GLA Policy: Cape Joint Pension Fund (Defined Contribution Section) Group Life Insurance Benefits L4314

Transcription

1 GLA Policy: Cape Joint Pension Fund (Defined Contribution Section) Group Life Insurance Benefits L4314

2 POLICY NUMBER (herein referred to as the policy) A POLICY OF INSURANCE for the CAPE JOINT PENSION FUND (Defined Contribution Section) (herein referred to as the FUND) underwritten by METROPOLITAN LIFE LTD An authorised Financial Services Provider (hereinafter referred to as METROPOLITAN) Signed by For METROPOLITAN 08 June 2009 Date

3 Page 2 INDEX Page 1. Preamble 3 2. Definitions 4 3. Membership Premiums Death benefit DISABILITY benefit Conversion option INSURED BENEFIT COVER increases Temporary absence Amendments to RULES Information Records Endorsements Cancellation of policy Enquiries Domicilium citandi et executandi and notices Money payments Jurisdiction Benefits inalienable Indemnification Non-indulgence Life fund Sole contract 34 SCHEDULE 35

4 Page 3 1. PREAMBLE 1.1 METROPOLITAN will in return for the payment of premiums pay those benefits specified in the SCHEDULE on the terms and conditions contained in this policy. 1.2 In this policy where the context so permits, words signifying the singular include the plural, words indicating the masculine gender include the feminine and vice versa. 1.3 Any provision contained in this policy shall be read, understood and interpreted in the context of the provisions of this policy as a whole. 1.4 This policy replaces all previous policies and endorsements issued to the FUND in respect of this policy with effect from 1 July 2008.

5 Page 4 2. DEFINITIONS The following words and expressions used in this policy have been defined to prevent any doubt about their respective meanings. These words and expressions are indicated by capital letters throughout. Unless the context indicates otherwise, the following words and expressions shall have the following meanings and cognate expressions shall bear corresponding meanings: ACCIDENT - an unlooked-for event, which could not reasonably be expected to occur and/or was not designed, and which results in death or DISABILITY caused directly and independently of all other causes by some external and visible means arising from the said event; ACTIVELY AT WORK - at work for the duration of a normal work day (as defined in the ELIGIBLE MEMBER S employment contract) performing the key functions of his/her INSURED OCCUPATION; ANNUAL SALARY/IES - the ELIGIBLE MEMBER S annual salary/wage as advised by the FUND and agreed to by METROPOLITAN for purposes of this policy. Changes to an ELIGIBLE MEMBER S ANNUAL SALARY shall, for purposes of this policy, be effective from the first day of the month in which the ELIGIBLE MEMBER S annual salary/wage increases; COMMENCEMENT DATE - the first day of July 2002, in respect of fixed-term contract employees as defined in clause 3.1, and shall mean, in respect of any person who becomes a MEMBER of the FUND after the said date, the first day of the month during which such a person became a MEMBER of the FUND;

6 Page 5 DATE OF DISABLEMENT - the date from which the ELIGIBLE MEMBER has suffered DISABILITY as determined by METROPOLITAN having regard to: (i) the medical evidence, (ii) the key functions of his/her INSURED OCCUPATION, (iii) his/her last DAY ACTIVELY AT WORK, (iv) the definition of DISABILITY; DATE OF IMPAIRMENT - the date on or after the COMMENCEMENT DATE from which an ELIGIBLE MEMBER'S potential IMPAIRMENT, due to illness or injury, became apparent. The impairment is impacting on how the ELIGIBLE MEMBER is fulfilling the key functions of his INSURED OCCUPATION without the need for accommodations or changes to the standard terms and conditions of the employment contract and could include, but is not limited to, the following: (i) The first DAY after the ELIGIBLE MEMBER, due to illness or injury did not attend work for 2 consecutive weeks; (ii) The first DAY that the ELIGIBLE MEMBER was booked off by a medical practitioner for injury, illness, rehabilitation or surgical intervention / treatment / hospitalisation for a period longer than 2 weeks; (iii) (iv) The first DAY after which the ELIGIBLE MEMBER has taken more than 30 DAYS sick leave during a 1 year period; The first DAY after which an ELIGIBLE MEMBER has taken more than 5 DAYS (with or without medical proof, consecutive or non consecutive) sick leave in a 1 month period;

7 Page 6 (v) The DAY after the ELIGIBLE MEMBER complains of impairment/difficulty in meeting work requirements as a result of illness or injury or stress; (vi) The date when it is decided to make any changes to the terms and conditions of employment such as: (a) adjust the workplace; and/or (b) the standard requirements of the work; and/or (c) the work hours; and/or (d) work environment; and/or (e) the duties the ELIGIBLE MEMBER has been performing; DAY - any day including a Saturday, Sunday or official public holiday in South Africa; DISABILITY / DISABLED - shall mean the condition specified in the SCHEDULE; DISABILITY BENEFIT - the Cape Joint Income Continuation SCHEME Benefit Scheme (policy number ); ELIGIBLE MEMBER - a MEMBER who satisfies the requirements set out in clause 3; EMPLOYER - 1 or more LOCAL AUTHORITIES; ENTRY DATE - the date on which a person was admitted to the FUND or the PREVIOUS SCHEME; FINAL SALARY - (i) an ELIGIBLE MEMBER'S ANNUAL SALARY at the date of his/her death or his/her DATE OF DISABLEMENT, with the proviso that fluctuating emoluments will be averaged

