The first time a member is required to submit medicals, a grace period may apply. This allows the member time and more importantly a form of interim cover (normally accidental only), whilst underwriting is done.
Medicals are requested for all members where there is no proof free limit or where benefits exceed the proof free limit or previously accepted cover (for those who have previously submitted evidence of health).
Below are the grace periods for each insurer and an overview on each, in terms of cover and premiums.
Capital Alliance – 6 months
Capital Alliance offers a 6 month interim accident cover, during this period the member must submit the required medical evidence and be underwritten.
If the requested medical evidence is submitted within the 6 month period, Capital Alliance will continue to provide the interim accident cover, until the underwriting decision is finalised, or for an additional 6 months, whichever occurs first.
Members who do not submit medical evidence by the end of the 6 month period will not be granted the interim accident benefit in future until they submit medical evidence. Interim accident cover will not be granted in cases where the member’s previous cover was declined / restricted or interim accident cover previously denied. Full premiums are due, unless a member is medically declined and the scheme has no proof-free limits. Where there is no proof free limit members will enjoy the Interim Accident Benefit for the first 6 months and, thereafter, will enjoy no cover.
These benefits will be restricted to a maximum amount above the free cover limit or previously granted cover, as per the quote document.
Hollard – 4 months
Hollard offer temporary accident cover during assessment which covers the difference between the full potential death benefit and the free cover limit or the higher limit previously accepted. It is subject to the maximum temporary accident cover benefit as set out in the policy schedules.
Full premiums are due, unless a member is medically declined and the scheme has no proof-free limits. Where there is no proof free limit members will enjoy the temporary accident cover for the first 4 months and, thereafter, will enjoy no cover.
If Hollard complete their assessment before the end of the 4 month period, the temporary accident cover benefit ends on the date they give their decision in writing. The remaining terms and conditions of the policy will then apply.
Old Mutual – Accident plus applies
As opposed to a limited grace period, Old Mutual offer Accident Plus enhancements that provide insurance against accidental causes for the difference between the Evidence of Health limit and their full potential cover, even if the Evidence of Health limit is zero. For this reason they require full premiums at all times.
Sanlam – 3 months
Sanlam offer members full cover in the first 3 months (as opposed to cover in the event of an accident only). They require full premiums on a scheme where a proof-free limit applies even after the grace period of 3 months expires but benefits thereafter will be restricted to the proof-free limit. If a member has been medically restricted, a restricted premium is arranged. For schemes where there is no proof free limit, there is no cover and no premiums are due until the member has provided full medical proof and it has been accepted by Sanlam.
Should you require more information, please contact your Associate or the office on 031 561 1044.
Thank you and regards,
The TSA Team
You’ll find all back issues of TSA Connect by visiting our blog.
All information provided is intended to inform and explain, but please remember to always check the current terms on policies when considering options and advising clients.
(Vol. 6 Issue 18)
