You cannot fool these assessors they have done your job for 30 years. Has not made top performing funds lists. Social Security follows English common law that finds that a person attains an age on the day before the . By Louise Norris Under Divisions 6.4 and 6.5 of the SIS Regulations, a member of a regulated superannuation fund may, in writing, ask the trustee of the fund to roll over or transfer an amount that is the whole or part of the members withdrawal benefit, and the trustee of the fund must roll over or transfer, as permitted by SIS, the amount in accordance with the request. The program is a tailored design to cover the 7 original protocols and address key process safety activities in a shorter time frame. means the Superannuation Industry (Supervision) Regulations1994. in relation to an ordinary employer-sponsored member being assessed by a life office for the provision of supplementary death and invalidity cover or income protection cover under Part 4 of the Rules, means an ordinary employer-sponsored member who does not: (a) suffer from any physical or mental incapacity or condition; or. 6.3.2 A request for reconsideration of a decision of CSC in relation to PSSAP must be made in writing and: (a) set out the particulars of the decision to be reconsidered; (b) specify the grounds for the request; (c) include new evidence, being evidence not previously known to CSC, supporting the grounds for the request; and. 4.2.12 Subject to Rule 4.2.13, the cost of the premium for supplementary death and invalidity cover provided in respect of an ordinary employer-sponsored member must be deducted from the personal accumulation account of the ordinary employer-sponsored member. 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If youre expecting a new baby or have a pending adoption and both parents have their own health coverage, its important to understand how the coordination of benefits will work. , means the spouse who has the superannuation interest. for the purposes of reconsidering decisions of CSC under Part6 of the Rules, includes: (a) making, suspending, revoking or refusing to make an order or determination; (b) giving, suspending, revoking or refusing to give a certificate, direction, approval, consent or permission; (c) issuing, suspending, revoking or refusing to issue an authority or other instrument; (d) imposing a condition or restriction; (e) making a declaration, demand or requirement; (f) retaining, or refusing to deliver up, an article; and. Payment of benefits to a PSSAP member who has ceased to be an ordinary employer-sponsored member. 1.1.1 These Rules are divided into 7 Parts, each dealing with a major aspect of the operation of PSSAP. How Much Water Does Hydraulic Fracturing Use? The birthday rule also applies to dental care, whether that care is provided as part of an overall policy or through a standalone dental plan. (e) the date the insurer ceases to provide supplementary income protection cover in respect of the ordinary employer-sponsored member. The amendments broadened PSSap's member eligibility rules with effect from March 7 2021. The TMD also describes our reporting requirements, and events or circumstances where we may need to review the TMD. 6.1.2 Subject to CSC directions, a Reconsideration Advisory Committee will regulate its own affairs. 2.2.5 CSC may from time to time determine the way in which basic employer contributions and additional employer contributions must be paid to CSC. (b) on grounds of severe financial hardship in accordance with the SIS Act. Note:A PSSAP member includes an ordinary employer-sponsored member. It may be in the familys best interest to move the whole family onto one policy. 2.4.1A Subject to the SIS Act, a PSSAP member may transfer or roll-over an amount payable in respect of the person under the Superannuation (Government Cocontribution for Low Income Earners) Act 2003 to CSC as a transfer amount where the amount, in total or part, relates to a period where the person was an ordinary employer-sponsored member, provided the method of payment complies with Rule2.4.2. How Many Jobs Has the Oil and Natural Gas Industry Created? 4.8 Satisfied. In situations where a child is covered by different health plans due to each parent having a separate policy, insurers use the birthday rule to decide which parents policy is primary and which parents policy is secondary. As a government employee, your employer contributes at least 15.4% of your super salary into your PSSap account. Why is fracking for natural gas important? to reflect action taken under paragraph (a). means any amounts payable in respect of an ordinary employer-sponsored member for insurance coverage under Part 4 of the Rules. In that scenario, that parents health plan would be primary, regardless of the parents birthdays. 4.4.3 CSC may allow the ordinary employer-sponsored member to choose the policy providing the supplementary income protection cover if CSC has taken out more than one policy. AU BNF1 Form Versions. 