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Long Term Insurance Act, 1998 (Act No. 52 of 1998)

Regulations

Regulations under the Long-term Insurance Act, 1998

Part 7 : Contracts Identified as Health Policies under Section 72(2A)(a) of the Act

7.1 Definitions and interpretation

 

In this Part 7, unless the context indicates otherwise—

 

"condition-specific waiting period"

means a period in which a policyholder is not entitled to claim policy benefits in respect of a specific condition for which medical advice, diagnosis, care or treatment was recommended or received within a period of 12 months preceding the day on which the policy was entered into;

 

"general waiting period"

means a period in which a policyholder is not entitled to claim any, or may only claim certain, policy benefits;

 

"hospitalisation"

means any admission for a procedure or administration of a therapeutic or diagnostic medical intervention wherein a person is expected to stay overnight in a facility;

 

"insurer''

means a long-term insurer;

 

"medical scheme"

has the meaning assigned under section 1 of the Medical Schemes Act;

 

"member"

has the meaning assigned under section 1 of the Medical Schemes Act;

 

"policy"

means a long-term policy;

 

"product line"

in relation to a category and type of contract referred to in Regulation 7.2(1), means health policies that have the same or closely related contractual terms offered or entered into by an insurer;

 

"relevant health service"

has the meaning assigned under section 1 of the Medical Schemes Act;

 

"rider benefit"

means an additional insurance obligation under a long-term policy which obligation is ancillary to the primary insurance obligations assumed under that policy;

 

"this Part"

means this Part 7;

 

"underwritten on a group basis"

means where the risks relating to a policy forming part of a product line are rated based on the characteristics of a group of people (other than characteristics that relate to or may result in specific health conditions) together as opposed to that of the individual to whom the policy relates.