ALGEMENE RAAD OM PROBLEME MET TOEKOMSTIGE EISE TE VOORKOM
ALGEMENE RAAD OM PROBLEME MET TOEKOMSTIGE XXXX XX VOORKOM
Alhoewel ons net ‘n standaard wagperiode van 6 maande gebruik vir alle siekte toestande kan daar in sekere gevalle vrae gevra word deur die versekeraar. Die aansoekvorm wat die kliënt voltooi is in wese ‘n kontrak tot toekomstige dekking vir die waarde waarvoor die kliënt geteken het. Indirek is daardie kontrak xxx ook ‘n kontrak met die versekeraar waar ons julle verseker. DIE Versekeraar vereis dus eerlikheid van informasie in alle gevalle. In meeste gevalle van natuurlike sterfte xxx die versekeraar geen vrae vra nie MAAR daar is enkele gevalle waar hulle wel die reg xxx hê om vrae te vra veral waar die persoon aan siektes xxxx KANKER, HIV/AIDS, TB te sterwe kom skaars 6 maande na aanvang van die polis. Die rede daarvoor is eenvoudig, beide genoemde siektes is langdurige prosesse en die Versekeraar xxx xxx ‘n redelike afleiding maak dat die kliënt opsetlik inligting weerhou het wat ‘n impak op risiko kan hê. Onthou ons mag nie diskrimineer teen sulke mense deur versekering xx xxxxx nie, maar ons het die reg om ‘n hoër premie te hef of die standaard premie en xxx ‘n xxxxxx wagperiode.
Om julle te help xx xxxxx gevalle in die toekoms beter te kan hanteer en julle eisegeskiedenis te help bestuur heg ons ‘n alternatiewe Aansoekvorm aan met ‘n wagperiode van 12 maande vir alle reeds bestaande siektes. Dit xxx xxxxx vir julle help om xxxxx xxxx geskiedenis te help bestuur en daardie gevalle te hanteer wat vir julle xx xxxxx gevalle lyk. Dit is belangrik dat die persoon vir wie die polis uitgeneem word self teken en dat u of u agent daardie xxxxxxx xxxx. As iemand anders die polis uitneem en teken, neem u dalk ‘n reeds sterwende persoon op risiko EN die versekeraar kan die polis xxxxx aangesien die versekerde nie self geteken het nie.
Die Versekeraar het ook die reg om van tyd tot die boekies van die oorledenes aan te vra om xx xxxx of hulle op datum betaal was ten xxxx xxx xxxx asook om te bepaal dat die bedrag waarvoor geëis word, die bedrag is wat op hulle boekies staan.
ALGEMENE RAAD VIR DIE HANTERING XXX XXXX
1. Xxxx altyd dat alle dokumente gesertifiseer is.
2. Voltooi die eisvorm volledig in XXXXX ink.
3. Vir dood aan natuurlike oorsake het ons die volgende nodig:
a) Indien Hooflid: Volledig leesbare doodsertifikaat met die reeksnommer leesbaar,
Duidelik leesbare ID waar die ID nommer duidelik wys, Aansoekvorm van Xxxxxxx en BI 1663.
b) Indien Xxxx: Alle dokumentasie by (a) plus Huweliksertifikaat. Xxxx Xxxxxxx en Xxxx dieselfde van het maar nie getroud is nie, bewyse dat hulle nie xxxxx/suster of neef/xxxxxx of ander direkte familie is.
c) Indien Kind: Alle dokumentasie by (a) en (b) asook ID en/of Geboortesertifikaat. In die geval dat die kind oor 21 maar nog nie 26 jaar oud is nie, bewyse dat die kind wel om opvoedkundige of mediese redes op ouers xx xxxxx is. Indien kind nie dieselfde van as ouers het nie, wie die kind is en skriftelike bewyse van voogdyskap of aanneming.
d) Indien doodgebore kind: Alle dokumentasie by (a) en (b) asook Hospitaal bewyse van geboorte en sterfte tesame met Tydelike Doodsertifikaat.
4. Onnatuurlike sterfte: Alle dokumentasie hierbo asook ‘n voltooide polisie verslag.
5. Xxxx nie persone vir wie daar doodseise rapporteer is kanselleer nie, ons dit self in die volgende maand aanteken.
NB! Moet nie ‘n begrafnis doen uit julle eie sak voordat xxxxx xxx seker gemaak het dat die eis wel xxx kwalifiseer nie.
EN NATUURLIK MOET SKEMA PREMIES OP DATUM WEES.
GENERAL ADVICE TO CIRCUMVENT PROBLEMS WITH FUTURE CLAIMS
Although we only have a standard waiting period of 6 months for all illnesses, questions can be asked in certain cases by the Insurer. The Application form that the client completes is a contract to future cover for the value that the client signs to. Indirectly this contract is also a contract with the Insurer where we insure you. THE Insurer thus requires honesty of information in all cases. In most cases of natural deaths the insurer will not ask any questions, BUT there are cases where the insurer will have the right to ask questions especially in cases where a person has died of CANCER, HIV/AIDS, TB just after the 6 month waiting period has expired. The reason for this is simply that these mentioned illnesses usually has a long history and a deduction can thus be made that the client has willfully withheld information from the insurer that can have an impact ob risk..
Remember, we may not discriminate against such people by refusing insurance, but we have the right to charge a higher premium or the standard premium and a longer waiting period.
In order to assist you in this in the future and assist you in managing your claims ratio we attach an alternative Application form with a waiting period of 12 months for all pre-existing illnesses. This should help to keep your claims experience much lower and to help you in cases where you have to handle borderline cases.
It is important that the person who takes out the policy signs personally and that you or your agent sees the person. If someone else takes out the policy, you may be taking a already dying person on risk AND the insurer could refuse the policy because the Insured did not sign the policy personally.
The Insurer also has the right from time to time to ask for the membership books to see if a person was paid up to date at time of death and to deduce whether the amount Insured for was the amount of cover the client paid for.
GENERAL INFORMATION FOR THE HANDLING OF CLAIMS
1. Always make sure that all documents have been certified.
2. Fully complete the Claim form in BLACK INK.
3. For death due to natural causes we need the following:
a) If Main member: Complete death certificate with readable serial number,
Clear readable ID that clearly shows the ID number, Application Form of main member plus BI 1663
b) If Spouse: All documents at (a) plus Marriage certificate. Where Main member and spouse have same surname but not married, Proof that they are not brother/sister or cousins or other direct family.
c) If Child: All documentation at (a) and (b) plus ID and/or Birth certificate. In the case of a child over 21 but not yet 26 years of age, proof that the child is on the parents policy for educational or medical purposes. If child does not have same surname as parents, written proof of Guardianship or Adoption.
d) If Still Birth: All documentation at (a) and (b) and also Hospital proof of birth and death as well as Abridged Death certificate.
4. Unnatural death: All documentation above as well as a completed Police report.
5. Don’t cancel persons for whom there was death claims. We will cancel them ourselves in the following month.
NB! Don’t do a funeral out of your own pocket before you have not made sure that the claim does qualify.