1.Definitions
1.1 “Principal member”: A person who is below age 65 at entry, who is a policyholder of Rand Mutual Assurance (RMA), who is a member of this policy, who accepts the conditions as stated herein and the premiums indicated in the schedule to this policy and who is fully described in the schedule to this policy. The person must have the ability to afford and pay the monthly premiums stated in the schedule. The principal member must be a citizen or permanent resident of South Africa. The principal member where specified will be a person who qualifies for the eligibility conditions as specified in the schedule to this policy. A person over the age of 65 years may not be a principal member on a new policy. The Principal member may not be younger than 18 years old.
1.2 “Spouse”: A person who is below age 65 at entry who is married to the principal member by law, tribal custom or under the tenets of any religion and where applicable, a relationship between two people of the same gender. The principal member may, due to a life changing incident, apply to Rand Mutual Assurance (RMA) in writing to change the spouse details. The spouse as nominated in the schedule to this policy document shall be the only spouse covered under this definition. The Spouse must be a South African citizen or permanent resident of South Africa
1.3 “Child”: An unmarried child not older than 21 years old of the principal member including a posthumous child, stepchild, child of any common law spouse of the
principal member, or legally adopted child, provided that proof of any child is submitted to Rand Mutual Assurance (RMA) and acceptance acknowledged by the
underwriter. A child who is stillborn shall be covered for funeral benefits if the death occurred after the 26th week of pregnancy. Only 2 (two) stillbirth claims will be
accepted per family during the term of the policy. Claims for stillborn cases will be capped to the less of 10% of the principal member cover or R3000.00 per claim. The
child must be a South African citizen or permanent resident of South Africa.
1.4 “Unmarried Children”: Are covered to below age 21 and to below age 26 years if they are a full-time student. Unmarried children who are mentally impaired or totally or permanently disabled prior to age 22, who are unable to care for themselves are covered to death, cessation age of the principal member or withdrawal. (In both instances, satisfactory proof to the underwriter of the condition of disablement or confirmation of full-time study must be submitted when policy is signed up. This does not include part-time and correspondence students). The unmarried child must be a South African citizen or permanent resident of South Africa.
1.5 Still Born: This means a baby being born deceased after the 26th week of pregnancy. The stillborn child must have been born to either the policyholder or the
spouse of the policyholder.
1.6 “Extended family member”: A person for whose funeral costs the principal member is financially responsible for in the event of their death and shall include:
own children, adopted children, stepchildren, parents, parents-in-law, grandparents, brothers, sisters, uncles, aunts, nieces, nephews, grandchildren, additional spouses and any other person that the Principal member has an insurable interest in. There is a maximum joining age for extended family members is 84 years
old. The cover amount will be limited in accordance with the age at entry and indicated in the schedule to this policy. The cover at entry will always be applicable
unless the policyholder elects to change benefits. The principal member may due to a life-changing incident apply in writing to Rand Mutual Assurance (RMA) to change
the details of the extended family members within three (3) months of the occurrence of such an event. Any life insured may be covered on a maximum of two
policies and/or for a maximum benefit of R50 000. The principal member must inform Rand Mutual Assurance (RMA) in writing within 90 days of the birth date of
any births of immediate children for the children to be covered under this policy. No cover will be in place if this is not done. It is the responsibility of the Policyholder to
supply the accurate and correct information about the details (names, surname and ID number) of the lives assured. Failure to supply correct and accurate details of the
lives assured will lead to repudiation in claims. A person aged 84 Years and above may not be added on a new policy or on a converted policy. The extended family
member must be a South African citizen or permanent resident of South Africa
1.7 “Beneficiary”: Is the person fully described in the schedule to this policy who has been nominated by the principal member to receive the benefits or direct the
usage of the benefits claimed as a result of death of the principal member. The nominated beneficiary should not be younger than 18 years old. The Policyholder
must nominate a beneficiary on the policy to receive the benefits.
1.8 “Claimant”: a natural person or juristic person legally entitled to lodge a claim on the policy including but not limited to the policyholder, nominated beneficiary, legal
spouse, or any other individual nominated by the master of the high court to receive policy benefits upon the death of the principal member
1.9 “Repatriation”: The transportation of mortal remains within the borders of South Africa. NB Only applicable if your policy provides this benefit and the
premium is paid
1.10 “Accident”: An unlooked for, unforeseen event which could not reasonably have been expected that directly caused the death of an insured life. Accidental
death excludes self-inflicted injury, suicide, a criminal act, drug abuse or alcohol abuse (where a person is deemed unfit for driving because the blood alcohol limit
exceeds the prescribed limit as applicable by law).
