2 We cannot predict if or when unfortunate circumstances may strike, but statistics show that the majority of people will eventually face hospitalisation or expensive medical procedures in their lifetime. Have you ever considered whether your current medical insurer provides suf ficient cover in the event of untimely hospitalisation, expensive medical procedures or the death of an immediate family member? That is why Medway have created a flexible insurance package that is as unique as you are. A package that puts the power of CHOICE in your hands and bridges the GAP so that you can get the healthcare and peace of mind you deserve. Cover of a further R per person per annum for charges above any sub-limitation imposed by the Medical Scheme whilst: o Confined to hospital as an in-patient o An out-patient for either chemotherapy, radiotherapy or kidney dialysis Covers cost of in-hospital treatment as a Day Admission for a non-pmb condition, up to R per person per annum, above any benef it payable by the Medical Scheme. Hospital Expenses Cash Back pays a daily stated benef it in the event of hospital admission due to accidental injury - to a maximum of R per Insured Person per annum. ER24 Medical Evacuation provides you and your immediate family with free access to ambulance services for medically justified reasons. Immediate Family Funeral Plan provides you with a cash payout to cover funeral expenses in the event of the death of either yourself or your spouse - each covered for R12 000; or your child dependants - each covered for R Additional R5 000 cash payout in the event of accidental death of either yourself or your spouse. Hired car with free usage for four days (including a free tank of petrol) in the event of the death of yourself or your spouse. Repatriation of Mortal Remains covers transportation of mortal remains to your burial hometown (within South Africa) to the value of R TWO-IN-ONE PREMIUM WAIVER Covers the premium of the surviving Dependants, in the event of the death of the Principal Member for : o Medical Scheme for 6 months o Your Heritage Plan for 6 months Heritage PLUS policy
3 Heritage PLUS truly is a PLUS plan that provides you and your family with arguably the most comprehensive insurance solution in the market today. The key to our unique offer is that YOU get to design your cover the way YOU want to. Below are options for your consideration, which will give you even more peace of mind! Covers the expenses charged by a medical practitioner in-hospital above medical scheme tariff - to a maximum of 5x the medical scheme tariff; up to R per family per annum. o PLUS chemo and radio therapy for treatment of cancer. o PLUS kidney dialysis as an out-patient. o PLUS certain traditional hospital procedures performed out of hospital by doctors, e.g. scopes. Gap Cover Covers Casualty (out-patient) expenses in the event of accidental injury - to a maximum of R per Insured Person per annum. Doubles the Premium Waiver Cover (part of the Core benef it) to 12 months. Hospital Expenses Booster Increases Immediate Family Funeral Plan cash payout in the event of the death of either yourself or your spouse - each covered for R25 000, or your child dependant covered for R Additional R5 000 each in the event of accidental death of either yourself or your spouse. Bereavement Plan PLUS Covers yourself and immediate family in the event of an accident Death benefit - R Permanent disability - R (or % thereof as per schedule). Temporary disability - R1 000 per week for up to 52 weeks. Accidental Death and Disability CO-PAYMENT COVER Covers charges in the form of either a co-payment or a deductable applied by your chosen Medical Scheme for treatment received whilst admitted as an in-patient to hospital. Covers charges in the form of either a co-payment or a deductable applied for MRI and CT Scans performed on an out-patient basis. Co-payment Cover
