Quotation: terms and conditions
The terms and conditions provided are a summary only. For the complete terms and conditions, please read the policy document.
A copy of the policy document can be requested from Hollard Group Risk.
In the event of any dispute or any discrepancy between this summary and the provisions of the policy, the policy will prevail.
A. General
1. Eligibility Any person to be insured under this policy must: a. be an employee of the employer, or be a contractor for the employer b. be a member of the fund, if the policyholder is a fund c. be within the age limits d. ordinarily reside in the SADC region, unless agreed to by us in writing e. be a citizen of the Republic of South Africa or have been given the necessary permission from the South African authorities to live and work in the Republic of South Africa It is compulsory for all employees and/or contractors and/or members who meet the conditions for eligibility to be insured for all the benefits under this policy.
2. Actively at work If an employee and/or contractor and/or member is actively at work on his entry date, his cover starts on his entry date. If not, his cover starts when: - we receive satisfactory proof of his good health, or - he completes two months of consecutive service with the employer without absence. The actively at work condition will be partially waived for any employee and/or contractor and/or member: - who, immediately before the policy start date, was covered by another insurer under a policy taken out by the employer that provided the same benefits as this policy. The employee and/or contractor and/or member must have met the actively at work conditions for cover under that policy; - who is on leave approved by the employer, other than sick leave; or - for whom we agree in writing to waive this condition. We will not automatically waive the actively at work condition for any employee and/or contractor and/or member receiving disability income benefits.
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3. Temporary absence from work We will continue to cover an insured who is temporarily absent from work, but only if all four of the following conditions are met: a. The insured and the employer intend the absence to be temporary. b. The absence is not longer than six months. c. During the temporary absence, the employer continues to pay the insured’s salary. d. During the temporary absence, the employer continues to pay the premiums on behalf of the insured.
4. Temporary absence from the SADC region We will continue to cover an insured who temporarily leaves the SADC region for work or holiday, but only if all five of the following conditions are met: a. The insured and the employer intend the absence to be temporary. b. The employer gives written approval for the insured temporarily leaving the SADC region. c. The absence is not longer than 12 months. d. During the temporary absence, the employer continues to pay the insured’s salary. e. During the temporary absence, the employer continues to pay premiums on behalf of the insured.
SADC region: The Southern African Development Community comprising Angola, Botswana, Democratic Republic of Congo, Lesotho, Madagascar, Malawi, Mauritius, Mozambique, Namibia, Seychelles, the Republic of South Africa, Swaziland, Tanzania, Zambia and Zimbabwe.
5. Proof of good health We will automatically cover each insured up to the free cover limit set out in the policy schedule. The temporary accident cover benefit is available for a period of four months from the date that cover for an insured went above the free cover limit or the higher limit previously accepted. We will pay for any medical expenses the insured incurs in obtaining the information we need. We will consider the previous insurer’s underwriting decision if you send us the letter of acceptance, including: - the date of acceptance; - details of the accepted cover; - if applicable, forward underwriting terms; and - if applicable, details of any exclusions, loadings or special conditions.
6. Continuing cover if disabled We will continue to cover an insured for the death benefit if the insured receives disability income benefits under any disability income policy taken out by his employer. This is not an automatic benefit and the policyholder must select this option. If the continuing cover for death benefit applies to your policy, then you must tell us about any insured who is receiving a disability income benefit before the policy start date under a policy taken out by the employer, with another insurer.
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We will tell you the premium rates, terms, conditions and exclusions on which we will provide cover.
7. Premiums You must pay the premium at the premium rate set out in the policy schedule, by the last day of each month. If you pay us any premium for any period of insurance after the date that this policy ends, we will refund the premiums to you. We will review your premium every year on the policy review date. We may change your premium rate on one month’s written notice if: a. the number of insureds changes by more than 20%; b. the total benefits and/or salary for all insureds changes by more than 20%; c. the benefit weighted average age of insureds changes by more than two years; d. the majority occupation split of insureds changes, for example if the occupation split changes from 80% administrative to 50% administrative; e. the geographical spread changes materially; f. the male-to-female ratio of insureds changes by more than 20%; and/or g. the nature of the employer’s business changes materially.
