Pukwana ya Kganya Terms & Conditions

58 3.2 The Insurer shall only pay 1 (one) Claim per Dread Disease Category regardless of the number of Claims made in respect of the same Dread Disease occurring and/or being diagnosed forming part of the same Dread Disease Category. 3.3 The Insurer may, in writing, notify the Policyholder that an examination is required by a Medical Practitioner selected by, and at the cost of the Insurer, to independently determine the cause and/or extent of the purported Dread Disease. 3.4 Subject to the Forgiveness Rules as provided for in in clause 9.3 of Part I and Annexe E.5 , Dread Disease Benefits in respect of a Policyholder as Assured Life will only be paid upon the occurrence of a Dread Disease if: 3.4.1 the Insurer (or its duly appointed administrator, Kganya Insurance Administrators), recorded a Premium in respect of the Policyholder with Dates of Payment in each of the 3 (three) consecutive Months preceding the Month in which the Date of Dread Disease occurred; and 3.4.2 the Date of Dread Disease is 91 (ninety-one) days after the Inception Date, being the Waiting Period, as provided for in clause 4 of this Part III. 3.5 All Premiums recorded by the Insurer (or its duly appointed administrator, Kganya Insurance Administrators) shall be paid to the Insurer in accordance with the terms of the Premium Payment Agreement. 3.6 Death of the Policyholder 3.6.1 The Insurer shall not pay any Dread Disease Benefit if the Policyholder dies (whether as a result of the Insured Event or any cause whatsoever) prior to the date on which the claim for a Dread Disease Benefit is submitted. 3.6.2 In the event that the Insurer accepts a claim for Dread Disease Benefits and the Policyholder dies, the Insurer shall make payment of the Dread Disease Benefit to the Beneficiary (as contemplated in the Funeral Policy), in addition to any Claims payable in terms of the Funeral Policy. 4. Waiting Period 4.1 AWaiting Period of 91 (ninety-one) days will apply to the Policyholder in terms of this Dread Disease and Personal Accident Policy in respect of the Dread Disease Benefits, calculated with effect from the Inception Date. 4.2 In terms of clause 11 of Part I, no Dread Disease Benefits will be paid in the event that the Insured Event occurs within the Waiting Period. 5. Exclusions and limitations The exclusions and limitations applied by the Insurer in respect of the Dread Disease Benefits in terms of this Dread Disease and Personal Accident Policy are indicated in Annexe E.3 . 6. Claim Documents for Dread Disease Benefits 6.1 Without limitation to the provisions of clause 13 of Part I, the following Claim Documents must be submitted to the Insurer in respect of a claim for Dread Disease Benefits: 6.1.1 DDCN Form signed by 3 (three) Committee Members and all such documents as set out in the DDCN Form. In the event that the Committee Members are unable or unwilling for whatsoever reason to sign the DDCN Form, the Beneficiary can approach the Insurer directly with such claim, or lodge a complaint as contemplated in clause 19 of Part I; 6.1.2 original or certified copy of the Medical Report; 6.1.3 original or certified copy of the identity document or identity card (copied both sides) of the Policyholder; 6.1.4 confirmation of Membership to the Kganya Benefits Fund Trust; 6.1.5 original and/or certified copy of the Payment Receipt Booklet to verify the Receipts; 6.1.6 confirmation of bank account into which the Dread Disease Benefits must be paid; and 6.1.7 any other documents required by the Insurer. 7. Cessation of cover for Dread Disease Benefits in terms of the Dread Disease and Personal Accident Policy 7.1 Insurance cover ceases for Dread Disease Benefits in terms of the Dread Disease and Personal Accident Policy if - 7.1.1 this Pukwana ya Kganya Contract is cancelled; or 7.1.2 the Policyholder ceases to be a Member of the Kganya Benefits Fund Trust in accordance with the terms of the Master Regulations, read with the Basic Benefits Regulations; or 7.1.3 upon the death of the Policyholder, subject to clause 3.6 of this Part III; or 7.1.4 upon the payment of Dread Disease Benefits in all of the Dread Disease Categories; or 7.1.5 the Kganya Benefits Fund Trust fails to pay the Premiums in respect of the Policyholder as Assured Life as a result of the Policyholder’s failure, as a Member, to pay his/her Membership Contribution, subject at all times to the Forgiveness Rules. Personal Accident Benefits 8. Personal Accident Benefits 8.1 Upon the happening of an Insured Event as specified in clause 6.1.37.2.1 of Part I, the Personal Accident Benefits payable in terms of this Dread Disease and Personal Accident Policy will be paid by the Insurer to the Policyholder in respect of the Permanent Disability of an Assured Life, where the Date of Permanent Disability occurs after the Inception Date. 8.2 The Personal Accident Benefits are calculated, as follows: 8.2.1 the aggregate of the Base Amount per Permanent Disability incurred in an Accident (as specified in Table A of Annexe E.4 ); 8.2.2 multiplied by the designated Percentage of Base Amount per Assured Life (as specified in Table B of Annexe E.4 ), subject at all times to the minimum Permanent Disability amount and the maximum Permanent Disability amount as specified in Table B of Annexe E.4 , as may be amended from time to time. 8.3 The Insurer shall only pay 1 (one) Claim per Permanent Disability Category in respect of Permanent Disabilities incurred by an Assured Life pursuant to an Accident, regardless of the number of Claims made in respect of such Assured Life. 8.4 The Insurer may, in writing, notify the Policyholder that an examination is required by a Medical Practitioner selected by, and at the cost of the Insurer, to independently determine the cause and/or extent of the purported Permanent Disability. 8.5 Subject to the Forgiveness Rules set out in clause 9.3 of Part I and Annexe E.5 , Personal Accident Benefits in respect of an Assured Life will only be paid in the event of the Permanent Disability of an Assured Life if: 8.5.1 1 (one) Premium is recorded by the Insurer (or its duly appointed administrator, Kganya Insurance Administrators) –