THE EMPLOYER WHOSE DETAILS ARE SPECIFIED IN THE EMPLOYER PARTICIPATION CERTIFICATE

Transcription

1 COIDA AUGMENTATION POLICY FOR THE [ ] EMPLOYER GROUP concluded between RMA LIFE ASSURANCE COMPANY LIMITED (Registration Number 1990/006308/06 ) and THE EMPLOYER WHOSE DETAILS ARE SPECIFIED IN THE EMPLOYER PARTICIPATION CERTIFICATE

2 1 Table of Contents Page No 1. Introduction Definitions and interpretation Substitution of Replaced Policy Term of the Group Policy Membership to the Group Employer Participation Certificate Insurance Cover Cessation of cover Benefits Payment of Premiums Exclusions and limitations in respect of the Benefits: Claims procedure for benefits Subrogation and Cession Cancellation Effect of cancellation Access to information Consent to the disclosure of Personal Information Complaints procedure Notices and Domicilia Amendments General Miscellaneous matters Annexure A Annexure B Limitations... 1 Schedule of calculation of Benefits in the event of Permanent Disablement (loss of limbs)... 3

3 1 1. Introduction 1.1 The Parties to this Group Policy are: RMA Life; and The Employer, whose details are specified in the Employer Participation Certificate. 1.2 The Parties agree as set out below. 2. Definitions and interpretation 2.1 In this Group Policy, the following words shall, unless otherwise stated or inconsistent with the context in which they appear, bear the following meanings and other words derived from the same origins as such words (that is, cognate words) shall bear corresponding meanings: "Accident" means an "accident" as defined in section 1 of COIDA; "Acknowledgement form" means the acknowledgement to be completed by an Employee in the form and manner prescribed by RMA Life from time to time, whereby the Employee acknowledges certain duties imposed on him/her in the event of payment of a Benefit, which acknowledgement is a condition to payment of such a Benefit; "Act(s) of Terrorism" means any act including but not limited to the use of force or violence and/or the threat thereof, by any person or group(s) of persons, whether acting alone or on behalf of or in connection with any organisation(s) or government(s), committed for political, religious, ideological or similar purposes, including the intention to influence any government and/or to put the public, or any

4 2 section of the public, in fear, whether determined in terms of any relevant legislation to have been an act of terrorism or not; "Annexures" means the annexures attached to this Group Policy; "Applicable Interest Rate" "Augmented Earnings" means the rate equal to the prime rate charged by the bankers of RMA Life on overdraft facilities afforded to their first class commercial customers; means the Earnings of an Employee in excess of the Maximum COIDA Earnings at such levels as prescribed in Annexure A as it relates to the Benefits, used to determine the Benefits payable in terms of this Group Policy, but provided that the Augmented Earnings Exceed the Start Rate of Augmented Earnings for the cover to be applicable; "Benefits" means either the Death Benefits or Disability Benefits as the case may be, payable upon the occurrence of an Insured Event in respect of an Employee; "Business Day" means any day other than a Saturday, Sunday or gazetted national public holiday in the Republic of South Africa; "Calculation Period" means a period of 12 (twelve) months commencing on each anniversary of the Effective Date, or such shorter period in the event of cancellation as provided for in clause 19 before expiry of the 12 (twelve)

5 3 month period; "COIDA" means the Compensation for Occupational Injuries and Diseases Act,130 of 1993; "COIDA Benefits" means the benefits as stipulated in terms of COIDA and underwritten by RMA in terms of the COIDA Policy,; "COIDA Policy" means the policy of insurance entered into between RMA and the Employer in respect of the liability of the Employer in terms of COIDA towards his/her or its Employees; "Data Protection Legislation" "Date of Disablement" means any and all laws relating to or regulating the protection of data or of Personal Information, direct marketing, or unsolicited electronic communications and which may be applicable in the Republic of South Africa from time to time, including without limitation the Protection of Personal Information Act, 4 of 2013, the Consumer Protection Act, 68 of 2008, and the Electronic Communications and Transactions Act, 25 of 2002; means the date of Disablement of an Employee, which date shall be determined by RMA Life in its sole and unfettered discretion; "Death" means the death of the Employee as a direct cause, of or directly attributable to the occurrence of an Insured Event; "Death Benefits" means the Benefits payable as set out in clause in the event of the Death of an Employee;

6 "Dependant" means a "dependant of an Employee" as defined in section 1 of COIDA; "Dependent Child" has the meaning as assigned to it in the definition of a "dependent of an Employee" as defined in section 1 of COIDA; "Disabled / Disablement" "Disability Benefit(s)" means either Temporary Total Disablement; Temporary Partial Disablement, Permanent Disablement or Serious Disfigurement, as the case may be; means the benefit payable as set out in clause 14.5 in the event of the Disablement of an Employee; "Due Date" means the date upon which the Premium is due and payable to RMA Life, being 30 days from the date of the invoice provided by RMA Life as specified in clause 15.4; "Effective Date" means 1 January 2016; "Employee(s)" means an "employee" as defined in section 1 of COIDA and qualifying as such in terms of the COIDA Policy, provided the Employee satisfies the conditions of eligibility for membership to the Group as set out in clause 7; "Employer" means an "employer" as defined in section 1 of COIDA and who i) is identified as such in the Employer Participation Certificate; and ii) who is the Policyholder; "Employer Participation Certificate" means the long-term insurance policy schedule issued to the Employer in terms of section 48 of the Long-term Insurance Act;