1.11 “Complaint”: Refers to a specific complaint relating to a financial service rendered by a financial services provider or representative to the complainant on or
after the date of 30 September 2004, and in which it is alleged that Rand Mutual Assurance (RMA) Limited:
1.11.1 has contravened or failed to comply with the provisions of the FAIS Act and that as a result thereof the complainant has suffered or is likely to suffer financial
prejudice or damage;
1.11.2 has willfully or negligently rendered a financial service to the complainant which has caused prejudice or damage to the complainant or which is likely to result
in such prejudice or damage; or
1.11.3 has treated the complainant unfairly.
1.12.“Commencement date/Inception Date”: refers to the date of receipt of the first premium on a new policy.
1.13 “Policy Anniversary Date” An annual re-occurring date that occurs every 12 months after the date of inception of the policy.
Only applicable if applied for and appears on your policy schedule. NB Only applicable to the lives assured as per the Policy Certificate issued by Rand Mutual Assurance (RMA) Ltd.
2.1 The benefits will only be applicable if the policy premium is paid and your policy is up to date.
2.2 If added to your chosen product, the benefit will only apply if you pay the benefit premiums due. The benefit amount is not included in your funeral policy premium; it
is an additional premium that is payable monthly.
2.3 Repatriation Benefit: This is an additional benefit that only applies to products as per the product information leaflet. It provides for the transportation of the mortal
remains from one location to another in respect of death of the principal member, spouse, dependent children and extended family members.
2.4 The benefit is only applicable within the borders of South Africa.
3 CANCELLATION:
3.1 The policyholder has the right to cancel this policy within 31 (thirty-one) days from the date of receipt of the first premium on the new policy.
3.2 Cancellation of the policy must be communicated in writing by the policy holder to the underwriter and send to [email protected] or
3.3 At the end of the 31 (thirty-one) day period, you may still give notice to us to cancel the policy, but you will not be entitled to a refund of premiums
3.4 We may cancel the policy by giving you 31 (thirty-one) days’ notice.
4.1 A waiting period refers to a window period of the calculated time during the life of an active policy when premiums must be paid, but no benefit will be paid if a claim
event happens as a result of natural causes. It is a mechanism to help Rand Mutual Assurance (RMA) manage risk around cover and protect other policyholders.
4.2 The Waiting periods are applicable to each life assured under a policy and are calculated from the policy commencement date as stipulated above and from the
date each life was added on the policy thereof.
4.3 There is no waiting period if the Principal Member can provide proof of having a previous policy with another registered insurer within the last 31 Days prior to
entering into a policy with Rand Mutual Assurance (RMA).
It is very important to ensure that the product or transaction meets your needs and that you feel you have all the information you need before making the decision. It is
recommended that you discuss with the intermediary or insurer the possible impact of the proposed transaction on your finances, your other insurance/assurance
policies or your broader investment portfolio. You should ask for information about the flexibility of any proposed policy.
Where paper forms are required, it is advisable to sign them only once they are fully completed. Feel free to make notes regarding verbal information, and to ask for
written confirmation or copies of documents.
Remember that you may contact either the FAIS Ombudsman, Long-Term Insurance Ombudsman or the Financial Sector Conduct Authority (FSCA), whose details are
set out below, if you have any concerns regarding the products sold to you or advice given to you.
13.COMPLAINTS AND COMPLIANCE:
If you feel that a representative of Rand Mutual Assurance (RMA) or Rand Mutual Assurance (RMA) Limited, has not complied with the Policyholder Protection Rules
(PPRs), the Financial Advisory and Intermediary Services Act, Long-Term Insurance Act, and/or any other related laws, kindly contact the Compliance Officer on the
contact details provided below. If your complaint remains unresolved to your satisfaction, you may refer your complaint to the Ombud for Long-Term Insurance,
Ombud for Financial Services Providers or the Financial Sector Conduct Authority (FSCA)
All complaints must be submitted in writing and e-mailed or posted to
E-mail: [email protected]
13.1 Upon receipt of a written complaint Rand Mutual Assurance (RMA) will provide written acknowledgement of receipt of the complaint not later than the expiry of
the 48 working hours.
13.2 We will endeavor to resolve your complaint within a period of not more than six (6) weeks from receipt of a written complaint. Should there be any delays in this, we
will advise you timeously.
