Electronic Version. GapCARE XtraCARE ProfessionalCARE

Transcription

1 Electronic Version GapCARE XtraCARE ProfessionalCARE

2 Medway MedCARE Plan WHO IS MEDWAY? Medway is a leading network of healthcare advisors in South Africa. First established in 1990, Medway has consistently looked for ways to enhance the value proposition financial advisors offer their clients, in a meaningful and reliable way. Our credible client base ensures that we are well positioned to interact and associate with various medical schemes and insurers delivering product and service mechanisms that add real value when you need it most. Medway supports contracted financial advisors who ensure that our tailor made solutions always address your medical cover requirements fully. WHY DO I NEED MEDCARE? MedCARE is a selection of insurance products designed exclusively for medical scheme members who require additional medical cover to that which is provided by their medical scheme. Medway MedCARE Plan core benefits include: GapCARE A choice of two top up options provide tariff difference cover to ensure you do not experience shortfalls when it comes to settling your hospital bills. Cover is provided to your immediate family for in-hospital associated services rendered by a medical practitioner who charges above the medical scheme tariff. Cover is extended for treatment on an out-patient basis for chemotherapy, radiotherapy and kidney dialysis. Certain traditional hospital procedures performed in a Doctor s room (e.g. scopes) are also covered. GapCARE can be selected as a standalone benefit, or combined with one or more of the other MedCARE options. GapCARE is for medical scheme members where scheme benefits for associated in-hospital services are limited to 100% of medical scheme tariff, or any rate less than 200% of medical scheme tariff. GapCARE is for medical scheme members where scheme benefits for associated in-hospital services are limited to 200% of medical scheme tariff. Both GapCARE options also include the following additional insured benefits: Personal Accident Death Cover: A cash payout of R to the nominated beneficiary in the event of the accidental death of the principal member, spouse or children. Personal Accident Hospital Expenses Cover: A cash payout of up to R per person per annum for in-hospital expenses in the event of accidental injury to the principal member, spouse or children. MedCARE PLAN I GapCARE I XtraCARE I ProfessionalCARE 01

3 Medway MedCARE Plan optional benefits include: XtraCARE This option can only be selected in combination with GapCARE. Available to members of Fedhealth and Medshield medical schemes only. Provides a cash payout when a medical scheme sub-limit is exceeded, for a defined set of treatments. Please ask your advisor for the table of benefits. ProfessionalCARE This option can only be selected in combination with GapCARE. ProfessionalCARE includes limited insured benefits, while emphasising the additional professional services provided by your financial advisor. This option is available to all medical scheme members. ProfessionalCARE includes the following benefits: Professional service benefits provided by your financial advisor Handling enquiries in relation to your membership with your medical aid scheme. Keeping your medical aid scheme informed of changes to your membership details. Informing you of changes to your medical scheme benefits. Assisting you with any claims you have with your medical aid scheme (including a possible premium waiver benefit that may be applicable on your death). Conducting an annual needs analysis to determine the most appropriate medical aid option to suit your needs. Insured benefits Personal Accident Death Cover: A cash payout of R to the nominated beneficiary in the event of the accidental death of the principal member, spouse or children. Personal Accident Hospital Expenses Cover: A cash payout of up to R per person per annum for in-hospital expenses in the event of accidental injury to the principal member, spouse or children. MedCARE PLAN I GapCARE I XtraCARE I ProfessionalCARE 02

