sanlam risk cover child: illness and injury benefit

Transcription

1 sanlam risk cover child: illness and injury benefit

2 product flashfact: for intermediaries only august

3 child: illness and injury benefit The Child: Illness and injury benefit pays a lump sum in the event of a child life insured suffering a defined dread disease, injury, impairment or infection-type claim event. 1

4 insurable interest The benefit can be selected only if the life insured is the planholder s child (biological, adopted or step-), or if the life insured is financially dependent on the planholder, the planholder also being the child s legal guardian. child A biological, adopted or stepchild, who on the date that he or she is added to the policy is financially dependent on the planholder for support (including where the obligation for support was determined in accordance with a custom, indigenous law, or court of law). 2

5 benefit features availability standalone only Available on whole-life and term products, but only on the comprehensive model (not available on the Matrix Topcover Core option). benefit cease age 20 anb For entry ages > 15 anb (remaining term < 5 years) and if there are no other benefits on the plan, only the Yearly rated payment pattern is allowed entry age Minimum: 2 anb Maximum: 18 anb maximum cover amount Maximum cover amount will depend on the rate group of the parent, as follows: Rate group 1 3: R0 000 Rate group 4 5: R maximum guarantee term 10 years 3

6 benefit features (continued) payment and cover growth Available in accordance with the normal options Please note: For this benefit (as well as the Funeral benefit), the Fixed compulsory payment pattern is available to lives younger than 30. For other benefits the pattern is however still excluded for lives younger than 30. Mr Smith is a parent aged 28 next birthday, who wants to take the Child: Illness and injury benefit on the life of his 5-year-old son. He will be able to take the child benefit on a plan with a Fixed compulsory payment pattern, but will not be able to take any benefits (other than the Funeral benefit) on his own life on the same plan, due to his age being less than 30 next birthday. eg Mrs Jones is a parent aged 40 next birthday, who wants to take out the child benefit on the life of her daughter, aged 16. She will be able to take the child benefit as well as any benefits on her own life, on a plan with a Fixed compulsory payment pattern. 4

7 claim events Claim event Vascular system Surgery to major blood vessel: aorta, carotid, pulmonary, coronary or femoral artery Claim event explained in layman's terms* Fixing a damaged section of a major blood vessel. Cardiomyopathy An enlarged heart with very poor function. Stroke resulting in permanent impairment Open-heart surgery Paralysis of one side of the body due to a blood clot or bleeding on the brain. Repairing a heart valve or hole in the heart, usually after rheumatic fever or discovering a birth defect. This is done by open-heart surgery, in other words, the chest is cut open. Heart attack Heart attack. Primary pulmonary hypertension (PPH) Abnormal blood flow and abnormal pressure in the lungs. Heart valve surgery by endoscopic procedures (keyhole surgery) Arrhythmia requiring pacemaker or ablation Replacing a heart valve through a small hole in the chest, in other words, the chest is not cut open. An irregular heartbeat requiring a pacemaker or the destruction of an abnormal electric pathway by a cardiologist. Pulmonary embolism Blood clot in the lungs. 30 % of the cover amount

8 Claim event Claim event explained in layman's terms* Organ failure Renal failure Chronic kidney failure. Liver failure Chronic failure of the liver with yellow jaundice. End-stage lung disease End stage lung disease that requires the use of oxygen at home. Bone marrow failure (aplastic anaemia) A disease that permanently damages the bone marrow. This will require regular blood transfusions, chemotherapy or a bone marrow transplant. Organ transplant Cancer Cancer in situ of the breast requiring a mastectomy Any other cancer, except the cancers excluded under "Exclusions" Premalignant conditions Fibrocystic disease of the breasts requiring a mastectomy Applies if the life insured receives a transplanted kidney, heart, liver, lung, pancreas or bone marrow. A very early stage of breast cancer without any spreading, for which the breast is removed as a precautionary measure. Any other type of cancer, excluding most skin cancers and very early stages of some cancers that recover completely with minimal treatment. Lumps in the breasts diagnosed as fibro-adenosis. This is not a cancer, but in the presence of a family history of breast cancer, one or both breasts are sometimes removed as precaution. This benefit only pays if the latter has been performed. % of the cover amount

