TYB Pukwana ya Kganya Contract Summary & Disclosures
will then become the Policyholder upon Your death, subject to the conditions as set out in the Contract). 3.5 “ Stillbirth” means the death of a foetus 28 weeks or longer after conception, immediately prior to or during delivery. 4 Inception Date 4.1 In terms of this Contract, insurance cover in respect of the Assured Lives commences on the later of the date on which You i) completed the MPP Form and purchased a Membership Book from the Trust; or ii) paid the initial Membership Contribution to the Trust, and on which date You accept the offer for insurance cover and Benefits in terms of the Contract (" Inception Date "). We waive the requirement to receive notification of acceptance of the offer. 4.2 If You are a member of the Trust before 1 January 2023 (" an Existing Member "), please refer to the section Information for Members who were members of the Trust before 1 January 2023 for details about Your Inception Date. 4.3 If You are a Member before 1 April 2023 (" Basic Needs Existing Member "), the cover in terms of the Thari ya Baruti Basic Needs Benefit Policy will commence on 1 April 2023. Payment of Your Membership Contributions will be deemed acceptance of the offer for insurance cover and Benefits in terms of the Thari ya Baruti Basic Needs Benefit Policy. We waive the requirement to receive notification of acceptance of the offer. 4.4 For all persons who are not Basic Needs Existing Members, and who become Members after 1 April 2023, insurance cover in terms of the Thari ya Baruti Basic Needs Benefit Policy will commence on the Inception Date as stipulated in clause 4.1. 5 Premium payment obligations 5.1 The Premiums and Additional Premiums payable in terms of the Policies, are payable by the Trust. 5.2 Premiums and Additional Premiums are due and payable monthly in advance on the 1 st day of each Month (“ the due date ”) for the cover to be enjoyed during that Month. 5.3 The Trust will only pay the Premiums if You i) qualify as a Member in terms of the Master Regulations, read with the Enhanced Benefits 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 and Additional Premiums to Us until such time as You resume payment of Your Membership Contributions. 5.4 If the Trust fails to pay the Premiums and Additional 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 and Additional Premiums payable in terms of the Contract are as follows: Policy Premium Additional Premium Thari ya Baruti Funeral Policy R72.68 R19.53 Thari ya Baruti Dread Disease and Personal Accident Policy R2.07 R0.23 Thari ya Baruti Basic Needs Benefit Policy R6.90 N/A 5.6 The Premiums and Additional Premiums are not fixed and may change if We review the Premiums and Additional 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). The Forgiveness Rules apply to a Claim for a Thari ya Baruti Funeral Benefit, a Thari ya Baruti Personal Accident Benefit, Dread Disease Benefit and the core Thari ya Baruti Basic Needs Benefit. The Forgiveness Rules do not apply to the loyalty Basic Needs Benefits. 6.2 You shall thereby be allowed such number of Missed Premiums and/or Additional Premiums as specified below, without affecting the payment of Benefits even where a Premium and/or Additional 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 and Additional Premium review 7.1 We will review Your Premiums and Additional Premiums at least annually to ensure that the Policies remain actuarially sound. 7.2 We also have the right to review the Premiums and Additional 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 and Additional 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 and Additional Premium review requires a change to Your Premiums and/or Additional Premiums We will notify You of the change in Your Premiums and/or Additional 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 0 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 the Waiting Periods for Existing Members. 9 Waiting Periods in respect of the Thari ya Baruti 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 Thari ya Baruti 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 Thari ya Baruti Funeral Policy. 10 How to claim 10.1 You may submit a claim Claim for Benefits at any one of the Kganya Insurance Administrators Service Centres (see https://mykganya.com ); 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 Claims: 10.3.1 where the claim Claim was not made in accordance with the Contract or within the time period prescribed; 10.3.2 where the insured Insured event 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 Premium and/or Additional Premiums as required in the Contract, due to Your failure to pay Your Membership Contributions to the Trust, 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 Claim documents Documents to be submitted are set out in the table below (see 0 below).
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