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1 qwertyuiopasdfghjklzxcvbnmqwerty uiopasdfghjklzxcvbnmqwertyuiopasd fghjklzxcvbnmqwertyuiopasdfghjklzx cvbnmqwertyuiopasdfghjklzxcvbnmq NAPTOSA GAP & FAMILY FUNERAL COVER wertyuiopasdfghjklzxcvbnmqwertyui Product Guide 2016 opasdfghjklzxcvbnmqwertyuiopasdfg Memp Financial Services (Pty) Ltd hjklzxcvbnmqwertyuiopasdfghjklzxc vbnmqwertyuiopasdfghjklzxcvbnmq wertyuiopasdfghjklzxcvbnmqwertyui opasdfghjklzxcvbnmqwertyuiopasdfg hjklzxcvbnmqwertyuiopasdfghjklzxc vbnmqwertyuiopasdfghjklzxcvbnmq wertyuiopasdfghjklzxcvbnmqwertyui opasdfghjklzxcvbnmqwertyuiopasdfg hjklzxcvbnmrtyuiopasdfghjklzxcvbn mqwertyuiopasdfghjklzxcvbnmqwert yuiopasdfghjklzxcvbnmqwertyuiopas dfghjklzxcvbnmqwertyuiopasdfghjklz xcvbnmqwertyuiopasdfghjklzxcvbnm 1 qwertyuiopasdfghjklzxcvbnmqwerty

2 Contents 1 RONBEL GAP COVER WHAT IS GAP COVER? WHO IS COVERED WHO IS NOT COVERED PROCEDURES APPLICATION PROCEDURE PREMIUM PAYMENT PROCEDURES CLAIMS PROCEDURE WHEN CAN I SUBMIT CLAIM COMPLAINTS PROCEDURE TERMINATION OF COVER AMENDMENTS RONBEL FUNERAL COVER WHAT IS FUNERAL COVER WHO IS COVERED WHO IS NOT COVERED PREMIUMS WAITING PERIODS CHANGES TO MEMBERSHIP PROCEDURES APPLICATION PROCEDURE PREMIUM PAYMENT PROCEDURES CLAIMS PROCEDURE WHEN CAN I SUBMIT CLAIM TERMINATION OF COVER AMENDMENTS MEDICAL AID ADDENDUMS

3 1 RONBEL GAP COVER 1.1 WHAT IS GAP COVER? Gap Cover provides cover for a. You and your direct dependants who are registered on your medical scheme b. Services provided by specialists, general practitioners and medical professionals such as physiotherapists for the period of hospitalisation, charged above the benefit paid by the medical tariff and c. limited to 5 X your medical scheme tariff and up to 2 million rand per family per annum Gap Cover does NOT provide cover for a. Charges above the medical scheme tariff for hospital costs, prosthesis and medication, e.g. cost of bed, food, bandages etc. b. Any procedure not covered or declined by the medical aid scheme c. Any PMB (Prescribed Minimum Benefits- any benefits which should be provided the medical aid scheme, this includes ward fees, medicines and theatre fees) d. Pregnancy or child birth during the first 12 months of the contract e. No benefit will be payable for any biological cancer drugs for any form of pre-existing form of cancer f. Standard exclusions as per the master policy documents WHO IS COVERED a. Principal insured member must be a member of a South African registered medical scheme b. One Spouse (if more than one, an irrevocable nomination of one of the eligible spouses) c. Eligible children o Natural/biological child o Legally adopted, stepchild or placed under foster children o Under 21 unmarried o Unmarried child, up to 25 who is a full time student o Mentally & physically incapacitated WHO IS NOT COVERED a. Parents b. Relatives c. Adult children that are o over the age of 21 or o over the age of 25 if a full time student o any married dependant over the age of 21 3

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5 2 PROCEDURES APPLICATION PROCEDURE Refer Application form Manual Application forms must be completed as follows: a. All information to be provided b. Forms must be legible c. Must include the following: i. Details of principal person ii. Physical and Postal Address iii. Contact details iv. Details of insured persons v. Bank details or premium payer (note that any claims will be paid to this account) vi. Option ticked and amount inserted vii. Funeral section completed if applicable viii. Summary of premium and total to be paid d. Debit order clause must be completed and the sum of the debit order and the total premium must be the same e. Inception date THE DATE THAT THE DEBIT ORDER PAYMENT IS SUCCESSFULLY RECEIVED (Allow four (4) days to load the policy and debit order instruction before required strike date/inception date) f. Agreement date is the date on which the application is signed g. Completed forms can be ed to Memp Financial Services (Pty) Ltd ed to Or Faxed to the office on Online application link a. All information to be provided by completing the necessary cells b. Bank details c. Accept terms and conditions (note that scheme rules and policy details apply at all times if MPD has not been received please request from the office. 5

