Standard Bank Unity Hospital Cash Plan

Transcription

1 Standard Bank Unity Hospital Cash Plan Standard Insurance Limited Registration number: 1993/007593/06 Between Standard Insurance Limited (Us) and the Policyholder (You) 1 Important information about the Policy 1.1 The Policy is based on Your application and declaration and any other information You give Us. 1.2 The Policy forms the main insurance contract between You (the Policyholder) and Us (Standard Insurance Limited) and starts when You pay the first premium. 1.3 You must read the Policy together with the Certificate of Insurance and any change or endorsement (stamp or writing on the Policy) because they are all part of the insurance contract. Words with a specific meaning keep that meaning wherever they appear. 1.4 We will Cover You based on the terms and conditions of the Policy and as long as You pay the premium. 2 Definitions These words have the following meanings where they appear in the Policy: Accident Aids a sudden and unexpected event at a specific time and place. It must cause external visible Bodily injury to the Insured Person that could lead to a claim for death. or disability; acquired immune deficiency syndrome, human immunodeficiency virus (HIV) and all related conditions. Bodily injury Certificate of Insurance Bodily injury or physical suffering within 12 months of the Accident that caused it, as listed in the Policy s benefits table below. The injury cannot have any other cause such as a physical problem, weakness or illness that existed before the Accident. Injury includes exposure to the elements (having no shelter) because of an Accident. But it excludes any sickness or infection, unless this was directly because of an accidental Bodily injury. means a document issued by the insurance company to prove the existence of an insurance Policy. It states the type of Cover, value of Cover, the commencement date of the Policy and the name of the insured.

2 Child Cover Day Doctor FAIS Act Group Hospital Hospital stay Insured Person Personal Information Policy Policyholder Pre-existing conditions Process any natural Child, step Child, or adopted Child who is unmarried and depends completely or mainly on You for financial support. A Child must be younger than 18 to be an Insured Person, or younger than 25 if they are a full time student at a recognised university or other tertiary institution. benefit offered by Us to the Policyholder in exchange for a premium. 24 hours in a row. a person who is registered and licensed to practise medicine in the relevant country, except any Insured Person or their immediate family members. means the Financial Advisory and Intermediary Services Act, 37 of 2002, as amended from time to time and including subordinate legislation; means Our affiliates, associates, subsidiaries and divisions together with Our holding company and the affiliates, associates, subsidiaries and divisions of Our holding company; a medical facility where patients can stay overnight, be diagnosed and have surgery or treatment. It excludes any nursing or old age home or similar place for extended recovery, care or rehabilitation. stays in Hospital as a patient for at least one Day. any of the following people (or a combination of them, depending on the circumstances): You, the Policyholder in the Certificate of Insurance; Your Spouse named in the Certificate of Insurance; or any natural Child, stepchild, or legally adopted Child of yours who is unmarried and who depends mostly on You for financial support. means information relating to an identifiable, natural or juristic person, including but not limited to, information relating to race, gender, sex, marital status, nationality, ethnic or social origin, colour, sexual orientation, age, physical or mental health, religion, belief, disability, language, birth, education, identity number, telephone number, , postal or street address, biometric information and financial, criminal or employment history as well as correspondence sent by the person that is implicitly or explicitly of a private or confidential nature or further correspondence that would reveal the contents of the original correspondence; the insurance contract in this Policy document and Certificate of Insurance, including any endorsements (later changes) or additions. You, who pays the premium and is named in the Policy schedule. any medical condition (diagnosed or not) if: You had symptoms of it or received medicine, advice, tests or treatment for it in the 24 months before the Start date; You knew or should have known about it on the Start date; or Our Doctor thinks it is a cause of any injury or illness You claim for under this Policy, or directly related to it; and Pre-existing conditions for the past two years are excluded for the first 2 years. means any operation or activity, whether automated or not, concerning Personal Information, including: collection; receipt;

