Pukwana ya Kganya Terms & Conditions

52 9.1.4 The Kganya Benefits Fund Trust shall only pay the Premiums in respect of the Policyholder in terms of the Policies if - 9.1.4.1 the Policyholder qualifies as a Member in terms of the Master Regulations, read with the Basic Benefits Regulations; and 9.1.4.2 without limitation to the provisions of clause 9.1.4.1 above, the Policyholder has paid his/her Membership Contribution to the Kganya Benefits Fund Trust. 9.1.5 In the event that any of the above conditions in clause 9.1.4 of this Part I are not met, the Kganya Benefits Fund Trust shall not be obliged, and shall no longer pay, the Premiums to the Insurer in respect of the Policyholder, until such time as the Policyholder resumes payment of his/her Membership Contribution to the Kganya Benefits Fund Trust, as provided for in the Master Regulations, read with the Basic Benefits Regulations. 9.1.6 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. 9.1.7 Payment of the Premiums by the Kganya Benefits Fund Trust does not entitle the Kganya Benefits Fund Trust to any rights in terms of this Pukwana ya Kganya Contract nor entitle it to any Benefits. 9.2 Review of Premiums 9.2.1 The Insurer shall review the Premiums payable at least annually to ensure that the Policies remain actuarially sound. 9.2.2 Without limitation to the provisions of clause 9.2.1 of this Part I, the Insurer shall review and change 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, subject at all times to the Applicable Laws. 9.2.3 Without limitation to the provisions of clause 9.2.1 or clause 9.2.2 of this Part I, the Insurer reserves the right to review and change the Premium at any time upon the occurrence of any of the following events: 9.2.3.1 if the Membership Contributions change; and/or 9.2.3.2 if the claims ratio exceeds 80% (eighty percent) in respect of all Policyholders. 9.2.4 The Insurer shall, following the outcome of the review mentioned above, 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. 9.3 Non-payment of Premiums and Forgiveness Rules 9.3.1 In the event of non-payment of a Premium of a Policyholder referred to in clause 9.1.5 of Part I, no Benefits shall be paid in respect of such Policyholder unless - 9.3.1.1 the requirements of clause 8.2 of this Part I are met; or 9.3.1.2 the Forgiveness Rules as set out in Annexe E.5 can be applied in respect of the Missed Premium(s). 9.3.2 If the requirements set out in clause 9.3.1 are not met, then no Benefits will be paid by the Insurer in respect of the Policyholder upon the happening of an Insured Event. 10. Exclusions and limitations All exclusions and limitations applicable to the Policies are set out in Part II and Part III, respectively. 11. Waiting Periods 11.1 The Waiting Periods in terms of the Policies, if applicable, are as set out in Part II and Part III below. 11.2 As provided for in clause 8.2 of this Part I, payment of Benefits will always depend on whether or not the applicable Waiting Period in terms of the Policies has ended. 11.3 If the Insured Event happens during the Waiting Period (i.e before the Waiting Period has ended) (if applicable in terms of the Policies), the Benefits will not be paid. 12. Dependent Children 12.1 A Dependent Child in relation to a Policyholder is the following persons: 12.1.1 a child born to the Policyholder, subject to the provisions of clause 12.4 of this Part I; 12.1.2 a legally adopted child of the Policyholder; 12.1.3 a child adopted by custom (provided that both natural parents are deceased) by the Policyholder, who are indicated as Dependent Children in the Payment Receipt Booklet, but excludes – 12.1.4 a child who survives a Policyholder and does not qualify as a Paid-up Dependant; 12.1.5 a child of any Dependent Child of a Policyholder (i.e. grandchildren); or 12.1.6 a child who is 25 (twenty-five) years or older, subject to clause 12.2 of this Part I. 12.2 Notwithstanding the provisions of clause 12.1.6 above, a child who is 25 (twenty-five) years or older and permanently dependent on the Policyholder because of mental and/or physical disability, will qualify as a Dependent Child if - 12.2.1 the mental and/or physical disability existed or occurred whilst the child otherwise qualified as a Dependent Child; and 12.2.2 at least 1 (one) Premium was paid by the Kganya Benefits Fund Trust in respect of the Policyholder prior to the date the child would otherwise cease to qualify as a Dependent Child. 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 (six) Months after the date of birth or adoption, as the case may be. 12.4 A child of a Policyholder (who is the father) shall not be a Dependent Child of the Policyholder unless – 12.4.1 the natural mother is (i) deceased, or (ii) not a Member of the ZCC; or 12.4.2 the Policyholder is the legal guardian of such a child. 12.5 The Policyholder shall provide all such documentary and other evidence, as may be required by the Insurer from time to time, to establish whether a child qualifies as a Dependent Child for purposes of this Pukwana ya Kganya Contract.