Policy Wording

ACC CoverPlus Extra Fact Sheet

Tailored ACC cover for self-employed people and non-PAYE shareholder-employees

ACC CoverPlus Extra is the flexible alternative to ACC CoverPlus which enables you to negotiate your level of lost earnings cover.1 That way you know exactly what you’ll receive if you’re injured and can’t work – and it doesn’t matter whether the injury is work related.

At A Glance

  • ACC CoverPlus Extra is available to all self-employed and non-PAYE shareholder-employees who work 30 hours or more per week – and to part-timers whose earnings exceed the ACC CoverPlus Extra minimum2 (which changes each year).
  • You negotiate your level of lost earnings cover.
  • You receive 100% of this lost earnings cover (less tax) if you can’t work because of an injury, starting one week after your injury. This stays the same even if your business continues to generate income during your time off work or you return to work part-time.
  • You can opt for Lower Levels of Weekly Compensation (LLWC) which offers a lower levy rate because weekly compensation will reduce if your business continues to generate income during your time off work or you return to work part-time.
    You don’t have to prove loss of earnings when you make a claim.
  • You have access to medical and work-related help as part of your ACC CoverPlus Extra policy.

Who Qualifies?

ACC CoverPlus Extra is a great option for self-employed people and non-PAYE shareholder-employees:

  • if you work 30 hours or more a week or, if you work part-time, earn an income that’s above the ACC CoverPlus Extra minimum (which changes every year)
  • if your income fluctuates from year to year
  • if your personal income is not a true reflection of your actual earnings. For example, you might split your income with a partner or spouse, or take advantage of options to reduce your tax
  • if your business would continue generating income if you were injured and couldn’t work
  • if you are starting out in your own business and don’t have an income history
  • if you want a guaranteed level of lost earnings compensation.

What does ACC CoverPlus Extra cover?

  • With ACC CoverPlus Extra, you will receive all the normal entitlements of ACC CoverPlus. Some or all of the following benefits may be available depending on the nature of your injury and needs.

Help for partial disabilities

  • If you can’t work full time or continue receiving business earnings because of your injury, you still qualify for 100% of your agreed cover (less tax).
  • If your injury has a serious long-term effect through a permanent impairment, lump-sum payments may be available.

Treatment

  • ACC can contribute to a wide range of medical and related costs, including those for doctors’ visits, treatment by various other health professionals, surgery, X-rays and prescriptions.


Returning to work

  • As part of our commitment to helping you to recover and get back to work as quickly as possible, we will help you to return to your job – and if you can’t return to your old job because of injury, we help you to prepare for finding a new one.

Personal help

  • If you need help managing at home after an injury, we can arrange help with things like housework, personal care, transport, aids, modifications and childcare.
  • If you have to travel for assessments, ACC can help with transport and accommodation costs. This may also include assistance for your support people.

In case of death

  • ACC has a number of grants available in case you or one of your family dies as a result of injury. These include funeral grants, survivors’ grants, help with childcare and weekly compensation.

Income Protection Cover benefits in detail

Asteron Life’s Loss of Earnings

What is Income Protection Cover?

Income Protection Cover pays you a regular monthly payment if you’re unable to work temporarily or permanently because you are sick or injured. Income Protection Cover is designed to provide you with money to live on while you’re not receiving income. We will pay you until you can return to work, or reach the payment period on your policy.

What do most people use Income Protection Cover for?

People can use their Income Protection Cover when they have to take more than two weeks unpaid leave from work because of illness or injury. A combination of sick leave and annual leave will help most employed people cope without working for up to four to six weeks, but what will happen if the disability continues beyond six weeks? What if the condition renders you unable to work for months or even years? Income Protection Cover will continue to pay you a benefit for as long as you remain unable to work, up to the benefit payment term that you select.

How does Income Protection Cover work?

A benefit is paid to you if you continue to be disabled after a 30 day waiting period. We will pay your income protection benefit based on 75% of your actual loss of income.

What does Income Protection Cover include?