7 "Earnings" means the total monthly earnings of an Employee for a Calculation Period calculated by an Employer in the manner prescribed in COIDA; "Group" means all Employees employed by the Employer on a compulsory basis; "Group Policy" means this insurance agreement concluded between RMA Life and the Employer in respect of the Group, together with all Annexures; "Inception Date" means the date on which insurance cover in respect of an Employee commences as set out in clause 10.1; "Insured Event" means the Death or Disablement of an Employee arising out of: an Accident as contemplated in COIDA; or an event occurring in a dwelling, hostel or other dwelling provided by the Employer to the Employee on the Employer's premises in which the Employee normally resides and which arises out of a defect or deficiency in the building or premises; participation in any of the following formal sporting events: while competing as a team member at inter-mine level, inter-mine club level, inter-employer group level, in external leagues and at a provincial level provided the team is confined to mining Employees only; or

8 while competing in essentially individual or semi-individual sports, including but not limited to, tennis, cycling, boxing, provided that the particular sporting event is stipulated by the Employer in the Sporting Events Schedule and participation in the event is as a formal representation of the Employer; or whilst engaging in organised and authorised practices, preliminaries or rehearsals leading up to and before any events referred to in clauses and ; or while Journeying directly to or from any sporting function referred to in and in authorised transport arranged by the Employer; "Journeying" means the moving by any means (including without limitation on foot) along any public road, rail, air and sea to which the public has routine access and per the reasonable and most direct route to and from the relevant destination; "Long-term Insurance Act" "Maximum Aggregate Amount" means the Long-term Insurance Act, 52 of 1998; means the aggregate of COIDA Benefits payable in terms of the COIDA Policy and the Benefits payable in terms of this Group Policy in respect of an Employee as specified in Annexure A, and amended from time to time;

9 "Maximum COIDA Earnings" "Medical Practitioner" means the maximum amount of Earnings that will be taken into account when determining the COIDA Benefits payable in terms of the COIDA Policy, which maximum amount is prescribed in COIDA from time to time and set out in Annexure A as increased annually at CPI or amended from time to time; means a person registered as such in terms of the Health Professions Act, 56 of 1974; "Parties" means the parties to this Group Policy, being RMA Life and the Employer; "Permanent Disablement" "Personal Information" means "permanent disablement" as defined in section 1 of COIDA; means any personal information as defined in the Data Protection Legislation including but not limited to information relating to race, gender, marital status, nationality, age, physical or mental health, disability, language, education, identity number, telephone number, , postal or street address, biometric information and financial, criminal or employment history; "Policyholder" means the Employer, being the party entitled to payment of the Benefits in respect of the Employees as assured lives, subject to clause ; "Premium" means the amount payable by the Employer to RMA Life for each Calculation Period in order to secure the cover and the Benefits provided in this Group Policy respect of the

10 8 Employees; Process means process as defined in the Protection of Personal Information Act, 4 of 2013, including any operation or activity, whether automated or not, concerning Personal Information, including collection, receipt, recording, organisation, collation, storage, updating or modification, retrieval, alteration, consultation, use, dissemination by means of transmission, distribution or making available in any other form, merging, linking, as well as blocking, degradation, erasure or destruction of information and "Processing" will have a similar meaning; "Replaced Policy" means the augmentation policy previously underwritten by RMA with policy number ; "RMA" means The Rand Mutual Assurance Company Limited, registration number 1899/000876/06, a public company incorporated and registered in terms of the companies laws of South Africa, and licensed as a short-term insurer in terms of the Short-term Insurance Act, 53 of 1998; "RMA Life" means RMA Life Assurance Company Limited, registration number 1990/006308/06, a public company incorporated and registered in terms of the companies laws of South Africa, and licensed as a long-term insurer in terms of the Long-term Insurance Act; "Serious means a permanent change in a person's body, particularly by leaving visible scars or

11 9 Disfigurement" disfigurement which affect the person's appearance; "Signature Date" means, when this Group Policy has been signed by each Party (whether or not in counterpart), the latest of the dates on which this Group Policy (or any counterpart) was signed by any Party; "Sporting Events Schedule" "Start Rate of Augmented Earnings" "Temporary Partial Disablement" "Temporary Total Disablement" means the sporting events schedule provided by the Employer to RMA Life and attached to the Employer Participation Certificate which stipulates the sporting event endorsed by the Employer; means the amount of Earnings from which the cover in respect of an Employee shall commence as set out in Annexure A and amended from time to time; means "temporary partial disablement" as defined in section 1 of COIDA; means "temporary total disablement" as defined in section 1 of COIDA; and "Widow" has the meaning as assigned to it in the definition of a "dependent of an Employee" as defined in section 1 of COIDA but includes a party to a same sex marriage in accordance with civil law, indigenous law or custom. 2.2 In this Group Policy: clause headings are for convenience only and are not to be used in its interpretation; an expression which denotes -