8 Page 7 over the 12 months preceding death/ disablement; and (ii) if the ELIGIBLE MEMBER was in receipt of an income continuation benefit in terms of the DISABILITY BENEFIT SCHEME, the ANNUAL SALARY the ELIGIBLE MEMBER earned immediately prior to the date on which such disability commenced, increased annually by the percentage with which the income continuation benefit increased in terms of the DISABILITY BENEFIT SCHEME, as the case may be; FREE COVER LIMIT - a certain limit up to which ELIGIBLE MEMBERS are granted INSURED BENEFIT COVER without having to submit medical evidence of good health to METROPOLITAN, as determined by METROPOLITAN from time to time; FUND - shall mean the fund specified in the SCHEDULE; IMPAIRMENT - the inability of an ELIGIBLE MEMBER, due to illness or injury, to fulfil the key functions of his/her INSURED OCCUPATION before adjustments or accommodations are made to the standard terms and conditions of the employment contract; INSURED BENEFIT - cover for the death and DISABILITY COVER benefits set out in the SCHEDULE; INSURED OCCUPATION - the ELIGIBLE MEMBER S occupation as defined in his/her job description and shall mean those duties that the ELIGIBLE MEMBER was routinely performing while ACTIVELY AT WORK immediately prior to the DATE OF DISABLEMENT, and encompasses any

9 Page 8 adaptations to such duties and / or to the ELIGIBLE MEMBER S work circumstances which may reasonably be made or be expected to be made by the EMPLOYER to accommodate the ELIGIBLE MEMBER S disablement in light of the requirements of the Labour Relations Act, or its successor in title. Where the ELIGIBLE MEMBER S duties have changed within 3 months prior to the DATE OF DISABLEMENT as a direct consequence of any such adaptations, the duties performed prior to the change will constitute his/her INSURED OCCUPATION; LOCAL AUTHORITY - a local authority as defined in the RULES; MEMBER - shall mean a person who has qualified for, been admitted to and not ceased to qualify for active ongoing membership of the FUND; NORMAL RETIREMENT - the age set out in the SCHEDULE; AGE POLICY ANNIVERSARY - the date set out in the SCHEDULE; POLICY YEAR - a year commencing on a POLICY ANNIVERSARY; PREVIOUS SCHEME - the Cape Joint Pension Fund risk benefit policy (policy number x9) underwritten by Sanlam in respect of current members; RISK BENEFIT OPTION A, - the risk benefit options available to a B, C or D MEMBER as described in the SCHEDULE;

10 Page 9 RULES - the rules of the FUND in force from time to time, registered with the Registrar of Pension Funds and approved by the Commissioner for the South African Revenue Service; SCHEDULE - the SCHEDULE attached to this policy; WAITING PERIOD - the period as set out in the SCHEDULE starting from the DATE OF DISABLEMENT. If there is any doubt that the ELIGIBLE MEMBER is DISABLED, METROPOLITAN may apply a longer waiting period, but not longer than 6 months. If the ELIGIBLE MEMBER experiences DISABILITY as described in paragraph (a) of the definition of DISABILITY, it is not necessary for the ELIGIBLE MEMBER to be DISABLED for 6 months before a benefit is payable in terms of this policy.

11 Page MEMBERSHIP 3.1 INSURED BENEFIT COVER in terms of this policy shall be compulsory for and restricted to all existing ELIGIBLE MEMBERS covered in terms of this policy as at 30 June 2003; all members of the PREVIOUS SCHEME who, as at 30 June 2003, elected to participate in the FUND with effect from 1 July 2003 (this election, once made, shall be irrevocable); and all employees who join the EMPLOYER S service on or after 1 July 2003 who: (i) are employed in the permanent and full-time service with the EMPLOYER or on a fixed-term contract basis with the EMPLOYER; (ii) elected, as at the date of joining the EMPLOYER S service, to become MEMBERS of the FUND; and (iii) have not yet attained the NORMAL RETIREMENT AGE INSURED BENEFIT COVER shall not be applicable to an employee who had the option of becoming a MEMBER of the FUND, but who has failed to become a MEMBER of the FUND within 3 months of becoming entitled to do so. Should the employee, however, become a MEMBER of the FUND at a later date, METROPOLITAN reserves the right to request that he/she submits evidence of his/her proof of insurability to the satisfaction of METROPOLITAN. The cost of providing such evidence shall be for the ELIGIBLE MEMBER S account. 3.2 INSURED BENEFIT COVER in terms of this policy shall commence on: July 2002 in respect of the persons mentioned in 3.1 above; or such later date on which any person qualifies for cover under this policy. 3.3 Actively at work condition Notwithstanding anything to the contrary contained herein, METROPOLITAN requires that, before accepting an ELIGIBLE MEMBER for INSURED BENEFIT COVER in terms of this policy, the ELIGIBLE MEMBER be ACTIVELY AT WORK performing the duties of his/her INSURED OCCUPATION on his/her ENTRY DATE.

12 Page Should an ELIGIBLE MEMBER be absent from work due to illness or injury at his/her ENTRY DATE, then that ELIGIBLE MEMBER'S INSURED BENEFIT COVER will not commence before completion of 2 consecutive months in the active permanent service of the EMPLOYER once he/she has returned to work However, if the ELIGIBLE MEMBER dies as a result of an ACCIDENT, the ELIGIBLE MEMBER S INSURED BENEFIT COVER shall be deemed to have commenced on his/her ENTRY DATE The conditions set out above will be waived, should the ELIGIBLE MEMBER submit evidence of good health to the satisfaction of METROPOLITAN, within 10 working days of returning to work These provisions shall also be applicable to those ELIGIBLE MEMBERS whose INSURED BENEFIT COVER increases as a result of them having become covered under this policy on or after 1 July 2003 and shall only be applicable to the increased portion of the ELIGIBLE MEMBERS INSURED BENEFIT; unless the ELIGIBLE MEMBER is absent from work as set out in clause below Notwithstanding the above, an ELIGIBLE MEMBER who is absent from work due to any type of leave other than sick leave shall be regarded as being actively at work and his/her INSURED BENEFIT COVER shall commence on his/her ENTRY DATE. This provision shall mutatis mutandis apply to those MEMBERS who make use of the options available in terms of clause INSURED BENEFIT COVER in terms of this policy shall cease on the day that: the ELIGIBLE MEMBER leaves the service of the EMPLOYER, unless (i) a benefit in respect of him/her remains payable to the FUND in terms of the policy; or (ii) the ELIGIBLE MEMBER is in receipt of an income continuation benefit in terms of the DISABILITY BENEFIT SCHEME, or the ELIGIBLE MEMBER ceases to be a MEMBER of the FUND, or the ELIGIBLE MEMBER attains the NORMAL RETIREMENT AGE, or

