Pukwana ya Kganya Terms & Conditions

37 Regulations; and (ii) have paid Your Membership Contribution to the Trust. If these conditions are not met, the Trust shall no longer pay the Premiums to Us until such time as You resume payment of Your Membership Contributions. 5.4. If the Trust fails to pay the Premiums due to Us, Your Benefits in terms of the Policies may be forfeited, subject to the Forgiveness Rules (see 6 below). 5.5. The Premiums payable in terms of the Contract are as follows: Policy Premium amount Funeral Policy R72.68 Dread Disease and Personal Accident Plan R2.07 5.6. The Premiums are not fixed and may change if We review the Premiums as permitted in terms of the Contract (see 7 below). 6. How the Forgiveness Rules work 6.1. The Forgiveness Rules provide for leniency (where a Claim would ordinarily be declined) by considering the consistency of Your Premium payment history (with reference to Your payment of Membership Contributions as contained in the Payment Receipt Booklet). 6.2. You shall thereby be allowed such number of Missed Premiums as specified below, without affecting the payment of Benefits even where a Premium may have been missed. Period Cumulative number of Premiums required Missed Premiums 1 11 1 2 22 2 3 33 3 4 44 4 5 55 5 6+ 66 6 7. Premium review 7.1. We will review Your Premium at least annually to ensure that the Policies remain actuarially sound. 7.2. We also have the right to review the Premiums at any time if there are reasonable actuarial grounds to do so or where the review is required for Your benefit, subject to the terms of the Contract and the Applicable Laws. 7.3. The Contract also allows for a review of the Premiums if the Membership Contributions change, or if the claims ratio in respect of all Policyholders of the Contract, exceeds the claims ratio percentage as set out in the Contract. 7.4. If the premium review requires a change to Your Premium, We will notify You of the change in Your Premiums within the time periods prescribed in terms of the Applicable Laws. A change in Your premium may or may not affect (increase or decrease) the Benefits. 8. How Waiting Periods work 8.1. A waiting period is a period when the Policies (and the cover in terms thereof) are in force, but during which period no Benefits will be payable. The Waiting Period is calculated from the Inception Date. 8.2. The Waiting Periods are indicated in the table below (see 15 below). 8.3. If you are an Existing Member, please refer to the section Information for Members who were members of the Trust before 1 January 2023 for details about Waiting Periods. 9. Waiting Periods in respect of the Funeral Policy 9.1. Note that no Waiting Period will be applied if: 9.1.1. death occurs as a result of an unforeseen external, violent and visible event, which occurs independently of other causes, which accident is not reasonably expected, or designed (“ Accident ”); or 9.1.2. You provide confirmation that i) you were covered in terms of another funeral policy that had lapsed or had been terminated or cancelled (“ the previous policy ”) with another insurer, which previous policy was in force at least 31 (thirty one) days before the Inception Date; ii) the previous policy provided cover for similar risks covered in terms of the Funeral Policy; iii) the previous policy imposed a Waiting Period shorter than 91 (ninety-one days), which had been completed in full and iv) the previous policy imposed a Waiting Period of 91 (ninety- one) days or longer and which 91 (ninety-one) days had been completed in full. 9.2. If the previous policy provided a Waiting Period of 91 days or longer, and only a part thereof had been completed by You in terms of the previous policy, We will reduce the Waiting Period with completed portion if the previous policy covered risks similar to the risks covered in terms of the Funeral Policy 10. How to claim 10.1. You may submit a claim for Benefits at any one of the Kganya Insurance Administrators Service Centres; or any of Our designated Client Care Offices. 10.2. You must do so in the manner and within the period as set out in Your Contract. 10.3. We will not be liable for claims: 10.3.1. where the claim was not made in accordance with the Contract or within the time period prescribed; 10.3.2. where the insured event happened (i) before the Inception Date, (ii) after cancellation of the Contract, iii) after cover in respect of an Assured Life ceased; 10.3.3. where the Trust has not paid Your Premiums as required in the Contract, subject to the Forgiveness Rules; or 10.3.4. where a Waiting Period is applicable which has not yet expired. 10.4. Details of the claims documents to be submitted are set out in the table below (see 15 below). 11. Cooling off 11.1. You have 31 days from the Inception Date to cancel the Contract (“ cooling-off period ”) unless a benefit is claimed or paid or an insured event has occurred. 11.2. Please notify Us if You wish to cancel Your Contract within the cooling- off period by way of communication via our administrator, Kganya Insurance Administrators as follows: 11.2.1. at any one of the Kganya Insurance Administrators Service Centres; or 11.2.2. Per telephone: 0800 000 538 11.2.3. Per email: help@kganya.co.za 11.3. If You cancel the Contract, it will be deemed that You have similarly elected to cancel Your Membership to the Trust in accordance with the Master Regulations. This is so since You can only gain access to this Contract through Your Membership, and that all Members to the Trust automatically receive, as part of the Membership, the Benefits in terms of the Contract. 11.4. Furthermore, if You cancel Your Membership to the Trust, it will be deemed that You similarly cancelled this Contract. 11.5. A notification to the Trust for cancellation of Your Membership, shall also be deemed to constitute a notice of cancellation of this Contract and the other way around as well. 12. Cancellation 12.1. We will be entitled to cancel this Contract by means of 31 days’ written notice to You, or such longer period, in the event that: 12.1.1. fraud is committed; 12.1.2. any false and/or untrue representation was made to Us and/ or any relevant information was not disclosed to Us which materially affected Our ability to assess the risk under this Contract at the date of conclusion or variation of this Contract; 12.1.3. termination of the Contract is required as a result of any change in the Applicable Laws; 12.1.4. You no longer qualify as a Member of the Trust; or 12.1.5. the Trust and/or We terminate Our relationship with each other, for whatever reason. This is necessary as the Trust is the premium payer and stands in a relationship with Us which is required for purposes of this Contract. 13. Effect of cancellation If the Contract is cancelled, no Benefits will be paid if an insured event happens after the date of cancellation.