Plan guide
13
BCM1
The
co-insurance
chosen will apply for the first 24 months’ continuous
cover under this
plan
.
Benefit conditions for the Personal accident add-on plan
Claims
will only be paid under the
plan
if
you
meet
benefit
condition BC13 in the
‘
Benefit
conditions’ section and the extra
benefit
conditions listed below.
BCPA1
We
provide cover for managerial, clerical and administrative occupations
only. If
you
engage in any manual or dangerous occupation or
hazardous pursuit
which puts
you
at greater risk of a
bodily injury
caused by an
accident
, the
planholder
or
your plan administrator
must tell
us
.
We
will tell the
planholder
or
plan administrator
if
we
agree to cover
you
and let them know any extra
premium that applies.
BCPA2
No amount above the maximum accumulation limit shown on the Table
of
benefits
will be paid for
claims
arising from any one event in any one location
or
vehicle
, if they are made by multiple
members
on the same Personal accident
add-on
plan
.
If the total value of
claims
exceeds the maximum accumulation limit,
the amount paid for each
claim
will be reduced proportionately to the amount
each
member
is due, up to the maximum accumulation limit.
BCPA3
You
will not be paid more than the overall maximum limit for each unit
shown in the Table of
benefits
for any one or more
accidents
.
BCPA4
If
you
suffer one or more permanent total or permanent partial
disablements within 12 months of an
accident
,
you
will only be paid up to the
benefit
limits shown on
your
Table of
benefits
that applied in the
plan year
when
you
had the
accident
.
You
will not be paid any more than the overall limit shown
on
your
Table of
benefits
.
BCPA5
If
you
die within 12 months of an
accident
, payment will only be made
up to the
benefit
limit shown on
your
Table of
benefits
that applied in the
plan
year
when
you
had the
accident
, in line with the instructions received from
your
personal representative. If
you
die before any disablement
benefit
is paid, only the
accidental death
benefit
will be paid.
If any disablement
benefit
has already been paid under this
plan
for any
accident
that happened in the same
plan year
, the accidental death
benefit
amount paid
will be reduced by the value of any
claims
already paid.
No payment will be made for any more than the overall limit shown on
your
Table
of
benefits
.
BCPA6
We
must be told as soon as possible about any
accident
that causes or
may cause a
claim
.
BCPA7
Cover is not provided for sickness or disease.
BCPA8
You
must make all medical records, notes and correspondence
we
need
available to
us
, and any medical advisor
we
have appointed.
BCPA9
For any
claim
to be considered for loss of sight of both eyes,
you
must be
diagnosed as blind on the authority of a fully qualified ophthalmic
specialist
.
BCPA10
For any
claim
to be considered for loss of sight of one eye, the degree of
sight after correction must be 3/60 or less on the Snellen Scale, seeing at 3 feet
what
you
should see at 60 feet, or an equivalent scale.
BCPA11
If
you
have an existing
medical condition
and suffer a
bodily injury
because of an
accident
,
we
will ask an independent
specialist
to assess if
your
existing
medical condition
has contributed to
your
disability after the
accident
,
or if
your
disability after the
accident
has made
your
existing
medical condition
worse.
We
will decide the difference between
your
existing
medical condition
and the disability suffered after the
accident
and pay any
claim
based on this
difference. This will be expressed as a percentage and applied to the appropriate
benefit
.
An example of this is:
You
are partially deaf in
your
right ear.
You
have an
accident
that causes total
permanent loss of hearing in
your
right ear.
We
will ask an independent ENT
specialist
to assess the difference between the
level of deafness
you
had before and after the
accident
. If the independent ENT
specialist
advises that the deafness in
your
right ear before the
accident
was at
25%,
you
will be paid 75% of
your benefit
limit for total deafness of one ear.
Benefit exclusions for the Personal accident add-on plan
The Personal accident add-on
plan
does not cover
claims
for, arising from or
connected with the
benefit
exclusions, BE3 to BE4, BE11 to BE14, BE23 to BE27,
BE29, BE43, BE44, BE47, BE52 and BE53 listed in the ‘
Benefit
exclusions’ section
and the extra
benefit
exclusions listed below.
BEPA1
Aviation other than as a fare-paying passenger in a fully-certified
passenger carrying aircraft, flown in the course of licensed operation for
transporting passengers by licensed crew.
BEPA2
Engaging in manual or dangerous occupations or
hazardous pursuits
.
BEPA3
Any
accident
that happens before
your start date
or after
your end date
.
Benefit conditions for the Travel add-on plan
Claims
will only be paid under the
plan
if
you
meet the
benefit
conditions listed
in the ‘
Benefit
conditions’ section and the extra
benefit
conditions listed below.
BCT1
You
should tell
us
about a
claim
no later than 31 days after a
trip
has ended
and send the
claim
within a maximum period of six months
.
BCT2
We
have the right to move
you
from one
hospital
to another or arrange to
move
you
to a different location.
We
will do this if, in
our
opinion or that of the
attending
medical practitioner
,
you
can be moved safely to continue
treatment
.
BCT3
You
must take care of
your
property at all times and take all practical steps
to recover any item or items lost or stolen. If
you
do not do this, it may affect
your
claim
.
BCT4
Any loss of, or damage to, an item or items when in the custody of an airline
or other carrier:
•
must be reported to the airline or other carrier immediately upon
discovering the loss or damage; and
•
must be supported by a written report from the airline or other carrier.
BCT5
Any theft, suspected theft or loss must be reported to the local police within
24 hours of discovery and supported by a police report.
BCT6
You
must keep any damaged items that
you
want to
claim
for and, if
we
ask, send them to
us
at
your
own cost. If a
claim
is paid
for the full value of an
item, it will become
our
property.
BCT7
We
may discharge any of
our
legal responsibilities under this
plan
by
replacing or repairing any item or items lost or damaged.
BCT8
If
you
want to change
your
original plans for returning home and
claim
any
extra costs,
you
must tell
us
.
If
you
do not tell
us
, it may affect
your claim
.
BCT9
When making a
claim
for a delayed departure or delayed baggage
you
must provide
us
with a written report from
your
carrier giving the details.
BCT10
When making a
claim
for a missed departure
you
must have planned
to arrive at
your
departure point before
your
earliest scheduled check-in time
and give
us
a written report from the carrier at the place of departure, police or
relevant
public transport
authority, confirming the delay and stating its cause.
BCT11
When making a
claim
because
your
transport was hijacked
you
must
provide
us
with a police report giving the details.
Benefit exclusions for the Travel add-on plan
Section A of the Travel add-on
plan
does not cover
claims
for, arising from or
connected with
benefit
exclusions BE3 to BE5, BE9 to BE27, BE29 to BE45, BE47
to BE53 and BE56 listed in the ‘
Benefit
exclusions’ section and the extra
benefit
exclusions below.
BET1
Trips
made for the specific purpose of receiving medical
treatment
.
BET2
A
medical condition
that:
•
clearly showed itself;
•
you
had signs or symptoms of;
•
you
asked for advice about;
•
you
received
treatment
for;
•
to the best of
your
knowledge,
you
were aware
you
had;
within the 24-month period before:
•
the date of booking a
trip
; or
•
your date of joining
as shown on
your
Certificate of insurance;
whichever is later.
BET3
A pregnancy when:
•
you
are travelling against
your medical practitioner’s
advice;
•
you
are 26 weeks or more into
your
pregnancy when
you
start
your trip
;
•
there have been complications relating to your pregnancy before
your trip
;