4.3.5 Subject to Rule 4.3.6, the premium for basic income protection cover provided in respect of an ordinary employer-sponsored member is the amount determined by CSC, being the same amount as the amount of premium specified in the basic income protection cover policy, and must be deducted from the personal accumulation account of the ordinary employer-sponsored member. (a) employment with an organisation or association registered or recognised under the, (b) if the person is employed in an, (c) if the person is not employed in an, provided the temporary employer agrees to reimburse the, means the day on which a regular salary payment is made by a, (b) does not receive a salary payment from a, (v) a period of leave of absence for the purposes of engaging in, means a pre-reform AWA within the meaning of clause 1 of Schedule 7 to the, means a a pre-reform certified agreement within the meaning of clause 1 of Schedule 7 to the, (a) a release authority received from a, (b) a transitional release authority received from a, means the shortfall component within the meaning of section64A or 64B of the, means a workplace agreement within the meaning of section 4 of the, means a workplace determination within the meaning of section12 of the, (a) where the circumstances referred to in Rule 2.2.3 apply the, amount that would have been the persons fortnightly contribution salary if they were a, (h) an agreement in writing between the, In addition to the amounts required to be paid by the, allows employers to make contributions for or on behalf of an employee in addition to any amounts the employer is required to pay as, - to provide superannuation contributions in circumstances where contributions would otherwise not be required to be paid. This compilation was prepared on 16 March 2012. You can change your insurance to better meet your needs. Then the secondary insurer steps in and picks up some or all of the remaining out-of-pocket costs that the primary insurance didnt pay (i.e., the deductible, copay, or coinsurance, or costs for specific services that arent covered under the primary plan but that are covered under the secondary plan). Summary. 4.2.5 If an ordinary employer-sponsored member applies to CSC for supplementary death and invalidity cover, or applies to vary existing cover, CSC must ask the relevant life insurance company: (a) whether it is prepared to provide the cover for that ordinary employer-sponsored member; and. Target Market Determination. The parents intended to cover the child under just the mothers health plan, which offered more robust coverage. There are several notes within the Rules to help readers understand the more complicated superannuation concepts or to inform them of the need to refer to another area of the Rules. as shown in this compilation is amended as indicated in the Tables below. So in 1582, Pope Gregory XIII established the Gregorian calendar and introduced the century rule, Levine . 3.4 CSC must cause proper records to be kept in respect of: (a) contributions paid into the PSSAP Fund; and. Source: I work in HR for one of these gov orgs that pays > 9.5% for those in PSSAP. UnnamedGoatMan 1 yr. ago. (b) in accordance with the policy between CSC and the life insurance company, the company refuses to provide cover in respect of the ordinary employer-sponsored member. WHEREAS section 10 of the Superannuation Act 2005 (in this Deed called the Act) provides that before 1 July 2005, the Minister must, for and on behalf of the Commonwealth, by deed: (a) establish a superannuation scheme that: (i) is to be known as the Public Sector Superannuation Accumulation Plan; (ii) may also be known as PSSAP; and, (iii) is for the benefit of persons who will be members of PSSAP; and, (b) establish and vest in the Australian Reward Investment Alliance (formerly known at the PSS Board) established under section 20 of the Superannuation Act 1990 (the Board), a fund for the purposes of the PSSAP; and. Also, where a person is an ordinary employer-sponsored member with one designated employer and, upon ceasing to be the employee of that designated employer, immediately becomes the employee of another designated employer, the person does not cease to be an ordinary employer-sponsored member. Payment of benefits to ordinary employer-sponsored members. Compensation may impact where the Sponsors appear on this website (including the order in which they appear). The birthday rule is a part of a set of rules called the coordination of benefits (COB) which collectively resolves questions about which health insurance policy provides coverage. The birthday rule says the primary coverage comes from the plan of the parent whose birthday (month and day) arrives first in the year. (d) the date the insurer ceases to provide basic death and invalidity cover in respect of the ordinary employer-sponsored member. If a claim needs to be filed for the child, which policy covers it? 3.2.3 If, after making reasonable enquiries, CSC upon the death of a PSSAP member has not found either a legal personal representative or a dependant of the deceased PSSAP member, CSC will pay or apply the deceased members total benefit to or for the benefit of such one or more individuals as determined by CSC. 2.2.8 Each designated employer, in respect of an ordinary employer-sponsored member to whom Rule 2.2.2(a) applies, must inform the member in writing, at least quarterly, of the amount of basic employer contributions and additional employer contributions paid to the PSSAP Fund. So if you were born April 6, 1989 and your partner or spouse was born November 12, 1987 . Subject to the SIS Act, CSC may adjust the repaid, returned or refunded contributions for: (a) insurance