3 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. Processing will have a similar meaning. Spouse Start date the husband, wife or any legal partner who You have lived with permanently and continuously in the same household. This Policy only covers one Spouse, who You choose and must be named in the Certificate of Insurance. the Policy Start date shown in the Certificate of Insurance Waiting period We, Our or Us You or Your the 30 days an Insured Person must wait before they are covered under this Policy. We will not pay any benefit for a Hospital stay during a Waiting period. It starts when the Policy starts or a new Insured Person is added to the Policy. The Waiting period will not apply if the first premium has been paid. Standard Insurance Limited. the Policyholder named in the Certificate of Insurance (the main Insured Person) 3 What this Policy covers If the Insured Person has a Bodily injury or illness that must be treated in Hospital, We will pay the amount of the daily benefit for each Day of their Hospital stay. But We will not pay any benefit unless the Policy terms allow it and the Waiting period has passed. 4 Benefits 4.1 Daily benefit The daily benefit is the amount shown in Your Certificate of Insurance. We pay this for each Day an Insured Person must stay in Hospital while this Policy covers them. 4.2 Overseas benefit We pay the overseas daily benefit in Your Certificate of Insurance for up to 90 days that an insured person must stay in Hospital, outside South Africa, while this Policy covers them. All benefit amounts are in South African Rand. This means We pay foreign expenses according to the rate of exchange that applies when We pay. 5 General conditions of this Policy the length of any Hospital stay is the number of nights (starting at midnight) that the Insured Person spends in Hospital as a patient because of any particular injury or illness. We will pay daily benefits as a lump sum at the end of a Hospital stay, or for 30 days at a time if the stay is longer than this. We will not pay interest on any benefit under this Policy. This Policy has no value that builds up or that can be paid out in any situation other than a Hospital stay. It has no cancellation, paid-up or maturity value. 6 Personal Information 1 We may and you expressly consent to the collecting and Processing of your Personal Information by us, to: administer your Policy; provide any combination of services, analysis, advice or intermediary service linked to your Policy, to you; monitor and analyse your conduct relating to the Policy for fraud, compliance and other riskrelated purposes; carry out statistical and other analysis to identify potential markets and trends; and develop new products and services. 2 You hereby expressly consent that we may:

4 Process and further Process your Personal Information within the Group for the above purposes; Disclose your Personal Information to any person who provides services to us or acts as our agent or to whom we have transferred or propose to transfer any of our rights and duties in respect of your Policy. Some of these persons may be located in countries outside of the Republic of South Africa; and Share your personal information with our service providers, locally and outside South Africa, as necessary. We ask persons who provide services to us to agree to our privacy policies if they need access to any Personal Information to carry out their services. 3 You acknowledge that: We will at all times remain responsible for determining the purpose of and means for Processing your personal information; We are required by various laws, including the FAIS Act, to collect some of your personal Information; Without your Personal Information we may be unable to open or continue to offer services to you; and You are providing us with your Personal Information voluntarily. 4 Our address is stated in the service address clause in the Policy.] 7 Cooling off period of 30 days if the Cover does not suit Your needs, You may cancel it up to 30 days after You get the Policy document and Certificate of Insurance. We will refund any premium You paid, within 30 days of You cancelling the Policy, unless a claim has already been made. 8 Cancelling the Policy after the cooling off period You may cancel this Policy by calling Us on between 8am and 5pm from Monday to Friday. Cover ends on the date You tell Us You have cancelled the Policy. We may cancel the Policy by telling You in writing at least 30 days before We do this. We may write to the last postal, street or electronic address You gave Us. 9 Important: Fraud or misrepresentation It is very important for You to be honest when You apply for this Policy, make any claim or give Us any information. If You are not honest, You will lose any benefit You would have received. It is dishonest if You give Us wrong information on purpose or commit fraud, for example. Not giving Us important information is the same as giving Us wrong information. This Policy is invalid if You are dishonest when You apply for it. This means there is no contract between Us and You. If You are dishonest when You make any claim or give Us other information, We may reject the claim and cancel the Policy. You must repay any benefit within 14 days that We have already paid You. We will not refund any premiums. 10 Law and jurisdiction South African law governs this Policy. 11 Paying benefits We will pay any benefit to the Insured Person for that claim. We will pay the benefit to You if the Insured Person is a Child. 12 Changing the Policy or premiums We may change the terms of this Policy or the premiums You must pay. We usually do this because of new factors to consider or a change in any law that applies. We will tell You in writing about any changes at least 30 days before they apply. We may write to the last postal, street or electronic address You gave Us. 13 Paying Your premiums You must pay the first premium on the date in the Certificate of Insurance. After that, You must pay the premium on the due date, which is the first working Day of each month. Each premium You pay on its due date buys Cover on this Policy s terms for that calendar month only.