13 Page the premium deduction in respect of the MEMBER ceases, or this policy is cancelled, whichever of the aforementioned events may first occur. 3.5 Notwithstanding the above, an ELIGIBLE MEMBER who retires from the service of the EMPLOYER or ceases to be a MEMBER of the FUND, will enjoy INSURED BENEFIT COVER for a period of 30 days following termination of the employee or membership agreement (as the case may be). No premium will be required in respect of this 30 day period. Thereafter, all INSURED BENEFIT COVER will cease. 3.6 An ELIGIBLE MEMBER who submitted a DISABILITY INSURED BENEFIT COVER claim, and is still in the WAITING PERIOD at the expiry of the termination notice period, will enjoy full INSURED BENEFIT COVER if premiums are paid during the WAITING PERIOD. 3.7 Risk Benefit Options Persons joining on or after 1 July 2003: Employees who become covered for benefits under this policy on or after 1 July 2003 will automatically become RISK BENEFIT OPTION A MEMBERS. These ELIGIBLE MEMBERS will be given the option to change to RISK BENEFIT OPTION B, C or D. The FUND must inform METROPOLITAN in writing of any change in RISK BENEFIT OPTION within 1 month of the ELIGIBLE MEMBER S entry into the FUND. Notwithstanding the aforementioned, where an employee becomes covered under this policy on or after 1 July 2003 and his/her life assurance cover in terms of this policy is higher than that enjoyed under the PREVIOUS SCHEME, METROPOLITAN shall, before accepting an ELIGIBLE MEMBER for the increased portion of his/her life insurance cover, have the right to require that the ELIGIBLE MEMBER be actively at work on the effective date of such increase. The provisions of clause 3.3 will apply mutatis mutandis with ENTRY DATE being substituted with the effective date of the increase Subsequent changes in RISK BENEFIT OPTIONS: (1) An ELIGIBLE MEMBER whose employment contract changes from an employee in the permanent and full-time service of the EMPLOYER to an employee employed on a fixed-term contract with the EMPLOYER or vice versa may change his/her then current RISK BENEFIT OPTION, in the manner described in clauses 3.7.2(2) to 3.7.2(7) mutatis mutandis below, on the effective date of his/her employment contract change.

14 Page 13 (2) An ELIGIBLE MEMBER may change from RISK BENEFIT OPTION B to RISK BENEFIT OPTION A, C or D, from RISK BENEFIT OPTION C to RISK BENEFIT OPTION A or D, or from RISK BENEFIT OPTION A to RISK BENEFIT OPTION D on the following events: (i) (ii) a single ELIGIBLE MEMBER gets married; a married ELIGIBLE MEMBER gets divorced or widowed; (iii) an ELIGIBLE MEMBER increases his/her dependants through the birth of a child or the like; (iv) (v) (vi) (vii) an ELIGIBLE MEMBER loses a dependant by way of death or a child reaching majority age; an ELIGIBLE MEMBER reaches age 40 years; an ELIGIBLE MEMBER reaches age 50 years; an ELIGIBLE MEMBER S employment contract changes as described in clause 3.7.2(1). (3) An ELIGIBLE MEMBER may change from RISK BENEFIT OPTION D to RISK BENEFIT OPTION A, B or C, from RISK BENEFIT OPTION A to RISK BENEFIT OPTION B or C, or from RISK BENEFIT OPTION C to RISK BENEFIT OPTION B on the following events: (i) a single ELIGIBLE MEMBER gets married; (ii) an ELIGIBLE MEMBER increases his/her dependants through the birth of a child or the like; (iii) an ELIGIBLE MEMBER S employment contract changes as described in clause 3.7.2(1). (4) An ELIGIBLE MEMBER may change from RISK BENEFIT OPTION B to RISK BENEFIT OPTION A, C or D, from RISK BENEFIT OPTION C to RISK BENEFIT OPTION A or D, or from RISK BENEFIT OPTION A to RISK BENEFIT OPTION D with effect from the first of July each year or when his/her employment contract changes as described in clause 3.7.2(1). No medical evidence of the ELIGIBLE MEMBER S state of health is required. (5) An ELIGIBLE MEMBER may change from RISK BENEFIT OPTION D to RISK BENEFIT OPTION A, B or C, from RISK BENEFIT OPTION A to RISK BENEFIT

15 Page 14 OPTION B or C, or from RISK BENEFIT OPTION C to RISK BENEFIT OPTION B with effect from the first of July each year or when his/her employment contract changes as described in clause 3.7.2(1). Medical evidence of the ELIGIBLE MEMBER S state of health will be required. This will initially consist of a medical questionnaire to be completed by any MEMBER who wants to change cover as described in this clause 3.7.2(5). Based on the information on the medical questionnaire and information gathered, METROPOLITAN will decide on further medical information required (if any) and the terms on which the benefits are provided. The cost of the medical evidence required by METROPOLITAN will be for the ELIGIBLE MEMBER S account. METROPOLITAN shall, before accepting an ELIGIBLE MEMBER for the increased portion of his/her life insurance cover, have the right to require that the ELIGIBLE MEMBER be actively at work on the effective date of such increase. The provisions of clause 3.3 will apply mutatis mutandis with ENTRY DATE being substituted with the effective date of the increase. (6) Where an ELIGIBLE MEMBER changes from one RISK BENEFIT OPTION to another as described in clauses 3.7.2(1), 3.7.2(2) and 3.7.2(3) above, the FUND must inform METROPOLITAN, in writing, of any change in category within 3 months of the happening of the event. (7) An ELIGIBLE MEMBER who changes from one category to another as described in clauses 3.7.2(4) and 3.7.2(5) above, the FUND must inform METROPOLITAN, in writing, 1 month prior to 1 July each year.

