Medical Emergency Cover Terms and Conditions

The Medic Plus Emergency and Evacuation Plan is Marketed by Oversurance (Pty) Ltd

which is an authorised and registered Financial Service Provider, Licence Number 46318.

Insurance Agreement

Premium Payment

  • 1The Policyholder and the Insurer agree that the Policyholder is liable to pay the Premium as follows:
  • 2This Policy is issued in consideration of the payment of the premium stated in The Schedule
  • 3This insurance shall commence on the Effective Date shown in The Schedule. All Periods of Insurance will begin and end at 00H00 South African time
  • 4Premiums are payable monthly to the Collection Agent(s) so authorised by the Insurer to collect premium on behalf of the Intermediary in accordance with the Conditions stated in the Continuation of Cover section
  • 5The Premium Due Date will be the selected debit date of every calendar month where premium is payable monthly
  • 6Where applicable a pro-rata premium shall be become payable for any Period of Insurance prior to the Premium Due Date and shall be collected on the Premium Due Date
  • 7The Insurer reserve the right to request proof of payment of premium

Continuation of Cover (where premium is payable by bank debit order)

The premium is payable every month before the beginning of the month to which cover applies

  • 1If premium is not received on the date the Collection Agent has been advised to collect premium;
  • 2As a result of a Policyholders instruction not to honour the debit order, all cover under this Policy will end at midnight on the last day of the month for which premium has been received
    • 2.1For any reason other than stated in 2 Continuation of Cover, the Collection Agent will present the Policyholders debit order again and collect it with the debit order for the following month. If both premiums are collected, the Policy will continue to remain in force. In the event that both debit orders cannot be collected this Policy will end automatically from the first Premium Due Date that premium was not paid
    • 2.2Subject to 2 and b above Premium is due on the Premium Due Date, this insurance shall be deemed to have been cancelled at midnight on the last day of the preceding Period of Insurance unless failure to make payment was as a result of inadvertent error on the part of the bank, paying agent or Collection Agent(s)
  • 3Premium received or collected by the Collection Agent(s) shall be deemed to have been received by the Insurer(s).
  • 4The Insurer(s) will not be obliged to accept Premium tendered to them, or to any Collection Agent(s), outside of the terms of trade agreed with the Collection Agent(s), but may do so upon such terms as it in its sole discretion may determine
  • 5 In the event of the Insurer(s) not accepting premium, the Policy will lapse from the date from which the premium became due. The Insurer(s) will not be liable for any claim that occurs prior to receiving the premium
  • 6The Insurer(s) will subject to the Terms, Conditions, Provisions and Exclusions of this Policy, provide the insurance in the manner and to the extent provided in this Policy
  • 7All information supplied to the Insurer(s) by the Policyholder shall be incorporated into and be the basis of this Policy

