MI
Welcome Letter
Everest Funerals Mpumalanga (Pty) Ltd
Underwritten by RMA (FSP 46113)
Welcome to Everest Financial Services Funeral Scheme underwritten by RMA Life, we would like to thank you for choosing Everest Funeral Cover to provide you with peace of mind and take care of your needs when you need it most. We wish you a warm welcome and look forward to being of service to you.
We have attached your policy schedule, which details the members covered under the policy. Please go through your policy schedule thoroughly to familiarise yourself with the available benefits, and to ensure that we have the correct details for you and the insured members.
For enquiries or claims, call Everest on 013 590 5435 during working hours and after hours on 082 422 9117 or The RMA Contact center on 0860 102 532. We are available to assist you Mondays to Thursdays between 8am and 5pm, and Fridays between 8am and 4:30pm.
Yours sincerely,
Policy Schedule
Group Name: Everest Funerals Mpumalanga (Pty) Ltd
Underwritten by RMA (FSP 46113)
| Name & Surname | Doreen Ntjwaki Rabothata | Payment Method | EFT |
| ID No. | 9303150946084 |
Policy Holder's
Home Address (Physical Address) |
Sebota Street |
| Age | 29 | 558b | |
| Cell Phone No. | 0679173673 | Meadowlands Zone 7 soweto | |
| Alternative No. | N/A | Johannesburg Gauteng | |
| Email Address | rabothatadoreen90@gmail.com | 1559 |
| Your Policy Number is : 01-202203-191476 | Premium Collection Date | :31st |
|---|
| Inception Date | Required Package | Benefits | Monthly Premium | Cover Amount |
|---|---|---|---|---|
| John | Doe | john@example.com | john | john |
| The premium amount is 15% VAT inclusive. Maximum commission amount of 30% of each premium is payable with each premium collected, including any VAS (Value Added Service) premium. Premiums are payable in advance and your cover will only start once your premium has been received. The premium payer on the policy does not have any rights to the policy unless the Main member and the Premium payer are the same person. Your deductions will start on the date that you selected. For your peace of mind, please note that your funeral benefit scheme is underwritten by Rand Mutual Assurance. If any of your personal contact details change and it needs to be updated, please notify us immediately, as these are important in ensuring effective administration and communication with you in the future. | ||||
| Name & Surname | Dob / ID No | Relationship | Benefit Amount |
|---|---|---|---|
| John | Doe | john@example.com | john |
| John | Doe | john@example.com | john |
| John | Doe | john@example.com | john |
| John | Doe | john@example.com | john |
| John | Doe | john@example.com | john |
| John | Doe | john@example.com | john |
| John | Doe | john@example.com | john |
| John | Doe | john@example.com | john |
| Your child means an unmarried, financially dependent biological Child of the Main Life Assured or Spouse, who has not yet attained the age of 21 and will include: a posthumous Child, a stepchild, a grandchild, a legally fostered Child and an adopted Child and a Stillborn Child. All ages referred to in this Policy are Age Next Birthday. Cover for the Child will end when the Child reaches the age of 25 years | |||
| Name & Surname | Dob / ID No | Relationship | Contact No | Percentage |
|---|---|---|---|---|
| John | Doe | john@example.com | john | john |
| John | Doe | john@example.com | john | john |
| This is the person nominated by the Policyholder to receive the payment of the benefit under circumstances where the benefit is not paid to the Policyholder. | ||||
Terms and Conditions
Everest Funerals Mpumalanga (Pty) Ltd
Underwritten by RMA (FSP 46113)
RMA Life Assurance Company Limited, Reg No 1990/06308/06 (RMA Life) is the Insurer under this policy. The names of any intermediaries who are rendering services on this policy are reflected on the Policy Schedule together with the fees they will receive for these services.
This individual policy is underwritten on a group basis. The Policyholder will provide Everest Financial Services and RMA Life with all information required by RMA Life to enable RMA Life to underwrite this policy on a group basis. The risks covered under this insurance policy are rated based on the characteristics of a group of people together, as opposed to that of the individuals who are the Lives Assured under this policy. The group is reflected on the Policy Schedule and the Main Life Assured under this policy must be a member of the group for the Assured Lives to be included in the group of people on whose characteristics the policy is rated.
RMA Life will pay the benefits set out in this policy according to the terms and conditions set within this document. The policy will be amended if and when required as provided for in these General Terms and Conditions, and the amendments will then form part of the insurance contract. Should there be any conflict between this policy and any other document issued by RMA Life, the terms and conditions set out in this policy will prevail.
The Individual Funeral Policy is a funeral policy that will pay a lumpsum upon the death of an Assured Life. Please keep this document in a safe place.
1. Definitions
1.1. Accident/Accidental: An Accident means a sudden, unexpected, unusual, specific event occurring at a particular moment and a particular place which even the Assured Life could not foresee, anticipate or envisage and which results in visible, violent, external and traumatic death of the Assured Life.
1.2. Natural Death: is medically defined as death brought on by a disease or age rather than caused by other factors like Accident or crime.
1.3. Age Next Birthday: Insured's age at a particular time with the addition of 1 year.
1.4. Assured Life: This means the person whose life is insured under this policy and upon whose death the benefit will pay out if the conditions of this policy are met. All Assured Lives must be South African citizens or a Permanent Resident, or a person with a legal South African work permit. The Assured Lives are the Main Life Assured and his / her Spouse and Children,. The names of the Assured Lives are reflected on the Policy Schedule.
1.5. Beneficiary: This is the person nominated by the Policyholder to receive the payment of the benefit under circumstances where the benefit is not paid to the Policyholder.
1.6. Benefit start date: means the date on which cover commences in respect of an Assured Life, which is the day on which the first Premium is paid with respect to that Assured Life.
1.7. Child/Children: Will mean an unmarried, financially dependent biological Child of the Main Life Assured or Spouse, who has not yet attained the age of 21 and will include: a posthumous Child, a stepchild, a grandchild, a legally fostered Child and an adopted Child and a Stillborn Child.
1.8. All ages referred to in this Policy are Age Next Birthday.
The benefit for Children is age-dependent and limited in terms of applicable legislation. Notwithstanding anything included in the table hereunder, the claim amount will be limited to the maximum amount allowed in applicable legislation.
Benefit tables for Children:
| Child Age | % Main Life Assured’s Cover Amount |
|---|---|
| Stillbirths | 12.5% |
| < 1 | 12.5% |
| 1 - 5 | 25% |
| 6 - 13 | 50% |
| > 14 | 100% |
1.9. Insurer: RMA Life is the Insurer, and in return for a stipulated Premium, RMA Life accepts the risks and will payout the benefit if a claim event occurs.
1.10. Not taken up (NTU): This is when the Premium Payer does not pay the first Premium payable on the policy. The policy is considered as Not taken up by the Policyholder (NTU) and cancelled from inception.
1.11. Policyholder: The person that has taken out the policy, has an insurance contract with RMA Life and is also the Premium Payer. The Policyholder and the Main Life Assured is the same person.
1.12. Policy start date: means the date on which the policy becomes effective.
1.13. Premium: the amount specified as payment for the policy benefits and confirmed in the Policy Schedule and amended as provided for in this General Terms and Conditions.
1.14. Repudiation: In relation to a claim means any action by which RMA Life rejects or refuses to pay a claim or any part of a claim, for any reason, and includes instances where a Claimant lodges a claim –
1.14.1. in respect of a loss event or risk not covered by the policy; and
1.14.2. in respect of a loss event or risk covered by a policy, but the Premium or Premiums payable in respect of those Assured Lives are not paid.
