Founding Affidavit and Annexures

Provisionsof theexistingDreadDiseaseRegulations ("DDR") 4of8 1.1.7andSchedule3DreadDiseaseClassification HeartAttack: Where thedeathofaportionof theheartmuscle results from inadequateblood supply to the relevantarea.Thediagnosiswill bebasedon: (i)ahistoryof typical chestpain; (ii)new characteristicelectrocardiogramchanges;and (iii)elevationof infarction specificenzymes,Troponinsorotherbiochemical markers. Stroke: Wherea cerebrovascularaccidentor incidentoccurs,producing permanentneurological sequelae lastingmore than48 (forty eight)hoursasa resultof infarctionofbrain tissue,haemorrhage andembolisation fromanextracranial source,excluding traumatic injury.Evidenceofneurologicaldeficit forat least3 (three)monthshas tobeproduced. Cancer: Whereanymalignant tumouroccurscharacterisedby the uncontrolled growthofmalignantcellsand invasionof tissue.The termmalignant tumour includes lymphomaand sarcoma. CoronaryArtery (bypass)Surgery: Theactualundergoingofheart surgery to correctnarrowingor blockageof twoormorecoronaryarterieswithbypassgrafts.The surgerymusthavebeenproven tobenecessarybymeansof coronaryangiographyand realisationof the surgeryhas tobe confirmedbyaMedicalSpecialist. TotalKidneyFailure: Theend stage renal functionpresentingaschronic irreversible failureofbothkidneys to functionasa resultofwhich regular peritonealdialysisorhaemodialysis is instituted. MajorOrganTransplant: Theactualundergoingasa recipientofa transplantofanyoneor moreofadonorheart, liver,pancreas,bonemarrow,kidneyor lungs.Realisationof the transplantationhas tobeconfirmedbya Medical Specialist. Blindness: The total,permanentand irreversible lossofsight inbotheyesas a resultofsicknessordisease.Visionmeasuredat3/60orworse in thebettereyeusinga Snelleneyechart. Coma: A stateofunconsciousnessasa resultofsicknesswithno reaction toexternal stimulior internalneedspersistingcontinuously fora periodofat least96 (ninety six)hourswith theuseof life support systems, resulting inpermanentneurologicaldeficit. Multiple sclerosis: Theunequivocaldiagnosis thereofbyaMedicalSpecialist (preferablybyaneurologist).Thediseasehas tobeevidencedby typical clinical symptomsofdemyelinationand impairmentof motorand sensory functionsaswellasby typicalMRI findings. Forproving thediagnosis, themembermust: (i)eitherexhibit neurologicalabnormalities thathaveexisted fora continuous periodofat least6months;or (ii)havehadat least twoclinically documentedepisodesat least1monthapart;or (iii)havehadat least1clinicallydocumentedepisode togetherwith characteristic findings in thecerebrospinal fluidaswellasspecificcerebralMRI lesions. 6.Exclusions HeartAttack: The followingareexcluded: (i) Non-ST-segment (NSTEMI); (ii) ElevationofTroponin IorT; (iii)OtheracuteCoronarySyndromes (e.g. stable/unstableAnginapectoris);and (iv)Silentmyocardial infarction. Nobenefit ispayable ifa claim forCoronaryArtery (bypass) SurgeryoraHeartTransplanthasbeenpreviouslyadmitted in respectof theClaimant. Stroke: The followingareexcluded: (i)Transient ischemicattacks (TIA); (ii) Neurological symptomsdue tomigraine;and (iii)Lacunarstrokes withoutneurologicaldeficit. Cancer: The followingareexcluded: (i)All tumourswhicharehistologically classifiedaspremalignant,asnon-invasiveorascancer in situ includinganyGIN stage (cervical intraepithelialneoplasia); (ii)Non- malignant conditions thatcanbecomemalignant, including essential thrombocythaemiaandpolycythaemia rubra vera; (iii) All tumoursof theprostateunlesshistologically classifiedas havingaGleason scoregreater than6orhavingprogressed toat leastclinicalTNM classificationT2nOMO; (iv)All cancersarising in the skinother thanmalignantmelanomahistologicallyclassified