General Definitions

The following General Definitions are applicable to the Policy as a whole:
  • 1 Accident shall mean a sudden, unexpected external and specific event which occurs at an identifiable time and place, which results in Bodily Injury. The word "Accidental" shall be construed accordingly. If an Insured Person suffers Bodily Injury as a result of unavoidable exposure to severe weather conditions, the Insurer(s) will consider it as having been caused by an Accident. This shall also include insect, spider or animal bites other than those causing Malaria
  • 2Acquired Immune Deficiency Syndrome or AIDS has the meanings assigned to it by the World Health Organisation including Opportunistic Infection, Malignant Neoplasm, Human Immune Deficiency Virus (HIV), Encephalopathy (Dementia), HIV Wasting Syndrome or any disease or Illness in the presence of a zero-positive test for HIV
  • 3Annual Earnings shall mean the annual rate of wage or basic earnings payable per annum by the Policyholder to the Insured Person as remuneration for services provided as set out in the Insured Person’s contract of employment immediately preceding the date of Bodily Injury. Annual Earnings shall be deemed to include allowances of a constant nature being paid or allowed by the Policyholder under contract to the Insured Person at the time immediately preceding the date of Bodily Injury provided such emoluments are specifically included in the Annual Earnings on which the Premium has been based excluding loans, benefits in kind, profit share payments, discretionary bonuses and overtime or expense payments Provided always that, if the Insured Person is under a contract the period of which is less than 1-year, the term Annual Earnings shall mean the amount due to be paid to the Insured Person during the contract period, including the value of accommodation and food allowances, but excluding any expenses of a reimbursive nature
  • 4Any One Event Limit shall mean the maximum amount shown in the Schedule of Benefits that the Insurer(s) will pay per Event. Where more than one Schedule of Benefits or Policy exists, one Limit, the greatest, shall apply over all
  • 5 Any One Life Limit shall mean the maximum amount shown in the Schedule of Benefits payable for any Insured Person for all Bodily Injury arising from any one Event. Where more than one Schedule of Benefits or Policy exists one Limit, the greatest, shall apply over all
  • 6Any Other Aircraft Limit shall mean any aircraft, other than any Multi-Engine Fixed Wing Aircraft, operated by a licensed commercial carrier from an internationally or locally recognised airport
  • 7 Benefit(s) means the appropriate Sum Insured(s) selected as stated in the Schedule of Benefits and the Benefit Level so reflected in The Schedule
  • 8Benefit Period means the maximum (but not necessarily consecutive) period for which Benefits are payable in respect of an Insured Person for any one Accident. The Benefit Period commences at the end of the Franchise Period, if any. In respect of Daily In-Hospital Cash following Accidental Bodily Injury the Benefit Period is up to a maximum period of 90- Days
  • 9Bodily Injury physical injury which is caused solely by Accidental means and which independently of Illness or any other cause results in the Insured Person's death or disability, within 12-calendar months from the date of the Accident. Bodily Injury shall exclude any psychological or psychiatric condition howsoever arising
  • 10Business Sponsor means the Company or organisation, shown in The Schedule, with whom we have worked to present this Policy
  • 11Child/Children unmarried natural children, lawfully adopted children, step children by marriage or foster children who have been placed in the custody and care of the Insured Person as foster Children, who are financially dependent upon the Insured Person and between the ages of 6-months and 18-years (or under 25-years if they are unmarried, not pregnant and in Full Time Education)Country of Domicile shall mean the country in which the Insured Person is habitually resident during the Period of Insurance
  • 12Collection Agent(s) means the party / parties authorised by the Insurer(s) to collect receive, hold and deal with premiums for Policies in terms of section 45 of the Act
  • 13Confinement means admission as an in-patient to Hospital for a period of greater than 24-consecutive hours on the advice of, and under the regular care and attendance of, a qualified medical practitioner which is medically necessary for the diagnosis and/or treatment
  • 14Country of Domicile means the Republic of South Africa being the country in which the Insured Person is habitually resident during the Period of Insurance
  • 15Daily Benefit means the maximum amount we can pay in respect of each 24-hour period of Confinement as stated in the Schedule of Benefits
  • 16Date of Loss means
    • 16.1for Hospitalisation, the first day of Confinement to a Hospital for a period exceeding 24- consecutive hours;
    • 16.2for Accidental Death, Accidental Disability, Emergency Medical Evacuation and In-hospital Medical Expenses, date of accident
  • 17Day means a period of 24-consecutive hours of Hospitalisation subject to the Franchise Period and excluding the day of discharge
  • 18Effective Date means the day, month and year shown in The Schedule that cover shall commence. Any amendment to this insurance shall be effective from the Effective Date shown by endorsement
  • 19Effective Time shall mean the time during the Period of Insurance which cover is effective as stated in the Schedule
  • 20Eligible Person means the Insured Person is domicile in the Republic of South Africa, is aged 18 (except in respect of Children) or over and has not reached 65-years of age before the Effective Date and must not be serving in the armed forces or any country or international organisation. Where cover has been purchased by a company or Business Sponsor, Eligible Person shall mean the Employee or the active account holder of the company provided such Insured Person meets the eligibility criteria
  • 21Emergency shall mean Bodily Injury caused by an Accident requiring medical or surgical treatment, where failure to provide medical or surgical treatment would result in serious impairment to bodily functions or serious dysfunction of a bodily organ or part or would place the Insured Persons life in serious jeopardy
  • 22 Employee(s) means an Insured Person(s) in active employment at the Date of loss under a contract of service or apprenticeship with the Policyholder
  • 23Emergency Medical Evacuation means the transfer of an Insured Person following Accidental Bodily Injury to the closest appropriate location to obtain necessary Emergency Medical Treatment provided that such Evacuation is;
    • 23.1Medically necessary; and
    • 23.2Is organised by the appointed Service Provider
  • 24Emergency Medical Treatment means a Qualified Medical Practitioner's medical advice, treatment, consultations and prescribed or repeat maintenance medication, necessarily incurred by the Insured Person on advice of a Qualified Medical Practitioner appointed by the Insurer(s) within a hospital
  • 25Event shall mean all instances of Bodily Injury arising out of and directly occasioned by one sudden, unexpected, unusual and specific incident occurring at an identifiable time and place. The duration and extent of an Event shall be limited to 72- consecutive hours and within a 20-kilometer radius of the place where the Accident occurred. No instance of Bodily Injury occurring outside such period and/or radius shall be included in that event
  • 26Excess means the first amount of a claim, expressed as a monetary amount or a percentage of the loss, which the Policyholder must bear
  • 27 Excess Period shall mean the initial period during which no Benefit is payable
  • 28Franchise Period in respect of Hospital Confinement means the initial period during which no Benefit is payable unless the Insured Person is hospitalised for a period of greater than 24-consecutive hours