  • A monthly payment. You’ll receive a monthly payment if you’re unable to work for more than 10 hours a week because of illness or injury.
  • Partially Disabled benefit. Many disability claims result in you unexpectedly becoming totally disabled and then progressively getting better over time – i.e. shifting from total disablement to partial disablement before being able to resume work full time. Having a Partially Disabled benefit helps to ensure you are protected until you resume work full time.

See Below for more built in benefits

Policy Wording

When we talk about income protection, we use ‘you’ to mean the policy owner and the insured person. We do this because payments for the Income support benefit will be made to the insured person.

If you are disabled, we will calculate your benefit payments as the lesser of:

  1. the monthly benefit

  2. (A – B) × 75%; where:
    • A = pre-disability income

    • B = monthly income and other income received while disabled.

More Built-in benefits

This section explains the benefits that are built into Income Protection Cover.

Premium waiver benefit

We will waive the premiums if you are disabled and are entitled to receive an Income Protection Cover monthly benefit (as applicable). The premiums will be waived or refunded until the earlier of:

  • the date you are no longer disabled
  • the date you are not entitled to receive payments 
for that disablement under this policy. 


The Premium waiver benefit applies to any payments for the Crisis benefit or Specific injury support benefit
(if applicable) under Income Protection Cover during the Crisis benefit or Specific injury support benefit payment period. Otherwise, the Premium waiver benefit is backdated to the first day of the waiting period, if a benefit is payable after the end of the waiting period. Premiums paid by you during the waiting period will
be refunded with the first payment from us. 


Rehabilitation and retraining support benefit

We will work with you to put a plan in place to help your return to work if you become disabled and, in our opinion, your disablement is likely to last beyond your waiting period.

Contact us as soon as possible and we will discuss how we can help.

We will reimburse you for rehabilitation, retraining or support costs included in the agreed plan, if all of the following apply:

  • you will be able, in our opinion, to return to 
a gainful occupation sooner with those expenses than without them 

  • we agree to the plan and any expenses before they are incurred 

  • these expenses are not being reimbursed from elsewhere. 


Rehabilitation or support expenses may include (but are not limited to) government-sponsored or approved rehabilitation programme fees, wheelchairs, artificial limbs, prosthetic devices as well as house and car modifications and additional childcare assistance. 


Retraining expenses may include (but are not limited to) government-sponsored or approved vocational training expenses. 
We will make payments when all requirements of this benefit are met, and after we have received sufficient evidence. 
Our acceptance of a claim under this benefit does not mean we will automatically accept another benefit on this policy. 
The maximum we will pay under this benefit is 18 times the monthly benefit per claim. If you experience a recurring disability, we will only reimburse expenses up to the remainder (if any) of
 the 18-months’ maximum payment under this benefit. If you experience a new disablement, a new maximum payment will apply. 


Income support benefit

We will pay you the Income support benefit if all of the following apply:

  • you are disabled
• you were continuously disabled for the entire

waiting period

  • unless your disablement is a recurring disability (section 11.1.10), you have been continuously disabled since the end of the waiting period.

What we mean by disablement

For the purpose of the Income support benefit, we will consider you to be disabled if, solely due to injury or sickness, your earning capacity is reduced and either:

  • your capacity to perform your usual occupation is reduced to less than 75% of the average hours you worked in your usual occupation before your injury or sickness
  • you are unable to perform one or more of the important income-producing duties of your usual occupation. 
In both cases, your injury or sickness and inability
to work must be supported by clinical evidence that is approved by us, and you must be following advice about that sickness or injury from a registered doctor. 
Following the advice of a registered doctor means you are following that advice on an ongoing basis, including recommended courses of treatment and rehabilitation. 


How we pay you the Income support benefit


Payments will begin from the end of the waiting period. The waiting period you have chosen is shown in your policy schedule. After the end of the waiting period, payments will accrue from the first day of each period during which you are disabled. We will normally pay monthly in advance, unless another method has been agreed upon by you and us at the time of claim. 
Payment is conditional on us having received all relevant information and the claim being accepted. 
At the start of a month, an Income support benefit payments may be assessed as being payable for less than a month. To calculate the payment, we will divide your normal Income support benefit payment by 30 and then multiply it by the number of days that it is payable for that month. 
If the monthly income or other income you received, or could have received, during a month changes from our assessment at the start of the month, we will adjust your following month’s payment to take that into account. 
You must tell us if you receive any other income retrospectively. We will adjust benefit payments we have already made to you based on this additional other income. You must reimburse us for any benefit overpayment up to the amount of the other income retrospectively received. 