1.15. Spouse: means a person who is the permanent life partner (whether in a heterosexual or homosexual partnership) or Spouse or civil union partner of the Main Life Assured in accordance with:
1.15.1. the Marriage Act, 68 of 1961;
1.15.2. the Recognition of Customary Marriages Act, 68 of 1997;
1.15.3. the Civil Union Act, 17 of 2006; or
1.15.4. the tenets of any Asiatic religion.
1.15.5. A permanent life partner is a partner who the Main Life Assured has lived with for longer than 12 months.
1.15.6. A maximum of 1 Spouse will be covered for benefits under this policy at any one time.
1.16. Stillbirth (Stillborn Child): Is a Child of a Life Assured that did not breathe or show any other signs of life after being delivered, expelled or surgically removed from its mother after the 26th week of pregnancy. This excludes instances where the mother chooses to have an abortion (i.e. termination of pregnancy).
1.17. Main Life Assured: means the individual that is a member of the group and is listed as the Main Life Assured on the Policy Schedule. The Main Life Assured and the Policyholder is the same person.
2. What documents form part of the policy?
2.1. The Application Form;
2.2. The Policy Schedule; and
2.3. The General Terms and Conditions (this document).
3. Duration and Term of the Policy
3.1. The insured event for this policy is death of the Assured Life.
3.2. The term of this policy is 12 months from the Policy start date.
3.3. The policy is automatically renewed for another 12 months on an ongoing basis provided that the group still exists and the Main Life Assured is still a member of the group.
4. Will the Premium increase?
4.1. The Premium will have no automatic increase. However, RMA Life may review and increase Premiums:
4.1.1. Within the term of the policy if there are reasonable actuarial grounds to change or vary the terms, conditions or provisions of the policy; or if the variation will be to the benefit of the policyholder; and
4.1.2. Annually upon renewal. Upon annual renewal the following factors will be taken into account to determine the increase: the size of the group; take-up rate or level of participation by members of the group in the individual policies underwritten on a group basis; average risk profile (age, gender and location of Assured Lives will be used to determine the groups average risk profile) and claims profile (the average claims ratio of the group will be taken into consideration).
4.2. Should RMA Life review Premiums, RMA Life will give the Policyholder 31 (Thirty-One) days’ notice of any Premium change.
5. What benefits does the Policyholder have?
The Policyholder can choose from the following options in terms of the Assured Lives they would like to cover (where Premiums will be quoted at a Family Option level):
Family Option 1: Main Life Assured only.
Family Option 2: Main Life Assured and Spouse.
Family Option 3: Main Life Assured and up to 6 Children.
Family Option 4: Main Life Assured, Spouse, and up to 6 Children.
The Policyholder may also choose a Body Repatriation Value Added Service benefit for an additional Premium. If this benefit is added to the policy, it will apply to all Assured Lives covered on the policy. The benefits that the Policyholder chose will be reflected on the Policy Schedule.
6. How does the body repatriation service work?
6.1. If the Policyholder chose this benefit, it will be reflected on the Policy Schedule.
6.2. This is an optional benefit available for an additional Premium that applies to all Lives Assured on a policy.
6.3. This benefit will only be available if the death claim is valid under this policy.
6.4. This benefit assists the bereaved family and next-of-kin with the road or air repatriation of the mortal remains of Assured Lives to a funeral home closest to their normal place of residence.
6.4.1. Repatriation is arranged when the deceased’s body is more than 100km from their place of residence, within South Africa and neighboring countries i.e. Lesotho, Namibia or Mozambique. All the arrangements to transport mortal remains as requested by the family are managed and special care is taken to consider particular customs and beliefs.
6.4.2. Assistance is provided with the necessary documentation and co-ordination with the authorities to transport the deceased’s mortal remains back to the normal area of residence.
6.4.3. This benefit also includes the transfer of the ashes of the deceased to their normal place of residence after cremation.
6.4.4. Where family is required to identify the deceased or wishes to accompany the deceased to the final funeral home, closest to the place of burial, 1-night accommodation to the value of R1 000 is arranged and paid for.
6.4.5. The service is provided through the Europ Assistance Contact Centre 24 hours a day, 7 days a week and 365 days a year.
6.4.6. Commission is not payable on this benefit Premium.
7. What are the minimum and maximum entry ages?
| Insured Life | Minimum Entry Age | Maximum Entry Age | Cease Age |
|---|---|---|---|
| Main Life Assured | 18 | 75 | - |
| Spouse | 18 | 75 | - |
| Children | 1 | 21 | 25 |
8. What is the Insurance Cover amount?
8.1. The cover amount per Life Assured is as follows:
| Insured Lives | Minimum Cover | Maximum Cover |
|---|---|---|
| Family Options (1 – 4) | R 10 000 | R 70 000 |
8.2. The Cover amount selected for Family Options will apply to both the Main Life Assured & Spouse.
8.3. The Children Cover Amount will be limited as set out in section 1.
8.4. The Cover amount that the Policyholder is entitled to under this Policy is reflected in the Policy Schedule.
9. How are the Premiums paid?
9.1. Premiums are payable monthly or annually.
9.2. The Premiums are set out in the Policy Schedule.
9.3. The Premiums set out in the Policy Schedule in respect of the Assured Lives shall be paid by the Policyholder.
9.4. Premiums may be paid via debit order or EFT.
9.5. Cash payments will be accepted.
10. Missing the first Premium
10.1. If the Policyholder misses the first Premium payment on the policy, the Policy start date will be moved to the following month.
10.2. If the Policyholder fails to pay the first Premium again in the second month, the policy will be deemed Not taken up (NTU) and the Policyholder will be notified of the cancellation of the policy from inception.
11. What happens if Premiums are not paid?
11.1. Grace Period: RMA Life allows a 31 day grace period for monthly Premiums and 45 days for annual Premiums as Grace Period. Cover continues until the end of the Grace Period. The Grace Period is only applicable after the first Premium on the policy was paid and the policy is in force or incepted.
11.2. Lapse: The policy will lapse if two consecutive Premiums are missed and/ or the policy will also lapse at any stage if two Premiums are outstanding. If the policy is lapsed, the Policyholder will be informed of the lapse.
12. Can the policy be reinstated?
12.1. The policy may only be reinstated once in a 24-month period.
12.2. The policy may only be reinstated within a 3-month period after lapse or cancellation occurred.
12.3. If reinstatement is requested, all outstanding Premiums must be paid up to date.
12.4. No new waiting period will apply for Funeral benefits on reinstatement for Assured Lives that were covered before the lapse or cancelation and to which Assured Lives no waiting period was applicable before the lapse or cancellation.
12.5. For those Assured Lives where a waiting period was applicable before the lapse or cancellation, the waiting period will continue from the date of reinstatement.
13. When does the cover start?
13.1. The insurance cover in respect of an Assured Life shall commence on the Benefit Start date reflected in the Policy Schedule.
14. When does the cover end?
14.1. Insurance cover in terms of this policy in respect of an Assured Life shall cease on the occurrence of the events mentioned below, whichever occurs first:
14.1.1. This policy is cancelled.
14.1.2. The Policyholder fails to pay the Premium on the due date thereof and fails to remedy such failure within the grace period set out in clause 11.