  • 29Full Time Education means a programme of learning provided by a recognised educational body, which leads to a qualification by examination or assessment which is either full-time study or a combination of study and work experience as long as at least two thirds of the total time for the course is spent on study
  • 30Hazardous Activity means aviation sports, paragliding, underwater diving, hunting, spear-fishing, rock-climbing, mountaineering, motor boat racing, motor-cycle racing, quad-biking, bungee jumping, sky diving and horseback sports
  • 31Hospital mean a registered medical facility (other than an institution for the aged, terminally ill or convalescent rest or nursing home and/or drug or alcohol rehabilitation facilities) operated pursuant to the law for the care and treatment of injured or sick persons with organised facilities for diagnosis and surgery and having 24-hour nursing service and medical supervision
  • 32Hospital Confinement shall mean admission to a Hospital as an In-Patient as a result of Bodily Injury for a continuous period of 24-hours or more on the advice of and under the constant supervision of a Qualified Medical Practitioner
  • 33In-Patient shall mean an Insured Person who has gone through the full admission procedure and for whom a clinical case record has been opened and whose admission is necessary for the medical care and treatment of Bodily Injury and not merely for any form of nursing, convalescence, rehabilitation, rest or extended care
  • 34Insured Event shall mean the list of insured events stated in the Schedule of Benefits
  • 35Immediate Family Members means 1-Partner and up to a maximum of 3- Dependent Children of the Insured Person for who premium has been paid under the Family Cover Plan
  • 36 Inception Date means the first date the Insured Person(s) joins this insurance program
  • 37Insured Person shall mean any person or category of persons between the ages of 16 and 65-years shown as being an Insured Person in the Schedule of Benefits. Cover applies until the end of the Period of Insurance in which the Insured Person attains the age of 70-years or the date upon which the Insured Person ceases their employment with the Policyholder, whichever occurs first
  • 38Jurisdiction means Insured Persons residing in the Republic of South Africa
  • 39Level means the benefit level selected as stated in The Schedule of Benefits and reflected in the Schedule
  • 40Loss of Hearing shall mean total and irreversible loss of hearing of all sound confirmed by medical evidence relying on audio-metric and sound-threshold tests without expectation of recovery
  • 41 Loss of Intellectual Capacity shall mean severely restricted sensory and motor functioning (as determined by a Qualified Medical Practitioner appointed by the Insurer(s)) following Bodily Injury resulting in substantial loss of self- protection and self-care skills and requiring constant aid and supervision for the remainder of the Insured Persons life
  • 42Loss of Limb shall mean:
    • 42.1 in respect of an arm: permanent physical severance of the four fingers at or above the metacarpal phalangeal joints (where the fingers join the palm of the hand); or
    • 42.2the permanent total loss of use of an entire hand or arm; and
    • 42.3in respect of a leg: physical severance or total loss of use above the level of the ankle (talo-tibial joint)
  • 43 Loss of Sight shall mean total and irreversible loss of sight confirmed by medical evidence of a qualified ophthalmic specialist and the Insurer(s) are satisfied that the condition is permanent and without expectation of recovery
  • 44Loss of Speech shall mean total and permanent loss of the ability to make a comprehensible word or an understandable verbal language
  • 45Multi-Engine Fixed Wing Aircraft shall mean any multi-engined fixed wing aircraft operated by a licensed commercial carrier operating from internationally or locally recognised airports
  • 46Non-Mandated Intermediary means the person or entity named in The Schedule and appointed by the Insured Person or Policyholder to carry out any duties under this Policy on behalf of the Insured Person or Policyholder
  • 47Paraplegia shall mean a Permanent Disability which results in complete paralysis of the lower half of the body including both legs
  • 48Partner shall mean a person recognised in South African Law as the Insured Person’s spouse or someone of either sex with whom the Insured Person co-habits as though they are their spouse at the time of the Insured event. Cover is limited to one nominated partner where a person has more than one
  • 49Period of Insurance the period commencing from the Effective Date and monthly thereafter for which premium has been paid
  • 50Permanent and Incurable Paralysis shall mean the complete and permanent loss of use of arms or legs, or one arm and or leg, through paralysis
  • 51Permanent and Total Loss shall mean the loss by physical severance or the permanent and total loss of use of a hand, foot, thumb, finger, toe, arm or leg
  • 52Permanent Disability means a disability which has lasted for at least 12-months and which in the Insurer(s) opinion is beyond hope of recovery and will in all probability continue for the remainder of the Insured Person's life. Benefit shall become payable once the degree of Disability has been confirmed and established by medical evidence
  • 53Permanent Disfigurement shall mean disfigurement of the external features or appearance including scarring as a result of a surgical procedure required as a direct result of an Accident
  • 54Plan means the option reflected in the Schedule and for which the appropriate premium is being paid. The following Plans are available
    • 54.1Individual Cover means cover shall apply in respect of 1 named Policyholder as stated in The Schedule ZAMFRF7003
    • 54.2Family Cover means the Policyholder and if applicable 1 partner of the Policyholder and up to a maximum of 3- Dependent Children of the Policyholder as stated in The Schedule ZAMFRF7004
  • 55Policy shall mean the contract of insurance embodied in this document, all Schedule(s), memoranda and any subsequent endorsements, amendments and declarations in respect of this document
  • 56Policyholder means the company or individual stated in The Schedule who has purchased this insurance and is responsible for the payment of premium
  • 57Premium Due Date means the selected debit date that the Policyholder has elected for premiums to be paid or in the case of a group/company when invoice is issued
  • 58Pre-existing condition means a medical condition or disability which existed at any time before an Insured Person’s Inception Date of this insurance
  • 59Qualified Medical Practitioner mean a person registered with a current legal licence to practice medicine under the laws of the country in which they practice other than an Insured Person or a member of the immediate family of the Policyholder or of an Insured Person
  • 60Service Provider means the party authorised by the Insurer(s) to conduct the Emergency Medical Evacuation
  • 61Sum Insured shall mean the maximum amount of cover up to which the Insured or Insured Person can claim
  • 62 The Schedule indicates the Plan and Level applicable to an Insured Person and for which the appropriate premium has been paid to Insure(s). If The Schedule does not correctly record the insurance applied for, or if any agreed endorsement has not been issued or has been issued incorrectly, the Intermediary, Loyalty Life Management Services (Pty) Limited should be notified as soon as possible
  • 63Territorial Limits means the following territories Angola, Botswana, Lesotho, Malawi, Mauritius, Mozambique, Namibia, South Africa, Swaziland, Tanzania, Zambia, Zimbabwe
  • 64War shall mean armed conflict between nations, invasion, act of foreign enemy, civil war, military or usurped power
  • Operative Clause in respect of Items 1 - 4
  • 65If during the Period of Insurance an Insured Person sustains Bodily Injury during the Effective Time, which solely and independently of all other causes results, within 12 calendar months of the Accident, results in an Insured Event, the Insurer(s) agree to compensate the Policyholder, the compensation stated in the Schedule of Benefits in accordance with the percentage specified in Items 1 – 2 of the Table of Benefits