16 Page PREMIUMS 4.1 Payment INSURED BENEFIT COVER provided in terms of this policy is subject to payment of the required premium, the rate of which shall be notified to the FUND by METROPOLITAN from time to time The FUND will remit the premiums so calculated to METROPOLITAN monthly in arrears, with 15 days' grace. A breakdown of the premium payment (listing the information contained in the Service Level Agreement) should be provided by the FUND together with the premium payment METROPOLITAN will notify the FUND of any arrear premiums within 1 month after the expiry of the grace period The ELIGIBLE MEMBER will enjoy full INSURED BENEFIT COVER if premiums are paid during the WAITING PERIOD. Cover will lapse if no premiums are paid during this period. 4.2 Premium rate guarantee The premium rate used to calculate the INSURED BENEFIT COVER premium was guaranteed until 31 December Thereafter the premium rate is guaranteed from the date of notification to the FUND for the lesser of: (i) 12 months; or (ii) the period ending immediately prior to next POLICY ANNIVERSARY. 4.3 Revisions Notwithstanding the provisions in clause 4.3.4, METROPOLITAN will notify the FUND of the premium rate that will apply for the next POLICY YEAR 1 month prior to the POLICY ANNIVERSARY or, during a POLICY YEAR by giving 2 months written notice, subject to the data requirements of in respect of the COMMENCEMENT DATE or the previous POLICY ANNIVERSARY (as the case may be) being met METROPOLITAN reserves the right to adjust the premium rate at its sole discretion if the relevant information described in clause is not received timeously.

17 Page Should the revision process be delayed due to the FUND not providing METROPOLITAN with the necessary information, METROPOLITAN will apply the premium rate adjustments retrospectively to the beginning of the applicable POLICY YEAR METROPOLITAN shall request the annual membership data from the FUND 1 month prior to the POLICY ANNIVERSARY This data (indicating the information contained in the Service Level Agreement) must be provided to METROPOLITAN no later than 1 month after the POLICY ANNIVERSARY. The data should have an effective date as at the POLICY ANNIVERSARY reflecting the revised ANNUAL SALARIES Notwithstanding anything to the contrary contained elsewhere in this policy, METROPOLITAN reserves the right to alter the premium rate during a POLICY YEAR in the event of: (i) (ii) a change in membership; or a change in the principal business activities carried out by the EMPLOYER that may materially affect METROPOLITAN S risk under this policy and which occurs during that POLICY YEAR; or (iii) a new associated or subsidiary company joins the EMPLOYER; or (iv) the INSURED BENEFIT COVER as set out in the SCHEDULE changes METROPOLITAN will have the right to alter the premium rate retrospectively to the last POLICY ANNIVERSARY, if it is discovered that there has been a material and significant error or difference in the data supplied to METROPOLITAN when the premium rate was last determined For the purposes of this clause 4, a change in the membership will be deemed to have occurred if there is: (i) a 5% increase or decrease in the average age of ELIGIBLE MEMBERS; or (ii) a 10% increase or decrease in the total number of ELIGIBLE MEMBERS.

18 Page Differences between premiums paid and premiums required Depending on the actual premiums paid in comparison to the premiums required in terms of this policy, an adjustment premium may become payable or refundable. If so, the adjustment premium will be calculated at the same time as the revised premium rate referred to in clause 4.3. This adjustment premium will amount to the difference between premiums which should have been paid for the current POLICY YEAR and actual premiums paid. 4.5 Failure to pay premiums timeously In the event of the FUND failing to pay the premiums within the days of grace or such extended period as METROPOLITAN may allow, any benefits payable will be reduced in the same proportion as the actual premium paid differs from the required premium.

19 Page DEATH BENEFIT 5.1 Payment of death benefit On the death of an ELIGIBLE MEMBER, METROPOLITAN will have the obligation to pay to the FUND the death benefit described in the SCHEDULE when the following conditions have been fulfilled: (i) The documents contained in the Service Level Agreement are submitted to METROPOLITAN; and (ii) Proof to the satisfaction of METROPOLITAN that the deceased was at the date of his/her death: (a) a MEMBER of the FUND, and (b) (c) in receipt of an income continuation benefit in terms of the DISABILITY BENEFIT SCHEME, or in the permanent and full-time service of the EMPLOYER, or (d) employed on a fixed-term contract with the EMPLOYER. (iii) The claim is admitted by METROPOLITAN Should an ELIGIBLE MEMBER die during the WAITING PERIOD, the death benefit described in the SCHEDULE will be payable when the following conditions have been fulfilled: (i) The documents contained in the Service Level Agreement are submitted to METROPOLITAN; (ii) The claim is admitted by METROPOLITAN; and (iii) METROPOLITAN received premiums in respect of the deceased ELIGIBLE MEMBER since the commencement of the WAITING PERIOD until his/her date of death The death benefit payable in terms of this clause in respect of an ELIGIBLE MEMBER shall be reduced by all amounts that have already been paid to the FUND regarding the ELIGIBLE MEMBER S DISABILITY in terms of DISABILITY benefits comprising accelerated payment of the death benefit.