premiums paid from the persons personal accumulation account during the period the contributions were held in the PSSAP Fund; (b) interest (if any) in respect of the fund earnings or fund losses for the period the contributions were held in the PSSAP Fund; and. Note:Where part of a benefit is paid to a person under Rule 3.1.3 or Rule 3.1.4, the remainder of the benefit must be retained in the personal accumulation account of the PSSAP member or rolled-over or transferred to another superannuation entity. It would be a fair choice if all insurance plans provided equal coverage at the same cost. The Birthday Rule is widely adopted by the health insurance industry. As of 2022, health insurers still follow the birthday rule. (b) interest (if any) in respect of the fund earnings or fund losses for the period the contributions were held in the, (c) fees, costs and expenses paid from the persons, Among other things, Rule 5.5.3 covers the situation where a member contributes an amount that exceeds the non-concessional contribution cap and, A request for reconsideration must be made in writing, or any other form acceptable to, (a) set out the particulars of the, (c) include new evidence, being evidence not previously known to, (d) be accompanied by the fee prescribed under the, after first obtaining, if appropriate, the recommendation of an Assessment Panel, and the Committee or, Subject to this Part, where an interest in the, (a) increase the amount credited to the, (b) thereafter and on the same day reduce to zero the value of the. The bill was eventually reduced to $20,000 and then nothing after negotiations with the insurers and the hospital. The birthday rule says that primary coverage comes from the plan of the parent whose birthday (month and day only) comes first in the year. Basic death and invalidity cover is to be on the terms and conditions, including the circumstances, agreed between CSC and the relevant life insurance company or companies. He has researched and written about personal finance since 2012, with a special focus on entrepreneurship, freelancing and other small business operations. (v) a period of leave of absence for the purposes of engaging in other approved employment. 4.4.1 CSC may take out a policy or policies with a life insurance company or companies in its name to provide supplementary income protection cover for ordinary employer-sponsored members. Centers for Medicare & Medicaid Services. means contributions paid by a PSSAP member under Rules 2.3.1, 2.3A.1 or 2.3B.1. PSSap has received the highest SuperRatings Platinum Performance award for strong investment performance for 16 years straight. API's Monthly Statistical Report. 3.1.7 If CSC receives or is taken to have received a benefit application from or on behalf of an ordinary employer-sponsored member pursuant to Rule 3.1.1(a)(ii) and CSC approves the invalidity retirement of the ordinary employer-sponsored member, CSC must, if the person ceases to be an ordinary employer-sponsored member following approval of their invalidity retirement, pay the person as a lump sum such part of their total benefit as the SIS Act permits as soon as possible. Note:Among other things, Rule 5.5.3 covers the situation where a member contributes an amount that exceeds the non-concessional contribution cap and CSC must return that amount, in accordance with the SIS Act. They dont want you, or a hospital, pocketing extra money. To prevent those kinds of payment problems, when children are covered under each parents group health plan, one plan is designated as primary and the other secondary. A basic income protection cover policy is to be on the terms and conditions, including the circumstances, agreed between CSC and the relevant life insurance company but subject to the requirements of the SIS Act. 7.3.3 Subject to the SIS Act, the rights of persons claiming death benefits upon the death of a non-member spouse in relation to their non-member spouse interest are the same as the rights of persons claiming death benefits upon the death of a PSSAP member in relation to the interest in the PSSAP Fund of the deceased PSSAP member. 4.2.9 Where an ordinary employer-sponsored member with supplementary death and invalidity cover dies or an application for approval of their invalidity retirement is made under Rule 3.3.1, CSC must make a claim against the policy providing the supplementary death and invalidity cover. (b) must be paid directly to the ordinary employer-sponsored member as a non-commutable income stream. This can help ensure the best coverage possible and avoid any unforeseen costs and lapses in care and coverage for the newborn. 3.1.8 If CSC receives a benefit application from or on behalf of an ordinary employer-sponsored member pursuant to Rule 3.1.1(a)(iii), the member, subject to Rules 3.4.2 and 3.4.5, is entitled to income protection benefits in accordance with Rule3.4.3. I'm pretty sure this doesn't apply to the PSSap, or if it does then it must be EBA specific. While the parent whose birthday comes first is still the primary insurance plan, the birthday rule doesnt apply to children whose parents have divorced or are members of a blended family. (b) if, under Rule 5.4.1, a PSSAP member may choose between two or more investment strategies the investment strategies chosen by the PSSAP member for their personal accumulation account. *At this time, the protocols are only being provided to refining and petrochemical sites. A child can be on both parents health insurance, which is when the birthday rule takes effect unless special exemptions apply. See Rules 3.4.3 and 3.4.4. 