6 2.1.2 PREMIUM PAYMENT PROCEDURES a. Premium collection is by means of debit order b. Debit order strike dates are as follows, 1st, 15th, 20th and 25th c. New policies must be submitted to the Administrator four (4) days prior to the debit order strike date d. Should the new application be submitted after the deadline, special arrangements can be made through the Broker e. Premiums are paid in arrears f. Should the member cancel the policy which has been active for 15 days or more in that month, a full month s premium is due g. Should a debit order not be met, it will be double debited on the next month s strike date - The cover will still apply however it will be suspended until payment is made h. The company will allow a forty (40) day grace period from the premium payment date i. If the outstanding premium (double debit) is not received within the forty (40) day grace period, then the policy will be deemed to have been cancelled at midnight on the last day of the month for which the last premium was received j. The company may offer terms of reinstatement, but is not obliged to do so, or to reinstate the insured persons policy k. The company is not obliged to accept premium tendered to it after the grace period or after the period of insurance detailed in the schedule l. The company will not consider any claim that arises during the grace period unless the company receives the full outstanding premium before the end of the grace period m. Once the policy has lapsed and should the member wish to reinstate the policy all waiting periods and pre-existing conditions will apply CLAIMS PROCEDURE Refer Claim Form a. All claims must be submitted to: Memp Financial Services (Pty) Ltd for processing b. Correctly completed and signed legible Gap Claim Form which are available from MEMP FINANCIAL SERVICES (PTY) LTD c. The broker will check the following: Details completed correction, e.g. age, id number, etc. Invoice from the service provider/s Medical Aid Statement/s reflecting doctor/s account/s and treatment date for which the Gap claim is being submitted Documents can be sent by (napadmin@memp.co.za) or Fax for checking and submission to the administrator 6

7 b. Documents must be legible (special note for copies) d. The underwriters will assess the claim and reimburse the member in accordance with the benefits as per the policy document within fifteen (15) working days from receipt of correct documentation e. Claims will be paid directly into the claimant s (principal member) bank account as detailed on the claim form f. It is the responsibility of the member to make payment to the service provider WHEN CAN I SUBMIT CLAIM Members have six months (180 days) from date of procedure to submit claims and supporting documentation COMPLAINTS PROCEDURE When the company rejects or disputes a claim or the quantum of a claim, or voids the policy, the principal insured member has ninety (90) days from receipt of the company s written notification to dispute the decision of the company. In writing to the company The Ombudsman for short term insurance Note: Refer to the Master Policy document for further details 2.2 TERMINATION OF COVER a. This policy may be cancelled by either party at any time by giving thirty (30) days notice in writing. Letter of cancellation to be sent to Memp Financial Services (Pty) Ltd for submission to the administrator b. An incident will only qualify if the hospitalisation caused by such incident commences before the date of cancellation in which case all outstanding claims must be submitted to the company within 3 months after the date of cancellation c. Cover terminates on the death of the principal insured person, however, on the death of the principal insured person the cover of the eligible spouse under the policy may be continued should such spouse elect to do so within sixty (60) days of the death of the principal insured person on condition of continuation of medical scheme cover d. The policy shall be voidable in the event of misrepresentation, mis-description or nondisclosure by or on behalf of the insured person regarding any fact material to this insurance. e. No premium refund shall be due in the case of cancellation by either party 7

8 2.3 AMENDMENTS The company reserves the right to amend the policy wording by way of endorsement as well as to adjust the premiums by giving thirty (30) days written notice. 8