When we will not pay an Income Protection Cover benefit

  • A benefit will not be paid if the event giving rise
to the claim is caused directly or indirectly by any of:
  • a self-inflicted act, whether sane or insane your participation in any criminal activity
  • pregnancy, miscarriage or childbirth, unless you are disabled for more than three months from the later of the date your pregnancy finishes and the date your disablement begins (the later date being the date we will consider your disablement to have started).

We will not pay for any period while you are in jail or home detention.

When we will limit an Income Protection Cover benefit

We will calculate the amount payable under the Income support benefit to reflect any monthly income and other income you receive or are entitled to receive.

If you are not working to your capacity, monthly income and other income will be calculated based on what we consider you could reasonably be expected to earn if you were working to the extent of your capacity. In our assessment we will consider all relevant information, including:

  • the opinions of your registered doctor(s)
  • the opinions of our medical and rehabilitation 
specialists 

  • results of any functional assessments you have undertaken. 
We may compare your monthly income or other income from any business, partnership, trust, company or other entity to either your pre-existing income or your market value. If we find your income while disabled is disproportionately low, we will adjust your monthly income or other income to be proportionate and properly reflect of both of these factors. 
When we review your monthly income and other income we will take into account factors including, but not limited to: 

  • your capacity to work while you are disabled 

  • any change in accounting practices where the effect is to alter your business expenses, other income
or monthly income while disabled. 


When we will stop paying you the Income Protection Cover

We will stop paying you the Income support benefit on the first to occur of the following events:

  • you are no longer disabled 

  • the end of the benefit period
  • the date cover ends under the policy. 


Concurrent wait period benefit

The Concurrent wait period benefit applies if you are disabled and entitled to receive an Income Protection Cover payment under this Personal Insurance policy, and you also hold a Business Insurance policy with Business Disability or Farmers Disability Cover.

The waiting periods on both benefits will start at the same time.

If you return to full-time work during your waiting period for this Income Protection Cover, but then suffer a recurring disability under your Business Disability or Farmers Disability Cover (if applicable), only the remaining part of the waiting period for the Income Protection Cover will apply.

Funeral assistance benefit

If you die, we will reimburse direct funeral costs up to three times the monthly benefit.

Direct funeral costs include (but are not limited to) funeral director fees, flowers, a coffin, cremation, death notices or plot fees.

For payment of this benefit we need to be sent all of the following:

  • a request for reimbursement of direct funeral costs 

  • receipts confirming payment of direct funeral costs 

  • acceptable written evidence of your death. 
If you have multiple Asteron Life policies with funeral benefits, we will reimburse each direct funeral cost only once. 


Elective surgery benefit

We will pay the Income support benefit if your disability is as a result of having an elective surgical procedure, rather than a sickness or injury, for one of the following purposes:

  • organ donation 

  • improving your appearance 

  • preventing disease or disfigurement. 
The elective surgical procedure must have been undertaken on the advice of a registered doctor. 


Overseas assist benefit

The Overseas assist benefit applies if you are overseas you are entitled to receive payments from us under the Income support benefit.

We will reimburse reasonable expenses up to $10,000 for you and one support person to return to either your home address in New Zealand or Australia or a medical facility in New Zealand or Australia.

You must advise us in advance of your return journey to New Zealand or Australia. Payment will be made after appropriate evidence is received.

This benefit will not apply if either of the following are true:

  • if your journey overseas before becoming disabled was taken against the advice of the treating registered doctor; or
  • expenses are covered by any other policy of insurance, for example travel insurance.

Payments while overseas benefit

If you are disabled while overseas and entitled to receive payments from us, we will pay you while you are overseas, but only if you are able to meet our claim requirements (section 12.8).

Return to work benefit

We will pay the Return to work benefit if both of the following apply:

  • we have agreed to pay a Rehabilitation and retraining support benefit
  • you start a gainful occupation immediately following retraining or support. 
We will make up to two payments: 

  • one payment of one times the monthly benefit after you have returned full-time to a gainful occupation, for three continuous months 

  • one payment of two times the monthly benefit after you have returned full-time to a gainful occupation, for six continuous months. 


