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COVER

Life Cover

Section 3 - Life cover, permanent total disability and critical illness cover

What we will pay:
If you should die or become permanently totally disabled or suffer from a critical illness during the period of insurance, we will pay a benefit on your behalf across to the Membership Provider. This benefit will equal all current and future Service Fees payable in accordance with your Membership Agreement at the date the insured event occurred:

- Less any rebate to which you would have been entitled had you settled the Membership Agreement on the day the insured event occurred;

- Less any amount owing in excess of the maximum benefit payable under the policy.


What we do not pay for:

• LIFE COVER

We will not pay any benefit on your behalf to the Membership Provider if your death arises directly or indirectly from any of the following:

  • a self-inflicted injury or suicide within 2 years of the start date;
  • any condition you had at the start date;
  • any condition for which you have received treatment or advice during the 12 months immediately before the start date;
  • a condition related to AIDS or HIV unless contracted during medical treatment which is not as a result of drug abuse or a sexually transmitted disease;
  • war, riot, radioactive contamination, nuclear accidents and similar risks;
  • your participation in a criminal act;
  • your participation in a hazardous pursuit;
  • under the influence or above the legal limit of alcohol intake or drug abuse;
  • refusing medical treatment as recommended by your own medical practitioner.
  • Accidental death or injury arising out of chemical and/or biological substances unless used for peaceful means;

• PERMANENT TOTAL DISABILITY and CRITICAL ILLNESS COVER

We will not pay any benefit on your behalf to the Membership Provider if your permanent total disability or your critical illness arises directly or indirectly from any of the following:

  • any condition for which the life cover will not be paid;
  • any condition which arises within 30 days of the start date of the Membership Agreement;
  • any condition for which you had received treatment or advice for during the 12 months immediately before the start date of the Membership Agreement;
  • pregnancy, childbirth, the ending of pregnancy or any related complications;
  • a medical procedure undertaken at your request which is in the opinion of a doctor not necessary to maintain the quality of your life;
  • unreasonable failure to obtain or follow medical advice;
  • a permanent total disability or critical illness arising while you are working outside of South Africa.

 

 

 

 

Disability & Critical Illness Cover

Section 4 – Temporary Disability Cover

What we will pay:
If during a period of insurance you become disabled for more than 30 consecutive days we will pay a benefit on your behalf across to the Membership Provider equal to your monthly Service Fee.
The disability benefit is payable on condition that you:

  • have been in work when your disability occurred;
  • be under the continuous care of a doctor for this disability;
  • be prevented from working only as a result of this disability;
  • give us any evidence we may ask for in order to prove your claim is valid and continues to be so;

When paying your claim we will consider the first day of disability to be the day a doctor certifies you are disabled and unable to attend work.

Thereafter will pay your monthly Service Fee for each further 30 continuous days you remain disabled, or until the end date occurs, whichever is first.

What we do not pay for:
We will not pay your disability benefit across to the Membership Provider if your disability arises directly or indirectly from any of the following:

  • any exclusion/conditions listed in Section 3 above “What We Do Not Pay For”
  • a condition or mental or nervous origin including stress, anxiety or depression unless the condition is being treated under the direct, and regular care of a consultant psychiatric specialist;
  • a back or spinal condition (NOT BEING AN EXISTING CONDITION) unless it is shown to exist by a MRI or CT scan conducted or supervised by an appropriate specialist.