It’s important to know when claims will not be paid so you can decide if My Protection Plan is right for you.
A benefit will not be paid for any claim if an exclusion or qualifying period applies. Please refer to the PDS for more information about exclusions that apply.
Pre-existing medical conditions affect claims
Any claim arising directly or indirectly from a pre-existing medical condition will not be paid.
A pre-existing medical condition is an illness, injury or condition that was the subject of a medical consultation in the 5 years immediately before the policy start date, and:
• the life insured was aware of; or
• a reasonable person in the circumstances could be expected to be aware of.
To determine if your claim relates to a pre-existing medical condition, we may ask for information about the life insured’s medical history.
For example: Sian bought a My Protection Plan policy and is the life insured. Ten months before the policy start date, Sian was treated for breast cancer. Because Sian knew she had a breast cancer condition within the 5 years before she bought the policy, she will not be able to claim for any medical condition directly or indirectly related to her breast cancer.
Trauma Benefit qualifying periods for certain conditions
My Protection Plan does not provide a Trauma Benefit for certain conditions which first occur, become reasonably apparent or are first diagnosed in the 90 days after:
• your policy start date
• your policy reinstatement date
• the date you increase any benefits, for that increased benefit amount.
The 90-day qualifying period applies to each trauma condition with an asterisk (*) on the list on page 15 of the PDS.
Further, we will not pay any benefit for a trauma condition that is directly or indirectly related to a condition which we do not cover because of the 90-day qualifying period explained above.
For example: Charles bought a My Protection Plan policy. He is the only life insured on the policy and is the policy owner. Six weeks after his policy start date, Charles was diagnosed with prostate cancer (of specified severity). The Trauma Benefit qualifying period applies to this condition. Unfortunately, because it’s less than 90 days after his policy start date, Charles is not covered and will not receive a Trauma Benefit for this event.