12 any gender includes the other genders; a natural person includes a juristic person and vice versa; and the singular includes the plural and vice versa, references to a statutory provision include any subordinate legislation made from time to time under that provision and include that provision as modified or re-enacted from time to time; if there is any conflict between any definitions contained in this clause 2 and a definition appearing within a paragraph or sentence, then, for purposes of interpreting any clause of the Group Policy or paragraph of any Annexure, the definition appearing in that clause or paragraph shall prevail over any other conflicting definition appearing elsewhere in the Group Policy; where any number of days is prescribed, those days shall be reckoned exclusively of the first and inclusively of the last day unless the last day falls on a day which is not a Business Day, in which event the last day shall be the next succeeding Business Day; where the day upon or by which any act is required to be performed is not a Business Day, the Parties shall be deemed to have intended such act to be performed upon or by the next succeeding Business Day; any provision in this Group Policy which is or may become illegal, invalid or unenforceable in any jurisdiction affected by this Group Policy shall, as to such jurisdiction, be ineffective to the extent of such prohibition or unenforceability and shall be treated as having not been written (ie pro non scripto) and severed from the balance of this Group Policy, without invalidating the remaining provisions of this Group Policy or affecting the validity or enforceability of such provisions in any other jurisdiction; the use of any expression covering a process available under South African law (such as but not limited to a winding-up) shall, if any of the Parties is subject to the law of any other jurisdiction, be interpreted in relation to that Party as including any equivalent or analogous proceeding under the law of such other jurisdiction; and

13 the rule of construction that if general words or terms are used in association with specific words or terms which are a species of a particular genus or class, the meaning of the general words or terms shall be restricted to that same class (ie the eiusdem generis rule) shall not apply. 2.3 Any substantive provision, conferring rights or imposing obligations on a party and appearing in any of the definitions in this clause 2 or elsewhere in this Group Policy, shall be given effect to as if it were a substantive provision in the body of the Group Policy. 2.4 Words and expressions defined in any clause shall, unless the application of any such word or expression is specifically limited to that clause, bear the meaning assigned to such word or expression throughout this Group Policy. 2.5 Defined terms appearing in this Group Policy in title case shall be given their meaning as defined, while the same terms appearing in lower case shall be interpreted in accordance with their plain English meaning. 2.6 Reference to "days" shall be construed as calendar days unless qualified by the word "business", in which instance it will refer to a Business Day. 2.7 The words "include" and "including" means "include without limitation" and "including without limitation". The use of the words "include" and "including" followed by a specific example or examples shall not be construed as limiting the meaning of the general wording preceding it. 2.8 Where figures are referred to in numerals and in words, and there is any conflict between the two, the numerals shall prevail unless the context indicates a contrary intention. 2.9 This Group Policy and Annexures hereto constitute an indivisible transaction and shall be interpreted as such. To the extent that there are any discrepancies between the terms and conditions stipulated in the body of this Group Policy and the terms and conditions specified in the relevant Annexure the provisions of the Group Policy will prevail The expiration or cancellation of this Group Policy shall not affect such of the provisions of this Group Policy which are expressly provided to operate after any such expiration or cancellation, or which of necessity must continue to have effect

14 12 after such expiration or cancellation, notwithstanding that the relevant provisions themselves do not provide for this Each of the provisions of this Group Policy have been negotiated by the Parties and drafted for the benefit of the Parties, and accordingly the rule of construction that the contract shall be interpreted against or to the disadvantage of the Party responsible for the drafting or preparation of the Group Policy (ie the contra proferentem rule), shall not apply. 3. Substitution of Replaced Policy 3.1 RMA has, up to the day immediately preceding the Effective Date, underwritten the Benefits in terms of the Replaced Policy. 3.2 RMA and RMA Life, however, entered into a substitution agreement in terms whereof all rights and liabilities of RMA in respect of the Replaced Policy towards the Employers and/or Employees (if applicable in the event of payment of a Benefit) are to be substituted with rights and obligations of RMA Life, with effect from the Effective Date, subject to approval by the Registrar of Short-term Insurance ("the Substitution Transaction"). 3.3 It is at all times the intention of RMA and RMA Life that the Replaced Policy be substituted and replaced by the terms and conditions of the Group Policy, subject to the provisions of clause 4 below. 4. Undertakings of RMA Life after implementation of the Substitution Transaction 4.1 After obtaining the approval by the Registrar of Short-term Insurance for the implementation of the Substitution Transaction it will be deemed that RMA Life underwrites the Group with effect from the Effective Date, subject to the terms and conditions of this Group Policy; to the extent that benefits are payable in terms of the Replaced Policy, it shall be deemed that such benefits are payable in terms of this Group Policy; and the terms and conditions of this Group Policy will be applicable to the continued payment of such benefits,

