That Easy SIMPLE INSURANCE FROM EDGARS EDGARS LIFE COVER Underwritten By Hollard Life Assurance Company Limited (Reg No. 1993/001405/06) an Authorised Financial Services Provider. Edcon is a juristic representative of Hollard. Terms and Conditions apply.
The following is your Edgars Life Cover Plan Policy Wording. Hollard has set out the details of the policy for your information. This policy is underwritten by Hollard Life Assurance Company Limited (Hollard). Edgars is a juristic representative of Hollard to market and sell this policy and Hollard is an authorised Financial Services Provider (FSP) who can sell long-term insurance products. Hollard agrees to accept any eligible person who has successfully applied for this cover and will, in the event of a valid claim, pay the Funeral Benefit to the Main Insured Person, the Nominated Beneficiary or to the Main Insured Person s estate subject to the terms, conditions and exceptions of this policy. This policy wording as amended from time to time, various administrative forms, application forms, policy schedule, benefit schedule, declarations, authorisations, any voice-logged conversations pertaining to this policy and agreements supplied by Hollard shall form the basis of this insurance contract. In the event of any conflict between the provisions of this policy wording and that of any other documents as mentioned above, the provisions of this policy wording shall prevail. COMMUNICATION INFORMATION To communicate with Hollard in connection with claims and queries regarding this policy, kindly contact: Edcon Insurance Services, PO Box 87428, Houghton, 2041 Tel Number: 011 351 5503, Fax Number: 011 351 3503 To communicate with Edcon in connection with this policy kindly contact: Customer Care Services, Edcon Financial Services, PO Box 100, Crown Mines, 2025 Share Call Number: 0860 112 442 BENEFITS The benefits applicable to each Insured Person are subject to waiting periods as stated in this policy wording. LIFE COVER BENEFIT The Life Cover Benefit provides a payment, the sum insured specified in the Policy Schedule, in the event of the Main Insured Person s death during the Period of Insurance. The Policy Schedule will specify the Life Cover Benefit, the sum insured and the monthly premium applicable to the Main Insured Persons. This benefit does not acquire any surrender value or paid-up value. The Main Insured Person may not cede this benefit and any cession shall be null and void. The Policy Inception Date for the Main Insured Person shall be the date that the Main Insured Person becomes covered for this benefit under this policy. LIMITATION OF BENEFITS In the event that an Insured Person is covered on more than 1 (one) Hollard policies, the maximum total benefit amount per Insured Person from all Life Cover, Funeral, Memorial and Monthly Provider Benefits (as applicable) is as follows: - R600 000 (six hundred thousand Rand) where the Insured Person is 18 years or older. For purposes of the maximum total benefit amounts above, where benefits are payable monthly, the accumulated total of all amounts that are payable will be used in calculating the maximum total benefit amount. Hollard may increase the maximum total benefit amounts above from time to time. The maximum total benefit amounts above apply at the Benefit Inception Date and take into consideration any existing cover (including any past benefit increases) with Hollard. In the event that claims are submitted for more than the maximum amount allowed, the amount payable by Hollard will be limited to the benefits provided for in terms of this policy and up to the maximum amount allowed. All benefit payments are subject to the verification of the validity of any claim. The Life Cover sum insured will be reduced by any claims paid on any accelerator benefits attached to this policy. NOMINATION OF BENEFICIARY or BENEFICIARIES The Main Insured Person may nominate a person as the Beneficiary in terms of this policy. The Beneficiary will receive the benefit on the Main Insured Person s death. If there is no Beneficiary or the Beneficiary has died, then Hollard will pay the benefit to your estate. Once a Beneficiary nomination has been made, it remains in force until the Main Insured Person informs Hollard in writing of any change.