20 Page No claim in respect of a deceased ELIGIBLE MEMBER shall be admitted by METROPOLITAN unless METROPOLITAN receives written notice thereof within 6 months after the date of death, and receives the required documents within 12 months of the date of death or 3 months after an inquest in respect of the death of the ELIGIBLE MEMBER. Notwithstanding the above, METROPOLITAN may, at its sole discretion, consider a claim which is submitted after the 6 month period of grace. METROPOLITAN further reserves the right to ask for such evidence, as it deems necessary, explaining the delay in the submission of the claim The FUND will effect payment to the person or persons entitled thereto in terms of the provisions of the Pension Funds Act, No 24 of 1956, as amended and the regulations framed thereunder. 5.2 Proof of insurability An ELIGIBLE MEMBER S INSURED BENEFIT COVER under this policy is limited to the FREE COVER LIMIT, unless proof of insurability for the amount by which his/her INSURED BENEFIT COVER exceeds the FREE COVER LIMIT is submitted to the satisfaction of METROPOLITAN An ELIGIBLE MEMBER S INSURED BENEFIT COVER in excess of the FREE COVER LIMIT shall be granted if METROPOLITAN accepts the proof of insurability. Should METROPOLITAN not accept the proof of insurability, the part of the INSURED BENEFIT COVER dependent on proof of insurability and any subsequent increases thereof may be declined or granted on special terms at the discretion of METROPOLITAN. Such special terms shall be notified in writing to the FUND and cover shall commence on the date of such notification On a monthly basis the FUND will notify METROPOLITAN of any ELIGIBLE MEMBERS whose benefits exceed the FREE COVER LIMIT and who were not underwritten previously. Where an ELIGIBLE MEMBER S increased INSURED BENEFIT COVER exceeds the FREE COVER LIMIT and he/she does not submits proof of insurability in terms of clause 5.2.1, the increased INSURED BENEFIT COVER shall only be payable if he/she dies as a result of an ACCIDENT within 3 months of such increase As long as an ELIGIBLE MEMBER'S membership remains unbroken, he/she shall not have to submit proof of insurability again for any INSURED BENEFIT COVER for which he/she previously submitted proof of insurability.

21 Page If proof of insurability was submitted in terms of clause 5.2.1, further INSURED BENEFIT COVER is granted without proof of insurability up to an amount that METROPOLITAN determines from time to time INSURED BENEFIT COVER in respect of which proof of insurability was required, becomes effective on a date determined by METROPOLITAN The cost of the proof of insurability which is required according to clause 5.2.1, is borne by METROPOLITAN, unless otherwise specified For the purpose of this clause, proof of insurability means proof to the satisfaction of METROPOLITAN of the insurability of the ELIGIBLE MEMBER concerned for INSURED BENEFIT COVER. 5.3 Exclusions METROPOLITAN shall not pay the death benefit in respect of an ELIGIBLE MEMBER if the death was caused, directly or indirectly by: (i) (ii) active participation in war, invasion, acts of foreign enemies, hostilities, warlike operations (whether war be declared or not), civil war, rebellion, revolution, insurrection, civil commotion assuming the proportions of or amounting to an uprising, military or usurped power; (a) the use of nuclear, biological or chemical weapons, or any radioactive contamination; or (b) attacks on or sabotage of facilities (including, but not limited to, nuclear power plants, reprocessing plants, final repository sites and research reactors) and storage depots, which lead to the release of radioactivity or nuclear, biological or chemical warfare agents, irrespective of whether any of the aforesaid has been performed with the specific use of information technology; (iii) any act of civil commotion, riot, strike, labour disturbance or disturbance of the public peace; (iv) any act of terrorism; i.e. an 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

22 Page 21 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 section of the public, in fear that has been determined by the appropriate federal authority to have been an act of terrorism both sub-paragraphs (iii) and (iv) in clause are waived, subject to METROPOLITAN reserving the right to reinstate these waived exclusions by giving the FUND 3 months written notice.

23 Page DISABILITY BENEFIT 6.1 Amount of DISABILITY benefit The DISABILITY benefit cover in respect of each ELIGIBLE MEMBER shall be equal to the DISABILITY benefit described in the SCHEDULE. 6.2 Payment of DISABILITY benefit If an ELIGIBLE MEMBER becomes DISABLED, METROPOLITAN will have the obligation to pay to the FUND the ELIGIBLE MEMBER'S DISABILITY benefit, provided that such payment will only occur once: (i) all the relevant terms and conditions of this policy are fulfilled, (ii) proof to the satisfaction of METROPOLITAN that the DISABLED ELIGIBLE MEMBER was at the date of his/her DISABLEMENT: (a) a MEMBER of the FUND, and (b) in the permanent and full-time service of the EMPLOYER, or (c) employed on a fixed-term contract with the EMPLOYER. (iii) METROPOLITAN has assessed and approved the claim, and (iv) the WAITING PERIOD has expired. Payment of the benefit is subject to the provision that the documents contained in the Service Level Agreement are submitted to METROPOLITAN in respect of the DISABLED ELIGIBLE MEMBER METROPOLITAN must be provided with the required documents listed in the Service Level Agreement, within 6 months of the DATE OF IMPAIRMENT. METROPOLITAN will not be liable to pay a benefit in terms of this policy until such required documentation has been received. Failure to provide METROPOLITAN with the indicated documentation within the stated period will result in METROPOLITAN declining the claim due to the late submission of the claim documentation.

