sum Insured being 100% of the Sum Insured stated in the
Schedule.
8.2 becomes entitled to the payment of Weekly compensation for the maximum period stated in the
Schedule. The maximum period is one hundred and four (104) weeks from the date of entitlement to
the payment of weekly compensation commences. The benefit period ceases at the expiration of the
maximum period. The maximum period commences from the time the Insured Person first sought
medical attention following Injury.
8.3 becomes entitled to both a Sum Insured stated in the Schedule and Weekly compensations and is
paid 100% of the Sum Insured stated in the Schedule and Weekly compensations for the total period
stated in the Schedule.
9.
No compensations are payable unless as soon as possible after the happening of any Injury or Sickness
the Insured Person obtains and follow medical advice from a legally qualified medical practitioner. The
Insured Person’s benefit commences from the time medical attention was first sought following their Injury.
10.
The Insurer may request a progressive claim form be completed by the Insured Person’s attending
physician or specialist.
11.
All Weekly compensations shall be paid monthly in arrears.
12.
All compensations shall be paid to the Insured Person, or in the case of the Insured Person’s death, to their
legal personal representative.
th
Exclusions Applicable to Section 2 – Personal Accident
No compensations are payable under this Policy for any Insured Event resulting from Injury or Sickness:
1. which is attributable wholly or partly to childbirth or pregnancy or the complications of these;
2. which results from the Insured Person being under the influence of alcohol or an illegal drug or there is more
alcohol or drugs in the Insured Person’s blood than the law permits;
3. which results from any Pre-Existing Condition (as defined);
4. where sick leave payments are received.
ABT ASSOCIATES AUSTRALIA PTY LTD
Members Booklet 2016 - 2017
Page 9
SECTION 3 – EVACUATION COVER AND
PERSONAL SAFETY
SUM INSURED
$25,000 any one evacuation or emergency situation
An Insured person is entitled to the services of AHI Assist in the Event of an emergency evacuation. It is
recommended you contract the Insurer’s authorised security and political assistance company, AHI Assist for advice
and management of the evacuation or situation.
To contact AHI Assist in an Emergency, call:
+61 29978 6666
EXTENT OF COVER
1. If an Insured Person, during the Period of Insurance, is in a country or region that Australian officials recommend
certain categories or persons (which include the Insured Person) in that country or region should leave because
of:
a.
b.
a security threat such as insurrection, war, rebellion, civil unrest or political instability,
or
a natural disaster such as earthquake, cyclone, flooding or volcanic eruption,
after the Insured Person has arrived in the country or region and it is unsafe for the Insured Person to remain in
the country or region,
The Insurer will pay:
1.1 the cost of evacuating the Insured Person to the nearest place of safety, and the reasonable cost of
accommodation, up to a maximum of five hundred ($500) dollars per day any one Insured Person to a
maximum of fourteen (14) days any one event; or
1.2 when necessary, the reasonable cost of returning the Insured Person to their country of domicile if
commercial flights are unavailable; or if commercial flights are available the cost will be limited to a direct
business class flight; and
1.3 provided the evacuation is authorised by Accident & Health International or AHI Assist.
2. If an Insured Person, during the Period of Insurance, is in an emergency situation where their personal safety
and security is at risk, the Insurer will provide assistance where possible and pay the reasonable and necessary
expenses incurred for each Insured Person. The emergency situation must be unforeseen and outside the
control of the Insured or the Insured Person and the expenses must be authorised by Accident & Health
International or AHI Assist.
However, the Insurer will not pay in excess of two hundred and fifty thousand ($250,000) dollars for any one
evacuation or emergency situation for all persons covered under the Policy.