4 Medway Heritage Plus is a combination of products. All insured benefits are underwritten by Guardrisk. Administration is provided by Manage Plus Fund Administrators on behalf of the product insurers. It is important for the policy owner to read this information and store in a safe place. PRODUCT Funeral Cover Hospital Expenses Cash Back, Gap Cover, XtraCare, Accidental Death and Disability Cover and Casualty Care INSURER Guardrisk Life Limited Guardrisk Insurance Company Limited ADDRESS 2nd Floor, Alexander Forbes Place 115 West Street, Sandton 2nd Floor, Alexander Forbes Place 115 West Street, Sandton CONTACT TELEPHONE NUMBER REG. NO. 1999/013922/ /001639/06 FSP NO CONTACT DETAILS FOR ALL ADMINISTRATIVE QUERIES Manage Plus Fund Administrators (Pty) Ltd, (M.P.F.A), FSP No , Reg. No. 1994/001877/07 Tel: Fax: Box 5466 Cape Town 8000 COMPLAINTS PROCEDURE If you have a complaint regarding this product or service, please contact the Compliance Department of the Insurer at the address listed above. COMPLIANCE OFFICERS If you believe that any legislation or regulatory considerations have been contravened, you may contact the relevant Compliance Officer of the Insurer at the address listed above. CLAIMS NOTIFICATION In the event of a claim, please contact MPFA on OMBUD DETAILS Long-term Ombud Private Bag X45, Claremont, 7735 Tel: Fax: Short-term Insurance Ombud PO Box 32334, Braamfontein, 2017 Tel: Fax: FAIS Ombud PO Box 74571, Lynnwood Ridge, 0040 Tel: Fax: COOLING OFF The issued policy may be cancelled within 30 days from the date of commencement. You may cancel the policy by written notice to Box 5466 Cape Town REPLACEMENT OF POLICIES Replacement of any insurance is generally to the disadvantage of the policy owner, due to the duplication of initial existing costs. However, in the case of Heritage, there are no initial costs. NAME, CLASS AND TYPE OF POLICY Core Benefits i. ii. iii. Bereavement Plan: A lump sum to be paid on death of the insured lives aimed at covering funeral costs. Hospital Expenses Cash Back: A stated cash benefit, paid after hospitalisation of the lives insured as a result of accidental injury aimed to cover recovery costs. XtraCare: A cash benefit paid to the insured after hospitalisation, to cover charges exceeding scheme sub-limits. Choice Benefits i. Gap Cover: A cash benefit paid to the member, after hospitalisation, to cover tariff difference costs. ii. Hospital Expenses Booster, a cash benefit paid to the member for: Casualty expenses due to accidental injury and pays premiums due on behalf of the Insured Person for Medical Aid and Heritage Plan, in the event of death of the Principal Member. iii. Accidental Death and Disability Plan: A lump sum paid to the member in the event of either death or permanent total disability due to accidental injury. A weekly sum payable to the member in the event of temporary total disability. iv. Bereavement Plan Plus: A lump sum to be paid on death of the lives insured aimed at covering funeral costs. v. Co-payment Cover: A cash benefit paid to the member for co-payments and deductable charges imposed due to hospitalisation. BENEFITS The benefits provided by this policy, are as described in the individual policy wordings. COMMENCEMENT The policy will commence on the acceptance of the application and receipt of the first premium. The commencement date of the policy is indicated on the certificate of participation. DURATION OF COVER Cover continues for as long as premiums are paid in accordance with the policy conditions, but cover will cease on the death of the Principal Member. PREMIUM OBLIGATIONS The premium payable for this policy is shown in the application form and will be confirmed in the Policy Pack. Premiums are paid monthly by the chosen payment method and may be reviewed from time to time. NON-PAYMENT OF PREMUIMS Should premiums not be paid according to policy conditions, the policy will lapse and all premiums and benefits will be forfeited. ADMINISTRATION CHARGES Administration Fees are paid to the administrator in the amount of 12.5% of gross premium payable. COMMISSIONS Commission is paid to an intermediary in the amount of 20% of gross premium payable. EXCLUSIONS AND WAITING PERIODS A summary of claims exclusions and waiting periods are more fully described in the individual policy wordings. RESTRICTIONS Principal Member may not be covered by more than one Medway Heritage PLUS. Plan Principal Member must be a member of a registered Medical Scheme. Principal Member must be younger than 60 years at inception. PLEASE NOTE: This document does not contain all the terms and conditions of the policy and once the certificate of membership and benefit summaries are received, they should be read carefully and be understood completely.