9 3 RONBEL FUNERAL COVER 3.1 WHAT IS FUNERAL COVER Funeral Cover is a funeral assistance policy that provides a lump sum payment on the death of an insured person. 3.2 WHO IS COVERED a. The cover is only applicable to immediate family members b. Principal insured member (maximum entry age is 65 and cover is continuous until death of the principal member, the spouse can be older than 65) c. One Spouse (if more than one, an irrevocable nomination of one of the eligible spouses) d. Eligible children i. Natural/biological child ii. Legally adopted, stepchild or placed under foster children iii. Under 21 unmarried iv. Unmarried child, up to 25 who is a full time student v. Mentally & physically incapacitated 3.3 WHO IS NOT COVERED a. Parents b. Relatives e. Adult children, i. over the age of 21 or ii. over the age of 25 if a full time student iii. any married dependant over the age of 21 NOTE Suicide No benefit will be payable where a member commits suicide within two years of either the commencement date or any reinstatement date. 3.4 PREMIUMS a. Premiums are as per the table on page 4 b. The insurer reserves the right to review the premium rate annually. Any amendment to the premium will be advised to the principal member, in writing, giving sixty (60) days notice to the effect 9

10 3.5 WAITING PERIODS a. Accidental death for all members Claims can be made after the policy has been in force for one calendar month. (This calendar month commences on the commencement date or the reinstatement date of the policy in the event of the policy having lapsed and then being reinstated.) b. Natural causes for death of a result of any cause other than that per (a) and (c) for three calendar months Claims can be made after the policy has been in force for these calendar months. (These calendar months commences on the commencement date or the reinstatement date of the policy in the event of the policy having lapsed and then being reinstated.) c. Pre-existing Chronic Illnesses and Opportunistic diseases caused by a direct result of either HIV or Aids six calendar months Claims can be made after the policy has been in force for these calendar months. (These calendar months commences on the commencement date or the reinstatement date of the policy in the event of the policy having lapsed and then being reinstated.) 3.6 CHANGES TO MEMBERSHIP The principal member may add, delete or amend spouses, children or additional members. a. To add members the insurer requires all the relevant information on an application form for these amendments to take effect b. The insurer reserves the right to grant or decline any member c. All new members will be subject to the above waiting periods and conditions as well as the maximum number of members, that is, maximum number of ten (10) lives 3.7 PROCEDURES APPLICATION PROCEDURE Refer Application form a. Application forms must be completed as follows i. All information to be provided ii. Forms must be legible iii. Must include the following iv. Details of principal member 1. Physical and Postal Address 2. Contact details 10

11 3. Details of insured persons 4. Option ticked and amount inserted 5. Summary of premium and total to be completed v. Debit order clause must be completed and the sum of the debit order and the total premium must be the same vi. Inception date THE DATE THAT THE DEBIT ORDER PAYMENT IS SUCCESSFULLY RECEIVED (Allow four (4) days to load the policy and debit order instruction before required strike date/inception date) vii. Agreement date is the date on which the application is signed viii. Principal members identity documents must be attached Completed forms can be ed to: Memp Financial Services (Pty) Ltd ed to Or Faxed to the office on Online application link a. All information to be provided by completing the necessary cells b. Bank details c. Accept terms and conditions (note that scheme rules and policy details apply at all times if MPD has not been received please request from the office PREMIUM PAYMENT PROCEDURES a. Premium collection is by means of debit order b. Debit order strike dates are as follows, 1 st, 15 th, 20 th and 25 th c. New policies must be submitted to the Administrator four (4) days prior to the debit order strike date d. Should the new application be submitted after the deadline, special arrangements can be made through the Broker e. Premiums are paid in arrears f. Should the member cancel the policy which has been active for 15 days or more in that month, a full month s premium is due g. Should a debit order not be met, it will be double debited on the next month s strike date. The cover will still apply however it will be suspended until payment is made 11