15 13 subject to the condition that in the event of a conflict between the Replaced Policy and this Group Policy, RMA Life shall honour the terms of conditions of the Replaced Policy unless the provisions of this Group Policy are more beneficial to the Employer and/or the Employee (in the event of payment of a benefit in terms of the Replaced Policy), provided in respect of any Benefit increases, that the provisions of clause of this Group Policy shall in all instances prevail, notwithstanding such conflict. 5. Background and purpose of the Group Policy 5.1 The Employer receives cover in terms of the COIDA Policy against a liability incurred due to the Death or Disability of an Employee as a result of an Accident as provided for in COIDA. 5.2 The purpose of this Group Policy is to augment the cover and the COIDA Benefits payable in terms of the COIDA Policy with the cover and Benefits as set out in this Group Policy upon the occurrence of the Insured Events against payment of the Premium; the nature of the Insured Events covered in terms of this Group Policy as set out in clause to ; and the Earnings above the Maximum COIDA Earning, which results in increased Benefits being paid on such Augmented Earnings. 5.3 It is therefore a condition of membership to the Group, as set out in clause 7, that cover and Benefits are provided in respect of the Employees in terms of the COIDA Policy, notwithstanding the fact that the cover and Benefits provided in terms of this Group Policy are stand-alone benefits, applied for by the Employer on a voluntary basis against payment of the relevant Premium. 5.4 It is furthermore specifically recorded that the cover and Benefits provided in terms of this Group Policy differs from the cover and COIDA Benefits provided in terms of the COIDA Policy, in particular it is recorded that no medical or funeral benefits are provided in terms of this Group Policy. 5.5 It is furthermore recorded that the aggregate of i) the cover and COIDA Benefits provided in terms of the COIDA Policy; and ii) the cover and the Benefits

16 14 provided in terms of this Group Policy may not exceed the Maximum Aggregate Amount, irrespective of the fact that the same or different benefits may be provided in terms of the COIDA Policy and this Group Policy. The Benefits payable in terms of this Group Policy shall be reduced in order to ensure that the Maximum Aggregate Amount is not exceeded in respect of the aggregate of the benefits payable in terms of the COIDA Policy and this Group Policy. 6. Term of the Group Policy 6.1 Subject to the provisions of clause 4.1, RMA Life undertakes to provide the cover and the Benefits to the Employer in respect of the Group with effect from the Effective Date for the duration of a Calculation Period, unless cancelled in accordance with clause 19 before expiry of the Calculation Period. 6.2 The Group Policy provides term cover only. 6.3 This Group Policy shall automatically renew on the inception of each new Calculation Period ("Policy Anniversary Date"), unless cancelled in terms of clause RMA Life shall inform the Employer at least 30 (thirty) days before the Policy Anniversary Date of any new terms and conditions and the revised Benefits and Premiums payable in terms of this Group Policy, which will become of full force and effect from the Policy Anniversary Date. 6.5 To the extent that the Employer requests increased cover or Benefits in terms of this Group Policy, it shall do so no later than 30 (thirty) days before the Policy Anniversary Date by written notice to RMA Life. 6.6 RMA Life shall at all times be entitled to refuse or reject the request mentioned in clause 6.5 above, which entitlement RMA Life shall exercise in its sole and unfettered discretion without giving reasons to the Employer for such rejection or refusal. 7. Membership to the Group 7.1 Membership to the Group shall be available to all Employees of the Employer, provided that the Employee receives cover in terms of a COIDA Policy;

17 the Employee's Earnings exceed the Start Rate of Augmented Earnings; the Employee is not an illegal immigrant; and the Employee is over the age of 16 (sixteen) years. 7.2 Membership to the Group shall be compulsory for all Employees of the Employer. 7.3 The maximum number of Dependent Children covered in terms of this Group Policy shall be 8 (eight). Any additional Dependent Children will not be covered in terms of this Group Policy. 7.4 In the event that a Dependent Child no longer qualifies as such, the Employee shall not be entitled to substitute another child in his/her place whereby the number of Dependent Children covered in terms of this Group Policy shall be reduced with the number of Dependent Children who no longer qualifies as such. 8. Employer Participation Certificate 8.1 RMA Life shall issue this Group Policy and the Employer Participation Certificate to the Employer, which documents shall constitute the entire agreement between the Parties and must be read as a whole. 8.2 The Employer Participation Certificate shall set out the information prescribed in terms of section 48 of the Long-term Insurance Act, and shall set out information which is specific to the Group. 8.3 The Employer shall be obliged to provide or make available and bring to the Employees' attention as soon as reasonably possible from the Inception Date, the existence of the Group Policy and must, upon request by RMA Life, provide proof to the reasonable satisfaction of RMA Life, that such Group Policy has been provided or made available to the Employees and brought to the Employees' attention. 9. Material changes 9.1 Should the nature of the Employer's business or the employment activities in which the Employees are engaged, change in whole or in part, which includes without limitation a change in the type of business conducted, to such an extent that it may affect the risk in terms of this Group Policy, the Employer shall inform

