Group Risk Terms and Conditions

General

The benefits quoted on will pay out a lump sum to the beneficiary (or employee) on the death or disability of the employee (or family member on the Funeral Benefit).
There must be a minimum of 10 employees insured overall. The benefits must be compulsory for all employees.
Premiums are subject to annual review with revised premiums effective from 1 May in the years following the commencement of cover.

Underwriting

No medical underwriting is required.

Tax treatment

If the premiums are paid by the employee from after-tax income, any benefits are tax free. If the premiums are paid by the by the company a section 11(a) tax deduction may be claimed, but then the premiums should be included as a fringe benefit to the employee

Terms and Conditions - Death and Disability Cover

In the event of a valid death or permanent disability claim the insured employee or nominated beneficiary will be paid the benefit amount of cover. The Death Benefit will be paid in the event of insured employee’s death. This is a lump sum benefit calculated as a multiple of the employees’ annual salary as agreed and stated to in the Group Life and Disability Policy Schedule. The Death Benefit may not be the full amount at time of claim as any Permanent Disability Benefit that has been paid in advance of the insured’s death will be deducted from the Death Benefit amount.

The Disability Benefit is paid out in the event of an insured employees’ total and permanent disability as a result of illness, disease or injury. To qualify for the insurer’s definition of disability, the disabled employee, in the opinion of the insurer, must be totally and permanently unable to pursue the occupational duties in which he/she was practising immediately prior to the onset of such disability. Or be able to assume the duties of an alternate occupation that the employee is reasonably suited or may become suited by virtue of his/her experience, knowledge, training, education, age or ability, even if your employee is not following such occupation or is unable to secure such position.

1. Pre-existing conditions

Employees will not be entitled to a benefit if their claim arises within 12 months after their cover commences and it is related directly or indirectly to a physical defect, medical condition or injury which manifested symptoms within 12 (twelve) months before the commencement of their cover.

2. General exclusions

No claim for any benefit shall be payable in the event of the claim arising directly or indirectly as a result of:

War (whether war has been declared or not), invasions, hostilities, civil war, acts of foreign enemy, war like actions, including accidental explosion and/or deliberate explosion of weapons of war, during war or directly as a result of a previous war.
Acts of terrorism, where acts of terrorism mean an act:
1. whether involving violence or the use of force or not; or
2. the threat or the preparation thereof, of any person or group(s) of persons whether acting alone or on behalf of or in connection with any organisation(s) or government(s) which appears to be intended to intimidate or influence a de jure or de facto government or the public or a section of the public, or disrupt any segment of the economy or
3. from its nature or context is done in connection with political, social, religious, ideological or similar causes or objective
The insured person being under the influence of intoxicating liquor or drugs, unless such drugs have been prescribed and taken in accordance with the instructions of a medical doctor.
Suicide or attempted suicide within the first 12 months of the employee being covered by this policy.
Participation in any criminal activity, strikes, riots and civil commotion.
Refusing medical treatment where such treatment will improve the disability or illness resulting in disability.
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.

Duration of cover
An employee’s cover ends on:

the last day of the month in which an employee turns 70 in respect of the Life Cover Benefit and 65 for the Disability Cover benefit
termination of this policy
cessation of payment of premiums
ceasing to be in full time employment
the absence of the employee from the company for a period of twelve consecutive months

Terms and Conditions - Funeral Cover

There are two Funeral Cover options, Option 1 pays a benefit amount on the death of employee. And Option 2 pays a benefit amount on the death of employee and on the death of employee’s spouse and/or children. For the full terms and conditions please refer to the policy document in Annexure 3.

In the case of cover under Option 2, the death of employee’s spouse and children are also covered. Spouse: 100% of the employees sum assured as reflected in the Policy Schedule; Children 0 to 6 years: 50% of the employees sum assured as reflected in the Policy Schedule, subject to a maximum of R10 000. Children 6 to 14 years: 50% of the employee sum assured as reflected in the Policy Schedule subject to a maximum of R30 000.

