TRIPLE S (SPOUSE)
INSURANCE
LIMITATIONS
Fact Sheet
Spouse members of Triple S have the option to purchase one or more units of voluntary
Death insurance cover. This fact sheet tells you about what happens when you apply
and how limitations work.
For information on Death insurance please see the “Spouse Members and Spouse
Accounts” fact sheet, available on the website and from Super SA.
What is underwriting?
If you apply for Death insurance, you are required to provide Super SA with information
about your medical history, which will allow us to assess the risk involved in providing
the cover you have requested. This process is known as underwriting. Insurance
providers, including Super SA, use the underwriting process to ensure all scheme
members are treated equitably and that the provider is covering an acceptable level of
risk.
Applying for insurance
When you apply for Death insurance you will be asked to complete an “Application for
Voluntary Death Insurance – Spouse Members” form, which includes a short personal
statement about your health. This asks for details of your personal medical history and
information about any activities, illnesses or injuries that are likely to increase the
probability that a claim will be made. It is very important that you provide all relevant
information and answer all questions in full. Upon reviewing this information in
consultation with our medical adviser, Super SA decides on the acceptance terms for
your insurance.
Triple S - exceptional quality!
Super SA is committed to meeting your needs and
providing you with the best value for money.
That’s why we’re proud that Triple S, the super
scheme for SA public sector employees, has been
recognised as an exceptional quality super scheme
by two independent financial services research and
ratings companies.
SuperRatings has once again awarded Triple S its
highest possible Platinum rating, naming it a “best
value for money” super scheme. Chant West has
recognised Triple S as a quality super scheme with
its highest rating of 5 Apples.
Here are just some of the reasons Triple S is an
exceptional quality super scheme:
– We’ve got the strength of more than 169,000
members.
– We’re not for profit so we don’t charge you huge
fees.
– We don’t use an external insurance provider so we
can keep insurance costs low.
On completion of this underwriting process, Super SA will advise you in writing of your
insurance cover and any applicable acceptance terms. A limitation for certain preexisting medical conditions may form part of these acceptance terms. You should be
notified of your insurance cover within three weeks of Super SA receiving your
application.
What are limitations?
Insurance is designed to cover future unforeseeable events. Some of us are, however,
more likely to make a claim than others, and Super SA needs to place limitations on
certain pre-existing medical conditions and activities that increase the risk of a claim
being made, such as heart disease and smoking.
Telephone (08) 8207 2094 (for calls from within
the State Government Network)
or 1300 369 315
Fax (08) 8226 0593
Website www.supersa.sa.gov.au
Email [email protected]
The Chant West ratings logo is a trademark of Chant West
Pty Limited and used under licence.
Last updated
January 2011
Page 1 of 3
TSFS34
Limitations are used to ensure that Super SA is not put at risk for foreseeable events
that are caused by an already existing injury or illness. A limitation relates to an
increased risk of the likelihood that a member will make a claim. For example, a person
who has heart problems, now or in the past, is more likely to suffer heart disease in the
future than a person who doesn’t have heart problems. Super SA’s medical adviser is
skilled in determining which medical conditions are likely to lead to future claims.
If you do have a limitation placed on your insurance, it is important to remember that
you are still covered in the event of your death caused by unforeseeable illness or
injury.
The underwriting process ensures
that all Triple S members are
insured on fair terms.
Why does Super SA use limitations?
Super SA has a responsibility to protect the financial interests of all members. The
underwriting process ensures that all Triple S members are insured on fair terms. It
generally means that we can cover more people on terms that are mutually
acceptable and still be around in 10, 20, 50 years or more to honour any future
insurance claims. These limitations are fundamental in maintaining the viability of our
insurance cover.
What does the limitation mean for me?
If Super SA places a limitation on your Death insurance cover, any future claims
which are medically connected to your limitation will be denied. During the claim
process, Super SA will ascertain if there is a connection when reviewing your
medical history and will seek expert medical opinions. If there is a proven connection
between your limitation and your death, any claim for insurance cover with the
limitation attached will be declined.
Does Super SA use “premium loadings”?
Unlike many insurance providers, Super SA does not load, or increase premiums, for
members who have certain conditions or for different types of jobs.
Can I have my limitation reviewed?
If Super SA has applied a limitation to your insurance cover and you would like this
reviewed, you should discuss your situation with your doctor and request that your
doctor provide up-to-date medical information that supports that the condition is no
longer present, or will cause no risk in the future. Super SA will then forward this
information to our medical adviser for review.
If your medical condition is being controlled with the use of medication the limitation
will not be removed, as the medical condition still exists.
Super SA has a smoking policy, which means if you are, or have been a smoker in the
last five years, you will have a “smoking related conditions” limitation placed on your
Death cover. Once you have ceased smoking for a period of five years, this limitation
may be removed by providing a statutory declaration.
Super SA also has a weight and height policy, which means if you are under or over
what is considered a “healthy weight range” for your height you will have a “weight
related conditions” limitation placed on your Death insurance cover. This policy was
developed by our medical adviser in line with industry standards and is available
upon request. To enable removal of this limitation you must be within the indicated
weight range corresponding to your height for at least 12 months.
It is important to note that the final decision of whether or not to fully insure you lies
with the Super SA Board. If the Super SA Board feels your pre-existing illness or
injury puts Super SA at risk, they have the right to decline the application or apply a
limitation to the cover.
Telephone (08) 8207 2094 (for calls from within
the State Government Network)
or 1300 369 315
Fax (08) 8226 0593
Website www.supersa.sa.gov.au
Email [email protected]
Last updated
January 2011
Page 2 of 3
What if I do not disclose a medical condition on my application form?
When a claim is lodged, part of the claim process is to review the claim/medical
information received in conjunction with your original application/s. If there is medical
evidence stating that the cause of death is related to a condition that existed before
you were granted your insurance, and this was not disclosed on your application,
Super SA has the right to deny this insurance claim. This is known as
non-disclosure, and any insurance cover can be denied where non-disclosure can
be proven.
Once you have ceased smoking for
a period of five years, this
limitation may be removed by
providing a statutory declaration.
If you require further information on Super SA’s underwriting processes, please contact
the Claims Management Team on 1300 369 315 or email
[email protected].
Disclaimer
This fact sheet provides a general summary to help you
understand your entitlements in Triple S. Super SA does its
best to make sure the information is accurate and
up to date. However, you need to be aware that it may not
include all the technical details relevant to the topic. For the
complete rules of Triple S, please refer to the Southern State
Superannuation Act 2009 and Southern State Superannuation
Regulations 2009. The Act and accompanying Regulations
set out the rules under which Triple S is administered and
entitlements are paid. You can access a copy from the
Super SA website.
Super SA and the State Government disclaim all liability for
all claims, losses, damages, costs or expenses whatsoever
(including consequential or incidental loss or damage),
which arise as a result of or in connection with any use of, or
reliance upon, any information in this fact sheet.
Telephone (08) 8207 2094 (for calls from within
the State Government Network)
or 1300 369 315
Fax (08) 8226 0593
Website www.supersa.sa.gov.au
Email [email protected]
Last updated
January 2011
Page 3 of 3