Accident means a sudden, uncertain and unexpected event which is caused solely and directly by violent, external, physical and visible means and independently of any other cause, excluding any events that are traceable to psychiatric trauma and the Insured Person's state of mental or physical health prior to the event.
Accidental Permanent and Total Disablement means disablement, due to an accident, where an Insured Person is unable to carry out the functions of any occupation or an Insured Person who suffered total and permanent loss of one of the following due to an accident: sight in both eyes; ability to speak; loss of use of a combination of any 2 (two) limbs (hand, foot, leg, arm) provided that they are not part of the same limb; loss of use of both feet (ankle or below); or both legs (above the knee, including the knee and below); loss of the use of both hands (below the wrist); or both arms (above the elbow, including the elbow and below).
Administration Fee refers to a percentage deduction from the Sum Assured which covers the claims administration costs. This percentage deduction may change from time-to-time.
Application Date means the date on which this Policy was recorded by Clientèle Life.
Beneficiary is the natural person nominated by the Policy Owner to receive the Life Cover Benefit in the event of death.
Child means an unmarried dependent child, step-child, illegitimate child or adopted child (legally or by custom) of the Insured Person and includes a child who is over 21 (twenty-one) and dependent on the Insured Person by reason of mental or physical incapacity.
This definition further includes a grandchild being the child of any of the Insured Person's children where both child's parents are deceased or the child is a dependent of the Insured Person and satisfactory proof of dependency is submitted to the Insurer.
A dependent child that has attained the age of 18 (eighteen) years shall no longer be covered under this Policy, unless enrolled as a full time student at a registered tertiary institution until a maximum age of 21 (twenty-one). Proof will be requested at claim stage.
Commencement Date means the first day of the month during which the first Premium is paid.
Currency means the period from the Commencement or Reinstatement Date (whichever occurred last) whilst due Premiums are paid.
Insured Person means the person(s) named as such in the Policy Schedule who is/are a resident(s) of the RSA (Republic of South Africa) residing in the RSA and in possession of a valid RSA identity document.
Illness means sickness or disease contracted and commencing during the Currency of this Policy.
Physician means a medical practitioner duly qualified, registered, licensed and practicing within the scope of his/her license pursuant to the laws of South Africa. Physician shall not include a relative by blood or marriage of such an Insured Person unless approved by the Company.
Policy Owner shall be the person named as such in the Policy Schedule and is the initial payer of this Policy unless the Company is advised otherwise in writing.
Pre-Existing Medical Condition means Sickness contracted and commencing or Bodily Injury sustained by an Insured Person for which he or she has or should reasonably have received relevant medical treatment or advice by a Physician, prior to such an Insured Person's initial Commencement or Reinstatement Date of Insurance under this Policy (whichever occurred last), including but is not limited to, any physical or mental defect, disease, infirmity or condition which existed prior to the initial Commencement or Reinstatement Date of this Policy (whichever occurred last).
Main Policy Premium means the regular monthly contractual payment made by a policyholder in return for an undertaking by the Company to provide Policy Benefits as specified in this Insurance Policy.
This specifically excludes the Premium covering any additional rider benefits where a separate Policy Schedule of Benefit Terms and Conditions are provided.
Spouse means the person married (whether by civil, customary, tribal or religious union) to the Insured Person and named as such in the Policy Schedule. Cover is limited to one nominated spouse where a person has more than one.
Survival Period means a period of 14 (fourteen) days which the Insured Person survives without the use of life support after being diagnosed with a Dread Disease.
Waiting Period means 6 (six) months or (depending on the plan chosen) following the Commencement or Reinstatement Date (whichever occurred last) during which the Insured Person is not covered under this Policy for the Dread Disease and Cancer Benefit.
If this Policy is reinstated, then the Waiting Period and Cash Back Period will recommence again from the Reinstatement Date.
Heart Attack – being the death of a portion of the heart muscle as a result of inadequate blood supply to the relevant area. The diagnosis shall be based on the following 3 (three) criteria:
- A history of typical central chest pain;
- New ECG changes diagnostic of myocardial infarction
- Diagnostic rise in cardiac markers with CK-MB of twice the upper limit of normal, or Troponin T in excess of 1.0 ng/ml.
Stroke – any cerebrovascular incident producing an abrupt onset of neurological consequence lasting more than 24 (twenty-four) hours, including infarction and ischaemia of the brain tissue, haemorrhage or embolisation from an extracranial source. Evidence of permanent neurological deficit must be produced at the earliest 6 (six) weeks after the event and no claims can be admitted earlier. The following are specifically excluded:
- Transient ischaemic attacks;
- Cerebral symptoms due to migraine;
- Cerebral injury resulting from trauma or hypoxia; and Ischaemic vascular disease affecting the eye, optic nerve, or vestibular system.
Cancer – a disease including breast cancer in situ manifested by the presence of a malignant tumour positively diagnosed with histological confirmation characterised by the uncontrolled growth and spread of malignant cells, and the invasion of tissue. The following are specifically excluded:
- All skin cancers other than malignant melanoma where the thickness of the melanoma is greater than 1.5mm or there is evidence of the melanoma having metastasized;
- Stage 1 Hodgkin’s Disease
- Any other cancer-in-situ, as well as pre-cancerous conditions CIN 1, CIN 2 and CIN 3 of the cervix.
- Tumours of the Prostate unless histologically classified as having a Gleason score greater than 6 or having progressed to at least clinical TNM classification T2N0M0
- Any pre-existing cancers prior to the Commencement or Reinstatement Date (whichever occurred last) of this benefit.
Renal Failure – end stage renal failure presenting as chronic irreversible failure of both kidneys to function as a result of which regular renal dialysis is instituted.
Major Organ Transplant – the human to human organ transplant from a donor to the Insured Person of one or more of the following organs: heart, lung, liver, pancreas, small bowel, kidney or bone marrow.