15. Are there any Waiting Periods?
15.1. The following waiting periods are applicable. No Benefits will be paid during the waiting period:
15.1.1. Cover for Accidental death starts immediately provided that the policy has commenced i.e., the first Premium is received by RMA Life. If the policy is in arrears but still in force the outstanding premiums will be deducted from the sum insured.
15.1.2. A 3 (three) month waiting period shall apply from the Benefit Start Date, in respect of a death due to natural causes.
15.1.3. A 12 (twelve) month waiting period shall apply from the Benefit Start Date in respect of a death due to suicide.
15.2. The waiting period is applicable per Assured Life and will commence when cover for that Assured Life commences.
15.3. Where new cover is added a new waiting period will be applicable to the new cover.
15.4. Where cover is decreased no new waiting period will be applicable.
15.5. The waiting period will be waived/reduced If the Main Life Assured had another active policy with similar benefits that was cancelled within 31 days of taking out this policy. Similar benefits refer to the same or less cover amount and benefit payout type (e.g. lump-sum payment) on the following basis:
15.5.1. The waiting period will be reduced by the number of months the previous policy was active.
16. How long are lives assured covered under this policy?
16.1. All Assured Lives are covered for the term of the policy or until the insurance cover is terminated for whatsoever reason in terms of clause 17 below.
16.2. Cover for Children will end when the child reaches the age of 25.
17. Can this policy be cancelled?
17.1. Cooling off period: The Policyholder may cancel the policy within 31 days of receiving the terms and conditions.
17.1.1. If the Policyholder chooses to cancel the policy in this period, RMA Life will refund any Premiums already received, in a case where a claim was paid, no refund will be provided.
17.2. The right to cancel: This policy may be cancelled, by RMA Life and/or the Policyholder at any time during the term of the policy by giving 31 (Thirty-One) Days’ notice to the other party.
17.3. There will be no refund of Premiums if the policy is cancelled outside the cooling-off period.
17.4. No claim shall be entertained for death that occurred after the termination of this policy.
17.5. This policy will terminate when the Main Life Assured passes away.
17.6. In any instance where the policy is cancelled, is an NTU or ends for whatever reason, the Policyholder and Main Life Assured will be informed.
18. Can I make changes to the policy?
18.1. Only the Policyholder may make changes to the policy. Changes can include:
18.1.1. Change debit order details.
18.1.2. Change contact details or personal details.
18.1.3. Change contact details or address.
19. Amendments and/or variations and Waivers
19.1. RMA Life will at all times be entitled to amend any provisions of the Policy or the funeral benefits, by sending 31 (Thirty-One) days written notice to the Policyholder.
19.2. No amendments, waiver or cancellation of the Policy as a whole or of any terms or condition of the Policy will be effective unless such amendment, waiver or cancellation is in writing and accepted by RMA Life.
19.3. Any alteration or variation to this policy may be enforced or put into effect if permitted by legislation within 31 (Thirty-One) days.
19.4. Formal notification will be provided before any alterations or variations are made within 31 (Thirty-One) days.
20. Child/Children specific events:
20.1. What happens if the Child reaches the maximum age for cover?
20.1.1. Cover for the Child will end when the Child reaches the age of 25 years.
20.2. There will be no waiting period applicable to changes under this clause.
20.3. Stillbirth claims will be limited to 2 claims over the lifetime of the policy (initial 12 months include any renewal thereafter). Stillbirth claims will not count towards the Children limit of 6 and are only payable once the insured Parent’s waiting period for natural causes has passed.
20.4. If the Stillborn Child has both Parents insured under this policy:
20.4.1. waiting periods applicable to the parents will be applicable to the stillborn;
20.4.2. the parent with the lower remaining waiting period will be used (where relevant), and
20.4.3. only one Stillbirth claim is payable per Stillbirth death.
21. How to submit a claim for funeral benefits?
21.1. Claims may be reported to Everest Customer Service Department on 013 243 7528 during working hours and after hours on 082 422 9117 or emailed to claims@everestmpu.co.za
21.2. If the Everest Customer Service Department cannot be reached for whatever reason, the claim may be reported to any RMA Life branch during normal office hours; or
21.3. to the RMA Life Contact Centre on telephone number 086 010 2532; or
21.4. By email to: funeralclaims@randmutual.co.za.
21.5. RMA Life will not pay or be liable for a claim for Funeral Benefits unless written notification of the claim, together with all supporting documents as prescribed by RMA Life is received by RMA Life within 180 days after the occurrence of the Accident.
21.6. If any information that is provided on any Assured Life is incorrect, any benefit that becomes payable may be recalculated or declined.
21.7. All claims must be reported to RMA Life within 180 days of the date of death of the Assured Life on the policy.
21.8. RMA Life will pay all valid claims within 48 hours of receiving all the required documentation. Should RMA Life require any additional documentation or information to validate the claim, the payment may take longer. The 48 hours will only apply once the additional documentation or information is received. RMA Life has the right to investigate any claim submitted. Once a claim is under investigation, the 48- hour payment turnaround time will fall away, and the investigation will determine the new timeframe in which a decision will be reached on the validity of the claim. In this instance RMA Life will inform the Policyholder that the claim is being disputed.
21.9. All benefits under this Policy will be provided to the Policyholder or a person or entity nominated to receive the benefit.
22. Documentation to be submitted to RMA:
22.1. To enable RMA Life to process a claim, the following documents must be submitted:
22.1.1. Completed claim form;
22.1.2. RMA Life’s Death Notification Form;
22.1.3. Certified Copy of ID of the deceased;
22.1.4. Certified Copy of ID of the Claimant;
22.1.5. Certified Copy of the death certificate issued by the Department of Home Affairs;
22.1.6. Original or certified copy of all four (4) pages of the DHA1663 (Notification of death);
22.1.7. Proof of bank account of the claimant (stamped by the bank); and
22.1.8. A police report must be completed and submitted in the event of unnatural deaths.
22.2. RMA Life will only entertain claims for the Assured Lives reflected on the Policy Schedule.
23. Repudiation of Claims
23.1. RMA Life aims to settle all claims; however, claims may be repudiated in circumstances where the claims do not comply with conditions of the policy. If a claim has been rejected, RMA Life will inform the claimant of the decision and reasons for rejection in writing.
23.2. The claimant has up to 90 days from the date of receiving the Repudiation Letter to lodge a complaint to RMA Life’s Complaints Officer if they want to object against RMA Life’s decision. The Complaints Officer will respond within 15 days, whereby the decision to repudiate the claim may be overturned or upheld. See the Complaints Procedure for the detailed complaints process.
23.3. No cover will be provided to any insured life that lives permanently outside the Republic of South Africa.
23.4. RMA needs to be informed if a person covered under the policy leaves the country for more than 3 months in a row. This may affect the terms and conditions of the contract, as well as whether or not cover can continue.
23.5. If RMA is not informed then RMA has the right to reject any claim and/or terminate the policy, in which event Premiums will not be refunded. RMA can only do so after the Policy Owner receives at least 31 days written notice of the intended termination.
24. What are the exclusions on this policy?
24.1. The Benefit will not be paid if death is directly or indirectly caused by or attributable to:
24.1.1. Active participation in war, invasion, acts of foreign enemies, hostilities, warlike operations (whether war is declared or not), civil war, rebellion, revolution, insurrection, civil commotion assuming the proportions of or amounting to an uprising, military action, or usurped power.