ashavingprogressed toat leastClark'sLevel II; (v)Lymphoma limited to1 (one) regionof lymphnodes;and (vi)Anycancer diagnosedand treatedbyprimarybiopsyonlyanddoesnot requireanyadditional surgical,medical, radiotherapyorother modalities, shallnotqualifyas"cancer". CoronaryArtery (bypass)Surgery: The followingareexcluded: (i)Angioplasty; (ii)Anyother intra- arterialprocedures;and (iii)Key-hole surgery. Nobenefit ispayable ifa claim foraheartattackorheart transplanthasbeenpreviouslyadmitted in respectof the Claimant. TotalKidneyFailure: Nobenefit ispayable ifa claim foraKidneyTransplantorKidney Cancerhasbeenpreviouslyadmitted in respectof theClaimant. MajorOrganTransplant: Nobenefit ispayable foraHeartTransplant ifa claim forCoronary Artery (bypass)SurgeryoraHeartAttackhasbeenpreviously admitted in respectof theClaimant. Nobenefit ispayable foraKidneyTransplant ifa claim forTotal KidneyFailurehasbeenpreviouslyadmitted in respectof the Claimant. Nobenefit ispayable foranyorgan requiring transplantand for whichorgana claim forCancerhasbeenpreviouslyadmitted in respectof. Blindness: No furtherexclusionsapply. Coma: The followingareexcluded:A coma secondary toalcoholordrug misuse isnotcovered. Multiple sclerosis: Noexclusionshavebeenprovided for. GeneralExclusions:Therearenogeneralexclusions ReviewofChanges to theDreadDiseaseBenefitsof theKganyaBenefitsFundTrust *To theextentanydifferencesbetween theprovisionsof theexistingDreadDiseaseRegulationsand theproposedPukwanayaKganyaContractshavebeen identified thatdonotadverselyaffect the rightsof themembers to theKganyaBenefits FundTrust,such changeshavebeenmarked inorange in the correspondingcellsbelow. **To theextentanydifferencesbetween theprovisionsof theexistingDreadDiseaseRegulationsand theproposedPukwanayaKganyaContractshavebeen identified thatdoadverselyaffect the rightsof themembers to theKganyaBenefits FundTrust,such changeshavebeenmarked in red in the correspondingcellsbelow. ***Materialdifferencesor changes indicated in red shadingshallbeaccompaniedbya letter referencing thematerialdifferenceor change in the leftmostcolumnof the tableand the corresponding letter referencingsuchmaterialdifferenceor changewillbeaccompaniedbyanexplanation for thematerialdifferenceor change. ****Capitalised termsused in this comparison shallhave themeaningascribed to them in thedocuments considered in this comparison,unless indicatedotherwise Reasons formaterialdifferences N/A Part3 -3.andAnnexeDreadDisease Classification HeartAttack: Thedeathofaportionof theheartmuscle results from inadequateblood supply to the relevantarea.Thediagnosiswillbebasedon: (i)ahistoryof typical chestpain; (ii)new characteristicelectrocardiogramchanges;and (iii)elevationof infarction specificenzymes, Troponinsorotherbiochemicalmarkers. All three factorsare requiredand confirmation in theaffirmative is requiredon theprovided Medical report (thiswaspreviously included in theGroupPolicy) . Part3 -3.andAnnexeDreadDisease Classification Stroke: Wherea cerebrovascularaccidentor incident occurs,producingpermanentneurological sequelae lastingmore than48 (fortyeight) hoursasa resultof infarctionofbrain tissue, haemorrhageandembolisation froman extracranial source,excluding traumatic injury. Evidenceofneurologicaldeficit forat least3 (three)monthshas tobeproduced. Neurological sequelaearemedical conditions associatedwithdamagedneurons resulting fromapreviousdisease, injuryorother trauma (thiswaspreviously included in theGroup Policy). Part3 -3.andAnnexeDreadDisease Classification Cancer: Whereanymalignant tumouroccurs characterisedby theuncontrolledgrowthof malignant cellsand invasionof tissue.The term malignant tumour