SPECIFIC RESTRICTIONS, EXCLUSIONS, PROVISIONS AND CONDITIONS RESTRICTIONS ON THE NUMBER OF INSURED PERSONS For the Life Cover Benefit: - The Main Insured Person is covered. ELIGIBILITY For the Life Cover Benefit: - The Main Insured Person is eligible to be covered provided he/she is over the age of 18 (eighteen) and below the age of 60 (sixty) on the Benefit Inception Date. TERMINATION OF BENEFITS The Life Cover Benefit for the Main Insured Person will cease if any of the following happens: - The Main Insured Person cancelling this policy and the cover provided; or - The death of the Main Insured Person; or - If Hollard does not receive the policy premium within the grace period the policy will lapse. No claims will be accepted or paid during this period of time; or - The termination of your Edgars retail account. COMPULSORY ANNUAL INCREASES The premiums increase every year by the Annual Premium Increase percentage specified in your Policy Schedule. The benefit amounts increase every year by the Annual Benefit Increase percentage specified in your Policy Schedule. The premium and benefit increases will cease on the earlier of the Main Insured Person s 75th birthday or the Partner s 75th birthday. You may cancel the compulsory annual increases only once during the lifetime of your policy. WAITING PERIODS Benefits are not payable if the cause of the claim occurs during any applicable Waiting Period. The waiting period in respect of the Main Insured Person commences on the Policy Inception date in terms of this policy. Should cover in respect of the Main Insured Person be terminated and subsequently restarted the Waiting Periods will commence from the date that cover is restarted unless waived in writing by Hollard. No waiting period applies in the event of the Main Insured Person dying as a result of an Accident. In the event of the Main Insured Person dying before the Benefit Inception Date or dying during the waiting period as a result of an Accident that occurred before the Benefit Inception Date, there will be no benefit payable. Should additional benefits and/or cover be applied for in respect of the Main Insured Person the Main Insured Person will have to start a new policy and all waiting periods will apply again for that policy and its benefits. WAITING PERIOD DEATH FROM SUICIDE A Waiting Period of 24 (twenty-four) consecutive months and 24 (twenty-four) consecutive premium payments will apply on the death of the Main Insured Person by suicide, where death is caused directly or indirectly by or arising from or resulting from or contributed to by or traceable to any attempted suicide. RESTRICTION NATURAL CAUSES For claims as a result of natural causes: - Cover is set at 100% of the sum insured of the Life Cover Benefit for the first 3 (three) months of the policy; - Cover will be set at 10% of the sum insured of the Life Cover Benefit for the remainder of the policy if a negative HIV is not provided, or the HIV test is reactive; - Cover will be set at 100% of the sum insured of the Life Cover Benefit as soon as a negative HIV test is provided. For claims as a result of an Accident: - Cover is set at 100% of the sum insured of the Life Cover Benefit. GENERAL RESTRICTIONS, EXCLUSIONS, PROVISIONS AND CONDITIONS TRANSFERABILITY / CESSIONABILITY No rights or benefits payable under this policy may be ceded or transferred to any third party. You may exercise all rights provided for by this policy without the consent of any of the beneficiaries. CURRENCY AND LAW Premiums and benefits payable under this policy shall be paid in the Republic of South Africa and in South African Rands only. This policy shall be governed by and interpreted in accordance with South African Law in the courts of the Republic of South Africa. TERRITORY COVERED Any Insured Person ordinarily resident in the Republic of South Africa will be covered in terms of this policy. Cover is extended to include a visit lasting for a period of less than three months outside the territory covered. The Main Insured Person who is not a South African citizen, a legal permanent resident or who ordinarily resides outside of the Republic of South Africa will not be covered in terms of this policy. POLICY FEE A monthly policy fee, as reflected in the Policy Schedule, is payable in addition to the benefit premiums, as reflected in the Policy Schedule.
