Founding Affidavit and Annexures
Provisions of the existing Dread Disease Regulations ("DDR") 3 of 8 2. Background The DDR are issued in terms of the Master Regulations and regulate the Dread Disease Benefits provided by the Trust (a) 3. Commencement The DDR shall commence on 1 April 2021 and replaces the DDRs previously issued by the Trust 4. Determination of dread disease benefit The Trust shall determine the benefits payable by specifying the classification of the dread diseases for which cover is provided and the benefit amount payable. (b) The Benefit Amount is R27,000 5. and 7. Payment of Dread Disease Benefits The Trust shall pay a benefit amount to a Member in Good Standing in respect of a Dread Disease that was contracted, experienced or suffered by a Member where the Date of Dread Disease is after 1 August 2012. (c) (d) The liability of the Trust shall be limited to payment of the Benefit Amount only. Only one Benefit Amount per Dread Disease will be paid during the lifetime of a Member. Only one Benefit Amount will be paid to any Member where a condition or set of conditions experienced under a certain Dread Disease Classification can be proven to have directly caused separate but related conditions under another Dread Disease Classification Personal information Not dealt with in the DDR. (e) Cover Cessation of cover not dealt with in the DDR. (f) Premiums Determination of Contributions not dealt with in the DDR. Assured Lives Not dealt with in the DDR as it is not applicable to DDR. Policy documents Not dealt with in the DDR . Reasons for material differences a) The reason for this specific change is due to the fact that due to the promulgation of the Insurance Act 18 of 2017, the dread disease benefits could no longer be provided under group insurance policies in the current scheme and must rather be provided through individual insurance policies issued to each member. Therefore, whereas the DDRs constitute the regulations detailing the trust benefits, and which trust benefits are underwritten in terms of separate group policies entered into between the Trust and SDM with the Trust as the policyholder entitled to the insurance benefits, the PYK Contract provides insurance benefits to the members as policyholders. b) The reason for this change is due to the fact that the relevant insurance laws specifically require that the insurer must determine the insurance benefit payable, unless it has entered into a binder agreement (as prescribed) with another person to perform this exact function as a binder holder. Note that the relationship agreement requires continued cooperation between SDM, the Trust, the ZCC and KIA. c) The individual insurance policy provides that the insurer may request a Member to undergo an assessment. This was provided for in the previous group policy. d) The DDRs impose a waiting period in respect of any dread disease in that the date of dread disease must be 91 days from payment of the initial Membership Contribution. e) The reason for this change is to ensure compliance by the Trust and SDM with the Protection of Personal Information Act 4 of 2013 but to further allow SDM to provide the Benefits under the structure of the new scheme. f) Under the DDRs, a Member's access to vested trust benefits against the Trust was dependent on such Members qualifying as Members in terms of the Trust and further qualifying for trust benefits in terms of the relevant benefit regulations, which included qualifying as a Member in Good Standing (determined, broadly speaking, with reference to periodic and continuous payment of contributions). Therefore, access such vested trust benefits would cease where these requirements were not met. The same principles remain applicable in respect of some vested benefits. In respect of the vested trust benefits which will become insurance benefits under individual policies pursuant to the amended insurance scheme, the terms of the policy will need to comply with the Policyholder Protection Rules and the termination provisions in the PYK Contract (in addition to the requirements giving effect to previous grounds of termination of vested rights), now makes provision for that alignment. However, it should be noted that the instances in which cover will cease are similar to those provided for under the existing trust regime and further that the policy will never lapse despite the cessation of cover (i.e. cover can be reinstated once the relevant requirements are met). It is key to note here that SDM is now entitled to terminate the policy where the Trust was not previously able to do so. This is however, standard wording for insurance policies and such cancellation is (due to recent case law) still subject to it being in line with public policy. *To the extent any differences between the provisions of the existing Dread Disease Regulations and the proposed Pukwana ya Kganya Contracts have been identified that do not adversely affect the rights of the members to the Kganya Benefits Fund Trust, such changes have been marked in orange in the corresponding cells below. ** To the extent any differences between the provisions of the existing Dread Disease Regulations and the proposed Pukwana ya Kganya Contracts have been identified that do adversely affect the rights of the members to