Exclusions Applicable to Section 3 – Evacuation Cover and Personal Safety
The Insurer shall not be liable for claims arising from:
1. Expenses related to evacuation out of a country which the Insured Person has travelled to after the Australian
Department of Foreign Affairs and Trade (DFAT) has issued a Travel Warning which recommends that
travellers do not undertake travel at all, i.e. Do Not Travel. Such Travel Warning information can be acquired
by contacting the Australian Embassy in the country travel is anticipated or DFAT in Canberra or via the
Insurer website address: www.acchealth.com.au
2. Expenses related to evacuation out of a country or region which the Insured Person has remained in after the
Australian Department of Foreign Affairs and Trade (DFAT) has issued a Travel Warning which recommends
that travellers should leave the area and such warning or recommendation has been ignored. Such Travel
information can be acquired by contacting the Australian Embassy in the country travel is anticipated or DFAT
in Canberra or via the Insurer website address: www.acchealth.com.au
ABT ASSOCIATES AUSTRALIA PTY LTD
Members Booklet 2016 - 2017
Page 10
IMPORTANT INFORMATION
(FOR AUSTRALIAN EXPATRIATES)
MEDICARE / MEDICARE LEVY SURCHARGE
All Australian expatriates, eligible for Medicare, are affected by measures, introduced through legislation by the
Commonwealth Government, designed to encourage Private Health Fund membership. Things to note include:

Expatriate Australian citizens who have resided outside the country for less than five (5) years still retain
their entitlement to Medicare.

Expatriate Australian citizens, who continue to lodge a tax return in Australia, may be liable for the Medicare
Levy Surcharge (MLS).
This legislation is not a matter of choice and doesn’t stop at the border. There are no exceptions.
The Expatriate health plan does not qualify as an “appropriate” policy under the Medicare Levy Surcharge
definition, hence does not offer an exemption.
Your personal circumstances should be checked with your accountant and/or the Australian Taxation Office. For
more information about the Medicare Levy Surcharge, please visit the ATO website: www.ato.gov.au
PERMANENT RETURN TO AUSTRALIA
On your permanent return to Australia, you will no longer be covered under the Expatriate policy.
To ensure continuity of private health fund cover, you will need to enrol into the Continuation Option via
Willis Towers Watson, to which you are guaranteed membership or make arrangements with your own
health fund.
The continuation option will recognise the period of time spent on the Expatriate policy.
Please note, we cannot guarantee that other health funds will recognise this plan for continuity purposes.
You must enrol within 28 days after permanent return.
If you do not enrol in a Registered Private Health Insurance Fund on your permanent return to Australia you may
jeopardise your entitlement to continuity of private health fund cover. This means you may be required to serve
waiting periods before the health insurer will reimburse you for the costs of certain treatments, including costs
associated with pre-existing medical conditions.
You will also be subject to the Medicare Levy Surcharge (MLS) for days without private health fund membership
starting from the date of your permanent return.
Australian citizens who have been residing outside of Australia for more than 5 years will be required to reestablish their residency status upon permanent return. Once residency status is confirmed Medicare eligibility
will be reinstated.
Please go to www.humanservices.gov.au/medicare for further information about Medicare and how this may
apply to you.
ABT ASSOCIATES AUSTRALIA PTY LTD
Members Booklet 2016 - 2017
Page 11
HOW TO CLAIM
HOW TO CLAIM OUT-PATIENT MEDICAL EXPENSES
For settlement of Out of Hospital/Outpatient Medical Expenses, you will need to pay the expenses up-front and
then seek reimbursement from the Insurer. This is undertaken either by:
Mail
Posting the required documents* to the following:
Accident & Health International Underwriting Pty Ltd
GPO Box 4213
SYDNEY NSW 2001
Email
Lodge the required documents via the following address:
[email protected]
24 hour Helpline
AHI Assist offers a 24 hour/365 days a year service helpline at the following:
Tel: +61 2 9978 6666
*Documentation required to be provided when claiming expenses includes the following:
1.
A completed claim form, along with copies of receipts for all medical, hospital and pharmaceutical expenses,
etc. (Originals may be requested). Please submit your claims within 6 months of the expense being incurred.
2.
The actual medical account which contains specific item codes and treatment codes that are required to
assess your claim.
HOW TO ARRANGE HOSPITAL INPATIENT OR DAY SURGERY
If you are about to undergo emergency or planned surgery or you are pregnant, it is advisable that you contact
AHI Assist as soon as possible.
