Exclusions

In the event of a war involving Australia or you country of residence the insurer may offer increased premium rates. No benefit is payable if the event giving rise to the claim is caused directly or indirectly by war as defined in the Insurance Policy.

1. Unlikely to return to work

If the insured member is employed or engaged in a gainful occupation, business, profession or employment or within 6 months of the date an insured member ceases to be so employed or engaged:

1.1 that insured member has suffered an injury or illness
and, as a result of that injury or illness, the insured
member:

1.1.1 is totally unable to be
employed or engaged in that occupation,
business, profession or employment for a
period of 6 consecutive months; and

1.1.2 is determined by us at the end of that 6 month
period (or such later time as we agree with the
policy owner), to be permanently incapacitated
to such an extent as to render the insured
member unlikely ever to be employed or
engaged in any gainful occupation, business,
profession or employment for which the
insured member is reasonably suited by
education, training or experience.

NOTE: For the avoidance of doubt, the six month periods referred to in tier 1 above do not apply to tiers 2 to 5.

OR

2. Permanent impairment

The insured member suffers an injury or illness and, as a result of that injury or illness, the insured member:

2.1 suffers a permanent impairment of at least 25% of
whole person function as defined in the American
Medical Association publication 'Guides to the
Evaluation of Permanent Impairment', 4th edition, or
an equivalent guide to impairment approved by us; and

2.2 is disabled to such an extent, as a result of this
impairment, that the insured member is unlikely ever
again to be able to be employed or engaged in any
gainful occupation, business, profession or
employment for which the insured member is
reasonably suited by education, training or experience.

OR

3. Specific loss

As a result of illness or injury, the insured member suffers the total and permanent loss of the use of:

• two limbs (where 'limb' is defined as the whole hand or the whole foot), or
• the sight in both eyes, or
• one limb and the sight in one eye.

OR

4. Loss of independent existence

As a result of illness or injury, the insured member suffers loss of independent existence.

'Loss of independent existence' means we have determined the insured member is totally and irrevsibly unable to perform at least two of the following five 'activities of daily living' wihtout the assistance of another adult person:

• bathing and/or showering,
• dressing and undressing,
• eating and drinking,
• using a toilet to maintain personal hygiene,
• getting in and out of bed, a chair or wheelchair, or moving from place to place by walking, whellchair or with assistance of a walking aid.

OR

5. Cognitive loss

As a result of illness or injury, the insured member suffers cognitive loss.

'Cognitive loss' means we have determined that a total and permanent deterioration or loss of intellectual capacity has required the insured member to be under continuous care and supervision by anoth adult person for at least six consectutive months and, at the end of those six consecutive months, the insured member is likely to require permanent ongoing continuous care and supervision by another adult person.

Having suffered an illness that is such that, in the opinion of an appropriate specialist, the illness or injury is likely to lead to the death of the insured member within 12 months fro the date the opinion is provided.

A permanent employee means an employee who:

• is employed on a full-time basis
• is required to work on a regular basis
• is required to work a minimum number of hours per work cycle as specified in the relevant industrial award or agreement, and
• accrues entitlements for payment of sick leave and annual leave.

A casual employee means an employee who:

• is required to work on a temporary or 'as required' basis
• is paid on an hourly basis for the period actually worked
• does not accrue entitlements for payment of sick leave and annual leave
• is otherwise not a permanent employee, and
• a person performing all their normal duties of their occupation for less than 30 hours per week.

An employee member is:

• a member whoe employer has agreed with the trustee to make contributions to HOSTPLUS.