24.1.2. In the event that a claim arises as a direct or indirect consequence of the use of nuclear, biological or chemical weapons, or any radioactive contamination, or attacks on or sabotage of facilities (including, but not limited to, nuclear power plants, reprocessing plants, final repository sites and research reactors) and storage depots, which lead to the release of radioactivity or nuclear, biological or chemical warfare agents, irrespective of whether any of the aforesaid has been performed with the specific use of information technology.
24.1.3. The influence of drugs or narcotics, unless administered or prescribed by a medical professional (other than themselves);
24.1.4. Operating, learning to operate, serving as a crew member of or jumping, parachuting, or falling from any aircraft or hot-air balloon, including those which are not motor-driven. This does not include flying as a fare-paying passenger;
24.1.5. Deliberate exposure to exceptional danger (excluding an attempt to save human life);
24.1.6. Criminal acts, participating or attempting to participate in illegal activity and/or being incarcerated in a penal institution;
24.2. No benefit is payable if the Insurer is notified of a claim later than 180 days after the date of death.
24.3. Benefits are subject to prudential standard limitations.
25. What are the Policyholder’s rights?
25.1. The Policyholder may not cash in this policy or transfer/cede the rights under this policy to a third party as security or for any other reason whatsoever.
26. Fraud and Misrepresentation
26.1. Notwithstanding the provisions of this Policy relating to claims, RMA Life reserves the right to cancel the cover in respect of an Assured Life and declare all Premiums in respect of that life forfeited, should there be evidence of, or an attempted submission of a fictional claim, fraud, misrepresentation or non-disclosure of any material fact.
26.2. If RMA Life finds any non-disclosure, misrepresentation or any incorrect information to any material facts or circumstances with regards to the policy, we may reject the application.
26.3. Should this information come up during the term of the policy or at claim stage, RMA Life will declare the contract null and void. This will result in RMA Life cancelling the policy contract from inception and no paid Premiums will be refunded.
27. What are the responsibilities of the RMA Life staff?
27.1. All staff, who are not authorized FAIS Representatives, may explain to Policyholders the policy benefits, and the processes to be followed (Factual information only).
27.2. However, only RMA Life staff who are authorized FAIS Representatives may give financial advice to the Policyholder.
28. What are the Policyholder’s responsibilities?
28.1. The claimant is responsible to answer all questions on the application form, claim form, or any other form that he/she might complete during the life of the policy, correctly and honestly.
28.2. The Policyholder warrants that he will provide all information required in the sole discretion of RMA Life to underwrite this policy and to assess claims under this policy.
28.3. Any neglect to complete these forms correctly, RMA Life may decrease the benefits or cancel the policy or insurance under the policy.
28.4. This may also result in the claim being repudiated.
28.5. For legal purposes, you should not sign any blank or incomplete forms.
29. What are the charges and fees?
29.1.All the charges and fees for this policy are included in the Premium as indicated in the Policy Schedule
30. GENERAL PROVISIONS
30.1.Policy review
30.1.1. RMA Life reserves the right to change the policy from time-to-time and will notify the Policyholder and Main Life Assured of any policy changes
31. Liability of RMA Life
31.1.RMA Life will pay benefits after the first Premium has been received if the claim is valid and no policy waiting periods are applicable.
31.2.After benefits have been paid, RMA Life will have no further liability towards the claim
32. Currency and the law
32.1.RMA Life will make all payments in South African Rands (ZAR). Should the law of South Africa change, the conditions of this contract will be amended.
32.2.RMA Life shall only make payment into South African bank accounts.
33. No rights to other individuals?
33.1. Unless otherwise provided, nothing in this Policy shall give any rights to benefit other than to the Policyholder or the claimant. Any extension providing indemnity to any person other than the Assured Life shall not give any rights of claims to such person, the intention being that the Claimant shall claim on behalf of such person.
34. Non-disclosure and Misrepresentation
34.1.This Policy shall not be void or voidable by reason of any
34.1.1. Inadvertent misrepresentation, misdescription or non-disclosure;.
34.1.2 Inadvertent breach of condition or warranty.
34.1.3. Inadvertent act, error or omission of the Policyholder, provided that notice be given to RMA Life as soon as reasonably practicable after the Policyholder becomes aware of the same. If required, the Policyholder shall pay any pro-rata additional Premium due, following such notice. It is the Policyholder’s responsibility to ensure that the information for the Policyholder and Lives Assured and their Beneficiary(ies) are always accurate and kept up to date.
34.1.4.The Policyholder needs to inform RMA Life as soon as any life assured or contact information changes.
35. Commission and Fees
35.1. The commission is charged for each Premium. Premiums are worked out based on the total commission charge reflected in the Policy Schedule, according to the applicable legislation, and VAT will only be charged for Brokers who are VAT registered.).
36. Policy Replacement
36.1. Similar Policy: Means a product with benefits made available by an Insurer and has homogenous features to a product offered by RMA, identifiable by the following attributes
36.1.1. Benefits.
36.1.2. Exclusions.
36.1.3. The duration of a policy.
36.1.4. Policy Conditions.
36.1.5. Waiting Periods.
36.2.Replacement Policy: Means a new policy or a variation of an existing policy due to any reason other than the annual Premium increase, where
36.2.1. The Policyholder or Main Life Assured was also the Policyholder or Main Life Assured in respect of another policy, and the Life Assured was covered under the previous policy in the last 31 days.
36.2.2. The previous policy termination event occurred in anticipation of, or as a consequence of effecting the new policy or variation.
36.2.3. If you have never had a funeral policy or not been a member of a group funeral policy and you take out cover, your cover is new to RMA, as it is the first time you are insured on a funeral policy.
36.2.4. A new policy can be the above, 38.2.3 or it can be a funeral policy from a different Insurer. This would happen if you cancelled funeral cover with one Insurer and take out cover with RMA Life. In this case, you have a new policy, but your cover is not new because you already had cover on a previous policy
37. Complaints or Queries
37.1. If you have any questions or complaints about the policy, please call the RMA Life contact center on 086 010 2532 or the Everest Customer Service Department on 013 243 7528
37.2. If you are not satisfied with the outcome or answer, you may send your complaint in writing to: complaints@randmutual.co.za
37.3. If you have a complaint about how the policy was sold to you, and RMA Life could not resolve your query to your satisfaction, you may contact the FAIS Ombud at
P.O. BOX 74571, Lynwood Ridge, 0040
Telephone: 012 762 5000
Fax: 012 348 3447
E-mail: info@faisombud.co.za
37.4. If you have a complaint about the policy itself or any claim under the policy and RMA Life could not resolve your query to your satisfaction you may contact the Ombudsman for Long Term Insurance at
THE OMBUDSMAN FOR LONG TERM INSURANCE
Private Bag X45, Claremont, Cape Town, 7735
Telephone: 021 657 5000
Sharecall: 0860 103236
Email: info@ombud.co.za
Conclusion
We trust that you will have a long and pleasant association with Everest Funeral and we pledge our commitment to giving you the best possible service far exceeding your expectations. You, our policyholder, is our number one priority. We are determined to live up to your expectations in every way. Your satisfaction as a policyholder is vital to our success as a business
Welcome Letter
Everest Funerals Mpumalanga (Pty) Ltd
Underwritten by RMA Life Assurance Company Limited,
a licensed life insurer ("RMA Life") and administered by
Rand Mutual Admin Services(Pty) Ltd FSP 46113
Welcome to Everest Financial Services Funeral Scheme underwritten by RMA Life, we would like to thank you for choosing Everest Funeral Cover to provide you with peace of mind and take care of your needs when you need it most. We wish you a warm welcome and look forward to being of service to you.