24 Page 23 The provisions of this clause relate only to the submission of documents in support of the claim and in no way detracts from METROPOLITAN'S right to determine the DATE OF DISABLEMENT It is the ELIGIBLE MEMBER S responsibility to support the presence of an IMPAIRMENT which might result in DISABILITY as defined in this policy by submitting the documents listed in the Service Level Agreement. If no such documents or outdated or incomplete documents are submitted, the cost for the necessary medical evidence required to commence the assessment will be for the ELIGIBLE MEMBER S account. Where METROPOLITAN requires, in addition to the above specialist medical evidence, reports from an independent or another specialist, the cost of such reports will be for METROPOLITAN S account If the ELIGIBLE MEMBER is being assessed for DISABILITY and additional information is required in order to further assess the claim, the required information should be provided within 3 months of the date of the request in order to further evaluate the current claim. Should the additional information not be received within: (i) (ii) 3 months of the date of request, the claim will, on receipt of the additional information, be considered to be the first occurrence of DISABILITY which shall be subject to the terms and provisions of this policy in all respects; and 6 months from the request, METROPOLITAN will decline the claim With the consent of the ELIGIBLE MEMBER, METROPOLITAN may share medical evidence with other parties concerned with the assessment of the claim. 6.3 Repudiation and appeal If METROPOLITAN has declined a claim, an ELIGIBLE MEMBER may lodge a written appeal within 3 months of METROPOLITAN S written repudiation. Should the ELIGIBLE MEMBER wish to pursue the repudiated claim, the costs would be for the ELIGIBLE MEMBER S account.

25 Page Further medical evidence, with which to appeal the decision made by METROPOLITAN, must be received within 3 months from the date that the claim was declined or the additional evidence will be used as the assessment of a new bout of disability with a new DATE OF DISABLEMENT The claim shall be subject to the provisions of this policy in all respects, unless the claim is being pursued by submitting additional medical or other relevant evidence within 3 months from the time that the claim is repudiated. 6.4 Cost of medical evidence The cost of initial medical evidence required for the proof of DISABILITY, which must be supplied by the medical practitioner and specialist who provides the ELIGIBLE MEMBER with the regular care or whom the ELIGIBLE MEMBER has consulted in connection with the condition which is contributing to his/her DISABILITY, shall be for the ELIGIBLE MEMBER'S account. The cost of any further medical evidence will be for METROPOLITAN'S account. 6.5 Exclusions Payment of the DISABILITY benefit shall however be subject to the following further provisions: that the ELIGIBLE MEMBER'S DISABILITY did not directly or indirectly arise from one of the following causes: (i) (ii) (iii) wilful self-injury; active participation in war, invasion, acts of foreign enemies, hostilities, warlike operations (whether war be declared or not), civil war, rebellion, revolution, insurrection, civil commotion assuming the proportions of or amounting to an uprising, military or usurped power; (a) the use of nuclear, biological or chemical weapons, or any radioactive contamination; or (b) attacks on or sabotage of facilities (including, but not limited to, nuclear power plants, reprocessing plants, final repository sites and research reactors) and storage depots, which lead to the release of radioactivity or nuclear, biological or chemical warfare agents,

26 Page 25 irrespective of whether any of the aforesaid has been performed with the specific use of information technology; (iv) any act of civil commotion, riot, strike, labour disturbance or disturbance of the public peace; (v) any act of terrorism; i.e. an 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 section of the public, in fear that has been determined by the appropriate federal authority to have been an act of terrorism both sub-paragraphs (iv) and (v) in clause are waived, subject to METROPOLITAN reserving the right to reinstate these waived exclusions by giving the FUND 3 months written notice that the ELIGIBLE MEMBER does not reach NORMAL RETIREMENT AGE before the expiry of the WAITING PERIOD that during the first 12 months after the ELIGIBLE MEMBER'S ENTRY DATE, his/her DISABILITY did not directly or indirectly arise from a condition for which the ELIGIBLE MEMBER was treated, or about which he/she knew or could reasonably have been expected to know, or about which he/she sought medical advice in the 6 months before his/her ENTRY DATE. 6.6 Maximum benefits from other sources METROPOLITAN may limit the benefit payable in terms of this part so that the ELIGIBLE MEMBER'S monthly income after disability (as defined below) does not exceed 75% of his/her average monthly earnings before disability (as defined below) The average monthly earnings of the ELIGIBLE MEMBER before disability shall be determined by taking into account the total of all income and remuneration which accrued to the ELIGIBLE MEMBER from his/her engaging in his/her occupation during the 12 months before the DATE OF DISABLEMENT, but excluding any form of fringe benefits of a non-recurrent nature. Further, all expenditure and costs incurred directly with a view to earning such income and remuneration shall be deducted from the total income and remuneration.

27 Page For the purpose of this clause 6, the ELIGIBLE MEMBER'S monthly income after disability shall be determined by taking into account the following receipts, namely - (i) (ii) all income and remuneration payable to the ELIGIBLE MEMBER directly or indirectly for services which he/she renders or rendered or regarding an occupation which he/she follows or followed, decreased by all expenditure and costs incurred directly with a view to earning that income and remuneration; and any form of benefit or remuneration (whether in cash or not) to which anybody becomes entitled to in regard to, or as a result of the ELIGIBLE MEMBER'S DISABILITY or to which anybody would have been entitled if this benefit had not existed, and this includes any gratuity or other payment from a fund or scheme which provides benefits at retirement or disability and benefits of the Compensation for Occupational Injuries and Diseases Act, 1993, as amended, but not including the following, namely - (a) (b) (c) (d) (e) any waiver of the employer's contributions to pension and provident funds in terms of group disability policies; the benefits in terms of the Motor Vehicle Accidents Act, 1986, as amended, read together with section 3 of the Multilateral Motor Vehicle Accidents Fund Act, 1989, as amended; the benefits in terms of any policy owned by the employer from which no benefit consequent upon the DISABILITY of the ELIGIBLE MEMBER shall become payable to the ELIGIBLE MEMBER or to his/her spouse or to any member of the ELIGIBLE MEMBER'S family; disability income benefits which are payable for not more than 2 years to cover continued business expenses; lump sum receipts of which the aggregate does not exceed the larger of R and 2,5 times the ANNUAL SALARY of the ELIGIBLE MEMBER before the DATE OF DISABLEMENT; (f) any benefit which would have been payable at the surrender of a policy or at early retirement or withdrawal from any fund or scheme for reasons other than ill health. For this purpose a retirement annuity policy is deemed to have a surrender value;

