Additional terms
6. Fraud:
a) Incorrect disclosure/non-disclosure of any material facts, by you or your dependants,
which may affect our assessment of the risk, including, but not limited to, those
material facts declared on the relevant application form will render the contract void
from the commencement date, unless we confirm otherwise in writing. Conditions
arising between completing the relevant application form and the start date of the
polilcy will be deemed to be pre-existing and will not be covered if not disclosed. If the
applicant is not sure whether something is material, the applicant is obliged to inform
us. If the contract is rendered void due to incorrect disclosure or non-disclosure of any
material facts, we will refund the premium amount(s) paid to date minus the cost of
any medical claims already paid. If the cost of claims exceeds the balance of the
premium, we will seek reimbursement of this amount from the principal member.
b) If a claim is, in any respect, false, fraudulent, intentionally exaggerated or if fraudulent
means/devices have been used by you or your dependants or anyone acting on your or
their behalf to obtain benefit under this policy, we will not pay any benefits for that
claim. The amount of any claim settlement made to you, before the fraudulent act or
omission was discovered, will become immediately due and owing to us. If the contract
is rendered void due to false, fraudulent, intentionally exaggerated claims or if
fraudulent means/devices have been used, premium will not be refunded, in part or in
whole, and any pending claims settlements will be forfeited. In the event of fraudulent
claims, the contract will be cancelled from the date of our discovery of the fraudulent
event.
7. Legal action:
You shall not institute any legal proceedings to recover any amount under
the policy until at least 60 days after the claim has been submitted to us and not more than
two years from the date of this submission, unless otherwise required by mandatory legal
regulations.
8. Liability:
Our liability to you is limited to the amounts indicated in the Table of Benefits
and any subsequent policy endorsements. In no event will the amount of reimbursement,
whether under this policy, public medical schemes and any other insurance, exceed the
amount of the invoice.
9. Making contact with dependants:
In order to administer your policy in accordance with
the insurance contract, there may be circumstances when we will need to request further
information. If we need to make contact in relation to a dependant on a policy (e.g. where
further information is required to process a claim), the policyholder, acting for and on
behalf of the dependant, may be contacted by us and asked to provide the relevant
information. Similarly, all information in relation to any person covered by the insurance
policy, for the purposes of administering claims, may be sent directly to the policyholder.
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Allianz Worldwide Care