Hollard may increase the policy fee on an annual basis in-line with any increase in administration costs by giving you 30 (thirty) days written prior notice thereof. CRIMINAL ACTIVITIES Hollard shall have no liability whatsoever under this policy where any claim arises from, or is the result of any intentional contravention of any criminal law, whether legislative or at common-law (including fraud), by the Insured Person, or by anyone acting on behalf of the Insured Person or with the Insured Person s connivance and/or consent, or by any person claiming any benefit under this policy. In the event of such a claim all benefits afforded in terms of this policy and all premiums paid in respect of this policy shall be forfeited, and this policy may be voided or cancelled as from the date of the criminal offence, at Hollard s discretion. MISREPRESENTATION, MISDESCRIPTION OR NON-DISCLOSURE Misrepresentation, misdescription or non-disclosure of any material fact or circumstances in connection with this policy, a claim or the application for this policy may result in this policy being cancelled, a claim rejected or the policy voided from inception and all your premiums forfeited. In the event that a benefit has been paid as a result of any misrepresentation, non-disclosure, misdescription or fraudulent action by the Main Insured Person or by any person claiming any benefit under this policy, such person will be required to repay or return the benefit paid. Hollard shall be entitled to take legal action to recover the benefit and any costs involved. In order to provide you with clarity as to how non-disclosure would be treated at claim stage, our philosophy is as follows: - If, in the opinion of Hollard, non-disclosure would not have changed the original underwriting decision, then the non-disclosure will not be taken into account in assessing the claim. - If, in the opinion of Hollard, there was material non-disclosure and the non-disclosure was relevant to the cause of the claim, then no claim will be admitted. - If, in the opinion of Hollard, non-disclosure would have changed the underwriting decision but the nondisclosure was not relevant to the cause of the claim then all the benefits will be re-rated to reflect the terms that would have applied had the (non-disclosed) information been disclosed at the underwriting stage. Furthermore, an amount of 10% of the revised benefit amount will be deducted as a nondisclosure penalty and the claim will then be assessed on the basis of the revised cover amount. CHANGE OF CIRCUMSTANCES Hollard must be advised in writing of any change in circumstances regarding occupation, smoking habits or participation in a Hazardous Pursuit within 30 (thirty) days of such change occurring. In this event, Hollard reserves the right to adjust the benefit or premium, add exclusions to the policy as necessary or cancel this policy. Failure to notify Hollard of a change will result in the benefit being reassessed at claims stage in line with Hollard s underwriting practice at the time, and this may result in a claim being reduced or rejected. In addition, a penalty of 10% (ten percent) of the claim amount will be applied. CLERICAL ERROR A clerical error by Hollard shall not invalidate insurance otherwise validly in force, nor continue insurance otherwise not validly in force. PREMIUM PAYMENT DAYS OF GRACE A period of 30 (thirty) days from the Premium Due Date is allowed for the payment of each premium for the first 12 (twelve) premiums. For every 12 (twelve) premiums that is paid in a row the period within which to pay the premium is extended by another 30 (thirty) days from the Premium Due Date, subject to a maximum grace period of 6 (six) months. Once a grace period has been used it cannot be used again until all the premiums that are in arrears have been paid. During the grace period all benefits will remain in force. If any event occurs during the grace period that results in a valid claim, the unpaid premiums will be deducted from any amount paid out. If any premium is not paid and received by Hollard during the grace period, the policy will automatically be cancelled and no Life Cover Benefit will be paid. The premium grace period does not apply to the payment of the first premium on inception of the policy. PREMIUM PAYMENT Premiums are due monthly on the date of billing of your Edgars account. Edgars will notify the Main Insured Person of any non-payment of premium. 30 DAY POLICY REVIEW PERIOD Hollard will provide you with a copy of the policy document and policy schedule within 30 (thirty) days of receiving the application form from you. Where no claim has been instituted in terms of this policy or where no right has accrued to the Main Insured Person to institute a claim or receive any benefit in terms of the policy, you may, within 30 (thirty) days after receipt of the policy documentation, cancel the policy by contacting Edcon Customer Care Services on 0860 112 442 and informing them of the cancellation. All premiums paid to Hollard during this 30 (thirty) day review period will be refunded by Hollard, subject to the deduction of the cost of any cover actually enjoyed. NO PREMIUM NO COVER This policy is conditional upon and will only commence following the payment of the first premium. Premiums are due and payable monthly on the date of billing of your Edgars account. CANCELLATION You may cancel this policy at any time by giving 30 (thirty) days notice, in writing, to Edgars of the cancellation of the policy. Hollard may cancel this policy at any time by giving 30 (thirty) days notice, in writing and/or telephonically, to you of the cancellation of the policy.