the Kganya Benefits Fund Trust, such changes have been marked in red in the corresponding cells below. *** Material differences or changes indicated in red shading shall be accompanied by a letter referencing the material difference or change in the left most column of the table and the corresponding letter referencing such material difference or change will be accompanied by an explanation for the material difference or change. **** Capitalised terms used in this comparison shall have the meaning ascribed to them in the documents considered in this comparison, unless indicated otherwise Part 1 - 2. and 3. Background / Introduction The PYK Contract is issued by Sanlam Developing Markets Limited ("SDM"), constituting the Funeral Policy and the Dread Disease and Personal Accident Policy and regulates, amongst others, the dread disease benefits provided in terms of the Trust Deed. The terms and conditions as set out in this Part I and Part IV, apply to the Funeral Policy, and the Dread Disease and Personal Accident Policy in respect of all Members who acquired Membership to the Kganya Benefits Fund Trust before the Effective Date ("Existing Member"). In respect of such Existing Members, the terms and conditions as set out in this Part I and Part IV must be read with – the Funeral Policy contained in Part II; and the Dread Disease and Personal Accident Policy contained in Part III The provisions of Part IV do not apply to new Members. Part 1 - 1.1 and 21.6 Background The PYK Contract is a binding policy contract between SDM and the Policyholders, pursuant to their Membership. Part 1 - 7.2. Commencement The scheme relating to the PYK Contract commences with the amendment to the Trust Deed, providing Members with access to the PYK Contract as vested right, but cover for Assured Lives, subject to the provisions of clause 6 of part IV insofar as it relates to insurance cover for Existing Members,will only commence when the Member accepts the offer of insurance by SDM pursuant to : (i) the payment of the initial Membership Contribution, or (ii) completion of the MPP Form, and purchasing a Membership Book. Part 1 - 8.1, and 8.4 Determination of benefit SDM shall determine the Benefits payable. SDM shall at all times be entitled to amend the Benefits, by way of 31 days' written notice to the policyholder. Part 1 - 3.6, 6.1.17 and 6.1.22 and Part 3 - 3.3. and Annexe D. Determination of dread disease benefit Part 1 - 3.6 - Dread Disease Benefits shall at all times comply with the Financial Sector Charter to the extent applicable. Part 1 - 6.1.17 and 6.1.22 - Payable on the contraction, experience or suffering of a Dread Disease by a Policyholder as Assured Life and as diagnosed by a Medical Practitioner as set out in a Medical Report. Part 3 - 3.3. - SDM may, in writing, notify the policyholder that the Policyholder shall be examined by a doctor selected by and at the cost of SDM to independently determine the cause and/or extent of the purported Dread Disease. Annexe D - The Benefit is R27,000 for a policyholder. Part 3 - 3.1 and 3.2. Payment of Benefits Part 3 - 3.1. - The Dread Disease Benefits will be paid by SDM to the Policyholder in respect of a Dread Disease having been contracted, experience or suffered by the Policyholder. Part 3 - 3.2. - SDM shall only pay 1 Claim for Benefits per Dread Disease Category regardless of the number of Claims made in respect of the same Dread Diseases occurring and/or being diagnosed forming part of the same Dread Disease Category Part 1 - 8.2. and 8.3 - Payment of Benefits Part 1 - 8.2. - In order to qualify for payment of the Benefits, the Premiums must be paid in respect of the Policies, subject at all times to the Waiting Periods that may be applicable and/or the provisions of Part IV in respect of Existing Members. Part 1 - 8.3 - SDM shall not allow any deductions from the benefit payable. Part 3 - 4. Waiting Period Benefit payments are subject to a waiting period of 91 days, calculated from the Inception Date. No Dread Disease Benefits will be paid in the event that the Insured Event occurs within the Waiting Period Part 1 - 4. and 15. Personal information The policyholders have consented to their personal information being shared with SDM by the Trust (or its duly appointed administrator) and for SDM (or its duly appointed administrator) to share such information with a third party that assists SDM in providing the Benefits. The Member (as Policyholder) will not be required to complete separate documents for insurance purposes. The Member agrees that the information completed by the Member as part of Membership, may be used by the Insurer for purposes of this Pukwana ya Kganya Contract SDM will only retain such information for as long as it is needed and will at all times comply with the relevant data protection legislation. Part 3 - 7. Cover Cover shall cease when: (i) the PYK Contract is cancelled; (ii) the Policyholder ceases to be a member of the Trust; (iii) on the death of the Policyholder; (iv) on payment of the Dread Disease Benefit in all of the Dread Disease Categories; and (v) the Trust fails to pay a premiums in respect of the Assured Lives as a result of the Policyholder's failure to pay his/her Membership Contribution, subject at all times to the Forgiveness Rules. Part 1 - 3.1, 