includes lymphomaand sarcoma. A tumourmaybebenignormalignant.A malignant tumour iscancerand can invade neighbouring tissueandorgans throughblood or lymph system (thiswaspreviously included in theGroupPolicy). Part3 -3.andAnnexeDreadDisease Classification CoronaryArtery (bypass)Surgery: Theactualundergoingofheart surgery to correctnarrowingorblockageof twoormore coronaryarterieswithbypassgrafts.The surgerymusthavebeenproven tobenecessary bymeansofcoronaryangiographyand realisationof the surgeryhas tobeconfirmed byaMedicalPractitioner. Part3 -3.andAnnexeDreadDisease Classification TotalKidneyFailure: Theend stage renal functionpresentingas chronic irreversible failureofbothkidneys to functionasa resultofwhich regularperitoneal dialysisorhaemodialysis is instituted. Part3 -3.andAnnexeDreadDisease Classification MajorOrganTransplant: Theactualundergoingasa recipientofa transplantofanyoneormoreofadonorheart, liver,pancreas,bonemarrow,kidneyor lungs. Realisationof the transplantationhas tobe confirmedbyaMedicalPractitioner. Part3 -3.andAnnexeDreadDisease Classification Blindness: The total,permanentand irreversible lossof sight inbotheyesasa resultofsicknessor disease.Visionmeasuredat3/60orworse in thebettereyeusinga Snelleneyechart. Part3 -3.andAnnexeDreadDisease Classification Coma: A stateofunconsciousnessasa resultof sicknesswithno reaction toexternal stimulior internalneedspersistingcontinuously fora periodofat least96 (ninety six)hourswith the useof life support systems, resulting in permanentneurologicaldeficit. Part3 -3.andAnnexeDreadDisease Classification Multiple sclerosis: Theunequivocaldiagnosis thereofbyaMedical Practitioner (preferablybyaneurologist).The diseasehas tobeevidencedby typical clinical symptomsofdemyelinationand impairmentof motorand sensory functionsaswellasby typical MRI findings. Multiple sclerosis (MS) isademyelinatingdisease inwhich the insulatingcoversofnervecells in the brainand spinal cordaredamaged.Thisdamage disrupts theabilityofpartsof thenervoussystem to communicate, resulting ina rangeofsignsand symptoms, includingphysical,mentaland sometimespsychiatricproblems (thiswas previously included in theGroupPolicy). Forproving thediagnosis, themembermust: (i) eitherexhibitneurologicalabnormalities that haveexisted fora continuousperiodofat least6 months;or (ii)havehadat least twoclinically documentedepisodesat least1monthapart;or (iii)havehadat least1clinicallydocumented episode togetherwith characteristic findings in thecerebrospinal fluidaswellas specificcerebral MRI lesions. Part3 -5.andAnnexeDExclusions HeartAttack: The followingareexcluded: (i) Non-ST-segment (NSTEMI) - (ASTEMIorST-elevationmyocardial infarction iscausedbya sudden complete (100%) blockageofaheartartery (coronaryartery).Anon- STEM/ isusually causedbya severelynarrowedartery but theartery isusuallynotcompletelyblocked.The diagnosis is initiallymadebyanelectrocardiogram (ECGorEKG) (thiswaspreviously included in theGroup Policy); (ii)ElevationofTroponin IorT - (ElevationofT or I is indicativeofcardiacdamage,but thiscanoccur asa resultofcausesother thanheartattacke.g. myocarditis,coronaryartery spasm, severecardiac failure,cardiac trauma from surgeryetc) (thiswas previously included in theGroupPolicy); (iii)Other acuteCoronarySyndromes (e.g. stable/unstable Anginapectoris) - (Angina,a/soknownasangina pectoris, ischestpainorpressure,usuallydue tonot enoughblood flow to theheartmuscle.Worsening anginaattacks, sudden-onsetanginaat rest,and angina lastingmore than15 (fifteen)minutesare symptomsofunstableangina (usuallygroupedwith similarconditionsas theacutecoronary syndrome).As thesemayprecedeaheartattack, they requireurgent