3.1, 4.4 and 4.8: 29 June 2007 Remainder: 1 July 2007, Cc. Coordination of benefits and third party liability. The birthday rule is a part of a set of rules called the coordination of benefits (COB) which collectively resolves questions about which health insurance policy provides coverage. Says Norris: "The birthday rule is just a way of making sure that there's a fair, uniform method for determining which plan is secondary and which plan is primary when a child is covered under . See Rule 3.4.2. For more information, please contact us at pssap@api.org. Each Part is further divided into Divisions addressing unique groupings within the Part and each Division is made up of Rules containing specific provisions. PSSAP Focused will help lead to better process safety performance and improved industry safety around the world. National Association of Insurance Commissioners. This article will explain how the birthday rule works, when it applies, and what parents need to take into consideration when deciding whether to maintain double coverage for a child. 5.1.5 If any or all of the following amounts are paid to the PSSAP Fund in respect of a PSSAP member, the amounts must be credited to the persons personal accumulation account: (b) any additional employer contributions; (c) employee contributions that have been paid by the ordinary employer-sponsored member; (d) eligible spouse contributions accepted by CSC under Rule 2.3.4 paid on behalf of the ordinary employer-sponsored member; (e) the interest credited (if any) in respect of fund earnings on the persons accumulation amount as decided by CSC under Rule5.2.1; (f) any amount paid by a life insurance company to CSC in respect of the person in response to a claim against a life policy unless the amount is an amount referred to in Rule3.4.3; (h) any amount credited to the persons personal accumulation account under Rule7.2.2; (i) amount of any tax offset as determined by CSC. The birthday rule is part of a longstanding model act from the National Association of Insurance Commissioners. 2.2.10 If the percentage reported under Rule 2.2.9(b) is less than 9%, the designated employer is required to notify in writing the ordinary employer-sponsored member and CSC of an employer contribution shortfall. So, in addition to unparalleled assessments, the mentorship that the assessors bring to your site is priceless. As part of the industrys ongoing commitment to continuous process safety improvements, API, in collaboration with industry partners, has developed a Process Safety Site Assessment Program (PSSAP). As PSSAP does not directly provide for such benefits members will roll over all or part of their entitlement to a provider of such benefits. It doesnt matter which parent is older the year of birth isnt a factor. means the termination of the employment of an ordinary employer-sponsored member on the ground that they are unable to perform their duties because of any mental or physical condition. 12 were here. However, CSC must reject any contributions paid under this Rule if the SIS Act would prevent the PSSAP Fund from accepting the contributions or if acceptance of the contributions by CSC may jeopardise the status of the PSSAP Fund as a complying superannuation fund. Here are some basic examples of how the birthday rule functions: The birthday rule is different from policy to policy and state to state. 3.1.10 On receiving a benefit application from the legal personal representative of a PSSAP member under Rule 3.1.1(d), CSC may pay to the legal personal representative such part of the total benefit as the SIS Act permits if CSC is satisfied that: (a) the PSSAP member is under a legal disability; and. If the custodial parent then remarries and the new spouse has their own health insurance plan to which the child is also added, the new spouses coverage becomes secondary, with the non-custodial parents acting as a third line of coverage, only covering charges that arent paid by the primary or secondary plans. Birthday Rule: This is a method used to determine when a plan is primary or secondary for a dependent child when covered by both parents' benefit plan. PSSap can be your super fund wherever your career takes you, even if you leave the APS. The birthday rule is used to determine how coordination of benefits work when a child is covered by both parents' health insurance policies. 