28 Page 27 (g) (h) (i) benefits payable if the ELIGIBLE MEMBER, due to an ACCIDENT, experiences the total and permanent loss of the sight of 1 or both eyes or the use of any part of his/her body; benefits payable due to the ELIGIBLE MEMBER being permanently, continuously and totally prevented from performing the normal actions and function with regard to the care of his/her body or from taking care of his/her personal interests; and during the period of 2 years commencing on the commencement of DISABILITY, regular receipts which shall in total not be more than a monthly receipt of 25% of the ELIGIBLE MEMBER'S average monthly earning before disability Lump sum receipts taken into account in the determination of the average monthly income after disability shall be deemed regular monthly income equal to such lump sum receipts divided by Any receipt as a capital amount payable by instalments over a period of 10 years or less, shall also be deemed to be a lump sum receipt Where a receipt is expressed as a capital amount by instalment over a period exceeding 10 years, the instalments shall be treated for the purposes of determining the average monthly income after disability as an income benefit payable at regular intervals The ELIGIBLE MEMBER shall, at the request of METROPOLITAN and to its satisfaction, submit proof of the extent of his/her average monthly income after disability, and if the ELIGIBLE MEMBER fails to submit such proof, the benefit payable in terms of this part may be decreased at METROPOLITAN'S discretion. 6.7 Termination of service If an ELIGIBLE MEMBER'S service is terminated with the EMPLOYER and he/she is DISABLED on the date of termination of service, he/she shall continue to be an ELIGIBLE MEMBER in terms of and subject to clause 9, as if the EMPLOYER had consented to his/her absence from work and to the assurance on his/her life being continued, provided that he/she shall not continue to be an ELIGIBLE MEMBER later than the date on which a benefit becomes payable in terms of this clause or a claim for the benefit is declined.

29 Page Special cases of DISABILITY In the case of the entire and permanent loss of the sight of both eyes the DISABILITY benefit shall always be equal to the death benefit.

30 Page CONVERSION OPTION 7.1 Should an ELIGIBLE MEMBER terminate his/her employment with the EMPLOYER he/she shall be given the option to effect a METROPOLITAN Odyssey endowment policy or whole life policy at then current rates, without giving evidence of good health, except for the requirements of clause The sum insured of such policy shall however be limited to that part of the ELIGIBLE MEMBER'S insurance benefit that was not subject to special terms immediately prior to his/her termination of employment. 7.3 The acceptance of individual insurance in terms of this option is, notwithstanding any provision to the contrary herein, subject to the requirements, restrictions and conditions with respect to the HIV virus and AIDS, which METROPOLITAN in its sole discretion considers necessary (as per normal new business requirements) at the date on which the option is exercised. 7.4 This option expires at NORMAL RETIREMENT AGE. 7.5 The conversion option must be exercised with 31 days of the termination of employment. METROPOLITAN will not provide any cover to the ELIGIBLE MEMBER until the conversion option is exercised and all fully completed application forms are submitted to METROPOLITAN. 7.6 The METROPOLITAN Odyssey product range available for such options will be determined by METROPOLITAN Odyssey, and may be reviewed as new products are provided by METROPOLITAN Odyssey. 8. INSURED BENEFIT COVER INCREASES 8.1 Should an ELIGIBLE MEMBER S INSURED BENEFIT COVER be increased for any reason at any time after the COMMENCEMENT DATE: he/she must be at work attending to and capable of attending to all of his/her normal duties on the date of the increase. If he/she is not so at work, the provisions of clause 3.3 shall apply in respect of the amount of INSURED BENEFIT COVER in excess of that provided for him/her under this policy immediately prior to the increase of such INSURED BENEFIT COVER, subject to the same terms and conditions applicable under the policy at that point.

31 Page The provisions of clause will be waived if the ELIGIBLE MEMBER S increased INSURED BENEFIT COVER exceeds the FREE COVER LIMIT and he/she submits proof of insurability in terms of clause Where an ELIGIBLE MEMBER S DISABILITY benefit is increased for any reason at any time after the COMMENCEMENT DATE, the exclusion contained in clause will also be applied from the effective date of such increase to the increased portion of an ELIGIBLE MEMBER S DISABILITY benefit. The exclusion contained in clause will however not apply to any increase in an ELIGIBLE MEMBER S DISABILITY benefit attributable to an improvement in his ANNUAL SALARY not exceeding 20% per annum. 9. TEMPORARY ABSENCE 9.1 An ELIGIBLE MEMBER'S absence from the EMPLOYER'S service with no, reduced or full remuneration may, subject to the EMPLOYER'S discretion and acceptance by METROPOLITAN, be regarded as approved temporary absence. 9.2 The FUND shall provide METROPOLITAN with such information as METROPOLITAN may require in order to recognise the interruption in service as approved temporary absence. If the information is acceptable, the ELIGIBLE MEMBER'S INSURED BENEFIT COVER shall continue during the period of approved temporary absence provided the required premium is paid in respect of the ELIGIBLE MEMBER. 9.3 In the event that the information provided is not acceptable to METROPOLITAN then the ELIGIBLE MEMBER'S INSURED BENEFIT COVER shall cease during the period of temporary absence. 9.4 The period of approved temporary absence shall not exceed 12 months. In the case of an ELIGIBLE MEMBER who through injury or illness is unable to follow his/her INSURED OCCUPATION, the maximum period of approved temporary absence will be 6 months. Periods of approved temporary absence which are interrupted by less than 6 consecutive calendar months are regarded for the purposes of these provisions as one period of approved temporary absence. 9.5 Notwithstanding the provisions of clause 9.4, the period of temporary absence exceeding 12 months may be approved by METROPOLITAN subject to: (i) the ELIGIBLE MEMBER receiving full remuneration from the EMPLOYER, and