We have attached your policy schedule, which details the members covered under the policy. Please go through your policy schedule thoroughly to familiarise yourself with the available benefits, and to ensure that we have the correct details for you and the insured members.
For enquiries or claims, call Everest on 013 590 5435 during working hours and after hours on 082 422 9117 or The RMA Contact center on 0860 102 532. We are available to assist you Mondays to Thursdays between 8am and 5pm, and Fridays between 8am and 4:30pm.
Yours sincerely,
Policy Schedule
Group Name: Everest Funerals Mpumalanga (Pty) Ltd
Underwritten by RMA Life Assurance Company Limited,
a licensed life insurer ("RMA Life") and administered by
Rand Mutual Admin Services(Pty) Ltd FSP 46113
| Name & Surname | Doreen Ntjwaki Rabothata | Payment Method | EFT |
| ID No. | 9303150946084 |
Policy Holder's
Home Address (Physical Address) |
Sebota Street |
| Age | 29 | 558b | |
| Cell Phone No. | 0679173673 | Meadowlands Zone 7 soweto | |
| Alternative No. | N/A | Johannesburg Gauteng | |
| Email Address | rabothatadoreen90@gmail.com | 1559 |
| Your Policy Number is : 01-202203-191476 | Premium Collection Date | :31st |
|---|
| Inception Date | Required Package | Benefits | Monthly Premium | Cover Amount |
|---|---|---|---|---|
| John | Doe | john@example.com | john | john |
| The premium amount is 15% VAT inclusive. Maximum commission amount of 30% of each premium is payable with each premium collected, including any VAS (Value Added Service) premium. Premiums are payable in advance and your cover will only start once your premium has been received. The premium payer on the policy does not have any rights to the policy unless the Main member and the Premium payer are the same person. Your deductions will start on the date that you selected. For your peace of mind, please note that your funeral benefit scheme is underwritten by Rand Mutual Assurance. If any of your personal contact details change and it needs to be updated, please notify us immediately, as these are important in ensuring effective administration and communication with you in the future. | ||||
| Name & Surname | Dob / ID No | Relationship | Monthly Premium | Benefit Amount |
|---|---|---|---|---|
| John | Doe | john@example.com | john | john |
| John | Doe | john@example.com | john | john |
| John | Doe | john@example.com | john | john |
| John | Doe | john@example.com | john | john |
| John | Doe | john@example.com | john | john |
| John | Doe | john@example.com | john | john |
| John | Doe | john@example.com | john | john |
| John | Doe | john@example.com | john | john |
| Your child means an unmarried, financially dependent biological Child of the Main Life Assured or Spouse, who has not yet attained the age of 21 and will include: a posthumous Child, a stepchild, a grandchild, a legally fostered Child and an adopted Child and a Stillborn Child. All ages referred to in this Policy are Age Next Birthday. Cover for the Child will end when the Child reaches the age of 25 years | ||||
| Name & Surname | Dob / ID No | Relationship | Contact No | Percentage |
|---|---|---|---|---|
| John | Doe | john@example.com | john | john |
| John | Doe | john@example.com | john | john |
| This is the person nominated by the Policy Owner to receive the payment of the benefit under circumstances where the benefit is not paid to the Policy Owner. | ||||
Terms and Conditions
Everest Funerals Mpumalanga (Pty) Ltd
Underwritten by RMA Life Assurance Company Limited,
a licensed life insurer ("RMA Life") and administered by
Rand Mutual Admin Services(Pty) Ltd FSP 46113
RMA Life Assurance Company Limited, Reg No 1990/06308/06 (RMA Life) is the Insurer under this policy.
The names of any intermediaries, brokers and binder holders who are rendering services on this policy are reflected on the Policy Schedule together with the fees they will receive for these services.
This individual policy is underwritten on a group basis. The Policy Owner will provide RMA Life with all information required by RMA Life to enable RMA Life to underwrite this policy on a group basis. The risks covered under this insurance policy are rated based on the characteristics of a group of people together, as opposed to that of the individuals who are the Lives Assured under this policy. The group Everest Funeral Mpumalanga Pty Ltd, and the Main Life Assured under this policy must be a member of the group for the Assured Lives to be included in the group of people on whose characteristics the policy is rated.
RMA Life will pay the benefits set out in this policy according to the terms and conditions set within this document. The policy will be amended if and when required as provided for in these General Terms and Conditions, and the amendments will then form part of the insurance contract. Should there be any conflict between this policy and any other document issued by RMA Life, the terms and conditions set out in this policy will prevail.
The Individual Funeral Policy is a funeral policy that will pay a lumpsum upon the death of an Assured Life. Please keep this document in a safe place.
1. Definitions
1.1. Accident/Accidental: An Accident means a sudden, unexpected, unusual, specific event occurring at a particular moment and a particular place which even the Assured Life could not foresee, anticipate or envisage and which results in visible, violent, external and traumatic death of the Assured Life.
1.2. Natural Death: is medically defined as death brought on by a disease or age rather than caused by other factors like Accident or crime.
1.3. Age Next Birthday: Insured's age at a particular time with the addition of 1 year.
1.4. Assured Life: This means the person whose life is insured under this policy and upon whose death the benefit will pay out if the conditions of this policy are met. All Assured Lives must be South African citizens or a Permanent Resident, or a person with a legal South African work permit. The Assured Lives are the Main Life Assured and his / her Spouse, Children, Parents and Extended Family. The names of the Assured Lives are reflected on the Policy Schedule. The maximum number of assured lives allowed on this policy are 12.
1.5. Beneficiary: This is the person nominated by the Policy Owner to receive the payment of the benefit on the death of the Main Life Assured.
1.6. Benefit start date: means the date on which cover commences in respect of an Assured Life, which is the day on which the first Premium is paid with respect to that Assured Life.
1.7. Child/Children: Financially dependent biological, adopted, stepchildren or a posthumous child of the Main Life Assured.
1.8. All ages referred to in this Policy are Age Next Birthday. The benefit for Children is age-dependent and limited in terms of applicable legislation. Notwithstanding the sum assured reflected on the Policy Schedule, the claim amount will be limited to the maximum amount allowed in applicable legislation
1.9. Extended Family: means parents, grandparents, siblings, siblings-in-law, cousins, uncles, grand uncles, aunts, grand aunts, nieces, nephews or grandchildren of the Main Life Assured. A parent is defined as a person who is the biological parent, parent-in-law, adoptive parent or step-parent of the Main Life Assured. A maximum of 6 Extended Family members can be covered under this policy.
1.10. Insurer: RMA Life is the Insurer, and in return for a stipulated Premium, RMA Life accepts the risks and will payout the benefit if a claim event occurs.
1.11. Not taken up (NTU): This is when the Premium Payer does not pay the first Premium payable on the policy. The policy is considered as Not taken up by the Policy Owner (NTU) and cancelled from inception.
1.12. Parents(s): means the persons who are the biological Parents, Parents-In-Law, adoptive Parents and step-parents of the Main Life Assured.
1.13. Policy Owner: The person that has taken out the policy, has an insurance contract with RMA Life. The Policy Owner and the Main Life Assured is the same person.
1.14. Policy start date: means the date on which the policy becomes effective.
1.15. Premium: the amount specified as payment for the policy benefits and confirmed in the Policy Schedule and amended as provided for in this General Terms and Conditions.