AHI Assist
Phone: +61 2 9978 6666
Available 24 hours a day / 7 days a week
Most hospitals will require full payment or a guarantee of payment for treatment or services prior to providing their
services and treatment. AHI Assist will be able to liaise directly with the hospital to arrange admission, guarantee
of payment and settlement on discharge. This will assist you in not having any up-front payment of expenses for
hospital treatment.
NORMAL HOSPITALISATION IN HOME COUNTRY
Although there are no limitations afforded for treatment received in your home country, please note that local
legislation dictates what insurers can provide cover for. All benefits under this Plan will exclude any amount
payable/recoverable from Medicare or any other similar Government sponsored fund, plan, or medical benefit
scheme.
This is of particular relevance to Australians who choose to receive treatment in Australia. All Medicare claimable
expenses (either in whole or part) are required to be lodged with Medicare and cannot be claimed under this
policy.
This includes any resultant Medicare “GAP” which by law cannot be paid by anyone other than a registered
Australian Health Fund. Cover afforded in these instances, is therefore limited to principally non Medicare/medical
related expenses.
Unless as a result of a medical evacuation, please note that the cost of airfares and other travel costs associated
with returning home will be the responsibility of the Insured Person.
ABT ASSOCIATES AUSTRALIA PTY LTD
Members Booklet 2016 - 2017
Page 12
CLAIMS PROCESS
– CLAIMS INCURRED OVERSEAS
INSURED PERSON
Requires necessary
medical attention
Major medical emergency or
Hospitalisation
Contact AHI Assist, 24 hours a
day
Phone: +61 2 9978 6666







Complete claim form

Attached original receipts

Attach referral documents

Forward to postal address on
claim form
Insured person reimbursed in
accordance with the plan benefits
Advise of:


Day to day medical services
Membership number
Person requiring
assistance – name, age
and gender
Caller – name, location and
relationship
Location of insured person
– country, address and
contact number
Reason for assistance
Hospital/clinic details
Treating doctor details
Home doctor details
AHI Assist will make all of the
necessary arrangements based
on the severity of the medical
condition involved.
AHI Assist reimbursed directly by
insurer for advisory services in
general and medical evacuation
expenses in particular
ABT ASSOCIATES AUSTRALIA PTY LTD
Members Booklet 2016 - 2017
Page 13
– CLAIMS INCURRED IN AUSTRALIA
INSURED PERSON
Requires necessary
medical attention
Essential medical and public
hospital care



Hospital accommodation,
dental, optical and ancillary




Submit claim to Medicare
Include original receipts
Include referral documents
Insured person reimbursed to the
prescribed percentage of the
Medicare schedule fee
Complete claim form
Attached original receipts
Attach referral documents
Forward to postal address on
claim form
Insured person reimbursed in
accordance with the plan benefits.
PLEASE NOTE:
It is illegal for an Insurer or
an Employer to pay the
Medicare ‘GAP’ in hospital
or for doctors’
consultations
If a claim is denied by Medicare,
submit your accounts to the
Expatriate Plan insurer who will
reimburse insurable claims in
accordance with the Policy.

Include the denial letter
from Medicare

Include original receipts

Include referral documents
ABT ASSOCIATES AUSTRALIA PTY LTD
Members Booklet 2016 - 2017
Page 14
FREQUENTLY ASKED QUESTIONS
(AUSTRALIAN EXPATRIATES)
1. What do I need to do with Medicare prior to departure?
You will not need to do anything. As an Australian expatriate you automatically retain entitlement to
Medicare for a 5 year period whilst in Australia on temporary return.