4 Medway MedCARE is a combination of products. Insured benefits are underwritten by Hollard Insurance. Administration is provided by ManagePlus Fund Administrators on behalf of the Insurer. INSURER ADDRESS REG. NO. 195/003004/06 FSP NO It is important for the policy owner to read this information and store it in a safe place. Hollard Insurance Company Limited 22 Oxford Road Parktown CONTACT DETAILS FOR ALL Manage Plus Fund Administrators (Pty) Ltd, FSP No (M.P.F.A) ADMINISTRATIVE QUERIES Tel: 0860 MEDWAY Fax: Box 5466, Cape Town, 8000 COMPLAINTS PROCEDURE If you have a complaint regarding this product or service, please contact the Compliance Department at the insurer s address listed above. COMPLIANCE OFFICERS If you believe that any legislation or regulatory considerations have been contravened, you may contact the Compliance Officer of the insurer at the address listed above. CLAIMS NOTIFICATION In the event of a claim, please contact MPFA at: OMBUD DETAILS Short-term Insurance Ombud FAIS Ombud PO Box 30619, Braamfontein, 2017 PO Box Lynnwood Ridge, 0040 Tel: Tel: Fax: Fax: info@faisombud.co.za COOLING OFF The issued policy may be cancelled within 30 days from the date of issue. You may cancel the policy by written notice to Box 5466, Cape Town, REPLACEMENT OF POLICIES Replacement of any insurance is generally to the disadvantage of the policy owner, due to the duplication of initial existing costs. However, in the case of MedCARE, there are no initial costs. NAME, CLASS AND TYPE GapCARE OF POLICY Gap Cover: A top-up cash benefit paid to the member after hospitalisation. Personal Accident Death Cover: A cash benefit paid to the member on accidental death. Personal Accident Hospital Expenses Cover: A cash benefit paid to the member after hospitalisation. XtraCARE An additional cash benefit paid to the member after (defined) treatments when medical scheme benefits are inadequate. ProfessionalCARE Includes limited insured benefits, while emphasising the additional professional services provided by your financial advisor. This option is generic and available to all medical scheme members. BENEFITS IMPORTANT INFORMATION COMMENCEMENT DURATION OF COVER PREMIUM OBLIGATIONS The benefits provided by this policy, depending on selection are described elsewhere under description of benefits. The policy will commence on the acceptance of the application and receipt of the first premium. The commencement date of the policy is indicated on the certificate of membership. Cover continues for as long as premiums are paid in accordance with the policy conditions, but cover will cease at the death of the Principal Member. The premium payable for this policy is shown in the application form and will be confirmed in the Policy pack. Premiums are paid monthly and may be reviewed from time to time. NON-PAYMENT OF PREMIUMS Should premiums not be paid according to policy conditions, the policy will lapse and all premiums and benefits will be forfeited. CHARGES & FEES Admin fee of R15.00 per month per member. Policy fee of R7.50 per month per option selected. COMMISSIONS EXCLUSIONS & WAITING PERIODS RESTRICTIONS Commission is paid to an intermediary in the amount of 20% of gross premium payable. A summary of claims exclusions and waiting periods is described elsewhere under terms and conditions. These exclusions are more fully described in the policy wording. Principal Member may not be covered by more than one Medway MedCARE Plan (but may include multiple options within a single policy). Principal Member must be a paid up member of an approved registered medical scheme - check with your intermediary. XtraCARE only available to members of Fedhealth Maxima and Medshield medical aid schemes. Medway MedCARE Plan includes various short term insurance policies for which (in terms of the short term insurance act) the member may not benefit from duplicate cover. Check with your intermediary to confirm you do not have duplicate cover. PLEASE TAKE NOTE: This document does not contain all the terms and conditions of the policy and once the certificate of membership and benefit summaries are received, they should be read carefully and be understood completely. MedCARE PLAN I GapCARE I XtraCARE I ProfessionalCARE 03

5 Application form 1. PRINCIPAL MEMBER DETAILS (Please attach a copy of your ID - Maximum entry age = 60) Membership no Surname Full first name/s Date of birth Marital status Gender Postal address Tel (H) ( ) Cell no address D D M M Y Y Y Y ID no Single Married Divorced Male Female Tel (W) ( ) Fax ( ) Preferred starting date D D M M Y Y Y Y Do you currently belong to a medical aid scheme? Medical aid scheme option Name of employer Yes No Scheme name Membership no Unemployed Accept policy document via Yes No Code 2. PRODUCT SELECTION GapCARE 100* GapCARE 200* XtraCARE ProfessionalCARE * Select either one of these options. Include Signature Premium total 3. DEPENDANT DETAILS (Immediate family members only - ie. spouse and own children) First name/s Surname Date of birth or ID no Relationship 4. DEBIT ORDER DETAILS Full name/s (premium payer) Branch/branch code Type of account Bank name Bank account number Savings Cheque Date of debit order D D M M Y Y Y Y Declaration (to be signed by debit order payers only) I authorise MPFA* to draw against my bank account all amounts due in terms of the policy contracts. I understand that either MPFA* or myself can terminate this request in writing to the other party at any time, but that termination will have no effect on any withdrawals already made by the bank and credited to MPFA*. I understand and undertake that MPFA* will receive all premiums as per this request, without prejudice to its rights. Should the bank reclaim from MPFA* for any reason, any amounts paid as per this request, I agree to refund such amounts to MPFA*. I agree to advise MPFA* of any changes to the above banking details. Signature (premium payer) Date D D M M Y Y Y Y 04