18 16 RMA Life within 30 (thirty) days of such change. RMA Life shall in such an event be entitled to amend the cover and Benefits by giving 20 (twenty) days written notice to the Employer; or change the Premiums by giving 20 (twenty) days written notice to the Employer; or cancel this Group Policy in terms of clause 19, and shall inform the Employer in writing of such cancellation or change and the implementation date of such change. 9.2 Should the Employer fail to provide the information as prescribed in clause 9.1 above, the cover in respect of the Employees shall cease with effect from the date on which the Employer became aware of the change in circumstances until such date that the information is provided to RMA Life and RMA Life shall not be liable for any claims for Benefits which arose during such period. 9.3 Upon receipt of the information as prescribed in clause 9.1 above, the cover in respect of the Employees shall resume and RMA Life shall be entitled to enforce the provisions of clause to above, which election it may exercise in its sole and unfettered discretion. 10. Insurance Cover 10.1 Subject to the provisions of clause 13.2, insurance cover in respect of an Employee shall commence the day on which the Employee commences employment with the Employer, or such other date determined by RMA Life in its sole discretion which may not be later than 14 (fourteen) days from the date of commencement of employment with the Employer, provided that this Group Policy is in force at the time The Employer shall, within 30 (thirty) days of the commencement of each Calculation Period; and again within 6 (six) months thereafter provide RMA Life with the following information in respect of each Employee in such form and format as RMA Life may from time to time direct in writing, namely:

19 Initial, surname, gender, physical address, identity number and date of birth; Nationality; Date of employment; and Earnings To the extent that the Employer fails to provide RMA Life with the information required in terms of clause 10.2, RMA Life shall be entitled to immediately cancel this Group Policy in accordance with the provisions of clause 19 below; or refuse an Employee to be admitted to membership to the Group other than upon such terms and conditions as RMA Life may agree to in writing. 11. Cessation of cover 11.1 Insurance cover in terms of this Group Policy in respect of an Employee shall cease on the occurrence of the events mentioned below, whichever occurs first, namely that this Group Policy is cancelled; the Employee no longer meets the Start Rate of Augmented Earnings; the Death Benefits are paid; the COIDA Policy is terminated, in which event this Group Policy will automatically terminate and come to an end, subject to clause 20; the Employer fails to pay the Premium on the Due Date thereof and fails to remedy such failure within 15 (fifteen) days from the Due Date; the Employee is temporarily absent from the Republic of South Africa for a period exceeding 12 (twelve) months as provided in clause 13.1 below; or is no longer employed by the Employer; or

20 no longer qualifies for membership to the Group; or is deceased. 12. Occurrence of Insured Event The Employees shall receive cover and Benefits irrespective whether the Insured Event occurs in the Republic of South Africa or in another country, subject at all times to the provisions of clause 13 below. 13. Temporary absence from the Republic of South Africa 13.1 In the event that an Employee is temporarily employed by the Employer outside the Republic of South Africa for a period not exceeding 12 (twelve) consecutive months ("Permissible Period") the cover in respect of such Employee shall remain in force and continue uninterrupted for the duration of the Permissible Period; and the Premiums shall remain payable in respect of the Employee for the duration of the Permissible Period for a period exceeding 12 (twelve) consecutive months ("the Impermissible Period") the cover in respect of the Employee shall cease with effect from the commencement of the Impermissible Period; and no further Premiums shall be payable in respect of such Employee; and no Benefits shall be payable in respect of such Employee upon the occurrence of the Insured Event, irrespective whether or not such Insured Event occurs within the Republic of South Africa or elsewhere, unless an extension of the Permissible Period is agreed to in writing between RMA Life and the Employer at least 30 (thirty) days prior to the

21 19 termination of the Permissible Period, subject at all times to such rights and limitations as RMA Life may prescribe in its sole and unfettered discretion In the event that an Employee is employed by an Employer outside the Republic of South Africa, however performs his/her employment duties for a consecutive period of 12 (twelve) months in the Republic of South Africa, such Employee shall receive cover in terms of this Group Policy with effect from the expiry of the 12 (twelve) month period, provided that the Premiums are paid in respect of such Employee; and the Benefits shall be payable in the event that the Insured Event occurs in South Africa, notwithstanding the fact that the Employee is primarily employed and resident in a country other than the Republic of South Africa, subject to clause Benefits 14.1 General RMA Life shall, subject to the terms and conditions of this Group Policy and for the duration of this Group Policy, provide the Benefits to the Employer in respect of the Employees upon the occurrence of an Insured Event The Benefits shall only be provided in the event that the Augmented Earnings of an Employee exceeds the Start Rate of Augmented Earnings The contractual nexus created in terms of this Group Policy is between the Employer and RMA Life and the Employees do not stand in any contractual relationship towards RMA Life other than as assured lives in terms of this Group Policy, subject at all times to the provisions of clause The Benefits shall at all times be paid by RMA Life to the Employer, provided that the Employer be entitled to instruct RMA Life to make payment of the Benefit directly to the relevant Employee (or his/her Dependants) in full and final settlement of a claim for Benefits In the event that RMA Life makes payment of the Benefits to the Employer as contemplated above, the Employer shall, upon request from RMA Life,