Accommodation benefit 


We will reimburse actual costs of up to $200 per day that an immediate family member directly incurs for accommodation near where you are confined to bed, if you are confined to bed as a result of being disabled and either of the following is true:

  • 
 you are disabled more than 100km from your usual place of residence; or 

  • you travel, on the advice of a registered doctor,
to a place more than 100km from your usual place of residence. 


We will pay the Accommodation benefit for a maximum of 30 days in any 12-month period. We will not reimburse amounts that are reimbursed from elsewhere.

Payments will be made monthly in arrears after the terms of this benefit are met.

Transportation benefit

We will reimburse up to three times the monthly benefit for actual costs directly incurred for transporting you within New Zealand, if you become disabled and require emergency transportation. This benefit is payable only once in any 12-month period and will not cover expenses reimbursed from elsewhere.

We will make payments will be made when the requirements of this benefit are met, and after we receive sufficient evidence.

Family assist benefit

If we have paid the Income support benefit for at least 30 days and you continue to be disabled and require full-time care at home, we will pay you a monthly benefit for up to six months for either:

  • an immediate family member who was in a full-time gainful occupation immediately before you became disabled to cease all paid employment to care
for you 

  • a registered nurse (who is not an immediate family member) to care for you at home at least three times per week.


The monthly benefit we will pay you will be the lesser of the following:

  • 
$3,500
  • your monthly benefit.

We will consider medical advice, including the opinion from a registered doctor approved by us to determine if full-time care is required.

Payments will accrue from the first day the requirements of this benefit are met and will be paid monthly in advance, unless another method has been agreed on by you and us at the time of claim.

We will pay the Family assist benefit until the earliest date that:

  • you no longer require full-time care
the immediate family member or registered nurse
  • are no longer providing care
  • six monthly payments have been made for the Family assist benefit
  • you return to a gainful occupation.

Dependent relative benefit

If a dependent relative of yours becomes disabled and requires full-time care, we will pay you a monthly benefit for up to six months, if you provide the required full- time care and all the following apply:

  • you are required to take leave without pay or cease being available from your full-time gainful occupation to undertake the full-time care
  • you were working in a full-time gainful occupation immediately prior to the dependent relative’s disability 

  • you have exhausted all leave entitlements available to you before claiming under this Dependent relative benefit 

  • the injury or sickness that results in the dependant relative requiring full-time care happens after the commencement date of this benefit.

The monthly benefit we will pay you will be the lesser of the following:

  • $3,500

  • your monthly benefit


We will consider medical advice, including the opinion from a registered doctor approved by us, to determine if: 


  • full-time care of the dependent relative is required and 

  • the need for care was caused directly by an injury or sickness that occurred after the commencement date of this benefit. 
Payments will accrue from the first day the requirements of this benefit are met and will be paid monthly in advance, unless another method has been agreed on by you and us at the time of claim. 
We will pay the Dependent relative benefit until the earliest date that:
  • the dependent relative no longer requires full-time care
  • you are no longer providing full-time care for the dependent relative
  • six monthly payments have been made for the Dependent relative benefit 

  • the dependent relative returns to a gainful occupation
  • you return to a gainful occupation. 


Inflation adjustment benefit

On each policy anniversary, we will offer to increase the sum insured without considering any changes 
to your health, occupation or pastimes.

Grief support benefit

We will reimburse you or your immediate family members (‘the recipients’) up to $900 for the cost of receiving grief counselling from an accredited counsellor approved by us, if we pay a benefit because the insured person has:

  • suffered a trauma
  • suffered total and permanent disablement 

  • been diagnosed with cancer
  • been diagnosed with a condition under the Needlestick benefit 

  • been diagnosed as terminally ill
  • died.

This benefit will be paid on no more than two occasions during the term of the policy, and is payable only once for any particular claim. 
The counsellor cannot be: 


  • you or any other policy owner 

  • a business partner of you or any other policy owner 

  • an immediate family member or a person otherwise related to you or any other policy owner.


