BENEFITS SUMMARY
All participating members will enjoy the
following benefits:
|
Benefit
Description |
Benefit |
Bronze |
Gold |
Platinum |
|
1. Funeral Cover |
Member / Spouse Children 14-20/25 Children 6-13 Children 1-5 Stillborn |
5000 5000 2 500 1 250 1 250 |
10 000 10 000 5 000 2 500 2 500 |
15 000 15 000 7 500 3 750 3 750 |
|
2. Additional Accidental Death |
Main Member Spouse |
10 000 10 000 |
20 000 20 000 |
30 000 30 000 |
|
3. KGA Assist |
Whole Family |
Platinum |
Platinum |
Platinum |
|
TOTAL MONTHLY PREMIUM [including intermediary costs] |
R38.00 |
R62.00 |
R86.00 |
|
|
Annual Premium in Advance to qualify for Immediate Cover |
R456.00 |
R744.00 |
R1032.00 |
|
KGA ASSIST : PLATINUM |
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|
Services
available 24 hours per day in all 11 official languages : |
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|
Benefits Include |
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|
HIV Protection Treatment Service |
Repatriation of Mortal Remains |
|
|
·
24 hour access to telephonic trauma and
post-traumatic stress disorder counsellors ·
Three psychiatric consultations with a
specialist for every incident that may have put the member in danger of HIV
infection - the specialist concerned may be a general practitioner, a trauma
trained registered nurse or a trauma counsellor ·
Three HIV blood tests per incident: one
immediately after the event, the second after six weeks and the third after
three months - unless the client is HIV positive at the time of the initial
blood test, in which case further testing will not be covered. If an HIV negative member has been exposed to HIV
then, on doctor’s orders only, he or she will be provided with: ·
A 30 day starter pack of anti-retroviral
medication ·
A seven day course of medication to prevent
the development of STI (Sexually Transmitted Infections) ·
A 'morning-after' pill to prevent pregnancy ·
Registration for an HIV management
programme, if appropriate ·
24 hour a day, 365 days a year telephonic
access to KGA ASSIST's HIV counselling centre for information,
advice and support. In the case of HIV positive members, KGA ASSIST
will provide: ·
24 hour a day, 365 days a year telephonic
trauma counselling ·
24 hour a day, 365 days a year telephonic
HIV counselling ·
Three consultations (per incident) with a specialist
- a general practitioner, trauma trained registered nurse or trauma
counsellor ·
Registration for an HIV management
programme, if appropriate ·
A seven day course of STI medication ·
A 'morning after' pill to prevent pregnancy.
|
·
Repatriation of mortal remains to the
nearest funeral home of choice closest to the place of burial anywhere within
the borders of RSA ·
Assistance with funeral arrangements ·
Accommodation for a maximum of one night,
if required, for a single relative accompanying the mortal remains ·
Legal assistance regarding the funeral
procedures e.g. death certificate, removal of body, etc; ·
Assistance in the arrangement of a
funeral or cremation, it being recorded that any costs shall not be for the
account of KGA ASSIST. ·
NB !!! In the event of the Eligible Person’s representatives making
their own arrangements and incurring repatriation costs without referral to KGA
ASSIST, KGA ASSIST will not be held responsible for these costs, although KGA
ASSIST may still give the Eligible Person other assistance in terms of this
agreement |
|
|
24 Hour Legal Assistance |
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|
·
Services include a 24-hour telephonic legal advice line, a standard
legal document service; and a direct legal consultation service. ·
The free 30 (thirty) minute consultation service is available to
Eligible Persons provided it takes place at a firm that is within the
magisterial district within which the Eligible Person resides, but if this is
not practical, then in a nearby jurisdiction.
Upon an Eligible Person consenting to attend such meeting, the
relevant advisor will arrange the meeting and revert back to the Eligible
Person to confirm. ·
If requested to, the panel attorney will draft a one-page letter of
demand or make one telephone call on an Eligible Person's behalf, both of
which will be free of charge. ·
If, after the consultation, the Eligible Person wishes to mandate the
attorney at the Eligible Person's own cost and expense, it will be the
Eligible Person's prerogative to do so. |
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|
24 Hour Access Health Line |
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·
Access Health’s nurses do not diagnose callers’ ailments
and illnesses. ·
Access Health will further make outbound
calls to Eligible Person pertaining to: [a] Quality Assurance [b] Access
Health’s risk management policies and procedures [c] All calls will be made
in Access Health’s nurses’ discretion ·
Access Health will provide clinical
information, factual data and general information through its nurses using
Access Health’s Health Counselling Guidelines to Eligible Person who are
faced with major medical decisions.
The information will include general information, health education,
non-directive treatment options and questions for an Eligible Person to ask
their physicians |
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|
24 Hour Emergency Evacuation |
||
|
·
KGA Assist will provide an Eligible Person (or caller on his
behalf) with advice and information regarding any emergency medical condition
by telephone so that emergency assistance can immediately be provided to a
person suffering illness or injury until a medical team arrives at the
scene. The advice and information will
be regarded as such and not as an accurate or definite diagnosis of any
condition any person might suffer. ·
Immediate response is undertaken to the
scene of a medical emergency where appropriate advanced life saving
resuscitation will be provided to an Eligible Person. Where necessary, the member will be
stabilised before transportation is provided to the closest appropriate
medical facility. ·
Guaranteed hospital admission (R2 000
maximum) - refundable by the Eligible Person or the Eligible Person’s medical
aid. ·
KGA Assist will have the right to make
decisions and take action after having considered available medical evidence
as to what it deems to be in the best interest of the person calling for assistance. Based on the aforementioned KGA Assist will
determine the timing and mode of transportation or repatriation |
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Trauma and Assault Service |
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·
By phoning the KGA ASSIST Trauma Helpline,
the nearest local emergency assistance service can be arranged for the
member, as well as emergency transport to the nearest, most appropriate
medical facility, if required ·
The helpline is manned by professional
nurses, maintaining a high level of service ·
Cover for assault is provided: indicated
medical treatment to the value of R5 000 per eligible person with a maximum
of R10 000 per family per occurrence ·
The nurses also assist with referrals for
psychiatric consultations ·
Cover for trauma is provided: indicated
psychiatric consultations to the value of R5 000 per eligible person with a
maximum of R10 000 per family per occurrence. |
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1. Introduction
a.
The definition below will be applied by KGA Life in
determining if a claim constitutes a valid claim under the KGA Accidental Death
benefits offered to our clients
b.
KGA Life will continue to apply our stringent claims
management in this regard as well and will insist on a proper SAP (South
African Police) report accompanying all such claims where so appropriate, given
the cause of accidental death
2. Definition
a.
“To insure the insured against the event of bodily injury
caused by violent, accidental, external and visible means which leads to the
death of the insured within 6 (SIX) months of the happening of such event. The
accident must be the sole cause, independent from any other cause, of the death
of the insured.
b.
In support of this, there must be at least the following two
[2] chains of causation:
i.
The death must be caused by the bodily injury,
ii.
The bodily injury must be caused by an accident.
3. Exclusions
a.
The following exclusions will apply:
i.
Air travel except as a passenger
ii.
Suicide or intentional self-injury
iii.
Influence of alcohol, drugs or any related narcotics
iv.
War
v.
Deliberate exposure to exceptional danger or criminal acts
vi.
Professional sport
vii.
Nuclear risks
viii.
Acts of terrorism
ix.
Pre-existing medical conditions
4. Benefits
a.
These benefits are re-insured via Price Forbes / Lloyds of
London