Insured Events

  1. Accidental Death
    Where Bodily Injury results in the death of an Insured Person, the Insurer(s) will compensate the Policyholder up to but not exceeding the amount shown in the Schedule of Benefits. The percentage payable shall be as shown in the

Table of Benefits

  • Permanent Total Disability

Relocation Benefit

  • R 100 000.00 RELOCATION cost cover (REPATRIATION)

  • Relocation Costs


Should anyone entitled to the benefit pass away, we will transport the deceased by road or air to the final funeral home closest to the place of burial in South Africa. This benefit covers transportation of the body to the place of burial from anywhere in South Africa, Lesotho, Swaziland, Zimbabwe, Botswana, Namibia and Mozambique (south of the 22º latitude) provided the burial takes place within South Africa, at no additional cost.


We are very aware that the surviving family may have special needs or cultural preferences regarding the transportation of the deceased. We will take special care to meet these needs and preferences and can also recommend a Funeral Parlour if required.


In addition to the transportation of the deceased to the final funeral home, the benefit includes the following features:


  • One relative may accompany the body to the final funeral home and, if needed, overnight accommodation will be provided at no additional cost.
  • Assistance and advice on claims procedures is provided to the surviving family.
  • Legal assistance can be arranged to assist in interpreting the Will and handling of documentation if necessary.
  • Advice on the handling of all the necessary documentation such as obtaining a death certificate and cross-border documentation.
  • Referral to a pathologist if an autopsy is necessary.
  • Referral to reputable Funeral Parlours and providers of other funeral services e.g. catering, tents, etc.
  • Assistance in finding a tombstone provider.
  • This benefit is available 24 hours a day, 7 days a week.