5.1.2 CSC may keep only one personal accumulation account for each PSSAP member. The advice is to include a statement of the reasons for the decision. Contributing members of PSS are generally eligible for a retirement benefit on leaving employment from the age of 55 onwards. One would be considered primary and the other would be secondary. If you were to do that before the child is born, youll have only one plan (your spouses). As one of Australias first super funds, weve partnered with millions of Australians to grow their savings for retirement. Subclauses 1.3, 1.6 and 1.8 deleted in the 5th amending deed. Employee contributions not able to be credited to non-member spouse interest account. It is not a law. birthday rule: A method of determining which parent's medical coverage will be primary for dependent children (m) charge reasonable fees in relation to the administration of the PSSAP Fund, including arrangements connected with PSSAP members and non-member spouses choosing particular investment strategies and arrangements connected with splitting of superannuation interests under the Family Law Act 1975. The birth year is not taken into consideration. Does Hydraulic Fracturing Cause Earthquakes? The 10-year rule refers to members who have contributed to PSS for 260 public service pay days or contribution due days (CDDs)the equivalent of ten years' continuous employment. If a young adult has coverage under a parents plan and a spouses plan, the plan covering them for longer will typically be primary. An NPR story about a newborn baby in Kansas is a good example of unexpected coordination of benefits. The birthday rule works for dental insurance the same way it does for other health insurance policies the insurance policy of the parent with the birthday earliest in the calendar year is considered the primary policy for children. For some, the birthday rule is seen as a non-biased, random and ultimately fair way to choose primary and secondary payers when dual coverage exists for a child. Our default balanced option is designed to maximise the likelihood that you'll achieve a comfortable retirement income standard as recommended by our industry association. 4.1.3 Where an ordinary employer-sponsored member dies or an application for approval of their invalidity retirement is made under Rule 3.3.1, CSC must make a claim against the policy providing the basic death and invalidity cover, unless the life insurance company does not provide cover in respect of the member under that policy. Our hand-picked assessors have an average of 35 years processsafety experiencein the refining and petrochemical industry, and are recognized as leading experts in their respective fields. Although theres usually an option to put the whole family on one policy, thats not always the best solution. Regulations 6.33 and 6.34 of the SIS Regulations set out that a trustee must roll-over or transfer an amount as soon as possible or within a timeframe allowed under the SIS Regulations, in response to a request from a scheme member. 9.1 The Minister may by signed instrument delegate all or any of his or her powers under the Deed, other than this power of delegation, to: (b) an APS employee in the Department referred to in subclause 1.4; or. In that case, you may want to drop your plan and get added to your spouses plan. The coordination of benefits establishes a process for determining primary and secondary insurance payers. (a) the Commonwealth Minister of State for Finance and Administration; (b) if 2 or more Commonwealth Ministers administer Departments which have functions in relation to the administration of matters to which the Deed relates, the Minister who administers the Department which has the function in relation to each of those matters; or, (c) a member of the Executive Council acting for the time being for and on behalf of any of those Ministers; or. A child can be covered by both parents health insurance policies. Establishment of the Public Sector Superannuation Accumulation Plan (PSSAP) and the PSSAP Fund. They appear throughout the Rules in, means an Agency within the meaning of the, means an AWA within the meaning of clause 1 of Schedule 7A to the, means insurance coverage provided in respect of an, means insurance cover provided in respect of an, means a notice in such form and manner as, means any period during which a person is absent full-time from his/her employment due to an incapacity for work resulting from an injury in respect of which compensation is payable under section 19 or 22 of the, (short for Commonwealth Superannuation Corporation), means the superannuation scheme established by the, for the purposes of reconsidering decisions of, means a enterprise agreement within the meaning of section 12 of the, means any amounts payable in respect of an, means the termination of the employment of an, in relation to a superannuation interest in the. The plans coordinate benefits to make sure that neither you nor your doctor is paid more than 100% of a medical claims actual cost. 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A special focus on entrepreneurship, freelancing and other small business operations at PSSAP api.org! Rules are divided into Divisions addressing unique groupings within the Part and each Division made... Determining primary and the other would be considered primary and the PSSAP Fund performance! 6, 1989 and your partner or spouse was born November 12, 1987 addressing! For insurance coverage under Part 4 of the Public Sector superannuation accumulation plan ( PSSAP ) and other! Of: ( a ) contributions paid by a PSSAP member by the health insurance which... Member for insurance coverage under Part 4 of the operation of PSSAP those in PSSAP by both parents health,! In Kansas is a good example of unexpected coordination of benefits establishes a process for primary. Nothing after negotiations with the insurers and the hospital will regulate its own.. Government employee, your employer contributes at least 15.4 % of your super salary into PSSAP! 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