5 If any premium is not paid on time You must pay it within 30 days or else the Policy will automatically be cancelled from the due date. If the premium is paid within the 30 days then the Policy covers You as if the premium was paid on time. 14 Rejection (of claims) and disputes about this: If We reject Your claim or do not agree with the value of Your claim and You are unhappy with this, You may do the following within 90 days from receipt of Your rejection letter: ask Our management to reconsider Your claim; or write to The Ombudsman for Short Term Insurance, PO Box 32334, Braamfontein, We will accept the decision of the Ombudsman. If You remain unhappy after We have reconsidered Your claim You may take legal action against Us within six months from the end of the 90 days mentioned above. You will lose Your rights to claim if You do not take legal action in time. This means We will not have to pay You anything. 15 Important: Exclusions that apply to this Policy We will not pay any benefit if an Insured Person goes to Hospital because of any: Pre-existing condition;(this will be covered after a two year Waiting period) pregnancy, having a baby, infertility, abortion or any related condition; effects of alcohol; sexually transmitted disease or Aids;(this will be covered after a two year Waiting period) mental or psychiatric illness; drug they take unless they followed the manufacturer s instructions or a Doctor prescribed it; drug they take for treating drug addiction; injury or illness while flying unless they were a paying passenger; Accident that happens while they were driving any motor vehicle while the alcohol content in their blood or urine is over the legal limit; Bodily injury suffered while directly involved in an illegal activity; dangerous situation they get into on purpose; sport they play or train for as a professional, even if this is not a direct or main cause; Accident directly caused by war; congenital defect (a problem they were born with); cosmetic surgery, for example a skin graft or face-lift; or sex-change operation or similar procedure. 16 Important: Limits of Cover under this Policy The most We pay for each Day in Hospital under this Policy is R Please read the daily Hospital benefit in the Certificate of Insurance. We will only pay the daily benefit for up to 185 days (not necessarily all in a row) for any Hospital stay in South Africa because of any particular injury or illness. For overseas Hospital stays We will only pay the benefit for up to 90 days. If You return to Hospital within 180 days of leaving, We regard both Hospital stays as part of the same claim. This means We will not pay benefits for more than 185 days in total (90 days overseas); including the days for the original claim for the earlier Hospital stay. If You go back into Hospital after more than 180 days after leaving, We will regard the later Hospital stay as a new claim. But if You showed symptoms of the injury or illness that led to the original Hospital stay during the 180 days, We regard it as the same claim. The benefit for any Child is the same as for You. An Insured Person may not be older than 60 when they are added to the Policy. But Cover continues for life after this as long as We receive all the premiums on time. 17 Cash Back Every three years We will pay back 20% of the premiums You paid in that time, as long as We have not paid any claims under this Policy during that time. 18 How to make a claim Making a claim is easy. Just follow these steps:

6 18.1 Phone between 8am and 5pm from Monday to Friday, within 14 days of the Insured Person going into Hospital Give Your Policy number and say You want to claim Fill in the claim forms when You get them from Us. We will tell You what You need to do Make sure You have a statement from the Hospital that shows the admission date, and any discharge date (if the Insured Person has already left Hospital) Fax the claims forms and the Hospital statement to Send Us any more information (or arrange any tests) We ask for to support Your claim. Please read the conditions below about these. 19 We will pay all valid claims quickly. But We may reject a claim if You do not tell Us about it within 14 days, unless: You have a good reason for why it was not practical, and You tell Us about it within one year of the Hospital admission. 20 Conditions about information or tests We need We may ask for any information or certificate We need to decide about the claim. You must pay the costs of this. We may reject any claim if We do not get the information. We may ask an Insured Person to have medical check-ups in connection with any claim under this Policy. We will pay for the check-ups and any reasonable travel costs We agree to first. We may reject any claim if an Insured Person refuses to have a medical check up without a good reason. If an Insured Person dies, We may also ask for a medical examination of the body (a post mortem), which We will pay for. 21 Rejection of claims or disputes 21.1 If We reject Your claim or do not agree about the amount and You are unhappy about this: You may ask Us to take another look at Your claim within 90 days of Our response. You may also write to: The Ombudsman of Short Term Insurance, PO Box 32334, Braamfontein, We will accept the Ombudsman s decision If You are still unhappy after taking these steps, You may still take legal action against Us for up to six months after the end of the 90 Day period. If You do not, You will give up Your claim and We will have no responsibility for it after the six months has ended. 22 How to contact Us If You have any questions about Your Policy or need to change any Personal Information please contact Us: Postal address: PO Box 32028, Braamfontein, 2017 Share-call number: Fax number: address: SBIBMDR@standardbank.co.za Contact information for making claims is above. Standard Bank Insurance Brokers (Pty) Limited is a licensed financial services provider that manages the Policy for Us. CPA Version 2012

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