  • Permanent Total Disability


    Where Bodily Injury results in the Permanent Total Disability of an Insured Person, the Insurer(s) will compensate the Policyholder up to but not exceeding the amount shown in the Schedule of Benefits. The percentage payable shall be as shown in the Table of Benefits

3. Emergency Medical Evacuation and Emergency In-Hospital Medical Expenses

In the event that an Insured Person sustains Bodily Injury which requires Emergency Medical Evacuation and Emergency In-Hospital Medical Expenses within 30-days from the date of the Accident, the Insurer(s) will pay the Service Provider up to but not exceeding the amount shown in The Schedule in respect of expenses necessarily incurred


4. In-Hospital Daily Benefit following Accidental Bodily Injury

In the event that an Insured Person sustains Bodily Injury which, independently of Illness or any other cause, results in Emergency Hospital Confinement, the Insurer(s) will pay the Policyholder the amount shown in The Schedule for each Day of such Emergency Hospital Confinement up to the Benefit Period shown the Schedule of Benefits

Level 1 Level 2 Level 3 Level 4 Level 5
1. Accidental Death R 100 000 R 75 000 R 50 000 R 25 000 R 10 000
2. Accidental Disability R 100 000 R 75 000 R 50 000 R 25 000 R 10 000
2.1 Permanent Total Disability R 100 000 R 75 000 R 50 000 R 25 000 R 10 000
2.2 Permanent Disability Such % as specified for the particular disability Such % as specified for the particular disability Such % as specified for the particular disability Such % as specified for the particular disability Such % as specified for the particular disability
3. Emergency Medical Evacuation and Emergency In-Hospital Medical Expenses. Actual Expenses up to a maximum of: R 100 000 R 75 000 R 50 000 R 25 000 R 10 000
4. In-Hospital Daily Benefit Following Accidental Bodily Injury: Subject to the Benefit Period of a maximum of 90-Days subject to the Franchise Period R 1 000 Per Day R 1 000 Per Day R 1 000 Per Day R 1 000 Per Day R 1 000 Per Day


   Schedule of Compensation  
     The Benefit Payable
1. Accidental Death  100% of the Sum Insured specified in the Schedule of Benefits
2. Accidental Disability 100% of the Sum Insured specified in the Schedule of Benefits
2.1 Permanent Total Disability 100% of the Sum Insured specified in the Schedule of Benefits 100% of the Sum Insured
2.1.1 Permanent Total Disability as a result of an Accident 100% of the Sum Insured specified in the Schedule of Benefits 100% of the Sum Insured
2.1.2 Permanent Total Disability as a result of exposure to 100% of the Sum Insured specified in the Schedule of the elements of nature as a direct result of an Accident  100% of the Sum Insured specified in the Schedule of the elements of nature as a direct result of an Accident Benefits 100% of the Sum Insured
2.2 Permanent Disability 100% of the Sum Insured specified in the Schedule of Benefits
2.2.1 Permanent and Total Loss of One Hand or One Foot 100% of the Sum Insured specified in the Schedule of Benefits
2.2.2 Permanent and Total Loss of Both Hands or Both Foot  100% of the Sum Insured specified in the Schedule of Benefits
2.2.3 Permanent and Total Loss of Hearing in Both Ears 100% of the Sum Insured specified in the Schedule of Benefits
2.2.4 Loss of Intellectual Capacity 100% of the Sum Insured specified in the Schedule of Benefits
2.2.5 Permanent and Total Loss of Sight in Both Eyes 100% of the Sum Insured specified in the Schedule of Benefits
2.2.6 Permanent and Total Loss of Sight in One Eye 100% of the Sum Insured specified in the Schedule of Benefits
2.2.7 Permanent and Total Loss of Speech 100% of the Sum Insured specified in the Schedule of Benefits
2.2.8 Permanent and Incurable Paralysis 100% of the Sum Insured specified in the Schedule of Benefits
3. Emergency Medical Evacuation Actual Expenses incurred up to the Sum Insured
specified in the Schedule of Benefits
4. Daily In-Hospital Cash 100% of the Sum Insured specified in the Schedule of Benefits