8. Administrative responsibilities You must provide us with an electronic register of lives insured and it is your responsibility to ensure the information on the register of lives insured is correct. The register of lives insured must show, for each insured: - full name - identity number - employee or membership number - date of birth - gender - yearly salary - all other material information - the contract period for each contractor (if applicable)
9. Cancelling the policy You may cancel this policy by giving us: - immediate notice if it is within the first month from the policy start date; or - one month’s notice after the end of the first month from the policy start date. Cooling off period In the case where no benefit has been paid or no insured event has yet occurred, you may within one month of receiving either the policy wording or a summary of the policy wording, request us in writing to cancel this policy and we will refund any premiums paid, less the deduction of costs for any cover provided for risk benefits. Page 3 of 10 Hollard Group Risk - terms and conditions – V3 (20131115)
10. Consent to disclosure of private information Each insured, by virtue of being insured under this policy, authorises us to access any information about him and to obtain any such information, which we may reasonably need to: - assess his cover above the free cover limit; - assess the validity of a claim; and/or - trace him in the event of an unclaimed benefit; and authorise any person and/or institution from whom we may request such access and information to grant access and provide the information. Each insured, by virtue of being insured under this policy, also authorises us to share and provide any information which we obtain about him, with other insurers. This right of access extends to claims made by any dependants or beneficiaries of the insured or any other party claiming benefits. The information which we are authorised to access and obtain includes, but is not limited, to information about the insured’s health, even if we have not asked for proof of good health. Any medical information required will only relate to that of the insured and no other person. You must advise each insured of the contents of this clause. Unless we receive written notice to the contrary, we will assume that each insured has accepted the contents of this clause and we will be entitled to act accordingly.
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B. Exclusions
Benefits to which exclusion Exclusion applies Warlike activities - Accidental death
We will not pay a claim if the insured’s claim is directly or indirectly - Accidental disability - Critical illness caused by: - Death a. nuclear, biological and chemical warfare or sabotage - Disability income b. the insured actively taking part in: - Dismemberment - Funeral - any war, invasion, rebellion, revolution, uprising, riot, civil - Lump sum disability commotion, strike, labour disturbance, and the seizing of - Spouse’s death power - Total and temporary disability
- overthrowing or influencing any government by force or terrorism.
Criminal activity - Accidental disability - Critical illness We will not pay a claim if the claim is directly or indirectly caused by - Disability income the insured committing a crime. - Dismemberment - Lump sum disability - Total and temporary disability
Self-inflicted - Accidental death
We will not pay a claim if the insured’s claim is directly or indirectly - Accidental disability - Critical illness caused by: - Disability income The insured: - Dismemberment - deliberately or negligently exposing himself to the risks and - Lump sum disability - Total and temporary disability events that led to the claim, except where the insured attempts
to save a human life; - attempting suicide or deliberately inflicting injury on himself; - refusing to seek and follow reasonable medical advice or treatment; - driving when over the legal alcohol limit; - taking drugs or poison; or - taking medication unless a qualified medical practitioner prescribes them.
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Benefits to which exclusion Exclusion applies Not because of an accident - Accidental death
We will not pay an accidental benefit if the claim is not because of - Accidental disability - Dismemberment an accident.
Failing to disclose all material information about the insured - Critical illness
We will not pay a claim above the free cover limit (or higher limit - Disability income - Lump sum disability previously accepted) if you were required to give material - Total and temporary disability information about the insured but did not do so.
The disability existed before - Accidental disability
We will not pay any disability claim within the first 12 months of - Critical illness - Disability income cover for a disability that was caused by an illness or injury that - Lump sum disability existed in the six months before the insured's entry date. - Total and temporary disability If, within the first 12 months of any increase in the benefit, a claim is made for a disability that was caused by an illness or injury that existed in the six months before the increase, we will not pay the amount of the increase. We will partially waive the pre-existing conditions clause if an insured is actively in the service of the employer and has previously satisfied the conditions for cover under a policy issued by any insurer for the same benefits immediately prior to the policy start date. The waiver is only allowed for conditions covered by the previous insurer and is a partial waiver.
C. Claims
The following claim notification periods apply to the submission of claims:
Period to submit claim Benefit Notification period documents
Death benefits 9 months 3 months
Disability benefits 3 months 3 months
Funeral 6 months 3 months
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We typically need to following documentation to assess a claim.
All benefits Death benefits Disability benefits
- Original signed claim form/s - an original certified copy of - medical reports - an original certified copy of the insured’s death - clinical evidence the insured’s and/or main certificate - if applicable, proof of members identity document - if requested, a copy of the continuous premium payment - a copy of the insured’s or main completed BI-1663 report during the waiting period member’s last payslip - if applicable, an original - if applicable, a copy of the - proof of banking details certified copy of proof of the insured’s job description - if applicable, a copy of the relationship of the insured to - if applicable, a copy of the relevant policy report the main member insured’s sick leave records
- if applicable, a copy of the completed accident reports required by COID (Compensation for Occupational Injuries and Diseases Act 1993) - if applicable, a copy of the insured’s medical aid certificate
Unintentional delays, omissions or errors made by either party in connection with this agreement shall not be held to relieve either of the parties hereto from any liability which would have attached to them hereunder, regardless of such delay, omission or error provided that any such delays, omissions or errors shall be rectified immediately upon discovery.