Such cancellation notice shall be accepted from the date of posting such notice. The cancellation shall commence on the next Premium Due Date of the policy. If a premium has been paid for a period beyond the date of cancellation of this policy, Hollard shall refund the relevant premium. Hollard cannot be held responsible for any damages suffered by you due to a cancellation requested by you. If a cession has been registered against this policy, cancellation shall be subject to the cessionary s written approval of the cancellation of the policy and the cession. CONTINUATION OF COVER Following the termination of the policy cover may be restarted, subject to Hollard agreeing to such restart and the receipt of an administration charge, subject to the terms and conditions advised at the time of the restart request. PREMIUM AND POLICY AMENDMENTS Hollard may increase the premium amount from time to time by giving you 30 (thirty) days written notice of such increase. In this event, you will be required to pay the increased premiums to maintain the full benefits. If the recommended premium increase is not accepted, Hollard will reduce the benefits accordingly. Hollard may amend this policy by way of endorsement, provided that any amendment will not affect the extent of cover already provided for and in force in terms of this policy. Submission of a claim, other than for the Life Cover Benefit, will not result in any change of the premium payable. The premium must be paid until admission of the claim. Following the admission of a claim, the premium payable may be adjusted to reflect the remaining benefits on the Policy. CONSENT TO DISCLOSURE OF PRIVATE INFORMATION It is essential for insurance companies to share claims and underwriting information (as well as credit information) in order to enable the fair assessment and underwriting of risks and to reduce the number of fraudulent claims. You hereby waive any right to privacy and consent to the disclosure of any insurance information provided by you or on your behalf for any insurance policy or claim made or lodged by you or on your behalf and you agree to such information being disclosed to any other insurance company, whether on your behalf or on behalf of any person you represent herein. This consent clause will survive the termination for whatever reason of the policy, including the cancellation or lapsing thereof. The information provided may be verified against other sources or databases. CONDITION PRECEDENT Hollard s liability in terms of this policy is conditional on you, or anyone acting on your behalf, complying with all the terms, conditions and warranties of this policy. Qualified medical advice shall be sought and followed promptly on the occurrence of any claim event and Hollard shall not be liable for any claim which arises from the unreasonable or wilful neglect or failure of an Insured Person to seek and remain under the care of a Physician. HOLLARD S LIABILITY Hollard will not be liable to make any payment unless the premium due in terms of this policy has been received, and the applicable documentation, data or medical evidence and satisfactory proof of a claim, as required by Hollard has been provided to Hollard at your, or if applicable the Nominated Beneficiary or appointed Executor s expense. Payment by Hollard of the benefits provided in the event of a valid claim in terms of this policy will be a full and effective discharge by Hollard of its liability and obligations in terms of the policy. No benefit payable under this policy shall carry interest. REJECTION OF CLAIM AND TIME BAR If Hollard declines liability for a claim made in terms of this policy, voids this policy, or if there is a dispute regarding the amount of the claim, representation may be made to Hollard within 90 (ninety) days (the representation period ) of the date of your receipt of the letter of rejection or avoidance. Representation must be submitted in writing to: Edcon Insurance Services, PO Box 87428, Houghton, 2041 Fax: 011 351 5303 Alternatively, you may contact: The Ombudsman for Long Term Insurance, Private Bag X45, Claremont, 7735 Telephone: 021 657 5000 Fax: 021 674 0951 If the dispute is not satisfactorily resolved in this manner, legal action may be instituted against Hollard for the enforcement of the claim by way of the service of summons against Hollard. Summons must be served on Hollard within 180 (one hundred and eighty) days of the expiry of the representation period, failing which all benefits in respect of such claim shall be forfeited and no liability can arise in terms of such claim.
CLAIM NOTIFICATION PERIOD On the happening of an event, which may result in a claim in terms of this policy, the Nominated Beneficiary or appointed Executor shall, at their own expense submit the claim to Hollard. The Nominated Beneficiary or appointed Executor must submit to Hollard, the full details in writing of the claim as soon as reasonably possible up to a maximum of 180 (one hundred and eighty) days from the date of the event giving rise to the claim. Hollard shall in no way whatsoever be liable to pay any benefit if the full details of the claim are not received within the maximum period as stipulated above. CLAIM PROCESS All certificates, information and evidence required by Hollard shall be furnished in the form prescribed and without expense to Hollard. Hollard shall be entitled to access any medical and hospital records in relation to the Main Insured Person s health and make copies of such records. All certificates, information and evidence required by Hollard shall be furnished in the form prescribed and without expense to Hollard. Should Hollard require confirmatory diagnosis or a second opinion on the evidence submitted to Hollard, the Insured Persons shall submit to medical examinations by a Medical