2. What are the Lifetime Health Cover (LHC) implications of living overseas?
If you have private health insurance hospital cover and are going overseas, there are two ways to cease
paying for your hospital cover during the period you are overseas without incurring a LHC loading on your
private hospital insurance.
i)
Suspension
You can apply to your health insurer for a suspension of your private hospital insurance. Periods of
suspension may be granted at the discretion of your insurer. Your insurer decides how long the
suspension will be. For LHC purposes, periods of suspension count as periods with private hospital
insurance. You do not pay a loading for any period you were granted a suspension.
ii) Cancellation
If you will be overseas for at least 12 months, you can cancel your private hospital insurance and when
you return to Australia you do not have to pay a loading to cover your period overseas. This is different
from suspension because it lasts as long as you are overseas – your insurer does not decide how long
you can cancel for.
You can return to Australia for visits up to 90 days at a time and you will still be considered to be overseas.
When you return to Australia for a period longer than 90 days you will be taken to be using your 1094
“permitted days without hospital cover” from when you return until when you take out hospital cover. If you
exceed your “permitted days without hospital cover” i.e. remain without hospital cover for a period longer
th
than 1094 days after your return to Australia, you will incur a LHC loading on the 1095 day.
If you commence private health insurance after you return, your insurer may ask you to provide evidence of
your period overseas. You can obtain a copy of your international movement record from the Department of
Immigration and Citizenship.
3. Does expatriate health insurance include coverage for maternity costs and can I
choose to have the baby back in Australia?
Under this plan you are able to have the baby in Australia however travel and accommodation are at your
cost. Please see later regarding the impact of Medicare on the costs that you can claim for under this policy.
4. Who decides whether medical repatriation is necessary and will I be repatriated
to Australia?
Emergency medical evacuation means an evacuation from the location at the time of the life threatening
Injury or Sickness which is recommended by a Medical Practitioner as being medically necessary to obtain
appropriate medical attention for the Injury or Sickness and which is authorised by the Emergency
Assistance Company or insurer. This will be to the nearest place where appropriate treatment can be
obtained which may not be Australia.
5. How am I covered on temporary return in Australia?
Expatriate Australian citizens who have resided outside the country for less than 5 years still retain their
Medicare entitlement. Any expenses incurred for Medicare eligible items such as GP, Specialist, etc can be
claimed from Medicare only. Private Hospital accommodation (including theatre fees) and ancillary benefits
will be covered under the Plan.
If you have been residing outside of Australia for longer than 5 years, then the Plan may respond for all
expenses, however medical expenses will have to be lodged with Medicare in the first instance.
ABT ASSOCIATES AUSTRALIA PTY LTD
Members Booklet 2016 - 2017
Page 15
6. What in-patient cover does Medicare provide?
Whilst on temporary return to Australia, if you choose to be admitted as a public (Medicare) patient in a
public hospital, you will receive treatment by doctors and specialists nominated by the hospital. You will not
be charged for care and treatment, or after-care by the treating doctor.
If you are admitted as a private patient in a public or private hospital, you will have a choice of doctor who
treats you. Medicare will pay 75% of the Medicare Schedule fee for services and procedures provided by the
treating doctor.
You will be charged separately for hospital accommodation and items such as theatre fees and medicines.
These costs will be covered by the Plan.
7. Can I travel overseas with PBS medicine?
If you are planning a trip overseas, organising your medicine is one of the most important things you can do.
However taking or sending PBS subsidised medicine out of Australia that is not for your own personal use or
the personal use of someone travelling from Australia with you is illegal.
For further information, please refer to the following link:
http://www.humanservices.gov.au/customer/services/medicare/travelling-overseas-with-pbsmedicine?utm_id=9
ABT ASSOCIATES AUSTRALIA PTY LTD
Members Booklet 2016 - 2017
Page 16
WHAT YOU ARE NOT COVERED FOR
General Exclusions applicable to the Policy
1.
Result from the Insured Person engaging in or taking part in or training for any professional sports of any
kind;
2.
Are recoverable by the Insured or the Insured Person from any other source to the extent to which they
are so recoverable;
3.
Are caused by or arising out of the Insured Person engaging in air travel except as a passenger in any
properly licensed aircraft;
4.
Relate to a deliberately self-inflicted injury, including suicide or attempted suicide whether sane, insane or
under any mental distress;
5.