22 20 provide such documents as requested by RMA Life, indicating the manner in which the Employer complied with the obligations set out in clause The Employees shall not have any claim against RMA Life and the Employer shall be the sole party entitled to the Benefits in terms of this Group Policy, which Benefit shall be paid to the Employer for the direct or indirect benefit of the Employees. The provisions in this Group Policy shall not create or establish any rights or obligations between RMA Life and the Employees and shall further not constitute a stipulatio alteri for the benefit of a third party Notwithstanding the status of the Employer as Policyholder and notwithstanding the provisions of clause to above, it is specifically recorded that the Benefits shall at all times be used and/or applied by the Employer for the sole and direct benefit of the injured or deceased Employee and/or his/her Dependants and for no other purpose whatsoever A claim for Benefits in terms of this Group Policy will only be considered if such a claim for COIDA Benefits is accepted in terms of the COIDA Policy, subject to clause below RMA Life shall not be obliged to accept a claim for Benefits purely due to the fact that a claim for COIDA Benefits are accepted in terms of the COIDA Policy. All claims for Benefits shall be independently assessed in terms of this Group Policy notwithstanding the fact that the claim (except claims arising from the occurrence of the Insured Events listed in clauses , and ) is conditional upon the successful acceptance of the claim for COIDA Benefits in terms of the COIDA Policy as provided in clause All Benefits payable in terms of this Group Policy shall be paid only into a South African bank account in the South African currency (ZAR) and RMA Life shall not be liable for any deductions, penalties, charges or applicable taxes in relation to such payments and RMA Life's payment obligations in terms of this Group Policy shall at all times be limited to the Benefits as stipulated herein.

23 Amendment to Benefits RMA Life shall at all times be entitled to amend the Benefits payable in terms of this Group Policy by way of a 14 (fourteen) day written notice to the Employer RMA Life shall be entitled, but not obliged, to increase the Benefits payable in terms of this Group Policy in the event of an increase in the COIDA Benefits payable in terms of the COIDA Policy, provided that any such increases shall at all times be in RMA Life's sole and unfettered discretion The Employer shall give notice of the amendments to the Benefits to the Employees, the costs of which communication shall be borne by the Employer, and shall upon request by RMA Life provide proof to the reasonable satisfaction of RMA Life that the Employees were adequately informed of the amendment of the Benefits It is recorded that the level of Disability Benefits (in the event of a monthly pension payment) shall at all times remain unchanged as a result of increase in Earnings (if any) of a Disabled Employee Death Benefits The Death Benefits shall be paid in the event of the Death of an Employee upon the occurrence of an Insured Event, subject to the terms and conditions of this Group Policy In the event of the Death of an Employee immediately after the occurrence of an Accident without diagnoses of Disablement before such Death, a Death Benefit in the form of a monthly pension payment equal to 75% (seventy five percent) of the Augmented Earnings shall be payable, provided such Augmented Earnings exceed the Start Rate of Augmented Earnings The Death Benefit as specified in clause shall at all times be subject to the Maximum Aggregate Amount The Death Benefit shall be apportioned between the Dependants as follows:

24 In the event that the deceased Employee leaves only one Widow and no Dependent Children, 40% (forty percent) of the Death Benefit shall be paid to the Widow and the remainder of the Death Benefit shall be forfeited In the event that the deceased Employee leaves a Widow and up to 3 (three) Dependent Children, the Death Benefit shall be apportioned as follows: Widow: 40% of the Death Benefit; and Each Dependent Child: 20% of the Death Benefit In the event that the deceased Employee leaves a Widow and up to 8 (eight) Dependent Children, the Death Benefit shall be apportioned as follows: Widow: 40% of the Death Benefit; Dependent Child #1: 20% of the Death Benefit; Dependent Child #2: 20% of the Death Benefit; Dependent Child #3: 20% of the Death Benefit; Dependent Child #4: 10% of the Death Benefit; Dependent Child #5: 7.5% of the Death Benefit; Dependent Child #6: 7.5% of the Death Benefit; Dependent Child #7: 5% of the Death Benefit; and Dependent Child #8: 3.3% of the Death Benefit In the event that the deceased Employee leaves more than 1 (one) Widow and no Dependent Children, the Death Benefit payment specified in clause shall be equally distributed between such Widows.