General Conditions

  • 1Meaning of words The Policy, all Schedule(s), memoranda and endorsements, if any, shall be read together as one contract and any word or expression to which specific meaning has been attached shall unless the context otherwise requires bear such meaning wherever it may appear
  • 2 Official version Communication of and in connection with this Policy shall be in English
  • 3 Variations Amendments Definitions, Conditions, Exclusions, Termination , Policy Schedules and any Endorsements will apply;
  • 3.1to any subsequent increase in Benefits from the date of such increase;
  • 3.2any Insured Person being added to this Policy from the date of acceptance onto the Policy
  • 4 Country of Domicile Any reference to the Republic of South Africa shall, where the context permits, be construed as including a reference to an Insured Person’s Country of Domicile where the Insured Person is not domiciled in the Republic of South Africa
  • 5 Jurisdiction This Policy shall be governed and construed in accordance with the Law of the Republic of South Africa and the South African Courts alone shall have jurisdiction in any dispute
  • 6
  • Rights to the Policy Only the Insurer(s) and the Policyholder can enforce the terms of this Policy. No other party may benefit from this contract as of right. The Policy may not be varied or cancelled without the consent of any third party
  • 7 Cession Subject to General Condition 10, all Benefits under this Policy may not be ceded and/or assigned by the Policyholder. The Insurer(s) shall not be bound to accept or be affected by any notice or any trust, charge, lien, purported cession and/or assignment or other dealing with or relating to this Policy
  • 8 Interest No sum payable by the Insurer(s) under this Policy shall carry interest
  • 9 Misrepresentation / Non disclosure This Policy will be voidable in the event of misrepresentation, miss-description or non-disclosure of any material particular by or on behalf of the Policyholder
  • 10 Observance of Policy Where the Policyholder or an Insured Person or their personal representatives do not comply with any obligation to act in a certain manner specified in this Policy the Insurer(s) reserve the right not to pay a claim
  • 11 Discharge Notwithstanding General Condition 6, where in relation to any Claim the Policyholder, at its discretion, directs the Insurer(s) to do so, the Insurer(s) shall pay Benefits to, or indemnify, a named Insured Person and the receipt of such Insured Person shall be a sufficient discharge of the Insurer’s liability to indemnify or pay the Benefits concerned
  • 12 Cancellation The Insurer(s) may cancel;
  • 12.1 this Policy by giving 30-days’ written notice to the Policyholder at their last known address and in such event the Premium for the period up to the date when the cancellation takes effect shall be calculated and the Insurer(s) shall promptly return any unearned portion of the Premium paid;
  • 13 Right to Return The Policyholder may return this Policy within 14-Days after the Effective Date should this insurance not meet the Policyholder’s requirements provided no claim has been lodged against this Policy. The Policyholder shall be entitled to a refund of premium paid, less any administration fees applicable to this Policy
  • 14 Cancellation by the Insurer(s) The Insurer(s) may cancel;
  • 14.1 This Policy by giving 30-days’ written notice to the Policyholder at their last known address; and
  • 15 Cancellation by the Policyholder The Policyholder may cancel this Policy by giving 30-days written notice to the Insurer(s)
  • 16
  • Maximum Payable
  • 16.1 All benefits shall be limited to the maximum amount of the benefit stated in the schedule in respect of any one accident. Limited to a total overall per any one life per any one accident of:
  • Level 1: R300 000
    Level 2: R225 000
    Level 3: R150 000
    Level 4: R75 000
    Level 5: R30 000
  • 16.2 In respect of Accidental Disability the total amount payable shall not exceed 100% of the amount shown in The Schedule Item 2, in respect of any one Accident
  • 17 Contributory Conditions Any contributory degenerative condition or disability (as determined by a Qualified Medical Practitioner) known by the Insured Person to be in existence at the time of sustaining Bodily Injury will be taken into account by the Insurer(s) in assessing the level of Benefit payable
  • 18 Waiting period A waiting period of 90-days shall apply to
  • 18.1 Additional Insured Persons, added to this Policy after the Inception Date
  • 18.2 The increased portion of the sum insured

    The waiting period shall only be applicable to Illness covers. Cover in respect of all Accidental Benefits shall become effective immediately upon the addition of additional Persons Insured or upon an increase in Benefits
  • 19 Heart Attack If an Insured Person dies as a direct result of a road or traffic Accident of which the cause or the consequence could be a heart attack, the Insurer(s) shall deem the Accident to be an Insured Event
  • 20 VAT All Sums Insured, first loss amounts, indemnity limits or insured values, by whatever name such are referred to are expressed on a VAT inclusive basis
  • 21 Tax Liability The onus shall always be upon the Policyholder and/or Insured Person to ascertain, correctly admit and pay any tax liability in respect of any Benefit paid
  • 22 Other Products The Insurer(s) do not accept any liability for any financial products and/or services sold or provided or underwritten in conjunction with this Policy by any other insurance, assurances and/or assistance companies including medical aid societies, financial service providers or the like
  • 23 Limitation of Benefits. The Accidental death sum insured in respect of any minor shall be limited to that which is allowed by Government Legislation as amended from time to time. The current limits are;
  • 23.1 R 10,000 if the Insured Person is under 6-years of age;
  • 23.2 or R30,000 if the Insured Person is over the age of 6-years and under the age of 14-years
  • 24 Compensation in respect of Accidental Medical Reimbursement shall only be payable for expenses incurred in the Insured Person’s Country of Domicile or where the Accident occurred.