Relate to War, invasion, acts of foreign enemies, hostilities (whether war be declared or not), civil war,
rebellion, revolution, insurrection or military or usurped power in the Insured Person’s Country of
Expatriation, Iraq or Afghanistan;
6.
Are caused by or arising out of the use, existence or escape of nuclear weapons material or ionising
radiation from or contamination by radioactivity from any nuclear fuel or nuclear waste from the
combustion of nuclear fuel;
7.
Result from losses arising from nuclear, chemical or biological terrorism. Terrorism includes, but is not
limited to, any act, preparation in respect of action or threat of action, designed to:
a. influence a government or any political division within it for any purpose, and/or
b. influence or intimidate the public or any section of the public with the intention of advancing a political,
religious, ideological or similar purpose;
8.
Result from the Insured Person engaging in or taking part in naval, military or air force service or
operations;
9.
Result from a criminal or illegal act committed by the Insured or the Insured Person;
10. Relate to a sexually transmitted disease, or Acquired Immune Deficiency Syndrome (AIDS) disease or
Human Immunodeficiency Virus (HIV) infection (unless HIV / AIDS is contracted by means other than
sexually).
ABT ASSOCIATES AUSTRALIA PTY LTD
Members Booklet 2016 - 2017
Page 17
DEFINITIONS UNDER THE POLICY
General Definitions applying to the Policy
COUNTRY OF DOMICILE means the country in which the Insured Person would normally reside if not but for
the Insured Person’s period of expatriation. It is usually the country in which the Insured Person is considered
to be a “resident” outside of the Insured Person’s country of expatriation. It is normally the country from which
the Insured Person departed in order to commence the period of expatriation, or is the country to which the
Insured Person will be expected to return to following the completion of their period of expatriation. Please note
that for the purpose of this policy the Insured Person is considered to only have one country of domicile.
Important: When receiving treatment in the Insured Person’s Country of Domicile the benefits provided under
this policy may be governed or limited by local legislation. If this is the case then the respective local legislation
or regulations will prevail over the terms and conditions of the policy.
COUNTRY OF EXPATRIATION means the country named in the Schedule of Insured Persons and is the
country in which you will spend most of your time overseas. It does not mean Your Country of Domicile.
DEFERRAL PERIOD is the period stated in the Schedule during which no Benefits are payable for Temporary,
Total or Partial Disablement (applies to Section 2 – Personal Accident)
DENTAL SERVICES means expenses incurred and made to a duly qualified oral surgeon or Dentist for
examinations, scaling and cleaning, applications of fluoride, composite resin filling, dental filling and
restorations, diagnostic services, x-rays, endodontics, periodontics, oral surgery and injections and extractions
of teeth.
DEPENDANT CHILDREN means the unmarried Dependant Children of the Insured Person, who are residing
with the Insured Person in the Country of Expatriation, are under nineteen (19) years of age or under twentyfive (25) years of age whilst they are a full time student at an accredited institution of higher learning and
primarily dependent on the Insured Person for maintenance and support. Dependant Children includes step or
legally adopted children.
DOCTOR means a legally qualified and registered medical practitioner and who is not an Insured Person or a
relation of the Insured Person.
EMERGENCY ASSISTANCE COMPANY means AHI Assist.
FAMILY means the Insured Person’s Spouse, Partner or De-facto and any unmarried dependent children,
stepchildren or legally adopted children who are living with the Insured Person and who are under nineteen (19)
years of age or under twenty-five (25) years of age if they are a full-time student and primarily dependent on the
Insured Person for maintenance and support.
INSURED PERSON means any person nominated by the Insured from time to time for the insurance cover
selected by the Insured and with respect to whom a premium has been paid as per a), b) and c) below:
a)
b)
c)
if the Single Plan is selected, the person named in the Schedule of Insured Persons;
if the Couple Plan is selected:
i. the person named in the Schedule of Insured Persons and his or her Spouse, Partner or De-facto; or
ii. if the Insured Person does not have a Spouse or Partner and requires pregnancy cover the Couple
Plan must be selected 12 months prior to the first date of claim;
if the Family Plan is selected, the person covered under a) and b) above and their Dependent Children,
providing the Insurer has agreed to cover the person(s) referenced above and the premium required for
such person(s) has been paid or agreed to be paid to the Insurer. The Family Plan must be selected on
the birth of a new-born.