6 5. DECLARATION BY PRINCIPAL MEMBER 1. I hereby apply for the Medway MedCARE Plan in accordance with the provisions and conditions as contained in the policy contract. 2. I acknowledge that the level of cover and the rate at which contributions increase are not guaranteed and can be reviewed in the event of unforeseen circumstances, which materially affect the cost of providing cover. 3. I understand and agree that, subject to the waiting periods, Insurer will only be at risk once MPFA* accepts this application and the first contribution is received. 4. MPFA* will send me the Medway MedCARE Plan membership certificates and policy summaries to examine. If the plan does not suit my needs, I must cancel it within 30 days of receipt, by providing written notification to MPFA* in order to qualify for a refund. 5. I warrant that all information given in this MedCARE Plan application form, whether in my handwriting or not, is true and complete. I understand that any misrepresentation or non-disclosure or provision of false information can lead to cancellation of these benefits, in which case, all monies paid to MPFA* will be forfeited. 6. I undertake to keep MPFA* informed of changes to any banking details and my address to enable them to communicate with me. 7. I have read and understand the Important information about Medway MedCARE Plan as contained in this application form and accept it as part of the terms and conditions of the policy. 8. I have confirmed to my Intermediary (who has explained the possible disadvantages of replacing existing insurance policies) that I am not replacing an existing insurance policy with the Medway MedCARE Plan. 9. Have you, or any of your dependants sought any advice, been diagnosed with, or treated for any of the folllowing conditions in the past 12 months: Tuberculosis, cancer, heart disease, HIV/Aids, diabetes? Yes No If yes, please give details Signature (Principal Member) Date D D M M Y Y Y Y * Manage Plus Fund Administrators (Pty) Ltd, an authorised financial services provider. 6. INTERMEDIARY Name of FSP Name of financial advisor FSP no Code Tel (W) ID no ( ) Cell no Declaration by the Intermediary who submitted this application form: 1. I have explained the meaning of the replacement of an insurance policy to the applicant policy owner. 2. I am a representative of an Authorised Financial Services Provider in terms of the Financial Advisory and Intermediary Services Act, 37 of 2002 and confirm that the Applicant Policy holder has been provided with all information required in terms of the Act. 3. I declare that I am accredited to sell this Medway MedCARE Plan, that I did conduct a financial needs analysis and that this product is designed to fulfil the applicant's needs. 4. I further declare that all the information contained in this application was obtained from the applicant and was completed and signed in his/her presence. Signature of Intermediary Date D D M M Y Y Y Y 05

7 Terms and conditions GENERAL Maximum age of entry for principal member and/or spouse is 60. Must be a member of a registered medical scheme. Covers one spouse only. GapCARE Limited to 5 x the medical scheme tariff for in-hospital defined tariff charges calculated above the medical scheme tariff. Limited to R per person per annum. Limited to R per family per annum. Pre-existing conditions excluded for 12 months. PERSONAL ACCIDENT Level of cover of R is maximum payout per insured person per annum. Pays up to a maximum for any one accident (involving multiple insured persons) of 4 x level of cover. Excess of R250 per claim applies. XtraCARE Specific benefits and limits depend on name and option of medical scheme of the principal member. Benefits only payable after medical scheme benefit limits are reached. Benefits are per principal member per annum - unless otherwise specified. All benefits are payable in proportion to the number of months cover that has been afforded to any one beneficiary. Benefits for step-down facilities excluded. Pre-existing conditions excluded. Once you have completed your application form it will be processed by Medway. If your application is successful you will be contacted by a Medway consultant who will telephonically confirm your MedCARE Plan package and benefit options. In the event of a claim, please call Medway on 0860 MEDWAY, and one of our friendly and efficient consultants will gladly assist you. MedCARE PLAN I GapCARE I XtraCARE I ProfessionalCARE 06

8 Your medway consultant is: Medway Marketing (Pty) Ltd 7th Floor, 80 Strand Street, Cape Town 8001 PO Box 5466, Cape Town 8000 Authorised Financial Services Provider Registration Number 1996/001296/07 Licence Number Directors: L Allam, G T Banwell t 0860 MEDWAY f