The first counselling session must be within 13 months of the applicable event, that is:

  • 13 months of the insured person’s death 

  • 13 months of payment from us for trauma, cancer, 
TPD, Needlestick, or terminal illness.


All counselling must be complete within two years 
of the first counselling session. 
For payment of the benefit we need the recipients to send us all of the following: 


  • a request for reimbursement for grief counselling 

  • a receipt confirming payment 

  • the details of the qualifications the counsellor holds. 
Payment of the Grief support benefit will not reduce any other benefit payable under this policy, and is subject
to our normal claim requirements. 


Recurrent disability benefit

We will consider your disablement as recurring, if you suffer from the same sickness or injury within 12 months of a disability claim ending.

If we consider the insured person’s disablement as recurring, we will begin assessing the benefit without applying a new waiting period, but only for the remaining part, if any, of the benefit period.

The benefit period will reduce by the previous periods for which we paid a disability or recurring disability benefit.

Disability reset benefit

If the insured person’s disablement is not a recurring disability, you will become eligible to submit a new claim for the same or a related sickness or injury if the insured person becomes disabled again and one of the following are true:

  • the insured person has not suffered from the same or a related sickness or injury for at least 12 consecutive months after the disability claim ended 

  • the insured person has returned to full-time
work for at least six continuous months after
the disability claim ended, and during that period has continuously performed all of the important income-producing duties of their usual occupation without restriction.


You will become eligible to submit a new claim if the insured person becomes disabled for an unrelated sickness or injury at any point. 
A new waiting period and benefit period will apply to each new claim. 


Pregnancy premium waiver benefit

We will waive the premiums for up to six months, if you become pregnant and you give us confirmation of pregnancy from a registered doctor; and all of the following apply:

  • you become pregnant more than six months after the later of: 
– the commencement date 
– the most recent reinstatement of your cover. 

  • you are on maternity leave from your gainful occupation
  • you tell us in writing when the Pregnancy premium waiver benefit is to start. 
You can choose to use the Pregnancy premium waiver benefit at any stage between the second trimester and six months after your pregnancy finishes. 
Unless cover has ended under section 12.1, the Pregnancy premium waiver benefit will end when a total of six months’ premiums, including any premiums waived during an earlier pregnancy, have been waived. 



Income update benefit

You have the option to increase the monthly benefit each policy anniversary, without needing to provide further medical evidence, if all of the following are true:

  • you are younger than age 55 

  • we are not paying you and you are not eligible for a benefit under this policy and premiums are not being waived 

  • your monthly benefit is less than $12,000 


In addition to any increase under the Inflation adjustment benefit, you can increase the monthly benefit by up to 10% by providing us with financial evidence to justify the increase. 


The total of all increases in the monthly benefit made using the Income update benefit cannot exceed the original monthly benefit at the commencement date of this policy. For example, if your monthly benefit was $3,000 per month when your cover began, the total of all increases using the Income update benefit cannot make your monthly benefit more than $6,000 per month. 
You can use this benefit by writing to us (including financial evidence) within 90 days of the policy anniversary. 


ACC CoverPlus Extra Terms & Conditions

1 Your ACC CoverPlus Extra Policy

1.1 Your CoverPlus Extra Policy (the ‘Policy’) sets out the following:

  1. The date on which your Policy begins;
  2. The period for which you are covered under your Policy;
  3. Your agreed level of weekly compensation;
  4. Your levy; and
  5. Whether you have opted to purchase Lower Levels of Weekly Compensation. (If you have chosen this option, section 7 Abatement of Earnings applies.)

1.2 By signing the Policy Acceptance Form, you are agreeing to the Policy and these Terms and Conditions.

1.3 Your Policy will come into effect once the Policy Acceptance Form has been signed and returned to the Corporation.

2 Review rights

2.1 If you are dissatisfied with the level of weekly compensation offered and wish to file an application for review, you must sign and return the Policy Acceptance Form but still apply for a review within three months of having received the offer. The Policy comes into effect subject to your review rights.

2.2 If, as a result of the review, the level of weekly compensation is changed, the Policy will apply from your acceptance of the Policy but subject to the change. The amount of levy payable will be subject to adjustment.