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Notice on FAIS disclosure requirements (Financial Advisory and Intermediary Services Act 37 of 2002)
About the FAIS disclosure requirements Your Financial Services Provider (FSP) is your appointed intermediary. In terms of the FAIS General Code of Conduct 2003, your FSP is required to make certain disclosures at the earliest reasonable opportunity about the FSP as well as about the product supplier (insurer). For your convenience, please find below the required information on the insurer.
About the Service
– All the policies we offer are Long-term Insurance category B1 policies, with the exception of our Funeral benefit which is split as: Funeral benefit R30,000 or less: Category A Funeral benefit more than R30,000: Category B1 – For the complete nature and extent of benefits, please refer to the policy and/or risk terms and conditions and/or quotation document. – For your monetary obligations, premium payment obligations, manner and frequency thereof, and the consequences of non-payment of premium please refer to the policy and/or risk terms and conditions and/or quotation document. – Details regarding brokerages, remuneration, commission, fees and incentives paid to the FSP (if any) and who pays it please refer to the policy and/or risk terms and conditions and/or quotation document. – Details of special conditions, exclusions, excesses or restrictions please refer to the policy and/or risk terms and conditions and/or quotation document. – For a detailed claims procedure please refer to the policy and/or risk terms and conditions and/or quotation document. – For details on cancellation of policies and the “cooling off” period please refer to the policy document.
About the Insurer (Product Supplier) This policy will be underwritten by Hollard Group Risk, a division of Hollard Life Assurance Company Limited, also known as Hollard. Hollard is a registered insurer and a licensed Financial Services Provider (FSP number 17697). Hollard is a public unlisted company and its registration number is 1993/001405/06. Hollard’s contact details are: Postal address Physical address PO Box 87428 Hollard Villa Arcadia Houghton 22 Oxford Road 2041 Parktown 2193 Tel: +27 (11) 351-5000 Fax: +27 (11) 351-5001 Web: www.hollard.co.za
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If you have a query or a complaint about this product, please contact: Hollard Group Risk Compliance A division of Hollard Life Assurance Company Limited PO Box 87428 Houghton 2041 Tel: +27 (11) 351-5000 Fax: +27 (11) 351-3221 Email: [email protected]
If you have a claim on the policy, please contact your FSP, or Hollard: The Claims Department, Hollard Group Risk A division of Hollard Life Assurance Company Limited PO Box 87428 Houghton 2041 Tel: +27 (11) 351-1026 Fax: +27 (11) 351-3262 Email: [email protected]
Matters of Importance 1. If you have a complaint about advice, service or a claim under the policy, first try and resolve it with your FSP by contacting them on the details provided to you on its FAIS disclosure document. 2. If the matter cannot be resolved, you can submit a complaint in writing to Hollard as stated above. 3. If you have a dispute regarding a claim that is not resolved to your satisfaction by the FSP or Hollard, you may submit the complaint to the Ombudsman for Long-term Insurance, contact details below. 4. All material facts must be accurately, fully and properly disclosed by you. All information provided by you or on your behalf is your own responsibility. You need to be satisfied with the accuracy of any transaction submitted by your FSP on your behalf. 5. Misrepresentation, incorrect or non-disclosure by you of any material facts or circumstances may impact negatively on any claims arising from your insurance contract. 6. The risk application form, policy schedule and the policy wording must be read as one document. 7. You are entitled to a full copy of the policy. You are also entitled to a summary of the policy. If you have not received a summary or a full copy of the wording within 60 days from the date of acceptance of a quotation, or you feel that this policy does not meet legal requirements, please submit your complaint in writing to The Compliance Officer, Hollard Life Assurance Company Ltd, PO Box 87428, Houghton, 2041. 8. Do not sign any incomplete or blank documents. No person may request or insist that you do so.
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Particulars of the Ombudsman for Long-term Insurance The Ombudsman for Long-term Insurance is available to advise you in the event of claim disputes which are not satisfactorily resolved by your FSP and/or Hollard: The Ombudsman for Long-term Insurance Private Bag X45 Claremont 7735 Tel: +27 (21) 657-5000 Fax: +27 (21) 674-0951 Email: [email protected]
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