3.2. and 3.3 and 9.1. Premiums Part 1 - 3.1., 3.2. and 3.3. - The Trust procured access to this Pukwana ya Kganya Contract for all Members (other than Church Officials who are Members) who satisfy the requirements for Membership to the Trust. The Trust (as the premium payer) merely pays the premiums on behalf of the policyholders to SDM, which premium is made pursuant to the vested right of a Member against the Trust for the payment of such Premium. The Trust will not pay premiums if the Policyholder (as Member) fails to pay their Membership Contribution to the Trust pursuant to their Membership. Part 1 - 9.1. Premiums are paid in terms of a separate premium payment agreement. Premiums are paid only if the policyholder is a Member, and without limitation to this requirement, pays its Membership Contribution. If the Membership Contributions are not paid, the Trust will not be obliged to pay the premiums will not be paid until Membership Contributions are paid again Premiums must be paid in full and are due monthly in advance. In the event that any of the above conditions are not met, the Trust shall not be obliged, and shall no longer pay, the Premiums to SDM in respect of the Policyholder, until such time as the Policyholder resumes payment of his/her Membership Contributions to the Trust, as provided for in the Master Regulations, read with the Basic Benefits Regulations. Payment of Premiums shall at all times be made in accordance with, and subject to, the terms of the Premium Payment Agreement, which Premium Payment Agreement can be made available on request in writing. Payment of the Premiums by the Trust does not entitle the Trust to any rights in terms of the PYK Contract nor entitle it to any Benefits. Part 1 - 9.2. Premiums SDM shall be entitled to review and change the premiums at least on an annual basis in line with the Policyholder Protection Rules, subject to any Applicable Laws. SDM shall review the Premiums at any time if there are reasonable actuarial grounds to do so, or where the review is required in the interest of the Policyholder. SDM reserves the right to review and change the Premium at any time upon the occurrence of any of the following events: (i) the Membership Contributions change; and/or (ii) the claims ratio exceeds 80% in respect of all Policyholders. SDM shall, following the outcome of the review, be entitled to change the Premium with effect from the date as specified by the Insurer, by giving 31 (thirty one) days prior written notice to the Policyholder, subject at all times to the Applicable Laws. Part 1 - 6.1.5 and 12.1 and 12.2 Assured Lives Part 1 - 6.1.5 - For purposes of the Dread Disease and Personal Accident Policy and in respect of the Dread Disease Benefits, the Policyholder in respect of whom SDM will provide cover in terms of the PYK Contract. Part 1 - 12.1 and 12.2 - A Dependant shall be the following persons indicated on the Payment Receipt Booklet as Dependant Children: (i) a child born to the Policyholder; (ii) a legally adopted child of the Policyholder; (iii) a child adopted by custom by the Policyholder (provided that both natural parents are deceased). This does however, exclude (i) a child who survives the policyholder and is not a Paid- up Dependent; (ii) a child of a Dependant Child of the Policyholder (i.e. grandchildren); and (iii) children over the age of 25 (unless this child is permanently dependent on the Policyholder by virtue of mental illness or physical disability which occurred whilst the person qualified as a Dependant and provided that at least one Premium was paid by the Trust in respect of the Policyholder prior to the date the child would otherwise cease to qualify as a Dependant Child and thereafter Premiums were paid in respect of the Policyholder in each ensuing Month). Part 1 - 12.3 to 12.5 Part 1 - 12.3 - New-born children born to the Policyholder and children adopted by the Policyholder must be indicated in the Payment Receipt Booklet within 6 Months after the date of birth or adoption as the case may be. Part 1 - 12.4 - A child of a Policyholder (who is the father) shall not be a Dependent Child of the Policyholder unless (i) the natural mother is deceased or is not a Member of the ZCC, or (ii) the Policyholder is the legal guardian of such a child. Part 1 - 12.5 - The Policyholder shall provide all such documentary and other evidence, as may be required by SDM from time to time, to establish whether a child qualifies as a Dependent Child for purposes of the PYK Contract. Part 1 - 5. Policy documents The PYK Contract and the Policy Schedule will form part of the Membership Terms and Conditions Booklet, despite it constituting a separate agreement between the Member in his/her capacity as Policyholder and SDM. All notices and disclosures to be distributed by the Insurer in terms of the Applicable Laws shall be supplied by the Insurer or its duly appointed administrator, being Kganya Insurance Administrators, to the Policyholder through the Church Branches affiliated with the ZCC, or such other means of communication as may be appropriate in the circumstances. Provisions of the Pukwana ya Kganya Contract ("PYK Contract") Review of Changes to the Dread Disease Benefits of the Kganya Benefits Fund Trust
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