9 Claim event Tumours Benign brain tumour that is inoperable or recurrent or results in permanent neurological impairment Benign brain tumour that is only partially removable or treated with chemotherapy or radiotherapy Nervous system Motor neuron disease Multiple sclerosis Gullian Barre with permanent impairment Hydrocephalus Coma Uncontrolled epilepsy Claim event explained in layman's terms* A brain tumour that is not cancerous, but impossible to operate or keeps coming back after surgery or results in permanent brain damage. A brain tumour that is not cancerous, but only partially removable or treated with chemotherapy or radiotherapy. A disease that affects the muscles in the body, including the ability to speak, walk and swallow. A disease that damages the nerves in the brain and spinal cord. Also known as MS. A disease that affects the nervous system and causes paralysis. Some patients recover fully. Those that do not recover, may qualify for this benefit. Accumulation of water on the brain, requiring an operation to drain the fluid. Being in a coma in the intensive care unit (ICU), for example, as a result of a head injury, near drowning, accidental poisoning, bleeding on the brain, blood clot in the brain. Epilepsy that is uncontrolled with frequent attacks, even with the best treatment. % of the cover amount

10 Claim event Psychiatric conditions Anorexia Claim event explained in layman's terms* Anorexia with severe weight loss for more than 6 months, requiring hospitalisation. Schizophrenia A split personality mental disorder. 25 Senses Loss of vision in both eyes Total and permanent blindness in both eyes. Loss of vision in one eye Total and permanent blindness in one eye. Hearing loss Total and permanent deafness in both ears. Loss of speech Permanently losing the ability to speak; muteness. Not due to psychiatric reasons. Locomotor system Total loss of function of one arm Total loss of function of one leg Muscular dystrophy Losing the total use of an arm permanently, usually caused by an injury. Losing the total use of a leg permanently, usually caused by an injury. A disease that causes the muscles to waste away. Also known as MD. Perthe's disease A disease of the hips. 30 Septic arthritis An abscess or infection in a major joint. 25 Osteomyelitis An abscess or infection of the bone or bone marrow. 25 % of the cover amount

11 Claim event Claim event explained in layman's terms* Gastro-intestinal system Permanent colostomy or ileostomy The need to permanently wear a bag for stools. Loss of control of bladder or rectum Incontinence of urine or stool due to an anal or rectal injury, tumour or spine injury. Crohn's disease Ulcerative colitis A disease affecting the digestive tract that is serious enough to cause weight loss and growth failure. A disease of the colon that is serious enough to cause weight loss and growth failure. Injuries Head injury Serious head injury, requiring surgery. Paraplegia Permanently lame in both legs, requiring the use of a wheelchair. Quadriplegia Permanently lame in both legs and both arms. Fracture dislocation of the spine Fracture and dislocation of the bodies of two spinal vertebrae. 75 Near drowning Near drowning, requiring care in ICU. Choking or suffocation Choking or suffocation, requiring care in ICU. Amputation of one hand Amputation of a hand at the wrist. 40 Amputation of one arm Amputation of an arm above the elbow. Amputation of one foot Amputation of a foot at the ankle joint. 25 Amputation of one leg Amputation of a leg above the knee. 30 % of the cover amount

12 Claim event Claim event explained in layman's terms* Injuries (continued) Amputation of one thumb Amputation of a thumb as a whole. 20 Skull fracture requiring reconstruction A skull fracture that needs to be operated. Gunshot wound A wound to the skull, chest or abdomen, caused by a bullet, that needs emergency surgery. Penetrating stab wound Major burns Fracture of the facial bones requiring reconstructive surgery A wound to the skull, chest or abdomen, caused by a knife, that needs emergency surgery. Serious burn wounds requiring skin grafts over at least 20% of the body. Severe fractures of the face that needs to be operated. 25 Unstable pelvis fracture A pelvis fracture that needs to be operated. 25 Multiple rib fractures with unstable ribcage Breaking several ribs, requiring care in ICU. 25 Abdominal injury with liver rupture, spleen rupture or kidney damage requiring emergency surgical repair Bilateral orchidectomy Dog bite to the face requiring plastic surgery Liver, spleen or kidney injury that needs emergency surgery. 25 An operation to remove both testes, mostly due to cancer or injury. Dog bite to the face requiring a single session of plastic surgery under general anaesthesia. Dog bite to the face requiring multiple sessions of plastic surgery under general anaesthesia. % of the cover amount