1.16. Premium payer: means the Main Life Assured or any other individual who has an insurable interest in the life of the Main Life Assured.
1.17. Repudiation: In relation to a claim means any action by which RMA Life rejects or refuses to pay a claim or any part of a claim, for any reason, and includes instances where a Claimant lodges a claim –
1.18. Spouse: means legally recognized husband or wife, permanent life partner or partner of the Main Life Assured by law, tradition, religion, or civil union. Satisfactory proof of the permanency of the relationship with his/her life partner may be requested. Only one Spouse is allowed under this policy.
1.19. Stillbirth (Stillborn Child): Is a Child of a Life Assured that did not breathe or show any other signs of life after being delivered, expelled, or surgically removed from its mother after the 26th week of pregnancy. This excludes instances where the mother chooses to have an abortion (i.e. termination of pregnancy).
1.20. Main Life Assured: means the individual that is a member of the group and is listed as the Main Life Assured on the Policy Schedule. The Main Life Assured and the Policy Owner are the same person. Only one Main Life Assured is allowed under this policy.
2. What documents form part of the policy?
2.1. The Application Form;
2.2. The Policy Schedule; and
2.3. The General Terms and Conditions (this document).
3. Duration and Term of the Policy
3.1. The insured event for this policy is the death of the Assured Life.
3.2. The term of this policy is 12 months from the Policy start date.
3.3. The policy is automatically renewed for another 12 months on an ongoing basis provided that the group still exists and the Main Life Assured is still a member of the group.
4. Will the Premium increase?
4.1. The Premium will have no automatic increase. However, RMA Life may review and increase Premiums:
4.1.1. Within the term of the policy if there are reasonable actuarial grounds to change or vary the terms, conditions, or provisions of the policy; or if the variation will be to the benefit of the Policy Owner; and
4.1.2. Annually upon renewal. Upon annual renewal, the following factors will be taken into account to determine the increase: the size of the group; take-up rate or level of participation by members of the group in the individual policies underwritten on a group basis; average risk profile (age, gender, and location of Assured Lives will be used to determine the group's average risk profile) and claims profile (the average claims ratio of the group will be taken into consideration).
4.2. Should RMA Life review Premiums, RMA Life will give the Policy Owner 90 days’ notice of any Premium change. RMA Life will also give the Policy Owner alternative options (like lower cover amounts) if a premium amendment is not acceptable to the Policy Owner.
5. What benefits does the Policy Owner have?
The Policy Owner can choose from the plans listed hereunder. The plan that has been selected will be reflected on the Policy Schedule. Each plan offers three set cover amount options and entry age limitations and the applicable cover amounts will also be reflected on the Policy Schedule. The following plans are offered:
3-in-1 Budget Plan
3-in-1 Silver Plan
3-in-1 Elite Plan
3-in-1 Elite Plus Plan
3-in-1 Exclusive Plan
Within the chosen plan, the Policy Owner can choose from the following 3 Family Options to determine which Lives Assureds will be covered. The option that has been selected will be reflected on the Policy Schedule and premiums will be determined at Family Option level:
3-in-1 Family Option 1 (Individual): Main Life Assured only.
3-in-1 Family Option 2 (Single Parent): Main Life Assured and up to 4 Children.
3-in-1 Family Option 3 (Family): Main Life Assured, 1 Spouse, and up to 4 Children.
The Policy Owner can choose to insure Extended Family members in addition to the options reflected above. When Extended Family members are added, a premium per Life Assured is payable and the Lives Assured that are covered as Extended Family Members will be listed on the Policy Schedule.
The Policy Owner can add the additional optional Imali Benefit at an additional premium. The benefit offers eight set cover options to choose from and the option selected by the Policy Owner will be reflected on the Policy Schedule. The benefit provides a cash lump sum benefit on the death of the Assured Life reflected under the Imali Benefit on the Policy Schedule.
The benefits that the Policy Owner chose will be reflected on the Policy Schedule.
The Policy Owner may not increase or decrease the Cover Amount on a plan.
The Policy Owner may downgrade their plan to another plan within the 3-in-1 Product Plan options. Each plan type offers 3 family options. The Policy Owner will not be allowed to upgrade their plan. Each plan type offers 3 family options. In the event of a reduction of Cover Amount due to a change in plan, the waiting period prior to the amendment will apply
and no new waiting periods will apply.
The Policy Owner can add additional Assured Lives, subject to the limitations applicable to the number of Lives Assured. A new waiting period will apply to the new Life Assured.
The Policy Owner can remove Lives Assured from the policy.
The Premium may be impacted by changes to the Lives Assured.
6. Continuation Option
6.1. If cover under Family Option 2 or Family Option 3 is in place when the Main Life Assured passes away, a Life. Assured has the option to continue with this policy as the Policy Owner and Main Life Assured.
6.2. The option must be exercised within 6 months from the date of death of the Main Life Assured.
6.3. The Premium will be reviewed based on the age of the new Main Life Assured and the insurable interest of the new Main Life Assured will be validated.
6.4. The Life Assured taking over from the Main Life Assured may not be under the age of 18.
6.5. The maximum age to exercise the option is age 102 and a waiting period will apply where relevant.
7. What is the Insurance Cover amount?
7.1. The cover amount per Life Assured is reflected on the Policy Schedule.
8. How are the Premiums paid?
8.1. Premiums shall be payable monthly in advance on or before the 7th day of each month for which insurance is granted. If premiums are paid after the 7th of the month, the premium will be allocated to the following month, thereby resulting in a non-payment of premiums for the current month.
8.2. Premiums can be paid by debit order, stop order or cash.
8.3. The Premiums are set out in the Policy Schedule.
8.4. The Premiums set out in the Policy Schedule in respect of the Assured Lives shall be paid by the Premium Payer.
9. Missing the first Premium
9.1. If the Premium Payer misses the first Premium payment on the policy, the Policy start date will be moved to the following month.
9.2. If the Premium Payer fails to pay the first Premium again in the second month, the policy will be deemed Not taken up (NTU) and the Policy Owner will be notified of the cancellation of the policy from inception.
10. What happens if Premiums are not paid?
10.1. Grace Period: RMA Life allows a 31-day grace period for monthly Premiums. Cover continues until the end of the Grace Period. The Grace Period is only applicable after the first Premium on the policy was paid and the policy is in force or incepted.
10.2. Lapse: The policy will lapse if two consecutive Premiums are missed and/ or the policy will also lapse at any stage if two Premiums are outstanding. If the policy is lapsed, the Policy Owner will be informed of the lapse.
11. Can the policy be reinstated?
11.1. The policy may only be reinstated once in a 24-month period.
11.2. The policy may only be reinstated within a 3-month period after lapse or cancellation occurred.
11.3. If reinstatement is requested, all outstanding Premiums must be paid up to date.
11.4. No new waiting period will apply for Funeral benefits on reinstatement for Assured Lives that were covered before the lapse or cancelation and to which Assured Lives no waiting period was applicable before the lapse or cancellation.
11.5. For those Assured Lives where a waiting period was applicable before the lapse or cancellation, the waiting period will continue from the date of reinstatement.
12. When does the cover start?
12.1. The insurance cover in respect of an Assured Life shall commence on the Benefit Start date reflected in the Policy Schedule.