medicalattentionandare, ingeneral, treated in similar fashion tomyocardial infarction) (thiswaspreviously included in theGroupPolicy);and (iv)Silent myocardial infarction - ("Silent"myocardial infarctions canhappenwithoutany symptomsatall.Thesecases canbediscovered lateronelectrocardiograms,using bloodenzyme testsoratautopsyafterapersonhas died) (thiswaspreviously included in theGroup Policy). Nobenefit ispayable ifa claim forCoronaryArtery (bypass)SurgeryoraHeartTransplanthasbeen previouslyadmitted in respectof thePolicyholder (this waspreviously included in theGroupPolicy). Part3 -5.andAnnexeDExclusions Stroke: The followingareexcluded: (i)Transient ischemicattacks (TIA) - (A ischemicattack (TIA) isabriefepisodeofneurologicaldysfunction causedby lossofblood flow (ischemia) in the brain, spinal cordor retina,without tissue death (infarction) (thiswaspreviously included in theGroupPolicy); (ii)Neurological symptomsdue tomigraine;and (iii)Lacunar strokeswithoutneurologicaldeficit. Part3 -5.andAnnexeDExclusions Cancer: The followingareexcluded: (i)All tumours whicharehistologically classifiedas premalignant,asnon-invasiveorascancer in situ includinganyGIN stage (cervical intraepithelialneoplasia); (ii)Non-malignant conditions thatcanbecomemalignant, includingessential thrombocythaemiaand polycythaemia rubravera; (iii)All tumoursof theprostateunlesshistologically classifiedas havingaGleason scoregreater than6orhaving progressed toat leastclinicalTNM classificationT2nOMO; (iv)All cancersarising in the skinother thanmalignantmelanoma histologically classifiedashavingprogressed to at leastClark'sLevel II; (v)Lymphoma limited to 1 (one) regionof lymphnodes;and (vi)Any cancerdiagnosedand treatedbyprimary biopsyonlyanddoesnot requireany additional surgical,medical, radiotherapyor othermodalities, shallnotqualifyas"cancer". Part3 -5.andAnnexeDExclusions CoronaryArtery (bypass)Surgery: The followingareexcluded: (i)Angioplasty - (Angioplasty isaminimally invasive endovascularprocedure towidennarrowedor obstructedarteriesorveins, typically to treat arterialatherosclerosis) (thiswaspreviously included in theGroupPolicy); (ii)Anyother intra-arterialprocedures;and (iii)Key-hole surgery. Nobenefit ispayable ifa claim foraheart attackorheart transplanthasbeenpreviously admitted in respectof thePolicyholder. Part3 -3.5.1.Exclusions SDM shallnotpayanyDreadDiseaseBenefit if thePolicyholderdies (whetherasa resultof the InsuredEventoranycausewhatsoever) prior to thedateonwhich theclaim fora DreadDiseaseBenefit is submitted. In theevent thatSDMacceptsa claim for DreadDiseaseBenefits,and thePolicyholder dies,SDM shallmakepaymentof theDread DiseaseBenefit to theBeneficiary inaddition toany claimspayable in termsof theFuneral Policy . Provisionsof thePukwanayaKganyaContract ("PYKContract") Part3 -5.andAnnexeDExclusions TotalKidneyFailure: Nobenefit ispayable ifa claim foraKidney TransplantorKidneyCancerhasbeen previouslyadmitted in respectof the Policyholder. Part3 -4.andAnnexeDExclusions MajorOrganTransplant: Nobenefit ispayable foraHeartTransplant ifa claim forCoronaryArtery (bypass)Surgeryora HeartAttackhasbeenpreviouslyadmitted in respectof thePolicyholder. Nobenefit ispayable foraKidneyTransplant if a claim forTotalKidneyFailurehasbeen previouslyadmitted in respectof the Policyholder. Nobenefit ispayable foranyorgan requiring transplantand forwhichorgana claim for Cancerhasbeenpreviouslyadmitted in respect of. Part3 -5.andAnnexeDExclusions Blindness: No furtherexclusionsapply. Part3 -5.andAnnexeDExclusions Coma: The followingareexcluded:A coma secondary toalcoholordrugmisuse isnotcovered. Part3 -5.andAnnexeDExclusions Multiple sclerosis: Noexclusionshavebeenprovided for.