Practitioner appointed by Hollard, at Hollard s expense, as often as shall be required in connection with any claim. Any receipt or discharge which your personal representatives or Beneficiary may give to Hollard for any benefit paid under this policy shall be deemed as final and complete discharge of all liability of Hollard in respect of any and every contingency resulting to the Insured Person in consequence of the death whether resulting before or after the date of such receipt or discharge. Refer to your policy schedule for the claims and customer care contact details. INTERPRETATION Words importing the singular shall include the plural, and vice versa, words importing the masculine gender shall include the feminine and neuter genders, and vice versa, and words importing natural persons shall include legal persons, and vice versa. The clause headings in this policy are inserted for reference purposes only and shall not affect the interpretation of any of the provisions to which they relate. SPECIFIC DEFINITIONS Unless the contrary appears from the context, the following words and phrases shall have the meanings assigned to them where they appear in this policy: ACCIDENT Accident means a sudden, fortuitous and uncertain event which is caused solely and directly by violent, external, physical and visible means independently of any other cause. HOLLARD Hollard means the Hollard Life Assurance Company Limited. PERIOD OF INSURANCE The period commencing on the Inception Date or the date that cover is restarted and ceasing one month after the Inception Date or the date that cover is restarted. This period is extended by one month for each additional monthly premium received by Hollard. POLICY SCHEDULE The Policy Schedule is incorporated in and forms part of this Policy and sets out inter alia the Insured Person(s) details, premium(s) payable and the benefits applicable to the Main Insured Person and may be amended from time to time. INSURED PERSON Insured Person means an individual who is covered in terms of this policy and refers to a person who has been accepted by Hollard as the Main Insured Person where applied for by you in terms of this policy. The Main Insured Person will only be covered if reflected on the Policy Schedule as the Main Insured Person, and subject to the terms and conditions of this policy. The Main Insured Person s cover will continue until you notify Hollard of any changes or until cover ceases in terms of the terms and conditions of this policy. Persons who are not reflected on the Policy Schedule will not be covered in terms of this policy. The following Insured Persons may be covered in terms of this policy: MAIN INSURED PERSON or YOU or YOUR The person applying for cover. The person who has been accepted as the Main Insured Person in terms of this policy. INCEPTION DATE The Inception Date will be the later of the Benefit Inception Date, Restart Date and Policy Inception Date specified in your most recent Policy Schedule.
POLICY INCEPTION DATE The date of receipt of the first premium. BENEFIT INCEPTION DATE The Benefit Inception Date for each Insured Person may be different. For each benefit and Insured Person, the Benefit Inception Date as set out in your most recent Policy Schedule is the date from which the Insured Persons are covered in terms of this policy. RESTART A restart occurs when a policy which has lapsed or been reflected as not taken up (NTU d) (status is out-of-force) is returned to a position similar to that it was in before it lapsed (i.e. returned to an in-force premium paying status or quote status for NTU d policies). No arrear premiums are payable on a restart. However, an administration charge is payable. All waiting periods re-apply from the effective Restart Date. RESTART DATE The date of receipt of the first premium after Hollard agreeing to restart cover under this policy. PHYSICIAN OR MEDICAL PRACTITIONER Physician and Medical Practitioner means a person legally licensed and duly qualified to practise medicine and surgery (other than the Policyholder, an Insured Person or a member of their family). PREMIUM DEBIT DATE Premium Debit Date is the day in each month on which Edgars will debit the Premium Payer s Account. PREMIUM DUE DATE Premium Due Date is the day in each month on which the premium is payable to Edgars to extend the Period of Insurance and coincides with your Edgars account due date. PREMIUM PAYER The Premium Payer is the Main Insured Person. TREATMENT OR ADVICE Treatment or Advice means the regular or routine examination by, or consultation with, a Physician or Medical Practitioner for the purpose of monitoring existing medical conditions. HAZARDOUS PURSUITS Hazardous Pursuits include but are not limited to participation in the following sports on an income-earning basis or participating in the following sports more than once a month: aviation sports, paragliding, underwater diving necessitating the use of an artificial breathing apparatus, hanggliding, hunting, spear-fishing, rock-climbing or mountaineering necessitating the use of ropes and guides, microlighting, motor boat racing, motor racing, motor-cycle racing, sky diving/parachuting, target shooting, acrobatic flying, parasailing, go-carting, drag-racing, rally driving, bungee jumping, winter sports involving snow or ice, or racing other than on foot.
Life Cover WE COVER YOUR WORLD YOUR LIFE PERSONAL/FAMILY ACCIDENT PLAN EDGARS LIFE COVER PERSONAL FUNERAL PLAN PARENT FUNERAL PLAN FAMILY FUNERAL PLAN FAMILY PROVIDER PLAN ACCOUNT PROTECTION PLAN YOUR HEALTH HOSPITAL CASH BACK DENTAL ACCIDENT PLAN DENTAL HEALTH PLAN YOUR STUFF EDGARS HOME PROTECT CELLPHONE INSURANCE YOUR LAWYER EDGARS LEGAL INSURANCE Call 0860 555 334 to enrol for any of the above products. Visit www.edgars.co.za for more information. Pol ver: 140310 Mkt ver: 140424