Other Benefits

• Income Protector Benefit

  In the event of a valid claim the company will pay the claim amount monthly, in arrears, during the period of disability after the waiting period has expired, provided that the benefit is still in force. The company will waive the premium for this benefit while it is making payments on a claim.

  The claim event is temporary or permanent disability caused by a bodily injury or an illness to such an extent that the insured life is continuously unable to perform the main duties of his or her own occupation on a total or partial basis, or if the insured life qualifies for an impairment or illness claim.

  The impairment or illness claim events include functional impairment, critical illness, fractures and hospitalisation events.

• Comprehensive Critical Illness Benefit

  Typically, the payout percentage is 25%, 50%, 75% or 100% of the benefit amount, dependent on the severity of the critical illness event. If the benefit is a stand-alone benefit, the company will automatically reinstate the benefit amount for unrelated claims in different categories (and for unrelated claims within certain categories).

  The claim event is the diagnosis of the insured life (or the insured life’s biological or legally adopted child) with one of the following critical illnesses or a critical illness that affects any of the following :-

  Cardiac and arterial system; cancer; nervous system, connective tissue diseases; musculoskeletal system; gastrointestinal system; urinary tract; respiratory system; ear, nose and throat system; visual; HIV/aids; terminal illness, severe aplastic anaemia and major burns.

• Temporary Income Protector

  In the event of a valid claim, the company will pay the claim amount monthly in arrears during the period of disability for a maximum of the benefit payment term, after the waiting period has expired, provided that the benefit is still in force. The company will waive the premium for this benefit while it is making payments on a claim. The claim event involves temporary or permanent disability caused by a bodily injury or an illness to such an extent that the insured life is continuously unable to perform the main duties of his own occupation on a total or partial basis or if the insured life qualifies for an impairment or illness claim.

  The impairment or illness claim events consist of functional impairment, critical illness, fractures and hospitalisation events.

• Accidental HIV

  In the event of a valid claim, the company will pay the claim amount, provided that the benefit is still in force. The claim event is infection by any Human Immunodeficiency Virus (HIV), or being diagnosed as having acquired immunodeficiency syndrome (aids), if the insured life can prove to the satisfaction of the company that the infection is due to :-

  • The transfusion of infected blood or blood products from a South African blood transfusion service that the company recognises, after the starting date of the policy, or
  • The execution of his professional duties as a medical or dental practitioner registered with the Health Professions Council of South Africa (HPCSA) or a nurse registered with the South Africa nursing council, or
  • Receiving a transplanted organ that was previously infected with HIV or
  • Any other medical or dental procedure recognised by the HPCSA, that a medical or dental practitioner registered with the HPCSA or nurse registered with the South Africa nursing council, has performed on the insured life, or
  • Involvement in a road traffic accident or
  • Involvement in a violent crime, or
  • Involvement in a rape or an indecent assault crime.

• Accidental HIV Benefit Exclusions

  The company will not admit the claim if the claim event is brought about or accelerated directly or indirectly by any of the following :-

  • Willful breaking of any law by the insured life
  • The insured life fails to disclose information before inception of the cover
  • Intentional and grossly negligent self-inflicted injury
  • The excessive consumption of alcohol, intentional and negligent consumption of poisons, drugs, narcotics or medication unless prescribed by an independent medical practitioner and used as prescribed.

• Guaranteed Discount at Reassessment

  The company will often provide a guarantee that the new premium discount that we calculate after the three-yearly reassessment will not be less than 75% of the premium discount before the reassessment.

• Benefits

  • Physical Impairment Benefit
  • Functional Impairment Benefit
  • Own Occupation Disability Benefit
  • Comprehensive Disability Benefit
  • Income Protector
  • Temporary Income Replacer
  • Comprehensive Critical Illness Benefit
  • Comprehensive ADW Disability Benefit

• Benefit Exclusions

  Typically this includes the following clause :-

  It is not the intention of the company to rely on an exclusion to avoid payment of claims which, at the company’s sole discretion, were not caused, accelerated or made more likely by conditions which gave rise to the exclusion or which existed before the start of the risk.

  The company will not admit the claim if the claim event is brought about or accelerated directly or indirectly by any of the following –

  • War (whether declared or not)
  • Participation in any terrorist activity, riots, civil commotion and / or rebellion
  • Radioactivity and nuclear explosion
  • Willful breaking of any law by the insured life
  • The insured life fails to disclose information before the cover starts
  • Intentional and grossly negligent self-inflicted injury
  • The excessive consumption of alcohol, intentional and negligent consumption of poisons, drugs, narcotics or medication unless prescribed by an independent medical practitioner and used as prescribed
  • The company will also specifically exclude maternity leave