25 Cessation of Death Benefit payments The Death Benefit payments shall cease to be paid in the event that the death COIDA Benefit payments in terms of the COIDA Policy ceases to be payable; or a Widow is deceased, in which event the component of the Death Benefit payable to that Widow will cease; or a Dependent Child is deceased in which event the component of the Death Benefit payable to that Dependent Child will cease; or a Dependent Child is married before attaining the age of 18 (eighteen) years of age, in which event the component of the Death Benefit payable to the Dependent Child will cease; or at the end of the month during which the Dependent Child reaches the age of 18 (eighteen) years of age unless such Dependent Child is physically or mentally disabled and unable to earn an income pursuant to such disability; or attending secondary or tertiary education and therefore unable to earn an income, provided that it could reasonably be expected that the Employee would have contributed to the maintenance of that Dependant Child, in which event the monthly pension payment shall continue despite such Dependent Child having attained the age of 18 (eighteen) years of age until such time as the conditions in clauses and are no longer applicable.

26 Disability Benefits In order for a Disability Benefit to be payable, the Employee must be away from work for a period of at least 3 (three) days before an assessment of Disablement shall be made by RMA Life The Disablement of an Employee shall be categorised as either Temporary Total Disablement, Temporary Partial Disablement or Permanent Disablement with effect from the Date of Disablement, which categorisation shall be done by RMA Life in its sole and unfettered discretion and which decision shall be final and binding RMA Life shall be entitled but not obliged to consider the reports procured by the Employer and/or Employee from a Medical Practitioner in making such assessment Temporary Total Disablement In the event of an Insured Event occurring resulting in the Temporary Total Disablement, RMA Life shall make payment of a Disability Benefit in the form of a monthly pension equal to 75% (seventy five percent) of the Disabled Employee's Augmented Earnings, multiplied by the number of days that the Disabled Employee is unable to earn an income, divided by 30.33, provided such Augmented Earnings exceed the Start Rate of Augmented Earnings The Disability Benefit as specified in clause shall at all times be subject to the Maximum Aggregate Amount The payments for Temporary Total Disablement shall not exceed 24 (twenty four) monthly payments, whereafter the Benefit may be converted to a Permanent Disablement payment, in the sole and unfettered discretion of RMA Life, subject to a review of the Disablement in the manner contemplated in clause Temporary Partial Disablement In the event of an Insured Event occurring resulting in the Temporary Partial Disablement, RMA Life shall make payment of a Disability

27 25 Benefit in the form of a monthly pension equal to 75% (seventy five percent) of the Disabled Employee's Augmented Earnings, multiplied by the number of days that the Disabled Employee is unable to earn an income, divided by 30.33, provided such Augmented Earnings exceed the Start Rate of Augmented Earnings The Disability Benefit as specified in clause shall at all times be subject to the Maximum Aggregate Amount The payments for Temporary Total Disablement shall not exceed 24 (twenty four) monthly payments, whereafter the Benefit may be converted to a Permanent Disablement payment, in the sole and unfettered discretion of RMA Life, subject to a review of the Disablement in the manner contemplated in clause Permanent Disablement and Serious Disfigurement In the event of an Insured Event occurring resulting in the Permanent Disablement or Serious Disfigurement of the Employee where the degree of Permanent Disablement or Serious Disfigurement is over 30% (thirty per cent) and up to 100% of the body of the Employee, a monthly amount equal to 75% (seventy-five percent) of Augmented Earnings will be payable, provided that such Augmented Earnings exceed the Start Rate of Augmented Earnings and provided that the Disability Benefits does not exceed the Maximum Aggregate Amount less than 30% (thirty per cent) of the body of the Employee a lump sum of 6 (six) times monthly Augmented Earnings will be payable, provided that such Augmented Earnings exceed the Start Rate of Augmented Earnings and provided that the total lump sum Disability Benefits does not exceed the Maximum Aggregate Amount In the event of the loss of a limb or body part on the body of the Employee, a lump sum payment will be payable, being a percentage of the Augmented Earnings, provided that the Augmented Earnings exceed the Start Rate of Augmented Earnings and provided that the

28 26 total lump sum Disability Benefits does not exceed the Maximum Aggregate Amount The Employer shall be liable for payment of the Disability Benefits for the first 3 (three) month period calculated from the date of the Accident, and shall be reimbursed for such payments made after 3 (three) month period excluding any interest, provided that the claim for Benefits is valid and accepted in terms of this Group Policy Review of Disability Continued payment of Disability Benefits is subject thereto that the Employee submits himself/herself to regular medical examinations or rehabilitation programmes as RMA Life may in its sole discretion direct from time to time If so instructed by RMA Life, the Employer shall ensure that the Disabled Employee undergoes such reasonable medical and/or other treatment as instructed from time to time by RMA Life to establish the continued entitlement to the Disability Benefits, or to a Disability Benefit at the level at which it is being paid and to assess whether such Disabled Employee is able to re-commence his/her employment with the Employer. The reasonable cost of these assessments and/or reports relating to continued Disablement, shall be paid by RMA Life Without limitation of the above, RMA Life shall from time to time review an Employee's Disablement in order to assess whether the Employee's Disablement is capable of rehabilitation. In such an event, RMA Life shall in its sole discretion and, if it deems necessary, in consultation with a Medical Practitioner, develop a programme of rehabilitation in respect of a Disabled Employee. The reasonable cost of these assessments and/or rehabilitation programmes, shall be paid by RMA Life In the event that the Employee refuses to undergo medical treatment, a rehabilitation programme and/or other treatment as instructed by RMA Life from time to time, or in the event that the Employer fails to provide RMA Life with such information as it may reasonably require in respect of such Disabled Employee, RMA Life may reduce or cease payment of the