32 Page 31 (ii) METROPOLITAN being informed thereof and accepting to continue INSURED BENEFIT COVER for the ELIGIBLE MEMBER. 10. AMENDMENTS TO RULES METROPOLITAN is not bound by any amendment to the RULES that affects the rights and liabilities of METROPOLITAN unless METROPOLITAN has approved such amendment. 11. INFORMATION 11.1 The FUND shall supply METROPOLITAN with such forms and ELIGIBLE MEMBERS' particulars as METROPOLITAN may require for the purposes of this policy Should the age notified to METROPOLITAN in respect of an ELIGIBLE MEMBER prove to be incorrect, METROPOLITAN shall not be liable to pay any greater benefit under this policy than would have been secured by the premiums paid in respect of the ELIGIBLE MEMBER had his/her age been correctly stated at the outset. Should the age notified to METROPOLITAN in respect of an ELIGIBLE MEMBER prove to be greater than his/her NORMAL RETIREMENT AGE, METROPOLITAN shall not be liable to pay any benefit in respect of the ELIGIBLE MEMBER and all premiums received by METROPOLITAN in respect of the ELIGIBLE MEMBER subsequent to his/her NORMAL RETIREMENT AGE shall be refunded. 12. RECORDS METROPOLITAN shall have the right to inspect the records kept by the FUND in connection with this policy. Should it become evident from such inspection that a claim has been admitted in respect of a person who was not entitled to a benefit under this policy, METROPOLITAN shall, notwithstanding anything to the contrary contained in this policy, recover from the FUND the amount of such claim. 13. ENDORSEMENTS Save for the premium guarantee provided in clause 4.2.1, METROPOLITAN may alter the terms and conditions of this policy at any time subject to giving the FUND 3 months' written notice of its intention to do so, or such shorter period as provided for elsewhere in this policy.

33 Page CANCELLATION OF POLICY 14.1 The FUND will have the right to cancel this policy by giving METROPOLITAN written notice thereof at least 1 month prior to the cancellation date METROPOLITAN will have the right to cancel this policy with immediate effect if: (i) (ii) the FUND has not fulfilled any of its obligations in terms of this policy; or the number of ELIGIBLE MEMBERS decreases to 5 or less at any point in time. 15. ENQUIRIES ELIGIBLE MEMBERS shall address enquiries in respect of this policy to the FUND. METROPOLITAN shall assist the FUND in answering enquiries but shall not correspond directly with ELIGIBLE MEMBERS. 16. DOMICILIUM CITANDI ET EXECUTANDI AND NOTICES 16.1 The parties choose as their domicilium citandi et executandi their respective addresses set out in this clause for all purposes arising out of or in connection with this agreement at which addresses all processes and notices arising out of or in connection with this agreement, its breach or termination may validly be served upon or delivered to the parties For the purposes of this agreement the parties' respective addresses shall be: METROPOLITAN - Mispel Street Parc du Cap Bellville The FUND - Bellmont Office Park Twist Street Bellville or such other address, not being a post office box or poste restante, of which the party concerned may notify the other in writing. The FUND shall notify METROPOLITAN of a change of address as indicated in clause within 14 days.

34 Page Any notice in terms of this agreement shall be in writing and shall: if delivered by hand be deemed to have been duly received by the addressee on the date of delivery; if posted by prepaid registered post be deemed to have been received by the addressee on the 15 th day following the date of such posting; if given by telegram be deemed to have been received by the addressee 1 day after dispatch; if given by facsimile transmission, be deemed to have been received by the addressee on the same day, subject to clause 16.4; if given by electronic mail be deemed to have been received by the addressee on the date of delivery of the electronic mail message The original document sent by post shall be deemed, in the absence of proof to the contrary to have been received by the addressee by the 15th day following the date of facsimile transmission. 17. MONEY PAYMENTS All monies payable to METROPOLITAN shall be paid in the currency of the Republic of South Africa at such place as shall be agreed upon between METROPOLITAN and the FUND from time to time. 18. JURISDICTION Any question of law arising relating to the operation of this policy shall be decided upon by a South African court of law and according to the law of the Republic of South Africa. Any party aggrieved by a decision made by METROPOLITAN relating to this policy, may direct his/her grievance to the office of the Pension Funds Adjudicator and/or the Ombudsman for Long- Term Insurance (whichever is applicable). 19. BENEFITS INALIENABLE Save to the extent permitted by the Pension Funds Act, the Income Tax Act and the Maintenance Act, no ELIGIBLE MEMBER or dependant has the right to assign, transfer, cede, pledge, alienate or otherwise dispose of any benefit available in terms of this policy. Such benefit and any contributions made by or in respect of the ELIGIBLE MEMBER are safeguarded against any form of

35 Page 34 confiscation under a judgement or order of a court of law, and do not vest in the estate of the ELIGIBLE MEMBER or dependant on insolvency or assignment. 20. INDEMNIFICATION The FUND shall indemnify the ELIGIBLE MEMBERS against all losses resulting from the negligence, dishonesty or fraud of any of its officers having the receipt or charge of monies payable in terms of this policy. 21. NON-INDULGENCE No indulgence on the part of any of the parties in exercising any right conferred upon such party in terms of this policy shall constitute a waiver of any such right nor shall any single or partial exercise of any right preclude any other or future exercise thereof or the exercise of any other right under this policy. 22. LIFE FUND 22.1 This policy is issued subject to the memorandum and articles of association of METROPOLITAN The liability of METROPOLITAN is limited to the capital and assets in its life fund. 23. SOLE CONTRACT This policy is the consequence of the negotiations between the FUND and METROPOLITAN and constitutes the whole and entire agreement between the parties with regard to the subject matter hereof. Therefore there are and have been no agreements, representations or warranties between the parties other than those specifically set forth herein.