13.3 Should you not be satisfied with our final response with regard to your complaint, you may direct a written complaint to the Office of the Ombud for Financial Services Providers within the six (6) months period after receipt of our response to you.
13.4 The contact details for the Ombud for Financial Services Providers are as indicated below.
14 DETAILS OF THE 3SIXTY LIFE COMPLIANCE OFFICER:
Compliance Officer
BDO Building, 1st Floor, 22 Wellington Road, Parktown, 2193
Tel: 0860 222 132
E-mail: [email protected]
15 PRODUCT SUPPLIER, UNDERWRITER & ADMINISTRATOR:
Rand Mutual Assurance (RMA) is the product supplier authorized to render services as an underwriter under the Long-term Insurance Act 52 of 1998. See contact
details of the product supplier below:
Rand Mutual Assurance (RMA) Limited
Reg No 1990/006308/06
Tel: 0860 222 132 Tip-Offs Fraud Line: 0800 21 22 56
E-mail: [email protected]
16 DETAILS OF THE OMBUDSMAN FOR LONG-TERM INSURANCE:
Ombudsman for Long-Term Insurance
Private Bag X45, Claremont, 7735
Tel: (021) 657 5000 Fax: (021) 674 0951 www.ombud.co.za
17 DETAILS OF OMBUD FOR FINANCIAL SERVICE PROVIDERS:
Ombud for Financial Service Providers
P.O. Box 74571, Lynnwood Ridge, 0040
Tel: 0860 324 766 Fax: (012) 348-3447
E-mail: [email protected] www.faisombud.co.za
18 DETAILS OF THE FINANCIAL SECTOR CONDUCT AUTHORITY:
The Financial Services Conduct Authority
P.O Box 35655, Menlo Park, 0102
Tel: (012) 428 8000 Fax: (012) 346 6941
19 CONSENT AND PERMISSION TO PROCESS PERSONAL INFORMATION:
19.1. The policyholder hereby provides authorization to Rand Mutual Assurance (RMA) to process the personal information provided for the purpose stated.
19.2. Withholding of or failure to disclose personal information will result in Rand Mutual Assurance (RMA) not being able to perform its functions and/or provide any
services or benefits that may be required from them.
19.3. Where the policyholder shared personal information of other individuals with Rand Mutual Assurance (RMA) Ltd, the policyholder hereby provides consent on their behalf to the collection, use and disclosure of their personal information in accordance with this consent provided and warrant that they are authorized to give
this consent on their behalf.
19.4. The policyholder indemnifies and holds Rand Mutual Assurance (RMA) harmless in respect of any claims by any other person on whose behalf the
policyholder has consented.
19.5. Policyholder understands that in terms of POPI Act and other applicable legislation, there are instances where express consent is not necessary in order to
permit the processing of personal information, which may be related to police investigations, litigation or when personal information is of public interest.
19.6. The policyholder shall not hold Rand Mutual Assurance (RMA) responsible for any improper or unauthorized use of personal information that is beyond
reasonable control of Rand Mutual Assurance (RMA) Ltd. For further information related to the above, please refer to our POPI Policy on:
www.randmutual.co.za
The policy benefits under the previous policy must have provided cover in respect of similar risks relating to the same lives covered under the new policy with Rand Mutual Assurance (RMA). The Policyholder must provide proof that they have completed the waiting period in respect of the previous insurance policy. The policyholder must have completed the waiting period with the previous insurer, if not the waiting period applied will be the balance of the waiting period from the previous insurance policy.
4.4 There is a 6 (Six) months waiting period for claims due to natural causes (including suicide) for all lives.
4.5 Immediate cover for accidental death on condition that the first premium is paid (refer to the definition of accident).
4.6 A principal member on a policy may not be replaced. A deceased person insuredon the policy may not be replaced if a claim has been submitted in respect of that life
(whether the claim was paid or declined).
Rand Mutual Assurance (RMA) reserves the right to amend, revoke, vary or alter any of the terms and conditions of this policy provided that Rand Mutual Assurance
(RMA) gives the Principal Member at least 31(thirty-one) days written notice of such revision.
The policy, cover and waiting periods will be effective from the commencement date that appears on your policy certificate and on condition that the first premium
is paid. The cover will continue as long as future premiums are paid. Cover is provided for a month and this month is calculated from the date the client has
nominated on the application form as the due date for premium payment.
