U-PLUS Insurance Benefits Explained
The following table provides an explanation of the standard benefits provided under U-PLUS.
Benefit Type
Amount Payable
Full Death Cover
Provides a death benefit of $5,000 if an insured person dies whilst covered under the policy.
Accidental Death Cover
Provides an accidental death benefit of $20,000 on top of the full death benefit if an insured person dies while covered under U-PLUS insurance as a result of an accident for which benefits are not payable under any workers compensation insurance policy.
Total Disability Benefit
Provides a monthly income benefit if an insured person becomes totally disabled while covered under U-PLUS due to an accident or sickness, and remains totally disabled for the 30 day waiting period (or 14 day or 21 day waiting period whichever is applicable). We will pay a benefit each month of up to 85% of the employee's pre-disability income paid as an income payment and this includes a 10% superannuation contribution payable to the insured person's nominated superannuation fund.
Should an insured person have enhanced cover, this cover extends to situations where the total
disability is due to a sickness that manifests itself while the insured person is covered under U-PLUS.
The benefit amount is capped at a maximum of $2,000 per week, and is payable while the insured
person remains totally disabled for a benefit period of up to 3 years for an accident, or 2 years for a
sickness (or 3 years for sickness if applicable).
The total disability benefit payable may be reduced by any amounts that are payable to you or the
insured person under any workers compensation legislation, workers compensation policy or any
other similar legislation or disability income insurance, but not social security payments.
Discretionary Partial Disability Benefit
If an insured person is considered partially disabled and returns to work in a reduced capacity and suffers a reduction in income as a result, a partial disability benefit may be payable. This benefit and the amount payable is in Our absolute discretion. If We pay this benefit, the benefit period will be reduced by the period over which this benefit is paid.
Should We agree to pay the partial disability benefit, the maximum benefit amount We will pay would
be the difference between the total disability benefit, less the income received from the reduced duties
and income from other sources.
Recurring Disablement
If within six months after the date a total disability benefit payment ceases, the insured person again becomes totally disabled due to the same or a related injury or sickness, the waiting period will be waived and we will regard it as a continuation of the previous claim.
Where total disability benefits have been paid in respect of an insured person and where total disability
recurs from the same or a related cause or causes at least six (6) months after the cessation of benefit
payments, We will not pay any further benefits under the policy unless, prior to the commencement of
the second claim, the insured person has:
- returned to work for at least six (6) months working an average of at least twenty (20) hours
per week over eighteen (18) weeks of the twenty four (24) weeks immediately prior to the
recommencement of total disability; or - returned to work for at least six (6) months but is in the insurer's opinion not capable, due solely to the same or related cause, of working an average of at least twenty (20) hours per week over eighteen (18) weeks of the twenty four (24) weeks immediately prior to the recommencement of total disability. In both instances where benefits are reinstated, a waiting period will be applied.
Notes:
• If an insured person attempts to return to work for five days or less during the waiting period, the waiting period does not recommence. These days are
simply added to the waiting period in order to determine when benefit payments begin. However, if the return to work exceeds a five day period, the
waiting period recommences.
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