    If, in the opinion of a Medical Practitioner appointed by the Insurer(s), the Insured Person requires Emergency treatment other than in the Insured Person’s Country of Domicile or where the Accident occurred, written authorisation from the Insurer(s) is required prior the incurring of such costs
  • 25 No Insurer shall be deemed to provide cover and no Insurer shall be liable to pay any claim or provide any benefit hereunder to the extent that the provision of such cover, payment of such claim or provision of such benefit would expose the Insurer to any sanction, prohibition or restriction under United Nations resolutions or the trade and economic sanctions, laws or regulations of the European Union or United States of America
  • 26 Post Mortem: In the event of the accidental death of an insured person and sufficient evidence is produced satisfactory to the Insurers that leads them inevitably to the conclusion that there are no extenuating circumstances that would warrant a post mortem report the insurers shall forthwith pay the accidental death benefit without the post mortem report. In the event that the circumstances do warrant a post mortem report the insurers can pay 25% of the accidental death benefit subject to a limit, provided that the person or persons to whom such sum is paid shall sign an undertaking to refund such sum to the insurers if according to the post mortem report the circumstances that caused the death are not covered within the terms and conditions of the policy.

Special Conditions

  • 1 In respect of Item 3 of the Schedule of Benefits, Emergency Medical Evacuation
  • 1.1 Every Event Where a Policyholder or an Insured Person has an evacuation plan or any form of medical aid, medical insurance or similar by any other name, such fund must act as a first response in respect of costs associated in respect of Evacuation. The Evacuation Benefit provided by this insurance is supplemental to any other programs or cover currently in place.
  • 2 In respect Item 4 of the Schedule of Benefits, Daily In-Hospital Cash; Successive periods of Hospital Confinement due to the same Bodily Injury or related causes will be considered as one continuous period unless separated by 180-days during which an Insured Person is not confined to a Hospital as the result of such Bodily Injury

Claims Provisions

  • 1 In the event of any occurrence likely to give rise to a claim under this Policy written notice shall be given to to the Intermediary as soon as reasonably possible after the date of the occurrence but no later than 30-days of the Event. All claims must be notified to the Insurer(s) no later than 60-days of the Event
  • 2 The Insured Person shall as soon as possible after the occurrence of any Event other than Accidental Death; obtain and follow the advice of a Qualified Medical Practitioner co-operate with and follow the advice of an independent rehabilitation case manager where appointed by the Insurer(s) and the Insurer(s) shall not be liable for any consequences of the Insured Person’s failure to cooperate and obtain and follow such advice and use such appliance or remedies as may be prescribed

  • Obligation of Policyholder and/or Insured Person
  • 3 The Policyholder and/or Insured Person shall at their own expense furnish to the Insurer(s) such certificates, information and evidence as the Insurer(s) may from time to time reasonably require in the form prescribed by the Insurer(s). The Insurer(s) shall be allowed at its own expense, upon reasonable notice to the Insured Person to request a medical examination of an Insured Person as appropriate. In the event of the death of an Insured Person the Insurer(s) shall have the right to the results of the post-mortem examination or toxicology results before settlement of the claim

  • Paying Claims / Beneficiary
  • 4 Subject to General Conditions 4, all Benefit payable shall be payable to the Policyholder. In the event of the death of an Insured Person, the Benefit payable for death will be paid to the Insured Persons’ nominated beneficiary, Estate or legal representative.

  • Dispute
  • 5 In the event that the Insurer(s) declines to indemnify the Policyholder, the Policyholder may within a period of not less than 90-days after receipt of our notice, make written representation to the Insurer(s) in respect of that decision and the Insurer(s) will respond in writing within 45-days of receipt of such representation notifying the Policyholder of our decision
  • 6 Should the Policyholder not be satisfied with the decision of the Policyholder Claims Condition 5 above, the Policyholder may issue written summons against the Insurer(s) within 12-months of the expiry of the 90-day period for representation, failing which all benefits under such claim shall be forfeited

  • Excess
  • 7 Any Excess and/or Excess Period, where applicable, will apply separately under each section, in respect of each and every claim and for each Insured Person

  • Foreign Currency
  • 8 Claims involving foreign currency will be converted into the currency in which the Premium and Benefits/indemnity limits are shown, at the selling rate of exchange published by the Insurer(s) bankers on the day nearest to the date of claims settlement.