1. General exclusions

No claim for any benefit shall be payable in the event of the claim arising directly or indirectly as a result of:

War (whether war has been declared or not), invasions, hostilities, civil war, acts of foreign enemy, war like actions, including accidental explosion and/or deliberate explosion of weapons of war, during war or directly as a result of a previous war.
Acts of terrorism, where acts of terrorism mean an act:
1. whether involving violence or the use of force or not; or
2. the threat or the preparation thereof, of any person or group(s) of persons whether acting alone or on behalf of or in connection with any organisation(s) or government(s) which appears to be intended to intimidate or influence a de jure or de facto government or the public or a section of the public, or disrupt any segment of the economy or
3. from its nature or context is done in connection with political, social, religious, ideological or similar causes or objective.
The insured person being under the influence of intoxicating liquor or drugs, unless such drugs have been prescribed and taken in accordance with the instructions of a medical doctor.
Suicide or attempted suicide within the first 12 months of the employee being covered by this policy.
Participation in any criminal activity, strikes, riots and civil commotion
Refusing medical treatment where such treatment will improve the disability or illness resulting in disability.
Any loss or expense of whatsoever nature directly or indirectly caused by, resulting from, or in connection with any of the following
1. use of nuclear, biological or chemical weapons, or any radioactive contamination; or
2. 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.

2. Benefit limits

There are two options to choose from. Option 1 provides benefits on the death of your employee only and Option 2 provides benefits on the death of your employee and upon the death of your employee’s spouse and/or child as defined. A maximum of 1 Spouse and 5 Children can be covered under Option 2.

Spouse is the person married to your employee by law, tribal custom, or tenets of any religion. It shall include a common law husband/wife of your employee or such person staying with your employee for at least 2 years, who is normally regarded by the community as your employee’s husband/wife. A person of the same gender staying with your employee for at least 2 years, who is regarded by themselves and the community as a common law couple shall also be regarded as a spouse.

Child(ren) means your employee’s child or children, legally adopted children, grandchildren and step children under the age of 21. It shall include a stillborn child provided that there is at least 26 weeks of intra- uterine existence and that the foetus showed no life after complete birth. Stillborn shall include the internal termination of the life of the child.

The Policy Schedule specifies the employees insured and the amount which they are insured for as well as their benefit option.

Option 1: Employee Cover Only

Employee is covered 100% of benefit subject to a maximum of R60 000.

Option 2: Employee and Family Cover

Employee and Spouse: 100% of benefit subject to a maximum of R10 000.
Children 0-6 years: 50% of benefit subject to a maximum of R10 000.
Children 6-14 years: 50% of benefit subject to a maximum of R30 000.
Children 15-21 years: 100% of benefit subject to maximum of R60 000.

3. Duration of cover

An employee’s cover ends on:

the last day of the month in which an employee turns 70
termination of this policy
cessation of payment of premiums
ceasing to be in full time employment
the absence of the employee from the company for a period of twelve consecutive months

Disclosures

This policy is underwritten by Guardrisk Life Limited (FSP 76).
Guardrisk can be contacted at: Tel: 011 669 1000, Email: info@guardrisk.co.za.
The policy is administered by Zest Life Investments (Pty) Ltd, which is an authorised financial services provider (FSP number 37485).
Zestlife does not have any circumstances that could give rise to an actual or potential conflict of interest in dealing with the policyholder.
You can lodge a complaint with Chris McCallum at Zestlife, at email: chrism@zestlife.co.za, telephone 021 180 4203.
If you are dissatisfied with the feedback received from your Intermediary and/or Zestlife, or your complaint remains unresolved, feel free to contact the Guardrisk Complaints Department at email: complaints@guardrisk.co.za, telephone 0860 333 361.
If you are dissatisfied with the feedback you receive from your Intermediary, Zestlife or Guardrisk you can lodge a complaint with the Long Term Ombudsman at Private Box x45, Claremont, Cape Town, 7700, telephone 021 657 5000 / 0860 103 236, email: info@ombud.co.za.
Zest Life Investments (Pty) Ltd earns 9% for performing binder functions.
Should you not be completely satisfied with the policy and wish to cancel the policy during the cooling-off period, you must let us know in writing within 31 days after the commencement of the policy and provided that no claim is outstanding or paid you will be entitled to a refund of premium paid.

Contact details

Phone: 021 180 4220 / 0860 009 378
Email: info@zestlife.co.za