3 Application of the Act

3.1 The Policy wording applies (in accordance with sections 208 to 211) where it expressly differs from what is otherwise provided for in the Accident Compensation Act 2001 (the Act).

3.2 Otherwise, the Policy applies subject to and in accordance with the Act.

3.3 Despite paragraph 3.2, Part 2 of Schedule 1 of the Act does not apply to the Policy other than clauses 42, 46, 52 and 53 and, where Abatement of Earnings applies, clauses 49 to 51.

4 Care and recovery

4.1 If you suffer an incapacity resulting from a personal injury during the period of the Policy and you have cover for that

personal injury, your weekly compensation payments will start seven days after your incapacity.

4.2 The Policy does not cover any personal injury you suffered before the start date of the Policy.

4.3 While you receive weekly compensation under the Policy or under any previous ACC CoverPlus Extra Policy or the Act:

  1. You are not entitled to any other weekly compensation that is otherwise payable under this or any future Policy or the Act for the loss of your earnings as a self-employed person or a non-PAYE shareholder-employee;
  2. If an assessment determines that you are no longer incapacitated or that you have regained or acquired vocational independence, you will no longer be eligible to receive weekly compensation; and
  3. If at any time you require subsequent time off work for a personal injury for which you have received weekly compensation, the amount of weekly compensation payable will not be greater than that which you would have already received had you still been receiving weekly compensation for that personal injury.

4.4 If you are injured during the period of the Policy and you have cover for personal injury as set out in the Act:

  1. You may be entitled to rehabilitation (treatment and social and vocational rehabilitation) and/or lump sum compensation (in addition to any weekly compensation payable), depending on the nature and severity of your injury; and
  2. Payments may be made in the event of your death by personal injury.

4.5 ACC will adjust your weekly compensation payments every year to allow for changes in the relevant cost of living index.

5 Levies

5.1 Under the Policy, you must pay the levy by the due date or pay an instalment of the levy by the date required under any agreed levy payment option. This applies even if you are applying for a review. If you do not make payment by the required date, clause 5.2 applies.

5.2 If you do not pay your levy by the due date or by any date required under an agreed levy payment option, ACC will terminate the Policy at any time afterwards and your cover under the Policy will stop. You will then receive ACC’s standard cover and be required to pay levies for the year that the standard cover applies.

6 Termination

6.1 You can terminate the Policy in writing at any time.

6.2 You must notify ACC immediately if:

  1. You stop self-employment;
  2. You stop being a non-PAYE shareholder-employee;
  3. You start receiving NZ superannuation (or an equivalent);
  4. You change your business classification; or
  5. There is any other material change in your circumstances.

6.3 If you stop being self-employed or a non-PAYE shareholder-employee (other than as a result of an injury) while the Policy is current, your cover under the Policy will stop from that time.

6.4 ACC can terminate the Policy, or amend the amount of cover provided, if:

  1. You do not pay your levy in accordance with clause 5.1;
  2. You did not, at any time, disclose any material information to ACC;
  3. You provide ACC at any time with any false statement;
  4. There is a legislative or government policy change that means the Policy is no longer effective or can no longer be applied;
  5. You do not comply with an obligation you have under the Act; and
  6. You do not advise ACC of any change in circumstance.

6.5 If ACC terminates the Policy, it must explain to you in writing the reasons for termination, the effective date of termination, and your cover and obligations from the date of termination.

6.6 If you or ACC terminate the Policy, your cover will stop. You will then receive ACC’s standard cover and be required to pay levies for the part of the year to which the standard cover applies.

6.7 If you are receiving weekly compensation payments and ACC becomes aware that you failed to disclose any material information (including the information listed in clause 6.2), your Policy will be cancelled and you will be required to pay back any weekly compensation overpayment.

7 Abatement of earnings

7.1 If the accompanying documentation of your personalised ACC CoverPlus Extra details states that you opted for Lower Levels of Weekly Compensation, the amount of weekly compensation payable to you under section 4 Care and recovery will be abated for any earnings you may receive to ensure that the total weekly compensation and earnings after incapacity does not exceed weekly compensation payments as determined by the ACC CoverPlus Extra Policy.