  • Fraud
  • 9 If any claim under this Policy is in any respect fraudulent or if any fraudulent means or devices are used by the Policyholder and/or Insured Person or anyone acting on their behalf or their legal representative to obtain Benefit under this Policy, the Insurer(s) shall be under no liability in respect of such claim

General Exclusions

The Insurer(s) shall not be liable to pay any Benefit for any Insured Event caused by or arising directly or indirectly from:

  • 1 Bodily Injury resulting from the Insured Person suffering from Illness, sickness or disease which is not itself the direct result of Bodily Injury
  • 2 Engaging in underground activities, including mining and prospecting activities, occupational or other activities requiring the use of explosives
  • 3 Repetitive stress (strain) injury or syndrome or any gradually operating cause
  • 4 Any pre-existing condition
  • 5 Any psychological or psychiatric condition
  • 6 Injury affecting the spine or the musculature, ligamentous system, cartilages, dura, nervous system or blood supply to the spine other than once during any 12-month period of insurance from the Effective Date of the Policy and each 12- month anniversary thereafter
  • 7 Dental or optical treatment, except as a result of Bodily Injury
  • 8 Any congenital abnormality and any conditions arising or resulting therefrom
  • 9 Routine physical or any other examinations
  • 10 Abortion, miscarriage, pregnancy, complications arising from childbirth or any condition arising therefrom unless as a direct result of an Accident
  • 11 Any stress-related condition or complaint
  • 12 Any investigative treatment, operations or treatment of a purely cosmetic nature; or for obesity; or undertaken to facilitate pregnancy or to cure impotence or to improve potency; or for psychotic or psychoneurotic or any other mental related disorders
  • 13 Human Immunodeficiency Virus (HIV) or other forms of the virus, Acquired Immune Deficiency Syndrome (AIDS) and AIDS related complex (ARC) other than if contracted as a result of a blood transfusion given by a qualified medical practitioner following Accidental Bodily Injury. Such onus will rest upon the Insured Person to prove that HIV contracted was as a direct result of a blood transfusion following Accidental Bodily Injury
  • 14 Sickness declaring itself within the first 90 (Ninety) days after the inception of this Policy
  • 15 Bodily Injury resulting from wilful or deliberate exposure to danger (except in an attempt to save human life) or from the Insured Person committing or attempting to commit suicide or intentionally inflicting self- injury
  • 16 The Insured Person engaging in aviation as a pilot or crew member of an aircraft or other aerial device, or for the purpose of any trade or technical operation therein or thereon
  • 17 This insurance shall not cover Losses arising from travel booked as a passenger, pilot or aircrew member of any privately chartered aircraft or on a non-scheduled passenger airline flight
  • 18 Participating in any sport as a Professional Player, or whilst hang gliding or micro lighting or participating in any Hazardous Activity
  • 19 Bodily Injury resulting from the Insured person being under the influence of or in a state of “intoxication” of any controlling substance whilst driving any motorised or mechanically operated vehicle unless administered on the advice of a Qualified Medical Practitioner and taken in accordance with the Qualified Medical Practitioner instructions. The term “intoxication” shall mean having a blood alcohol level concentration (BAC) greater than the statutory limit at the time of the Accident, or the level applicable according to prevailing legislation where the Accident occurs, whichever is the lesser
  • 20 Bodily Injury resulting from being under the influence of drugs or narcotics unless such drugs or narcotics were administered by a Qualified Medical Practitioner or unless prescribed by and taken in accordance with the directions of a Qualified Medical Practitioner, but not in respect of the treatment for the abuse of such drugs or narcotics.
  • 21 The direct participation of the Insured Person in any labour disturbances, strike, lock-out, riot, civil commotion or public disorder
  • 22 Active service or on duty with or undergoing training with any military, police force, militia or paramilitary organisation


Policy termination


All cover under this Insurance will end on the earliest of the following;

  • 1 On the date this Program is cancelled
  • 2 In the event on non-payment of premium, from the date premium is owed
  • 3 In respect of an Insured Person, upon their Death
  • 4 In respect of the Partner and or Children of the Policyholder on the date that such Insured Person ceases to be eligible as defined herein
  • 5 Where cover has been purchased by a company or Business Sponsor, where an Insured Person is no longer an employee or active accountholder
  • 6 In respect of an Insured Person on the attainment of 70-years of age