13 Claim event Infections Accidental HIV infection Bacterial meningitis or encephalitis with permanent impairment Cerebral malaria Rabies Claim event explained in layman's terms* HIV infection / AIDS that is acquired accidentally through a needlestick injury, blood transfusion, organ transplant, violent crime, rape or medical emergency procedure. A severe and contagious form of meningitis that results in permanent damage to the brain or nerves. Malaria affecting the brain, and resulting in permanent damage to the brain or nerves. A deadly infection after being bitten by a dog or other animal with mad dog disease. Polio with permanent impairment Polio with permanent lameness or weakness of a limb. 75 Rheumatic fever with heart valve involvement Rheumatic fever resulting in damage to a heart valve. 75 Tetanus Haemorrhagic fever A disease that results in muscle spasms, usually obtained from a wound, for example, stepping into a rusty nail. Also known as lock-jaw. An infectious disease that causes bleeding disorders, like Congo fever, or other infections caused by the Ebola, Marburg, Lassa, Nairo or yellow fever viruses. % of the cover amount 75 11

14 Claim event Rheumatology Claim event explained in layman's terms* % of the cover amount Juvenile rheumatoid arthritis Polymiositis Systemic illnesses Cystic fibrosis Polycystic kidneys An autoimmune disease that affects the joints in children younger than 16 causing pain and deformity in large joints, not only the hands. A disease that affects the muscles, to the extent that it is difficult to do normal daily activities. A genetic disorder affecting multiple organs including the lungs. Also known as Mucoviscidosis. A familial disease of the kidneys that ultimately leads to kidney failure. Addison's disease A disease of the glands causing abnormal hormone production. 30 Hirschsprung's disease Amino acid disorders Diabetes A genetic deficiency of the nerve supply of the oesophagus, stomach or large bowel, leading to severe constipation or obstruction of the bowels. It is treated by removing the affected part by surgery. A genetic disorder of protein building blocks called amino acids, which may lead to a wide spectrum of symptoms including delay in development of the child, epileptic seizures, rash, hyperactivity, aggressive behaviour, abnormalities of the bones, poor vision. Sugar disease in children that requires the use of insulin injections

15 Claim event Other Admission into an intensive care unit (ICU) with ventilation for at least 48 hours Catch all Claim event explained in layman's terms* Any serious condition that needs care in ICU for at least 48 hours, for example as a result of a snake bite, scorpion bite, electric shock, smoke inhalation, accidental poisoning. Any other disease or injury not specifically listed, but severe enough to warrant a payment. Specific criteria are used as published in a Guideline to determine the severity. % of the cover amount * The explanations provided in this column are intended only to give a better understanding of the claim events in the first column. They are not to be used in the legal interpretation of the claim events. The definitions of the claim events as described under the Explanations section of the contract are the only contractual definitions applicable. 13

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17 more information underwriting survival period 96 hours, with the exception of the following claim events, which will have a survival period of only 48 hours: Rabies, Tetanus and Bacterial meningitis or encephalitis with permanent impairment. waiting period None, except for a 1-year waiting period on the Anorexia -claim event. multiple claim rules Each claim reduces the cover amount until the latter runs out. If the same cause results in simultaneous claims, and we admit a claim, we will only pay for the claim event with the highest percentage of the cover amount in the table above, despite anything to the contrary in the plan. Medical underwriting will involve medical questions only. Depending on the answers we might request medical reports or a medical exam by the treating doctor, but we will not request new medical tests. No HIV test will be required. Pre-existing conditions will be excluded. BMI is not a rating requirement. 15

18 With our Child: Illness and Injury benefit we are addressing the very real need of covering the planholder s children against claim events other than death. 24 of the 81 claim events covered with this benefit are unique in the market and 37 claim events are covered by only one other competitor and then often at a lower pay-out percentage! 16