INSURED PERSON’S CANCELLATION DATE means:
a) the date the Policy is cancelled
b) the date of termination of the Insured Person’s expatriate contract or employment
c)
the date the Insured Person or the Insured advised that the Insured Person is no longer to be covered
under this Policy.
ABT ASSOCIATES AUSTRALIA PTY LTD
Members Booklet 2016 - 2017
Page 18
General Definitions applying to the Policy (continued)
NUCLEAR, CHEMICAL OR BIOLOGICAL TERRORISM means terrorism which includes, but is not limited to,
any act, preparation in respect of action or threat of action designed to:
a.
Influence a government or any political division within it for any purpose, and/or
b.
Influence or intimidate the public or any section of the public with the intention of advancing a political,
religious, ideological or similar purpose.
SPECIAL DENTAL SERVICES means emergency or urgent dental treatment from trauma of the face, mouth or
teeth after a recent accident or injury which occurs during the Period of Insurance.
SPECIALIST means a Doctor recognised and referred to by another Doctor for his or her experience,
qualification and training in a particular branch of medicine or surgery or in the treatment of a specific Injury or
Sickness and who is not an Insured Person or a relation of the Insured Person.
SPOUSE means the husband or wife or any de-facto partner of the Insured Person, who is residing with the
Insured Person in the Country of Expatriation.
Definitions applying to Section 1 – Medical Expenses
EMERGENCY EVACUATION means an evacuation due to medical treatment being immediately required and
the medical condition being sudden and life threatening.
MEDICAL EXPENSES means expenses incurred and paid to a legally qualified medical practitioner, nurse,
hospital or ambulance service for medical surgery, hospitalisation or nursing treatment including the cost of
medical supplies and ambulance hire as per the Table of Benefits.
OCCUPATIONAL THERAPY means occupational therapy expenses incurred and paid to a legally qualified
Occupational Therapist provided such occupational therapy is undertaken with the Insurer’s prior written
agreement and the agreement of the Insured Person’s attending physician. Expenses will only be paid
following an injury to an Insured Person during the Period of Insurance.
PRE-EXISTING CONDITION means any condition for which within the twelve (12) consecutive months period
prior to the Effective Date the Insured Person:
a.
has consulted a Doctor or Specialist, or
b.
received treatment or advice for treatment or medication or were prescribed medication; or
c.
the manifestation of symptoms would have caused a reasonable person to seek medical advice.
It also includes any condition known to the Insured Person prior to the Effective Date under this Policy and
where they:
i)
are on a waiting list for treatment
ii)
are travelling for the purpose of obtaining treatment (even when this is not the sole reason for the travel);
iii) have received a terminal prognosis;
iv) have been recommended to continue or to commence any medical treatment or medication after the
Effective Date
REHABILITATION EXPENSES means expenses paid for tuition or advice from a licensed vocational school,
provided the tuition or advice is undertaken with the Insurer’s prior written agreement and the agreement of the
Insured Person’s attending physician. Expenses will only be paid following an injury to an Insured Person
during the Period of Insurance.
TABLE OF BENEFITS specifies maximum annual benefit amounts for specific treatments.
ABT ASSOCIATES AUSTRALIA PTY LTD
Members Booklet 2016 - 2017
Page 19
Definitions applying to Section 2 – Personal Accident
DEFERRAL PERIOD means the period stated in the schedule during which no Benefits are payable for
Temporary, Total or Partial Disablement.
GUARANTEED INCOME means the Insured Person’s income that can be proven or substantiated.
INCOME means
a.
the Insured Person is an employee, their gross weekly rate of pay exclusive of bonuses, commission,
overtime payments and any allowances;
b.
if the Insured Person is not an employee, their gross weekly Income derived from personal exertion after
deducting any expenses necessarily incurred by deriving that Income.