7.1 Premiums are payable in advance.
7.2 Premiums are due on a date nominated on the application form and reflected on the Policy Certificate
7.3 Payments need to be made before or on the above nominated date for cover to be provided for that month.
7.4 Premiums are payable in advance.
7.5 The premium due date is the date that you have selected for the debit order to operate on each month.
7.6 Premiums will be collected from your chosen bank account each month on your selected date. Collection will be done in accordance with the client agreement as
completed on the policy application form.
7.7 In the event that the premium is returned by the bank for non payment, the premium will then become due by the Principal member and payment must be made
to the banking details provided by the insurer.
7.8 If the premium is not received within the 1 Month grace period allowed, there is no cover in terms of this policy until the date the premium is paid and claims may be
declined. Stop Order payments (salary deductions)
7.10 Premiums are paid in advance
7.11 The premium will be deducted weekly/monthly from your salary by your employer and paid to Rand Mutual Assurance (RMA)
7.12 It is your responsibility to ensure that premiums are deducted from your salary
8.1 Rand Mutual Assurance (RMA) reserves the right to review the monthly premiums each year in order to ensure that the policy obligations are met.
8.2 Rand Mutual Assurance (RMA) will notify the policyholder of a pending review and provide notice 31 days prior to the expected premium increase.
9.1. Claims:
9.1.1 Benefits under this policy can only be claimed if the claim event occurred while the policy is active
9.1.2 The information provided by you at the time of entering into the policy agreement or when a change is made to your policy, will be used to assess the
validity of a claim.
9.1.3 Should there be a discrepancy between the information provided by you at the time of entering into the policy or any subsequent change, and the information on
the claims document provided, we will at our sole discretion determine the validity of the claim.
9.1.4 We have the right not to pay a claim on any life assured if the claim event happened during the waiting period as described in 4 above.
9.1.6 If any information that you have provided on any life assured is incorrect, any benefit that becomes due may be repudiated.
9.1.7 You will be responsible for the costs of obtaining all relevant medical records and submitting them to us.
9.1.8 Any outstanding premiums will be deducted from the cover amount before the claim is settled
9.2 How to claim
9.2.1. You may submit a claim by visiting our website at www.randmutual.co.za or
9.2.2. You may email [email protected]
9.3 Supporting documents required
The following supporting documents must be provided when You submit a claim:
9.3.1. All claims:
9.3.1.1. Original or certified copy of the claimant’s ID
9.3.1.2. Original or certified copy of the beneficiary’s ID
9.3.1.3 Original or certified copy of the death certificate
9.3.1.4. Original or certified copy of fully completed BI-1663/BI-1680
9.3.1.5. Beneficiary’s proof of bank account
9.3.1.6. A police report with details of the cause of death in a case of an accidental death.
9.3.1.7. Certified copy of an unabridged birth certificate in case of a new born baby.
9.3.1.8. Medical report letter with stamp of the medical institution concerned in the case of a still born child.
9.4. Failure to lodge a claim and submit documents within twelve (12) months after the date of death, may invalidate your claim. Claims, in respect of dependents, will only be paid where such dependents have been nominated on the original application form.
9.5. Rand Mutual Assurance (RMA) reserves the right to request any further documentation or information as it may deem necessary to accurately assess a claim. Failure to supply the requested documentation within 48 hours may invalidate the claim
10.GRACE PERIOD:
PLEASE note that the grace period is only applicable from the 2nd month of cover
10.1 A grace period of 1 (one) month is allowed for the payment of a missed premium from the date on which the premium is due and notice given.
10.2 The insurer will notify the policy holder within 15 days after the premium payment was due of non-payment.
10.3 During the grace period, the policy will be placed in arrears and any outstanding premium amounts during the grace period will be deducted from the Claim settlement.
11 REINSTATMENT OF LAPSED POLICY
11.1. If payment of an outstanding premium is not made in the second month after the date on which the premium was due, then the policy will lapse and there will be no cover from the date on which the missed premium was due.
11.2. The policy may be reinstated at the sole discretion of Rand Mutual Assurance (RMA) by requesting Rand Mutual Assurance (RMA) in writing to reinstate the policy within 3 months of the policy having lapsed.
11.3. No arrear premium payments will be accepted once a policy has lapsed.
11.4. If the policy is reinstated within 3 months from the lapsed date and the waiting period has not been completed on the policy, the unexpired portion of the waiting period will still be applicable. If a policy is reinstated after the waiting period is completed, no reinstatement waiting period will be imposed