29 27 Disability Benefits in respect of the Disabled Employee in RMA Life's sole discretion Cessation of payment of Disability Benefits Without limitation of any other provisions of this Group Policy, RMA Life shall at all times be entitled to stop payment of Disability Benefits upon the occurrence of any of the following events, whichever occurs first, namely in the event that the Employee resumes employment with the Employer (or any other employer) and his/her Augmented Earnings is the same or higher than the Augmented Earnings of the Employee at the date of the Accident; the Employee is no longer Disabled in the sole and unfettered discretion of RMA Life; the Employee is deceased, subject to the provisions of clause 14.8 below Payments in the event of the death of a Disabled Employee In the event of the death of a Disabled Employee as a direct result of the injuries sustained as a result of an Accident leading to the diagnosis of Disablement, the Disability Benefits shall be converted into Death Benefit payments and the provisions of clause 14.3 and 14.4 shall apply to such payments Maximum Aggregate Amount The Maximum Aggregate Amount shall be applied to the Benefits payable in terms of this Group Policy and the COIDA Benefits payable in terms of the COIDA Policy irrespective whether the same or different benefits are provided in terms of the COIDA Policy and this Group Policy; and irrespective of the number of Insured Events occurring as part of the same incident The total of all COIDA Benefits payable in terms of the COIDA Policy and the Benefits payable in terms of this Group Policy shall be taken into

30 28 consideration to calculate whether the Maximum Aggregate Amount is achieved In the event that the Maximum Aggregate Amount is achieved, no further benefits shall be paid in terms of the COIDA Policy and/or this Group Policy. 15. Payment of Premiums 15.1 The Premium payable by the Employer in respect of the Employees shall be calculated with reference to the Augmented Earnings of an Employee for the Calculation Period and shall be based on the information provided by the Employer as specified in clause 10.2, in particular the estimated Earning at the Inception Date or the commencement of a Calculation Period ("the Deposit Premium") The details as specified in clause 10.2 shall constitute prima facie proof of the amount due and payable by the Employer to RMA Life in respect of the Group for the upcoming Calculation Period The Deposit Premium shall be paid in two equal tranches, which payments shall be made on or before the Due Date The invoices shall be provided by RMA Life on or before 1 January and 1 July of every year that the Group Policy is in force Due to the fact that the Premium is calculated on the estimated Augmented Earnings of each Employee forming part of the Group, RMA Life shall recalculate the Premium at the end of each Calculation Period based on the actual Earnings of the Employees for the Calculation Period ("the Final Premium") In order to enable RMA Life to calculate the Final Premium, the Employer shall, within 30 (thirty) days after the end of each Calculation Period, provide RMA Life with the particulars of each Employee's actual Augmented Earnings for the relevant Calculation Period in the form and manner as prescribed by RMA Life in writing from time to time, together with such additional information as RMA Life may require.

31 In the event that the Final Premium is greater than the Deposit Premium, the Employer shall be liable to RMA Life for the difference between the Final Premium and the Deposit Premium and shall pay such amount to RMA Life within 30 (thirty) days of receipt of an invoice from RMA Life into the bank account nominated by RMA Life from time to time in writing; or the Final Premium is less than the Deposit Premium, RMA Life shall refund to the Employer the difference between the Deposit Premium and the Final Premium within 30 (thirty) days of finalising such calculations and shall pay such amount into the bank account of the Employer nominated in writing from time to time. RMA Life shall be entitled to elect to set off any overpayment against a Deposit Premium due and payable for the following Calculation Period unless the Group Policy is cancelled in terms of clause In the event of failure by the Employer to provide the particulars prescribed in clause 10.2 or the updated information within the period prescribed in clause 15.6 above in order to enable RMA Life to calculate either the Deposit Premium or the Final Premium for a Calculation Period, RMA Life shall be entitled to elect, in the alternative and without prejudice to any other rights it may have, to claim an amount equal to the full Final Premium of the previous Calculation Period plus interest at the Applicable Interest Rate, calculated from the Due Date of payment as pre-estimated liquidated damages from the Employer, based on the failure by the Employer to fulfil its obligations in terms hereof, which amount shall be payable on demand; and/or give notice of cancellation of this Group Policy as provided in clause 19, in which event all outstanding Premiums, calculated in the manner set out in clause , shall immediately become due and payable plus interest at the Applicable Interest Rate, calculated from the Due Date of payment It is recorded for the sake of clarity, in the event of cancellation of this Group Policy before expiry of a Calculation Period, that the outstanding Premium shall be calculated as if the Group Policy endured for the duration of the Calculation Period.