INJURY means bodily injury resulting from an accident which is an external event that occurs fortuitously to the
Insured Person during the Period of Insurance and results in any of the Insured Events specified in the Table of
Benefits within twelve (12) calendar months from the date thereof. Injury does not include:
a.
any consequences of an Injury which are ordinarily described as being a disease including but not limited
to any congenital condition, heart condition, stroke or any form of cancer;
b.
an aggravation of a pre-existing injury;
c.
any other Pre-Existing Condition;
d.
any degenerative condition.
LOSS OF USE means loss of, by physical severance, or total and permanent loss of the effective use of the
part of the body referred to in the Table of Benefits.
PERMANENT in relation to disablement means disablement lasting at least twelve (12) consecutive months,
and at the end of that time being beyond hope or improvement.
PRE-EXISTING CONDITION means:
1.
in respect of injury:
a condition with which the Insured Person was aware of (whether diagnosed or not) or has sought
treatment prior to the inception of his or her Policy.
2.
in respect of Sickness
i. a condition or side-effect with which the Insured Person was aware of (whether diagnosed or not) or
has sought treatment prior to the inception of his or her Policy. If any form of cancer is a Pre-Existing
Condition, then there is no cover for cancer or cancer-related conditions.
ii a condition caused by a Pre-Existing Condition
Any medical condition that the Insured Person has suffered from or been treated for, irrespective of whether a
complete recovery has occurred, is still treated as a Pre-Existing Condition
SALARY means
a.
the Insured Persons Guaranteed Income for the twelve (12) months following the Injury or Sickness
b.
if the Insured Person does not have a Guaranteed Income for the twelve (12) months following the Injury
or Sickness, then the average of Income (as defined) for the preceding twelve (12) months shall be
applied or over such shorter period provided that the continuous employment has occurred or the Insured
Person has been engaged in their occupation or business for a period of at least three (3) months.
c.
If a. or b. above are not met, then the Salary shall be Nil.
SICKNESS means illness or disease which is not a Pre-Existing Condition and which must continue for a period
of note less than seven (7) days from the date the Insured Person first sought treatment for the Sickness from a
legally qualified medical practitioner
TABLE OF BENEFITS specified maximum benefit amounts for specific Insured Events
TEMPORARY PARTIAL DISABLEMENT means disablement which entirely prevents the Insured person from
carrying out a substantial part of the duties normally undertaken in connection with the Insured Person’s usual
occupation or employment.
ABT ASSOCIATES AUSTRALIA PTY LTD
Members Booklet 2016 - 2017
Page 20
Definitions applying to Section 2 – Personal Accident (continued)
TEMPORARY TOTAL DISABLEMENT means disablement which entirely prevents the Insured Person from
engaging in their usual occupation or employment.
TOTAL DISABLEMENT means disablement which entirely prevents the Insured Person from engaging in their
usual occupation or employment, or any other occupation or employment for which the Insured Person is suited
by reason of education, training, experience, or skill. Or, if not employed, entirely prevents the Insured Person
from engaging in any and every occupation for the rest of their life.
Definitions applying to Section 3 – Evacuation Cover and Personal Safety
EMERGENCY means any time the Insured Person’s personal safety is at risk or is perceived to be at risk.
EMERGENCY ASSISTANCE COMPANY means AHI Assist.
EVACUATION means the transportation of the Insured Person to the nearest place of safety.
ABT ASSOCIATES AUSTRALIA PTY LTD
Members Booklet 2016 - 2017
Page 21
IMPORTANT NOTICES
Please read these notices carefully. If there is anything in them that you do not understand or if you
would like any further information, please contact us.
General
Material Change of Risk
Many areas of insurance are complex and some
implications may not be evident to you. Your Client
Servicer will keep you informed, but if at any time you are
unsure of any aspect of your insurances, please contact
Willis Towers Watson to discuss the matter.