12 h. If the outstanding premium (double debit) is not met, then the policy will be suspended. If the triple debit is not met the policy is deemed to have been cancelled with immediate effect i. The company may offer terms of reinstatement, but is not obliged to do so, or to reinstate the insured persons policy j. The company is not obliged to accept premium tendered to it after the grace period or after the period of insurance detailed in the schedule k. The company will not consider any claim that arises during the grace period unless the company receives the full outstanding premium before the end of the grace period l. Once the policy has lapsed and should the member wish to reinstate the policy all waiting periods and pre-existing conditions will apply CLAIMS PROCEDURE a. All claims must be submitted to Memp Financial Services (Pty) Ltd for processing b. Correctly completed and signed legible Gap Claim Form which is available from or MEMP FINANCIAL SERVICES (PTY) LTD Refer Claim form c. The broker must check that the following: o Details completed correctly, e.g. age, id number, etc. o Attach relevant documentation of the deceased Certified copy of death certificate Certified copy of identity document claimant and deceased In the event of a death from unnatural causes, a police report from must be obtained from Memp Financial Services Where the deceased is a child over the age of 21, a certificate, signed by the principal of the educational institute the child attended until date of death, stating that the child was a full time student Where the deceased is a child over age 21 and was incapacitated by mental or physical infirmity from maintaining himself, a declaration signed by a medical practitioner setting out the nature of the infirmity of the child from his 21st birthday until date of death Any other documentation or evidence by the insurer Documents can be sent by (napadmin@memp.co.za) Fax for checking and submission to the administrator 12

13 d. The underwriters will assess the claim and reimburse the member in accordance with the benefits as per the policy document within four (4) working days from receipt of correct documentation e. Claims will be paid directly into the claimant s bank account as detailed on the claim form WHEN CAN I SUBMIT CLAIM The principal member/beneficiary nominated must notify the insurer within three months (90 days) from date of death to submit claims and supporting documentation. 3.8 TERMINATION OF COVER a. This policy may be cancelled by either party at any time by giving thirty (30) days notice in writing b. Letter of cancellation to be sent to Memp Financial Services (Pty) Ltd c. Cover terminates on the death of the principal insured person d. The policy shall be voidable in the event of misrepresentation, mis-description or nondisclosure by or on behalf of the insured person regarding any fact material to this insurance e. No premium refund shall be due in the case of cancellation by either party f. If it later transpires that the principal member s age at the commencement date was greater than the maximum allowed per the schedule (65), the policy shall cease with immediate effect. The insurer shall refund the premiums paid less any claims paid and less any expenses incurred in the issue of the policy 3.9 AMENDMENTS The company reserves the right to amend this policy wording by way of endorsement as well as to adjust the premiums by giving thirty (30) days written notice. 13

14 4 MEDICAL AID This is a free service offered to non-gems members (GEMS has their own healthcare consultants) by Memp Financial Services (Pty) Ltd. Memp Financial Services (Pty) Ltd are remunerated by the schemes and your premium is in no way affected i.e. you pay the same whether you use a consultant or not. The services provided include but are not limited to: Handling enquiries on Products and Services of the Scheme regarding: o o o o o o o Benefit structures offered and furnish advice on best suited choice Premiums to be paid on each product and/or parts thereof Exclusions related to specific circumstances Enrolment conditions applying to specific situation Service provider details where necessary Rules of the Medical Scheme Administrative procedures to be followed Continuous updating on: o The Scheme s products and benefits o The Scheme s Rules and where applicable, procedures Enquiries and completed forms can be ed to Memp Financial Services (Pty) Ltd ed to napadmin@memp.co.za Or Faxed to the office on

15 5 ADDENDUMS 1. Underwriting Concession Gap & Family Funeral Cover Flyer 3. Gap Cover Infographic 4. Funeral Cover Infographic 5. Gap and Family Funeral Cover Site Rep Communication 6. Gap & Family Funeral Cover Application Form 7. Gap Senior Application Form 8. Gap Cover Claim Form 9. Family Funeral Cover Claim Form 10. Memp Needs Analysis Form 11. Single Needs Analysis Form 12. Medical Scheme Broker Note (Excluding GEMS) For more information, please visit Existing members wishing to migrate can do so online by following the link: New members can apply online by following the link: DISCLAIMER: Please note that this information is for illustrative purposes only. Any claim is subject to the actual policy document and that the scheme rules and regulations will be binding at all times. While all reasonable care has been taken by MEMP Financial Services (Pty) Ltd in compiling this brochure, we have relied upon the accuracy and completeness of the information made available to us and subsequently cannot accept any liability for any errors or omissions herein. CONFIDENTIALITY All information, data and conclusions contained herein has been prepared for the exclusive use of Naptosa. This manual may not be distributed to any other third party without the prior written permission of MEMP Financial Services (Pty) Ltd and that such third party agrees to abide by this confidentiality provision. Naptosa acknowledges that all information disclosed herein is proprietary to Memp Financial Services (Pty) Ltd and does not confer any rights of whatever nature to such information and data. 15