13. When does the cover end?
13.1. Insurance cover in terms of this policy in respect of an Assured Life shall cease on the occurrence of the events mentioned below, whichever occurs first:
13.1.1. This policy is cancelled.
13.1.2. The Main Life Assured dies and the Continuation Option is not taken up.
13.1.3. The policy is not renewed.
13.1.4. The Policy Owner fails to pay the Premium on the due date thereof and fails to remedy such failure within the grace period set out in clause 11.
14. Are there any Waiting Periods?
14.1. The following waiting periods are applicable. No Benefits will be paid during the waiting period:
14.1.1. Cover for Accidental death starts immediately provided that the policy has commenced i.e., the first Premium is received by RMA Life. If the policy is in arrears but still in force the outstanding premiums will be deducted from the sum insured.
14.1.2. A 3 (three) month waiting period shall apply from the Benefit Start Date, in respect of a death due to natural causes.
14.1.3. A 12 (twelve) month waiting period shall apply from the Benefit Start Date in respect of a death due to suicide or attempted suicide or self-inflicted injuries.
14.2. The waiting period is applicable per Assured Life and will commence when cover for that Assured Life commences.
14.3. Where cover is increased, a new waiting period will be applicable to the increased portion of the cover.
14.4. Where cover is decreased no new waiting period will be applicable.
14.5. There are no new waiting periods as a result of a renewal of this policy.
14.6. The waiting period will be waived/reduced If the Main Life Assured had another active policy with similar benefits that was cancelled within 31 days of taking out this policy. Similar benefits refer to the same or less cover amount and benefit payout type (e.g. lump-sum payment) on the following basis:
14.6.1. The waiting period will be reduced by the number of months the previous policy was active.
15. How long are lives assured covered under this policy?
15.1. All Assured Lives are covered for the term of the policy or until the insurance cover is terminated for whatsoever reason in terms of clause 17 below.
16. Can this policy be cancelled?
16.1. Cooling off period: The Policy Owner may cancel the policy within 31 days of receiving the terms and conditions.
16.1.1. If the Policy Owner chooses to cancel the policy in this period, RMA Life will refund any Premiums already received, in a case where a claim was paid, no refund will be provided.
16.2. The right to cancel: This policy may be cancelled, by RMA Life and/or the Policy Owner at any time during the term of the policy by giving 31 (Thirty-One) Days’ notice to the other party.
16.3. There will be no refund of Premiums if the policy is cancelled outside the cooling-off period.
16.4. No claim shall be entertained for death that occurred after the termination of this policy.
16.5. This policy will terminate when the Main Life Assured passes away and the Continuation option is not elected.
16.6. In any instance where the policy is cancelled, is an NTU or ends for whatever reason, the Policy Owner and Main Life Assured will be informed.
17. Can I make changes to the policy?
17.1. Only the Policy Owner may make changes to the policy. Changes can include:
17.1.1. Change debit order details.
17.1.2. Change contact details or personal details.
17.1.3. Change to address.
17.1.4. Change the nominated Beneficiary once a year.
18. Amendments and/or variations and Waivers
18.1. RMA Life will at all times be entitled to amend any provisions of the Policy or the funeral benefits, by sending 90 days written notice to the Policy Owner.
18.2. No amendments, waiver or cancellation of the Policy as a whole or of any terms or condition of the Policy will be effective unless such amendment, waiver or cancellation is in writing and accepted by RMA Life.
18.3. Any alteration or variation to this policy may be enforced or put into effect if permitted by legislation within 90 days.
18.4. Formal notification will be provided before any alterations or variations are made within 90 days.
19. Child/Children specific events:
19.1. Cover for Children attaining the age of 21 years will terminate and such Children attaining the age of 21 years who are dependents and Lives Assured on existing policies, can take out a new policy with equivalent cover.?
19.2. Notwithstanding clause 19.1 , cover for Children can continue until age 25 if the child is a full-time student at a recognized educational institution and until this Policy ends if the child is disabled (disability will be determined in the sole discretion of RMA Life and he / she receives a disability grant).
19.3. Stillbirth claims will be limited to 2 claims over the lifetime of the policy. Stillbirth claims will not count towards the Children limit of 6 and are only payable once the insured Parent’s waiting period for natural causes has passed.
19.4. If the Stillborn Child has both Parents insured under this policy:
19.4.1. waiting periods applicable to the parents will be applicable to the stillborn;
19.4.2. the parent with the lower remaining waiting period will be used (where relevant), and
19.4.3. only one Stillbirth claim is payable per Stillbirth death.
20. How to submit a claim for funeral benefits?
20.1. Claims may be reported to Everest Customer Service Department on 013 243 7528 during working hours and after hours on 082 422 9117
20.2 or emailed to claims@everestmpu.co.za
20.3. You can also submit claims to any RMA Life branch during normal office hours; or
20.4. to the RMA Life Contact Centre on telephone number 086 010 2532; or
20.5. By email to: funeralclaims@randmutual.co.za.
20.6. RMA Life will not pay or be liable for a claim for Funeral Benefits unless written notification of the claim, together with all supporting documents as prescribed by RMA Life is received by RMA Life within 180 days after the occurrence of the Accident.
20.7. If any information that is provided on any Assured Life is incorrect, any benefit that becomes payable may be recalculated or declined.
20.8. All claims must be reported to RMA Life within 6 months of the date of death of the Assured Life on the policy.
20.9. RMA Life will pay all valid claims within 48 hours of receiving all the required documentation. Should RMA Life require any additional documentation or information to validate the claim, the payment may take longer. The 48 hours will only apply once the additional documentation or information is received. RMA Life has the right to investigate any claim submitted. Once a claim is under investigation, the 48- hour payment turnaround time will fall away, and the investigation will determine the new timeframe in which a decision will be reached on the validity of the claim. In this instance RMA Life will inform the Policy Owner that the claim is being disputed.
20.10. All benefits under this Policy will be provided to the Policy Owner.
20.11. On the death of the Main Life assured the benefits will be provided to the Beneficiary
20.12. If the Main Life Assured and the Beneficiary is deceased, the benefits will be provided to the Main Life Assured’s Estate.
21. Documentation to be submitted to RMA:
21.1. To enable RMA Life to process a claim, the following documents must be submitted:
21.1.1. Completed claim form;
21.1.2. RMA Life’s Death Notification Form;
21.1.3. Certified Copy of ID of the deceased;
21.1.4. Certified Copy of ID of the Claimant;
21.1.5. Certified Copy of the death certificate issued by the Department of Home Affairs;
21.1.6. Original or certified copy of all four (4) pages of the DHA1663 (Notification of death);
21.1.7. Proof of bank account of the claimant (stamped by the bank); and
21.1.8. BI-1663 form stamped by the medical practitioner
21.1.9. Supporting proof of relationship if Principal member and spouse are not legally married.
21.1.10. A police report in the case of accidental death if death occurred in the first 24 months after inception of cover.
21.1.11. In respect of a child aged 22 years to 25 years and who was full time student at the time of death, confirmation satisfactory to the underwriter from the recognized educational institution is required.
21.1.12. For a disabled child, confirmation of the Disability Grant, copy of the medical application or medical report is required.
21.2. RMA Life will only entertain claims for the Assured Lives reflected on the Policy Schedule.
22. Repudiation of Claims
22.1. RMA Life aims to settle all claims; however, claims may be repudiated in circumstances where the claims do not comply with conditions of the policy. If a claim has been rejected, RMA Life will inform the claimant of the decision and reasons for rejection in writing.