Many policies require you to notify the Insurer in writing
of any material change to the insured risk during the
period of insurance. The Insurer can then decide
whether to cover the new risk. Some examples of
material changes are if you:
 change your profession or occupation;
 acquire or merge with another business;
 commence manufacturing plastics, or commence
woodworking activity;
 commence manufacturing a new kind of product;
 are unable to pay your debts as they fall due and you
enter into an arrangement with your creditors.
If you are in any doubt as to whether the Insurer should
be told about any particular change to the insured risk,
please ask us.
Utmost Good Faith
A contract of insurance is a contact of the utmost good
faith. This means that you and the Insurer must act
towards each other, in respect of any matter arising
under or in relation to the contract, with the utmost good
faith. For example:
 you must act with the utmost good faith when
submitting any claim to the Insurer
 if you fail to act towards the Insurer with the utmost
good faith, it may prejudice the claim; and
 the Insurer must act with the utmost good faith when
handling the claim.
Your Duty of Disclosure
You and everyone who is insured under your policy must
comply with the duty of disclosure. Make sure you
explain the duty to any other insureds you apply on
behalf of.
The duty requires you to tell the Insurer certain matters
which will help it decide whether to insure you and, if so,
on what terms. The duty applies when you first apply for
your policy and on any renewal, variation, extension or
replacement of the policy. i.e. This is an ongoing
responsibility throughout the duration of the policy.
The type of duty that applies can vary according to the
type of policy.
If we act on your behalf, to assist us in protecting your
interests, it is important that you tell us every matter that
you know or a reasonable person in the circumstances
could be expected to know, is relevant to the Insurer's
decision whether to insure you and, if so, on what terms.
We will then assist you in determining what needs to be
disclosed to the Insurer in order to meet your duty.
If we act on behalf of the Insurer, you need to refer to the
policy which will set out the duty that applies.
When you answer any questions asked by the Insurer,
you must give honest and complete answers and tell the
Insurer, in answer to each question, about every matter
that is known to you and which a reasonable person in
the circumstances could be expected to have told the
Insurer in answer to the question.
Examples of matters that should be disclosed are:
 any claims you have made in recent years for the
particular type of insurance;
 refusal by an Insurer to renew your policy;
 any unusual feature of the insured risk that may
increase the likelihood of a claim.
If you (or anyone who is insured under the policy) do not
comply with the duty, the Insurer may cancel the policy or
reduce the amount it pays in the event of a claim. If the
failure to comply with the duty is fraudulent, the Insurer
may treat the policy as if it never existed and pay
nothing.
General Advice Warning
It is important that you understand and are happy with
the policies Willis Towers Watson can arrange for you.
Any recommendations we have made have been based
on a consideration of the premium quoted and the scope
of cover offered by an Insurer. We can give you general
information to help you decide but unless we have
specified otherwise, we have not advised you on whether
the terms are specifically appropriate for your individual
objectives, financial situation or needs. We therefore
recommend that you should carefully read the relevant
Product Disclosure Statement and other information
before deciding.
Interests of Third Parties
Many policies do not cover the interests of third parties
(eg co-owners, lessors and mortgagees) whose interest
is not noted on the policy. If you require the interest of
any third party to be covered, please let us know, so that
we can ask the Insurer to note that Party’s interest on the
policy.
Recovery Rights / Hold Harmless / Waiver of
Subrogation
Many policies exclude or limit the Insurer's liability if you
have entered, or enter, into an agreement that excludes
or limits your rights of recovery against third parties
whose acts, errors, omissions or other conduct have
caused or contributed to your loss or liability. (These are
often called "hold harmless" agreements.)
If you have entered, or consider entering, such an
agreement, please let us know, so that we can advise
you about how the agreement affects, or will affect, your
cover.
Financial Services Guide (FSG)
Our FSG contains important information about our
relationship with you. A copy of our FSG can be obtained
by contacting your Client Servicer, or from our website at
www.willis.com.au
ABT ASSOCIATES AUSTRALIA PTY LTD
Members Booklet 2016 - 2017
Page 22