5 (Please attach a copy of your ID - Maximum age = 60) Core Benef its Gap 500 Hospital Expenses Booster Bereavement Plan Plus Accidental Death and Disability Co-payment Cover (Immediate family members only - ie. spouse and own children) (Recipient of funeral benefit/s payout - over 21 years only)
6 (NB: Please attach a cancelled cheque or Bank Statement) I hereby apply for the Medway Heritage PLUS policy in accordance with the provisions and conditions as contained in the policy contract. I acknowledge that the level of cover and the rate at which contributions increase are not guaranteed and can be reviewed in the event of unforeseen circumstances, which materially affect the cost of providing cover. I understand and agree that, subject to the waiting periods, the Insurer will only be at risk once MPFA* accepts this application and the first contribution is received. I understand that Pregnancy will not be covered for the first 12 months of this Medway Heritage PLUS policy. MPFA* will send me the Medway Heritage PLUS membership certificate and policy summaries to examine. If the plan does not suit my needs, I may cancel it within 30 days of receipt, by providing written notification to MPFA* in order to qualify for a refund. I warrant that all information given in this Medway Heritage PLUS application form, whether in my handwriting or not, is true and complete. I understand that any misrepresentation or non-disclosure of provision of false information can lead to cancellation of these benefits, in which case, all monies paid to MPFA* will be forfeited. I undertake to keep MPFA* informed of any changes to banking details and my address to enable them to communicate with me. I have read and understand the Important information about Medway Heritage PLUS as contained in this application form and accept it as part of the terms and conditions of the policy. I have confirmed to my Intermediary that I am not replacing an existing insurance policy with the Medway Heritage PLUS policy. Yes No Are you aware of any condition that may require medical treatment in the next 12 months for either you or any of your dependants? Yes No If yes, please give details Signature (Principal member) * Manage Plus Fund Administrators (Pty) Ltd, an authorised f inancial services provider.
7 Xtra Care Covers Member, Spouse and Children (as def ined) Pre-existing conditions excluded Annual Benef it Limits: o Sub-Limitation Cover: R in the aggregate per Insured Person and R for any one prosthesis (with maximum of R per annum per Insured Person). o Day Admission Cover: limited to R per Insured Person. Trauma Plan Hospital Expenses Cash Back Covers Member, Spouse and Children (as def ined). Pays a stated benef it directly to the member in the event of hospital admission due to accidental injury. When surgery included: o Day 1 - R o Day 2 and 3 - R2 500 per day. o Day 4 and after - R1 000 per day. When surgery excluded, pays R1 000 per day. Pays to a maximum of R per annum per Insured Person and R per annum per Family. ER24 Medical Evacuation Covers medically justif ied road transportation to the nearest appropriate facility. Bereavement Plan Immediate Family Funeral Plan Covers Member, Spouse and legal Children up to age 21. Cover when Principal Member reaches age 65 is optional and benef its are halved. Waiting periods: o None for accidental death. o Six months for natural death. o 24 months for HIV/Aids related death, or suicide. Premium Waiver On the death of the Principal Member, pays on behalf of remaining Dependants: o Existing Medical Scheme premium for 6 months. o Medway Heritage Plus premium for 6 months. A waiting period of 6 months applies. The combined limit of this benef it is R Gap Cover Covers Member, Spouse and Children (as def ined). Pre-existing conditions excluded for 12 months. Annual benef it per Family limited to R1.0m. 5x the Medical Scheme tariff, ie the difference between actual cost and your Medical Scheme stated tariff. Does not cover co-payments. Hospital Expenses Booster Covers Member, Spouse and Children (as defined). Casualty Cover o Annual benef it per Insured Person limited to R o Excludes cover for expenses incurred in-hospital o Excess of R250 per claimable incident Premium Waiver Plus o As per Premium Waiver (above), with cover extended to 12 months, and the combined limit extended to R Accidental Death and Disability Plan Temporary disability benef it pays from week two for a maximum of 52 weeks. Limit of R per event. Bereavement Plan Plus As per Bereavement Plan. Co-payment Cover Annual Benef it per Insured Person limited to R Annual Benef it per Family limited to R Pre-existing conditions excluded for 12 months. Once you have completed your application form it will be processed by Medway. If your application is successful you will be contacted by a Medway consultant who will telephonically confirm your Heritage PLUS package and benefit options. In the event of a claim, please call Medway on , and one of our friendly and ef ficient consultants will gladly assist you.
8 C B Ekermans