22.2. The claimant has up to 90 days from the date of receiving the Repudiation Letter to lodge a complaint to RMA Life’s Complaints Officer if they want to object against RMA Life’s decision. The Complaints Officer will respond within 15 days, whereby the decision to repudiate the claim may be overturned or upheld. See the Complaints Procedure for the detailed complaints process.
22.3. No cover will be provided to any insured life that lives permanently outside the Republic of South Africa.
22.4. RMA Life needs to be informed if a person covered under the policy leaves the country for more than 3 months in a row. This may affect the terms and conditions of the contract, as well as whether or not cover can continue.
22.5. If RMA Life is not informed then RMA Life has the right to reject any claim and/or terminate the policy, in which event Premiums will not be refunded. RMA Life can only do so after the Policy Owner receives at least 31 days written notice of the intended termination.
23. What are the exclusions on this policy?
No Benefit shall be payable in respect of claims arising wholly, or partly, directly or indirectly as a consequence of:
23.1. Terrorism and war (whether declared or not).
23.2. Radioactive contamination, whether arising directly or indirectly.
23.3. Divorced spouses at inception of the policy are not covered, and cover for spouses who divorce during the term of the policy will cease immediately on divorce. Where a couple may have divorced but due to some circumstance, agreement or court order, either of the spouse is still financially responsible for the other where the ex-spouse was covered either as husband or wife under the policy prior to the divorce becoming active, RMA Life will use its discretion to either settle or reject the claim based on the merits of each claim. In such cases, the spouse who is financially responsible for the other can claim funeral insurance benefits in respect of a deceased ex-spouse.
23.4. No benefit is payable if the Insurer is notified of a claim later than 6 months after the date of death.
23.5. Benefits are subject to prudential standard limitations.
24. What are the Policy Owner’s rights?
24.1. The Policy Owner may not cash in this policy or transfer/cede the rights under this policy to a third party as security or for any other reason whatsoever.
25. Fraud and Misrepresentation
25.1. Notwithstanding the provisions of this Policy relating to claims, RMA Life reserves the right to cancel the cover in respect of an Assured Life and declare all Premiums in respect of that life forfeited, should there be evidence of, or an attempted submission of a fictional claim, fraud, misrepresentation or non-disclosure of any material fact.
25.2. If RMA Life finds any non-disclosure, misrepresentation or any incorrect information to any material facts or circumstances with regards to the policy, we may reject the application.
25.3. Should this information come up during the term of the policy or at claim stage, RMA Life will declare the contract null and void. This will result in RMA Life cancelling the policy contract from inception and no paid Premiums will be refunded.
26. What are the responsibilities of the RMA Life staff?
26.1. All staff, who are not authorized FAIS Representatives, may explain to Policy Owners the policy benefits, and the processes to be followed (Factual information only).
26.2. However, only RMA Life staff who are authorized FAIS Representatives may give financial advice to the Policy Owner.
27. What are the Policy Owner’s responsibilities?
27.1. The claimant is responsible to answer all questions on the application form, claim form, or any other form that he/she might complete during the life of the policy, correctly and honestly.
27.2. The Policy Owner warrants that he will provide all information required in the sole discretion of RMA Life to underwrite this policy and to assess claims under this policy.
27.3. Any neglect to complete these forms correctly, RMA Life may decrease the benefits or cancel the policy or insurance under the policy.
27.4. This may also result in the claim being repudiated.
27.5. For legal purposes, you should not sign any blank or incomplete forms.
28. What are the charges and fees?
28.1.All the charges and fees for this policy are included in the Premium as indicated in the Policy Schedule
29. GENERAL PROVISIONS
29.1.Policy review
29.1.1. RMA Life reserves the right to change the policy from time-to-time and will notify the Policy Owner of any policy changes
30. Liability of RMA Life
30.1.RMA Life will pay benefits after the first Premium has been received if the claim is valid and no policy waiting periods are applicable.
30.2.After benefits have been paid, RMA Life will have no further liability towards the claim
31. Currency and the law
31.1.RMA Life will make all payments in South African Rands (ZAR). Should the law of South Africa change, the conditions of this contract will be amended.
31.2.RMA Life shall only make payment into South African bank accounts.
32. No rights to other individuals?
32.1. Unless otherwise provided, nothing in this Policy shall give any rights to benefit other than to the Policy Owner or the claimant. Any extension providing indemnity to any person other than the Assured Life shall not give any rights of claims to such person, the intention being that the Claimant shall claim on behalf of such person.
33. Non-disclosure and Misrepresentation
33.1.This Policy shall not be void or voidable by reason of any
33.1.1. Inadvertent misrepresentation, misdescription or non-disclosure;.
33.1.2 Inadvertent breach of condition or warranty.
33.1.3. Inadvertent act, error or omission of the Policy Owner, provided that notice be given to RMA Life as soon as reasonably practicable after the Policy Owner becomes aware of the same. If required, the Policy Owner shall pay any pro-rata additional Premium due, following such notice. It is the Policy Owner’s responsibility to ensure that the information for the Policy Owner and Lives Assured and their Beneficiary(ies) are always accurate and kept up to date.
33.1.4.The Policy Owner needs to inform RMA Life as soon as any life assured or contact information changes.
34. Commission and Fees
34.1. The commission is charged for each Premium. Premiums are worked out based on the total commission charge reflected in the Policy Schedule, according to the applicable legislation, and VAT will only be charged for Brokers who are VAT registered.).
35. Policy Replacement
35.1. Similar Policy: Means a product with benefits made available by an Insurer and has homogenous features to a product offered by RMA, identifiable by the following attributes
35.1.1. Benefits.
35.1.2. Exclusions.
35.1.3. The duration of a policy.
35.1.4. Policy Conditions.
35.1.5. Waiting Periods.
35.2.Replacement Policy: Means a new policy or a variation of an existing policy due to any reason other than the annual Premium increase, where
35.2.1. The Policy Owner or Main Life Assured was also the Policy Owner or Main Life Assured in respect of another policy, and the Life Assured was covered under the previous policy in the last 31 days.
35.2.2. The previous policy termination event occurred in anticipation of, or as a consequence of effecting the new policy or variation.
35.2.3. If you have never had a funeral policy or not been a member of a group funeral policy and you take out cover, your cover is new to RMA, as it is the first time you are insured on a funeral policy.
35.2.4. A new policy can be the above, 38.2.3 or it can be a funeral policy from a different Insurer. This would happen if you cancelled funeral cover with one Insurer and take out cover with RMA Life. In this case, you have a new policy, but your cover is not new because you already had cover on a previous policy
36. Complaints or Queries
36.1. If you have any questions or complaints about the policy, please call the Everest Customer Service Department on 013 243 7528 or the RMA Life contact center on 086 010 2532.
36.2. If you are not satisfied with the outcome or answer, you may send your complaint in writing to: complaints@randmutual.co.za
36.3. If you have a complaint about how the policy was sold to you, and RMA Life could not resolve your query to your satisfaction, you may contact the FAIS Ombud at
P.O. BOX 74571, Lynwood Ridge, 0040
Telephone: 012 762 5000
Fax: 012 348 3447
E-mail: info@faisombud.co.za
36.4. If you have a complaint about the policy itself or any claim under the policy and RMA Life could not resolve your query to your satisfaction you may contact the Ombudsman for Long Term Insurance at
THE OMBUDSMAN FOR LONG TERM INSURANCE
Private Bag X45, Claremont, Cape Town, 7735
Telephone: 021 657 5000
Sharecall: 0860 103236
Email: info@ombud.co.za
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